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Servillo A, Kesim C, Sacconi R, Battista M, Capuano V, Fragiotta S, Querques L, Parravano M, Souied EH, Bandello F, Querques G. NONEXUDATIVE INTRARETINAL FLUID IN INTERMEDIATE AGE-RELATED MACULAR DEGENERATION. Retina 2024; 44:997-1005. [PMID: 38261803 DOI: 10.1097/iae.0000000000004054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND To describe the occurrence of nonexudative intraretinal fluid (IRF) in intermediate age-related macular degeneration. METHODS A retrospective study was designed to include consecutive cases with intermediate age-related macular degeneration associated with IRF. A multimodal imaging approach was used to confirm diagnosis of IRF in intermediate age-related macular degeneration. Multimodal imaging included color fundus photograph, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography. RESULTS Ten eyes of 10 patients (2 male and 8 female patients, ages 68-80 years) showing IRF in intermediate age-related macular degeneration were included in the study. The mean best-corrected visual acuity was 20/40 Snellen equivalent. Multimodal imaging including fluorescein angiography/indocyanine green angiography and optical coherence tomography demonstrated the absence of macular neovascularization in all cases; optical coherence tomography-angiography did not detect any abnormal flow signal associated with IRF. Seven of 10 patients developed IRF in correspondence of pigment epithelium detachment. Three of 10 patients presented IRF in correspondence of an area of nascent geographic atrophy. CONCLUSION Nonexudative intraretinal fluid in intermediate age-related macular degeneration is a novel, distinctive feature that is characterized by the presence of IRF with no evidence of macular neovascular lesions. The authors described different phenotypes of IRF in intermediate age-related macular degeneration. The definite diagnosis of this condition requires further studies with thorough application of multimodal imaging.
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Affiliation(s)
- Andrea Servillo
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Cem Kesim
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
- Department of Ophthalmology, Koç University School of Medicine, Istanbul, Turkey
| | - Riccardo Sacconi
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Battista
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Vittorio Capuano
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | | | - Lea Querques
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
| | | | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Francesco Bandello
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Querques
- Division of Head and Neck, Ophthalmology Unit, IRCSS Ospedale San Raffaele, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Fragiotta S, Bassis L, Abdolrahimzadeh B, Marino A, Sepe M, Abdolrahimzadeh S. Exploring Current Molecular Targets in the Treatment of Neovascular Age-Related Macular Degeneration toward the Perspective of Long-Term Agents. Int J Mol Sci 2024; 25:4433. [PMID: 38674018 PMCID: PMC11050199 DOI: 10.3390/ijms25084433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Long-lasting anti-vascular endothelial growth factor (anti-VEGF) agents have become an option to reduce treatment frequency, with ongoing research exploring optimal responses and safety profiles. This review delves into molecular targets, pharmacological aspects, and strategies for achieving effective and enduring disease control in neovascular age-related macular degeneration (AMD). The molecular pathways involved in macular neovascularization, including angiogenesis and arteriogenesis, are explored. VEGF, PlGF, Ang-1, and Ang-2 play crucial roles in regulating angiogenesis, influencing vessel growth, maturation, and stability. The complex interplay of these factors, along with growth factors like TGFβ and bFGF, contributes to the pathogenesis of neovascular membranes. Current anti-VEGF therapies, including bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab, are discussed with a focus on their pharmacokinetics and clinical applications. Strategies to achieve sustained disease control in AMD involve smaller molecules, increased drug dosages, and novel formulations. This narrative review provides a comprehensive overview of the molecular targets and pharmacological aspects of neovascular AMD treatment.
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Affiliation(s)
- Serena Fragiotta
- Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00189 Rome, Italy; (S.F.); (L.B.); (A.M.)
- UOC Ophthalmology, Department of Surgical Areas, S.M. Goretti Hospital, 04100 Latina, Italy;
| | - Lorena Bassis
- Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00189 Rome, Italy; (S.F.); (L.B.); (A.M.)
| | | | - Alessandra Marino
- Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00189 Rome, Italy; (S.F.); (L.B.); (A.M.)
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
| | - Massimiliano Sepe
- UOC Ophthalmology, Department of Surgical Areas, S.M. Goretti Hospital, 04100 Latina, Italy;
| | - Solmaz Abdolrahimzadeh
- Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00189 Rome, Italy; (S.F.); (L.B.); (A.M.)
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
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3
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De Geronimo D, Parravano M, Sacconi R, Fragiotta S, Giannini D, Costanzo E, Varano M, Querques G. Impact of intravitreal anti-VEGF therapy on intraretinal microvascular abnormalities in proliferative diabetic retinopathy. Acta Diabetol 2024; 61:525-528. [PMID: 38302784 DOI: 10.1007/s00592-023-02227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Affiliation(s)
| | | | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Serena Fragiotta
- Department NESMOS, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | | | | | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
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Fragiotta S, Dysli C, Parravano M, Sacconi R, Fantaguzzi F, Servillo A, Severo AA, Tombolini B, Costanzo E, De Geronimo D, Capuano V, Souied E, Bandello F, Querques G. Phenotypic characterization of predictors for development and progression of geographic atrophy using optical coherence tomography. Retina 2024:00006982-990000000-00622. [PMID: 38471039 DOI: 10.1097/iae.0000000000004090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
PURPOSE To evaluate the impact of optical coherence tomography (OCT) phenotypes preceding atrophy related to age-related macular degeneration (AMD) on the progression of atrophic lesions. METHODS In this observational retrospective cohort study, a total of 70 eyes of 60 consecutive patients with intermediate AMD with a minimum follow-up of 24 months were included. The atrophy was quantified using fundus autofluorescence, also considering the directionality of atrophy as centrifugal and centripetal progression rates.Main outcome measures were geographic atrophy (GA) progression rate (mm2/year) and square root-transformation GA (mm2/year). RESULTS The best-fit model for GA (OR: 1.81, p<0.001) and square root-transformation GA (OR: 1.36, p<0.001) areas revealed that the main baseline predictor was the presence of an RPE-basal lamina-(BL)-Bruch's membrane (BrM) splitting. Large drusen at baseline appeared protective for the GA area lesion expansion over time (OR: 0.52, p<0.001) when considered with other confounders. CONCLUSION A thin RPE-BL-BrM splitting without evidence of neovascularization on OCT angiography likely represents an OCT signature for late basal laminar deposits. Identifying this phenotype can help identify individuals with a higher risk of rapid progression and atrophy expansion.
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Affiliation(s)
- Serena Fragiotta
- Ophthalmology Unit, "Sapienza" University of Rome, NESMOS Department, St. Andrea Hospital, Rome, Italy
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
| | | | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Federico Fantaguzzi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Andrea Servillo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Alice Antonella Severo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Beatrice Tombolini
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | | | - Daniele De Geronimo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Vittorio Capuano
- Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | - Eric Souied
- Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Mafrici M, Fragiotta S, Tarsitano MG, Lorenzi U, Toscani L. Topical anesthesia versus topical and subconjunctival anesthesia combined in diabetic retinopathy photocoagulation. Eur J Ophthalmol 2024; 34:529-533. [PMID: 37654069 DOI: 10.1177/11206721231199206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE comparison between two anesthetic techniques on the ability to reduce pain during panretinal photocoagulation (PRP) treatment. METHODS Observational retrospective single center study. Medical charts of patients who underwent PRP for proliferative diabetic retinopathy were revised. Patients were included if they had the first eye treated with oxybuprocaine hydrochloride drops, and in case of severe pain, the fellow eye received topical anesthesia in combination with 2% subconjunctival lidocaine. The groups were compared for pain perception using an analog visual scale (VAS), number of laser spots, number of interruptions, and laser session duration. RESULTS Forty-two eyes of 21 patients (mean age: 58.3 ± 7.6 years) were analyzed. The mean number of laser spots was significantly higher under combined anesthesia (+84.2 ± 155.9 spots, p = 0.01), with a reduced time for laser execution (-2.5 ± 3.12, p = 0.0008). The use of combined anesthesia significantly decreased the number of interruptions (-40.8%, p < 0.0001) into a single session. On the pain grading scale, the pain perception was significantly lower in the combined anesthesia group (p < 0.0001). In eyes receiving topical anesthesia the treatment was stopped for pain in 5 eyes (23.8%), while 5 eyes under combined anesthesia presented subconjunctival hemorrhage (23.8%). CONCLUSION Using combined anesthesia in patients subjected to PRP appeared to reduce pain perception limiting the treatment duration and the interruptions for pain without significant complications. Further studies on a larger scale would be desirable to replicate such findings and standardize the analgesic procedures in ophthalmology.
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Affiliation(s)
- M Mafrici
- Department of Ophthalmology, Ales-Cevennes Hospital, Ales, France
| | - S Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - U Lorenzi
- Department of Ophthalmology, Charles-Nicolle Hospital, Rouen, France
| | - L Toscani
- Department of Anesthesiology and Intensive Care, Sandro Pertini Hospital, Rome, Italy
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Ruggeri F, Ciancimino C, Guillot A, Fumi D, Tizio FD, Fragiotta S, Abdolrahimzadeh S. Posterior Polar Annular Choroidal Dystrophy: Genetic Insights and Differential Diagnosis in Inherited Retinal Diseases. Curr Issues Mol Biol 2024; 46:1383-1397. [PMID: 38392207 PMCID: PMC10887594 DOI: 10.3390/cimb46020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Posterior polar annular choroidal dystrophy (PPACD) is a rare ocular disorder and presents as symmetric degeneration of the retinal pigment epithelium (RPE) and the underlying choriocapillaris, encircling the retinal vascular arcades and optic disc. This condition distinctively preserves the foveal region, optic disc, and the outermost regions of the retina. Despite its distinct clinical presentation, due to the infrequency of its occurrence and the limited number of reported cases, the pathophysiology, and the genetic foundations of PPACD are still largely uncharted. This review aims to bridge this knowledge gap by investigating potential genetic contributors to PPACD, assessing current findings, and identifying genes that warrant further study. Emphasis is also placed on the crucial role of multimodal imaging in diagnosing PPACD, highlighting its importance in understanding disease pathophysiology. By analyzing existing case reports and drawing comparisons with similar retinal disorders, this paper endeavors to delineate the possible genetic correlations in PPACD, providing a foundation for future genetic research and the development of targeted diagnostic strategies.
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Affiliation(s)
- Francesco Ruggeri
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00185 Roma, Italy
| | - Chiara Ciancimino
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00185 Roma, Italy
| | - Antonio Guillot
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00185 Roma, Italy
| | - Daniele Fumi
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00185 Roma, Italy
| | - Federico Di Tizio
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
| | - Serena Fragiotta
- UOC Ophthalmology, Department of Surgical Areas, S.M. Goretti Hospital, 04100 Latina, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, 00185 Roma, Italy
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
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Viggiano P, Costanzo E, Giannini D, Fragiotta S, De Geronimo D, Giorno P, Picconi F, Frontoni S, Varano M, Parravano M. In vivo assessment of associations between photoreceptors structure and macular perfusion in type 1 diabetes. Br J Ophthalmol 2023; 107:1672-1679. [PMID: 36126103 DOI: 10.1136/bjo-2022-321617] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To explore the potential relationships between macular vascular network and different adaptive optics (AO) metrics in patients with type 1 diabetes mellitus (DM1) with no signs (NoDR) or mild non-proliferative diabetic retinopathy (NPDR). DESIGN Observational cross-sectional study. METHODS Forty eyes of consecutive patients with DM1 (12 NoDR and 28 NPDR) and 10 healthy age-matched control subjects were included. All patients and controls were imaged using AO retinal camera and PLEX Elite 9000 optical coherence tomography (OCT) angiography (OCTA). The AO outcome measures to evaluate the cone photoreceptor mosaic characteristics were as follows: (1) Cone density (CD); (2) Linear Dispersion Index (LDi) and (3) Heterogeneity Packing Index (HPi). The OCTA outcome measures included: (1) superficial capillary plexus (SCP) perfusion density (PD); (2) deep capillary plexus (DCP) PD and (3) the choriocapillaris (CC) flow deficit percentage (FD%). RESULTS NPDR group exhibited a close relationship between cone metrics and CC FD. Notably, CC FD% increase along with LDi (p=0.035), while the increasing CC FD% were associated with reducing CD (p=0.042) and the HPi (p=0.017). Furthermore, the OCTA parameters, including PD SCP and DCP, showed a significant negative correlation with CD. CONCLUSIONS Our results demonstrated the relationship between macular perfusion at both retinal and choroidal levels and the cone mosaic in patients with DM1 interpolating swept-source-OCTA and AO metrics. In NPDR eyes, the photoreceptor damage was accompanied by CC insufficiency since the early stages of the disease.
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Affiliation(s)
| | | | | | - Serena Fragiotta
- Department of Medicine and Surgery, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Paola Giorno
- Ophthalmology, IRCCS-Fondazione Bietti, Rome, Italy
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Mafrici M, Tona F, Fragiotta S, Lorenzi U, Gitto L, Toscani L. Idiopathic Intracranial Hypertension Papillopathy due to Hormonal Changes during Pregnancy. Case Rep Ophthalmol Med 2023; 2023:6688445. [PMID: 37469477 PMCID: PMC10353893 DOI: 10.1155/2023/6688445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/15/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
Background The underlying mechanisms of papilledema associated with intracranial hypertension remain unclear. A case of bilateral papillary edema in a patient with chronic idiopathic intracranial hypertension who was asymptomatic during her two pregnancies is reported. Case Presentation. A 19-year-old Caucasian female, in her third month of pregnancy, complained of difficulties with close reading. The patient's visual acuity was 20/20 on the Snellen chart and improved with a 0.50 D correction in both eyes. Near vision and slit lamp examinations revealed normal findings bilaterally. However, a fundus examination showed bilateral papillary edema without evidence of hemorrhages or neovascularization. Blood tests were unremarkable, except for a slight increase in C-reactive protein levels. The patient had a prepregnancy weight of 63 kilograms, with a BMI of 24.91 kg/m2. Magnetic resonance imaging of the brain revealed features consistent with chronic idiopathic intracranial hypertension, which resolved after delivery. Two and a half years later, during a subsequent pregnancy, the patient experienced a recurrence of bilateral papillary edema due to the IIH. It was managed similarly as the first occurrence, resulting in bilateral anatomical and functional recovery. Recent research revealed that, during pregnancy, hormones interact with the central nervous system, leading to an increase in the size of neurons which could potentially result in intracranial hypertension. Conclusions The influence of hormonal fluctuations during pregnancy on the development of transient central nervous system abnormalities in individuals with chronic intracranial hypertension, leading to papillary edema, remains a matter of debate.
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Affiliation(s)
- Marco Mafrici
- Department of Ophthalmology, Ales-Cevennes Hospital, Ales, France
| | - Francesca Tona
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy
| | - Umberto Lorenzi
- Department of Ophthalmology, Charles-Nicolle Hospital, Rouen, France
| | - Lorenzo Gitto
- Cook County Medical Examiner's Office, Chicago, Illinois, USA
| | - Laura Toscani
- Department of Anesthesiology and Intensive Care, CTO Andrea Alesini Hospital, Roma, Italy
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Scuderi L, Fragiotta S, Di Pippo M, Abdolrahimzadeh S. The Role of Diabetic Choroidopathy in the Pathogenesis and Progression of Diabetic Retinopathy. Int J Mol Sci 2023; 24:10167. [PMID: 37373315 DOI: 10.3390/ijms241210167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Diabetic choroidopathy was first described on histopathological specimens of diabetic eyes. This alteration was characterized by the accumulation of PAS-positive material within the intracapillary stroma. Inflammation and polymorphonuclear neutrophils (PMNs) activation are crucial elements in choriocapillaris impairment. The evidence of diabetic choroidopathy in vivo was confirmed with multimodal imaging, which provides key quantitative and qualitative features to characterize the choroidal involvement. The choroid can be virtually affected in each vascular layer, from Haller's layer to the choriocapillaris. However, the damage on the outer retina and photoreceptor cells is essentially driven by a choriocapillaris deficiency, which can be assessed through optical coherence tomography angiography (OCTA). The identification of characteristic features of diabetic choroidopathy can be significant for understanding the potential pathogenic and prognostic implications in diabetic retinopathy.
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Affiliation(s)
- Luca Scuderi
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
- UOC Ophthalmology, Department of Surgical Areas, S.M. Goretti Hospital, 04100 Latina, Italy
| | - Mariachiara Di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
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Fragiotta S, Parravano M, Costanzo E, De Geronimo D, Varano M, Fernández-Avellaneda P, Freund KB. SUBRETINAL LIPID GLOBULES AN EARLY BIOMARKER OF MACULAR NEOVASCULARIZATION IN EYES WITH INTERMEDIATE AGE-RELATED MACULAR DEGENERATION. Retina 2023; 43:913-922. [PMID: 36763979 DOI: 10.1097/iae.0000000000003760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
PURPOSE To explore the association between subretinal lipid globules (SLGs) detected in eyes with intermediate age-related macular degeneration with the presence of nonexudative macular neovascularization. METHODS This was a retrospective analysis of 113 consecutive patients with bilateral intermediate age-related macular degeneration (226 eyes) followed for a least 6 months. All eyes underwent multimodal imaging with fundus autofluorescence, spectral-domain optical coherence tomography, and optical coherence tomography angiography. Subretinal lipid globules were identified on spectral-domain optical coherence tomography as round hyporeflective lesions measuring 31 to 157 µ m located between the ellipsoid zone and the retinal pigment epithelium/Bruch membrane complex. Nonexudative macular neovascularization was detected with optical coherence tomography angiography. The features of NE-MNV lesions detected in eyes with SLGs were compared with those in eyes without SLGs. RESULTS Subretinal lipid globules were identified in 15 eyes of which 14 eyes (93.3%) demonstrated NE-MNV on optical coherence tomography angiography. In the remaining 98 eyes without SLGs, 18 (18.4%) displayed NE-AMD on optical coherence tomography angiography. The macular neovascularization area was larger in the SLG subgroup (+0.38 vs. +0.21 mm 2 , P = 0.008) and showed faster horizontal growth (+727 µ m, CI 95% 250.4, 1,205.4) than MNV in eyes without SLGs (+64.9 µ m, CI 95%, 24.3, 154) on optical coherence tomography B-scans. After a mean of 11.6 months, the conversion rate to exudative MNV was similar between eyes with SLGs and those without SLGs [8/26 (38.5%) versus 3/13 (27.3%), P = 0.56)]. CONCLUSION The detection of SLGs in eyes with intermediate age-related macular degeneration was strongly correlated with the presence of NE-MNV. Although these MNV lesions were larger and grew faster than NE-MNV detected in eyes lacking SLGs, the rates of conversion to exudative MNV appeared similar.
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Affiliation(s)
- Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | | | | | | | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; and
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
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Breazzano MP, Oh JK, Batson SA, Kucherich JA, Karani R, Rohrmann CM, Sparrow JR, Fragiotta S, Tsang SH. Vitamin A deficiency and the retinal "double carrot" sign with optical coherence tomography. Eye (Lond) 2023; 37:1489-1495. [PMID: 35840717 PMCID: PMC10169789 DOI: 10.1038/s41433-022-02137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 04/30/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spectral-domain optical coherence tomography (SD-OCT) and full-field electroretinography (ERG) allow retinal assessment with vitamin A deficiency (VAD). Using SD-OCT, this study aimed to characterize and follow a novel retinal abnormality in patients with VAD and intramuscular supplementation. METHODS Patients with VAD were retrospectively reviewed, including SD-OCT and electroretinography. RESULTS Three patients had VAD following bariatric or colon surgery and varying supplementation. All had nyctalopia, extinguished scotopic rod-specific function with ERG, and decreased serum vitamin A. None demonstrated surface abnormalities. All received intramuscular vitamin A with subjective resolution of symptoms. On SD-OCT, four of six eyes exhibited homogenous foveal hyperreflectivity anterior to retinal pigment epithelium-Bruch complex, reminiscent of a "double carrot", which improved following supplementation. ERG findings demonstrated improved scotopic rod-specific function in all cases; however, photopic function remained diminished in two cases. CONCLUSIONS Structural improvement of the proposed "double carrot" sign occurs soon after vitamin A supplementation. While scotopic function improves rapidly following supplementation, cone function recovers more slowly. Therefore, foveal changes such as the "double carrot" sign suggest that structural recovery of cones precedes functional recovery.
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Grants
- R01 EY024091 NEI NIH HHS
- R21 AG050437 NIA NIH HHS
- R01 EY018213 NEI NIH HHS
- U01 EY030580 NEI NIH HHS
- U54 OD020351 NIH HHS
- R01 EY026682 NEI NIH HHS
- R24 EY027285 NEI NIH HHS
- P30 CA013696 NCI NIH HHS
- R24 EY028758 NEI NIH HHS
- R01 EY024698 NEI NIH HHS
- P30 EY019007 NEI NIH HHS
- U.S. Department of Health & Human Services | NIH | National Eye Institute (NEI)
- Foundation Fighting Blindness (Foundation Fighting Blindness, Inc.)
- Research to Prevent Blindness (RPB) Physician-Scientist Award, and unrestricted funds from RPB, New York, NY, USA
- U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI)
- U.S. Department of Health & Human Services | NIH | NIH Office of the Director (OD)
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (U.S. National Institute on Aging)
- The Schneeweiss Stem Cell Fund, New York State [SDHDOH01-C32590GG-3450000], Nancy & Kobi Karp, the Crowley Family Funds, The Rosenbaum Family Foundation, Alcon Research Institute, the Gebroe Family Foundation, the Research to Prevent Blindness (RPB) Physician-Scientist Award, and unrestricted funds from RPB, New York, NY, USA.
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Affiliation(s)
- Mark P Breazzano
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Ophthalmology, New York University Langone Health, New York, NY, USA
- Manhattan Eye, Ear and Throat Hospital, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jin Kyun Oh
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Julia A Kucherich
- Department of Nutrition & Therapeutic Services, Morgan Stanley Children's Hospital at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Hospital, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - Rabia Karani
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Caitlin M Rohrmann
- Department of Nutrition & Therapeutic Services, Morgan Stanley Children's Hospital at New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet R Sparrow
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Serena Fragiotta
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Stephen H Tsang
- Jonas Children's Vision Care, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA.
- Columbia Stem Cell Initiative, and Institute of Human Nutrition, Columbia University, New York, NY, USA.
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12
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Fragiotta S, Costanzo E, Picconi F, Giorno P, De Geronimo D, Giannini D, Frontoni S, Varano M, Parravano M. Progression Biomarkers of Microvascular and Photoreceptor Changes Upon Long-Term Evaluation in Type 1 Diabetes. Invest Ophthalmol Vis Sci 2023; 64:23. [PMID: 37227747 DOI: 10.1167/iovs.64.5.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Purpose To assess demographic, metabolic, and imaging predictors influencing microvasculature and photoreceptors changes over a 4-year follow-up in type 1 diabetes mellitus (DM1). Methods This prospective cohort study enrolled patients with DM1 with mild non-proliferative diabetic retinopathy. Complete medical records, glycosylated hemoglobin (HbA1c), optical coherence tomography angiography, and adaptive optics were collected for the 4 years of follow-up. The main outcome measures included perfusion density at the superficial capillary plexus (SCP) and deep capillary plexus (DCP), choriocapillaris (CC) flow deficits (FDs, %), cone density, linear dispersion index (LDi), and heterogeneity packing index (HPi). Results The SCP presented a dichotomic perfusion trend, with increasing PD at 1 and 2 years and a subsequent decline (P < 0.001). DCP presented a similar trend in the first 2 years (P < 0.01) but not at the following time points, whereas CC FDs constantly increased over time (P < 0.01). The best-fitted model for the microvascular parameters demonstrated that the main factors affecting SCP included time (P < 0.001), duration of diabetes (P = 0.007), and HbA1c (P = 0.03), whereas the DCP was influenced by LDi modifications (P = 0.006). The LDi and HPi were mainly influenced by SCP and CC perfusion in the parafovea (P = 0.02). Conclusions This study demonstrated an initial vasodilatory phenomenon resulting from a compensatory mechanism from the superficial vasculature, followed by capillary dropout. Initially, it would seem that there was an adaptive response by the DCP to the needs of the photoreceptors. Although the SCP may initially support the DCP, when the microvascular damage becomes diffuse and involves the SCP and CC it directly affects photoreceptor integrity.
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Affiliation(s)
- Serena Fragiotta
- Ophthalmology Unit, Neuroscience, Mental Health and Sense Organs Department, St. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | | | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Isola Tiberina Gemelli Isola, Rome, Italy
| | | | | | | | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Isola Tiberina Gemelli Isola, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
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13
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Costanzo E, Giannini D, De Geronimo D, Fragiotta S, Varano M, Parravano M. Prognostic Imaging Biomarkers in Diabetic Macular Edema Eyes Treated with Intravitreal Dexamethasone Implant. J Clin Med 2023; 12:jcm12041303. [PMID: 36835839 PMCID: PMC9968175 DOI: 10.3390/jcm12041303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The aim was to evaluate predictive value of baseline optical coherence tomography (OCT) and OCT angiography (OCTA) parameters in diabetic macular edema (DME) treated with dexamethasone implant (DEXi). METHODS OCT and OCTA parameters were collected: central macular thickness (CMT), vitreomacular abnormalities (VMIAs), intraretinal and subretinal fluid (mixed DME pattern), hyper-reflective foci (HRF), microaneurysms (MAs) reflectivity, ellipsoid zone disruption, suspended scattering particles in motion (SSPiM), perfusion density (PD), vessel length density, and foveal avascular zone. Responders' (RES) and non-responders' (n-RES) eyes were classified considering morphological (CMT reduction ≥ 10%) and functional (BCVA change ≥ 5 ETDRS letters) changes after DEXi. Binary logistic regression OCT, OCTA, and OCT/OCTA-based models were developed. RESULTS Thirty-four DME eyes were enrolled (18 treatment-naïve). OCT-based model combining DME mixed pattern + MAs + HRF and OCTA-based model combining SSPiM and PD showed the best performance to correctly classify the morphological RES eyes. In the treatment-naïve eyes, VMIAs were included with a perfect fit for n-RES eyes. CONCLUSION The presence of DME mixed pattern, a high number of parafoveal HRF, hyper-reflective MAs, SSPiM in the outer nuclear layers, and high PD represent baseline predictive biomarkers for DEXi treatment responsiveness. The application of these models to treatment-naïve patients allowed a good identification of n-RES eyes.
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Affiliation(s)
| | | | | | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, Sant’ Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy
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14
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Zhang L, Van Dijk EHC, Borrelli E, Fragiotta S, Breazzano MP. OCT and OCT Angiography Update: Clinical Application to Age-Related Macular Degeneration, Central Serous Chorioretinopathy, Macular Telangiectasia, and Diabetic Retinopathy. Diagnostics (Basel) 2023; 13:diagnostics13020232. [PMID: 36673042 PMCID: PMC9858550 DOI: 10.3390/diagnostics13020232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Similar to ultrasound adapting soundwaves to depict the inner structures and tissues, optical coherence tomography (OCT) utilizes low coherence light waves to assess characteristics in the eye. Compared to the previous gold standard diagnostic imaging fluorescein angiography, OCT is a noninvasive imaging modality that generates images of ocular tissues at a rapid speed. Two commonly used iterations of OCT include spectral-domain (SD) and swept-source (SS). Each comes with different wavelengths and tissue penetration capacities. OCT angiography (OCTA) is a functional extension of the OCT. It generates a large number of pixels to capture the tissue and underlying blood flow. This allows OCTA to measure ischemia and demarcation of the vasculature in a wide range of conditions. This review focused on the study of four commonly encountered diseases involving the retina including age-related macular degeneration (AMD), diabetic retinopathy (DR), central serous chorioretinopathy (CSC), and macular telangiectasia (MacTel). Modern imaging techniques including SD-OCT, TD-OCT, SS-OCT, and OCTA assist with understanding the disease pathogenesis and natural history of disease progression, in addition to routine diagnosis and management in the clinical setting. Finally, this review compares each imaging technique's limitations and potential refinements.
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Affiliation(s)
- Lyvia Zhang
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, 20132 Milan, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy
| | - Mark P. Breazzano
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY 13088, USA
- Correspondence: ; Tel.: +1-(315)-445-8166
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15
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Sacconi R, Fragiotta S, Sarraf D, Sadda SR, Freund KB, Parravano M, Corradetti G, Cabral D, Capuano V, Miere A, Costanzo E, Bandello F, Souied E, Querques G. Towards a better understanding of non-exudative choroidal and macular neovascularization. Prog Retin Eye Res 2023; 92:101113. [PMID: 35970724 DOI: 10.1016/j.preteyeres.2022.101113] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
Non-exudative macular and choroidal neovascularization (MNV and CNV) usually refers to the entity of treatment-naïve type 1 neovascularization in the absence of associated signs of exudation. Histopathological studies, dating back in the early 70s, identified the presence of non-exudative MNV, but the first clinical report of this finding was in the late 90s using indocyanine green angiography in eyes with age-related macular degeneration (AMD). With more advanced retinal imaging, there has been an ever increasing appreciation of non-exudative MNV associated with AMD and CNV with other macular disorders. However, consensus regarding the exact definition and the clinical management of this entity is lacking. Furthermore, there may be variation in the imaging features and clinical course suggesting that a spectrum of disease may exist. Herein, we review the large body of published work that has provided a better understanding of non-exudative MNV and CNV in the last decade. The prevalence, multimodal imaging features, clinical course, and response to treatment are discussed to elucidate further key insights about this entity. Based on these observations, this review also proposes a new theory about the origin and course of different sub-types of non-exudative MNV/CNV which can have different etiologies and pathways according to the clinical context of disease.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Fragiotta
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | | | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric Souied
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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16
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Fragiotta S. Targeting neuroinflammation in early diabetic retinopathy. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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17
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Fragiotta S, Parravano M, Sacconi R, Costanzo E, De Geronimo D, Prascina F, Capuano V, Souied EH, Han IC, Mullins R, Querques G. Sub-retinal pigment epithelium tubules in non-neovascular age-related macular degeneration. Sci Rep 2022; 12:15198. [PMID: 36071082 PMCID: PMC9452588 DOI: 10.1038/s41598-022-19193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
To describe a novel optical coherence tomography (OCT) signature resembling sub-retinal pigment epithelium (RPE) tubules (SRT) in non-neovascular age-related macular degeneration (AMD). Patients suffering from non-neovascular AMD with complete medical records and multimodal imaging were retrospectively revised in three different tertiary care centers. Multimodal imaging included color fundus photograph, spectral-domain OCT (Spectralis, Heidelberg Engineering, Germany), fundus autofluorescence, OCT angiography (RTVue XR Avanti, Optovue, Inc., Fremont, CA). A total of 7 eyes of 7 patients with drusenoid pigment epithelium detachment (PED) were consecutively analyzed. The sub-RPE tubules appeared as ovoidal structures with a hyperreflective contour and hyporeflective interior appreciable in the sub-RPE-basal lamina (BL) space on OCT B-scan. The anatomical location of the sub-RPE formations was lying above the Bruch’s membrane in 5/7 cases (71.4%) or floating in the sub-RPE-BL space in 2/7 cases (28.6%). En-face OCTA revealed a curvilinear tubulation-like structure corresponding to SRT without flow signal. Sub-RPE tubules represent a newly identified OCT signature observed in eyes with drusenoid PED. The presumed origin may include a variant of calcified structure or alternatively activated RPE cells with some residual BL or basal laminar deposits attracted to BrM for craving oxygen.
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Affiliation(s)
- Serena Fragiotta
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132, Milan, Italy
| | | | | | - Francesco Prascina
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132, Milan, Italy
| | | | - Eric H Souied
- Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Ian C Han
- The Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Robert Mullins
- The Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132, Milan, Italy.
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18
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Parravano M, Fragiotta S, Querques G. Prognostic relevance of optical coherence tomography angiography biomarkers in diabetic macular edema. Expert Review of Ophthalmology 2022. [DOI: 10.1080/17469899.2022.2108406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Serena Fragiotta
- Ophthalmology Unit, NESMOS Department, “Sapienza” University of Rome, St. Andrea Hospital, Rome, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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19
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Di Pippo M, Di Staso F, De Ponte C, Fragiotta S, Abdolrahimzadeh S. Nab-Paclitaxel related cystoid macular edema. Clin Ter 2022; 173:377-383. [PMID: 35857057 DOI: 10.7417/ct.2022.2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Nab-paclitaxel is a chemotherapeutic drug used to treat various solid malignant tumors. It was conceived with a solvent free formulation to overcome toxicity events and hypersensitivity reactions associated with paclitaxel. However, it still carries ocular adverse effects. The present review examines nab-paclitaxel related cystoid macular edema (CME) and the available therapeutic options. MATERIALS AND METHODS The literature was reviewed on nab-paclitaxel related CME on published articles through January 2021 using the keywords "nab-paclitaxel "and "cystoid macular edema". RESULTS Bilateral CME is found in patients in treatment with nab-paclitaxel and causes considerable visual acuity decline. In ophthalmology multimodal imaging has an integral role in the diagnostic work up of patients and shows characteristic findings in nab-paclitaxel related CME. The case of a patient with treatment for bilateral CME is presented and analyzed. CONCLUSIONS The preferred management strategy for nab-paclitaxel-related CME is drug cessation that leads to complete resolution of edema. When discontinuation of treatment is not possible due to the systemic conditions of patients, effective alternative therapeutic modalities are topical dorzolamide or steroidal treatment. Given the higher complication hazards of intravitreal therapy topical treatment should be preferred owing to comparable efficacy.
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Affiliation(s)
- M Di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
| | - F Di Staso
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
| | - C De Ponte
- Pharmacy Unit, INMI Lazzaro Spallanzani, Rome Italy
| | - S Fragiotta
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
| | - S Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
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20
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Parravano M, Fragiotta S, Costanzo E, Giannini D, De Geronimo D, Viggiano P, Riccardo S, Querques G. Differences in cysts characteristics and related influence on the anatomical response after dexamethasone implant in diabetic macular oedema. Eye (Lond) 2022; 36:1329-1331. [PMID: 34815531 PMCID: PMC9151728 DOI: 10.1038/s41433-021-01857-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the clinical significance of suspended scattering particles in motion (SSPiM) and different cystic phenotypes in diabetic macular oedema (DME) treated with dexamethasone implant (DEX-i). METHODS A retrospective review of type 2 diabetic patients with DME treated with a DEX-i was conducted. Swept-source optical coherence tomography angiography (OCTA, PLEX Elite 9000) with a 3-mm volume cube was performed. Regions of interest were delineated with Fiji software (version 2.1.0/1.53.c) in the superficial vascular complex (SVC) and deep capillary plexus (DCP) at baseline, 2- and 4-months after DEX-i. SSPiM was defined as regions of variable reflectivity with a decorrelation signal. Without a detectable decorrelation signal, its counterpart was addressed as 'corpuscular,' while hyporeflective cysts were optical empty without hyperreflective material enclosed. RESULTS After treatment, the hyporeflective component demonstrated substantial reabsorption in the SVC (-95.4% at 2- and -84.4% at 4-months, p < 0.01 both) and DVC (-84.4%, 2-months), with a less critical decrease of the corpuscular component in the SVC (2-months: -41.9%, p = 0.001 and 4 months: -1.8%, p = 0.73), and not significant in the DVC. SSPiM did not significantly change in the SVC and DVC neither at 2- and 4-months (p > 0.05, all). CONCLUSIONS After a single DEX-i, the clearance of different cystic phenotypes proceeds with resorption of hyporeflective, followed by corpuscular components. SSPiM demonstrated minimal response, indicating a severe BRB breakdown that may require repeated treatment to reach a satisfactory anatomical response.
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Affiliation(s)
| | - Serena Fragiotta
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | | | | | | | - Sacconi Riccardo
- grid.15496.3f0000 0001 0439 0892Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Giuseppe Querques
- grid.15496.3f0000 0001 0439 0892Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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21
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de Paula A, Perdicchi A, Pocobelli A, Fragiotta S, Scuderi G. The “Topography” of Glaucomatous Defect Using OCT and Visual Field Examination. J Curr Glaucoma Pract 2022; 16:31-35. [PMID: 36060037 PMCID: PMC9385384 DOI: 10.5005/jp-journals-10078-1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim To describe the modifications in the superior and inferior retinal nerve fiber layer (RNFL) thickness regarding the distribution of the VF defects for the horizontal meridians in glaucomatous patients and the differences in the RNFL thickness topography between glaucomatous and healthy subjects. Methods One hundred twenty eyes of 91 patients affected by glaucoma and 94 eyes of 51 normal patients were retrospectively reviewed. Computerized 30°VF (Octopus G1 Dynamic strategy) and optical coherence tomography (OCT) ONH and 3D disk analysis were performed in all cases. The RNFL thickness measures analyzed in both groups were superior-nasal (SN), superior-temporal (ST), inferior-nasal (IN), and inferior temporal (IT) sectors. The VFs were classified according to the distribution of the VF defect as for the horizontal meridian in the pattern deviation plot as superior, inferior, predominantly superior, or predominantly inferior. Result In the glaucomatous group, 78 eyes (65%) showed a predominantly superior VF defect, while 38 eyes (32%) showed a predominantly inferior VF defect. Fifty-six eyes (46.7%) presented an exclusively superior, and 27/120 eyes (22.5%) presented an exclusively inferior VF defect. In the control group, the thickest RNFL sector was IT. The ST sector showed the thickest RNFL in presence of an exclusive superior VF defect. In case of an exclusive inferior VF defect, the thickest RNFL was the IT sector. VF showing superior defect presented a more altered MD than the VF with an inferior defect. Conclusion Glaucomatous damage affects both the superior and inferior neural rim almost simultaneously. However, the neural rim loss seems to be asymmetric, involving the inferior or superior rim depending on the predominant involvement of the superior or inferior hemifield at the VF test. Particularly, the IT sector appears to be the most compromised in glaucomatous eyes. Therefore, the asymmetry between superior and inferior RNFL could support the diagnosis of glaucoma. How to cite this article de Paula A, Perdicchi A, Pocobelli A, et al. The “Topography” of Glaucomatous Defect Using OCT and Visual Field Examination. J Curr Glaucoma Pract 2022;16(1):31-35.
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Affiliation(s)
- Alessandro de Paula
- Department of Head-neck, San Giovanni Addolorata Hospital, Uoc Oftalmologia - Banca Degli Occhi, Rome, Italy
- Alessandro de Paula, Department of Head-neck, San Giovanni Addolorata Hospital, Uoc Oftalmologia - Banca Degli Occhi, Rome, Italy, Phone: +39 0677052950, e-mail:
| | - Andrea Perdicchi
- Department of NESMOS, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Augusto Pocobelli
- Department of Head-neck, San Giovanni Addolorata Hospital, Uoc Oftalmologia - Banca Degli Occhi, Rome, Italy
| | - Serena Fragiotta
- Department of NESMOS, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Gianluca Scuderi
- Department of NESMOS, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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Fragiotta S, Costanzo E, Viggiano P, De Geronimo D, Scuderi G, Varano M, Parravano M. Functional Correlates of Outer Retina Remodeling in Intermediate Age-Related Macular Degeneration Using Microperimetry. Invest Ophthalmol Vis Sci 2022; 63:16. [PMID: 35289843 PMCID: PMC8934566 DOI: 10.1167/iovs.63.3.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effect of drusen morphometric changes and choroidal vascular modifications on retinal sensitivity (RS) evaluated through microperimetry in intermediate age-related macular degeneration (iAMD). Methods A retrospective review of 18 iAMD patients (18 eyes) with a 12-month follow-up was performed. Eye-tracked spectral-domain optical coherence tomography was obtained, with automatic segmentation of the outer retinal layer (ORL) delineating the drusen area from the external limiting membrane to Bruch's membrane and outer nuclear layer (ONL) thickness maps adjusted manually, as needed. Advanced retinal pigment epithelium analysis was also performed with a ZEISS PLEX Elite 900. Microperimetry obtained under mesopic conditions was overlaid with the corresponding thickness maps with Fiji software. The choroidal vascularity index (CVI) was calculated in the subfoveal b-scan and volumetric in the central 1-mm subfield. Results A reduced central ONL thickness was strongly associated with RS decline at the same region (r = 0.69, P = 0.002) and globally (r = 0.80, P < 0.001) at baseline, but also at 1 year in the central subfield (central: r = 0.70, P = 0.001). One-year subfoveal CVI variation, differently from volumetric CVI, directly influenced the central (r = 0.64, P = 0.004) and global RS (r = 0.59, P = 0.009), indicating that a CVI reduction negatively affected RS. A greater volumetric CVI within central 1-mm was associated with ORL thickening at 1 year (r = 0.61, P = 0.008). Conclusions Progressive degeneration of the ONL is related to irreversible photoreceptor dysfunction in iAMD. Likewise, choroidal vascular modifications are associated with a significant functional decline in the central region and diffusely.
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Affiliation(s)
- Serena Fragiotta
- Ophthalmology Unit, "Sapienza" University of Rome, NESMOS Department, St. Andrea Hospital, Rome, Italy
| | | | | | | | - Gianluca Scuderi
- Ophthalmology Unit, "Sapienza" University of Rome, NESMOS Department, St. Andrea Hospital, Rome, Italy
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Fragiotta S, Fernández-Avellaneda P, Breazzano MP, Scuderi G. Clinical Manifestations of Cuticular Drusen: Current Perspectives. Clin Ophthalmol 2021; 15:3877-3887. [PMID: 34584401 PMCID: PMC8464647 DOI: 10.2147/opth.s272345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Cuticular drusen are part of the spectrum of age-related macular degeneration (AMD) with particular clinical and multimodal imaging characteristics. This drusen subpopulation shares several high-risk single nucleotide polymorphisms with AMD. Despite this feature, they can manifest at a relatively young age, presenting with a female preponderance. Multimodal imaging is essential for characterizing such lesions, using a combination of color fundus photographs, optical coherence tomography (OCT), fluorescein angiography (FA), and fundus autofluorescence (FAF). The classic starry-sky pattern visible on FA and the typical central hypoautofluorescent lesion with hyperautofluorescent rim on FAF is considered the result of a central retinal pigment epithelium (RPE) erosion from these triangular elevations of the RPE-basal lamina. This finding may also be responsible for the typical choroidal hypertransmission appreciated through OCT. The clinical course of cuticular drusen may be relatively benign at early stages, with small drusen presenting at a young age. However, the presence of clinical phenotypes characterized by diffuse involvement and/or accompanying large drusen in patients older than 60 years may confer a significant risk for either macular neovascularization or geographic atrophy.
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Affiliation(s)
- Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, UA
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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Abdolrahimzadeh S, Ciancimino C, Grassi F, Sordi E, Fragiotta S, Scuderi G. Near-Infrared Reflectance Imaging in Retinal Diseases Affecting Young Patients. J Ophthalmol 2021; 2021:5581851. [PMID: 34373789 PMCID: PMC8349282 DOI: 10.1155/2021/5581851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Near-infrared reflectance (NIR) is a noninvasive, contactless, and rapid in vivo imaging technique for visualizing subretinal alterations in the photoreceptor layer, retinal pigment epithelium, and choroid. The present report describes the application of this imaging method in retinal and choroidal pathologies affecting young patients where scarce cooperation, poor fixation, and intense glare sensation can result in a challenging clinical examination. A literature search of the MEDLINE database was performed using the terms "near-infrared reflectance" and "spectral-domain optical coherence tomography." Articles were selected if they described the diagnostic use of NIR in children or young adults. Of 700 publications, 42 manuscripts published between 2005 and 2020 were inherent to children or young adults and were considered in this narrative literature review. The first disease category is the phakomatoses where NIR is essential in visualizing choroidal alterations recognized as cardinal biomarkers in neurofibromatosis type 1, microvascular retinal alterations, and retinal astrocytic hamartomas. Another diagnostic application is the accurate visualization of crystals of various nature, including the glistening crystals that characterize Bietti crystalline dystrophy. Acute macular neuropathy and paracentral acute middle maculopathy represent a further disease category with young adulthood onset where NIR is not only diagnostic but also essential to monitor disease progression. A further interesting clinical application is to facilitate the detection of laser-induced maculopathy where funduscopic examination can be normal or subnormal. In conclusion, NIR imaging has a noninterchangeable role in diagnosing certain retinal diseases, especially in children and young adults where there is scarce collaboration and a lack of evident clinical findings. Moreover, this technique can reveal unique retinal and choroidal biomarkers highly specific to rare conditions.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Chiara Ciancimino
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Flaminia Grassi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Edoardo Sordi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
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Fragiotta S, Ciancimino C, Perdicchi A, de Paula A, Abdolrahimzadeh S, Scuderi G. Volume Rendering of Angiographic Optical Coherence Tomography Angiography in Fovea Plana and Normal Foveal Pit. Front Neurol 2021; 12:633492. [PMID: 33986716 PMCID: PMC8111301 DOI: 10.3389/fneur.2021.633492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
This paper aims to study adaptative vascular arrangements in idiopathic fovea plana with volume-rendered optical coherence tomography angiography (OCTA). A retrospective review of two cases of idiopathic fovea plana (mean age: 26.5 years) and two age-matched controls imaged with OCTA was conducted using spectral-domain OCTA (RTVue XR Avanti, Optovue, Inc., Fremont, CA) equipped with the AngioVue software. Both en face OCTA slabs and OCTA b scans were processed through Fiji software (http://fiji.sc; software version 2.0.0-rc-68/1.52e), and then extracted as image sequences for volume rendering reconstructions using the ImageVis3D volume rendering system (3.1.0 release). Eyes with idiopathic fovea plana demonstrated a regular superficial vascular plexus connecting to a single vascular monolayer representing the deeper vascular plexuses. At this location, several vertical short path connections were demonstrated, in contraposition with normal eyes where short path connections were infrequently observed. Advances in three-dimensional OCTA reconstruction increase the understanding of vascular connections and arrangement in retinal plexuses and possible anatomical variations that cannot be detected with conventional two-dimensional b scans.
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Affiliation(s)
- Serena Fragiotta
- Ophthalmology Unit, Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Chiara Ciancimino
- Ophthalmology Unit, Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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de Paula A, Abdolrahimzadeh S, Fragiotta S, Di Pippo M, Scuderi G. Current concepts on ocular vascular abnormalities in the phakomatoses. Semin Ophthalmol 2021; 36:549-560. [PMID: 33755531 DOI: 10.1080/08820538.2021.1900284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurofibromatosis, Von Hippel Lindau disease, and tuberous sclerosis complex are classified under the term phakomatoses. They are characterized by ocular vascular abnormalities such as vascular tortuosity, corkscrew retinal vessel configuration, moyamoya-like aspect, microaneurysms, hemangioblastomas, and focal sheathing of retinal arteries, possibly due to abnormal formation, migration, and differentiation of neural crest cells. These alterations can be the first sign or the hallmark of disease and can be related to vasoproliferative tumors. PURPOSE Novel imaging technologies in ophthalmology, such as near-infrared reflectances and spectral domain optical coherence tomography, have improved our knowledge in the diagnosis of these pathologies. Previously undetected macular vascular alterations have been reported in phakomatoses using optical coherence tomography angiography. This review will summarize the ophthalmic vascular abnormalities and novel imaging methods in the phakomatoses. CONCLUSION Active research is being led into the ophthalmic management of these conditions and their complications, and owing to elevated vascular endothelial growth factor production from hemangioblastoma, hamartoma, and retinal vascular proliferative tumors, increasing interest in this line of therapy has been conducted although research is still ongoing in this area.
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Affiliation(s)
- Alessandro de Paula
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mariachiara Di Pippo
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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Fernández-Avellaneda P, Freund KB, Wang RK, He Q, Zhang Q, Fragiotta S, Xu X, Ledesma-Gil G, Sugiura Y, Breazzano MP, Yannuzzi LA, Liakopoulos S, Sarraf D, Dolz-Marco R. Multimodal Imaging Features and Clinical Relevance of Subretinal Lipid Globules. Am J Ophthalmol 2021; 222:112-125. [PMID: 32918902 DOI: 10.1016/j.ajo.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To describe the presence of subretinal lipid globules (SLG), analyze the multimodal imaging features inherent in their optical properties, and provide a means to distinguish them from other retinal structures and clinical signs. DESIGN Retrospective cohort study. METHODS The clinical data and multimodal imaging features of 39 patients (49 eyes) showing SLG were evaluated. Patients underwent color fundus photography, near-infrared reflectance (NIR), spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) and OCT angiography. In vitro phantom models were used to model OCT optical properties of water, mineral oil, and intralipid droplets and to investigate the optical mechanisms producing hypertransmission tails beneath SLG. RESULTS The SLG were not visible in color fundus photographs or in NIR images. With both SD- and SS-OCT B-scans, SLG appeared as 31-157 μm, round, hyporeflective structures demonstrating a characteristic hypertransmission tail previously described with lipid globules found in the choroid and in neovascular membranes. Similarly, with en face OCT, SLG appeared as small, round, hyporeflective structures. SLG were encountered most often in eyes with neovascular age-related macular degeneration (AMD) that had type 1 macular neovascularization (MNV) (91.1%). Of those eyes, 93.3% were receiving intravitreal antivascular endothelial growth factor (VEGF) therapy (median of 15 injections) with a mean follow-up of 52.6 months. The number of prior injections positively correlated with the number of SLG. The detection of MNV preceded the presence of SLG in 66.7% of cases. En face OCT showed that, in many eyes (49%), SLG appeared in clusters of >10. In 38.8% of eyes, SLG were found overlying type 1 MNV, and in 44.9% of eyes, often those with more numerous SLG, the SLG were located near the lesion border. In 2 eyes with AMD followed for nonexudative type 1 MNV, SLG were detected prior to the detection of other imaging signs of exudation. SLG were observed in several other exudative macular diseases. Phantom models demonstrated that the hypertransmission tail beneath SLG is related to a lensing effect produced by these hyporeflective spherical structures. CONCLUSIONS SLG are a newly recognized OCT feature frequently seen in eyes receiving intravitreal anti-VEGF therapy for type 1 MNV due to AMD. OCT B-scans show SLG as small, round, hyporeflective structures with a characteristic hypertransmission tail. This OCT signature is influenced by the OCT focal plane, and it relates to reduced signal attenuation through oil and a lensing effect created by a higher refractive index compared to surrounding tissue.
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Affiliation(s)
- Pedro Fernández-Avellaneda
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York City, New York, USA; Department of Ophthalmology, Basurto University Hospital, Bilbao, SP; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York City, New York, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York City, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York City, New York, USA; Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York City, New York, USA.
| | - Reeking K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Qinghua He
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Serena Fragiotta
- Neuroscienze Salute Mentale e Organi di Senso Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome La Sapienza, Rome, IT
| | - Xiaoyu Xu
- State Key Laboratory of Ophthalmology, Zhongshan, CH; Ophthalmic Center, Sun Yat-sen University, Guangzhou, CH
| | | | - Yoshimi Sugiura
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, JA
| | - Mark P Breazzano
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York City, New York, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York City, New York, USA; Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York City, New York, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York City, New York, USA; Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Sandra Liakopoulos
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, GM
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
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de Paula A, Perdicchi A, Di Tizio F, Fragiotta S, Scuderi G. Effect of intraocular pressure lowering on the capillary density of optic nerve head and retinal nerve fiber layer in patients with glaucoma. Eur J Ophthalmol 2020; 31:3003-3009. [DOI: 10.1177/1120672120967233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: To evaluate the effect of IOP lowering on the capillary density of optic nerve head and retinal nerve fiber layer in patients with primary open angle glaucoma. Methods: Twenty eyes of 14 glaucomatous patients and 15 eyes of nine normal patients were enrolled. The most appropriate hypotonic treatment was applied to every patient. A HD Angio Disc 4.5 scan (Avanti-AngioVue) was performed at baseline and after a month in the glaucomatous eyes. The following parameters were analyzed: Radial Papillary Capillaries (RPC) density, inside disc, peripapillary, superior-hemi, inferior-hemi, quadrants, and peripapillary, hemi-superior, hemi-inferior, and quadrants RNFL thickness. Optic nerve head analysis was also evaluated. In addition, the RPC density and the RNFL were assessed in the eight sectors provided by the software. Results: The RPC density did not significantly change after IOP reduction ( p > 0.05). The inferior-temporal ( p = 0.005) and inferior-nasal sectors ( p < 0.001) showed a greater capillary density than the respective superior sectors in healthy eyes. In contrast in the glaucomatous eyes, the superior-nasal exhibited greater capillary density with respect to the inferior-nasal sectors. The aggregate RPC density of the inferior sectors was greater than the superior ones in the control group ( p < 0.001). An improvement of the average disc area ( p = 0.01) and the average cup volume ( p = 0.059) were also observed along with increased RNFL thickness at different locations (all, p < 0.05) after IOP lowering therapy was initiated. Conclusion: The glaucomatous eyes presented rarefaction of the radial papillary capillaries density in the inferior sectors, but no significant changes in the density after IOP-lowering medications.
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Affiliation(s)
- Alessandro de Paula
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | - Federico Di Tizio
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome “La Sapienza,” Rome, Italy
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Fragiotta S, Mangino G, Iuliano M, Potenza C, Bernardini N, Skroza N, Vingolo EM, Romeo G. Role of CD 20 + T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis. Cytokine 2020; 136:155253. [PMID: 32858439 DOI: 10.1016/j.cyto.2020.155253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the role of CD3+ CD20+ CD4- CD8- double-negative (DN) or CD3+CD20+ CD4/CD8+ T cells and the related pro-inflammatory cytokines in the humor aqueous, in mediating retinal microvascular changes in patients with chronic plaque-type moderate to severe psoriasis. DESIGN A total of 76 patients (57.6 ± 11.7 years) with chronic plaque-type psoriasis were initially evaluated. Nineteen patients (19 eyes) and 19 healthy volunteers (19 eyes) were subjected to dermatological evaluation with Psoriasis Area Severity Index (PASI) and the Dermatology life quality index (DLQI). Retinal images were processed using an automatized software. On the same day, a venous sample was collected and analyzed using multiparametric flow cytometry. Three out of 6 patients who presented cataract, consented to perform surgery with humor aqueous collection. The samples were analyzed using a Multi-Analyte ELISA kit for the simultaneous quantification of IL1α, IL1β, IL2, IL4, IL6, IL8, IL10, IL12, IL17A, IFNγ, TNF-α, GMCSF. RESULTS The CD3+CD4+/CD8+CD20+CD56- T cells expression was greater in the psoriatic patients (+73.9%, P < 0.001) compared to controls, but not the DN T cells (-8.2%, P = 0.30). Ocular complications were diagnosed in 61.1% of patients, microvascular parameters including artero-venous ratio (P = 0.04), subfoveal choriocapillaris/Sattler's layer, and choroidal thickness (CT, both P < 0.001) were significantly altered in psoriasis subgroup. The increased circulating levels of the CD3+CD4+/CD8+CD20+CD56- T cells were associated with thinning of subfoveal CT (P = 0.03) and Haller's layer (P = 0.01). Instead, the DN T cells presented an inverse relationship with disease duration (P = 0.02), DLQI score (P = 0.02), and the use of biological therapy (P = 0.05). The related cytokine patterns possibly modified in this cellular context have been investigated. No significant differences were observed in cytokines levels between psoriasis and controls, the most significant difference was detected on IL-6, without reaching statistical significance (fold change of 1.4, P = 0.13). CONCLUSION Our findings demonstrated that CD20+ T cell subpopulation is highly represented in psoriasis regardless of the use of immunomodulatory therapies, and the diffuse microvascular alterations suggested possible endothelial damage as mainstream for the genesis of psoriatic-mediated complications as further supported by the comparable concentrations of cytokines, at least as humor aqueous content, with respect to healthy eyes.
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Affiliation(s)
- Serena Fragiotta
- Department of Medico-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy
| | - Giorgio Mangino
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Center for Biophotonics, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy
| | - Marco Iuliano
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy
| | - Concetta Potenza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy
| | - Nicoletta Bernardini
- Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy
| | - Nevena Skroza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy
| | - Enzo Maria Vingolo
- Department of Medico-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy
| | - Giovanna Romeo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Center for Biophotonics, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy.
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Breazzano MP, Giurgea LT, Day HR, Fragiotta S, Fernández-Avellaneda P, van Dijk EH, Bearelly S, Bond JB. The controversial drive for intervention with ophthalmologic screening for Candida bloodstream infections. Int J Infect Dis 2020; 96:363-364. [DOI: 10.1016/j.ijid.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/01/2020] [Indexed: 01/05/2023] Open
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Scuderi G, Fragiotta S, Scuderi L, Iodice CM, Perdicchi A. Ganglion Cell Complex Analysis in Glaucoma Patients: What Can It Tell Us? Eye Brain 2020; 12:33-44. [PMID: 32099501 PMCID: PMC6999543 DOI: 10.2147/eb.s226319] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
Glaucoma is a group of optic neuropathies characterized by a progressive degeneration of retina ganglion cells (RGCs) and their axons that precedes functional changes detected on the visual field. The macular ganglion cell complex (GCC), available in commercial Fourier-domain optical coherence tomography, allows the quantification of the innermost retinal layers that are potentially involved in the glaucomatous damage, including the retinal nerve fiber (RNFL), ganglion cell and inner plexiform layers. The average GCC thickness and its related parameters represent a reliable biomarker in detecting preperimetric glaucomatous damage. The most accurate GCC parameters are represented by average and inferior GCC thicknesses, and they can be associated with progressive visual field loss. Although the diagnostic accuracy increases with more severe glaucomatous damage and higher signal strength values, it is not affected by increasing axial length, resulting in a more accurate discrimination of glaucomatous damage in myopic eyes with respect to the traditional RNFL thickness. The analysis of the structure-function relationship revealed a good agreement between the loss in retinal sensitivity and GCC thickness. The use of a 10-2° visual field grid, adjusted for the anatomical RGCs displacement, describes more accurately the relationship between RGCs thickness and visual field sensitivity loss.
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Affiliation(s)
- Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Department of Sense Organs, Azienda Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | | | - Andrea Perdicchi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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32
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Leong BC, Fragiotta S, Kaden TR, Freund KB, Zweifel S, Engelbert M. OCT En Face Analysis of the Posterior Vitreous Reveals Topographic Relationships among Premacular Bursa, Prevascular Fissures, and Cisterns. ACTA ACUST UNITED AC 2020; 4:84-89. [DOI: 10.1016/j.oret.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
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Fragiotta S, Fernández-Avellaneda P, Breazzano MP, Yannuzzi LA, Curcio CA, Freund KB. Linear and planar reflection artifacts on swept-source and spectral-domain optical coherence tomography due to hyperreflective crystalline deposits. Graefes Arch Clin Exp Ophthalmol 2019; 258:491-501. [PMID: 31879821 DOI: 10.1007/s00417-019-04565-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To describe novel spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) linear and planar reflection artifacts produced by hyperreflective crystalline deposits (HCD). METHODS Imaging from 10 eyes with HCD producing linear and planar artifacts on OCT was retrospectively analyzed. All eyes had SD-OCT (Spectralis HRA + OCT, Heidelberg Engineering, Germany) and SS-OCT angiography (PLEX Elite 9000, Carl Zeiss Meditec, Inc., Dublin, CA) acquired on the same day. The horizontal extent of planar artifacts and the corresponding HCD on B-scans was measured using a digital caliper. Artifact features from HCD in eyes with non-neovascular age-related macular degeneration (AMD) were analyzed and compared to those seen in two eyes with the "onion sign," an OCT signature previously shown to represent cholesterol crystals (CC) in the sub-retinal pigment epithelium-basal laminar space of eyes with neovascular AMD. A third eye with the "onion sign" was imaged with dense B-scan (DB)-OCTA. RESULTS Ten eyes of ten patients (77.4 ± 8.7 years) with HCD were analyzed. On SS-OCTA, HCD produced linear artifacts of high signal intensity passing through the HCD and spanning the entire scan depth. On SD-OCT, HCD produced planar artifacts located anterior to both the retina and a hyporeflective space representing normal vitreous signal. The horizontal extent of the artifact did not differ significantly from the corresponding HCD on OCT B-scans (P = 0.62). The OCT artifacts produced by the "onion sign" appeared similar to those of HCD. The additional eye with neovascular AMD imaged with DB-OCTA was characterized by a single, vertical, linear false-flow signal crossing retinal layers. CONCLUSIONS To the authors' knowledge, this is the first description of SD- and SS-OCT/OCTA artifacts corresponding to both HCD and the "onion sign." These artifacts are likely due to highly reflective CC previously shown on histology to correspond to both of these OCT signatures.
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Affiliation(s)
- Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Department of Medico-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Pedro Fernández-Avellaneda
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Department of Ophthalmology, Basurto University Hospital, Bilbao, Spain
| | - Mark P Breazzano
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA. .,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA. .,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
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Fragiotta S, Fernández-Avellaneda P, Breazzano MP, Curcio CA, Leong BCS, Kato K, Yannuzzi LA, Freund KB. The Fate and Prognostic Implications of Hyperreflective Crystalline Deposits in Nonneovascular Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 60:3100-3109. [PMID: 31323680 DOI: 10.1167/iovs.19-26589] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore patterns of disease progression in nonneovascular age-related macular degeneration (AMD) associated with hyperreflective crystalline deposits (HCDs) in the sub-retinal pigment epithelium-basal laminar space. Methods Retrospective review of medical records, multimodal imaging, and longitudinal eye-tracked near-infrared reflectance (NIR) and optical coherence tomography (OCT) spanning ≥2 years. NIR/OCT images were analyzed with ImageJ software to identify HCD morphology and location. Associated macular complications were reviewed from the time of HCD detection to the most recent follow-up, using NIR/OCT. Results Thirty-three eyes with HCDs from 33 patients (mean age: 72 ± 7.5 years) had 46.7 months (95% confidence limits: 33.7, 59.6) of serial eye-tracked NIR/OCT follow-up. Baseline best-corrected visual acuity (BCVA) was 0.44 logMAR (Snellen equivalent 20/55). At a mean of 11.3 months (3.1, 19.6) after HCD detection, 31/33 (93.9%) eyes had developed macular complications including de novo areas of complete retinal pigment epithelium and outer retinal atrophy (cRORA) in 21/33 (64%) eyes, enlargement of preexisting cRORA in 4/33 (12%) eyes, and incident macular neovascularization in 3/33 (9%) eyes. Movement and clearance of HCDs in 9/33 (27%) eyes was associated with enlargement of preexisting cRORA (r = 0.44, P = 0.02). BCVA at the last follow-up visit had decreased to 0.72 logMAR (20/105). Conclusions Eyes with nonneovascular AMD demonstrating HCDs are at risk for vision loss due to macular complications, particularly when movement and clearance of these structures appear on multimodal imaging. HCD reflectivity and dynamism may be amenable to automated recognition and analysis to assess cellular activity related to drusen end-stages.
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Affiliation(s)
- Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Department of Medico-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Pedro Fernández-Avellaneda
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Department of Ophthalmology, Basurto University Hospital, Bilbao, Spain
| | - Mark P Breazzano
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States.,Columbia University College of Physicians and Surgeons, Harkness Eye Institute, New York, New York, United States
| | - Christine A Curcio
- Department of Ophthalmology and Visual Science, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, United States
| | - Belinda C S Leong
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
| | - Kenneth Kato
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States.,Columbia University College of Physicians and Surgeons, Harkness Eye Institute, New York, New York, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States.,Columbia University College of Physicians and Surgeons, Harkness Eye Institute, New York, New York, United States
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35
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Fragiotta S, Sepe M, Perdicchi A, Scuderi L, Trani M, Scuderi G. Postural changes revealing orbital venous malformation using ultrasound in blue rubber bleb nevus syndrome. Orbit 2019; 39:293-297. [PMID: 31691617 DOI: 10.1080/01676830.2019.1688357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 62-year-old white woman presented with a diagnosis of blue rubber bleb nevus syndrome (BRBNS). The right eye appeared enophthalmic, yet the patient complained of episodes of right proptosis on bending forward. The remainder of the examination was unremarkable. Orbital ultrasound (US) in an upright posture revealed a single low reflectivity cavity (4.27 mm x 2.82 mm) of uncertain interpretation. In a forward-leaning posture the lesion increased in size (maximum thickness of 13.72 mm), demonstrating multiple low reflectivity spaces with highly reflective septae. This case first reports the use of US with postural changes to assess the presence of orbital venous malformation in BRBNS. The expansile nature upon postural changes supports the venous origin of the orbital lesion.
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Affiliation(s)
- Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
| | - Massimiliano Sepe
- Ophthalmology Department, Santa Maria Goretti Hospital , Latina (LT), Italy
| | - Andrea Perdicchi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome "Sapienza" , Rome, Italy
| | - Maria Trani
- Ophthalmology Department, Santa Maria Goretti Hospital , Latina (LT), Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza" , Rome, Italy
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Au A, Hou K, Dávila JP, Gunnemann F, Fragiotta S, Arya M, Sacconi R, Pauleikhoff D, Querques G, Waheed N, Freund KB, Sadda S, Sarraf D. Volumetric Analysis of Vascularized Serous Pigment Epithelial Detachment Progression in Neovascular Age-Related Macular Degeneration Using Optical Coherence Tomography Angiography. ACTA ACUST UNITED AC 2019; 60:3310-3319. [DOI: 10.1167/iovs.18-26478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adrian Au
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Kirk Hou
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Juan Pablo Dávila
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | | | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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Abstract
Acute exudative polymorphous vitelliform maculopathy (AEPVM) is a rare bilateral maculopathy characterized by chronic and long-term course. We report a case of AEPVM with an unusual presentation and management in a middle-aged man. He presented with clinical features of bilateral AEPVM accompanied by multiple intraretinal cysts, with a sudden increase of intraretinal fluid and visual function deterioration over a span of few days. Therefore, we administered empirically an intravenous bolus injection of methylprednisolone. One week after, there was a full recovery of visual acuity and cystic intraretinal spaces completely disappeared.
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Affiliation(s)
- Pier Luigi Grenga
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Serena Fragiotta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alessandro Cutini
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Enzo Maria Vingolo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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38
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Fragiotta S, Leong BCS, Kaden TR, Bass SJ, Sherman J, Yannuzzi LA, Freund KB. A proposed mechanism influencing structural patterns in X-linked retinoschisis and stellate nonhereditary idiopathic foveomacular retinoschisis. Eye (Lond) 2018; 33:724-728. [PMID: 30518975 DOI: 10.1038/s41433-018-0296-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To explore the structural differences between X-linked retinoschisis (XLR) and stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS A case series of two patients, a 9-year-old male with XLR and a 58-year-old woman with SNIFR were imaged with swept-source optical coherence tomography angiography (SS-OCTA; PLEX Elite 900, Carl Zeiss Meditec, Inc, Dublin, CA). Automated segmentation was manually adjusted to include the areas of retinoschisis within en face flow and structural slabs. The flow data were binarized using ImageJ 1.51s (Wayne Rasband, National Institutes of Health, USA, http://imagej.nih.gov.ij ) and superimposed onto the structural slab. RESULTS In the eye with XLR, OCTA flow data superimposed on the structural slab demonstrated flow signal within numerous bridging structures connecting the inner and outer plexiform layers containing the intermediate (ICP) and deep (DCP) capillary plexuses. In contrast, the same technique applied to the eye with SNIFR demonstrated an absence of flow signal in the cystic retinal spaces within Henle's fiber layer. CONCLUSIONS The vascular pattern of bridging vessels between the ICP and DCP is closely related to the structural "retinoschisis" pattern of XLR and appears to be structurally different from that seen in SNIFR. Moreover, the connecting vessels appear to be highly represented and regularly distributed, thereby supporting a serial arrangement of the retinal capillary plexuses within the perifoveal macula.
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Affiliation(s)
- Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Department of Medico-Surgical Science and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Belinda C S Leong
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Talia R Kaden
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - Sherry J Bass
- State College of Optometry, The State University of New York (SUNY), New York, NY, USA
| | - Jerome Sherman
- State College of Optometry, The State University of New York (SUNY), New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA. .,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA. .,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA. .,Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA.
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Fragiotta S, Kaden TR, Freund KB. Cuticular drusen associated with aneurysmal type 1 neovascularization (polypoidal choroidal vasculopathy). Int J Retina Vitreous 2018; 4:44. [PMID: 30534417 PMCID: PMC6280435 DOI: 10.1186/s40942-018-0148-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aneurysmal type 1 neovascularization (AT1) is a term recently introduced to better describe the aneurysmal dilatation that may arise from neovascular lesions, more commonly known as polypoidal choroidal vasculopathy. The proposed term, AT1, includes an expanded clinical spectrum of aneurysmal (polypoidal) lesions observed in both different ethnicities and associated with varied clinical phenotypes. CASE PRESENTATION A 61-year-old woman of European descent was referred for a new, asymptomatic retinal hemorrhage found on routine examination. Ophthalmoscopy revealed cuticular drusen in both eyes best appreciated on fundus autofluorescence, and a hemorrhagic retinal pigment epithelium detachment above the superior arcade in the right eye. In the fellow eye, a reddish appearing pigment epithelial detachment was noted nasal to the optic nerve. Indocyanine green angiography showed findings of AT1 in both eyes. Optical coherence tomography angiography showed intrinsic flow signal within the aneurysmal lesions. CONCLUSIONS Eyes with cuticular drusen may develop AT1 which, to our knowledge, has not been described. This is an important observation because the documented coexistence of AT1 in the setting of a variant of age-related macular degeneration lends supports to this new understanding of AT1 as a growth pattern of neovascular tissue proliferating between the RPE and Bruch membrane, rather than as a distinct disease entity.
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Affiliation(s)
- Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, 460 Park Ave., New York, NY 10022 USA
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY USA
- Department of Medico-Surgical Science and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Talia R. Kaden
- Vitreous Retina Macula Consultants of New York, 460 Park Ave., New York, NY 10022 USA
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY USA
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY USA
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, 460 Park Ave., New York, NY 10022 USA
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY USA
- Department of Ophthalmology, New York University School of Medicine, New York, NY USA
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40
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Pichi F, Fragiotta S, Freund KB, Au A, Lembo A, Nucci P, Sebastiani S, Gutierrez Hernandez JC, Interlandi E, Pellegrini F, Dolz-Marco R, Gallego-Pinazo R, Orellana-Rios J, Adatia FA, Munro M, Abboud EB, Ghazi N, Cunha Souza E, Amer R, Neri P, Sarraf D. Cilioretinal artery hypoperfusion and its association with paracentral acute middle maculopathy. Br J Ophthalmol 2018; 103:1137-1145. [PMID: 30257961 DOI: 10.1136/bjophthalmol-2018-312774] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To study the multimodal imaging findings of a large series of eyes with cilioretinal artery obstruction (CILRAO) and describe the systemic associations. METHODS Multicentre, retrospective chart review from 12 different retina clinics worldwide of eyes with CILRAO, defined as acute retinal whitening in the distribution of the cilioretinal artery, were identified. The clinical, systemic information and multimodal retinal imaging findings were collected and analysed. RESULTS A total of 53 eyes of 53 patients with CILRAO were included in the study. In 100% of eyes, fundus photography illustrated deep retinal whitening corresponding to the course of the cilioretinal artery. Twenty-eight patients (52.8%) presented with isolated CILRAO (baseline best-corrected visual acuity (BCVA) 20/50, final BCVA 20/25) associated with nocturnal hypotension, 23 patients (43.4%) with CILRAO secondary to central retinal vein occlusion (CRVO) (baseline BCVA 20/40, final BCVA 20/20) and two patients with CILRAO due to biopsy-proven giant cell arteritis (GCA) (baseline BCVA 20/175, final BCVA 20/75). With spectral domain optical coherence tomography (SD-OCT), a hyper-reflective band involving the inner nuclear layer (ie, paracentral acute middle maculopathy or PAMM) was noted in 51 eyes (28/28 eyes with isolated CILRAO and 23/23 eyes with CILRAO+CRVO) corresponding to the retinal whitening. In the two eyes with CILRAO+GCA, SD-OCT illustrated hyper-reflective ischaemia of both the middle and inner retina. CONCLUSIONS Isolated CILRAO and CILRAO secondary to CRVO are the result of hypoperfusion or insufficiency, rather than occlusion, of the cilioretinal artery and are associated with PAMM or selective infarction of the the inner nuclear layer. With GCA, there is complete occlusion of the cilioretinal artery producing ischaemia involving both the middle and inner retina associated with worse visual outcomes.
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Affiliation(s)
- Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates .,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA
| | - Adrian Au
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - Andrea Lembo
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Paolo Nucci
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Stefano Sebastiani
- University Eye Clinic of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Jorge Orellana-Rios
- New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,University of Antofagasta, Antofagasta, Chile
| | | | - Monique Munro
- Mitchell Eye Center and Rockyview, Calgary, Alberta, Canada
| | - Emad B Abboud
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Nicola Ghazi
- Lebanese American University, Medical Center, Rizk Hospital, Beirut, Lebanon
| | | | | | - Piergiorgio Neri
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
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Vingolo EM, Napolitano G, Fragiotta S. Microperimetric biofeedback training: fundamentals, strategies and perspectives. Front Biosci (Schol Ed) 2018; 10:48-64. [PMID: 28930518 DOI: 10.2741/s500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Microperimetric biofeedback training (MBFT) is a visual rehabilitative strategy based on fixation stability improvement reinforcing or creating a new preferential fixation locus. The rationale consists in reeducating visual system to a new visual condition, promoting retina-brain transmission, and thus cortical plasticity. The use of MBFT found is major application in visual diseases involving central vision, but later it revealed promising functional outcomes even in myopia, inherited retinal degenerations and nystagmus. However, the use of microperimetric biofeedback is still limited due to poor knowledge of the procedure and inconsistent standards of practice, and thus an incipient skepticism on its efficacy. This review provides an overview of the rationale, current implications, procedures and future perspectives of microperimetric biofeedback training.
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Affiliation(s)
- Enzo Maria Vingolo
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019, Terracina, Italy
| | - Giuseppe Napolitano
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019, Terracina, Italy
| | - Serena Fragiotta
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019, Terracina, Italy,
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Grenga PL, Fragiotta S, Cutini A, Meduri A, Vingolo EM. Microperimetric evaluation in patients with adult-onset foveomacular vitelliform dystrophy. Indian J Ophthalmol 2017; 65:385-389. [PMID: 28573994 PMCID: PMC5565886 DOI: 10.4103/ijo.ijo_984_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: To compare mean best-corrected visual acuity (BCVA), retinal sensitivity (RS), and bivariate contour ellipse area (BCEA) in patients with adult-onset foveomacular vitelliform dystrophy (AOFVD) and healthy subjects (HSs), reporting also functional disease-related changes in the different stages of the AOFVD disease. Materials and Methods: In this observational cross-sectional study, a total of 19 patients (30 eyes; 12 female and 7 male) with AOFVD were enrolled, and 30 patients (30 eyes; 16 female and 14 male) were recruited as age-matched control group (74.36 ± 9.17 years vs. 71.83 ± 6.99 years respectively, P = 0.11). All patients underwent a complete ophthalmologic examination, fundus autofluorescence and fluorescein angiography, spectral-domain optical coherence tomography and microperimetry (MP)-1 analysis. The data collection included mean BCVA, mean RS measured by means of MP-1, BCEA, and central retinal thickness. Results: All the functional parameters (BCVA, RS, and BCEA) were significantly worse in AOFVD group than HS. Subgroup analysis showed that the most significant functional changes, quantified by mean BCVA, RS, and BCEA, were in the atrophic stage (P = 0.03, P = 0.01, and P = 0.001, respectively). All the functional parameters were well correlated in the different stages. Conclusions: This study further confirms the good visual prognosis in the AOFVD eyes. Fixation stability measurement using BCEA demonstrates good evaluation of visual performance integrating traditional functional parameters. It may also serve for further rehabilitative purposes in atrophic eyes.
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Affiliation(s)
- Pier Luigi Grenga
- Department of Medico-Surgical Sciences and Biotechnologies, UOC Ophthalmology, Sapienza University of Rome, "A.Fiorini" Hospital, Terracina (LT), Italy
| | - Serena Fragiotta
- Department of Medico-Surgical Sciences and Biotechnologies, UOC Ophthalmology, Sapienza University of Rome, "A.Fiorini" Hospital, Terracina (LT), Italy
| | - Alessandro Cutini
- Department of Medico-Surgical Sciences and Biotechnologies, UOC Ophthalmology, Sapienza University of Rome, "A.Fiorini" Hospital, Terracina (LT), Italy
| | - Alessandro Meduri
- Department of Surgical Specialities, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Enzo Maria Vingolo
- Department of Medico-Surgical Sciences and Biotechnologies, UOC Ophthalmology, Sapienza University of Rome, "A.Fiorini" Hospital, Terracina (LT), Italy
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43
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Fragiotta S, Carnevale C, Cutini A, Vingolo EM. Correlation between retinal function and microstructural foveal changes in intermediate age related macular degeneration. Int J Retina Vitreous 2017; 3:8. [PMID: 28491460 PMCID: PMC5421337 DOI: 10.1186/s40942-017-0061-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/21/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess foveal microstructural changes influencing retinal sensitivity (RS) and fixation stability using microperimeter MP-1 in intermediate age-related macular degeneration (AMD). METHODS In this cross-sectional study, 22 eyes of 22 patients (mean age: 75 ± 9.02 years) with intermediate AMD were enrolled. Retinal sensitivity and bivariate contour ellipse area (BCEA) were obtained by microperimetry MP-1 (Humphrey 10-2 68-loci grid) under mesopic conditions. Drusen type, drusenoid pigment epithelial detachment, hyperreflective foci (HF), integrity of external limiting membrane (ELM), inner ellipsoid zone (ISel), RPE/Bruch's membrane complex (RPE/B) and subfoveal choroidal thickness were analyzed in the foveal region and compared with RS and BCEA. Spearman's rank correlation coefficient was used to evaluate the relationship between variables. Logistic regression analysis was also used to assess morphological predictor influencing RS or BCEA. RESULTS RS was strongly and inversely related with the presence of HF (r = -0.66, P = 0.001), integrity of ELM (r = -0.70, P < 0.001), ellipsoid zone (r = -0.45, P = 0.03). Instead, BCEA is positively related to the ellipsoid zone integrity (r = 0.45, P = 0.03). Logistic regression analysis confirmed that disruption of ISel influenced fixation stability (ExpB: 9.69, P = 0.04) but not RS. Instead, the presence of HF and disruption of ELM predicted RS reduction (ExpB: 0.55, P = 0.02 and ExpB: 0.29, P = 0.04, respectively). CONCLUSIONS The integrity of ELM and the presence of HF are both predictors of RS. The ELM status may be considered a new biomarker of retinal function together with HF. Instead, the integrity of ISel band seems to be a more selective predictor of BCEA than RS.
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Affiliation(s)
- Serena Fragiotta
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze, 04019 Terracina, Italy
| | - Carmela Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze, 04019 Terracina, Italy
| | - Alessandro Cutini
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze, 04019 Terracina, Italy
| | - Enzo Maria Vingolo
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze, 04019 Terracina, Italy
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Vingolo EM, Fragiotta S, Mafrici M, Cutini A, Marinelli C, Concistrè A, Iannucci G, Petramala L, Letizia C. Vitreous and plasma changes of endothelin-1, adrenomedullin and vascular endothelium growth factor in patients with proliferative diabetic retinopathy. Eur Rev Med Pharmacol Sci 2017; 21:662-668. [PMID: 28272719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess vitreous and plasma changes of vascular endothelial growth factor A (VEGF-A), adrenomedullin (ADM) and endothelin-1 (ET-1) in proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS 9 patients with PDR in type 2 diabetes (T2DM) and 11 age-matched non-diabetic patients were enrolled. The levels of VEGF-A, ADM and ET-1 were measured using an enzyme (ELISA) and a radioimmunoassay (RIA) both in vitreous and plasma samples. RESULTS Vitreous ADM and VEGF-A levels were significantly higher in PDR patients (p=0.04 and p=0.02), whereas no differences were found in ET-1 levels (p=0.29). Plasma ADM levels were significantly higher in the PDR group (p<0.01), whereas no significant differences were found in the plasma ET-1 and VEGF-A levels (p=0.30 and p=0.37). The ADM vitreous/plasma ratio was significantly reduced in PDR group. CONCLUSIONS The role of ET-1 in advanced PDR is still controversial; it has been supposed a role limited to induce hypoxic state and promote angiogenesis in the early phases. Once the neo-angiogenic process starts, other mediators are mainly involved as VEGF and ADM. Our findings suggest that ADM is an important marker of advanced PDR as well as VEGF. Conversely, ET-1 is not significantly involved in the advanced stage of PDR.
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Affiliation(s)
- E M Vingolo
- Department of Medical-Surgical Sciences and Biotechnologies, U.O.S. Ophthalmology, "Sapienza" University of Rome, Terracina, Italy.
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45
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Domanico D, Fragiotta S, Cutini A, Carnevale C, Zompatori L, Vingolo EM. Circulating levels of reactive oxygen species in patients with nonproliferative diabetic retinopathy and the influence of antioxidant supplementation: 6-month follow-up. Indian J Ophthalmol 2016; 63:9-14. [PMID: 25686055 PMCID: PMC4363979 DOI: 10.4103/0301-4738.151455] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aims: The aim was to evaluate circulating levels of reactive oxygen species (ROS) and changes in central macular thickness (CMT) in patients with nonproliferative diabetic retinopathy (NPDR) after antioxidant supplementation. Materials and Methods: A total of 68 patients (68 eyes) with NPDR were enrolled. Patients were randomly divided into two groups: Treated with antioxidant supplement (Group A) and untreated control group (Group B). Each tablet, for oral administration, containing pycnogenol 50 mg, Vitamin E 30 mg and coenzyme Q10 20 mg. CMT and free oxygen radical test (FORT) were analyzed at baseline (T0), 3 (T1) and 6 (T2) months in both groups. Results: In Group A, FORT levels and CMT were significantly reduced over time (P < 0.001 for both). In Group B, FORT levels were increased (P < 0.001) and CMT did not vary significantly (P = 0.81) over 3 time points. Conclusions: This is the first study showing the reduction of ROS levels in patients with NPDR thanks to antioxidant therapy. Moreover, our findings have suggested also an influence on retinal thickness.
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Affiliation(s)
| | | | | | - Carmela Carnevale
- Department of Sense Organs UOC B, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Vingolo EM, Carnevale C, Fragiotta S, Rigoni E, Iacobelli L. Visual Outcomes and Contrast Sensitivity after Bilateral Implantation of Multifocal Intraocular Lenses with +2.50 or +3.0 Diopter Addition: 12-Month Follow-Up. Semin Ophthalmol 2016; 32:588-592. [PMID: 27129111 DOI: 10.3109/08820538.2015.1131839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate visual acuity and contrast sensitivity after bilateral implantation of AcrySof® IQ ReSTOR® +2.50 D or +3.00 D. METHODS A total of 56 eyes with cataract had bilateral implantation of a multifocal IOL. Inclusion criteria were corneal astigmatism less than 1.0 diopters, axial length between 22.0 and 24.0 mm, and no associated ocular disease. Outcome measures recorded 12 months postoperatively were binocular uncorrected and corrected distance, intermediate and near visual acuities, and contrast sensitivity. Postoperative quality of life and patient satisfaction were assessed with the VF-14 Questionnaire. RESULTS Twenty months postoperatively, the mean uncorrected and best-corrected distance visual acuities, UCIVA at 60 cm, and contrast sensitivity were similar in all two groups. UCNVA were better in the +3.00 IOL group than in the +2.50 D group. Patients reported good performance for visual tasks. CONCLUSION Apodized multifocal IOLs seem a good compromise for non-spectacles life in elderly patients; our study indicates that this solution has a good long-term stability on patients' visual function.
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Affiliation(s)
- Enzo Maria Vingolo
- a Department of Ophthalmology , "Sapienza" University of Rome, Polo Pontino, "A. Fiorini" Hospital , Terracina , Italy
| | - Carmela Carnevale
- b Department of Ophthalmology , "Sapienza" University of Rome, Policlinico Umberto I , Rome , Italy
| | - Serena Fragiotta
- a Department of Ophthalmology , "Sapienza" University of Rome, Polo Pontino, "A. Fiorini" Hospital , Terracina , Italy
| | - Erika Rigoni
- a Department of Ophthalmology , "Sapienza" University of Rome, Polo Pontino, "A. Fiorini" Hospital , Terracina , Italy
| | - Luca Iacobelli
- c Ophthalmologic Division of House of Health INI Group , Rome , Italy
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Domanico D, Fragiotta S, Cutini A, Grenga PL, Vingolo EM. Psychosis, Mood and Behavioral Disorders in Usher Syndrome: Review of the Literature. Med Hypothesis Discov Innov Ophthalmol 2015; 4:50-5. [PMID: 26060830 PMCID: PMC4458326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this review is to focus the current knowledge about mental and behavioral disorders in Usher syndrome. Previous studies described the presence of various mental disorders associated with Usher syndrome, suggesting possible mechanisms of association between these disorders. The most common manifestations are schizophrenia-like disorder and psychotic symptoms. Mood and behavioral disorders are rarely described, and often are associated with more complex cases in co-occurrence with other psychiatric disorders. Neuroimaging studies reported diffuse involvement of central nervous system (CNS) in Usher patients, suggesting a possible role of CNS damage in the pathogenesis of psychiatric manifestations. Genetic hypothesis and stress-related theories have also been proposed.
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Grenga PL, Fragiotta S, Meduri A, Lupo S, Marenco M, Vingolo EM. Fixation stability measurements in patients with neovascular age-related macular degeneration treated with ranibizumab. Can J Ophthalmol 2014; 48:394-9. [PMID: 24093186 DOI: 10.1016/j.jcjo.2013.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 04/07/2013] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate which of 2 measuring units (bivariate contour ellipse area [BCEA] vs Fujii) yields more accurate measurements of fixation stability, obtained using the MP-1 device, in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal injections of ranibizumab, during a 12-month follow-up period. DESIGN Small retrospective, noncomparative, interventional case series. PARTICIPANTS A total of 25 eyes in 25 patients (13 males, 12 females; mean age 71.72 ± 7.98 years). METHODS All participants were older than 50 years, diagnosed with active subfoveal choroidal neovascularization, had best corrected visual acuity (BCVA) values above 20/100, and all lesion types were included. All patients underwent a loading phase with 3 consecutive intravitreal injections of 0.05 mg ranibizumab at monthly intervals. Patients were retreated after the third injection if they exhibited a 100-μm increase in macular thickness or evidence of intraretinal and/or subretinal fluid and new subretinal hemorrhage, observed with spectral-domain optical coherence tomography and fluorescein angiography. The data collected included BCVA and mean macular sensitivities, BCEA, and fixation patterns, performed at baseline and at months 4 and 12, using the MP-1 device. RESULTS The mean total injection number was 5.92 ± 1.18 (minimum 3, maximum 8). Mean BCVA at baseline was 0.55 ± 0.28 logMAR and increased significantly to 0.50 ± 0.33 logMAR. Mean macular sensitivity at baseline was 7.06 ± 4.59 dB and increased significantly to 8.40 ± 4.82. Mean BCEA was 2.19 ± 1.38 deg(2) and decreased significantly to 1.68 ± 1.43 deg(2). Fixation stability patterns, according to the protocol set out by Fujii, did not change significantly during follow-up. CONCLUSIONS Compared with Fujii fixation stability patterns, BCEA correlated better with variations in macular sensitivity and BCVA. BCEA can be added to the traditional parameters used to evaluate the efficacy of intravitreal injections in patients with nAMD.
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Affiliation(s)
- Pier Luigi Grenga
- Department of Ophthalmology, University of Rome "Sapienza," Polo Pontino, "A. Fiorini" Hospital, Terracina.
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Grenga PL, Trabucco P, Meduri A, Fragiotta S, Vingolo EM. Microperimetric biofeedback in a patient with oculocutaneous albinism. Can J Ophthalmol 2013; 48:e105-7. [PMID: 24093197 DOI: 10.1016/j.jcjo.2012.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Pier Luigi Grenga
- University of Rome "Sapienza," Polo Pontino, "A. Fiorini" Hospital, Terracina (LT).
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Verallo O, Fragiotta S, Carnevale C, De Rosa V, Vingolo EM. [Subconjunctival Loiasis: case reports and review of cases described in Italy]. Clin Ter 2013; 164:e127-31. [PMID: 23698214 DOI: 10.7417/ct.2013.1544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Filariasis or Loiasis is an eye infection caused by a parasite belonging to the species Loa loa, also known as "African eye worm" since it is present in the rainforests belt of western and central Africa. The purpose of this study is the description of a clinical case presented to our department. A 40-years-old Congolese woman, in the third month of pregnancy, complained a foreign body sensation in the right eye for which she was submitted to complete ophthalmologic examination. Slit-lamp examination revealed, in the infero-temporal subconjunctival space, the presence of a live whitish worm that moved slowly in the thickness of the tissues. Place a clinical suspicion of subconjunctival filariasis, were performed parasitological and serological analysis; laboratory test showed peripheral blood eosinophilia and the blood film examination was negative for the presence of circulating microfilariae. The worm was surgically removed under topical anesthesia and the histological examinations of the parasite confirmed that it was an adult male worm belonging to the species Loa loa. Due to the large increase of migratory flows to Europe, number of reports of loiasis is becoming more frequent; the knowledge of this emerging pathogens is essential for diagnosis and treatment planning.
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Affiliation(s)
- O Verallo
- Dipartimento di Oftalmologia, Ospedale S.M. Goretti, Latina, Italia
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