1
|
Elubous K, Alryalat SA, Qawasmeh S, Al-Ebous A, Abu-Ameereh M. Teleophthalmology research: Where do we stand? Eur J Ophthalmol 2023; 33:74-82. [PMID: 35570821 DOI: 10.1177/11206721221101360] [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: 01/11/2023]
Abstract
PURPOSE To identify global research trends in teleophthalmology, as well as productivity and its association with Human development index (HDI). METHODS A cross-sectional study. The main outcome measures were publication count, citation count, and publications count per million populations. Bibliographic data were derived from the Web of Science website. HDI data were derived from Human Development Report [2020]. One-way ANOVA test was used to examine the association between HDI and the outcome measures. We studied the correlation between continuous variables using Spearman's. Bibliometric analysis software's VOSviewer and Citspace were used to analyse results and creating visualizing maps. RESULTS The results retrieved 355 publications, one-third of them have been published in the year of the COVID-19 pandemic; (2020). The USA has contributed to one-half of all publications, and just five countries have contributed to about 90% of all records. Very high HDI countries had significantly more publications count per million populations, than high (p-value = 0.0047), medium (p-value = 0.0081) or low HDI countries (p-value = 0.002). The main themes are screening programmes, reliability, photography, COVID-19, access, artificial intelligence, and cost-effectiveness. The leading countries in terms of both publications and citation count are the USA and India. In terms of publications count per million populations, the leading countries are Singapore and Australia. CONCLUSION Most of the contribution in teleophthalmology research was confined to a small number of countries. More effort is needed to expand the global contribution. The hotspots in this field are artificial intelligence applications and COVID-19 impact.
Collapse
Affiliation(s)
- Khaled Elubous
- Department of Ophthalmology, 54658University of Jordan, Amman, Jordan
| | | | - Sarah Qawasmeh
- Department of Ophthalmology, 54658University of Jordan, Amman, Jordan
| | - Ali Al-Ebous
- Department of Surgery, 37559King Hussein Cancer Center, Amman, Jordan
| | | |
Collapse
|
2
|
Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Cervera Taulet E. Optical coherence tomography angiography quantitative analysis of retinal and choroidal microvasculature in patients with dyslipidemia. Eur J Ophthalmol 2022:11206721221146680. [PMID: 36562094 DOI: 10.1177/11206721221146680] [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: 12/24/2022]
Abstract
INTRODUCTION The purpose of this investigation was to report swept source-optical coherence tomography angiography (SS-OCTA) quantitative information of retinal and choroidal microvascularization in patients with dyslipidemia (DL). METHODS We performed a retrospective study. The study enrolled 37 eyes of 20 patients with DL and 40 eyes of 23 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP) and choriocapillaris (CC)) in 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes were recorded. RESULTS No differences in VD in SCP, MCP and DCP were demonstrated between DL group and control group (p > 0,05). Conversely, VD in the central region at CC was diminished in patients with DL in both cubes (p < 0,05). Moreover, total VD in CC was decreased in the DL group in 6 mm × 6 mm cube (p < 0,05). Regarding FAZ area, we demonstrated and enlargement of FAZ in each retinal capillary plexus, but it did not reach statistical significance (p > 0,05). CONCLUSION We objectified a diminution of VD in the CC, suggesting that DL mainly affects the choroidal microvasculature. Nonetheless, further studies with a larger population are needed.
Collapse
Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
3
|
Bartolomei F, Biagini I, Sato G, Falchini E, Di Simone A, Mastrantuono C, Micarelli S, Virgili G. Low-vision rehabilitation in Italy: Cross-sectional data from the Device and Aids Registry (D.A.Re). Eur J Ophthalmol 2022; 32:1942-1946. [PMID: 35369783 DOI: 10.1177/11206721221091367] [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: 11/16/2022]
Abstract
OBJECTIVES We are reporting on the characteristics of low-vision adults attending large rehabilitation services which provide data to D.A.Re (Devices & Aids REgister) in Italy. D.A.Re aims to gather information about low-vision aids owned by Italian patients with visual impairment. METHODS We included consecutive patients attending low-vision rehabilitation centres providing data to D.A.Re from 2019 to July 2021. Demographic features, self-reported use of technology and aids, vision performance, and the Instrumental Activity of Daily Living (IADL) score were collected. RESULTS 720 patients were included in the D.A.Re. About half of the patients were affected by Age-related Macular Degeneration (389, 54.9%). Patients reported a long interval between onset of vision disability and access to low-vision rehabilitation, which was over two years in almost 30% of cases. Blindness registration status was almost complete when reported, but almost 40% were unable to report on this. IADL scores were higher for younger people and those with better visual acuity and critical print size (CPS), and lower for visual field restriction (p < 0.01 for all predictors). Of interest, better IADL scores were recorded for those with computer knowledge who used optical aids and software in univariate analyses and multivariate analyses, adjusting for level of visual disability and employment status (p < 0.01 for all predictors). CONCLUSIONS We report on the profile of low-vision patients using rehabilitation services in Italy. Longitudinal data during and after vision rehabilitation were collected. Our results support the validity of the D.A.Re to monitor the use of low-vision devices in Italy.
Collapse
Affiliation(s)
| | - Ilaria Biagini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence and AOU Careggi, Firenze, Italy
| | - Giovanni Sato
- Centro Oculistico S. Paolo Hospital, S. Antonio Padova, Italy
| | - Elisabetta Falchini
- Centro integrato per la Riabilitazione Visiva 'Carlo Monti', AOU Careggi, Firenze, Italy
| | | | | | - Silvia Micarelli
- Azienda Servizi alla Persona disabile visiva S. Alessio - Margherita di Savoia, Rome, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence and AOU Careggi, Firenze, Italy.,Centre for Public Health, Queen's University of Belfast, Belfast, Northern Ireland (UK)
| |
Collapse
|
4
|
Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Hernández Garfella ML, Hernández Bel L, Navarro Palop C, Montero Hernández J, Cervera Taulet E. New insights in pathogenic mechanism of hydroxychloroquine retinal toxicity through optical coherence tomography angiography analysis. Eur J Ophthalmol 2022; 32:3599-3608. [PMID: 35084246 DOI: 10.1177/11206721221076313] [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: 11/16/2022]
Abstract
INTRODUCTION There is only a unique report with a small sample size studying hydroxychloroquine (HCQ) retinal toxicity with swept-source (SS) optical coherence tomography angiography (OCTA). The aim of this study was to quantify OCTA quantitative parameters in patients who underwent HCQ therapy. METHODS We conducted a retrospective study. The study included 43 eyes of 22 patients taking HCQ for more than 5 years (high-risk group), 57 eyes of 29 patients taking HCQ for 5 years or less (low-risk group) and 25 eyes of 50 age-matched healthy controls. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area in superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP), total capillary plexus (TCP), and choriocapillaris (CC)) were recorded. RESULTS In the low-risk group, VD in the SCP and MCP was increased compared to control group (p value <.05). In the high-risk group, VD in the SCP, MCP and TCP was increased (p value <.05). The subgroup analysis revealed an increased VD at SCP in systemic lupus erythematosus (SLE) high-risk patients, an increased VD at TCP and CC in rheumatoid arthritis (RA) high-risk subjects, and a decreased VD at CC level in the high-risk group patients with Sjögren's syndrome (SS) and connective tissue disease (CTD) (p value <.05). Furthermore, we demonstrated a significant enlargement of FAZ area at MCP level in the high-risk group patients with SS and CTD (p value <.05). CONCLUSION We demonstrated an increase of VD in patients who underwent HCQ treatment, so we suggest that HCQ retinal toxicity is not vascular mediated.
Collapse
Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | | | - Laura Hernández Bel
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
5
|
Remolí Sargues L, Monferrer Adsuara C, Rodríguez López R, Gallego Pinazo R, Montero Hernández J, Castro Navarro V, Cervera Taulet E. Twelve-year follow up of a case of autosomal recessive bestrophinopathy with transient resolution of retinal edema in one eye. Eur J Ophthalmol 2022; 33:NP88-NP92. [PMID: 34989278 DOI: 10.1177/11206721211073211] [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: 11/16/2022]
Abstract
PURPOSE To report 12-year follow-up of a patient with ARB. CASE REPORT A 25-year-old man presented with blurred vision in his both eyes (OU). Best-corrected visual acuity (BCVA) was 20/63 Snellen equivalent in the right eye (OD) and 20/32 Snellen equivalent in the left eye. The intraocular pressures and anterior segment examination were unrevealing in OU. Posterior segment examination revealed multiple yellowish flecks and dots in the posterior pole in OU. Optical coherence tomography (OCT) showed subretinal fluid (SRF), intraretinal hyporeflective spaces, elongated and shaggy photoreceptors and outer retinal defects. Fundus autofluorescence demonstrated mottling hyperautofluorescence and hypoautofluorescence in the posterior pole in OU. Fluorescein angiography illustrated hyperfluorescence in the posterior pole and surrounding the arcades in OU. Multifocal electroretinography objectified mild to markedly abnormal responses in all ring areas in OU. Molecular genetic testing confirmed two heterozygous sequence variations in the BEST1 gene. At 4 years of follow-up, OCT revealed a complete resolution of SRF and a partial resolution of intraretinal hyporeflective spaces in the OD with corresponding improvement in the BCVA to 20/23 Snellen equivalent in the OD, even though outer retinal defects persisted. Our patient denied recent changes in his alimentary habits and medical history at that time. Posteriorly, SRF and intraretinal hyporeflective spaces reappeared in the OD. CONCLUSION To the best of our knowledge, this is the first case report of ARB with a transient resolution of retinal edema in one eye without medical treatment and dietary therapy.
Collapse
Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Raquel Rodríguez López
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | | | - Javier Montero Hernández
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
6
|
Ji MH, Callaway NF, Ludwig CA, Vail D, Al-Moujahed A, Rosenblatt TR, Leng T, Sanislo SR, Moshfeghi DM. Visual acuity and progression of macular atrophy in patients receiving intravitreal anti-VEGF for age-related macular degeneration. Eur J Ophthalmol 2022; 32:429-435. [PMID: 33781106 PMCID: PMC10699280 DOI: 10.1177/11206721211001708] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE Whether intravitreal anti-vascular endothelial growth factors (VEGFs) cause retinal atrophy is still a subject of debate. We reported 13 eyes that received several injections of anti-VEGF for wet age-related macular degeneration (AMD) with good visual acuity despite geographic atrophy on imaging. METHODS This is a case series study conducted at Byers Eye Institute at Stanford University. Patients of three retina specialists with wet AMD who received six or more intravitreal injection of anti-VEGFs with visual acuity of 20/60 or better and incomplete RPE and outer retina atrophy (iRORA) or complete RPE and outer retinal atrophy (cRORA) were enrolled in this case series. Different imaging modalities were reviewed by three retina specialists comparing the baseline with the most recent exam. RESULTS About 13 eyes of 10 patients met the selection criteria. Eleven eyes were classified as iRORA and 2 as cRORA. Despite the development of macular atrophy on imaging after an average of 38.1 injections, eyes maintained stable visual acuity. CONCLUSION The discrepancy between structural and functional findings in this cohort suggests that patients treated by anti-VEGF drugs exhibit divergent clinical outcomes for currently unknown reasons. The authors propose anti-VEGF may affect melanosomes within RPE without disrupting RPE and photoreceptors function completely. This requires further investigation.
Collapse
Affiliation(s)
- Marco H Ji
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalia F Callaway
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Daniel Vail
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ahmad Al-Moujahed
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tatiana R Rosenblatt
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Theodore Leng
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Steven R Sanislo
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
7
|
Abstract
Glaucoma is a serious and progressive optic neuropathy, the exact pathophysiology of which is still poorly understood. Furthermore, glaucoma exhibits significant comorbidity with obstructive sleep apnea (OSA) that warrants an in-depth study in view of highly probable beneficial and far-reaching clinical implications. In this brief paper, the authors have studied the existing theories in an attempt to explain the comorbidity and its underlying pathophysiology. From the ensuing evidence, the role of connective tissue strength has emerged as a major factor and which appears to play a pivotal role not only in the development of glaucoma but also in the underlying pathophysiology of its enigmatic comorbidity with OSA. Understanding the pathophysiology of the comorbidity can stimulate newer therapeutic strategies targeted toward strengthening of connective tissues that may at least retard if not arrest the progression of glaucomatous changes and their complications.
Collapse
Affiliation(s)
- Manish Goyal
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Uma Sharan Tiwari
- Department of Ophthalmology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
| | | |
Collapse
|
8
|
Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Soler Sanchis MI, Cervera Taulet E. Quantitative analysis of retinal and choroidal vasculature in patients with chorioretinal folds secondary to hyperopia. Eur J Ophthalmol 2021; 32:1694-1701. [PMID: 34308685 DOI: 10.1177/11206721211035618] [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: 11/15/2022]
Abstract
INTRODUCTION There is a lack of information on quantitative parameters of optical coherence tomography angiography (OCTA) in cases of chorioretinal folds (CRF). The aim of this study was to compare OCTA retinal and choriocapillary vessel density (VD) between normal subjects and patients with CRF. METHODS We conducted an observational retrospective study. A total of 16 eyes of eight patients were recruited (eight eyes with CRF and eight control eyes). Data on best-corrected visual acuity (BCVA), refractive error, central macular thickness (CMT), central subfoveal thickness (CST), and OCTA findings (VD and foveal avascular zone (FAZ) area in superficial capillary plexus (SCP), middle capillary plexus (MCP), and deep capillary plexus (DCP), and VD in choriocapillaris (CC)) were recorded in each eye. RESULTS Compared with control group, CRF group showed decreased VD in the foveal region of SCP and MCP (p value 0.003 and 0.001), and increased VD in nasal region of SCP and MCP (p value 0.02 and 0.001), and in parafoveal area of MCP (p value 0.005). No differences were found in DCP and CC layers. Furthermore, we observed an enlargement of FAZ in CRF group at SCP and MCP slabs (p value <0.001 and 0.015). Respect to optical coherence tomography parameters, we demonstrated a thicker choroid in the CRF group (p value 0.002). CONCLUSION To the best of our knowledge, this is the first study reported in the literature quantifying VD of retinal capillary plexus and CC in a group of patients with a diagnosis of CRF secondary to hyperopia.
Collapse
Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | | | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
9
|
Stanga PE, Pastor-Idoate S, Reinstein U, Vatas P, Patel U, Dubovy S, Reinstein D, Zahavi O. Navigated single-capture 3D and cross-sectional wide-field OCT of the mid and peripheral retina and vitreoretinal interface. Eur J Ophthalmol 2021; 32:1642-1651. [PMID: 34218694 DOI: 10.1177/11206721211026100] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Assess the mid and peripheral neuroretina and vitreoretinal interface using a novel Navigated Single-Capture 3D and Cross-Sectional Wide-Field Swept-Source Optical Coherence Tomography (WF SS-OCT) technology with correlation to Multi-Wavelength Ultra-Widefield Imaging (MW UWFI) and Histopathology reference. METHODS Retrospective observational study. A total of 74 patients (148 eyes) were imaged using WF SS-OCT and Navigated Single-Capture twelve 23 mm cross-sectional radial scan pattern at 15° intervals. Image diagnosis included: congenital hypertrophy of the retinal pigment epithelium, choroidal nevus, ora serrata pearls, retinal tuft, lattice, snail track, cobblestone degeneration, retinal hole, retinal tear, degenerative retinoschisis, peripheral laser retinopexy, white without pressure, vitreous floaters, subclinical peripheral rhegmatogenous retinal detachment (RD), and tractional RD in proliferative diabetic retinopathy. WF SS-OCT images were correlated with MW UWFI and histopathological references where available. RESULTS WF SS-OCT successfully imaged structural features in all diagnoses with significant improvement in diagnostic capability and increased the diagnosis of specific features such as vitreoretinal attachment, full thickness hole or tear and subretinal fluid. Histopathological correlation was available for five (5) different peripheral retinal pathologies imaged by both WF SS-OCT and MW UWFI and good anatomical correlation was observed in all diagnosis. CONCLUSIONS Navigated Single-Capture 3D and Cross-Sectional WF SS-OCT provides detailed anatomic information of the mid and peripheral neuroretina and vitreoretinal interface, allowing early recognition of vision-threatening features that may influence clinical management, particularly in an era of telemedicine or when there is limited or no access to Indirect Ophthalmoscopy with 360° Scleral Indentation.
Collapse
Affiliation(s)
- Paulo Eduardo Stanga
- The Retina Clinic London and London Vision Clinic, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Salvador Pastor-Idoate
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain.,Clinical University Hospital, Valladolid, Spain
| | | | - Pooja Vatas
- The Retina Clinic London and London Vision Clinic, London, UK
| | - Umangi Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dan Reinstein
- The Retina Clinic London and London Vision Clinic, London, UK
| | - Ori Zahavi
- Canon Medical Systems Europe, Business Unit Eye Care, Zoetermeer, Zuid-Holland, The Netherlands
| |
Collapse
|
10
|
Remolí Sargues L, Montero Hernández J, Ortiz Salvador M, Moratal Peiro B, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Cervera Taulet E. Vitamin A retinopathy secondary to Billroth II anastomosis triggered after the beginning of dialysis. Eur J Ophthalmol 2021; 32:NP50-NP54. [PMID: 34154441 DOI: 10.1177/11206721211027416] [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: 11/16/2022]
Abstract
PURPOSE To report a case of vitamin A retinopathy secondary to Billroth II anastomosis triggered after the beginning of dialysis in a patient with a chronic renal failure. CASE REPORT A 73-year-old male complained of nyctalopia that had started 9 months ago, coinciding with the beginning of dialysis. His medical history is remarkable for hepatic cirrhosis and Billroth II anastomosis 20 years ago. Best-corrected visual acuity (BCVA) was 60 letters in both eyes. Dilated fundus examination showed faint white-yellowish dots. Optical coherence tomography (OCT) illustrated hyperreflective dots and small hyporreflective cavities between the retinal pigment epithelium (RPE) and the ellipsoid zone (EZ). En face OCT showed multiple hyperreflective dots that coincide with white-yellowish dots of the fundus, and multiple hyporreflective defects which correspond to hyporreflective cavities seen in the OCT. Visual field examination showed concentric narrowing of the visual field. A diagnosis of vitamin A deficiency was confirmed and oral vitamin A supplementation was initiated. One month after treatment, the patient reported a subjective improvement of nyctalopia, and BCVA ameliorated up to 80 and 85 letters. Fundus examination, OCT, and en face OCT showed a diminution of the observed lesions. Moreover, visual field improved. CONCLUSION Early diagnosis of vitamin A deficiency can prevent irreversible visual sequelae. This highlights the crucial role of ophthalmologists in the prompt detection of this condition. A lifelong monitoring should be needed in patients undergoing biliopancreatic diversion surgery. Furthermore, OCT and en face OCT becomes a main tool in the diagnosis and monitor response to treatment.
Collapse
Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Miguel Ortiz Salvador
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Baltasar Moratal Peiro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
11
|
Kakisu M, Baba T, Iwase T, Yokouchi H, Yamamoto S. Relationship between retinal sensitivities and optical coherence tomographic findings in eyes with myopic chorioretinal atrophy. Eur J Ophthalmol 2021; 32:NP24-NP28. [PMID: 33827282 DOI: 10.1177/11206721211008038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
PURPOSE To determine whether there is a significant correlation between the retinal sensitivity and the integrity of the ellipsoid zone (EZ) of the photoreceptors in eyes with myopic chorioretinal atrophy (CRA). We also determined the significance of the correlation between the retinal sensitivity and the retinal and choroidal thicknesses. METHODS The medical records of 10 eyes of six subjects with myopic CRA were reviewed. The integrity of the EZ was determined in the spectral-domain optical coherence tomographic (OCT) images at 37 points of six scans corresponding to the locations where the retinal sensitivities were measured by MP-3 microperimetry. The mesopic retinal sensitivities were determined within the central 16°. The significance of the correlations between the integrity of the EZ and the mesopic retinal sensitivities was determined. The relationships between the retinal and choroidal thickness and the retinal sensitivity were also determined. RESULTS The average age of the patients was 70.0 ± 6.7 years, and the average axial length of the eye was 29.2 mm. The mesopic sensitivities at the points where the EZ was present were significantly higher than those where the EZ was absent (p < 0.01). The mesopic sensitivity was significantly correlated with the retinal thickness (p < 0.01, r = 0.30) and the choroidal thickness (p < 0.01, r = 0.23). CONCLUSIONS The significant correlation between the mesopic retinal sensitivity and the integrity of the EZ indicates that the mesopic sensitivities can be used to assess the integrity of the photoreceptors in eyes with myopic CRA.
Collapse
Affiliation(s)
- Masato Kakisu
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takehito Iwase
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hirotaka Yokouchi
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Yamamoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
12
|
Stanga PE, Tsamis E, Siso-Fuertes I, Dorn JD, Merlini F, Fisher A, Crawford FI, Kasbia SS, Papayannis A, Baseler HA, Morland AB, Hanson RL, Humayun M, Greenberg RJ. Electronic retinal prosthesis for severe loss of vision in geographic atrophy in age-related macular degeneration: First-in-human use. Eur J Ophthalmol 2021; 31:920-931. [PMID: 33736500 DOI: 10.1177/11206721211000680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Abstract
BACKGROUND To date there are yet no available approved therapies for Geographic Atrophy (GA) secondary to age-related macular degeneration (AMD). METHODS Single site, non-randomized safety and efficacy study presenting the preliminary results in a cohort of five late stage AMD (GA) patients successfully implanted with the Argus II Retinal Prosthesis System (Second Sight Medical Products Inc., Sylmar, CA, USA). Extensive fundus imaging including retinal photographs from which the GA area was measured. A combination of custom and traditional tests designed for very low vision subjects assessed visual function in study subjects. A Functional Low-Vision Observer Rated Assessment was carried out to evaluate the impact of the system on the subject's daily life. In addition, a study to evaluate structural characteristics of the visual cortex of the brain was performed in one subject using magnetic resonance imaging. RESULTS Seven device-related adverse events were reported, four of which were classed as serious adverse events. Retinal detachment was reported in three patients and was successfully treated within 12 months of onset. Testing showed an improvement in visual function in three of five patients with the system turned on. Magnetic resonance imaging assessed in one patient after implantation indicates a selective increase in cortical myelin and thickness in visual brain regions 1 year post implantation. CONCLUSIONS Epiretinal prostheses can successfully be implanted in those affected by GA secondary to late-stage AMD and can elicit visual percepts by electrical stimulation of residual neuroretinal elements and improve basic visual function in those affected.
Collapse
Affiliation(s)
- Paulo E Stanga
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, UK.,Division Evolution & Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Retina Service, London Vision Clinic, London, UK
| | - Emmanouil Tsamis
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, UK.,Division Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Irene Siso-Fuertes
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, UK
| | - Jessy D Dorn
- Second Sight Medical Products, Inc, Sylmar, CA, USA
| | | | | | - Fiona Ij Crawford
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, UK
| | - Shakti S Kasbia
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, UK
| | - Alessandro Papayannis
- Manchester Vision Regeneration (MVR) Lab at Manchester Royal Eye Hospital, NIHR Manchester Clinical Research Facility and Manchester University NHS Foundation Trust, Manchester, UK.,SC di Oculistica Ospedali di Monfalcone e Gorizia, Azienda Sanitaria Universitaria Giuliano Isontina, Monfalcone, Italy
| | - Heidi A Baseler
- Hull York Medical School, Hull, Kingston upon Hull, UK.,Department of Psychology, University of York, UK.,York Neuroimaging Centre, University of York, UK
| | - Antony B Morland
- Department of Psychology, University of York, UK.,York Neuroimaging Centre, University of York, UK
| | - Rachel L Hanson
- Department of Psychology, University of York, UK.,York Neuroimaging Centre, University of York, UK
| | - Mark Humayun
- Ophthalmology and Biomedical Engineering, USC Roski Eye Institute, Los Angeles, CA, USA
| | | |
Collapse
|
13
|
Lai CC, Chang CH. Hyperviscosity-related retinopathy and serous macular detachment in Waldenström's macroglobulinemia: A mortal case in 5 years. Eur J Ophthalmol 2021; 32:NP109-NP114. [PMID: 33719618 DOI: 10.1177/11206721211002066] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To present a 5-year mortal case of Waldenström's macroglobulinemia-related retinopathy and serous macular detachment. CASE REPORT A 63-year-old man, with unremarkable medical history, presented with bilateral decreased vision for 2 months. Fundus examination revealed bilateral scattered retinal hemorrhages, exudates, venous tortuosity, and serous macular detachment. Hematologic and biochemistry profiles showed pancytopenia with blood smear demonstrating erythrocyte rouleaux formation. Hyperviscosity syndrome was suspected and later Waldenström's macroglobulinemia was diagnosed by bone marrow biopsy and high concentration of serum IgM. Plasmapheresis and subsequent chemotherapy were arranged. In spite of resolution of most retinal abnormalities, his visual acuity still showed no improvement with a persistent bilateral macular detachment. The patient then died 5 years after the diagnosis of Waldenström's macroglobulinemia. CONCLUSIONS Long-term toxicity of IgM to the retinal pigment epithelium may impede the resolution of the persistent serous macular detachment, resulting in an inability of recovery in his vision. Therefore, early diagnosis and timely reduction of serum paraproteins by plasmapheresis and chemotherapy is critical for preventing permanent damages to patients' health and vision.
Collapse
Affiliation(s)
- Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
| | - Chun-Hsiang Chang
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan
| |
Collapse
|
14
|
Marques M, Alves F, Leitão M, Rodrigues C, Ferreira JT. Methylenetetrahydrofolate reductase polymorphisms as risk factors for retinal venous occlusive disease: A literature review. Eur J Ophthalmol 2021; 31:884-891. [PMID: 33715478 DOI: 10.1177/11206721211000647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/18/2022]
Abstract
The role of polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene in retinal vein occlusion (RVO) is a theme of discussion since the first reports of RVO in patients with MTHFR C677T mutation and without classic acquired risk factors for retinal vascular disease. The association between MTHFR polymorphisms and RVO has been studied over the last 20 years producing conflicting results. This review aims to summarize the literature concerning the role MTHFR polymorphisms as risk factors for RVO.
Collapse
Affiliation(s)
- Manuel Marques
- Instituto Oftalmológico Doutor Gama Pinto, Lisboa, Portugal
| | | | - Miguel Leitão
- Instituto Oftalmológico Doutor Gama Pinto, Lisboa, Portugal
| | | | | |
Collapse
|
15
|
Leal C, De Bats F, Morales M, Decullier E, Denis P, Amoaku W, Kodjikian L. Anatomical-functional concordance of microperimetry and the simplified age-related macular degeneration study classification: A pilot study. Eur J Ophthalmol 2021; 32:402-409. [PMID: 33648371 DOI: 10.1177/1120672121999348] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The principal aim of this pilot study was to investigate the concordance between the different stages of Age-Related Macular Degeneration (AMD), as determined by the simplified classification of the Age Related Eye Disease Study Group (AREDS), and new evaluation criteria using a microperimetry system. METHODS A complete eye examination and a microperimetry MAIATM (Macular Integrity Assessment, CenterVue, Padova, Italy) examination was performed on 59 eyes with early, intermediate or advanced AMD. We analysed 19 evaluation criteria for every clinical group category. RESULTS There were 20 female and 12 male participants included with a median age of 74 years (min: 54, max: 87). Thirteen eyes (22%) were classified as category 1, 11 eyes (18.6%) as category 2, 17 eyes (28.8%) as category 3 and 18 eyes (30.6%) as category 4 AMD.All evaluated microperimetry criteria related to retinal sensitivity were found to have a statistically significant difference among the stages (p < 0.05). Fixation stability was unstable in 55.6% of the eyes classified as stage 4 (p = 0.001). The analysis of the distance between the two PRLs - PRL_initial and PRL_final was larger for the stage 4 (p = 0.0258). The mean sensitivity in stages 2 and 3 correlated with the presence or not of reticular pseudodrusen (p = 0.0137). CONCLUSIONS The mean sensitivity and the categorized sensitivity (set to 25, 15 and 5 dB), the five higher and lower stimuli sensitivity appeared to be the most sensitive criteria to differentiate the four AMD categories. Microperimetry provides a new reproducible method of anatomical-functional macular analysis.
Collapse
Affiliation(s)
- Cecilia Leal
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | | | - Marco Morales
- Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Evelyne Decullier
- Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse Teaching Hospital, Lyon, France
| | - Winfried Amoaku
- Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse Teaching Hospital, Lyon, France
| |
Collapse
|
16
|
Christodoulou PD. Optical coherence tomography analyses based segmentation and relative intensity evaluation of outer retinal layers in patients affected with X-linked juvenile retinoschisis. Eur J Ophthalmol 2021; 32:NP38-NP42. [PMID: 33594896 DOI: 10.1177/1120672121995110] [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: 11/15/2022]
Abstract
PURPOSE We aim to provide a description of the optical coherence tomography findings in the outer macula hyperreflective bands of our patients with X-linked juvenile retinoschisis. Also to categorize these changes and to quantitatively and qualitatively correlate their reflectivity levels with visual function. METHODS We manually segmented the borders, and depicted relative intensity of the inner segment ellipsoid band, and quantified the volume of edema. RESULTS The average relative intensity of the ellipsoid zone, ISe band, for the control subject was 14.864, our patient's, with the mild disease was, 28.238 and 34.943 in OD and OS, respectively, and for the patient with severe disease was, 44.442 and 40.154 for OD and OS respectively. Thresholding showed a significant difference in edema volume between mild disease (~20%), and severe form (~50%). Relative intensity analyses are indicative of homogeneity variability. High standard deviation value illustrates the high dispersion of data values and is a safe marker of ellipsoid zone homogeneity. CONCLUSION Data suggested that both anatomic and functional characteristic of outer macula hyperreflective bands were notably associated with the pathogenesis cascade in the photoreceptor cells. External limiting membrane line disruption is initiated by the volume of macular edema and followed by disorganization of the three lines in a stepwise pattern, first at the ellipsoid zone, followed by the cone outer segment tips zone and finally at the External limiting membrane.
Collapse
|
17
|
Viggiano P, Toto L, Ferro G, Evangelista F, Porreca A, Mastropasqua R. Choroidal structural changes in different intermediate AMD patterns. Eur J Ophthalmol 2021. [PMID: 33506710 DOI: 10.1177/1120672121992009.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system. DESIGN A prospective, observational, cross-sectional study. SUBJECTS Eighty-four participants. METHODS The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis. MAIN OUTCOME MEASURES This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI). RESULTS CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p < .005) and healthy eyes (p < .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p < 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy. CONCLUSIONS We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.
Collapse
Affiliation(s)
- Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giada Ferro
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
18
|
Viggiano P, Toto L, Ferro G, Evangelista F, Porreca A, Mastropasqua R. Choroidal structural changes in different intermediate AMD patterns. Eur J Ophthalmol 2021; 32:460-467. [PMID: 33506710 DOI: 10.1177/1120672121992009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/26/2022]
Abstract
PURPOSE To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system. DESIGN A prospective, observational, cross-sectional study. SUBJECTS Eighty-four participants. METHODS The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis. MAIN OUTCOME MEASURES This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI). RESULTS CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p < .005) and healthy eyes (p < .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p < 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy. CONCLUSIONS We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.
Collapse
Affiliation(s)
- Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giada Ferro
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
19
|
de Oliveira Loureiro T, Cardoso JN, Lopes CDPL, Carreira AR, Rodrigues-Barros S, Vide-Escada A, Campos NP. The effect of insulin pump therapy in retinal vasculature in type 1 diabetic patients. Eur J Ophthalmol 2021; 31:3142-3148. [PMID: 33499670 DOI: 10.1177/1120672121990576] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES Continuous subcutaneous insulin infusion (CSII) is a treatment for type 1 diabetes that improves metabolic control and reduces micro and macrovascular complications. The aim of this study was to compare the effect of CSII versus traditional multiple daily injections (MDI) therapy on retinal vasculature. METHODS We performed a prospective study with type 1 diabetic patients with no prior history of ocular pathology other than mild diabetic retinopathy. The patients were divided into two groups according to their therapeutic modality (CSII vs MDI). The retinal nerve fiber layers thickness and vascular densities were compared between groups in both macula and optic disc. The correlations between vascular density and clinical features were also determined. Statistical significance was defined as p < 0.05. RESULTS The study included 52 eyes, 28 in the insulin CSII group. The mean age was 36.66 ± 12.97 years, with no difference between groups (p = 0.49). The mean glycated hemoglobin (HbA1c) was found to be lower in the CSII group (7.1% ± 0.7 vs 7.5% ± 0.7 p < 0.01). The parafoveal vascular density was found to be higher in the CSII group (42.5% ± 0.4 vs 37.7% ± 0.6, p < 0.01). We found an inverse correlation between HbA1c value and parafoveal vascular densities (p < 0.01, r = -0.50). CONCLUSION We found that CSII provided better metabolic control than MDI and this seemed to result in higher parafoveal vascular density. As lower vascular density is associated with an increased risk of diabetic retinopathy, these results suggest that CSII could be the safest therapeutic option to prevent retinopathy.
Collapse
Affiliation(s)
| | - João Nobre Cardoso
- Medical Doctor, Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Ana Rita Carreira
- Medical Doctor, Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Ana Vide-Escada
- Ophthalmology Consultant, Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | | |
Collapse
|
20
|
Puell MC, Contreras I, Pinilla I, Escobar JJ, Soler-García A, Blasco AJ, Lázaro P. Beyond visual acuity: Patient-relevant assessment measures of visual function in retinal diseases. Eur J Ophthalmol 2021; 31:3149-3156. [PMID: 33482694 DOI: 10.1177/1120672121990624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/21/2023]
Abstract
PURPOSE To identify patient-reported outcomes (PROs) and other clinical outcome measures (contrast sensitivity (CS), low-luminance visual acuity (LLVA) and reading acuity or reading speed (RA-RS)), relevant to patients with age-related macular degeneration (AMD) or diabetic retinopathy (DR), which would be recommended for use in clinical practice. METHODS The RAND/UCLA Appropriateness Method, based on the synthesis of the scientific evidence and the collective judgment of an expert panel using the two-round Delphi method, was applied. The evidence synthesis was performed by searching for articles on outcome measures for AMD and/or DR published between 2005 and 2018 in English or Spanish. The expert panel consisted of 14 Spanish ophthalmologists, who rated the recommendation degree for each outcome measure on a scale of 1 (extremely irrelevant) to 9 (maximum relevance). The recommended outcome measures were established according to the panel median score and the level of the panelists' agreement. RESULTS Through the evidence search, 33 PRO-specific questionnaires (21 for visual function, six for AMD, three for DR, one for AMD and DR) and two treatment satisfaction questionnaires (one on AMD and one on DR) were identified. In addition, 21 methods were found for measuring CS, five for LLVA, and nine for RA-RS. According to the panel ratings, 11 of the 64 outcome measures evaluated for AMD, and seven of the 61 evaluated for DR were recommended. CONCLUSION The AMD and DR outcome measures recommended will help ophthalmologists choose the outcome measure most appropriate for their patients. Furthermore, the use of PROs will contribute to shifting clinical practice towards patient-centered medicine.
Collapse
Affiliation(s)
- María Cinta Puell
- School of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Inés Contreras
- Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS) and Clínica Rementería, Madrid, Spain
| | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain; Department of Ophthalmology, Hospital Clinico Universitario, Zaragoza, Spain
| | | | | | | | - Páblo Lázaro
- Independent Health Services Researcher, Madrid, Spain
| |
Collapse
|
21
|
Querques G, Sacconi R, Capuano V, Carnevali A, Colantuono D, Battista M, Borrelli E, Miere A, Parravano M, Costanzo E, Querques L, Souied EH, Bandello F. Treatment-naïve quiescent macular neovascularization secondary to AMD: The 2019 Young Investigator Lecture of Macula Society. Eur J Ophthalmol 2021; 31:3164-3176. [PMID: 33445977 DOI: 10.1177/1120672120986370] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/17/2022]
Abstract
PURPOSE To analyze different clinical and anatomical features in treatment-naïve non-exudative macular neovascularizations (MNVs) secondary to age-related macular disease (AMD). METHODS In this retrospective longitudinal study with a minimum follow-up of 1 year, 31 eyes of 28 consecutive AMD patients (mean age 75 ± 9 years) with treatment-naïve non-exudative MNV were enrolled. Patients were divided in: short-term activated MNV group (exudation before 6-month) and quiescent MNV group (per definition no exudation during a minimum 6-month follow-up) showing no or late activation during follow-up (persistently quiescent and long-term activated MNV group, respectively). RESULTS During the follow-up (mean duration: 22 ± 9 months) four eyes (13%) showed exudation before 6-month follow-up (short-term activated MNV group), whereas 21 eyes (68%) did not develop signs of exudation (persistently quiescent group), and six eyes (19%) developed exudation after the minimum 6-month follow-up (long-term activated MNV group). Monthly MNV growth rate was significantly higher in the short-term activated MNV group (growth rate of 13.30%/month), vs persistently quiescent MNV group (0.64%/month, p < 0.001) and long-term activated quiescent MNV group (1.07%/month, p < 0.001). Furthermore, at the baseline, perfusion density of short-term activated MNV group was significantly greater in comparison to persistently quiescent MNV group (p = 0.001) and long-term activated MNV group (p = 0.106). CONCLUSION We reported two different patterns for subclinical MNVs: subclinical MNVs characterized by short-term activation which could represent simply a pre-exudative stage in the development of an ordinary type 1 MNV, and quiescent MNVs characterized by low rate of growth and possible long-term activation. Analysis of OCT-A features may predict short-term activation for subclinical MNV but no features could predict the long-term activation.
Collapse
Affiliation(s)
- 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.,Department of Ophthalmology, Centre Hospitalier Intercommunal Creteil University Paris Est, Creteil, France
| | - 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
| | - Vittorio Capuano
- Department of Ophthalmology, Centre Hospitalier Intercommunal Creteil University Paris Est, Creteil, France
| | - Adriano Carnevali
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Ophthalmology, University Hospital "Magna Graecia," Catanzaro, Italy
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal Creteil University Paris Est, Creteil, France
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal Creteil University Paris Est, Creteil, France
| | | | | | - Lea Querques
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal Creteil University Paris Est, 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
| |
Collapse
|
22
|
Amoroso F, Souied EH, Cohen SY, Pedinielli A, Astroz P, Blanco Garavito R, Capuano V, Querques G, Miere A. OCTA-guided navigated laser therapy for advanced macula neovascularization secondary to age related macular degeneration. Eur J Ophthalmol 2020; 31:3182-3189. [PMID: 33353405 DOI: 10.1177/1120672120983191] [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: 11/15/2022]
Abstract
INTRODUCTION To evaluate the effects of the Navilas system guided by optical coherence tomography angiography for advanced macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). METHODS Prospective case-series including nine eyes presenting with advanced MNV with persistence of exudative signs, no longer responding to anti-VEGF therapy, best-corrected visual acuity at least of 1.3 logMar. All patients were treated with Navilas guided by overlaid optical coherence tomography angiography (OCTA) images at the site of branching large neovascular trunks. RESULTS Occlusion of large neovascular trunks successfully occurred in all nine included patients. OCTA analysis revealed, at 1 month follow up, MNV total area decreasing from 6.2 ± 3.1 to 2.6 ± 3.4 mm2. At 6 months follow up, mean MNV area was 3.3 ± 3.4 mm2 (p = 0.008). CONCLUSION This preliminary study showed that Navilas treatment guided by OCTA may represent an attractive therapeutic option in advanced neovascular lesions secondary to AMD.
Collapse
Affiliation(s)
- Francesca Amoroso
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Eric H Souied
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Salomon Yves Cohen
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France.,Ophthalmic Center for Imaging and Laser, Paris, France
| | - Alexandre Pedinielli
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Polina Astroz
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Rocio Blanco Garavito
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| | - Giuseppe Querques
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France.,Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Hopital Intercommunal and Paris Est University, Créteil, France
| |
Collapse
|
23
|
Caretti L, La Gloria Valerio A, Verzola G, Badin G, Monterosso C, Daniele AR. Functional and morphological outcomes after surgery in lamellar macular holes versus epiretinal membrane foveoschisis. Eur J Ophthalmol 2020; 31:3294-3299. [PMID: 33246377 DOI: 10.1177/1120672120974287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
PURPOSE To compare the clinical findings and outcomes of vitrectomy for lamellar macular holes (LMH) versus epiretinal membrane foveoschisis (ERMF). MATERIALS AND METHODS This retrospective study enrolled 36 eyes of 35 patients with a minimum follow-up of 6 months. Spectral domain optical coherence tomography (SD-OCT) parameters and best-corrected visual acuity (BCVA) were analyzed preoperatively and postoperatively. RESULTS The 19 (52.8%) ERMF and 17 (47.2%) LMH were included. Preoperatively, eyes with LMH were characterized by a lower central foveal thickness (CFT) (102.18 ± 31.44 µm vs 159.37 ± 25.25 µm, p < 0.001) and a greater incidence of outer retinal disruption (p < 0.001). Primary anatomical success was achieved in 34/36 eyes (94.4%). Preoperative BCVA was better in ERMF (0.16 - IQR 0.09 - logarithm of the minimal angle of resolution (LogMAR) - 20/28 Snellen) than LMH (0.40 - IQR 0.30 - LogMAR, 20/50 Snellen) (p = 0.008). At 6 months after surgery, BCVA significantly improved in the ERMF group (p < 0.001), but showed insignificant change in LMH (p = 0.125). Two cases, both in the LMH group, developed full thickness macular hole after surgery. CONCLUSION Eyes with LMH showed visual stabilization after surgery, whereas the eyes in the ERMF group were susceptible to functional improvement. These differences in BCVA outcomes may be the consequence of a higher damage in the outer retina in the LMH group; an accurate SD-OCT examination is a fundamental step when deciding to proceed or not to the surgery.
Collapse
Affiliation(s)
- Luigi Caretti
- Department of Ophthalmology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Giacomo Verzola
- Department of Ophthalmology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gloria Badin
- Department of Ophthalmology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Anna Rita Daniele
- Department of Ophthalmology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| |
Collapse
|
24
|
Abstract
AIM To validate mobile-based funduscope for diabetic retinopathy screening in Estonia. METHODS Quality validation comparison of HEINE® iC2 funduscope and Zeiss Visucam camera with image scoring and diagnostic test accuracy measurement by sensitivity and specificity. Study took place from January 2020 until March 2020 in East-Tallinn Central Hospital's eye clinic. RESULTS Based on 90 patients, the Zeiss Visucam showed 35.6% DR prevalence while iC2 had 18.9% for images and 17.8% for videos. The average Likert score was 4.7 for Zeiss Visucam and 2.4 for both iC2 images and iC2 videos. The sensitivity of iC2 images was 72.7% (95%CI 49.6-88.4) for grader 1 and 61.9% (95%CI 38.7-81.0) for grader 2, iC2 video sensitivity was 57.1% (95%CI 37.4-75.0) and 65.4% (95%CI 44.4-82.1), respectively. The grader-based specificity for iC2 images was 96.7% (95%CI 80.9-99.8) and 93.5% (95%CI 77.2-98.9). iC2 videos had a 100% (95%CI 91.7-1.0; 92.0-1.0) specificity by both graders. Cohen's kappa agreement was 0.82 and 0.96 for images and videos. CONCLUSION Mobile-based funduscope iC2 is not valid for DR screening with non-dilated pupils and thus not suitable for clinics that do not have experienced specialist present. Moreover, the screening specialist needs to be experienced fundus photographer with extra multiple day training for funduscope use. As main resolution, mobile-based funduscope was not validated for DR screening in Estonia based on pre-set study criteria. Additional research and development of funduscope algorithm for image stripping from videos is needed for validation as iC2 benefits do not offset the gold standard at the moment.
Collapse
Affiliation(s)
- Birgit Krieger
- Tallinn University of Technology, Tallinn, Harjumaa, Estonia
| | - Riina Hallik
- Tallinn University of Technology, Tallinn, Harjumaa, Estonia
| | - Kristina Kala
- East Tallinn Central Hospital, Tallinn, Harjumaa, Estonia
| | - Karina Ülper
- East Tallinn Central Hospital, Tallinn, Harjumaa, Estonia
| | | |
Collapse
|
25
|
Abstract
INTRODUCTION Central serous chorioretinopathy (CSC) is a disease of the retina that is a frequent cause of mild to moderate visual impairment. The disease can be precipitated by psychosocial stress and hypercortisolism while full remission will often be spontaneous within a few months. Risk factors have included male gender, increased plasma cortisol due to other conditions or steroid use and Type A behavior. METHODS This is a cross-sectional study comparing three research groups that included 100 CSC patients, 200 healthy volunteers, and 200 patients with other ophthalmic disease on their results in the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). RESULTS CSC patients differed from the other subjects on increased high Neuroticism-Anxiety, low Sociability, and high Aggression-Hostility. CONCLUSIONS Since high Neuroticism is related to increased cortisol levels only in males, and high Aggression-Hostility is related to increased cortisol response, these findings point to the possibility of a robust neurobiological background to the etiopathogenesis of CSC that merits further research. The association of Type A behavior with CSC may be a spurious one and its widespread reference in ophthalmology texts should be re-examined.
Collapse
Affiliation(s)
- Ioanna Mylona
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Maria Dermenoudi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Tsinopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Georgios Floros
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Psychiatric Hospital of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
26
|
Fallico M, Lotery AJ, Longo A, Avitabile T, Bonfiglio V, Russo A, Castellino N, Parisi G, Pulvirenti A, Eandi C, Cennamo G, Furino C, Cicinelli MV, Alovisi C, Reibaldi M. Treat and extend versus fixed regimen in neovascular age related macular degeneration: A systematic review and meta-analysis. Eur J Ophthalmol 2020; 31:2496-2504. [PMID: 33118382 DOI: 10.1177/1120672120964699] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare efficacy of treat and extend (T&E) versus fixed regimen treatment protocols in neovascular age-related macular degeneration (nAMD). METHODS Randomized clinical trials (RCTs) comparing T&E versus fixed regimen protocols for nAMD were systematically searched. Primary outcome was to compare the mean best corrected visual acuity (BCVA) change in T&E regimen versus fixed regimen. Secondary outcomes were change in the mean optical coherence tomography (OCT) central retinal thickness (CRT) and mean number of injections. Standardized mean difference (SMD) along with 95% confidence intervals (CIs) were calculated. Random-effect models were used for meta-analyses. RESULTS Four RCTs were included, with a total of 649 and 621 eyes in the T&E and fixed regimen cohort at 12 months, and 267 and 249 eyes at 24 months. Pooled analysis of mean BCVA change included all four RCTs at 12 months and two RCTs at 24 months, showing no difference between the two groups (12-month: SMD = 0.08, 95% CI: -0.20 to 0.35, p = 0.55; 24-month: SMD = 0.04, 95% CI: -0.13 to 0.21, p = 0.64). Pooled analysis of OCT CRT change at 12 months included three studies, showing no difference between the two groups (SMD = 0.03, 95% CI: -0.46 to 0.51, p = 0.91). Pooled analysis of mean injection number included all four RCTs at 12 months and two RCTs at 24 months, showing significant difference between the two groups (12-month: SMD = -1.11, 95% CI: -1.67 to -0.56, p < 0.001; 24-month: SMD = -1.34, 95% CI: -1.54 to -1.15, p < 0.001). CONCLUSION A T&E regimen proved as effective as a fixed dosage regimen throughout a 24-month follow-up and with a lower number of injections.
Collapse
Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
- Eye Unit, Southampton University Hospital, Southampton, UK
| | - Andrew J Lotery
- Eye Unit, Southampton University Hospital, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | | | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Guglielmo Parisi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Sicilia, Italy
| | - Chiara Eandi
- Department of Surgical Science, Eye Clinic, University of Torino, Torino, Piemonte, Italy
| | - Gilda Cennamo
- Department of Public Health, University of Naples Federico II, Naples, Campania, Italy
| | - Claudio Furino
- Department of Ophthalmology, University of Bari, Bari, Italy
| | | | - Camilla Alovisi
- Department of Surgical Science, Eye Clinic, University of Torino, Torino, Piemonte, Italy
| | - Michele Reibaldi
- Department of Surgical Science, Eye Clinic, University of Torino, Torino, Piemonte, Italy
| |
Collapse
|
27
|
Sacconi R, Borrelli E, Vella G, Querques L, Prascina F, Zucchiatti I, Bandello F, Querques G. TriPla Regimen: A new treatment approach for patients with neovascular age-related macular degeneration in the COVID-19 "era". Eur J Ophthalmol 2020; 31:849-852. [PMID: 33023326 DOI: 10.1177/1120672120963448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the last months, a rapidly increasing number of people have been infected with severe acute respiratory syndrome coronavirus 2, the virus causing coronavirus disease 2019 (COVID-19). Due to the risk of cross-infections, the number of visits and injections was dramatically reduced in the last months, and the time between visits has been rescheduled from every 15 to 45 min, significantly impairing the total number of available visits. Although continuity of care has been allowed, a series of measures to diminish the risk of contamination need to be adopted until the end of this pandemic outbreak, which may persist until the development of an effective vaccine. For these reasons, we have introduced a new treatment regimen that is aimed at reducing the number of in-person visits and achieving continuity of treatment. This regimen is named "Triple and Plan" (TriPla). The main advantage of the TriPla regimen is to reduce the number of visits of patients in comparison to the pro re nata and treat and extend regimen. Using the TriPla regimen, the risk of contamination would be reduced. Furthermore, by reducing the number of scheduled visits, physicians could guarantee an adequate number of examinations for each patient, lengthening the interval between visits, and reducing the risk of cross-infections.
Collapse
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
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Vella
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Lea Querques
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Prascina
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Zucchiatti
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - 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
| | - 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
| |
Collapse
|
28
|
Giacomelli G, Farini A, Baldini I, Raffaelli M, Bigagli G, Fossetti A, Virgili G. Saccadic movements assessment in eccentric fixation: A study in patients with Stargardt disease. Eur J Ophthalmol 2020; 31:2556-2562. [PMID: 33008267 DOI: 10.1177/1120672120960336] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate saccadic movements in subjects with eccentric fixation due to a deep central scotoma in Stargardt disease (STGD). METHODS We studied 10 patients with STGD and 10 healthy subjects (control group). Saccadic movements of all the 20 subjects were assessed by using the eye tracker technique Tobii Glasses Pro 2. Standard measurements of reading ability (MNREAD charts), visual acuity (ETDRS charts), contrast sensitivity (Pelli-Robson charts), reading contrast threshold and speed (REX charts), retinal sensitivity and stability and localization of the fixation (MP1 fundus perimetry) were obtained in all subjects. RESULTS The saccadic movements time was significantly slower in STGD than in healthy subjects (699 ± 193 ms vs 299 ± 40 ms, p < 0.001). When STGD patients moved fixation to the target localized in retinal scotomatous areas, the movement was significantly slower compared to non scotomatous areas in the retina (1103 ± 798 ms vs 524 ± 187 ms, p = 0.039). There was a trend toward a correlation between slow saccadic movements in STGD subjects and the reading performance indices, although statistical significance was not achieved. CONCLUSION Ocular saccades guided by eccentric fixation in STGD patients are significantly slower than in the control group, especially when the target corresponds to retinal areas with a deep scotoma. These results can explain the worse reading performance in STGD subjects, in particular when a non-viewing area on the right part of the text is present.
Collapse
Affiliation(s)
| | | | | | | | - Giulia Bigagli
- Institute for Research and Studies in Optics and Optometry, Vinci, Italy
| | | | | |
Collapse
|
29
|
Gündüz AK, Shields CL, Bekdemir Ş, Shields JA. Multimodal imaging of chorioretinal folds induced by orbital vascular malformation in two cases. Eur J Ophthalmol 2020; 32:NP212-NP217. [PMID: 32951443 DOI: 10.1177/1120672120957582] [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: 11/17/2022]
Abstract
PURPOSE To investigate the alterations in the retinal pigment epithelium (RPE) in the crest and trough portions of chorioretinal folds (CRFs) induced by an orbital vascular tumor. METHODS Review of multimodal imaging in two eyes of two patients with globe compression and CRFs from an orbital vascular tumor. RESULTS Fundus photography demonstrated obliquely extending CRFs with alternating hyperpigmented and hypopigmented linear alterations in both eyes. Fundus autofluorescence (AF) imaging showed obliquely oriented hypoAF lines, incompletely alternating with hyperAF lines. In Case 1, the hyperAF lines had interspersed hypoAF segments and Case 2 had peripapillary mottling of AF. Fluorescein angiography (FA) showed alternating hyper and hypofluorescent lines in the late phase in Case 1. Optical coherence tomography (OCT) documented relative thinning of RPE at the folded crests in Case 1 and preservation of RPE in Case 2. Swept-source OCT angiography (SS-OCTA) demonstrated oblique hyporeflective lines in the outer retina and choriocapillaris layers in Case 2. These findings suggest that the crest of a CRF represents thinned or rarified RPE with hypoAF, transmission hyperfluorescence (FA), partially attenuated RPE layer (OCT), and isoreflectivity (SS-OCTA) while the trough represents compressed RPE with irregular hyperAF, transmission hypofluorescence (FA), thickened RPE layer (OCT), and hyporeflectivity (SS-OCTA). CONCLUSION The anatomic and functional status of the RPE in CRFs based on multimodal imaging reveals normal to attenuated RPE with hypofunctionality at the fold crest and compacted, thickened RPE at the trough with segmental functional impairment on AF imaging. Anatomic information regarding CRFs is evident on OCT, FA, and SS-OCTA while the functional status is depicted on AF.
Collapse
Affiliation(s)
- Ahmet Kaan Gündüz
- Department of Ophthalmology, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA USA
| | - Şükran Bekdemir
- Department of Ophthalmology, Polatlı Duatepe State Hospital, Polatlı, Ankara, Turkey
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA USA
| |
Collapse
|
30
|
Montero Hernández J, Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Cervera Taulet E. Peripapillary pachychoroid neovasculopathy: A novel entity. Eur J Ophthalmol 2020; 32:NP149-NP153. [PMID: 32842763 DOI: 10.1177/1120672120953071] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Peripapillary pachychoroid syndrome is a new variant of pachychoroid disease recently described. It is important to establish the features and pathogenic mechanisms of this novel entity and its possible association with type 1 neovascularization. The aim of this study is to report a case of peripapillary pachychoroid neovasculopathy, a novel entity of pachychoroid spectrum disease. CASE REPORT A 51-year-old woman was referred to our macula service due to macular pigmentary changes in her right eye. On examination, best corrected visual acuity was 20/20 Snellen equivalent in both eyes. Funduscopy revealed pigmentary changes in the papillonasal bundle in her right eye with mottled autofluorescence in the same area where pigmentary changes. Spectral-domain optical coherence tomography illustrated a shallow irregular pigment epithelium detachment (PED) which appears as "double layer sign" overlying pachyvessels, with hyper-flow signal beneath it and a large network of neovascularization revealed by cross-sectional optical coherence tomography angiography. Indocyanine green angiography confirmed the pachyvessels and choroidal hyper-permeability in the peripapillary region. A diagnosis of peripapillary pachychoroid neovasculopathy was made and good visual and anatomical outcomes were achieved with a treat-and-extend regimen with intravitreal aflibercept. CONCLUSION We report a novel entity within the pachychoroid spectrum disease, the peripapillary pachychoroid neovasculopathy, which could improve our understanding of the pathogenic mechanism of choroidal neovascularization in pachychoroid disorders.
Collapse
Affiliation(s)
- Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| |
Collapse
|
31
|
Khanna RK, Ferguson A, Pisella PJ, Le Lez ML. Calcium oxalate crystals retinopathy following domino liver transplant: A case report. Eur J Ophthalmol 2020; 32:NP159-NP162. [PMID: 32811178 DOI: 10.1177/1120672120950220] [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: 11/15/2022]
Abstract
INTRODUCTION Hyperoxaluria is a rare cause of hereditary crystalline retinopathy. We report the first case of acquired calcium oxalate crystalsretinopathy following domino liver transplantation (DLT). CLINICAL CASE A 72-year-old patient was referred for bilateral visual impairment 9 months after DLT. Slit lamp examination was unremarkable. Fundus examination revealed calcium oxalate crystals accumulation within both retina. Owing to multi-organ failure, the patient underwent combined liver-kidney retransplantation. During the following two years, calcium oxalate crystals accumulation within the retina gradually decreased and visual acuity improved. Nevertheless, OCT-angiography revealed abnormalities in the inner and outer retinal vascular plexus (i.e. retinal vessels occlusion and dilatation). Visual field examination revealed bilateral constriction associated with decreased optic nerve fibre layer thickness suggesting optic nerve atrophy. CONCLUSION This case highlights the need for ophthalmologists to consider the diagnosis of acquired hyperoxaluria in patients with progressive bilateral visual impairment following DLT, especially if the postoperative course is marked by renal failure. Moreover, even after liver-kidney transplantation with a conventional graft, visual function can remain impaired owing to maculopathy and optic atrophy.
Collapse
Affiliation(s)
- Raoul Kanav Khanna
- Ophthalmology Department, Centre Hospitalier Universitaire Régional de Bretonneau, Tours, France
| | - Adriana Ferguson
- Ophthalmology Department, Centre Hospitalier Universitaire Régional de Bretonneau, Tours, France
| | - Pierre-Jean Pisella
- Ophthalmology Department, Centre Hospitalier Universitaire Régional de Bretonneau, Tours, France
| | - Marie-Laure Le Lez
- Ophthalmology Department, Centre Hospitalier Universitaire Régional de Bretonneau, Tours, France
| |
Collapse
|
32
|
Insausti-García A, Reche-Sainz JA, Ruiz-Arranz C, López Vázquez Á, Ferro-Osuna M. Papillophlebitis in a COVID-19 patient: Inflammation and hypercoagulable state. Eur J Ophthalmol 2020; 32:NP168-NP172. [PMID: 32735134 PMCID: PMC7399568 DOI: 10.1177/1120672120947591] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [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] [Indexed: 01/08/2023]
Abstract
Introduction: Papillophlebitis is a rare condition characterized by venous congestion and optic disc
edema, which has been suggested to occur as a consequence of inflammation of the retinal
veins or, possibly, the capillaries of the optic disc, leading to venous insufficiency
and compression of the central retina vein. The disease affects healthy young adults and
commonly has a benign course, however, if complications such as macular edema or
ischemia appears, treatment should be instituted immediately to avoid poor
prognosis. Case report: A 40-year old white male patient consulted for a slight decrease in the sensitivity of
the visual field in his left eye (OS). Visual acuities (VA) were 20/20 in both eyes. OS
fundus examination showed dilated and tortuous retinal vessels, disc edema, and retinal
hemorrhages. The patient was diagnosed with papillophlebitis. OS VA decreased to 20/200
due to macular edema, and he was treated with a intravitreal dexamethasone implant. An
exhaustive and interdisciplinary exploration process was performed, identifying a recent
disease and recovery of Covid-19 as the only factor of inflammation and coagulation
alteration. Other systemic diseases were excluded. We also describe a rapid decrease in
disc and macular edema after intravitreal dexametasone injection, which could support
the inflammatory hypothesis. Conclusion: The importance of this case lies in the possible association of papillophlebitis with
the new Covid-19 disease. We believe that the inflammatory reaction and the coagulation
alteration present in our patient due to Sars-Cov2 coronavirus may have acted as risk
factors for the development of papillophlebitis.
Collapse
Affiliation(s)
- Alfredo Insausti-García
- Vitreous and Retina Unit, Department of Ophthalmology, University Hospital 12 de Octubre, Madrid, Spain
| | - José Alberto Reche-Sainz
- Neuro-ophthalmology Unit, Department of Ophthalmology, University Hospital 12 de Octubre, Madrid, Spain
| | - Celia Ruiz-Arranz
- Department of Ophthalmology, University Hospital 12 de Octubre, Madrid, Spain
| | - Ángel López Vázquez
- Department of Ophthalmology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Manuel Ferro-Osuna
- Department of Ophthalmology, University Hospital 12 de Octubre, Madrid, Spain
| |
Collapse
|
33
|
Lukic M, Eleftheriadou M, Hamilton RD, Rajendram R, Bucan K, Patel PJ. Four-year outcomes of aflibercept treatment for neovascular age-related macular degeneration: Results from real-life setting. Eur J Ophthalmol 2020; 31:1940-1944. [PMID: 32586117 DOI: 10.1177/1120672120938565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/09/2023]
Abstract
BACKGROUND To assess long-term structural and functional outcomes of intravitreal aflibercept (Eylea®) treatment for neovascular macular degeneration (nAMD) in a real-word setting. DESIGN AND METHODS This was a retrospective, single-centre, non-randomized interventional cohort analysis. Data from treatment-naive patients with nAMD funded for treatment with intravitreal aflibercept in the period between 1 September 2013 and 28 February 2014 and who finished 4-year follow-up entered the analysis. Epidemiological data, visual acuity (VA) measured on ETDRS charts and injection numbers were recorded. Spectral domain optical coherence tomography (SD-OCT) data including presence or absence of macular fluid and automated central subfield macular thickness (CSMT) at year 1, 2, 3 and 4 were also recorded. RESULTS Ninety-four eyes of 89 patients finished 4-year follow-up. The mean number of aflibercept injections received over 4 years was 19.3. At baseline, the mean VA (SD) (Snellen) was 54.1 ± 15.5 (20/100) ETDRS letters whilst the mean CSM (SD) was 296 ± 81 µm. At 4 years, the mean VA (SD) (Snellen) was 60.4 ± 20.0 (20/63) ETDRS letters (p < 0.0001). Mean CSMT (SD) was 218 ± 79 μm (p < 0.0001). Thirty-three percent of eyes gained ⩾15 ETDRS letters at end of 4 years, and 66 (70%) eyes had no macular fluid at the end of the follow-up. CONCLUSION AND RELEVANCE The results suggest that good long-term morphological and functional treatment outcomes can be achieved using intravitreal aflibercept for nAMD in a real-life clinical setting.
Collapse
Affiliation(s)
- Marko Lukic
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Maria Eleftheriadou
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Robin D Hamilton
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Ranjan Rajendram
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Kajo Bucan
- Ophthalmology Department, University Hospital Centre Split, Split, Croatia
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
34
|
Fernandes TF, Sousa K, Azevedo I, Gouveia P, Calvão-Santos G, Gomes N, Falcão M. Baseline visual acuity and interdigitation zone as predictors in idiopathic epiretinal membranes: A retrospective cohort study. Eur J Ophthalmol 2020; 31:1291-1298. [PMID: 32507054 DOI: 10.1177/1120672120932094] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Determine which functional and anatomical characteristics may be predictors of final visual acuity in patients with idiopathic ERM (iERM) submitted to pars plana vitrectomy (PPV) with ERM and internal and internal limiting membrane (ILM) peeling. DESIGN Retrospective cohort study. SUBJECTS Patients with iERM submitted to PPV between 2016 and 2017. METHODS Data regarding the best-corrected visual acuity (BCVA) and the characteristics of the retinal layers observed in SD-OCT were collected preoperatively and until 12 months postoperatively. Central macular thickness (CMT), disorganization of the retinal inner layers (DRIL), outer nuclear layer (ONL) thickness, integrity of subfoveal external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) were evaluated. RESULTS A total of 128 eyes with iERM from 121 patients were included. BCVA improved significantly (p < 0.001). Significant improvement of BCVA, CMT, DRIL, ONL, ELM, and EZ were obtained. The final IZ was not different from baseline until the end of the study. A significant correlation was observed between the baseline BCVA, EZ, IZ, and the postoperative BCVA (p < 0.001). However, only the baseline BCVA and the integrity of the subfoveal baseline IZ were predictive factors for final BCVA (p < 0.005 and p < 0.001, respectively). CONCLUSION PPV provides a significant improvement of BCVA and retinal anatomy recovery in iERM eyes. Baseline IZ didn't change during the 12 months following surgery. Baseline BCVA and subfoveal IZ at baseline were prognostic factors for the final BCVA.
Collapse
Affiliation(s)
| | - Keissy Sousa
- Ophthalmology Department, Hospital de Braga, Rua das Sete Fontes, Braga, Portugal.,Faculdade de Medicina Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Inês Azevedo
- Escola de Medicina da Universidade do Minho, Campus de Gualtar, Braga, Portugal
| | - Petra Gouveia
- Ophthalmology Department, Hospital de Braga, Rua das Sete Fontes, Braga, Portugal
| | - Gil Calvão-Santos
- Ophthalmology Department, Hospital de Braga, Rua das Sete Fontes, Braga, Portugal
| | - Nuno Gomes
- Ophthalmology Department, Hospital de Braga, Rua das Sete Fontes, Braga, Portugal
| | - Manuel Falcão
- Faculdade de Medicina Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.,Ophthalmology Department, Centro Hospitalar S. João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| |
Collapse
|
35
|
Lukic M, Williams G, Shalchi Z, Patel PJ, Hykin PG, Hamilton RD, Rajendram R. Intravitreal aflibercept for diabetic macular oedema in real-world: 36-month visual acuity and anatomical outcomes. Eur J Ophthalmol 2020; 31:1201-1207. [PMID: 32429690 DOI: 10.1177/1120672120925034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/22/2023]
Abstract
BACKGROUND/AIMS To assess structural and functional outcomes of treatment with intravitreal aflibercept (®Eylea) for diabetic macular oedema in treatment-naïve patients. METHODS Sixty-four eyes receiving intravitreal anti-vascular endothelial growth factor therapy were included in the data analysis of this retrospective, real-life study which follow-up was 3 years. Each patient had corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters and optical coherence tomography central foveal thickness and macular volume performed at baseline, 12, 24 and 36 months. Patients were initiated on a loading phase of five 1-monthly intravitreal aflibercept injections, followed by injections if needed as per clinicians' discretion. RESULTS The mean number of aflibercept injections received over 3 years was 12.59. At baseline, the mean visual acuity (standard deviation) (Snellen) was 61.45 (16.30) (20/63) Early Treatment Diabetic Retinopathy Study letters, the mean central foveal thickness (standard deviation) was 422 (138) µm, while the mean macular volume (standard deviation) was 9.51 (2.01) mm3. At 36 months, the mean visual acuity (standard deviation) (Snellen) was 68.34 (13.66) (20/50) Early Treatment Diabetic Retinopathy Study letters (p = .0003). Mean central foveal thickness (standard deviation) was 303 (106) µm (p < .0001) and mean macular volume (standard deviation) was 8.35 (1.62) mm3 (p = .0022) at 36 months. Sixteen (25%) eyes gained ≥15 ETDRS letters at month 36, and 33 (52%) eyes had a decrease in central foveal thickness of ≥ 100 µm at the same time. CONCLUSION There was a significant improvement in visual acuity and in anatomical outcomes in aflibercept-treated eyes at 36 months after commencing treatment for diabetic macular oedema in real-life settings. The good vision and anatomical outcomes were maintained over second and third year of treatment with mean 2.93 and 2.57 intravitreal injections, respectively.
Collapse
Affiliation(s)
- Marko Lukic
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Gwyn Williams
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Zaid Shalchi
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Philip G Hykin
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Robin D Hamilton
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Ranjan Rajendram
- NIHR Biomedical Research Centre, 4960Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
36
|
Levinger N, Beykin G, Grunin M, Almeida D, Levy J, Levine H, Averbukh E, Chowers I. Socioeconomic status and visual outcome in patients with neovascular age-related macular degeneration. Eur J Ophthalmol 2020; 31:1094-1100. [PMID: 32363931 PMCID: PMC8369906 DOI: 10.1177/1120672120920783] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Visual outcome in patients with neovascular age-related macular degeneration is variable. We aimed to evaluate for association between socioeconomic status visual acuity in neovascular age-related macular degeneration. METHODS A retrospective single-center study of a consecutive group of neovascular age-related macular degeneration patients was performed. Socioeconomic status was determined for each patient based on the 2008 Israeli census. Medical information was extracted from medical records and included visual acuity and optical coherence tomography parameters. Associations between socioeconomic status and clinical outcomes were analyzed. RESULTS A total of 233 patients were included in the analysis. A correlation was found between low baseline visual acuity of the first eye diagnosed with neovascular age-related macular degeneration and low socioeconomic status (r = -0.13, p = 0.049; n = 233). The difference between the visual acuity of the lowest and the highest socioeconomic status categories at baseline was approximately 3 ETDRS lines (p = 0.048). Socioeconomic status and baseline visual acuity of the second eye of the same individual with neovascular age-related macular degeneration were not correlated (r = -0.05, p = 0.95). Socioeconomic status was not associated with the number of anti-vascular endothelial growth factor injections of the first or second eye, or the visual acuity outcome of the first or second eye after 1 year of therapy (p = 0.421, p = 0.9, respectively). Central subfield thickness of the first eye at presentation as measured by spectral-domain optical coherence tomography was associated with socioeconomic status (r = -0.31 p = 0.001). CONCLUSION Individuals of lower socioeconomic status presented at more advanced stage of the disease when developing neovascular age-related macular degeneration in the first eye but not in the second eye. The research underscores the importance of improving referral patterns and awareness for the lowest socioeconomic status classes.
Collapse
Affiliation(s)
- Nadav Levinger
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gala Beykin
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michelle Grunin
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Diego Almeida
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Edward Averbukh
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
37
|
Donati MC, Murro V, Mucciolo DP, Giorgio D, Cinotti G, Virgili G, Rizzo S. Subthreshold yellow micropulse laser for treatment of diabetic macular edema: Comparison between fixed and variable treatment regimen. Eur J Ophthalmol 2020; 31:1254-1260. [PMID: 32290705 DOI: 10.1177/1120672120915169] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/02/2023]
Abstract
PURPOSE To compare the efficacy between fixed and variable treatment regimens of subthreshold yellow micropulse laser for the treatment of diabetic macular edema. METHODS This is a retrospective, comparative, 12-month study of 39 eyes: 24 eyes received fixed treatment regimen of subthreshold micropulse laser treatment and 15 eyes underwent variable treatment regimen of subthreshold micropulse laser, all eyes were followed up for 12 months. Subthreshold micropulse laser was performed with the following parameters: 100 μm spot size on slit lamp, 5% duty cycle of 0.2 s, and 250 mW power. To choose the power of the variable treatment regimen of subthreshold micropulse laser group, continuous laser power was titrated to a barely visible burn and then switched to MicroPulse mode, multiplying the test burn power by 4 and using a 5% duty cycle of 0.2 s. Main outcomes included changes in central macular thickness and best-corrected visual acuity. RESULTS At baseline, the mean LogMAR best-corrected visual acuity was 0.297 ± 0.431 in the variable treatment regimen of subthreshold micropulse laser group and 0.228 ± 0.341 in the fixed treatment regimen of subthreshold micropulse laser group. At the end of follow-up, the mean LogMAR best-corrected visual acuity was 0.289 ± 0.473 (p = 0.785) and 0.245 ± 0.376 (p = 0.480) in the variable and fixed treatment regimens of subthreshold micropulse laser groups, respectively. Similarly, central macular thickness decreased in both groups after treatment; at baseline, the mean central macular thickness was 371.06 ± 37.8 in the variable treatment regimen of subthreshold micropulse laser group and improved to 325.60 ± 110.0 μm (p = 0.025) at the end of the follow-ups, while it was 342.30 ± 35.4 in the fixed treatment regimen of subthreshold micropulse laser group and improved to 308.51 ± 67.5 (p = 0.037). CONCLUSION Both treatment regimens are effective for the treatment of mild center-involving diabetic macular edema: fixed treatment appears more suitable minimizing treatment time and reducing the possible errors due to wrong titration in the switch from continuous to micropulse mode.
Collapse
|
38
|
Borroni D, Erts R, Vallabh NA, Bonzano C, Sepetiene S, Krumina Z, Romano V, Parekh M, Iannetta D. Solar retinopathy: a new setting of red, green, and blue channels. Eur J Ophthalmol 2020; 31:1261-1266. [PMID: 32204617 PMCID: PMC8358560 DOI: 10.1177/1120672120914852] [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] [Indexed: 11/16/2022]
Abstract
Purpose: To introduce a new color imaging technique using improved settings of red, green, and blue channels for improved delineation of retinal damage in patients with solar retinopathy. Method: A retrospective case series of patients with poor vision secondary to solar retinopathy were analyzed. All patients underwent visual acuity, refraction, and dilated fundus examination. A spectral domain–optical coherence tomography of the macula and color fundus imaging using optimized red, green, and blue color setting was performed. Patients were reviewed over a 6-month period. The data were analyzed for statistical significance using an independent t test and a receiver operating characteristic curve. Results: In total, 20 eyes of 10 patients were included between 2009 and 2017. The mean age was 24.9 ± 18.1 years. Best corrected visual acuity at first consultation was 0.78 ± 0.11 and after 6 months was 0.83 ± 0.09. Spectral domain–optical coherence tomography demonstrated retinal abnormalities at the myoid zone, ellipsoid zone, and the outer segment of photoreceptors. Receiver operating characteristic curve analysis showed an improving effect (area under the curve = 0.62; 95% confidence interval = 0.42–0.79). The color channels parameters, which improve visualization of the lesions were found to be 67-0.98-255 for the R-guided setting, 19-0.63-121 for the B-guided setting, and 7-1.00-129 for the G-guided setting. The ideal red, green, and blue setting was in 24-0.82-229. Conclusion: The use of a new setting of red, green, and blue channels could improve the diagnosis and monitoring of solar retinopathy, hence improving patient care.
Collapse
Affiliation(s)
- Davide Borroni
- Department of Ophthalmology, Riga Stradins University, Riga, Latvia.,Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.,International Center for Ocular Physiopathology (ICOP), The Veneto Eye Bank Foundation, Venice, Italy.,St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Renars Erts
- Department of Ophthalmology, Riga Stradins University, Riga, Latvia
| | - Neeru A Vallabh
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.,St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Chiara Bonzano
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DiNOGMI), University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | | | - Zita Krumina
- Department of Biology and Microbiology, Riga Stradins University, Riga, Latvia
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK.,St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Mohit Parekh
- International Center for Ocular Physiopathology (ICOP), The Veneto Eye Bank Foundation, Venice, Italy.,Institute of Ophthalmology, University College London, London, UK
| | - Danilo Iannetta
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| |
Collapse
|
39
|
Pierro L, Battista M, Arrigo A, Manitto MP, Bandello F. Multimodal imaging in pediatric arterial macroaneurysm: A case report. Eur J Ophthalmol 2020; 31:NP58-NP62. [PMID: 31910654 DOI: 10.1177/1120672119899033] [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: 11/15/2022]
Abstract
Our aim is to report a case of asymptomatic retinal arterial macroaneurysm in a 9-year-old female patient. She was referred to our Ophthalmology clinic for a routine ophthalmologic examination and, after the detection of a juxtafoveal saccular vascular enlargement in indirect ophthalmoscopy, underwent a multimodal imaging assessment. Optical coherence tomography-angiography and fluorescein angiography were important to determine the nature of the lesion, identified as a congenital retinal arterial macroaneurysm. Retinal vascular abnormalities represent a rare finding in pediatric patients and must be carefully explored to establish the correct diagnosis. A multimodal imaging approach was very useful to thoroughly reach this target. Vascular abnormalities represent a rare finding in pediatric patients and must be carefully explored to establish the correct diagnosis. A multimodal imaging approach is very useful to study in deep the reported arterial macroaneurysm in a non-invasive way.
Collapse
Affiliation(s)
- Luisa Pierro
- Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | |
Collapse
|
40
|
Caporossi T, De Angelis L, Pacini B, Rizzo S. Amniotic membrane for retinal detachment due to paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia. Eur J Ophthalmol 2019; 30:392-395. [PMID: 31766876 DOI: 10.1177/1120672119891415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/16/2022]
Abstract
PURPOSE To describe a new surgical technique, using a human amniotic membrane patch, in two cases of retinal detachment with paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia, already underwent pars plana vitrectomy with the internal limiting membrane peeling for myopic foveoschisis. METHODS Surgical technique description with surgical video. A 23-gauge pars plana vitrectomy was performed. A human amniotic membrane patch was implanted under the neuroretina to seal the posterior retinal break. Standard silicone oil tamponade was performed at the end of the surgery. The patients were positioned face down after the operation for the first week. Optical coherence tomography scans were used in the follow-ups. RESULTS The 2 weeks postoperative optical coherence tomography showed a new tissue growth over the human amniotic membrane patch. The 3 months optical coherence tomography showed the new tissue entirely covering the human amniotic membrane plug. Visual acuity improved from 20/2000 (2 LogMAR) to 20/250 (1.1 LogMAR) 3 months after the operation in both patients. The silicone oil was extracted 2 months after surgery, and no recurrences were observed. The patient's visual acuity remained stable at 20/250 after the silicone oil extraction. CONCLUSION In these complex cases, human amniotic membrane transplantation can be a valid option, when internal limiting membrane has already been peeled in previous surgeries, to seal the posterior retinal breaks over high myopic chorioretinal atrophy, with encouraging results.
Collapse
Affiliation(s)
- Tomaso Caporossi
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo De Angelis
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Bianca Pacini
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Stanislao Rizzo
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| |
Collapse
|