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Rowe LW, Belamkar A, Antman G, Hajrasouliha AR, Harris A. Vascular imaging findings in retinopathy of prematurity. Acta Ophthalmol 2024; 102:e452-e472. [PMID: 37874229 PMCID: PMC11039572 DOI: 10.1111/aos.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Retinopathy of prematurity (ROP) is a vascular disease among preterm infants involving incomplete or abnormal retinal vascularization and is a leading cause of preventable blindness globally. Measurements of ocular blood flow originating from a variety of imaging modalities, including colour Doppler imaging (CDI), fluorescein angiography (FA) and ocular coherence tomography angiography (OCTA), have been associated with changes in ROP patients. Herein, we discuss and summarize the relevant current literature on vascular imaging and ROP reviewed through December 2022. Differences in vascular imaging parameters between ROP patients and healthy controls are reviewed and summarized. The available data identify significantly increased peak systolic velocity (PSV) in the central retinal artery and ophthalmic artery as measured by CDI, increased vascular tortuosity as measured by FA, smaller foveal avascular zone (FAZ) as measured by FA and OCTA, and increased foveal vessel density (VD) and reduced parafoveal VD as measured by OCTA in ROP patients compared with controls. None of the above findings appear to reliably correlate with visual acuity. The studies currently available, however, are inconclusive and lack robust longitudinal data. Vascular imaging demonstrates the potential to aid in the diagnosis, management and monitoring of ROP, alongside retinal examination via indirect ophthalmoscopy and fundus photography.
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Affiliation(s)
- Lucas W. Rowe
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aditya Belamkar
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gal Antman
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir R. Hajrasouliha
- Department of Ophthalmology, Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Yuan Y, Dong M, Wen S, Yuan X, Zhou L. Retinal microcirculation: A window into systemic circulation and metabolic disease. Exp Eye Res 2024; 242:109885. [PMID: 38574944 DOI: 10.1016/j.exer.2024.109885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024]
Abstract
The retinal microcirculation system constitutes a unique terminal vessel bed of the systemic circulation, and its perfusion status is directly associated with the neural function of the retina. This vascular network, essential for nourishing various layers of the retina, comprises two primary microcirculation systems: the retinal microcirculation and the choroidal microcirculation, with each system supplying blood to distinct retinal layers and maintaining the associated neural function. The blood flow of those capillaries is regulated via different mechanisms. However, a range of internal and external factors can disrupt the normal architecture and blood flow within the retinal microcirculation, leading to several retinal pathologies, including diabetic retinopathy, macular edema, and vascular occlusions. Metabolic disturbances such as hyperglycemia, hypertension, and dyslipidemia are known to modify retinal microcirculation through various pathways. These alterations are observable in chronic metabolic conditions like diabetes, coronary artery disease, and cerebral microvascular disease due to advances in non-invasive or minimally invasive retinal imaging techniques. Thus, examination of the retinal microcirculation can provide insights into the progression of numerous chronic metabolic disorders. This review discusses the anatomy, physiology and pathophysiology of the retinal microvascular system, with a particular emphasis on the connections between retinal microcirculation and systemic circulation in both healthy states and in the context of prevalent chronic metabolic diseases.
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Affiliation(s)
- Yue Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China.
| | - Meiyuan Dong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China; Graduate School of Hebei Medical University, Shijiazhuang, China.
| | - Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China.
| | - Xinlu Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China.
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China; Graduate School of Hebei Medical University, Shijiazhuang, China; Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Shanghai, China.
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Sun G, Wang X, Yi Z, Su Y, He L, Zheng H, Chen C. RELATIONSHIP BETWEEN RETINAL HEMORRHAGE ON GREEN AND RED CHANNELS OF ULTRA-WIDEFIELD FUNDUS IMAGES AND RETINAL PERFUSION IN ACUTE BRANCH RETINAL VEIN OCCLUSION. Retina 2024; 44:887-894. [PMID: 38165995 DOI: 10.1097/iae.0000000000004030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
PURPOSE To explore the relationship between retinal hemorrhage in the green and red channels on ultra-widefield fundus images and the nonperfusion area (NPA) on ultra-widefield fundus fluorescein angiography in patients with acute branch retinal vein occlusion (BRVO). METHODS This was a retrospective cross-sectional study with 96 patients, including 46 with ischemic BRVO and 50 with nonischemic BRVO. Correlation analysis between green channel hemorrhage (GCH), red channel hemorrhage (RCH), and NPA was performed. Panretina was divided into posterior and peripheral areas. RESULTS Ischemic BRVO showed significantly higher GCH% and RCH% than nonischemic BRVO in the peripheral regions (both P < 0.001), whereas no significant differences were observed in the panretinal and posterior areas (all P > 0.05). Significant correlations were found between NPA% in the panretinal and peripheral areas and the corresponding GCH% and RCH% (all P < 0.01). However, no significant correlation was observed between posterior NPA% and posterior GCH% or RCH% (both P > 0.05). In addition, peripheral GCH% and RCH% were related to panretinal NPA% (r = 0.506, P < 0.001; r = 0.558, P < 0.001). CONCLUSION Retinal hemorrhage on ultra-widefield fundus image was significantly associated with NPA, providing insights for assessing retinal perfusion status in acute BRVO patients.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Yu Su
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Lu He
- Physical Examination Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China ; and
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Lin PW, Chiu LW. Evaluation of Optic Nerve Head Microcirculation in Open-Angle Glaucoma Patients with Unilateral Visual Field Defect. Ophthalmic Res 2024; 67:257-265. [PMID: 38508153 DOI: 10.1159/000538407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Microcirculation of optic nerve head (ONH) in open-angle glaucoma (OAG) patients with unilateral visual field (VF) loss has yet to be fully investigated, especially the perimetrically unaffected fellow eyes. METHODS Thirty-eight OAG patients with VF defect in one eye and normal VF in the other eye, and thirty-one healthy participants were analyzed. All participants underwent laser speckle flowgraphy (LSFG), spectral-domain optical coherence tomography (SD-OCT) imaging, and VF test for further analyses. LSFG measurements included mean blur rate in all area of ONH (MA), big vessel area of ONH (MV), and tissue area of ONH (MT). SD-OCT parameters included circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macula thicknesses. The difference of LSFG and SD-OCT indices between glaucoma patients and healthy controls were compared. The diagnostic accuracy was analyzed with the areas under the receiver operating characteristic curves (AROCs). RESULTS Global cpRNFL thickness and macular thickness in unaffected eyes of OAG patients were higher than their fellow eyes and lower than healthy eyes. MA and MV in healthy eyes and unaffected eyes were significantly higher than in affected eyes. MT in unaffected eyes of OAG patients was higher than in their fellow affected eyes but lower than in healthy eyes. The AROCs were highest for cpRNFL (0.925), followed by macular thickness (0.838), and MT (0.834). CONCLUSIONS ONH microcirculation in perimetrically unaffected fellow eyes was decreased in OAG patients with unilateral VF loss. LSFG can detect changes of ONH in high-risk eyes before detectable VF damage, which may reflect the vascular pathophysiology for glaucoma.
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Affiliation(s)
- Pei-Wen Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Wen Chiu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Bisen JB, Heisel CJ, Duffy BV, Decker NL, Fukuyama H, Boughanem GO, Fawzi AA, Lavine JA. Association between macrophage-like cell density and ischemia metrics in diabetic eyes. Exp Eye Res 2023; 237:109703. [PMID: 38652673 PMCID: PMC11040107 DOI: 10.1016/j.exer.2023.109703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 04/25/2024]
Abstract
We previously showed that macrophage-like cells (MLCs) are increased in eyes with advanced diabetic retinopathy (DR). Here, we hypothesized that MLC density was correlated with ischemia using optical coherence tomography angiography (OCTA) and ultra-widefield fluorescein angiography (UWF-FA). Treatment-naïve diabetic eyes were prospectively imaged with repeated OCTA (average 5.3 scans per eye) and UWF-FA imaging. OCTA images were registered and averaged to generate a superficial capillary plexus (SCP), deep capillary plexus (DCP), and MLC slab. We calculated geometric perfusion deficit (GPD), vessel length density, and vessel density for the SCP and DCP. MLC density was quantified by two masked graders and averaged. Ischemia on UWF-FA was measured to generate a non-perfusion area (NPA) and index (NPI). Since MLC density was non-parametrically distributed, MLC density was correlated with ischemia metrics using Spearman correlations. Forty-five treatment-naïve eyes of 45 patients (59 ± 12 years of age; 56% female) were imaged. We included 6 eyes with no DR, 7 eyes with mild non-proliferative DR (NPDR), 22 moderate NPDR, 4 severe NPDR, and 6 PDR eyes. MLC density between graders was highly correlated (r = 0.9592, p < 0.0001). MLC density was correlated with DCP GPD (r = 0.296, p = 0.049), but no other OCTA ischemia metrics. MLC density was also correlated with UWF-FA NPA (r = 0.330, p = 0.035) and NPI (r = 0.332, p = 0.034). MLC density was correlated with total ischemia on UWF-FA and local DCP GPD. Since both UWF-FA and DCP non-perfusion are associated with higher risk for DR progression, MLC density could be another potential biomarker for DR progression.
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Affiliation(s)
- Jay B Bisen
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Curtis J Heisel
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Brandon V Duffy
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Nicole L Decker
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Hisashi Fukuyama
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ghazi O Boughanem
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jeremy A Lavine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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Vautier A, Lebreton AL, Codron P, Awada Z, Gohier P, Cassereau J. Retinal vessels as a window on amyotrophic lateral sclerosis pathophysiology: A systematic review. Rev Neurol (Paris) 2023; 179:548-562. [PMID: 36842953 DOI: 10.1016/j.neurol.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 02/28/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare fatal motor neuron disease. Although many potential mechanisms have been proposed, the pathophysiology of the disease remains unknown. Currently available treatments can only delay the progression of the disease and prolong life expectancy by a few months. There is still no definitive cure for ALS, and the development of new treatments is limited by a lack of understanding of the underlying biological processes that trigger and promote neurodegeneration. Several scientific results suggest a neurovascular impairment in ALS providing perspectives for the development of new biomarkers and treatments. In this article, we performed a systematic review using PRISMA guidelines including PubMed, EmBase, GoogleScholar, and Web of Science Core Collection to analyze the scientific literature published between 2000 and 2021 discussing the neurocardiovascular involvement and ophthalmologic abnormalities in ALS. In total, 122 articles were included to establish this systematic review. Indeed, microvascular pathology seems to be involved in ALS, affecting all the neurovascular unit components. Retinal changes have also been recently highlighted without significant alteration of the visual pathways. Despite the peripheral location of the retina, it is considered as an extension of the central nervous system (CNS) as it displays similarities to the brain, the inner blood-retinal barrier, and the blood-brain barrier. This suggests that the eye could be considered as a 'window' into the brain in many CNS disorders. Thus, studying ocular manifestations of brain pathologies seems very promising in understanding neurodegenerative disorders, mainly ALS. Optical coherence tomography angiography (OCT-A) could therefore be a powerful approach for exploration of retinal microvascularization allowing to obtain new diagnostic and prognostic biomarkers of ALS.
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Affiliation(s)
- A Vautier
- Department of Ophthalmology, University Hospital, Angers, France.
| | - A L Lebreton
- Department of Ophthalmology, University Hospital, Angers, France
| | - P Codron
- Amyotrophic Lateral Sclerosis (ALS) Center, Department of Neurology, University Hospital, Angers, France; Department of Neurobiology and Neuropathology, University Hospital, Angers, France; University of Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France
| | - Z Awada
- Department of neuroscience, LHH-SIUH, New York, USA
| | - P Gohier
- Department of Ophthalmology, University Hospital, Angers, France
| | - J Cassereau
- Amyotrophic Lateral Sclerosis (ALS) Center, Department of Neurology, University Hospital, Angers, France; University of Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France.
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Bradley C, Berry C. Retinal microvascular function: a tractable biomarker of cardiovascular risk? Cardiovasc Res 2022; 118:3169-3170. [PMID: 36310539 DOI: 10.1093/cvr/cvac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Conor Bradley
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom
- NHS Golden Jubilee, Agamemnon Street, Clydebank, G81 4DY, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom
- NHS Golden Jubilee, Agamemnon Street, Clydebank, G81 4DY, United Kingdom
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Tan Q, Zhu M, Du F, Jiang X, Huang X, Chen J, Peng H, Wang D. Changes in Retinal Vessel Flow after Small Incision Lenticule Extraction. Comput Math Methods Med 2022; 2022:8437066. [PMID: 35309847 PMCID: PMC8926514 DOI: 10.1155/2022/8437066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/18/2022]
Abstract
Objective In order to analyze changes in retinal vessel flow after small incision lenticule extraction (SMILE). Methods A total of 32 patients (62 eyes) who underwent SMILE were enrolled in this prospective study. Optical parameters, including vessel density (VD), and perfusion density (PD) of foveal, parafoveal, and perifoveal regions, respectively, were measured before surgery and at 1 day, 1 week, 1 month, and 3 months postoperation. Preoperative parameters and surgical parameters were recorded. Results Significant decreases in VD and PD on postoperative day 1 were detected in all quadrants, both in 3 mm and in 6 mm regions (P < 0.001). One month after surgery, VD returned to preoperative levels. None of the preoperative and surgical parameters were significantly correlated with the VD and PD fluctuations (all P > 0.05). Conclusion. VD may decrease significantly with regional disparity 1 day after SMILE while recovering at 1 month. Elevation of intraocular pressure due to suction may account for such changes.
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Affiliation(s)
- Qian Tan
- Department of Ophthalmology, Shenzhen People's Hospital, Shenzhen 518000, China
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Minyi Zhu
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Fangfang Du
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Xianming Jiang
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Xiaoshan Huang
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Jingfang Chen
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Hongjun Peng
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Danyang Wang
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
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Zhang SJ, Wang LF, Xiao Z, Liu ZQ, Xing C, Li Q, Sun HJ, Yang ZZ, Lyu LN, Peng XY. Analysis of Radial Peripapillary Capillary Density in Patients with Bietti Crystalline Dystrophy by Optical Coherence Tomography Angiography. Biomed Environ Sci 2022; 35:107-114. [PMID: 35197175 DOI: 10.3967/bes2022.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We wanted to investigate the radial peripapillary capillary (RPC) network in patients with Bietti crystalline dystrophy (BCD). METHODS We compared RPC densities in the disk and different peripapillary regions, obtained using optical coherence tomography angiography in 22 patients with BCD (37 eyes) and 22 healthy subjects (37 eyes). The BCD group was then divided into Stage 2 and Stage 3 subgroups based on Yuzawa staging, comparing the RPC densities of the two. RESULTS The disk area RPC density was 38.8% ± 6.3% in the BCD group and 49.2% ± 6.1% in the control group ( P < 0.001), and peripapillary region RPC density was significantly lower in the BCD group than in the control group (49.1% ± 4.7% and 54.1% ± 3.0%, respectively, P < 0.001). There were no significant RPC density differences between the tempo quadrant and inside disk of Stages 2 and 3 subgroups; the other areas showed a significantly lower RPC density in Stage 3 than in Stage 2 BCD. CONCLUSION The BCD group RPC density was significantly lower than the control group. The reduction of RPC density in the tempo quadrant occurred mainly in the Stage 1 BCD. In contrast, the reduction of RPC density in superior, inferior, and nasal quadrants occurred mainly in Stage 2.
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Affiliation(s)
- Sheng Juan Zhang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology, and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China;Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Li Fei Wang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Zhe Xiao
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Zhi Qiang Liu
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Chen Xing
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Qian Li
- Beijing Institute of Ophthalmology, Beijing Ophthalmology, and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Hui Jing Sun
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Zan Zhang Yang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Li Na Lyu
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Xiao Yan Peng
- Beijing Institute of Ophthalmology, Beijing Ophthalmology, and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
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Levine ES, Moult EM, Greig EC, Zhao Y, Pramil V, Gendelman I, Alibhai AY, Baumal CR, Witkin AJ, Duker JS, Fujimoto JG, Waheed NK. MULTISCALE CORRELATION OF MICROVASCULAR CHANGES ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH RETINAL SENSITIVITY IN DIABETIC RETINOPATHY. Retina 2022; 42:357-368. [PMID: 34510129 PMCID: PMC8892687 DOI: 10.1097/iae.0000000000003299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess global, zonal, and local correlations between vessel density changes measured by optical coherence tomography angiography and retinal sensitivity measured by microperimetry across diabetic retinopathy severity. METHODS Diabetic patients and nondiabetic controls underwent optical coherence tomography angiography imaging and microperimetry testing. Pearson's correlation was used to assess associations between average sensitivity and skeletonized vessel density (SVD) or foveal avascular zone area centrally. Linear mixed effects modeling was used to assess relationships between local SVD measurements and their spatially corresponding retinal sensitivity measurements. RESULTS Thirty-nine eyes from 39 participants were imaged. In all slabs, there was a statistically significant positive correlation between retinal sensitivities and SVDs on both global and zonal scales. No statistically significant correlation was found between central retinal sensitivities and the foveal avascular zone areas. Assessment of 1,136 spatially paired retinal sensitivity and SVD measurements revealed a statistically significant local relationship; this seemed to be driven by eyes with proliferative diabetic retinopathy that had reduced retinal sensitivities. CONCLUSION This study supports positive correlations between SVD and retinal sensitivity at global and zonal spatial scales in diabetic eyes. However, our analysis did not find evidence of statistically significant correlations between retinal sensitivity and SVD on a local scale until advanced diabetic retinopathy.
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Affiliation(s)
- Emily S. Levine
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Eric M. Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Yi Zhao
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Varsha Pramil
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - A. Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Caroline R. Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Andre J. Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
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He J, Rui Z, Gao J, Chen Y, Li Y, Xu T, Wang S. Expression of Long Non-Coding RNA (lncRNA) SNHG5 in Patients with Refractory Diabetic Macular Edema and Its Regulatory Mechanism. Med Sci Monit 2022; 28:e932996. [PMID: 35001073 PMCID: PMC8762959 DOI: 10.12659/msm.932996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess use of lncRNAs as biomarkers in serum and aqueous humor of patients with diabetic macular edema (DME). MATERIAL AND METHODS Optical coherence tomography and fundus photography were used to analyze the retinal features of the patients. RT-qPCR was used to analyze the differential expression of lncRNA snhg5 in patients who have idiopathic macular hole (MH), DME, or refractory DME. The relationship between SNHG5 and the clinical characteristics of the patients was analyzed. The effect of SNHG5 on the hyperplasia and apoptosis of human retino-microvascular endothelial cells (HRMECs) and its mechanism were analyzed in vitro. RESULTS Patients with idiopathic MH developed retinal nerve epithelium rupture and retinal fundus thickening, and patients with DME or refractory DME showed significant macular edema with hemorrhaging. The refractory DME patients improved after treatment but still showed significant macular edema and multiple laser scarring. SNHG5 expression was not only low in the atrial fluid and plasma in DME patients, but also lower in the refractory DME group compared to the idiopathic MH patients. SNHG5 expression in the aqueous humor and plasma was negatively correlated with disease duration, body mass index, and levels of fasting blood glucose, glycated hemoglobin, proteinuria, and glycosuria. In the in vitro experiments, SNHG5 expression was significantly downregulated in high glucose-induced HMECs. After SNHG5 overexpression, cell proliferation, angiogenesis, and VEGF-A protein levels were distinctly downregulated. CONCLUSIONS SNHG5 correlates with the development of DME and is a potential target for therapy.
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Affiliation(s)
- Junwen He
- Department of Retinal and Vitreous Diseases, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Zhang Rui
- Department of Retinal and Vitreous Diseases, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Jing Gao
- Department of Ophthalmic Imaging, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Yanhong Chen
- Department of Ophthalmic Imaging, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Yanzi Li
- Department of Retinal and Vitreous Diseases, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Tao Xu
- Department of Retinal and Vitreous Diseases, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Shan Wang
- Department of Ophthalmic Imaging, Aier Eye Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
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12
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Li H, Deng Y, Sampani K, Cai S, Li Z, Sun JK, Karniadakis GE. Computational investigation of blood cell transport in retinal microaneurysms. PLoS Comput Biol 2022; 18:e1009728. [PMID: 34986147 PMCID: PMC8730408 DOI: 10.1371/journal.pcbi.1009728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
Microaneurysms (MAs) are one of the earliest clinically visible signs of diabetic retinopathy (DR). MA leakage or rupture may precipitate local pathology in the surrounding neural retina that impacts visual function. Thrombosis in MAs may affect their turnover time, an indicator associated with visual and anatomic outcomes in the diabetic eyes. In this work, we perform computational modeling of blood flow in microchannels containing various MAs to investigate the pathologies of MAs in DR. The particle-based model employed in this study can explicitly represent red blood cells (RBCs) and platelets as well as their interaction in the blood flow, a process that is very difficult to observe in vivo. Our simulations illustrate that while the main blood flow from the parent vessels can perfuse the entire lumen of MAs with small body-to-neck ratio (BNR), it can only perfuse part of the lumen in MAs with large BNR, particularly at a low hematocrit level, leading to possible hypoxic conditions inside MAs. We also quantify the impacts of the size of MAs, blood flow velocity, hematocrit and RBC stiffness and adhesion on the likelihood of platelets entering MAs as well as their residence time inside, two factors that are thought to be associated with thrombus formation in MAs. Our results show that enlarged MA size, increased blood velocity and hematocrit in the parent vessel of MAs as well as the RBC-RBC adhesion promote the migration of platelets into MAs and also prolong their residence time, thereby increasing the propensity of thrombosis within MAs. Overall, our work suggests that computational simulations using particle-based models can help to understand the microvascular pathology pertaining to MAs in DR and provide insights to stimulate and steer new experimental and computational studies in this area.
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Affiliation(s)
- He Li
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
| | - Yixiang Deng
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shengze Cai
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, United States of America
| | - Zhen Li
- Department of Mechanical Engineering, Clemson University, Clemson, South Carolina, United States of America
| | - Jennifer K. Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - George E. Karniadakis
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, United States of America
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Naidorf-Rosenblatt H, Landau-Part D, Moisseiev J, Alhalel A, Huna-Baron R, Skaat A, Pilus S, Levi L, Leshno A. OCULAR SURFACE TEMPERATURE DIFFERENCES IN RETINAL VASCULAR DISEASES. Retina 2022; 42:152-158. [PMID: 34369439 DOI: 10.1097/iae.0000000000003278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To define the effect of age-related macular degeneration (AMD) and diabetic retinopathy (DR) on the ocular thermographic profile. METHODS This retrospective cross-sectional study included subjects diagnosed with DR or AMD between January and April 2019. Individuals without ocular disease served as controls. A thermal imaging camera was used for ocular surface temperature (OST) acquisition. The mean temperatures of the medial cantus, lateral cantus, and cornea were calculated. RESULTS Thermographic images were obtained from 133 subjects (260 eyes, 97 DR and 163 AMD) and 48 controls (55 eyes). Ocular surface temperature was higher among patients with AMD and lowest among patients with DR (P < 0.001). A subgroup analysis revealed that eyes with diabetic macular edema had significantly higher OSTs than DR eyes without diabetic macular edema. Moreover, the OST in eyes with diabetic macular edema was similar to the measurements of the AMD group. There were no differences in OSTs between neovascular and nonneovascular AMD eyes. CONCLUSION Although AMD and DR are considered posterior segment conditions, their effect on OST implies that the entire globe is involved. Although both conditions result from similar multifactorial pathophysiologic changes, the differences in OST between DR and AMD might be due to dissimilarity in the balance of pathologic processes involved in each condition. Further research is required to better understand the pathophysiology of these diseases and their effect on OST as well as to determine the effect of vasculature, circulation, and tissue metabolism on ocular temperature.
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Affiliation(s)
- Hadar Naidorf-Rosenblatt
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Daphna Landau-Part
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
- The Sheba Talpiot Medical Leadership Program
| | - Joseph Moisseiev
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Amir Alhalel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Ruth Huna-Baron
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Alon Skaat
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Sima Pilus
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Lior Levi
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
| | - Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; and
- The Sheba Talpiot Medical Leadership Program
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14
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Yang JY, Wang Q, Chen MX, Yan YN, Zhou WJ, Liu YM, Wei WB. RETINAL MICROVASCULAR CHANGES IN UVEAL MELANOMA FOLLOWING CONBERCEPT INJECTION AFTER PLAQUE RADIOTHERAPY AS DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2021; 41:2605-2611. [PMID: 34155168 DOI: 10.1097/iae.0000000000003236] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate macular microvascular characteristics imaged by optical coherence tomography angiography in patients with uveal melanoma following conbercept injections after plaque radiotherapy. METHODS Prospective comparative analysis comprising 15 patients with uveal melanoma with conbercept injections and 30 patients without conbercept injections after plaque radiotherapy by optical coherence tomography angiography. The conbercept group received intravitreal conbercept injections at the time of plaque removal, 1 month, 3 months, 6 months , 9 months and 12 months after plaque removal (total, 6 injections). The control group had no intravitreal conbercept injection. RESULTS After initiation of conbercept injections, superficial retinal vascular density in the whole image and parafoveal region were significantly higher at 6 months, whereas there was no significant difference at 9 months and 12 months. In analysis of variance analysis, superficial retinal vascular density in the whole image remained stable after conbercept injections (P = 0.069), whereas the superficial retinal vascular density decreased significantly after plaque radiotherapy in the control group (P = 0.011). In multivariable linear regression, a higher superficial retinal vascular density in the whole image region at 6 months was significantly associated with intravitreal conbercept injection (P = 0.018), wider tumor base (P = 0.026), and thinner tumor thickness (P = 0.04). CONCLUSION Optical coherence tomography angiography can provide a quantitative evaluation of early retinal microvascular changes after radiotherapy. Intravitreal conbercept treatment could partly relieve the retinal vascular damage in response to radiation therapy at early stage in patients with uveal melanoma; however, it may not be able to provide long-term positive functional outcomes.
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Affiliation(s)
- Jing Yan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, and Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
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15
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Abstract
PURPOSE To compare changes of chorioretinal blood perfusion between Bietti crystalline dystrophy (BCD) and typical retinitis pigmentosa and perform a staging and a longitudinal analysis of chorioretinal perfusion in BCD. METHODS Twenty-eight patients with BCD (56 eyes), 28 patients with typical retinitis pigmentosa (56 eyes), and 28 healthy subjects (56 eyes) were enrolled. Macular structural parameters and subfoveal choroidal thickness were measured using optical coherence tomography. Retinal vessel and perfusion densities were calculated using optical coherence tomography angiography. Choroidal blood perfusion was assessed through indocyanine green angiography. The results of the BCD group were compared with those of the retinitis pigmentosa and control groups and followed by a staging and a longitudinal analysis of BCD. RESULTS Macular structural and perfusion parameters were decreased less in the BCD group than those in the retinitis pigmentosa group. Subfoveal choroidal thickness was significantly thinner in the BCD group, with a remarkable choroidal perfusion deficit using indocyanine green angiography. The staging analysis revealed damage of both retinal and choroidal perfusion in BCD; however, the longitudinal analysis showed the impairment of choroidal perfusion outweighed retinal. CONCLUSION Both retinal and choroidal blood perfusion are impaired in BCD, but choroidal perfusion deficit caused by CYP4V2 mutations may play a more vital pathologic role.
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Affiliation(s)
- Yufei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Zuoxin Qin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Nan Wu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Tongtao Zhao
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Peng Gu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Bangqi Ren
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Lin Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xiaohong Meng
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Yong Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
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Reich M, Dreesbach M, Boehringer D, Schottenhamml J, Gehring E, Scholl HPN, Inglin N, Agostini H, Reinhard T, Lagrèze WA, Spaide RF, Lange C, Maloca PM. NEGATIVE VESSEL REMODELING IN STARGARDT DISEASE QUANTIFIED WITH VOLUME-RENDERED OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2021; 41:1948-1957. [PMID: 33438899 DOI: 10.1097/iae.0000000000003110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To quantify retinal vasculature changes in Stargardt disease1 (STGD1) with volume-rendered optical coherence tomography angiography. METHODS Optical coherence tomography angiography volumes from healthy subjects and two subgroups of patients with STGD1 with the presence/absence of definitely decreased autofluorescence areas were compared. Optical coherence tomography angiography vessel surface area and vessel volume were measured in central zones (Z) of 1-, 2-, and 3-mm diameter. RESULTS Twenty nine eyes of 15 patients with STGD1 (20/9 eyes with/without definitely decreased autofluorescence) and 30 eyes of 15 controls contributed data. An enlarged foveal avascular zone was found in patients with STGD1 without and even more with definitely decreased autofluorescence associated with a vessel rarefication in central and also paracentral zones with unnoticeable autofluorescence. Vessel surface area and vessel volume were reduced in both STGD1 subgroups for all zones (P < 0.0001). Stargardt disease 1 eyes when compared to without definitely decreased autofluorescence showed reduced vessel surface area and vessel volume in Z2+3 (both P < 0.05). CONCLUSION Volume rendering of optical coherence tomography angiography in STGD1 shows a reduced retinal flow in the central macula. This is most likely secondary to loss of neurosensory tissue with disease progression and therefore not likely be favorably influenced by gene transfer and retinal pigment epithelial transplantation. Retinal blood flow assessed by 3D volume-rendered optical coherence tomography angiography could serve as surrogate marker for vascular changes of the central retina.
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Affiliation(s)
- Michael Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michelle Dreesbach
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniel Boehringer
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Esteban Gehring
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Hansjuergen Agostini
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants, New York City, New York; and
| | - Clemens Lange
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Le HM, Souied EH, Querques G, Colantuono D, Borrelli E, Sacconi R, Amoroso F, Capuano V, Jung C, Miere A. CHORIOCAPILLARIS FLOW IMPAIRMENT IN TYPE 3 MACULAR NEOVASCULARIZATION: A Quantitative Analysis Using Swept-Source Optical Coherence Tomography Angiography. Retina 2021; 41:1819-1827. [PMID: 33464024 DOI: 10.1097/iae.0000000000003119] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To quantitatively analyze choriocapillaris alterations using swept-source optical coherence tomography angiography in eyes presenting with Type 3 macular neovascularization (MNV) and to compare these alterations with eyes presenting with intermediate AMD (iAMD). METHODS Macular 3 × 3-mm swept-source optical coherence tomography angiography scans were retrospectively analyzed in eyes with Type 3 MNV and in eyes with iAMD. The choriocapillaris en face slabs were extracted from the swept-source optical coherence tomography angiography device after manual segmentation. En face choriocapillaris flow images were compensated with en face choriocapillaris structure images, followed by the Phansalkar local thresholding method using a window radius of 4 and 8 pixels. The percentage of flow deficits (FD%), the number, size, and total area of FDs were computed for comparison. A secondary analysis was performed in the four corners of the image to include equidistant regions in all eyes. RESULTS Twenty-six Type 3 MNV eyes of 21 patients and 26 iAMD eyes of 17 patients were included. Compared with iAMD eyes, eyes with Type 3 MNV displayed a higher FD% (41.37% ± 14.74 vs. 19.80% ± 9.63 using radius 4 pixels [P < 0.001]; 45.24% ± 11.9 vs. 26.63% ± 8.96 using radius 8 pixels [P < 0.001]). The average size of FDs was significantly larger in Type 3 MNV eyes compared with iAMD eyes (P < 0.001), whereas the number of FDs was significantly lower in Type 3 MNV compared with iAMD eyes (P < 0.001). CONCLUSION Type 3 MNV eyes present with increased choriocapillaris flow impairment compared with iAMD eyes. Reduced choriocapillaris perfusion may contribute to Type 3 MNV development and pathogenesis.
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Affiliation(s)
- Hoang Mai Le
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
- Sorbonne University, Faculty of Medicine, Paris, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
- Clinical Research Center, GRC Macula, and Biological Ressources Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Giuseppe Querques
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy ; and
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
| | - Enrico Borrelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy ; and
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy ; and
| | - Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
| | - Camille Jung
- Clinical Research Center, GRC Macula, and Biological Ressources Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, France
- Laboratory of Images, Signals and Intelligent Systems (LISSI, EA No. 3956), University Paris-Est Créteil, France
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18
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Haensli C, Sugiura Y, Freund KB, Zweifel SA. CORRELATION OF OUTER RETINAL TUBULATIONS AND CHORIOCAPILLARIS FLOW SIGNAL DEFICITS SURROUNDING GEOGRAPHIC ATROPHY. Retina 2021; 41:1940-1947. [PMID: 33625113 DOI: 10.1097/iae.0000000000003135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate and compare paralesional and perilesional choriocapillaris vascular impairment in eyes with geographic atrophy with and without outer retinal tubulations (ORT). METHODS Using swept-source optical coherence tomography angiography, 6 × 6 mm scans of eyes with geographic atrophy with and without ORT were acquired. Choriocapillaris en-face flow and structural images were binarized, before flow signal deficit (FD) analysis in the paraatrophy zone (a 500-µm-wide band adjacent to the geographic atrophy) and the periatrophy zone (a 500-µm-wide band adjacent to the latter). RESULTS Twenty-four eyes of 19 patients with ORT and 18 eyes of 15 patients without ORT were analyzed. With and without ORT, mean percental area of FD (%FD) was greater in para- than in periatrophy zone. The difference of %FD between para- and periatrophy zone (deltaFD) was lower in eyes with ORT (mean 1.8477%, 95% confidence interval 0.8607-2.8346) than without ORT (mean 4.0018%, 95% confidence interval 2.8622-5.1414). CONCLUSION In eyes with geographic atrophy caused by non-neovascular age-related macular degeneration, smaller reductions in FDs were found between the para- and periatrophy zone in eyes with ORT. In both cohorts, the paraatrophy zone had more FD than the periatrophy zone.
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Affiliation(s)
- Christof Haensli
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zürich, Switzerland
| | - Yoshimi Sugiura
- Vitreous Retina Macula Consultants of New York, New York, New York
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; and
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Sandrine A Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zürich, Switzerland
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Mori A, Sumida D, Kondo R, Nakano A, Arima S, Asano D, Morita A, Sakamoto K, Nagamitsu T, Nakahara T. Impairment of endothelium-dependent vasodilator function of retinal blood vessels in adult rats with a history of retinopathy of prematurity. J Pharmacol Sci 2021; 146:233-243. [PMID: 34116737 DOI: 10.1016/j.jphs.2021.04.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/03/2021] [Accepted: 04/27/2021] [Indexed: 01/04/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease, initiated by delayed retinal vascular growth after premature birth. In the majority of cases, ROP resolves spontaneously; however, a history of ROP may increase the risk of long-term visual problems. In this study, we evaluated the endothelial function of retinal blood vessels in adult rats with a history of ROP. ROP was induced in rats by subcutaneous injection of a vascular endothelial growth factor receptor tyrosine kinase inhibitor (KRN633) on postnatal day (P) 7 and P8. On P56, vasodilator responses to acetylcholine, GSK1016790A (an activator of transient receptor potential vanilloid 4 channels), NOR3 (a nitric oxide [NO] donor), and salbutamol (a β2-adrenoceptor agonist) were assessed. Compared to age-matched controls, retinal vasodilator responses to acetylcholine and GSK1016790A were attenuated in P56 rats with a history of ROP. No attenuation of acetylcholine-induced retinal vasodilator response was observed under inhibition of NO synthase. Retinal vasodilator responses to NOR3 and salbutamol were unaffected. These results suggest that the production of and/or release of NO is impaired in retinal blood vessels in adult rats with a history of ROP. A history of ROP might increase the risk of impaired retinal circulation in adulthood.
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Affiliation(s)
- Asami Mori
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Daiki Sumida
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Ryo Kondo
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Ayuki Nakano
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Shiho Arima
- Department of Organic Synthesis, Kitasato University School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Daiki Asano
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Akane Morita
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Kenji Sakamoto
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Tohru Nagamitsu
- Department of Organic Synthesis, Kitasato University School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Tsutomu Nakahara
- Department of Molecular Pharmacology, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
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Mirzapour-Shafiyi F, Kametani Y, Hikita T, Hasegawa Y, Nakayama M. Numerical evaluation reveals the effect of branching morphology on vessel transport properties during angiogenesis. PLoS Comput Biol 2021; 17:e1008398. [PMID: 34133418 PMCID: PMC8238234 DOI: 10.1371/journal.pcbi.1008398] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/28/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
Blood flow governs transport of oxygen and nutrients into tissues. Hypoxic tissues secrete VEGFs to promote angiogenesis during development and in tissue homeostasis. In contrast, tumors enhance pathologic angiogenesis during growth and metastasis, suggesting suppression of tumor angiogenesis could limit tumor growth. In line with these observations, various factors have been identified to control vessel formation in the last decades. However, their impacts on the vascular transport properties of oxygen remain elusive. Here, we take a computational approach to examine the effects of vascular branching on blood flow in the growing vasculature. First of all, we reconstruct a 3D vascular model from the 2D confocal images of the growing vasculature at postnatal day 5 (P5) mouse retina, then simulate blood flow in the vasculatures, which are obtained from the gene targeting mouse models causing hypo- or hyper-branching vascular formation. Interestingly, hyper-branching morphology attenuates effective blood flow at the angiogenic front, likely promoting tissue hypoxia. In contrast, vascular hypo-branching enhances blood supply at the angiogenic front of the growing vasculature. Oxygen supply by newly formed blood vessels improves local hypoxia and decreases VEGF expression at the angiogenic front during angiogenesis. Consistent with the simulation results indicating improved blood flow in the hypo-branching vasculature, VEGF expression around the angiogenic front is reduced in those mouse retinas. Conversely, VEGF expression is enhanced in the angiogenic front of hyper-branching vasculature. Our results indicate the importance of detailed flow analysis in evaluating the vascular transport properties of branching morphology of the blood vessels. Blood vessels are important for the transport of various substances, such as oxygen, nutrients, and cells, to the entire body. Control of blood vessel formation is thought to be important in health and disease. In the last decades, various factors which regulate blood vessel branching morphology have been identified. Gene modification of some of these identified factors results in hyper-branching of the vasculature while others cause hypo-branching of the vessel. Given the importance of the transport property of the blood vessel, it is important to examine the effect of these identified factors on the transport property of the affected vascular morphology. In line with these facts, we reconstruct 3D vessel structures from 2D confocal microscopy images. We then numerically simulate blood flow in the structures. Interestingly, our results suggest vessel network complexity negatively affects the blood perfusion efficiency and tissue oxygenation during angiogenesis. Thus, our results highlight the importance of flow analysis considering the detailed 3D branching pattern of the vascular network to quantitatively evaluate its transport properties.
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Affiliation(s)
- Fatemeh Mirzapour-Shafiyi
- Max Planck Institute for Heart and Lung Research, Laboratory for Cell Polarity and Organogenesis, Bad Nauheim, Germany
- DFG Research Training Group, Membrane Plasticity in Tissue Development and Remodeling, Philipps-Universität Marburg, Marburg, Germany
| | - Yukinori Kametani
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Takao Hikita
- Max Planck Institute for Heart and Lung Research, Laboratory for Cell Polarity and Organogenesis, Bad Nauheim, Germany
| | - Yosuke Hasegawa
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
- * E-mail: (YH); (MN)
| | - Masanori Nakayama
- Max Planck Institute for Heart and Lung Research, Laboratory for Cell Polarity and Organogenesis, Bad Nauheim, Germany
- DFG Research Training Group, Membrane Plasticity in Tissue Development and Remodeling, Philipps-Universität Marburg, Marburg, Germany
- Kumamoto University International Research Center for Medical Science, Kumamoto, Japan
- * E-mail: (YH); (MN)
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21
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Brücher VC, Egbring C, Plagemann T, Nedvetsky PI, Höffken V, Pavenstädt H, Eter N, Kremerskothen J, Heiduschka P. Lack of WWC2 Protein Leads to Aberrant Angiogenesis in Postnatal Mice. Int J Mol Sci 2021; 22:5321. [PMID: 34070186 PMCID: PMC8158494 DOI: 10.3390/ijms22105321] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 01/03/2023] Open
Abstract
The WWC protein family is an upstream regulator of the Hippo signalling pathway that is involved in many cellular processes. We examined the effect of an endothelium-specific WWC1 and/or WWC2 knock-out on ocular angiogenesis. Knock-outs were induced in C57BL/6 mice at the age of one day (P1) and evaluated at P6 (postnatal mice) or induced at the age of five weeks and evaluated at three months of age (adult mice). We analysed morphology of retinal vasculature in retinal flat mounts. In addition, in vivo imaging and functional testing by electroretinography were performed in adult mice. Adult WWC1/2 double knock-out mice differed neither functionally nor morphologically from the control group. In contrast, the retinas of the postnatal WWC knock-out mice showed a hyperproliferative phenotype with significantly enlarged areas of sprouting angiogenesis and a higher number of tip cells. The branching and end points in the peripheral plexus were significantly increased compared to the control group. The deletion of the WWC2 gene was decisive for these effects; while knocking out WWC1 showed no significant differences. The results hint strongly that WWC2 is an essential regulator of ocular angiogenesis in mice. As an activator of the Hippo signalling pathway, it prevents excessive proliferation during physiological angiogenesis. In adult animals, WWC proteins do not seem to be important for the maintenance of the mature vascular plexus.
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Affiliation(s)
- Viktoria Constanze Brücher
- Department of Ophthalmology, University of Münster Medical School, 48149 Münster, Germany; (V.C.B.); (C.E.); (T.P.); (N.E.)
| | - Charlotte Egbring
- Department of Ophthalmology, University of Münster Medical School, 48149 Münster, Germany; (V.C.B.); (C.E.); (T.P.); (N.E.)
| | - Tanja Plagemann
- Department of Ophthalmology, University of Münster Medical School, 48149 Münster, Germany; (V.C.B.); (C.E.); (T.P.); (N.E.)
- Department of Nephrology, Internal Medicine D, Hypertension and Rheumatology, University of Münster Medical School, 48149 Münster, Germany; (P.I.N.); (H.P.); (J.K.)
| | - Pavel I. Nedvetsky
- Department of Nephrology, Internal Medicine D, Hypertension and Rheumatology, University of Münster Medical School, 48149 Münster, Germany; (P.I.N.); (H.P.); (J.K.)
| | - Verena Höffken
- Medical Cell Biology, Medical Clinic D, University of Münster Medical School, 48149 Münster, Germany;
| | - Hermann Pavenstädt
- Department of Nephrology, Internal Medicine D, Hypertension and Rheumatology, University of Münster Medical School, 48149 Münster, Germany; (P.I.N.); (H.P.); (J.K.)
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical School, 48149 Münster, Germany; (V.C.B.); (C.E.); (T.P.); (N.E.)
| | - Joachim Kremerskothen
- Department of Nephrology, Internal Medicine D, Hypertension and Rheumatology, University of Münster Medical School, 48149 Münster, Germany; (P.I.N.); (H.P.); (J.K.)
| | - Peter Heiduschka
- Department of Ophthalmology, University of Münster Medical School, 48149 Münster, Germany; (V.C.B.); (C.E.); (T.P.); (N.E.)
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Hardarson SH, Stefánsson E, Bek T. Retinal oxygen saturation changes progressively over time in diabetic retinopathy. PLoS One 2021; 16:e0251607. [PMID: 33979414 PMCID: PMC8115819 DOI: 10.1371/journal.pone.0251607] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE According to cross-sectional studies, oxygen saturation is elevated in retinal vessels in diabetic patients. We evaluated how retinal oxygenation (metabolic marker), vessel diameters and retinopathy grade (structural markers) change over time in diabetic patients. DESIGN Prospective cohort study following screening in a hospital setting. METHODS Retinal oximetry images were acquired in 214 patients with the Oxymap T1 oximeter. Imaging was repeated after a median of 3.0 years (range 0.76-6.8 years). Oxygen saturation and vessel diameters were measured in the right eye. Semiquantitative grading of retinopathy according to international guidelines and red lesion count were performed on fundus photographs. RESULTS Retinopathy grade according to the international semiquantitative grading system was unchanged. Arteriolar saturation increased by 0.75±0.15 percentage points per year of follow-up (p<0.0001). Venular saturation increased by 1.74±0.26 percentage points per year (p<0.0001) and arteriovenous difference decreased by 0.99±0.20 percentage points per year (p<0.0001). Arteriolar diameters decreased by 2.7±8.5μm (p<0.0001) between visits and venular diameters decreased by 2.4±9.1μm (p = 0.0002). Median increase in red lesion count between visits was 2 lesions (range -128 to 212 lesions, p<0.0001). The change in red lesion count and change in diameters did not correlate with the length of follow-up (p>0.44). CONCLUSIONS Oxygen saturation in larger retinal vessels can increase and arteriovenous difference can decrease over time in diabetic patients without any observable changes in retinopathy grade. The results suggest that changes in retinal oxygen saturation may precede progression of diabetic retinopathy or that oxygen saturation is more sensitive to disease progression than retinopathy grade.
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Affiliation(s)
- Sveinn Hakon Hardarson
- Institute of Physiology, Department of Medicine, University of Iceland, Reykjavik, Iceland
- * E-mail:
| | - Einar Stefánsson
- Institute of Physiology, Department of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Ophthalmology, Landspitali University Hospital, Reykjavik, Iceland
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
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23
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Zola M, Ambresin A, Zografos L. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGING OF A CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM. Retin Cases Brief Rep 2021; 15:289-293. [PMID: 30074568 DOI: 10.1097/icb.0000000000000788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the case of a small pigmented tumor in the macular region investigated using optical coherence tomography angiography (OCT-A) in the context of a multimodal approach. METHODS Case report. RESULTS A 24-year-old man was referred for evaluation of an asymptomatic unilateral round comma-shaped pigmented tumor located in the macular region of his right eye. Spectral-domain OCT revealed an irregular hyperreflective mass within the retina, with a thickened hyaloid membrane and abrupt margins, and a complete posterior shadowing effect. On fluorescein angiography, early hyperfluorescence without leakage in the middle and late phases and a subtle halo of hyperfluorescence in the late phase were observed. OCT-A revealed the presence of intrinsic vascularization at the level of the inner capillary plexus, with signal intensity present at the level of the outer capillary plexus. In the superficial scans, the retinal vessels were oriented radially to the lesion and were in continuity with the vascular network within the tumor mass. No choroidal vessels could be identified. CONCLUSION We report the case of a congenital simple hamartoma of the retinal pigment epithelium investigated using OCT-A as part of multimodal imaging. OCT-A provided a new insight in the assessment of the lesion, differential diagnosis, and follow-up of the patient. This imaging modality could be an important non-invasive tool in the management of congenital hamartomas of the retinal pigment epithelium.
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Affiliation(s)
- Marta Zola
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
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24
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Cai S, Li H, Zheng F, Kong F, Dao M, Karniadakis GE, Suresh S. Artificial intelligence velocimetry and microaneurysm-on-a-chip for three-dimensional analysis of blood flow in physiology and disease. Proc Natl Acad Sci U S A 2021; 118:e2100697118. [PMID: 33762307 PMCID: PMC8020788 DOI: 10.1073/pnas.2100697118] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Understanding the mechanics of blood flow is necessary for developing insights into mechanisms of physiology and vascular diseases in microcirculation. Given the limitations of technologies available for assessing in vivo flow fields, in vitro methods based on traditional microfluidic platforms have been developed to mimic physiological conditions. However, existing methods lack the capability to provide accurate assessment of these flow fields, particularly in vessels with complex geometries. Conventional approaches to quantify flow fields rely either on analyzing only visual images or on enforcing underlying physics without considering visualization data, which could compromise accuracy of predictions. Here, we present artificial-intelligence velocimetry (AIV) to quantify velocity and stress fields of blood flow by integrating the imaging data with underlying physics using physics-informed neural networks. We demonstrate the capability of AIV by quantifying hemodynamics in microchannels designed to mimic saccular-shaped microaneurysms (microaneurysm-on-a-chip, or MAOAC), which signify common manifestations of diabetic retinopathy, a leading cause of vision loss from blood-vessel damage in the retina in diabetic patients. We show that AIV can, without any a priori knowledge of the inlet and outlet boundary conditions, infer the two-dimensional (2D) flow fields from a sequence of 2D images of blood flow in MAOAC, but also can infer three-dimensional (3D) flow fields using only 2D images, thanks to the encoded physics laws. AIV provides a unique paradigm that seamlessly integrates images, experimental data, and underlying physics using neural networks to automatically analyze experimental data and infer key hemodynamic indicators that assess vascular injury.
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Affiliation(s)
- Shengze Cai
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - He Li
- Division of Applied Mathematics, Brown University, Providence, RI 02912
| | - Fuyin Zheng
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139
- School of Biological Sciences, Nanyang Technological University, 639798 Singapore
| | - Fang Kong
- School of Biological Sciences, Nanyang Technological University, 639798 Singapore
| | - Ming Dao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
| | - George Em Karniadakis
- Division of Applied Mathematics, Brown University, Providence, RI 02912;
- School of Engineering, Brown University, Providence, RI 02912
| | - Subra Suresh
- Nanyang Technological University, 639798 Singapore
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25
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Wysocka-Mincewicz M, Gołębiewska J, Baszyńska-Wilk M, Olechowski A, Byczyńska A, Szalecki M. Influence of puberty on retinal microcirculation in children with type 1 diabetes without retinopathy using optical coherence tomography angiography. Diab Vasc Dis Res 2021; 18:14791641211004427. [PMID: 33787376 PMCID: PMC8481741 DOI: 10.1177/14791641211004427] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study aimed to assess the influence of pubertal status on the results of optical coherence tomography angiography (OCTA) in children with type 1 diabetes (T1D). METHODS We enrolled 167 consecutive children with T1D. Retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density data underwent analysis. We divided the study population into three subgroups depending on the pubertal status. RESULTS Analysis of the prepubertal and pubertal subgroups revealed statistically significant differences in foveal thickness (FT) (p < 0.05) and foveal SCP (p < 0.02). Analyzing subgroups of the prepubertal and postpubertal children, we observed statistically significant differences in FT (p < 0.03), whole SCP (p < 0.02), and foveal SCP (p < 0.02). Comparison of the pubertal and postpubertal subjects revealed differences in parafoveal DCP (p < 0.003). In the groups matched depending on diabetes duration, we observed differences between prepubertal, pubertal, and postpubertal children in FT, PFT, and parafoveal SCP and DCP. CONCLUSION Our data suggest that in a cohort of pubertal children with a short duration of diabetes, alterations in retinal vessel density occur early and progress during puberty.
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Affiliation(s)
- Marta Wysocka-Mincewicz
- Department of Endocrinology and Diabetology, Children’s Memorial Health Institute, Warsaw, Poland
- Marta Wysocka-Mincewicz, Department of Endocrinology and Diabetology, Children’s Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw 04-730, Poland.
| | - Joanna Gołębiewska
- Department of Ophthalmology, Children’s Memorial Health Institute, Warsaw, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Marta Baszyńska-Wilk
- Department of Endocrinology and Diabetology, Children’s Memorial Health Institute, Warsaw, Poland
| | - Andrzej Olechowski
- Department of Ophthalmology, Children’s Memorial Health Institute, Warsaw, Poland
- Ophthalmology Department, James Cook University Hospital, Middlesbrough, UK
| | - Aleksandra Byczyńska
- Department of Endocrinology and Diabetology, Children’s Memorial Health Institute, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children’s Memorial Health Institute, Warsaw, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Sędziak-Marcinek B, Teper S, Chełmecka E, Wylęgała A, Marcinek M, Bas M, Wylęgała E. Diabetic Macular Edema Treatment with Bevacizumab Does Not Depend on the Retinal Nonperfusion Presence. J Diabetes Res 2021; 2021:6620122. [PMID: 33728349 PMCID: PMC7936894 DOI: 10.1155/2021/6620122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 01/27/2023] Open
Abstract
This study evaluated the relationship between the retinal nonperfusion area (NPA) presence and the effectiveness of bevacizumab treatment (IVB) in patients with diabetic macular edema (DME). It also tested the prognostic usefulness of ultra-wide-field fluorescein angiography (UWFFA) and OptosAdvance software for diabetic retinopathy monitoring. Eighty-nine patients with DME with a macular central subfield thickness (CST) ≥ 250 μm, with (N = 49 eyes) and without (N = 49 eyes) retinal NPA, underwent nine bevacizumab injections over 12 months. NPA distribution, leakage area distribution, microaneurysm (MA) count, macular CST, diabetic retinopathy severity, and best-corrected visual acuity (BCVA) were assessed. The results show that bevacizumab reduced the macular CST from 420 to 280 μm (p < 0.001) and improved BCVA (p < 0.001) by about 10 ETDRS letters in both groups of patients. Additionally, the therapy reduced total retinal NPA from 29 (14-36) mm2 to 12 (4-18) mm2 (Me (Q1-Q3); p < 0.001) in patients with diagnosed nonperfusion. The effect of the therapy measured with vascular leakage, MA count, BCVArelative, and CSTrelative strongly depended on the zone of the retina and the NPA distribution. We conclude that the bevacizumab treatment had a positive effect on DME and BCVA in both study groups and on the size of retinal NPA in patients with retinal nonperfusion.
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Affiliation(s)
- Bogumiła Sędziak-Marcinek
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
| | - Sławomir Teper
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
| | - Elżbieta Chełmecka
- Department of Statistics, Department of Instrumental Analysis, Faculty of Pharmaceutical Sciences in Sosnowiec, 41-200 Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Adam Wylęgała
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-728 Katowice, Poland
| | - Mateusz Marcinek
- Department of Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-760 Katowice, Poland
| | - Mateusz Bas
- Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland
| | - Edward Wylęgała
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
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Affiliation(s)
- Shaun Sebastian Sim
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore
| | - Chui Ming Gemmy Cheung
- Section Editor, Retina and Vitreous, Canadian Journal of Ophthalmology; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore.
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Werfel S, Günthner R, Hapfelmeier A, Hanssen H, Kotliar K, Heemann U, Schmaderer C. Identification of cardiovascular high risk groups from dynamic retinal vessel signals using untargeted machine learning. Cardiovasc Res 2021; 118:612-621. [PMID: 33576412 DOI: 10.1093/cvr/cvab040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 02/09/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Dynamic retinal vessel analysis (DVA) provides a noninvasive way to asses microvascular function in patients and potentially to improve predictions of individual cardiovascular (CV) risk. The aim of our study was to use untargeted machine learning on DVA in order to improve CV mortality prediction and to identify corresponding response alterations. METHODS AND RESULTS We adopted a workflow consisting of noise reduction and extraction of independent components within DVA signals. Predictor performance was assessed in survival random forest models. Applying our technique to the prediction of all-cause mortality in a cohort of 214 hemodialysis patients resulted in the selection of a component which was highly correlated to maximal venous dilation following flicker stimulation (vMax), a previously identified predictor, confirming the validity of our approach. When fitting for CV mortality as the outcome of interest, a combination of three components derived from the arterial signal resulted in a marked improvement in predictive performance. Clustering analysis suggested that these independent components identified groups of patients with substantially higher CV mortality. CONCLUSIONS Our results provide a machine learning workflow to improve the predictive performance of DVA and identify groups of hemodialysis patients at high risk of CV mortality. Our approach may also prove to be promising for DVA signal analysis in other CV disease states. TRANSLATIONAL PERSPECTIVE DVA is a noninvasive technique which can help to assess microvascular dysfunction, one of the driving factors of CV disease. This study demonstrates a machine learning method which improves DVA interpretation for the estimation of CV risk in hemodialysis patients. Similar techniques can help doctors to identify high risk patients for timely therapeutic interventions and to monitor the effects of these interventions.
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Affiliation(s)
- Stanislas Werfel
- Department of Nephrology, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Roman Günthner
- Department of Nephrology, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University Munich, Munich, Germany
- Institute of General Practice and Health Services Research, School of Medicine, Technical University Munich, Munich, Germany
| | - Henner Hanssen
- Division of Sports Medicine, Institute of Exercise and Health Sciences (ISSW), University of Basel, Basel, Switzerland
| | - Konstantin Kotliar
- Department of Biomedical Engineering and Technomathematics, Aachen University of Applied Sciences, Juelich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
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Dormegny L, Jeanjean LC, Liu X, Messerlin A, Bourcier T, Sauer A, Speeg-Schatz C, Gaucher D. VISUAL IMPAIRMENT AND MACULAR VASCULAR REMODELING SECONDARY TO RETROGRADE MACULOPATHY IN RETINAL DETACHMENT TREATED WITH SILICON OIL TAMPONADE. Retina 2021; 41:309-316. [PMID: 32404843 DOI: 10.1097/iae.0000000000002812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the frequency of macular cysts (MCs) in retinal detachment treated with silicone oil and evaluate their impact on visual acuity and macular vascularization using optical coherence tomography-angiography. METHODS Forty-three eyes of 41 patients treated with silicone oil for retinal detachment were retrospectively studied. Best-corrected visual acuity and 6- × 6-mm optical coherence tomography-angiography examination at least 3 months after silicone oil removal were reviewed. In eyes with MCs, cyst area was measured on the en face optical coherence tomography-angiography image using ImageJ. Density of superficial capillary plexus and area of superficial foveal avascular zone were generated by the optical coherence tomography-angiography. Density of deep capillary plexus and deep foveal avascular zone area were measured using ImageJ. RESULTS Twenty-five eyes (58%) presented with MCs. Cysts were exclusively located in the inner nuclear layer in 60% of cases. Mean best-corrected visual acuity in the MC group was lower than that of the non-MC group (P = 0.012). Macular cyst area negatively correlated with best-corrected visual acuity (P = 0.0201). Density of superficial capillary plexus was higher in the MC group (P < 0.0001), whereas area of superficial foveal avascular zone was lower (P < 0.0001). Macular cyst area negatively correlated with density of deep capillary plexus (P < 0.001). CONCLUSION The incidence of INL-MCs after silicone oil removal is high. These are associated with impaired vision and macular vascular remodeling. We highlight their similarity with the "retrograde maculopathy" phenomenon.
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Affiliation(s)
- Lea Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Ludovic C Jeanjean
- IIMIS team, Cube-CNRS UMR 7357, Neurophysiology, FMTS, University of Strasbourg, Strasbourg, France. ; and
| | - Xuanli Liu
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, P.R. China
| | - Arnaud Messerlin
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Claude Speeg-Schatz
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
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Tangtammaruk P, Petpiroon P, Supakonatanasan W, Teekhasaenee C, Suwan Y. Peripapillary perfused capillary density in true versus pseudoexfoliation syndrome: An OCTA study. PLoS One 2020; 15:e0239109. [PMID: 33301460 PMCID: PMC7728275 DOI: 10.1371/journal.pone.0239109] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare peripapillary perfused capillary density (PCD) among eyes with true exfoliation syndrome (TEX), eyes with pseudoexfoliation syndrome (PEX), and healthy control eyes. MATERIALS AND METHODS In this observational cross-sectional study, eyes with and without TEX or PEX were assessed by optical coherence tomography angiography (OCTA) imaging. Bilateral OCTA images (4.5 × 4.5 mm2) centered at the optic nerve head were obtained using a commercial spectral domain OCTA system. Optic nerve head perfusion was quantified using the split-spectrum amplitude decorrelation angiography algorithm. Categorical and continuous variables were compared using the chi-squared test and one-way analysis of variance, respectively. The generalized estimating equation was used to adjust for confounding factors and determine inter-ocular associations. RESULTS We enrolled 39 eyes with TEX, 31 eyes with PEX, and 32 control eyes. There were no significant differences among the three groups regarding age, intraocular pressure, cup-to-disc ratio, blood pressure, or axial length (all p>0.05). There were significant differences in global PCD among the three groups (p = 0.01). There were significant differences in annular PCD between the TEX and PEX groups (p = 0.027). CONCLUSIONS While both global and annular PCDs did not differ between the TEX and control groups, greater loss of annular PCD in the PEX group than in the TEX and control groups suggests more pronounced microvascular disturbance in PEX. SYNOPSIS/PRECIS Greater microvascular attenuation in PEX compared with TEX and normal control measured by OCTA.
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Affiliation(s)
| | - Purit Petpiroon
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Supakonatanasan
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Teekhasaenee
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanin Suwan
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Told R, Georgopoulos M, Reiter GS, Wassermann L, Aliyeva L, Baumann L, Abela-Formanek C, Pollreisz A, Schmidt-Erfurth U, Sacu S. Intraretinal microvascular changes after ERM and ILM peeling using SSOCTA. PLoS One 2020; 15:e0242667. [PMID: 33259500 PMCID: PMC7707569 DOI: 10.1371/journal.pone.0242667] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To prospectively investigate retinal vascular changes in patients undergoing epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling using swept source optical coherence tomography angiography (SSOCTA). METHODS Consecutive patients were grouped based on ERM severity and followed using SSOCTA up to month 3 after surgical intervention. Superficial and deep foveal avascular zone (s/dFAZ) as well as foveal and parafoveal vessel density (VD) were correlated with ERM severity and visual acuity. Differences between groups were evaluated. RESULTS Significant correlations were found between ERM severity and baseline sFAZ, dFAZ and best corrected visual acuity (BCVA), central retinal subfield thickness (CST) and ΔCST (r = -0.52, r = -0.43, r = -0.42, r = 0.58, r = 0.39; all p<0.05). Vascular flow parameters did not correlate with age, peeling size, pseudophakia or CST, but correlated with intraretinal cysts presence. No associations of BCVA with any of the OCTA parameters across time were found. Significant differences between ERM severity groups 1 and 2 were found for sFAZ at baseline (p = 0.005) and at the 3-month follow-up (p = 0.014), and for dFAZ at baseline (p = 0.017). Superficial foveal and parafoveal VD were not significantly different between groups (all p>0.05). CONCLUSIONS This study clearly shows that ERM severity based on ERM staging has to be taken into account when undertaking studies in patients with idiopathic ERM using SSOCTA. Further, specific changes in the superficial and deep retinal vasculature in eyes undergoing ERM and ILM peeling were found. However, the clinical usefulness and prognostic value for post-surgical treatment BCVA of the SSOCTA-derived variables (sFAZ and dFAZ area, as well as foveal and parafoveal VD) used remains questionable.
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Affiliation(s)
- Reinhard Told
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Gregor Sebastian Reiter
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Lorenz Wassermann
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Leyla Aliyeva
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Lukas Baumann
- Department of Medical Statistics Vienna, Medical University of Vienna, Vienna, Austria
| | - Claudette Abela-Formanek
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
- * E-mail:
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Hajdu D, Told R, Angeli O, Weigert G, Pollreisz A, Schmidt-Erfurth U, Sacu S. Identification of microvascular and morphological alterations in eyes with central retinal non-perfusion. PLoS One 2020; 15:e0241753. [PMID: 33170872 PMCID: PMC7654769 DOI: 10.1371/journal.pone.0241753] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the characteristics and morphological alterations in central retinal ischemia caused by diabetic retinopathy (DR) or retinal vein occlusion (RVO) as seen in optical coherence tomography angiography (OCTA) and their relationship to visual acuity. Methods Swept-source optical coherence tomography (SSOCT) and OCTA (Topcon, Triton) data of patients with central involving retinal ischemia were analyzed in this cross-sectional study. The following parameters were evaluated: vessel parameters, foveal avascular zone (FAZ), intraretinal cysts (IRC), microaneurysms (MA), vascular collaterals in the superficial (SCP) and deep plexuses (DCP), hyperreflective foci (HRF), epiretinal membrane (ERM), external limiting membrane (ELM) and ellipsoid zone (EZ) disruption, as well as the disorganization of retinal inner layers (DRIL). Best-corrected visual acuity (BCVA), age, gender, disease duration and ocular history were also recorded. Results 44 eyes of 44 patients (22 with RVO, 22 with DR) were analyzed. The mean age was 60.55 ± 11.38 years and mean BCVA 0.86 ± 0.36 (Snellen, 6m). No significant difference was found between DR subgroups (non proliferative vs. proliferative). Between RVO subgroups (CRVO vs. BRVO) a significant difference was found in term of collateral vessel of the DCP (p = 0.014). A pooled DR and RVO group were created and compared. Significantly more MAs (p = 0.007) and ERM (p = 0.007) were found in the DR group. Statistically significant negative correlation was demonstrated between FAZ and BCVA (p = 0.45) when analyzing all patients with retinal ischemia. Conclusion This study has shown that the best predictor of visual outcome in center involved ischemic diseases is the size of FAZ. Besides the presence of MAs and ERM, all other OCT and OCTA parameters were present in a similar extent in DR and RVO group despite the completely different disease origins. Our results suggest that as soon as retinal ischemia in the macular region is present, it has a similar appearance and visual outcome independently of the underlying disease.
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Affiliation(s)
- Dorottya Hajdu
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
| | - Reinhard Told
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
| | - Orsolya Angeli
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Guenther Weigert
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Centre (VTC), Medical University of Vienna, Vienna, Austria
- * E-mail:
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Tiryaki Demir S, Bas EK, Karapapak M, Karatas ME, Uslu HS, Bulbul A, Guven D. Effect of Prematurity on Foveal Development in Early School-Age Children. Am J Ophthalmol 2020; 219:177-185. [PMID: 32569738 DOI: 10.1016/j.ajo.2020.06.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the foveal development in preterm children with optical coherence tomography and OCT angiography. DESIGN Retrospective cohort study. METHODS This study included children aged 6-8 years who were born prematurely and who did not receive retinopathy treatment. They were evaluated between September 2018 and July 2019, categorized according to gestational age (GA) (group I: GA ≤30 weeks; group II: GA between 31 and 34 weeks), and compared with full-term children (group III). Central foveal thickness (CFT), inner retinal thickness (IRT), outer retinal thickness (ORT), subfoveal choroidal thickness (CT), temporal and nasal CT, foveal avascular zone (FAZ) diameter, and vessel densities of superficial (SCP-VD) and deep capillary plexuses (DCP-VD) of the foveal and parafoveal areas were examined in detail. RESULTS The study included 126 eyes of 63 patients (group I: 40 eyes; group II: 46 eyes; and group III: 40 eyes). In group I, CFT, IRT, ORT, foveal SCP-VD, and foveal DCP-VD were significantly greater than those in the other groups, and temporal CT and FAZ diameter were significantly lower (P < .05). GA showed a significant negative correlation with CFT, IRT, ORT, foveal SCP-VD, and foveal DCP-VD and a significant positive correlation with subfoveal CT, temporal and nasal CT, and FAZ diameter (P < .05). CONCLUSION The morphological and vascular foveal structures in early school-age children who were born premature were different from those of full-term children. These differences were correlated with GA and more pronounced in those with GA of ≤30 weeks.
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Affiliation(s)
- Semra Tiryaki Demir
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Evrim Kiray Bas
- Department of Neonatology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Karapapak
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Egemen Karatas
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hasan Sinan Uslu
- Department of Neonatology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali Bulbul
- Department of Neonatology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Guven
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Tao X, Sigireddi RR, Westenskow PD, Channa R, Frankfort BJ. Single transient intraocular pressure elevations cause prolonged retinal ganglion cell dysfunction and retinal capillary abnormalities in mice. Exp Eye Res 2020; 201:108296. [PMID: 33039455 DOI: 10.1016/j.exer.2020.108296] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 12/22/2022]
Abstract
Transient intraocular pressure (IOP) elevations are likely to occur in certain forms of glaucoma and after intravitreal injections to treat various retinal diseases. However, the impact of these transient IOP elevations on the physiology of individual retinal ganglion cells (RGCs) is unknown. In this report, we explore how transient IOP elevations in mice affect RGC physiology, RGC anatomy, and retinal arteriole and capillary structure. Transient IOP elevation was induced in 12-week old wild type C57BL6J mice by injecting sodium hyaluronate into the anterior chamber. IOP was measured immediately after the injection and again 1 and 7 days later. Average peak IOP after injection was ~50 mmHg and subsequent IOPs returned to normal. RGC physiology was assessed with a multielectrode array (MEA) by calculating a spike triggered average (STA) at the same time points. RGC counts and retinal vascular structure were assessed 14 days after injection with immunohistochemistry to label RGCs and blood vessels. Transient IOP elevation caused a marked reduction of scotopic STA presence and delayed center and surround STA peak times that did not recover. Transient IOP elevation also caused a reduced photopic receptive field size and spontaneous firing rate, both of which showed some recovery with time. Transient IOP elevation also induced vascular remodeling: the number of capillary branches was decreased within the superficial and intermediate vascular plexi. RGC counts, retinal arteriole diameter, and deep capillary plexus branching were unaffected. These previously unappreciated findings suggest that transient IOP elevation may cause unrecognized and potentially long-term pathology to RGCs and associated neurovascular units which should be accounted for in clinical practice.
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Affiliation(s)
- Xiaofeng Tao
- Department of Ophthalmology, Baylor College of Medicine, United States
| | | | | | - Roomasa Channa
- Department of Ophthalmology, Baylor College of Medicine, United States
| | - Benjamin J Frankfort
- Department of Ophthalmology, Baylor College of Medicine, United States; Department of Neuroscience, Baylor College of Medicine, United States.
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Zhuang X, Cao D, Zeng Y, Yang D, Yao J, Kuang J, Xie J, He M, Cai D, Zhang S, Wang W, Zhang L. Associations between retinal microvasculature/microstructure and renal function in type 2 diabetes patients with early chronic kidney disease. Diabetes Res Clin Pract 2020; 168:108373. [PMID: 32827591 DOI: 10.1016/j.diabres.2020.108373] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/17/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
AIMS To explore the associations between the microvascular/microstructural changes in the retina measured by optical coherence tomography angiography (OCTA) and renal function in type 2 diabetes patients with early chronic kidney disease (CKD). METHODS This cross-sectional study, including 150 type 2 diabetes patients, was conducted from July 2017 to January 2019. We obtained retinal vessel density (VD) and retinal thickness using OCTA. The correlations between OCTA-derived parameters and CKD-related systemic data were assessed by multiple regression analyses. RESULTS We found a significant decrease of VD in patients with CKD. Multiple regression analyses showed that: a) decreased eGFR (estimated glomerular filtration rate) was significantly correlated with decreased VD of superficial vascular complex (SVC) in macular area; b) increased UACR (urine albumin to creatinine ratio) was significantly associated with increased macular thickness; c) decreased HGB/HCT (Hemoglobin or Hematocrit) was significantly correlated with both decreased VD of SVC and increased retinal thickness in macular area. CONCLUSIONS Decrease in the microcirculation of the retina and thickening of the macula associated with impaired renal function in type 2 diabetes. Our finding encourages the application of OCTA-derived metrics in diabetic eyes to monitor the progression of CKD.
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Affiliation(s)
- Xuenan Zhuang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515000, Guangdong, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Yunkao Zeng
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515000, Guangdong, China
| | - Dawei Yang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515000, Guangdong, China
| | - Jie Yao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515000, Guangdong, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Jianteng Xie
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Miao He
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Danna Cai
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Shuting Zhang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Wenjian Wang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
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Tapp RJ, Owen CG, Barman SA, Welikala RA, Foster PJ, Whincup PH, Strachan DP, Rudnicka AR. Retinal Vascular Tortuosity and Diameter Associations with Adiposity and Components of Body Composition. Obesity (Silver Spring) 2020; 28:1750-1760. [PMID: 32725961 PMCID: PMC7116641 DOI: 10.1002/oby.22885] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/18/2020] [Accepted: 05/06/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to assess whether adiposity or body composition relates to microvascular characteristics of the retina, indicative of cardiometabolic function. METHODS A fully automated QUARTZ software processed retinal images from 68,550 UK Biobank participants (aged 40-69 years). Differences in retinal vessel diameter and tortuosity with body composition measures from the Tanita analyzer were obtained by using multilevel regression analyses adjusted for age, sex, ethnicity, clinic, smoking, and Townsend deprivation index. RESULTS Venular tortuosity and diameter increased by approximately 2% (P < 10-300 ) and 0.6 μm (P < 10-6 ), respectively, per SD increase in BMI, waist circumference index, waist-hip ratio, total body fat mass index, and fat-free mass index (FFMI). Venular associations with adiposity persisted after adjustment for FFMI, whereas associations with FFMI were weakened by FMI adjustment. Arteriolar diameter (not tortuosity) narrowing with FFMI was independent of adiposity (-0.6 μm; -0.7 to -0.4 μm per SD increment of FFMI), while adiposity associations with arteriolar diameter were largely nonsignificant after adjustment for FFMI. CONCLUSIONS This demonstrates, on an unprecedented scale, that venular tortuosity and diameter are more strongly associated with adiposity, whereas arteriolar diameter relates more strongly to fat-free mass. Different attributes of the retinal microvasculature may reflect distinct roles of body composition and fatness on the cardiometabolic system.
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Affiliation(s)
- Robyn J Tapp
- Population Health Research Institute, St George's, University of London, London, UK
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sarah A Barman
- Faculty of Science, Engineering and Computing, Kingston University, Surrey, UK
| | - Roshan A Welikala
- Faculty of Science, Engineering and Computing, Kingston University, Surrey, UK
| | - Paul J Foster
- Integrative Epidemiology Research Group, UCL Institute of Ophthalmology, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
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Scharf JM, Corradetti G, Alagorie AR, Grondin C, Hilely A, Wang D, Sadda S, Sarraf D. Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2020; 61:11. [PMID: 32902576 PMCID: PMC7488611 DOI: 10.1167/iovs.61.11.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate choriocapillaris (CC) flow deficits (FD) in eyes with treatment-naïve macular neovascularization (MNV) and to compare CC FD around exudative versus nonexudative MNV. Methods Treatment-naïve eyes with a diagnosis of either exudative or nonexudative AMD and type 1 MNV were included. Normal control eyes were age-matched to each AMD eye one to one. En face optical coherence tomography angiograms were analyzed for percentage of CC FD (FD%) in two concentric 500 µm rings, ring 1 and ring 2, surrounding the dark halo around MNV. The mean CC FD% in ring 1 and ring 2 was evaluated for each eye. A secondary analysis was similarly carried out to investigate the differences in CC FD% in exudative versus nonexudative treatment-naïve MNV. Results Twenty-three eyes with treatment-naïve MNV were age matched with 23 normal controls. The mean CC FD% was significantly greater in both rings in the MNV versus the normal control group (P < 0.05) and was significantly greater in the inner ring, closer to the lesion, than the outer ring. The mean FD% was also greater in both rings in the exudative versus the nonexudative MNV group, but this difference did not reach statistical significance. Conclusions The CC FD% was greater in the area surrounding MNV versus age-matched normal controls and in the ring closer to the MNV lesion. Further, CC FD was greater in eyes with exudative versus nonexudative MNV in both rings surrounding the associated dark halo, although this difference was not statistically significant.
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Affiliation(s)
- Jackson M. Scharf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
| | - Giulia Corradetti
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California, United States
| | - Ahmed Roshdy Alagorie
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California, United States
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Christelle Grondin
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Assaf Hilely
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Derrick Wang
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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Scharf J, Freund KB, Sadda S, Sarraf D. Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses. Prog Retin Eye Res 2020; 81:100884. [PMID: 32783959 DOI: 10.1016/j.preteyeres.2020.100884] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
The retinal capillary vasculature serves the formidable role of supplying the metabolically active inner and middle retina. In the parafoveal region, the retinal capillary plexuses (RCP) are organized in a system of three capillary layers of varying retinal depths: the superficial capillary plexus (SCP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). While the dynamic flow through these plexuses is complex and not completely understood, current research points to a hybrid model that includes both parallel and in series components in which blood flows in a predominantly serial direction between the superficial vascular complex (SVC) and deep vascular complex (DVC). Each capillary plexus autoregulates independently, so that under most conditions the retinal vasculature supplies adequate blood flow and oxygen saturation at varying depths despite diverse environmental stressors. When the flow in the deep vascular complex (i.e. ICP and DCP) fails, an ischemic lesion referred to as Paracentral Acute Middle Maculopathy (PAMM) can be identified. PAMM is an optical coherence tomography (OCT) finding defined by the presence of a hyperreflective band at the level of the inner nuclear layer (INL) that indicates INL infarction caused by globally impaired perfusion through the retinal capillary system leading to hypoperfusion of the DVC or specifically the DCP. Patients present with an acute onset paracentral scotoma and typically experience a permanent visual defect. Lesions can be caused by a diverse set of local retinal vascular diseases and systemic disorders. PAMM is a manifestation of the retinal ischemic cascade in which the mildest forms of ischemia develop at the venular end of the DCP, i.e. perivenular PAMM, while more severe forms progress horizontally to diffusely involve the INL, and the most severe forms progress vertically to infarct the inner retina. Management is targeted toward the identification and treatment of related vasculopathic and systemic risk factors.
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Affiliation(s)
- Jackson Scharf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - K Bailey Freund
- Retina Department, Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States.
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Sawada S, Tsuchiya S, Kodama S, Kurosawa S, Endo A, Sugawara H, Hosaka S, Kawana Y, Asai Y, Yamamoto J, Munakata Y, Izumi T, Takahashi K, Kaneko K, Imai J, Ito A, Yasuda M, Kunikata H, Nakazawa T, Katagiri H. Vascular resistance of carotid and vertebral arteries is associated with retinal microcirculation measured by laser speckle flowgraphy in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2020; 165:108240. [PMID: 32502691 DOI: 10.1016/j.diabres.2020.108240] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/01/2020] [Accepted: 05/21/2020] [Indexed: 01/31/2023]
Abstract
AIMS Evaluation of the retinal microcirculation is key to understanding retinal vasculopathies, such as diabetic retinopathy. Laser speckle flowgraphy (LSFG) has recently enabled us to directly evaluate the vascular resistance in both retinal vessels and capillaries, non-invasively. We therefore assessed whether retinal vessel blood flow and/or the capillary microcirculation are associated with blood flow in the cervical arteries in diabetic patients without severe retinopathy. METHODS We enrolled 110 type 2 diabetes patients, with no or mild non-proliferative diabetic retinopathy, in this prospective cross-sectional study. We measured the resistivity indices (RIs) of the retinal vessel and capillaries by LSFG and those of cervical arteries by Doppler ultrasonography, followed by analyzing associations. RESULTS The RIs of not only the carotid but also vertebral arteries were associated with those of retinal vessel blood flow and the retinal capillary microcirculation. Multiple regression analyses revealed these associations to be independent of other explanatory variables including age and diabetes duration. CONCLUSIONS We obtained novel and direct evidence demonstrating a close association between the retinal microcirculation and cervical artery hemodynamics in diabetic patients. These findings suggest shared mechanisms to underlie micro- and macro-angiopathies. Thus, high vascular resistance of cervical arteries may be a risk of developing retinopathy.
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Affiliation(s)
- Shojiro Sawada
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Satoko Tsuchiya
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinjiro Kodama
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoko Kurosawa
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Endo
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroto Sugawara
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichiro Hosaka
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yohei Kawana
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoichiro Asai
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junpei Yamamoto
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuichiro Munakata
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohito Izumi
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takahashi
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keizo Kaneko
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junta Imai
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Azusa Ito
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Katagiri
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Kasumovic A, Matoc I, Rebic D, Avdagic N, Halimic T. Assessment of Retinal Microangiopathy in Chronic Kidney Disease Patients. Med Arch 2020; 74:191-194. [PMID: 32801434 PMCID: PMC7406003 DOI: 10.5455/medarh.2020.74.191-194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Optical coherence tomography angiography (OCT-A) is a useful diagnostic tool for assessing eyes' health in patients with chronic diseases, such as diabetes, hypertension, Parkinson's disease and chronic kidney disease (CKD). AIM To detect changes in macular structure and retinal vascular meshwork in the macular area and peripapillary in patients with chronic kidney disease (CKD). METHODS This cross-sectional study included 80 eyes of patients with CKD in stages 2, 3 or 4, who were followed-up in the Nephrology Clinic of University Clinical Center Sarajevo. All patients were categorized according to the stage of CKD. All patients were scanned by a high-speed 840-nm-wavelength spectral-domain optical coherence tomography instrument (RTVue XR Avanti; Optovue, Inc, Fremont, California, USA). Blood flow was detected using a split-spectrum amplitude-decorrelation angiography algorithm. A fully automated microstructural analysis of the foveal avascular zone (FAZ), FAZ perimeter, foveal vessel density in a 300-μm area around the FAZ (FD), nonflow area, flow index in superficial and deep vascular plexus, choriocapillary flow, vascular density, radial peripapillary capillary density was performed. RESULTS When comparing patients with CKD stage 2 and stage 3 there were no statistically significant changes in microvascular parameters on OCT angiography, as well as when comparing patients with CKD stage 3 and stage 4. But in the comparison between patients with less developed CKD (stage 2) and terminal CKD (stage 4) there was a significant difference between some microvascular parameters such as FAZ area, FAZ perimeter, choriocapillary flow. CONCLUSION Many studies demonstrated that evaluation of the microvascular changes in different retinal layers using SS-OCTA may be considered as a key to assessing the systemic perfusion status. Evaluation of retinal microvasculature may ease the management and approach of patients with CKD, having in mind that the retinal and the kidney vascular network are, concerning structure, development and the function, very similar.
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Affiliation(s)
- Aida Kasumovic
- Eye Polyclinic “Dr. Sefić”, Sarajevo, Bosnia and Herzegovina
| | - Ines Matoc
- Eye Polyclinic “Dr. Sefić”, Sarajevo, Bosnia and Herzegovina
| | - Damir Rebic
- University Clinical Center Sarajevo, Nephrology Clinic, Sarajevo, Bosnia and Herzegovina
| | - Nesina Avdagic
- Department of Human Physiology, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina
| | - Tarik Halimic
- Eye Polyclinic “Dr. Sefić”, Sarajevo, Bosnia and Herzegovina
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Patel DD, Lipinski DM. Validating a low-cost laser speckle contrast imaging system as a quantitative tool for assessing retinal vascular function. Sci Rep 2020; 10:7177. [PMID: 32346043 PMCID: PMC7188677 DOI: 10.1038/s41598-020-64204-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/10/2020] [Indexed: 11/18/2022] Open
Abstract
The ability to monitor progression of retinal vascular diseases like diabetic retinopathy in small animal models is often complicated by their failure to develop the end-stage complications which characterize the human phenotypes in disease. Interestingly, as micro-vascular dysfunction typically precedes the onset of retinal vascular and even some neurodegenerative diseases, the ability to visualize and quantify hemodynamic changes (e.g. decreased flow or occlusion) in retinal vessels may serve as a useful diagnostic indicator of disease progression and as a therapeutic outcome measure in response to treatment. Nevertheless, the ability to precisely and accurately quantify retinal hemodynamics remains an unmet challenge in ophthalmic research. Herein we demonstrate the ability to modify a commercial fundus camera into a low-cost laser speckle contrast imaging (LSCI) system for contrast-free and non-invasive quantification of relative changes to retinal hemodynamics over a wide field-of-view in a rodent model.
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Affiliation(s)
- Dwani D Patel
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel M Lipinski
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK.
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Babiuch AS, Uchida A, Hu M, Khan M, Srivastava SK, Singh RP, Kaiser PK, Rachtiskaya A, Reese JL, Ehlers JP. Use of OCTA Capillary Perfusion Density Measurements to Detect and Grade Macular Ischemia. Ophthalmic Surg Lasers Imaging Retina 2020; 51:S30-S36. [PMID: 32348532 DOI: 10.3928/23258160-20200401-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/25/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare optical coherence tomography angiography (OCTA) capillary perfusion density (CPD) measurements of normal eyes and eyes with macular ischemia (MI). PATIENTS AND METHODS AVATAR is an institutional review board-approved, prospective, observational imaging study using the Avanti RTVue XR HD. OCTA reports were reviewed for the presence of MI. Qualitative MI grading was performed, and CPD metrics in the superficial and deep fovea and parafovea were analyzed. A normal eye cohort was identified for comparative assessment. RESULTS The MI and normal cohorts included 55 and 58 eyes, respectively. Compared to normal eyes, eyes with MI had significantly lower CPD values in all regions. There was a statistically significant correlation between qualitative MI grade and VA in the superficial (P = .003) and deep plexuses (P = .029). Only deep parafoveal CPD values demonstrated correlation with VA (P = .043). CONCLUSIONS Eyes with MI determined by masked qualitative OCTA grading demonstrated significantly reduced CPD values compared to normal eyes. Categorical assessment of MI severity correlated with VA. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S30-S36.].
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Zeng Y, Cao D, Yang D, Zhuang X, Hu Y, He M, Yu H, Wang J, Yang C, Zhang L. Retinal vasculature-function correlation in non-proliferative diabetic retinopathy. Doc Ophthalmol 2020; 140:129-138. [PMID: 31552568 DOI: 10.1007/s10633-019-09724-4] [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] [Received: 06/11/2019] [Accepted: 09/16/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare and correlate retinal microcirculation and function in patients with non-proliferative diabetic retinopathy (NPDR). METHODS Thirty-three healthy controls (33 eyes), 36 diabetic patients with no clinically detectable retinopathy (NDR, 36 eyes) and 101 patients (101 eyes) with NPDR (35 mild NPDR, 34 moderate NPDR, 32 severe NPDR) were involved in the study. We used optical coherence tomography angiography (OCTA) to quantify the macular vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP) and foveal density in a 300 μm region around foveal avascular zone. Retinal function was assessed by a mydriasis-free, full-field flicker electroretinogram (FERG) recording device, and the amplitudes and implicit time were recorded. The association between microvascular parameters and FERG results was analyzed with stepwise multiple linear regression model. RESULTS Decreased amplitudes and delayed implicit time, as well as lower parafoveal/perifoveal VD in both SCP and DCP, were found in NDR group and NPDR groups compared with the control group (all p < 0.05). Specifically, the FERG parameters and microvascular indices were comparable between NDR group and mild NPDR group (all p > 0.05). However, compared to mild NPDR, the reduction in FERG amplitude was more pronounced than the reduction in parafoveal VD (both SCP and DCP) in severe NPDR. Stepwise multiple linear regression analyses showed that delayed implicit time was significantly correlated with increased age and decreased VD of parafoveal region in both SCP and DCP in patients with NPDR. Meanwhile, decreased amplitude was significantly associated with decreased VD of parafoveal region in both SCP and DCP in patients with NPDR. CONCLUSION Macular VD in both superficial and deep capillary plexus correlated with ERG implicit time and amplitude in mild-to-severe NPDR. OCTA and FERG may both be useful in detection of preclinical DR and early DR, but once the disease deteriorates, FERG may be more sensitive to discern progression of DR.
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Affiliation(s)
- Yunkao Zeng
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Dawei Yang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Xuenan Zhuang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Yunyan Hu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Miao He
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Jun Wang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Cheng Yang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China.
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Bertelli PM, Pedrini E, Guduric-Fuchs J, Peixoto E, Pathak V, Stitt AW, Medina RJ. Vascular Regeneration for Ischemic Retinopathies: Hope from Cell Therapies. Curr Eye Res 2020; 45:372-384. [PMID: 31609636 DOI: 10.1080/02713683.2019.1681004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/11/2019] [Indexed: 12/18/2022]
Abstract
Retinal vascular diseases, such as diabetic retinopathy, retinopathy of prematurity, retinal vein occlusion, ocular ischemic syndrome and ischemic optic neuropathy, are leading causes of vision impairment and blindness. Whilst drug, laser or surgery-based treatments for the late stage complications of many of these diseases are available, interventions that target the early vasodegenerative stages are lacking. Progressive vasculopathy and ensuing ischemia is an underpinning pathology in many of these diseases, leading to hypoperfusion, hypoxia, and ultimately pathological neovascularization and/or edema in the retina and other ocular tissues, such as the optic nerve and iris. Therefore, repairing the retinal vasculature may prevent progression of ischemic retinopathies into late stage vascular complications. Various cell types have been explored for their vascular repair potential. Endothelial progenitor cells, mesenchymal stem cells and induced pluripotent stem cells are studied for their potential to integrate with the damaged retinal vasculature and limit ischemic injury. Clinical trials for some of these cell types have confirmed safety and feasibility in the treatment of ischemic diseases, including some retinopathies. Another promising avenue is mobilization of endogenous endothelial progenitors, whereby reparative cells are moved from their niche to circulating blood to target and home into ischemic tissues. Several aspects and properties of these cell types have yet to be elucidated. Nevertheless, we foresee that cell therapy, whether through delivery of exogenous or enhancement of endogenous reparative cells, will become a valuable and beneficial treatment for ischemic retinopathies.
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Affiliation(s)
- Pietro Maria Bertelli
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Edoardo Pedrini
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jasenka Guduric-Fuchs
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Elisa Peixoto
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Varun Pathak
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Alan W Stitt
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Reinhold J Medina
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Science, Queen's University Belfast, Belfast, UK
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Meyer ML, Klein BE, Klein R, Palta P, Sharrett AR, Heiss G, Nambi V, Wong TY, Tanaka H. Central arterial stiffness and retinal vessel calibers: the Atherosclerosis Risk in Communities Study-Neurocognitive Study. J Hypertens 2020; 38:266-273. [PMID: 31584520 PMCID: PMC6949400 DOI: 10.1097/hjh.0000000000002252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/20/2022]
Abstract
BACKGROUND The retinal microvasculature provides a window to the cerebral vasculature and enables examination of changes in retinal caliber that may mimic those occurring in cerebrovascular disease. The association of central arterial stiffness and retinal vessel caliber in a population sample is not fully understood. METHODS In 1706 older adults (mean age 76.3, 58.1% women) from the population-based Atherosclerosis Risk in Communities Study, we examined the cross-sectional association of central arterial stiffness [carotid-femoral pulse wave velocity (cfPWV)] with retinal vessel calibers [central retinal arteriolar equivalent (CRAE) and central retinal vein equivalent (CRVE)]. We estimated the association of cfPWV with CRAE narrowing (<25th percentile) and CRVE widening (>75th percentile) after adjustment for age, sex, race-field center, BMI, smoking, and type 2 diabetes. We tested for effect modification by sex, hypertension, and type 2 diabetes. RESULTS Carotid-femoral PWV (m/s) was not associated with the odds of CRAE narrowing [odds ratio (OR): 0.99; 95% CI: 0.95-1.03]. The association of cfPWV with CRVE widening was stronger in those without hypertension (OR: 1.10; 95% CI: 1.01-1.20) versus those with hypertension (OR: 1.01 95% CI: 0.96-1.05) and slightly stronger in those with type 2 diabetes (OR: 1.07; 95% CI: 1.00-1.14) versus without type 2 diabetes (OR: 1.01; 95% CI: 0.96-1.06). CONCLUSIONS In older adults, cfPWV was associated with wider retinal venular caliber, particularly in individuals without hypertension. Central arterial stiffening may be associated with cerebral microvascular changes, as exhibited in its retinal vasculature component.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Barbara E Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Ronald Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Priya Palta
- Department of Medicine, Columbia University, New York City, NY
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
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Dąbrowska E, Harazny JM, Miszkowska-Nagórna E, Stefański A, Graff B, Kunicka K, Świerblewska E, Rojek A, Szyndler A, Gąsecki D, Wolf J, Gruchała M, Laurent S, Schmieder RE, Narkiewicz K. Aortic stiffness is not only associated with structural but also functional parameters of retinal microcirculation. Microvasc Res 2020; 129:103974. [PMID: 31923388 DOI: 10.1016/j.mvr.2020.103974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/22/2019] [Accepted: 01/01/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of the study was to test the hypothesis that alterations in large arteries are associated with microvascular remodelling and decreased retinal capillary blood flow. METHODS The study group comprised of 88 patients with essential hypertension and 32 healthy controls. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of arterial stiffness measurement (carotid-femoral pulse wave velocity), its hemodynamic consequences (central pulse pressure, augmentation pressure, augmentation index) and intima media thickness of common carotid artery. RESULTS Pulse wave velocity was inversely correlated to mean retinal capillary blood flow in hypertensive patients (R = -0.32, p < 0.01). This relationship remained significant in multivariate regression analysis after adjustment for age, sex, central systolic blood pressure (BP) and body mass index (β = -31.27, p < 0.001). Lumen diameter (LD) of retinal arterioles was significantly smaller in hypertensive then normotensive subjects (79.4 vs. 83.8, p = 0.03). Central and brachial systolic, diastolic and mean BPs were significantly correlated with LD and outer diameter of retinal arterioles. The relationship between LD and central BPs remained significant in multivariate analysis (β = -0.15, p = 0.03 for cSBP; β = -0.22, p = 0.04 for cDBP; β = -0.21, p = 0.03 for cMBP). Moreover, in a subgroup with cardiac damage central and brachial pulse pressure were positively associated with retinal wall thickness, wall cross sectional area, and wall to lumen ratio. CONCLUSION In conclusion, the study provides a strong evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters.
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Affiliation(s)
- Edyta Dąbrowska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland; First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
| | - Joanna M Harazny
- Department of Pathophysiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Clinical Research Centre, Department of Nephrology and Hypertension, Univerity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany
| | - Eliza Miszkowska-Nagórna
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Adrian Stefański
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Beata Graff
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Kunicka
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Świerblewska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Rojek
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Anna Szyndler
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Gąsecki
- Department of Neurology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Roland E Schmieder
- Clinical Research Centre, Department of Nephrology and Hypertension, Univerity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
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Pfeiffer RL, Marc RE, Jones BW. Persistent remodeling and neurodegeneration in late-stage retinal degeneration. Prog Retin Eye Res 2020; 74:100771. [PMID: 31356876 PMCID: PMC6982593 DOI: 10.1016/j.preteyeres.2019.07.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 02/06/2023]
Abstract
Retinal remodeling is a progressive series of negative plasticity revisions that arise from retinal degeneration, and are seen in retinitis pigmentosa, age-related macular degeneration and other forms of retinal disease. These processes occur regardless of the precipitating event leading to degeneration. Retinal remodeling then culminates in a late-stage neurodegeneration that is indistinguishable from progressive central nervous system (CNS) proteinopathies. Following long-term deafferentation from photoreceptor cell death in humans, and long-lived animal models of retinal degeneration, most retinal neurons reprogram, then die. Glial cells reprogram into multiple anomalous metabolic phenotypes. At the same time, survivor neurons display degenerative inclusions that appear identical to progressive CNS neurodegenerative disease, and contain aberrant α-synuclein (α-syn) and phosphorylated α-syn. In addition, ultrastructural analysis indicates a novel potential mechanism for misfolded protein transfer that may explain how proteinopathies spread. While neurodegeneration poses a barrier to prospective retinal interventions that target primary photoreceptor loss, understanding the progression and time-course of retinal remodeling will be essential for the establishment of windows of therapeutic intervention and appropriate tuning and design of interventions. Finally, the development of protein aggregates and widespread neurodegeneration in numerous retinal degenerative diseases positions the retina as a ideal platform for the study of proteinopathies, and mechanisms of neurodegeneration that drive devastating CNS diseases.
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Affiliation(s)
- Rebecca L Pfeiffer
- Dept of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA.
| | - Robert E Marc
- Dept of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Bryan William Jones
- Dept of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA.
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Brücher VC, Storp JJ, Eter N, Alnawaiseh M. Optical coherence tomography angiography-derived flow density: a review of the influencing factors. Graefes Arch Clin Exp Ophthalmol 2019; 258:701-710. [PMID: 31820079 DOI: 10.1007/s00417-019-04553-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 01/09/2023] Open
Abstract
Research interest in the possibility of quantifying macular and optic nerve head perfusion through optical coherence tomography angiography (OCTA) is rapidly advancing. Numerous scientific trials have furthered our understanding of the capabilities and the limitations of this novel technology, while applying OCTA to various ocular pathologies. In recent years, different parameters such as age, gender, intraocular pressure, spherical equivalent, physical activity, systemic diseases, and medication have been shown to have a significant impact on quantitative OCTA metrics. Since OCTA is likely to remain a "hot topic" in the near future, it is crucial to be aware of influencing factors in order to ensure correct interpretation of imaging results. This article reviews the factors currently known to influence flow density (FD) as measured by OCTA in healthy eyes.
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Affiliation(s)
- Viktoria C Brücher
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany.
| | - Jens J Storp
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
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Lipecz A, Miller L, Kovacs I, Czakó C, Csipo T, Baffi J, Csiszar A, Tarantini S, Ungvari Z, Yabluchanskiy A, Conley S. Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions. GeroScience 2019; 41:813-845. [PMID: 31797238 PMCID: PMC6925092 DOI: 10.1007/s11357-019-00138-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of age-related diseases, from heart failure to Alzheimer's disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative stress, mitochondrial dysfunction, and impaired resistance to molecular stressors in the choriocapillaris are also considered in terms of their contribution to the pathogenesis of AMD. The pathogenic roles of cardiovascular risk factors that exacerbate microvascular aging processes, such as smoking, hypertension, and obesity as they relate to AMD and choroid and choriocapillaris changes in patients with these cardiovascular risk factors, are also discussed. Finally, future directions and opportunities to develop novel interventions to prevent/delay AMD by targeting fundamental cellular and molecular aging processes are presented.
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Affiliation(s)
- Agnes Lipecz
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lauren Miller
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA
| | - Illes Kovacs
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA
| | - Cecília Czakó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Tamas Csipo
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Baffi
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Csiszar
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Stefano Tarantini
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA.
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Nagasato D, Tabuchi H, Masumoto H, Enno H, Ishitobi N, Kameoka M, Niki M, Mitamura Y. Automated detection of a nonperfusion area caused by retinal vein occlusion in optical coherence tomography angiography images using deep learning. PLoS One 2019; 14:e0223965. [PMID: 31697697 PMCID: PMC6837754 DOI: 10.1371/journal.pone.0223965] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022] Open
Abstract
We aimed to assess the ability of deep learning (DL) and support vector machine (SVM) to detect a nonperfusion area (NPA) caused by retinal vein occlusion (RVO) with optical coherence tomography angiography (OCTA) images. The study included 322 OCTA images (normal: 148; NPA owing to RVO: 174 [128 branch RVO images and 46 central RVO images]). Training to construct the DL model using deep convolutional neural network (DNN) algorithms was provided using OCTA images. The SVM used a scikit-learn library with a radial basis function kernel. The area under the curve (AUC), sensitivity and specificity for detecting an NPA were examined. We compared the diagnostic ability (sensitivity, specificity and average required time) between the DNN, SVM and seven ophthalmologists. Heat maps were generated. With regard to the DNN, the mean AUC, sensitivity, specificity and average required time for distinguishing RVO OCTA images with an NPA from normal OCTA images were 0.986, 93.7%, 97.3% and 176.9 s, respectively. With regard to SVM, the mean AUC, sensitivity, and specificity were 0.880, 79.3%, and 81.1%, respectively. With regard to the seven ophthalmologists, the mean AUC, sensitivity, specificity and average required time were 0.962, 90.8%, 89.2%, and 700.6 s, respectively. The DNN focused on the foveal avascular zone and NPA in heat maps. The performance of the DNN was significantly better than that of SVM in all parameters (p < 0.01, all) and that of the ophthalmologists in AUC and specificity (p < 0.01, all). The combination of DL and OCTA images had high accuracy for the detection of an NPA, and it might be useful in clinical practice and retinal screening.
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Affiliation(s)
- Daisuke Nagasato
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
- * E-mail:
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | - Hiroki Masumoto
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | | | | | - Masanori Niki
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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