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Christou EE, Katsanos A, Georgalas I, Kozobolis V, Kalogeropoulos C, Stefaniotou M. The Choroid after Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy. ACTA MEDICA (HRADEC KRALOVE) 2023; 65:89-98. [PMID: 36735886 DOI: 10.14712/18059694.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To characterize choroidal structure and vasculature after half-dose verteporfin photodynamic therapy (hd-vPDT) in eyes with chronic central serous chorioretinopathy using Enhanced Depth Imaging Optical Coherence Tomography (EDI OCT) and Optical Coherence Tomography Angiography (OCT-A). METHODS This prospective case-control study included 10 eyes. Choroid was examined before and at 1 month following hd-vPDT. We measured choroidal thickness (CT) at subfoveal area and at 750 μm nasal and temporal of fovea and thickness of Haller and choriocapillaris/Sattler layers. Whole (WA), luminal (LA) and interstitial area (IA) at EDI-OCT, and perfusion density at OCT-A were analyzed. The unaffected fellow eyes were used for comparisons. RESULTS Mean CT at subfoveal area and at 750 μm nasal and temporal of fovea, values of Haller and choriocapillaris/Sattler layers and those of WA, LA and IA were reduced, while PD increased at 1 month after hd-vPDT (all p < 0.001). There was a significant (p < 0.05) negative correlation (ρ = -0.658) between PD and post-treatment logMARVA. None of analyzed parameters reached values of unaffected fellow eye. CONCLUSION Following hd-vPDT, choroidal thickness with both luminal and interstitial components markedly decreased, while perfusion of choriocapillaris improved.
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Affiliation(s)
- Evita Evangelia Christou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Andreas Katsanos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vassilios Kozobolis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Christos Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Clemente L, Cennamo G, Montorio D, Fossataro F, Passaro ML, Costagliola C. OCT-A in chronic central serous chorioretinopathy treated with oral eplerenone and half-fluence photodynamic therapy: A comparative study. Eur J Ophthalmol 2022; 33:11206721221131129. [PMID: 36214140 DOI: 10.1177/11206721221131129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate retinal and choriocapillary vessel density (VD) changes in patients with chronic central serous chorioretinopathy (CSC) treated with half-fluence verteporfin photodynamic therapy (vPDT) or eplerenone, using optical coherence tomography angiography (OCTA). METHODS Patients affected by CSC and treated with vPDT and eplerenone were retrospectively studied. At baseline and 3 months after each treatment, all patients underwent a complete ophthalmological examination, including an evaluation of best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomography (SD-OCT) and OCTA. RESULTS Forty-eight eyes of patients with CSC were analysed. Twenty-four eyes were placed in the vPDT group, and 24 eyes formed the eplerenone group. In both groups, OCTA showed a significant improvement in the VD of deep capillary plexus (DCP) and choriocapillaris (CC) after treatments with respect to baseline (p < 0.001), whereas the VD of superficial capillary plexus (SCP) did not show significant differences (p > 0.05). The PDT group demonstrated a statistically significant increase in the VD of DCP and CC with respect to the eplerenone group (DCP p = 0.012; CC p = 0.004). A statistically significant reduction with respect to baseline in subfoveal choroidal thickness (SFCT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) and in central foveal thickness (CFT) (p = 0.001 for vPDT group; p = 0.001 for eplerenone group) was also found. The SFCT was significantly thinnest in the PDT group with respect to the eplerenone group (p = 0.021). CONCLUSION OCTA allowed us to study retinal and choriocapillary vascular changes in patients with CSC treated with vPDT and eplerenone.
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Affiliation(s)
- Lidia Clemente
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Gilda Cennamo
- Eye Clinic, Public Health Department, 9307University of Naples "Federico II", Naples, Italy
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Federica Fossataro
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, 9307University of Naples "Federico II", Naples, Italy
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Iovino C, Peiretti E, Tatti F, Querques G, Borrelli E, Sacconi R, Chhablani J, Agrawal H, Boon CJF, van Dijk EHC, Cennamo G, Lupidi M, Muzi A, Di Iorio V, Iglicki M, Smadar L, Loewenstein A, Zur D. Photodynamic therapy as a treatment option for peripapillary pachychoroid syndrome: a pilot study. Eye (Lond) 2022; 36:716-723. [PMID: 33824506 PMCID: PMC8956648 DOI: 10.1038/s41433-021-01515-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the anatomical and functional results in eyes with peripapillary pachychoroid syndrome (PPS) undergoing photodynamic therapy (PDT). METHODS A total of 25 eyes from 23 patients with PPS treated with PDT were retrospectively evaluated in this multicentric study. Main outcome measure was the proportion of eyes that achieved treatment success, defined as a decrease in both subretinal fluid (SRF) height and central subfield thickness (CST), at 3 months after PDT compared to baseline. Secondary outcomes were the change in CST, SRF, and best-corrected visual acuity (BCVA) 3 months after treatment and predictive factors for treatment success. When available, data between 3 and 12 months were also reviewed. RESULTS Treatment success was achieved in 16 eyes (64%). In the total cohort, CST decreased significantly from 356 ± 118 µm at baseline to 282 ± 90 µm and 270 ± 91 µm at 1 and 3 months, respectively (p < 0.001). Maximal SRF height decreased significantly from 102 ± 83 µm at baseline to 38 ± 46 µm and 32 ± 42 µm at 1 and 3 months, respectively (p < 0.001), and remained stable at month 6 (29 ± 44 µm) and month 12 (23 ± 35 µm). BCVA improved significantly from baseline to month 3 (p = 0.021). CONCLUSIONS PDT can be considered an efficacious treatment option in patients with PPS. Prospective data with longer follow-up in a bigger cohort are needed in order to determine the optimal treatment algorithm in this relatively novel disease.
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Affiliation(s)
- Claudio Iovino
- grid.9841.40000 0001 2200 8888Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Enrico Peiretti
- grid.7763.50000 0004 1755 3242Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Filippo Tatti
- grid.7763.50000 0004 1755 3242Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Giuseppe Querques
- grid.18887.3e0000000417581884Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Enrico Borrelli
- grid.18887.3e0000000417581884Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Riccardo Sacconi
- grid.18887.3e0000000417581884Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Jay Chhablani
- grid.21925.3d0000 0004 1936 9000UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA USA
| | - Hitesh Agrawal
- grid.417748.90000 0004 1767 1636LV Prasad Eye Institute, Hyderabad, India
| | - Camiel J. F. Boon
- grid.10419.3d0000000089452978Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands ,grid.7177.60000000084992262Department of Ophthalmology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Elon H. C. van Dijk
- grid.10419.3d0000000089452978Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gilda Cennamo
- grid.4691.a0000 0001 0790 385XEye Clinic, Public Health Department, University of Naples Federico II, Naples, Italy
| | - Marco Lupidi
- grid.9027.c0000 0004 1757 3630Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Muzi
- grid.9027.c0000 0004 1757 3630Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Di Iorio
- grid.9841.40000 0001 2200 8888Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Matias Iglicki
- grid.7345.50000 0001 0056 1981Private Retina Practice, University of Buenos Aires, Buenos Aires, Argentina
| | - Lital Smadar
- grid.12136.370000 0004 1937 0546Division of Ophthalmology, Tel Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- grid.12136.370000 0004 1937 0546Division of Ophthalmology, Tel Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dinah Zur
- grid.12136.370000 0004 1937 0546Division of Ophthalmology, Tel Aviv Sourasky Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Christou EE, Stavrakas P, Kozobolis V, Katsanos A, Georgalas I, Stefaniotou M. Evaluation of the choriocapillaris after photodynamic therapy for chronic central serous chorioretinopathy. A review of optical coherence tomography angiography (OCT-A) studies. Graefes Arch Clin Exp Ophthalmol 2022; 260:1823-1835. [PMID: 35044503 DOI: 10.1007/s00417-022-05563-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Emerging evidence suggests that choroidal microcirculation and microstructural changes after verteporfin photodynamic therapy (vPDT) for chronic central serous chorioretinopathy (CSC) can be shown in detail using OCT-Angiography (OCT-A). The use of OCT-A for the examination of choriocapillaris (CC) has attracted significant attention as the technique offers potential explanations for the effects of vPDT on choroidal tissue. METHODS A meticulous literature search was performed in the PubMed database without restriction on year of publication until June 2021. The reference list of all electronically retrieved articles was carefully reviewed for potentially relevant articles that had not been identified. RESULTS We identified and reviewed 11 studies reporting a comprehensive update on microvasculature and morphologic changes of the CC layer as seen on OCT-A in chronic CSC. The reviewed articles extensively analyze both the qualitative and quantitative characteristics of the CC flow pattern after applying vPDT safety-enhanced protocols. The changes in the CC plexus indicate the potential of beneficial or deleterious treatment effect on choroidal tissue remodeling. The reviewed series have revealed variability of flow pattern, vessel density, and perfusion of the CC over time. CONCLUSION The CC plexus alterations during the post-vPDT period in chronic CSC may imply the treatment effect on choroidal tissue, indicating the potential of anatomical or functional recovery over time. The reviewed literature may confirm the diagnostic value of OCT-A in the assessment of the pathophysiology of eyes with CSC.
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Affiliation(s)
- Evita Evangelia Christou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece.
| | - Panagiotis Stavrakas
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Vassilios Kozobolis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupoli, Greece.,Eye Institute of Thrace, Democritus University of Thrace, Komotini, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
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Applications of Multimodal Imaging in Central Serous Chorioretinopathy Evaluation. J Ophthalmol 2021; 2021:9929864. [PMID: 34350034 PMCID: PMC8328719 DOI: 10.1155/2021/9929864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022] Open
Abstract
Central serous chorioretinopathy (CSCR) is a macular disease characterized by serous retinal detachment commonly involving the macular region. CSCR has a wide spectrum of clinical presentations. Although a significant proportion of CSCR cases are self-limiting, patients can suffer from persistent or recurrent disease, sometimes complicated with choroidal neovascularization, resulting in permanent visual loss. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and optical coherence tomography, has advanced the diagnosis and classification of CSCR cases. Evolution of new imaging techniques including optical coherence tomography angiography, wide-field imaging, and en face reconstruction imaging has also contributed to better understandings of the pathophysiology of CSCR. This review article summarizes the features of multimodal imaging for CSCR and discusses the application of such features in evaluating the disease.
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Early alterations in retinal microvasculature on swept-source optical coherence tomography angiography in acute central serous chorioretinopathy. Sci Rep 2021; 11:3129. [PMID: 33542349 PMCID: PMC7862300 DOI: 10.1038/s41598-021-82650-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
The purpose of the study was to evaluate the retinal blood flow in patients with acute central serous chorioretinopathy (CSC) over an observational period of 1 month using swept-source optical coherence tomography (SS-OCTA), focusing especially on changes in the area of subretinal fluid (A-SRF). We correlated these findings with conventional indocyanine green angiography (ICGA). ICGA and SS-OCTA images were collected and analyzed of 12 eyes of 12 patients. The A-SRF was annotated and a qualitative analysis of choriocapillaris, the vessel density (VD) and perfusion density (PD) of the retinal superficial capillary plexus (SCP) and the deep capillary plexus (DCP) was performed in A-SRF and the unaffected remaining area (RA). The VD and PD in the DCP were statistically significantly lower in A-SRF than in the RA at baseline. (VD: p = 0.014; PD: p = 0.036). After 1 month, there was a statistically significant difference in the VD and PD of the DCP (VD: p = 0.015; PD: p = 0.014), and for the PD of the SCP between the A-SRF and the RA (p = 0.015), with lower values in the A-SRF. We found low perfused areas in choriocapillaris corresponding to hypofluorescent areas on ICGA. In conclusion there is a difference in VD and VD of the DCP in the area of SRF in acute CSC. These alterations may lead to a chronic change in the microvasculature and potentially to morphological changes.
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Han KJ, Kim HJ, Woo JM, Min JK. Comparison of Retinal Layer Thickness and Capillary Vessel Density in the Patients with Spontaneously Resolved Acute Central Serous Chorioretinopathy. J Clin Med 2020; 10:jcm10010045. [PMID: 33375674 PMCID: PMC7795401 DOI: 10.3390/jcm10010045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
We investigate retinal layer thickness and capillary vessel density (VD) in the patients with central serous chorioretinopathy (CSC) who recovered spontaneously and evaluate the correlation between the changes in these values and visual outcomes using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). This retrospective case–control study included 34 eyes of 34 patients with spontaneously resolved acute CSC. The changes in retinal layer thickness and capillary VD were examined using SS-OCT and OCTA after complete resolution of subretinal fluid (SRF). The fellow eyes and 34 healthy eyes were used as controls. In the eyes with CSC, the outer retinal layer was significantly thinner than in the eyes of fellow and healthy controls. The foveal avascular zone area and VDs in the superficial and deep capillary plexus in the eyes with CSC were not significantly different from those in the eyes of fellow and healthy controls. The VD of the choriocapillaris in the eyes with CSC was significantly lower than that in the eyes of fellow and healthy controls. Correlation analyses revealed that the outer retinal layer thickness and initial visual acuity were positively correlated with the final visual acuity. Furthermore, the initial SRF area and height were negatively correlated with the outer retinal layer thickness after SRF resolution. Attenuation of outer retinal layer thickness and decreased VD of the choriocapillaris were observed in the eyes with spontaneously resolved acute CSC. The outer retinal layer thickness could be an important visual predictor of CSC.
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Arslan U, Özmert E. Treatment of resistant chronic central serous chorioretinopathy via platelet-rich plasma with electromagnetic stimulation. Regen Med 2020; 15:2001-2014. [PMID: 33107400 DOI: 10.2217/rme-2020-0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: To evaluate whether subtenon injection of platelet-rich plasma (PRP) with retinal electromagnetic stimulation (rEMS) is effective in therapy-resistant chronic central serous chorioretinopathy (CSCR). Design: Prospective, sequential. Materials & methods: The study included 22 eyes with resistant chronic CSCR. Cases receiving micropulse laser or additional photodynamic therapy, subtenon PRP, and subtenon PRP + rEMS were classified as times 1, 2 and 3, respectively. Results: At time 3, the mean best-corrected visual acuity was 85.7 and 97.0 letters before and after the procedures, respectively (p = 0.01). Submacular thickness improved by 17, 27 and 51% at times 1, 2 and 3 respectively. Conclusion: For treating resistant CSCR, subtenon PRP + rEMS should be considered as an effective and safe option. Trial Registration: ClinicalTrials.gov ID: NCT04224831.
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Affiliation(s)
- Umut Arslan
- Ankara University Technopolis, Ankara, Turkey
| | - Emin Özmert
- Ankara University Faculty of Medicine Department of Ophthalmology, Ankara, Turkey
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Cennamo G, Montorio D, Bernardo R, Farella A, Liuzzi R, Breve MA, Reibaldi M, Cennamo G. Retinal Vascular Changes in Radiation Maculopathy after Intravitreal Ranibizumab by Optical Coherence Tomography Angiography. J Clin Med 2020; 9:jcm9061618. [PMID: 32471149 PMCID: PMC7356529 DOI: 10.3390/jcm9061618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/16/2022] Open
Abstract
In this prospective study, we investigated the structural and vascular retinal changes at baseline and after Ranibizumab injections at the last follow up to one year in patients affected by Radiation Maculopathy (RM) after plaque brachytheraphy in choroidal melanoma, using Spectral Domain Optical Coherence Tomography (SD-OCT) and OCT Angiography (OCTA). A total of 40 eyes with RM of 40 patients (18 females, 22 males, mean age 51.9 ± 11 years) that underwent ruthenium-106 plaque brachytherapy were included. All patients received one monthly intravitreal injection of Ranibizumab (Pro Re Nata regimen). We analyzed the Foveal Avascular Zone (FAZ) area, the retinal vessel density (VD) of the superficial capillary plexus (SCP) and of the deep capillary plexus (DCP), using OCTA, and we detected the Central Foveal Thickness (CFT) by SD-OCT at baseline and after treatment. At the last follow up, we found a significant improvement of the CFT (p < 0.001) while OCTA parameters revealed no change in VD of the SCP (p = 0.402), DCP (p = 0.282), and FAZ area (p = 0.255), resulting in a stabilization of the visual acuity (p = 0.210) respect to baseline. The absence of functional improvement, despite the anatomical recovery of the macula, could be due to the absence of improvement in FAZ area and in retinal VD after treatment. OCTA parameters could represent predictive biomarkers to anti-vascular endothelial growth factor (anti-VEGF) intravitreal response and to help to better understand the physiopathological mechanisms of the RM.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Roberta Bernardo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Antonio Farella
- Functional and Morphologic Department of Radiotherapy and Legal Medicine, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council (CNR), 80145 Naples, Italy;
| | - Maria Angelica Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10124 Torino, Italy
- Correspondence:
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
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