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Sarvestani MT, Cugati S, Chen C. Correlation of Structure With Function: Future Utilities for Optical Coherence Tomography Angiography in Neuro-Ophthalmology. Clin Exp Ophthalmol 2025. [PMID: 40269483 DOI: 10.1111/ceo.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 04/02/2025] [Accepted: 04/10/2025] [Indexed: 04/25/2025]
Abstract
Optical coherence tomography angiography is a burgeoning imaging modality in Ophthalmology. In this review, we outline the breadth of potential utility for optical coherence tomography angiography for diagnosis and prognostication in neuro-ophthalmology. Further mapping of the characteristics and natural history of the optic disc vascular network in neuro-ophthalmic conditions is necessary to increase the utility of this imaging modality for neuro-ophthalmic conditions, as the specificity and sensitivity of optical coherence tomography angiography are currently limited by the small pool of available observational data.
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Affiliation(s)
- Marzieh Tahmasebi Sarvestani
- Department of Ophthalmology, Modbury Hospital, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sudha Cugati
- Department of Ophthalmology, Modbury Hospital, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medicine Centre and Flinders University, Adelaide, South Australia, Australia
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Bostan M, Li C, Cheong JW, Wong DWK, Tan B, Ismail MB, Garhöfer G, Coroleuca R, Schmetterer L, Popa-Cherecheanu A, Chua J. Longitudinal analysis of retinal and choriocapillaris in patients with multiple sclerosis: a 3-year study. J Neurol 2025; 272:237. [PMID: 40025301 PMCID: PMC11872746 DOI: 10.1007/s00415-025-12930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/18/2025] [Accepted: 01/21/2025] [Indexed: 03/04/2025]
Abstract
OBJECTIVES This study investigated the longitudinal progression of retinal structure and microvasculature over 3 years in patients with relapsing-remitting multiple sclerosis (RRMS) using optical coherence tomography (OCT) and OCT angiography (OCTA). It also explored the correlation between these changes and the Expanded Disability Status Scale (EDSS) scores. METHODS In this prospective, longitudinal study, we enrolled 66 patients with RRMS without history of optic neuritis and 124 healthy controls. All participants underwent full ophthalmological examination, OCT/OCTA scans, and disability scoring (EDSS) at baseline and after 12 and 24 months. OCT data were analyzed for retinal layer thickness, while OCTA assessed microvascular perfusion in the retinal capillary plexuses and choriocapillaris. Statistical models evaluated yearly rates of change and their association with EDSS scores. RESULTS The patients with RRMS exhibited 3.6 times faster thinning of the inner plexiform layer (IPL; - 0.47 µm per year, P = 0.001) compared to controls over 3 years. Additionally, superficial retinal capillary layer perfusion density decreased more rapidly at - 0.44% per year (P = 0.006) in patients with MS. A strong correlation was found between worsening EDSS scores and accelerated ONL thinning (estimated coefficient: - 1.62 µm/per unit change of EDSS score, P = 0.004). DISCUSSION This study demonstrates progressive retinal neurodegeneration and microvascular dysfunction in patients with RRMS without a history of optic neuritis. The association between ONL thinning and increased disability supports the potential of OCT/OCTA as valuable tools for monitoring disease progression and severity in RRMS.
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Affiliation(s)
- Mihai Bostan
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Chi Li
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
| | - Jia Wei Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
| | - Damon Wing Kee Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Munirah Binte Ismail
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Ruxandra Coroleuca
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania.
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore, 169856, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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Iacovazzo C, Vargas M, Marra A. A new device for monitoring end-tidal carbon dioxide during light sedation in surgical procedures. Med Gas Res 2024; 14:167-168. [PMID: 40434380 PMCID: PMC11257190 DOI: 10.4103/mgr.medgasres-d-23-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 05/29/2025] Open
Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, via Pansini, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, via Pansini, Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, via Pansini, Naples, Italy
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Merola R, Vargas M. Economic Indicators, Quantity and Quality of Health Care Resources Affecting Post-surgical Mortality. J Epidemiol Glob Health 2024; 14:613-620. [PMID: 38801492 PMCID: PMC11442816 DOI: 10.1007/s44197-024-00249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE to identify correlations between quality and quantity of health care resources, national economic indicators, and postoperative in-hospital mortality as reported in the EUSOS study. METHODS Different variables were identified from a series of publicly available database. Postoperative in-hospital mortality was identified as reported by EUSOS study. Spearman non-parametric and Coefficients of non-linear regression were calculated. RESULTS Quality of health care resources was strongly and negatively correlated to postoperative in-hospital mortality. Quantity of health care resources were negatively and moderately correlated to postoperative in-hospital mortality. National economic indicators were moderately and negatively correlated to postoperative in-hospital mortality. General mortality, as reported by WHO, was positively but very moderately correlated with postoperative in-hospital mortality. CONCLUSIONS Postoperative in-hospital mortality is strongly determined by quality of health care instead of quantity of health resources and health expenditures. We suggest that improving the quality of health care system might reduce postoperative in-hospital mortality.
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Affiliation(s)
- Raffaele Merola
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Maria Vargas
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Yılmaz Tuğan B, Bünül SD, Kara B, Alikılıç D, Karabaş L, Efendi H, Yüksel N. Retinal and Choroidal Vascularity Evaluation in Pediatric Radiologically Isolated Syndrome and Multiple Sclerosis. Pediatr Neurol 2024; 153:34-43. [PMID: 38320456 DOI: 10.1016/j.pediatrneurol.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND To assess vessel density (VD) and flow of retinal plexuses and peripapillary region related with the pediatric radiologically isolated syndrome (RIS) and multiple sclerosis (MS). METHODS We analyzed 24 eyes of 12 participants with the diagnosis of RIS, 24 eyes of 12 participants with the diagnosis of MS, and 26 eyes of 13 age- and sex-matched healthy controls in this prospective, cross-sectional study. The superficial capillary plexus (SCP) and deep capillary plexus, foveal avascular zone, and the flow of choriocapillaris were investigated using optical coherence tomography angiography. RESULTS Parafoveal VD and all subregion parameters in SCP were significantly decreased in the MS group compared with the controls, whereas only nasal and inferior VD were significantly decreased in the pediatric RIS group compared with the controls. Ganglion cell layer (GCL) thickness of all subregions of the inner ring was significantly decreased in the pediatric MS group compared with the control group. No significant difference was observed between the pediatric RIS group and the control group regarding thickness. CONCLUSIONS We showed lower parafoveal VD in all subregions of SCP in pediatric MS, whereas only parafoveal nasal and inferior VD were decreased in pediatric RIS. GCL thickness of inner ring was significantly decreased in the pediatric MS, whereas GCL thickness did not change in pediatric RIS. Therefore, a decrease of parafoveal nasal and inferior VD without a decrease in thickness implies an early impairment of microvasculature in the RIS before impairment of thickness and that microvascular alterations begin from highly vascular superficial parafovea.
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Affiliation(s)
| | | | - Bülent Kara
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Defne Alikılıç
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
| | - Hüsnü Efendi
- Department of Neurology, Kocaeli University, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
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Iacovazzo C, Capasso L, Visani C, Salomè S, Vargas M. Pregnant Patients with COVID-19 Admitted to an ICU: A Comparison with a Historical Cohort of Critical Pregnant Patients without COVID-19. Life (Basel) 2024; 14:165. [PMID: 38398674 PMCID: PMC10890200 DOI: 10.3390/life14020165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
AIM OF THE STUDY Maternal mortality and ICU admissions have increased during the COVID-19 pandemic. We reported a case-series of pregnant patients with COVID-19 admitted to an ICU and we compared them with a historical cohort of pregnant patients admitted to an ICU without COVID-19. METHODS We included all pregnant patients with laboratory-confirmed COVID-19 infection admitted to our ICU in 2021. As a historical control group, we included all pregnant women who were admitted to our ICU between 1 January 2008 and 31 December 2013. RESULTS In 2021, 11 pregnant patients (pts) with COVID-19 were admitted to an ICU, representing 2.87% of ICU admissions. We found that pregnant patients with COVID-19 (1) had a higher BMI (34.6 vs. 28.8, p = 0.04) and a lower gestational age (30.6 vs. 34 weeks, p = 0.03), (2) were mainly admitted for respiratory failure (100% vs. 2.7%; p = 0.001) and (3) required more days of invasive and non-invasive ventilations (54.5% vs. 5.2%, p = 0.002), a longer duration of stay at the ICU (21.9 vs. 4.8 days, p < 0.0001) and had a higher mortality rate (27.3% vs. 0%, p = 0.0192). CONCLUSIONS Pregnant patients with COVID-19 represent a challenge for ICU physicians due to their different characteristics and outcomes when compared to pregnant patients without COVID-19.
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Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100 Naples, Italy
| | - Letizia Capasso
- Department of Translational Medical Sciences, Division of Neonatology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (S.S.)
| | - Carola Visani
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100 Naples, Italy
| | - Serena Salomè
- Department of Translational Medical Sciences, Division of Neonatology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (S.S.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100 Naples, Italy
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Romahn EF, Wiltgen T, Bussas M, Aly L, Wicklein R, Noll C, Berthele A, Dehmelt V, Mardin C, Zimmer C, Korn T, Hemmer B, Kirschke JS, Mühlau M, Knier B. Association of retinal vessel pathology and brain atrophy in relapsing-remitting multiple sclerosis. Front Immunol 2023; 14:1284986. [PMID: 38090586 PMCID: PMC10715309 DOI: 10.3389/fimmu.2023.1284986] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal vessel structures. Thinning and loss of retinal vessels is evident in eyes of patients with multiple sclerosis (MS) and might be associated with a proinflammatory disease phenotype and worse prognosis. We investigated whether changes of the retinal vasculature are linked to brain atrophy and disability in MS. Material and methods This study includes one longitudinal observational cohort (n=79) of patients with relapsing-remitting MS. Patients underwent annual assessment of the expanded disability status scale (EDSS), timed 25-foot walk, symbol digit modalities test (SDMT), retinal optical coherence tomography (OCT), OCTA, and brain MRI during a follow-up duration of at least 20 months. We investigated intra-individual associations between changes in the retinal architecture, vasculature, brain atrophy and disability. Eyes with a history of optic neuritis (ON) were excluded. Results We included 79 patients with a median disease duration of 12 (interquartile range 2 - 49) months and a median EDSS of 1.0 (0 - 2.0). Longitudinal retinal axonal and ganglion cell loss were linked to grey matter atrophy, cortical atrophy, and volume loss of the putamen. We observed an association between vessel loss of the superficial vascular complex (SVC) and both grey and white matter atrophy. Both observations were independent of retinal ganglion cell loss. Moreover, patients with worsening of the EDSS and SDMT revealed a pronounced longitudinal rarefication of the SVC and the deep vascular complex. Discussion ON-independent narrowing of the retinal vasculature might be linked to brain atrophy and disability in MS. Our findings suggest that retinal OCTA might be a new tool for monitoring neurodegeneration during MS.
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Affiliation(s)
- Eva Feodora Romahn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christina Noll
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Vera Dehmelt
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Coviello A, Iacovazzo C, Cirillo D, Diglio P, Bernasconi A, D’Abrunzo A, Barone MS, Posillipo C, Vargas M, Servillo G. The Twenty-Five Most Cited Articles About Adductor Canal Block: A Bibliometric Analysis from 1980 to 2022. J Pain Res 2023; 16:3353-3365. [PMID: 37808463 PMCID: PMC10557973 DOI: 10.2147/jpr.s415184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Loco-regional anesthesia role is increasingly important in surgery, especially in postoperative pain control. Using ultrasound-guided techniques has made the loco-regional approach increasingly safe and manageable, guaranteeing excellent analgesic results and patient compliance. This bibliometric research aimed to identify the most influential papers on the adductor canal blocks and outline their characteristics. Methods All articles published from 1980 to 2022 were included in the Web of Science, PubMed, and Scopus databases and found using the keywords "Adductor canal block" or "Saphenous nerve block" or "Peripheral nerve block" or "Hunter canal block" or "Subsartorial canal block" or "ACB" or "Knee" or "TKR" or "TKA" or "Analgesia" or "Arthroplasty" or "Replacement" in the title section had bibliometric analysis performed. The first 25 papers were selected and analyzed by the number of citations. The correlation between numerical variables was evaluated using the Pearson Correlation coefficient. Results Literature screening found 252 publications. One hundred ten were only about the adductor canal block. Of these, 25 articles were selected for our bibliometric study, published in 8 different journals and with a total number of citations equal to 1.457. "Regional Anesthesia and pain medicine" journal - with 9 articles - was the one that produced the most. There was a significant strong correlation between the n. of citations and the citation rate (R = 0.84, p < 0.001). Conclusion The purpose of this study is to be a guide on regional anesthesia and, particularly, on adductor canal block, making the most effective as well as the most cited articles available to anesthesiologists or other researchers interested in this topic.
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Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Dario Cirillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Pasquale Diglio
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Alessio Bernasconi
- Department of Public Health, School of Medicine, “Federico II” University of Naples, Unit of Orthopedics and Traumatology, Naples, Italy
| | - Anella D’Abrunzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Maria Silvia Barone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Concetta Posillipo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Naples, Italy
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Leister N, Bachmann B, Matthaei M, Trieschmann U, Schumacher C, Löw V, Böttiger BW, Schrittenlocher S, Heindl LM, Cursiefen C. Immediate postoperative topical lidocaine gel for the treatment of eye pain following corneal abrasion in descemet membrane endothelial keratoplasty (DMEK) under general anaesthesia: a pilot retrospective analysis. BMC Anesthesiol 2023; 23:305. [PMID: 37689627 PMCID: PMC10492328 DOI: 10.1186/s12871-023-02258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Patients undergoing corneal abrasion as part of Descemet membrane endothelial keratoplasty (DMEK) under general anesthesia suffer from early burning pain postoperatively. This pain appears to be poorly treatable with systemic analgesics. This study aims to evaluate postoperative pain management using topical lidocaine gel after DMEK with iatrogenic corneal abrasion. METHODS Retrospective analysis of 28 consecutive patients undergoing DMEK with corneal abrasion from October 19, 2021, to November 12, 2021, at a German university hospital. Patients during week 1 and 2 received peri-operative standard pain treatment (cohort S) and additional local lidocaine gel during week 3 and 4 immediately postoperatively (cohort L). RESULTS 13 patients were included in cohort S and 15 patients in cohort L. At awakening all patients (100%) in cohort S reported burning pain, and six of 15 patients (40%) in cohort L reported burning pain. Burning pain scores were significantly lower in cohort L (p < 0.001 at awakening, p < 0.001 at 10 min, p < 0.001 at 20 min, p < 0.001 at 30 min, p = 0.007 at 40 min after awakening, and p < 0.001 at leaving recovery room). No significant differences between cohort S and cohort L were detected concerning surgical outcome during 1-month-follow-up (p = 0.901 for best corrected visual acuity). CONCLUSION Patients undergoing DMEK with corneal abrasion suffer significant pain in the recovery room. A single dose of topic lidocaine gel reduces the early postoperative burning pain sufficiently and does not affect the surgical outcome.
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Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Björn Bachmann
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Mario Matthaei
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Christine Schumacher
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Vanessa Löw
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Silvia Schrittenlocher
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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Iacovazzo C, Buonanno P, Massaro M, Ianniello M, de Siena AU, Vargas M, Marra A. Robot-Assisted versus Laparoscopic Gastrointestinal Surgery: A Systematic Review and Metanalysis of Intra- and Post-Operative Complications. J Pers Med 2023; 13:1297. [PMID: 37763064 PMCID: PMC10532788 DOI: 10.3390/jpm13091297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The use of robotic surgery is attracting ever-growing interest for its potential advantages such as small incisions, fine movements, and magnification of the operating field. Only a few randomized controlled trials (RCTs) have explored the differences in perioperative outcomes between the two approaches. METHODS We screened the main online databases from inception to May 2023. We included studies in English enrolling adult patients undergoing elective gastrointestinal surgery. We used the following exclusion criteria: surgery with the involvement of thoracic esophagus, and patients affected by severe heart, pulmonary and end-stage renal disease. We compared intra- and post-operative complications, length of hospitalization, and costs between laparoscopic and robotic approaches. RESULTS A total of 18 RCTs were included. We found no differences in the rate of anastomotic leakage, cardiovascular complications, estimated blood loss, readmission, deep vein thrombosis, length of hospitalization, mortality, and post-operative pain between robotic and laparoscopic surgery; post-operative pneumonia was less frequent in the robotic approach. The conversion to open surgery was less frequent in the robotic approach, which was characterized by shorter time to first flatus but higher operative time and costs. CONCLUSIONS The robotic gastrointestinal surgery has some advantages compared to the laparoscopic technique such as lower conversion rate, faster recovery of bowel movement, but it has higher economic costs.
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Codron P, Masmoudi I, Tran THC. Retinal Vascular Density Using Optical Coherence Tomography-Angiography in Optic Neuritis. J Clin Med 2023; 12:5403. [PMID: 37629445 PMCID: PMC10455229 DOI: 10.3390/jcm12165403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study is to access the perifoveolar and peripapillary vascular density (VD) using optical coherence tomography-angiography (OCT-A) in eyes with optic neuritis (ON) and in fellow eyes, then compare that to healthy controls. METHOD This is a cross-sectional study including 22 patients with unilateral ON and 20 control eyes of healthy subjects. A complete clinical examination and OCT-A were performed at least 6 months after the acute episode of optic neuritis. Vascular plexuses of the peripapillary and perifoveolar images obtained from OCT-A were used to calculate the VD in each plexus: superficial, deep, and peripapillary capillaries for each group (ON eyes, fellow eyes, healthy eyes). RESULTS Compared to healthy control eyes, in the peripapillary area, we found a significant decrease in VD not only in ON eyes but also in fellow eyes in average (p ≤ 0.05) and in the temporal sector (p < 0.001). In the perifoveolar area, the VD of the superficial capillary plexus is decreased in all sectors (p < 0.001) in ON eyes and only in the upper sector (p = 0.037) of fellow eyes compared to control eyes. VD correlates with ganglion cell layer (GCL) thickness in ON and in fellow eyes. CONCLUSION Peripapillary vascular density is decreased in both affected eyes and fellow eyes after a unilateral episode of optic neuritis, suggesting a subclinical involvement of the disease. Further studies are needed to clarify the mechanism and clinical implications of these data.
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Affiliation(s)
- Paul Codron
- Department of Ophthalmology, Amiens University Hospital, 80000 Amiens, France;
| | - Ines Masmoudi
- Department of Neurology, Amiens University Hospital, 80000 Amiens, France;
| | - Thi Ha Chau Tran
- Department of Ophthalmology, Amiens University Hospital, 80000 Amiens, France;
- Laboratory of Lille Neurosciences & Cognition, INSERM U1172, 59000 Lille, France
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Mohammadi S, Gouravani M, Salehi MA, Arevalo JF, Galetta SL, Harandi H, Frohman EM, Frohman TC, Saidha S, Sattarnezhad N, Paul F. Optical coherence tomography angiography measurements in multiple sclerosis: a systematic review and meta-analysis. J Neuroinflammation 2023; 20:85. [PMID: 36973708 PMCID: PMC10041805 DOI: 10.1186/s12974-023-02763-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent literature on multiple sclerosis (MS) demonstrates the growing implementation of optical coherence tomography-angiography (OCT-A) to discover potential qualitative and quantitative changes in the retina and optic nerve. In this review, we analyze OCT-A studies in patients with MS and examine its utility as a surrogate or precursor to changes in central nervous system tissue. METHODS PubMed and EMBASE were systematically searched to identify articles that applied OCT-A to evaluate the retinal microvasculature measurements in patients with MS. Quantitative data synthesis was performed on all measurements which were evaluated in at least two unique studies with the same OCT-A devices, software, and study population compared to controls. A fixed-effects or random-effects model was applied for the meta-analysis based on the heterogeneity level. RESULTS The study selection process yielded the inclusion of 18 studies with a total of 1552 evaluated eyes in 673 MS-associated optic neuritis (MSON) eyes, 741 MS without optic neuritis (MSNON eyes), and 138 eyes without specification for the presence of optic neuritis (ON) in addition to 1107 healthy control (HC) eyes. Results indicated that MS cases had significantly decreased whole image superficial capillary plexus (SCP) vessel density when compared to healthy control subjects in the analyses conducted on Optovue and Topcon studies (both P < 0.0001). Likewise, the whole image vessel densities of deep capillary plexus (DCP) and radial peripapillary capillary (RPC) were significantly lower in MS cases compared to HC (all P < 0.05). Regarding optic disc area quadrants, MSON eyes had significantly decreased mean RPC vessel density compared to MSNON eyes in all quadrants except for the inferior (all P < 0.05). Results of the analysis of studies that used prototype Axsun machine revealed that MSON and MSNON eyes both had significantly lower ONH flow index compared to HC (both P < 0.0001). CONCLUSIONS This systematic review and meta-analysis of the studies reporting OCT-A measurements of people with MS confirmed the tendency of MS eyes to exhibit reduced vessel density in the macular and optic disc areas, mainly in SCP, DCP, and RPC vessel densities.
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Affiliation(s)
- Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151 Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151 Iran
| | - Mohammad Amin Salehi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151 Iran
| | - J. Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven L. Galetta
- Department of Neurology, New York University Langone Medical Center, New York, NY USA
| | - Hamid Harandi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151 Iran
| | - Elliot M. Frohman
- Laboratory of Neuroimmunology, Stanford University School of Medicine, Stanford, CA USA
| | - Teresa C. Frohman
- Laboratory of Neuroimmunology, Stanford University School of Medicine, Stanford, CA USA
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD USA
| | - Neda Sattarnezhad
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, Stanford Multiple Sclerosis Center, Stanford University, Stanford, USA
| | - Friedemann Paul
- Department of Neurology, Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
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A prospective study of disease modifying therapy and retinal atrophy in relapsing-remitting multiple sclerosis. J Neurol Sci 2023; 446:120552. [PMID: 36774748 DOI: 10.1016/j.jns.2023.120552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND To compare the rate of retinal atrophy over time in patients with relapsing-remitting multiple sclerosis (RRMS) treated with various disease-modifying therapies (DMT). METHODS Patients with RRMS on various DMT and those observed without treatment were prospectively enrolled into the study between September 2015 and June 2018. All subjects with follow-up of 1-4 years were included and categorized into groups as "no drug", "low efficacy drug", "high efficacy drug", or "dimethyl fumarate" (DMF), based on treatment modality used for the longest duration of their follow-up. Ocular coherence tomography (OCT) was used to measure peripapillary retinal nerve fiber layer thickness (RNFL) and ganglion cell/inner plexiform layer (GC-IPL) thickness at baseline and every 6 months. A linear mixed effects regression model was performed to compare rates of retinal atrophy across treatment groups. RESULTS Out of 67 participants who met inclusion criteria (mean age = 37; 76% female), 13 were untreated, 12 on low efficacy therapy, 18 on DMF, and 24 on high efficacy therapy. History of optic neuritis was associated with lower baseline GC-IPL thickness (p = 0.003). Higher baseline GC-IPL thickness was associated with increased rate of GC-IPL thinning (p = 0.009). Age, disease duration, and ethnicity were not predictors of baseline RNFL or GC-IPL thickness, or rate of atrophy of these layers. CONCLUSIONS There were no differences in rate of GC-IPL atrophy between patients with RRMS on different treatments in this cohort. Age, disease duration, and ethnicity also did not predict retinal atrophy. History of ON was associated with reduced GC-IPL thickness at baseline, consistent with previous research. Rate of GC-IPL thinning was higher for subjects with higher baseline GC-IPL thickness, suggesting a plateau effect.
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Noll C, Hiltensperger M, Aly L, Wicklein R, Afzali AM, Mardin C, Gasperi C, Berthele A, Hemmer B, Korn T, Knier B. Association of the retinal vasculature, intrathecal immunity, and disability in multiple sclerosis. Front Immunol 2022; 13:997043. [PMID: 36439131 PMCID: PMC9695398 DOI: 10.3389/fimmu.2022.997043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/20/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCT-A) is a novel technique allowing non-invasive assessment of the retinal vasculature. During relapsing remitting multiple sclerosis (RRMS), retinal vessel loss occurs in eyes suffering from acute optic neuritis and recent data suggest that retinal vessel loss might also be evident in non-affected eyes. We investigated whether alterations of the retinal vasculature are linked to the intrathecal immunity and whether they allow prognostication of the future disease course. MATERIAL AND METHODS This study includes two different patient cohorts recruited at a tertiary German academic multiple sclerosis center between 2018 and 2020 and a cohort of 40 healthy controls. A total of 90 patients with RRMS undergoing lumbar puncture and OCT-A analysis were enrolled into a cross-sectional cohort study to search for associations between the retinal vasculature and the intrathecal immune compartment. We recruited another 86 RRMS patients into a prospective observational cohort study who underwent clinical examination, OCT-A and cerebral magnetic resonance imaging at baseline and during annual follow-up visits to clarify whether alterations of the retinal vessels are linked to RRMS disease activity. Eyes with a history of optic neuritis were excluded from the analysis. RESULTS Rarefication of the superficial vascular complex occured during RRMS and was linked to higher frequencies of activated B cells and higher levels of the pro-inflammatory cytokines interferon-γ, tumor necrosis factor α and interleukin-17 in the cerebrospinal fluid. During a median follow-up of 23 (interquartile range 14 - 25) months, vessel loss within the superficial (hazard ratio [HR] 1.6 for a 1%-point decrease in vessel density, p=0.01) and deep vascular complex (HR 1.6 for a 1%-point decrease, p=0.05) was associated with future disability worsening. DISCUSSION Optic neuritis independent rarefication of the retinal vasculature might be linked to neuroinflammatory processes during RRMS and might predict a worse disease course. Thus, OCT-A might be a novel biomarker to monitor disease activity and predict future disability.
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Affiliation(s)
- Christina Noll
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Hiltensperger
- Institute for Experimental Neuroimmunology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Ali Maisam Afzali
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Christiane Gasperi
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Montorio D, Cennamo G, Carotenuto A, Petracca M, Brescia Morra V, Costagliola C. Correlation analysis between foveal avascular zone and near peripheral retinal hypoperfusion in multiple sclerosis: a wide field optical coherence tomography angiography study. Front Med (Lausanne) 2022; 9:1032514. [PMID: 36353224 PMCID: PMC9637691 DOI: 10.3389/fmed.2022.1032514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
The identification of non-invasive biomarkers to investigate and monitor retinal structural and vascular changes in multiple sclerosis (MS) represents an interesting source of debate. Until now optical coherence tomography angiography (OCTA) evaluated the foveal avascular zone (FAZ) and areas of retinal non-perfusion only in the macular region in MS patients. It could be interesting to identify possible biomarkers, useful in assessing the ischemic areas also in the near peripheral retina, since FAZ enlargement and the areas of peripheral retinal non-perfusions share common pathogenic processes. In this cross-sectional study, we investigated the correlation between the FAZ area and retinal vessel density (VD) in the near peripheral retina by new wide-field optical coherence tomography angiography (OCTA) in patients affected by relapsing-remitting multiple sclerosis (RR-MS). Moreover, we compared the FAZ area and the VD of superficial and deep capillary plexuses in the fovea region and in the near peripheral retina (6.4 × 6.4 mm) between RR-MS patients and healthy controls by means of a Solix full-range OCTA. Last, we also detected the changes in structural OCT parameters (ganglion cell complex and retinal nerve fiber layer). Thirty-three eyes of 33 RR-MS patients and 35 eyes of 35 healthy controls were enrolled. RR-MS patients showed a lower VD in the superficial capillary plexus and a significant increase in the FAZ area compared with controls. The deep capillary plexus revealed a reduced VD although not statistically significant in patients with respect to controls. In the patients' group, the FAZ area showed significantly negative correlations with VD of superficial capillary plexuses in the foveal and whole region, while the FAZ area did not negatively correlate with the VD of the deep capillary plexus. The significant correlations among OCTA parameters could demonstrate the FAZ area as a possible biomarker for assessing the perfusion status in the near peripheral retina, useful in RR-MS management. These findings could confirm the role of vascular dysfunction in the pathogenetic mechanisms of MS.
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Affiliation(s)
- Daniela Montorio
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gilda Cennamo
- Eye Clinic, Department of Public Health, University of Naples Federico II, Naples, Italy
- *Correspondence: Gilda Cennamo
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Petracca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Ciro Costagliola
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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Yılmaz Tuğan B, Bünül SD. The Effect of Radiologically Isolated Syndrome on Retinal and Choroidal Hemodynamics - An Optical Coherence Tomography Angiography Study. Curr Eye Res 2022; 47:1312-1321. [DOI: 10.1080/02713683.2022.2078493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Cunha LP, Pires LA, Cruzeiro MM, Almeida ALM, Martins LC, Martins PN, Shigaeff N, Vale TC. Optical coherence tomography in neurodegenerative disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:180-191. [PMID: 35352756 PMCID: PMC9648920 DOI: 10.1590/0004-282x-anp-2021-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/21/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Structural imaging of the brain is the most widely used diagnostic tool for investigating neurodegenerative diseases. More advanced structural imaging techniques have been applied to early or prodromic phases, but they are expensive and not widely available. Therefore, it is highly desirable to search for noninvasive, easily accessible, low-cost clinical biomarkers suitable for large-scale population screening, in order to focus on making diagnoses at the earliest stages of the disease. In this scenario, imaging studies focusing on the structures of the retina have increasingly been used for evaluating neurodegenerative diseases. The retina shares embryological, histological, biochemical, microvascular and neurotransmitter similarities with the cerebral cortex, thus making it a uniquely promising biomarker for neurodegenerative diseases. Optical coherence tomography is a modern noninvasive imaging technique that provides high-resolution two-dimensional cross-sectional images and quantitative reproducible three-dimensional volumetric measurements of the optic nerve head and retina. This technology is widely used in ophthalmology practice for diagnosing and following up several eye diseases, such as glaucoma, diabetic retinopathy and age-related macular degeneration. Its clinical impact on neurodegenerative diseases has raised enormous interest over recent years, as several clinical studies have demonstrated that these diseases give rise to reduced thickness of the inner retinal nerve fiber layer, mainly composed of retinal ganglion cells and their axons. In this review, we aimed to address the clinical utility of optical coherence tomography for diagnosing and evaluating different neurodegenerative diseases, to show the potential of this noninvasive and easily accessible method.
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Affiliation(s)
- Leonardo Provetti Cunha
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Divisão de Oftalmologia, Juiz de Fora MG, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Oftalmologia, São Paulo SP, Brazil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
| | - Leopoldo Antônio Pires
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
| | - Marcelo Maroco Cruzeiro
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
| | - Ana Laura Maciel Almeida
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
| | - Luiza Cunha Martins
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora MG, Brazil
| | - Pedro Nascimento Martins
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora MG, Brazil
| | - Nadia Shigaeff
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Instituto de Ciências Humanas, Departamento de Psicologia, Juiz de Fora MG, Brazil
| | - Thiago Cardoso Vale
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Pós-Graduação em Saúde, Núcleo de Pesquisa em Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
- Universidade Federal de Juiz de Fora, Hospital Universitário, Serviço de Neurologia, Juiz de Fora MG, Brazil
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Optical coherence tomography angiography (OCTA) in differential diagnosis of aquaporin-4 antibody seronegative NMOSD and multiple sclerosis. Mult Scler Relat Disord 2022; 58:103503. [PMID: 35030370 DOI: 10.1016/j.msard.2022.103503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/06/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022]
Abstract
BACKROUND Optic neuritis(ON) is a common feature of both relapsing-remitting multiple sclerosis(RRMS) and neuromyelitis optica spectrum disorders(NMOSD). It is crucial to early differentiate these two diseases, as they differ in pathophysiology and treatment. OBJECTIVE To compare NMOSD and RRMS patients using optical coherence tomography(OCT) and OCT angiography(OCTA) to assess retinal microvascular network differences. METHODS Fourteen RRMS (28 eyes) and 9 NMOSD patients(18 eyes), and 11 controls were enrolled. Seropositivity for aquaporin-4 antibody (anti-AQP4 Abs) was 44.4%. Peripapillary and macular retinal nerve fiber layer(RNFL) thickness, superficial peripapillary and macular vessel density(VD), area, perimeter and circularity of foveal avascular zone(FAZ) were analyzed. RESULTS OCTA showed reduction in peripapillary and macular VD and FAZ size in NMOSD+ON compared to RRMS+ON and controls (p = 0.001, p<0.001 and p = 0.010, p<0.001 respectively). Peripapillary VD was similar in RRMS +ON and controls. Peripapillary VD in monophasic seronegative NMOSD+ON eyes was significantly lower than monophasic RRMS+ON eyes (p = 0.030), which was no different from controls. FAZ area was smaller in unaffected eyes in NMOSD than RRMS and controls. CONCLUSIONS Both OCT and OCTA revealed considerable differences between RRMS and NMOSD patients, providing promising results in favor of clinical utility of OCTA in differential diagnosis of ON, particularly in anti-AQP4 antibody negative patients. OCTA might be a useful biomarker in differentiating NMOSD from MS.
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Yu J, Huang Y, Quan C, Zhou L, ZhangBao J, Wu K, Zong Y, Zhou X, Wang M. Alterations in the Retinal Vascular Network and Structure in MOG Antibody-Associated Disease: An Optical Coherence Tomography Angiography Study. J Neuroophthalmol 2021; 41:e424-e432. [PMID: 33136671 DOI: 10.1097/wno.0000000000001116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine retinal vessel density in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS Twenty-five patients with MOGAD and 20 healthy participants were enrolled. Patients with MOGAD were divided into myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-positive eyes with a history of optic neuritis (ON; MOG-Ab-ON+ group) or without a history of ON (MOG-Ab-ON- group). Visual function, retinal vessel densities, and thickness were measured. RESULTS The retinal nerve fiber layer, parafoveal ganglion cell and inner plexiform layers, and vessel densities in the peripapillary and parafoveal areas were significantly decreased in the MOG-Ab-ON+ eyes compared with healthy eyes and MOG-Ab-ON- eyes (all P < 0.05). An increasing number of ON episodes was associated with greater decreases in these variables (all P < 0.05). Visual field mean deviation was not significantly decreased in patients with a history of 1 or 2 episodes of ON, although the relative decreases in retinal nerve fiber layer thickness, parafoveal ganglion cell and inner plexiform layer thickness, peripapillary vessel density, and parafoveal vessel density reached 33.1%, 23.2%, 17.0%, and 11.5% (all P < 0.05), respectively, in eyes with 2 episodes of ON. The mean deviation was significantly correlated with peripapillary vessel density (P < 0.05) after adjustment for other variables. Best-corrected visual acuity was not significantly correlated with optical coherence tomography variables (all P > 0.05). CONCLUSIONS MOG-Ab-associated ON was associated with significant decreases in retinal structure and vessel density, without significant deteriorations in visual function. The peripapillary vessel density might predict the visual outcomes in patients with MOG-Ab-associated ON.
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Affiliation(s)
- Jian Yu
- Department of Ophthalmology and Vision Science (JY, YH, KW, YZ, XZ, MW), Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China ; Key Laboratory of Myopia of State Health Ministry (JY, YH, KW, YZ, XZ, MW), and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China ; NHC Key Laboratory of Myopia (Fudan University) (JY, YH, KW, YZ, XZ, MW), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China ; Department of Ophthalmology (YH), Kiang Wu Hospital, Macau Special Administration Region, China ; and Department of Neurology (LZ, JZB, CQ), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Analysis of choroidal vessel density in patients with multiple sclerosis. Biomark Neuropsychiatry 2021. [DOI: 10.1016/j.bionps.2021.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Chen Q, Fang M, Miri S, Thakor K, Delgado S, Hernandez J, Alba DE, Gregori G, Porciatti V, Wang J, Jiang H. Retinal microvascular and neuronal function in patients with multiple sclerosis: 2-year follow-up. Mult Scler Relat Disord 2021; 56:103314. [PMID: 34634624 DOI: 10.1016/j.msard.2021.103314] [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] [Received: 02/25/2021] [Revised: 09/11/2021] [Accepted: 10/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the longitudinal changes in retinal microstructure, microvasculature, microcirculation, and axonal and neuronal functions in patients with relapsing-remitting multiple sclerosis (RRMS) over the time course of about two years. METHODS A total of 30 patients (60 eyes) with RRMS were followed for a period of 27 ± 6 months and evaluated with a battery of clinical tests including low contrast letter acuity (LCLA), intraretinal layer thicknesses by optical coherence tomography (OCT), ganglion cell function by steady-state pattern electroretinography (PERG), axonal function by polarization-sensitive OCT, volumetric vessel density (VVD) by OCT angiography, and retinal tissue perfusion (RTP) by retinal function imager. RESULTS Axonal function measured as retinal nerve fiber layer birefringence in the temporal quadrant and vessel density in the deep vascular plexus were significantly decreased at 2-year follow-up (P < 0.05). Subgroup analyses showed that the increased retinal blood flow volume occurred in patients with no evidence of disease activity (NEDA), and with stable or improved visual function (P < 0.05). There was no significant difference in the expanded disability state scale, LCLA, RTP, VVD, or PERG measures between the two visits (P > 0.05). CONCLUSION To our best knowledge, this is the first 2-year prospective comprehensive study with a detailed assessment of retinal microstructure and neuronal functions in patients with RRMS. The recovery of retinal microcirculation occurred in patients with NEDA, and stable or improved visual function, suggesting these measurements as potential imaging biomarkers for monitoring disease progression.
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Affiliation(s)
- Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Min Fang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States; Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Shahnaz Miri
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kinjal Thakor
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeffrey Hernandez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Diego Eduardo Alba
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Vittorio Porciatti
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States.
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22
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Yu J, Huang Y, Wu K, ZhangBao J, Zhou L, Zong Y, Zhou X, Quan C, Wang M. Alterations in the Retinal Vascular Network and Structure in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis: A Longitudinal OCTA Study. Ocul Immunol Inflamm 2021; 30:1055-1059. [PMID: 33750277 DOI: 10.1080/09273948.2020.1860231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To investigate the longitudinal microstructural and microvascular changes in patients with myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) without new attacks.Methods: We included 20 eyes of 12 MOG-ON patients without new attacks during the follow-up and 24 eyes of 12 age- and sex-matched healthy controls.Results: The BCVA, retinal vessels and structure were significantly lower in MOG-ON eyes than in healthy eyes(all P < .05). In MOG-ON eyes, the BCVA (p = .408) and mean deviation (p = .854) were not significantly decreased at the follow-up visit. However, there were small, significant decreases in parafoveal vessel density (p = .026), peripapillary vessel density (p = .008), and RNFL thickness (p = .03), but not GCIPL thickness (p = .107).Conclusions: Ongoing deterioration was observed in RNFL thickness and parafoveal and peripapillary vessel density, but not GCIPL thinning, in MOG-ON eyes without a new attack of ON.
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Affiliation(s)
- Jian Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yongheng Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,Department of Ophthalmology, Kiang Wu Hospital, Macau Special Administration Region, People's Republic of China
| | - Kaicheng Wu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Zong
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xujiao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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23
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Jiang H, Delgado S, Wang J. Advances in ophthalmic structural and functional measures in multiple sclerosis: do the potential ocular biomarkers meet the unmet needs? Curr Opin Neurol 2021; 34:97-107. [PMID: 33278142 PMCID: PMC7856092 DOI: 10.1097/wco.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Multiple sclerosis is a heterogeneous disorder. Biomarkers to monitor disease activities are highly desirable especially because of the recent shift toward personalized medicine that coincides with the expansion of disease-modifying therapy. The visual system is highly involved in multiple sclerosis, and the rapid advancement of ophthalmic techniques has boosted the development of potential ocular biomarkers for multiple sclerosis management. RECENT FINDINGS Recent studies have found that the rapid thinning of the peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer (GCIPL) occurs in the progressive stage. Furthermore, the inter-eye thickness difference of the GCIPL could be used in identifying unilateral optic neuritis to facilitate the early diagnosis of multiple sclerosis. Moreover, the retinal microvascular alterations measured as vessel density were found to be related to the disability and visual function, although a standardized protocol to measure retinal microvascular alterations has not been well established. Additionally, aberrant ocular motility, such as fixation microsaccades, can be used to measure disability objectively. SUMMARY The fast expansion of potential ocular biomarkers measured as retinal microstructural, microvascular, and ocular motility changes may facilitate the diagnosis and management of multiple sclerosis.
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Affiliation(s)
- Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Electrical and Computer Engineering, University of Miami, Miami, FL, USA
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24
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Cennamo G, Carotenuto A, Montorio D, Petracca M, Moccia M, Melenzane A, Tranfa F, Lamberti A, Spiezia AL, Servillo G, De Angelis M, Petruzzo M, Criscuolo C, Lanzillo R, Brescia Morra V. Peripapillary Vessel Density as Early Biomarker in Multiple Sclerosis. Front Neurol 2020; 11:542. [PMID: 32625163 PMCID: PMC7311750 DOI: 10.3389/fneur.2020.00542] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To evaluate retinal vessel density (VD) in macular and in peripapillary regions in patients with recent onset of multiple sclerosis, at initial demyelinating event (IDE) and in matched relapsing-remitting multiple sclerosis (RRMS) patients. Methods: We evaluated VD in superficial capillary plexus, deep capillary plexus, choriocapillaris and radial peripapillary capillary plexus in IDE, RRMS patients and in matched healthy controls (HCs) through Optical Coherence Tomography Angiography (OCT-A). Clinical history, including history of optic neuritis, Expanded Disability Status scale and disease duration of patients were collected. Results: Thirty patients (20 with IDE and 10 with RRMS) and 15 HCs were enrolled. IDE patients showed a lower VD in radial peripapillary capillary plexus compared with controls (coeff. β = −3.578; p = 0.002). RRMS patients displayed a lower VD in both superficial capillary plexus and radial peripapillary capillary plexus compared with HCs (coeff. β = −4.955; p = 0.002, and coeff. β = −7.446; p < 0.001, respectively). Furthermore, RRMS patients showed a decreased VD in radial peripapillary capillary plexus compared with IDE patients (coeff. β = −3.868; p = 0.003). Conclusions: Peripapillary region vessel density reduction, revealed through OCT-A, might be considered as an early event in MS, and might be relevant as a biomarker of disease pathology.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples Federico II, Naples, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Daniela Montorio
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Maria Petracca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Antonietta Melenzane
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Fausto Tranfa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Anna Lamberti
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Antonio L Spiezia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Marcello De Angelis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Martina Petruzzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Chiara Criscuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
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25
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Pellegrini M, Vagge A, Ferro Desideri L, Bernabei F, Triolo G, Mastropasqua R, Del Noce C, Borrelli E, Sacconi R, Iovino C, Di Zazzo A, Forlini M, Giannaccare G. Optical Coherence Tomography Angiography in Neurodegenerative Disorders. J Clin Med 2020; 9:E1706. [PMID: 32498362 PMCID: PMC7356677 DOI: 10.3390/jcm9061706] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/29/2020] [Indexed: 12/15/2022] Open
Abstract
Retinal microcirculation shares similar features with cerebral small blood vessels. Thus, the retina may be considered an accessible 'window' to detect the microvascular damage occurring in the setting of neurodegenerative disorders. Optical coherence tomography angiography (OCT-A) is a non-invasive imaging modality providing depth resolved images of blood flow in the retina, choroid, and optic nerve. In this review, we summarize the current literature on the application of OCT-A in glaucoma and central nervous system conditions such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis. Future directions aiming at evaluating whether OCT-A can be an additional biomarker for the early diagnosis and monitoring of neurodegenerative disorders are also discussed.
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Affiliation(s)
- Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy; (L.F.D.); (C.D.N.)
| | - Lorenzo Ferro Desideri
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy; (L.F.D.); (C.D.N.)
| | - Federico Bernabei
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Giacinto Triolo
- Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy;
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Chiara Del Noce
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy; (L.F.D.); (C.D.N.)
| | - Enrico Borrelli
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Riccardo Sacconi
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy;
| | - Antonio Di Zazzo
- Department of Ophthalmology, University Campus Bio-Medico of Rome, 00128 Rome, Italy;
| | - Matteo Forlini
- Domus Nova Hospital, 48121 Ravenna, Italy;
- Department of Ophthalmology, Ospedale dello Stato della Repubblica di San Marino, 47893 Città di San Marino, San Marino
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University “Magna Graecia”, 88100 Catanzaro, Italy;
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26
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Silverstein SM, Demmin DL, Schallek JB, Fradkin SI. Measures of Retinal Structure and Function as Biomarkers in Neurology and Psychiatry. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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27
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Jiang H, Gameiro GR, Liu Y, Lin Y, Hernandez J, Deng Y, Gregori G, Delgado S, Wang J. Visual Function and Disability Are Associated with Increased Retinal Volumetric Vessel Density in Patients with Multiple Sclerosis. Am J Ophthalmol 2020; 213:34-45. [PMID: 31926161 DOI: 10.1016/j.ajo.2019.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The goal of this study was to determine the volumetric vessel density (VVD) in the intraretinal layers and its relationship with visual function and disability in patients with multiple sclerosis (MS). DESIGN Cross-sectional study. METHODS A total of 80 patients with relapsing-remitting MS and 99 age- and sex-matched healthy controls (HC) were recruited. The retinal microvascular network in the macular area was imaged using optical coherence tomography angiography in 123 eyes without a history of optic neuritis (ON) (MSNON) and 36 eyes with a history of ON (MSON). The VVD was calculated as the vessel densities in the retinal vascular network (RVN), superficial vascular plexus (SVP), or deep vascular plexus (DVP) of an annulus (0.6-2.5 mm in diameter), divided by the corresponding tissue volume of the intraretinal layers respectively. RESULTS The VVD of RVN and DVP in MSNON were significantly higher than in HC (P < .05). The VVD of RVN, SVP, and DVP in MSON were significantly higher than in MSNON and HC (P < .05). The VVD in both RVN and SVP were positively related to EDSS and disease duration, but negatively related to low-contrast letter acuity (P < .05). The VVD measurements were also negatively and strongly related to the corresponding tissue volumes (P < .05). CONCLUSIONS This is the first study to reveal increased retinal VVD in patients with relapsing-remitting MS. The measurements of VVD in the RVN and SVP were related to disability and visual function, which may be developed as image markers for tracking disease progression.
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28
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Assessments of vessel density and foveal avascular zone metrics in multiple sclerosis: an optical coherence tomography angiography study. Eye (Lond) 2019; 34:771-778. [PMID: 31857713 DOI: 10.1038/s41433-019-0746-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/09/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate optical coherence tomography angiography (OCT-A) findings of foveal avascular zone (FAZ) metrics and macular & peripapillary vessel densities (VD) in subjects with multiple sclerosis (MS). METHODS The study design was prospective and cross-sectional. FAZ metrics and VDs of the superficial capillary plexus (SCP), deep capillary plexus (DCP), retinal peripapillary capillary plexus (RPCP) along with the structural OCT measurements were scanned by using the Nidek's RS-3000 Advance in MS patients and healthy controls. All subject also underwent an assessment of visual evoked potentials (VEPs). The relationships between the OCT-A parameters with other clinical findings were analysed. RESULTS Forty-seven MS patients (94 eyes) and 61 healthy volunteers (122 eyes) were included in this study. Thirty-five eyes of the MS patients had an ON history. The structural OCT measurements were significantly differed between the groups (P < 0.001). All FAZ metrics were inversely correlated with central foveal thickness (CFT) (P < 0.001). The FAZ area and perimeter were inversely correlated with the VD of both SCP and DCP (P < 0.05). The VDs of SCP and DCP were significantly differed between the study groups (P < 0.001). The VEP latency was inversely correlated with the retinal nerve fibre layer, macular and ganglion cell layer thicknesses, the VD of SCP, and the VD of the DCP (P < 0.001). CONCLUSIONS Based on OCT angiography, VDs of macular and peripapillary area may be useful in detecting damage from ON in patients with MS.
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29
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Yap TE, Balendra SI, Almonte MT, Cordeiro MF. Retinal correlates of neurological disorders. Ther Adv Chronic Dis 2019; 10:2040622319882205. [PMID: 31832125 PMCID: PMC6887800 DOI: 10.1177/2040622319882205] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Considering the retina as an extension of the brain provides a platform from which to study diseases of the nervous system. Taking advantage of the clear optical media of the eye and ever-increasing resolution of modern imaging techniques, retinal morphology can now be visualized at a cellular level in vivo. This has provided a multitude of possible biomarkers and investigative surrogates that may be used to identify, monitor and study diseases until now limited to the brain. In many neurodegenerative conditions, early diagnosis is often very challenging due to the lack of tests with high sensitivity and specificity, but, once made, opens the door to patients accessing the correct treatment that can potentially improve functional outcomes. Using retinal biomarkers in vivo as an additional diagnostic tool may help overcome the need for invasive tests and histological specimens, and offers the opportunity to longitudinally monitor individuals over time. This review aims to summarise retinal biomarkers associated with a range of neurological conditions including Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and prion diseases from a clinical perspective. By comparing their similarities and differences according to primary pathological processes, we hope to show how retinal correlates can aid clinical decisions, and accelerate the study of this rapidly developing area of research.
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Affiliation(s)
- Timothy E. Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - Shiama I. Balendra
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Melanie T. Almonte
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - M. Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College, London, NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, 11–43 Bath Street, London, EC1V 9EL UK
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