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Zhuang X, Su Y, Li M, Zhang L, Mi L, Ji Y, Deng F, Xiao O, Zhang X, Zhou L, Cao D, He G, Zeng Y, Pu J, Hao X, Chen X, Gan Y, Zhang Y, Wen F. A prospective observation of influence of anti-VEGF on optic disc vasculature in nAMD patients. Photodiagnosis Photodyn Ther 2024; 45:103863. [PMID: 37890814 DOI: 10.1016/j.pdpdt.2023.103863] [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: 09/10/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND This study aims to investigate the short-term changes in relatively normal retinal vessels following anti-vascular endothelial growth factor (anti-VEGF) therapy in nAMD patients, an area that currently represents a research gap. METHODS In this prospective study, we enrolled patients newly diagnosed with neovascular age-related macular degeneration (nAMD) and received standardized monthly anti-VEGF therapy for three months. Follow-ups were conducted at baseline and 1-week, 1-month, 2-months and 3-months post first injection. Assessment indicators included radial peripapillary capillary vascular density (RPC-VD) and retinal nerve fiber layer (RNFL) thickness in different optic disk regions using optical coherence tomography angiography, as well as intraocular pressure (IOP). RESULTS 68 nAMD patients (68 eyes) were included in this study. Significant reductions of RPC-VD and increases of RNFL thickness primarily in the nasal regions were observed 1-week post anti-VEGF (adjusted P < 0.05). Significant negative correlations were found between 1-week changes in RPC-VD and RNFL thickness in the nasal sectors (P < 0.05). From 1 to 3 months post-injection, RPC-VD and RNFL thickness essentially returned to baseline levels. Throughout the follow-up periods, IOP remained stable (P > 0.05). CONCLUSION Anti-VEGF treatments transiently influence the relatively normal retinal vessels, which might lead to nerve fiber edema, predominantly on the nasal side of the optic disk.
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Affiliation(s)
- Xuenan Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China; Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yongyue Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Yuying Ji
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Fei Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Ou Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Guiqin He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Yunkao Zeng
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxin Pu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Xinlei Hao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Xuelin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Yuhong Gan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Yining Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060, China.
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Murphy TI, Douglass AG, van Wijngaarden P, Armitage JA. Programmatically Localizing Diabetic Retinopathy Features in 45-Degree Retinal Photographs Using Anatomical Colocation. J Clin Med 2024; 13:807. [PMID: 38337501 PMCID: PMC10856732 DOI: 10.3390/jcm13030807] [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: 12/20/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Background: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. Methods: This study extracted diabetic retinopathy feature locations from 757 macula-centered 45-degree fundus photographs in the publicly available DDR dataset. Arteriole and venule locations were also extracted from the RITE (n = 35) and IOSTAR (n = 29) datasets. Images were normalized to collocate optic disc and macula positions, and feature positions were collated to generate a frequency distribution matrix. Sørensen-Dice coefficients were calculated to compare the location of different features. Results: Arterioles occurred in two main, distinct arcuate patterns. Venules showed a more diffuse distribution. Microaneurysms were diffusely located around the posterior pole. Hemorrhages and exudates occurred more frequently at the temporal aspect of the macula. Cotton wool spots occurred in a region approximating the radial peripapillary capillaries. Intraretinal microvascular abnormalities and neovascularization were seen throughout the posterior pole, with neovascularization at the disc (n = 65) being more common than neovascularization elsewhere (n = 46). Venous beading occurred primarily between the first and third bifurcations of the venules. Diabetic retinopathy overall was more frequent in the temporal aspect of the macula. The location of cotton wool spots and exudates showed moderate similarity (0.52) when all data were considered, reducing to low similarity (0.18) when areas of low frequency were removed. Conclusions: Diabetic retinopathy occurs throughout the posterior pole but is more frequent in the temporal aspect of the macula. Understanding the location of diabetic retinopathy features may help inform visual search strategies for diabetic retinopathy screening.
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Affiliation(s)
- Timothy I. Murphy
- School of Medicine (Optometry), Deakin University, Geelong, VIC 3216, Australia; (T.I.M.); (A.G.D.)
| | - Amanda G. Douglass
- School of Medicine (Optometry), Deakin University, Geelong, VIC 3216, Australia; (T.I.M.); (A.G.D.)
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia;
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, VIC 3002, Australia
| | - James A. Armitage
- School of Medicine (Optometry), Deakin University, Geelong, VIC 3216, Australia; (T.I.M.); (A.G.D.)
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Church KA, Rodriguez D, Mendiola AS, Vanegas D, Gutierrez IL, Tamayo I, Amadu A, Velazquez P, Cardona SM, Gyoneva S, Cotleur AC, Ransohoff RM, Kaur T, Cardona AE. Pharmacological depletion of microglia alleviates neuronal and vascular damage in the diabetic CX3CR1-WT retina but not in CX3CR1-KO or hCX3CR1 I249/M280-expressing retina. Front Immunol 2023; 14:1130735. [PMID: 37033925 PMCID: PMC10077890 DOI: 10.3389/fimmu.2023.1130735] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Diabetic retinopathy, a microvascular disease characterized by irreparable vascular damage, neurodegeneration and neuroinflammation, is a leading complication of diabetes mellitus. There is no cure for DR, and medical interventions marginally slow the progression of disease. Microglia-mediated inflammation in the diabetic retina is regulated via CX3CR1-FKN signaling, where FKN serves as a calming signal for microglial activation in several neuroinflammatory models. Polymorphic variants of CX3CR1, hCX3CR1I249/M280 , found in 25% of the human population, result in a receptor with lower binding affinity for FKN. Furthermore, disrupted CX3CR1-FKN signaling in CX3CR1-KO and FKN-KO mice leads to exacerbated microglial activation, robust neuronal cell loss and substantial vascular damage in the diabetic retina. Thus, studies to characterize the effects of hCX3CR1I249/M280 -expression in microglia-mediated inflammation in the diseased retina are relevant to identify mechanisms by which microglia contribute to disease progression. Our results show that hCX3CR1I249/M280 mice are significantly more susceptible to microgliosis and production of Cxcl10 and TNFα under acute inflammatory conditions. Inflammation is exacerbated under diabetic conditions and coincides with robust neuronal loss in comparison to CX3CR1-WT mice. Therefore, to further investigate the role of hCX3CR1I249/M280 -expression in microglial responses, we pharmacologically depleted microglia using PLX-5622, a CSF-1R antagonist. PLX-5622 treatment led to a robust (~70%) reduction in Iba1+ microglia in all non-diabetic and diabetic mice. CSF-1R antagonism in diabetic CX3CR1-WT prevented TUJ1+ axonal loss, angiogenesis and fibrinogen deposition. In contrast, PLX-5622 microglia depletion in CX3CR1-KO and hCX3CR1I249/M280 mice did not alleviate TUJ1+ axonal loss or angiogenesis. Interestingly, PLX-5622 treatment reduced fibrinogen deposition in CX3CR1-KO mice but not in hCX3CR1I249/M280 mice, suggesting that hCX3CR1I249/M280 expressing microglia influences vascular pathology differently compared to CX3CR1-KO microglia. Currently CX3CR1-KO mice are the most commonly used strain to investigate CX3CR1-FKN signaling effects on microglia-mediated inflammation and the results in this study indicate that hCX3CR1I249/M280 receptor variants may serve as a complementary model to study dysregulated CX3CR1-FKN signaling. In summary, the protective effects of microglia depletion is CX3CR1-dependent as microglia depletion in CX3CR1-KO and hCX3CR1I249/M280 mice did not alleviate retinal degeneration nor microglial morphological activation as observed in CX3CR1-WT mice.
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Affiliation(s)
- Kaira A. Church
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Derek Rodriguez
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Andrew S. Mendiola
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Difernando Vanegas
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Irene L. Gutierrez
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- Department of Pharmacology and Toxicology, Universidad Complutense de Madrid, Centro de Investigacion Biomedica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Ian Tamayo
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Abdul Amadu
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Priscila Velazquez
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Sandra M. Cardona
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Stefka Gyoneva
- Human Genetics, Cerevel Therapeutics, Cambridge, MA, United States
- Acute Neurology, Biogen, Cambridge, MA, United States
| | | | - Richard M. Ransohoff
- Acute Neurology, Biogen, Cambridge, MA, United States
- Department of Neurosciences, The Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
- Neuroinflammation Research Center, The Cleveland Clinic Lerner Research Institute, Cleveland, OH, United States
| | - Tejbeer Kaur
- Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
| | - Astrid E. Cardona
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX, United States
- South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
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Torm MEW, Dorweiler TF, Fickweiler W, Levine SR, Fort PE, Sun JK, Gardner TW. Frontiers in diabetic retinal disease. J Diabetes Complications 2023; 37:108386. [PMID: 36608490 PMCID: PMC10350338 DOI: 10.1016/j.jdiacomp.2022.108386] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Diabetic retinal disease (DRD) remains a leading cause of vision loss and blindness globally. Although treatments can be effective when given at vision-threatening stages of DRD, there is a lack of knowledge about the earliest mechanisms leading to the development of clinically evident DRD. Recent advances in retinal imaging methods for patients with diabetes allow a more precise and granular characterization of the different stages of DRD than is provided by the classic Diabetic Retinopathy Severity Scale based on fundus photographs. In addition, recent clinical studies have yielded more information on how to adjust blood glucose levels, lipid levels and blood pressure to minimize the risk of DRD. Given the incomplete success of current therapies, there is a critical need for better understanding of the mechanisms underlying DRD and novel treatment targets that address the entire neurovascular retina. Moreover, the causes for interindividual variability in the development of DRD in patients with similar glycemic history and other metabolic factors are not yet clarified either. Finally, greater focus on patients' experience with visual disabilities and treatment effects should be addressed in research in this field.
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Affiliation(s)
- Marie E Wistrup Torm
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Tim F Dorweiler
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Ward Fickweiler
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - S Robert Levine
- Mary Tyler Moore and S. Robert Levine, M.D. Charitable Foundation, Greenwich, CT, USA
| | - Patrice E Fort
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
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Parsa CF, Williams ZR, Van Stavern GP, Lee AG. Does Vitreopapillary Traction Cause Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol 2022; 42:260-271. [PMID: 34974483 DOI: 10.1097/wno.0000000000001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cameron F Parsa
- Department of Ophthalmology (CFP), Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium ; Faculty of Medicine (CFP), Sorbonne University, Paris, France ; Department of Ophthalmology (ZRW), University of Rochester Medical Center, Rochester, New York; Department of Ophthalmology and Visual Sciences (GPV), Washington University in St. Louis School of Medicine, St Louis, Missouri; and Blanton Eye Institute (AGL), Houston Methodist Hospital, Houston Texas
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Blegen HM, Justin GA, Bishop BA, Cox AR, Aden JK, Wedel ML, Hobbs SD. The Association Between Obstructive Sleep Apnea and Cotton-Wool Spots in Nonproliferative Diabetic Retinopathy. JOURNAL OF VITREORETINAL DISEASES 2021; 5:495-500. [PMID: 37007183 PMCID: PMC9976155 DOI: 10.1177/2474126421989576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work reports the association of obstructive sleep apnea (OSA) and cotton-wool spots (CWS) seen in patients with nonproliferative diabetic retinopathy (DR). Methods: A random sample of patients diagnosed with DR between January 1, 2015 and December 31, 2018, were selected from medical-billing codes. Dilated funduscopic examination findings and medical history were analyzed by reviewing medical records. Results: CWS were present in 12 of 118 patients without OSA, compared with 11 of 32 patients with OSA (10.2% vs 34.4%, respectively; P = .002). OSA was more common in men (68.8%, P = .03) and associated with a higher body mass index (30.0 ± 5.0 without OSA vs 33.6 ± 5.5 with OSA, P < .001). When comparing those with and without OSA, there was no association with age; glycated hemoglobin A1c; stage of DR; insulin dependence; presence of diabetic macular edema; smoking status; or a history of hypertension, hyperlipidemia, cardiovascular disease, or other breathing disorder. Conclusions: The presence of OSA is associated with CWS in patients with DR, as well as male sex and a higher body mass index. Further research is needed to determine the ophthalmologist’s role in the timely referral of patients with CWS for OSA evaluation.
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Affiliation(s)
- Halward M.J. Blegen
- Department of Ophthalmology, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Grant A. Justin
- Department of Ophthalmology, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Bradley A. Bishop
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Anthony R. Cox
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - James K. Aden
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Marissa L. Wedel
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Samuel D. Hobbs
- Department of Ophthalmology, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA
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Tu Z, Gormley J, Sheth V, Seydel KB, Taylor T, Beare N, Barrera V, Proudlock FA, Manda C, Harding S, Gottlob I. Cerebral malaria: insight into pathology from optical coherence tomography. Sci Rep 2021; 11:15722. [PMID: 34344903 PMCID: PMC8333417 DOI: 10.1038/s41598-021-94495-9] [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: 06/03/2021] [Accepted: 07/08/2021] [Indexed: 01/25/2023] Open
Abstract
We aimed to investigate structural retinal changes in malarial retinopathy (MR) using hand-held optical coherence tomography (HH-OCT) to assess its diagnostic potential. Children with MR (n = 43) underwent ophthalmoscopy, fluorescein angiography and HH-OCT during admission, 1-month (n = 31) and 1-year (n = 8) post-discharge. Controls were comatose patients without malaria (n = 6) and age/sex-matched healthy children (n = 43). OCT changes and retinal layer thicknesses were compared. On HH-OCT, hyper-reflective areas (HRAs) were seen in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whitening on fundus photography. Cotton wool spots were present in 37% and abnormal hyper-reflective dots, co-localized to capillary plexus, in 93%. Hyper-reflective vessel walls were present in 84%, and intra-retinal cysts in 9%. Vascular changes and cysts resolved within 48 h. HRAs developed into retinal thinning at 1 month (p = 0.027) which was more pronounced after 1 year (p = 0.009). Ischaemic retinal whitening is located within inner retinal layers, distinguishing it from cotton wool spots. Vascular hyper-reflectivity may represent the sequestration of parasitized erythrocytes in vessels, a key CM feature. The mechanisms of post-ischemic retinal atrophy and cerebral atrophy with cognitive impairment may be similar in CM survivors. HH-OCT has the potential for monitoring patients, treatment response and predicting neurological deficits.
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Affiliation(s)
- Zhanhan Tu
- Department of Neuroscience, Psychology and Behaviour, Ulverscroft Eye Unit, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Jack Gormley
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Viral Sheth
- Department of Neuroscience, Psychology and Behaviour, Ulverscroft Eye Unit, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Karl B Seydel
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Terrie Taylor
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Nicholas Beare
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Valentina Barrera
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Frank A Proudlock
- Department of Neuroscience, Psychology and Behaviour, Ulverscroft Eye Unit, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Chatonda Manda
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Simon Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
| | - Irene Gottlob
- Department of Neuroscience, Psychology and Behaviour, Ulverscroft Eye Unit, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
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Kesserwani H. Space Flight-Associated Neuroocular Syndrome, Idiopathic Intracranial Hypertension, and Pseudotumor Cerebri: Phenotypic Descriptions, Pathogenesis, and Hydrodynamics. Cureus 2021; 13:e14103. [PMID: 33907644 PMCID: PMC8067672 DOI: 10.7759/cureus.14103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Recent data from astronauts who have returned to Earth from a long-duration space flight have unequivocally distinguished spaceflight-associated neuro-ocular syndrome (SANS) from idiopathic intracranial hypertension (IIH) and pseudotumor cerebri (PTC). We review the semiology and pathogenesis of these three entities, noting that optic disc edema is what unites them, and this where the similarities between SANS and IIH/PTC end. We distinguish between PTC and IIH and between SANS and IIH/PTC and review the medical and surgical therapy of IIH/PTC. The key to understanding the phenomenon of optic disc edema is the geometry of the optic nerve sheath, which is a simulacrum of an inverted Venturi tube. This allows us to theoretically study the hydrodynamics of the optic nerve sheath by applying simple physical laws, including the Venturi effect, Poiseuille’s law, and Reynold’s number, and we speculate on nature’s design and the correlation of form and function in understanding how cerebrospinal fluid (CSF) circulates in the optic nerve sheath as it approaches the optic nerve head. Recent spectacular data on the histology of the blood nerve-barrier of the optic nerve disc and the glymphatic system of the optic nerve sheath will also help us understand the development of optic disc edema due to the microgravity-induced cephalad shift of CSF in SANS. We will explore the role of the sodium/potassium adenosine triphosphatase (ATPase) pump on choroid plexus epithelial cells and the aquaporin-4 water receptors located on astrocyte end-feet and their complex interactions with the tetracyclines, mineralocorticoids, and therapeutic agents with carbonic anhydrase activity. We also adumbrate the complex interactions between obesity, vitamin A, and 11-beta-hydroxysteroid dehydrogenase and how the aquaporin-4 receptor relates to these interactions.
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The association of primary aldosteronism with glaucoma-related fundus abnormalities. PLoS One 2020; 15:e0242090. [PMID: 33156869 PMCID: PMC7647098 DOI: 10.1371/journal.pone.0242090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/26/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To elucidate glaucoma-related fundus abnormalities in patients with primary aldosteronism (PA). Methods The study compared 272 eyes from 137 PA patients and 352 eyes from 177 control subjects selected randomly from 1173 participants of a public glaucoma screening. The presence of glaucomatous optic disc appearance (rim thinning and cup enlargement) and retinal nerve fiber layer defects (RNFLDs) was determined independently from fundus photographs. The results were compared between the PA and control groups. Results There were 9 patients (6.6%) with glaucomatous optic disc abnormalities in the PA group and 10 cases (5.6%) identified in the control group (p = 0.92). RNFLDs were detected more frequently in the PA group (55 eyes, 20.2%) than in the control group (26 eyes, 7.4%; p<0.001). The two types of RNFLDs were classified as either having their central ends at the disc margin (D) or away from the disc margin and around the retinal vessels (V). Type D and V RNFLDs were detected in 35 (12.9%) and 26 (9.6%) eyes in the PA group and in 25 (7.1%) and 4 (1.1%) eyes in the control group, respectively. Both types of RNFLDs were more frequent in the PA group than in the control group (Type D and V, p = 0.03, <0.001, respectively). Conclusion Although the prevalence of glaucomatous optic disc appearance did not differ between the two groups, RNFLDs were more frequent in PA patients than in the control group. Moreover, RNFLDs with their central ends located around retinal vessels were characteristic of PA patients.
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Wright WS, Eshaq RS, Lee M, Kaur G, Harris NR. Retinal Physiology and Circulation: Effect of Diabetes. Compr Physiol 2020; 10:933-974. [PMID: 32941691 PMCID: PMC10088460 DOI: 10.1002/cphy.c190021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this article, we present a discussion of diabetes and its complications, including the macrovascular and microvascular effects, with the latter of consequence to the retina. We will discuss the anatomy and physiology of the retina, including aspects of metabolism and mechanisms of oxygenation, with the latter accomplished via a combination of the retinal and choroidal blood circulations. Both of these vasculatures are altered in diabetes, with the retinal circulation intimately involved in the pathology of diabetic retinopathy. The later stages of diabetic retinopathy involve poorly controlled angiogenesis that is of great concern, but in our discussion, we will focus more on several alterations in the retinal circulation occurring earlier in the progression of disease, including reductions in blood flow and a possible redistribution of perfusion that may leave some areas of the retina ischemic and hypoxic. Finally, we include in this article a more recent area of investigation regarding the diabetic retinal vasculature, that is, the alterations to the endothelial surface layer that normally plays a vital role in maintaining physiological functions. © 2020 American Physiological Society. Compr Physiol 10:933-974, 2020.
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Affiliation(s)
- William S Wright
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
| | - Randa S Eshaq
- Department of Molecular and Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Minsup Lee
- Department of Molecular and Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Gaganpreet Kaur
- Department of Molecular and Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Norman R Harris
- Department of Molecular and Cellular Physiology, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
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11
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Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension. Can J Neurol Sci 2020; 47:661-665. [PMID: 32362301 DOI: 10.1017/cjn.2020.89] [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: 11/07/2022]
Abstract
OBJECTIVES To determine whether optic disc hemorrhages (ODH) and cotton wool spots (CWS) at presentation are associated with worse visual outcomes in pediatric patients with idiopathic intracranial hypertension (IIH). METHODS Retrospective institutional review of 100 eyes of 50 consecutive pediatric IIH patients (aged 16 years or less) who had baseline optic disc photographs before or within 30 days of their diagnostic lumbar puncture and initiation of medical treatment. Optic disc photographs were independently graded by three ophthalmologists in a standardized manner. Visual function was assessed using visual acuity (VA) and visual field grade (VFG). RESULTS At least one ODH was found in 41% of eyes, at least one CWS was found in 27% of eyes, and 20% of eyes had both ODH and CWS. At presentation, Frisén grade was associated with the presence of CWS (p = 0.013) and showed no association with ODH (p = 0.060). When controlling for Frisén grade, ODH and CWS were not associated with worse VA or VFG at final follow-up. Severe ODH were associated with worse VA and VFG at presentation (p < 0.03), but not at final follow-up. Severe CWS at presentation was strongly associated with a worse Humphrey mean deviation of 5.0 dB (95% confidence interval 1.6-8.3) at final follow-up (p = 0.002). CONCLUSION When controlling for the severity of papilledema, ODH do not provide any additional prognostic value in pediatric IIH patients. Frisén grade and severe CWS at presentation were independently associated with worse visual outcomes at the final follow-up.
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12
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Mahdjoubi A, Bousnina Y, Barrande G, Bensmaine F, Chahed S, Ghezzaz A. Features of cotton wool spots in diabetic retinopathy: a spectral-domain optical coherence tomography angiography study. Int Ophthalmol 2020; 40:1625-1640. [DOI: 10.1007/s10792-020-01330-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
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13
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McLeod D. Misery Perfusion, Diffusive Oxygen Shunting and Interarterial Watershed Infarction Underlie Oxygenation-Based Hypoperfusion Maculopathy. Am J Ophthalmol 2019; 205:153-164. [PMID: 30905727 DOI: 10.1016/j.ajo.2019.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe and explain the entire range of acute ischemic macular damage that follows panretinal hypoperfusion from central retinal artery or vein occlusion. DESIGN Perspective article. METHODS To correlate the fundoscopic, fluorescein angiographic, oximetric, and optical coherence tomographic (OCT) features developing within the posterior inner retina following incremental reductions in arteriovenous perfusion pressure across the retinal circulation. RESULTS The spectrum of acute oxygenation-based hypoperfusion maculopathy (OHM) is consistent with that predictable from a modified Krogh cylinder model of tissue oxygenation. Diffusive oxygen shunting plays a significant role in the "artery-dominated" generation of ischemic signs during misery perfusion. Three major grades of OHM severity can be discerned according to the predominant oxygenation status of ganglion cells within the superficial inner retina, whether this is normoxic (OHM1), hypoxic (OHM2), or anoxic (OHM3). Densely opaque axoplasmic sentinels are arranged along normoxic/hypoxic interfaces in OHM2. In OHM1 and OHM2, relative hypermetabolism and interarterial watershed infarction of fundal interneurons (WIFI) underpin subtle middle-retinal opacification with periarterial sparing. The fundal signs are optimally displayed en face using autofluorescence imaging whereas cross-sectional OCT reveals Paques' plaque formation. CONCLUSIONS An exquisite and supremely accessible exhibition of classical oxygen physiopathology unfolds in eyes with panretinal hypoperfusion courtesy of the transparent ocular media and the pattern of macular neuroretinal opacification that evolves as upstream tissues extract oxygen to the detriment of tissues downstream. Recent attempts to overrule the simple conceptual framework embodied in WIFI have no plausible anatomical nor physiological basis. Overreliance on OCT can result in misdiagnosis.
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Affiliation(s)
- David McLeod
- Academic Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester University National Health Service Foundation Trust, and Centre for Ophthalmology and Vision Research, Institute of Human Development, University of Manchester, Manchester, United Kingdom.
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14
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Deep learning based computer-aided diagnosis systems for diabetic retinopathy: A survey. Artif Intell Med 2019; 99:101701. [DOI: 10.1016/j.artmed.2019.07.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023]
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15
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Mahdjoubi A, Haouas M, Caliot J, Jaillant R, Idlefqih W, Amari FZ, Chahed S. Optical Coherence Tomography Angiography of Macula in Chronic Anterior Ischaemic Optic Neuropathy Associated with Giant Cell Arteritis. Neuroophthalmology 2019; 43:192-195. [PMID: 31312244 DOI: 10.1080/01658107.2018.1488175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/17/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022] Open
Abstract
A 74-year-old man presented with bilateral optic nerve atrophy related to arteritic anterior ischaemic optic neuropathy (AION) which started 22 years ago. Atrophic papilla was noted in both eyes and optical coherence tomography showed thinning of the retinal nerve fibres layer as well as the macular ganglion cell complex. Optical coherence tomography angiography of the macula found a decreased density of the superficial capillary complex, whereas deep capillary complex was well-preserved. Inner retinal layer atrophy in chronic arteritic AION is followed by a loss of vascularisation in these layers as a consequence of the neurodegeneration.
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Affiliation(s)
- Amir Mahdjoubi
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France.,Ophthalmology Department, Hôpital Simone Veil, Eaubonne, France
| | - Maher Haouas
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France.,Ophthalmology Department, Hôpital Simone Veil, Eaubonne, France
| | - Jessy Caliot
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France.,Ophthalmology Department, Hôpital Simone Veil, Eaubonne, France
| | - Romain Jaillant
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France.,Ophthalmology Department, Hôpital Simone Veil, Eaubonne, France
| | - Wafa Idlefqih
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France
| | - Fatima Zohra Amari
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France.,Ophthalmology Department, Hôpital Simone Veil, Eaubonne, France
| | - Sadri Chahed
- Ophthalmology Department, Hôpital Victor Dupouy, Argenteuil, France.,Ophthalmology Department, Hôpital Simone Veil, Eaubonne, France
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16
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Virdee J, Horsburgh J, Roque M, Mollan S. A giant escape. Postgrad Med J 2019; 95:346. [PMID: 30992417 DOI: 10.1136/postgradmedj-2019-136623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Jasvir Virdee
- Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Horsburgh
- Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marianne Roque
- Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan Mollan
- Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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17
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18
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Micieli JA, Bruce BB, Vasseneix C, Blanch RJ, Berezovsky DE, Peragallo JH, Newman NJ, Biousse V. Optic nerve appearance as a predictor of visual outcome in patients with idiopathic intracranial hypertension. Br J Ophthalmol 2018; 103:1429-1435. [PMID: 30530819 DOI: 10.1136/bjophthalmol-2018-313329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS It remains unclear whether the presence of optic disc haemorrhages (ODH) or cotton wool spots (CWS) at presentation in patients with papilloedema from idiopathic intracranial hypertension (IIH) has prognostic value. The aim of this study was to determine if optic disc appearance at presentation predicts visual outcome in patients with IIH. METHODS Retrospective study of 708 eyes of 360 consecutive patients with IIH who had baseline optic disc photographs before or within 30 days of their diagnostic lumbar puncture and initiation of medical treatment. Optic disc photographs were independently graded by three ophthalmologists in a standardised manner. Visual function was assessed using Snellen converted to logMAR visual acuity, Humphrey mean deviation and visual field grade. RESULTS At least one ODH was found in 201 (28.4%) eyes, at least one CWS was found in 101 (14.3%) eyes and 88 eyes had both ODH and CWS (12.4%). At presentation, Frisén grade was associated with the presence and severity of ODH and CWS (p<0.001). ODH were associated with a worse visual acuity and CWS were associated with a worse visual field grade and mean deviation at presentation (p<0.05). Frisén grade was associated with worse visual function at presentation and final follow-up (p<0.001). Neither ODH nor CWS at presentation were associated with visual function at final follow-up when controlling for the Frisén grade. CONCLUSIONS AND RELEVANCE ODH and CWS at baseline are not independent predictors of final visual function in IIH when controlling for the severity of papilloedema.
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Affiliation(s)
- Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Beau B Bruce
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | | | - Richard J Blanch
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Damian E Berezovsky
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.,Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University, Atlanta, Georgia, USA.,Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA .,Department of Neurology, Emory University, Atlanta, Georgia, USA
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19
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Palmer E, Gale J, Crowston JG, Wells AP. Optic Nerve Head Drusen: An Update. Neuroophthalmology 2018; 42:367-384. [PMID: 30524490 PMCID: PMC6276953 DOI: 10.1080/01658107.2018.1444060] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/22/2022] Open
Abstract
Optic nerve head drusen are benign acellular calcium concretions that usually form early in life, just anterior to the lamina cribrosa. Improving imaging using optical coherence tomography suggests they are common and may be present in many clinically normal discs. These drusen may change in appearance in early life, but are generally stable in adulthood, and may be associated with visual field defects, anterior ischaemic optic neuropathy, or rarer complications. Based on long-term clinical data and optical coherence tomography, we propose a refined hypothesis as to the cause of optic disc drusen. Here we summarise recent findings and suggest future studies to better understand the forces involved.
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Affiliation(s)
- Edward Palmer
- Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
| | - Jesse Gale
- Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Capital and Coast District Health Board, Wellington, New Zealand
- Capital Eye Specialists, Wellington, New Zealand
| | - Jonathan G. Crowston
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Anthony P. Wells
- Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Capital and Coast District Health Board, Wellington, New Zealand
- Capital Eye Specialists, Wellington, New Zealand
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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20
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Amin J, Sharif M, Rehman A, Raza M, Mufti MR. Diabetic retinopathy detection and classification using hybrid feature set. Microsc Res Tech 2018; 81:990-996. [DOI: 10.1002/jemt.23063] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Javeria Amin
- Department of Computer ScienceUniversity of WahPakistan
| | - Muhammad Sharif
- Department of Computer ScienceCOMSATS University Islamabad Wah Campus Pakistan
| | - Amjad Rehman
- College of Computer and Information Systems, Al‐Yamamah University Riyadh 11512 Saudi Arabia
| | - Mudassar Raza
- Department of Computer ScienceCOMSATS University Islamabad Wah Campus Pakistan
| | - Muhammad Rafiq Mufti
- Department of Computer ScienceCOMSATS Institute of Information Technology Vehari Pakistan
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21
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Gupta RK, Kaur I, Nag TC, Chhablani J. Diagnostic Electron Microscopy of Retina. Semin Ophthalmol 2018; 33:700-710. [PMID: 29388866 DOI: 10.1080/08820538.2017.1416415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The electron microscopy techniques were used in various fields as an analytical technique under in vitro conditions, which provides the sufficient resolution for better visualization and interpretation. This review gives a brief overview of the analytical application of transmission electron microscopy (TEM) and scanning electron microscopy (SEM) techniques and critical findings in different retinal pathologies. This review article aims to improvise understanding of retinal microstructures for clinicians which will help to improve the interpretation of the current advanced imaging techniques.
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Affiliation(s)
- Rishikesh Kumar Gupta
- a Kallam Anji Reddy Molecular Genetics Laboratory, Brien Holden Eye Research Centre , L V Prasad Eye Institute (KAR Campus) , Hyderabad , Telangana , India
| | - Inderjeet Kaur
- a Kallam Anji Reddy Molecular Genetics Laboratory, Brien Holden Eye Research Centre , L V Prasad Eye Institute (KAR Campus) , Hyderabad , Telangana , India
| | - Tapas C Nag
- c All India Institute of Medical Sciences , Department of Anatomy , New Delhi , India
| | - Jay Chhablani
- b Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases , L V Prasad Eye Institute (KAR Campus) , Hyderabad , Telangana , India
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22
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Mystery of Retinal Vein Occlusion: Vasoactivity of the Vein and Possible Involvement of Endothelin-1. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4816527. [PMID: 28904960 PMCID: PMC5585553 DOI: 10.1155/2017/4816527] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 01/24/2023]
Abstract
Retinal vein occlusion (RVO) is a common vascular disease of retina; however, the pathomechanism leading to RVO is not yet clear. In general, increasing age, hypertension, arteriosclerosis, diabetes mellitus, dyslipidemia, cardiovascular disorder, and cerebral stroke are systemic risk factors of RVO. However, RVO often occur in the unilateral eye and sometimes develop in young subjects who have no arteriosclerosis. In addition, RVO show different variations on the degrees of severity; some RVO are resolved without any treatment and others develop vision-threatening complications such as macular edema, combined retinal artery occlusion, vitreous hemorrhage, and glaucoma. Clinical conditions leading to RVO are still open to question. In this review, we discuss how to treat RVO in practice by presenting some RVO cases. We also deliver possible pathomechanisms of RVO through our clinical experience and animal experiments.
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23
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Mansour RF. Evolutionary Computing Enriched Computer-Aided Diagnosis System for Diabetic Retinopathy: A Survey. IEEE Rev Biomed Eng 2017; 10:334-349. [PMID: 28534786 DOI: 10.1109/rbme.2017.2705064] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complications caused due to diabetes mellitus result in significant microvasculature that eventually causes diabetic retinopathy (DR) that keeps on increasing with time, and eventually causes complete vision loss. Identifying subtle variations in morphological changes in retinal blood vessels, optic disk, exudates, microaneurysms, hemorrhage, etc., is complicated and requires a robust computer-aided diagnosis (CAD) system so as to enable earlier and efficient DR diagnosis practices. In the majority of the existing CAD systems, functional enhancements have been realized time and again to ensure accurate and efficient diagnosis of DR. In this survey paper, a number of existing literature presenting DR CAD systems are discussed and analyzed. Both traditional and varoius evolutionary approaches, including genetic algorithm, particle swarm optimization, ant colony optimization, bee colony optimization, etc., based DR CAD have also been studied and their respective efficiencies have been discussed. Our survey revealed that evolutionary computing methods can play a vital role for optimizing DR-CAD functional components, such as proprocessing by enhancing filters coefficient, segmentation by enriching clustering, feature extraction, feature selection, and dimensional reduction, as well as classification.
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25
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Kochar A, Kalra P, Sb V, Ukirade V, Chahar A, Kochar DK, Kochar SK. Retinopathy of vivax malaria in adults and its relation with severity parameters. Pathog Glob Health 2016; 110:185-93. [PMID: 27533797 DOI: 10.1080/20477724.2016.1213948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Malarial retinopathy is a set of retinal signs in severe malaria due to falciparum malaria. With increased recognition of severe manifestations of vivax malaria, a systematic study to evaluate retinal changes in vivax malaria could elaborate our knowledge about this neglected entity. This observational study included retinal examination of 104 adult patients (>14 years) with varying severity of vivax malaria admitted to a tertiary care center during peak seasons of 2012 and 2013. Thirty-eight percent of severe cases had a retinal sign as compared to 6% of non-severe cases (p < 0.01). No statistically significant effect of residence or age on the presence of retinopathy was noted. Females were found to be more prone to develop a retinal sign (p < 0.01). Presence of retinal signs was significantly associated with anemia and jaundice. No statistical association was noted for retinal signs to be present in either renal dysfunction or altered thrombocytes count. The most common signs were arteriovenous changes, present in eight cases (19%) of severe malaria and three cases (5%) of non-severe malaria. Retinal hemorrhage was present in five cases (12%) of severe malaria and no case of non-severe malaria. Both superficial and deep hemorrhages were seen including white-centered hemorrhages. Other signs included cotton wool spots, hard exudates, blurred disk margins with spontaneous venous pulsations and bilateral disk edema. A correlation between retinal signs and severity parameters was drawn from the study. This is the first systemic study to evaluate the retinal changes in vivax malaria. Larger prospective studies should be done for further knowledge regarding retinal changes in vivax malaria, especially severe disease. Apart from its clinical significance, it might lead to a better understanding of the pathogenesis of the systemic disease of vivax malaria.
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Affiliation(s)
- Anju Kochar
- a Department of Ophthalmology , Sardar Patel Medical College and A.G. of Hospitals , Bikaner , India
| | - Paavan Kalra
- a Department of Ophthalmology , Sardar Patel Medical College and A.G. of Hospitals , Bikaner , India
| | - Vijeth Sb
- b Department of Medicine , Sardar Patel Medical College and A.G. of Hospitals , Bikaner , India
| | - Vinayak Ukirade
- b Department of Medicine , Sardar Patel Medical College and A.G. of Hospitals , Bikaner , India
| | - Anita Chahar
- a Department of Ophthalmology , Sardar Patel Medical College and A.G. of Hospitals , Bikaner , India
| | | | - Sanjay Kumar Kochar
- b Department of Medicine , Sardar Patel Medical College and A.G. of Hospitals , Bikaner , India
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De Smit E, O’Sullivan E, Mackey DA, Hewitt AW. Giant cell arteritis: ophthalmic manifestations of a systemic disease. Graefes Arch Clin Exp Ophthalmol 2016; 254:2291-2306. [DOI: 10.1007/s00417-016-3434-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 11/30/2022] Open
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27
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Association between retinal hemorrhagic pattern and macular perfusion status in eyes with acute branch retinal vein occlusion. Sci Rep 2016; 6:28554. [PMID: 27334338 PMCID: PMC4917831 DOI: 10.1038/srep28554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
This prospective study included 63 eyes with acute branch retinal vein occlusion (BRVO) to evaluate the retinal hemorrhagic patterns at the posterior poles and explore their clinical relevance in macular perfusion differentiation. Retinal hemorrhagic patterns and macular perfusion status were evaluated via fundus photography and fluorescein angiography, respectively. Macular perfusion was judged as nonischemic in 30, ischemic in 28, and undeterminable in 5 among the 63 eyes. Predominant hemorrhagic patterns were flame-shaped in 39 (67.2%) and non-flame-shaped in 19 (32.8%) eyes. All 39 eyes with a flame-shaped hemorrhage showed a nonischemic macula. Of the 19 eyes classified as having a non-flame-shaped hemorrhage, 13 (68.4%) had an ischemic macula and 6 (31.6%) had a nonischemic macula (P < 0.001). Parallelism in eyes with a flame-shaped hemorrhage was higher than in those with a non-flame-shaped hemorrhage (P < 0.001), and in those with a nonischemic macula versus those with an ischemic macula (P < 0.001). The area under the curve for parallelism was 0.975 (P < 0.001), suggesting an accurate diagnostic parameter for macular perfusion differentiation. In conclusion, we objectively evaluated retinal hemorrhagic patterns at the posterior pole in BRVO using the parallelism method, which was useful in differentiating macular perfusion status.
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Razavi H, Al-Qureshi S, Harper A. Exudative cotton wool spots: an under-recognized variant of a common lesion. Clin Exp Ophthalmol 2016; 44:631-634. [DOI: 10.1111/ceo.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Hessom Razavi
- Royal Victorian Eye and Ear Hospital; East Melbourne Victoria Australia
- Centre for Eye Research Australia; East Melbourne Victoria Australia
| | - Salmaan Al-Qureshi
- Royal Victorian Eye and Ear Hospital; East Melbourne Victoria Australia
- Centre for Eye Research Australia; East Melbourne Victoria Australia
| | - Alex Harper
- Royal Victorian Eye and Ear Hospital; East Melbourne Victoria Australia
- Centre for Eye Research Australia; East Melbourne Victoria Australia
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Sustained intraocular VEGF neutralization results in retinal neurodegeneration in the Ins2(Akita) diabetic mouse. Sci Rep 2015; 5:18316. [PMID: 26671074 PMCID: PMC4680939 DOI: 10.1038/srep18316] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 11/06/2015] [Indexed: 02/04/2023] Open
Abstract
Current therapies that target vascular endothelial growth factor (VEGF) have become a mainstream therapy for the management of diabetic macular oedema. The treatment involves monthly repeated intravitreal injections of VEGF inhibitors. VEGF is an important growth factor for many retinal cells, including different types of neurons. In this study, we investigated the adverse effect of multiple intravitreal anti-VEGF injections (200 ng/μl/eye anti-mouse VEGF164, once every 2 weeks totalling 5-6 injections) to retinal neurons in Ins2(Akita) diabetic mice. Funduscopic examination revealed the development of cotton wool spot-like lesions in anti-VEGF treated Ins2(Akita) mice after 5 injections. Histological investigation showed focal swellings of retinal nerve fibres with neurofilament disruption. Furthermore, anti-VEGF-treated Ins2(Akita) mice exhibited impaired electroretinographic responses, characterized by reduced scotopic a- and b-wave and oscillatory potentials. Immunofluorescent staining revealed impairment of photoreceptors, disruptions of synaptic structures and loss of amacrine and retinal ganglion cells in anti-VEGF treated Ins2(Akita) mice. Anti-VEGF-treated WT mice also presented mild amacrine and ganglion cell death, but no overt abnormalities in photoreceptors and synaptic structures. At the vascular level, exacerbated albumin leakage was observed in anti-VEGF injected diabetic mice. Our results suggest that sustained intraocular VEGF neutralization induces retinal neurodegeneration and vascular damage in the diabetic eye.
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Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy. Prog Retin Eye Res 2015; 49:82-119. [PMID: 26113210 DOI: 10.1016/j.preteyeres.2015.06.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/13/2015] [Accepted: 06/18/2015] [Indexed: 12/15/2022]
Abstract
The rationale behind hyperacute fibrinolytic therapy for cerebral and retinal arterial occlusion is to rescue ischaemic cells from irreversible damage through timely restitution of tissue perfusion. In cerebral stroke, an anoxic tissue compartment (the "infarct core") is surrounded by a hypoxic compartment (the "ischaemic penumbra"). The latter comprises electrically-silent neurons that undergo delayed apoptotic cell death within 1-6 h unless salvaged by arterial recanalisation. Establishment of an equivalent hypoxic compartment within the inner retina following central retinal artery occlusion (CRAO) isn't widely acknowledged. During experimental CRAO, electroretinography reveals 3 oxygenation-based tissue compartments (anoxic, hypoxic and normoxic) that contribute 32%, 27% and 41% respectively to the pre-occlusion b-wave amplitude. Thus, once the anoxia survival time (≈2 h) expires, the contribution from the infarcted posterior retina is irreversibly extinguished, but electrical activity continues in the normoxic periphery. Inbetween these compartments, an annular hypoxic zone (the "penumbra obscura") endures in a structurally-intact but functionally-impaired state until retinal reperfusion allows rapid recovery from electrical silence. Clinically, residual circulation of sufficient volume flow rate generates the heterogeneous fundus picture of "partial" CRAO. Persistent retinal venous hypoxaemia signifies maximal extraction of oxygen by an enduring "polar penumbra" that permeates or largely replaces the infarct core. On retinal reperfusion some days later, the retinal venous oxygen saturation reverts to normal and vision improves. Thus, penumbral inner retina, marginally oxygenated by the choroid or by residual circulation, isn't at risk of delayed apoptotic infarction (unlike hypoxic cerebral cortex). Emergency fibrinolytic intervention is inappropriate, therefore, once the duration of CRAO exceeds 2 h.
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Parsa CF, Hoyt WF. Nonarteritic anterior ischemic optic neuropathy (NAION): a misnomer. Rearranging pieces of a puzzle to reveal a nonischemic papillopathy caused by vitreous separation. Ophthalmology 2015; 122:439-42. [PMID: 25703466 DOI: 10.1016/j.ophtha.2014.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/24/2022] Open
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Fort PE, Losiewicz MK, Pennathur S, Jefferson LS, Kimball SR, Abcouwer SF, Gardner TW. mTORC1-independent reduction of retinal protein synthesis in type 1 diabetes. Diabetes 2014; 63:3077-90. [PMID: 24740573 PMCID: PMC4141367 DOI: 10.2337/db14-0235] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Poorly controlled diabetes has long been known as a catabolic disorder with profound loss of muscle and fat body mass resulting from a simultaneous reduction in protein synthesis and enhanced protein degradation. By contrast, retinal structure is largely maintained during diabetes despite reduced Akt activity and increased rate of cell death. Therefore, we hypothesized that retinal protein turnover is regulated differently than in other insulin-sensitive tissues, such as skeletal muscle. Ins2(Akita) diabetic mice and streptozotocin-induced diabetic rats exhibited marked reductions in retinal protein synthesis matched by a concomitant reduction in retinal protein degradation associated with preserved retinal mass and protein content. The reduction in protein synthesis depended on both hyperglycemia and insulin deficiency, but protein degradation was only reversed by normalization of hyperglycemia. The reduction in protein synthesis was associated with diminished protein translation efficiency but, surprisingly, not with reduced activity of the mTORC1/S6K1/4E-BP1 pathway. Instead, diabetes induced a specific reduction of mTORC2 complex activity. These findings reveal distinctive responses of diabetes-induced retinal protein turnover compared with muscle and liver that may provide a new means to ameliorate diabetic retinopathy.
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Affiliation(s)
- Patrice E Fort
- Kellogg Eye Center, Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Mandy K Losiewicz
- Kellogg Eye Center, Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Leonard S Jefferson
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, Hershey, PA
| | - Scot R Kimball
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, Hershey, PA
| | - Steven F Abcouwer
- Kellogg Eye Center, Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Thomas W Gardner
- Kellogg Eye Center, Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
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Coady PA, Cunningham ET, Vora RA, McDonald HR, Johnson RN, Jumper JM, Fu AD, Haug SJ, Williams SL, Lujan BJ. Spectral domain optical coherence tomography findings in eyes with acute ischaemic retinal whitening. Br J Ophthalmol 2014; 99:586-92. [DOI: 10.1136/bjophthalmol-2014-304900] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/10/2014] [Indexed: 11/03/2022]
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Gohari M, Soleimani AR, Manaviat MR, Shojaei A. Single cotton wool spot as a late manifestation of head trauma. J Ophthalmic Vis Res 2014; 9:272-5. [PMID: 25279131 PMCID: PMC4181212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 02/02/2014] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To report a patient with a single cotton wool spot (CWS) following head trauma. CASE REPORT A 37-year-old male electrician presented with painless paracentral blurred vision in his left eye of one month duration together with three transient episodes of obscuration of vision in the same eye lasting for 10 minutes. He reported blunt head trauma due to a fall 40 days before referral. Fundus examination at presentation was normal but after 4 months, revealed the appearance of a white spot along the superotemporal arcade in the absence of other fundus lesions. A comprehensive systemic workup was performed revealing no specific findings. Ophthalmoscopic examination after 6 weeks disclosed resolution of the CWS with no intervention. The patient's complaint of paracentral visual field defect improved and subsequent optical coherence tomography showed retinal thinning in that area. CONCLUSION Herein, we report a patient with a single CWS near the optic disc four months after head trauma along with normal systemic and paraclinical evaluations. Head trauma may thus be considered as a cause of CWS.
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Affiliation(s)
- Mohsen Gohari
- Ophthalmology Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Reza Soleimani
- Ophthalmology Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Reza Manaviat
- Ophthalmology Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Shojaei
- Ophthalmology Department, Baghiatallah University of Medical Sciences, Tehran, Iran,Correspondence to: Ahmad Shojaei, MD. Ophthalmology Department, Baghiatallah University of Medical Sciences, Tehran 14359, Iran; Tel: +98 21 6659 2626, Fax: +98 21 6659 2626;
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Mookiah MRK, Acharya UR, Chua CK, Lim CM, Ng EYK, Laude A. Computer-aided diagnosis of diabetic retinopathy: a review. Comput Biol Med 2013; 43:2136-55. [PMID: 24290931 DOI: 10.1016/j.compbiomed.2013.10.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022]
Abstract
Diabetes mellitus may cause alterations in the retinal microvasculature leading to diabetic retinopathy. Unchecked, advanced diabetic retinopathy may lead to blindness. It can be tedious and time consuming to decipher subtle morphological changes in optic disk, microaneurysms, hemorrhage, blood vessels, macula, and exudates through manual inspection of fundus images. A computer aided diagnosis system can significantly reduce the burden on the ophthalmologists and may alleviate the inter and intra observer variability. This review discusses the available methods of various retinal feature extractions and automated analysis.
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Abstract
The diagnosis of Behçet disease is clinical and based on the presence of characteristic ocular and systemic inflammatory manifestations. Patients may present with anterior, posterior, or panuveitis in one or both eyes. The differential diagnosis includes a variety of infectious and noninfectious causes of acute nongranulomatous anterior uveitis, intermediate uveitis, occlusive retinal vasculitis, focal or multifocal retinitis, and necrotizing retinitis. A course characterized by sudden onset with improvement followed by recurrence of inflammatory signs is most typical for Behçet uveitis.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
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Phipps JA, Jobling AI, Greferath U, Fletcher EL, Vessey KA. Alternative pathways in the development of diabetic retinopathy: the renin-angiotensin and kallikrein-kinin systems. Clin Exp Optom 2012; 95:282-9. [PMID: 22594546 DOI: 10.1111/j.1444-0938.2012.00747.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Diabetic retinopathy is a common complication of both type 1 and type 2 diabetes and is the leading cause of blindness in people of working age. Current treatment strategies are mostly limited to laser photocoagulation, which restricts proliferative retinopathic changes but also causes irreversible damage to the retina. This review examines two important pathways involved in regulating vascular function and their role in the development of diabetic retinopathy. One, the renin-angiotensin system, is well known and has established angiogenic effects on the retina that increase in diabetic retinopathy. The other, the kallikrein-kinin system, has recently been found to be important in the development of diabetic retinal complications. This review describes the components of the two signalling networks, examines the current animal model studies investigating the role of these pathways in diabetic retinopathy and reviews the clinical studies that have been undertaken examining systemic inhibition of different points in these pathways. These systems are promising targets for therapies aimed at inhibiting the development of diabetic retinopathy and in the future, combination therapies that take advantage of both pathways might result in new treatment options for this debilitating complication of diabetes.
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Affiliation(s)
- Joanna A Phipps
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, Victoria, Australia.
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Mavija M, Jakšić V. Purtscher's retinopathy. SCRIPTA MEDICA 2012. [DOI: 10.5937/scriptamed1202119m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Park SM, Cho IH, Park TK, Ohn YH. A Single Isolated Cotton-Wool Spot not Associated with Systemic Diseases. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.12.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sae Mi Park
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - In Hwan Cho
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae Kwann Park
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young Hoon Ohn
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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McLeod D. Letter to the editor: partial central retinal artery occlusion offers a unique insight into the ischemic penumbra. Clin Ophthalmol 2011; 6:9-22. [PMID: 22259231 PMCID: PMC3259095 DOI: 10.2147/opth.s28232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- David McLeod
- University of Manchester and Manchester Royal Eye Hospital, UK
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Zaharova E, Sherman J. The use of SD-OCT in the differential diagnosis of dots, spots and other white retinal lesions. Eye Brain 2011; 3:69-80. [PMID: 28539776 DOI: 10.2147/eb.s23208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To demonstrate the utility of a retinal imaging technique using spectral domain optical coherence tomography (SD-OCT) for creating a B-scan layer-by-layer analysis to aid in the differential diagnosis of various retinal dots, spots, and other white lesions. DESIGN Review. METHODS A retrospective review of imaging studies performed with SD-OCT (Topcon, 3DOCT-2000, Oakland, NJ) at SUNY State College of Optometry. RESULTS B-scan layer-by-layer analysis and unique SD-OCT reflectivity patterns of the following retinal white lesions are reviewed in the order of their retinal layer localization: myelinated nerve fiber layer, cotton wool spot, exudates, edema residues, drusen, fundus albipunctatus, Stargardt disease, Bietti crystalline dystrophy, punctate inner choroidopathy (PIC), presumed ocular histoplasmosis syndrome (POHS), post-photocoagulation chorioretinal scarring, and osseous choristoma. CONCLUSION The reviewed images demonstrate the utility of SD-OCT in the identification of the unique characteristics of the presented retinal pathologies. SD-OCT is ideal for retinal layer localization of lesions, thus enhancing the differential diagnosis of retinal dots, spots, and other white lesions. Even though true pathognomonic patterns are rare, highly suggestive findings of certain retinal abnormalities often facilitate immediate recognition and diagnosis.
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Affiliation(s)
- Elena Zaharova
- State University of New York's State College of Optometry, University Eye Center, New York, NY, USA
| | - Jerome Sherman
- State University of New York's State College of Optometry, University Eye Center, New York, NY, USA.,SUNY Eye Institute, New York, NY, USA.,New York Eye Institute and Laser Center, New York, NY, USA
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Similarities and differences in early retinal phenotypes in hypertension and diabetes. J Hypertens 2011; 29:1667-75. [DOI: 10.1097/hjh.0b013e3283496655] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hayreh SS. Acute retinal arterial occlusive disorders. Prog Retin Eye Res 2011; 30:359-94. [PMID: 21620994 DOI: 10.1016/j.preteyeres.2011.05.001] [Citation(s) in RCA: 214] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/09/2011] [Accepted: 05/12/2011] [Indexed: 12/22/2022]
Abstract
The initial section deals with basic sciences; among the various topics briefly discussed are the anatomical features of ophthalmic, central retinal and cilioretinal arteries which may play a role in acute retinal arterial ischemic disorders. Crucial information required in the management of central retinal artery occlusion (CRAO) is the length of time the retina can survive following that. An experimental study shows that CRAO for 97min produces no detectable permanent retinal damage but there is a progressive ischemic damage thereafter, and by 4h the retina has suffered irreversible damage. In the clinical section, I discuss at length various controversies on acute retinal arterial ischemic disorders. Classification of acute retinal arterial ischemic disorders: These are of 4 types: CRAO, branch retinal artery occlusion (BRAO), cotton wool spots and amaurosis fugax. Both CRAO and BRAO further comprise multiple clinical entities. Contrary to the universal belief, pathogenetically, clinically and for management, CRAO is not one clinical entity but 4 distinct clinical entities - non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, arteritic CRAO associated with giant cell arteritis (GCA) and transient non-arteritic CRAO. Similarly, BRAO comprises permanent BRAO, transient BRAO and cilioretinal artery occlusion (CLRAO), and the latter further consists of 3 distinct clinical entities - non-arteritic CLRAO alone, non-arteritic CLRAO associated with central retinal vein occlusion and arteritic CLRAO associated with GCA. Understanding these classifications is essential to comprehend fully various aspects of these disorders. Central retinal artery occlusion: The pathogeneses, clinical features and management of the various types of CRAO are discussed in detail. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual acuity improvement during the first 7 days differs significantly (p<0.001) among the 4 types of CRAO; among them, in eyes with initial visual acuity of counting finger or worse, visual acuity improved, remained stable or deteriorated in non-arteritic CRAO in 22%, 66% and 12% respectively; in non-arteritic CRAO with cilioretinal artery sparing in 67%, 33% and none respectively; and in transient non-arteritic CRAO in 82%, 18% and none respectively. Arteritic CRAO shows no change. Recent studies have shown that administration of local intra-arterial thrombolytic agent not only has no beneficial effect but also can be harmful. Prevalent multiple misconceptions on CRAO are discussed. Branch retinal artery occlusion: Pathogeneses, clinical features and management of various types of BRAO are discussed at length. The natural history of visual acuity outcome shows a final visual acuity of 20/40 or better in 89% of permanent BRAO cases, 100% of transient BRAO and 100% of non-arteritic CLRAO alone. Cotton wools spots: These are common, non-specific acute focal retinal ischemic lesions, seen in many retinopathies. Their pathogenesis and clinical features are discussed in detail. Amaurosis fugax: Its pathogenesis, clinical features and management are described.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University Hospitals and Clinics, 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242-1091, USA.
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McCannel CA, Khan AR. Spectral-domain optical coherence tomography assessment of an epiretinal membrane with axoplasmic stasis from nerve fiber layer traction. Retin Cases Brief Rep 2011; 5:358-359. [PMID: 25390435 DOI: 10.1097/icb.0b013e3182051e1f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of visible axoplasmic stasis on fundus examination correlating with spectral-domain optical coherence tomography findings of nerve fiber layer traction. METHODS Case report. RESULTS Spectral-domain optical coherence tomography images show nerve fiber layer traction and distortion at the sites where visible cotton wool spot-like changes were seen on examination. These visible changes are likely because of axoplasmic stasis from the severe traction on the nerve fiber layer. CONCLUSION Spectral-domain optical coherence tomography demonstrates that cotton wool spot-like changes may be caused by nerve fiber layer traction in some epiretinal membranes. This is of interest in understanding the pathophysiology of these changes.
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Affiliation(s)
- Colin A McCannel
- From the *Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and †Mayo Clinic College of Medicine, Department of Ophthalmology, Rochester, Minnesota
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Ophthalmological Emergencies in Rheumatic and Autoimmune Diseases. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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46
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Reversal of ischemic retinopathy following balloon angioplasty of a stenotic ophthalmic artery. J Neuroophthalmol 2010; 30:228-30. [PMID: 20418775 DOI: 10.1097/wno.0b013e3181dc2078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 65-year-old woman who had undergone internal carotid artery stenting and was being maintained on antiplatelet therapy developed features suggesting ipsilateral reduced retinal artery perfusion. Injection of urokinase into the ophthalmic artery provided temporary improvement. When manifestations of retinal arterial ischemia recurred, angiography revealed worsening stenosis at the origin of the ophthalmic artery. Balloon angioplasty at that site successfully restored visual acuity and reversed the ischemic fundus abnormalities. This is the first report of ophthalmic artery balloon angioplasty in this setting.
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Abstract
The volume of cells that a length of capillary supplies with O(2) is called a Krogh cylinder. This geometric 'tissue unit' was named after the Danish zoophysiologist and Nobel laureate August Krogh who made important discoveries in the fields of external and internal respiration in the first half of the last century. Krogh's ideas concerning tissue O(2) distribution can be extrapolated to retinal oxygenation by larger vessels (including arterioles, arteries and even veins) and by vessel groups within higher-order 'microvascular units' (including the choroid). During retinal development, for example, the difference in pO(2) levels within arteries and capillaries determines Krogh cylinders of different radius and establishes the periarterial capillary-free zone of His. The O(2) supply to the venous end of a tissue unit may be compromised during periods of reduced perfusion, increased O(2) consumption or hypoxaemia, resulting in an 'anoxic corner' of the Krogh cylinder. A funnel of hypometabolic (and therefore hypoxia-tolerant) cells will likely intervene between the necrotic cells and unaffected cells located closer to the O(2) source. Macular perivenular whitening heralds anoxic corners and/or hypoxic funnels owing to hypoperfusion within second-order microvascular units. In eyes with extensive retinal capillary closure from diabetes, Krogh cylinders surround the medium-sized arteries and veins that form arteriovenous shunts while traversing the midperipheral retina. These isolated tissue units incorporate an outer sheath of hypoxic cells within which vascular endothelial growth factor is upregulated. This 'angiogenic sheath' expands following retinal detachment; it corresponds to the hypoxia-tolerant funnel within capillary-based tissue units and to the cerebral penumbra after stroke.
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Affiliation(s)
- David McLeod
- Academic Department of Ophthalmology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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Koh JW, Park KH, Kim MS, Kim JM. Localized retinal nerve fiber layer defects associated with cotton wool spots. Jpn J Ophthalmol 2010; 54:296-9. [DOI: 10.1007/s10384-010-0830-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/04/2010] [Indexed: 11/25/2022]
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Abstract
Diabetic retinopathy is a common and specific microvascular complication of diabetes, and remains the leading cause of preventable blindness in working-aged people. It is identified in a third of people with diabetes and associated with increased risk of life-threatening systemic vascular complications, including stroke, coronary heart disease, and heart failure. Optimum control of blood glucose, blood pressure, and possibly blood lipids remains the foundation for reduction of risk of retinopathy development and progression. Timely laser therapy is effective for preservation of sight in proliferative retinopathy and macular oedema, but its ability to reverse visual loss is poor. Vitrectomy surgery might occasionally be needed for advanced retinopathy. New therapies, such as intraocular injection of steroids and antivascular endothelial growth-factor agents, are less destructive to the retina than are older therapies, and could be useful in patients who respond poorly to conventional therapy. The outlook for future treatment modalities, such as inhibition of other angiogenic factors, regenerative therapy, and topical therapy, is promising.
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Affiliation(s)
- Ning Cheung
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Lee JH, Chin HS, Chung MH, Moon YS. Retinal hemorrhage in Plasmodium vivax malaria. Am J Trop Med Hyg 2010; 82:219-22. [PMID: 20133995 DOI: 10.4269/ajtmh.2010.09-0439] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Retinal hemorrhage is a frequently observed sign in Plasmodium falciparum infection. In Plasmodium vivax infection, however, retinal hemorrhage is very rare; only five cases have been reported in the literature. In this case report, we review the literature and the case of 52-year-old man who had retinal hemorrhages in P. vivax infection. We analyzed the structural characteristics of the lesions using fluorescein angiography and spectral-domain optical coherence tomography. Physicians should be aware of the possibility of retinal hemorrhage in malaria patients, even those with P. vivax infection, and should consider a diagnosis of malaria in a patient with unexplained retinal hemorrhage and fever.
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Affiliation(s)
- Ji Hwan Lee
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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