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Gedik B, Erol MK, Bulut M, Dogan B, Bozdogan YC, Ekinci R, Ayan A. Proximal nailfold videocapillaroscopy findings of patients with idiopathic macular telangiectasia type 2. Indian J Ophthalmol 2024; 72:S148-S152. [PMID: 38131558 PMCID: PMC10833163 DOI: 10.4103/ijo.ijo_1731_23] [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: 07/02/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Idiopathic macular telangiectasia type 2 (IMT) is a neurodegenerative disease characterized by bilateral, idiopathic, and perifoveal retinal telangiectatic vessel formations. We aimed to compare proximal nailfold videocapillaroscopy (NV) findings between patients with IMT and healthy individuals and evaluate the optical coherence tomography angiography (OCTA) parameters of the patients with IMT according to their NV findings. METHODS The study included 43 patients with IMT and 92 healthy controls of similar age and gender without any additional diseases. The OCTA and NV findings of the patients and controls were examined. RESULTS The mean age was 59.76 ± 5.73 years in the IMT group and 58.23 ± 4.96 years in the control group. Of the 43 patients with IMT, 19 were found to have increased capillary tortuosity, six had microhemorrhage, and 18 had bizarre capillaries (P < 0.001). In the IMT group, the total vascular density value of the superficial capillary plexus was higher among the patients with capillary microhemorrhage (P = 0.001), and the subfoveal choroidal thickness was lower among those with increased capillary tortuosity and bizarre capillaries (P = 0.04 and P = 0.07, respectively). CONCLUSION This is the first study in which the NV findings of patients with IMT were compared with those of a control group. We found higher rates of increased capillary tortuosity, microhemorrhage, and bizarre capillaries in the IMT group compared to the controls. We consider that this situation is caused by microvascular damage. We also think that IMT is a systemic disease that affects both proximal nailfold capillaries and eye vessels.
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Affiliation(s)
- Birumut Gedik
- Department of Ophthalmology, Antalya Serik State Hospital, Antalya, Turkey
| | - Muhammet K Erol
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Mehmet Bulut
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Berna Dogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Yigit C Bozdogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Rojbin Ekinci
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Ayse Ayan
- Department of Internal Medicine, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
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Erol MK, Gedik B, Bozdogan YC, Ekinci R, Bulut M, Dogan B, Suren E, Akidan M. Evaluation of Optic Disc, Retinal Vascular Structures, and Acircularity Index in Patients with Idiopathic Macular Telangiectasia Type 2. Diagnostics (Basel) 2023; 13:3046. [PMID: 37835789 PMCID: PMC10572724 DOI: 10.3390/diagnostics13193046] [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: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND We aimed to compare the retinal, optic disc vascular density (ODVD) values, and acircularity index (AI) of patients with idiopathic macular telangiectasia type 2 (IMT) and healthy individuals using the optical coherence tomography angiography (OCTA) device. METHODS The study included 39 patients with IMT and 37 healthy controls. The OCTA findings of the patients and controls were examined. RESULTS The total, parafoveal and perifoveal vascular density of the superficial capillary plexus, choriocapillaris blood flow, inside-disc ODVD, retinal nerve fiber layer (RNFL), and retinal thicknesses were found to be statistically significantly lower, and the foveal avascular zone value was statistically significantly higher in the IMT group compared to the control group (p = 0.001, p = 0.01, p = 0.02, p = 0.01, p = 0.009, p = 0.002, p = 0.02, respectively). There was a statistically significant negative correlation between best-corrected visual acuity (BCVA) and AI (p = 0.02), and a statistically significant positive correlation between peripapillary vascular density and BCVA (p = 0.04). CONCLUSIONS We consider that the lower retinal, choriocapillaris, ODVD values, and retinal and RNFL thicknesses in the patients with IMT compared to the controls were due to vascular damage, remodeling, fibrosis, proliferation, and Müller cell damage. Ellipsoid zone defect, AI, and peripapillary vascular density are important indicators in the evaluation of visual acuity in these patients.
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Affiliation(s)
- Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Birumut Gedik
- Department of Ophthalmology, Serik State Hospital, 07500 Antalya, Turkey;
| | - Yigit Caglar Bozdogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Rojbin Ekinci
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Mehmet Bulut
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Berna Dogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Elcin Suren
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (Y.C.B.); (R.E.); (M.B.); (B.D.); (E.S.)
| | - Melih Akidan
- Department of Ophthalmology, Kepez State Hospital, 07320 Antalya, Turkey;
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Szabelska P, Paczwa K, Ciszewska J, Różycki R, Gołębiewska J. Unilateral Tamoxifen-Induced Retinopathy as a Consequence of Breast Cancer Treatment—Multimodal Imaging Value. Diagnostics (Basel) 2023; 13:diagnostics13071250. [PMID: 37046468 PMCID: PMC10093114 DOI: 10.3390/diagnostics13071250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Tamoxifen is a drug used in breast cancer therapy, which inhibits the division of neoplastic cells targeting estrogen receptors. The drug is generally well-tolerated and its use does not cause serious side-effects. The standard dose of the drug is 20 mg once a day for 3 to 5 years. Available epidemiological data have shown that the incidence of ocular toxicity of tamoxifen ranges between 0.9% and 12.0% and increases with higher tamoxifen dose. A rare known complication of tamoxifen use is the development of retinopathy. We present a case of 57-year-old woman presented to an ophthalmologist with decreased visual acuity in her right eye. She has been treated with tamoxifen 20 mg daily for 7 years for breast cancer. Clinical examination and multimodal imaging methods help confirm the diagnosis of unilateral tamoxifen associated retinopathy (TAR). Optical coherence tomography angiography (OCTA) was crucial in the diagnostic process and differential diagnosis, especially in differentiating it from type 2 macular telangiectasias. The correct diagnosis of TAR is very important in deciding the treatment option of tamoxifen. Based on our diagnosis, the oncologist recommended another course of treatment. Tamoxifen therapy was discontinued and switched to letrozole 2.5 mg once a day. The patient attends ophthalmological examination regularly. Visual acuity, OCT and OCTA results remain stable.
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Foveal photoreceptor disruption in ocular diseases: An optical coherence tomography-based differential diagnosis. Surv Ophthalmol 2023:S0039-6257(23)00046-2. [PMID: 36934831 DOI: 10.1016/j.survophthal.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Fovea centralis, located at the center of the macula, is packed with cone photoreceptors and is responsible for central visual acuity. Isolated foveal photoreceptor disruption may occur in a variety of hereditary, degenerative, traumatic, and toxic chorioretinal diseases. These have been known previously by multiple synonyms including macular microhole, foveal spot, and outer foveal microdefects. A common clinical feature underlying these conditions is the presence of apparently normal fovea or subtle hypopigmented lesion at the foveal or juxtafoveal area. A detailed history along with high-resolution optical coherence tomography is often helpful to derive a conclusive diagnosis in majority of these cases. Focal photoreceptor disruption usually involves loss or rarefaction of ellipsoid/interdigitation zone, either in isolation or associated with external limiting membrane or retinal pigment epithelium disruption in the fovea. Vitreomacular interface (VMI) disorders including vitreomacular traction, posterior vitreous detachment, epiretinal membrane, and impending macular hole possibly remain the most common cause. Retinal dystrophies such as cone dystrophy, occult macular dystrophy, and achromatopsia may present with diminution of vision and normal appearing fundus in a younger age group. Other causes include photic retinopathy (e.g., from a history of sun gazing, or laser pointer exposure), blunt trauma, drug exposure (e.g., poppers maculopathy or tamoxifen retinopathy), and acute retinal pigment epitheliopathy (ARPE). Visual prognosis depends on the underlying etiology with complete recovery common in the subset of patients with VMI, and ARPE, whereas persistent outer retinal defects are the rule in other conditions. We discuss the differential diagnoses that lead to isolated foveal photoreceptor defects. Identifying and understanding the underlying disease processes that cause foveal photoreceptor disruption may help predict visual prognosis.
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Macular Telangiectasia Type 2: A Classification System Using MultiModal Imaging MacTel Project Report Number 10. OPHTHALMOLOGY SCIENCE 2022; 3:100261. [PMID: 36846105 PMCID: PMC9944556 DOI: 10.1016/j.xops.2022.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Purpose To develop a severity classification for macular telangiectasia type 2 (MacTel) disease using multimodal imaging. Design An algorithm was used on data from a prospective natural history study of MacTel for classification development. Subjects A total of 1733 participants enrolled in an international natural history study of MacTel. Methods The Classification and Regression Trees (CART), a predictive nonparametric algorithm used in machine learning, analyzed the features of the multimodal imaging important for the development of a classification, including reading center gradings of the following digital images: stereoscopic color and red-free fundus photographs, fluorescein angiographic images, fundus autofluorescence images, and spectral-domain (SD)-OCT images. Regression models that used least square method created a decision tree using features of the ocular images into different categories of disease severity. Main Outcome Measures The primary target of interest for the algorithm development by CART was the change in best-corrected visual acuity (BCVA) at baseline for the right and left eyes. These analyses using the algorithm were repeated for the BCVA obtained at the last study visit of the natural history study for the right and left eyes. Results The CART analyses demonstrated 3 important features from the multimodal imaging for the classification: OCT hyper-reflectivity, pigment, and ellipsoid zone loss. By combining these 3 features (as absent, present, noncentral involvement, and central involvement of the macula), a 7-step scale was created, ranging from excellent to poor visual acuity. At grade 0, 3 features are not present. At the most severe grade, pigment and exudative neovascularization are present. To further validate the classification, using the Generalized Estimating Equation regression models, analyses for the annual relative risk of progression over a period of 5 years for vision loss and for progression along the scale were performed. Conclusions This analysis using the data from current imaging modalities in participants followed in the MacTel natural history study informed a classification for MacTel disease severity featuring variables from SD-OCT. This classification is designed to provide better communications to other clinicians, researchers, and patients. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- BCVA, best-corrected visual acuity
- BLR, blue light reflectance
- CART, Classification and Regression Trees
- CF, color fundus
- Classification
- Classification and Regression Trees (CART)
- EZ, ellipsoid zone
- FAF, fundus autoflorescence
- FLIO, fluorescence lifetime imaging ophthalmoscopy
- MacTel, macular telangiectasia type 2
- Machine learning
- Macular telangiectasia type 2
- NHOR, natural history observation registry
- NHOS, natural history observation study
- Neurovascular degeneration
- OCTA, OCT angiography
- SD-OCT, spectral domain-OCT
- VA, visual acuity
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Venkatesh R, Reddy NG, Mishra P, Yadav NK, Chhablani J. Structural-vascular-functional correlation in type 2 non-proliferative macular telangiectasia. Int J Retina Vitreous 2022; 8:59. [PMID: 36028918 PMCID: PMC9419364 DOI: 10.1186/s40942-022-00410-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To correlate the structural-vascular-functional changes in type 2 non-proliferative macular telangiectasia (MacTel) using optical coherence tomography (OCT) angiography (OCTA). METHODS In this retrospective study, OCTA and enface OCT image analysis of eyes with confirmed diagnosis of non-proliferative type 2 MacTel was performed. The 'MacTel area' was calculated by marking the outer boundary of an area affected by MacTel on superficial (SCP) and deep capillary plexus (DCP) on OCTA images and photoreceptor layer (PRL) on enface OCT scan. At every follow-up OCTA scan visit, best-corrected visual acuity, MacTel area and stage of disease was documented. Analyses between disease stage, MacTel area and logMAR visual acuity was carried out. RESULTS In total, 38 single-visit OCTA scans of 22 patients were included. The mean age was 58.9 ± 10.98 years. An increase in disease severity stage correlated positively with MacTel area in SCP segmentations slab (r = 0.334; p = 0.04) and logMAR visual acuity (r = 0.338; p = 0.038). No correlation in the DCP area or PRL area (p > 0.05) was noted with disease stage. A statistically significant positive correlation was noted between the structural changes in PRL layer with vascular changes in SCP (p = 0.021) but not in DCP (p = 0.199). No correlation of visual acuity with changes in SCP, DCP or PRL was noted (p > 0.05). CONCLUSION OCTA is a useful adjunct for determining disease severity in type 2 non-proliferative MacTel by assessing the structural-vascular changes. Further longitudinal studies need to be considered in future for understanding the pathomechanism of retinal damage in type 2 MacTel.
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Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India. .,Deptartment of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Nikitha Gurram Reddy
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Pranjal Mishra
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Heng JS, Arevalo JF, Handa JT. Visual acuity after cataract surgery in Macular Telangiectasia Type 2 Stage 3 to 5. Int J Retina Vitreous 2022; 8:38. [PMID: 35690847 PMCID: PMC9188048 DOI: 10.1186/s40942-022-00386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate visual acuity after cataract surgery in eyes with Macular Telangiectasia (MacTel) Type 2. METHODS Single-center retrospective cohort study of patients with MacTel Type 2 who underwent cataract surgery and were managed at the same institution. Patients underwent pre-operative assessment by a retinal specialist with examination and optical coherence tomography (OCT) at the same institution. The main outcome measure was the post-operative change in best corrected visual acuity (BCVA). Secondary study outcomes were achieving post-operative BCVA better than Snellen acuity of 20/40 and time to BCVA loss by two lines or more (10 or more ETDRS letters). RESULTS A total of 20 eyes (11 patients) underwent cataract surgery and were followed for a median of 25.5 months (IQR 17.5-44.2 months). The median post-operative BCVA improvement was 10.5 letters (IQR 3.50-20.25). Nuclear sclerosis severity [β = 8.99 (95% CI 3.35, 14.6), p = 0.00177] was associated with post-operative change in BCVA and central foveal ellipsoid zone (EZ) breaks [OR 1.33 × 10-9 (95% CI 5.12 × 10-10-3.43 × 10-9), p < 0.001] on OCT was inversely correlated with post-operative BCVA > 20/40 using a multivariate generalized linear model. Central foveal EZ breaks [HR 1.77 × 109 (95% CI 3.86 × 108, 8.11 × 109), p < 0.001] and MacTel Type 2 disease stage [HR 2.83, (95% CI 1.12, 7.12), p = 0.027] were independently associated with shorter time to vision loss of two lines or more in a multivariate Cox regression model. CONCLUSIONS Visual acuity significant improved after cataract surgery in eyes with MacTel Type 2 regardless of disease severity. The presence of central foveal EZ breaks may predict poorer post-operative visual acuity and subsequent vision loss from disease progression.
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Affiliation(s)
- Jacob S Heng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.,Wilmer Eye Institute, The Johns Hopkins Hospital, 400 N. Broadway, Smith 3015, Baltimore, USA
| | - J Fernando Arevalo
- Wilmer Eye Institute, The Johns Hopkins Hospital, 400 N. Broadway, Smith 3015, Baltimore, USA
| | - James T Handa
- Wilmer Eye Institute, The Johns Hopkins Hospital, 400 N. Broadway, Smith 3015, Baltimore, USA.
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Bhende M. Commentary: Imaging in macular telangiectasia type 2 - Correlating structural change with vision. Indian J Ophthalmol 2021; 69:3577-3578. [PMID: 34826998 PMCID: PMC8837293 DOI: 10.4103/ijo.ijo_2086_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Service, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Kang KH, Yoon JH, Kim JW, Kim CG, Kim JH. Long-term Clinical Course of Korean Patients Diagnosed with Macular Telangiectasia Type 2. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.8.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To evaluate long-term visual prognosis and changes in the retinal microstructure in patients with macular telangiectasia type 2.Methods: Retrospective analysis of medical records were performed for 61 eyes (32 patients) diagnosed with macular telangiectasia type 2. The visual acuity at diagnosis was compared with that at the final visit. In addition, cases were classified into three grades based on optical coherence tomography (OCT) findings: grade 1, inner retinal cavities only; grade 2, outer retinal cavities with ellipsoid zone disruption; and grade 3, ellipsoid zone disruption with proliferation of retinal pigment epithelium. Change in the grade during the follow-up was verified. In addition, visual acuities were compared between eyes with and without a change in grade.Results: The mean follow-up period was 41.5 ± 33.2 months. Visual acuity had deteriorated significantly from the mean logarithm of the minimal angle of resolution 0.23 ± 0.26 at diagnosis to a mean of 0.31 ± 0.31 at the final visit (p < 0.001). When classified using OCT, 65.6%, 22.9%, and 11.5% were grades 1, 2, and 3, respectively, at diagnosis and 47.5%, 36.1%, and 16.4% at the final visit. Progression of grade was noted in 22.9%. A higher degree of visual deterioration was noted in eyes showing progression than in eyes without (p = 0.002).Conclusions: During the long-term follow-up period, visual deterioration was noted in patients with macular telangiectasia type 2. However, the degree of deterioration was not high. Progression in the disruption of the retinal microstructure was the likely cause of visual deterioration.
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Berger TA, Manry MW, Lindsell LB, Osher JM, Miller DM, Foster RE, Riemann CD, Petersen MR, Sisk RA. Outcome of Off-Label AREDS 2 Supplementation for the Treatment of Macular Degeneration in Non-Proliferative Idiopathic Type 2 Macular Telangiectasia. Clin Ophthalmol 2021; 15:1133-1143. [PMID: 33758496 PMCID: PMC7979356 DOI: 10.2147/opth.s294789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate if off-label Age-Related Eye Disease Study 2 (AREDS2) supplementation prevents visual and anatomical deterioration in non-proliferative Idiopathic Macular Telangiectasia Type 2 (IMT2). Patients and Methods This is a single-center retrospective, comparative study of 82 IMT2 eyes treated with AREDS2 from January 1st, 2013 to January 1st, 2018. The study analysis consisted of a non-comparative arm, which included all AREDS2 eyes, and a comparative arm (27 AREDS2 and 42 untreated eyes) that only included eyes with complete follow-up data. Eyes were evaluated at baseline, 12 and 24 months. Better/worse eye sub-analysis was performed in the comparative study arm. Primary outcomes were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) anatomical characteristics including largest cavitation diameter, central macular thickness (CMT), and length of ellipsoid zone (EZ) loss at 24 months. Results In the non-comparative arm, AREDS2 eyes showed stable BCVA (0.28 ± 0.18 logMAR at baseline vs 0.26 ± 0.19 logMAR at 24 months; p = 0.35) and OCT anatomical features after 24 months of supplementation. In the comparative arm, BCVA mean difference was greater for untreated eyes at 24 months (−0.09 ± 0.15 vs 0.03 ± 0.11 logMAR; p = <0.001). AREDS2 eyes had decreased cavitary diameter and EZ loss compared to untreated eyes at the study endpoint (p = 0.01 and p = 0.02, respectively). CMT remained stable for both cohorts throughout the study. For better/worse eye analysis, untreated eyes had worse BCVA at 24 months in both better and worse eyes (both p = 0.01). For anatomical outcomes, increases in both EZ loss (p = 0.04) and cavitary diameter (p = 0.001) among untreated eyes were only significant for eyes with worse baseline BCVA. Conclusion Our results suggest that off-label AREDS2 supplementation in non-proliferative IMT2 may prevent anatomical and visual deterioration in a subset of eyes.
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Affiliation(s)
- Tyler A Berger
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew W Manry
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Lucas B Lindsell
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - James M Osher
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Daniel M Miller
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Robert E Foster
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Christopher D Riemann
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Michael R Petersen
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Robert A Sisk
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Eye Institute, Cincinnati, OH, USA.,Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Loo J, Cai CX, Choong J, Chew EY, Friedlander M, Jaffe GJ, Farsiu S. Deep learning-based classification and segmentation of retinal cavitations on optical coherence tomography images of macular telangiectasia type 2. Br J Ophthalmol 2020; 106:396-402. [PMID: 33229343 DOI: 10.1136/bjophthalmol-2020-317131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Abstract
AIM To develop a fully automatic algorithm to segment retinal cavitations on optical coherence tomography (OCT) images of macular telangiectasia type 2 (MacTel2). METHODS The dataset consisted of 99 eyes from 67 participants enrolled in an international, multicentre, phase 2 MacTel2 clinical trial (NCT01949324). Each eye was imaged with spectral-domain OCT at three time points over 2 years. Retinal cavitations were manually segmented by a trained Reader and the retinal cavitation volume was calculated. Two convolutional neural networks (CNNs) were developed that operated in sequential stages. In the first stage, CNN1 classified whether a B-scan contained any retinal cavitations. In the second stage, CNN2 segmented the retinal cavitations in a B-scan. We evaluated the performance of the proposed method against alternative methods using several performance metrics and manual segmentations as the gold standard. RESULTS The proposed method was computationally efficient and accurately classified and segmented retinal cavitations on OCT images, with a sensitivity of 0.94, specificity of 0.80 and average Dice similarity coefficient of 0.94±0.07 across all time points. The proposed method produced measurements that were highly correlated with the manual measurements of retinal cavitation volume and change in retinal cavitation volume over time. CONCLUSION The proposed method will be useful to help clinicians quantify retinal cavitations, assess changes over time and further investigate the clinical significance of these early structural changes observed in MacTel2.
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Affiliation(s)
- Jessica Loo
- Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Cindy X Cai
- Ophthalmology, Duke Medicine, Durham, North Carolina, USA
| | - John Choong
- Ophthalmology, Duke Medicine, Durham, North Carolina, USA
| | - Emily Y Chew
- Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin Friedlander
- The Lowy Medical Research Institute, La Jolla, California, USA.,Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Glenn J Jaffe
- Ophthalmology, Duke Medicine, Durham, North Carolina, USA
| | - Sina Farsiu
- Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Ophthalmology, Duke Medicine, Durham, North Carolina, USA
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