APOE ε4 Gene Carriers Demonstrate Reduced Retinal Capillary Densities in Asymptomatic Older Adults

Structural and Vascular Features of Macula Related to the Recurrence of Macular Edema in Central Retinal Vein Occlusion After Anti-VEGF Therapy

Purpose: To identify the structural and vascular features of the macula related to the recurrence of macular edema (ME) in central retinal vein occlusion (CRVO) after intravitreal anti-VEGF injections. Methods: This was a cross-sectional study including CRVO patients without ME and age-matched individuals. CRVO patients were divided into the ME-resolved group and the ME-recurrence group on the basis of whether ME recurred within 3 months. All subjects provided a detailed history and underwent a comprehensive ophthalmological examination. Measurements of the macula by swept-source optical coherence tomography angiography (SS-OCTA) were recorded. We also created the Δparameter, which represents the difference in OCTA parameters between CRVO-affected eyes and their fellow eyes. Results: The study included 13 ME-resolved CRVO patients, 20 ME-recurrence CRVO patients, and 24 age-matched controls. Compared with the ME-recurrence group, the ME-resolved group had a longer CRVO duration, more previous intravitreal anti-VEGF injections, and a higher proportion of previous retinal photocoagulation (all p < 0.05). Additionally, retinal thickness (RT) and choroidal thickness (CT) were thinner in the ME-resolved group than in the ME-recurrence and control groups (all p < 0.01). The ME-resolved group also had significantly lower vessel density (VD) in both superficial and deep vascular complexes (SVC/DVC) and larger foveal avascular zone area (FAZa) in SVC and DVC than the ME-recurrence group and the control group (all p < 0.01). The results were the same with the Δparameters. Multivariate logistic regression revealed that ΔVD and ΔFAZa in SVC and DVC were independently associated with ME recurrence after adjusting for the effects of CRVO duration, previous anti-VEGF injections, and retinal photocoagulation (all p < 0.05). Conclusion: With prolonged CRVO duration, more anti-VEGF injections, and more retinal photocoagulation procedures, retinal, choroidal, and vascular atrophy in the macula occurs in CRVO eyes, making ME less likely to recur. Macular vascular atrophy is vital for the resolution of ME and might be a manifestation of capillary remodeling.

Lower Retinal Arteriolar Density Is Associated With Higher Cerebral Small Vessel Disease Burden: An Optical Coherence Tomography Angiography Study

INTRODUCTION

It is suggested that cerebral small vessel disease (SVD) plays a role in strokes and dementia. Retinal microvasculature imaged by optical coherence tomography angiography (OCTA) is suggested to be associated with cerebral microvessels. We measured the density of the retinal arterioles and venules on the superficial vascular complex (SVC) of OCTA images and investigated associations with SVD markers in older adults.

METHODS

Participants underwent cerebral magnetic resonance imaging and OCTA imaging. An external algorithm (OCTA-Net) was used to segment the retinal vessels into arterioles and venules. SVD indicators [lacunes, white matter hyperintensity (WMH), perivascular spaces (PVS) and cerebral microbleeds (CMBs)] were determined according to the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) RESULTS: 246 older adults (mean age = 58.84 ± 7.00 years; 38.21 % males) were included in our data analysis. After adjusting for covariates, lower retinal arteriole densities correlated with higher periventricular WMH (p = 0.025) and PVS in the basal ganglia (p = 0.027). Lower retinal venule density correlated with higher deep WMH burden (p = 0.014). Lower arteriolar density was associated with increased SVD burden (p = 0.035). Arteriolar complex branching was associated with periventricular WMH (p = 0.020) while venular complex branching was associated with deep WMH (p = 0.041).

CONCLUSION

Retinal vascular changes may reflect cerebral vascular changes as evidenced by OCTA-derived metrics.

The current state of apolipoprotein E in dyslipidemia

PURPOSE OF REVIEW

Apolipoprotein E (apoE) plays a pivotal role in lipid metabolism in the peripheral circulation and in the brain. This has been recognized for decades; however, the importance of the full spectrum of variation in the APOE gene has been less investigated. This review focusses on current progresses in this field with main focus on apoE in dyslipidemia and vascular disease.

RECENT FINDINGS

Whereas ε4 is the risk increasing allele for Alzheimer disease, ε2 is associated with increased risk for age-related macular degeneration. Rare functional ε2-like variants in APOE have previously been reported to have protective associations for Alzheimer disease but recent findings suggest a simultaneous high risk of age-related macular degeneration, in line with observations for the ε2 allele.

SUMMARY

ApoE plays an important and well established role in dyslipidemia, vascular disease, and dementia. Recent evidence from large general population studies now also suggests that apoE is involved in age-related macular degeneration. ApoE-targeted therapeutics are being developed for multiple purposes; this heralds a promising change in the approach to disease processes involving apoE. The different risk profile for dementia and age-related macular degeneration should, however, be kept in mind when developing drugs targeting mechanisms resembling these variants.

Optical Coherence Tomography Angiography: Revolutionizing Clinical Diagnostics and Treatment in Central Nervous System Disease

Optical coherence tomography angiography (OCTA), as a new generation of non-invasive and efficient fundus imaging technology, can provide non-invasive assessment of vascular lesions in the retina and choroid. In terms of anatomy and development, the retina is referred to as an extension of the central nervous system (CNS). CNS diseases are closely related to changes in fundus structure and blood vessels, and direct visualization of fundus structure and blood vessels provides an effective "window" for CNS research. This has important practical significance for identifying the characteristic changes of various CNS diseases on OCTA in the future, and plays a key role in promoting early screening, diagnosis, and monitoring of disease progression in CNS diseases. This article reviews relevant fundus studies by comparing and summarizing the unique advantages and existing limitations of OCTA in various CNS disease patients, in order to demonstrate the clinical significance of OCTA in the diagnosis and treatment of CNS diseases.