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Lindziute M, Kaufeld J, Hufendiek K, Volkmann I, Brockmann D, Hosari S, Hohberger B, Christian M, Framme C, Jan T, Hufendiek K. Correlation of retinal vascular characteristics with laboratory and ocular findings in Fabry disease: exploring ocular diagnostic biomarkers. Orphanet J Rare Dis 2023; 18:314. [PMID: 37807078 PMCID: PMC10561444 DOI: 10.1186/s13023-023-02932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The goal of this study was to evaluate macular microvascular changes in patients with Fabry disease (FD) using optical coherence tomography angiography (OCTA) and to explore their correlation with laboratory and ocular findings. METHODS A total of 76 eyes (38 patients) and 48 eyes of 24 healthy controls were enrolled in this prospective study. Vessel Area Density (VAD) and Foveal Avascular Zone (FAZ) area were calculated on 2.9 × 2.9 mm OCTA images scanned with the Heidelberg Spectralis II (Heidelberg, Germany). VAD was measured in three layers: Superficial Vascular Plexus (SVP), Intermediate Capillary Plexus (ICP), and Deep Capillary Plexus (DCP). All scans were analyzed with the EA-Tool (Version 1.0), which was coded in MATLAB (The MathWorks Inc, R2017b). FAZ area was manually measured in full-thickness, SVP, ICP and DCP scans. RESULTS Average VAD in SVP, ICP and DCP was higher in Fabry disease patients than in controls (49.4 ± 11.0 vs. 26.5 ± 6.2, 29.6 ± 7.4 vs. 20.2 ± 4.4, 32.3 ± 8.8 vs. 21.7 ± 5.1 respectively, p < 0.001). Patients with cornea verticillata (CV) had a higher VAD in ICP and DCP compared to patients without CV (p < 0.01). Patients with increased lysoGb3 concentration had a higher VAD in DCP when compared to patients with normal lysoGb3 concentration (p < 0.04). There was no difference in VAD in patients with and without vascular tortuosity. However, a significantly higher VAD was observed in patients with vascular tortuosity compared to controls (p < 0.03). CONCLUSIONS Increased lysoGb3 and VAD in DCP could be reliable biomarkers of disease activity. Cornea verticillata could be adopted as a predictive biomarker for VAD changes and disease progression. The combination of cornea verticillata and increased VAD may serve as a diagnostic biomarker for Fabry disease, however due to the discrepancies in VAD values in various studies, further research has to be done to address this claim.
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Affiliation(s)
- Migle Lindziute
- University Eye Hospital, Hannover Medical School, Hannover, Germany.
| | - Jessica Kaufeld
- Division of Nephrology, Center for Internal Medicine, Hannover Medical School, Hannover, Germany
| | | | - Ingo Volkmann
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | | | - Sami Hosari
- Department of Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bettina Hohberger
- Department of Ophthalmology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mardin Christian
- Department of Ophthalmology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carsten Framme
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Tode Jan
- University Eye Hospital, Hannover Medical School, Hannover, Germany
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Hufendiek K, Lindziute M, Kaufeld J, Volkmann I, Brockmann D, Hosari S, Hohberger B, Mardin C, Framme C, Tode J, Hufendiek K. Investigation of OCTA Biomarkers in Fabry Disease: A Long Term Follow-Up of Macular Vessel Area Density and Foveal Avascular Zone Metrics. Ophthalmol Ther 2023; 12:2713-2727. [PMID: 37542614 PMCID: PMC10441980 DOI: 10.1007/s40123-023-00776-z] [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: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Retinal microvasculature is known to be altered in patients with Fabry disease (FD). We aimed to investigate the long-term changes in macular microvasculature and explore a reliable retinal biomarker for treatment monitoring in FD. METHODS Prospective study of 26 eyes with FD followed up to 48 months (mean 24, range 8-48). OCT angiography (OCTA) images (2.9 × 2.9 mm) were obtained using Heidelberg Spectralis II at baseline and follow-up. Macular vessel area density (VAD, %) was measured in three layers: superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) in three peri-macular circular sectors (c1, c2, c3). Additionally, foveal avascular zone (FAZ) area (mm2) and horizontal and vertical diameters (µm) were assessed. RESULTS VAD decreased over time in SVP, ICP (in sectors c2 and c3) and DCP (all sectors) (p < 0.04). VAD reduction was predominantly seen in treated FD patients. FAZ and horizontal diameters increased at follow-up in FD patients compared to baseline (p ≤ 0.025). Correlation analysis showed a moderate to strong negative correlation between VAD of SVP and DCP in the innermost circle and FAZ in treated patients (r = - 0.6; p < 0.0001). CONCLUSIONS This is the first long-term follow-up OCTA study in FD to our knowledge. A decrease in VAD, pronounced in the peripheral circle and deeper layers, as well as an enlargement of the FAZ could be observed over time. These changes reflect the vascular remodelling during the course of the disease. Interestingly, the reduction of VAD was more pronounced in treated patients. This could be a result of enzyme replacement therapy and could be potentially used as a reliable biomarker for monitoring the treatment of the disease. A baseline examination of VAD and FAZ before treatment initiation is meaningful. Larger studies are needed to establish the use of VAD and FAZ as biomarkers for treatment monitoring.
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Affiliation(s)
| | - Migle Lindziute
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Jessica Kaufeld
- Division of Nephrology, Center for Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Ingo Volkmann
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | | | - Sami Hosari
- Department for General, Visceral and Vascular Surgery, Kantonsspital Baden, Im Engel 1, 5404 Baden, Switzerland
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bettina Hohberger
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Mardin
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carsten Framme
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Jan Tode
- University Eye Hospital, Hannover Medical School, Hannover, Germany
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Gambini G, Scartozzi L, Giannuzzi F, Carlà MM, Boselli F, Caporossi T, De Vico U, Baldascino A, Rizzo S. Ophthalmic Manifestations in Fabry Disease: Updated Review. J Pers Med 2023; 13:904. [PMID: 37373893 DOI: 10.3390/jpm13060904] [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: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder, causing Gb-3 (globotriaosylceramide) buildup in cellular lysosomes throughout the body, in particular in blood vessel walls, neuronal cells, and smooth muscle. The gradual accumulation of this glycosphingolipid in numerous eye tissues causes conjunctival vascular abnormalities, corneal epithelial opacities (cornea verticillata), lens opacities, and retinal vascular abnormalities. Although a severe vision impairment is rare, these abnormalities are diagnostic indicators and prognostics for severity. Cornea verticillata is the most common ophthalmic feature in both hemizygous men and heterozygous females. Vessel tortuosity has been linked to a faster disease progression and may be useful in predicting systemic involvement. New technologies such as optical coherence tomography angiography (OCTA) are useful for monitoring retinal microvasculature alterations in FD patients. Along with OCTA, corneal topographic analysis, confocal microscopy, and electro-functional examinations, contributed to the recognition of ocular abnormalities and have been correlated with systemic involvement. We offer an update regarding FD ocular manifestations, focusing on findings derived from the most recent imaging modalities, to optimize the management of this pathology.
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Affiliation(s)
- Gloria Gambini
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Luca Scartozzi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Francesco Boselli
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy
| | - Umberto De Vico
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", 20123 Rome, Italy
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Wiest MRJ, Toro MD, Nowak A, Bajka A, Fasler K, Al-Sheikh M, Hamann T, Zweifel SA. Relationship of Vessel Density to Vessel Length Density in Patients with Treated Fabry Disease. Diagnostics (Basel) 2023; 13:diagnostics13071227. [PMID: 37046445 PMCID: PMC10093750 DOI: 10.3390/diagnostics13071227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Fabry disease (FD) is a potentially lethal lysosomal disorder with systemic vascular changes. Previous studies demonstrated retinal vascular involvement using optical coherence tomography angiography (OCTA) in affected patients; Aim: To analyze and quantify the retinal vasculature measuring vessel density (VD), vessel length density (VLD), and the ratio of VD to VLD (VD/VLD) in superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) using OCTA in patients with FD and to show whether they differ from healthy controls (HC); Patients and methods: Single-center, retrospective, consecutive cohort study of patients with genetically proven FD. Patients underwent an ophthalmological examination including OCTA. VD, VLD, foveal avascular zone (FAZ), and the VD/VLD were compared to an HC group using a linear mixed model; Results: A statistically significant difference in the VLD and VD/VLD of DCP was observed between the two groups (p < 0.001). Using ROC curves with AUC and Youden's Index, a cut-off value for differentiating both groups using VD/VLD in DCP FD with high specificity and high sensitivity was established; Conclusions: FD and HC groups seem to be separable using the VD/VLD ratio in DCP. This new biomarker might differentiate changes in the retinal microvasculature that are not detectable by VD or VLD alone.
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Affiliation(s)
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Eye Clinic, Public Health Department, Federico II University, 80131 Naples, Italy
- Chair and Department of Ophthalmology with Pediatric Service, Medical University of Lublin, 20079 Lublin, Poland
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Department of Internal Medicine, Psychiatry University Clinic Zurich, 8091 Zurich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Mayss Al-Sheikh
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Retinal microvasculature is a potential biomarker for acute mountain sickness. SCIENCE CHINA. LIFE SCIENCES 2023:10.1007/s11427-022-2271-x. [PMID: 36811802 DOI: 10.1007/s11427-022-2271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023]
Abstract
Increased cerebral blood flow resulting from altered capillary level autoregulation at high altitudes leads to capillary overperfusion and then vasogenic cerebral edema, which is the leading hypothesis of acute mountain sickness (AMS). However, studies on cerebral blood flow in AMS have been mostly restricted to gross cerebrovascular endpoints as opposed to the microvasculature. This study aimed to investigate ocular microcirculation alterations, the only visualized capillaries in the central neural system (CNS), during early-stage AMS using a hypobaric chamber. This study found that after high altitude simulation, the optic nerve showed retinal nerve fiber layer thickening (P=0.004-0.018) in some locations, and the area of the optic nerve subarachnoid space (P=0.004) enlarged. Optical coherence tomography angiography (OCTA) showed increased retinal radial peripapillary capillary (RPC) flow density (P=0.003-0.046), particularly on the nasal side of the nerve. The AMS-positive group had the largest increases in RPC flow density in the nasal sector (AMS-positive, Δ3.21±2.37; AMS-negative, Δ0.01±2.16, P=0.004). Among multiple ocular changes, OCTA increase in RPC flow density was associated with simulated early-stage AMS symptoms (beta=0.222, 95%CI, 0.009-0.435, P=0.042). The area under the receiver operating characteristics curve (AUC) for the changes in RPC flow density to predict early-stage AMS outcomes was 0.882 (95%CI, 0.746-0.998). The results further confirmed that overperfusion of microvascular beds is the key pathophysiologic change in early-stage AMS. RPC OCTA endpoints may serve as a rapid, noninvasive potential biomarker for CNS microvascular changes and AMS development during risk assessment of individuals at high altitudes.
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Michaud L, Garon ML, Forcier P, Diaconu V. Frequency Doubling Technology Visual Field Loss in Fabry Subjects Related to Retinal Ganglion Cell Function as Explored by ERG and OSOME. Clin Ophthalmol 2022; 16:1893-1908. [PMID: 35711968 PMCID: PMC9192351 DOI: 10.2147/opth.s356245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aims to evaluate potential causes of FDT visual field loss in a selected group of Fabry subjects. Patients and Methods This is a pilot observational study. Subjects were assessed during 2 visits. The following tests were performed: visual acuity, tonometry, optical coherence tomography (OCT) optic nerve scan, frequency doubling time (FDT) and threshold (SAP) VF, ERG, and Online Spectro-reflectometry Oxygenation Measurement in the Eye (OSOME). Results are compared across visits and, when indicated, interpreted against those collected on non-Fabry population matched for age and sex. Results The study population was composed of 3 males (34.3 ± 8.9 y.o.) and 5 females (46.4 ± 6.5 y.o). For all subjects, BCVA remained 6/6 OU throughout the study and OCT optic nerve scans were normal. FDT showed a defect in at least 1 quadrant for all participants, in contrast with SAP. FDT PSD value was found different vs SAP. For ERG, the i-wave (52.1 + 2.7 ms) and B-waves (31.6 ± 2.1 ms) peak times were significantly longer compared to a non-Fabry population (p < 0.05). Overall blood oxygenation varied from 61.3% ± 4% to 68.1% ± 4% at the second visit, suggesting a loss of capillary perfusion. Blood volume varied based on location (superior/inferior), eye tested (OD/OS) and time (visit 1/2). The range of values exceeds normal subjects findings (p < 0.05). Blood volume was correlated to FDT PSD value for the superior area of the optic nerve. Conclusion The results suggest that Fabry subjects present FDT deficits and abnormal ERG patterns that may be explained by a retinal dysfunction affecting retinal ganglion cells (RGCs), second to vascular alterations.
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Affiliation(s)
- Langis Michaud
- École d’optométrie de l’Université de Montréal, Montréal, Canada
- Correspondence: Langis Michaud, École d’optométrie de l’Université de Montréal, 3744 Jean-Brillant, Suite 260-15, Montréal, H3T 1P1, Canada, Tel +1-514-343-6111 ext 8945; Tel +1-514-343-6111 ext 8945, Email
| | - Marie-Lou Garon
- École d’optométrie de l’Université de Montréal, Montréal, Canada
| | - Pierre Forcier
- École d’optométrie de l’Université de Montréal, Montréal, Canada
| | - Vasile Diaconu
- École d’optométrie de l’Université de Montréal, Montréal, Canada
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Biffi E, Turple Z, Chung J, Biffi A. Retinal biomarkers of Cerebral Small Vessel Disease: A systematic review. PLoS One 2022; 17:e0266974. [PMID: 35421194 PMCID: PMC9009626 DOI: 10.1371/journal.pone.0266974] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cerebral Small Vessel Disease (CSVD), a progressive degenerative disorder of small caliber cerebral vessels, represents a major contributor to stroke and vascular dementia incidence worldwide. We sought to conduct a systematic review of the role of retinal biomarkers in diagnosis and characterization of CSVD. METHODS We conducted a systematic review of MEDLINE, PubMed, Scopus, the Cochrane Library Database, and Web of Science. We identified studies of sporadic CSVD (including CSVD not otherwise specified, Cerebral Amyloid Angiopathy, and Hypertensive Arteriopathy) and the most common familial CSVD disorders (including CADASIL, Fabry disease, and MELAS). Included studies used one or more of the following tools: visual fields assessment, fundus photography, Optical Coherence Tomography and OCT Angiography, Fluorescein Angiography, Electroretinography, and Visual Evoked Potentials. RESULTS We identified 48 studies of retinal biomarkers in CSVD, including 9147 cases and 12276 controls. Abnormalities in retinal vessel diameter (11 reports, n = 11391 participants), increased retinal vessel tortuosity (11 reports, n = 617 participants), decreased vessel fractal dimension (5 reports, n = 1597 participants) and decreased retinal nerve fiber layer thickness (5 reports, n = 4509 participants) were the biomarkers most frequently associated with CSVD. We identified no reports conducting longitudinal retinal evaluations of CSVD, or systematically evaluating diagnostic performance. CONCLUSION Multiple retinal biomarkers were associated with CSVD or its validated neuroimaging biomarkers. However, existing evidence is limited by several shortcomings, chiefly small sample size and unstandardized approaches to both biomarkers' capture and CSVD characterization. Additional larger studies will be required to definitively determine whether retinal biomarkers could be successfully incorporated in future research efforts and clinical practice.
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Affiliation(s)
- Elena Biffi
- New England College of Optometry, Boston, MA, United States of America
- * E-mail:
| | - Zachary Turple
- New England College of Optometry, Boston, MA, United States of America
| | - Jessica Chung
- New England College of Optometry, Boston, MA, United States of America
| | - Alessandro Biffi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
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Yanık Ö, Çıkı K, Özmert E, Sivri S. Vascular and structural analyses of retinal and choroidal alterations in Fabry disease: the effect of hyperreflective foci and retinal vascular tortuosity. Ophthalmic Genet 2022; 43:344-353. [PMID: 35038962 DOI: 10.1080/13816810.2022.2025607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effects of Fabry disease (FD) on the retinal microvasculature and choroidal vascular and structural characteristics. METHODS This study included 10 patients with FD and 10 age-matched healthy controls. Binarized enhanced depth imaging optical coherence tomography (OCT) images were used to measure the total choroidal area, luminal area, and stromal area with ImageJ software. The choroidal vascularity index (CVI) was assessed. The vessel densities (VD) of the retinal capillary plexuses and foveal avascular zone (FAZ) area were measured with OCT-angiography. RESULTS The most common anterior segment finding was cornea verticillata (60.0%) and the most frequent posterior segment finding was vascular tortuosity (50.0%). Intraretinal hyperreflective foci on B-scan OCT was observed in 50.0% of the cases. In Fabry cases, a linear mixed model with random intercept revealed that 1% change in CVI was related to -0.009 mm2 (p = .015) change in FAZ area and -0.047 mm change, (p = .024) in FAZ perimeter. In the presence of retinal vascular tortuosity, 1% change in CVI was related to -0.013 mm2 (p = .002) change in FAZ area and -0.052 mm change (p = .004) in FAZ perimeter. In the presence of hyperreflective foci, 1% change in CVI was related to -0.014 mm2 (p = .004) change in FAZ area and -0.064 mm change (p = .003) in FAZ perimeter. CONCLUSION The significant negative associations between FAZ measurements and CVI suggest a possible interaction between the choroidal and retinal microvasculature of patients with FD. These alterations were more pronounced in the presence of hyperreflective foci and retinal vascular tortuosity.
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Affiliation(s)
- Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Kismet Çıkı
- Department of Pediatric Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Serap Sivri
- Department of Pediatric Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
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The central vein sign helps in differentiating multiple sclerosis from its mimickers: lessons from Fabry disease. Eur Radiol 2022; 32:3846-3854. [PMID: 35029733 DOI: 10.1007/s00330-021-08487-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/26/2021] [Accepted: 11/28/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Although the use of specific MRI criteria has significantly increased the diagnostic accuracy of multiple sclerosis (MS), reaching a correct neuroradiological diagnosis remains a challenging task, and therefore the search for new imaging biomarkers is crucial. This study aims to evaluate the incidence of one of the emerging neuroradiological signs highly suggestive of MS, the central vein sign (CVS), using data from Fabry disease (FD) patients as an index of microvascular disorder that could mimic MS. METHODS In this retrospective study, after the application of inclusion and exclusion criteria, MRI scans of 36 FD patients and 73 relapsing-remitting (RR) MS patients were evaluated. Among the RRMS participants, 32 subjects with a disease duration inferior to 5 years (early MS) were also analyzed. For all subjects, a Fazekas score (FS) was recorded, excluding patients with FS = 0. Different neuroradiological signs, including CVS, were evaluated on FLAIR T2-weighted and spoiled gradient recalled echo sequences. RESULTS Among all the recorded neuroradiological signs, the most striking difference was found for the CVS, with a detectable prevalence of 78.1% (57/73) in RRMS and of 71.4% (25/32) in early MS patients, while this sign was absent in FD (0/36). CONCLUSIONS Our results confirm the high incidence of CVS in MS, also in the early phases of the disease, while it seems to be absent in conditions with a different etiology. These results corroborate the possible role of CVS as a useful neuroradiological sign highly suggestive of MS. KEY POINTS • The search for new imaging biomarkers is crucial to achieve a correct neuroradiological diagnosis of MS. • The CVS shows an incidence superior to 70% in MS patients, even in the early phases of the disease, while it appears to be absent in FD. • These findings further corroborate the possible future central role of CVS in distinguishing between MS and its mimickers.
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Bacherini D, Vicini G, Nicolosi C, Tanini I, Lenzetti C, Finocchio L, Cirami LC, Dervishi E, Rizzo S, Virgili G, Giansanti F, Sodi A. Optical Coherence Tomography Angiography for the Evaluation of Retinal Vasculature in Fabry Disease: Our Experience and Review of Current Knowledge. Front Neurol 2021; 12:640719. [PMID: 33767663 PMCID: PMC7985262 DOI: 10.3389/fneur.2021.640719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: Optical coherence tomography angiography (OCTA) is a non-invasive and objective tool for the evaluation of the retinal microvascular changes in Fabry disease (FD). We investigated changes in retinal vasculature in FD patients, and the possible correlation with systemic parameters, by using OCTA, and reviewed the current status of literature. Methods: Thirteen FD patients (eight females, five males, mean age 49.85 ± 14.7 years) were compared with 13 age- and sex-matched healthy controls. OCTA 3 × 3 mm macular scans were performed in all subjects. We evaluated the vessel density and vessel perfusion in distinct macular areas (whole, inner, and outer) of both the superficial capillary plexus (SCP VD and SCP VP) and of the deep capillary plexus (DCP VD and DCP VP). We also evaluated the foveal avascular zone (FAZ) metrics (area, perimeter, and circularity), and correlation between systemic and OCTA parameters. A literature review on the current understanding of OCTA in FD is then presented. Results: FD patients showed significantly lower SCP VD values in the whole area (17.37 ± 2.08 mm−1 vs. 18.54 ± 1.21 mm−1; p-value 0.022), as well as in the outer area (17.46 ± 2.10 mm−1 vs. 19.08 ± 1.14 mm−1; p-value 0.002), but not in the inner. Even the DCP VD was significantly lower in all the imaged areas: whole (17.75 ± 3.93 mm−1 vs. 19.71 ± 1.20 mm−1; p-value 0.024), outer (18.25 ± 4.17 mm−1 vs. 20.33 ± 1.20 mm−1; p-value 0.023), and inner (19.54 ± 4.17 mm−1 vs. 21.96 ± 1.55 mm−1; p-value 0.011). There were no significant differences in vessel perfusion parameters (both SCP VP and DCP VP ones) and FAZ. No significant correlations were found between the OCTA parameters and systemic parameters (maximal left ventricular wall thickness and glomerular filtration rate) in FD patients. Conclusions: OCTA can be considered as a promising non-invasive tool, which enables a quantitative evaluation of retinal vascular involvement in FD, despite the varying data reported in literature. Our results support the use of OCTA as an objective tool to evaluate retinal vascular abnormalities in FD. The utility of OCTA in FD needs to be validated by longitudinal studies taking into account the overall progression of the disease.
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Affiliation(s)
- Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giulio Vicini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Ilaria Tanini
- Cardiomyopathy Unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Chiara Lenzetti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Lucia Finocchio
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Lino Calogero Cirami
- Nephrology Dialysis Transplant Unit, Medical Geriatric Department, Careggi University Hospital, Florence, Italy
| | - Egrina Dervishi
- Nephrology Dialysis Transplant Unit, Medical Geriatric Department, Careggi University Hospital, Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Consiglio Nazionale della Ricerca (CNR), Pisa, Italy
| | - Gianni Virgili
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Sodi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
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11
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Wiest MRJ, Toro MD, Nowak A, Baur J, Fasler K, Hamann T, Al-Sheikh M, Zweifel SA. Globotrioasylsphingosine Levels and Optical Coherence Tomography Angiography in Fabry Disease Patients. J Clin Med 2021; 10:jcm10051093. [PMID: 33807900 PMCID: PMC7961664 DOI: 10.3390/jcm10051093] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background: To date, there are no studies associating the dried blood spot (DBS) levels of globotrioasylsphingosine (lysoGb3) with quantitative optical coherence tomography angiography (OCTA) parameters in Fabry disease (FD) patients. Here, we aimed to investigate the association between OCTA vessel density (VD), vessel length density (VLD) with DBS lysoGb3. Methods: A retrospective, single center analysis of all consecutive FD patients enrolled at the Department of Ophthalmology of the University Hospital of Zurich from 1 December 2017 to 9 September 2020. An association between VD and VLD detected by OCTA and lysoGb3 was investigated using a linear mixed model. Results: A total of 57 FD patients (23 male, 34 female; 109 eyes) were included. Forty-one patients suffered from the classic phenotype and 16 from the later-onset phenotype. LysoGb3 inversely correlated with VD and VLD in both the superficial (VD: p = 0.034; VLD: p = 0.02) and deep capillary plexus (VD: p = 0.017; VLD: p = 0.018) in the overall FD cohort. Conclusions: Our study shows an association between lysoGb3 and OCTA VD and VLD. This supports the hypothesis that quantitative OCTA parameters might be useful as diagnostic biomarkers for evaluating systemic involvement in FD, and possibly other diseases.
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Affiliation(s)
- Maximilian Robert Justus Wiest
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
- Department of Internal Medicine, Psychiatry University Clinic Zurich, 8091 Zurich, Switzerland
| | - Joel Baur
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
| | - Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
| | - Mayss Al-Sheikh
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (M.R.J.W.); (M.D.T.); (J.B.); (K.F.); (T.H.); (M.A.-S.)
- Correspondence: ; Tel.: +41-44-255-87-94
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12
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Chalkias E, Topouzis F, Tegos T, Tsolaki M. The Contribution of Ocular Biomarkers in the Differential Diagnosis of Alzheimer's Disease versus Other Types of Dementia and Future Prospects. J Alzheimers Dis 2021; 80:493-504. [PMID: 33554918 DOI: 10.3233/jad-201516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With dementia becoming increasingly prevalent, there is a pressing need to become better equipped with accurate diagnostic tools that will favorably influence its course via prompt and specific intervention. The overlap in clinical manifestation, imaging, and even pathological findings between different dementia syndromes is one of the most prominent challenges today even for expert physicians. Since cerebral microvasculature and the retina share common characteristics, the idea of identifying potential ocular biomarkers to facilitate diagnosis is not a novel one. Initial efforts included studying less quantifiable parameters such as aspects of visual function, extraocular movements, and funduscopic findings. However, the really exciting prospect of a non-invasive, safe, fast, reproducible, and quantifiable method of pinpointing novel biomarkers has emerged with the advent of optical coherence tomography (OCT) and, more recently, OCT angiography (OCTA). The possibility of analyzing multiple parameters of retinal as well as retinal microvasculature variables in vivo represents a promising opportunity to investigate whether specific findings can be linked to certain subtypes of dementia and aid in their earlier diagnosis. The existing literature on the contribution of the eye in characterizing dementia, with a special interest in OCT and OCTA parameters will be reviewed and compared, and we will explicitly focus our effort in advancing our understanding and knowledge of relevant biomarkers to facilitate future research in the differential diagnosis between Alzheimer's disease and common forms of cognitive impairment, including vascular dementia, frontotemporal dementia, and dementia with Lewy bodies.
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Affiliation(s)
- Efthymios Chalkias
- A' Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Fotis Topouzis
- A' Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Magda Tsolaki
- 1st Neurology Department, AHEPA University Hospital, Thessaloniki, Greece
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13
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Lin Z, Pan X, Mao K, Jiao Q, Chen Y, Zhong Y, Cheng Y. Quantitative evaluation of retinal and choroidal changes in Fabry disease using optical coherence tomography angiography. Lasers Med Sci 2021; 37:269-277. [PMID: 33409749 DOI: 10.1007/s10103-020-03242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
To examine the retinal and choroidal changes in patients with Fabry disease (FD) using optical coherence tomography angiography (OCTA). FD patients and age- and sex-matched healthy subjects were enrolled. A detailed ophthalmological examination was performed for all participants. The retinal thickness, ganglion cell layer with inner plexiform layer (GCIPL) thickness, choroidal thickness (CT), vessel length density (VLD), vessel perfusion density (VPD), and foveal avascular zone (FAZ) were analyzed in a detailed way with OCTA. Moreover, all FD patients underwent several laboratory tests to evaluate systemic conditions. A total of 54 subjects comprising 26 FD patients and 28 normal controls were enrolled. The retinal thickness, GCIPL thickness, and FAZ area showed no significant differences between the two groups (all P > 0.05). Only the superior CT in FD patients was significantly thinner than that in the normal subjects (P = 0.040). The macular VLD and VPD in the FD group were significantly reduced compared with the healthy controls (P = 0.026, P = 0.008). The macular VLD in FD patients had no significant correlations with different laboratory results (all P > 0.05), while the macular VPD were negatively correlated with creatinine (r = - 0.432, P = 0.028) and cystatin C (r = - 0.422, P = 0.032). FD patients may have retinal vascular dropout and choroidal vascular alterations. Analysis of vessel density using OCTA might be useful in the clinical assessment in FD patients.
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Affiliation(s)
- Zhongjing Lin
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ke Mao
- Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qin Jiao
- Department of Ophthalmology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yanwei Chen
- Department of Ophthalmology, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yisheng Zhong
- Department of Ophthalmology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Yu Cheng
- Department of Ophthalmology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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14
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Cennamo G, Montorio D, Santoro C, Cocozza S, Spinelli L, Di Risi T, Riccio E, Russo C, Pontillo G, Esposito R, Imbriaco M, Pisani A. The Retinal Vessel Density as a New Vascular Biomarker in Multisystem Involvement in Fabry Disease: An Optical Coherence Tomography Angiography Study. J Clin Med 2020; 9:jcm9124087. [PMID: 33352849 PMCID: PMC7766384 DOI: 10.3390/jcm9124087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
In this study, we evaluated the possible relationship between the changes in retinal vessel density (VD) by optical coherence tomography angiography (OCTA) and the vascular alterations involving renal, cardiovascular and central nervous systems in patients affected by Fabry disease (FD). In 50 FD patients, the retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) in macular region were evaluated by OCTA examination. The patients also underwent a brain magnetic resonance imaging scan, renal and echocardiographic examinations with quantification of systolic pulmonary arterial pressure (PAPs) and left atrial volume index (LAVi). The VD of SCP and DCP was inversely related with E/e’ ratio, LAVi, interventricular septal thickness, global longitudinal strain (GLS) and PAPs (p < 0.05). No relationship was found, with a multivariate analysis, between OCTA parameters and kidney function and neuroradiological signs of central nervous system involvement. OCTA could be a new vascular biomarker in FD, revealing a strong correlation between retinal capillary damage and myocardial impairment, possibly preceding both renal dysfunction and cerebrovascular involvement.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Teodolinda Di Risi
- CEINGE—Advanced Biotechnologies, 80145 Naples, Italy;
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
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15
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Dogan C, Gonen B, Dincer MT, Mergen B, Kiykim E, Bakir A, Trabulus S, Yetik H, Seyahi N. Evaluation of the reasons for the microvascular changes in patients with Fabry disease using optic coherence tomography angiography. Eur J Ophthalmol 2020; 31:3231-3237. [PMID: 33225739 DOI: 10.1177/1120672120974288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the blood flow changes in the choriocapillaris and the superficial and deep capillary plexus of the retina using optic coherence tomography angiography (OCTA) in patients with Fabry disease (FD) and reveal any possible association of these changes with the systemic findings. METHODS This cross-sectional study included 38 patients with FD and age- and gender-matched 40 healthy controls. OCTA images were obtained from all patients. Superficial (sCVD) and deep capillary vascular density (dCVD) in the foveal, parafoveal, and perifoveal zones and the whole image were recorded for each patient. Flow area in the choriocapillaris and central macular thickness (CMT) were also recorded. RESULTS Patients with FD showed a lower whole image (54.45 ± 5.99% vs 57.32 ± 6.71%, p = 0.004), foveal (34.94 ± 7.60% vs 39.65 ± 7.03%, p = 0.003), parafoveal (57.41 ± 4.85% vs 59.19 ± 4.67%, p = 0.043), and perifoveal (55.87 ± 6.43% vs 58.87 ± 7.02%, p = 0.003) dCVD compared to the healthy controls without a significant difference in the sCVD and choriocapillaris blood flow (p > 0.05). A significantly lower whole image and foveal dCVD in the FD patients with renal involvement was observed compared to the healthy controls (p = 0.027 and p = 0.024, respectively) without any significant difference between the FD patients without renal involvement and healthy controls (p = 0.17 and p = 0.13, respectively). CMT was significantly higher in FD patients with renal involvement compared to the ones without renal involvement (252.1 ± 18.5 µm vs 235.5 ± 17.6 µm, p = 0.016). CONCLUSION Patients with FD showed a lower dCVD without any change in sCVD and choriocapillaris compared to the healthy controls. This decrease was associated mostly with the renal involvement and duration of treatment.
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Affiliation(s)
- Cezmi Dogan
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Busenur Gonen
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mevlut Tamer Dincer
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Mergen
- Basaksehir Cam ve Sakura City Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Ertugrul Kiykim
- Cerrahpasa Medical Faculty, Department of Pediatrics, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Alev Bakir
- Department of Biostatistics, Halic University, Istanbul, Turkey
| | - Sinan Trabulus
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Huseyin Yetik
- Cerrahpasa Medical Faculty, Department of Ophthalmology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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16
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Everett M, Magazzeni S, Schmoll T, Kempe M. Optical coherence tomography: From technology to applications in ophthalmology. TRANSLATIONAL BIOPHOTONICS 2020. [DOI: 10.1002/tbio.202000012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | - Tilman Schmoll
- Carl Zeiss Meditec Inc. Dublin California USA
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
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17
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Cakmak AI, Atalay E, Cankurtaran V, Yaşar E, Turgut FH. Optical coherence tomography angiography analysis of fabry disease. Int Ophthalmol 2020; 40:3023-3032. [PMID: 32607948 DOI: 10.1007/s10792-020-01486-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Fabry disease (FD) is characterized by a deficiency in α-galactosidase A activity that leads to the cumulative deposition of unmetabolized glycosphingolipids within organs, including the vascular endothelium and the eyes. The purpose of this study was to assess the effects of FD on the retinal microvasculature, foveal avascular zone (FAZ), macular thickness and retinal nerve fiber layer (RNFL) using optical coherence tomography angiography (OCT-A). METHODS Twenty-five patients (14 female and 11 male; mean age 33.16 ± 11.44) with genetically verified FD were compared with 37 age- and sex-matched healthy controls (mean age 32.36 ± 15.54). The vessel density (VD) values of the superficial and deep capillary plexuses (SCP and DCP), the area of the FAZ, the density of radial peripapillary capillaries (RPC), the macular thickness and the retinal nerve fiber layer thickness were measured by OCT-A examination. RESULTS The patients showed significantly lower VD values than controls in the foveal regions of both SCP and the DCP (21.15 ± 5.56 vs. 23.79 ± 4.64 (p = 0.048), 37.92 ± 6.78 vs. 41.11 ± 5.59 (p = 0.048), respectively). The FAZ was significantly larger in the FD group than in the control group (0.3 ± 0.1 vs. 0.24 ± 0.08 (p = 0.011)). No significant difference was identified in measurements of RPC density, peripapillary RNFL thickness or macular thickness between the two groups (p > 0.05 for all). CONCLUSION Decreased VD and an enlarged foveal avascular area suggest possible changes in the retinal microvasculature of patients with FD. OCT-A can serve as a useful, noninvasive, quantitative tool for diagnosing FD and monitoring its progression.
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Affiliation(s)
- Ayse Idil Cakmak
- Tayfur Ata Sokmen Medical School, Department of Ophthalmology, Hatay Mustafa Kemal University, 31040, Antakya, Hatay, Turkey.
| | - Eray Atalay
- Department of Ophthalmology, Eskişehir Osmangazi University Medical School, Eskişehir, Turkey
| | - Veysel Cankurtaran
- Tayfur Ata Sokmen Medical School, Department of Ophthalmology, Hatay Mustafa Kemal University, 31040, Antakya, Hatay, Turkey
| | - Erdoğan Yaşar
- Department of Ophthalmology, Aksaray University Medical School, Aksaray, Turkey
| | - Faruk Hilmi Turgut
- Tayfur Ata Sokmen Medical School, Department of Internal Medicine, Nephrology Clinics, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
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18
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Zhang JF, Wiseman S, Valdés-Hernández MC, Doubal FN, Dhillon B, Wu YC, Wardlaw JM. The Application of Optical Coherence Tomography Angiography in Cerebral Small Vessel Disease, Ischemic Stroke, and Dementia: A Systematic Review. Front Neurol 2020; 11:1009. [PMID: 33013667 PMCID: PMC7511809 DOI: 10.3389/fneur.2020.01009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/31/2020] [Indexed: 12/26/2022] Open
Abstract
Objective: To investigate the application of optical coherence tomography angiography (OCTA) in cerebral small vessel disease (SVD), ischemic stroke and dementia. Methods: We conducted a systematic search in MEDLINE (from inception) and EMBASE (from 1980) to end 2019 for human studies that measured retinal parameters in cerebral SVD, ischemic stroke, and dementia using OCTA. Results: Fourteen articles (n = 989) provided relevant data. Ten studies included patients with Alzheimer disease (AD) and mild cognitive impairment (n = 679), two investigated pre-symptomatic AD participants (n = 154), and two investigated monogenic SVD patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (n = 32) and Fabry disease (n = 124). Methods to reduce bias and risk factor adjustment were poorly reported. Substantial methodological variations between studies precluded a formal meta-analysis. Quantitative measurements revealed significant yet inconclusive changes in foveal avascular zone, perfusion density, and vessel density (VD) in AD, presymptomatic AD, and SVD patients. Two (n = 160) of three studies (n = 192) showed association between decreased VD and increased white matter hyperintensities. In three (n = 297) of seven studies (n = 563), better cognitive function was associated with increased VD. One study (n = 52) suggested increased VD was associated with increased ganglion cell-inner plexiform layer thickness in AD yet with no covariate adjustment. Conclusions: Changes in retinal microvasculature identified using OCTA are associated with monogenic SVD and different stages of AD, but data are limited and partly confounded by methodological differences. Larger studies with risk factors adjustment and more consistent OCTA methods are needed to fully exploit this technology. PROSPERO registration number: CRD42020166929.
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Affiliation(s)
- Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart Wiseman
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria C. Valdés-Hernández
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fergus N. Doubal
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, United Kingdom
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yun-Cheng Wu
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Joanna M. Wardlaw
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19
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Sodi A, Nicolosi C, Vicini G, Lenzetti C, Virgili G, Rizzo S. Computer-assisted retinal vessel diameter evaluation in Fabry disease. Eur J Ophthalmol 2019; 31:173-178. [PMID: 31718270 DOI: 10.1177/1120672119886985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Fabry disease retinal vascular involvement has been widely reported, with narrowing of the retinal arterioles, dilation and irregularity of the retinal veins, and exaggerated tortuosity of the retinal vessels. We evaluated retinal vessel diameter in Fabry disease, by means of a dedicated software, aiming to provide a quantitative marker of retinal vascular network abnormalities in Fabry disease patients. MATERIAL AND METHODS Observational case-control study evaluating different branches of vessels, peripapillary vessels (group A), temporal vascular arcades (group B), and second-order collaterals of the temporal arcades (group C). We obtained the vessel diameters values from eye fundus digital images of eight Fabry disease patients and eight age-sex matched controls, using a semiautomatic software. Mann-Whitney test was used to compare the Fabry disease group versus the control group. RESULTS The difference between the average diameters of all the types of vessels considered were significantly smaller in Fabry disease patients compared to healthy controls, resulting in a decrease in size (mm) of 10.9% for group A, 7.8% for group B, and 7.4% for group C. The most evident difference between Fabry disease patients and controls was found in the largest vessels. CONCLUSION A computer-assisted analysis of retinal vessel diameter in Fabry disease by means of dedicated software showed narrower retinal arteries in Fabry disease patients than in controls. Our data support the use of semiautomatic assessment of retinal vessel attenuation as an objective and reproducible method to evaluate retinal vascular alterations in Fabry disease, providing a clinical non-invasive tool for early diagnosis and disease monitoring.
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Affiliation(s)
- Andrea Sodi
- Department of Surgery and Translational Medicine, Eye Clinic, Careggi University Hospital, University of Florence, Florence, Italy
| | - Cristina Nicolosi
- Department of Surgery and Translational Medicine, Eye Clinic, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giulio Vicini
- Department of Surgery and Translational Medicine, Eye Clinic, Careggi University Hospital, University of Florence, Florence, Italy
| | - Chiara Lenzetti
- Department of Surgery and Translational Medicine, Eye Clinic, Careggi University Hospital, University of Florence, Florence, Italy
| | - Gianni Virgili
- Department of Surgery and Translational Medicine, Eye Clinic, Careggi University Hospital, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Surgery and Translational Medicine, Eye Clinic, Careggi University Hospital, University of Florence, Florence, Italy
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