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Faatz H, Lommatzsch A. Overview of the Use of Optical Coherence Tomography Angiography in Neovascular Age-Related Macular Degeneration. J Clin Med 2024; 13:5042. [PMID: 39274255 PMCID: PMC11396513 DOI: 10.3390/jcm13175042] [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: 06/17/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
The aim of this review is to present and discuss the use of optical coherence tomography angiography (OCTA) in age-related macular degeneration (AMD). OCTA is a non-invasive imaging procedure that gives a detailed indirect view of physiological and pathological vessels in the retina and choroid membrane. Compared with dye-based imaging, OCTA provides a segmented presentation of the individual vascular layers and plexuses, thus enabling previously unattainable differentiation and classification of pathological vascular changes within or underneath the retina. In particular, OCTA facilitates early detection of exudative macular neovascularizations (MNV) so that treatment with anti-VEGF medication can be initiated. Moreover, in the context of both screening and therapy monitoring, it is hoped that OCTA can provide more detailed data to enable greater personalization of treatment and follow-up. The image quality of OCTA is, however, susceptible to artifacts, and validation of the results by studies is required. Recent developments have shown constant improvement both in the algorithms for image calculation and avoidance of artifacts and in image quality, so the scope of OCTA will certainly expand with time.
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Affiliation(s)
- Henrik Faatz
- Eye Center, St. Franziskus Hospital Münster, 48145 Münster, Germany
- Achim Wessing Institute for Imaging in Ophthalmology, University of Essen-Duisburg, 45147 Essen, Germany
- Department of Ophthalmology, University of Essen-Duisburg, 45147 Essen, Germany
| | - Albrecht Lommatzsch
- Eye Center, St. Franziskus Hospital Münster, 48145 Münster, Germany
- Achim Wessing Institute for Imaging in Ophthalmology, University of Essen-Duisburg, 45147 Essen, Germany
- Department of Ophthalmology, University of Essen-Duisburg, 45147 Essen, Germany
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2
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Brinkmann M, Viggiano P, Boscia G, Müller T, Castellino N, Schweighofer J, Boscia F, Toro MD, El-Shabrawi Y. Analysis of Choriocapillaris Reperfusion Topography Following Faricimab Treatment for Neovascular Age-Related Macular Degeneration in Therapy-Naïve Patients. Ophthalmol Ther 2024; 13:1981-1992. [PMID: 38801614 PMCID: PMC11178690 DOI: 10.1007/s40123-024-00967-2] [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: 03/04/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION To assess changes in choriocapillaris (CC) vascular density surrounding macular neovascularization (MNV) in treatment-naïve age-related macular degeneration (AMD) after faricimab application using optical coherence tomography angiography (OCTA). METHODS Twenty-five eyes of 25 treatment-naïve individuals who underwent intravitreal faricimab injections for neovascular AMD (nAMD) with type 1 MNV were included. Spectral-domain optical coherence tomography (SD-OCT) images and en-face swept-source OCTA images were analyzed, and the percentage of CC flow deficit (FD%), FD average area (FDa) and FD number (FDn) in five progressive 20.0-μm-wide concentric rings (R1, R2, R3, R4 and R5) surrounding the dark halo around the MNV were calculated. Image acquisition was carried out prior to the first faricimab injection (T0) and 1 month after the injection (T1). RESULTS The topographical sub-analysis revealed noteworthy changes in all rings at T1 compared to T0. There was a notable progressive reduction in FD% at T1 compared to T0 values across all rings, indicating a gradual CC reperfusion following anti-VEGF treatment. Additionally, the average size of FD decreased after the loading phase. Although not reaching statistical significance, there was a progressive reduction in the FDa across all rings. CONCLUSION Our study highlights a CC FD reduction following the administration of three consecutive faricimab injections. This effect was detected in all rings surrounding the dark halo. These observations suggest a partial CC reperfusion surrounding the MNV, potentially serving as an indicator for disease regression.
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Affiliation(s)
- Max Brinkmann
- Department of Ophthalmology, Klinikum Klagenfurt, 9020, Klagenfurt, Austria.
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, 23564, Lübeck, Germany.
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Tom Müller
- Department of Ophthalmology, Klinikum Klagenfurt, 9020, Klagenfurt, Austria
| | | | - Jakob Schweighofer
- Department of Ophthalmology and Optometry, Medical University of Vienna, 1090, Vienna, Austria
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Mario Damiano Toro
- Public Health Department, Eye Clinic, University of Naples Federico II, 80133, Naples, Italy.
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079, Lublin, Poland.
| | - Yosuf El-Shabrawi
- Department of Ophthalmology, Klinikum Klagenfurt, 9020, Klagenfurt, Austria
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Bae SH, Bae K, Yoon CK, Park UC, Park KH, Lee EK. MORPHOLOGICAL BIOMARKERS PREDICTING EXUDATIVE CONVERSION IN TYPE 1 NONEXUDATIVE MACULAR NEOVASCULARIZATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2024; 44:1006-1014. [PMID: 38346091 DOI: 10.1097/iae.0000000000004066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
PURPOSE To investigate the incidence and morphological biomarkers to predict the exudative conversion in eyes with type 1 nonexudative macular neovascularization using swept-source optical coherence tomography angiography. METHODS Macular neovascularizations were detected using the retinal pigment epithelium-to-retinal pigment epithelium-fit slab of swept-source optical coherence tomography angiography scan. Depending on whether exudation developed within a year, the eyes were divided into two groups: active and silent. Qualitative and quantitative optical coherence tomography angiography parameters of the two groups were evaluated to discriminate the biomarkers associated with exudative conversion. RESULTS Of the 40 eyes, nine developed exudation within 1 year (incidence rate 22.5%). The active group exhibited a significantly higher "anastomosis and loops" pattern, greater "vessel density," increased "junction density," fewer "number of end points," and lower "lacunarity" compared with the silent group. "Anastomosis and loops" and higher "vessel density" were correlated with the active group in multivariate analyses. A predictive model combining these biomarkers achieved 95% accuracy in predicting exudative conversion. CONCLUSION At 12 months, the risk of exudation was 22.5%, and "anastomosis and loops" and "vessel density" were useful optical coherence tomography angiography biomarkers for predicting exudative conversion in eyes with type 1 nonexudative macular neovascularization. For eyes with a high risk of exudative conversion, more frequent follow-up is recommended.
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Affiliation(s)
- Su Ho Bae
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Rispoli M, Cennamo G, Antonio LD, Lupidi M, Parravano M, Pellegrini M, Veritti D, Vujosevic S, Savastano MC. Practical guidance for imaging biomarkers in exudative age-related macular degeneration. Surv Ophthalmol 2023:S0039-6257(23)00039-5. [PMID: 36854371 DOI: 10.1016/j.survophthal.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
We provide an overview of current macular imaging techniques and identify and describe biomarkers that may be of use in the routine management of macular diseases, particularly exudative age-related macular degeneration (n-AMD). This perspective includes sections on macular imaging techniques including optical coherence tomography (OCT) and OCT angiography (OCTA), classification of exudative AMD, and biomarkers in structural OCT and OCTA. Fluorescein angiography remains a vital tool for assessing the activity of neovascular lesion, while indocyanine green angiography is the preferred option for choroidal vessels imaging in neovascular AMD. OCT provides a non-invasive three-dimensional visualization of retinal architecture in vivo and is useful in the diagnosis of many imaging biomarkers of AMD-related neovascular lesions including lesion activity. OCTA is a recent advance in OCT technology that allows accurate visualization of retinal and choroidal vascular flow. OCT and OCTA have led to an updated classification of exudative AMD lesions and provide several biomarkers that help to establish a diagnosis and the disease activity status of neovascular lesions. Individualization of therapy guided by OCT and OCTA biomarkers has the potential to further improve visual outcomes in exudative AMD. Moving forwards, integration of technologically advanced imaging equipment with AI software will help ophthalmologists to provide patients with the best possible care.
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Affiliation(s)
| | - Gilda Cennamo
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University; Public Health Department, University of Naples Federico II, Naples, Italy
| | - Luca Di Antonio
- UOC Ophthalmology and Surgery Department, ASL-1 Avezzano-Sulmona, L'Aquila, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
| | | | - Marco Pellegrini
- Department of Biomedical and Clinical Science "Luigi Sacco", Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Italy
| | - Stela Vujosevic
- University Eye Clinic, IRCCS Multimedica, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
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Sacconi R, Fragiotta S, Sarraf D, Sadda SR, Freund KB, Parravano M, Corradetti G, Cabral D, Capuano V, Miere A, Costanzo E, Bandello F, Souied E, Querques G. Towards a better understanding of non-exudative choroidal and macular neovascularization. Prog Retin Eye Res 2023; 92:101113. [PMID: 35970724 DOI: 10.1016/j.preteyeres.2022.101113] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
Non-exudative macular and choroidal neovascularization (MNV and CNV) usually refers to the entity of treatment-naïve type 1 neovascularization in the absence of associated signs of exudation. Histopathological studies, dating back in the early 70s, identified the presence of non-exudative MNV, but the first clinical report of this finding was in the late 90s using indocyanine green angiography in eyes with age-related macular degeneration (AMD). With more advanced retinal imaging, there has been an ever increasing appreciation of non-exudative MNV associated with AMD and CNV with other macular disorders. However, consensus regarding the exact definition and the clinical management of this entity is lacking. Furthermore, there may be variation in the imaging features and clinical course suggesting that a spectrum of disease may exist. Herein, we review the large body of published work that has provided a better understanding of non-exudative MNV and CNV in the last decade. The prevalence, multimodal imaging features, clinical course, and response to treatment are discussed to elucidate further key insights about this entity. Based on these observations, this review also proposes a new theory about the origin and course of different sub-types of non-exudative MNV/CNV which can have different etiologies and pathways according to the clinical context of disease.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Fragiotta
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | | | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, United States; Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, NY, United States; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States
| | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | | | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric Souied
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Resch MD, Balogh A, Kurth T, Nagy ZZ, DeBuc DC, Papp A. Atrophy of retinal vessels in neovascular age-related macular degeneration following long-term treatment with 20 intravitreal anti-VEGF injections. BMC Ophthalmol 2022; 22:469. [PMID: 36471292 PMCID: PMC9721060 DOI: 10.1186/s12886-022-02700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/22/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The study aimed to evaluate the changes in retinal vascular density in exudative age-related macular degeneration (AMD) after long-term anti-VEGF treatment using optical coherence tomography angiography (OCT-A), and to compare these changes with the vascular density in AMD treated for one year and healthy eyes. METHODS In our cross-sectional study OCT-A was performed on 60 eyes of 60 patients. Group AMD 20 × consisted of patients receiving long-term (minimum 20 injections) aflibercept therapy (n = 17), and Group AMD one year consisted of patients treated for one year with a treat & extend protocol (n = 25). The vascular density values obtained with OCT-A were compared with an age-matched control group of 18 healthy eyes. We examined the central retinal thickness (CRT), the vascular density of the fovea and parafovea in the superficial and deep retinal plexus, and evaluated the extent of the non-flow area and the foveal avascular zone (FAZ) on a 3 × 3 mm macular region. Kruskal-Wallis test was performed for statistical analysis. RESULTS In Group AMD 20x, the vascular density of superficial retinal plexus in the fovea (p = 0.0022) and parafovea (p < 0.0001) was significantly lower compared to Group one year and control group. In the deep retinal plexus, vascular density in the fovea (p = 0.0033) was significantly lower in both AMD groups compared to the control group, with no difference in the parafoveal region (p = 0.0774). The extent of non-flow area (p = 0.0003) and FAZ (p = 0.0008) were significantly larger in both AMD groups compared to the control group. There was a significant difference in CRT between those treated for one year and control eyes (p = 0.0036). CONCLUSIONS In our study, we demonstrated that macular vessel density was lower in the foveal area in the superficial retinal plexus in AMD patients after one year and long-term anti-VEGF treatment. These vascular density changes were absent in the parafoveal and whole areas of the deep retinal plexus. Our results indicate that long-term anti-VEGF treatment reduces the vascular density of the superficial retinal plexus to a greater extent compared to the deep retinal plexus.
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Affiliation(s)
- Miklós D. Resch
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Aniko Balogh
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary ,grid.417105.60000 0004 0621 6048Department of Ophthalmology Uzsoki Hospital, Budapest, Hungary
| | - Tilmann Kurth
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Z. Nagy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Delia Cabrera DeBuc
- grid.26790.3a0000 0004 1936 8606Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL USA
| | - András Papp
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Cennamo G, Iacucci G, Breve MA, Montorio D, Xompero C, Costagliola C. The role of choriocapillaris vessel density in the pathogenesis of macular neovascularization associated with choroidal osteoma. Graefes Arch Clin Exp Ophthalmol 2022; 261:1283-1287. [PMID: 36454322 DOI: 10.1007/s00417-022-05921-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/26/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To detect the vessel density of choriocapillaris (CC) vascular network in eyes affected by choroidal osteoma and in eyes complicated by macular neovascularization (MNV), using optical coherence tomography angiography (OCTA). METHODS In this retrospective study, twenty-eight eyes of 28 patients were divided into three groups: group 1 including patients with calcified choroidal osteoma, group 2 including patients with decalcified choroidal osteoma, and group 3 including patients with decalcified choroidal osteoma complicated by MNV. OCTA analyzed the vessel density of CC in these lesions localized in the peripapillary region. RESULTS We enrolled 12 eyes with calcified choroidal osteoma, 11 eyes with decalcified choroidal osteoma, and 5 eyes with decalcified choroidal osteoma complicated by MNV. The eyes with decalcified choroidal osteoma and MNV revealed a statistically significant reduction in vessel density of the CC respect to the other groups (p < 0.001). Moreover, the vessel density of CC in decalcified choroidal osteoma was significantly reduced compared to calcified choroidal osteoma (p < 0.001). CONCLUSIONS OCTA allowed a quantitative evaluation of choriocapillaris vessel density in choroidal osteoma, in order to detect the changes of this vascular network, which could lead to the development of MNV. Therefore, OCTA could be a new diagnostic tool in the clinical management of the choroidal osteoma. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05342324.
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Viggiano P, Grassi MO, Pignataro M, Boscia G, Borrelli E, Molfetta T, Evangelista F, Alessio G, Boscia F. Topographical Analysis of the Choriocapillaris Reperfusion After Loading Anti-VEGF Therapy in Neovascular AMD. Transl Vis Sci Technol 2022; 11:18. [PMID: 36135978 PMCID: PMC9513736 DOI: 10.1167/tvst.11.9.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate choriocapillaris vascular density changes around macular neovascularization (MNV) before and after anti-vascular endothelium growth factor (VEGF) injections by optical coherence tomography angiography (OCTA). Methods Treatment-naïve eyes with a diagnosis of exudative AMD and type 1 MNV were included. En face optical coherence tomography angiograms were analyzed for percentage of choriocapillaris (CC) flow deficit percentage (FD%), the FD average area (FDa), and the FD number (FDn) in 5 progressive 200-µm-wide concentric rings (R1, R2, R3, R4, and R5) surrounding the dark halo around the MNV. The OCTA acquisition was performed at the following visits: (i) before the loading phase of intravitreal injection of aflibercept or ranibizumab (T1), and (ii) 1 month after the last intravitreal injection of loading phase comprising 3 monthly injections (T2). Results A total of 30 eyes of 30 Caucasian patients with treatment naïve neurovascular AMD (nAMD) were included in the study. All rings showed a progressive FD% reduction at T2 in comparison to T1 values indicating gradual CC reperfusion of the peripheral rings. Furthermore, we found a progressive contraction of the FD average area in all the rings considered (P < 0.05). On the other hand, at T2, a significant increase in the FD number of the 5 rings was displayed, as compared to T1 (P < 0.05). Conclusions Our analysis showed topographical CC reperfusion after loading anti-VEGF therapy. CC flow deficits were greater around the associated dark halo before treatment, followed by a progressive recovery of CC flow after intravitreal therapy. Translational Relevance OCTA may be used to assess the development and progression of MNV but also in assessing response to intravitreal injections of anti-VEGF.
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Affiliation(s)
- Pasquale Viggiano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Oliva Grassi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mariagrazia Pignataro
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giacomo Boscia
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Teresa Molfetta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti- Pescara, Chieti, Italy
| | - Giovanni Alessio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Boscia
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Fossataro F, Cennamo G, Montorio D, Clemente L, Costagliola C. Dark halo, a new biomarker in macular neovascularization: comparison between OCT angiography and ICGA-a pilot prospective study. Graefes Arch Clin Exp Ophthalmol 2022; 260:3205-3211. [PMID: 35522297 PMCID: PMC9477905 DOI: 10.1007/s00417-022-05693-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/15/2022] [Accepted: 04/27/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA) in terms of reliability in detecting dark halo in patients affected by age-related macular degeneration (AMD) complicated with type 1 macular neovascularization (MNV). METHODS Eighty-nine eyes of 89 patients were analyzed at the University of Naples Federico II between January 2018 and October 2021. Each patient underwent a complete ophthalmological evaluation including fluorescein angiography, ICGA, spectral domain optical coherence tomography (SD-OCT), and OCTA. OCTA and ICGA images of dark halo were compared. The paired Student's test and intraclass correlation coefficients were used to evaluate the differences in dark halo measurements between OCTA and ICGA images. RESULTS Thirty-six eyes of 36 patients were included in this prospective study. Dark halo area was significantly larger in OCTA than in ICGA (1.49 ± 1.8 mm2 vs. 0.54 ± 0.5 mm2; p = 0.001). Moreover, the agreement between the two types of devices for measuring dark halo areas was poor, with a low intraclass coefficient correlation (0.397). CONCLUSION OCTA could be a useful and necessary tool to investigate dark halo in neovascular AMD due to its ability to visualize the areas of reduced vessel density around MNV in greater detail compared to ICGA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05108285.
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Affiliation(s)
- Federica Fossataro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Gilda Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy. .,Eye Clinic, Public Health Department, University of Naples "Federico II", Via S. Pansini 5, 80133, Naples, Italy.
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Lidia Clemente
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
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Short-term changes in retinal and choroidal relative flow volume after anti-VEGF treatment for neovascular age-related macular degeneration. Sci Rep 2021; 11:23723. [PMID: 34887454 PMCID: PMC8660908 DOI: 10.1038/s41598-021-03179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
The effects of anti-vascular endothelial growth factor (anti-VEGF) agents on the native ocular vasculature are poorly understood. This pilot study aimed to assess short-term changes in retinal and choroidal perfusion after anti-VEGF treatment for neovascular exudative age-related macular degeneration (nAMD) using the relative flow volume (RFV) parameter derived from laser speckle flowgraphy. Ten treatment-naïve nAMD patients underwent measurements of mean, maximum, minimum, and differential RFV within a retinal arteriolar segment and a choroidal vessel segment outside the neovascular area. Measurement of retinal RFV (rRFV), choroidal RFV (cRFV), and subfoveal choroidal thickness (SCT) was repeated 9 and 35 days after a single anti-VEGF injection. The treatment caused a statistically significant decrease in the mean rRFV, mean cRFV, and SCT during the follow-up (p < 0.05). At the intermediate visit, the mean cRFV and SCT were − 17.6% and − 6.4% compared to baseline, respectively. However, at the final measurement, the mean cRFV was not different from the baseline value, which indicated waning of the anti-VEGF effect. In conclusion, a single anti-VEGF injection in treatment-naïve nAMD resulted in a decrease in retinal arteriolar and choroidal perfusion, according to the RFV parameter, which is a promising tool to simultaneously assess retinal and choroidal perfusion changes in response to anti-VEGF therapy.
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Savastano MC, Rizzo C, Gambini G, Savastano A, Falsini B, Bacherini D, Caputo CG, Kilian R, Faraldi F, De Vico U, Rizzo S. Choriocapillaris Vascular Density Changes: Healthy vs. Advanced Exudative Age-Related Macular Degeneration Previously Treated with Multiple Anti-VEGF Intravitreal Injections. Diagnostics (Basel) 2021; 11:diagnostics11111958. [PMID: 34829305 PMCID: PMC8621604 DOI: 10.3390/diagnostics11111958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: To assess choriocapillaris vascular density (VD) in healthy and advanced exudative age-related macular degeneration (ae-AMD) patients by new full-range optical coherence tomography angiography (OCT-A). Method: In this observational, cross-sectional study, 21 healthy and 21 ae-AMD eyes, already treated with anti-VEGF, were enrolled. Angio-View retina patterns centered on fovea (6.4 × 6.4 mm) were acquired for all participants using Solix full-range OCT (Optovue Inc., Freemont, CA, USA). The main outcome was to compare choriocapillaris VD between healthy and ae-AMD eyes. Automated measurements of whole image choriocapillaris VD (%) and fovea grid-based (%) were collected for the analysis. Angio-View patterns were used to assess the flow area (mm2) of macular neovascularization (MNV) by contour flow measure algorithm. Best-corrected visual acuity (BCVA) of both groups was also used for the statistical analysis. Results: The mean age was 60.9 (±8.3) in healthy and 73.33 (±15.05) in ae-AMD eyes. The mean BCVA (ETDRS letters) was 98.47 (±1.50) in healthy and 7.04 (±5.96) in ae-AMD eyes. The Mann–Whitney test comparing choriocapillaries VD for whole and fovea healthy and ae-AMD eyes showed statistical significance (p < 0.0001 (t = 4.91; df = 40) and p < 0.0001 (t = 6.84; df = 40), respectively). Regarding, the correlation between MNV and VD of choriocapillaries, neither whole nor fovea areas were statistically significant (F = 0.38 (R2 = 0.01) and 1.68 (R2 = 0.08), respectively). Conclusions: Choriocapillaris VD showed a statistically significant reduction in comparison to healthy eyes in ae-AMD eyes. Choriocapillaris impairment can be seen in the early phase of MNV pathogenesis.
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Affiliation(s)
- Maria Cristina Savastano
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Correspondence: (M.C.S.); (C.R.)
| | - Clara Rizzo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence: (M.C.S.); (C.R.)
| | - Gloria Gambini
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Alfonso Savastano
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Benedetto Falsini
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Daniela Bacherini
- Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, 50139 Florence, Italy;
| | - Carmela Grazia Caputo
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Raphael Kilian
- Ophthalmology Unit, University of Verona, 37134 Verona, Italy;
| | | | - Umberto De Vico
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
| | - Stanislao Rizzo
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, 56124 Pisa, Italy
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12
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Hsu CR, Lai TT, Hsieh YT, Ho TC, Yang CM, Yang CH. Combined quantitative and qualitative optical coherence tomography angiography biomarkers for predicting active neovascular age-related macular degeneration. Sci Rep 2021; 11:18068. [PMID: 34508170 PMCID: PMC8433312 DOI: 10.1038/s41598-021-97652-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
To investigate choroidal neovascularization (CNV) characteristics after anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with neovascular age-related macular degeneration by optical coherence tomography angiography (OCTA) and to assess the potential predictive role of combined qualitative and quantitative biomarkers for disease activity. Patients diagnosed with type 1 or type 2 CNV via multimodal imaging who had received anti-VEGF treatment were retrospectively reviewed. Qualitative and quantitative CNV responses on OCTA after serial injections were analyzed. The enrolled eyes were divided into two groups based on treatment intervals during follow-up, including an active group with less than 12 weeks intervals and a stable group with 12 weeks or longer intervals. Fifty-six eyes of 56 patients were included in the study. Twenty-seven eyes (48.2%) were classified as the “active group”, and 29 eyes (51.8%) were categorized as the “silent group”. Qualitative biomarkers of CNV showed significant differences between the two groups (branching capillaries: 48.1% vs 6.9%, p = 0.001; anastomoses and loops: 81.5% vs 13.8%, p < 0.001; peripheral arcade: 40.7% vs 10.3%, p = 0.013, and hypointense halo: 81.5% vs 41.4%, p = 0.002). A significantly higher vessel density was found in the active group (median 39.6% vs 30.5%, p = 0.003). “Anastomoses and loops” and “vessel density” predicted an active CNV status with a probability of 93.7% and achieved the best performance. The combination of two potential biomarkers of CNV on OCTA shows good discrimination for the prediction of recurrent exudation auxiliary to structural OCT that might associate with disease activity.
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Affiliation(s)
- Cherng-Ru Hsu
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan. .,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan.
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13
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Ng DSC, Chan LKY, Ng CM, Lai TYY. Visualising the choriocapillaris: Histology, imaging modalities and clinical research - A review. Clin Exp Ophthalmol 2021; 50:91-103. [PMID: 34387023 DOI: 10.1111/ceo.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
The choriocapillaris plays a considerable role in the normal physiology of the eye as well as in various diseases. Assessing the changes in the choriocapillaris can therefore provide important information about normal ageing and pathogenesis of visual impairment, and even some systemic diseases. In vivo imaging of the choriocapillaris has evolved from non-depth resolved, dye-based angiography to advanced, high-resolution optical coherence tomography angiography (OCTA). However, the intricate microvascular networks within the choriocapillaris are still beyond the resolving limits of most OCTA instruments. Knowledge of histology, meticulous image acquisition methods, recognition of artefact and post-acquisition processing techniques are necessary for optimising OCTA choriocapillaris images. Qualitative and quantitative analyses of the choriocapillaris provide clinical information in age-related macular degeneration (AMD), diabetic retinopathy (DR), pathologic myopia and central serous chorioretinopathy (CSC). Furthermore, studies have revealed choriocapillaris changes in posterior uveitis that are correlated with treatment outcome and have important prognostic significance. In addition to retinal diseases, choriocapillaris changes have been observed in systemic vascular diseases and complications associated with pregnancy.
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Affiliation(s)
- Danny Siu-Chun Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Mong Kok, Hong Kong
| | - Leo Ka-Yu Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Mong Kok, Hong Kong
| | - Ching Man Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,2010 Retina & Macula Centre, Kowloon, Hong Kong
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14
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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15
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Nesper PL, Ong JX, Fawzi AA. Exploring the Relationship Between Multilayered Choroidal Neovascularization and Choriocapillaris Flow Deficits in AMD. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 33687474 PMCID: PMC7960838 DOI: 10.1167/iovs.62.3.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose We used optical coherence tomography angiography to test the hypothesis that more complex, multilayered choroidal neovascular (CNV) membranes in AMD are associated with worse flow deficits (FD) in the choriocapillaris. Methods Retrospective, cross-sectional study including 29 eyes of 29 subjects with neovascular AMD. En face choriocapillaris images were compensated for signal attenuation using the structural OCT slab and signal normalization based on a cohort of healthy subjects. We binarized the choriocapillaris using both local Phansalkar and global MinError(I) methods and quantified FD count, FD density, and mean FD size in the entire area outside the CNV, in the 200-µm annulus surrounding the CNV, and in the area outside the annulus. We used projection-resolved optical coherence tomography angiography to quantify CNV complexity, including highest CNV flow height, number of flow layers, and flow layer thickness. We explored the relationship between CNV complexity and choriocapillaris FD using Spearman correlations. Results The highest CNV flow signal significantly correlated with lower FD count (P < 0.01), higher FD density (P < 0.05), and higher mean FD size (P < 0.05) in the area outside the annulus and the entire area outside the CNV using both Phansalkar and MinError(I). Within the annulus, CNV complexity was not consistently correlated with choriocapillaris defects. Conclusions CNV vascular complexity is correlated with choriocapillaris FD outside the CNV area, providing evidence for the importance of choriocapillaris dysfunction in neovascular AMD, as well as the potential role of choroidal ischemia in the pathogenesis of complex CNV membranes.
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Affiliation(s)
- Peter L Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Janice X Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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16
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Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10040751. [PMID: 33668537 PMCID: PMC7918036 DOI: 10.3390/jcm10040751] [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: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is still unclear if neovascularization features with OCTA can predict the lesion’s level of activity. The choriocapillaris surrounding macular neovascularization is impaired while the more peripheral choriocapillaris is spared, implying that choriocapillaris disruption may drive neovascularization growth. With continued innovation in OCTA image acquisition and analysis methods, advancement in clinical applications and pathophysiologic discoveries in AMD are set to follow.
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17
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The Impact of Oxidative Stress on Blood-Retinal Barrier Physiology in Age-Related Macular Degeneration. Cells 2021; 10:cells10010064. [PMID: 33406612 PMCID: PMC7823525 DOI: 10.3390/cells10010064] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
The blood retinal barrier (BRB) is a fundamental eye component, whose function is to select the flow of molecules from the blood to the retina and vice-versa, and its integrity allows the maintenance of a finely regulated microenvironment. The outer BRB, composed by the choriocapillaris, the Bruch's membrane, and the retinal pigment epithelium, undergoes structural and functional changes in age-related macular degeneration (AMD), the leading cause of blindness worldwide. BRB alterations lead to retinal dysfunction and neurodegeneration. Several risk factors have been associated with AMD onset in the past decades and oxidative stress is widely recognized as a key factor, even if the exact AMD pathophysiology has not been exactly elucidated yet. The present review describes the BRB physiology, the BRB changes occurring in AMD, the role of oxidative stress in AMD with a focus on the outer BRB structures. Moreover, we propose the use of cerium oxide nanoparticles as a new powerful anti-oxidant agent to combat AMD, based on the relevant existing data which demonstrated their beneficial effects in protecting the outer BRB in animal models of AMD.
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18
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D'andrea L, Fossataro F, Cennamo G. Choriocapillary vascular density changes in choroidal neovascularization associated with choroidal nevus after anti-VEGF injections. Eur J Ophthalmol 2020; 32:1120672120982946. [PMID: 33334167 DOI: 10.1177/1120672120982946] [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: 11/17/2022]
Abstract
PURPOSE To evaluate choriocapillary vascular density changes in choroidal neovascularization (CNV) type 2 associated with choroidal nevus using optical coherence tomography angiography (OCT-A) before and after anti-VEGF treatment. METHODS Observational case report. RESULTS A 25-year-old woman, was referred to Eye Clinic and presented a decreased visual acuity in right eye. Fundus examination showed a pigmented lesion located in macular region associated with subretinal hemorrhages adjacent to the mass in right eye. The diagnosis of choroidal nevus-associated with CNV was made and confirmed by spectral domain (SD)-OCT, OCT-A, and ultrasound examination. Two monthly ranibizumab intravitreal injections (IVT) were performed and a regression of the activity of neovascular lesion was noted. OCT-A showed a reduction of choriocapillaris vessel density (VD) before the treatment and an increase of VD after IVT injections. CONCLUSION OCT-A could be a non-invasive and diagnostic tool to evaluate choriocapillaris vascular changes after IVT injections in CNV associated with choroidal nevus.
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Affiliation(s)
- Luca D'andrea
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Campania, Italy
| | - Federica Fossataro
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Campania, Italy
| | - Gilda Cennamo
- Eye Clinic, Department of Public Health, Federico II University, Naples, Campania, Italy
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19
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Laiginhas R, Cabral D, Falcão M. Evaluation of the different thresholding strategies for quantifying choriocapillaris using optical coherence tomography angiography. Quant Imaging Med Surg 2020; 10:1994-2005. [PMID: 33014731 PMCID: PMC7495317 DOI: 10.21037/qims-20-340] [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: 02/22/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this paper, we evaluate the different thresholding strategies that have been used for the quantification of the choriocapillaris (CC) and explore their repeatability and the interchangeability of the measurements resulting from its application. METHODS Observational study. Eighteen eyes from nine healthy volunteers aged >18 years were imaged four consecutive times with a SD-OCTA system (Heidelberg Engineering, Germany) using a 10°×10° high-resolution protocol centered on the fovea. Projection artifacts were removed, and the CC was bracketed between 10 and 30 µm below Bruch's membrane. For the quantification of CC, we used four flow deficits (FD) parameters: FD number, mean FD size, total FD area and FD density. We performed a systematic review of literature to collect the thresholding methods that have been used for the quantification of CC. The CC quantification parameters were then evaluated after applying each of the thresholding strategies. Intraclass correlation coefficient (ICC) and Pearson's correlation analysis were used to compare the repeatability and interchangeability among the different thresholding strategies for quantifying the CC. RESULTS A total of 72 optical coherence tomography angiography (OCTA) examinations were considered. The systematic review allowed us to conclude that three local thresholding strategies (Phansalkar, mean and Niblack) and three global thresholding strategies (mean, default, Otsu) have been used for CC quantification. These strategies were evaluated in our observational study. We found a high agreement within the same method in the quantification of FD number, mean FD size, total FD area and FD density but a poor agreement with different strategies. Local strategies achieved a significantly superior ICC than global ones in CC quantification. CONCLUSIONS In conclusion, the interchangeability of the CC quantification using different thresholding strategies is low, and direct comparisons should not be performed. Local thresholding strategies are significantly superior to global ones for quantifying CC and should be preferred. There is an unmet need for a uniform strategy to quantify CC in future studies.
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Affiliation(s)
- Rita Laiginhas
- Department of Ophthalmology, CHEDV, Portugal
- PDICSS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Diogo Cabral
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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20
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Scharf JM, Corradetti G, Alagorie AR, Grondin C, Hilely A, Wang D, Sadda S, Sarraf D. Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2020; 61:11. [PMID: 32902576 PMCID: PMC7488611 DOI: 10.1167/iovs.61.11.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate choriocapillaris (CC) flow deficits (FD) in eyes with treatment-naïve macular neovascularization (MNV) and to compare CC FD around exudative versus nonexudative MNV. Methods Treatment-naïve eyes with a diagnosis of either exudative or nonexudative AMD and type 1 MNV were included. Normal control eyes were age-matched to each AMD eye one to one. En face optical coherence tomography angiograms were analyzed for percentage of CC FD (FD%) in two concentric 500 µm rings, ring 1 and ring 2, surrounding the dark halo around MNV. The mean CC FD% in ring 1 and ring 2 was evaluated for each eye. A secondary analysis was similarly carried out to investigate the differences in CC FD% in exudative versus nonexudative treatment-naïve MNV. Results Twenty-three eyes with treatment-naïve MNV were age matched with 23 normal controls. The mean CC FD% was significantly greater in both rings in the MNV versus the normal control group (P < 0.05) and was significantly greater in the inner ring, closer to the lesion, than the outer ring. The mean FD% was also greater in both rings in the exudative versus the nonexudative MNV group, but this difference did not reach statistical significance. Conclusions The CC FD% was greater in the area surrounding MNV versus age-matched normal controls and in the ring closer to the MNV lesion. Further, CC FD was greater in eyes with exudative versus nonexudative MNV in both rings surrounding the associated dark halo, although this difference was not statistically significant.
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Affiliation(s)
- Jackson M. Scharf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
| | - Giulia Corradetti
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California, United States
| | - Ahmed Roshdy Alagorie
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California, United States
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Christelle Grondin
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Assaf Hilely
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Derrick Wang
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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Tang W, Guo J, Liu W, Xu G. Optical Coherence Tomography Angiography of Inflammatory Choroidal Neovascularization Early Response after Anti-VEGF Treatment. Curr Eye Res 2020; 45:1556-1562. [PMID: 32394732 DOI: 10.1080/02713683.2020.1767790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Wenyi Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Jingli Guo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Wei Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Laboratory of Myopia, Fudan University, Chinese Academy of Medical Sciences, Shanghai, China
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22
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Solecki L, Loganadane P, Gauthier AS, Simonin M, Puyraveau M, Delbosc B, Saleh M. Predictive factors for exudation of quiescent choroidal neovessels detected by OCT angiography in the fellow eyes of eyes treated for a neovascular age-related macular degeneration. Eye (Lond) 2020; 35:644-650. [PMID: 32398845 DOI: 10.1038/s41433-020-0936-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To identify predictive factors for exudation for quiescent choroidal neovessels (qCNV) in the fellow eyes of eyes treated for a neovascular age-related macular degeneration (AMD). METHODS Prospective observational study. One hundred and forty-four contralateral eyes of 144 patients treated for wet AMD were analysed. At a baseline visit, multimodal imaging including dye angiographies and optical coherence tomography angiography (OCT-A) was performed in order to detect qCNV. Patients were followed up for 12 months with a monthly assessment. The manifestation of any type of exudation (either intra- or subretinal fluid or hyperreflective subretinal material) was monitored. RESULTS The prevalence of qCNV in the treatment-naive eyes was 15.9% with an incidence over a 12-month period of 2.8%. In total, 40.7% of the overall neovessels remained stable with no sign of exudation, while 59.3% presented some fluid during the follow-up. A statistically significant relationship was established for the following variables preceding the exudation: increase in central macular thickness (OR = 116; 95% CI [4.74; 50530] p = 0.038), increase in pigment epithelial detachment height (OR = 1.76; 95% CI [1.17; 3.18] p = 0.021) and width (OR = 1.53; 95% CI [1.12; 2.62] p = 0.042), increase in neovessels' surface on OCT-A (OR = 6.32; 95% CI [1.62; 51.0] p = 0.033), emergence of a branching pattern (OR = 7.50; 95% CI[1.37; 61.5] p = 0.032) and appearance of a hypointense halo surrounding the lesion (OR = 10.00; 95% CI [1.41; 206] p = 0.048). CONCLUSIONS The risk of exudation in the treatment-naive fellow eyes of eyes treated for neovascular AMD was notably increased in the presence of qCNV. The biomarkers identified will help to detect their activation in order to ensure prompt antiangiogenic therapy.
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Affiliation(s)
- Lauriana Solecki
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Prisca Loganadane
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | | | - Manon Simonin
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Marc Puyraveau
- Center of Clinical Methodology, Besançon University Hospital, Besançon, France
| | - Bernard Delbosc
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Maher Saleh
- Department of Ophthalmology, Besançon University Hospital, Besançon, France.
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23
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Type 1 Choroidal Neovascularization Evolution by Optical Coherence Tomography Angiography: Long-Term Follow-Up. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4501395. [PMID: 32382551 PMCID: PMC7196959 DOI: 10.1155/2020/4501395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022]
Abstract
Purpose To evaluate structural changes in response to antivascular endothelial growth factor (anti-VEGF) treatment in patients with long-term type 1 choroidal neovascularization (CNV) by optical coherence tomography (OCT) and OCT angiography (OCTA). Method This is a longitudinal study that involved a total of 51 eyes with type 1 CNV (35 female and 16 male eyes). Structural OCT and OCTA were performed on all the subjects. AngioVue OCTA (XR Avanti, Optovue, Inc., Fremont, CA) was used to obtain qualitative and quantitative information. All eyes were treated with an anti-VEGF ProReNata (PRN) approach and were followed for a mean of 38.9 months (SD ± 7.22). Best-corrected visual acuity (BCVA) was assessed at each follow-up timepoint. Results We observed two kinds of possible evolution of type 1 CNV: “positive evolution,” including stabilization in 20% of patients and chronicity in 35%, and “negative evolution,” in which fibrosis was shown in 18% of patients, chorioretinal atrophy in 25%, and hemorrhage or RPE tears in 2%. The mean BCVA at baseline was 33.67 ± 15.85 ETDRS letters; after 1 and 2 years, it was 31.61 ± 18.04 and 31.18 ± 18.58 ETDRS letters, respectively. The mean BCVA at the end of follow-up was 25.27 ± 20 ETDRS letters. The difference between the values at baseline and at the end of follow-up was not statistically significant (P = 0.06, r2 = 0.10). Conclusions This study describes an in vivo structural long-term evolution of type 1 CNV by OCT and OCTA. Different possible CNV outcomes were observed. This study suggests that new retinal imaging techniques could be useful tools for assessing the potential retinal changes in the evolution of type 1 CNV to develop personalized medicine. Further studies using OCTA in the long term are needed to better understand why similarly treated type 1 CNV cases evolve differently and produce different results.
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Resch MD, Balogh A, Deák GG, Nagy ZZ, Papp A. Vascular density in age-related macular degeneration after one year of antiVEGF treatment with treat-and-extend and fixed regimens. PLoS One 2020; 15:e0229388. [PMID: 32101581 PMCID: PMC7043775 DOI: 10.1371/journal.pone.0229388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/05/2020] [Indexed: 01/11/2023] Open
Abstract
Treatment of neovascular age-related macular degeneration (nAMD) with VEGF can be performed with several posologies. The purpose of our cross-sectional study was to analyze retinal vessel density by quantitative OCT-angiography (OCT-A) and to compare treat-and-extend (T&E) and fixed treatment protocols to a control group with dry AMD. Altogether 48 patients were enrolled: 13 eyes with T&E protocol ranibizumab treatment (group A) and 17 eyes with fixed regimen aflibercept therapy (group B), the control group comprised 18 eyes with dry AMD (group C). One year after the start of the treatment, quantitative OCT-A (AngioVue—Optovue, Fermont, USA) was performed: superficial and deep retinal vessel densities were analyzed in the foveal and parafoveal regions. Our results show, that the density of retinal superficial vasculature in the fovea was not different between the treatment groups (A: 25.9±9.1%; B: 24.3%±8.9), neither from group C (25.6±4.8%). Superficial parafoveal vascular density of the retina, however, was decreased in both treated groups (A: 46.7±9.1%, B: 42.9±6.1%, C: 49.7±4.9%). In the deep retinal plexus, vascular density was lower in both treatment groups compared to that of in controls in both the foveal and parafoveal area (A: 29.8±6.3%, B: 32.5±6.9%, C: 36.4±1.7% and A: 46.3±3.8%, B: 47.1±5.3%, C: 49.7±4.9%, foveal and parafoveal respectively). Our data suggest, that after one year of anti-VEGF treatment, reduced macular vessel density in three of the four examined vascular regions can be found independent of the treatment regimen.
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Affiliation(s)
- Miklós D. Resch
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Anikó Balogh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Uzsoki Hospital, Budapest, Hungary
| | - Gábor Gy Deák
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Zoltán Z. Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - András Papp
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Lipecz A, Miller L, Kovacs I, Czakó C, Csipo T, Baffi J, Csiszar A, Tarantini S, Ungvari Z, Yabluchanskiy A, Conley S. Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions. GeroScience 2019; 41:813-845. [PMID: 31797238 PMCID: PMC6925092 DOI: 10.1007/s11357-019-00138-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of age-related diseases, from heart failure to Alzheimer's disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative stress, mitochondrial dysfunction, and impaired resistance to molecular stressors in the choriocapillaris are also considered in terms of their contribution to the pathogenesis of AMD. The pathogenic roles of cardiovascular risk factors that exacerbate microvascular aging processes, such as smoking, hypertension, and obesity as they relate to AMD and choroid and choriocapillaris changes in patients with these cardiovascular risk factors, are also discussed. Finally, future directions and opportunities to develop novel interventions to prevent/delay AMD by targeting fundamental cellular and molecular aging processes are presented.
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Affiliation(s)
- Agnes Lipecz
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lauren Miller
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA
| | - Illes Kovacs
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA
| | - Cecília Czakó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Tamas Csipo
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Baffi
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Csiszar
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Stefano Tarantini
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA.
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Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration. J Ophthalmol 2019; 2019:4806061. [PMID: 31360542 PMCID: PMC6652027 DOI: 10.1155/2019/4806061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the relationship between signs of activity in exudative neovascular age-related macular degeneration (nAMD) following anti-vascular endothelial growth factor (anti-VEGF) treatment and morphology of choroidal neovascularization (CNV) based on neovascular density as imaged using swept source-optical coherence tomography angiography (SS-OCTA) in a qualitative manner. Methods A single-cohort retrospective data analysis from one tertiary eye care center. Seventy-seven eyes of 72 patients were included and their charts reviewed which had been started on intravitreal injections with anti-VEGF for nAMD at least one year prior to enrollment. Clinically active disease was evaluated by slit-lamp fundus examination and spectral domain-OCT B-scans. Morphological appearance in SS-OCTA was characterized based on 5 different criteria and subsequently divided into 3 groups: predominantly hyperdense, minimally hyperdense, and hypodense lesions. Results Fifty-eight eyes (75%) were considered clinically active and 19 eyes (25%) clinically inactive. CNV was depicted in 71 eyes (92%) by SS-OCTA and separated accordingly into predominantly hyperdense (32%), minimally hyperdense (34%), and hypodense lesions (34%). A borderline significant difference in the probability of neovascular activity for predominantly hyperdense lesions compared to hypodense lesions was detected (p=0.05). Conclusions Hyperdense choroidal neovascularization based on qualitative assessment of flow density showed a significant relation to active disease. Inactivity could not be matched adequately. This study demonstrated the potential usefulness of SS-OCTA for guidance of treatment in age-related macular degeneration.
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