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Salcedo-Ledesma A, Ledesma-Gil G, Spaide RF. DESCRIBING THE LOCATION AND MORPHOLOGY OF THE DOTS IN WHITE DOT FOVEA USING ADAPTIVE OPTICS. Retin Cases Brief Rep 2024; 18:275-278. [PMID: 36657154 DOI: 10.1097/icb.0000000000001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE To characterize the white dots in white dot fovea, an entity chiefly described in Japan, using adaptive optics imaging and propose a hypothesis regarding their origin. METHOD The patient underwent comprehensive ophthalmic examination, including color and green monochromatic fundus photography, fluorescein angiography, spectral-domain optical coherence tomography, and adaptive optics imaging. RESULTS An asymptomatic 66-year-old Korean woman presented with bilateral white, glistening deposits in a ring pattern around the fovea of both eyes. The dots were highly reflective on green monochromatic images, were not visible on fluorescein angiography, and appeared hyperreflective in the inner retina using spectral-domain optical coherence tomography. Adaptive optics showed polygonal granules ranging from 1 to 10 μ m in size. The patient denied any systemic disorder or the use of any medications related to crystalline retinopathy. The patient had lived in Japan for 35 years before just moving to the United States. CONCLUSION The location, small size, and polygonal shape of the dots in white dot fovea are suggestive of intraretinal deposition of crystals, and not cells on the surface of the fovea as has been previously proposed. Carotenoid deposition related to dietary habits is a plausible cause because of the similarity to other retinopathies associated to these compounds.
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Savant SV, Soukiasian SH, Spaide RF, Klein-Mascia KA. Retinal Vasculitis in a Patient with Hansen's Disease. Retin Cases Brief Rep 2024:01271216-990000000-00299. [PMID: 38447130 DOI: 10.1097/icb.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Hansen's disease is endemic in over 140 countries worldwide and a potentially blinding condition. We describe a case of retinal vasculitis in a patient with Hansen's disease with concomitant positive antiphospholipid antibody serology, a potentially under-reported complication in this setting. METHODS A 37-year-old Brazilian man systemically stable on triple therapy (clofazimine, rifampin, dapsone) for Hansen's disease presented for a comprehensive ophthalmic evaluation. RESULTS Dilated exam revealed diffuse peripheral intraretinal hemorrhages in his right eye. Fluorescein angiography showed peripheral non-perfusion, abnormal shunt vessels and leakage from the retinal veins in the right eye and peripheral non-perfusion and vascular leakage in the fellow eye, consistent with vasculitis. Laboratory workup was notable for positive antiphospholipid antibodies (lupus anticoagulant, anticardiolipin IgM, anti-beta-2 glycoprotein 1 IgM) and normocytic anemia. CONCLUSION As antiphospholipid antibodies are present in a large proportion of patients with Hansen's disease, it is possible that retinal vasculitis may be more common than previously thought. The extent to which retinal vasculitis occurs in Hansen's disease remains uncertain and possibly underestimated due to the frequency of anterior segment scarring, which impedes retinal evaluation. Heightened surveillance for potential retinal vascular complications is warranted.
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Affiliation(s)
- Shravan V Savant
- Beth Israel Lahey Health- Lahey Clinic, Burlington Massachusetts 01805, USA
- Tufts University, Boston Massachusetts 02111, USA
| | - Sarkis H Soukiasian
- Beth Israel Lahey Health- Lahey Clinic, Burlington Massachusetts 01805, USA
- Tufts University, Boston Massachusetts 02111, USA
| | - Richard F Spaide
- Vitreous-Retina-Macula Consultants of New York, New York, New York 10022, USA
| | - Kendra A Klein-Mascia
- Beth Israel Lahey Health- Lahey Clinic, Burlington Massachusetts 01805, USA
- Tufts University, Boston Massachusetts 02111, USA
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Norel JOV, Spaide RF. Severe Recurrence and Retinal Inflammatory Infiltration After Cessation of Immunosuppression for Multifocal Choroiditis and Panuveitis. Retin Cases Brief Rep 2024:01271216-990000000-00300. [PMID: 38437813 DOI: 10.1097/icb.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE To describe a severe recurrence of intraocular inflammation following the cessation of immunosuppression, previously administered for multifocal choroiditis and panuveitis (MCP). METHODS Retrospective chart review. RESULTS A 27-year-old woman with MCP initially was treated with intravenous and oral corticosteroids and photodynamic therapy because of an active macular neovascularization in both eyes. Mycophenolate was soon started and the recurrences during tapering of the oral corticosteroids in the first months were treated with periocular corticosteroids and anti-vascular endothelial growth factor injections as they became available. After a decade of immunosuppression without recurrences, the patient, having relocated, discontinued mycophenolate upon the advice of a new ophthalmologist who diagnosed her with punctate inner choroidopathy. This led to a severe recurrence in both eyes, characterized by new inflammatory lesions, ellipsoid zone loss, and widespread inflammatory cell infiltration into the outer retina. Intravitreal triamcinolone injections resulted in the resolution of sub- and intraretinal inflammatory lesions and ellipsoid zone defects. CONCLUSION The abrupt discontinuation of immunosuppression in a patient with MCP was associated with a rebound phenomenon, characterized by multi-level inflammatory activity in the posterior pole. This rebound phenomenon may offer clues as to the inflammatory targets in MCP.
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Affiliation(s)
- Jeannette Ossewaarde-van Norel
- Vitreous, Retina, Macula Consultants of New York, New York, United States
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, United States
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Keshet Y, Weseley PE, Ceisler EJ, Ngo WK, Salcedo A, Walia J, Spaide RF. THE EVOLUTION Of FULL-THICKNESS MACULAR HOLE AFTER SHORT EXPOSURE TO HIGH-POWERED HANDHELD LASER POINTER. Retin Cases Brief Rep 2024; 18:177-180. [PMID: 36730459 DOI: 10.1097/icb.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To report a case of a full-thickness macular hole after exposure to an extremely powerful handheld laser pointer. METHODS A 14-year-old boy with a laser-induced full-thickness macular hole was evaluated 1 month after a momentary exposure to a 5,000 mW blue laser pointer. Imaging modalities including fundus color, autofluorescence, and spectral-domain optical coherence tomography, acquired both at our clinic and by the referring physician soon after the injury, are used to describe the clinical evolution of the case. RESULTS Soon after the injury, an intensely white, circular opacification of the retina approximately 400 μm in diameter was seen in the fovea. Early spectral-domain optical coherence tomography images showed full-thickness hyperreflectivity, likely representing tissue necrosis. One month later, a full-thickness macular hole and eradication of the retinal pigment epithelium at its base were evident in the fundus color, autofluorescence, and spectral-domain optical coherence tomography images. CONCLUSION High-power laser pointers have become easily available online. The presenting findings after exposure to such high-power devices are distinct from those reported after exposure to weaker laser pointers. Although long exposure to weaker lasers typically produces extensive, calligraphic figures and yellow placoid lesions involving only the outer retina, in our case, a very brief exposure led to focal full-thickness injury of the fovea.
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Affiliation(s)
- Yariv Keshet
- Vitreous Retina Macula Consultants of New York, New York; and New York University Langone, New York, New York
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Spaide RF. METHOD OF POVIDONE-IODINE APPLICATION AND ENDOPHTHALMITIS RISK. Retin Cases Brief Rep 2024; 18:141-144. [PMID: 36730810 DOI: 10.1097/icb.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the proportion of patients developing endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents according to the mode of povidone-iodine (PI) antisepsis. METHODS A retrospective review of the anti-vascular endothelial growth factor injections given in a 7-year period at a community-based retinal practice. Endophthalmitis was diagnosed to have occurred if an eye developed intraocular inflammation and was given antibiotics with or without supportive culture identification of an organism. As part of their habitual clinical practice, component physicians used 5% PI as two drops, one drop, or just a dot of PI administered with a cotton-tipped applicator to the site before injection. RESULTS There were 113,610 intravitreal injections administered and 23 cases were diagnosed with endophthalmitis over the 7-year period, for a rate of 1 case per 4,940 injections. The mode of PI antisepsis showed no significant relation to the rate of endophthalmitis ( P = 0.55, chi-square test). The proportion of endophthalmitis by physician demonstrated no significant difference ( P = 0.39, chi-square test). CONCLUSION The use of PI has been associated with decreased incidence of endophthalmitis, but the mode of application has not been standardized. The results of this study suggest that "more is not better" in PI antisepsis in endophthalmitis. Moreover, the toxicity of PI on the ocular surface is known to be dose-related.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
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Feu-Basilio S, Maloca PM, Hasler P, Scholl HPN, Marin-Martinez S, Rosinés-Fonoll J, Suarez-Valero X, Reich M, Lange C, Egan C, Zweifel S, Tufail A, Spaide RF, Zarranz-Ventura J. Retinal vessel volume reference database derived from volume-rendered optical coherence tomography angiography. Sci Rep 2024; 14:2721. [PMID: 38302574 PMCID: PMC10834445 DOI: 10.1038/s41598-024-53000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
Optical coherence tomography angiography (OCTA) enables three-dimensional reconstruction of the functional blood vessels in the retina. Therefore, it enables the quantification of 3D retinal vessel parameters such as surface area and vessel volume. In spite of the widespread use of OCTA, no representative volume-rendered vessel volume (VV) data are published to date. In this study, OCTA 3 × 3 mm macular cubes were processed with volume-rendering techniques to measure VV in 203 eyes from 107 healthy volunteers. Generalized linear models (GLM) were constructed to assess the impact of age, gender, visual acuity (VA), spherical equivalent (SE), and axial length (AL) on VV. Overall mean VV was 0.23 ± 0.05mm3. Age and axial length showed a negative correlation with VV. However, GLM model analysis found that AL exerted the most pronounced influence on VV. No statistically significant associations were identified between gender or between left and right eyes. This is the first study to assess 3D OCTA VV and its naturally occurring variations in a large series of healthy subjects. It offers novel insights into the characterization of normal retinal vascular anatomy in healthy individuals, contributing to a valuable reference for future research in this field.
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Affiliation(s)
- Silvia Feu-Basilio
- Hospital Clínic de Barcelona, University of Barcelona, Carrer de Sabino Arana, 1, 08028, Barcelona, Spain
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, 4031, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Pascal Hasler
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, 4031, Basel, Switzerland
| | - Sara Marin-Martinez
- Hospital Clínic de Barcelona, University of Barcelona, Carrer de Sabino Arana, 1, 08028, Barcelona, Spain
| | - Josep Rosinés-Fonoll
- Hospital Clínic de Barcelona, University of Barcelona, Carrer de Sabino Arana, 1, 08028, Barcelona, Spain
| | - Xavier Suarez-Valero
- Hospital Clínic de Barcelona, University of Barcelona, Carrer de Sabino Arana, 1, 08028, Barcelona, Spain
| | - Michael Reich
- Faculty of Medicine, Eye Center, Albert-Ludwig University Freiburg, 79085, Freiburg, Germany
- Augenärzte Am Städel, Hans-Thoma-Strasse 24, 60596, Frankfurt Am Main, Germany
| | - Clemens Lange
- Faculty of Medicine, Eye Center, Albert-Ludwig University Freiburg, 79085, Freiburg, Germany
- Department of Ophthalmology, St. Franziskus Hospital, 48145, Münster, Germany
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, 8006, Zurich, Switzerland
- University of Zurich, 8006, Zurich, Switzerland
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA
| | - Javier Zarranz-Ventura
- Hospital Clínic de Barcelona, University of Barcelona, Carrer de Sabino Arana, 1, 08028, Barcelona, Spain.
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
- Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain.
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Ngo WK, Spaide RF. PRIMARY OCCLUSIVE PANVASCULITIS WITH SEGMENTAL PERIARTERIAL PLAQUES. Retin Cases Brief Rep 2024; 18:1-5. [PMID: 36007193 DOI: 10.1097/icb.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to describe a new clinical entity of bilateral occlusive panvasculitis with segmental periarterial plaques and its clinical course in two patients. METHODS This was a retrospective chart review. RESULTS Two patients with no medical history of any systemic inflammatory diseases presented with bilateral segmental periarterial plaques (Kyrieleis plaques), cotton wool spots, and microaneurysms. Segmental leakage, staining, and vascular occlusions involved the arterioles, venules, and capillaries. Leakage from the superficial capillary plexus in some areas bordering deep capillary plexus nonperfusion was observed. Both had recurrent episodes of vascular occlusions, normal brain MRI, and audiology tests. Complete workup including serology for infections, inflammatory markers, and antibody titers was unremarkable. They were started on with corticosteroids and immunosuppressant, and there were no further vascular occlusions. Both developed neovascularization adjacent to the areas of capillary nonperfusion. The second patient also developed vitreomacular traction and cystoid macular edema. He required intravitreal anti-VEGF injection, sector laser photocoagulation, and underwent a vitrectomy with membrane peeling. At the last visit, the visual acuity was 20/30 in both eyes for the first patient and 20/20 in the right eye and 20/40 in the left eye for the second patient, 12 and 6.5 years after initial presentation, respectively. CONCLUSION Both patients presented with findings of bilateral panvasculitis with prominent segmental periarterial plaques and had repeated episodes of vascular occlusions before corticosteroid and immunosuppressants treatment, after which no additional occlusions were observed. We propose that the constellation of findings constitutes a novel clinical entity, occlusive panvasculitis with segmental periarterial plaques.
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Affiliation(s)
- Wei Kiong Ngo
- Vitreous Retina Macula Consultants of New York, New York, New York
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Lee JG, Spaide RF. RECONSTITUTION OF THE CHORIOCAPILLARIS IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY. Retin Cases Brief Rep 2024; 18:87-90. [PMID: 36731107 DOI: 10.1097/icb.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to describe findings derived from extensions of optical coherence tomography, including volume rendering and frame-averaged optical coherence tomography angiography (OCT-A), in a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). METHODS This is a case report of a patient with APMPPE imaged during the acute and convalescent stages. RESULTS A 20-year-old man presented with an acute change in vision. He had multiple yellow-white placoid lesions at the level of the retinal pigment epithelium in the macula and nasal to the optic nerve in both eyes. Within 2 weeks, his visual acuity worsened to 20/80 and 20/400 in the right and left eyes, respectively. Spectral domain OCT showed focal defects in the ellipsoid and retinal pigment epithelium layers. Volume-rendering OCT-A showed inflammatory cells in the outer nuclear layer above the APMPPE lesion. Frame-averaged OCT-A revealed significant loss of capillary flow signal within capillary segments of the choriocapillaris. Ten weeks after presentation, there was resolution of the placoid changes, discontinuance of the inflammatory infiltrate in the outer nuclear layer, and significant reconstitution of flow in the choriocapillaris. The visual acuity was 20/20 in both eyes. CONCLUSION Novel volume-rendered and frame-averaged OCT-A images in a patient with APMPPE allowed detection of inflammatory cell infiltrate in the outer nuclear layer and reversible capillary segment nonperfusion of associated APMPPE lesions. The findings suggest short-term insults to choriocapillaris function may be reversible and can be tracked with modern imaging techniques.
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Affiliation(s)
- Jessica G Lee
- Vitreoretinal Consultants of New York, Great Neck, New York
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York; and
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
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Affiliation(s)
- Richard F Spaide
- The Vitreous Retina, Macula Consultants of New York, New York, NY
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10
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Maunz A, Barras L, Kawczynski MG, Dai J, Lee AY, Spaide RF, Sahni J, Ferrara D. Machine Learning to Predict Response to Ranibizumab in Neovascular Age-Related Macular Degeneration. Ophthalmol Sci 2023; 3:100319. [PMID: 37304043 PMCID: PMC10251067 DOI: 10.1016/j.xops.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 06/13/2023]
Abstract
Purpose Neovascular age-related macular degeneration (nAMD) shows variable treatment response to intravitreal anti-VEGF. This analysis compared the potential of different artificial intelligence (AI)-based machine learning models using OCT and clinical variables to accurately predict at baseline the best-corrected visual acuity (BCVA) at 9 months in response to ranibizumab in patients with nAMD. Design Retrospective analysis. Participants Baseline and imaging data from patients with subfoveal choroidal neovascularization secondary to age-related macular dengeration. Methods Baseline data from 502 study eyes from the HARBOR (NCT00891735) prospective clinical trial (monthly ranibizumab 0.5 and 2.0 mg arms) were pooled; 432 baseline OCT volume scans were included in the analysis. Seven models, based on baseline quantitative OCT features (Least absolute shrinkage and selection operator [Lasso] OCT minimum [min], Lasso OCT 1 standard error [SE]); on quantitative OCT features and clinical variables at baseline (Lasso min, Lasso 1SE, CatBoost, RF [random forest]); or on baseline OCT images only (deep learning [DL] model), were systematically compared with a benchmark linear model of baseline age and BCVA. Quantitative OCT features were derived by a DL segmentation model on the volume images, including retinal layer volumes and thicknesses, and retinal fluid biomarkers, including statistics on fluid volume and distribution. Main Outcome Measures Prognostic ability of the models was evaluated using coefficient of determination (R2) and median absolute error (MAE; letters). Results In the first cross-validation split, mean R2 (MAE) of the Lasso min, Lasso 1SE, CatBoost, and RF models was 0.46 (7.87), 0.42 (8.43), 0.45 (7.75), and 0.43 (7.60), respectively. These models ranked higher than or similar to the benchmark model (mean R2, 0.41; mean MAE, 8.20 letters) and better than OCT-only models (mean R2: Lasso OCT min, 0.20; Lasso OCT 1SE, 0.16; DL, 0.34). The Lasso min model was selected for detailed analysis; mean R2 (MAE) of the Lasso min and benchmark models for 1000 repeated cross-validation splits were 0.46 (7.7) and 0.42 (8.0), respectively. Conclusions Machine learning models based on AI-segmented OCT features and clinical variables at baseline may predict future response to ranibizumab treatment in patients with nAMD. However, further developments will be needed to realize the clinical utility of such AI-based tools. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Andreas Maunz
- Roche Pharma Research and Early Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Laura Barras
- Roche Data & Statistical Sciences, Genentech, Inc, South San Francisco, California
| | - Michael G. Kawczynski
- Roche Personalized Healthcare Program, Genentech, Inc, South San Francisco, California
| | - Jian Dai
- Roche Personalized Healthcare Program, Genentech, Inc, South San Francisco, California
| | - Aaron Y. Lee
- Department of Ophthalmology, School of Medicine, University of Washington, Seattle, Washington
| | | | - Jayashree Sahni
- Roche Pharma Research and Early Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Daniela Ferrara
- Roche Personalized Healthcare Program, Genentech, Inc, South San Francisco, California
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Salcedo-Ledesma A, Ledesma-Gil G, Keshet Y, Spaide RF. Retinal Pigment Epithelial Detachments Devoid of Retinal Pigment Epithelium. Retin Cases Brief Rep 2023:01271216-990000000-00233. [PMID: 37769240 DOI: 10.1097/icb.0000000000001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE To describe two patients with chronic central serous chorioretinopathy (CSC) showing what appeared to be retinal pigment epithelium detachments (PED) lacking imaging findings consistent with retinal pigment epithelium (RPE) over the elevation. METHOD The patients underwent comprehensive ophthalmic examination, including multicolor fundus photography, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT). RESULTS A 70-year-old male and a 58-year-old male, both diagnosed with chronic CSC, showed PED-like lesions that were hypoautofluorescent, suggesting an absence of RPE. SD-OCT B-scans showed serous, dome-shaped elevations composed of a narrow, mildly hyperreflective band (9-10 μm thick) that demonstrated hypertransmission of light. The material that constituted the elevation was contiguous with the outer portion of the RPE band at the lesion borders. CONCLUSION Based on the multimodal imaging findings we hypothesize that these elevations of the retina have lost their overlying RPE. A thin layer of material that could represent a residual layer of basal laminar deposit produced by the RPE remains overlying the detachments, possibly accounting for their dome shape and structural stability.
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Ngo WK, Keshet Y, Salcedo-Ledesma A, Walia J, Ledesma-Gil G, Spaide RF. THE WAY PATIENTS SEE FLOATERS: Widefield Dynamic Scanning Laser Ophthalmoscopy Imaging of Vitreous Abnormalities. Retina 2023; 43:1240-1245. [PMID: 36977315 DOI: 10.1097/iae.0000000000003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE To investigate the use of dynamic widefield scanning laser ophthalmoscopy (SLO) and B-scan ultrasonography in imaging vitreous abnormalities in patients with complaints of floaters. METHODS Twenty-one patients underwent both dynamic SLO and B-scan ultrasonography to image their vitreous abnormalities. After reviewing these videos, patients graded each imaging technique on a scale of 1 to 10, based on how closely it represented their visual perception of floaters. RESULTS The mean age of the patients (12 women and nine men) was 47.7 ± 18.5 years. The patients graded a median score of nine for SLO imaging (mean = 8.43) compared with a median score of 5 (mean = 4.95) for ultrasound ( P = 0.001). Widefield SLO imaging demonstrated three-dimensional interconnectivity within the condensations of the formed vitreous that exhibited translational and rotational movements with eye saccades. CONCLUSION Floaters are a common complaint, but it is difficult to know whether imaging findings of the vitreous correlate to what patients perceive. Widefield SLO seems to image vitreous abnormalities related to how patients perceive their own floaters better than B-scan ultrasonography. Despite the term "floaters", the vitreous abnormalities in the videos seemed to be manifestations of a complex three-dimensional degeneration of the vitreous framework.
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Affiliation(s)
- Wei Kiong Ngo
- Vitreous Retina Macula Consultants of New York, New York, New York
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Abstract
PURPOSE To evaluate available rationale and outcomes of randomized trial results for complement inhibition for geographic atrophy. METHODS Data from recently completed randomized trials of complement inhibition, particularly for pegcetacoplan and avacincaptad pegol, were evaluated for both the outcome, area of autofluorescence loss, and functional vision tests. RESULTS Pegcetacoplan 2 mg showed statistically significant reduction in expansion of the area of autofluorescence loss with monthly, but not every-other-month dosing, in a 12-month phase two trial. Nearly 40% of patients recruited for the monthly arm did not complete the treatment. In two parallel phase 3 studies there was a statistically significant reduction in the area of atrophy in one but not both studies as compared with untreated controls. Data released at 24 months follow-up showed statistically significant reduction in the area of autofluorescence-detected atrophy in both studies compared with sham. Patients did not show functional difference in best-corrected visual acuity, maximum reading speed, Functional Reading Independence Index, and mean microperimetry threshold sensitivities in the treatment versus sham arms. Avacincaptad pegol was evaluated in two randomized pivotal studies and showed a statistically significant reduction in the expansion of autofluorescence loss at 12 months. Patients in the treatment arms did not show any difference as compared with sham in the best-corrected visual acuity or low luminance visual acuity, the only functional outcomes mentioned. Both drugs increased the risk of macular neovascularization. CONCLUSION Both avacincaptad pegol and pegcetacoplan show significant differences compared with sham in autofluorescence imaging but no benefit in visual function at 12 and 24 months, respectively.
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Affiliation(s)
- Richard F Spaide
- The Vitreous Retina, Macula Consultants of New York, New York, New York; and
| | - Demetrios G Vavvas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Rana V, Gupta V, Spaide RF, Sukhija J, Singh SR, Agrawal R, Takkar A, Lal V. VENOUS OVERLOAD CHOROIDOPATHY ASSOCIATED WITH IDIOPATHIC INTRACRANIAL HYPERTENSION. Retin Cases Brief Rep 2023; 17:448-454. [PMID: 37364207 DOI: 10.1097/icb.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To report a case of venous overload choroidopathy associated with idiopathic intracranial hypertension in a 41-year-old man. METHODS History and clinical examination, fluorescein angiography, ultra-widefield indocyanine green angiography, swept-source optical coherence tomography, and contrast-enhanced magnetic resonance imaging. RESULTS The patient was diagnosed as having idiopathic intracranial hypertension 2 years ago, was being managed on oral acetazolamide, and retained 20/20 visual acuity in both eyes until now when he presented with a complaint of visual loss in the right eye. Ophthalmoscopy revealed serous detachment in the fovea of the right eye. Swept-source optical coherence tomography showed the presence of subretinal fluid and detachments of the retinal pigment epithelium in both eyes. Fundus fluorescein angiography showed multiple dot leaks at the level of the retinal pigment epithelium in both eyes. Indocyanine green angiography revealed vortex vein anastomoses and choroidal vascular hyperpermeability in both eyes. Contrast-enhanced magnetic resonance imaging revealed dilated optic nerve sheath diameter and a partial empty sella and magnetic resonance venography showed bilateral stenosis of the transverse sinus. CONCLUSION Transverse sinus stenosis is a common finding in "idiopathic" intracranial hypertension and contributes to the intracranial pressure through intracranial venous hypertension. Increased venous back pressure seemed to have overloaded the choroid resulting in choroidal vascular congestion and hyperpermeability, leaks from the level of the retinal pigment epithelium, and accumulation of subretinal fluid.
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Affiliation(s)
- Vipin Rana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jaspreet Sukhija
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Simar R Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; and
| | - Aastha Takkar
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
PURPOSE To evaluate a patient with multiple evanescent white dot syndrome with multimodal imaging including high-resolution spectral-domain optical coherence tomography. METHODS The patient was evaluated with wide-field color and autofluorescence imaging, microperimetry, and near-infrared imaging. Spectral-domain optical coherence tomography was performed using an instrument capable of 3- μ m axial resolution, the high-resolution Heidelberg Spectralis. RESULTS A 28-year-old woman developed photopsias and a scotoma in the field of vision of her left eye. She had multiple whitish spots with granularity in her fovea, consistent with the diagnosis of multiple evanescent white dot syndrome. She had supportive fluorescein angiographic and autofluorescence findings. Because of the high resolution and good layer contrast, it was possible to create en face slab images of the external limiting membrane, ellipsoid zone, interdigitation zone, and retinal pigment epithelium. The external limiting membrane showed no abnormalities. There were multiple regions of decreased reflectance in the ellipsoid zone slab but even more prominent changes in the interdigitation zone. The retinal pigment epithelium showed nearly no variation in layer reflectivity. With resolution of symptoms, the color and autofluorescence images returned to normal, the defects in the ellipsoid zone almost completely resolved, and the interdigitation zone continued to show abnormalities. CONCLUSION Although past studies concluded that the ellipsoid zone was the main region of involvement in multiple evanescent white dot syndrome, high-resolution spectral-domain optical coherence tomography suggests the interdigitation zone was more prominently affected in this case.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York; and
| | - David R Lally
- New England Retina Consultants, Springfield, Massachusetts
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16
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Jonas JB, Spaide RF, Ostrin LA, Logan NS, Flitcroft I, Panda-Jonas S. IMI-Nonpathological Human Ocular Tissue Changes With Axial Myopia. Invest Ophthalmol Vis Sci 2023; 64:5. [PMID: 37126358 PMCID: PMC10153585 DOI: 10.1167/iovs.64.6.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose To describe nonpathological myopia-related characteristics of the human eye. Methods Based on histomorphometric and clinical studies, qualitative and quantitative findings associated with myopic axial elongation are presented. Results In axial myopia, the eye changes from a spherical shape to a prolate ellipsoid, photoreceptor, and retinal pigment epithelium cell density and total retinal thickness decrease, most marked in the retroequatorial region, followed by the equator. The choroid and sclera are thin, most markedly at the posterior pole and least markedly at the ora serrata. The sclera undergoes alterations in fibroblast activity, changes in extracellular matrix content, and remodeling. Bruch's membrane (BM) thickness is unrelated to axial length, although the BM volume increases. In moderate myopia, the BM opening shifts, usually toward the fovea, leading to the BM overhanging into the nasal intrapapillary compartment. Subsequently, the BM is absent in the temporal region (such as parapapillary gamma zone), the optic disc takes on a vertically oval shape, the fovea-optic disc distance elongates without macular BM elongation, the angle kappa reduces, and the papillomacular retinal vessels and nerve fibers straighten and stretch. In high myopia, the BM opening and the optic disc enlarge, the lamina cribrosa, the peripapillary scleral flange (such as parapapillary delta zone) and the peripapillary choroidal border tissue lengthen and thin, and a circular gamma and delta zone develop. Conclusions A thorough characterization of ocular changes in nonpathological myopia are of importance to better understand the mechanisms of myopic axial elongation, pathological structural changes, and psychophysical sequelae of myopia on visual function.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York, United States
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Ian Flitcroft
- Centre for Eye Research, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
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17
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Ngo WK, Fisher YL, Silverman RH, Tsang SH, Spaide RF. Scleral Thickness in Autosomal Dominant Best Vitelliform Macular Dystrophy. Retin Cases Brief Rep 2023; Publish Ahead of Print:01271216-990000000-00168. [PMID: 37104812 DOI: 10.1097/icb.0000000000001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE To investigate the posterior and equatorial scleral thickness in patients with autosomal dominant Best disease, a condition that has chronic subretinal fluid. METHODS Retrospective study involving patients with Best disease and age-matched controls. Participants were evaluated with contact B-scan ultrasonography and enhanced depth imaging optical coherence tomography to evaluate scleral thickness in the posterior pole and equator. Univariate analysis and generalized estimating equations were used. RESULTS Of 9 patients with genetically proven Best disease and 23 age-matched controls, there was no significant difference in the age or the gender proportion between groups. Subfoveal choroidal thickness and axial length were not significantly different between groups. Both posterior scleral (OD; 1.38mm vs. 0.89mm, P<.001 and OS; 1.39mm vs. 0.83mm, P<.001) and equatorial scleral (OD; 0.61mm vs. 0.42mm, P=.003, and OS; 0.55mm vs. 0.41mm, P=.017) thicknesses were much greater in cases as compared with controls. Multivariate analysis showed male sex and having Best disease were each significant predictors of posterior scleral thickness and Best disease was the sole significant predictor for equatorial scleral thickness. CONCLUSION BEST1 gene may have a developmental role leading to having a thicker sclera, influencing disease manifestation, and contributing to the accumulation of subretinal fluid in Best disease.
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Affiliation(s)
- Wei Kiong Ngo
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, United States
| | - Yale L Fisher
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - Ronald H Silverman
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States
| | - Stephen H Tsang
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, United States
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, United States
- Department of Pathology & Cell Biology, Institute of Human Nutrition, & Columbia Stem Cell Initiative, Columbia University, New York, NY, United States
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, United States
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Anegondi N, Gao SS, Steffen V, Spaide RF, Sadda SR, Holz FG, Rabe C, Honigberg L, Newton EM, Cluceru J, Kawczynski MG, Bengtsson T, Ferrara D, Yang Q. Deep Learning to Predict Geographic Atrophy Area and Growth Rate from Multimodal Imaging. Ophthalmol Retina 2023; 7:243-252. [PMID: 36038116 DOI: 10.1016/j.oret.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop deep learning models for annualized geographic atrophy (GA) growth rate prediction using fundus autofluorescence (FAF) images and spectral-domain OCT volumes from baseline visits, which can be used for prognostic covariate adjustment to increase power of clinical trials. DESIGN This retrospective analysis estimated GA growth rate as the slope of a linear fit on all available measurements of lesion area over a 2-year period. Three multitask deep learning models-FAF-only, OCT-only, and multimodal (FAF and OCT)-were developed to predict concurrent GA area and annualized growth rate. PARTICIPANTS Patients were from prospective and observational lampalizumab clinical trials. METHODS The 3 models were trained on the development data set, tested on the holdout set, and further evaluated on the independent test sets. Baseline FAF images and OCT volumes from study eyes of patients with bilateral GA (NCT02247479; NCT02247531; and NCT02479386) were split into development (1279 patients/eyes) and holdout (443 patients/eyes) sets. Baseline FAF images from study eyes of NCT01229215 (106 patients/eyes) and NCT02399072 (169 patients/eyes) were used as independent test sets. MAIN OUTCOME MEASURES Model performance was evaluated using squared Pearson correlation coefficient (r2) between observed and predicted lesion areas/growth rates. Confidence intervals were calculated by bootstrap resampling (B = 10 000). RESULTS On the holdout data set, r2 (95% confidence interval) of the FAF-only, OCT-only, and multimodal models for GA lesion area prediction was 0.96 (0.95-0.97), 0.91 (0.87-0.95), and 0.94 (0.92-0.96), respectively, and for GA growth rate prediction was 0.48 (0.41-0.55), 0.36 (0.29-0.43), and 0.47 (0.40-0.54), respectively. On the 2 independent test sets, r2 of the FAF-only model for GA lesion area was 0.98 (0.97-0.99) and 0.95 (0.93-0.96), and for GA growth rate was 0.65 (0.52-0.75) and 0.47 (0.34-0.60). CONCLUSIONS We show the feasibility of using baseline FAF images and OCT volumes to predict individual GA area and growth rates using a multitask deep learning approach. The deep learning-based growth rate predictions could be used for covariate adjustment to increase power of clinical trials. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Neha Anegondi
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California; Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Simon S Gao
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California; Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Verena Steffen
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Biostatistics, Genentech, Inc., South San Francisco, California
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Frank G Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Christina Rabe
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Biostatistics, Genentech, Inc., South San Francisco, California
| | - Lee Honigberg
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Biomarker Development, Genentech, Inc., South San Francisco, California
| | - Elizabeth M Newton
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Julia Cluceru
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California; Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Michael G Kawczynski
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Data Science Imaging, Genentech, Inc., South San Francisco, California
| | - Thomas Bengtsson
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Data Science Imaging, Genentech, Inc., South San Francisco, California
| | - Daniela Ferrara
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Qi Yang
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Data Science Imaging, Genentech, Inc., South San Francisco, California.
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19
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Spaide RF. Treatment of Sorsby fundus dystrophy with anti-tumor necrosis factor-alpha medication. Eye (Lond) 2022; 36:1810-1812. [PMID: 34376817 PMCID: PMC9391384 DOI: 10.1038/s41433-021-01735-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Tissue inhibitor of matrix metalloproteinase (TIMP)-3 has many functions, including preventing the constituent formation of tumor necrosis factor-alpha (TNFα) in tissue. Sorsby macular dystrophy is caused by a mutation in the gene responsible for TIMP-3, suggesting a potential treatment. METHODS Comprehensive ophthalmologic examination with multimodal imaging to include optical coherence tomography (OCT) and OCT angiography were used to evaluate a patient with Sorsby fundus dystrophy treated first with intravitreal triamcinolone, then with adalimumab. RESULTS A 35-year-old woman presented in 2003 with aggressive macular neovascularization in both eyes related to Sorsby macular dystrophy c.610A>T (p.Ser204Cys). Her visual acuity was 20/25 in the right and 20/400 in the left eye. She was treated with periodic intravitreal injections of 4 mg triamcinolone, which caused the neovascularization to become inactive. When switched to intravitreal bevacizumab, she showed disease activity. She was switched back to intravitreal triamcinolone with minimal signs of exudation and hemorrhage. Because of the high lifetime risk of complication, she was switched to subcutaneous adalimumab and in follow-up over 18 months had no signs of disease activity. The visual acuity in the right eye was 20/20. CONCLUSIONS TIMP3 has numerous effects including controlling local TNFα production. It is possible with the mutation in the gene for TIMP-3, abnormally high tissue levels of TNFα are produced in the eye. Direct inhibition of TNFα action by adalimumab offers a molecularly targeted approach to the disease pathophysiology and merits increased study.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA.
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20
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Grant MB, Bernstein PS, Boesze-Battaglia K, Chew E, Curcio CA, Kenney MC, Klaver C, Philp NJ, Rowan S, Sparrow J, Spaide RF, Taylor A. Inside out: Relations between the microbiome, nutrition, and eye health. Exp Eye Res 2022; 224:109216. [PMID: 36041509 DOI: 10.1016/j.exer.2022.109216] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Age-related macular degeneration (AMD) is a complex disease with increasing numbers of individuals being afflicted and treatment modalities limited. There are strong interactions between diet, age, the metabolome, and gut microbiota, and all of these have roles in the pathogenesis of AMD. Communication axes exist between the gut microbiota and the eye, therefore, knowing how the microbiota influences the host metabolism during aging could guide a better understanding of AMD pathogenesis. While considerable experimental evidence exists for a diet-gut-eye axis from murine models of human ocular diseases, human diet-microbiome-metabolome studies are needed to elucidate changes in the gut microbiome at the taxonomic and functional levels that are functionally related to ocular pathology. Such studies will reveal new ways to diminish risk for progression of- or incidence of- AMD. Current data suggest that consuming diets rich in dark fish, fruits, vegetables, and low in glycemic index are most retina-healthful during aging.
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Affiliation(s)
- Maria B Grant
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Paul S Bernstein
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | | | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, MD, USA
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M Cristina Kenney
- Department of Ophthalmology, University of California at Irvine, Irvine, CA, USA
| | - Caroline Klaver
- Department of Ophthalmology, Department of Epidemiology, Erasmus Medical Center Rotterdam, the Netherlands; Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Nancy J Philp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sheldon Rowan
- JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Janet Sparrow
- Department of Ophthalmology, Columbia University, New York City, NY, USA
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA
| | - Allen Taylor
- JM-USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
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21
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Bloom SM, Spaide RF. AUTOFLUORESCENCE AND YELLOWING SUBHYALOID BLOOD WITH PROLIFERATIVE DIABETIC RETINOPATHY. Retin Cases Brief Rep 2022; 16:401-402. [PMID: 32796227 DOI: 10.1097/icb.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To present a patient with a subhyaloid hemorrhage from proliferative diabetic retinopathy who showed a unique contrast between the fundus autofluorescent patterns of yellow with red blood. METHODS Analysis of color and autofluorescence fundus photographs of a patient with an aging subhyaloid hemorrhage. RESULTS The remnants of a resorbing subhyaloid hemorrhage had two layers, a superior yellow portion that was intensely hyperautofluorescent and an inferior relatively hypoautofluorescent red portion. We argue that the yellow appearance of the devitalized blood and fluorophores imaged are related to free-base porphyrins. CONCLUSION Fundus autofluorescence is a useful modality to image subhyaloid blood and may lend important insights into the fluorophores that hyperfluoresce. The blood breakdown products are potentially toxic and autofluorescence imaging may offer clues to their presence.
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Affiliation(s)
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
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22
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Maloca PM, Feu-Basilio S, Schottenhamml J, Valmaggia P, Scholl HPN, Rosinés-Fonoll J, Marin-Martinez S, Inglin N, Reich M, Lange C, Egan C, Zweifel S, Tufail A, Spaide RF, Zarranz-Ventura J. Reference database of total retinal vessel surface area derived from volume-rendered optical coherence tomography angiography. Sci Rep 2022; 12:3695. [PMID: 35256644 PMCID: PMC8901674 DOI: 10.1038/s41598-022-07439-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/18/2022] [Indexed: 12/19/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) enables three-dimensional, high-resolution, depth-resolved flow to be distinguished from non-vessel tissue signals in the retina. Thus, it enables the quantification of the 3D surface area of the retinal vessel signal. Despite the widespread use of OCTA, no representative spatially rendered reference vessel surface area data are published. In this study, the OCTA vessel surface areas in 203 eyes of 107 healthy participants were measured in the 3D domain. A Generalized Linear Model (GLM) model analysis was performed to investigate the effects of sex, age, spherical equivalent, axial length, and visual acuity on the OCTA vessel surface area. The mean overall vessel surface area was 54.53 mm2 (range from 27.03 to 88.7 mm2). OCTA vessel surface area was slightly negatively correlated with age. However, the GLM model analysis identified axial length as having the strongest effect on OCTA vessel surface area. No significant correlations were found for sex or between left and right eyes. This is the first study to characterize three-dimensional vascular parameters in a population based on OCTA with respect to the vessel surface area.
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Affiliation(s)
- Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland. .,Department of Ophthalmology, University Hospital Basel, 4031, Basel, Switzerland.
| | - Silvia Feu-Basilio
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, 08036, Barcelona, Spain
| | - Julia Schottenhamml
- Pattern Recognition Lab, University Erlangen-Nürnberg, 91058, Erlangen, Germany
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, 4031, Basel, Switzerland
| | - Josep Rosinés-Fonoll
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, 08036, Barcelona, Spain
| | - Sara Marin-Martinez
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, 08036, Barcelona, Spain
| | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel, 4031, Basel, Switzerland
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens Lange
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Sandrine Zweifel
- University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.,University of Zurich, Rämistrasse 71, 8006, Zürich, Switzerland
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| | - Richard F Spaide
- Vitreous-Retina-Macula Consultants of New York, New York, NY, USA
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, 08036, Barcelona, Spain.,Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
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23
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Abstract
PURPOSE To describe the clinical, optical coherence tomography (OCT), and OCT angiography findings of a patient with a foveal disturbance from the acute phase to the resolution of the visual disturbances. METHOD The patient had a comprehensive ophthalmic examination to include OCT and OCT angiography. RESULTS A 36-year-old man presented with decreased vision and distortion in the right eye. The right eye showed yellow-white punctate opacities in the central fovea. OCT showed numerous, well-defined, globular, aggregated, hyperreflective lesions that corresponded to the visible opacities along with a focal discontinuity of the outer retinal layers. Over 3 weeks, the patient's findings resolved, and the VA improved to 20/20. No abnormalities of the choriocapillaris flow were detected using OCT angiography. The lesion resolved without pigmentary change. CONCLUSION The configuration of the hyperreflective deposits, the lack of pigmentary change, and the absence of OCT angiographic findings of flow problems in the choriocapillaris argue against a primary retinal pigment epithelial or choriocapillaris abnormality as the fundamental cause of the disease. The name acute fovealitis is suggested.
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24
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Spaide RF, Otto T, Caujolle S, Kübler J, Aumann S, Fischer J, Reisman C, Spahr H, Lessmann A. Lateral Resolution of a Commercial Optical Coherence Tomography Instrument. Transl Vis Sci Technol 2022; 11:28. [PMID: 35044444 PMCID: PMC8787587 DOI: 10.1167/tvst.11.1.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/18/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The lateral resolution of an optical coherence tomography (OCT) instrument was considered to be equal to the illumination spot size on the retina. To evaluate the potential lateral resolution of the Spectralis OCT, an instrument calculated to have a 14 µm resolution. Methods The lateral point spread function (PSF) was evaluated using diamond abrasive powder 0 to 1 µm in diameter in silicone elastomer and a validated target with 800 nm FeO particles in urethane. The amplitude transfer function was calculated from human OCT images. Finally, resolution was measured using the 1951 USAF target. Results Measurement of the lateral PSF from 1215 diamond particle images yielded a full-width half maximum (FWHM) to be 5.11 µm and for 732 FeO particles, 4.9 µm. From the amplitude transfer function, the FWHM of the diffraction limited PSF was calculated to be 5.0 µm. The USAF target imaging showed a lateral resolution of 4.6 µm. Conclusions Although a calculation of the spot size of the illumination beam was reported in the past as the lateral resolution of the OCT instrument, the actual lateral resolution is better by a factor of at least 2.5 times. The clinically used A-scan spacing was derived from the calculated, and not the true resolution, and results in under sampling. This set of findings likely apply to all commercial clinical instruments. Translational Relevance The scan density parameters of past and present commercial OCT instruments were based on earlier translational concepts, which now appear to have been incorrect.
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Affiliation(s)
- Richard F. Spaide
- Vitreous Retina, Macula Consultants of New York, New York, New York, USA
| | - Tilman Otto
- Heidelberg Engineering GmbH, Heidelberg, Germany
| | | | | | - Silke Aumann
- Heidelberg Engineering GmbH, Heidelberg, Germany
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25
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Abstract
PURPOSE To describe a transient positive scotoma and corresponding optical coherence tomography (OCT) structural and angiographic findings. METHODS The patient was evaluated with a comprehensive ophthalmic examination to include OCT structural and angiographic imaging with two different instruments, the Zeiss Plex Elite and the Optovue RTVue XR Avanti. RESULTS A 45-year-old man had a sudden onset of a positive scotoma in the visual field of the left eye. No abnormalities were noted by ophthalmoscopy or fundus photography. Optical coherence tomography angiography was performed to evaluate the macular perfusion status. With each instrument, a small hyperreflective area, 175 μm in diameter, was imaged in the inner nuclear layer. The OCT angiographic images suggested a small area of decreased perfusion in the deep capillary plexus. Except for the diminutive size, the lesion had an appearance suggestive of paracentral acute middle maculopathy. The symptoms lessened rapidly, and when examined 4 days later, the lesion was less hyperreflective. Two weeks after presentation, the positive scotoma was not present and there was no longer any hyperreflectivity in the inner nuclear layer. CONCLUSION Detection of the lesion was aided by using OCT angiographic scans, which have a much higher scan density than conventional OCT evaluations. The diminutive abnormality was consistent with a paracentral acute middle maculopathy lesion, although smaller than those previously reported. Micro-paracentral acute middle maculopathy lesions should be considered in the differential diagnosis of positive scotomas.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
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26
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Abdelmassih Y, Azar G, Bonnin S, Scemama Timsit C, Vasseur V, Spaide RF, Behar-Cohen F, Mauget-Faysse M. COVID-19 Associated Choroidopathy. J Clin Med 2021; 10:4686. [PMID: 34682810 PMCID: PMC8541653 DOI: 10.3390/jcm10204686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of the study is to report on the indocyanine green angiography (ICGA) and OCT findings in patients hospitalized for severe COVID infection. In this observational prospective monocentric cohort study, we included patients hospitalized for severe COVID infection. The main outcomes were ICGA and OCT findings. A total of 14 patients with a mean age of 58.2 ± 11.4 years and a male predominance (9/14 patients; 64%) were included. The main ICGA findings included hypofluorescent spots in 19 eyes (68%), intervortex shunts in 10 eyes (36%), and characteristic "hemangioma-like" lesions in five eyes (18%). "Hemangioma-like" lesions were both unique and unilateral, and showed no washout on the late phase of the angiogram. The main OCT findings included focal choroidal thickening in seven eyes (25%), caverns in six eyes (21%) and paracentral acute middle maculopathy lesions in one eye (4%). All patients hospitalized for severe COVID infection had anomalies on ICGA and OCT. Lesions to both retinal and choroidal vasculature were found. These anomalies could be secondary to vascular involvement related directly or indirectly to the SARS-CoV2 virus.
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Affiliation(s)
- Youssef Abdelmassih
- Pediatric Ophthalmology and Retina Department, Rothschild Foundation Hospital, 75019 Paris, France
| | - Georges Azar
- Anterior Segment Department, Rothschild Foundation Hospital, 75019 Paris, France;
| | - Sophie Bonnin
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France; (S.B.); (C.S.T.)
| | - Claire Scemama Timsit
- Ophthalmology Department, Rothschild Foundation Hospital, 75019 Paris, France; (S.B.); (C.S.T.)
| | - Vivien Vasseur
- Clinical Research Department, Rothschild Foundation Hospital, 75019 Paris, France; (V.V.); (M.M.-F.)
| | - Richard F. Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY 10022, USA;
| | - Francine Behar-Cohen
- Ophthalmology Department, Cochin Hospital, 75014 Paris, France;
- Centre de Recherche des Cordeliers, INSERM U1138, Team 17, Université de Paris, 75006 Paris, France
| | - Martine Mauget-Faysse
- Clinical Research Department, Rothschild Foundation Hospital, 75019 Paris, France; (V.V.); (M.M.-F.)
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27
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Reich M, Dreesbach M, Boehringer D, Schottenhamml J, Gehring E, Scholl HPN, Inglin N, Agostini H, Reinhard T, Lagrèze WA, Spaide RF, Lange C, Maloca PM. NEGATIVE VESSEL REMODELING IN STARGARDT DISEASE QUANTIFIED WITH VOLUME-RENDERED OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2021; 41:1948-1957. [PMID: 33438899 DOI: 10.1097/iae.0000000000003110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To quantify retinal vasculature changes in Stargardt disease1 (STGD1) with volume-rendered optical coherence tomography angiography. METHODS Optical coherence tomography angiography volumes from healthy subjects and two subgroups of patients with STGD1 with the presence/absence of definitely decreased autofluorescence areas were compared. Optical coherence tomography angiography vessel surface area and vessel volume were measured in central zones (Z) of 1-, 2-, and 3-mm diameter. RESULTS Twenty nine eyes of 15 patients with STGD1 (20/9 eyes with/without definitely decreased autofluorescence) and 30 eyes of 15 controls contributed data. An enlarged foveal avascular zone was found in patients with STGD1 without and even more with definitely decreased autofluorescence associated with a vessel rarefication in central and also paracentral zones with unnoticeable autofluorescence. Vessel surface area and vessel volume were reduced in both STGD1 subgroups for all zones (P < 0.0001). Stargardt disease 1 eyes when compared to without definitely decreased autofluorescence showed reduced vessel surface area and vessel volume in Z2+3 (both P < 0.05). CONCLUSION Volume rendering of optical coherence tomography angiography in STGD1 shows a reduced retinal flow in the central macula. This is most likely secondary to loss of neurosensory tissue with disease progression and therefore not likely be favorably influenced by gene transfer and retinal pigment epithelial transplantation. Retinal blood flow assessed by 3D volume-rendered optical coherence tomography angiography could serve as surrogate marker for vascular changes of the central retina.
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Affiliation(s)
- Michael Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michelle Dreesbach
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniel Boehringer
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Esteban Gehring
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Hansjuergen Agostini
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants, New York City, New York; and
| | - Clemens Lange
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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28
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Cheung CMG, Teo KYC, Tun SBB, Busoy JM, Barathi VA, Spaide RF. Correlation of choriocapillaris hemodynamic data from dynamic indocyanine green and optical coherence tomography angiography. Sci Rep 2021; 11:15580. [PMID: 34341447 PMCID: PMC8329180 DOI: 10.1038/s41598-021-95270-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
To investigate the correlation between posterior pole choroidal blood flow evaluated with digital subtraction indocyanine green angiography and enface optical coherence tomography angiography (OCTA). Imaging in animal study. The anatomy of 2 cynomogulus monkeys was studied. Each monkey was given a 0.75 mg/kg injection of indocyanine green in the saphenous vein. The dynamic angiographic filling sequence was recorded at 15 frames per second using the Heidelberg Spectralis. After image registration, sequential frame subtraction was used to image the dye front moving through the choroid. The OCTA was obtained by frame averaging nine separate choriocapillaris slab flow images obtained from the Zeiss Plex Elite 9000. Posterior pole choriocapillaris filling pattern in relation to the choriocapillaris anatomy as imaged by OCTA. In the posterior pole, the choriocapillaris fills in the pattern of discrete units with variable sizes and shapes. The cycle of dye filling begins in the peripapillary area and progresses toward the periphery in a wavelike manner. This filling pattern repeats in a cyclical manner, consistent with the cardiac cycle. OCTA shows a uniform mesh of vessels. While OCTA shows a uniform meshwork appearance of the choriocapillaris, the dynamic dye angiography suggests an irregular configuration of functional units partitioned by pressure gradients as opposed to structural boundaries. Disturbance of local perfusion pressure within choroidal vasculature may result in abnormal flow patterns, which could be evaluated in the clinic using commercially available equipment.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.,Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sai Bo Bo Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Joanna Marie Busoy
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Veluchamy A Barathi
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
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29
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Spaide RF, Caujolle S, Otto T. INTERMEDIATE AND DEEP CAPILLARY PLEXUSES IN MACHINE LEARNING SEGMENTATION OF HIGH-RESOLUTION OPTICAL COHERENCE TOMOGRAPHY IMAGING. Retina 2021; 41:1314-1317. [PMID: 34001833 DOI: 10.1097/iae.0000000000003097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe imaging produced by machine learning-based segmentation of high-resolution optical coherence tomography imaging of the intermediate capillary plexus and deep capillary plexus, layers of vessels not imaged well by dye-based angiography. METHODS Three healthy subjects with no ocular problems were imaged with spectral domain optical coherence tomography using an instrument with a scanning speed of 85,000 A-scans per second and 3 µm axial optical resolution. A random forest segmentation strategy was used to segment the intermediate capillary plexus and deep capillary plexus. The depth-resolved imaging data was visualized with the help of volume rendering. RESULTS The high-resolution optical coherence tomography showed the intermediate capillary plexus and deep capillary plexus at the outer borders of the inner nuclear layer. These vessels could be visualized with unprecedented detail in three dimensions. There were multiple bridging vessels connecting to the whorl-like patterns of capillary mesh of the deep capillary plexus, a feature only previously imaged in histologic evaluation of excised eyes. CONCLUSION High-resolution optical coherence tomography, machine learning, and advanced image display techniques have wide relevancy in studying the retina in health and disease. Application of this approach has provided images of the deeper vascular layers of the eye that approximate histologic imaging, but noninvasively.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York; and
| | | | - Tilman Otto
- Heidelberg Engineering GmbH, Heidelberg, Germany
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30
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Spaide RF, Gemmy Cheung CM, Matsumoto H, Kishi S, Boon CJF, van Dijk EHC, Mauget-Faysse M, Behar-Cohen F, Hartnett ME, Sivaprasad S, Iida T, Brown DM, Chhablani J, Maloca PM. Venous overload choroidopathy: A hypothetical framework for central serous chorioretinopathy and allied disorders. Prog Retin Eye Res 2021; 86:100973. [PMID: 34029721 DOI: 10.1016/j.preteyeres.2021.100973] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Abstract
In central serous chorioretinopathy (CSC), the macula is detached because of fluid leakage at the level of the retinal pigment epithelium. The fluid appears to originate from choroidal vascular hyperpermeability, but the etiology for the fluid is controversial. The choroidal vascular findings as elucidated by recent optical coherence tomography (OCT) and wide-field indocyanine green (ICG) angiographic evaluation show eyes with CSC have many of the same venous patterns that are found in eyes following occlusion of the vortex veins or carotid cavernous sinus fistulas (CCSF). The eyes show delayed choroidal filling, dilated veins, intervortex venous anastomoses, and choroidal vascular hyperpermeability. While patients with occlusion of the vortex veins or CCSF have extraocular abnormalities accounting for the venous outflow problems, eyes with CSC appear to have venous outflow abnormalities as an intrinsic phenomenon. Control of venous outflow from the eye involves a Starling resistor effect, which appears to be abnormal in CSC. Similar choroidal vascular abnormalities have been found in peripapillary pachychoroid syndrome. However, peripapillary pachychoroid syndrome has intervortex venous anastomoses located in the peripapillary region while in CSC these are seen to be located in the macular region. Spaceflight associated neuro-ocular syndrome appears to share many of the pathophysiologic problems of abnormal venous outflow from the choroid along with a host of associated abnormalities. These diseases vary according to their underlying etiologies but are linked by the venous decompensation in the choroid that leads to significant vision loss. Choroidal venous overload provides a unifying concept and theory for an improved understanding of the pathophysiology and classification of a group of diseases to a greater extent than previous proposals.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, USA.
| | | | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Japan.
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | | | | | | | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
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31
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Abstract
PURPOSE To evaluate the choroidal vascular patterns of patients with pachychoroid-related diseases in eyes images with wide-field indocyanine green angiography. METHODS Retrospective study of wide-field indocyanine green angiographic images of patients with pachychoroid, peripapillary pachychoroid syndrome, central serous chorioretinopathy, and pachychoroid-associated neovascularization that were evaluated for anastomoses between vortex vein systems, which are ordinarily separated by a watershed zone. RESULTS There were 21 subjects with a mean age of 57.4 years and 15 were male. Among the 42 eyes evaluated, central serous chorioretinopathy was found in 24 eyes (57.1%), peripapillary pachychoroid syndrome in 5 (11.9%), pachychoroid associated neovascularization in 7 (16.7%), and pachychoroid in 6 (14.3%). Every eye showed anastomosis between the superonasal, superotemporal, and inferotemporal vortex vein systems. The inferonasal vortex vein system was less likely to demonstrate anastomosis except for peripapillary pachychoroid syndrome, which showed anastomosis in all eyes. The anastomotic connections were prominent in the central macula in the central serous chorioretinopathy and pachychoroid-associated neovascularization cases, and around the nerve in the peripapillary pachychoroid syndrome cases. Although the large choroidal veins were particularly prominent in the neovascular cases, the number was fewer in the macular region than in other pachychoroid-related diseases in this series. Compared with a control group of nine eyes, the inferotemporal-superotemporal-superonasal anastomotic connections were more common in the case group (P < 0.001) and inferonasal quadrant (P = 0.023 right eye; P = 0.01, left eye). CONCLUSION Intervortex venous anastomosis is common in pachychoroid, central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid-associated neovascularization. This finding has important implications concerning pathogenesis and classification of disease.
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Affiliation(s)
| | - Gerardo Ledesma-Gil
- Vitreous, Macula, Retina Consultants, New York, New York
- Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; and
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
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32
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Mendonça LSM, Perrott-Reynolds R, Schwartz R, Madi HA, Cronbach N, Gendelman I, Muldrew A, Bannon F, Balaskas K, Gemmy Cheung CM, Fawzi A, Ferrara D, Freund KB, Fujimoto J, Munk MR, Querques G, Ribeiro R, Rosenfeld PJ, Sadda SR, Sahni J, Sarraf D, Spaide RF, Schmidt-Erfurth U, Souied E, Staurenghi G, Tadayoni R, Wang RK, Chakravarthy U, Waheed NK. Deliberations of an International Panel of Experts on OCT Angiography Nomenclature of Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 128:1109-1112. [PMID: 33359557 DOI: 10.1016/j.ophtha.2020.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Luísa S M Mendonça
- New England Eye Center-Tufts Medical Center, Boston, Massachusetts; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Rhianon Perrott-Reynolds
- Department of Ophthalmology, Aneurin Bevan University Health Board, Newport, South Wales, United Kingdom
| | - Roy Schwartz
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Haifa A Madi
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Nicola Cronbach
- Department of Ophthalmology, Stoke Mandeville Hospital, Buckinghamshire, United Kingdom
| | - Isaac Gendelman
- New England Eye Center-Tufts Medical Center, Boston, Massachusetts
| | - Alyson Muldrew
- Center for Public Health, Queen's University of Belfast, Belfast, United Kingdom
| | - Finnian Bannon
- Center for Public Health, Queen's University of Belfast, Belfast, United Kingdom
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | | | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniela Ferrara
- New England Eye Center-Tufts Medical Center, Boston, Massachusetts; Ophthalmology Personalized Healthcare Program, Genentech Inc., South San Francisco, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; New York University Grossman School of Medicine, New York, New York
| | - James Fujimoto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Giuseppe Querques
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - SriniVas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jayashree Sahni
- Pharma Research and Early Development, Roche Innovation Center, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | | | - Eric Souied
- Service d'Ophtalmologie, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Ramin Tadayoni
- Service d'Ophtalmologie, Hôpital Lariboisière, Université de Paris, Paris, France
| | - Ruikang K Wang
- Departments of Bioengineering and Ophthalmology, University of Washington, Seattle, Washington
| | - Usha Chakravarthy
- Professor of Ophthalmology and Vision Science, Queen's University of Belfast, Belfast, United Kingdom; Consultant in Ophthalmology, The Belfast Trust, Belfast, United Kingdom
| | - Nadia K Waheed
- New England Eye Center-Tufts Medical Center, Boston, Massachusetts.
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33
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Jaffe GJ, Chakravarthy U, Freund KB, Guymer RH, Holz FG, Liakopoulos S, Monés JM, Rosenfeld PJ, Sadda SR, Sarraf D, Schmitz-Valckenberg S, Spaide RF, Staurenghi G, Tufail A, Curcio CA. Imaging Features Associated with Progression to Geographic Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 5. Ophthalmol Retina 2020; 5:855-867. [PMID: 33348085 DOI: 10.1016/j.oret.2020.12.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To provide an image-based description of retinal features associated with risk for development of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD), as visualized with multimodal imaging anchored by structural OCT. DESIGN Consensus meeting. PARTICIPANTS International group that included those with expertise in imaging and AMD basic science and histology, and those with Reading Center experience in AMD clinical trials. METHODS As part of the Classification of Atrophy Meeting program, an international group of experts analyzed and discussed retinal multimodal imaging features in eyes with AMD associated with GA, risk of progression to GA, or both. Attendees undertook premeeting grading exercises that were reviewed during the meeting sessions. Meeting presentations illustrated established and investigational multimodal imaging features and associated histologic features. Each of these different features were then discussed openly by the entire group to arrive at consensus definitions. These definitions were applied to 40 additional images that were graded independently by attendees to refine the consensus definitions and descriptions further. RESULTS Consensus was reached on images with descriptors for 12 features. These features included components of outer retinal atrophy (e.g., ellipsoid zone disruption), components of complete retinal pigment epithelium (RPE) and outer retinal atrophy (e.g., RPE perturbation with associated hypotransmission or hypertransmission), features frequently seen in eyes with atrophy (e.g., refractile drusen), and features conferring risk for atrophy development (e.g., hyperreflective foci, drusen, and subretinal drusenoid deposits). CONCLUSIONS An international consensus on terms and descriptions was reached on multimodal imaging features associated GA and with risk for GA progression in eyes with AMD. We believe this information will be useful to clinicians who manage patients with AMD, researchers who study AMD disease interventions and pathogenesis, and those who design clinical trials for therapies targeting earlier AMD stages than GA expansion.
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Affiliation(s)
- Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina.
| | - Usha Chakravarthy
- Center for Public Health, The Queen's University of Belfast, Belfast, United Kingdom
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sandra Liakopoulos
- Department of Ophthalmology, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Jordi M Monés
- Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Trust and Institute of Ophthalmology, University College London, London, United Kingdom
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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34
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Cheung CMG, Teo KYC, Tun SBB, Busoy JM, Veluchamy AB, Spaide RF. Differential reperfusion patterns in retinal vascular plexuses following increase in intraocular pressure an OCT angiography study. Sci Rep 2020; 10:16505. [PMID: 33020568 PMCID: PMC7536233 DOI: 10.1038/s41598-020-73585-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/18/2020] [Indexed: 11/09/2022] Open
Abstract
To describe patterns of reperfusion in the superficial vascular plexus (SVP), deep capillary plexus (DCP) and choriocapillaris (CC) as detected on optical coherence tomography (OCTA) in cynomogulus macaque monkey model following increase in intraocular pressure by an intravitreal injection. Animal imaging study. Two cynomogulus macaque monkeys. A 100 µL intravitreal injection (IVI) of saline was given in one eye of each monkey. Serial OCTA using a Zeiss Plex Elite 9000 was used to evaluate reperfusion patterns within the SCP, DCP, and CC. OCTA evidence of perfusion. Pulsation of the central retinal artery was detected after the intraocular pressure was elevated to 98 and ≥ 99 mmHg from IVI. Episodic flow within the SVP arterioles and venules and poor visualization of flow in capillaries was noted during the initial phase of elevated pressure. As the pressure declined, the flow signal within the DCP appeared initially as dots, which progressed laterally to loops which form capillary vortex configuration. Recovery of flow within the SVP and CC appeared sooner than in the DCP. At 40 min after the injection, well after the intraocular pressure normalized, the retinal and choriocapillaris vascular perfusion showed focal defects in every layer. Compared with pre-injection images, vessel density in the DCP was 68.8% and 78.6% of baseline in monkey 1 and monkey 2, respectively. In contrast vessel density in the SVP recovered to 84.2% and 88.9% of baseline. Increases in intraocular pressure from IVI have the potential to affect every layer of blood flow in the fundus. After nominal return of intraocular pressure, focal defects in flow persisted, which may result in longer term damage to the retina.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.,University of Sydney, Sydney, Australia
| | - Sai Bo Bo Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Joanna Marie Busoy
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Amutha Barathi Veluchamy
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
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Hilely A, Au A, Freund KB, Loewenstein A, Souied EH, Zur D, Sacconi R, Borrelli E, Peiretti E, Iovino C, Sugiura Y, Ellabban AA, Monés J, Waheed NK, Ozdek S, Yalinbas D, Thiele S, de Moura Mendonça LS, Lee MY, Lee WK, Turcotte P, Capuano V, Filali Ansary M, Chakravarthy U, Lommatzsch A, Gunnemann F, Pauleikhoff D, Ip MS, Querques G, Holz FG, Spaide RF, Sadda S, Sarraf D. Non-neovascular age-related macular degeneration with subretinal fluid. Br J Ophthalmol 2020; 105:1415-1420. [PMID: 32920528 DOI: 10.1136/bjophthalmol-2020-317326] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes. METHODS This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes. RESULTS Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy. CONCLUSION Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.
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Affiliation(s)
- Assaf Hilely
- Division of Ophthalmology, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
| | - Adrian Au
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
| | - Eric H Souied
- Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Yoshimi Sugiura
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan
| | - Abdallah A Ellabban
- Hull University Teaching Hospitals NHS Trust, Hull, UK.,Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Jordi Monés
- Barcelona Macula Foundation, Barcelona, Spain
| | - Nadia K Waheed
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sengul Ozdek
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Duygu Yalinbas
- Department of Ophthalmology, Gazi University, School of Medicine, Ankara, Turkey
| | - Sarah Thiele
- Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Mee Yon Lee
- Catholic University of Korea College of Medicine, Seoul, South Korea
| | | | | | - Vittorio Capuano
- Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | | | - Usha Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, Belfast, UK
| | - Albrecht Lommatzsch
- Department of Ophthalmology, Sankt Franziskus-Hospital Münster GmbH, Munster, Germany
| | - Frederic Gunnemann
- Department of Ophthalmology, Sankt Franziskus-Hospital Münster GmbH, Munster, Germany
| | - Daniel Pauleikhoff
- Department of Ophthalmology, Sankt Franziskus-Hospital Münster GmbH, Munster, Germany
| | - Michael S Ip
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | | | - Frank G Holz
- Ophthalmology, University of Bonn, Bonn, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA .,Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California, USA
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Schmitz-Valckenberg S, Pfau M, Fleckenstein M, Staurenghi G, Sparrow JR, Bindewald-Wittich A, Spaide RF, Wolf S, Sadda SR, Holz FG. Fundus autofluorescence imaging. Prog Retin Eye Res 2020; 81:100893. [PMID: 32758681 DOI: 10.1016/j.preteyeres.2020.100893] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, USA
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital University of Milan, Italy
| | - Janet R Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Almut Bindewald-Wittich
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Augenheilkunde Heidenheim MVZ, Heidenheim, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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Baumal CR, Spaide RF, Vajzovic L, Freund KB, Walter SD, John V, Rich R, Chaudhry N, Lakhanpal RR, Oellers PR, Leveque TK, Rutledge BK, Chittum M, Bacci T, Enriquez AB, Sund NJ, Subong ENP, Albini TA. Retinal Vasculitis and Intraocular Inflammation after Intravitreal Injection of Brolucizumab. Ophthalmology 2020; 127:1345-1359. [PMID: 32344075 DOI: 10.1016/j.ophtha.2020.04.017] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration. DESIGN Retrospective case series. PARTICIPANTS Fifteen eyes from 12 patients identified from 10 United States centers. METHODS Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. MAIN OUTCOME MEASURES Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies. RESULTS The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P = 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P = 0.033). CONCLUSIONS Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.
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Affiliation(s)
- Caroline R Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts.
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
| | | | - K Bailey Freund
- Vitreous, Retina, Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University, New York, New York
| | | | - Vishak John
- Vistar Eye Center, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Ryan Rich
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado
| | - Nauman Chaudhry
- Department of Ophthalmology, Yale University School of Medicine, New Have, Connecticut
| | - Rohit R Lakhanpal
- The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey
| | - Patrick R Oellers
- Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York
| | - Thellea K Leveque
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Bryan K Rutledge
- Retina-Vitreous Surgeons of Central New York, PC, Liverpool, New York
| | - Mark Chittum
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado
| | - Tommaso Bacci
- Vitreous, Retina, Macula Consultants of New York, New York, New York
| | - Ana Bety Enriquez
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts
| | - Newman J Sund
- The Retina Care Center, LLC, Associated Retinal Consultants, LLC, Union, New Jersey
| | | | - Thomas A Albini
- Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Hubschman JP, Govetto A, Spaide RF, Schumann R, Steel D, Figueroa MS, Sebag J, Gaudric A, Staurenghi G, Haritoglou C, Kadonosono K, Thompson JT, Chang S, Bottoni F, Tadayoni R. Optical coherence tomography-based consensus definition for lamellar macular hole. Br J Ophthalmol 2020; 104:1741-1747. [PMID: 32107208 DOI: 10.1136/bjophthalmol-2019-315432] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/13/2020] [Accepted: 02/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND A consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed. METHODS The panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions. RESULTS The panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness. CONCLUSIONS The use of the proposed definitions may provide uniform language for clinicians and future research.
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Affiliation(s)
- Jean Pierre Hubschman
- Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Andrea Govetto
- Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Ricarda Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - David Steel
- Ophthalmology, Sunderland Eye Infirmary, Sunderland, UK
| | - Marta S Figueroa
- Department of Ophthalmology, Ramon and Cajal Hospital, University of Alcala of Henares, Madrid, Spain
| | - Jerry Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | - Alain Gaudric
- Department of Ophthalmology, Lariboisière Hospital, University of Paris 7 Denis Diderot, Paris, France
| | - Giovanni Staurenghi
- Dipartimento di Scienze Cliniche Luigi Sacco, Eye Clinic, University of Milan, Milan, Italy
| | - Christos Haritoglou
- Department of Ophthalmology, Herzog Carl Theodor Clinic Munich, Munich, Germany
| | | | | | - Stanley Chang
- Ophthalmology, Vagelos Columbia College of Physicians and Surgeons, New York, New York, USA
| | - Ferdinando Bottoni
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
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Sakurada Y, Parikh R, Gal-Or O, Balaratnasingam C, Leong BCS, Tanaka K, Cherepanoff S, Spaide RF, Freund KB, Yannuzzi LA. CUTICULAR DRUSEN: Risk of Geographic Atrophy and Macular Neovascularization. Retina 2020; 40:257-265. [PMID: 31972795 DOI: 10.1097/iae.0000000000002399] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cuticular drusen (CD) have been associated with manifestations of age-related macular degeneration such as atrophy and neovascularization in the macula. In this study, eyes with CD were followed and investigated for the estimated 5-year risk of progression to sequelae of age-related macular degeneration such as geographic atrophy (GA) and macular neovascularization (MNV). METHODS A consecutive series of patients with CD were followed for the development of GA and MNV. Whenever possible, they were also studied retrospectively. The patients with CD were categorized into three phenotypic groups. Phenotype 1: eyes had concentrated, densely populated CD in the macular and paramacular area, Phenotype 2: eyes showed scattered CD in the posterior fundus, and Phenotype 3: involved eyes with CD mixed with large drusen (>200 µm). The 5-year incidence of progression was then estimated using a Kaplan-Meier estimator. RESULTS A total of 63 eyes from 38 patients (35 women with a mean age at presentation of 58.9 ± 14.2 years) were studied and followed for a mean of 40 ± 18 months. Thirteen patients had single eyes with GA (84.5%; 11/13) or MNV (15.5%; 2/13) in one eye at presentation and were subsequently excluded. Geographic atrophy developed in 19.0% (12/63) of eyes and MNV in 4.8% (3/63) of eyes. The cumulative estimated 5-year risk of GA and MNV was 28.4% and 8.7%, respectively. The estimated 5-year incidence of MNV or GA was 12.6%, 50.0%, and 51.6% in Phenotype 1, Phenotype 2, and Phenotype 3, respectively (P = 0.0015, log-rank test). No difference in risk was found in the development of GA or MNV (P = 0.11) between the subgroup of patients presenting with GA or MNV in their fellow eye and those with both eyes included. CONCLUSION When patients with CD are followed longitudinally, there was a significant risk of progression to GA or MNV for Phenotype 2 and Phenotype 3. Patients with CD are commonly first diagnosed in the fifth decade of life, and there is a female predominance. Clinicians should use multimodal imaging to detect and be aware of the risk of progression to manifestations of GA and MNV. These risks of GA and MNV suggest that patients with CD may be part of the overall spectrum of age-related macular degeneration.
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Affiliation(s)
- Yoichi Sakurada
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Ravi Parikh
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Orly Gal-Or
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Israel
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Belinda C S Leong
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Koji Tanaka
- Department of Ophthalmology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Richard F Spaide
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, New York University of Medicine, New York, New York; and
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Lawrence A Yannuzzi
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, New York University of Medicine, New York, New York; and
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
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Abstract
PURPOSE To describe two cases of retinal detachment with hydration folds and discuss the possible cause of these outer retinal abnormalities. METHODS The medical and imaging records of two patients with retinal detachment and hydration folds were examined. PATIENTS A 43-year-old myopic woman who developed a retinal detachment secondary to a macular hole and a 35-year-old man referred with a rhegmatogenous retinal detachment masquerading as an exudative detachment were each found to have retinal hydration folds. RESULTS On near-infrared reflectance imaging, the hydration folds appeared similar to eddy currents, and these corresponded to curvilinear outer retinal plications on optical coherence tomography. The photoreceptor outer segments appeared thickened and elongated, and there was apparent lateral expansion of the outer retinal layers. CONCLUSION Hydration folds are found in rhegmatogenous retinal detachment and demonstrate reproducible imaging characteristics on near-infrared imaging and optical coherence tomography. The cause for such outer retinal plications is currently unknown. We suspect that they form as a result of hydration of the glycosaminoglycans in the interphotoreceptor matrix, which lies between the photoreceptors. Additional studies are warranted to explore this pathophysiology.
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Affiliation(s)
- Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York; and
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; and
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
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41
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Spaide RF, Jaffe GJ, Sarraf D, Freund KB, Sadda SR, Staurenghi G, Waheed NK, Chakravarthy U, Rosenfeld PJ, Holz FG, Souied EH, Cohen SY, Querques G, Ohno-Matsui K, Boyer D, Gaudric A, Blodi B, Baumal CR, Li X, Coscas GJ, Brucker A, Singerman L, Luthert P, Schmitz-Valckenberg S, Schmidt-Erfurth U, Grossniklaus HE, Wilson DJ, Guymer R, Yannuzzi LA, Chew EY, Csaky K, Monés JM, Pauleikhoff D, Tadayoni R, Fujimoto J. Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data: Consensus on Neovascular Age-Related Macular Degeneration Nomenclature Study Group. Ophthalmology 2019; 127:616-636. [PMID: 31864668 DOI: 10.1016/j.ophtha.2019.11.004] [Citation(s) in RCA: 362] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To establish a process to evaluate and standardize a state-of-the-art nomenclature for reporting neovascular age-related macular degeneration (AMD) data. DESIGN Consensus meeting. PARTICIPANTS An international panel of retina specialists, imaging and image reading center experts, and ocular pathologists. METHODS During several meetings organized under the auspices of the Macula Society, an international study group discussed and codified a set nomenclature framework for classifying the subtypes of neovascular AMD and associated lesion components. MAIN OUTCOME MEASURES A consensus classification of neovascular AMD. RESULTS The study group created a standardized working definition of AMD. The components of neovascular AMD were defined and subclassified. Disease consequences of macular neovascularization were delineated. CONCLUSIONS The framework of a consensus nomenclature system, a definition of AMD, and a delineation of the subtypes of neovascular AMD were developed. Establishing a uniform set of definitions will facilitate comparison of diverse patient groups and different studies. The framework presented is modified and updated readily, processes that are anticipated to occur on a periodic basis. The study group suggests that the consensus standards outlined in this article be used in future reported studies of neovascular AMD and clinical practice.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York.
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - David Sarraf
- Doheny Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | | | - Nadia K Waheed
- New England Eye Center, Tufts University, Boston, Massachusetts
| | - Usha Chakravarthy
- Center for Public Health, The Queen's University of Belfast, Belfast, United Kingdom
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Eric H Souied
- Department of Ophthalmology, Université Paris-Est Créteil, Paris, France
| | | | - Giuseppe Querques
- IRCCS San Raffaele Hospital, University Vita-Salute San Raffele, Milan, Italy
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology, Tokyo Medical and Dental University, Tokyo, Japan
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, California
| | - Alain Gaudric
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université de Paris, Paris, France
| | - Barbara Blodi
- Department of Ophthalmology and Visual Sciences, Fundus Photograph Reading Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Xiaoxin Li
- Department of Ophthalmology, People's Eye Center of People's Hospital of Beijing University, Beijing, China
| | - Gabriel J Coscas
- Department of Ophthalmology, University of Paris XII, Paris, France
| | - Alexander Brucker
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Singerman
- Department of Ophthalmology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Phil Luthert
- Institute of Ophthalmology, University College London, London, United Kingdom
| | | | | | | | | | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | | | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Jordi M Monés
- Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain
| | | | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université de Paris, Paris, France
| | - James Fujimoto
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Spaide RF. Measurable Aspects of the Retinal Neurovascular Unit in Diabetes, Glaucoma, and Controls. Am J Ophthalmol 2019; 207:395-409. [PMID: 31078537 DOI: 10.1016/j.ajo.2019.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To study the structural and angiographic optical coherence tomography (OCT) data of the macula from controls, patients with diabetes, and patients with glaucoma to evaluate neurovascular and structural relationships. METHODS This was a retrospective study of 89 eyes from 49 patients in a community-based retinal referral practice with diabetes, glaucoma, and normal controls. The patients were evaluated with OCT to include retinal nerve fiber layer (RNFL) thickness measurement and ganglion cell layer (GCL) volume determination. The vascular density of the radial peripapillary capillary network and the vascular plexuses in the macula were evaluated with OCT angiography. The main outcome measures were the data obtained per disease state and the interrelationships the data displayed. RESULTS The mean GCL volumes were significantly lower than the control group in both the diabetic (P = .016) and glaucoma (P < .001) groups. The difference between the diabetic and glaucoma groups was not significant (P = .052). The mean global vascular density was greater in the control group than the diabetic group (P = .002) and the glaucoma group (P < .001). The mean RNFL thicknesses were lowest in the glaucoma group. Both the diabetic and glaucoma groups had significantly lower radial peripapillary network and deep vascular plexus density values compared to controls. CONCLUSIONS Although there are important differences in disease pathogenesis between diabetes and glaucoma, they share certain similarities in the structural and angiographic abnormalities eventually produced. This suggests that, in addition to canonical pathways of disease, a component of both could represent neurodegenerative disease, offering the possibility for the development of new treatments. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.
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Zhang Y, Wang X, Sadda SR, Clark ME, Witherspoon CD, Spaide RF, Owsley C, Curcio CA. Lifecycles of Individual Subretinal Drusenoid Deposits and Evolution of Outer Retinal Atrophy in Age-Related Macular Degeneration. Ophthalmol Retina 2019; 4:274-283. [PMID: 31924545 DOI: 10.1016/j.oret.2019.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the progression and regression of individual subretinal drusenoid deposits (SDDs) and surrounding photoreceptors and retina in patients with age-related macular degeneration (AMD) over a 3.5-year period using multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO). DESIGN Longitudinal observational study. PARTICIPANTS Four patients with intermediate AMD. METHODS Six eyes of 4 patients with intermediate AMD each were imaged 4 times over 3.5 years. Five eyes of 3 patients showed only SDD and no drusen. Subretinal drusenoid deposit presence and progression were assessed by multimodal imaging and a 3-stage grading system based on spectral-domain (SD) OCT. Morphologic features and the fine structure of individual SDD lesions identified at baseline were examined by AOSLO at follow-up visits. Reflectivity of photoreceptors surrounding SDD were assessed with AOSLO and SD OCT. MAIN OUTCOME MEASURES Morphologic features, fine structure, and size of individual SDD lesions by AOSLO; photoreceptor integrity surrounding SDD via AOSLO and SD OCT; and retinal layer thicknesses via SD OCT. RESULTS Individual SDDs followed independent lifecycle trajectories, exhibiting growth, shrinkage, fusion, and disappearance. Alterations in shape, morphologic features, and internal structure were not obviously the result of the presence of invading phagocytes. Of 822 lesions across all stages examined at baseline, 566 (69%) grew, 123 (15%) shrank, 47 (6%) remained of similar size, 86 (11%) disappeared, and 5 (0.6%) reappeared after regression. A return of characteristic photoreceptor reflectivity in AOSLO (punctate) and in SD OCT (prominent ellipsoid zone) was observed after regression of some SDD in 5 eyes of 4 patients. All eyes exhibited thinning of photoreceptor layers, despite intact retinal pigment epithelium (RPE), to approximately 70% of baseline thicknesses, as well as poorly visible or undetectable outer retinal bands. CONCLUSIONS Adaptive optics scanning laser ophthalmoscopy and SD OCT imaging of individual SDDs over 3.5 years revealed independent trajectories of progression and regression, believed to reflect the activities of local outer retinal cells. Restoration of some photoreceptor reflectivity and intact RPE after SDD regression should be seen in the larger context of outer retinal atrophy, previously suggested as a new form of advanced AMD, and herein replicated.
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Affiliation(s)
- Yuhua Zhang
- Doheny Eye Institute, University of California-Los Angeles, Los Angeles, California; Department of Ophthalmology, University of California-Los Angeles, Los Angeles, California.
| | - Xiaolin Wang
- Doheny Eye Institute, University of California-Los Angeles, Los Angeles, California
| | - Srinivas R Sadda
- Doheny Eye Institute, University of California-Los Angeles, Los Angeles, California; Department of Ophthalmology, University of California-Los Angeles, Los Angeles, California
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - C Douglas Witherspoon
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard F Spaide
- Vitreous-Retina-Macula Consultants of New York, New York, New York
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
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Guymer RH, Rosenfeld PJ, Curcio CA, Holz FG, Staurenghi G, Freund KB, Schmitz-Valckenberg S, Sparrow J, Spaide RF, Tufail A, Chakravarthy U, Jaffe GJ, Csaky K, Sarraf D, Monés JM, Tadayoni R, Grunwald J, Bottoni F, Liakopoulos S, Pauleikhoff D, Pagliarini S, Chew EY, Viola F, Fleckenstein M, Blodi BA, Lim TH, Chong V, Lutty J, Bird AC, Sadda SR. Incomplete Retinal Pigment Epithelial and Outer Retinal Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 4. Ophthalmology 2019; 127:394-409. [PMID: 31708275 DOI: 10.1016/j.ophtha.2019.09.035] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/26/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To describe the defining features of incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA), a consensus term referring to the OCT-based anatomic changes often identified before the development of complete RPE and outer retinal atrophy (cRORA) in age-related macular degeneration (AMD). We provide descriptive OCT and histologic examples of disease progression. DESIGN Consensus meeting. PARTICIPANTS Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists. METHODS As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed longitudinal multimodal imaging of eyes with AMD. Consensus was reached on a classification system for OCT-based structural alterations that occurred before the development of atrophy secondary to AMD. New terms of iRORA and cRORA were defined. This report describes in detail the CAM consensus on iRORA. MAIN OUTCOME MEASURES Defining the term iRORA through OCT imaging and longitudinal cases showing progression of atrophy, with histologic correlates. RESULTS OCT was used in cases of early and intermediate AMD as the base imaging method to identify cases of iRORA. In the context of drusen, iRORA is defined on OCT as (1) a region of signal hypertransmission into the choroid, (2) a corresponding zone of attenuation or disruption of the RPE, and (3) evidence of overlying photoreceptor degeneration. The term iRORA should not be used when there is an RPE tear. Longitudinal studies confirmed the concept of progression from iRORA to cRORA. CONCLUSIONS An international consensus classification for OCT-defined anatomic features of iRORA are described and examples of longitudinal progression to cRORA are provided. The ability to identify these OCT changes reproducibly is essential to understand better the natural history of the disease, to identify high-risk signs of progression, and to study early interventions. Longitudinal data are required to quantify the implied risk of vision loss associated with these terms. The CAM classification provides initial definitions to enable these future endeavors, acknowledging that the classification will be refined as new data are generated.
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Affiliation(s)
- Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Department of Surgery (Ophthalmology), Melbourne, Australia.
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
| | | | - Janet Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Adnan Tufail
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Usha Chakravarthy
- Center for Public Health, The Queen's University of Belfast, Belfast, United Kingdom
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Karl Csaky
- Retina Foundation of the Southwest, Dallas, Texas
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jordi M Monés
- Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7-Sorbonne, Paris, France
| | - Juan Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ferdinando Bottoni
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | | | - Sergio Pagliarini
- Department of Ophthalmology, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Francesco Viola
- Cà Granda Foundation, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences, Fundus Photograph Reading Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tock Han Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | | | - Jerry Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alan C Bird
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Maloca PM, Tufail A, Hasler PW, Rothenbuehler S, Egan C, Ramos de Carvalho JE, Spaide RF. 3D printing of the choroidal vessels and tumours based on optical coherence tomography. Acta Ophthalmol 2019; 97:e313-e316. [PMID: 29240288 DOI: 10.1111/aos.13637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Peter M. Maloca
- Department of Ophthalmology University Hospital Basel Basel Switzerland
- Moorfields Eye Hospital London UK
| | | | - Pascal W. Hasler
- Department of Ophthalmology University Hospital Basel Basel Switzerland
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Maloca PM, Spaide RF, Rothenbuehler S, Scholl HPN, Heeren T, Ramos de Carvalho JE, Okada M, Hasler PW, Egan C, Tufail A. Enhanced resolution and speckle-free three-dimensional printing of macular optical coherence tomography angiography. Acta Ophthalmol 2019; 97:e317-e319. [PMID: 29131515 DOI: 10.1111/aos.13567] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Peter M. Maloca
- Department of Ophthalmology University Hospital Basel Basel Switzerland
- Moorfields Eye Hospital London UK
| | | | | | | | | | | | - Mali Okada
- Royal Victorian Eye and Ear Hospital Melbourne VIC Australia
| | - Pascal W. Hasler
- Department of Ophthalmology University Hospital Basel Basel Switzerland
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Mrejen S, Balaratnasingam C, Kaden TR, Bottini A, Dansingani K, Bhavsar KV, Yannuzzi NA, Patel S, Chen KC, Yu S, Stoffels G, Spaide RF, Freund KB, Yannuzzi LA. Long-term Visual Outcomes and Causes of Vision Loss in Chronic Central Serous Chorioretinopathy. Ophthalmology 2019; 126:576-588. [PMID: 30659849 DOI: 10.1016/j.ophtha.2018.12.048] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 12/14/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the long-term visual outcomes and causes of vision loss in chronic central serous chorioretinopathy (CSC). DESIGN Retrospective, longitudinal study. PARTICIPANTS A total of 133 participants (217 eyes) with chronic CSC. METHODS A retrospective review of clinical and multimodal imaging data of patients with chronic CSC managed by 3 of the authors between May 1977 and March 2018. Multimodal imaging comprised color photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence (FAF), and OCT. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) at the final visit; change in BCVA between first visit and 1-, 5-, and 10-year follow-up visits; and causes of vision loss at final visit. RESULTS Data from 6228 individual clinic visits were analyzed. Mean age of patients at the first visit was 60.7 years, and mean period of follow-up from first to last visit was 11.3 years. The cohort included 101 male patients (75.9%). At the final visit, 106 patients (79.7%) maintained driving-standard vision with BCVA of 20/40 or better in at least 1 eye, and 17 patients (12.8%) were legally blind with BCVA of 20/200 or worse in both eyes. Mean BCVA at first visit was not significantly different from mean BCVA at 1- or 5-year follow-up visits (both P ≥ 0.65) but was significantly better than the mean BCVA at the 10-year follow-up visit (P = 0.04). Seventy-nine percent of eyes with 20/40 or better vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Ninety-two percent of eyes with 20/200 or worse vision at the first visit maintained the same level of vision at the 10-year follow-up visit. Cystoid macular degeneration, choroidal neovascularization (CNV), outer retinal disruption on OCT, and FAF changes were associated with poorer vision at the final visit (all P ≤ 0.001). Multivariable analysis revealed that greater age at first visit was associated with greater BCVA change at the 10-year follow-up visit (P = 0.001). CONCLUSIONS Chronic CSC can be a sight-threatening disease leading to legal blindness. Age at presentation and outer retinal changes on multimodal imaging were associated with long-term BCVA changes and may be predictors of long-term visual outcomes.
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Affiliation(s)
- Sarah Mrejen
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Quinze-Vingts Hospital, DHU SightMaintain, INSERM-DHOS CIC 1423, Paris, France.
| | - Chandrakumar Balaratnasingam
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia; Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Talia R Kaden
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Ophthalmology, Manhattan Eye Ear and Throat Hospital, New York, New York
| | - Alexander Bottini
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Kunal Dansingani
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kavita V Bhavsar
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; Portland VA Healthcare System, Portland, Oregon
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascolm Palmer Eye Institute, Miami, Florida
| | - Samir Patel
- Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kevin C Chen
- Department of Ophthalmology, New York University School of Medicine, New York, New York; Vantage Eye Center, Salinas, California
| | - Suqin Yu
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
| | - Guillaume Stoffels
- Biostatistics Unit of Feinstein Institute for Medical Research, New York
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
| | - K Bailey Freund
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Lawrence A Yannuzzi
- Vitreous, Retina, Macula Consultants of New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York
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Abstract
A distinction between conventional drusen and pseudodrusen was first made in 1990, and more recently knowledge of pseudodrusen, more accurately called subretinal drusenoid deposits (SDDs), has expanded. Pseudodrusen have a bluish-white appearance by biomicroscopy and color fundus photography. Using optical coherence tomography, pseudodrusen were found to be accumulations of material internal to the retinal pigment epithelium that could extend internally through the ellipsoid zone. These deposits are more commonly seen in older eyes with thinner choroids. Histologic evaluation of these deposits revealed aggregations of material in the subretinal space between photoreceptors and retinal pigment epithelium. SDDs contain some proteins in common with soft drusen but differ in lipid composition. Many studies reported that SDDs are strong independent risk factors for late age-related macular degeneration. Geographic atrophy and type 3 neovascularization are particularly associated with SDD. Unlike conventional drusen, eyes with SDD show slow dark adaptation and poor contrast sensitivity. Outer retinal atrophy develops in eyes with regression of SDD, a newly recognized form of late age-related macular degeneration. Advances in imaging technology have enabled many insights into this condition, including associated photoreceptor, retinal pigment epithelium, and underlying choroidal changes.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.
| | - Sotaro Ooto
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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Abstract
PURPOSE To develop a mathematical model of local blood flow in the choriocapillaris using an Ising model. METHODS A JavaScript Ising model was used to create images that emulated the development of signal voids as would be seen in optical coherence tomography angiography of the choriocapillaris. The model was produced by holding the temperature near criticality and varying the field strength. Individual frames were evaluated, and a movie video was created to show the hypothetical development of flow-related signal voids over a lifetime. RESULTS Much the same as actual choriocapillaris images in humans, the model of flow-related signal voids followed a power-law distribution. The slope and intercept both decreased with age, as is seen in human subjects. CONCLUSION This model is a working hypothesis, and as such can help predict system characteristics, evaluate conclusions drawn from studies, suggest new research questions, and provide a way of obtaining an estimate of behavior in which experimental data are not yet available. It may be possible to understand choriocapillaris blood flow in health and disease states by determining by observing deviations from an expected model.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
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50
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Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res 2017; 64:1-55. [PMID: 29229445 PMCID: PMC6404988 DOI: 10.1016/j.preteyeres.2017.11.003] [Citation(s) in RCA: 931] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023]
Abstract
Optical coherence tomography (OCT) was one of the biggest advances in ophthalmic imaging. Building on that platform, OCT angiography (OCTA) provides depth resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging. This new modality is challenging because of the need for new equipment and processing techniques, current limitations of imaging capability, and rapid advancements in both imaging and in our understanding of the imaging and applicable pathophysiology of the retina and choroid. These factors lead to a steep learning curve, even for those with a working understanding dye-based ocular angiography. All for a method of imaging that is a little more than 10 years old. This review begins with a historical account of the development of OCTA, and the methods used in OCTA, including signal processing, image generation, and display techniques. This forms the basis to understand what OCTA images show as well as how image artifacts arise. The anatomy and imaging of specific vascular layers of the eye are reviewed. The integration of OCTA in multimodal imaging in the evaluation of retinal vascular occlusive diseases, diabetic retinopathy, uveitis, inherited diseases, age-related macular degeneration, and disorders of the optic nerve is presented. OCTA is an exciting, disruptive technology. Its use is rapidly expanding in clinical practice as well as for research into the pathophysiology of diseases of the posterior pole.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, NY, United States.
| | - James G Fujimoto
- Department of Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge MA, United States
| | - Nadia K Waheed
- The Department of Ophthalmology, Tufts University School of Medicine, Boston MA, United States
| | - Srinivas R Sadda
- Doheny Eye Institute, University of California - Los Angeles, Los Angeles, CA, United States
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
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