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Chandrasekaran PR, Chan HH, Tan TE, Ibrahim FN, Zhao J, Teo KY. A case of secondary multiple evanescent white dot syndrome in a patient with preexisting wet age-related macular degeneration. Am J Ophthalmol Case Rep 2024; 34:102016. [PMID: 38559365 PMCID: PMC10979012 DOI: 10.1016/j.ajoc.2024.102016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To report a case of secondary Multiple Evanescent White Dot Syndrome in a patient with preexisting wet age-related macular degeneration. Observation A 75-year-old male on treat and extend regimen for wet age-related macular degeneration (AMD) presented with a sudden loss of vision and saw central dark shadow in the right eye (RE) for a duration of 1 week. There was no significant history preceding the visual loss. Examination showed a visual acuity (VA) of counting fingers at 1 meter in the right eye and 20/25 in the left eye. Anterior segment examination was unremarkable with dilated fundus examination showing a clear vitreous, tortuous blood vessel, a hyperemic disc and fibrosis at the macula. The left eye (LE) examination was unremarkable. Optical Coherence Tomography (OCT) showed fibrosis due to the previous wet AMD and hyperreflective excrescences projecting from the retinal pigment epithelium (RPE) outside of the old area of wet AMD. Fundus Fluorescein Angiogram (FFA) showed hyperfluorescent spots in a wreath-like pattern increasing in intensity in the early phase and showing late staining towards the late phase while Indocyanine green angiography (ICGA) did not clearly delineate the lesions. Fundus autofluorescence (FAF) revealed hyper Autofluorescence (AF) at the posterior pole. Optical Coherence Tomography Angiography (OCTA) revealed a flow reduction in the choriocapillaris of the affected area. Basic blood investigations with Venereal Disease Research Laboratory (VDRL), syphilitic IgM and IgG antibodies, Quantiferon TB gold test, complete renal function tests and liver function tests were performed. All the blood investigations were within normal limits and the workup for syphilis and tuberculosis was negative. The patient was started on 1mg/kg body weight of oral prednisolone (after the non-response to low dose of oral steroids) with the diagnosis of secondary multiple evanescent white dot syndrome (MEWDS) secondary to wet AMD. The patient was followed up every weekly and the last visit showed improvement in visual acuity to 20/50 with resolution of lesions on FAF and OCT macula. Conclusion and importance Secondary MEWDS is extremely rare and unique in terms of its presentation and its association with preexisting chorioretinal disease where there is damage to the choriocapillaris- Bruch's membrane-RPE complex. This case report highlights one such rare case scenario and how multimodal imaging helps in the diagnosis, management and follow-up of patients with secondary MEWDS.
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Affiliation(s)
| | - Hiok Hong Chan
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Tien-En Tan
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Farah N.I. Ibrahim
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Jinzhi Zhao
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Tianjin Medical University Eye Hospital, Tianjin, 300392, China
| | - Kelvin Y.C. Teo
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Save Sight Institute, University of Sydney, Camperdown, NSW, Australia
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Mukai R, Itagaki K, Honjyo J, Tanaka K, Norikawa K, Sekiryu T. Association between the arm-to-choroidal circulation time and clinical profile in patients with polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2024; 68:211-215. [PMID: 38609716 DOI: 10.1007/s10384-024-01057-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE To investigate the association between the arm-to-choroidal circulation time (ACT) on indocyanine green angiography (IA) and clinical profile in patients with polypoidal choroidal vasculopathy (PCV). STUDY DESIGN Single-center retrospective study. METHODS We included 38 eyes of 38 patients with PCV diagnosed using multimodal imaging and did not undergo previous treatment. All patients were treated with monthly aflibercept injections for 3 months and treat-and-extend regimens for the subsequent 12 months. Posterior vortex vein ACT was assessed on the first visit using Heidelberg IA. The patients were divided into two groups: ACT ≥20 s (L group; eight eyes) and ACT <20 s (S group; 30 eyes). The clinical profiles before and after treatment were analyzed to assess associations with ACT. RESULTS The mean ACT was 16.39±3.3 s (L group: 21.25±1.49 s, women:men=2:6, mean age: 77.3±6.5 years; S group: 15.10±2.17 s, women:men=7:23, mean age: 75.5±6.9 years). No significant difference was observed in the mean subfoveal choroidal thickness between the L and the S groups (176±75 μm vs. 230±79 μm, P=0.10). However, there were significant differences between the L and S groups in retinal fluid accumulation and hemorrhage recurrence (eight/eight eyes, 100% vs. 13/30 eyes, 43%, P<0.001), mean aflibercept injections (8.8±1.6 vs. 7.0±1.6, P<0.01) during the 12-month period, and the number of polypoidal lesions (1.8±0.7 vs. 1.3±0.5, P<0.05). CONCLUSION Patients with PCV and ACT >20 s are more likely to experience exudative change recurrence in the retina during treatment because they have more polypoidal lesions.
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Affiliation(s)
- Ryo Mukai
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-cho, Fukushima, 960-1295, Japan.
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-cho, Fukushima, 960-1295, Japan
| | - Jyunichiro Honjyo
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-cho, Fukushima, 960-1295, Japan
| | - Keiichiro Tanaka
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-cho, Fukushima, 960-1295, Japan
| | - Koki Norikawa
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-cho, Fukushima, 960-1295, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-cho, Fukushima, 960-1295, Japan
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Fritch C, Church E, Wilkinson DA. Advances in Intraoperative Imaging for Vascular Neurosurgery. Neuroimaging Clin N Am 2024; 34:261-270. [PMID: 38604710 DOI: 10.1016/j.nic.2024.01.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Cerebrovascular surgery has many intraoperative imaging modalities available. Modern technologies include intraoperative digital subtraction angiogram, indocyanine green (ICG) angiography, relative fluorescent measurement with ICG, and ultrasound. Each of these can be used effectively in the treatment of open aneurysm and arteriovenous malformation surgeries, in addition to arteriovenous fistula surgery, and cerebral bypass surgery.
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Affiliation(s)
- Chanju Fritch
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Ephraim Church
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - David Andrew Wilkinson
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
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Lupidi M, Centini C, Castellucci G, Nicolai M, Lassandro N, Cagini C, Rizzo C, Chhablani J, Mariotti C. New insights on circumscribed choroidal hemangioma: "bench to bedside". Graefes Arch Clin Exp Ophthalmol 2024; 262:1093-1110. [PMID: 37505277 PMCID: PMC10995022 DOI: 10.1007/s00417-023-06179-x] [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: 04/02/2023] [Revised: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
Circumscribed choroidal hemangioma is a rare vascular hamartoma of the choroid, presenting as a red-orange mass at the posterior pole on fundoscopic examination. Despite its benign origin, associated complications such as subretinal fluid, serous retinal detachment, retinoschisis and neovascular glaucoma may lead to serious visual impairment in more than half patients. Because of its similarity to amelanotic choroidal melanoma and choroidal metastasis, differential diagnosis is still challenging for specialists. Multimodal imaging such as ultrasonography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography guides the clinician to the correct diagnosis and the proper follow-up. Treatment is indicated in symptomatic cases in order to resolve exudation and improve visual acuity. Treatment options include photocoagulation, transpupillary thermotherapy, radiation therapy, photodynamic therapy and anti-vascular endothelial growth factor therapy. Currently, photodynamic therapy is the treatment of choice due to its effectiveness and safety. The purpose of this review is to describe the latest knowledge in the etiopathogenesis of the circumscribed choroidal hemangioma, the most recent multimodal imaging findings, and the available treatment options.
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Affiliation(s)
- Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
- Fondazione Per La Macula Onlus, Dipartimento Di Neuroscienze, Riabilitazione, OftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genoa, Italy.
| | - Chiara Centini
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Greta Castellucci
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Michele Nicolai
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Nicola Lassandro
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Pauleikhoff LJB, Diederen RMH, Chang-Wolf JM, Moll AC, Schlingemann RO, van Dijk EHC, Boon CJF. Choroidal Vascular Changes on Ultrawidefield Indocyanine Green Angiography in Central Serous Chorioretinopathy: CERTAIN Study Report 1. Ophthalmol Retina 2024; 8:254-263. [PMID: 37839547 DOI: 10.1016/j.oret.2023.10.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Choroidal venous overload was recently suggested to be a pathogenetic factor in central serous chorioretinopathy (CSC). Manifestations of venous overload on ultrawidefield indocyanine green angiography (UWF ICGA) include asymmetric arterial choroidal filling (AACF), enlarged choroidal vessels ("pachyvessels"), and asymmetric venous drainage (AVD) leading to choroidal intervortex venous anastomoses (CVAs) accompanied by choroidal vascular hyperpermeability (CVH). The purpose of the current study is to assess the presence of these signs of venous overload in a large cohort of CSC patients. DESIGN Monocentric retrospective cohort study. PARTICIPANTS Consecutive CSC patients seen at a large tertiary referral center. METHODS For the CERTAIN study, patients underwent a standardized imaging protocol including UWF ICGA. Features of choroidal venous overload were graded for each eye individually by 2 independent graders and, in case of disagreement, by a third grader. MAIN OUTCOME MEASURES Presence of AAFC, pachyvessels, AVD, CVA, and CVH. RESULTS In total, 178 eyes of 91 patients were included in this study. Mean patient age was 47.6 (± 12.0) years and 75 patients (82%) were male. The 116 eyes (65%) that showed subretinal fluid were considered affected (bilateral disease in 29 patients). In affected eyes, AACF was present in 62 eyes (85% of gradable eyes), pachyvessels in 102 eyes (88%), AVD in 81 eyes (74%), CVA in 107 eyes (94%), and CVH in 100% of affected eyes. For fellow eyes, prevalence of pachyvessels (94%), AVD (67%), and CVA (90%) was similar to affected eyes, whereas CVH was present in 85% of fellow eyes. Intergrader agreement was excellent for CVH (94%), and 74%-82% for all other criteria. Patients with pachyvessels and AVD in 1 eye were more likely to also show the same characteristic in the fellow eye (odds ratios 22.2 and 9.9, P < 0.01). CONCLUSIONS Signs of venous overload are seen in the vast majority of CSC patients, both in affected and unaffected eyes. Although pachyvessels, AVD, and CVA are observed frequently, CVH was observed in all affected eyes, showed excellent intergrader reliability, and is diagnostic for CSC. This supports the concept of choroidal venous overload as a major factor in CSC pathogenesis. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Laurenz J B Pauleikhoff
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Roselie M H Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jennifer M Chang-Wolf
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Ocular Angiogenesis Group, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
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Gaudric A. Value and Significance of Hypofluorescent Lesions Seen on Late-Phase Indocyanine Green Angiography. Ophthalmol Sci 2024; 4:100406. [PMID: 38524378 PMCID: PMC10960065 DOI: 10.1016/j.xops.2023.100406] [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: 06/16/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 03/26/2024]
Abstract
Background and Purpose The hypofluorescence of fundus lesions observed during the late phase of indocyanine green angiography (ICGA) in various diseases has often been overlooked or misinterpreted. This article explores the significance of fundus lesions that are initially isofluorescent during the early phase of ICGA but become hypofluorescent later in the examination. Findings Pathologies such as multiple evanescent white spot syndrome, acute posterior placoid syphilitic chorioretinitis, chronic central serous chorioretinopathy, choroidal hemangioma, and some fundus with drusen, present this phenomenon of late hypofluorescence. Interpretation The interpretation of ICGA images and the role of indocyanine green (ICG) uptake by the retinal pigment epithelium (RPE) in late fundus fluorescence is debated. Experimental evidence suggests that ICG accumulates progressively in the RPE after intravenous injection of the dye or after direct contact in vitro, making it a potential marker of RPE activity. Although the exact mechanisms of ICG diffusion through the choroid and its binding to the RPE require further investigation, the late hypofluorescence observed in certain ICGA diseases provides information on different modalities of RPE dysfunction. Financial Disclosures The author has no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Alain Gaudric
- Ophthalmology Department, Hopital Lariboisière, APHP, Université Paris Cité, Paris, France, and Centre d'Imagerie et Laser, Paris, France
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Fenn G, Kennedy S, Morrison C, Dolan RT. Indocyanine green fluorescence angiography: A critical intra-operative assessment tool to aid decision making in complex hand trauma. Trauma Case Rep 2023; 48:100923. [PMID: 37720203 PMCID: PMC10502373 DOI: 10.1016/j.tcr.2023.100923] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
Indocyanine green fluorescence angiography (ICG-FA) is a validated non-invasive imaging tool used to assess tissue perfusion and guide intra-operative decision making in many surgical disciplines. Clinical assessment of tissue perfusion following crush or degloving traumatic hand injuries presents a significant challenge. This case report supports the critical role of intra-operative ICG-FA as a decision aid in complex hand trauma. We propose ICG-FA will minimise unnecessary tissue debridement, negating complex soft tissue reconstructive surgery and ultimately expediting tissue healing and return to function for hand trauma patients. A 35-year-old right hand dominant manual labourer presented to the emergency department after sustaining a crush injury to his right hand. Examination under anaesthetic revealed a comminuted open fracture of middle finger P2 with compromised soft tissue coverage. A formal assessment of hand perfusion was performed using a triad of clinical assessment, critical judgement and ICG-FA. The ICG-FA revealed a small skin flap affecting the dorsoradial P2 skin which was not perfused. This prompted meticulous minimal debridement of this tissue and prevented unnecessary over-debridement that would have resulted in complex soft tissue reconstruction. Currently the gold standard assessment for tissue perfusion in hand injuries is clinical judgement and is limited by subjective interobserver error [1]. IGA-FA has been proven to offer a real time assessment of tissue perfusion. This case demonstrates the use of ICG-FA as an adjunct to clinical examination and judgement, to optimise the accuracy of soft tissue perfusion assessment in complex hand trauma.
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Affiliation(s)
- Gary Fenn
- Corresponding author at: Department of Plastic & Reconstructive Surgery, St Vincent's University Hospital, Elm Park, Dublin 4 D04 T6F4, Ireland.
| | - Sharon Kennedy
- Department of Plastic, Reconstructive and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
- Department Radiology Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Colin Morrison
- Department of Plastic, Reconstructive and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
- Department Radiology Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Roisin T. Dolan
- Department of Plastic, Reconstructive and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
- Department Radiology Medicine, St Vincent's University Hospital, Dublin, Ireland
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Mukai R, Itagaki K, Honjyo J, Matsumoto H, Sekiryu T. Relationship between pulsation of posterior vortex vein, choroidal thickness, and choroidal vascular hyperpermeability in polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:3475-3480. [PMID: 37615698 DOI: 10.1007/s00417-023-06203-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE Posterior vortex vein pulsation on Heidelberg indocyanine green angiography (HRA-IA) video is reported to indicate the presence of congestion in these vessels. This study aimed to determine the relationship between posterior vortex vein pulsation, choroidal thickness, and choroidal vascular hyperpermeability (CVH) in polypoidal choroidal vasculopathy (PCV). METHODS Forty-three eyes of 43 patients who had not received previous treatment and were diagnosed with PCV using multimodal imaging were included and retrospectively investigated. On initial visit, presence or absence of pulsation in the posterior vortex vein was analysed using HRA-IA. Subfoveal choroidal thickness (SFCT) was assessed, and patients were divided into the SFCT ≥ 200 μm and < 200 μm (P and NP, respectively) groups. Presence or absence of CVH was investigated using IA in the late phase, and the associations between the three parameters were analysed. RESULTS Posterior vortex vein pulsation was detected in 24/43 eyes (55%). There were 27 eyes in the P group (mean SFCT, 286 ± 48 μm) and 16 eyes in the NP group (mean SFCT, 143 ± 41 μm). Pulsation was detected in 10 eyes (37%) in the P group and 14 eyes (88%) in the NP group. Incidence of pulsation was significantly higher in the NP group (P < 0.05). There were 17 (40%) patients with CVH-13 (48%) and four (25%) in the P and NP groups, respectively (P = 0.1994). There was no correlation between the presence or absence of pulsation and CVH (P = 0.1994). CONCLUSION Congestion of the vortex vein is potentially associated with the pathogenesis of PCV with a thin choroid.
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Affiliation(s)
- Ryo Mukai
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-Cho, Fukushima, 960-1295, Japan.
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-Cho, Fukushima, 960-1295, Japan
| | - Jyunichiro Honjyo
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-Cho, Fukushima, 960-1295, Japan
| | - Hidetaka Matsumoto
- Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, 1 Hikarigaoka-Cho, Fukushima, 960-1295, Japan
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Hsu A, Mu SZ, James A, Ibrahim MA, Saber AA. Indocyanine Green in Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:3539-3544. [PMID: 37713041 DOI: 10.1007/s11695-023-06801-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
Indocyanine green (ICG) is a fluorescent dye that can be used intraoperatively to assess tissue perfusion, as well as perform leak testing. This study aims to summarize published manuscripts on outcomes of ICG use and reduction of complications compared to traditional leak test and tissue perfusion evaluation. A PubMed search using "ICG and bariatric surgery," "ICG and gastric sleeve," "ICG and gastric bypass," and "ICG and revisional bariatric surgery" was performed. The proportion of patients who underwent an intraoperative decision change due to ICG was 3.8% (95% CI: 2.0 to 7.2%). ICG fluorescent imaging in bariatric surgery is a valuable tool, and further studies are needed to confirm its utility for routine use in both standard or complex cases (PROSPERO #418126).
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Affiliation(s)
- Angel Hsu
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Scott Z Mu
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Abi James
- Department of Metabolic and Bariatric Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Mina A Ibrahim
- Department of Metabolic and Bariatric Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Alan A Saber
- Department of Metabolic and Bariatric Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
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周 梦, 刘 元, 冉 小, 朱 珊, 李 杉, 陈 子, 韩 婷, 晋 圣, 汪 淼, 臧 梦. [Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1259-1265. [PMID: 37848322 PMCID: PMC10581876 DOI: 10.7507/1002-1892.202306095] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023]
Abstract
Objective To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. Methods A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. Results Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. Conclusion Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.
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Affiliation(s)
- 梦琪 周
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 元波 刘
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 小叶 冉
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 珊 朱
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 杉珊 李
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 子翔 陈
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 婷璐 韩
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 圣阳 晋
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 淼 汪
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 梦青 臧
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
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Kleefeldt N, Schneider A, Kühnel S, Hillenkamp J, William A. [Analysis of adverse drug reactions (ADR) in fluorescein angiography (FAG) and indocyanine green angiography (ICGA) and indications before and during the COVID-19 pandemic at a university eye hospital]. Ophthalmologie 2023; 120:1029-1036. [PMID: 37340244 DOI: 10.1007/s00347-023-01881-x] [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] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND This study was an analysis of fluorescein angiography (FAG) and indocyanine green angiography (ICGA) at a university eye hospital. The primary objective of the study was to analyze adverse drug reactions (ADRs) and their severity (mild, moderate, severe). The secondary objective was to investigate the indications of FAG and ICGA before and during the COVID-19 pandemic. METHODS A retrospective analysis of all FAG and ICGA at the University Eye Hospital in Würzburg from January 2016 to the end of December 2021 was performed. The ADRs, gender, age, examination time points and indications were evaluated. The ADRs were classified into mild, moderate, and severe, following the definition of Kornblau et al. [1] RESULTS: A total of 4900 examinations from 4193 patients were analyzed. An FAG was performed slightly more frequently in men (54.8%) than in women (45.2%) and the mean age was 63.2 ± 16.9 years (median: 65 years). The ADRs occurred in only 1.65% of all FAG, of which 1.27% were mild and 0.39% were moderate. No severe ADRs occurred. The most common ADR was nausea at 59.26%. No ADR occurred in ICGA. The annual number of FAGs averaged 816.7 ± 91.1 and was relatively constant throughout the period except for a significantly reduced number in 2016 (compared with 2018, 2019, and 2021). The most common indication for FAG was venous retinal occlusion at 22.93% (N = 774), showing a significant increase in 2021 compared to 2018-2020. An ICGA was performed in 4.18% of cases, with the most common indication being uveitis at 31.82% (N = 63). CONCLUSION Compared to other studies very few ADRs occurred and no life-threatening ADR occurred in any case. Venous retinal occlusions were very common indications for FAG, probably due to the frequent need for repeated examinations in this condition. Briefly, during the first lockdown (18 March-8 May 2020), a decrease in angiographies was observed, but over a longer period, no significant differences were seen compared with the prepandemic period.
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Affiliation(s)
- Nikolai Kleefeldt
- Augenklinik Würzburg, Uniklinikum Würzburg, Joseph-Schneider-Straße 11, 97080, Würzburg, Deutschland.
| | - Anna Schneider
- Augenklinik Würzburg, Uniklinikum Würzburg, Joseph-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Sophia Kühnel
- Augenklinik Würzburg, Uniklinikum Würzburg, Joseph-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Jost Hillenkamp
- Augenklinik Würzburg, Uniklinikum Würzburg, Joseph-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Antony William
- Augenklinik Würzburg, Uniklinikum Würzburg, Joseph-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Chen KC, Lin CH, Ma H, Wang TH, Shih YC, Chen MC, Chiu YJ, Chen CE. Outcome analysis of free flap reconstruction for head and neck cancer with intraoperative indocyanine green angiography. J Plast Reconstr Aesthet Surg 2023; 85:387-392. [PMID: 37549542 DOI: 10.1016/j.bjps.2023.07.037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/12/2023] [Accepted: 07/16/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Intraoperative indocyanine green (ICG) angiography is used in free flap surgery to evaluate the patency of vessel anastomosis. This study evaluated the outcomes of intraoperative ICG angiography in free flap surgery for head and neck cancer. MATERIALS AND METHODS This was a retrospective study of free flap reconstruction for head and neck cancer performed between 2015 and 2021. The outcomes analyzed were the total flap failure rate, re-exploration rate, and flap salvage rate. Differences in outcomes were compared in patients treated using intraoperative ICG angiography and those treated without. RESULTS Of the 520 free flap surgeries in the 486 enrolled patients, 259 cases underwent intraoperative ICG angiography. In this group, there were 10 (3.9%) cases of total flap failure. In the non-ICG group, there were 22 cases (8.4%). There were 35 (13.5%) cases requiring re-exploration in the ICG group and 40 (15.3%) in the non-ICG group. The difference was not statistically significant. The flap salvage rate was 75.8% (25/33) in the ICG group and 51.4% (18/35) in the non-ICG group, which was a significant difference. CONCLUSION We found that free flap surgery with intraoperative ICG angiography significantly decreased total flap failure rate and significantly increased salvage rate but did not significantly affect the re-exploration rate.
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Affiliation(s)
- Kuan-Cheng Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan
| | - Chih-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan.
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan
| | - Tien-Hsiang Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan
| | - Yu-Chung Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan
| | - Mei-Chun Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan
| | - Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan
| | - Ching-En Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming Chiao Tung University, Taiwan
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Lauritzen E, Bredgaard R, Laustsen-Kiel CM, Hansen L, Tvedskov T, Damsgaard TE. Indocyanine green angiography in oncoplastic breast surgery, a prospective study. J Plast Reconstr Aesthet Surg 2023; 85:276-286. [PMID: 37541044 DOI: 10.1016/j.bjps.2023.07.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION The use of Indocyanine green angiography (ICG-A) in oncoplastic breast-conserving surgery (OBCS) has not yet been investigated. This prospective trial applied ICG-A in volume displacement and replacement OBCS to localize perforators and determine tissue supplied by the perforator. Furthermore, to investigate and correlate the intraoperative ICG-A to postoperative surgical site infection, skin necrosis, epidermolysis, and timely onset of adjuvant therapy. METHODS ICG-A was performed at three pre-set timepoints during surgery; after lumpectomy, upon dissection of possible perforators, and after wound closure. All patients were followed with clinical evaluations before surgery, 4 weeks, 4-6 months, and 12 months postoperatively. RESULTS Eleven patients were included: seven volume displacement and four volume replacement OBCS. ICG-A located the tissue supplied by the perforator and demonstrated sufficient perfusion in all cases. The ICG-A corresponded to the surgeons' clinical assessment. One patient developed a postoperative infection and seroma and was treated conservatively. No patients had postoperative necrosis, loss of reconstruction, or lymphedema of the arm. Edema of the breast occurred in four patients (36.4%). Scar assessments were significantly worse at 4-weeks and 4-6 months. The quality of life improved significantly during follow-up. Adjuvant treatment was administered timely in all cases. CONCLUSION ICG-A was feasible for OBCS in assessing intraoperative perfusion. Perfusion was sufficient in all patients and corresponded to the surgeon's clinical evaluation. No patients developed postoperative necrosis. Though edema of the breast occurred in 36.4%, a larger sample size is needed to investigate a possible correlation with ICG-A. Further studies, which includes patients requiring extensive tissue replacement challenging the borders of perfusion, are needed.
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Affiliation(s)
- Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rikke Bredgaard
- Department of Plastic Surgery, Herlev Gentofte Hospital, Denmark
| | | | - Laura Hansen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tove Tvedskov
- Department of Breast Surgery, Herlev Gentofte Hospital, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Copenhagen, Denmark
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Yin B, Chen X, Chen J, Zhao W, Li Z. ICGA combined with EP monitoring in microclipping of cerebral aneurysms. Neurosurg Rev 2023; 46:222. [PMID: 37665412 DOI: 10.1007/s10143-023-02111-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/15/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023]
Abstract
Cerebral aneurysm is one of the common cerebrovascular diseases in neurosurgery, and rupture of cerebral aneurysm is the most important cause of spontaneous subarachnoid hemorrhage. How to precisely clip the aneurysm has been a topic worth discussing, so the authors explore the value of ICGA combined with electrophysiological monitoring in the microclipping of cerebral aneurysms. Using the method of retrospective analysis of cases, 661 patients with cerebral aneurysms admitted to the Department of Neurosurgery, Zhongnan Hospital of Wuhan University, from 2021.8 to 2022.10 were studied, 390 patients with aneurysm clipping were included, and patients with Hunt-Hess classification ≥ 4 were excluded, and whether to use ICGA combined with EP in microclipping of the ruptured and unruptured aneurysm in pterional approach was investigated at the time of discharge, respectively. The MRS and total hospital days were compared to investigate the value of ICGA combined with EP in the microclipping of cerebral aneurysms. All 390 patients enrolled in the group had successful aneurysm clipping, 178 patients were screened for ruptured aneurysm pterional approach and 120 patients for unruptured aneurysm pterional approach access; the MRS at discharge was significantly lower in the ICGA combined with EP group than in the no-EP group for ruptured aneurysm pterional approach microclipping (p < 0.001), and the mean number of days in hospital was significantly lower (p < 0.01). Patients in the ICGA combined with EP group in microclipping of unruptured aneurysms with pterional approach also had significantly lower MRS at discharge compared with patients in the ICGA alone group (p < 0.001), with no statistically significant difference in the mean number of days in hospital (p = 0.09). In open cerebral aneurysm microclipping, ICGA combined with EP monitoring for both ruptured and unruptured aneurysms can effectively reduce the false-negative rate of ICGA, significantly reduce the incidence of postoperative neurological deficits, and shorten the total hospital stay to some extent. ICGA combined with EP monitoring may be an effective means to reduce the rate of false clipping of the penetrating vessels and to avoid stenosis or occlusion of the aneurysm-carrying artery and is worth promoting in microclipping of cerebral aneurysms except for Hunt-Hess ≥ 4.
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Affiliation(s)
- Bokai Yin
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang District, Wuhan City, Hubei, 430070, China
- Department of Emergency Medicine, Yiling Hospital Affiliated to Three Gorges University, Yichang City, Hubei, China
| | - Xinjun Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang District, Wuhan City, Hubei, 430070, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang District, Wuhan City, Hubei, 430070, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang District, Wuhan City, Hubei, 430070, China.
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang District, Wuhan City, Hubei, 430070, China.
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Zhu Y, Yoo H, Min S, Chang H. Efficacy of superficial inferior epigastric vein superdrainage in free TRAM and DIEP flap: An indocyanine green angiography study of 68 cases. J Plast Reconstr Aesthet Surg 2023; 84:385-391. [PMID: 37399658 DOI: 10.1016/j.bjps.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND This study aimed to evaluate the clinical efficacy of venous augmentation using superficial inferior epigastric vein (SIEV) in free transverse rectus abdominis musculocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flap and investigate the factors that hinder the venous superdrainage. METHODS A retrospective review of 62 free muscle-sparing (MS)-TRAM and 6 DIEP unilateral breast reconstructions from September 2017 to July 2022. Intraoperative indocyanine green angiography was performed on the harvested flap, with the SIEV contralateral to the pedicle side clamped and unclamped for 20 min. The relative ratio of hypoperfused area to the total flap area was calculated and compared quantitatively. The preoperative computed tomography (CT) angiography was reviewed to obtain information on the SIEV diameter and number of midline-crossing medial branches. RESULTS The participants were categorized into three groups: 42 patients in Group 1 (>3% decrease in hypoperfused area), 20 patients in Group 2 (change in hypoperfused area ranging from -3% to 3%), and six patients in Group 3 (>3% increase in hypoperfused area). The mean number of midline-crossing branches (p = 0.002) and mean difference in the diameter of bilateral SIEVs (p = 0.039) were significantly greater in Group 1 than in the other groups. CONCLUSIONS Thirty-eight percent (26/68 cases) resulted in sustained or aggravated perfusion after SIEV superdrainage. Superdrainage using the contralateral SIEV in free MS-TRAM/DIEP flap is recommended when there are more than two midline-crossing medial branches of SIEV and when the caliber of SIEV is relatively greater compared with the pedicle side.
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Affiliation(s)
- Ying Zhu
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sally Min
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Aksu Ceylan N, Cebeci Z. Relationship between macular intervortex vein anastomosis and optical coherence tomography biomarkers in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2023; 42:103559. [PMID: 37028692 DOI: 10.1016/j.pdpdt.2023.103559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUNDS To evaluate the optical coherence tomography (OCT) biomarkers of patients with central serous chorioretinopathy (CSC) according to the presence or absence of direct anatomical relation to intervortex vein anastomosis (IVA) on indocyanine green angiography. METHODS We reviewed the records of 39 patients with chronic CSC. Patients were categorized in 2 groups: presence of IVA(Group A) or absence of IVA(Group B) in the macular region. Localization of IVA was categorized in 3 areas according to ETDRS grid:inner 1 mm circle (area-1), 1-3 mm middle circle (area-2) and 3-6 mm outer circle (area-3). RESULTS There were 31 eyes in Group A,21 eyes in Group B. Mean age of the patients was 52.5 ± 11.3years in Group A,47.2 ± 11years in Group B(p<0.001).Mean initial visual acuity (VA) was 0.38±0.38LogMAR in Group A, 0.19±0.21LogMAR in Group B(p<0.001).Mean subfoveal choroidal thickness(SFCT) was 436.3 ± 134.3µ in Group A,480.2 ± 136.6µ in Group B(p<0.001).Localization of IVA in area-1 was correlated with inner choroidal attenuation (ICA) and leakage on IVA(p = 0.011,p = 0.02). Localization of IVA in area-3 was correlated with irregular lesions on RPE(p = 0.042).Smokestack configuration,intraretinal cysts and ICA were correlated with worse initial VA(p<0.001,p = 0.001 and p = 0.04).Shaggy subtype of photoreceptor disruption was associated with better initial VA(p = 0.003). CONCLUSIONS We detected older age, worse initial VA and thinner SFCT in patients with chronic CSC and macular region IVA(m-IVA). Long term follow-up of patients with and without m-IVA may exhibit the difference in treatment outcomes and development of neovasculopathy.
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Affiliation(s)
- Nihan Aksu Ceylan
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey.
| | - Zafer Cebeci
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
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Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [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: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
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Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
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Abstract
Indocyanine green (ICG) angiography was first approved by the Food and Drug Administration for human use in the 1956. Prior to its use in chorioretinal angiograms, ICG was used to measure blood flow and track cardiac output. It was only in 1969 when two researchers, Kyuga Kogure and Earl Choromokos from the University of Miami, first used ICG to create more accurate angiograms. In the following years, researchers were able to hone the underlying science of this new form of angiography. As time passed and technology advanced, the application of ICG in clinical practice became widespread. Today ICG is used to diagnose and monitor the progression of retinal and choroidal diseases affecting millions of individuals across the globe. ICG utilizes the injection of indocyanine green dye into a patient's bloodstream to visualize abnormalities of the choroid and retina by evaluating choroidal circulation. ICG angiography is useful in the diagnosis and management of occult choroidal neovascularization in age-related macular degeneration and may be used in other inflammatory conditions with central serous chorioretinopathy. ICG angiography offers advanced imaging for improved monitoring and treatment of a wide variety of choroidal and retinal diseases.
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Affiliation(s)
- Divin O Baddam
- Department of Ophthalmology, New York-Presbyterian Hospital, New York, NY, USA.
| | - Sara D Ragi
- Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Stephen H Tsang
- Departments of Ophthalmology, Pathology & Cell Biology, Graduate Programs in Nutritional & Metabolic Biology and Neurobiology & Behavior, Columbia Stem Cell Initiative, New York, NY, USA
| | - Wei Kiong Ngo
- Department of Ophthalmology, New York-Presbyterian Hospital, New York, NY, USA
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University, New York, NY, USA
- National Healthcare Group Eye Institute, Singapore, Singapore
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Diaconita V, Kassotis A, Ngo WK. Optical Coherence Tomography Angiography (OCTA) Findings in Retinitis Pigmentosa. Methods Mol Biol 2022; 2560:101-109. [PMID: 36481887 DOI: 10.1007/978-1-0716-2651-1_9] [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] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a noninvasive new imaging modality that can be used to diagnose and monitor progression of retinitis pigmentosa (RP). Cohorts and case series have shown correlation between OCTA findings and visual function and disease severity. Although an early use of the technology is promising, there are concerns about segmentation errors and artifacts. There is also a paucity of data on genotype and how that correlates with OCTA findings. Despite its limitations, OCTA remains a useful tool for clinicians managing retinitis pigmentosa patients.
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Affiliation(s)
- Vlad Diaconita
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, New York, NY, USA.
| | - Alexis Kassotis
- Ophthalmology Resident, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, USA
| | - Wei Kiong Ngo
- Departments of Ophthalmology, Pathology & Cell Biology, Graduate Programs in Nutritional & Metabolic Biology and Neurobiology & Behavior, Columbia Stem Cell Initiative, New York, NY, USA
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Su Y, Zhang X, Gan Y, Zeng Y, Wen F. Detection of pachychoroid neovasculopathy with optical coherence tomography angiography versus dye angiography imaging. Photodiagnosis Photodyn Ther 2022; 40:103126. [PMID: 36152969 DOI: 10.1016/j.pdpdt.2022.103126] [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: 07/26/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To investigate the sensitivity and specificity of optical coherence tomography angiography (OCTA) versus dye angiography for detecting pachychoroid neovasculopathy (PNV) and to determine the morphological factors that affect PNV detection. METHODS Patients with pachychoroid phenotype were prospectively enrolled and underwent multimodal imaging examinations during the same visit. The diagnostic accuracy of fundus fluorescein angiography (FFA), FFA combined with indocyanine green angiography (ICGA) and OCTA for PNV was evaluated using multimodal imaging as the reference. Multimodal parameters of PNV were qualitatively and quantitatively assessed. RESULTS PNV was detected in 58 eyes (46 patients) out of 340 pachychoroid eyes (201 patients) according to reference standard. Patients with PNV eyes were significantly older (54.6±7.56 vs. 48.2±9.1 years), were more likely to have a chronic central serous chorioretinopathy history (CSC) (93.1% vs. 12.4%) and had a worse visual acuity (0.30±0.22 vs. 0.58±0.30) than those without PNV eyes (all P<0.001). The sensitivity of FFA, FFA combined with ICGA, and OCTA in detecting PNV in patients with the pachychoroid phenotype was 67.2%, 63.8% and 98.3%, respectively, and the specificity was 87.2%, 96.8% and 100.0%, respectively. PNV not identified by dye angiography was more manifested as the absence of late plaque hypercyanescence on ICGA (P<0.001) and overall smaller capillaries without a distinct pattern (P=0.001), fewer core vessels (P=0.002) and smaller area (P=0.044). CONCLUSIONS OCTA showed superior detection rate and accuracy for identifying PNV over dye angiography. In case multimodal imaging is unavailable, OCTA can be an effective and noninvasive method for monitoring PNV and guiding treatment decisions.
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Affiliation(s)
- Yongyue Su
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiongze Zhang
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yuhong Gan
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yunkao Zeng
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Feng Wen
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
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21
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Chandrasekaran PR, Aljneibi S, Agarwal A, Pichi F, Neri P. Interpreting posterior uveitis by integrating indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography data: A narrative review. Saudi J Ophthalmol 2022; 36:344-355. [PMID: 36618566 PMCID: PMC9811926 DOI: 10.4103/sjopt.sjopt_69_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 01/10/2023] Open
Abstract
Posterior uveitis is sight-threatening disease entity that can be caused by infectious and non-infectious entities. Vision loss in posterior uveitis can be following complications such as cystoid macular edema, epiretinal membrane, artery and vein occlusions, vasculitis, papillitis, choroidal neovascular membrane, retinal neovascularization, tractional retinal detachment, vitreous hemorrhage, glaucoma, cataract, among others. Diagnosis of posterior uveitic entities have been revolutionized following introduction of choroidal imaging with techniques such as indocyanine green angiography (ICGA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Med Line search and PubMed search was performed pertaining to causes of posterior uveitis, ICGA in posterior uveitis, OCT in posterior uveitis, OCTA in posterior uveitis, retinal and choroidal vascular changes in posterior uveitis, quantification of choriocapillaris lesion area in posterior uveitis, subfoveal choroidal thickness in posterior uveitis, quantification of choriocapillaris in posterior uveitis, vascular indices for quantification of choriocapillaris. This review article highlights various changes in the choroid and the quantification of choroid using various parameters in ICGA, OCT and OCTA.
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Affiliation(s)
- Priya R. Chandrasekaran
- Department of Medical Retina, Uvea and Neuro-Ophthalmology, Lotus Eye Hospital, Salem, Tamil Nadu, India
| | - Shaikha Aljneibi
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Francesco Pichi
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Piergiorgio Neri
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA,College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates, Ohio, USA,Address for correspondence: Prof. Piergiorgio Neri, The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. E-mail:
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22
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Yokoi K, Namba K, Iwata D, Mizuuchi K, Hase K, Suzuki K, Ando R, Hirooka K, Sekine N, Kitaichi N, Hiraoka M, Ishida S. Fundus autofluorescence imaging in acute posterior multifocal placoid pigment epitheliopathy. Am J Ophthalmol Case Rep 2022; 28:101732. [PMID: 36312789 PMCID: PMC9614854 DOI: 10.1016/j.ajoc.2022.101732] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/08/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a disease characterized by multiple yellowish-white placoid lesions. Although most lesions resolve spontaneously, some turn into scars and lead to permanent visual dysfunction. In this report, we found suggestive findings in fundus autofluorescence (FAF) that may be useful for distinguishing severe lesions requiring treatment in APMPPE. Observation Case 1: A 29-year-old woman was referred to our hospital with multiple yellowish-white placoid lesions on the fundi of both eyes (OU). FAF showed hyperautofluorescence in some of these placoid lesions. Based on the findings of fluorescein angiography, a diagnosis of APMPPE was established, and oral prednisolone (PSL) was initiated, given that some lesions were located in the macula. One week later, exacerbation occurred with the newly developed hyperautofluorescent lesions. Some lesions in the right eye (OD) that were hyperautofluorescent at the first visit became hypoautofluorescent. Afterward, although all hypoautofluorescent lesions persisted, most of the hyperautofluorescent lesions disappeared, so oral PSL could be stopped. Two months later, however, the recurrence occurred along with multiple new placoid lesions. Some lesions located at the macula were hyperautofluorescent on FAF OU, indicating the possibility of becoming scar lesions with hypoautofluorescence. Accordingly, oral PSL was given again. Case 2 A 47-year-old woman noticed decreased vision OD, and she was referred to us. Multiple yellowish-white placoid lesions were seen in the fundi OU. FAF showed hyperautofluorescence both with and without corresponding hypoautofluorescence in the placoid lesions OU. A diagnosis of APMPPE was established, and oral PSL was initiated. Four months later, some lesions that were hyperautofluorescent at the first visit had turned isoautofluorescent, and some lesions OU became hypoautofluorescent. However, all hypoautofluorescent lesions remained hypoautofluorescent OU. Only some hyperautofluorescent lesions recovered to isoautofluorescence without scars. Conclusions and Importance In APMPPE, lesions showing hyperautofluorescence on FAF may change into hypoautofluorescence indicating scar formation. Therefore, the presence of hyperautofluorescent lesions in the macula may be a good indicator of the need for intensive corticosteroid treatments to avoid leaving hypoautofluorescent scars that are related to irreversible visual dysfunction.
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Affiliation(s)
- Koichi Yokoi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan,Corresponding author. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keitaro Hase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Ando
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Miki Hiraoka
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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23
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Zeng Q, Yao Y, Li S, Yang Z, Qu J, Zhao M. Comparison of swept-source OCTA and indocyanine green angiography in central serous chorioretinopathy. BMC Ophthalmol 2022; 22:380. [PMID: 36138392 PMCID: PMC9502960 DOI: 10.1186/s12886-022-02607-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background To compare swept-source optical coherence tomography angiography (SS-OCTA) and indocyanine green angiography (ICGA) in patients with central serous chorioretinopathy (CSC). Methods SS-OCTA and ICGA images of 39 eyes with symptomatic CSC were collected and aligned. Spatial overlap of the annotations of the coarse granulated high reflective area on choriocapillary OCTA and the hyperfluorescence area on mid-phase ICGA was calculated according to the Jaccard index (JI). SS-OCTA findings of fellow eyes and changes in SS-OCTA abnormalities during the follow-up were also analyzed. Results Three main types of abnormalities in choriocapillaris SS-OCTA images were found: type A, coarse granulated high reflective area (39 eyes [100%]); type B, roundish dark halo around Type A (32 eyes [82.1%]); and type C, coarse granulated low reflective area (39 eyes [100%]). The mean JI of type A on SS-OCTA and the hyperfluorescence area on ICGA were 0.55 ± 0.15 for grader 1 and 0.49 ± 0.15 for grader 2. The mean area of type A abnormalities on SS-OCTA and hyperfluorescence on ICGA was 3.976 (IQR, 2.139–8.168) and 3.043 (IQR, 1.408–4.909) mm2 (P = 0.199). The areas of type A, B and C abnormalities on SS-OCTA after laser treatment or observation were 3.36mm2 (IQR, 2.399–9.312), 2.9mm2 (IQR, 2.15–3.7), and 0.19mm2 (IQR, 0.08–0.23), respectively, which was smaller than those in the baseline (7.311mm2 (IQR 3.788–11.209), P < 0.001; 4.3mm2 (IQR, 2.8–9.8), P = 0.002;0.33mm2 (IQR, 0.23–0.38), P < 0.001). The change in the type A, B or C area was not significantly different between the two groups (P = 0.679, 0.732, and 0.892). Conclusion The coarse granulated high reflective area in SS-OCTA corresponded well with the hyperpermeability area in ICGA. SS-OCTA promotes noninvasive visualization and follow-up quantifications of the choroidal vasculature in CSC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02607-4.
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Affiliation(s)
- Qiaozhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yuou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Siying Li
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhi Yang
- TowardPi (Beijing) Medical Technology, Beijing, China
| | - Jinfeng Qu
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China. .,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China.
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24
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Wang L, Lankry P, Rabinovitch D, Gallo R, Laiginhas R, Iyer P, Shulman S, Trivizki O. An Elderly Man with Atypical Multiple Evanescent White Dot Syndrome. Case Rep Ophthalmol 2022; 13:892-896. [PMID: 36466057 PMCID: PMC9710463 DOI: 10.1159/000526583] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/08/2022] [Indexed: 08/15/2023] Open
Abstract
A rare occurrence of an atypical case of multiple evanescent white dot syndrome (MEWDS) in a 75-year-old man without viral prodrome or white dots on fundus that presented with acute, severe left eye visual loss, which returned to baseline without treatment in several weeks. Multimodal imaging, including fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine green angiography (ICG), and optical coherence tomography (OCT) demonstrated classical presentation of MEWDS with wreath-like lesions and inflammatory foci in the retinal pigment epithelium that correlated among modalities. Possible underlying systemic disorders were ruled out through extended work up. To the best of our knowledge, this is the first report to show atypical MEWDS in an elderly man with classic changes on FA, FAF, ICG, and OCT.
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Affiliation(s)
- Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Polina Lankry
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - David Rabinovitch
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Ryan Gallo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rita Laiginhas
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Prashanth Iyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shiri Shulman
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
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25
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Xu LT, Huang Y, Liao A, Anthony CL, Voloschin A, Yeh S. Multimodal diagnostic imaging in primary vitreoretinal lymphoma. Int J Retina Vitreous 2022; 8:58. [PMID: 36028905 DOI: 10.1186/s40942-022-00405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Primary vitreoretinal lymphoma (PVRL) is an aggressive lymphoma that may present with protean features and represents a diagnostic challenge. Given that patients with PVRL are at high risk of CNS involvement with a high mortality and morbidity rate, prompt diagnosis is crucial to initiate treatment early in the disease course. A multimodality imaging approach including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), fluorescein and indocyanine angiography, and electroretinography (ERG) can provide information to establish a diagnosis and provide objective measures for management. We review key findings seen via these imaging modalities in patients with PVRL. Observations Fundus photography can highlight commonly seen patterns of PVRL including vitritis, subretinal disease, retinal pigment epithelial (RPE) abnormalities, optic nerve edema, retinal detachment, and less typical retinitis-like lesions. FAF can identify characteristic patterns of hyper- and hypoautofluorescent signal abnormalities in the macula. Spectral-domain OCT will demonstrate vitreous cells, RPE nodularity, and hyperreflectivity of the outer retina. The presence of a hyper-reflective band in the subretinal space and infiltrates between the RPE and Bruch’s membrane can assist in distinguishing PVRL from choroidal lymphoma. Vertical hyperreflective columns (VHRLs) are another pertinent finding that may represent microinfiltrates of the tumor. OCT has proven to be a particularly useful modality in assessing the progress of treatment in PVRL. Fluorescein angiography can show RPE changes, which include granularity, late staining at the RPE level, and blockage. Indocyanine green angiography (ICGA) primarily shows hypocyanescence, which corresponds to PVRL lesions on fundus photography and may occur secondary to loss of RPE and choriocapillaris. Conclusion While PVRL remains a challenging disease to diagnose and follow, the use of a multimodality imaging approach may assist in establishing a diagnosis. Because of the anatomic spaces PVRL may affect, fundus photography, OCT, FAF, angiography, and ERG can identify key characteristics of the disease, differentiate PVRL from other diseases, and provide baseline information for targeted systemic and local therapies. Further assessment of anatomic and functional targets will aid our clinical application of multimodal imaging in the management of PVRL.
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26
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Sheth JU, Narayanan R, Anantharaman G, Bhende M, Agarwal A, Chawla S, Rajendran A. Updated guidelines for the management of polypoidal choroidal vasculopathy: Recommendations from the Indian Polypoidal Choroidal Vasculopathy Panel and the Vitreoretinal Society of India. Indian J Ophthalmol 2022; 70:3102-3111. [PMID: 35918981 DOI: 10.4103/ijo.ijo_2985_21] [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] [Indexed: 11/05/2022] Open
Abstract
In Asians, polypoidal choroidal vasculopathy (PCV) is becoming more widely recognized as a significant cause of exudative maculopathy. The previous set of Indian guidelines on the management of PCV were published in 2018, with a literature search updated up to November 2015. As the treatment of PCV evolves, retinal physicians must constantly modify their current practice. The current guidelines are based on the most up-to-date information on PCV and are an update to the previous set of guidelines. These guidelines were developed by a panel of Indian retinal experts under the aegis of the Vitreoretinal Society of India (VRSI), based on a comprehensive search and assessment of literature up to September 2021. The final guidelines i) provide the updated nomenclature in PCV; ii) discusses the newer diagnostic imaging features of PCV, especially in the absence of indocyanine green angiography (ICGA); and iii) recommends the best possible therapeutic approach in the management of PCV, including the choice of anti-vascular endothelial growth factor (anti-VEGF) agents, treatment regimen, and the role of switching between the anti-VEGF agents. In the face of non-availability of photodynamic therapy (PDT) in India, we constructed practical recommendations on anti-VEGF monotherapy in PCV. The current updated recommendations would provide a broader framework to the treating retinal physician for the diagnosis and management of PCV for optimal therapeutic outcomes.
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Affiliation(s)
- Jay U Sheth
- Department of Clinical Research, Chaithanya Eye Hospital, Trivandrum, Kerala, India
| | - Raja Narayanan
- Vitreoretinal Society of India (VRSI) General Secretary, Vitreoretinal Society of India, Kochi, Kerala, India
| | | | - Muna Bhende
- Department of Vitreoretinal Services, Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Aniruddha Agarwal
- Department of Vitreoretina, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Shobhit Chawla
- Vitreoretinal Society of India (VRSI) President, Vitreoretinal Society of India, India
| | - Anand Rajendran
- Vitreoretinal Society of India (VRSI) Convenor Scientific Committee, Vitreoretinal Society of India, India
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27
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Chhablani J, Behar-Cohen F. Validation of central serous chorioretinopathy multimodal imaging-based classification system. Graefes Arch Clin Exp Ophthalmol 2022; 260:1161-1169. [PMID: 34669028 DOI: 10.1007/s00417-021-05452-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 07/12/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Validation of a recently described central serous chorioretinopathy (CSCR) classification system and assessment of levels of agreement among 10 retina physicians. METHODS This was a cross-sectional (inter-reader agreement) study. Ten retina physicians (assigned a role of masked grader) were provided with a comprehensive dataset of 61 eyes of 34 patients of presumed CSCR. Relevant clinical details and multimodal imaging (fundus autofluorescence, fluorescein and indocyanine green angiography, optical coherence tomography) of both involved and fellow eye were electronically shared. Later, only the fellow eye images were resent to understand the influence of affected eye on the grading of the fellow eye. Multiple inter-grader agreement using Fleiss Kappa was performed to determine the level of agreement among the 10 graders. p value of ≤ 0.05 was considered statistically significant. RESULTS Sixty-one eyes of 34 patients were evaluated. There was moderate agreement for major criteria with Fleiss Kappa value of 0.50 (p < 0.0001) with a single outlier observer. After excluding that observer, the Fleiss Kappa value increased to 0.57 (p < 0.0001) with statistically significant p values among all categories, i.e., simple CSC ([Formula: see text] = 0.575), complex CSC ([Formula: see text] = 0.621), and no CSC ([Formula: see text] = 0.452). Overall, moderate to substantial agreement was noted among the subtypes (primary, recurrent, and resolved). The influence of the affected eye on fellow eye grading was studied. The global Fleiss Kappa coefficient ([Formula: see text] = 0.642, p < 0.0001) showed substantial agreement when observers were aware of the affected eye grading. However, without prior available information on the affected eye, the inter-grader agreement was significantly lower (global [Formula: see text] = 0.255, p < 0.0001). CONCLUSION A fair-moderate inter-grader agreement among the masked graders suggests a need for further refinement of this novel classification system. Disease grading should include both eyes as lack of information on affected eye has a bearing on fellow eye grading and inter-grader agreement as shown by a significant difference in global [Formula: see text] values.
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Affiliation(s)
- Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh Eye and Ear Institute, PA, Pittsburgh, USA.
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28
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Villaret J, Errera MH, Sahel JA, Gaudric A, Mrejen S, Paques M. Indocyanine Green Angiography Features in Acute Syphilitic Posterior Placoid Chorioretinitis. Am J Ophthalmol 2022; 241:40-46. [PMID: 35192791 DOI: 10.1016/j.ajo.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare clinical manifestation of ocular syphilis. The cause of the placoid lesion is still up for debate but could be caused by an impaired choriocapillaris perfusion. However, less attention has been paid to the hypofluorescence of the plaque on late-phase indocyanine green angiography (ICGA). The aim of this study was to comprehensively analyze multimodal imaging findings in patients with ASPPC and to highlight the value of ICGA for the diagnosis of ASPPC. DESIGN Retrospective observational case study. METHODS The medical records of patients with uveitis who consulted our tertiary center between 2012 and December 2015 were reviewed. Patients who were diagnosed with uveitis related to syphilis infection with posterior placoid lesions seen on multimodal imaging were included. We compared the aspect of ASPPC on fundus color photography, blue autofluorescence, fluorescein angiography, optical coherence tomography, and early-, mid- and late-phase ICGA. RESULTS Fifteen eyes of 12 patients were included in the study. Hypofluorescent plaques were seen on late-phase ICGA in all eyes, corresponding to the placoid lesions visible on blue autofluorescence, while the choriocapillaris filling was normal on fluorescein angiography and ICGA. Within the plaques, optical coherence tomography showed ellipsoid zone disruptions, outer retinal disruptions, and retinal pigment epithelium granulations. CONCLUSION ASPPC could be caused by retinal pigment epithelium dysfunction secondary to an infectious or inflammatory disorder, characterized by a hypofluorescence visible only on late-phase ICGA, and resulting in photoreceptor disruptions. The RPE impairment was reversible after prompt antibiotic treatment.
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29
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Van Daele E, De Bruyne N, Vanommeslaeghe H, Van Nieuwenhove Y, Ceelen W, Pattyn P. Clinical utility of near-infrared perfusion assessment of the gastric tube during Ivor Lewis esophagectomy. Surg Endosc 2022; 36:5812-5821. [PMID: 35157124 DOI: 10.1007/s00464-022-09091-3] [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: 06/01/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) after Ivor Lewis esophagectomy with intrathoracic anastomosis carries a significant morbidity. Adequate perfusion of the gastric tube (GT) is an important predictor of anastomotic integrity. Recently, near infrared fluorescent (NIRF) imaging using indocyanine green (ICG) was introduced in clinical practice to evaluate tissue perfusion. We evaluated the feasibility and efficacy of GT indocyanine green angiography (ICGA) after Ivor Lewis esophagectomy. METHODS This retrospective analysis used data from a prospectively kept database of consecutive patients who underwent Ivor Lewis (IL) esophagectomy with GT construction for cancer between January 2016 and December 2020. Relevant outcomes were feasibility, ICGA complications and the impact of ICGA on AL. RESULTS 266 consecutive IL patients were identified who matched the inclusion criteria. The 115 patients operated with perioperative ICGA were compared to a control group in whom surgery was performed according to the standard of care. ICGA perfusion assessment was feasible and safe in all 115 procedures and suggested a poorly perfused tip in 56/115 (48.7%) cases, for which additional resection was performed. The overall AL rate was 16% (43/266), with 12% (33/266) needing an endoscopic our surgical intervention and 6% (17/266) needing ICU support. In univariable and multivariable analyses, ICGA was not correlated with the risk of AL (ICGA:14.8% vs non-ICGA:17.2%, p = 0.62). However, poor ICGA perfusion of the GT predicted a higher AL rate, despite additional resection of the tip (ICGA poorly perfused: 19.6% vs ICG well perfused: 10.2%, p = 0.19). CONCLUSIONS ICGA is safe and feasible, but did not result in a reduction of AL. The interpretation and necessary action in case of perioperative presence of ischemia on ICGA have yet to be determined. Prospective randomized trials are warranted to analyze its benefit on AL in esophageal surgery. Trial registration Ethical approval for a prospective esophageal surgery database was granted by the Ethical committee of the Ghent University Hospital. Belgian registration number: B670201111232. Ethical approval for this retrospective data analysis was granted by our institutional EC. Registration number: BC-09216.
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Affiliation(s)
- Elke Van Daele
- Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
| | - Naomi De Bruyne
- Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - Hanne Vanommeslaeghe
- Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, 2K12 IC, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
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Wanyan C, Wu Z, Zhang F, Li H, Yang Z, Wang J, Han X, Yang X, Lei D, Yang X, Wei J. An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap. Ann Transl Med 2022; 10:197. [PMID: 35280416 PMCID: PMC8908162 DOI: 10.21037/atm-22-220] [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: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
Background This study sought to explore the application value of indocyanine green angiography (ICGA) in the harvest of multi-angiosome perforator flap and the effect of low molecular weight heparin (LMWH) on the survival of postoperative flap. Methods Twenty-four SD male rats were selected to construct a three-angiosome perforator flap model with the unilateral iliolumbar artery perforator. They were randomly divided into two groups: the control group was injected with indocyanine green (ICG) into the femoral vein during the operation, and the fluorescence signal was collected and quantitatively analyzed using Real-Time Image Guided System to determine the intraoperative fluorescence imaging length. The experimental group was injected subcutaneously with LMWH (400 U/kg) after 0.5 h postoperatively, and the control group was injected with the same amount of normal saline. The injection was repeated at the same time each day from 0 to 7 days postoperatively. After the flap was sutured in situ, ICGA was performed at 0, 1, 3, 5, and 7 days postoperatively to observe the vascular structure of the two groups of flaps. The flap survival length of the control group was counted at 7 days postoperatively, and the correlation between the intraoperative fluorescence imaging length and the survival length at 7 days postoperatively was calculated. The proportion of distal necrosis of the flaps between the two groups was compared at 7 days postoperatively. Results The average length of intraoperative fluorescence imaging in the control group was 6.29±0.50 cm, and the survival length of the flap at 7 days postoperatively was 8.24±0.52 cm. The actual survival length was higher than the intraoperative fluorescence imaging length, with a ratio of 1.31±0.08. The difference was statistically significant (P<0.05). At 7 days postoperatively, the flap necrosis ratio of experimental group and control group were 10.92%±1.30% and 19.11%±1.19%, and the flap necrosis ratio of experimental group was lower than that of control group (P<0.001). Conclusions ICGA can locate the position of perforator, and can be used to predict and observe the length of distal survival of multi-angiosome perforator flap postoperatively. LMWH can promote the distal survival of flap and reduce flap necrosis.
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Affiliation(s)
- Chaojie Wanyan
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Zhongming Wu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Fengrui Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Huan Li
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Zihui Yang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Jun Wang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xuejiao Han
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xiangming Yang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Delin Lei
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xinjie Yang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Jianhua Wei
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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Jeong S, Kang W, Noh D, van Hemert J, Sagong M. Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:1887-1898. [PMID: 35022815 DOI: 10.1007/s00417-021-05461-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/24/2021] [Revised: 10/06/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to evaluate choroidal vascular alterations in patients with central serous chorioretinopathy (CSC) using ultra-widefield (UWF) indocyanine green angiography (ICGA). METHODS This was a retrospective case-control study conducted at a single tertiary eye center. In total, 36 eyes in patients with either unilateral (24 patients) or bilateral (six patients) treatment-naïve CSC and 30 eyes in 24 age-matched controls were evaluated. The number of quadrants with vortex vein engorgement on UWF ICGA was evaluated. Dilated choroidal vessels affecting the macula were regarded as extended vortex vein engorgement. Choroidal vascular hyperpermeability (CVH) area on late-phase ICGA was quantified using stereographic projection. The parameters were compared with clinical and optical coherence tomographic findings. RESULTS Eyes with CSC had larger CVH area, thicker choroid, and more quadrants with vortex vein engorgement and extended vortex vein engorgement compared with control eyes (all P < 0.001). In patients with unilateral CSC, affected eyes had larger CVH area, thicker choroid, and more extended vortex vein engorgements compared with unaffected fellow eyes (all P < 0.001), but vortex vein engorgement did not significantly differ. CVH was significantly correlated with extended vortex vein engorgement (P < 0.001) and subfoveal choroidal thickness (P = 0.007). CONCLUSIONS The increased number and binocular symmetry of engorged vortex veins suggest an anatomical predisposition for CSC. CVH area and extended vortex vein engorgement were indicators of choroidal outflow congestion. These parameters may serve as diagnostic clues or predictors of disease development in eyes with CSC.
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Affiliation(s)
- Seongyong Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Yeungnam Eye Center, Yeungnam University Hospital, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea
| | - Wonki Kang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Yeungnam Eye Center, Yeungnam University Hospital, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea
| | - Donghyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Good Doctors Eye Hospital, Ulsan, South Korea
| | | | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea. .,Yeungnam Eye Center, Yeungnam University Hospital, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea.
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Monferrer Adsuara C, Remolí Sargues L, Montero Hernández J, Hernández Garfella ML, Hernández Bel L, Castro Navarro V, Cervera Taulet E. Multimodal imaging in multiple evanescent white dot syndrome and new insights in pathogenesis. J Fr Ophtalmol 2021; 44:1536-1544. [PMID: 34728098 DOI: 10.1016/j.jfo.2021.05.011] [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: 02/23/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the multimodal imaging in multiple evanescent white dot syndrome (MEWDS) during the acute and convalescent stages in order to better understand the focus of the inflammatory process. METHODS Retrospective cohort study of 4 patients with MEWDS. Each patient underwent: enhanced depth imaging-optical coherence tomography (EDI-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and en-face OCT and OCT angiography (OCT-A). Choroidal subfoveal thickness (CST) was measured manually. All patients were studied in the acute stage and convalescent stage after disappearance of OCT abnormalities and resolution of visual symptoms. RESULTS Four MEWDS patients with a mean age of 23.5years were studied (range: 16-33years). Two patients were women. Initial mean visual acuity (VA) was 80.25 ETDRS. Final mean VA was 84.25 ETDRS. OCT imaging showed disruption of the ellipsoid zone and a slightly elevated RPE layer with overlying hyperreflective material, all of which corresponded to hyperautofluorescent FAF lesions. FA revealed multiple hyperautofluorescent lesions, correlated with hypocyanescent spots on the late ICGA. OCT-A showed normal superficial and deep retinal capillary plexus as well as choriocapillaris. The disease was self-limited in all the cases, with a mean time of 9weeks to resolution (range: 4-16). CONCLUSION The pathophysiology of MEWDS is still debated. We believe that there is still not enough evidence to implicate the outer retina as the primary cause. For now, we suggest that this transient disease is the consequence of choriocapillaris hypoperfusion, but further studies are required to elucidate this hypothesis.
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Affiliation(s)
- C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - L Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain.
| | - J Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - M L Hernández Garfella
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - L Hernández Bel
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - E Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
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Zicarelli F, Pichi F, Parrulli S, Oldani M, Mapelli C, Riva A, Agarwal A, Viola F, Staurenghi G, Invernizzi A. Acute Posterior Ocular Toxoplasmosis: An Optical Coherence Tomography Angiography and Dye Angiography Study. Ocul Immunol Inflamm 2021; 30:541-545. [PMID: 34637664 DOI: 10.1080/09273948.2021.1977831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare Indocyanine Green (ICGA) and fundus fluorescein angiography (FFA) with Optical Coherence Tomography Angiography (OCTA) findings in toxoplasmic chorioretinitis (TCR). METHODS Patients affected by active TCR were included. FFA, ICGA, and OCTA images were analyzed and lesions were compared between different modalities. Satellite dark dots (SDD) were compared between modalities. RESULTS Fifteen patients were enrolled. The mean lesion area was similar between fundus photography (FP), FFA, and OCTA-Retina. The mean lesion area was similar between ICGA and OCTA-Choroid slab. ICGA and OCTA-Choroid showed a larger extension of the lesion compared to FP, FFA, and OCTA-Retina (p = .01, 0.0001, and 0.0002 for ICG angiography and p = .03, 0.008, and 0.0002 for OCTA-Choroid, respectively). On OCTA B-scans, the retinal flow defects were smaller than the underlying choroidal non-perfusion. The number of SDD was similar between ICGA and OCTA. CONCLUSIONS OCTA is a reliable method to assess retinal and choroidal involvement in TCR. OCTA confirmed a wider involvement of the choroid than the retina.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marta Oldani
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Chiara Mapelli
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, Irccs-cà Grande Foundation-Ospedale Maggiore Policlinico, Milan, Italy
| | - Agostino Riva
- Department of Infectious Diseases, Asst Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, Irccs-cà Grande Foundation-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
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AlBloushi AF, Herbort CP Jr, Abu El-Asrar AM. Initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease presenting with unilateral exudative retinal detachment despite bilateral choroidal involvement. Int Ophthalmol 2021. [PMID: 34346004 DOI: 10.1007/s10792-021-01989-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the frequency of initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease presenting with unilateral exudative retinal detachment. METHODS A retrospective case series. RESULTS During the period between January 1998 and December 2020, we identified 135 patients with initial-onset acute uveitis associated with VKH disease. Among them, 5 (3.7%) patients were referred to have unilateral uveitis due to the presence of exudative retinal detachment in only one eye. Optical coherence tomography confirmed the presence of unilateral exudative retinal detachment, however, indocyanine green angiography (ICGA) revealed characteristic findings of bilateral granulomatous choroidal inflammation typical for initial-onset acute uveitis associated with VKH disease. CONCLUSIONS Patients with initial-onset acute uveitis associated with VKH disease can present with unilateral exudative retinal detachment. ICGA assessment of the choroid revealed the presence of subclinical involvement of the fellow eyes.
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Safi H, Ahmadieh H, Hassanpour K, Safi S. Multimodal Imaging in Pachychoroid Spectrum. Surv Ophthalmol 2021:S0039-6257(21)00165-X. [PMID: 34331955 DOI: 10.1016/j.survophthal.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
Diagnostic investigation on pachychoroid spectrum disease (PSD) has been growing along with the rapid advancement of imaging technology. In optical coherence tomography (OCT)-based studies, choroidal thickness profile, luminal and stromal choroidal ratio, and abnormalities in the neurosensory retina have demonstrated various patterns in different clinical entities related to PSD. The emerging role of OCT angiography (OCTA) has been expanded to involve the quantitative analysis of the OCTA parameters in different clinical entities of PSD and to evaluate the choriocapillaris signal void and vessel density as indicators of choriocapillaris ischemia. OCTA has broadened our knowledge in characterization and assessment of both active and quiescent choroidal neovascularization and its association with treatment response. Recent studies using indocyanine green angiography (ICG) have focused on the evaluation of choroidal vascular hyperpermeability and its relationship with other pachychoroid related features. Ultrawidefield ICG enables observation and characterization of peripheral choroidal pathologies and their associations with macular abnormalities. Multicolor imaging is an emerging modality with the capability to demonstrate early abnormalities in PSD. We summarize all investigations reflecting the new insights into the application of multimodal imaging for PSD and focuses on novel findings observed in different clinical entities with each imaging modality.
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Nerup N, Svendsen MBS, Rønn JH, Konge L, Svendsen LB, Achiam MP. Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue. Surg Endosc 2021; 36:2373-2381. [PMID: 33942183 PMCID: PMC8921116 DOI: 10.1007/s00464-021-08518-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/25/2021] [Accepted: 04/17/2021] [Indexed: 02/07/2023]
Abstract
Background Anastomotic leakage (AL) after gastrointestinal resection is a devastating complication with huge consequences for the patient. As AL is associated with poor blood supply, tools for objective assessment of perfusion are in high demand. Indocyanine green angiography (ICG-FA) and quantitative analysis of ICG-FA (q-ICG) seem promising. This study aimed to investigate whether ICG-FA and q-ICG could improve perfusion assessment performed by surgeons of different experience levels. Methods Thirteen small bowel segments with a varying degree of devascularization, including two healthy sham segments, were constructed in a porcine model. We recruited students, residents, and surgeons to perform perfusion assessment of the segments in white light (WL), with ICG-FA, and after q-ICG, all blinded to the degree of devascularization. Results Forty-five participants fulfilled the study (18 novices, 12 intermediates, and 15 experienced). ICG and q-ICG helped the novices correctly detect the healthy bowel segments to experienced surgeons’ level. ICG and q-ICG also helped novice surgeons to perform safer resections in healthy tissue compared with normal WL. The relative risk (RR) of leaving ischemic tissue in WL and ICG compared with q-ICG, even for experienced surgeons was substantial, intermediates (RR = 8.9, CI95% [4.0;20] and RR = 6.2, CI95% [2.7;14.1]), and experienced (RR = 4.7, CI95% [2.6;8.7] and RR = 4.0, CI95% [2.1;7.5]). Conclusion Q-ICG seems to guide surgeons, regardless of experience level, to safely perform resection in healthy tissue, compared with standard WL. Future research should focus on this novel tool’s clinical impact.
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Affiliation(s)
- Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark.
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Capital Region of Denmark, Denmark
| | - Jonas Hedelund Rønn
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Capital Region of Denmark, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
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Durner G, Wahler H, Braun M, Kapapa T, Wirtz CR, König R, Pala A. The value of intraoperative angiography in the time of indocyanine green videoangiography in the treatment of cerebrovascular lesions: Efficacy, workflow, risk-benefit and cost analysis A prospective study. Clin Neurol Neurosurg 2021; 205:106628. [PMID: 33895619 DOI: 10.1016/j.clineuro.2021.106628] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/28/2021] [Accepted: 03/28/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Intraoperative digital subtraction angiography (ioDSA) allows early treatment evaluation after neurovascular procedures. However, the value and efficiency of this procedure has been discussed controversially. We have evaluated the additional value of hybrid operating room equipped with an Artis Zeego robotic c-arm regarding cost, efficiency and workflow. Furthermore, we have performed a risk-benefit analysis and compared it with indocyanine green (ICG) angiography. METHODS For 3 consecutive years, we examined all neurovascular patients, treated in the hybrid operating theater in a risk-benefit analysis. After using microdoppler and ICG angiography for best operative result, every patient received an additional ioDSA to look for remnants or unfavorable clip placement which might lead to a change of operating strategy or results. Furthermore, a workflow-analysis reviewing operating steps, staff positioning, costs, technical errors or complications were conducted on randomly selected cases. RESULTS 54 patients were enrolled in the risk-benefit analysis, 22 in the workflow analysis. The average duration of a cerebrovascular operation was 4 h 58 min 2 min 35 s accounted for ICG angiography, 46 min 4 s for ioDSA. Adverse events occurred during one ioDSA. In risk-benefit analysis, ioDSA was able to detect a perfusion rest in 2 out of 43 cases (4,7%) of aneurysm surgery, which could not have been visualized by ICG angiography before. In arterio-venous-malformation (AVM) surgery, one of 11 examined patients (7,7%) showed a remnant in ioDSA and resulted in additional resection. The average cost of an ioDSA in Ulm University can be estimated with 1928,00€. CONCLUSION According to our results ioDSA associated complications are low. Relevant findings in ioDSA can potentially avoid additional intervention, however, due to the high costs and lower availability, the main advantage might lie in the treatment of selected patients with complexes neurovascular pathologies since ICG angiography is equally safe but associated with lower costs and better availability.
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Affiliation(s)
- Gregor Durner
- University of Ulm, Department of Neurosurgery, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany.
| | - Hellen Wahler
- University of Ulm, Department of Neurosurgery, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany
| | - Michael Braun
- University of Ulm, Department of Neuroradiology, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany
| | - Thomas Kapapa
- University of Ulm, Department of Neurosurgery, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany
| | - Christian Rainer Wirtz
- University of Ulm, Department of Neurosurgery, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany
| | - Ralph König
- University of Ulm, Department of Neurosurgery, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany
| | - Andrej Pala
- University of Ulm, Department of Neurosurgery, Ludwig Heilmeyerstr. 2, 89312 Günzburg, Germany
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Chaikitmongkol V, Upaphong P, Patikulsila D, Jirarattanasopa P, Choovuthayakorn J, Watanachai N, Kunavisarut P, Ratanasukon M, Bhurayanontachai P, Ingviya T, Bressler SB, Bressler NM. Timing of Complete Polypoidal Regression after Intravitreous Aflibercept Treatments in Polypoidal Choroidal Vasculopathy. Ophthalmol Retina 2021:S2468-6530(21)00101-9. [PMID: 33781929 DOI: 10.1016/j.oret.2021.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/19/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To understand timing of complete polypoidal regression on indocyanine green angiography (ICGA) after aflibercept injections for polypoidal choroidal vasculopathy (PCV). DESIGN Multicenter prospective study. PARTICIPANTS Adults with treatment-naïve PCV. METHODS After institutional review board approval, participants were enrolled and followed up for 1 year, from Apr 1, 2016, through Dec 30, 2018, at 2 university-based centers in Thailand. Diagnosis of PCV was based on the Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy criteria. Eligible eyes received fixed-dose aflibercept injections (3 monthly then every 8 weeks), or monthly if fluid persisted on OCT. Photodynamic therapy (PDT) was administered when fluid persisted despite 6 consecutive injections. Indocyanine green angiography was performed at baseline and then every 8 weeks. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline, 6 months, and 1 year. Two retina specialists reviewed posttreatment ICGA, categorized into: complete regression (complete disappearance of polypoidal lesions), partial regression (reduced in size or number), or no regression. Disagreements were resolved through open adjudication. MAIN OUTCOME MEASURES Timing of complete regression over 1 year. RESULTS Final analysis included 40 eyes (39 participants; 100% Thai, 59% women; mean age±standard deviation, 64 ± 8.3 years). At baseline, 90% had 5 or more polypoidal lesions. Ninety-five percent received aflibercept monotherapy, and 5% received rescue PDT per protocol. Polypoidal statuses at 1 year were 55% complete, 40% partial, and 5% no regression. Cumulative rates of complete regression at 2, 4, 6, and 12 months were 28%, 33%, 43%, and 55%. Of 22 eyes with complete regression at 1 year, complete regression was identified first at 2, 4, 6, 8, 10, 12 months in 50%, 9%, 18%, 5%, 9%, and 9%, respectively. Cumulative rates of complete regression among these eyes at 2, 6, and 12 months were 50%, 77%, and 100%, respectively. Median duration of complete regression was 3 months (interquartile range, 2-6 months). Median visual acuity improved from 20/125 (Snellen equivalent) to 20/50; median NEI VFQ-25 scores improved from 80 to 93 from baseline to 1 year. CONCLUSIONS Complete polypoidal regression could occur as early as 2 months after aflibercept injections. Most PCV eyes with complete polypoidal regression at 1 year already showed complete regression within the first 6 months. These findings support consideration of aflibercept for PCV to achieve both anatomic and visual outcomes.
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Pather K, Deladisma AM, Guerrier C, Kriley IR, Awad ZT. Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy. Surg Endosc 2021; 36:896-903. [PMID: 33580319 DOI: 10.1007/s00464-021-08346-9] [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: 10/24/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anastomotic leak is a serious complication following esophagectomy. The aim of the study was to report our experience with indocyanine green fluorescence angiography (ICG-FA)-PINPOINT® assisted minimally invasive Ivor Lewis esophagectomy (MILE) and assess factors associated with anastomotic leak. METHODS We reviewed consecutive patients undergoing MILE from 2013 to 2018. Intraoperative real-time assessment of gastric conduit was performed using ICG-FA with PINPOINT®. Perfusion was categorized as good perfusion (brisk ICG visualization to conduit tip) or non-perfusion (any demarcation along the conduit). RESULTS 100 patients (81 males, median age 68 [60-72]) underwent MILE for malignancy in 96 patients and benign disease in 4 patients. There were six anastomotic leaks all managed with endoscopic stent placement. There was no intraoperative mortality and no 30-day mortality in leak patients. Patients with a leak were more likely to be overweight with BMI > 25 (100% versus 53%, p = 0.03), have pre-existing diabetes (50% versus 13%, p = 0.04), and have higher intraoperative estimated blood loss (260 mL [95-463] versus 75 mL [48-150], p = 0.03). Anastomotic leaks occurred more frequently in the non-perfusion (67%) versus the good perfusion category (33%, p = 0.03). By multivariable analysis, diabetes (odds ratio [OR] 6.42; p = 0.04) and non-perfusion (OR 6.60; p = 0.04) were independently associated with leak. CONCLUSION Intraoperative use of ICG-FA may be a useful adjunct to assess perfusion of the gastric conduit with non-perfusion being independently associated with a leak. While perfusion plays an important role in anastomotic integrity, development of a leak is multifactorial, and ICG-FA should be used in conjunction with the optimization of patient and procedural components to minimize leak rates. Prospective, randomized studies are required to validate the interpretation, efficacy, and application of this novel technology in minimally invasive esophagectomies.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Adeline M Deladisma
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA
| | | | - Isaac R Kriley
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA
| | - Ziad T Awad
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA.,University of Florida, Jacksonville, FL, USA
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Papasavvas I, Herbort CP. Vogt-Koyanagi-Harada disease is always bilateral: reports of unilateral cases failed to use choroidal investigations showing subclinical involvement of the fellow eye. J Ophthalmic Inflamm Infect 2021; 11:6. [PMID: 33559795 PMCID: PMC7873149 DOI: 10.1186/s12348-021-00237-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background/purpose Vogt-Koyanagi-Harada (VKH) disease is a primary stromal choroiditis and a bilateral granulomatous panuveitis which, if not treated early and properly, could have a deleterious evolution. The purpose of our case report is to demonstrate that “so called” unilateral VKH disease should be investigated further with an Indocyanine Green Angiography (ICGA), in order to detect subclinical choroidal involvement of the other eye. Case report We present a case of 42-year old woman who came to see us for second opinion. She had consulted elsewhere for a left uveitis and had been treated with a periocular corticosteroid injection. At presentation she mentioned persistent headaches. Visual acuity on the Snellen scale was 1.0 OD and 0.5 OS. Slit-lamp examination showed granulomatous (rare mutton-fat KPs) signs in her left eye. Laser flare photometry showed a subclinical flare of 17.8 ph/ms OD and a flare of 66.4 ph/ms OS (normal values 3–6 ph/ms). Fundus examination showed left discoloration due to choroidal infiltration with a normal fundus aspect OD. ICGA showed a diffuse choroiditis also in the apparently normal right eye. Lumbar puncture confirmed the diagnosis of VKH and appropriate treatment was introduced. Conclusion VKH disease results from a generalized autoimmune process against melanocyte associated antigens starting in the choroidal stroma. It can be asymmetrical but is always bilateral, as long as investigations such as ICGA, able to detect subclinical choroiditis, are performed.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Teaching Centre Clinic Montchoisi, Lausanne, Switzerland.
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Lupidi M, Muzi A, Castellucci G, Kalra G, Piccolino FC, Chhablani J, Cagini C. The choroidal rupture: current concepts and insights. Surv Ophthalmol 2021; 66:761-770. [PMID: 33545177 DOI: 10.1016/j.survophthal.2021.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/01/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Choroidal rupture is a posterior segment affliction following a traumatic event that results in a break in the retinal pigment epithelium, Bruch membrane, and the underlying choriocapillaris. The visual prognosis may be extremely poor when involving the macular area or in cases with major comorbidities. On funduscopic examination the rupture appears as a whitish/yellowish curvilinear or crescent-shaped lesion with forked or tapered endings. Multimodal imaging including fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography can provide a detailed assessment of the extent of damage and the onset of complications. Although there is no treatment for choroidal rupture per se, associated complications such as angle-recession glaucoma, retinal detachment, or exudative choroidal neovascularization might need therapeutic interventions. We describe the pathophysiology of choroidal rupture, the recent multimodal imaging findings, and the available treatment options for the management of complications.
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Affiliation(s)
- Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy; Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Genova, Italy; Centre de l'Odéon, Paris, France
| | - Alessio Muzi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Greta Castellucci
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Gagan Kalra
- Government Medical College and Hospital, Chandigarh, India
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
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Herbort CP, Papasavvas I, Mantovani A. Choriocapillaris Involvement in Acute Syphilis Posterior Placoid Chorioretinitis is Responsible for Functional Impairment and Points towards an Immunologic Mechanism: A Comprehensive Clinicopathological Approach. J Curr Ophthalmol 2020; 32:381-389. [PMID: 33553841 PMCID: PMC7861097 DOI: 10.4103/joco.joco_184_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/08/2020] [Revised: 06/13/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the multimodal imaging of acute syphilitic posterior placoid chorioretinitis (ASPPC) lesions in order to elucidate their pathophysiology which seems to resemble choriocapillaritis as in primary inflammatory choriocapillaropathies such as multifocal choroiditis (MFC) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Methods Charts of patients with ASPPC seen in the Centre for Ophthalmic Specialised Care, Lausanne, Switzerland, were retrieved. Fundus autofluorescence (FAF), spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), and when available, OCT angiography were analyzed and compared to a case of MFC. Results One woman aged 58 and 2 men aged 50 and 31 with unilateral ASPPC were analyzed. All had positive syphilis serologies (venereal disease research laboratory [VDRL] and treponema Pallidum hemagglutination assay [TPHA]). Two were human immunodeficiency virus (HIV) positive. Mean best corrected visual acuity was 0.2 ± 0.1 at presentation and 1.0 for all patients 6 weeks later, after antibiotic treatment for neurosyphilis. All had central scotomata with a mean defect (MD) of 12.2 ± 2.6. Six weeks later, MD values were 3.9 ± 1.7. Microperimetry had a mean score of 25/560 at presentation and recovered to a mean of 444/560 6 weeks later. Multimodal imaging features consisted of FA tissue staining, ICGA hypofluorescent choriocapillaris non-perfusion, FAF hyperautofluorescence, and loss of the ellipsoid line in the diseased areas. The findings were consistent and identical in ASPPC and a case of MFC and pointed toward the involvement of the choriocapillaris. Conclusions Similarities seen in multimodal imaging features in ASPPC and choriocapillaritis highlight the role of the choriocapillaris in the pathophysiologic mechanism of both conditions. Inflammatory choriocapillaris non-perfusion triggered by infectious agents seems to be the common pathway through which the eye is reacting.
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Affiliation(s)
- Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
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Papasavvas I, Teuchner B, Herbort CP. Susac syndrome (Retino-cochleo-cerebral vasculitis), the ophthalmologist in the role of the whistleblower. J Ophthalmic Inflamm Infect 2020; 10:27. [PMID: 33125601 PMCID: PMC7599291 DOI: 10.1186/s12348-020-00217-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/PURPOSE Susac syndrome is a rare microangiopathy of suspected autoimmune origin affecting arteries of the retina, the cochlea and the brain. The aim of the study was to give a review of the disease entity and determine the proportion of cases and their characteristics in a uveitis referral centre. PATIENTS AND METHODS Charts of patients with the diagnosis of Susac syndrome seen in the Uveitis Clinic of the Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland were reviewed retrospectively to determine the frequency of such cases in a uveitis referral centre. Clinical symptoms and signs, functional data, imaging signs and evolution were analysed in the 3 COS cases and one case shared with the Uveitis Clinic of the Department of Ophthalmology, University of Innsbruck, Austria. Characteristic signs were searched possibly allowing a prompt diagnosis. RESULTS During the period from 1994 to 2019 (24 years, 2045 patients), 3 charts with the diagnosis of Susac syndrome were found (0.15%). The whole collective, including the additional case, comprised three women aged 28, 32 and 63 at presentation and one man, aged 42. None of the 3 cases that were referred were diagnosed beforehand. The characteristic item found in all 4 cases was the abrupt arterial stop or segmental interruption of arteries and increased staining of arterial wall on angiography more clearly shown on indocyanine green angiography that can potentially be proposed as a crucial diagnostic element. All 4 cases responded to dual steroidal and non-steroidal immunosuppression. Under treatment, all four patients did not show any further evolution. CONCLUSION Susac syndrome is a multilocation arteritis of the head that can involve the eye, ear and brain often first diagnosed by the ophthalmologist. The diagnosis is rapidly reached in uveitis referral centres but seems to be missed otherwise, A helpful angiographic sign to be searched is an abrupt or segmental arterial stop and increased staining of the arterial wall more clearly seen on indocyanine green angiography. Patients often present first to the ophthalmologist who should be acting as a whistleblower to avoid severe involvement of the brain.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland
| | - Barbara Teuchner
- Department of Ophthalmology, University of Innsbruck, Innsbruck, Austria
| | - Carl Peter Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.
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Sahu Y, Chaudhary N, Joshi M, Gandhi A. Idiopathic polypoidal choroidal vasculopathy: a review of literature with clinical update on current management practices. Int Ophthalmol 2020; 41:753-765. [PMID: 33079309 DOI: 10.1007/s10792-020-01620-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/04/2020] [Accepted: 10/05/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Polypoidal choroidal vasculopathy is a major cause of visual disability in a vast majority of Asian population due to exudative maculopathy. Although it is a distinctive disease entity with characteristic pathophysiology, genetics, immunology and clinical features, but it is still misdiagnosed as neovascular age related macular degeneration as both the diseases are a part of pachychoroid spectrum and have some similar features. Also, there are varied options for the management of this disease, but there are no clear recommendations. So, a detailed review of the literature has been done along with special attention to the recent therapeutic advances to help the readers get a better understanding of the disease and its current management practices. METHOD Detailed review of literature regarding polypoidal choroidal vasculopathy was done. The disease pathophysiology, genetics, risk factors, diagnostic modalities along with current treatment guidelines were extensively studied and compiled. RESULT A comprehensive clinical update on polypoidal choroidal vasculopathy was compiled with special emphasis on the recent diagnostic modalities and treatment guidelines. CONCLUSION Polypoidal choroidal vasculopathy is a distinct clinical entity which can be diagnosed based on indocyanine green angiography and optical coherence tomography. Treatment includes various options like photodynamic therapy, anti VEGF agents and thermal laser ablation. A review of literature has been done and recent diagnostic modalities with management practices have been compiled for the better understanding of the disease.
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Affiliation(s)
- Yamini Sahu
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110 029, India
| | - Niharika Chaudhary
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110 029, India.
| | - Mukesh Joshi
- Department of Ophthalmology, H.I.M.S.R and H.A.H. Centenary Hopsital, Nears GK.2, Alaknanda, New Delhi, India
| | - Aastha Gandhi
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110 029, India
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Zhang T, Wang W, Li M, Huang Y. Late-phase hypercyanescence during indocyanine green angiography for assessment of myopic choroidal neovascularization. Eur J Ophthalmol 2020; 31:2578-2587. [PMID: 32900221 DOI: 10.1177/1120672120951749] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Indocyanine green angiography (ICGA) is a major diagnostic modality but the clinical implications of specific staining patterns in active myopic choroidal neovascularization (mCNV) are unclear. We examined the associations of ICGA cyanofluorescence patterns with disease characteristics and response to an as-needed intravitreal ranibizumab (IVR) treatment regimen among active mCNV patients. METHODS Twenty-four subjects with active mCNV treated by IVR were enrolled in this retrospective cohort study. Information from medical records were reviewed, including best corrected visual acuity (BCVA), fluorescein angiography (FA) findings, ICGA cyanofluorescence patterns, and spectral-domain OCT (SD-OCT) results. The CNV lesion size, CNV thickness, and central retinal thickness (CRT) were measured from these images. RESULTS Two staining patterns were identified on late-phase ICGA images, hypercyanescence (9/24, 37.5%) and non-hypercyanescence (15/24, 62.5%). There were no differences in baseline BCVA, CNV thickness, and CRT between ICGA pattern groups; however, the hypercyanescence group demonstrated a larger CNV lesion size (p = 0.035) and required more IVR injections than the non-hypercyanescence group (2.67 ± 1.58 vs 1.07 ± 0.27, p = 0.016), while the non-hypercyanescence group demonstrated better final BCVA improvement (p = 0.041). Hypercyanescence could be divided into two types, a uniform type and rim type. A pseudopodia-like protrusion of CNV enlargement with a rim-enhanced type hypercyanescence at the protrusion rim was predictive of required retreatment. CONCLUSIONS Hypercyanescence on late-phase ICGA may assist in identifying more active mCNV requiring intensive treatment.
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Affiliation(s)
- Taoran Zhang
- Department of Ophthalmology, Beijing friendship hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Wang
- Department of Ophthalmology, Beijing friendship hospital, Capital Medical University, Beijing, P.R. China
| | - Mingming Li
- Department of Ophthalmology, Beijing friendship hospital, Capital Medical University, Beijing, P.R. China
| | - Yingxiang Huang
- Department of Ophthalmology, Beijing friendship hospital, Capital Medical University, Beijing, P.R. China
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Palme C, Wanner A, Romano V, Haas G, Kaye S, Steger B. Observation of angiographic dye leakage in ocular surface squamous neoplasia. Am J Ophthalmol Case Rep 2020; 20:100912. [PMID: 32984652 PMCID: PMC7495007 DOI: 10.1016/j.ajoc.2020.100912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/16/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose The clinical diagnosis of ocular surface squamous neoplasia is challenging, mostly requiring excisional biopsy. Human tumor angiogenesis is characterized by abnormal vessel architecture and transvascular hyperpermeability. This case report describes features of fluorescein and indocyanine green angiography in a case of conjunctival intraepithelial neoplasia. Observations Color photography, optical coherence tomography, fluorescein and indocyanine green angiography were performed in a patient with suspected conjunctival intraepithelial neoplasia before excisional biopsy and histologic confirmation of clinical diagnosis. Fluorescein dye showed extensive early extravascular dye leakage within the limits of the lesion. Indocyanine green dye displayed corneal terminal vessel bulbs with early leakage after 70 seconds and showed diffuse intralesional dye leakage after 7 minutes. Conclusions Increased fluorescein and early indocyanine green dye leakage can be used to confirm active angiogenesis already in early stages of dysplastic ocular surface squamous neoplasia. Late leakage of indocyanine green dye may be due to chronic transvascular hyperpermeability within intrinsic tumor vessels. The leakage behaviour of intravenous dyes has the potential to serve as a diagnostic indicator of active growth in dysplastic ocular surface neoplastic lesions.
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Affiliation(s)
- Christoph Palme
- Department of Ophthalmology, Medical University of Innsbruck, Austria
| | - Astrid Wanner
- Department of Ophthalmology, Medical University of Innsbruck, Austria
| | - Vito Romano
- St. Paul's Eye Unit, Royal Broadgreen University Hospital, Liverpool, UK
| | - Gertrud Haas
- Department of Ophthalmology, Medical University of Innsbruck, Austria
| | - Stephen Kaye
- St. Paul's Eye Unit, Royal Broadgreen University Hospital, Liverpool, UK
| | - Bernhard Steger
- St. Paul's Eye Unit, Royal Broadgreen University Hospital, Liverpool, UK
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Hayashida M, Miki A, Honda S, Nakamura M. Comparison between the outcomes of fluorescein angiography-guided and indocyanine green angiography-guided half-time photodynamic therapy for central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2020; 31:101955. [PMID: 32818640 DOI: 10.1016/j.pdpdt.2020.101955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/28/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to compare the efficacy of fluorescein angiography (FA)-guided and indocyanine green angiography (ICGA)-guided half-time photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). SUBJECTS AND METHODS Medical records of 61 eyes of 61 CSC patients who underwent half-time PDT were retrospectively reviewed. The irradiation area was determined using information from FA or ICGA with physicians' discretion. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SCT), and resolution of subretinal fluid (SRF) were evaluated at baseline and 1, 3, 6, and 12 months after PDT. RESULTS A total of 29 and 32 eyes received FA-guided PDT (irradiation area, 2898.3 ± 705.7 μm) and ICGA-guided PDT (irradiation area, 4993.8 ± 333.1 μm), respectively. A significant improvement in the mean BCVA was found at 1 month in the FA-guided group (P = 0.02), but not in the ICGA-guided group (P = 0.88). BCVA was significantly improved in both groups at 3, 6, and 12 months with no significant intergroup difference at any time points. CRT and SCT were significantly reduced in both groups at all time points with no significant intergroup differences. No significant intergroup differences were observed in the rate of recurrence and persistent SRF. However, there was a significant difference between groups in the rate of recurrence and/or persistent SRF (P = 0.04). Multivariate analysis revealed that choice of FA-guided was significantly associated with recurrence and/or persistent SRF (P = 0.04). CONCLUSION Half-time PDT with ICGA-guided irradiation spot might be more effective than that with FA-guided in treating CSC patients in complete resolution of SRF.
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Affiliation(s)
- Mayuka Hayashida
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, 545-8585, Osaka, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Cohen-Cohen S, Link MJ, Rangel-Castilla L. Transylvian Clip Occlusion of an Enlarging High-Flow Tentorial Arteriovenous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E172-E173. [PMID: 31828345 DOI: 10.1093/ons/opz344] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/04/2019] [Indexed: 11/15/2022] Open
Abstract
Endovascular therapy is the primary treatment for the majority of tentorial dural arteriovenous fistulas (dAVF). Surgical occlusion is an effective alternative when embolization is not possible. This video demonstrates microsugical occlusion of a right-sided tentorial dAVF in a symptomatic 45-yr-old male. The dAVF was fed directly by meningohypophyseal trunk. Venous drainage was retrograde through the sphenoparietal sinus, superficial sylvian vein, vein of Labee, and transverse sinus. The patient underwent a right-sided pterional craniotomy; the sylvian fissure was widely opened. Subarachoid dissection was performed until a large arterialized draining vein was identified exiting dura subtemporally. Intraoperative indocyanine green angiography confirmed the fistulous site and the draining vein was occluded and divided. The patient remained neurologically intact after surgery. Immediate angiography demonstrates complete occlusion of the dAVF. This video demonstrates the surgical access obtained through a transylvian approach for this tentorial dAVF. Occlusion of the draining vein, with or without resection of the fistula, is enough to permanently treat these lesions.
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Affiliation(s)
| | - Michael J Link
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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Matsuura S, Ishida T, Tobe M, Uchida M, Souma R, Ohno-Matsui K. Indocyanine green angiographic findings in seven eyes with vasoproliferative retinal tumor. Am J Ophthalmol Case Rep 2020; 19:100831. [PMID: 32715159 PMCID: PMC7374191 DOI: 10.1016/j.ajoc.2020.100831] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose Vasoproliferative tumors (VPTs) are rare benign tumors, and detailed indocyanine green angiographic (ICGA) findings in eyes with VPTs have not been reported. We present the characteristic ICGA findings in seven eyes with a VPT. Observations We present the fluorescein angiographic (FA) and ICGA findings of seven consecutive patients who were diagnosed with primary VPT from April 2013 to March 2015 in the Oncology Service of the Department of Ophthalmology, Tokyo Medical and Dental University. We reviewed the demographics of the seven patients with VPTs. Abnormal vessels within the tumor were observed in three cases with active tumors. These vessels were hypofluorescent in the ICGA images in the scar phase. On the other hand, three cases in which the exudation remained from the initial visit to the last examination had abnormal vessels in the ICGA images. The remaining case had one straight vessel in the tumor from the initial to the last examination in the scar phase. FA in the active phase changed from hyperfluorescent leakage to staining in one eye, and the remaining six eyes continued to show hyperfluorescent leakage throughout the examination period. Conclusions The leakage of fluorescein continued from the initial to the final examination even after the activity of the tumor had decreased. In the active phase, ICGA showed abnormal vessels with or without leakage, and the tumors at the scar phase show a hypofluorescent lesion. Importance ICGA supported the ophthalmoscopic findings, and can be used as a diagnostic aid to confirm a regression of the VPTs.
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Affiliation(s)
- Saya Matsuura
- Department of Ophthalmology, Ebara Hospital, Tokyo, Japan
- Department of Ophthalmology, Tokyo Medical Dental University, Tokyo, Japan
- Corresponding author. Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University; 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Tomoka Ishida
- Department of Ophthalmology, Tokyo Medical Dental University, Tokyo, Japan
| | - Miho Tobe
- Department of Ophthalmology, Tokyo Medical Dental University, Tokyo, Japan
| | - Minami Uchida
- Department of Ophthalmology, Tokyo Medical Dental University, Tokyo, Japan
| | - Ryoko Souma
- Department of Ophthalmology, Tokyo Medical Dental University, Tokyo, Japan
- Department of Ophthalmology, National Disaster Medical Center, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology, Tokyo Medical Dental University, Tokyo, Japan
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Lee J, Smith WM, Goldstein DA. Birdshot chorioretinopathy presenting in a teenager. Am J Ophthalmol Case Rep 2020; 19:100807. [PMID: 32695925 PMCID: PMC7365988 DOI: 10.1016/j.ajoc.2020.100807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/10/2020] [Revised: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe clinical features of the youngest patient with well-documented HLA-A29-positive birdshot chorioretinopathy (BCR). Observations A 17-year-old female presented with poor night vision and floaters. Examination revealed bilateral vitritis, retinal vasculitis, and numerous cream-colored ovoid lesions in the fundus. Fluorescein angiography revealed bilateral optic disc leakage, large vessel leakage and diffuse capillary ferning. There were hundreds of small hypocyanescent spots evenly distributed in the posterior pole of both eyes on indocyanine green angiography. Workup was positive for HLA-A29.2. Systemic immunosuppression with adalimumab 40mg/0.4mL was initiated every two weeks and escalated to weekly dosing. The patient's early age of disease onset prompted evaluation of her parents. The mother's exam was normal and she was HLA-A29 negative. Examination of the father revealed peripapillary choroidal lesions as well as hypocyanescent spots on ICG. HLA-typing revealed the presence of HLA-A29.2. Conclusions and Importance BCR rarely occurs in the pediatric population. We present the youngest patient with well-documented BCR in the literature to highlight that this disease deserves consideration even in young patients. Interestingly, choroidal lesions were also found in an asymptomatic parent with HLA-A29.2 positivity.
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Affiliation(s)
- Jennifer Lee
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
| | - Wendy M Smith
- Uveitis Service, Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
| | - Debra A Goldstein
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
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