Life | Special Issue : Novel Diagnosis and Therapeutics Approaches in Retina Diseases

Research

11 pages, 1201 KiB

Open AccessArticle

Retromode Scanning Laser Ophthalmoscopy for Choroidal Nevi: A Preliminary Study

by Claudia Azzolini, Maura Di Nicola, Francesco Pozzo Giuffrida, Francesca Cappelli, Claudia Bellina, Francesco Viola and Paolo Chelazzi

Life 2023, 13(6), 1253; https://doi.org/10.3390/life13061253 - 25 May 2023

Cited by 3 | Viewed by 1085

Abstract

The purpose of the present study was to document pathological findings on retromode imaging in choroidal nevi and evaluate its diagnostic validity, using the confocal scanning laser ophthalmoscope Nidek Mirante (cSLO). A total of 41 choroidal nevi from 41 patients were included. All [...] Read more.

The purpose of the present study was to document pathological findings on retromode imaging in choroidal nevi and evaluate its diagnostic validity, using the confocal scanning laser ophthalmoscope Nidek Mirante (cSLO). A total of 41 choroidal nevi from 41 patients were included. All patients underwent multicolor fundus (mCF), infrared reflectance (IR), green fundus autofluorescence (FAF), dark-field (DF) and retromode (RM) imaging and optical coherence tomography (OCT) scans. We investigated retromode images to evaluate choroidal nevus features by comparing the results with those of mCF, IR, FAF, DF and OCT. In 100% of available images, retromode scanning laser ophthalmoscopy was able to detect choroidal nevi with a characteristic “hypo-retro-reflective” pattern, even the cases not visible on mCF, IR and FAF images. It also made it possible to delineate the margins of lesions with the highest rate of sharpness and accuracy among the imaging modalities examined. These findings seem to demonstrate how RM-SLO is an innovative diagnostic tool to detect and follow up choroidal nevi in a fast, reliable and non-invasive way. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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12 pages, 5119 KiB

Open AccessArticle

Relationship Between Retinal Microcirculation and Renal Function in Patients with Diabetes and Chronic Kidney Disease by Laser Speckle Flowgraphy

by Takeshi Iwase, Yoshitaka Ueno, Ryo Tomita and Hiroko Terasaki

Life 2023, 13(2), 424; https://doi.org/10.3390/life13020424 - 02 Feb 2023

Cited by 4 | Viewed by 2102

Abstract

This study investigated the effect of renal dysfunction categorized by the stage of chronic kidney disease (CKD) on the retinal microcirculation assessed by laser speckle flowgraphy (LSFG) and retinal artery caliber measured by adaptive optics imaging in diabetic patients particularly the early stage [...] Read more.

This study investigated the effect of renal dysfunction categorized by the stage of chronic kidney disease (CKD) on the retinal microcirculation assessed by laser speckle flowgraphy (LSFG) and retinal artery caliber measured by adaptive optics imaging in diabetic patients particularly the early stage of retinopathy and nephropathy. We divided the patients with diabetes into three groups based on the CKD stage (non-CKD (n = 54); CKD stage 1 + 2 (n = 20); CKD stage 3 (n = 41)). The mean blur rate (MBR) of the stage 3 CKD group was significantly lower than that of the no-CKD group (p < 0.015). The total retinal flow index (TRFI) in the stage 3 CKD group was significantly lower than that of the no-CKD group (p < 0.002). Multiple regression analysis demonstrated that CKD stage was independently associated with MBR (β = −0.257, p = 0.031) and TRFI (β = −0.316, p = 0.015). No significant differences were observed in external diameter, lumen diameter, wall thickness, and wall to lumen ratio among the groups. These results indicated that the ONH MBR and TRFI as assessed by LSFG decreases in diabetic patients with stage 3 CKD, but the arterial diameter measured by adaptive optics imaging does not change, suggesting that impaired renal function may be associated with decreased retinal blood flow in early-stage diabetic retinopathy. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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9 pages, 1241 KiB

Open AccessArticle

Dynamics of Epiretinal Membrane Peeling under Perfluorocarbon Liquid Evaluated by Intraoperative OCT

by Tomaso Caporossi, Stefano Maria Picardi, Gloria Gambini, Antonio Baldascino, Matteo Mario Carlà, Andrea Molle, Alessandra Scampoli, Lorenzo Governatori and Stanislao Rizzo

Life 2023, 13(2), 253; https://doi.org/10.3390/life13020253 - 17 Jan 2023

Cited by 1 | Viewed by 1543

Abstract

Background: The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS). Methods: This is a prospective, interventional, single-center study on a [...] Read more.

Background: The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS). Methods: This is a prospective, interventional, single-center study on a series of 36 consecutive eyes of 36 patients affected by primary epiretinal membrane (ERM). Eighteen eyes underwent standard ERM peeling, while 18 eyes received a PFCL-assisted procedure. Intraoperative optical coherence tomography (iOCT) B-Scans were collected to evaluate the displacement angle (DA) between the underlying retinal plane and the flap of epiretinal tissue, along with the number of times the surgeon had to grab the flap during the intervention. Follow-up visits were carried out at postoperative week 1 and months 1, 3 and 6. Results: The mean DA was 164.8° ± 4.0 in the PFCL-assisted group and 119.7° ± 8.7 in the standard group, with a statistically significant difference between groups (p < 0.001). Moreover, we found a significant difference in the amount of ERM grabs between the two groups (7.2 ± 2.5 in the PFCL-assisted group vs. 10.3 ± 3.1 in the standard group, p = 0.005). The mean BCVA and metamorphopsia significantly improved in both groups (p < 0.05), with no significant intergroup difference at all follow-up visits. Similarly, CST significantly decreased in both groups, and final CST was similar between the two groups (p = 0.719). Overall, three eyes in the standard group developed postoperative dissociated optic nerve fiber layer (DONFL, 16.6%), compared to none of the PFCL-assisted group. Conclusion: We reported a statistically significant difference in the intraoperative peeling dynamics of the PFCL-assisted group, accounting for a decreased tendency in the tearing of the ERM flap and possibly reduced damage to the fiber layer, with equal effectiveness in improving visual function and foveal thickness. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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11 pages, 5944 KiB

Open AccessArticle

Subretinal Transplant of Human Amniotic Membrane in Advanced Age-Related Macular Degeneration

by Tomaso Caporossi, Alessandra Scampoli, Antonio Baldascino, Gloria Gambini, Bianca Pacini, Lorenzo Governatori, Daniela Bacherini, Matteo Mario Carlà, Emanuele Crincoli, Clara Rizzo, Raphael Kilian and Stanislao Rizzo

Life 2022, 12(12), 1998; https://doi.org/10.3390/life12121998 - 30 Nov 2022

Cited by 1 | Viewed by 1123

Abstract

Macular neovascularization (MNV) and geographic atrophy can complicate age-related macular degeneration (AMD) and lead to severe visual acuity reduction. Despite the medical treatments available, with a defect in the retinal pigmented epithelium (RPE) there is no possibility of restoring acceptable visual acuity. We [...] Read more.

Macular neovascularization (MNV) and geographic atrophy can complicate age-related macular degeneration (AMD) and lead to severe visual acuity reduction. Despite the medical treatments available, with a defect in the retinal pigmented epithelium (RPE) there is no possibility of restoring acceptable visual acuity. We evaluated postoperative outcomes in patients affected by advanced AMD who underwent subretinal implant of the human amniotic membrane (hAM) as a source of pluripotent stem cells. This retrospective, consecutive, non-randomized interventional study included 23 eyes of 21 patients affected by AMD complicated by MNV, and five eyes of five patients affected by geographic atrophy. All eyes underwent a pars plana vitrectomy, neovascular membrane removal for the MNV group, a subretinal implant of hAM, and gas tamponade, and were followed for 12 months. The primary study outcome was visual acuity improvement. Secondary outcomes were postoperative complications, OCT-angiography parameters correlated with best-corrected visual acuity (BCVA) and MNV recurrence. The mean preoperative BCVA was 1.9 logMAR, and the mean final BCVA value was 1.2 logMAR. In the MNV group, the mean BCVA improved from 1.84 logMAR to 1.26 logMAR, and from 1.84 logMAR to 1.32 logMAR in the geographic atrophy group. No MNV recurrence was evident in 12 months of follow-up. An OCT-angiography scan was used to evaluate the retinal vascularization in the treated eye, which showed a high correlation between BCVA and deep vascular density. This study demonstrates the hAM potential and safety in promoting a partial restoration of retinal function together with an increase in visual acuity. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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13 pages, 2761 KiB

Open AccessArticle

Comparison of Retinal Imaging Techniques in Individuals with Pulmonary Artery Hypertension Using Vessel Generation Analysis

by Mariana DuPont, John Hunsicker, Simona Shirley, William Warriner, Annabelle Rowland, Reddhyia Taylor, Michael DuPont, Jr., Mark Lagatuz, Taygan Yilmaz, Andrew Foderaro, Tim Lahm, Corey E. Ventetuolo and Maria B. Grant

Life 2022, 12(12), 1985; https://doi.org/10.3390/life12121985 - 28 Nov 2022

Viewed by 1909

Abstract

(1) Background: Retinal vascular imaging plays an essential role in diagnosing and managing chronic diseases such as diabetic retinopathy, sickle cell retinopathy, and systemic hypertension. Previously, we have shown that individuals with pulmonary arterial hypertension (PAH), a rare disorder, exhibit unique retinal vascular [...] Read more.

(1) Background: Retinal vascular imaging plays an essential role in diagnosing and managing chronic diseases such as diabetic retinopathy, sickle cell retinopathy, and systemic hypertension. Previously, we have shown that individuals with pulmonary arterial hypertension (PAH), a rare disorder, exhibit unique retinal vascular changes as seen using fluorescein angiography (FA) and that these changes correlate with PAH severity. This study aimed to determine if color fundus (CF) imaging could garner identical retinal information as previously seen using FA images in individuals with PAH. (2) Methods: VESGEN, computer software which provides detailed vascular patterns, was used to compare manual segmentations of FA to CF imaging in PAH subjects (n = 9) followed by deep learning (DL) processing of CF imaging to increase the speed of analysis and facilitate a noninvasive clinical translation. (3) Results: When manual segmentation of FA and CF images were compared using VESGEN analysis, both showed identical tortuosity and vessel area density measures. This remained true even when separating images based on arterial trees only. However, this was not observed with microvessels. DL segmentation when compared to manual segmentation of CF images showed similarities in vascular structure as defined by fractal dimension. Similarities were lost for tortuosity and vessel area density when comparing manual CF imaging to DL imaging. (4) Conclusions: Noninvasive imaging such as CF can be used with VESGEN to provide an accurate and safe assessment of retinal vascular changes in individuals with PAH. In addition to providing insight into possible future clinical translational use. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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29 pages, 5936 KiB

Open AccessArticle

Application of Machine Learning to Ranking Predictors of Anti-VEGF Response

by Janan Arslan and Kurt K. Benke

Life 2022, 12(11), 1926; https://doi.org/10.3390/life12111926 - 18 Nov 2022

Cited by 1 | Viewed by 1470

Abstract

Age-related macular degeneration (AMD) is a heterogeneous disease affecting the macula of individuals and is a cause of irreversible vision loss. Patients with neovascular AMD (nAMD) are candidates for the anti-vascular endothelial growth factor (anti-VEGF) treatment, designed to regress the growth of abnormal [...] Read more.

Age-related macular degeneration (AMD) is a heterogeneous disease affecting the macula of individuals and is a cause of irreversible vision loss. Patients with neovascular AMD (nAMD) are candidates for the anti-vascular endothelial growth factor (anti-VEGF) treatment, designed to regress the growth of abnormal blood vessels in the eye. Some patients fail to maintain vision despite treatment. This study aimed to develop a prediction model based on features weighted in order of importance with respect to their impact on visual acuity (VA). Evaluations included an assessment of clinical, lifestyle, and demographic factors from patients that were treated over a period of two years. The methods included mixed-effects and relative importance modelling, and models were tested against model selection criteria, diagnostic and assumption checks, and forecasting errors. The most important predictors of an anti-VEGF response were the baseline VA of the treated eye, the time (in weeks), treatment quantity, and the treated eye. The model also ranked the impact of other variables, such as intra-retinal fluid, haemorrhage, pigment epithelium detachment, treatment drug, baseline VA of the untreated eye, and various lifestyle and demographic factors. The results identified variables that could be targeted for further investigation in support of personalised treatments based on patient data. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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18 pages, 5887 KiB

Open AccessArticle

Distinguished Functions of Microglia in the Two Stages of Oxygen-Induced Retinopathy: A Novel Target in the Treatment of Ischemic Retinopathy

by Ziyi Zhou, Yutong Jing, Yali Niu, Tianfang Chang, Jiaxing Sun, Changmei Guo, Yusheng Wang and Guorui Dou

Life 2022, 12(10), 1676; https://doi.org/10.3390/life12101676 - 21 Oct 2022

Cited by 4 | Viewed by 1729

Abstract

Microglia is the resident immune cell in the retina, playing the role of immune surveillance in a traditional concept. With the heated focus on the mechanisms of microglia in pathological conditions, more and more functions of microglia have been discovered. Although the regulating [...] Read more.

Microglia is the resident immune cell in the retina, playing the role of immune surveillance in a traditional concept. With the heated focus on the mechanisms of microglia in pathological conditions, more and more functions of microglia have been discovered. Although the regulating role of microglia has been explored in ischemic retinopathy, little is known about its mechanisms in the different stages of the pathological process. Here, we removed microglia in the oxygen-induced retinopathy model by PLX5622 and revealed that the removal of activated microglia reduced pathological angiogenesis in the early stage after ischemic insult and alleviated the over-apoptosis of photoreceptors in the vessel remodeling phase. Our results indicated that microglia might play distinguished functions in the angiogenic and remodeling stages, and that the inhibition of microglia might be a promising target in the future treatment of ischemic retinopathy. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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10 pages, 1728 KiB

Open AccessArticle

Optical Coherence Tomography Reflectivity in Foveal Cysts: A Novel Biomarker for Early-Response Prediction of Diabetic Macular Edema Treated with Dexamethasone

by Daniel Duck-Jin Hwang

Life 2022, 12(10), 1475; https://doi.org/10.3390/life12101475 - 23 Sep 2022

Viewed by 1714

Abstract

This study investigated spectral-domain optical coherence tomography (OCT) biomarkers to predict short-term anatomical improvement for diabetic macular edema (DME) after dexamethasone (DEX) injection in intravitreal anti-vascular endothelial growth factor (anti-VEGF) non-responders. This retrospective comparative study included 31 eyes of 31 patients with DME [...] Read more.

This study investigated spectral-domain optical coherence tomography (OCT) biomarkers to predict short-term anatomical improvement for diabetic macular edema (DME) after dexamethasone (DEX) injection in intravitreal anti-vascular endothelial growth factor (anti-VEGF) non-responders. This retrospective comparative study included 31 eyes of 31 patients with DME unresponsive to anti-VEGF, divided into better and lesser responder groups. OCT prior to DEX injection was used to evaluate the morphological features including optical density (ODN) and optical density ratio (ODR) of the outer nuclear layer (ONL) cysts. Correlations between baseline OCT parameters and mean central macular thickness (CMT) changes at 1 month were analyzed. There were no between-group differences in age, sex, number of previous anti-VEGF injections, duration of diabetes, or HbA1c level. However, ODN and ODR values in ONL cysts were lower in the better responder group (p = 0.020 and p < 0.001, respectively). ODN and ODR showed negative correlations with CMT changes (R = −0.546, p = 0.002 and R = −0.436, p = 0.014, respectively). Higher OCT reflectivity in the foveal cystoid space was associated with a lesser decrease in CMT after DEX injection in anti-VEGF non-responders, suggesting the usefulness of this parameter in predicting short-term CMT responses after DEX injection. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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13 pages, 5446 KiB

Open AccessArticle

Adaptive Optics Imaging to Analyze the Photoreceptor Layer Reconstitution in Acute Syphilitic Posterior Placoid Chorioretinopathy

by Fabrizio Giansanti, Stefano Mercuri, Lorenzo Vannozzi, Andrea Govetto, Angelo Maria Minnella, Tomaso Caporossi, Alfonso Savastano, Maria Cristina Savastano, Gloria Gambini, Stanislao Rizzo, Gianni Virgili and Daniela Bacherini

Life 2022, 12(9), 1361; https://doi.org/10.3390/life12091361 - 31 Aug 2022

Cited by 2 | Viewed by 1265

Abstract

Acute posterior syphilitic placoid chorioretinopathy (ASPPC) is a rare ocular manifestation of syphilis characterized by outer retinal layers involvement and drop in visual acuity. The current work documents outer retinal layer involvement in this pathology and their reconstitution with treatment by means of [...] Read more.

Acute posterior syphilitic placoid chorioretinopathy (ASPPC) is a rare ocular manifestation of syphilis characterized by outer retinal layers involvement and drop in visual acuity. The current work documents outer retinal layer involvement in this pathology and their reconstitution with treatment by means of adaptive optics (AO). Three eyes of two patients together with four controls eyes were included in the study. Patients underwent optical coherence tomography (OCT) and OCT angiography (OCTA) scan centered on fovea, where vessel density (VD) and vessel perfusion (VP) were calculated. AO images centered on fovea were acquired and cone density (CD) and cone spacing (CS) were measured and compared to control group. Multimodal imaging was performed at presentation, at 10 days, and at 2-month follow-up. All eyes improved in visual acuity, with reconstitution in outer retinal layers at 2-month follow-up. Overall choriocapillary layer VD and VP improved. AO imaging was able to identify outer retinal alterations at presentation and at follow-ups, with improvement in tissue architecture. CD and CS was respectively lower and greater than controls at all follow-ups and improved within patients at the 2-month follow-up. In conclusion, AO was able to document outer retinal alterations in ASPPC at presentation and improvement over the follow-up, representing a tool to study photoreceptor layer involvement in this pathology. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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Review

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10 pages, 834 KiB

Open AccessReview

Relaxing Retinotomy in Recurrent and Refractory Full-Thickness Macular Holes: The State of the Art

by Luca Ventre, Erik Mus, Fabio Maradei, Roberto Imparato, Giulia Pintore, Guglielmo Parisi, Paola Marolo and Michele Reibaldi

Life 2023, 13(9), 1844; https://doi.org/10.3390/life13091844 - 31 Aug 2023

Viewed by 695

Abstract

The prevailing standard of care for primary repair of full-thickness macular holes (FTMHs) is pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, as it gives a high closure rate of roughly 90%. On the other hand, the surgical management [...] Read more.

The prevailing standard of care for primary repair of full-thickness macular holes (FTMHs) is pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, as it gives a high closure rate of roughly 90%. On the other hand, the surgical management of recurrent and refractory FTMHs represents, so far, a demanding and debated subject in vitreoretinal surgery since various approaches have been proposed, with no consensus concerning both adequate selection criteria and the best surgical approach. In addition, the existence of multiple case series/interventional studies showing comparable results and the lack of studies with a direct comparison of multiple surgical techniques may lead to uncertainty. We present an organized overview of relaxing retinotomy technique, a surgical approach available nowadays for the secondary repair of recurrent and refractory FTMHs. Besides the history and the description of the various techniques to perform relaxing retinotomies, we underline the results and the evidence available to promote the use of this surgical approach. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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Other

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8 pages, 10847 KiB

Open AccessCase Report

Inverted ILM Flap for a Needle Injury to the Macula after Peribulbar Anaesthesia: A Case Report and Literature Review

by Alessandra Scampoli, Lorenzo Governatori, Patrizio Bernardinelli, Stefano Maria Picardi, Carola Culiersi and Tomaso Caporossi

Life 2023, 13(6), 1390; https://doi.org/10.3390/life13061390 - 14 Jun 2023

Viewed by 778

Abstract

Globe perforation following peribulbar anesthetic injection is a rare but dreaded complication that often results in poor visual outcomes. This case report is on a female patient who sustained vitreous hemorrhage, retinal detachment, and macular breaks due to a peribulbar block administered in [...] Read more.

Globe perforation following peribulbar anesthetic injection is a rare but dreaded complication that often results in poor visual outcomes. This case report is on a female patient who sustained vitreous hemorrhage, retinal detachment, and macular breaks due to a peribulbar block administered in the setting of cataract extraction. The retina was repaired with pars plana vitrectomy, endolaser of the peripheral retinal break only, and an internal limiting membrane inverted flap for the macular breaks to avoid the endolaser on the macular area, achieving stable visual outcomes. The authors discussed various modes of local anesthesia for vitreoretinal surgery, risks for globe perforations, and how to approach retinal detachment secondary to needle perforations, which are complex cases at high risk for proliferative vitreoretinopathy. Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer axial length, superior, and multiple perforations are at higher risk of developing complications such as retinal detachment and vitreous hemorrhage. Complications such as retinal detachment, macular injury, and vascular occlusion are risk factors for poor prognosis. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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8 pages, 777 KiB

Open AccessBrief Report

External Subretinal Fluid Drainage in Scleral Buckling: Before Versus after Cryotherapy and Buckle Placement, A Pilot Study

by Tessnim R. Ahmad, Gregory J. Bever and Jay M. Stewart

Life 2023, 13(2), 284; https://doi.org/10.3390/life13020284 - 19 Jan 2023

Viewed by 1739

Abstract

In this retrospective comparative case series at a teaching hospital, we reviewed adult patients with rhegmatogenous retinal detachment who underwent scleral buckling surgery with external drainage of subretinal fluid performed before versus after placement of the scleral buckle. Eight eyes in each group [...] Read more.

In this retrospective comparative case series at a teaching hospital, we reviewed adult patients with rhegmatogenous retinal detachment who underwent scleral buckling surgery with external drainage of subretinal fluid performed before versus after placement of the scleral buckle. Eight eyes in each group were roughly matched for age, sex, baseline visual acuity (VA), and detachment characteristics. The complication rate was 0% for the “before” group and 37% for the “after” group (p = 0.100). In the “after” group, two eyes (25%) developed iatrogenic retinal holes and one eye (12%) developed self-limited subretinal hemorrhage during external needle drainage. The duration of surgery was significantly shorter for the “before” group (mean 89 ± 16 min) compared to the “after” group (118 ± 20 min) (p = 0.008). The primary anatomic success rate was 100% for the “before” group and 75% for the “after” group (p = 0.233). Final VA was not significantly different between the groups or from baseline. In conclusion, while limited by our small sample size, this pilot study suggests that drainage of subretinal fluid before scleral buckle placement may be safer and more efficient compared to draining after buckle placement. Initial drainage may facilitate retinochoroid apposition to allow targeted cryopexy and precise buckle placement. Full article

(This article belongs to the Special Issue Novel Diagnosis and Therapeutics Approaches in Retina Diseases)

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