Deep Plexus Research Articles

OCT-Angiography in Detecting Preclinical Diabetic Retinopathy

The introduction of OCT-angiography was a milestone in studying the early stages of diabetic retinopathy (DR). The latest findings show significant changes in foveal avascular zone (FAZ) parameters (FAZ area, FAZ perimeter, acirculatory index, axis ratio, FAZ angle) in diabetes mellitus (DM) patients with no ophthalmoscopic signs of DR. Many research groups evaluate vessel density (VD) in superficial and deep plexuses in these patients using different methods of image postprocessing, different qualitative and quantitative parameters. Nonperfusion areas (NA) are very important findings at the preclinical stage of DR, which can be detected in superficial and deep layers. With OCT-A it is possible not only to reveal them but also to calculate their area. Vascular tortuosity (VT) was described earlier using fundus photography. Nowadays VT can be assessed at the microcirculation level in OCT-A scans. Microaneurysms are the earliest clinical sign of DR. They can be missed in fundus photos, but easily detected with OCT-A. The aim of the current review is to analyze the latest OCT-A findings at the preclinical stage of DR and to discuss the future diagnostic value of OCT-A in DR.

Macular Telangiectasia Type 2: Case Report and Clinical Review

Background: Macular telangiectasia type 2 is a bilateral condition of unknown etiology, typically manifesting during the fourth to sixth decades of life. Its prevalence is likely underestimated as there is low disease awareness, both amongst clinicians and patients, and it is often misdiagnosed as age-related macular degeneration in later stages. It is important to understand the pathophysiology, natural history, prognosis, and potential complications to manage this condition properly and provide accurate patient education. Case Report: A 75-year-old white male presented with gradual worsening of vision at all distances for years. Fundus examination revealed bilateral foveal circular red spot with parafoveal pigment clumping in the left eye along with bilateral scattered refractile crystalline deposits. Optical coherence tomography of the macula revealed internal limiting membrane drape in both eyes with focal disruptions to the ellipsoid zone in the left eye. Optical coherence tomography angiography revealed telangiectatic vessels, evident in the superficial and deep plexus, increased intervascular spaces involving the superficial and deep plexus, as well as right-angled vessels and foveal avascular zone irregularities. There was no evidence of progression to proliferative disease and the patient’s vision had remained stable for six years. Conclusion: Macula telangiectasia type 2 is a neurodegenerative disease with the potential to cause vision loss. Newer imaging modalities, specifically optical coherence tomography and optical coherence tomography angiography, have become important diagnostic tools and useful in identifying this disease at earlier stages and differentiating it from other macular degenerative conditions. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/macular-telangiectasia-type-2-case-report-and-clinical-review) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Volume Rendering of Deep Retinal Age-Related Microvascular Anomalies

To characterize and distinguish non-neovascular deep retinal age-related microvascular anomalies (DRAMA) from type 3 macular neovascularization (MNV) using volume rendering of OCT and OCT angiography (OCTA). Retrospective, consecutive case series. Consecutive patients with age-related macular degeneration (AMD) exhibiting de novo non-neovascular abnormalities within the deep vascular plexus (DCP), as detected using high-resolution (High-Res) spectral-domain (SD) and swept-source (SS) OCT or OCTA. Patients with retinal vascular alterations attributable to other disease entities were excluded. Complete ophthalmic examination and multimodal imaging, including confocal fundus photography (CFP), SD-OCT, High-Res SD-OCT and OCTA, and volume-averaged SS-OCTA. The volume renderings of High-Res OCTA and averaged SS-OCTA were used to analyze capillary abnormalities and inflow or outflow connectivity pathways. The primary outcomes were the characteristics of capillary abnormalities (number, size, shape, reflectivity, and location) and inflow or outflow connectivity pathways. The secondary outcomes were nearby changes in CFP and structural OCT (hyperreflective foci [HRF], outer retinal atrophy, and retinal pigment epithelium [RPE] atrophy). From 8 eyes of 8 patients, 2 subtypes of DRAMA were identified: small-diameter perifoveal capillary dilations with hyperreflective walls within the inner nuclear layer (type 1, n= 4) and vascular outpouchings, typically multiple, extending posteriorly into the Henle fiber layer, with reflectivity similar to adjacent normal retinal capillaries (type 2, n= 10). Four eyes had both subtypes of DRAMA. The 3-dimensional visualization of OCTA data demonstrated DRAMA corresponding to the dilations of DCP capillaries without direct inflow or outflow connections to the superficial plexus. Fundus photographs showed circular red dots in 3 eyes, all corresponding to type 1 DRAMA. In all the cases, DRAMA colocalized with HRF. No lesions were found anterior to the areas of the RPE or outer retina atrophy. Asymptomatic intraretinal exudation varied through a follow-up duration of up to 6 years, with no lesions progressing to type 3 MNV. In eyes with non-neovascular AMD, DRAMA include 2 types of capillary dilations occurring without the remodeling of the surrounding vascular network. Deep retinal age-related microvascular anomalies can resemble microvascular changes due to other causes and can masquerade as type 3 MNV. Mild intraretinal exudation can vary during follow-up, without progression to type 3 MNV.

Retinal Microvascular Changes in COVID-19 Bilateral Pneumonia Based on Optical Coherence Tomography Angiography.

The purpose of this study was to evaluate retinal and choroidal microvascular alterations with optical coherence tomography angiography (OCTA) in COVID-19 patients hospitalized because of bilateral pneumonia caused by SARS-CoV-2. The vessel density (VD) and foveal avascular zone (FAZ) of 63 patients with SARS-CoV-2 pneumonia who had positive polymerase chain reaction (PCR) tests and who recovered after receiving treatment and 45 healthy age- and gender-matched controls were evaluated and compared using OCTA in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). The VD was also estimated in both groups in the choriocapillaris (CC). In COVID-19 patients, there was a statistically significant difference between the patients and a control group in both superficial (FAZs) and deep (FAZd) avascular zone (p = 0.000). The VD was significantly lower in the foveal area in choriocapillaris (p = 0.046). There were no statistically significant changes in the VD in the superior, inferior, nasal, and temporal quadrants in superficial and deep plexus, or in the choriocapillaris. The VD was not significantly lower in the foveal area in superficial or deep plexus. COVID-19 may affect the retinal vasculature, causing ischemia, enlargement of the FAZ, and lowering of the VD in the choriocapillaris area. Routine ophthalmic examination after SARS-CoV-2 infection should be considered in the course of post-infectious rehabilitation.

Evaluation of macular vascular density and foveal avascular zone changes by optical coherence tomography angiography (OCT-A) after intravitreal dexamethasone implant in diabetic macular edema resistant to Anti-VEGF treatment.

Analysis of foveal avascular zone (FAZ) width and vascular density (VD) changes before and after intravitreal dexamethasone implant (IDI) treatment in diabetic macular edema (DME) patients resistant to anti-VEGF treatment. In this retrospective study, patients who were regularly treated with at least 5 doses of intravitreal Anti-VEGF (bevacizumab, ranibizumab or aflibercept) for DME and whose DME continued were considered resistant to Anti-VEGF and were treated with IDI for the first time. Thirty-four eyes of 34 patients were included in the study. FAZ and VD values of optical coherence tomography angiography (OCT-A) scans at 0, 1 and 3months were examined. In OCT-A measurements, the pre-IDI superficial plexus FAZ (SFAZ) area (0.350 ± 0.120 mm2) was decreased at 1 (0.292 ± 0.132 mm2, p < 0.001) and at 3months (0.311 ± 0.153 mm2, p = 0.017). Pre-IDI deep plexus FAZ (DFAZ) area (0.651 ± 0.313 mm2) was decreased at 1-month post-IDI (0.481 ± 0.247 mm2, p < 0.001) while no significant change was observed at 3months (0.575 ± 0.259 mm2, p = 0.197). There was no significant change in the mean post-IDI total VD rate in both superficial (pre 39.2% ± 2.4; 1st month 39.2% ± 2.6%; 3rd month 39.5% ± 3.4%) and deep retinal plexus (pre 43.3% ± 2.6%; 1st month 43.5 ± 2.8%; 3rd month 43.6% ± 4.6%) (p = 0.408 and p = 0.607, respectively). The study showed that IDI caused a significant decrease in the FAZ area without any change in VD in patients with DME resistant to the anti-VEGF agents. IDI might be related to a decrease in the macular ischemia secondary to diabetic retinopathy.

Antioxidant Properties of Cerium Oxide Nanoparticles Prevent Retinal Neovascular Alterations In Vitro and In Vivo.

In this study, we investigated whether cerium oxide nanoparticles (CeO2-NPs), a promising antioxidant nanomaterial, may contrast retinal vascular alterations induced by oxidative damage in vitro and in vivo. For the in vivo experiments, the light damage (LD) animal model of Age-Related Macular Degeneration (AMD) was used and the CeO2-NPs were intravitreally injected. CeO2-NPs significantly decreased vascular endothelial growth factor (VEGF) protein levels, reduced neovascularization in the deep retinal plexus, and inhibited choroidal sprouting into the photoreceptor layer. The in vitro experiments were performed on human retinal pigment epithelial (ARPE-19) cells challenged with H2O2; we demonstrated that CeO2-NPs reverted H2O2-induced oxidative stress-dependent effects on this cell model. We further investigated the RPE–endothelial cells interaction under oxidative stress conditions in the presence or absence of CeO2-NPs through two experimental paradigms: (i) treatment of human umbilical vein endothelial cells (HUVECs) with conditioned media from ARPE-19 cells, and (ii) coculture of ARPE-19 and HUVECs. In both experimental conditions, CeO2-NPs were able to revert the detrimental effect of H2O2 on angiogenesis in vitro by realigning the level of tubule formation to that of the control. Altogether, our results indicate, for the first time, that CeO2-NPs can counteract retinal neovascularization and may be a new therapeutic strategy for the treatment of wet AMD.

Retinal Vascular Study Using OCTA in Subjects at High Genetic Risk of Developing Alzheimer's Disease and Cardiovascular Risk Factors.

In 103 subjects with a high genetic risk of developing Alzheimer’s disease (AD), family history (FH) of AD and ApoE ɛ4 characterization (ApoE ɛ4) were analyzed for changes in the retinal vascular network by OCTA (optical coherence tomography angiography), and AngioTool and Erlangen-Angio-Tool (EA-Tool) as imaging analysis software. Retinal vascularization was analyzed by measuring hypercholesterolemia (HCL) and high blood pressure (HBP). Angio-Tool showed a statistically significant higher percentage of area occupied by vessels in the FH+ ApoE ɛ4- group vs. in the FH+ ApoE ɛ4+ group, and EA-Tool showed statistically significant higher vascular densities in the C3 ring in the FH+ ApoE ɛ4+ group when compared with: i)FH- ApoE ɛ4- in sectors H3, H4, H10 and H11; and ii) FH+ ApoE ɛ4- in sectors H4 and H12. In participants with HCL and HBP, statistically significant changes were found, in particular using EA-Tool, both in the macular area, mainly in the deep plexus, and in the peripapillary area. In conclusion, OCTA in subjects with genetic risk factors for the development of AD showed an apparent increase in vascular density in some sectors of the retina, which was one of the first vascular changes detectable. These changes constitute a promising biomarker for monitoring the progression of pathological neuronal degeneration.

Исследование макулярного кровотока сетчатки при глаукоме нормального давления

Purpose. To study the blood flow of the macular area of the retina in the superficial and deep choroid plexuses using the OCTA method in patients with newly diagnosed normal tension glaucoma. Material and methods. 29 patients (50 eyes) with newly diagnosed normal pressure glaucoma aged 45 to 65 years with initial (28.0 %), advanced (42 %) and advanced (30 %) stages of the disease were examined. Results and discussion. The OCTA method revealed changes in the indicators of microcirculation of the macular zone of the retina in the fovea and parafovea. The index of vessel density in patients with different stages of the disease was significantly reduced in the superficial and deep vascular plexuses and by sector in the eyes with different stages of the disease. Conclusion. In patients with normal tension glaucoma, according to OCTA data, microcirculation disorders of the macular area of the retina at the levels of the superficial and deep vascular plexuses were revealed, increasing with the progression of the disease. Keywords: normal pressure glaucoma, primary open angle glaucoma, optical coherence tomography with angiography, microcirculation.

Microvascular changes in the recurrent cystoid macular edema secondary to posterior noninfectious uveitis on optical coherence tomography angiography

BackgroundPosterior uveitis represents the second most frequent type of uveitis (15–30% of all uveitis). Noninfectious posterior uveitis complicated with secondary cystoid macular edema (CME) affects the visual prognosis negatively. The objective of the current study is to detect possible microvascular changes causing relapsing uveitis-related CME using optical coherence tomography angiography (OCTA).MethodsThis is an interventional, observational, retrospective study with 1 year follow-up. Patients with noninfectious, posterior uveitis-related CME undergoing dexamethasone (DEX) implant were evaluated. Following the DEX-implant were carried out control visits after 1 month, 2-months, 4-months, 6-months, and for up 1-year. A total of 76 eyes of 38 consecutive patients with noninfectious posterior uveitis were enrolled (consecutive sample). Complicated noninfectious posterior uveitis with secondary CME was diagnosed in 56 eyes of uveitis patients (73.7%) and reviewed.ResultsOur investigation showed (1) a reduction in superficial vessel plexus (SVP) measurements within 2-month (84%), reaching 96.4% for up 1-year, (2) an irregular profile of SVP in 69.6% of cases, persisting for up 1-year; relapsing uveitis-related CME eyes with irregular superficial foveal avascular zone (FAZ) profile were in 51%, while the SVP measurements reestablished in 100% of cases. Conversely, (3) the deep vascular plexus (DVP) parameters restored in a lower number of eyes within the 2-month (39.3%), remaining abnormal in 46.4% of cases for up 1-year; despite DVP restored in 53.6% of cases for up 1 year, (4) a capillary rarefaction ring around the FAZ appeared in 80.4% of cases; the relapsing uveitis-related CME eyes with abnormal DVP parameters were present in 41% of cases, of which 92.1% showed a rarefaction ring had abnormal DVP.ConclusionsThe use of OCTA enabled the evaluation in detail of retinal microvascular changes. We suggested that the possibility of the recurrence of the uveitis-related CME depends on the persistence of modifications of the superficial and deep layers. In this regard, we propose to implement the current imaging armamentarium with OCTA for the follow-up of patients with noninfectious uveitis-related CME.

Pharmacological inhibition of Na+/K+-ATPase induces neurovascular degeneration and glial cell alteration in the rat retina

Na+/K+-ATPase (NKA) plays an important role in ion homeostasis and neurotransmitter uptake. In the retina, multidirectional communications among neurons, glia, and blood vessels (that is, neuro-glio-vascular interaction) are crucial for maintaining tissue homeostasis. We investigated the role of NKA in the elements of neuro-glio-vascular unit in neonatal and adult rat retinas. Male Sprague-Dawley rats (1- and 8-week-old) were injected intravitreally with ouabain (20 nmol/eye), an inhibitor of NKA. Morphological changes in retinal neurons, glia, and blood vessels were examined. The intravitreal injection of ouabain decreased the number of cells in the ganglion cell layer, as well as the thicknesses of the inner plexiform and inner nuclear layers in neonatal and adult rats compared to age-matched controls. The ouabain-induced neuronal cell damage was partially prevented by D-(−)-2-amino-5-phosphonopentanoic acid, an antagonist of N-methyl-D-aspartic acid receptors. In the deep retinal vascular plexus of the ouabain-injected eyes, angiogenesis was delayed in neonatal rats, whereas capillary degeneration occurred in adult rats. The immunoreactivity of glutamine synthetase and vascular endothelial growth factor (VEGF) decreased in the retinas of neonatal and adult rats injected intravitreally with ouabain. The immunoreactivity of glial fibrillary acidic protein was enhanced in the retinas of ouabain-injected adult eyes. After the ouabain injection, CD45-positive leukocytes and Iba1-positive microglia increased in the inner retinal layer of neonatal rats, whereas they increased in the middle retinal layer of adult rats. These results suggest that the inhibition of NKA induces the degeneration of neuronal and vascular cells and alteration of glial cells in both neonatal and adult retinas. In addition to the direct effects of NKA inhibition, the disturbance of retinal glutamate metabolism and decreased VEGF expression may contribute to neurovascular degeneration. The activity of NKA is crucial for maintaining elements of neuro-glio-vascular unit in the retina.

One-year follow-up of optical coherence tomography angiography microvascular findings: macular telangiectasia type 2 versus tamoxifen retinopathy.

To compare microstructural and microvascular changes in eyes with macular telangiectasia type 2 (MacTel2) and in those with tamoxifen retinopathy (TR) at baseline and at the 1-year follow-up using optical coherence tomography (OCT) and OCT angiography (OCTA). We followed up patients diagnosed with MacTel2 or TR for at least 1year. We included 17 patients with MacTel2 (31 eyes) and 15 with TR (25 eyes) who discontinued tamoxifen use after a TR diagnosis. We performed OCT and OCTA at baseline and after 1year. Patients with MacTel2 and TR showed intraretinal cavitation, ellipsoid zone (EZ) loss, and capillary telangiectasia in the superficial and deep plexuses. EZ disruption predominantly affected the temporal region in MacTel2 (32%) and was limited to the foveal center in TR (24%). Vascular density (VD) was significantly reduced within the deep temporal parafovea and superficial fovea in MacTel2 and TR eyes, respectively. After 1year, the MacTel2 eyes showed enlarged EZ loss, proliferative vascular invasion, and increased VD (p = 0.021) in the temporal deep plexus compared with TR eyes. After 1-year follow-up, the MacTel2 eyes showed proliferative vascular remodeling, particularly in the temporal parafovea of the deep plexus with EZ loss progression, whereas the TR eyes maintained their baseline capillary rarefaction.

Elevated α-synuclein and NfL levels in tear fluids and decreased retinal microvascular densities in patients with Parkinson's disease.

The pathognomonic hallmark of Parkinson's disease (PD), α-synuclein, has been observed in the retina of PD patients. We investigated whether biomarkers in the tears and retinal microvascular changes associate with PD risk and progression. This prospective study enrolled 49 PD patients and 45 age-matched healthy controls. The α-synuclein and neurofilament light chain (NfL) levels were measured using an electrochemiluminescence immunoassay. Retinal vessel density was assessed using optical coherence tomography angiography (OCT-A). The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Mini-Mental State Examination score were used to assess motor and cognitive progression. The α-synuclein and NfL levels in the tears were higher in PD patients than in controls (α-synuclein: 55.49 ± 8.12pg/mL vs. 31.71 ± 3.25pg/mL, P = 0.009; NfL: 2.89 ± 0.52pg/mL vs. 1.47 ± 0.23pg/mL, P = 0.02). The vessel densities in the deep plexus of central macula and the radial peripapillary capillary layer of disc region were lower in PD patients with moderate-stage compared with early-stage PD (P < 0.05). The accuracy of predicting PD occurrence using age and sex alone (area under the curve [AUC] 0.612) was significantly improved by adding α-synuclein and NfL levels and retinal vascular densities (AUC 0.752, P = 0.001). After a mean follow-up of 1.5 ± 0.3years, the accuracy of predicting motor or cognitive progression using age, sex, and baseline motor severity as a basic model was increased by incorporating retinal microvascular and biofluid markers as a full model (P = 0.001). Our results showed that retinal microvascular densities combined with α-synuclein and NfL levels in tears are associated with risk and progression of PD.

Клинический опыт сочетанного применения ингибитора ангиогенеза афлиберцепта в лечении окклюзий ретинальных вен

Purpose. To evaluate the effectiveness of the combined use of aflibercept and sulodexide in the treatment of macular edema (ME) in retinal vein occlusions (RVO). Material and methods. In the course of the study, 30 patients with MO with acute respiratory infections not exceeding 1.5 months ago were monitored. All underwent a standard ophthalmological examination, as well as optical coherence tomography with angiography function and electrophysiological studies. To assess the effectiveness of the combined use of aflibercept and sulodexide, all patients were divided into two groups. In patients of the first group (n = 16), the first intravitreal injection of aflibercept was supplemented with a course of sulodexide. The second group (n = 14) did not receive sulodexide. Results. The degree of improvement in the functions of the eye in patients of the first group, who received sulodexide in complex treatment, is due to the maximum level of restoration of retinal microcirculation in the macula due to an increase in the density of the capillary network in the superficial and deep vascular plexuses of the retina by more than 1.2 times and a decrease in the area of its foveal avascular zone 1.5 times in comparison with the initial state. Conclusion. The results of the study showed the high efficiency of the combined use of aflibercept and sulodexide in the treatment of MO in acute respiratory infections and allow us to recommend their use to improve hemomicrocirculation in the macular retina and increase visual functions. Keywords: macular edema, retinal vein occlusion, aflibercept, sulodexide.

Microvascular Retinal Changes in Patients with Marfan Syndrome

Purpose To determine microvascular changes in patients with genetically proven Marfan syndrome. Methods In a cross-sectional study, 32 eyes of 16 patients with genetically proven Marfan syndrome were evaluated using swept-source optical coherence tomography angiography (SS-OCTA). Patients were analyzed regarding lens status and systemic vascular disease. The foveal avascular zone (FAZ) and vessel density (VD) of the superficial and deep vascular plexus and central retinal thickness (CRT) were evaluated on SS-OCTA. Results 44/56% patients presented without/with subluxation of the lens. 69% of patients had presence of mitral valve insufficiency, aortic dilatation or aneurysm of the aortic root. In patients with Marfan syndrome the mean area of the FAZ was 0.2 ± 0.1 mm and the average VD of the superficial/deep vascular plexus was 36 ± 5%/22 ± 7%. In patients with subluxation of the lens FAZ area and perimeter were larger when compared to patients without subluxation of the lens (0.18 ± 0.08/0.28 ± 0.10 mm and 1.7 ± 0.4/2.3 ± 0.8; p = 0.02). VD of the superficial vascular plexus was reduced in patients with subluxation of the lens (on average 39 ± 3/33 ± 8; p = 0.01) together with an increased CRT in the inner segments of the ETDRS grid when compared to patients without subluxation of the lens. In patients with systemic vascular disease a larger FAZ area (0.19 ± 0.06/0.25 ± 0.1 mm; p = 0.04) and reduced VD of the superficial vascular plexus in the central ETDRS grid (28 ± 7/21 ± 6; p = 0.02) was observed in comparison to patients without systemic vascular changes. Conclusions In patients with Marfan syndrome SS-OCTA imaging revealed microvascular differences in patients with lens subluxation and/or systemic vascular disease.

Microvascular and Morphologic Changes of the Macula over Lifetime.

In ocular, neurologic, and cardiovascular diseases, macular segmentation data from spectral-domain optical coherence tomography (SD-OCT) provide morphologic, and OCT-angiography (OCTA) results give microvascular information about the macula. Age was shown to influence both methods’ measurements. To further characterize this association, macular SD-OCT and OCTA changes were investigated in a population of juvenile, adult, and older individuals. Macular segment thickness and superficial (SCP) and deep plexus (DCP) vascular density (VD) of 157 healthy individuals aged 10–79 years were analyzed retrospectively. One-way analysis of variance (ANOVA) was used to compare age groups. The association between macular segmentation and OCTA parameters and between these and age was evaluated using linear regression. ANOVA and linear regression analysis showed a thickness decrease in the whole macular and in the ganglion cell and inner plexiform layers with age. While the foveal avascular zone area remained constant between age groups, VD of the SCP and DCP also decreased with age. In multiple linear regression, SCP and DCP VD were associated with inner macular segment thickness in an age-independent way. To conclude, the age-related microvascular and morphological changes in the macula described in this study can contribute to improving the understanding of macular aging processes and better interpreting OCT(A) results in healthy individuals and patients suffering from various retinal diseases.

Optical Coherence Tomography with Angiography in the Diagnosis of Changes in the Organ of Vision at Atherosclerosis

Background. The study of the parameters of optical coherence tomography with angiography (OCTA) broadens the understanding of the state of hemodynamics for the early detection of vascular disorders of the organ of vision in atherosclerosis (AS).Purpose. To study the parameters of OCTA with changes in the organ of vision against the background of AS.Patients and methods. 26 patients (41 eyes) with changes in the organ of vision in AS. The age contingent of patients ranged from 32 to 78 years, the average age was 47.5 ± 2.0 year, of which 10 were women, 16 men. Depending on the damage to target organs, all patients were conditionally divided into 2 groups: group I (19 eyes) included patients without damage, and group II (22 eyes) consisted of patients with target organs damage.Results. The registration of OCTA in patients of group I, a decrease in the density of capillaries of the superficial vascular network was 15 % and amounted to 45.21 ± 2.62 % (p &lt; 0.05), of the deep vascular plexus by 19 %, which amounted to 45.89 ± 2, 71 % (p &lt; 0.05). In the macular region, the area of the hypoperfused retina was 1.07 ± 0.14 mm2 (p &lt; 0.05). In the region of the optic nerve disc, areas of hypoperfusion were noted in the superficial layers in 7 eyes and in the deep layers in 4 eyes. Analysis of OCTA in patients of group II revealed a sharp decrease (by 48 %) in the density of capillaries in both the superficial and deep vascular plexuses of the retina, which amounted to 33.91 ± 3.01 % (p &lt; 0.05); 33.65 ± 2.89 % (p &lt; 0.05), respectively. In the macular region, the area of the non-perfused retina was 2.19 ± 0.21 mm2 (p &lt; 0.05). In the area of the optic nerve disc, areas of nonperfusion were noted both in the surface layers and in the deep layers in 4 eyes.Conclusion. The use of OCTA allows to detect changes in hemoperfusion in all layers of the retina and optic nerve in the early stages of AS development, which will allow early diagnosis and monitoring of the disease.

Optical coherence tomography angiography metrics in different stages of diabetic macular edema

BackgroundTo investigate the optical coherence tomography angiography (OCTA) characteristics of diabetic macular edema (DME) at different stages.MethodsThis study was a cross-sectional study. Patients diagnosed with DME were recruited. DME was classified into early, advanced, and severe DME. The vessel density (VD) in the superficial vascular plexus (SVP), deep vascular plexus (DVP) and foveal avascular zone (FAZ) parameters, including FAZ area, FAZ perimeter, acircularity index and foveal VD in a 300-μm-wide region around the FAZ (FD-300), were calculated by the AngioVue software. A multivariate generalized estimating equation was used to evaluate the associations between visual acuity and OCTA metrics.ResultsNinety-two eyes from 74 patients with DME were included in this study. Compared to early (P = 0.006) and advanced DME (P = 0.003), the acircularity index was higher in severe DME. Both whole and parafoveal VD in the DVP decreased in eyes with severe DME compared to early DME (P = 0.018, P = 0.005, respectively) and advanced DME (P = 0.035, P = 0.012, respectively). In the multivariate generalized estimating equation, DME severity, FAZ area and foveal thickness were positively associated with worse visual acuity (P = 0.001, P = 0.007 and P = 0.001, respectively).ConclusionCompared to early and advanced DME, severe DME showed increased irregularity in the FAZ and more extensive vessel damage in the DVP. Greater severity level of DME, larger FAZ area, and increased foveal thickness could be risk factors for poor visual acuity.Trial registration The protocol was published in the Chinese Clinical Trial Registry (ChiCTR2000033082).

Functional and Structural Findings in Infants Treated for Retinopathy of Prematurity Using Optical Coherence Tomography Angiography.

To assess the foveal microvascular structure of children with retinopathy of prematurity (ROP) treated with diode laser photocoagulation using optical coherence tomography angiography (OCTA). OCTA was performed at a tertiary medical center in 17 children (27 eyes) aged 4 to 16 years with a history of diode laser photocoagulation treated ROP. OCTA parameters were compared with those of 12 healthy age-matched controls (23 eyes) attending the orthoptics clinic and correlated with clinical factors. Compared with controls, the ROP group had a smaller foveal avascular zone area (P < .001), lower deep vascular plexus density (P < .001), lower flow density (P = .025), and greater central macular thickness (P < .001). High intraventricular hemorrhage grade correlated with smaller foveal avascular zone area (P = .008) and greater inner macular thickness (P = .047). There was no impact of gestational age, birth weight, or refractive status. OCTA can identify significant quantifiable long-term macular microvascular and structural changes in this patient population. [Ophthalmic Surg Lasers Imaging Retina. 2022;53(4):194-201.].

Interventional Radiology Regional Anesthesia Approaches for Intra- and Postprocedural Pain Control.

Effective pain control enables procedural success and improved patient satisfaction in interventional radiology. Regional anesthesia techniques are now established for intraoperative and postoperative anesthesia during major surgery, and interventional radiologists (IRs) can readily apply these injections for intraprocedural nerve blocks that can reduce anesthetic requirements and ensure durable analgesia postprocedure. Moreover, IR is poised to advance this field with novel blocks unique to IR needs and by blocking deep plexi safely reachable with CT guidance (e.g., hepatic hilar plexus, aorticorenal plexus blocks). This report aims to provide a succinct IR-directed primer for image-guided nerve blocks usable in the interventional radiology suite.

Исследование частоты развития транзиторной ретинопатии у беременных женщин, страдающих сахарным диабетом

Purpose. Assessment of the incidence progression of transient retinopathy (TR) in pregnant women with diabetes mellitus (DM). Material and methods. 24 pregnant women with DM were examined in each trimester of pregnancy and 3 months after delivery. In 10 pregnant women, diabetic retinopathy (DR) was not detected, in 14 (58 %) DR was diagnosed. With the progression of DR panretinal photocoagulation (PRP) was performed. Results. Progression of DR during pregnancy was observed in 9 (64 %) patients with preproliferative and proliferative DR and uncompensated glycemia, macular edema (ME) developed in both eyes in 3 patients. According to optical coherence tomography angiography (OCT-A), in all these patients, a progressive expansion of retinal nonperfusion zones in the superficial or deep plexus during pregnancy was detected. In all patients with progression of DR, the symptoms of retinopathy persisted in the postpartum period. “Transient” was focal macular edema in one patient with preproliferative DR, which regressed after delivery. Conclusions. 1. DR, detected at the beginning of pregnancy, progressed in 64% of pregnant women against the background of glycemic status decompensation. 2. TR occurred in one case and was manifested by transient macular edema. 3. According to our data, DR manifesting during pregnancy is most often true. 4. Identification of non-perfusion zones in the superficial and deep retinal plexus using the OCT-A allows differential diagnosis of DR and TR in pregnant women with DM. Keywords: transient retinopathy, diabetic retinopathy, pregnancy, optical coherence tomography angiography.