Microvascular Anomalies Research Articles

The analysis of foveal microvascular anomalies in retinopathy of prematurity after anti-vascular endothelial growth factor therapy using optical coherence tomography angiography

BackgroundTo investigate the quantitative vascular and structural differences in the foveal region of the eyes in retinopathy of prematurity children with or without anti-vascular endothelial growth factor (VEGF) therapy and healthy children using optical coherence tomography angiography (OCTA).MethodsThis cross-sectional study analyzed 75 eyes from 44 subjects, categorized into four groups: ROP children treated with Conbercept or Ranibizumab, spontaneously regressed ROP, and healthy age-matched children. Using spectral-domain OCT and OCTA, we assessed parameters like central foveal thickness (CFT), foveal avascular zone (FAZ), superficial/deep capillary plexus (SCP/DCP), and choroidal vessel density (VD) at the fovea. Correlations between foveal microvasculature, preterm status and visual acuity were evaluated.ResultsSignificant differences were found in FAZ area, CFT, and VD-SCP (parafoveal) among the groups. The FAZ area was smaller in ROP children (with/without treatment) than in healthy counterparts(p = 0.009). CFT was higher in the Ranibizumab and spontaneously regressed groups compared to healthy ones (p = 0.043, p = 0.037), while Conbercept-treated children showed no significant difference (p = 0.886). Foveal VD trends were higher in groups A, B, and C compared to group D. FAZ area correlated negatively with CFT, VD-SCP (foveal), and VD-DCP (foveal) (p < 0.001, p < 0.001, p = 0.001), and positively with choroidal VD (p = 0.012). CFT showed positive correlations with VD-SCP (foveal) and VD-DCP (foveal) (p = 0.003, p = 0.001).ConclusionROP children exhibit a smaller FAZ area compared to healthy group, with no significant difference noted when comparing the use of different anti-VEGF agents. ROP children have a thicker CFT than healthy children, except for those treated with Conbercept. Furthermore, microvascular irregularities were correlated with central foveal thickness.

Review of type 3 macular neovascularization in age-related macular degeneration: no DRAMA (Deep Retinal Age-related Microvascular Anomalies).

Type 3 macular neovascularization (MNV) is a unique form of neovascular age-related macular degeneration (AMD) that presents distinct pathogenetic features, clinical manifestations, and prognostic considerations when compared to types 1 and 2 MNV. Insights gained from clinicopathological correlations, bridging in vivo examination techniques with ex vivo histological analysis, have significantly enhanced our comprehension of this MNV phenotype, shaped current management strategies and influenced future directions for therapeutics. The particularities of type 3 MNV, which may largely stem from its origin from the retinal vasculature, are critically important for predicting the disease course. Our current understanding suggests that type 3 MNV occurs in response to retinal pigment epithelium (RPE) disruption and photoreceptor loss when neovessels originating from the deep capillary plexus are accompanied by activated Müller glia as they infiltrate sub-retinal pigment epithelium basal laminar deposits. Dysregulation of angiogenic and angiostatic factors are thought to play a key role in its pathogenesis. The prognosis for type 3 MNV is likely bilateral involvement and progression towards macular atrophy. It may be imperative for practitioners to distinguish type 3 MNV from other mimicking pathologies such as intraretinal microvascular anomalies, which are also part of the type 3 disease spectrum. For instance, deep retinal age-related microvascular anomalies (DRAMA) may present with similar features on multimodal imaging yet may necessitate distinct management protocols. Distinguishing between these conditions may be vital for implementing tailored treatment regimens and improving patient outcomes in the diverse landscape of AMD phenotypes in the future.

Changes in the level of some tryptophan metabolites in the blood of patients with type 2 diabetes mellitus complicated by diabetic retinopathy

Aim: To study the content of tryptophan and the intermediate metabolites of kynurenine and serotonin pathways of its metabolism in the blood plasma of patients with type 2 diabetes mellitus (DM) and non-proliferative diabetic retinopathy as candidates for markers of the early stage of the pathological process.Material and Methods. Three groups of people were analyzed: the first group of 10 patients with type 2 diabetes mellitus and without diabetic retinopathy; the second group of 10 people with type 2 diabetes mellitus and non-proliferative stage of diabetic retinopathy; and the control group of 10 healthy people. The features of the first group were a decrease of macula’s photosensitivity in the fundus and a slight increase in the central thickness of the retina. Patients with diabetic retinopathy tended to have a moderate number of microaneurysms and microhemorrhages, moderately presented intraretinal microvascular anomalies in one quadrant, vein dilatation, clearness of the central retinal vein and its branches. In the macular zone there was an edema with hard exudates in the center and lateral to the fovea centralis. All participants of the study gave blood on an empty stomach in the morning, and after that in we measured the content of tryptophan (TRP), kynurenins ((kynurenine (KYN), 3-hydroxykynurenine (3-HKYN), kynurenic acid (KYNA)) and the level of L-5-hydroxytyrptophan (5HTrp) in blood plasma by HPLC method with fluorimetric and spectrophotometric detection.Results. The groups of people with type 2 diabetes mellitus showed the increasing of TRP level in blood relatively to healthy individuals: by 15.1% (p = 0.032) and 17.9% (p = 0.030) in the first and second groups, respectively. As for the patients of the first group, the content of their KYN was increased by 57.7% (p = 0.012) and KYNA by 33.6% (p = 0.012) relatively to the control and the concentration of 3-НKYN decreased by 18.1% (p = 0.020) relatively to healthy people. As for the patients in the second group, the changes in their level of kynurenines had the same direction, but were more visible. Thus, the concentration of KYN exceeded the same parameters of healthy individuals by 84.5% (p = 0.001) and the parameters of the first group by 18.0% (p = 0.049); the KYNA level increased by 56.6% (p = 0.001) relatively to the control and by 17.3% (p = 0.049) from that of the first group. There was a decrease in the content of 3-HKYN amounted to 18.6% of the control (p = 0.038) and an increase in the concentration of 5HTrp – 193,9% (p &lt; 0.001).

Retinal Structural and Vascular Changes in Patients with Coronary Artery Disease: A Systematic Review and Meta-Analysis.

Retinal microvascular anomalies have been identified in patients with cardiovascular conditions such as arterial hypertension, diabetes mellitus, and carotid artery disease. We conducted a systematic review and meta-analysis (PROSPERO registration number CRD42024506589) to explore the potential of retinal vasculature as a biomarker for diagnosis and monitoring of patients with coronary artery disease (CAD) through optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). We systematically examined original articles in the Pubmed, Embase, and Web of Science databases from their inception up to November 2023, comparing retinal microvascular features between patients with CAD and control groups. Studies were included if they reported sample mean with standard deviation or median with range and/or interquartile range (which were computed into mean and standard deviation). Review Manager 5.4 (The Cochrane Collaboration, 2020) software was used to calculate the pooled effect size with weighted mean difference and 95% confidence intervals (CI) by random-effects inverse variance method. Eleven studies meeting the inclusion criteria were incorporated into the meta-analysis. The findings indicated a significant decrease in the retinal nerve fiber layer (WMD -3.11 [-6.06, -0.16]), subfoveal choroid (WMD -58.79 [-64.65, -52.93]), and overall retinal thickness (WMD -4.61 [-7.05, -2.17]) among patients with CAD compared to controls (p < 0.05). Furthermore, vascular macular density was notably lower in CAD patients, particularly in the superficial capillary plexus (foveal vessel density WMD -2.19 [-3.02, -1.135], p < 0.0001). Additionally, the foveal avascular zone area was statistically larger in CAD patients compared to the control group (WMD 52.73 [8.79, 96.67], p = 0.02). Heterogeneity was significant (I2 > 50%) for most features except for subfoveal choroid thickness, retina thickness, and superficial foveal vessel density. The current meta-analysis suggests that retinal vascularization could function as a noninvasive biomarker, providing additional insights beyond standard routine examinations for assessing dysfunction in coronary arteries.

Lactylation-driven FTO targets CDK2 to aggravate microvascular anomalies in diabetic retinopathy

Diabetic retinopathy (DR) is a leading cause of irreversible vision loss in working-age populations. Fat mass and obesity-associated protein (FTO) is an N6-methyladenosine (m6A) demethylase that demethylates RNAs involved in energy homeostasis, though its influence on DR is not well studied. Herein, we detected elevated FTO expression in vitreous fibrovascular membranes of patients with proliferative DR. FTO promoted cell cycle progression and tip cell formation of endothelial cells (ECs) to facilitate angiogenesis in vitro, in mice, and in zebrafish. FTO also regulated EC-pericyte crosstalk to trigger diabetic microvascular leakage, and mediated EC–microglia interactions to induce retinal inflammation and neurodegeneration in vivo and in vitro. Mechanistically, FTO affected EC features via modulating CDK2 mRNA stability in an m6A-YTHDF2-dependent manner. FTO up-regulation under diabetic conditions was driven by lactate-mediated histone lactylation. FB23-2, an inhibitor to FTO’s m6A demethylase activity, suppressed angiogenic phenotypes in vitro. To allow for systemic administration, we developed a nanoplatform encapsulating FB23-2 and confirmed its targeting and therapeutic efficiency in mice. Collectively, our study demonstrates that FTO is important for EC function and retinal homeostasis in DR, and warrants further investigation as a therapeutic target for DR patients.

Optical coherence tomography-angiography findings of prediabetic patients.

The purpose of this study was to evaluate prediabetic patients for microvascular changes using optical coherence tomography-angiography (OCT-A) and compare with diabetic patients and healthy controls. OCT-A images of 60 eyes of 30 patients with diabetes mellitus (DM), 72 eyes of 36 prediabetic patients, and 108 eyes of 54 healthy controls were retrospectively evaluated and compared in this study. A swept-source OCTA (Triton, Topcon) instrument was used for collecting OCT-A images. Duration of the diabetic or prediabetic period, glycated hemoglobin, fasting blood glucose level, postprandial glucose (PPG) level, high-density lipoprotein, low-density lipoprotein, triglyceride, and creatinine values of all participants were recorded. Microaneurysm, nonperfusion areas, perifoveal capillary disruption, and capillary network disorganization were detected in both prediabetics and diabetics but statistically more common in diabetic patients. Neovascularization and intraretinal microvascular anomalies were detected only in diabetic patients. OCT-A seemed to be effective in detecting microvascular changes in diabetic patients. More importantly, results showed us that in prediabetic patients, microvascular changes can be seen before the onset of DM and before or concurrently with neurodegenerative changes.

Histology of Type 3 Macular Neovascularization and Microvascular Anomalies in Treated Age-Related Macular Degeneration: A Case Study.

To investigate intraretinal neovascularization and microvascular anomalies by correlating invivo multimodal imaging with corresponding exvivo histology in a single patient. A case study comprising clinical imaging from a community-based practice, and histologic analysis at a university-based research laboratory (clinicopathologic correlation). A White woman in her 90s treated with numerous intravitreal anti-VEGF injections for bilateral type 3 macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Clinical imaging comprised serial infrared reflectance, eye-tracked spectral-domain OCT, OCT angiography, and fluorescein angiography. Eye tracking, applied to the 2 preserved donor eyes, enabled the correlation of clinical imaging signatures with high-resolution histology and transmission electron microscopy. Histologic/ultrastructural descriptions and diameters of vessels seen in clinical imaging. Six vascular lesions were histologically confirmed (type 3 MNV, n= 3; deep retinal age-related microvascular anomalies [DRAMAs], n= 3). Pyramidal (n= 2) or tangled (n= 1) morphologies of type 3 MNV originated at the deep capillary plexus (DCP) and extended posteriorly to approach without penetrating persistent basal laminar deposit. They did not enter the subretinal pigment epithelium (RPE)-basal laminar space or cross the Bruch membrane. Choroidal contributions were not found. The neovascular complexes included pericytes and nonfenestrated endothelial cells, within a collagenous sheath covered by dysmorphic RPE cells. Deep retinal age-related microvascular anomaly lesions extended posteriorly from the DCP into the Henle fiber and the outer nuclear layers without evidence of atrophy, exudation, or anti-VEGF responsiveness. Two DRAMAs lacked collagenous sheaths. External and internal diameters of type 3 MNV and DRAMA vessels were larger than comparison vessels in the index eyes and in aged normal and intermediate AMD eyes. Type 3 MNV vessels reflect specializations of source capillaries and persist during anti-VEGF therapy. The collagenous sheath of type 3 MNV lesions may provide structural stabilization. If so, vascular characteristics may be useful in disease monitoring in addition to fluid and flow signal detection. Further investigation with longitudinal imaging before exudation onset will help determine if DRAMAs are part of the type 3 MNV progression sequence. Proprietary or commercial disclosure may be found after the references.

Artificial Intelligence Systems for Diabetic Retinopathy Screening: Appraisal on the 3rd US FDA Approved Algorithms- AEYE-DS

Artificial Intelligence (AI) has revolutionized the field of healthcare in recent years, and one of its most promising applications is on the interpretation of medical images [1]. In ophthalmology, the first success comes to the screening and diagnosis of Diabetic Retinopathy (DR) [2]. DR is a common complication of Diabetes Mellitus (DM) that affects the eyes, and early detection and treatment is crucial in preventing vision loss, especially over the working populations [3]. The use of AI in DR screening involves analyzing digital fundus images to detect any signs of DR, including microaneurysms, dot and blot haemorrhages, cotton-wool spots, venous beading, intraretinal microvascular anomalies [4]. Currently, there are 3 US FDA approved systems on DR screening, IDx-DR (Digital Diagnostics), EyeArt (Eyenuk, Inc) and AEYE-DS (AEYE Health, Inc) [5-7]. AI has several advantages over traditional screening methods, including usage by non-ophthalmologically trained medical personnel, accessible and stable performance over whatever time and place, increased speed of clinical workflow, these might potentially help to improve outcomes for patients with DM. In the era of rapidly advancing technology, the use of AI in ophthalmology is an exciting development that might transform our future practice [8]. In this appraisal, we focus on the 3rd US FDA approved AI algorithms for DR.

Retinal and peripapillary vascular deformations in prematurely born children aged 4–12 years with a history of retinopathy of prematurity

In this study, foveal, parafoveal, peripapillary anatomical, and microvascular anomalies in prematurely born children aged 4–12 years with a history of retinopathy of prematurity (ROP) were evaluated. Seventy-eight eyes of 78 prematurely born children ([tROP]: ROP with laser treatment, [srROP]: spontaneously regressed ROP) and 43 eyes of 43 healthy children were included. Foveal and peripapillary morphological parameters (including ganglion cell and inner plexiform layer (GCIPL) thickness, peripapillary retinal nerve fiber layer (pRNFL) thickness) and vasculature parameters (including foveal avascular zone area, vessel density from superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and radial peripapillary capillary (RPC) segments) were analyzed. Foveal vessel densities in SRCP and DRCP were increased and parafoveal vessel densities in SRCP and RPC segments vessel density were decreased in both ROP groups compared with those of control eyes. The best-corrected visual acuity was negatively correlated with pRNFL thickness in the tROP group. Refractive error was negatively correlated with vessel density of RPC segments in the srROP group. In children born preterm with a history of ROP, it was found that foveal, parafoveal, and peripapillary structural and vascular anomalies and redistribution were accompanied. These retinal vascular and anatomical structure anomalies showed close relationships with visual functions.

Anatomical changes in the retinal capillary plexuses assessed by optical coherence tomography angiography in diabetic patients

AbstractPurpose: To assess anatomical changes in the retinal superficial capillary (SCP) and deep capillary (PCP) plexuses, as well as choriocapillary (CC) in patients with diabetes mellitus (DM) without diabetic retinopathy (DR), and in DM patients with mild and moderate DR without diabetic macular edema (DME) using optical coherence tomography angiography (OCTA).Methods: Ninety eyes were included, 34 patients with long‐term DM (more than 10 years) but without DR signs, and 54 patients with mild or moderate DR (levels 35 and 43 on the ETDRS scale) without DME. All participants underwent a complete ophthalmic examination including best corrected visual acuity (BCVA) and OCTA examination using deep‐range imaging with the DRI‐Triton SS‐OCT.Results: The mean age was 63.82 ± 8.56 years and 63.00 ± 13.21 years in long‐term DM without DR and with DR, respectively. In patients with long‐term DM without DR, foveal avascular zone (FAZ) abnormalities were seen in both SCP and DCP (55% and 5%), and microaneurysms (MAs) were present in SCP and DCP (35% and 47.5%). Loss of perfusion was detected in SCP and DCP (30% and 47.5%), and ischemia was observed in SCP, DCP and CC (60%, 37.5% and 10%). In patients with mild or moderate DR without DME, OCTA also detected morphological abnormalities such as FAZ changes and MAs (79.6% and 81.11%), loss of perfusion (83.3% and 64.2%), and ischemia (66.67%, 81.1% and 18.5%) in SCP, DCP and CC respectively. Microvascular tortuosity and intraretinal microvascular anomalies (IRMAs) were detected in 48.1% and 46.3% in SCP vs 22.6% and 20.8% in DCP, respectively.Conclusions: Patients with long‐term DM without DR present morphological changes measured with OCTA, such as MAs in both retinal plexuses. The changes in the FAZ are more evident in the SCP due to the capillary anastomosis. Capillary dropout can be found in both plexuses. Patients with DR show more evident changes that include MAs, loss of perfusion and ischemia and other vascular abnormalities.

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.

Videocapillaroscopy of the oral mucosa as an non-invasive tool for early detection of sepsis

Introduction. Due to the high incidence, morbidity, mortality and high costs for the health system, sepsis stands out, among other things, by the firm indication of hospitalization in an intensive care unit. Dysfunction of microcirculation plays a central role in the genesis and maintenance of septic syndrome, as it represents a pathophysiological milestone of this syndrome. Videocapillaroscopy opens up the possibility of detecting microvascular anomalies in the early stages, allowing for new diagnostic and research opportunities. Material and method. Our unrandomized, prospective, multicenter, analytical study analyzed a group of 51 patients with various ethology of septic shock, a clinical condition that was diagnosed on the basis of standard clinical and biological criteria, hospitalized in three ICU clinical wards, over the course of 15 months (August 2019 - November 2020), where the parameters of the oral mucosa microcirculation were monitored with the help of a videocapillaroscope, the resulting prototype of an invention patent already implemented by the authors. Objectives. The main objective of our study was to validate, on a clinical level, the possibility of using videocapillaroscopy of the oral mucosa, as an efficient means of early detection of the changes that predict the early onset of septic shock in patients in ICU patients. Results. Videocapillaroscopy was performed with a prototype device, recording 357 images of the microcirculation of the oral mucosa in the patients that had already been confirmed, via classical clinical and paraclinical means, with the diagnosis of sepsis. Discussions. The statistical analysis of the essential 5 elements detected by videocapillaroscopy (capillary density, incidence in normal and parallel disposition, diameter and microhemorrhage) corroborated with the clinical and paraclinical elements of the sepsis state path clearly highlights the correlation power of these determinations. Conclusions. Given the completely non-invasive nature of this imaging method, the very low costs associated with the method, the ease in collecting and interpreting data as well as the results that bear strong statistical correlation, we can conclude that it can successfully be considered a method of prediction with high reliability and specificity in the early detection of sepsis, regardless of its etiology.

Foveal structure changes in infants treated with anti-VEGF therapy or laser therapy guided by optical coherence tomography angiography for retinopathy of prematurity.

To evaluate foveal vessel density (VD) and foveal thickness using optical coherence tomography angiography (OCTA) in retinopathy of prematurity (ROP) children treated with laser photocoagulation or anti-vascular endothelial growth factor (VEGF) injection. Additionally, we assessed the relationship between foveal microvascular anomalies and different therapies in ROP children. This was a single-center, retrospective study of patients with a diagnosis of type 1 ROP. Twenty-three eyes (14 patients) treated with anti-VEGF injection and twenty-nine eyes (17 patients) treated with laser coagulation were included in this study. The foveal VD, inner thickness and full thickness were measured at the central 0°, 2° to 8°, and 8° of the retina (centered on the fovea) using OCTA and cross-sectional OCT, respectively. Foveal VD, inner thickness and full thickness were significantly smaller within the central 8° of the retina in ROP children treated with anti-VEGF injection than in those treated with laser photocoagulation (P=0.013, 0.009, 0.036, respectively). The full thickness was also smaller in the anti-VEGF group than in the laser group at the central 0° of the retina (P=0.010). The grade of foveal hypoplasia is lower in the anti-VEGF group than in the laser group (P=0.045). Multivariable analysis did not find any risk factors associated with visual acuity in our study. In children with type 1 ROP, the better structural development of fovea in those who were treated with anti-VEGF injection compared with laser photocoagulation are identified. However, visual acuity outcomes are similar 70mo after the treatments.

Contribution of optical coherence tomography angiography OCT-A in diabetic maculopathy

IntroductionDiabetic retinopathy (DR) increases the risk of blindness by 25 times. Advanced researchs are justified for better management, leading to the role of Optical Coherence Tomography-Angiography (OCT-A), a new non-invasive imaging technique exploring retinal vascularization.Our purpose is to identify microvascular macular anomalies of DR on OCT-A with qualitative and quantitative evaluation of their impact on retinal vascularization. Patients and methodsThis is a descriptive cross-sectional study where 120 eyes of 66 diabetic patients were enrolled. All patients were diabetic and went through OCT-A imaging. ResultsMicroanevrysms were identified in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) where they were more frequently visualized. Macular edema was present in 16,7% of cases in the SCP, and in 30% in DCP. Edema spaces were more frequently present in DCP (p < 0,05). Capillary nonperfusion areas were identified in 82,5% of cases in SCP and in 60% of cases in DCP. The main peri-foveal vascular density was 18,95 ± 5,37%. The main surface of foveal avascular zone (FAZ) in the SCP was 462,52 μm2 and was 555,04 ± 329,11 μm2 in the DCP where it was larger. ConclusionOCT-A is a modern imaging tool that could be used for the diagnosis and monitoring of DR as well as the understanding of its pathophysiology.

Прогрессирование начальной диабетической ретинопатии: связь с состоянием углеводного обмена

Актуальность. Распознавание ранних стадий диабетической ретинопатии (ДР) у пациентов с сахарным диабетом 2-го типа (СД2) и прогнозирование их прогрессии имеет важное значение и является актуальной задачей современной офтальмологии. Цель исследования — изучить особенности возникновения и прогрессирования начальных стадий ДР и установить связь со степенью нарушения углеводного обмена у пациентов с СД2. Материалы и методы. Был обследован 91 пациент (182 глаза) с СД2. Согласно ETDRS по системе клинических признаков Airlie House определяли микроаневризмы (МА), микрогеморрагии (МГ), интраретинальные микрососудистые аномалии (ИРМА), ретинальные венозные аномалии, неперфузию сетчатки и связь их развития со степенью нарушения углеводного обмена у больных СД2. Результаты. У большинства пациентов (72,5 %) на начало исследования ДР не было (уровень ETDRS составил 0–10 на обоих глазах). У остальных (27,5 %) на одном глазу уровень ETDRS был 10, а на другом отмечены единичные изменения калибра сосудов, расширение и извитость вен, ИРМА или МГ, что соответствовало уровню ETDRS 14/15. У этих пациентов давность СД2 была больше (в среднем на 3 года), а нарушения углеводного обмена были более выраженными. В течение 1 года наблюдения глазные изменения прогрессировали по-разному: при отсутствии ДР в начале исследования прогрессия была отмечена в 50 % случаев, тогда как при их наличии — в 92 %. Пациенты с прогрессией имели больший стаж диабета и худшие показатели углеводного обмена. Выводы. Установлено, что диабетические изменения сетчатки начинаются с одиночных сосудистых изменений, при наличии которых в течение 1 года ДР развивается в большинстве случаев.

Капилляроскопия как скрининговое обследование сосудов при сахарном диабете. Обзор литературы

Nailfold capillaroscopy is currently one of the highly informative methods for assessing the state of microcirculation. The advantages are ease of implementation, non-invasiveness, accessibility of the research object, instant visualization of the microvasculature, painlessness. The object of the study is the nailfold capillaries of the fingers or toes, due to their horizontal position in relation to the surface of the body, which makes it possible to evaluate the capillary throughout. Many authors have shown pronounced microvascular anomalies in type 1 and type 2 diabetes mellitus: tortuosity and dilation of capillaries, a decrease in their density, microhemorrhages, avascular zones, ectasias and aneurysms, newly formed capillaries; a relationship with the duration and compensation of diabetes mellitus as well as the severity of diabetic retinopathy was revealed. Thus, nailfold capillaroscopy can be used as a method for diagnosing and predicting diabetic retinopathy in patients with diabetes mellitus with the aim of early detection of initial changes in the microvasculature and timely retinopathy treatment. Key words: capillaroscopy; nailfold; diabetes mellitus.

Echocardiographic assessment of coronary microvascular dysfunction: Basic concepts, technical aspects, and clinical settings.

Coronary flow reserve is the capacity of the coronary circulation to augment the blood flow in response an increase in myocardial metabolic demands and has a powerful prognostic significance in different clinical situations. It might assess with invasive and noninvasive technique. Transthoracic echocardiography Doppler is an emerging diagnostic technique, noninvasive, highly feasible, safe for patient and physician, without radiation, and able to detect macrovascular and microvascular anomalies in the coronary circulation. This review aims to describe the benefit and limits of echocardiographic assessment of coronary flow reserve.

Translational Research in Vitiligo.

Vitiligo is a disease of the skin characterized by the appearance of white spots. Significant progress has been made in understanding vitiligo pathogenesis over the past 30 years, but only through perseverance, collaboration, and open-minded discussion. Early hypotheses considered roles for innervation, microvascular anomalies, oxidative stress, defects in melanocyte adhesion, autoimmunity, somatic mosaicism, and genetics. Because theories about pathogenesis drive experimental design, focus, and even therapeutic approach, it is important to consider their impact on our current understanding about vitiligo. Animal models allow researchers to perform mechanistic studies, and the development of improved patient sample collection methods provides a platform for translational studies in vitiligo that can also be applied to understand other autoimmune diseases that are more difficult to study in human samples. Here we discuss the history of vitiligo translational research, recent advances, and their implications for new treatment approaches.

The cover photo shows different neovascularization types from the paper by Smid et al.

The cover photo shows different neovascularization types from the paper by Smid et al.

The impact of macular oedema on microvascular and metabolic alterations in retinitis pigmentosa

PurposeThe primary aim of our study was to evaluate retinal microvascular anomalies recorded with optical coherence tomography angiography (OCTA) and the retinal metabolic function measured with retinal oximetry (RO) in patients with retinitis pigmentosa (RP). The secondary aim of the study was to link the presence of macular oedema to evaluated microvascular and metabolic parameters in RP.MethodsOCTA and RO were performed on 94 eyes: 64 eyes diagnosed with RP with (ME‐RP) and without (no‐ME‐RP) macular oedema were compared to 30 control eyes. Study endpoints were: mean superficial (FAZ‐S) and deep foveal avascular zone (FAZ‐D) determined by OCTA. In addition, we evaluated the mean arterial (A‐SO2; %), venular (V‐SO2; %) oxygen saturation, their difference (A‐V SO2; %), as well as the corresponding mean diameter of the retinal arterioles (D‐A; μm) and venules (D‐V; μm).ResultsRP patients differed from controls by enlarged FAZ‐S and FAZ‐D (p ≥ 0.001), attenuated retinal vessels (p &lt; 0.001) and increased retinal vessel oxygen saturation (p ≥ 0.010). Subgroup analyses within RP patients revealed more pronounced alterations of microvascular parameters and metabolic function in the presence of macular oedema. In the no‐ME‐RP subgroup, significant interactions were present between FAZ‐S, A‐SO2 and V‐SO2, whereas in the ME‐RP subgroup, we found significant correlations between FAZ‐D and D‐A.ConclusionA combined microvascular structure‐metabolic function approach enhances our understanding of inherited retinal diseases. The presence of macular oedema in retinitis pigmentosa seems to be a result of more altered microvascular‐metabolic function. However, its presence should be taken into consideration, as it may also influence the interpretation of the results.