Peripheral Capillary Nonperfusion Research Articles

PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH SEVERE PLASMODIUM FALCIPARUM MALARIA.

To report a case of bilateral paracentral acute middle maculopathy (PAMM) lesions on spectral domain-optical coherence tomography (SD-OCT) secondary to severe Plasmodium falciparum malaria. Retrospective case report. SD-OCT, ultra-widefield fluorescein angiography, and OCT-angiography were performed and analysed. A 54-year-old healthy man presented with acute vision loss in both eyes few days after being diagnosed with severe Plasmodium falciparum malaria. Ophthalmoscopic examination was unremarkable but near-infrared reflectance imaging showed patchy hyporeflective areas located at the terminal tips of the venous branches. Corresponding SD-OCT demonstrated alternating bands of hyperreflectivity involving the inner nuclear layer and consistent with skip PAMM lesions. OCT-angiography illustrated corresponding flow signal loss at the level of the deep capillary plexus. Ultra-widefield fluorescein angiography showed peripheral retinal vein staining and capillary non-perfusion. PAMM may be an OCT manifestation of malaria retinopathy associated with severe Plasmodium falciparum infection.

Multimodal Structural and Functional Characterization of Retinal Vasculopathy with Cerebral Leukoencephalopathy

ObjectiveTo describe and quantify the structural and functional consequences of retinal vasculopathy and cerebral leukoencephalopathy (RVCL) on the neurosensory retina. DesignCross-sectional descriptive study from December 2021 to December 2022 ParticipantsRVCL patients (n=9, 18 eyes) recruited from the RVCL Research Center at Washington University in St. Louis MethodsRVCL patients underwent comprehensive ophthalmological evaluation including Optical Coherence Tomography (OCT), Optical Coherence Tomography Angiography (OCT-A), ultra-wide-field (UWF) fundus imaging, retinal autofluorescence, dark adaptation, electroretinography (ERG), Goldmann kinetic perimetry, and fluorescein angiography (FA). Main Outcomes MeasuresComprehensive characterization from various modalities including: best corrected visual acuity, central subfield thickness (μm) from OCT, foveal avascular zone (mm2) from OCT-A, dark adaptation rod intercept (sec), cone response in ERG, and presence or absence of vascular abnormalities, leakage, neovascularization, and nonperfusion on FA. ResultsA total of 18 eyes from 9 individuals were included in this study. The best-corrected visual acuity ranged from 20/15 to 20/70. The mean central subfield thickness from OCT was 275.8 μm (range 217-488 μm). The mean foveal avascular zone (FAZ) from OCT-A was 0.65 mm2 (range 0.18-1.76 mm2). On dark adaptometry, the mean time was 5.02 minutes (range 2.9 - 6.5 min) with 1 individual with impaired dark adaptation. ERG demonstrated mild cone response impairment in 4 eyes. On FA, there was evidence of macular and peripheral capillary non-perfusion in 16 of 18 eyes and notable areas of vascular leakage and retinal edema in 5 of the 18 eyes. ConclusionsThis study illustrates the phenotypic spectrum of disease and may be clinically valuable for aiding diagnosis, monitoring disease progression, and further elucidating the pathophysiology of RVCL to aid in the development of therapies.

Deep Capillary Plexus as Biomarker of Peripheral Capillary Nonperfusion in Central Retinal Vein Occlusion.

To identify the vascular biomarkers of peripheral capillary nonperfusion in patients affected by naive central retinal vein occlusion (CRVO), and to analyze their changes over the follow-up. Consecutive prospective case series with a planned follow-up of 2years. Thirty-five patients affected by CRVO and 35 healthy gender- and age-matched subjects were enrolled in the study. Ophthalmic examination included best corrected visual acuity (BCVA), ultrawidefield fluorescein angiography (UWFFA), OCT, and OCT angiography (OCTA). Vessel density (VD) at the superficial capillary plexus and deep capillary plexus (DCP) were calculated on OCTA images. The ischemic index (ISI) was calculated on UWFFA. The mean baseline ISI was 37%, increasing to 40% at the end of the follow-up, whereas it was 4.9% in the patients' fellow eyes and 4.5% in the control group with no change over the follow-up. OCT angiography revealed VD reduction in the DCP, considering both 3×3 mm and 12×12 mm scans. The correlation analyses revealed that DCP VD was the only parameter showing a statistically significant correlation with the foveal avascular zone (FAZ) area, BCVA, and ISI. Deep capillary plexus VD impairment is detectable in all CRVO cases, variably involving both the central retina (with enlarged FAZ) and the periphery (with VD reduction in the peripheral retina). The severity of DCP VD reduction has correlates with various clinical markers. Deep capillary plexus VD may represent a crucial biomarker to characterize CRVO, and further studies are necessary to identify the cutoff thresholds for the different clinicalmanifestations.

Non-perfusion severity correlates with central macular thickness and microvascular impairment in branch retinal vein occlusions.

To study peripheral capillary non-perfusion (PCN-P) in branch retinal vein occlusion (BRVO) by means of ultra wide-field fluorescein angiography (UWFFA), and to correlate its extent and severity with optical coherence tomography (OCT) and OCT-angiography (OCTA) parameters and best corrected visual acuity (BCVA). Prospective case series with 2 years of planned follow-up. We recruited patients from June 2019 to December 2019. Ophthalmologic examination included BCVA, UWFFA, OCT and OCTA. Partial (p) and complete (c) ischemic index (ISI) were evaluated on UWFFA images. Vessel density (VD) in both the macular region and the optic nerve head (ONH) was calculated. Twelve BRVO subjects and 12 healthy controls were recruited. Mean age was 63.8 ± 8.74 years. Mean BCVA improved from 0.43 ± 0.25 logMAR to 0.15 ± 0.18 after two years (p < 0.01), while mean central macular thickness (CMT) decreased from 463.83 ± 200.85 µm to 353.17 ± 108.85 µm (p > 0.05). Mean cISI, pISI and total ISI were 25.2 ± 13.0%, 6.3 ± 5.0% and 31.5 ± 12.0%, respectively. Except for VDs of the superficial capillary plexus and choriocapillaris in the macular region, all VDs were lower in the BRVO group (p < 0.01). cISI and tISI negatively correlated with mDCP (p < 0.01), whereas only pISI correlated with CMT at baseline (p < 0.05). Additionally, cISI also negatively correlated with VD at the ONH (p < 0.05). The amount of complete and partial ischemia may have different implications in BRVO, with the former being more associated with microvascular impairment and the latter with macular edema.

Peripheral and central capillary non-perfusion in diabetic retinopathy: An updated overview.

Capillary non-perfusion (CNP) is one of the key hallmarks of diabetic retinopathy (DR), which may develop both in the periphery and at the posterior pole. Our perspectives on CNP have extended with the introduction of optical coherence tomography angiography (OCTA) and ultra-widefield imaging, and the clinical consequences of peripheral and macular CNP have been well characterized. Fluorescein angiography (FA) continues to be the gold standard for detecting and measuring CNP, particularly when ultra-widefield imaging is available. OCTA, on the other hand, is a quicker, non-invasive approach that allows for a three-dimensional examination of CNP and may soon be regarded as an useful alternative to FA. In this review, we provide an updated scenario regarding the characteristics, clinical impact, and management of central and peripheral CNP in DR.

Ultra-Widefield Fundus Fluorescein Angiography Findings in Patients with Fuchs' Uveitis Syndrome.

Background:The aim of this study was to evaluate ultra-widefield (UWF) fundus fluorescein angiography (FFA) findings in patients with Fuchs’ uveitis syndrome (FUS).Materials and Methods:This cross-sectional study was conducted in patients with FUS. All the patients underwent a complete ophthalmologic examination, and FFA was carried out with Optos UWF retinal imaging. Standard FFA and image acquisition consisted of early phase (15–45 s) images, and late-phase (5–10 min) images were also obtained for both eyes.Results:Forty eyes from twenty unilateral FUS patients, including 11 females (55%), who had a mean age of 38.50 ± 6.97 years, were enrolled. Eighty-five percent of the FUS eyes had optic disc hyperfluorescence (ODH) in the FFA. A significant relationship was observed between ODH and iris heterochromia (P = 0.004). ODH was seen in all the patients with iris heterochromia (n = 16). Peripheral vascular leakage (PVL), capillary nonperfusion, chorioretinal scar, and vascular sheathing were observed in 3, 3, 2, and 8 of the patients’ eyes, respectively.Conclusion:UWF FFA imaging seemed to be mandatory for evaluating the prognosis of the FUS patients, and another investigation may require to be conducted to evaluate the effect of antivascular endothelial growth factor agents for the management of PVL in these patients.

Collateral Vessel Development in Central and Branch Retinal Vein Occlusions Are Associated With Worse Visual and Anatomic Outcomes.

PurposeThe purpose of this study was to investigate the effects of the extension of collateral vessels on the outcomes of eyes affected by central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO).MethodsThe study was designed as a cross-sectional case series. Patients affected by CRVO and BRVO were progressively recruited, along with an age- and sex-matched control group of healthy subjects. Structural optical coherence tomography (OCT) and OCT angiography (OCTA; 4.5 × 4.5 mm and 9.0 × 9.0 mm acquisitions) were performed on all participants in order to assess the relationship between the presence of collateral vessels and final anatomical outcomes – central macular thickness (CMT), foveal avascular zone – and functional outcomes – best corrected visual acuity (BCVA).ResultsFifty-six eyes affected by CRVO and 47 eyes affected by BRVO were included. Baseline LogMAR BCVA was 0.41 ± 0.33 LogMAR in CRVO, and 0.39 ± 0.25 LogMAR in BRVO (P < 0.01), improving to 0.20 ± 0.26 LogMAR in CRVO (P < 0.01), and 0.19 ± 0.22 LogMAR in BRVO (P < 0.01). Baseline CMT was 511 ± 214 µm in CRVO and 482 ± 178 µm in BRVO (P > 0.05), decreasing to 328 ± 105 µm (P < 0.01) and 321 ± 78 µm in CRVO and BRVO, respectively (P < 0.01). Collateral vessels were detected in 16 of 56 eyes (29%) in CRVO and in 47 of 47 eyes (100%) in BRVO. Their extension was correlated with worse anatomic and visual outcomes. Remarkably, no correlation was found with peripheral capillary nonperfusion and vessel density impairment.ConclusionsThe present study demonstrates that collateral vessel extension is associated with worse anatomic and functional outcomes in patients affected by CRVO and BRVO.

Fluorescein angiographic findings and Behcet's disease ocular attack score 24 (BOS24) as prognostic factors for visual outcome in patients with ocular Behcet's disease

PurposeTo determine the application of fluorescein angiographic (FA) findings and Behcet’s disease ocular attack score 24 (BOS24) scoring system in predicting poor visual outcome in patients with ocular Behcet’s disease.Study designRetrospective cohort study.MethodsWe included 73 eyes of 38 patients with ocular Behcet’s disease who underwent FA and reviewed FA images, anterior chamber cells, vitreous opacity, retinal and optic disc lesions, which are parameters in BOS24. The correlation between FA findings, BOS24, and visual acuity was assessed.ResultsOptic disc hyperfluoresence (74%), diffuse posterior pole leakage (52%) and diffuse peripheral leakage (52%) were the three most common findings. Common complications were peripheral capillary nonperfusion (29%), arterial narrowing (22%), and macular ischemia (19%). BOS24 scores of ≥ 6 (p < 0.0001), arterial narrowing (p < 0.0001), and severe posterior pole leakage (p = 0.004) were significantly associated with poor visual outcome. Combining significant FA findings: arterial narrowing and severe posterior pole leakage, to BOS24 ≥ 6 results in an increased relative risk of developing poor visual acuity from 7.30 to 10.43 and 1.89 to 2.02 respectively.ConclusionFluorescein angiography is an important investigation for predicting poor visual outcome. BOS24 may be a useful alternative when fluorescein angiographic is unavailable.

Multimodal imaging in IRVAN syndrome presenting with Branch Retinal Artery Occlusion.

To describe multimodal imaging findings in a patient with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome presenting with branch retinal artery occlusion (BRAO). A 33-year-old woman presented with acute BRAO in the right eye. A diagnosis of underlying IRVAN syndrome was made based on the presence of arteriolar aneurysms on the optic disc and along major arterioles and faint retinal hard exudates in both eyes. Eight months later, best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. The hard exudates had increased, and there were extensive areas of peripheral retinal capillary nonperfusion without new vessels. Optical coherence tomography (OCT) showed a localized retinal thinning corresponding to the prior BRAO. Fundus autofluorescence showed nodulo-linear periarterial hypoautofluorescence. OCT angiography (OCTA) showed localized ischemic changes, mainly involving the deep capillary plexus, corresponding to the area of resolved BRAO. It also clearly delineated the optic disc aneurysms. The patient received bilateral scatter laser photocoagulation directed to areas of peripheral capillary nonperfusion. Over a 6-month follow-up period, visual acuity remained unchanged, and there was no evidence of disease progression. Multimodal imaging, including fundus autofluorescence, OCT, and OCTA can provide additional valuable information in the evaluation of IRVAN syndrome complicated with BRAO.

PERIPHERAL RETINAL ANGIOGRAPHIC FINDINGS IN MACULAR TELANGIECTASIS TYPE 2.

To evaluate the retinal periphery in patients with idiopathic juxtafoveal telangiectasis or macular telangiectasis Type 2 (MacTel2), using widefield fluorescein angiography. Single-center, retrospective, observational case series of 50 eyes of 50 patients with MacTel2 and 50 eyes of 50 age-matched controls. Thirty-seven eyes in the MacTel2 group (74%) showed peripheral capillary nonperfusion or dropout, compared with 37 eyes in the control group (74%, P = 1.0). Morphologically, the MacTel2 group trended toward having a higher proportion of pruning-type capillary dropout (44%) compared with controls (28%), but this was not statistically significant (P = 0.12). Patients with MacTel2 had a higher incidence of microaneurysms compared with controls (MacTel2 56%; controls 42%; P = 0.048), independent of age or systemic risk factors. There was no difference in the incidence of venous-venous shunts (MacTel2 10%; controls 10%; P = 1.0), arteriovenous shunts (MacTel2 14%; controls 18%; P = 0.60), venous tortuosity (MacTel2 60%; controls 66%; P = 0.58), or arterial tortuosity (MacTel2 54%; controls 68%; P = 0.20), which was mild in most cases. We note a high incidence of peripheral vascular and retinal findings in both patients with MacTel2 and age-matched controls, using widefield fluorescein angiography. Patients with MacTel2 had significantly more microaneurysms, independent of age or other systemic risk factors.

Progressive bilateral ocular ischemic syndrome despite previously performed carotid endarterectomy

The ocular ischemic syndrome (OIS) is a rare condition with vision-threatening potentials. It is characterized by chronic ischemia of the anterior and/or posterior segment of the eye primarily caused by severe carotid artery occlusive diseases. In this article, we present a case of a 67-year-old male patient presented with the gradual diminution of vision in the right eye for 6 months. The patient had undergone a right internal carotid artery (ICA) endarterectomy (CEA) twice before. On the day of admission, intraocular pressure (IOP) was 34 mm Hg in the right eye (RE) and 20 mm Hg in the left eye (LE). On anterior segment examination, neovascularization of iris in the right eye was noted. On fundoscopy dilated retinal veins, attenuated retinal arteries, blot hemorrhages, cotton wool spots and microaneurysms were present. The patient underwent the appropriate investigations including computed tomography angiography (CTA) of carotid arteries, fundus fluorescence angiography (FFA) and Doppler ultrasound (DUS) of ophthalmic and central retinal arteries, which were all consistent with a diagnosis of bilateral OIS. Intraocular pressure was pharmacologically reduced and stabilized. Subsequently, panretinal photocoagulation (PRP) of peripheral capillary nonperfusion areas was performed in both eyes.

Management of florid diabetic retinopathy

Background: Florid diabetic retinopathy (FDR) is a severe form of proliferative diabetic retinopathy associated with high risk of blindness. Aim: The aim of this study is to evaluate the efficacy and safety of prompt intravitreal injection of bevacizumab followed by complete pan-retinal photocoagulation (PRP) for treating eyes with FDR. Setting and Design: Prospective, interventional case series. Patients and Methods: Patients with FDR were treated initially with intravitreal injections of bevacizumab 1.25 mg. One week after the injection, patients were sent for wide field fluorescein angiography (WFA), and PRP was performed in two sessions, 2 weeks apart. Patients were examined every 2–4 weeks to determine the status of new vessels (NVs). Additional laser burns were applied in cases with recurrence of NVs. Statistical Analysis: Numbers and percentages were calculated and reported. Results: Eleven patients (18 eyes) with FDR were included. All included patients had poorly controlled diabetes mellitus with mean glycated hemoglobin of 10.6%. One week after the injection, all eyes showed clinical regression of NVs. WFA showed extensive areas of peripheral retinal capillary nonperfusion. Eight weeks after the injection, three eyes (16.7%) showed recurrent increase in NVs, and additional laser therapy was performed for these eyes with special attention to ablating the areas of peripheral capillary non-perfusion. After 16 weeks from the primary treatment, 15 eyes (83.3%) had complete neovascular regression on clinical and angiographic assessment. Pars planavitrectomy was required for three eyes (16.7%) with tractional retinal detachment (2 eyes) or macular epi-retinal membranes (one eye). Conclusions: According to this study, most cases with FDR stabilized after prompt bevacizumab injection followed by complete PRP with special attention for ablating the peripheral capillary nonperfusion areas, guided by WFA images.

Combined Multimodal Analysis of Peripheral Retinal and Macular Circulation in Diabetic Retinopathy (COPRA Study)

To systematically examine the relationships between the microvascular indices that are measured on OCT angiography (OCTA) and the presence and extent of peripheral nonperfusion in persons with diabetic retinopathy. A retrospective cross-sectional study of patients who had varying degrees of diabetic retinopathy. The study sample was recruited from 2 large tertiary referral retina clinics. In total, 82 eyes of 45 patients with varying degrees of diabetic retinopathy were enrolled and analyzed. Relationships between peripheral ischemia measured on fluorescein angiography (FA) and OCTA metrics, including foveal avascular zone (FAZ) and vessel density measurements. A significant decrease in mean signal index in both the superficial and deep plexus and binarized flow index in the superficial plexus were found with increasing duration of diabetes mellitus. OCT and OCTA grading showed increasing central macular thickness and prevalence of microvascular abnormalities in the superficial and deep capillary bed with worse retinopathy as measured on the Diabetic Retinopathy Severity Scale. FAZ area and major axis and minor axis length were strongly associated with diabetic retinopathy severity. On classifying eyes into tertiles of peripheral ischemia measured on FA, significant increases in various FAZ metrics, including FAZ area and minor axis length, were noted. Statistically worsening of FAZ OCTA metrics was only seen between tertiles 2 and 3, indicating a non-linear relationship. The presence of neovascularization of the disc, neovascularization elsewhere, or intraretinal microvascular abnormality was associated with a significant increase in FAZ major axis length in the superficial plexus and a significant decrease in binarized flow index in the deep plexus. OCTA metrics are indicators of the severity of peripheral retinal nonperfusion. However, the central ischemic index did not exhibit a linear relationship with peripheral capillary nonperfusion. Our findings suggest that a rise in intraocular vascular endothelial growth factor as a consequence of mild peripheral capillary nonperfusion may play a compensatory role in maintaining the central macular microcirculation. Further investigations with studies employing longitudinal design will improve our understanding of the relationship between macular microcirculation and peripheral ischemia.

Correlating Changes in the Macular Microvasculature and Capillary Network to Peripheral Vascular Pathologic Features in Familial Exudative Vitreoretinopathy

To evaluate the macular microvasculature in patients with familial exudative vitreoretinopathy (FEVR) using OCT angiography (OCTA) and to assess for peripheral vascular changes using widefield fluorescein angiography (WFA). Multicenter, retrospective, comparative, observational case series. We identified 411 patients with FEVR, examined between September 2014 and June 2018. Fifty-seven patients with FEVR and 60 healthy controls had OCTA images of sufficient quality for analysis. Custom software was used to assess for layer-specific, quantitative changes in vascular density and morphologic features on OCTA by way of vessel density (VD), skeletal density (SD), fractal dimension (FD), vessel diameter index (VDI), and foveal avascular zone (FAZ). Widefield fluorescein angiography images were reviewed for peripheral vascular changes including capillary dropout, late-phase angiographic posterior and peripheral vascular leakage (LAPPEL), vascular dragging, venous-venous shunts, and arteriovenous shunts. Macular microvascular parameters on OCTA and peripheral angiographic findings on WFA. OCT angiography analysis of 117 patients (187 eyes; 92 FEVR patients and 95 control participants) demonstrated significantly reduced VD, SD, and FD and greater VDI in patients with FEVR compared with controls in the nonsegmented retina, superficial retinal layer (SRL), and deep retinal layer (DRL). The FAZ was larger compared with that in control eyes in the DRL (P < 0.0001), but not the SRL (P= 0.52). Subanalysis by FEVR stage showed the same microvascular changes compared with controls for all parameters. Widefield fluorescein angiography analysis of 95 eyes (53 patients) with FEVR demonstrated capillary nonperfusion in all eyes: 47 eyes (49.5%) showed LAPPEL, 32 eyes (33.7%) showed vascular dragging, 30 eyes (31.6%) had venous-venous shunts, and 33 eyes (34.7%) had arteriovenous shunts. Decreasing macular VD on OCTA correlated with increasing peripheral capillary nonperfusion on WFA. Decreasing fractal dimension on OCTA correlated with increasing LAPPEL severity on WFA. Patients with FEVR demonstrated abnormalities in the macular microvasculature and capillary network, in addition to the peripheral retina. The macular microvascular parameters on OCTA may serve as biomarkers of changes in the retinal periphery on WFA.

Comparison of ranibizumab alone versus ranibizumab with targeted retinal laser for branch retinal vein occlusion with macular edema.

Purpose:To determine the effect of ultra-widefield fluorescein angiography (UWFFA)-guided targeted retinal photocoagulation (TRP) in branch retinal vein occlusion (BRVO) with macular edema after intravitreal Ranibizumab (RBZ).Methods:33 eyes of 32 treatment naïve patients diagnosed as BRVO with macular edema were prospectively randomized to 0.5 mg Ranibizumab only (RBZ group) (n = 17) or Ranibizumab with UWFFA-guided laser (RBZ + TRP group) (n = 16). Both groups received three injections at monthly intervals and PRN henceforth. RBZ + TRP group additionally underwent UWFFA-guided TRP of peripheral capillary nonperfusion areas 1 week post injection. Outcome measures included improvement in visual acuity, central subfoveal thickness (CST), and the number of injections required with a minimum follow-up of 9 months.Results:Both groups showed significant improvement in mean BCVA (25.7 ± 8.19 letters, P < 0.001 vs. 23.38 ± 7.56 letters, P < 0.001; in RBZ and RBZ + TRP group, respectively) and reduction in mean central subfoveal thickness (379.12 ± 242.7 μm, P < 0.001 vs. 253.75 ± 137.9 μm, P < 0.001 in RBZ and RBZ + TRP group, respectively) at 9 months. The number of injections in the RBZ group (5.76 ± 1.3) was significantly greater than RBZ + TRP (4.06 ± 0.99) (P < 0.001). Both groups had significant improvement in contrast sensitivity and mean deviation on visual fields; however, the difference between the groups was not significant (P = 0.62 and P = 0.79, respectively).Conclusion:UWFFA-guided TRP reduced the number of injections of Ranibizumab in patients having BRVO with macular edema, while maintaining similar benefits in the improvement of BCVA, central subfoveal thickness without deleterious effect on the visual field, and contrast sensitivity.

Peripheral capillary non-perfusion in treatment-naïve proliferative diabetic retinopathy associates with postoperative disease activity 6 months after panretinal photocoagulation.

Background/aimsWith the perspective to provide individualised panretinal laser photocoagulation (PRP) for proliferative diabetic retinopathy (PDR), we evaluated if retinal peripheral capillary non-perfusion (PCNP) and oximetry, as non-invasive markers of retinal metabolism and function, could predict disease activity 6 months after PRP.MethodsWe performed a prospective, interventional study of patients with treatment-naïve PDR. Retinal oximetry and ultra-widefield fluorescein angiography were performed at baseline (BL) and three (3M) and 6 months (6M) after PRP by a navigated laser system. At 6M follow-up, patients were divided according to disease activity: active or inactive.ResultsWe included 33 eyes, and 69.6% were men. At BL, the median age and duration of diabetes (with IQRs) were 51.6±23.4 and 20.0±15.0 years. Haemoglobin A1c was 63.0±17.0 mmol/mol and blood pressure was 152±37/82±24 mm Hg. At BL and M6, patients with postoperative disease activity (30.3.%, n=10) had a larger area with PCNP than those with inactive PDR (BL: 51%–75% vs 26%–50%, p=0.03; 6M: 51%–75% vs 26%–50%, p=0.03). The area of PCNP did not change from BL to 6M in either group (inactive PDR: p=0.38, active PDR: p=0.87). Changes in retinal oxygen saturation were not found to be clinical relevant.ConclusionWe found the area of PCNP at all timepoints to be statistically larger in patients with active PDR 6 months after PRP treatment. Therefore, the area of PCNP, at baseline, may serve as a potential predictive marker for PDR activity after treatment.

Evaluation of rhegmatogenous retinal detachments using Optos ultrawide field fundus fluorescein angiography and comparison with ETDRS 7 field overlay

PurposeTo evaluate the ultrawide field fundus fluorescein angiography (UWFA) characteristics of rhegmatogenous retinal detachments (RRDs) and compare the findings with an early treatment diabetic retinopathy study (ETDRS) 7 field (ETDRS7F) overlay. MethodsUWFA (Optos, PLC, Dunfermline, UK) was performed in 10 eyes with macula-off RRDs in 9 patients. The findings of UWFA were compared with that of an overlay of standard ETDRS7F. ResultsVascular dilation, tortuosity of vessels, and blockage of choroidal fluorescence were noted in all eyes in both UWFA and ETDRS7F overlay. Other findings in UWFA and ETDRS7F included peripheral perivascular staining (10 versus 4 eyes), peripheral capillary nonperfusion (CNP) (9 eyes compared to none), vascular loop formation (7 eyes versus none), optic disc hyperfluorescence (5 eyes in both), petaloid leak at macula (2 eyes in both), and neovascularization elsewhere (3 eyes versus none). ConclusionsPeripheral perivascular staining and leak, CNP, and vascular tortuosity are common UWFA features of RRDs. Standard ETDRS7F missed peripheral CNP, peripheral vascular loops, and peripheral retinal new vessels in all eyes compared to UWFA in the current study.

Efeito terapêutico de Ranibizumabe em edema macular e perfusão retiniana associado a raro caso de Eales Central

Eales disease is an idiopathic peripheral vasculopathy involving the retina that primarily affects healthy young men. The clinical manifestations consist of three characteristic findings: peripheral retinal vasculitis, capillary nonperfusion, and neovascularization of the retina and the optic disc. Few case studies describe the rare form of central involvement in the disease, known as central Eales disease. In it, the typical findings of Eales disease occur in the posterior pole. Eales disease treatment depends on the clinical stage of the disease. Anti-VEGF therapy has recently been used. This report describes the case of a healthy young man with this rare form of Eales disease and the favorable outcome of intravitreal therapy with ranibizumab used in combination with panretinal photocoagulation. Satisfactory clinical improvement was observed in the eye that underwent intravitreal anti-VEGF treatment with ranibizumab, particularly in terms of the reduction in retinal thickness in the macular region and improvement in visual acuity.

Quantitative Analysis of Peripheral Vasculitis, Ischemia, and Vascular Leakage in Uveitis Using Ultra-Widefield Fluorescein Angiography

To investigate the relationships between peripheral vasculitis, ischemia, and vascular leakage in uveitis using ultra-widefield fluorescein angiography (FA). Cross-sectional, consecutive case series. Consecutive ultra-widefield FA images were collected from 82 uveitis patients (82 eyes) in a single center. The extent of peripheral vasculitis, capillary nonperfusion, and vessel leakage were quantified. Parameters included: (1) foveal avascular zone area and macular leakage, (2) peripheral diffuse capillary leakage and ischemia, (3) peripheral vasculitis, and (4) leakage from neovascularization. Central macular thickness measurements were derived with optical coherence tomography. Main outcome measures were correlations between central and peripheral fluorangiographic changes as well as associations between visual function, ultra-widefield FA-derived metrics, and central macular thickness. Although central leakage was associated with peripheral leakage (r= 0.553, P= .001), there was no association between foveal avascular zone size and peripheral ischemia (r= 0.114, P= .324), regardless of the underlying uveitic diagnosis. Peripheral ischemia was, however, correlated to neovascularization-related leakage (r= 0.462, P= .001) and focal vasculitis (r= 0.441, P= .001). Stepwise multiple regression analysis revealed that a poor visual acuity was independently associated with foveal avascular zone size and central macular thickness (R(2)-adjusted= 0.45, P= .001). We present a large cohort of patients with uveitis imaged with ultra-widefield FA and further describe novel methods for quantification of peripheral vascular pathology, in an attempt to identify visually significant parameters. Although we observed that relationships exist between peripheral vessel leakage, vasculitis, and ischemia, it was only macular ischemia and increased macular thickness that were independently associated with a reduced visual acuity.

Adult onset coats disease in a 56-year-old male: An atypical presentation

Coats disease is a congenital retinal vascular disease, which is seen commonly in childhood and remits and exacerbates throughout life. However, it is not rare for coats disease to present in adulthood for the first time. This has been referred to as adult onset coats disease. We do hereby present a rare case of adult onset coats disease in a 56-year-old male patient who presented with visual acuity of 20/200 in the left eye. Fundus findings typical of coats disease included telangiectasis, macular exudation and edema. Fluorescein angiography revealed peripheral capillary nonperfusion areas and telangiectasis. Optical coherence tomography showed cystoid macular edema. After the treatment with intravitreal injection of bevacizumab (1.25 mg in 0.05 ml) and sectoral panretinal photocoagulation to the area of capillary nonperfusion the macular edema was reduced by 100 microns, which translated to a visual acuity of 20/80, proving the point that the prognosis in these cases is not as grave as in classical coats disease.