Peripheral Retinal Leakage Research Articles

Peripheral Retinal Leakage after Intravenous Administration of a Gadolinium-based Contrast Agent: Age Dependence, Temporal and Inferior Predominance and Potential Implications for Eye Homeostasis.

Peripheral retinal leakage (PRL) of contrast medium from the ora serrata (i.e., the peripheral part of the retina) was recently reported in normal eyes using ultra-widefield fluorescein angiography. We occasionally see PRL of gadolinium-based contrast agents (GBCAs) in the vitreous from the temporal and inferior sides of the ora serrata on MR images of subjects without ophthalmic disease. In this study, we retrospectively evaluated these MR images to determine if PRL was associated with aging. We also evaluated whether the initial leakage appeared in the temporal and inferior sides, and whether there was uniform distribution within the vitreous after 24 hours. In 127 subjects (9 volunteers, 85 patients with sudden deafness, and 33 patients with a suspicion of endolymphatic hydrops), pre- and post-contrast-enhanced heavily T2-weighted 3D-fluid attenuated inversion recovery (FLAIR) images were obtained. The presence or absence of PRL was subjectively evaluated. For patients with a suspicion of endolymphatic hydrops, 3D-real inversion recovery (IR) images were also obtained at pre-, 10 mins, 4 hours, and 24 hours after intravenous administration (IV) of GBCA. Four circular ROIs were placed in the vitreous humor and the signal intensity was measured. In the cases with PRL (n = 88) and without PRL (n = 47), the median age was 59 and 47 years, respectively (P = 0.001). At 4 hours after IV-GBCA, the mean signal increase in the inferior temporal ROI was greater than all the other ROIs. At 24 hours after IV-GBCA, no significant difference in signal intensity was observed for the four ROIs. PRL of GBCA is age-dependent and occurs mainly from the inferior temporal side of the ora serrata. The contrast effect was uniformly distributed at 24 hours after IV-GBCA. Future observations in a variety of diseases will determine the clinical significance of these findings.

Peripheral retinal leakage in POEMS syndrome

BackgroundPOEMS (polyneuropathy, organomegaly, endocrinopathy, myeloma protein, skin changes) syndrome is a rare blood disorder with multi-system involvement. The cause is unknown. It is marked by elevated plasma cells, platelets, & VEGF (vascular endothelial growth factor) levels. 52% of patients develop optic disc edema which may be vision threatening but the exact etiology of optic disc edema is uncertain. We report a rare finding of peripheral retinal leakage in POEMS syndrome.Case presentationA 60 year-old female with POEMS syndrome presented with bilateral blurred vision. Fundi showed grade 3 disc edema OU. Lumbar puncture showed normal opening pressure. CSF analysis showed elevated proteins with no cells. MRI brain and MR Venogram head were unremarkable. Wide field fluorescein angiography demonstrated multifocal tiny vascular leakage and significant anterior temporal leakage.ConclusionThe authors hypothesize the disc edema in POEMS syndrome may be caused by increased vascular permeability at the optic disc secondary to increased VEGF (vascular endothelial growth factor) levels. Though disc leakage is a well-documented finding in fundus fluorescein imaging, peripheral retinal leakage in POEMS syndrome is not reported.

The application of ultra-wide field fluorescein angiography in the evaluation of peripheral vascular changes following retinal vein occlusion

Objective To investigate the peripheral vascular findings in eyes with branch retinal vein occlusion (BRVO) and hemi-retinal vein occlusion (HRVO) using ultra-wide field fluorescein angiography (UWFFA), and analyze the influence of relative systemic factors on retinal vascular leakage. Methods A retrospective case-control study was designed.The 153 eyes of 146 patients with BRVO and 40 eyes of 40 patients with HRVO were include in Tianjin Medical University Eye Institute from September 2017 to March 2018.UWFFA was carried out in the patients, and the images were analyzed by Vantage Review software.The eyes were divided into two groups based on the whether the leakage occurred in other quadrant or fellow eye.The eyes with the fluorescence leakage only in the quadrant of affected vessel in late stage of UWFFA were in the RVO1 group, and the eyes with the fluorescence leakage in other quadrants or fellow eye besides affected vessel were in the RVO2 group.Relative past medical histories were recorded, such as hypertension, high cholesterol and diabetes mellitus.The influence of medical histories on vascular leakage in RVO1 group and RVO2 group with different histories was analyzed, respectively, and systemic factors which affected leakage degree were evaluated. Results In 179 eyes with RVO, fluorescence leakage occurred in late stage of UWFFA besides affected vessel in 25 eyes (14.0%), including 19 eyes in the affected eyes (10.6%) and 6 eyes in fellow eyes (3.4%). Hypertension, high cholesterol and diabetes mellitus were found in 77, 28 and 21 patients, respectively.In 77 hypertension patients, 66 were in the RVO1 group, and 9 were in the RVO2 group (11.69%), and in 102 non-hypertension patients, 86 were in the RVO1 group, and 16 were in the RVO2 group (15.69%), without significant difference was seen in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between hypertension and non-hypertension patients (χ2=0.298, P=0.585). In 28 high cholesterol patients, 24 were in the RVO1 group, and 4 were in the RVO2 group (14.29%), and in the 151 patients without high cholesterol, 130 were in the RVO1 group, and 21 were in the RVO2 group (13.91%), without significant difference in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between high cholesterol and non-high cholesterol (χ2=0.000, P=1.000). In 21 diabetes mellitus patients, 17 patients were in the RVO1 group, and 4 patients were in the RVO2 group (19.05%), and in 158 patients without diabetes mellitus, 137 were in the RVO1 group, and 21 were in the RVO2 group (13.29%), without significant difference was seen in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between diabetes mellitus and non- diabetes mellitus (χ2=0.144, P=0.704). Conclusions Unexpected late peripheral retinal leakage can be seen on the UWFFA in the eyes with BRVO and HRVO.Hypertension, high cholesterol and diabetes mellitus are not the main cause of these findings.UWFFA can disclose more peripheral, wider retinal lesions. Key words: Retinal vein occlusion; Fluorescein angiography; Ultra-wide-field images; Fluorescein leakage; Periphery retinal vessels; Hypertension; High cholesterol; Diabetes mellitus

A Cross-Sectional Observational Study of Nailfold Capillary Morphology in Uveitis

ABSTRACTPurpose: We performed nailfold capillary microscopy to explore microvasculature abnormalities in uveitis overall and uveitis stratified in various ways.Methods: This was a cross-sectional, case–control, observational study. One hundred and seven uveitis patients and 130 control subjects were included. We used a JH-1004 capillaroscope to perform nailfold capillary video microscopy on the fourth and fifth digits of each subject’s nondominant hand. Videos were evaluated for hemorrhages, dilated capillary loops > 25 µm, and avascular zones > 200 µm. Univariate analyses were used for the assessment of case–control morphological differences and multivariate analyses were performed to assess the relation between nailfold capillaroscopic findings and uveitis subgroups.Results: In univariate analysis, uveitis patients were more likely to have higher tortuosity ratings and reduced capillary density compared to controls (p < 0.001 for both); furthermore, dilated capillary loops, avascular zone and hemorrhages were more frequent in uveitis versus control subjects (p < 0.001 for all). Among cases, every unit increase in capillary density (vessels/mm) was associated with active uveitis (n = 72 cases) versus inactive disease (n = 35 cases; odds ratio (OR) = 1.7; (95% confidence interval (CI), 1.2–2.5) in multivariate analysis. Furthermore, the presence of any nailfold hemorrhage versus the absence of hemorrhage was more likely to be associated with posterior and panuveitis (n = 41 cases combined) compared to anterior and intermediate uveitis (n = 66 cases combined; OR = 5.8; 95% CI, 2.3–14.2). Moreover, we found a positive correlation between peripheral retinal leakage and nailfold capillaries dilation (r = 0.33; p = 0.015) that was not strictly significant based on the number of comparisons made.Conclusions: Our study provides support for non-ocular capillary bed abnormalities in uveitis, with interesting correlations based on disease stage and anatomical classification.

Peripheral Fluorescein Angiographic Findings in Fellow Eyes of Patients with Branch Retinal Vein Occlusion

Introduction. Branch retinal vein occlusion (BRVO) is a common retinal vascular condition that results in intraocular inflammatory changes. Ultra wide field fluorescein angiography (UWFFA) is a retinal imaging device that can capture peripheral retinal findings. The purpose of this study was to look for peripheral findings in the fellow eye of patients with BRVO using UWFFA. Methods. Retrospective imaging review of patients diagnosed with BRVO that had both eyes imaged with UWFFA. Images were graded for peripheral findings in other quadrants of the same eye as well as in all quadrants of the fellow eye. Results. Of 81 patients, 14 (17%) patients had late vascular leakage in a quadrant other than the BRVO distribution. Five (6%) findings were in the same eye, 8 (10%) findings were in the fellow eye, and 1 (1%) finding was in both the same eye and the fellow eye. Of these 14 patients, 11 (80%) patients had hypertension. Conclusion. Late peripheral retinal leakage in the fellow eye of patients with BRVO was detected in this cohort of patients with UWFFA. This novel finding may represent underlying systemic inflammation, hypertension, or bilateral BRVOs.