Superficial Retinal Capillary Plexus Research Articles

Optical coherence tomography and optical coherence tomography angiography findings in optic nerve hypoplasia and their relationships with visual acuity

This study aimed to quantitatively assess the thickness of the peripapillary retinal nerve fiber layer (pRNFL) thickness, as well as the microvascular alterations in the macula and peripapillary regions, in optic nerve hypoplasia (ONH) patients compared to normal controls. This was achieved through the utilization of spectral-domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA), with a specific focus on elucidating the association between these structural alterations and visual acuity. We included a total of 17 eyes of 12 ONH patients, and 34 eyes of age-matched 34 healthy controls. The pRNFL thickness was quantified using SD-OCT, while OCTA facilitated the visualization and measurement of the microvascular structure images of the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and radial peripapillary capillary (RPC) segment in the macula and peripapillary area. pRNFL thickness was measured for eight sectors (superior, temporal, inferior, nasal, superotemporal, superonasal, inferotemporal, and inferonasal). SRCP, DRCP, and RPC were measured for four sectors (superior, temporal, inferior, and nasal). Age, gender, and spherical equivalent refractive errors were statistically adjusted for the analysis. Associations of structural parameters with visual acuity in ONH patients were analyzed using Spearman correlation analysis. pRNFL thickness was significantly thinner in ONH patients than in controls for all sectors. Vessel densities of temporal and nasal sectors in DRCP were significantly higher in ONH patients, but vessel densities of the inferior sector in RPC were significantly lower than those in controls. For all sectors, pRNFL thickness was strongly associated with visual acuity in ONH patients. ONH patients showed significant pRNFL thinning and microvascular alterations compared to controls, and pRNFL thickness was strongly associated with visual function. OCT and OCTA are useful tools for evaluating optic disc hypoplasia and its functional status.

Automated analysis of retinal microcirculation in type 1 diabetes mellitus

BACKGROUND: The paper is dedicated to the assessment of the retinal microvasculature in patients with type 1 diabetes mellitus (DM) with various features of the clinical course and different stages of diabetic retinopathy (DR). Automatic analysis of optical coherence tomogram angiograms (OCT-A) was carried out with specially developed software that provides the ability to estimate quantitative vascular parameters.AIM: The purpose of the study was to assess diagnostic accuracy of clinical parameters and imaging biomarkers in type 1 diabetes using a new algorithm for OCT-A analysis.MATERIALS AND METHODS: The study involved 186 people (365 eyes) with type 1 diabetes. The analysis of the OCT-A parameters was performed with a specially developed software. The range of studied parameters included: foveal avascular zone (FAZ), vessel area density (VAD), skeletonized vessel density (VSD), vessel diameter index (VDI), vascular curvature index (VCI) at the level of superficial (SCP) and deep (DCP) retinal capillary plexuses in the macular region. A correlation between the involvement of OCT-A biomarkers and age, degree of DM, increased glycated hemoglobin (HbA1c) level, stage of DR, and maximally corrected visual acuity (BCVA) was analysed.RESULTS: A significant dependence of all quantitative OCT-A parameters on the age of and duration of diabetes (p<0.05) was revealed. An increase in FAZ SCP (K=0.788, p=0) and DCP (K=0.764, p=0.03); decrease in VAD SCP (K=-0.476, p=0) and DCP (K=-0.485, p=0); VSD SCP (K=0.692, p=0) and DCP (K=0.713, p=0); an increase in VDI SCP (K=0.698, p=0) and DCP (K=787, p<0.01), as well as an increase in the VCI SCP (K=0.735, p=0) and DCP (K=0.694, p p=0). An inverse relationship was found between HbA1c level and VAD SCP (K=-0.636, p=0) and DCP (K=-0.619, p=0.05) were identified as well as a direct relationship with VDI DCP (K=0.717, p<0.05). The influence of the HbA1c level on other parameters was not confirmed (p>0.05). The presence of correlation between BCVA and FAZ DCP (K=-0.728, p=0), as well as VSD DCP (K=-0.754, p=0) was proved.CONCLUSION: As a result of a comprehensive analysis of clinical data and imaging biomarkers, a number of patterns that have diagnostic value in diabetic retinopathy were identified.

The use of optical coherence tomography (OCT) and OCT angiography in borderline personality disorder compared to health control subjects.

Optical coherence tomography (OCT) or OCT angiography (OCTA) has been investigated in few research studies of psychiatric disorders. No research has been done using OCT or OCTA in patients with borderline personality disorder (BPD). OCTA measured foveal avascular zone (FAZ), macular vessel density (MVD), and peripapillary vessel density (PVD). OCT measured the peripapillary retinal fiber layer (RNFL) and central retinal thickness (CRT). The study utilized the Ottawa Self-Injury Inventory, Hamilton Anxiety Rating Scale (HAMA), and Global Assessment of Functioning (GAF) to assess the symptom characteristics of individuals with BPD. Fifty-nine eyes of BPD patients and 58 eyes of normal subjects were analyzed, MVD of the superficial retinal capillary plexus declined noticeably in most subfields (p < 0.05). Significant differences were observed in the whole inner ring and outer ring index between BPD and HC groups (p < 0.05). The patients with BPD exhibited lower RNFL and CRT, the difference was significant (p < 0.05). CRT indicated a significant negative correlation with the Ottawa Self-Injury Inventory (p < 0.05). In addition, we observed that there was a negative correlation identified between the MVD of the inner ring and HAMA (p < 0.05). Meanwhile, the MVD of the outer ring was positively correlated with GAF (p < 0.05). The areas under the receiver operating characteristic curves (AUROCs) for distinguishing BPD and HC eyes in OCTA were the highest for fovea MVD (0.679), followed by outer ring MVD (0.669), inner ring MVD (0.641), FAZ (0.579). In OCT, CRT was highest for BPD (0.711), followed by RNFL (0.625). The OCT and OCTA can non-invasively detect microvascular and morphology changes of the retina in BPD patients compared to healthy control subjects.

Retinal structure and vessel density changes in cerebral small vessel disease.

Cerebral small vessel disease (CSVD) attaches people's attention in recent years. In this study, we aim to explore retinal structure and vessel density changes in CSVD patients. We collected information on retinal metrics assessed by optical coherence tomography (OCT) and OCT angiography and CSVD characters. Logistic and liner regression was used to analyze the relationship between retinal metrics and CSVD. Vessel density of superficial retinal capillary plexus (SRCP), foveal density- 300 length (FD-300), radial peripapillary capillary (RPC) and thickness of retina were significantly lower in CSVD patients, the difference only existed in the thickness of retina after adjusted relevant risk factors (OR (95% CI): 0.954 (0.912, 0.997), p = 0.037). SRCP vessel density showed a significant downward trend with the increase of CSVD scores (β: -0.087, 95%CI: -0.166, -0.008, p = 0.031). SRCP and FD-300 were significantly lower in patients with lacunar infarctions and white matter hypertensions separately [OR (95% CI): 0.857 (0.736, 0.998), p = 0.047 and OR (95% CI): 0.636 (0.434, 0.932), p = 0.020, separately]. SRCP, FD-300 and thickness of retina were associated with the occurrence and severity of total CSVD scores and its different radiological manifestations. Exploring CSVD by observing alterations in retinal metrics has become an optional research direction in future.

Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography.

To evaluate the predictive value of superficial retinal capillary plexus (SRCP) and radial peripapillary capillary (RPC) for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer (pRNFL) and ganglion cell complex (GCC). This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery. Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness pre- and post-operatively and with healthy controls. Logistic regression models were used to assess the relationship between preoperative GCC, pRNFL, SRCP, and RPC parameters and visual field recovery after surgery. The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls. Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values. The best predictive GCC and pRNFL models were based on the superior GCC [area under the curve (AUC)=0.866] and the tempo-inferior pRNFL (AUC=0.824), and the best predictive SRCP and RPC models were based on the nasal SRCP (AUC=0.718) and tempo-inferior RPC (AUC=0.825). There was no statistical difference in the predictive value of the superior GCC, tempo-inferior pRNFL, and tempo-inferior RPC (all P>0.05). Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion. This reduction persists despite the recovery of the visual field after decompression surgery. GCC, pRNFL, and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.

Quantitative Analysis of Retinal Perfusion in Patients with Frontotemporal Dementia Using Optical Coherence Tomography Angiography.

Optical coherence tomography angiography (OCT-A) provides detailed visualization of the perfusion of the vascular network of the eye. While in other forms of dementia, such as Alzheimer's disease and mild cognitive impairment, reduced retinal perfusion was frequently reported, data of patients with frontotemporal dementia (FTD) are lacking. Retinal and optic nerve head perfusion was evaluated in patients with FTD with OCT-A. Quantitative OCT-A metrics were analyzed and correlated with clinical markers and vascular cerebral lesions in FTD patients. OCT-A was performed in 18 eyes of 18 patients with FTD and 18 eyes of 18 healthy participants using RTVue XR Avanti with AngioVue. In addition, patients underwent a detailed ophthalmological, neurological, and neuropsychological examination, cerebral magnetic resonance imaging (MRI), and lumbar puncture. The flow density in the optic nerve head (ONH) and in the superficial capillary plexus (SCP) of the macula of patients was significantly lower compared to that of healthy controls (p < 0.001). Similarly, the VD in the deep capillary plexus (DCP) of the macula of patients was significantly lower compared to that of healthy controls (p < 0.001). There was no significant correlation between the flow density data, white matter lesions in brain MRI, cognitive deficits, and cerebrospinal fluid markers of dementia. Patients with FTD showed a reduced flow density in the ONH, and in the superficial and deep retinal capillary plexus of the macula, when compared with that of healthy controls. Quantitative analyses of retinal perfusion using OCT-A may therefore help in the diagnosis and monitoring of FTD. Larger and longitudinal studies are necessary to evaluate if OCT-A is a suitable biomarker for patients with FTD.

Effects of repeated low-level red-light therapy on macular retinal thickness and microvascular system in children with myopia

ObjectiveThe objective of the study was to use optical coherence tomography angiography (OCTA) to analyze the effects of repeated low-level red-light (LLLT) therapy on macular retinal thickness and the microvascular system in children with myopia to evaluate the safety of this therapy. MethodsThis prospective study included 40 school-age children with myopia (80 eyes), aged 7–14 years, who received therapy using a LLLT instrument. At baseline and therapy for 1 month, 3 months, 6 months, all children underwent comprehensive ophthalmological examinations, including slit-lamp examination, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent degree, axial length, and OCTA. The vessel densities of the superficial retinal capillary plexus, macular inner retinal thickness, and full-layer retinal thickness were measured. ResultsThe macular inner retinal thickness increased at 1 month and remained unchanged thereafter, It differed significantly in nine areas at 1, 3, and 6 months compared to the thicknesses before therapy (P < 0.05); however, we observed no significant differences between the different time points (P > 0.05). The macular full-layer retinal thickness increased at 1 month and remained unchanged thereafter; the changes showed significant differences at 1 month and 3 months compared to before therapy, for the inner nasal region (P < 0.05). The other eight areas showed significant differences at 1, 3, and 6 months compared with before therapy (P < 0.05); however, no significant difference was observed between the different time points after therapy (P > 0.05). The vessel density of the superficial retinal capillary plexus did not differ significantly among the four groups (P > 0.05). ConclusionsLLLT therapy was safe. The school-aged children exhibited macular thickening after LLLT therapy, which had no significant effect on macular microcirculation.

Association between functional parameter and structural, and vascular parameters in advanced glaucoma

Aims/Purpose: We aimed to evaluate the function‐vasculature, and function–structure relationships in advanced glaucoma patients.Methods: This cross‐sectional study included 29 eyes of 24 advanced glaucoma patients. Advanced glaucoma was classified as visual fields (VFs) with a mean deviation (MD) below ‐12 dB according to Hodapp‐Parrish‐Anderson classification system. The structural parameters, cup/disc area ratio, cup/disc vertical ratio, cup/disc horizontal ratio, rim area, disc area, cup volume, retinal nerve fibre layer thickness, macular ganglion cell complex (GCC) thickness, were measured using optical coherence tomography (OCT, Optovue, Fremont, CA). The vessel density of superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), outer retina (OR), and choriocapillaris (CC) were analysed by optical coherence tomography angiography (OCTA, DRI OCT Triton Plus, Topcon, Tokyo, Japan). For all layers, the average vessel density of the area between 1 mm and 3 mm diameter circles was calculated, assuming the 1 mm diameter area centered on the fovea as the central region. Relationships between 10–2 VF MD values, and structural and vascular parameters were assessed by Pearson's correlation coefficients. p &lt; 0.05 was considered statistically significant.Results: The mean ± SD age of all patients was 61.9 ± 15.8 years and 75% were male. For structural parameters, there was a positive correlation between the MD and GCC thickness values (p = 0.001, r = 0.617), while none of the parameters of the optic disc were related to the MD value. There were significant positive correlations with the vessel densities of the SRCP and CC layers (p = 0.001, r = 0.593 and p = 0.002, r = 0.541, respectively).Conclusions: Decreased vessel densities of the SRCP and CC were significantly associated with severity of visual field damage. This study showed that OCTA can be a promising method in daily use for monitoring advanced glaucoma.

Four years follow‐up OCTA changes in long‐term type 1 diabetic patients without diabetic retinopathy

Aims/Purpose: To assess changes in retinal capillary plexuses and choriocapillaris over 4 years' time in long‐term Type 1 diabetic patients (DM1) without diabetic retinopathy (DR).Methods: Twenty‐four eyes of 24 long‐term DM1 patients with no DR lesions were examined by optical coherence tomography angiography (OCTA) over a 4 year follow‐up period. Vascular density (VD) of both superficial and deep retinal capillary plexuses (SCP, DCP) and choriocapillaris (CC) were compared, as well as foveal avascular zone (FAZ) area and diameters.Results: Mean age was 46.84 ± 11.28 years and the average DM1 evolution time was 28.88 ± 8.04 years. Mean HbA1c level was 7.34 ± 0.94% at the last examination. SCP showed a statistically significant increase in VD in all areas except the inferior quadrant. There were no changes in the area or diameters of the FAZ in the SCP. In the DCP, there was a significant increase in VD in the temporal quadrant and a decrease in the inferior quadrant, along with a decrease in the horizontal diameter of the FAZ. The nasal area of the CC showed a significant increase in VD.Conclusions: DM1 patients present changes in the inner retina microvascularization after a follow‐up period of 4 years before displaying any signs of DR, mainly an increase in VD the SCP of the retina, along with a decrease in VD in the inferior quadrant of the DCP.

Optical Coherence Tomography Angiography in the Evaluation of Macular Retinal Microvasculature in Patients in the Early Clinical Stage of Alzheimer’s Disease – A Preliminary Report

IntroductionAlzheimer’s disease (AD) is a chronic neurodegenerative condition causing cognitive decline among elderly individuals. In addition to neurological deficits, a key role in the onset and subsequent progression of AD Alzheimer’s disease-specific changes is attributed to vascular factors. Retinal microvasculature and cerebral small vessels share similar anatomical features and physiological characteristics, and damage to the retinal vascular bed can be observed at any stage of AD Alzheimer’s disease. Retinal microvasculature can be visualized and assessed non-invasively using the technique of optical coherence tomography angiography (OCT-A).Aim of studyEvaluation of macular retinal microvasculature in the superficial capillary plexus based on OCT-A optical coherence tomography angiography images in patients diagnosed with the mild stage of Alzheimer’s dementia.Material and methodsThe study involved a total of 21 patients diagnosed with mild Alzheimer’s dementia confirmed by neuropsychological tests and neuroimaging studies. optical coherence tomography angiography OCT-A was used to determine vessel density in the superficial retinal capillary plexus (SRCP), i.e. generate a density map within five-field ETDRS circles with diameters of 3 mm and 6 mm.ResultsAlterations in the macular retinal capillary network were noted in all eyes studied. In the majority of eyes, there was a marked reduction in vessel density reflected in the quantitative metrics in the density map around the FAZ in at least one of the scans obtained for a given eye (3 mm x 3 mm and/ or 6 mm x 6 mm) and in the macroscopic evaluation of the superficial and deep capillary plexuses, capillary thinning, and irregular area/mexpansion of the FAZ.ConclusionsOptical coherence tomography angiography OCT-A has the potential to serve as a valuable tool for screening or monitoring the response to therapies in patients with Alzheimer’s disease AD. However, further research is necessary to standardize study methodologies and determine whether impaired retinal microvasculature in patients with Alzheimer-type MCI or preclinical Alzheimer’s disease AD correlates with the advancement of cognitive decline and loss of neurons and cerebral blood vessels in individual Alzheimer’s disease AD patients and, hence, has clinical utility.

32-year-old diabetic patient with progressive vision loss and crystalline retinopathy.

To report the case of severe bilateral retinal vascular occlusion in a patient with hyperoxalosis and chronic renal failure. Observational case report. Medical and imaging records were retrospectively reviewed. The patient was imaged with ultra-widefield (UWF) fundus photography and fluorescein angiography (UWF-FA), cross sectional and en face spectral-domain optical coherence tomography (SD-OCT), and OCT angiography. A 32-year-old diabetic patient receiving peritoneal dialysis was referred because of severe vision loss. UWF color fundus photography showed diffuse sclerotic retinal vessels and diffuse intraretinal crystals in both eyes. UWF-FA illustrated near-complete retinal vascular occlusion and capillary wipe out in both eyes. SD-OCT demonstrated diffuse inner and middle retina thinning in both eyes and multiple intraretinal hyperreflective foci consistent with crystalline deposits in all retina layers of both eyes. OCT angiography revealed severe capillary and large vessel non-perfusion in the superficial and deep retinal capillary plexus of each eye. The serum oxalate levels were increased at 28 µmol/L (reference range < 2 µmol/L) and genetic testing was positive for a heterozygous mutation of the AGXT (Alanine-Glyoxylate Amino Transferase) gene that causes type 1 autosomal recessive primary hyperoxaluria. A diagnosis of hyperoxalosis causing severe retinal vascular occlusion was rendered. Hyperoxalosis was the result of multiple factors including heterozygous AGXT mutation, chronic renal failure insufficiently treated with peritoneal dialysis, and a diet high in oxalate. This case highlights the importance of ruling out retinal oxalosis in patients on peritoneal dialysis in order to initiate prompt hemodialysis and prevent severe retinal vascular occlusion.

Intraretinal microvascular alterations in indirect traumatic optic neuropathy using optical coherence tomography angiography.

To quantitatively evaluate macular and peripapillary microvascular alterations in patients with indirect traumatic optic neuropathy (TON) compared to normal controls using optical coherence tomography angiography (OCT-A) and determine their associations with other ocular parameters. We enrolled 33 eyes of 33 patients with TON and 34 eyes of 34 healthy controls. OCT-A was used to generate microvascular structure images of the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and radial peripapillary capillary (RPC) segment in the macula and peripapillary area. Functional and structural parameters such as best-corrected visual acuity, visual field, peripapillary retinal nerve fibre layer (pRNFL) thickness, macular ganglion cell-inner plexiform layer (mGCIPL) thickness, OCT-A variables were compared between TON patients and controls. Age, gender, and spherical equivalent refractive errors were statistically adjusted for the analysis. OCT-A revealed a significant reduction of the average vessel density in the RPC segment in TON patients compared to controls (48.5% ± 6.28 vs. 57.88% ± 3.06%, P < 0.0001, corrected P < 0.0001). When comparing sectors, the vessel density of the RPC segment in TON patients was also significantly lower in all four quadrants compared to healthy controls. The inferior sector vessel density of the RPC segment was significantly associated with visual field defects (P = 0.0253) and visual acuity (P = 0.0369). The temporal sector vessel density of DRCP was also associated with visual field defects (P = 0.0377). The RPC segment in the superior and inferior sector vessel density displayed a significant association with the corresponding regional pRNFL thickness (P = 0.0248 and <0.0001, respectively). Patients with indirect TON exhibit significant microvascular alterations compared to controls. This study confirms that TON can induce intraretinal microvascular changes and suggests that OCT-A may serve as a useful biomarker for assessing visual functional and structural changes.

The prospects for early detection with optical coherence tomography (OCT) and OCT angiography in major depressive disorder

BackgroundResearch has shown the diagnostic potential of optical coherence tomography (OCT) and OCT angiography (OCTA) in various psychiatric disorders. However, there is few research focusing on changes specific to Major Depressive Disorder (MDD), and the diagnostic value of OCT combined with OCTA parameters for MDD remains unclear. MethodsIn this study, we investigated microvascular and morphology changes in the retina of MDD patients using a combination of OCTA and OCT parameters, and to examine their correlation with MDD mood and cognitive function in order to assess their diagnostic capability. ResultsOur findings revealed a significant decline in macular vessel density (MVD) in the superficial retinal capillary plexus (SRCP) across all subfields, except the NO area. We also observed a significant positive correlation between fovea and Stroop-1, as well as between temporal inner (TI) and Stroop-3 in MDD patients. Furthermore, we identified a negative correlation between fovea and Self-Rating Depression Scale, as well as between Superior outer (SO) and Difficulties in Emotion Regulation Scale-C in MDD patients. LimitationsThe sample size was small. Anatomical variables in blood flow may contribute to variability between subjects and outcomes. ConclusionsThe diagnostic value of OCTA suggests their potential as valuable tools for monitoring and diagnosing MDD.

Macular changes following cataract surgery in eyes with early diabetic retinopathy: an OCT and OCT angiography study.

To evaluate changes in macular status and choroidal thickness (CT) following phacoemulsification in patients with mild to moderate nonproliferative diabetic retinopathy (NPDR) using optical coherence tomography. In this prospective study, all of the patients underwent uncomplicated phacoemulsification. Retinal superficial capillary plexus vascular density (SCP-VD), macular thickness (MT), and CT were measured pre- and postoperatively. Twenty-two eyes of 22 cataract patients with mild to moderate NPDR without diabetic macular edema (DME) and 22 controls were enrolled. BCVA increased in two groups at 3 months postoperatively. At 1 and 3 months postoperatively, SCP-VD in the diabetic retinopathy (DR) group significantly increased; changes in SCP-VD in parafovea were significantly greater in the DR group than in the control group. MT and CT in the DR group significantly increased at all visits postoperatively in the fovea and perifovea. Changes in parafoveal MT were significantly greater in the DR group than in the control group at all visits postoperatively. Changes in CT and MT in the fovea were significantly greater in patients with DR than in the controls 1 and 3 months postoperatively. Uncomplicated phacoemulsification resulted in greater increases in SCP-VD, MT and CT in patients with early DR without preoperative DME than in controls.

Ocular hemodynamics in epileptic children treated with antiepileptic drugs.

To evaluate the quantitative measurements obtained for vessel density (VD) of the optic nerve head, macula, peripapillary retinal nerve fibre layer (p-RNFL) and total retinal thicknesses (Trt) by optical coherence tomography angiography (OCT-A) and the choroidal vascular structure using an image binarization method in children with epilepsy using three different antiepileptic drugs (AEDs) and to compare these measurements with healthy participants. This observational, cross-sectional study included 124 patients divided into 4 groups: Group-1: patients receiving carbamazepine(n = 30), group-2: patients receiving levetiracetam (n = 31), group-3: patients receiving valproic acid (n = 32), and group 4: healthy controls (n = 31).A fully automated microstructural analysis of the VD of the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and the choriocapillaris (CC) layers and radial peripapillary capillary, and Trt, p-RNFL thickness were analyzed by using OCT-A. Enhanced depth imaging (EDI)-OCT scans of the macula were obtained and the images were binarized using the ImageJ software. The mean age, gender distribution and the duration of epilepsy were similar in all groups. Evaluation of the p-RNFL thickness and perifoveal Trt between the groups showed a statistically significant difference in all quadrants.The p-RNFL thickness was lower in patients receiving carbamazepine and valproic acid. The lowest values of the luminal area and choroidal vascular index (CVI) were found in patients receiving valproic acid; comparison with matched healthy controls showed statistically significant differences. Valproic acid and carbamazepine are associated with thinning of the p-RNFL in epilepsy patients, but the macular and radial peripapillary VD were not affected.However, a reduction of choroidal vascular blood flow was found in epilepsy patients taking valproic acid.

Retinal vascular and structural recovery analysis by optical coherence tomography angiography after endoscopic decompression in sellar/parasellar tumors

We assessed the potential retinal microcirculation alterations for postoperative visual recovery in sellar/paraseller tumor patients with Optical Coherence Tomography Angiography (OCT-A). Two hundred ten eyes with sellar/parasellar tumor for which preoperative and postoperative (3 months) MRI Scans, Visual Acuity Test, Optical Coherence Tomography (OCT), OCT-A and, Visual Field Test data were available, besides 92 healthy eyes were evaluated. In the preoperative phase, significant reductions were observed in retinal vascular densities in various regions, including the Superficial Retinal Capillary Plexus (SRCP) (whole: p < 0.001, fovea: p = 0.025, parafovea: p < 0.001), Deep Retinal Capillary Plexus (DRCP) (whole: p < 0.001, fovea: p = 0.003, parafovea: p < 0.001), Peripapillary Vascular Density (PVD) (whole: p = 0.045, peripapillary: p < 0.001, nasal: p < 0.001, inferior: p < 0.001, temporal: p < 0.001), and Retinal Nerve Fiber Layer (RNFL) (nasal: p = 0.024, inferior: p < 0.001, temporal: p < 0.001, superior: p < 0.001) compared to the healthy control group. After surgery, the postoperative data of patients without chiasmal distortion were compared to their preoperative data. In the postoperative evaluation, significant increases were observed in vascular densities in patients without chiasmal distortion in the SRCP (whole: p < 0.001, parafovea: p = 0.045), DRCP (whole: p = 0.007, fovea: p = 0.006, parafovea: p = 0.040), PVD (peripapillary: p = 0.010, inferior: p < 0.001, temporal: p < 0.001, superior: p < 0.001), and RNFL (nasal: p = 0.011, inferior: p = 0.034, temporal: p = 0.046, superior: p = 0.011). Furthermore, significant associations were observed in the ROC analysis between the postoperative Visual Field Mean Deviation (VFMD) and SRCP (whole AUC = 0.793, p < 0.001, cut-off = 51.45, parafovea AUC = 0.820, p < 0.001, cut-off = 53.95), DRCP (whole AUC = 0.818, p < 0.001, cut-off = 55.95, parafovea AUC = 0.820, p < 0.001, cut-off = 59.05), PVD (temporal AUC = 0.692, p < 0.001, cut-off = 55.10), and RNFL (whole AUC = 0.690, p = 0.001, cut-off = 119.5, inferior AUC = 0.712, p < 0.001, cut-off = 144.75). These findings indicate a potential role of pre and post-operative OCT-A measurements in the assessment of surgical timing and postoperative visual recovery in patients with or without optic chiasm distortion.

Central macular choriocapillaris impairment as a manifestation of microvascular disease in eyes with subretinal drusenoid deposits

Background/ObjectivesMicrovascular alterations and choroidal impairment are emerging as a pathologic pathway in age-related macular degeneration (AMD). This study aimed to evaluate the central macular choriocapillaris (CC) in eyes with subretinal drusenoid deposits (SDD) and the retinal microvasculature in patients with early AMD phenotypes.Subjects/MethodsThis was an institutional, multicentric observational cross-sectional study. Ninety-nine eyes of 99 subjects; 33 eyes with SDD only, 33 eyes with conventional drusen (CD) only, and 33 eyes of healthy age-matched subjects were included. Comprehensive ophthalmologic examination and optical coherence tomography angiography (OCTA) was performed. The central macular flow area of the CC was analysed in the SDD group and the vessel density of the retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) was analysed in the SDD and CD groups using automated OCTA output parameters.ResultsThe flow area of the CC in the SDD group was significantly reduced (p ≤ 0.001) with respect to the healthy control group. There was a trend of reduction of vessel density of the SCP and the DCP in the SDD and CD group with respect to controls, although this did not reach statistical significance.ConclusionsOCTA data in the present report corroborate the role of vascular damage in early AMD with CC impairment in the central macular area in eyes with SDD.

Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection.

To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy (AMN) lesions following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Retrospective case series study. From December 18, 2022 to February 14, 2023, previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study. Totally 5 males and 9 females [mean age: 29.93±10.32 (16-49)y] were presented for reduced vision, with or without blurred vision. All patients underwent best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundoscopy. Simultaneously, multimodal imagings fundus photography (45° or 200° field of view) was performed in 7 cases (14 eyes). Near infrared (NIR) fundus photography was performed in 9 cases (18 eyes), optical coherence tomography (OCT) in 5 cases (10 eyes), optical coherence tomography angiography (OCTA) in 9 cases (18 eyes), and fundus fluorescence angiography (FFA) in 3 cases (6 eyes). Visual field was performed in 1 case (2 eyes). Multimodal imaging findings data from 14 patients with AMN were reviewed. All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA. Fundus photography (45° or 200° field of view) showed irregular hypo-reflective lesion around the fovea in 7 cases (14 eyes). OCTA demonstrated that the superficial retinal capillary plexus (SCP) vascular density, deep capillary plexus (DCP) vascular density and choriocapillaris (CC) vascular density was reduced in 9 case (18 eyes). Among the follow-up cases (2 cases), vascular density increased in 1 case with elevated BCVA; another case has vascular density decrease in one eye and basically unchanged in other eye. En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance. NIR image mainly show the absence of the outer retinal interdigitation zone in AMN. No abnormal fluorescence was observed in FFA. Corresponding partial defect of the visual field were visualized via perimeter in one case. The morbidity of SARS-CoV-2 infection with AMN is increased. Ophthalmologists should be aware of the possible, albeit rare, AMN after SARS-CoV-2 infection and focus on multimodal imaging features. OCT, OCTA, and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.

Value of optical coherence tomography angiography for the assessment of visual functions in children with retinopathy of prematurity

AIM: To compare and assess morphometric, structural, and microvascular parameters of the macular zone in children with cicatricial ROP grades IIII with different visual acuity from those in healthy peers.&#x0D; MATERIAL AND METHODS: Eighteen children (36 eyes) aged 818 years with cicatricial ROP grades IIII were examined. Ten peers (20 eyes) made up the control group. All children, in addition to the standard ophthalmological examination, underwent optical coherence tomography and optical coherence tomography with angiography (OCTA). The diagnosis was carried out on a tomograph RS-3000 Advance 2 (Nidek (Japan)). In the resulting 33 mm scans with a center in the fovea, the vascular and perfusion density of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DSP), and the foveolar avascular zone, were measured, the thickness of the retina in the fovea was evaluated, and the structure of the neuroepithelium in the macula was assessed.&#x0D; RESULTS: In children born before 27 weeks, the central retinal thickness was higher than that in more mature children (231.818.2 and 208.215.2 m, respectively), and the relationship of this parameter with visual acuity was not explored. The vascular density of SCP in children with ROP and best-corrected visual acuity (BCVA) up to 0.4 and more than 0.4 were 1.46 mm-1 and 1.35 mm-1, respectively; and in the control group, it was 1.89 mm-1.&#x0D; The perfusion densities of the SCP in these groups were 9.2%, 10.03%, and 13.3%, respectively. The vascular densities of the Deep capillary plexus (DCP) in children with ROP with BCVA up to 0.4 and more than 0.4 were 2.8 mm-1 and 3.0 mm-1, respectively; in the control group, it was 3.2 mm-1, and the perfusion density of the deep capillary plexus (DCP) in indicated groups were 25.7%, 30.9%, and 31.7%, respectively.&#x0D; CONCLUSION: The analysis of the architectonics of the retinal vascular bed in children with ROP using OCTA makes it possible to assess the relationship between microcirculation disorders in the central zone of the retina and visual acuity, which is of great scientific and practical importance.

Results of monitoring diabetic retinopathy in patients after simultaneous pancreas and kidney transplantation

BACKGROUND: Very few studies have focused on the state of the fundus and visual functions before and after simultaneous transplantation of the pancreas and kidney. In addition, the results and conclusions of authors on this topic are contradictory. AIMS: To evaluate the ophthalmological status of patients with diabetic retinopathy before and after kidney and pancreas transplantation. MATERIALS AND METHODS: The patients were divided into three groups: group 1 included patients on the transplant waiting list receiving hemodialysis, group 2 were kidney transplant recipients, and group 3 included patients who had undergone simultaneous pancreas and kidney transplantation. The ophthalmological status of patients was assessed through standard ophthalmic diagnostic methods and measurements of photosensitivity, central retinal thickness, choroid thickness, density perfusion of the superficial and deep retinal capillary plexus, choriocapillary layer, and deep choroidal layer in the foveal and parafoveal zones of the macular region. RESULTS: The study involved 76 patients (152 eyes) (group 1, n=30 patients undergoing dialysis; group 2, n=24 kidney transplant recipients; group 3, n=22 kidney and pancreaticoduodenal post-transplant recipients). Signs of the active phase of the proliferative stage of diabetic retinopathy (group 1, 54.1%; group 2, 53.3%; and group 3, 25.9%, p 0.05) and diabetic macular edema (group 1, 26.4%; group 2, 31.8%; and group 3, 12.8%, p 0.05) were more common in groups 1 and 2 than in group 3. Moreover, group 3 needed laser therapy (group 1, 45.3%; group 2, 43.2%; and group 3, 20.5%, p 0.05) and antiangiogenic therapy to a lesser extent (group 1, 18.9%; group 2, 25.0%; and group 3, 5.1%, p 0.05) than patients undergoing dialysis and kidney recipients. The eyes of patients after simultaneous pancreas and kidney transplantation were characterized by the smallest retinal thickness, highest retinal and choroidal perfusion, and highest visual acuity and photosensitivity (p 0.05). CONCLUSIONS: A surgical method for restoring euglycemia through transplantation of physiologically active pancreatic tissue favorably affects the morphological and histological state of the retina and retinal and choroidal hemoperfusion and reduces the frequency of the active phase of proliferative diabetic retinopathy and diabetic macular edema.