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13 pages, 2464 KiB

Open AccessArticle

A Multimodal Eye Assessment in Psoriatic Arthritis Patients sine-Psoriasis: Evidence for a Potential Association with Systemic Inflammation

by Maria Sole Chimenti, Paola Triggianese, Giorgia Salandri, Paola Conigliaro, Claudia Canofari, Francesco Caso, Luisa Costa, Carlo Nucci, Francesco Aiello, Massimo Cesareo and Roberto Perricone

J. Clin. Med. 2020, 9(3), 719; https://doi.org/10.3390/jcm9030719 - 6 Mar 2020

Cited by 15 | Viewed by 3501

Abstract

Background: Ocular involvement in Psoriatic Arthritis (PsA) patients is mainly associated with uveitis but there remains a paucity of data on dry eye and retinal abnormalities. We aimed to analyze dry eye and subclinical retinal abnormalities in a cohort of PsA patients sine-psoriasis [...] Read more.

Background: Ocular involvement in Psoriatic Arthritis (PsA) patients is mainly associated with uveitis but there remains a paucity of data on dry eye and retinal abnormalities. We aimed to analyze dry eye and subclinical retinal abnormalities in a cohort of PsA patients sine-psoriasis (PsO). Methods: PsA patients sine-PsO were enrolled. Best-corrected-visual-acuity, ocular-surface-disease-index (OSDI), Schirmer test, tear film breakup-time, standard-automated-perimetry (SAP, mean deviation—MD, pattern standard deviation—PSD), fundus-perimetry (FP), and spectral-domain-optical-coherence-tomography (SD-OCT) were performed. Results: A total of 80 eyes from 40 PsA patients with moderate-severe disease activity, and 70 eyes from 35 healthy control (HC) were evaluated. Higher dry eye prevalence occurred in PsA than HC (p < 0.0001). ESR was positively related with OSDI (p < 0.001) and negatively related with Schirmer (p = 0.007). In PsA, SAP registered higher MD (p < 0.0001) and higher PSD (p = 0.005) in comparison with HC. PSD resulted positively correlated with ESR (p = 0.04) and CRP (p = 0.01), while MD showed a negative correlation with CRP (p = 0.01). Both FP mean differential sensitivity and mean defect were lower in PsA then HC (p < 0.0001). In PsA, FP differential sensitivity was directly related with cumulative steroids (p = 0.02). Conclusions: In PsA patients sine-PsO, dry eye and subclinical abnormalities in visual functions occurred being potentially related to systemic inflammation. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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12 pages, 2100 KiB

Open AccessArticle

Morpho-Functional Evaluation of Full-Thickness Macular Holes by the Integration of Optical Coherence Tomography Angiography and Microperimetry

by Daniela Bacherini, Maria Cristina Savastano, Francesco Dragotto, Lucia Finocchio, Chiara Lenzetti, Alice Bitossi, Ruggero Tartaro, Fabrizio Giansanti, Francesco Barca, Alfonso Savastano, Tomaso Caporossi, Lorenzo Vannozzi, Andrea Sodi, Marino De Luca, Francesco Faraldi, Gianni Virgili and Stanislao Rizzo

J. Clin. Med. 2020, 9(1), 229; https://doi.org/10.3390/jcm9010229 - 15 Jan 2020

Cited by 14 | Viewed by 3425

Abstract

(1) Objective: To use optical coherence tomography angiography (OCTA) and microperimetry (MP) to evaluate the correlation between retinal structure and function in patients with idiopathic, full-thickness macular holes (FTMHs) (2) Methods: This prospective, observational study included 11 eyes of 10 patients with FTMHs [...] Read more.

(1) Objective: To use optical coherence tomography angiography (OCTA) and microperimetry (MP) to evaluate the correlation between retinal structure and function in patients with idiopathic, full-thickness macular holes (FTMHs) (2) Methods: This prospective, observational study included 11 eyes of 10 patients with FTMHs evaluated before surgery using OCTA and MP. MP sensitivity maps were superimposed and registered on slabs corresponding to superficial capillary plexus (SCP) and deep capillary plexus (DCP) on OCTA, and on the outer plexiform layer (OPL) and the Henle fiber layer (HFL) complex in en face OCT. On these maps, mean retinal sensitivity was calculated at 2° and 4°, all centered on the FTMH. Cystic cavity extension was assessed on the slab corresponding to the OPL + HFL complex in en face OCT and DCP in OCTA using the Image J software (Version 1.49v; National Institutes of Health, Bethesda, MD, USA); (3) Results: Absolute scotomas were observed corresponding to the FTMH. Additionally, rings of relative scotoma in the perilesional area were detected and correlated to the cystic spaces on en face OCT and OCTA. There was a significant correlation between reduced retinal sensitivity at 2° and 4° diameters around the FTMH and the extension of cystic areas (p < 0.01). There was a significant correlation between the extension of cystic cavities and BCVA (p < 0.01). (4) Conclusions: Morpho-functional analysis of FTMH using OCTA and MP, and the correlation between vascular abnormalities and impaired retinal sensitivity, may provide new, useful information. This integrated evaluation of FTMH may be useful to determine the function–structure correlation before and after vitreoretinal surgery, in order to gain a better understanding of the functional consequences induced by the morphological alterations, assessing outcomes in a more objective way, and potentially adding new surgical prognostic factors. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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11 pages, 8001 KiB

Open AccessArticle

Early Retinal Flow Changes after Vitreoretinal Surgery in Idiopathic Epiretinal Membrane Using Swept Source Optical Coherence Tomography Angiography

by Rodolfo Mastropasqua, Rossella D’Aloisio, Pasquale Viggiano, Enrico Borrelli, Carla Iafigliola, Marta Di Nicola, Agbéanda Aharrh-Gnama, Guido Di Marzio, Lisa Toto, Cesare Mariotti and Paolo Carpineto

J. Clin. Med. 2019, 8(12), 2067; https://doi.org/10.3390/jcm8122067 - 24 Nov 2019

Cited by 30 | Viewed by 3639

Abstract

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA); (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with [...] Read more.

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA); (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter); (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p < 0.001; p < 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one-month post vitrectomy, VLD and VT significantly changed in parafoveal region (p = 0.043; p = 0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p = 0.021, p = 0.018, p = 0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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12 pages, 867 KiB

Open AccessArticle

Retinal Nerve Fiber Layer Thickness and Higher Relapse Frequency May Predict Poor Recovery after Optic Neuritis in MS Patients

by Clara Grazia Chisari, Mario Damiano Toro, Vincenzo Cimino, Robert Rejdak, Maria Luca, Laura Rapisarda, Teresio Avitabile, Chiara Posarelli, Konrad Rejdak, Michele Reibaldi, Mario Zappia and Francesco Patti

J. Clin. Med. 2019, 8(11), 2022; https://doi.org/10.3390/jcm8112022 - 19 Nov 2019

Cited by 18 | Viewed by 3032

Abstract

Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS). Aiming to evaluate the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT), patients with relapsing-remitting (RR) MS experiencing ON were consecutively enrolled. RNFL, ganglion cell layer (GCL), foveal thickness, and [...] Read more.

Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS). Aiming to evaluate the retinal nerve fiber layer (RNFL) with optical coherence tomography (OCT), patients with relapsing-remitting (RR) MS experiencing ON were consecutively enrolled. RNFL, ganglion cell layer (GCL), foveal thickness, and macular volume were evaluated in both the ON and unaffected (nON) eye within six days from the relapse onset (T0) and after six months (T1). Ninety patients were enrolled. At T0, ON eyes showed a significantly increased RNFL when compared to the nON eyes (129.1 ± 19.5 vs. 100.5 ± 10.1, p < 0.001). At T1 versus T0, the ON eyes showed a thinner RNFL (129.1 ± 19.5 vs. 91.6 ± 20.2, p < 0.001) and a significantly decreased GCL (80.4 ± 8.8 vs. 73.8 ± 11.6; p < 0.005). No differences were found in the nON group in retinal parameters between T0 and T1. A multivariate logistic regression analysis showed that a higher number of relapses (not ON) and a greater swelling of RNFL at T0 were associated with poor recovery. The assessment of RNFL through OCT during and after ON could be used to predict persistent visual disability. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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8 pages, 735 KiB

Open AccessArticle

Sensitivity and Specificity of Ultrawide-Field Fundus Photography for the Staging of Sickle Cell Retinopathy in Real-Life Practice at Varying Expertise Level

by Roxane Bunod, Alexandra Mouallem-Beziere, Francesca Amoroso, Vittorio Capuano, Karen Bitton, Cynthia Kamami-Levy, Camille Jung, Eric H. Souied and Alexandra Miere

J. Clin. Med. 2019, 8(10), 1660; https://doi.org/10.3390/jcm8101660 - 11 Oct 2019

Cited by 6 | Viewed by 2290

Abstract

Purpose: To evaluate the sensitivity and specificity of ultrawide-field fundus photography (UWF-FP) for the detection and classification of sickle cell retinopathy (SCR) by ophthalmologists with varying degrees of expertise in retinal disease. Methods: Patients presenting with sickle cell disease (SCD) in the Créteil [...] Read more.

Purpose: To evaluate the sensitivity and specificity of ultrawide-field fundus photography (UWF-FP) for the detection and classification of sickle cell retinopathy (SCR) by ophthalmologists with varying degrees of expertise in retinal disease. Methods: Patients presenting with sickle cell disease (SCD) in the Créteil University Eye Clinic, having undergone UWF-FP and ultrawide-field fluorescein angiography (UWF-FA) on the same day, were retrospectively included. Eyes with previous retinal photocoagulation were excluded. SCR was graded independently by UWF-FP and UWF-FA using Goldberg classification by two ophthalmologists with varying expertise levels. Results: Sixty-six eyes of 33 patients were included in the study. The sensitivity of UWF-FP for the detection of proliferative SCR was 100%, (95% confidence interval [CI95%] 76.8–100) for the retinal specialist and 100% (CI95% 71.5–100) for the ophthalmology resident. The specificity of UWF-FP for the detection of proliferative SCR was 100% (CI95% 92.7–100) for the retinal specialist and 98.1% (CI95% 89.7–100) for the ophthalmology resident. Conclusions: UWF-FP is a valuable exam for proliferative SCR screening, with excellent sensitivity and specificity and a good inter-grader agreement for ophthalmologists with various degree of skills, and is easy to use in a real-life setting. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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10 pages, 1453 KiB

Open AccessArticle

Papillary Vessel Density Changes after Intravitreal Anti-VEGF Injections in Hypertensive Patients with Central Retinal Vein Occlusion: An Angio-OCT Study

by Michele Nicolai, Alessandro Franceschi, Serena De Turris, Alessandro Rosati, Vittorio Pirani and Cesare Mariotti

J. Clin. Med. 2019, 8(10), 1636; https://doi.org/10.3390/jcm8101636 - 6 Oct 2019

Cited by 15 | Viewed by 3452

Abstract

Purpose: To investigate papillary microvascular changes in patients affected by macular edema due to Central Retinal Vein Occlusions (CRVO) after anti-Vascular Endothelial Growth Factor (VEGF) therapy. Methods: Prospective analysis of papillary and peripapillary vessel density (VD) changes in 18 eyes of 18 hypertensive [...] Read more.

Purpose: To investigate papillary microvascular changes in patients affected by macular edema due to Central Retinal Vein Occlusions (CRVO) after anti-Vascular Endothelial Growth Factor (VEGF) therapy. Methods: Prospective analysis of papillary and peripapillary vessel density (VD) changes in 18 eyes of 18 hypertensive patients affected by CRVO before and after the loading-phase of intravitreal Ranibizumab (IVR) injections. Data were quantitatively measured by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) before as well as 1 month and 4 months after injections. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA was assessed. Results: 18 eyes of 18 consecutive patients with a known history of arterial hypertension and affected by an acute CRVO episode were enrolled. Central macular thickness (CMT) was significantly reduced after IVR injections (p < 0.001), while mean BCVA improved from 0.70 ± 0.26 logarithm of the minimal angle of resolution (logMAR) units at baseline to 0.25 ± 0.18 logMAR units after 4 months (p < 0.001). VD inside disc and peripapillary significantly increased (p < 0.001 and p = 0.01, respectively) after treatment. Conclusions: OCTA showed VD increase in the papillary area in patients affected by CRVO after anti-VEGF therapy. This area could represent a new region of interest to study microvasculature changes concomitant with severe macular edema. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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17 pages, 4993 KiB

Open AccessArticle

A Novel Automatic Method to Estimate Visual Acuity and Analyze the Retinal Vasculature in Retinal Vein Occlusion Using Swept Source Optical Coherence Tomography Angiography

by Marta Díez-Sotelo, Macarena Díaz, Maximino Abraldes, Francisco Gómez-Ulla, Manuel G. Penedo and Marcos Ortega

J. Clin. Med. 2019, 8(10), 1515; https://doi.org/10.3390/jcm8101515 - 20 Sep 2019

Cited by 9 | Viewed by 2542

Abstract

The assessment of vascular biomarkers and their correlation with visual acuity is one of the most important issues in the diagnosis and follow-up of retinal vein occlusions (RVOs). The high workloads of clinical practice make it necessary to have a fast, objective, and [...] Read more.

The assessment of vascular biomarkers and their correlation with visual acuity is one of the most important issues in the diagnosis and follow-up of retinal vein occlusions (RVOs). The high workloads of clinical practice make it necessary to have a fast, objective, and automatic method to analyze image features and correlate them with visual function. The aim of this study is to propose a fully automatic system which is capable of estimating visual acuity (VA) in RVO eyes, based only on information obtained from macular optical coherence tomography angiography (OCTA) images. We also propose an automatic methodology to rapidly measure the foveal avascular zone (FAZ) area and the vascular density (VD) in the superficial and deep capillary plexuses in swept-source OCTA images centered on the fovea. The proposed methodology is validated using a representative sample of 133 visits of 50 RVO patients. Our methodology estimates VA with very high precision and is even more accurate when we integrate depth information, providing a high correlation index of 0.869 with the real VA, which outperforms the correlation index of 0.855 obtained when estimating VA from the data obtained by the semiautomatic existing method. In conclusion, the proposed method is the first computational system able to estimate VA in RVO, with the additional benefits of being automatic, less time-consuming, objective and more accurate. Furthermore, the proposed method is able to integrate depth information, a feature which is lacking in the existing method. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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8 pages, 770 KiB

Open AccessArticle

Ultra-Widefield Retinal Imaging for Analyzing the Association Between Types of Pathological Myopia and Posterior Staphyloma

by Ririko Mimura, Kiwako Mori, Hidemasa Torii, Norihiro Nagai, Misa Suzuki, Sakiko Minami, Yoko Ozawa, Toshihide Kurihara and Kazuo Tsubota

J. Clin. Med. 2019, 8(10), 1505; https://doi.org/10.3390/jcm8101505 - 20 Sep 2019

Cited by 12 | Viewed by 2987

Abstract

High myopia may develop to pathologic myopia, which brings severe visual impairment; however, the etiology is not fully understood. We, therefore, investigated the relationship between the presence of posterior staphyloma and posterior ocular disorders by assessing the patients with high myopia. A retrospective [...] Read more.

High myopia may develop to pathologic myopia, which brings severe visual impairment; however, the etiology is not fully understood. We, therefore, investigated the relationship between the presence of posterior staphyloma and posterior ocular disorders by assessing the patients with high myopia. A retrospective study was performed for the patients, who have more than 26 mm of the axial length and of whom fundus photography was taken with an ultra-widefield retinal imaging system. The objectives were 138 cases encompassing 229 eyes. In 138 cases, 91 were bilateral and 47 were unilateral. The averages ± SD of axial length of bilateral and unilateral were 28.8 ± 2.2 mm, 27.3 ± 1.2 mm, respectively, showing statistically significant difference. The number of eyes with and without posterior staphyloma were 107 (46.7%) and 122 (53.3%), respectively. Retinal detachment and retinal breaks are more observed in cases without posterior staphyloma (p = 0.017). Myopic choroidal neovascularization (mCNV) (p = 0.002), chorioretinal atrophy (p < 0.001), retinoschisis (p < 0.001), and optic neuropathy (p = 0.038) are more often seen in cases with posterior staphyloma. In conclusion, the prevalence rates of myopic choroidal neovascularization, retinal choroidal atrophy, and optic neuropathy were significantly higher with posterior staphyloma. The rate of periocular disorders such as retinal detachment was significantly higher without posterior staphyloma. These results indicate associations between types of pathological myopia and presence or absence of posterior staphyloma analyzed by ultra-widefield retinal imaging. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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28 pages, 19115 KiB

Open AccessArticle

Aiding the Diagnosis of Diabetic and Hypertensive Retinopathy Using Artificial Intelligence-Based Semantic Segmentation

by Muhammad Arsalan, Muhammad Owais, Tahir Mahmood, Se Woon Cho and Kang Ryoung Park

J. Clin. Med. 2019, 8(9), 1446; https://doi.org/10.3390/jcm8091446 - 11 Sep 2019

Cited by 78 | Viewed by 6755

Abstract

Automatic segmentation of retinal images is an important task in computer-assisted medical image analysis for the diagnosis of diseases such as hypertension, diabetic and hypertensive retinopathy, and arteriosclerosis. Among the diseases, diabetic retinopathy, which is the leading cause of vision detachment, can be [...] Read more.

Automatic segmentation of retinal images is an important task in computer-assisted medical image analysis for the diagnosis of diseases such as hypertension, diabetic and hypertensive retinopathy, and arteriosclerosis. Among the diseases, diabetic retinopathy, which is the leading cause of vision detachment, can be diagnosed early through the detection of retinal vessels. The manual detection of these retinal vessels is a time-consuming process that can be automated with the help of artificial intelligence with deep learning. The detection of vessels is difficult due to intensity variation and noise from non-ideal imaging. Although there are deep learning approaches for vessel segmentation, these methods require many trainable parameters, which increase the network complexity. To address these issues, this paper presents a dual-residual-stream-based vessel segmentation network (Vess-Net), which is not as deep as conventional semantic segmentation networks, but provides good segmentation with few trainable parameters and layers. The method takes advantage of artificial intelligence for semantic segmentation to aid the diagnosis of retinopathy. To evaluate the proposed Vess-Net method, experiments were conducted with three publicly available datasets for vessel segmentation: digital retinal images for vessel extraction (DRIVE), the Child Heart Health Study in England (CHASE-DB1), and structured analysis of retina (STARE). Experimental results show that Vess-Net achieved superior performance for all datasets with sensitivity (Se), specificity (Sp), area under the curve (AUC), and accuracy (Acc) of 80.22%, 98.1%, 98.2%, and 96.55% for DRVIE; 82.06%, 98.41%, 98.0%, and 97.26% for CHASE-DB1; and 85.26%, 97.91%, 98.83%, and 96.97% for STARE dataset. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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11 pages, 1721 KiB

Open AccessArticle

Correlation between Choriocapillaris Density and Retinal Sensitivity in Stargardt Disease

by Rodolfo Mastropasqua, Alfonso Senatore, Luca Di Antonio, Marta Di Nicola, Michele Marchioni, Fabiana Perna, Filippo Amore, Enrico Borrelli, Chiara De Nicola, Paolo Carpineto and Lisa Toto

J. Clin. Med. 2019, 8(9), 1432; https://doi.org/10.3390/jcm8091432 - 10 Sep 2019

Cited by 11 | Viewed by 2684

Abstract

The aim of this work was to characterize the choriocapillaris (CC) in patients with Stargardt disease (STGD) using the swept source widefield optical coherence tomography angiography (SS WF OCTA) and to compare CC perfusion density to retinal sensitivity, analyzed using microperimetry (MP). This [...] Read more.

The aim of this work was to characterize the choriocapillaris (CC) in patients with Stargardt disease (STGD) using the swept source widefield optical coherence tomography angiography (SS WF OCTA) and to compare CC perfusion density to retinal sensitivity, analyzed using microperimetry (MP). This cross-sectional study included 9 patients (18 eyes) with STGD and central CC atrophy (stage 3 STGD). The CC was analyzed using SS WF OCTA and areas of different CC impairment were quantified and correlated with retinal sensitivity analyzed using MP. The main outcome measures were the percent perfused choriocapillaris area (PPCA), retinal sensitivity, and correlation between PPCA and retinal sensitivity. Seventeen eyes of 9 patients suffering from stage 3 STGD were analyzed. SS WF OCTA revealed a vascular rarefaction in central atrophic zones and a near atrophy halo of choriocapillaris impairment. In all eyes were noticed a central atrophy (CA) area with absolute absence of CC that corresponded to 0 dB points at MP, a near atrophy (NA) zone of PPCA impairment that included points with decreased sensitivity at MP and a distant from atrophy (DA) zone with higher PPCA and retinal sensitivity values. The mean difference of PPCA and retinal sensitivity between NA and CA and DA and CA was statistical significantly different (p < 0.01), the latter showing higher values. A direct relationship between PPCA and retinal sensitivity was found (p < 0.001). Choriocapillaris damage evaluated using SS WF OCTA correlates with MP, these data suggest that CC impairment may be a predictor of retinal function in patients with STGD. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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14 pages, 3728 KiB

Open AccessArticle

Multimodal Imaging Assessment of Vascular and Neurodegenerative Retinal Alterations in Type 1 Diabetic Patients without Fundoscopic Signs of Diabetic Retinopathy

by Riccardo Sacconi, Marco Casaluci, Enrico Borrelli, Giacomo Mulinacci, Francesca Lamanna, Francesco Gelormini, Adriano Carnevali, Lea Querques, Gianpaolo Zerbini, Francesco Bandello and Giuseppe Querques

J. Clin. Med. 2019, 8(9), 1409; https://doi.org/10.3390/jcm8091409 - 8 Sep 2019

Cited by 41 | Viewed by 3762

Abstract

The aim of this cross-sectional case-control study is to investigate the possible presence of vascular/neurodegenerative alterations in the retina of type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy (DR). Thirty-four eyes of 34 consecutive T1DM without DR (mean age 21 ± 2 [...] Read more.

The aim of this cross-sectional case-control study is to investigate the possible presence of vascular/neurodegenerative alterations in the retina of type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy (DR). Thirty-four eyes of 34 consecutive T1DM without DR (mean age 21 ± 2 years) were included. Another cohort of 27 eyes (27 healthy control subjects matched with age and sex) was also recruited. All patients underwent multimodal imaging evaluation using structural optical coherence tomography (OCT), OCT-angiography (OCT-A), dynamic vessel analyzer (DVA) and microperimetry. No significant differences were disclosed comparing diabetics and controls for visual acuity, central macular thickness, and subfoveal choroidal thickness. On retinal nerve fiber layer and ganglion cell complex thickness, no significant differences were disclosed comparing each 3-mm-diameter macular and peripapillary subfield between two groups. Using OCT-A, deep capillary plexus perfusion density (PD) of diabetics was significantly lower compared to control group, whereas PD of other retinal/choriocapillaris plexuses and foveal avascular zone area did not show any significant difference. Using DVA, diabetic eyes revealed a significantly decreased vessel response to flicker light in comparison to controls. No differences were disclosed using microperimetry analysis. Taken together, these results suggest that vascular alterations could be the first detectable retinal change in the development of DR. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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19 pages, 22302 KiB

Open AccessArticle

The Eye as a Window to Systemic Infectious Diseases: Old Enemies, New Imaging

by Vittorio Pirani, Paolo Pelliccioni, Serena De Turris, Alessandro Rosati, Alessandro Franceschi, Claudia Cesari, Michele Nicolai and Cesare Mariotti

J. Clin. Med. 2019, 8(9), 1392; https://doi.org/10.3390/jcm8091392 - 5 Sep 2019

Cited by 10 | Viewed by 4751

Abstract

Background: Syphilis, tuberculosis and toxoplasmosis are major infectious diseases worldwide; all of them are multisystem pathologies and share a possible ocular involvement. In this context, a fundamental help for the definitive diagnosis is provided by the ophthalmologist, through clinical evaluation and with the [...] Read more.

Background: Syphilis, tuberculosis and toxoplasmosis are major infectious diseases worldwide; all of them are multisystem pathologies and share a possible ocular involvement. In this context, a fundamental help for the definitive diagnosis is provided by the ophthalmologist, through clinical evaluation and with the aid of a multimodal imaging examination. Methods: We hereby describe selected cases who came to our attention and were visited in our eye clinic. In all clinics, the use of retinal and optic disc multimodal imaging during ophthalmological evaluation allowed to make a diagnosis of an infectious disease. Results: In our tertiary referral center more than 60 patients with syphilis, tuberculosis and toxoplasmosis have been evaluated in the last two years: In 60% of cases the ophthalmological evaluation was secondary to a previous diagnosis of an infectious disease, while in the remaining cases the ophthalmologist, with the help of a multimodal imaging examination and clinical evaluation, represented the physician who leads to the diagnosis. Conclusion: Our results confirm how in these life-threatening pathologies a prompt diagnosis is mandatory and may benefit from a multidisciplinary and multimodal imaging approach, especially during ophthalmological evaluation. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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15 pages, 908 KiB

Open AccessArticle

Characteristics of Patients Showing Discrepancy Between Bruch’s Membrane Opening-Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness

by Hyun-kyung Cho and Changwon Kee

J. Clin. Med. 2019, 8(9), 1362; https://doi.org/10.3390/jcm8091362 - 1 Sep 2019

Cited by 7 | Viewed by 3164

Abstract

Background: To investigate clinical characteristics of patients showing discrepancy between Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness. Correlation with the visual field (VF) was also inspected. Methods: In this prospective, cross-sectional study, 106 eyes (106 [...] Read more.

Background: To investigate clinical characteristics of patients showing discrepancy between Bruch’s membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness. Correlation with the visual field (VF) was also inspected. Methods: In this prospective, cross-sectional study, 106 eyes (106 subjects) showing normal BMO-MRW classification but abnormal RNFL classification were included. All patients underwent confocal scanning laser ophthalmoscopy, spectral-domain optical coherence tomography, and standard automated perimetry. Results: Clinical characteristics were as follows: mean age: 52.79 ± 14.75 years; spherical equivalent (SE), −2.52 ± 3.48 diopter (D); SE < −5.0 D, 34 (32.1%) eyes; large disc (>2.43 mm²), 40.6%; small disc (<1.63 mm²), 12.5%; VF index, 96.72 ± 9.58%; mean deviation, −1.74 ± 3.61 dB; β-peripapillary atrophy (PPA), 96.2%; γ-PPA, 75.5%. Majority (86.1%) of these cases demonstrated normal (71.3%) or borderline (14.9%) on VF. Temporal and nasal RNFL showed significant differences among disc size subgroups (all p < 0.05). Nasal RNFL was significantly thicker in a large disc group than other subgroups. Temporal, superotemporal, inferotemporal, inferonasal RNFL, and superior RNFL peak location showed significant differences (all p < 0.05) among SE subgroups. Temporal RNFL was significantly thicker in the high myopia group than other subgroups. Conclusions: Temporalization of RNFL peaks in myopia and nasalization of RNFL peaks in large disc that display abnormal classifications might show normal classification of BMO-MRW. These findings of discrepancy between classifications should be considered in the diagnosis of early glaucoma. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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14 pages, 9825 KiB

Open AccessArticle

Swept-Source Optical Coherence Tomography Angiography According to the Type of Choroidal Neovascularization

by Joon Hyung Yeo, Hum Chung and Jee Taek Kim

J. Clin. Med. 2019, 8(9), 1272; https://doi.org/10.3390/jcm8091272 - 22 Aug 2019

Cited by 14 | Viewed by 4147

Abstract

We analyzed and compared the sensitivity of choroidal neovascularization (CNV) detection according to CNV type in patients with active neovascular age-related macular degeneration (AMD) using swept-source optical coherence tomography (OCT) angiography (OCTA). A retrospective chart review was performed in patients with neovascular AMD. [...] Read more.

We analyzed and compared the sensitivity of choroidal neovascularization (CNV) detection according to CNV type in patients with active neovascular age-related macular degeneration (AMD) using swept-source optical coherence tomography (OCT) angiography (OCTA). A retrospective chart review was performed in patients with neovascular AMD. OCTA images were classified into three groups: Group A (well-circumscribed vascular complex); Group B (moderately circumscribed vascular complex); and Group C (poorly circumscribed vascular complex), according to CNV appearance. Demographic characteristics, OCT parameters, neovascularization subtypes, and OCTA image quality were analyzed to determine the effect on visualization of the neovascular complex. A total of 130 patients with CNV secondary to active neovascular AMD were analyzed. Among them, 52 eyes from 47 patients were included in the study. Eighteen eyes (34.6%) were classified into Group A, 24 (46.2%) into Group B, and 10 (19.2%) into Group C. Statistical analysis showed no significant differences in demographic characteristics or OCT parameters between the three groups. Overall sensitivity of active CNV detection was 80.7% (42/52 eyes). In 73.5% (25/34) of eyes with type 1 CNV (sub-retinal pigment epithelial type), 100.0% (9/9) of eyes with type 2 CNV (sub-retinal type), and 88.9% (8/9) of eyes with type 3 CNV (retinal angiomatous proliferation type), the vascular complex was well visualized on OCTA. OCTA provides adequate noninvasive imaging of CNV in patients with neovascular AMD, which may assist in CNV diagnosis and activity monitoring. In particular, type 2 CNV was well detected in OCTA in comparison with type 1 and type 3 CNV. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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12 pages, 3207 KiB

Open AccessArticle

Optical Coherence Tomography Parameters as Predictors of Treatment Response to Eplerenone in Central Serous Chorioretinopathy

by Enrico Borrelli, Biancamaria Zuccaro, Ilaria Zucchiatti, Mariacristina Parravano, Lea Querques, Eliana Costanzo, Riccardo Sacconi, Francesco Prascina, Fabio Scarinci, Francesco Bandello and Giuseppe Querques

J. Clin. Med. 2019, 8(9), 1271; https://doi.org/10.3390/jcm8091271 - 22 Aug 2019

Cited by 26 | Viewed by 4548

Abstract

Purpose: To present data on clinical response to eplerenone over a 1-year period in patients with central serous chorioretinopathy (CSC), and to evaluate optical coherence tomography (OCT) variables as predictors of treatment response at 3- and 12-month follow-up visits. Methods: Patients [...] Read more.

Purpose: To present data on clinical response to eplerenone over a 1-year period in patients with central serous chorioretinopathy (CSC), and to evaluate optical coherence tomography (OCT) variables as predictors of treatment response at 3- and 12-month follow-up visits. Methods: Patients with acute or chronic CSC treated with eplerenone were retrospectively included. Clinical and imaging characteristics were recorded at baseline and at the 3-month and 12-month follow-up visits. Changes from baseline in quantitative measurements were calculated at each follow-up. Logistic regression analysis was computed to correlate clinical and OCT parameters at baseline with response to treatment at 3 and 12 months of follow-up. Results: A total of 50 eyes of 50 patients were included in the study. Mean ± SD best corrected visual acuity (BCVA) was 0.20 ± 0.14 Logarithm of the Minimum Angle of Resolution (LogMAR) at baseline and significantly improved at both the 3-month (0.12 ± 0.13 LogMAR, p < 0.0001) and 12-month (0.10 ± 0.12 LogMAR, p < 0.0001) follow-up visits. At the 3-month follow-up visit, 25 out of 50 eyes (50.0%) demonstrated macular complete subretinal fluid (SRF) resolution, while 13 eyes (26.0%) showed macular partial SRF resolution, and 12 eyes (24%) had neither partial nor complete macular SRF resolution. Among those patients with macular partial or complete SRF resolution at 3 months and thus not shifted to photodynamic therapy, 36 out of 38 cases had macular complete SRF resolution at the 12-month follow-up visit. There was a significant change from baseline at both follow-up visits in all anatomical OCT parameters (except for reduction in choroidal thickness that did not reach the statistical significance at the 12-month follow-up visit). Several OCT parameters at baseline were independently significant predictors for macular subretinal fluid complete resolution at 3 months, including (i) a thicker subfoveal choroidal thickness; (ii) a smaller subretinal fluid maximum diameter; (iii) a lower number of serous pigment epithelium detachments; and (iv) a lower number of intraretinal hyperreflective foci. Conclusion: Treatment with eplerenone in CSC patients is confirmed to be beneficial for both anatomical and functional outcomes. We identified attractive OCT metrics that could potentially be used as a tool to select patients who might mainly benefit from this treatment. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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7 pages, 6685 KiB

Open AccessArticle

Optical Quality Assessment in Patients with Macular Diseases Using Optical Quality Analysis System

by Joon Hee Cho, So Hyun Bae, Ha Kyoung Kim and Young Joo Shin

J. Clin. Med. 2019, 8(6), 892; https://doi.org/10.3390/jcm8060892 - 21 Jun 2019

Cited by 9 | Viewed by 2610

Abstract

Macular diseases cause vision loss, as the macula is the functional center for vision. In this study we assessed optical quality in eyes with macular diseases and evaluated the effectiveness of the Optical Quality Analysis System (OQAS) to detect macular diseases. We analyzed [...] Read more.

Macular diseases cause vision loss, as the macula is the functional center for vision. In this study we assessed optical quality in eyes with macular diseases and evaluated the effectiveness of the Optical Quality Analysis System (OQAS) to detect macular diseases. We analyzed 88 eyes of 88 patients with macular diseases (51 men and 37 women; mean age: 65.24 ± 12.96 years) and 43 eyes of 43 control subjects (11 men and 32 women; mean age: 54.70 ± 15.03 years). The macular diseases included age-related macular disease (n = 62), diabetic macular edema (n = 19), and retinal vein occlusion (n = 7). We measured the objective scattering index (OSI), modulation transfer function (MTF), Strehl ratio, and predicted visual acuities (PVAs) at 100, 20, and 10% contrast levels in both groups using OQAS. We measured the retinal thickness in the macular disease group on optical coherence tomography. The macular disease and control groups significantly differed in OSI, MTF, Strehl ratio, and PVAs at 20 and 10% contrast levels (p < 0.05). In the macular disease group, retinal thickness correlated with OSI (r = 0.370, p < 0.001) and MTF (r = −0.264, p = 0.014). In conclusion, optical quality was worse in the patients with macular diseases compared to the control subjects, and retinal thickness affected optical quality. Therefore, the distortion of macular shape may contribute to vision disturbance in patients with macular diseases. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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8 pages, 853 KiB

Open AccessArticle

Optical Coherence Tomography Angiography Findings in Fabry Disease

by Gilda Cennamo, Laura Giovanna Di Maio, Daniela Montorio, Fausto Tranfa, Camilla Russo, Giuseppe Pontillo, Sirio Cocozza, Roberta Esposito, Teodolinda Di Risi, Massimo Imbriaco, Letizia Spinelli, Eleonora Riccio and Antonio Pisani

J. Clin. Med. 2019, 8(4), 528; https://doi.org/10.3390/jcm8040528 - 17 Apr 2019

Cited by 20 | Viewed by 3783

Abstract

Background: Fabry disease (FD) is a X-linked recessive lysosomal storage disorder characterized by altered biodegradation of glycosphingolipids. It is a multisystem pathology, also involving ophthalmological systems that show modifications of the vessel wall due to glycosphingolipid deposits. Optical coherence tomography angiography (OCT-A) allows [...] Read more.

Background: Fabry disease (FD) is a X-linked recessive lysosomal storage disorder characterized by altered biodegradation of glycosphingolipids. It is a multisystem pathology, also involving ophthalmological systems that show modifications of the vessel wall due to glycosphingolipid deposits. Optical coherence tomography angiography (OCT-A) allows for an objective analysis of retinal microvasculature alterations, evaluating retinal vessel density in macular region. Methods: A total of 54 FD patients (34 females, 20 males, mean age 44.1 ± 15.6 years) and 70 controls (36 females, 34 males, mean age 42.3 ± 15.6 years) were included in this study. We evaluated vessel density in different macular areas (whole image, fovea, and parafovea) of both the superficial capillary plexus (SCP) and of the deep capillary plexus (DCP). Results: In the SCP there was a significantly lower vascular density in patients compared with controls in whole image (49.95 ± 5.17% vs. 51.99 ± 2.52%; p < 0.001), parafovea (52.01 ± 6.69% vs. 54.30 ± 2.61%; p = 0.002), and fovea (22.38 ± 9.01% vs. 29.31 ± 5.84%; p < 0.0001). In the DCP the vessel density was statistically increased in each macular area in patients compared with controls (54.82 ± 8.07% vs. 50.93 ± 5.46%; p = 0.005, 57.76 ± 7.26% vs. 53.59 ± 5.46%; p = 0.0001, and 39.75 ± 8.59% vs. 34.43 ± 8.68%; p < 0.0001 for whole image, parafovea, and fovea, respectively). Conclusion: OCT-A analysis showed that the macular vessel density was significantly reduced in the SCP and increased in the DCP in FD patients compared with controls. These findings, which might be a consequence of the alteration of vascular wall occurring in FD, support the hypothesis that the evaluation of early retinal microvascular network changes could be a useful tool in the clinical evaluation of the disease. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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11 pages, 941 KiB

Open AccessArticle

Anatomical and Functional Changes of the Retina and the Choroid after Resolved Chronic CSCR

by Lisa Toto, Rossella D’Aloisio, Rodolfo Mastropasqua, Luca Di Antonio, Marta Di Nicola, Giuseppe Di Martino, Federica Evangelista, Emanuele Erroi, Emanuele Doronzo and Cesare Mariotti

J. Clin. Med. 2019, 8(4), 474; https://doi.org/10.3390/jcm8040474 - 7 Apr 2019

Cited by 13 | Viewed by 4557

Abstract

Background: To investigate anatomical/functional changes after oral eplerenone therapy for chronic central serous chorioretinopathy (CCSC) in successfully treated eyes and fellow eyes and assess timing of foveal subretinal fluid (SRF) resolution. Methods: Twenty-one eyes of 21 patients suffering from CCSC with monolateral foveal [...] Read more.

Background: To investigate anatomical/functional changes after oral eplerenone therapy for chronic central serous chorioretinopathy (CCSC) in successfully treated eyes and fellow eyes and assess timing of foveal subretinal fluid (SRF) resolution. Methods: Twenty-one eyes of 21 patients suffering from CCSC with monolateral foveal SRF successfully treated with oral eplerenone were enrolled in this retrospective study (group 1). The fellow eyes (21 eyes; group 2), healthy or affected by CCSC, without foveal SRF were considered in the analysis. A control healthy group was enrolled as well (healthy controls; n = 21). Main outcome measures during follow-up included changes of best corrected visual acuity (BCVA, logMAR), central macular thickness (CMT; µm), SRF (µm), subfoveal choroidal thickness (SFCT; µm), superficial capillary plexus density (SCPD, %), deep capillary plexus density (DCPD, %), and choriocapillaris density (CCD, %) and percentage of eyes showing foveal SRF resolution at different time points. Results: Functional and anatomical parameters significantly improved during the study in group 1. BCVA increased significantly (p < 0.001), while CMT, SFCT, and SRF decreased significantly (p < 0.001; p < 0.001, and p = 0.037, respectively). SCPD, DCPD, and CCD did not show any statistically significant difference during follow-up. In 71.4% of eyes, resolution of SRF was observed within 60 days and in the remaining 28.6%, at 120 days. In fellow eyes, SFCT decreased significantly (p < 0.001), whilst all other parameters did not modify. Conclusions: Eplerenone treatment in chronic CSCR potentially improves recovery of retinal and choroidal morphology as well as visual acuity gain. A complete resolution of foveal SRF was observed in all eyes during a 4-month follow-up, with most eyes healing at 2 months. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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Review

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18 pages, 2839 KiB

Open AccessReview

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

by Claudio Iovino, Marco Pellegrini, Federico Bernabei, Enrico Borrelli, Riccardo Sacconi, Andrea Govetto, Aldo Vagge, Antonio Di Zazzo, Matteo Forlini, Lucia Finocchio, Adriano Carnevali, Giacinto Triolo and Giuseppe Giannaccare

J. Clin. Med. 2020, 9(2), 595; https://doi.org/10.3390/jcm9020595 - 21 Feb 2020

Cited by 155 | Viewed by 9226

Abstract

Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. [...] Read more.

Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. In this regard, the choroidal vascularity index (CVI) is emerging as a new imaging tool for the measurement and analysis of the choroidal vascular system by quantifying both luminal and stromal choroidal components. Numerous reports have been published so far regarding CVI and its potential applications in healthy eyes as well as in the evaluation and management of several chorioretinal diseases. Current literature suggests that CVI has a lesser variability and is influenced by fewer physiologic factors as compared to choroidal thickness. It can be considered a relatively stable parameter for evaluating the changes in the choroidal vasculature. In this review, the principles and the applications of this advanced imaging modality for studying and understanding the contributing role of choroid in retinal and optic nerve diseases are discussed. Potential advances that may allow the widespread adoption of this tool in the routine clinical practice are also presented. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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15 pages, 1389 KiB

Open AccessReview

Optical Coherence Tomography Angiography Imaging in Inherited Retinal Diseases

by Sally S. Ong, Tapan P. Patel and Mandeep S. Singh

J. Clin. Med. 2019, 8(12), 2078; https://doi.org/10.3390/jcm8122078 - 28 Nov 2019

Cited by 24 | Viewed by 5070

Abstract

Optical coherence tomography angiography (OCTA) is a novel, noninvasive imaging modality that allows depth-resolved imaging of the microvasculature in the retina and the choroid. It is a powerful research tool to study the pathobiology of retinal diseases, including inherited retinal dystrophies. In this [...] Read more.

Optical coherence tomography angiography (OCTA) is a novel, noninvasive imaging modality that allows depth-resolved imaging of the microvasculature in the retina and the choroid. It is a powerful research tool to study the pathobiology of retinal diseases, including inherited retinal dystrophies. In this review, we provide an overview of the evolution of OCTA technology, compare the specifications of various OCTA devices, and summarize key findings from published OCTA studies in inherited retinal dystrophies including retinitis pigmentosa, Stargardt disease, Best vitelliform macular dystrophy, and choroideremia. OCTA imaging has provided new data on characteristics of these conditions and has contributed to a deeper understanding of inherited retinal disease. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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23 pages, 52261 KiB

Open AccessReview

Intraocular Biopsy and ImmunoMolecular Pathology for “Unmasking” Intraocular Inflammatory Diseases

by Rodolfo Mastropasqua, Emma Di Carlo, Carlo Sorrentino, Cesare Mariotti and Lyndon da Cruz

J. Clin. Med. 2019, 8(10), 1733; https://doi.org/10.3390/jcm8101733 - 19 Oct 2019

Cited by 12 | Viewed by 4128

Abstract

Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas [...] Read more.

Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas in those cases where history, clinical tests, and ophthalmic and systemic examinations are inconclusive. In such situations, the teamwork between the ophthalmologist and the molecular pathologist is critically important to discriminate between autoimmune diseases, infections, and intraocular tumors, including lymphoma and metastases, especially in those clinical settings known as masquerade syndromes. This comprehensive review focuses on the diagnostic use of intraocular biopsy and highlights its potential to enhance research in the field. It describes the different surgical techniques of obtaining the biopsy, risks, and complication rates. The review is organized according to the anatomical site of the sample: I. anterior chamber containing aqueous humor, II. iris and ciliary body, III. vitreous, and IV. choroid and retina. We have excluded the literature concerning biopsy for choroidal melanoma and retinoblastoma, as this is a specialized area more relevant to ocular oncology. Full article

(This article belongs to the Special Issue Application of Retinal and Optic Nerve Imaging in Clinical Medicine)

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