Diabetic microaneurysms detected by fluorescein angiography spatially correlate with regions of macular ischemia delineated by optical coherence tomography angiography

Purpose: To characterize the relationship between diabetic macular ischemia (DMI) delineated by optical coherence tomography angiography (OCTA) and microaneurysms (MAs) identified by fundus fluorescein angiography (FFA). Methods: Patients with diabetic retinopathy (DR) who underwent OCTA and FFA were retrospectively identified. FFA images were cropped and aligned with their respective OCTA images using i2k Align Retina software (Dual?Align, Clifton Park, NY, USA). Foveal avascular zone (FAZ) and ischemic areas were manually delineated on OCTA images, and MAs were marked on the corresponding FFA images before overlaying paired scans for analysis (ImageJ; National Institutes of Health, Bethesda, MD, USA). Results: Twenty?eight eyes of 20 patients were included. The average number of MAs identified in cropped FFA images was 127 ± 42. More DMI was noted in the superficial capillary plexus (SCP; 36 ± 13%) compared to the deep capillary plexus (DCP; 28 ± 14%, P < 0.001). Similarly, more MAs were associated with ischemic areas in SCP compared to DCP (92.0 ± 35.0 vs. 76.8 ± 36.5, P < 0.001). Most MAs bordered ischemic areas; fewer than 10% localized inside these regions. As DMI area increased, so did associated MAs (SCP: r = 0.695, P < 0.001; DCP: r = 0.726, P < 0.001). Density of MAs surrounding FAZ (7.7 ± 6.0 MAs/mm2) was similar to other DMI areas (SCP: 7.0 ± 4.0 MAs/mm2, P = 0.478; DCP: 9.2 ± 10.9 MAs/mm2, P = 0.394). Conclusion: MAs identified in FFA strongly associate with, and border areas of, DMI delineated by OCTA. Although more MAs are localized to SCP ischemia, the concentration of MAs associated with DCP ischemia is greater. By contrast, few MAs are present inside low?flow regions, likely because capillary loss is associated with their regression.

Posterior segment involvement in systemic lupus erythematosus – A series from South India

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS?related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

Novel optical coherence tomography angiography biomarkers in the diagnosis and assessment of diabetic macular edema and diabetic macular ischemia in patients with non-proliferative diabetic retinopathy

Purpose: The present study aims to determine the macular and choroidal optical coherence tomography angiography (OCTA) biomarkers in the assessment and monitoring of diabetic macular edema (DME) and diabetic macular ischemia (DMI) in patients with non?proliferative diabetic retinopathy (NPDR). Methods: In this cohort study, a total of 176 eyes of 110 patients with NPDR were investigated at our institute over a period of 10 months. Eyes were divided into four groups based on the severity of NPDR. Each eye was subjected to OCTA (Topcon 3D OCT?1 Maestro2) macula 6 × 6 mm2 en face. It features IMAGEnet 6 software for dynamic viewing of OCTA and imaging data. Four OCTA biomarkers for the macula were identified: foveal avascular zone area (FAZ area), foveal avascular zone contour irregularity (FAZ?CI), capillary dropout areas (CDA), and perifoveal intercapillary areas (PICA). The choroidal OCTA biomarker was the number of choroidal circulation flow voids (CCFV). For all analyses, P < 0.05 was considered statistically significant. Results: Increase in FAZ area and number of CDA were statistically significant (p < 0.0001) with an increase in central foveal thickness, suggesting a correlation of ischemic changes with an increase in DME. FAZ?CI, enlarged PICA, and CCFV were significantly associated with more severe NPDR patients. Conclusion: A correlation between DME and DMI in a patient of NPDR and its progression can be evaluated in a single visit. A unique feature of our study is it revealed novel diagnostic biomarkers of OCTA for DMI and DME.

The assessment of diabetic macular ischemia and the influence of intravitreal anti-vascular endothelial growth factor therapy to diabetic macular ischemia / 中华眼底病杂志

Diabetic macular ischemia (DMI) is one of the manifestation of diabetic retinopathy (DR).It could be associated with diabetic macular edema (DME),which may affect the vision of DR patients.FFA is the gold standard for the diagnosis of DMI,but with the advent of OCT angiography,a more convenient and diversified method for the evaluation of DMI has been developed,which makes more and more researchers start to study DMI.Intravitreal injection of anti-VEGF has become the preferred treatment for DME.When treating with DME patients,ophthalmologists usually avoid DMI patients.But if intravitreal anti-VEGF should be the contradiction of DME is still unclear.To provide references to the research,this article summarized the risk factors,assessment methods and influence of DMI.This article also analyzed the existing studies,aiming to offer evidences to a more reasonable and effective treatment decision for DME individual.

Macular Ischemia Correlated with Final Visual Outcome in Retinal Vein Occlusion Patients

PURPOSE: To identify the correlation between final visual outcome after at least 6 months of follow-up and the extent of macular ischemia on the first visit. METHODS: We performed a retrospective clinical analysis of macular ischemia using clinical records, fundus examinations, and fluorescein angiographies in 83 patients (86 eyes) diagnosed with retinal vein occlusion from January 1998 to July 2012 and followed up for over 6 months. We evaluated the extent and the location of macular ischemia, macular edema, initial and final visual acuities and systemic disease based on fluorescein angiography and optical coherence tomography performed within 2 weeks of the first visit. The patients were divided into the following 4 groups based on the extent and location of macular ischemia and edema: superotemporal, superonasal, inferotemporal, and inferonasal. RESULTS: Retinal vein occlusions (RVOs) consisted of 24 central RVOs (CRVOs) and 62 branch RVOs (BRVOs). Mean initial acuity (log MAR) was 0.35 +/- 0.31 (36 eyes) in the no macular ischemia group, 0.40 +/- 0.21 (11 eyes) in the 1-quadrant macular ischemia group, 0.71 +/- 0.32 (26 eyes) in the 2-quadrant macular ischemia group and 0.73 +/- 0.36 (13 eyes) in the over 3 quadrants macular ischemia group. Mean final acuity (log MAR) was 0.23 +/- 0.23 in the no macular ischemia group, 0.40 +/- 0.30 in the 1-quadrant macular ischemia group, 0.51 +/- 0.32 in the 2-quadrant macular ischemic group and 0.73 +/- 0.31 in the over 3 quadrants macular ischemia group. CONCLUSIONS: The initial and final visual outcomes were worse when more quadrants were affected by macular ischemia. The extent of macular ischemia was correlated with initial visual acuity and final visual outcome but not with macular edema.

Effects of Macular Ischemia and Early Treatment on Visual Outcome in Branch Retinal Vein Occlusion

PURPOSE: To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branch retinal vein occlusion (BRVO). METHODS: This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumab injection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least 4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6, 12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the first treatment, and the relationship of these with BCVA. RESULTS: Mean BCVA (log MAR) was significantly improved from 0.67 +/- 0.43 at baseline to 0.30 +/- 0.30 at 48 months (p 6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant (p 6 weeks) treatment groups with macular ischemia in BCVA after 48 months. CONCLUSIONS: In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections, despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining and improving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.

Unusual visual loss after snakebite

Snakebites are endemic in some parts of Thailand, being associated with several complications. Ocular disturbances are uncommon, except in cases of corneal or conjunctival injury, when the eye is directly exposed to the snake venom. The present study presents a case of combined ophthalmic artery occlusion and transient central retinal artery occlusion with macular ischemia after a Russell's viper bite.(AU)

Visual Prognosis of Macular Edema Associated with Macular Ischemia in Branch Retinal Vein Occlusion

PURPOSE: We compared the perifoveal capillary ring state and the size of the macular ischemic area in patients with the macular edema, then analyzed the effect of grid photocoagulation on macular edema. The aim of the present study was to evaluate visual prognosis and to determine treatment modality of macular edema with macular ischemia in branch retinal vein occlusion (BRVO). METHODS: We did retrospective clinical analysis on the macular edema and macular circulatory state using clinical records, and performed fluorescein angiography in 89 patients (92 eyes) who were diagnosed with BRVO at Inha University Hospital from June 1996 through October 2000 and were followed for over 6 months. RESULTS: The incidence of macular edema was not statistically correlated with occlusion site of retinal vein, size of macular ischemic area and perifoveal capillary ring state. The initial visual acuity was a statistically significant factor in the prognosis of final visual acuity. The macular ischemic area was statistically correlated with initial visual acuity, and the perifoveal capillary ring state was not correlated with initial and final visual acuities. The improvement of visual acuity after grid photocoagulation for macular edema was noted in patients with intact perifoveal capillary ring state and small macular ischemic area. CONCLUSIONS: The only facator to final visual acuity is initial visual acuity. Prospective study is needed to evaluate effect of early treatment of macular edema with grid photocoagulation at an early stage of BRVO in patients with intact perifoveal capillary ring state and small macular ischemic area.

Macular Ischemia in Temporal Branch Retinal Vein Occlusion: Fluorescein angiographic classification and Visual prognosis

There have been various report about visual prognosis in branch retinal vein occlusion according to location and size of occluded vessel, status of perifoveal capillary ring, presence of retinal ischemia and hypertension. We therefore sought to determine prognostic indicators of BRVO by observing retrospectively the natural course of the BRVO with macular ischemia. To do that, we devide 63 eyes with BRVO into groups according to the macular perfusion status on high-quality fluorescein angiography. The patients without broken capillary ring exhibited better initial, final visual acuity and visual improvement. The patients with the extent of macular ischemia under 90degree exhibited better initial and final visual acuity but same visual improvement. There were no statistically significant difference in visual prognosis according to the status of perifoveal capillary ring, extent of macular ischemia and presence of hypertension.