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.

Functional and Hemodynamic Efficacy of Non-Poliferative Diabetic Retinopathy Treatment by Endonasal Electrophoresis of Tanakan

Aims: To study the effectiveness of the treatment of patients with non-proliferative diabetic retinopathy by tanakan endonasal electrophoresis according to functional and hemodynamic data.Study Design: Cross-sectional comparative analysis.Place and Duration of Study: Department of Ophthalmology, clinic of Tashkent Medical Academy, between 2017 and 2020.Methodology: We included 66 patients (123 eyes), 23 men and 43 women; age range 18-75 years with non-proliferative diabetic retinopathy. The patients were divided into 2 groups: to receive daily tablets of Tanakan (control), or daily endonasal electrophoresis of Tanakan (main) within ten days. Before and after the course of therapy, the patients underwent determination of visual acuity, Doppler ultrasound imaging of the eye and computer static perimetry.Results: Improvements in visual acuity were observed in 87,3% of the main group patients, and in 22% of the control group. Statistically significant increase in blood flow velocity and a decrease in the resistance index were observed in the main group (P < 0.05). Retinal photosensitivity increased by 22% in the main group, and by 10% in the control group. The mean deviation from the age norm decreased by 33% in the main group and by 12% in the control group. Among the patients of the main group, 30% experienced a decrease in absolute scotomas and 100% in relative scotomas. Among the patients of the control group, 21% and 83% experienced a decrease in absolute and relative scotomas, respectively.Conclusion: Treatment with tanakan endonasal electrophoresis significantly improved visual acuity, eye hemodynamics, and retinal photosensitivity. This treatment is more effective than the traditional use of ginkgo- biloba tablets.

Detection of Exudates and Microaneurysms in the Retina by Segmentation in Fundus Images / Detección de Exudados y Microaneurismas en la Retina por Segmentación en Imágenes de Fondo

ABSTRACT This article proposes two methodologies for the detection of lesions in the retina, which may indicate the presence of diabetic retinopathy (DR). Through the use of digital image processing techniques, it is possible to isolate the pixels that correspond to a lesion of RD, to achieve segmenting microaneurysms, the edges of the objects contained in the image are highlighted in order to detect the contours of the objects to select by size those that meet an area of 15 to 25 pixels in the case of 512x512 images and identify the objects as possible microaneurysms, while for the detection of exudates the green channel is selected to contrast the luminous objects in the retinography and from the conversion to gray scale, a histogram is graphed to identify the ideal threshold for the segmentation of the pixels that belong to the exudates at the end of the optical disk previously identified by a specialist. A confusion matrix supervised by an ophthalmologist was created to quantify the results obtained by the two methodologies, obtaining a specificity of 0.94 and a sensitivity of 0.97, values that are outstanding to proceed with the classification stage.

RESUMEN Este artículo propone dos metodologías para la detección de lesiones en la retina, que pueden significar la presencia de retinopatía diabética (RD). Mediante el uso de técnicas de procesamiento de imágenes digitales se logra aislar los pixeles que corresponden a una lesión propia de RD, para lograr segmentar microaneurismas se resaltan los bordes de los objetos contenido en la imagen con la finalidad de detectar los contornos de los objetos para seleccionar por tamaño los que cumplan con un área de 15 a 25 pixeles en el caso de imágenes de 512x512 y se identifiquen los objetos como posibles microaneurismas, mientras que para la detección de exudados se selecciona el canal verde para contrastar los objetos luminosos en la retinografía y a partir de la conversión a escala de grises se grafica un histograma para identificar el umbral idóneo para la segmentación de los pixeles que pertenecen a los exudados al final eliminar el disco óptico previamente identificado por un especialista. Se creó una matriz de confusión supervisada por un oftalmólogo para cuantificar los resultados obtenidos por las dos metodologías obteniendo una especificidad del 0.94 y una sensibilidad del 0.97, unos valores que son sobresalientes para proceder con la etapa de clasificación.

Correlation of leaking microaneurysms with retinal thickening in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the contribution of fluorescein angiographic leaking microaneurysms (leak-MA) versus non-leaking microaneurysms (non-leak-MA) to retinal thickening in diabetic retinopathy.METHODS:A consecutive series of 38 eyes from 24 patients with diabetic retinopathy was included.Leak-MA and non-leak-MA in each eye were selected in pairs at corresponding topographic location.Leaking was defined by late phase fluorescein angiograms compared to early phase.Retinal thickness was measured with Heidelberg Spectralis OCT topographically aligned on early phase angiograms at the MA site and within a 1 mm circle.RESULTS:In all eyes,significant retinal thickening at the site of leaking compared to non-leaking microaneurysms was observed (356±69μm vs 318±56μm,P<0.001),showing a mean increase in thickness in the areas of leak-MA vs non-leak-MA of 38±39μm (95% confidence interval 25-51μm,P<0.001).All 1mm area measurements also showed significant (P<0.001) thickening of the leak-MA with average thickness of leak-MA vs non-leak-MA as 351±67μm vs 319±59μm;minimum thickness 311±62μm vs 284±60μm;maximum thickness 389±78μm vs 352±66μm;and retina volume 26.4±6.0mm3 vs 23.6±3.7mm3,respectively.CONCLUSION:Leaking of microaneurysms on fluorescein angiography appears to cause focal thickening of retina,which can be measured with high-resolution OCT.Therefore,targeting leaking microaneursyms in diabetic retinopathy has the potential to reduce retinal thickening.

Síndrome de Churg-Strauss: a propósito de un caso con manifestaciones poco usuales / Churg-Strauss syndrome: a case with unusual manifestations

El síndrome de Churg-Strauss, una vasculitis sistémica necrotizante que compromete vasos de pequeño y, rara vez, de mediano calibre, es junto con la granulomatosis de Wegener y la poliangeítis microscópica una de las vasculitis asociadas con anticuerpos contra el citoplasma de los neutrófilos. Se caracteriza por asma, hipereosinofilia y granulomas extravasculares eosinofílicos. Reportamos el caso de una mujer de 36 años con historia de asma de comienzo tardío y rinitis alérgica quien presentó compromiso del sistema nervioso central, neuropatía periférica, vasculitis leucocitoclástica y marcada eosinofilia. De manera interesante, esta paciente presentó manifestaciones inusuales del síndrome de Churg-Strauss tales como microaneurismas mesentéricos y claudicación mandibular. Además, presentamos una breve revisión de la literatura sobre síndrome de Churg-Strauss.

Churg-Strauss syndrome, a necrotizing systemic vasculitis which involves the small and (more rarely) the medium-sized vessels, is a primary vasculitis strongly associated with antineutrophil cytoplasm antibodies (ANCA). It is characterized by the presence of asthma, eosinophilia and extravascular eosinophilic granulomas. Herein, we report a 36-year-old woman with a history of late onset asthma and allergic rhinitis who developed central nervous system involvement, peripheral neuropathy, leukocytoclastic vasculitis and eosinophilia. Interestingly, unusual clinical manifestations of Churg-Strauss syndrome such as mesenteric microaneurysms and jaw claudication were present in this particular patient. A brief review of the literature of Churg-Strauss syndrome is presented.