ABSTRACT
PURPOSE: The aim of the study was to identify predictive factors for detection of impending retinal pigment epithelium (RPE) tears in patients under anti-VEGF therapy for treatment of retinal pigment epithelial detachment (PED) due to exudative age-related macular degeneration (AMD) using near-infrared reflectance imaging (NIR), spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FLA). METHODS: We retrospectively evaluated NIR, SD-OCT and FLA images, number of intravitreal injections as well as demographical data of 103 eyes of 98 patients with vascularized PED [48.5% fibrovascular PED (fPED), 51.5% serous vascularized PED (svPED)] secondary to AMD. RESULTS: Fifteen eyes with svPED of 103 included eyes (14.6%) developed an RPE tear under anti-VEGF therapy. Prior to RPE tear formation, we could identify radial hyperreflective lines spreading in a funnel-like pattern across the PED lesion in NIR images in 11 eyes correlating with folds in the RPE on corresponding SD-OCT scans (mean observation period: 115.4 ± 66.6 days; mean number of injections: 3.2 ± 1.5; mean PED height 828.2 ± 356.5 µm). In nine RPE tears (81.8%), the edge of the tear could be clearly localized on the opposite side of the PED lesion in relation to the origin of hyperreflective lines. None of the fPED patients showed the described signal. CONCLUSIONS: Patients under anti-VEGF therapy for treatment of svPED due to AMD frequently show radial hyperreflective lines in NIR images prior to RPE tear development that correspond to wrinkled changes in the RPE. Hyperreflective lines may serve as an indicator for an impending RPE tear in svPED patients.
Subject(s)
Neovascularization, Pathologic/diagnosis , Retinal Detachment/diagnosis , Retinal Perforations/diagnosis , Retinal Pigment Epithelium/blood supply , Wet Macular Degeneration/complications , Aged , Aged, 80 and over , Angiogenesis Inhibitors/therapeutic use , Female , Fluorescein Angiography , Humans , Infrared Rays , Intravitreal Injections , Male , Ophthalmoscopy , Retinal Detachment/etiology , Retrospective Studies , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Wet Macular Degeneration/drug therapyABSTRACT
Infections during pregnancy can adversely affect the development of the fetal brain. This may contribute to disease processes such as schizophrenia in later life. Changes in the (cyto-) architecture of the anterior cingulate cortex (ACC), particularly in GABA-ergic interneurons, play a role in the pathogenesis of schizophrenia. We hypothesized that exposure to infection during pregnancy could result in cyto-architectural changes in the fetal ACC, similar to the pathogenesis seen in schizophrenia. Fetal sheep of 110 days GA (term=150 days GA) received an intravenous injection of 100 ng or 500 ng lipopolysaccharide (LPS) or saline as control. After delivery at 113 days GA, the cyto-architecture of the cingulate cortex (CC) was examined by immunohistochemistry. High dose LPS exposure resulted in a decreased density of GFAP-, calbindin D-28K- and parvalbumin-immunoreactive cells in the CC. In addition, these cells and calretinin-immunoreactive cells showed a changed morphology with reduced cell processes. This study provides further evidence that intra-uterine endotoxemia can induce changes in the fetal brain which correspond with changes seen in schizophrenia.
