Changes in reticular pseudodrusen area in eyes that progressed from early to late age-related macular degeneration.

OBJECTIVE: This retrospective cohort study utilized 3 imaging modalities to analyze quantitatively reticular pseudodrusen (RPD) area changes in eyes that progressed from early to late age-related macular degeneration (AMD). METHODS: Subjects with AMD, unilateral choroidal neovascularization (CNV), and early AMD with RPD in the fellow eye (the study eye) were included. The study eyes underwent indocyanine green angiography (ICGA), near-infrared reflectance (NIR-R), and short-wavelength autofluorescence (AF) imaging of the macula at baseline and at follow-up. Study eyes were analyzed for RPD and for the development of late AMD-CNV and/or geographic atrophy (GA). RPD area was measured at baseline and at follow-up as a percentage of the 30-degree field. RESULTS: During the study period (mean follow-up time 23.5 ± 5.0 months), 12/31 study eyes developed CNV and 4/31 developed GA. In the eyes that developed CNV, there was a statistically significant decrease in mean RPD area over the follow-up period as seen on AF (P < 0.01) and NIR-R (P = 0.01), and the decrease in mean RPD area approached statistical significance on ICGA (P = 0.08). CONCLUSION: Using 3 en face imaging techniques, we demonstrate that RPD undergo dynamic spatiotemporal changes in eyes that progress from early AMD to CNV, namely a decrease in the area of lesions detected.

Choroidal thickness in patients with coronary artery disease.

PURPOSE: To evaluate choroidal thickness (CTh) in patients with coronary artery disease (CAD) compared to healthy controls. DESIGN: Cross-sectional. METHODS: Setting: Ambulatory clinic of a large city hospital. Patient population: Thirty-four patients had documented CAD, defined as history of >50% obstruction in at least one coronary artery on cardiac catheterization, positive stress test, ST elevation myocardial infarction, or revascularization procedure. Twenty-eight age-matched controls had no self-reported history of CAD or diabetes. Patients with high myopia, dense cataracts, and retinal disease were excluded. Observation procedures: Enhanced depth imaging optical coherence tomography and questionnaire regarding medical and ocular history. Main outcome measures: Subfoveal CTh and CTh 2000 µm superior, inferior, nasal, and temporal to the fovea in the left eye, measured by 2 readers. RESULTS: CTh was significantly lower in patients with CAD compared to controls at the subfoveal location (252 vs. 303 µm, P = 0.002) and at all 4 cardinal macular locations. The mean difference in CTh between the 2 groups ranged from 46 to 75 µm and was greatest in the inferior location. Within the CAD group, CTh was significantly lower temporally (P = 0.007) and nasally (P<0.001) than subfoveally, consistent with the pattern observed in controls. On multivariate analysis, CAD was negatively associated with subfoveal CTh (P = 0.006) after controlling for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS AND RELEVANCE: Patients with CAD have a thinner macular choroid than controls, with preservation of the normal spatial CTh pattern. Decreased CTh might predispose patients with CAD to high-risk phenotypes of age-related macular degeneration such as reticular pseudodrusen and could serve as a potential biomarker of disease in CAD.

The Relationship Between Reticular Macular Disease and Choroidal Thickness.

PURPOSE: Subretinal drusenoid deposits (SDD) are the main structural lesion of reticular macular disease (RMD), a phenotype of age-related macular degeneration (AMD). We aim to demonstrate spatiotemporal relationships between SDD and choroidal thickness (CTh) alterations in RMD+ and RMD- eyes. METHODS: Thirty-three eyes (26 subjects) with early AMD/no SDD (RMD-) and 18 eyes (16 subjects) with early AMD/SDD (RMD+) underwent enhanced depth imaging spectral domain optical coherence tomography (SD-OCT) for CTh measurements at 11 points per scan, in 5 horizontal B scans, creating a grid of 55 points/eye. The 55 points were treated as a cluster, controlling within-subject correlation. Marginal generalized estimating equation modeling was used to estimate the association between CTh and RMD status. All eyes were divided by their median age (≤82 and >82 years) for stratified analyses. RESULTS: CTh was not significantly reduced in RMD+ eyes compared with RMD- eyes (mean difference [MD] -16.84 µm, P = 0.24). Among younger subjects, mean CTh was significantly reduced in RMD+ versus RMD- eyes (MD -53.72 µm, P = 0.01). Conversely, among older subjects, there was no significant difference in CTh between RMD+ and RMD-. CONCLUSIONS: In RMD, the association of SDD and CTh alterations varies with age but not by macular region. Among younger subjects (<82 years old), CTh was significantly thinner in RMD+ versus RMD- eyes.

Endovascular-first approach is not associated with worse amputation-free survival in appropriately selected patients with critical limb ischemia.

OBJECTIVE: Endovascular interventions for critical limb ischemia are associated with inferior limb salvage (LS) rates in most randomized trials and large series. This study examined the long-term outcomes of selective use of endovascular-first (endo-first) and open-first strategies in 302 patients from March 2007 to December 2010. METHODS: Endo-first was selected if (1) the patient had short (5-cm to 7-cm occlusions or stenoses in crural vessels); (2) the disease in the superficial femoral artery was limited to TransAtlantic Inter-Society Consensus II A, B, or C; and (3) no impending limb loss. Endo-first was performed in 187 (62%), open-first in 105 (35%), and 10 (3%) had hybrid procedures. RESULTS: The endo-first group was older, with more diabetes and tissue loss. Bypass was used more to infrapopliteal targets (70% vs 50%, P = .031). The 5-year mortality was similar (open, 48%; endo, 42%; P = .107). Secondary procedures (endo or open) were more common after open-first (open, 71 of 105 [68%] vs endo, 102 of 187 [55%]; P = .029). Compared with open-first, the 5-year LS rate for endo-first was 85% vs 83% (P = .586), and amputation-free survival (AFS) was 45% vs 50% (P = .785). Predictors of death were age >75 years (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.7-6.6; P = .0007), end-stage renal disease (ESRD) (HR, 3.4; 95% CI, 2.1-5.6; P < .0001), and prior stroke (HR, 1.6; 95% CI, 1.03-2.3; P = .036). Predictors of limb loss were ESRD (HR, 2.5; 95% CI, 1.2-5.4; P = .015) and below-the-knee intervention (P = .041). Predictors of worse AFS were older age (HR, 2.03; 95% CI, 1.13-3.7; P = .018), ESRD (HR, 3.2; 95% CI, 2.1-5.11; P < .0001), prior stroke (P = .0054), and gangrene (P = .024). CONCLUSIONS: At 5 years, endo-first and open-first revascularization strategies had equivalent LS rates and AFS in patients with critical limb ischemia when properly selected. A patient-centered approach with close surveillance improves long-term outcomes for both open and endo approaches.