Aude Couturier

CAPILLARY PLEXUS ANOMALIES IN DIABETIC RETINOPATHY ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

Purpose: To analyze the foveal microvasculature in eyes with diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA) and fluorescein angiography (FA). Methods: In this retrospective study of 20 eyes of 14 patients with DR imaged using OCTA and FA, clinical features of DR such as microaneurysms, capillary nonperfusion areas, and intraretinal microvascular abnormalities were analyzed. Results: In the superficial plexus, a rarefaction of capillaries with capillary nonperfusion areas was present in all eyes. Some of these nonperfused areas were not detected on FA and were better delimited on OCTA. Conversely, in the deep plexus, capillary nonperfusion areas were seen only in 35% (7/20) of eyes, whereas DR led to an alteration of the normal capillary vortex pattern in all eyes. Only 62% of microaneurysms visualized on FA were detected by OCTA (P = 0.02). Intraretinal microvascular abnormalities were well detected by both FA and OCTA. Conclusion: Optical coherence tomography angiography allowed detecting DR anomalies in both superficial and deep capillary plexus in all eyes. The ability of OCTA to detect microaneurysms was lower than that of FA although its accuracy for assessing capillary nonperfusion was better and may enable a proper grading of DR progression.

NEW INSIGHT INTO THE MACULAR DEEP VASCULAR PLEXUS IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

Purpose: To describe the macular deep capillary plexus (DCP) in normal eyes using optical coherence tomography angiography. Methods: Retrospective study including 41 consecutive normal eyes imaged using optical coherence tomography angiography (RTVue XR Avanti; Optovue Inc). Default autosegmentation of the superficial capillary plexus (SCP) and DCP, and manual adjustments of “deep settings” were used to analyze the organization of the normal macular microvascularization and to investigate in vivo the connection between these capillary networks. Results: Mean age was 31 years (range, 22–55 years). The SCP and DCP had 2 different organizations, but the plexus autosegmentation was imperfect: In 68% of cases, the image of the SCP variably superimposed on the DCP, interfering with its analysis. The SCP was composed on average of 7 pairs of arterioles and venules obvious on each 3-mm × 3-mm optical coherence tomography angiography scanning area. The DCP was composed of a capillary vortex arrangement, whose centers were aligned along the course of the macular superficial venules. Conclusion: The SCP and DCP had two different topographic organizations. The pattern of the capillary units converging into capillary vortexes highly suggests that they drain into the superficial venules. The different structural properties of the SCP and DCP could explain the differences in flow resistance and perfusion.

Meaning of Visualizing Retinal Cone Mosaic on Adaptive Optics Images

PURPOSE To explore the anatomic correlation of the retinal cone mosaic on adaptive optics images. DESIGN Retrospective nonconsecutive observational case series. METHODS A retrospective review of the multimodal imaging charts of 6 patients with focal alteration of the cone mosaic on adaptive optics was performed. Retinal diseases included acute posterior multifocal placoid pigment epitheliopathy (n = 1), hydroxychloroquine retinopathy (n = 1), and macular telangiectasia type 2 (n = 4). High-resolution retinal images were obtained using a flood-illumination adaptive optics camera. Images were recorded using standard imaging modalities: color and red-free fundus camera photography; infrared reflectance scanning laser ophthalmoscopy, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography (OCT) images. RESULTS On OCT, in the marginal zone of the lesions, a disappearance of the interdigitation zone was observed, while the ellipsoid zone was preserved. Image recording demonstrated that such attenuation of the interdigitation zone co-localized with the disappearance of the cone mosaic on adaptive optics images. In 1 case, the restoration of the interdigitation zone paralleled that of the cone mosaic after a 2-month follow-up. CONCLUSION Our results suggest that the interdigitation zone could contribute substantially to the reflectance of the cone photoreceptor mosaic. The absence of cones on adaptive optics images does not necessarily mean photoreceptor cell death.

CORRELATION BETWEEN CYSTOID SPACES IN CHRONIC DIABETIC MACULAR EDEMA AND CAPILLARY NONPERFUSION DETECTED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

Purpose: To study the relationship between the location of cystoid spaces and retinal capillary nonperfusion areas in diabetic cystoid macular edema (DCME). Methods: In this retrospective study, 24 eyes of 21 patients with chronic DCME were followed using optical coherence tomography angiography. The capillary density of the superficial capillary plexus and deep capillary plexus was measured using AngioAnalytics software in all DCME eyes and in 20 healthy controls. Diabetic cystoid macular edema improved spontaneously or after treatment in 11 eyes. Results: The intraretinal cystoid spaces were surrounded by capillary-flow void areas in the superficial capillary plexus in 71% of cases and in the deep capillary plexus in 96% of cases. The deep capillary plexus had lost its regular pattern in all cases. The capillary density was decreased in both plexus (mean decrease of −23.0% in the superficial capillary plexus and −12.4% in the deep capillary plexus vs. normal). In the 11 cases with DCME resolution, the capillary did not reperfuse in areas of resolved cystoid spaces, and the capillary density did not change significantly. Conclusion: In chronic DCME, cystoid spaces were located within capillary dropout areas. No reperfusion occurred after DCME resolution. The impact of the severity of this nonperfusion on the risk of recurrence of DCME remains to be clarified.

Efficacy and safety of sustained-delivery fluocinolone acetonide intravitreal implant in patients with chronic diabetic macular edema insufficiently responsive to available therapies: a real-life study

Purpose To evaluate the efficacy and safety of sustained-delivery fluocinolone acetonide (FAc) intravitreal implant for diabetic macular edema (DME). Patients and methods Prospective study in patients with DME insufficiently responsive to laser and anti-vascular endothelial growth factor (anti-VEGF). Patients with history of rise of intraocular pressure after intravitreal corticosteroids were excluded. Results The macular edema rapidly decreased both in group 1 (prior laser only; n=7 eyes) and group 2 (prior laser and ≥3 monthly anti-VEGF therapy; n=10 eyes) and central subfield thickness was reduced by −299 μm (P=0.008) and −251 μm (P=0.016) at 12 months, respectively. Mean area under the curve from baseline to last value for pseudophakic eyes was +4.2 letters in group 1 and +9.5 letters in group 2. Overall, the FAc implant was well tolerated. Conclusion This prospective study confirms the efficacy of the FAc implant in DME patients insufficiently responsive to laser and anti-VEGF. Moreover, with a careful patient selection, our safety results would support an earlier use of FAc in the DME treatment pathway.

POSTERIOR VITREOUS DETACHMENT IN HIGHLY MYOPIC EYES UNDERGOING VITRECTOMY.

Purpose: To assess the rate of complete posterior vitreous detachment (PVD) in highly myopic eyes requiring vitreoretinal surgery based on intraoperative observations. Methods: Monocentric retrospective observational case series of consecutive highly myopic patients whose eyes underwent 25 G 3-port pars plana vitrectomy between 2009 and 2012. Patients were operated on for rhegmatogenous retinal detachment, epiretinal membrane, macular hole with retinal detachment, myopic foveoschisis, and myopic macular hole. Patient records were reviewed focusing on the intraoperative assessment of PVD which was assisted in most cases by a visualization agent. Results: Ninety-six eyes of 95 patients whose mean age was 62.15 ± 12.4 years (29–95) were included. Complete PVD was observed in 52.1% of eyes. The PVD rate varied depending on the disease (P < 0.0001). It was high in retinal detachment and epiretinal membrane (85 and 74.2%, respectively) and low in myopic foveoschisis and myopic macular hole (14.3 and 10%, respectively). Complete PVD was found in 42.9% of macular hole with retinal detachment. Conclusion: In highly myopic eyes, the rate of complete PVD varied widely depending on the vitreoretinal disease operated on. The posterior vitreous cortex was often detached from the retina in retinal detachment and epiretinal membrane but was most often attached in myopic foveoschisis and macular hole.

Surgical outcomes of florid diabetic retinopathy treated with antivascular endothelial growth factor.

Purpose: To evaluate the effectiveness of vitreoretinal surgery combined with antivascular endothelial growth factor therapy to treat florid diabetic retinopathy, a rare and severe form of diabetic retinopathy in young patients. Methods: Retrospective observational case series including 61 eyes of 45 patients operated on for florid diabetic retinopathy over the past 5 years, with preoperative or intraoperative intravitreal injection of bevacizumab. Cases were classified into three stages of disease severity, according to the extension of the fibrovascular membranes. Main outcome measures were mean change in visual acuity, anatomical outcome, and surgical complications. Results: After a mean follow-up of 20.3 months, the mean visual acuity significantly increased from +1.7 logMAR before surgery to +0.8 logMAR after surgery (P < 0.01). The visual gain was significant in Stages I and II (P < 0.05) but not significant in Stage III. A flat retina without silicone oil was achieved in 84% of eyes. Eight eyes (13%) progressed to neovascular glaucoma and/or phthisis despite repeated surgeries. Conclusion: Vitrectomy combined with antivascular endothelial growth factor therapy allows both favorable visual and anatomical outcomes in this rapidly evolving disease. Prognosis remains poor in severe stages, suggesting that the earlier the surgery performed, the better is the visual prognosis.

Measurement of full-thickness macular hole size using en face optical coherence tomography

PurposeTo assess the feasibility and interest of measuring macular hole (MH) size using en face optical coherence tomography (OCT) compared with manual diameter measurements on B-scans.MethodsAmong our previously published series of 100 patients operated for primary MH, patients whose images were acquired with Cirrus 5000 HD-OCT (Carl Zeiss Meditec) with a quality signal strength >5/10 were included. Three segmentations (internal limiting membrane, horizontal, and retinal pigment epithelium (RPE)) were compared for obtaining the most appropriate en face image. MH surface areas were measured using ImageJ software. Mean diameters calculated from surface areas (diameter=2 × √(surface area/π)) were compared with those measured on B-scans.ResultsNineteen patients were included with a mean age of 72±8 years (56–86) and a female predominance (3/16). The mean absolute difference between horizontal and vertical diameters measured on B-scans was of 54±47 μm (0–180) without reaching significance (P=0.874). RPE segmentation provided the best en face image and was feasible without and with adjustment, respectively, in 79% and 100% (cases with vitreomacular traction) of cases. No significant difference in mean diameters was observed between those calculated from en face images (435±143 μm (195–693)) and those measured on horizontal B-scans (426±139 μm (214–705), P=0.482).ConclusionMeasuring MH size on en face OCT images is feasible, reliable, and eliminates the potential bias related to manual measurements on B-scans. Its integration into OCT devices would offer an automated and easy-to-use option for clinical practice.