Daniela Fruttini

Macular Thickness Measured by Optical Coherence Tomography in a Healthy Population Before and After Uncomplicated Cataract Phacoemulsification Surgery

Purpose: To examine macular changes before and after uncomplicated cataract surgery in a healthy population. Material and Methods: In a prospective study, we evaluated 62 eyes of healthy patients having elective cataract phacoemulsification. We performed optical coherence tomography (OCT) measurements preoperatively and at 3, 6, 12, 20, and 28 weeks after surgery. The retinal map was divided into minimal foveal thickness, a central 1-mm disk area, and two peripheral ring areas with diameters of 3 mm and 6 mm, respectively, and centered on the fovea. We compared the postoperative OCT values against the respective preoperative values. Results: Two eyes (3.2%) developed cystoid macular edema (CME) after cataract surgery and were excluded from the study. With respect to preoperative values, visual acuity improved significantly postoperatively, and at 12 weeks, we observed an asymptomatic increase in retinal thickness at 3 mm and 6 mm. Macular volume showed a statistically significant increase at the 12th week after surgery. There was no correlation between macular changes and best corrected visual acuity (BCVA) or ultrasound time. Conclusions: Our data indicate that the onset of clinically significant CME is rare after uncomplicated phacoemulsification cataract surgery, but with respect to preoperative values we observed an asymptomatic increase in macular thickness and volume at 12 weeks. The possible onset of macular alterations after uncomplicated cataract surgery must be taken into account as a potential later complication, because it can lead to a permanent loss of visual acuity.

Factor analysis in the identification of dietary patterns and their predictive role in morbid and fatal events

OBJECTIVE The purpose was to examine the role of dietary patterns derived from factor analysis and their association with health and disease. DESIGN Longitudinal population study, with measurement of diet (dietary history method), cardiovascular risk factors and a follow-up of 20 years for CHD incidence and 40 years for mortality. SETTING Two population samples in rural villages in northern and central Italy. SUBJECTS Men (n 1221) aged 45-64 years were examined and followed up. RESULTS One of the factors identified with factor analysis, run on seventeen food groups, was converted into a factor score (Factor 2 score) and used as a possible predictor of morbid and fatal events. High values of Factor 2 score were characterized by higher consumption of bread, cereals (pasta), potatoes, vegetables, fish and oil and by lower consumption of milk, sugar, fruit and alcoholic beverages. In multivariate analysis, Factor 2 score (mean 0·0061; sd 1·3750) was inversely and significantly associated (hazard ratio for a 1 sd increase; 95% CI) with 20-year CHD incidence (0·88; 0·73, 0·96) and 40-year mortality from CHD (0·79; 0·66, 0·95), CVD (0·87; 0·78, 0·96), cancer (0·84; 0·74, 0·96) and all causes (0·89; 0·83, 0·96), after adjustment for five other risk factors. Men in quintile 5 of Factor 2 score had a 4·1 years longer life expectancy compared with men in quintile 1. CONCLUSIONS A dietary pattern derived from factor analysis, and resembling the characteristics of the Mediterranean diet, was protective for the occurrence of various morbid and fatal events during 40 years of follow-up.

The Mediterranean Adequacy Index: further confirming results of validity.

BACKGROUND AND AIMS Since dietary patterns can influence levels of major risk factors for chronic disease, various indexes or scores of overall diet quality have been proposed and related to risk factors for disease. The Mediterranean Adequacy Index (MAI) was developed to simply assess how close a diet is to the Healthy Reference National Mediterranean Diet (HRNMD), a healthful diet in which Mediterranean food patterns are inversely correlated with prevalence of risk factors for chronic disease. This report describes further evidence of MAI values for diets of population groups from different countries. METHODS AND RESULTS MAI is obtained by dividing the food group intakes typical of a healthy reference Mediterranean diet, expressed in g/day, by the food group intakes not characteristic of a healthy Mediterranean diet. In this paper, the MAI was computed based on the diets of 23 population groups from Italy, Greece, U.S.A., Costa Rica, Chile, Spain, and Germany. High MAI values were recorded among working class men from southern Italy, and Seven Countries Study (SCS) men from the Greek islands, and the lowest among U.S.A. men and a control group of German women; surprisingly low values were recorded among Madrid men and women and participants from Spanish-speaking Latin American countries. The inversely significant correlation between the 16 SCS cohort diet MAI values and the 25-year coronary heart disease death rate previously observed was stable when an appropriate statistical analysis was used. Furthermore, MAI values of diets in elderly participants from 10 European countries followed for 10 years were inversely associated with total mortality. CONCLUSIONS The above results further confirm the validity of MAI, indicating that it is as good as the most utilised indexes or scores proposed for adults in Europe.

Automated Quantitative Analysis of Retinal Microvasculature in Normal Eyes on Optical Coherence Tomography Angiography

PURPOSE To describe a new automated quantitative technique for displaying and analyzing macular vascular perfusion using optical coherence tomography angiography (OCT-A) and to determine a normative data set, which might be used as reference in identifying progressive changes due to different retinal vascular diseases. DESIGN Reliability study. METHODS A retrospective review of 47 eyes of 47 consecutive healthy subjects imaged with a spectral-domain OCT-A device was performed in a single institution. Full-spectrum amplitude-decorrelation angiography generated OCT angiograms of the retinal superficial and deep capillary plexuses. A fully automated custom-built software was used to provide quantitative data on the foveal avascular zone (FAZ) features and the total vascular and avascular surfaces. A comparative analysis between central macular thickness (and volume) and FAZ metrics was performed. Repeatability and reproducibility were also assessed in order to establish the feasibility and reliability of the method. RESULTS The comparative analysis between the superficial capillary plexus and the deep capillary plexus revealed a statistically significant difference (P < .05) in terms of FAZ perimeter, surface, and major axis and a not statistically significant difference (P > .05) when considering total vascular and avascular surfaces. A linear correlation was demonstrated between central macular thickness (and volume) and the FAZ surface. Coefficients of repeatability and reproducibility were less than 0.4, thus demonstrating high intraobserver repeatability and interobserver reproducibility for all the examined data. CONCLUSIONS A quantitative approach on retinal vascular perfusion, which is visible on Spectralis OCT angiography, may offer an objective and reliable method for monitoring disease progression in several retinal vascular diseases.

Repeatability and Reproducibility of Retinal Thickness Measurements in Diabetic Patients with Spectral Domain Optical Coherence Tomography

ABSTRACT Background: To determine the repeatability and reproducibility of optical coherence tomography (OCT) Spectralis retinal thickness measurements in diabetic patients with clinically significant macular edema (CSME). Methods: Twelve eyes of 12 volunteers (without macular pathology – control group) and 21 eyes of 21 diabetic patients with CSME were included in the study. Reproducibility, repeatability, intraclass correlation coefficients (ICCs) and intrasession correlation coefficients were tested with 20 × 15 degree raster scans consisting of 19 high-resolution line scans that were repeated three times by two experienced examiners. Results: In the control group, examining all regions, coefficient of repeatability was less than 1.1%, while coefficient of reproducibility was less than 2.2%. In diabetic patients, examining all regions, coefficient of repeatability was less than 2.6%, while coefficient of reproducibility was less than 2.4%. ICCs were, respectively, greater than or equal to 0.98 in the control group and 0.99 in diabetic patients. Intrasession coefficients of variation were less than 0.4% in the control group and less than 0.5% in diabetic patients. Conclusion: Retinal thickness measurements are repeatable and reproducible with OCT Spectralis in both the control group and diabetic patients. The results indicate that a change in central subfield thickness exceeding 12 µm and 3% in the diabetic patients is likely to be real.

Retinal Microvasculature in Nonproliferative Diabetic Retinopathy: Automated Quantitative Optical Coherence Tomography Angiography Assessment

Purpose: To perform a qualitative and quantitative assessment of the foveal microvasculature in eyes with diabetic maculopathy using optical coherence tomography angiography (OCT-A). Methods: Retrospective case series of 48 eyes with diabetic maculopathy and 47 healthy eyes evaluated by Spectralis OCT-A. Perifoveal arcade disruptions, linear vascular dilations, microaneurysms, intraretinal microvascular abnormalities and flow-void areas were qualitatively analyzed on OCT angiograms both for the superficial (SCP) and deep (DCP) capillary plexuses. A fully automated microstructural analysis of the foveal avascular zone (FAZ) metrics, vascular and avascular surfaces was performed. Quantitative values from diabetic patients were compared with those of healthy subjects. Results: A moderate agreement between SCP and DCP in terms of diabetes-induced vascular lesions in the qualitative assessment was shown. The comparative quantitative analysis between SCP and DCP in diabetic patients revealed a statistically significant difference (p < 0.05) in terms of FAZ perimeter and FAZ surface. No statistically significant difference was shown in total vascular and avascular surfaces. A statistically significant difference between the diabetic and control groups was noticed both for SCP and DCP considering FAZ metrics and vascular surfaces. Conclusions: A qualitative and quantitative OCT-A approach on retinal vascular perfusion may offer an objective and reliable method for monitoring disease progression in diabetic retinopathy.

Outer Retinal and Choroidal Evaluation in Multiple Evanescent White Dot Syndrome (MEWDS): An Enhanced Depth Imaging Optical Coherence Tomography Study

ABSTRACT Purpose: To perform an analysis of optical coherence tomography (OCT) abnormalities in patients with MEWDS, during the acute and recovery stages, using enhanced depth imaging-OCT (EDI-OCT). Methods: A retrospective case series of five patients with MEWDS was included. EDI-OCT imaging was evaluated to detect retinal and choroidal features. Results: In the acute phase, focal impairment of the ellipsoid zone and external limiting membrane, hyperreflective dots in the inner choroid, and full-thickness increase of the choroidal profile were observed in the affected eye; disappearance of these findings and restoration of the choroidal thickness (p = 0.046) was appreciated in the recovery phase. No OCT abnormalities were assessed in the unaffected eye. Conclusions: EDI-OCT revealed transient outer retinal layer changes and inner choroidal hyperreflective dots. A transient increased thickness of the whole choroid was also identified. This might confirm a short-lasting inflammatory involvement of the whole choroidal tissue in the active phase of MEWDS.

Repeatability of Retinal Macular Thickness Measurements in Healthy Subjects and Diabetic Patients with Clinically Significant Macular Edema: Evaluation of the Follow-Up System of Spectralis Optical Coherence Tomography

Background: It was the aim of this study to compare the repeatability of Spectralis optical coherence tomography (OCT) retinal thickness measurements in healthy subjects and diabetic patients with clinically significant macular edema (CSME) with or without the use of the follow-up system. Methods: Thirty-eight eyes of 38 healthy subjects (control group) and 68 eyes of 68 diabetic patients with CSME were included in the study. The coefficient of repeatability (CR) and intrasession coefficients of variation were tested with 20 × 15 degree raster scans consisting of 19 high-resolution line scans (15 frames per scan) that were repeated 3 times by 1 experienced examiner. The first scan was set as the reference scan, whereas the second and third scans were the follow-up scans and were performed with and without the use of the follow-up mode, respectively. Results: The means and standard deviations for the central foveal subfield (CSF) in healthy subjects and diabetic patients were 289 ± 21 and 402 ± 105 μm, respectively. Particularly in diabetic patients, examining the CSF, CR was 2.67% (10.73 µm) and 6.73% (27.01 µm) with and without using the follow-up mode, respectively, and the difference was statistically significant (p < 0.05). Conclusion: These results support the hypothesis that the follow-up system improves the repeatability either in healthy subjects or in diabetic patients with poor fixation. The wider improvement in repeatability in diabetic patients in the follow-up system group compared to the no follow-up system group are probably related to poor patient fixation or eye movement in patients with CSME.

Posterior Corneal Surface Stability after Femtosecond Laser-Assisted Keratomileusis

The purpose of this study was to evaluate posterior corneal surface variation after femtosecond laser-assisted keratomileusis in patients with myopia and myopic astigmatism. Patients were evaluated by corneal tomography preoperatively and at 1, 6, and 12 months. We analyzed changes in the posterior corneal curvature, posterior corneal elevation, and anterior chamber depth. Moreover, we explored correlation between corneal ablation depth, residual corneal thickness, percentage of ablated corneal tissue, and preoperative corneal thickness. During follow-up, the posterior corneal surface did not have a significant forward corneal shift: no significant linear relationships emerged between the anterior displacement of the posterior corneal surface and corneal ablation depth, residual corneal thickness, or percentage of ablated corneal tissue.

New Insights On Ocular Sarcoidosis: An Optical Coherence Tomography Angiography Study

ABSTRACT Purpose: To report optical coherence tomography angiography (OCT-A) findings in eyes with ocular sarcoidosis (OS) and to compare these findings with those of fluorescein angiography (FA). Methods: Observational, cross-sectional, case-control study. Patients presenting with OS involving the posterior segment were evaluated using FA, structural-OCT and OCT-A. OCT-angiograms of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) were qualitatively and quantitatively analyzed. Results: OCT-A seemed more sensitive than FA in detecting perifoveal capillary arcade disruptions, areas of hypoperfusion/non-perfusion and capillary abnormalities (p<0.05). Capillary hypoperfusion was more frequently detected in the DCP than in SCP, conversely capillary abnormalities were more often observed at the level of the SCP. Capillary vessel density values were significantly lower in eyes with OS than in healthy controls both at the level of DCP and CC (p<0.05). Conclusion: The depth-resolved nature of OCT-A allowed new insights on OS-induced microvascular and perfusion impairments.