Nunzio Velotti

Optical coherence tomography angiography versus fluorescein angiography in the diagnosis of ischaemic diabetic maculopathy

To evaluate the efficacy of optical coherence tomography (OCT) angiography versus fluorescein angiography (FA) in terms of retinal vessel imaging in ischaemic diabetic maculopathy defined according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification.

Evaluation of the retinal nerve fibre layer and ganglion cell complex thickness in pituitary macroadenomas without optic chiasmal compression

PurposeThe aim of this prospective study was to measure the thickness of the circumpapillary retinal nerve fibre layer (cpRNFL) and the ganglion cell complex (GCC) using spectral domain optical coherence tomography (SD-OCT) in a cohort of consecutive de novo patients with pituitary macroadenomas without chiasmal compression.Patients and methodsTwenty-two consecutive patients with pituitary macroadenoma without chiasmal compression (16 men, 6 women, aged 45.2±14.6 years, 43 eyes) entered the study between September 2011 and June 2013. Among them, 31.8% harboured a growth hormone-secreting pituitary adenoma, 27.3% a prolactin-secreting pituitary adenoma, 27.3% a corticotrophin-secreting pituitary adenoma, and 13.6% a non-secreting pituitary tumour. Eighteen subjects (nine females, nine males, mean age 36.47±6.37 years; 33 eyes) without pituitary adenoma, with normal ophthalmic examination, served as controls. In both patients and controls, cpRNFL and GCC thicknesses were measured by SD-OCT.ResultsPatients were significantly older (P=0.02) than controls. Best corrected visual acuity, intraocular pressure, colour fundus photography, and automatic perimetry test were within the normal range in patients and controls. Conversely, cpRNFL (P=0.009) and GCC (P<0.0001) were significantly thinner in patients than in controls. The average GCC (r=0.306, P=0.046) significantly correlated with the presence of arterial hypertension. OCT parameters did not differ significantly between patients with a tumour volume above the median and those with a tumour volume below the median.ConclusionPituitary macroadenomas, even in the absence of chiasmal compression, may induce GCC and retinal nerve fibre layer thinning. SD-OCT may have a role in the early diagnosis and management of patients with pituitary tumours.

Evaluation of choroidal tumors with optical coherence tomography: enhanced depth imaging and OCT-angiography features

AimTo describe the vascular features of choroidal tumors using enhanced depth imaging (EDI), optical coherence tomography (OCT), and OCT-angiography.MethodsIn this prospective study, we evaluated 116 Caucasian patients with choroidal tumors (60 eyes with choroidal nevi, 40 with choroidal melanoma, 6 with choroidal hemangioma, 2 with optic disc melanocytoma, 6 with choroidal osteoma, and 2 with retinal metastases). Patients underwent a complete ophthalmic examination including bulbar echography, EDI-OCT, OCT-angiography, and multicolor imaging. Sixteen patients also underwent fluorescein and indocyanine angiography.ResultsThe left eye was more involved than the right eye. The mean tumor thickness was 1.23±0.17 mm in the 60 eyes with choroidal nevi; 2.75±0.83 mm in the 40 eyes with choroidal melanoma; 3.28±0.78 mm in the 6 eyes with retinal angioma; 2.02±0.001 mm in the 2 eyes with optic disc melanocytoma; 2.40±0.31 mm in the 6 eyes with choroidal osteoma; and last, 3.49±0.001 mm in the 2 eyes with retinal metastases. OCT-angiography showed: (i) a lack of blood flow in the outer retinal layer (ORL) and a normal choroid capillary layer in choroidal nevi and optic disc melanocytomas; (ii) a lack of blood flow in the ORL of choroidal metastases; and (iii) a dense irregular vascular network in the ORL and choroid capillary layers of choroidal melanomas, choroidal hemangiomas, and choroidal osteomas.ConclusionsOCT-angiography is a noninvasive reliable method with which to evaluate the vascularization of small choroidal tumors and may improve the diagnosis of these tumors.

Evaluation of ischemic diabetic maculopathy with Fourier-domain optical coherence tomography and microperimetry.

OBJECTIVE To evaluate the efficacy of high-speed Fourier-domain optical coherence tomography (FD-OCT) and fundus microperimetry (MP-1) in identifying the anatomic and functional features of ischemic diabetic maculopathy. DESIGN Prospective noninterventional study. PARTICIPANTS Forty-two consecutive eyes (23 patients) with ischemic diabetic maculopathy and 40 normal eyes (25 control subjects) were included in this study. METHODS Best corrected visual acuity, ganglion cell complex (GCC) thickness measured with FD-OCT, and central light sensitivity recorded with MP-1 were evaluated. RESULTS GCC thickness and light sensitivity were significantly reduced in all affected eyes versus control eyes. logMAR BVCA was significantly correlated with mean macular sensitivity (R=0.783, R(2)=0.611). CONCLUSIONS GCC thickness and microperimetry integrated with fluorescein angiography could be a marker of retinal vascular abnormalities that is useful for the diagnosis of ischemic diabetic maculopathy.

Optical coherence tomography angiography retinal vascular network assessment in multiple sclerosis

Background: Optical coherence tomography (OCT) angiography is a new method to assess the density of the vascular networks. Vascular abnormalities are considered involved in multiple sclerosis (MS) pathology. Objective: To assess the presence of vascular abnormalities in MS and to evaluate their correlation to disease features. Methods: A total of 50 MS patients with and without history of optic neuritis (ON) and 46 healthy subjects were included. All underwent spectral domain (SD)-OCT and OCT angiography. Clinical history, Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and disease duration were collected. Results: Angio-OCT showed a vessel density reduction in eyes of MS patients when compared to controls. A statistically significant reduction in all SD-OCT and OCT angiography parameters was noticed both in eyes with and without ON when compared with control eyes. We found an inverse correlation between SD-OCT parameters and MSSS (p = 0.003) and between vessel density parameters and EDSS (p = 0.007). Conclusion: We report a vessel density reduction in retina of MS patients. We highlight the clinical correlation between vessel density and EDSS, suggesting that angio-OCT could be a good marker of disease and of disability in MS.

Anatomical and functional retinal changes in multiple sclerosis.

AimsThe aims of this study was to report anatomical changes of the ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thickness, and macular volume in patients with multiple sclerosis (MS). We also investigated the correlation between anatomical and functional changes in terms of visual acuity and macular sensitivity investigated and visual fields.MethodsProspective comparative study included 105 eyes of 53 consecutive patients. The patients were divided into two groups: group A included 56 eyes of 28 patients with diagnosis of MS; group B involved 49 eyes of 25 healthy patients. The examination included Goldmann tonometry, biomicroscopic and fundus oculi examination, retinography, GCC examination, circumpapillary RNFL (cpRNFL), and macular volume. The functional test included measurement of best-corrected visual acuity (BCVA), visual field, and MP.ResultsMS group showed a significant reduced GCC, cpRNFL, macular volume, BCVA, visual field, and macular sensitivity compared with the control group (P<0.001). This reduction was more representative (P<0.001) in patients with MS complicated by optic neuritis (ON). We found in the MS group a strong correlation between GCC thickness and macular volume (r2=0.59, P<0.001) and also between GCC and RNFL thickness (r2=0.48, P<0.001). There was also a correlation between macular sensitivity and macular volume reduction (r2=0.25, P<0.001) and also between RNFL and macular volume (r2=0.43, P<0.001).ConclusionsThe significant statistical evidence and the strong correlation between anatomical and functional parameters support the use of OCT and MP in the evaluation, treatment, and follow-up of patients diagnosed with MS.

OCT angiography in choroidal neovascularization secondary to choroidal osteoma.

F irst of all, we would like to thank Dr Yolcu and Dr. Civan for their interest and comments regarding our article on ‘Effect of topical prostaglandin (PG) analogues on corneal hysteresis’ recently published in Acta Ophthalmologica (Bolivar et al. 2015). As they correctly point out in their letter, there has been a great interest in the relationship between corneal viscoelastic parameters [such as central corneal thickness (CCT), corneal hysteresis (CH), etc.] and glaucoma. PG analogues seem to induce a minor change in the CCT, as Yolcu et al. correctly point out (Yolcu & Civan 2015), but it was out of scope of our study to measure the changes in CCT. Our work (Bolivar et al. 2015) was focused just on the change of the CH in newly diagnosed, previously untreated glaucomatous eyes, after topical treatment with PG analogues monotherapy. Nevertheless, the reported PG treatment induced decrease in the CCT is quite small, thus making unlikely that this minimal change, by itself, can modify the corneal response to a stress (compression by a jet of air or applanation by the Goldmann tip) (Maruyama et al. 2014). Furthermore, a change in the CCT must be induced by a change either in the stroma, in the epithelium or in both structures. In fact, Rosa et al. (2014) suggested that if it is found that PG analogue treatment does change the CH, this fact would suggest that it is not the epithelium, but the stroma, the part of the cornea affected by these drugs. In fact, our finding that CH does change in this scenario, strongly supports their hypothesis. Furthermore, the anecdotal report of a case of rapid progression of a previously stable keratoconus induced by topical treatment with latanoprost (Amano et al. 2008) further suggests that PG analogues, probably due to the upregulation of stromal metalloproteinases induced by them, do affect the stromal viscoelastic properties, at least to some extent. We completely agree with Yolcu et al. that more studies are needed to fully understand the effects of PG analogues and glaucomatous disease on the cornea.

Intravitreal bevacizumab combined with grid photocoagulation in recurrent macular edema secondary to retinal vein occlusion.

Purpose To evaluate improvement in best-corrected visual acuity (BCVA) and the reduction of central retinal thickness (CRT) in patients with macular edema secondary to retinal vein occlusion (RVO) after intravitreal bevacizumab (IVB) injection combined with macular grid photocoagulation. Methods A retrospective study of 54 consecutive eyes with macular edema associated with RVO. The BCVA and CRT, recorded with spectral-domain optical coherence tomography, were evaluated at baseline and 1, 3, 6, and 12 months after treatment onset. Intravitreal bevacizumab injection was administered at baseline, and macular grid photocoagulation 15 days later. During follow-up, additional IVB, at 1-month intervals, was administered if persistent or recurrent macular edema was observed on optical coherence tomography. Results Best-corrected visual acuity was improved and CRT was reduced at 1, 3, 6, and 12 months of follow-up. Compared with initial values, the final CRT was significantly reduced in patients with branch RVO (35 patients) and in patients with central RVO (19 patients) (p<0.05). Also, BCVA was significantly improved in both groups of patients (p<0.05). Conclusions Intravitreal bevacizumab injection combined with macular grid photocoagulation reduces recurrent macular edema associated with branch RVO and central RVO.

Optical coherence tomography angiography in myopic choroidal neovascularization after intravitreal ranibizumab

Purpose: To describe the optical coherence tomography angiography characteristics of myopic patients with choroidal neovascularization secondary to pathologic myopia during ranibizumab therapy. Methods: Nineteen patients were enrolled in this prospective study (13 females, 6 males, mean age 55.25 ± 9.63 years) for a total of 20 eyes examined (14 right eyes, 6 left eyes). Images were analyzed independently by two examiners. Results: Mean follow-up was 5.75 ± 1.88 months, with a mean intravitreal injections of 1.90 ± 0.44. Mean best-corrected visual acuity at baseline was 0.39 ± 0.18 logMAR versus 0.26 ± 0.16 logMAR 6 months after treatment. The neovascular area (Z = –2.091, p = 0.037) was significantly reduced after treatment, whereas vessel density was not (Z = –1.848, p = 0.065). Moreover, the best-corrected visual acuity was increased (Z = –3.055, p = 0.002). Neovascular area was significantly correlated with best-corrected visual acuity, at both baseline and follow-up (p < 0.05). Conclusion: Our data suggest that optical coherence tomography angiography is a reproducible non-invasive examination with which to monitor changes in the neovascular area in patients with pathologic myopia treated with ranibizumab.

Fundus autofluorescence of choroidal nevi and melanoma

osmotic diuretics, topical sympathomimetic or beta-adrenergic blocking agents to reduce intraocular pressure; and hyperbaric oxygen to improve oxygen delivery. In its updated review, Hedges et al. also claimed that conservative therapies were considered futile. Nevertheless, Stef ansson et al. (1985) reported a case of massive embolus of central retinal artery, treated with anterior chamber paracentesis and coughing, that resulted in restoration of retinal blood flow; however, in this case afferent pupillary defect remained present and angiography revealed occlusion of the inferior temporal arteriole with local retinal oedema. More recently, another successful conservative treatment of a likely central retinal artery thromboembolism after internal carotid artery aneurysm coil occlusion was reported; however, in this case authors reported that multiple small emboli could be seen within the peripheral branches of the retina. Moreover, both afferent pupillary defect and posttreatment angiography findings were not described (Duxbury et al. 2014). Systemic intravenous and local intra-arterial fibrinolytic therapies are now considered valid in many cases, despite controversial (Schrag et al. 2015; Page et al. 2016). As the patient was hemodynamically unstable, and the femoral access has already been closed with the Angio-Seal closure device, systemic abciximab was administered (Barreto 2012). Abciximab was the first glycoprotein IIb/IIIa inhibitor (GPI) approved by the FDA. The glycoprotein IIb/IIIa integrin receptor is the pivotal mediator of platelet aggregation, becoming abundant on the platelet surface when platelets are activated. In late 1990s, the introduction of GPI was associated with reduction of ischemic complication and clinical benefit in percutaneous coronary interventions. Abciximab is a genetically engineered, recombinant, monoclonal antibody Fab fragment. The binding of abciximab to the platelet prevents the interaction with other adhesive protein molecules (Usta et al. 2016). The most relevant point concerning thiscasereport is thefindingthatsystemic intravenous abciximab may represent a novelandpromptapproachinemergency room to CRAO induced by highly suspicious platelet thrombus. This is particularly relevant in centres with no neuroendovascularfacilitiesorinpatients where intra-arterialfibrinolytic therapy is not recommended. The potential effects of this approach in distal branch retinal artery occlusion (not accessed by catheter) may also be considered.