Journal Club 29-5-2021

CNV in Retinal Dystrophies

Journal Club 15-5-2021

Special Thanks to Dr Mahdizad

Curr Opin Ophthalmol

. 2021 May 1;32(3):203-208. doi: 10.1097/ICU.0000000000000760.

Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature

María H Berrocal 1Luis Acaba-Berrocal 2Affiliations expand

Abstract

Purpose of review: Diabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment.

Recent findings: Panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF.

Summary: Concerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.

Ophthalmol Retina

. 2021 Jan 1;S2468-6530(20)30508-X. doi: 10.1016/j.oret.2020.12.022. Online ahead of print.

Standardization of OCT Angiography Nomenclature in Retinal Vascular Diseases: First Survey Results

Marion R Munk 1Amir H Kashani 2Ramin Tadayoni 3Jean-Francois Korobelnik 4Sebastian Wolf 5Francesco Pichi 6Meng Tian 5Affiliations expand

Free article

Abstract

Purpose: To develop a consensus nomenclature for OCT angiography (OCTA) findings in retinal vascular diseases.

Design: Online survey using the Delphi Method.

Participants: Members of The Retina Society, the European Society of Retina Specialists, and the Japanese Retina and Vitreous Society.

Methods: An online questionnaire on OCTA terminology in retinal vascular diseases was sent to members of The Retina Society, the European Society of Retina Specialists, and the Japanese Retina and Vitreous Society. The respondents were divided into 2 groups (“experts” vs. “users”) according to the number of their publications in this field. The respondents who had more than 5 publications in the field of OCTA and retinal vascular diseases were considered the OCTA “experts” group.

Main outcome measures: Consensus and near consensus on OCTA nomenclature.

Results: The complete responses of 85 retina specialists were included in the analysis. Thirty-one were categorized as “experts.” There was a consensus in both groups that OCTA parameters such as foveal avascular zone (FAZ) parameters, areas of nonperfusion, and presence of neovascularization (NV) should be implemented in the identification and staging of diabetic retinopathy (DR) and that OCTA can be applied to differentiate between ischemic and nonischemic retinal vein occlusion (RVO). Diabetic macular ischemia (DMI) also can be assessed via OCTA. Further, there was consensus that the terminology should differ on the basis of the underlying causes of decreased vascular flow signal. There was disagreement in other areas, such as which terms should be applied to describe decreased OCTA signal from different causes, the definition of wide-field OCTA, and how to quantify DMI and area of decreased flow signal. These discrepancies form the basis for the upcoming expert Delphi rounds that aim to develop a standardized OCTA nomenclature.

Conclusions: Although there was agreement in some areas, significant differences were found in many areas of OCTA terminology among all respondents, but also between the expert and user groups. This indicates the need for standardization of the nomenclature among all specialists in the field of retinal vascular diseases.

Retina

. 2021 May 1;41(5):1084-1093. doi: 10.1097/IAE.0000000000002966.

POLYPOIDAL CHOROIDAL VASCULOPATHY FEATURES VARY ACCORDING TO SUBFOVEAL CHOROIDAL THICKNESS

Janice Marie Jordan-Yu 1Kelvin Yi Chong Teo 1 2Usha Chakravarthy 3Alfred Gan 1Anna Cheng Sim Tan 1 2Kai Xiong Cheong 1Tien Yin Wong 1 2Chui Ming Gemmy Cheung 1 2Affiliations expand

Abstract

Purpose: To evaluate associations between choroidal thickness and features of polypoidal choroidal vasculopathy (PCV) lesions based on multimodal imaging.

Methods: This cross-sectional analysis included treatment-naive PCV eyes from a prospectively recruited observational cohort. Associations between of subfoveal choroidal thickness (SFCT) and qualitative and quantitative morphologic features of PCV lesions on color fundus photographs, indocyanine green and fluorescein angiography, and spectral-domain optical coherence tomography were evaluated.

Results: We included 100 eyes with indocyanine green angiography-proven PCV. Subfoveal choroidal thickness showed a bimodal distribution with peaks at 170 µm and 350 µm. There was a significant linear increase in the total lesion area (P-trend = 0.028) and the polypoidal lesion area (P-trend = 0.030 and P-continuous = 0.037) with increasing SFCT. Pairwise comparisons between quartiles showed that the total lesion area (4.20 ± 2.61 vs. 2.89 ± 1.43 mm2, P = 0.024) and the polypoidal lesion area (1.03 ± 1.01 vs. 0.59 ± 0.45 mm2, P = 0.042) are significantly larger in eyes in Q4 (SFCT ≥ 350 μm) than eyes in Q1 (SFCT ≤ 170 μm). Although there was no significant linear trend relating SFCT to best-corrected visual acuity, pairwise comparisons showed that eyes in Q4 (SFCT ≥ 350 μm) have significantly worse vision (0.85 ± 0.63 vs. 0.55 ± 0.27 logMAR, P = 0.030) than eyes in Q2 (SFCT 170-260 μm).

Conclusion: Total lesion areas and polypoidal lesion areas tend to be larger in eyes with increasing SFCT. Choroidal background may influence the phenotype or progression pattern of PCV.

Retina

. 2021 May 1;41(5):997-1004. doi: 10.1097/IAE.0000000000003004.

INTERVORTEX VENOUS ANASTOMOSIS IN Pachychoroid-RELATED DISORDERS

Richard F Spaide 1Gerardo Ledesma-Gil 1 2Chui Ming Gemmy Cheung 3 4Affiliations expand

Abstract

Purpose: To evaluate the choroidal vascular patterns of patients with pachychoroid-related diseases in eyes images with wide-field indocyanine green angiography.

Methods: Retrospective study of wide-field indocyanine green angiographic images of patients with pachychoroid, peripapillary pachychoroid syndrome, central serous chorioretinopathy, and pachychoroid-associated neovascularization that were evaluated for anastomoses between vortex vein systems, which are ordinarily separated by a watershed zone.

Results: There were 21 subjects with a mean age of 57.4 years and 15 were male. Among the 42 eyes evaluated, central serous chorioretinopathy was found in 24 eyes (57.1%), peripapillary pachychoroid syndrome in 5 (11.9%), pachychoroid associated neovascularization in 7 (16.7%), and pachychoroid in 6 (14.3%). Every eye showed anastomosis between the superonasal, superotemporal, and inferotemporal vortex vein systems. The inferonasal vortex vein system was less likely to demonstrate anastomosis except for peripapillary pachychoroid syndrome, which showed anastomosis in all eyes. The anastomotic connections were prominent in the central macula in the central serous chorioretinopathy and pachychoroid-associated neovascularization cases, and around the nerve in the peripapillary pachychoroid syndrome cases. Although the large choroidal veins were particularly prominent in the neovascular cases, the number was fewer in the macular region than in other pachychoroid-related diseases in this series. Compared with a control group of nine eyes, the inferotemporal-superotemporal-superonasal anastomotic connections were more common in the case group (P < 0.001) and inferonasal quadrant (P = 0.023 right eye; P = 0.01, left eye).

Conclusion: Intervortex venous anastomosis is common in pachychoroid, central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid-associated neovascularization. This finding has important implications concerning pathogenesis and classification of disease.

Retina

. 2021 May 1;41(5):1057-1062. doi: 10.1097/IAE.0000000000002963.

CHARACTERISTICS OF PERIPAPILLARY INTRACHOROIDAL CAVITATION IN HIGHLY MYOPIC EYES: The Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study

Ran Liu 1 2Zhixi Li 1Ou Xiao 1Jian Zhang 1Xinxing Guo 1 3Jonathan Tak Loong Lee 4Decai Wang 1Peiying Lee 4Monica Jong 5 6Padmaja Sankaridurg 5 6Mingguang He 1Affiliations expand

Abstract

Purpose: To characterize peripapillary intrachoroidal cavitation (PICC) in highly myopic participants and its associated risk factors.

Methods: This observational, cross-sectional study recruited 890 Chinese participants with bilateral high myopia, defined as ≤-6.00 diopters spherical power. Fundus photography and spectral-domain optical coherence tomography were used to determine the presence of PICC, defined as a yellow-orange lesion adjacent to the disc border with a corresponding intrachoroidal hyporeflective space.

Results: Among 890 participants, 884 right eyes were included for analysis. The rate of PICC was 3.6% (32 eyes). Peripapillary intrachoroidal cavitation was observed in two eyes without myopic retinal lesions, nine eyes with tessellated fundus only, 16 eyes with diffuse chorioretinal atrophy, and five eyes with patchy chorioretinal atrophy. The most commonly affected area was inferior disc border (87.5%), followed by multiple (9.4%) and superior (3.1%) disc borders. The multiple linear logistic regression model showed that older age, more myopic spherical equivalent, and longer axial length were associated with the presence of PICC.

Conclusion: Peripapillary intrachoroidal cavitation was present in 3.6% of highly myopic eyes. It was more common in eyes with a higher myopic maculopathy category. Older age, more myopic spherical equivalent, and longer axial length were risk factors for the presence of PICC.

Fluid as a critical biomarker in neovascular age-related macular degeneration management: literature review and consensus recommendations

Eye (2021)Cite this article

Abstract

Current guidelines on the management of patients with neovascular age-related macular degeneration (nAMD) lack clear recommendations on the interpretation of fluid as seen on optical coherence tomography (OCT) imaging and the incorporation of this information into an ongoing disease treatment strategy. Our objective was to review current guidelines and scientific evidence on the role of fluid as a biomarker in the management of nAMD, and develop a clinically oriented, practical algorithm for diagnosis and management based on a consensus of expert European retinal specialists. PubMed was searched for articles published since 2006 relating to the role of fluid in nAMD. A total of 654 publications were screened for relevance and 66 publications were included for review. Of these, 14 were treatment guidelines, consensus statements and systematic reviews or meta-analyses, in which OCT was consistently recommended as an important tool in the initial diagnosis and ongoing management of nAMD. However, few guidelines distinguished between types of fluid when providing recommendations. A total of 52 publications reported primary evidence from clinical trials, studies, and chart reviews. Observations from these were sometimes inconsistent, but trends were observed with regard to features reported as being predictive of visual outcomes. Based on these findings, diagnostic recommendations and a treatment algorithm based on a treat-and-extend (T&E) regimen were developed. These provide guidance on the diagnosis of nAMD as well as a simple treatment pathway based on the T&E regimen, with treatment decisions made according to the observations of fluid as a critical biomarker for disease activity.

Pneumatic Vitreolysis with C3F8 for Vitreomacular Traction with and without Macular Hole: DRCR Retina Network Protocols AG and AH

Abstract

Objective

To evaluate pneumatic vitreolysis (PVL) in eyes with vitreomacular traction (VMT) with and without full-thickness macular hole (FTMH).

Design

Two multi-center (28 sites) studies: one randomized clinical trial comparing PVL with observation (sham injection) for VMT without FTMH (Protocol AG), and a single-arm study assessing PVL for closure of FTMH (Protocol AH).

Participants

Participants were adults with central VMT in which the vitreomacular adhesion was 3000 μm or less. In AG, visual acuity (VA) was 20/32 to 20/400. In AH, eyes had FTMH (≤250 μm at the narrowest point) and VA of 20/25 to 20/400.

Intervention

PVL using C3F8 gas.

Main Outcome Measures

Central VMT release without rescue treatment at 24 weeks (AG). FTMH closure without rescue treatment at 8 weeks (AH).

Results

From October 2018 to February 2020, 46 participants were enrolled in AG and 35 eligible participants were enrolled in AH. Higher than expected rates of retinal detachments and tears resulted in early termination of both protocols. Combining studies, 7 of 59 (12% [95% CI, 6%–23%]; 2 in AG, 5 in AH) eyes that received PVL developed rhegmatogenous retinal detachment (6) or retinal tear (1). At 24 weeks in AG, 18 of 23 eyes in the PVL group (78%) versus 2 of 22 eyes in the sham group (9%) had central VMT release without rescue vitrectomy (adjusted risk difference = 66% [95% CI, 44%–88%], P<.001). The mean change in VA letter score from baseline at 24 weeks in AG was 6.7 in the PVL group and 6.1 in the sham group (adjusted difference = -0.8 [95% CI, -6.1 to 4.5], P=.77; negative values indicate greater improvement in sham group). In AH,10 of 35 eyes (29% [95% CI, 16%–45%]) had FTMH closure without rescue vitrectomy at 8 weeks. The mean change in VA from baseline at 8 weeks in AH was -1.5 letters (95% CI, -10.3 to 7.3).

Conclusions

In most eyes with VMT, PVL induced hyaloid release. In eyes with FTMH, PVL resulted in hole closure in approximately one third of eyes. These studies were terminated early because of safety concerns related to retinal detachments and retinal tears.

Retina

. 2021 May 1;41(5):1047-1056. doi: 10.1097/IAE.0000000000002997.

POSTERIOR SCLERAL CONTRACTION TO TREAT MYOPIC FOVEOSCHISIS IN HIGHLY MYOPIC EYES

Jie Ye 1An-Peng PanShuangqian ZhuLinyan ZhengFan LuAn-Quan XueAffiliations expand

Abstract

Purpose: To evaluate the efficacy of posterior scleral contraction to treat myopic foveoschisis (MF).

Methods: The records of MF patients treated with posterior scleral contraction were reviewed. During posterior scleral contraction, a cross-linked fusiform strip from allogeneic sclera was used and designed axial length (AL) shortening amount was around 2.0∼3.0 mm based on preoperative AL. The middle part of the strip was placed at the posterior pole of the eye. After few aqueous humors were released, the strip was tightened to contract posterior sclera and shorten AL. Clinical data were collected at pre-operation (op) and post-op follow-ups for 12 months.

Results: Twenty-four eyes were collected. The AL at pre-op, post-op 1-week, 3-month, 6-month, and 12-month were 29.84 ± 1.24, 27.39 ± 1.32, 27.73 ± 1.23, 27.86 ± 1.26, and 27.91 ± 1.29 mm. There was no AL difference between post-op 6-month and 12-month (P = 0.242). The accumulated MF reattachment rate at post-op 1-week, 3-month, 6-month, and 12-month were 8.3%, 16.7%, 50.5%, and 95.8%. The best-corrected visual acuity at post-op 6-month and 12-month were 0.71 ± 0.39 (Snellen acuity 20/80) and 0.64 ± 0.37 (Snellen acuity 20/63), improving significantly compared with pre-op (P = 0.006 and <0.001).

Conclusion: The posterior scleral contraction was effective to treat MF. The AL stabilized after post-op 6-month and MF reattached gradually with improved visual acuity up to post-op 12-month.

Journal Club 5-8-2021

Special Thanks to Dr Amini

A 360-degree peripapillary hyper-reflective ovoid mass-like structure (PHOMS)

Bilateral cilioretinal artery occlusions in giant cell arteritis

A case of multifocal presumed solitary circumscribed retinal astrocytic proliferation lesions in the same eye

Serous retinal detachment following bronchoscopyinduced hypertensive emergency

Degenerative lamellar macular holes: tractional development and morphological alterations

Incidence of ocular inflammation among patients with active tuberculosis or nontuberculous mycobacterial infections in a tertiary hospital in Japan

Photoablative cosmetic iridoplasty: effective, safe, and predictable—eye color change in 1176 eyes

Micro-incision, trans-iridal aspiration cutter biopsy for ciliary body tumours

Journal Club 5-1-2021