Outcomes of Retinal Pigment Epithelial Detachment in Vogt-Koyanagi-Harada Disease

IntroductionThe aim of this study was to report the clinical profile and outcomes of retinal pigment epithelial detachment (PED) in Vogt-Koyanagi-Harada (VKH) disease, and to evaluate the correlation between PED and the subsequent development of central serous chorioretinopathy (CSC) throughout the whole corticosteroid treatment course.materials and methodsA total of 470 eyes with VKH were reviewed, and 12 eyes with VKH and PED were recruited. Patients were divided into two groups according to the CSC onset or not throughout the whole course (CSC group and non-CSC group). Best-corrected visual acuity (BCVA) improvement, and PED angle (PEDA, the angle between the two lines of the vertex of the lifted retinal pigment epithelium to the two edge points of the Bruch membrane) were compared between the two groups.ResultsThe prevalence of PED and CSC in VKH was 2.55% (12/470) and 1.06% (5/470), respectively. BCVA improvement in the non-CSC group was greater than that in the CSC group, but without a statistical difference (P=0.25). PEDA was significantly smaller in the CSC group than in the non-CSC group (P=0.03).DiscussionPEDA is an ideal parameter to reflect hydrostatic pressure and stretches for RPE. As PED predisposes to the development of CSC in selected VKH eyes, PEDA may be a valuable predictive factor for the development of CSC in VKH patients.

Modern trends in diagnostics and prediction of results of anti-vascular endothelial growth factor therapy of pigment epithelial detachment in neovascular agerelated macular degeneration using deep machine learning method (literature review)

Detachment of the pigment epithelium is the separation of the basement membrane of the retinal pigment epithelium from the inner collagen layer of Bruch’s membrane, which occurs in 80 % of cases in patients with neovascular age-related macular degeneration. The outcome of anti-VEGF therapy for pigment epithelial detachment may be adherence of the pigment epithelium, the formation of pigment epithelium tear, or preservation of the detachment. The pigment epithelium tear of 3–4th degrees can lead to a sharp decrease in visual acuity.Most retrospective studies confi rm the absence of a proven correlation between anatomical and functional outcomes in the treatment of pigment epithelial detachment in cases of maintaining the integrity of the pigment epithelium monolayer, and therefore the main attention of researchers is focused on studying the morphological features of pigment epithelial detachment during therapy with angiogenesis inhibitors. Modern technologies of spectral optical coherence tomography make it possible to evaluate detailed quantitative parameters of pigment epithelium detachment, such as height, width, maximum linear diameter, area, volume and refl ectivity within the detachment.Groups of Russian and foreign authors identify various biomarkers recorded on optical coherence tomography images. Dynamic registration of such biomarkers expands the ability of clinicians to predict morphological changes in pigment epithelial detachment during anti-VEGF therapy, as well as to optimize treatment regimens to prevent complications in the form of pigment epithelium tear leading to a decrease in visual acuity.Modern methods of deep machine learning and the use of neural networks allow achieving higher accuracy in diff erentiating the types of retinal fluids and automating the quantitative determination of fl uid under the pigment epithelium. These technologies allow achieving a high level of compliance with manual expert assessment and increasing the accuracy and speed of predicting morphological results of treatment of pigment epithelium detachments.

Autophagy Induction by Cyclic Stretch and Its Effect on Cytokines in Retinal Pigment Epithelial Cells

Background: Strong evidence of the correlation between age-related macular degeneration (AMD) and vitreomacular interface abnormality (VMIA). Meanwhile, as a crucial mechanism of retinal pigment epithelial (RPE) cells’ homeostasis, autophagy induction by cyclic stretch appears to be particularly significant.Methods: Cultured ARPE-19 cells were subjected to cyclic stretch (20% elongation, 1HZ) for 1h, 2h, 6h, 12h,24h and 48h by FX-5000 Tension System. Then, we observed the expression levels of LC3I, LC3II, Beclin-1, SQSTM1/p62, LAMP-1, mTOR and phosphorylated mTOR(pmTOR), AMPK and pAMPK, NADPH oxidase 4 (NOX4), and vascular endothelial growth factor (VEGF) in RPE cells under stretch by western blot and immunofluorescence.Results: We found autophagic proteins mostly induced by cyclic stretch in a time-dependent fashion via mTOR suppression and AMPK activation, except for SQSTM1/p62. 3-Methyladenine(3-MA), an inhibitor for autophagy, could reduce the up-regulation of autophagy due to cyclic stretch, leading to higher level of VEGF release after 24h cyclic stretch. Rapamycin could narrow the increase degree of VEGF and NOX4 by cyclic stretch by raise autophagic level in RPE cells.Conclusion: Stretch might induce autophagy in RPE cells by mTOR or AMPK pathway. Autophagy might play the protective function for RPE cells away from mechanical stress derived from VMIA-related AMD.