Use of nailfold video-capillaroscopy in Polycythemia vera

Objectives: In this study, we aimed to investigate capillary vessel diameters and structural changes of capillaries by using nailfold video-capillaroscopy in patients with Polycythemia Vera. Patients and Methods: This cross-sectional study was conducted with 24 patients (19 males, 5 females; mean age: 62.5±2 years; range, 50.2 to 68 years) with Polycythemia vera and 15 healthy controls (11 males, 4 females; mean age: 40±2 years; range, 36 to 44 years) between June 2016 and February 2017. Nailfold video-capillaroscopy was performed by an experienced rheumatologist, blinded to clinical data. The apical, arterial, and venous limb diameters of capillaries were measured and microvascular changes of capillaries were scored. Results: When capillaries were evaluated in terms of morphological structures, giant capillary was detected 67% in the patients with Polycythemia vera, while it was not detected in the control group. The arterial, venous and apical diameters of the capillaries were significantly higher in the patients with Polycythemia vera compared to the control group [(38.33 µm vs. 21.23 µm, p <0.001), (48.41 µm vs. 27.48 µm p <0.001), (55.80 µm etc. 36.61 µm, p <0.001), respectively]. Conclusion: The presence of giant capillaries and the marked increase of arterial, venous, and apical diameters of capillaries seem to be related to Polycythemia vera.

OCT-A evaluation of radiation vasculopathy following slotted plaque brachytherapy

Purpose: To determine a reliable diagnostic method to reveal and monitor subclinical progression of neural and perineural radiation vasculopathy. Methods: A retrospective cross-sectional study, where optical coherence tomography angiography (OCT-A) imaging data was collected and analyzed from 22 consecutive patients that had been treated with circumneural slotted plaque brachytherapy for peripapillary, juxtapapillary, or circumpapillary choroidal melanomas. Pre-operative dosimetry of palladium-103 radiation dose to the optic nerve and fovea were collected. Quantified differences in OCT-A-measured vessel density and length in treated verses untreated contralateral control eyes were collected. Vessel density and length were correlated to radiation dose, plaque slot depth, visual acuity outcomes, and circumpapillary retinal nerve fiber layer thickness. Results: Patients had post-irradiation follow-up of median 39 months, interquartile range 62 months). The mean optic disc radiation dose was 89.9 Gy ± 39.2 (86.5, 30.8–189.0). In comparison to controls, OCT-A imaging revealed significant differences in radial peripapillary capillary vessel density (18 μm2 in case eyes, 34 μm2 in control eyes; p < 0.001) and length (10 μm in case eyes, 14 μm in control eyes; p < 0.001). Change in vessel density did not show a significant correlation to radiation dose, slot depth, or visual acuity. However, change in vessel length was significantly correlated to radiation dose ( p = 0.049) and change in visual acuity ( p < 0.001). Conclusions: OCT-A imaging revealed that radial peripapillary capillary vessel density and length were significantly reduced after circumneural irradiation for choroidal melanoma. Therefore, OCT-A imaging can be used to monitor progression of papillary vasculopathy associated with radiation optic neuropathy.

High body weight-related retinal vasculopathy in children with obesity

Purpose: To investigate the foveal avascular zone (FAZ) and the microvascular alterations in both macula and peripapillary region in obese children. Methods: We included a total of 222 eyes of 111 children (54 obese children and 57 healthy subjects). Capillary vessel density (VD) of superficial (SCP) and deep (DCP) retinal capillary plexuses were measured in macular slabs. Peripapillary region was also evaluated. The FAZ parameters were measured based on the whole retinal slab. A commercial optical coherence tomography-angiography system was used. Results: The mean ages were 13.33 ± 2.55 years (range, 8–17) and 13.41 ± 2.90 years (range, 7–18) in patients with obesity and healthy controls, respectively ( p = 0.84). The mean area of the FAZ were 0.278 ± 0.10 mm2 and 0.272 ± 0.11 mm2 in children with obesity and in control participants, respectively ( p = 0.68). There were significant increases in the superior region of the parafoveal VD of SCP ( p = 0.008 for superior hemisphere and p = 0.003 for superior quadrant). There was no significant difference in any measure of the macular DCP and peripapillary region ( p > 0.05, for all). Conclusion: Increased vascular density measurements were found in the superior part of the parafoveal region of SCP in children with obesity. The results of the study should be taken into consideration during the course of the disease to define whole systemic response to obesity in childhood and will be of interest for pediatrician’s clinical practice.

Comparison of Retinal Layer Thickness and Capillary Vessel Density in the Patients with Spontaneously Resolved Acute Central Serous Chorioretinopathy

We investigate retinal layer thickness and capillary vessel density (VD) in the patients with central serous chorioretinopathy (CSC) who recovered spontaneously and evaluate the correlation between the changes in these values and visual outcomes using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). This retrospective case–control study included 34 eyes of 34 patients with spontaneously resolved acute CSC. The changes in retinal layer thickness and capillary VD were examined using SS-OCT and OCTA after complete resolution of subretinal fluid (SRF). The fellow eyes and 34 healthy eyes were used as controls. In the eyes with CSC, the outer retinal layer was significantly thinner than in the eyes of fellow and healthy controls. The foveal avascular zone area and VDs in the superficial and deep capillary plexus in the eyes with CSC were not significantly different from those in the eyes of fellow and healthy controls. The VD of the choriocapillaris in the eyes with CSC was significantly lower than that in the eyes of fellow and healthy controls. Correlation analyses revealed that the outer retinal layer thickness and initial visual acuity were positively correlated with the final visual acuity. Furthermore, the initial SRF area and height were negatively correlated with the outer retinal layer thickness after SRF resolution. Attenuation of outer retinal layer thickness and decreased VD of the choriocapillaris were observed in the eyes with spontaneously resolved acute CSC. The outer retinal layer thickness could be an important visual predictor of CSC.

Retinal Structural and Microvascular Alterations in Different Acute Ischemic Stroke Subtypes

Introduction. Retinal structural and microvascular damages reflect damage to cerebral microvasculature and neurons. We aimed to investigate neovascular unit abnormalities among patients with large-artery atherosclerosis (LAA) or small-vessel occlusion (SAA) and control subjects. Methods. Twenty-eight LAA patients, forty-one SAA patients, and sixty-five age- and gender-matched controls were recruited. Based on optical coherence tomography angiography (OCTA), retinal capillary vessel density was assessed in the general and local sectors, and the thickness of individual retinal layer was extracted from retinal structural images. The differences between structural and microvascular were analyzed. Results. The superior peripapillary retinal nerve fiber layer (pRNFL) thickness was significantly different among the three groups, and the LAA group had the thinnest thickness. Compared to the control group, the deep retinal capillary vessel density in other two stroke subgroups were significantly reduced in all regions except in the inferior region ( P < 0.05), and the fractal dimension in C2 and C4 regions of deep retina was significantly lower in the LAA group ( P < 0.05). Discussion. Compared with superficial microvascular network, deep microvascular network is more sensitive to ischemic stroke. In addition, we have demonstrated quadrant-specific pRNFL abnormalities in LAA and SAA patients. Superior quadrant pRNFL thickness differences between stroke subgroups may suggest that changes in retinal nerve fiber layer are more sensitive to subtype identification than changes in retinal microvascular structure. All in all, the alteration in retinal structural and microvascular may further elucidate the role of the neovascular unit in ischemic stroke, suggesting that the combination of these two indicators could be used for subtype identification to guide prognosis and establish a risk prediction model.

Quantitative measurements with optical coherence tomography angiography in Behçet uveitis

Purpose The aim of this study was to evaluate the quantitative measurements obtained by optical coherence tomography angiography in patients with Behçet uveitis. Methods A total of 22 consecutive patients with Behçet uveitis and 19 age-matched healthy individuals were included in the study. Quantitative analysis of optical coherence tomography angiography images was performed. Comparisons between the patients and the control groups and correlation analysis between optical coherence tomography angiography results and age, visual acuity, duration of uveitis, central macular thickness, and fluorescein angiography scores in the patient group was performed. Results The mean superficial foveal avascular zone area was 283.040 ± 113.003 µm2 in the patient group and 254.268 ± 75.813 µm2 in the control group (p = 0.821). The mean deep foveal avascular zone area was 317.657 ± 116.225 µm2 in the patient group and 332.954 ± 94.783 µm2 in the control group (p = 0.775). The foveal avascular zone area could not be calculated in eight eyes with macular atrophy in the patient group because of unclear foveal avascular zone borders. Both superficial and deep capillary vessel density in all regions were lower in the patient group than in the control. Superior, inferior, and temporal capillary vessel density were correlated with fluorescein angiography score (Pearson’s r = –0.380, 0.392, and –0.384, p < 0.05 in superficial plexus; r = –0.357, –0.401, and –0.321, p < 0.05 in deep plexus, respectively). The foveal avascular zone area was correlated with central macular thickness in both superficial and deep plexus (r = –0.387 and –0.331, p < 0.05, respectively). Conclusion Recurrent uveitis attacks affecting the macula are associated with a decrease in capillary vessel density and expansion in the foveal avascular zone area in Behçet disease. The qualitative evaluation of the optical coherence tomography angiography findings may be more valuable in patients with macular atrophy.