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Retinal Vascular Eye Disease: Diagnosis and Treatment

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (1 February 2023) | Viewed by 16142

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Prof. Dr. Mihnea Munteanu

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Department of Ophthalmology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
Interests: retinal diseases; medical and surgical retina; ocular surface
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Horia T. Stanca

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Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
Interests: medical and surgical retina; cataract surgery; glaucoma; lasers in ophthalmology; refractive surgery
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Wolfgang Radner

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University Hospital St. Pölten, Sankt Polten, Austria
Interests: medical and surgical retina; ocular surface

Special Issue Information

Dear Colleagues,

Retinal vascular diseases have distinct ways of affecting the eye function, but all of them are based on the mechanism of restricting blood circulation. Some produce changes in the blood flow, while others alter the blood vessel structure or even the consistency of the blood. This entity of diseases includes diabetic retinopathy, which is the most common retinal vascular disease; retinal vein occlusion, the second most common retinal vascular disease; central retinal artery occlusion; wet macular degeneration; hypertensive retinopathy; and ocular ischemic syndrome. Moreover, vascular anomalies with their specific early onset should be included due to their potential effect on visual prognosis.

Most retinal vascular diseases were first described in the 19th century. In 1854, Leibreich described the clinical appearance of central retinal vein occlusion as ‘retinal apoplexy’. Retinal diabetic changes were first mentioned in 1855 by Eduard Jäger Ritter von Jaxtthal. In 1859, von Graefe published a report on central retinal artery occlusion. Since their first description, retinal vascular diseases have been differently approached and treated over time, according to the level of knowledge and available treatments or equipment.

The aim of this Special Issue is to explore, compare and highlight the current advances in the field of retinal vascular diseases and their impact on visual acuity. Both treatment options and ocular imaging techniques.

have evolved greatly. The need for evolution is constant, as we aim for better prevention, earlier diagnosis, slower progression and better functional prognosis. We also aim for different perspectives concerning retinal vascular diseases as part of a complex pathology or in connection with other ocular pathologies.

Innovative ocular imaging investigations have become available due to digital imaging technology and computer processing power. Posterior pole diseases are better evaluated with the use of multimodal imaging with spectral-domain OCT (SD-OCT) and swept-source OCT, OCTA, fluorescein angiography, indocyanine green angiography (ICGA) and fundus autofluorescence (FAF). At present, the concept of artificial intelligence with deep learning can be used in the diagnosis and prognosis of vascular retinal diseases. New anti-vascular endothelial growth factor molecules are introduced in the treatment of macular edema.

What kinds of papers we are soliciting:

Reviews or original research papers about different new molecules used in the treatment of retinal vascular diseases.

Original research papers highlighting connections between clinical aspects and functional results in various retinal vascular diseases.

Original research papers highlighting connections between various retinal vascular diseases and other ocular or general pathologies.

Rare retinal vascular disease case reports.

Interesting features of innovative ocular imaging investigations.

The use of artificial intelligence with deep learning in the diagnosis of retinal vascular diseases.

Prof. Dr. Mihnea Munteanu
Prof. Dr. Horia T. Stanca
Prof. Dr. Wolfgang Radner
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

retinal vein occlusion
retinal artery occlusion
diabetic retinopathy
swept-source OCT
fluorescein angiography
indocyanine green angiography
anti-VEGF
congenital retinal vascular changes
visual prognosis

Published Papers (9 papers)

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Research

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16 pages, 3416 KiB

Open AccessArticle

Combined Treatment of Persistent Diabetic Macular Edema with Aflibercept and Triamcinolone Acetonide in Pseudophakic Eyes

by Nenad Petrovic, Dusan Todorovic, Tatjana Sarenac Vulovic, Suncica Sreckovic, Fatima Zivic and Dijana Risimic

Medicina 2023, 59(5), 982; https://doi.org/10.3390/medicina59050982 - 19 May 2023

Cited by 1 | Viewed by 1352

Abstract

Background and Objectives: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to examine whether the additional intravitreal application of triamcinolone acetonide to continuous anti-vascular endothelial growth factor therapy could improve therapeutic outcomes for pseudophakic eyes with persistent diabetic macular edema. Materials and Methods: twenty-four pseudophakic eyes with refractory diabetic macular edema, that had appeared despite three previously administered intravitreal injections of aflibercept, were divided into two groups (twelve eyes in each group). The first group continued to have aflibercept administered according to a fixed dosing regimen (once in two months). Triamcinolone acetonide 10 mg/0.1 mL (administered once per four months) was included for the second group, i.e., their treatment continued with a combination of aflibercept + triamcinolone acetonide. Results: The reduction in central macular thickness was higher in the eyes treated with combined therapy (aflibercept + triamcinolone acetonide) compared with the use of aflibercept alone during the entire 12-month follow-up period (3rd month p = 0.019; 6th month p = 0.023; 9th month p = 0.027; 12th month p = 0.031). As was evident from the p-values, the differences were statistically significant. No statistically significant difference was recorded for visual acuity: 3rd month p = 0.423; 6th month p = 0.392; 9th month p = 0.413; 12th month p = 0.418. Conclusions: Combined anti-vascular endothelial growth factor and steroid therapy leads to a better anatomical outcome of persistent diabetic macular edema in pseudophakic eyes, but does not lead to a more significant improvement in visual acuity than continuous anti-VEGF therapy alone. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

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10 pages, 1237 KiB

Open AccessArticle

The Influence of Myopia on the Foveal Avascular Zone and Density of Blood Vessels of the Macula—An OCTA Study

by Maja L.J. Živković, Lazar Lazić, Marko Zlatanovic, Nevena Zlatanović, Mladen Brzaković, Mihailo Jovanović, Sava Barišić and Diana-Maria Darabus

Medicina 2023, 59(3), 452; https://doi.org/10.3390/medicina59030452 - 24 Feb 2023

Cited by 2 | Viewed by 1877

Abstract

Background and Objectives: Myopia is the most common refractive eye anomaly with a prevalence that is constantly increasing. High myopia is associated with numerous complications that can lead to permanent vision loss. It is believed that the basis of these complications lies in changes in the microvasculature of the retina caused by an increase in the longitudinal axis of the eye. Materials and Methods: Optical coherence tomography angiography (OCTA) was used to analyze differences in macular zone vascular and perfusion density and foveal avascular zone (FAZ) parameters in myopic subjects. The following OCTA parameters were analyzed: the vessel and perfusion density of retinal blood vessels in the superficial plexus; the area, perimeter, and index of circularity of the foveal avascular zone (FAZ); and foveal and ganglion cell complex (GCC) thickness. Results: Subjects with low myopia did not show statistically significant differences compared to the control for any of the analyzed parameters. Groups with moderate and high myopia showed a significant decrease in vessel and perfusion density in the parafoveal and the entire 3 × 3 mm analyzed field. Foveal vessel and perfusion densities in the myopic groups were similar to those of the control regardless of the degree of myopia. The area and perimeter of the FAZ, as well as foveal and mean GCC thickness, did not differ significantly no matter the degree of myopia, while the index of circularity was lower in highly myopic subjects. The minimal thickness of the GCC was also lower in the high myopia group. Conclusions: High and moderate myopia led to a loss of blood vessels in the macular region. Perfusion and vascular densities were preserved in the foveal region and were not affected by different degrees of myopia. The FAZ was not significantly larger in myopic subjects, but its circularity was lower in subjects with high myopia. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

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7 pages, 298 KiB

Open AccessArticle

Influence of Multiple Anti-VEGF Injections on Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness in Patients with Exudative Age-Related Macular Degeneration

by Maja Zivkovic, Aleksandra Radosavljevic, Marko Zlatanovic, Vesna Jaksic, Sofija Davidovic, Miroslav Stamenkovic, Ivana Todorovic and Jana Jaksic

Medicina 2023, 59(1), 138; https://doi.org/10.3390/medicina59010138 - 10 Jan 2023

Cited by 2 | Viewed by 1220

Abstract

Backgrounds and Objectives: To analyze the influence of multiple anti-VEGF intravitreal injections for exudative age-related macular degeneration on the thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC + IPL) using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A prospective interventional study of consecutive patients treated with intravitreal bevacizumab (IVB) was performed. Average and sectorial values of RNFL and GC + IPL thickness were recorded using Cirrus SD-OCT at 0, 6, 12, and 24 months. Patients suffering from any ocular disease that could affect RNFL or GC + IPL thickness were excluded. Results: A total of 135 patients (70 women and 65 men, aged 65 ± 15 years) were included. The average number of injections per patient was 12.4 ± 2.4. Average RNFL and GC + IPL thickness prior to the first injection (87.6 ± 12.2 and 47.2 ± 15.5 respectively), and after 24-month follow-up (86.2 ± 12.6 and 46.7 ± 11.9 respectively) did not differ significantly (p > 0.05). There was a significant decrease in GC2, GC5 segments, and minimum GC + IPL thickness. Conclusion: Repeated anti-VEGF treatment did not cause significant changes in the thickness of RNFL and GC + IPL layers over a period of 24 months. The detected decrease in GC2 and GC5 sectors, as well as in minimum GC + IPL thickness, could be a sign of ganglion cell damage induced by the treatment or could occur during the natural course of the disease. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

8 pages, 299 KiB

Open AccessArticle

The Learning Curve of Surgery of Diabetic Tractional Retinal Detachment—A Retrospective, Comparative Study

by Ciprian Danielescu, Andreea Dana Moraru, Nicoleta Anton, Madalina-Ioana Bilha, Vlad-Constantin Donica, Diana-Maria Darabus, Mihnea Munteanu and Alin Stefan Stefanescu-Dima

Medicina 2023, 59(1), 73; https://doi.org/10.3390/medicina59010073 - 29 Dec 2022

Cited by 5 | Viewed by 1258

Abstract

Background and Objectives: There are few data in the literature concerning the learning curve of tractional retinal detachment (TRD) surgery. We have analyzed the experience gained by a vitreoretinal surgeon over 10 years. Materials and Methods: A retrospective, comparative study of 34 TRD cases operated using 20G instruments between 2008 and 2011 (group A) and 94 cases operated using 23G instruments between 2015 and 2019 (group B). The preoperative characteristics, the type of endotamponade, and the anatomical and functional success were reviewed. Results: The group A patients had a significantly higher rate of concomitant vitreous hemorrhage (VH) at presentation (64.7% vs. 37.2%) and of non-macular retinal detachments (52.9% vs. 39.3%). The rate of silicone oil endotamponade was high in both groups (76.4% vs. 68.1%), but in group B 25.5% were left without a tamponade (vs. none in group A). A postoperative anatomical success was obtained in 76.5% of eyes in group A and 84.04% of eyes in group B (where it was improved to 89.3% by reinterventions). The presenting visual acuity (VA) was very low in both groups (0.01 and 0.05, respectively). The proportion of eyes with improved or stabilized VA was 85.3% in group A and 79.8% in group B (statistically non-significant difference). Conclusions: The anatomical success rate improves quite slowly with increasing surgeon experience and can be further improved by reinterventions. Visual improvement does not match the rate of anatomical improvement. With increasing experience and self-confidence, the surgeon will approach more difficult cases, a fact that may slow down the increase in surgical success rates. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

10 pages, 296 KiB

Open AccessArticle

by Jelena B. Vasilijević, Igor M. Kovačević, Zoran M. Bukumirić, Gorica D. Marić, Nikola A. Slijepčević and Tatjana D. Pekmezović

Medicina 2022, 58(12), 1741; https://doi.org/10.3390/medicina58121741 - 28 Nov 2022

Cited by 2 | Viewed by 1558

Abstract

Background and Objectives: The aim of the study was to evaluate vision-related quality of life (VR-QOL) and treatment satisfaction (TS) in patients with diabetic retinopathy treated with panretinal photocoagulation (PRP). Material and Methods: The panel study included 95 patients who underwent PRP for diabetic retinopathy. Eligible patients with no history of previous PRP were interviewer-administered the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Retinopathy Treatment Satisfaction Questionnaire (RetTSQ) beforehandand one month after the last session of laser application. The study was conducted between June 2017 and June 2019 at tertiary care center in Serbia, Belgrade. We assessed pre- to post-PRP values of the composite score and subscale scores of VFQ-25 and RetTSQ, using a paired samples t-test. Univariate logistic regression was used to analyze the relationship between binary outcomes and potential predictors. Multivariate regression included predictors from univariate analyses that were statistically significant. Results: The mean VFQ-25 composite score was 65.4 ± 17.4 before and 63.3 ± 19.5 after PRP (p = 0.045). Subscale analysis showed that two of the 11 items achieved a significant decrease after laser application (general vision and dependency). The mean RetTSQ score at baseline was 60.0 ± 11.8 and at the exit visit was 60.3 ± 12.3 (p = 0.858). Sub-scale analysis showed significant deterioration for five of the 13 items. Multivariate logistic regression found that significant predictor of VFQ-25 composite score reduction was fewer laser burns (p = 0.002) while significant predictor of RetTSQ total score reduction was presence of hyperlipidaemia (p = 0.021). Conclusion: The use of vision-related quality of life and treatment satisfaction questionnaires in conjunction with clinical examination, appears to provide a more comprehensive overview of an individual’s daily well-being following PRP. Laser treatment for diabetic retinopathy leads to deterioration of some of the patients’ perceived VR-QOL and TS. Health-care providers should inform patients about their treatment options and together decide which therapeutic method is best for them. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

Review

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12 pages, 786 KiB

Open AccessReview

Aetiology, Diagnosis and Treatment of Arterial Occlusions of the Retina—A Narrative Review

by Barbara Daxer, Wolfgang Radner, Florian Fischer, Andreea-Liliana Cocoșilă and Armin Ettl

Medicina 2024, 60(4), 526; https://doi.org/10.3390/medicina60040526 - 23 Mar 2024

Viewed by 964

Abstract

Arterial occlusions of the retina are potentially sight-threatening diseases which often result in profound visual loss. The aim of this narrative review is to provide an overview of the aetiology, discuss major risk factors, describe the management and systemic assessments and evaluate existing therapies. For this review, an extensive literature search in PubMed was performed. Emboli from the heart or the carotid arteries can cause ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). Most patients with arterial occlusions have vascular risk factors such as arterial hypertension, hyperhomocysteinaemia, carotid stenosis and atrial fibrillation, which also increase the risk of cerebral stroke and myocardial infarction. Therapies such as ocular massage, thrombolysis and anterior chamber paracentesis have been suggested but are still equivocal. However, it is evident that retinal artery occlusion should be immediately treated and accompanied by interdisciplinary collaboration, since early diagnosis and the proper treatment of possible risk factors are important to reduce the risk of further damage, recurrences, other vascular diseases and mortality. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

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16 pages, 15681 KiB

Open AccessReview

Retromode Imaging in Age-Related Macular Degeneration

by Antonia-Elena Ranetti, Horia Tudor Stanca, Bogdana Tăbăcaru, Adrian Teodoru, Mihnea Munteanu and Simona Stanca

Medicina 2023, 59(4), 647; https://doi.org/10.3390/medicina59040647 - 24 Mar 2023

Cited by 2 | Viewed by 1866

Abstract

Background and Objectives: Retromode is a relatively new retinal-imaging technique that is based on the transillumination principle and is obtained with a scanning laser ophthalmoscope that uses light in the infrared spectrum. The laser light penetrates into the deep retinal layers and the choroid. Retromode images are captured with a laterally displaced aperture, and the detector captures only the scattered light. The result is a high-contrast pseudo-three-dimensional image. Age-related macular degeneration (AMD) is a disabling retinal disease. AMD is characterized in its early stage by small and intermediate drusen formation, while the signs of intermediate AMD are large drusen and/or pigmentary abnormalities. Late AMD has two forms, geographic atrophy, which is the advanced form of dry AMD, and wet AMD. Most of the lesions of AMD are located in the outer layers of the retina. This new imaging method can provide a glimpse of the deep retinal layers’ topographic changes in a non-invasive, fast, and effective way that can match the other imaging tools available. Materials and Methods: The literature review was performed by searching the PubMed database using the following combination of keywords: retromode imaging and age-related macular degeneration. Relevant images similar to the ones in the literature were identified and used as models. Results: The purpose of this article is to highlight the utility of incorporating retromode imaging into the multimodal evaluation of the retina in patients with AMD and to gather and integrate these findings into a brief but comprehensive paper. Conclusions: Retromode imaging is a good screening, diagnosis, and monitoring tool for patients with AMD. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

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11 pages, 1937 KiB

Open AccessReview

Management of Suprachoroidal Hemorrhage during Phacoemulsification: A Comprehensive Review

by Ana Flores Márquez, Facundo Urbinati, Carlos Rocha-de-Lossada, Juan Ángel Moreno Gutiérrez, Mihnea Munteanu, Mariantonia Ferrara and Joaquín Fernández

Medicina 2023, 59(3), 583; https://doi.org/10.3390/medicina59030583 - 15 Mar 2023

Cited by 2 | Viewed by 3007

Abstract

Suprachoroidal hemorrhage (SCH) is a rare and sight-threatening complication of various intraocular surgeries, including cataract surgery. Although the rate of SCH complicating cataract surgery has decreased in the era of phacoemulsification, most likely due to smaller self-sealing incisions and modern equipment, it remains a challenging complication to manage. The aim of this review is to summarize the current evidence of the pathophysiology and management of SCH complicating phaco surgery. A literature review was performed using the PubMed database searching for diagnosis, therapy, and management of SCH during phacoemulsification. The evidence available on the optimal management of this condition is low, and there is no consensus so far. An early diagnosis is thought to be essential to avoid progression to the devastating stage of expulsion of intraocular contents (expulsive hemorrhage). Sudden intraoperative anterior chamber shallowing, red reflex loss, and a significant increase in intraocular pressure are highly suspicious for this severe complication. A fundus examination and ocular ultrasound are crucial to confirm the diagnosis and, if it is confirmed, stabilize the globe immediately. The initial therapeutic approach includes aggressive topical and systemic medication focused on controlling ocular inflammation and intraocular pressure, whereas the timing and the indications of surgical intervention remain controversial. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

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Other

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5 pages, 1218 KiB

Open AccessCase Report

Cocaine Abuse as an Immunological Trigger in a Case Diagnosed with Eales Disease

by Ludovico Iannetti, Fabio Scarinci, Ludovico Alisi, Alessandro Beccia, Andrea Cacciamani, Maria Carmela Saturno and Magda Gharbiya

Medicina 2023, 59(1), 169; https://doi.org/10.3390/medicina59010169 - 14 Jan 2023

Cited by 1 | Viewed by 1947

Abstract

Background: Eales disease is a clinical syndrome affecting the mid-peripheral retina with an idiopathic occlusive vasculitis and possible subsequent retinal neovascularization. The disease can develop into visually threatening complications. Case Presentation: We report the case of a 40-year-old Caucasian male with a history of cocaine abuse who presented with blurred vision in the left eye (LE). Fundus examination showed vitreous hemorrhages, peripheral sheathing of venous blood vessels, areas of retinal neovascularization in the LE, and peripheral occlusive phlebitis in the right eye. The full serologic panel was negative except for the heterozygous mutation of factor V Leiden. Clinical and biochemical parameters suggested a diagnosis of Eales disease. Therapy with dexamethasone, 1 mg per kg per day, tapered down slowly over 4 months, and peripheral laser photocoagulation allowed a regression of clinical signs and symptoms. Conclusion: This case shows an uncommon presentation of Eales disease associated with cocaine abuse. Both cocaine abuse and a thrombophilic pattern, as cofactors, might have sensitized the retinal microcirculation on the pathogenetic route to this retinal pathology. Furthermore, in view of this hypothesis, a thorough ocular and general medical history investigating drug abuse and coagulation disorders is recommended for ophthalmologists in such cases. Full article

(This article belongs to the Special Issue Retinal Vascular Eye Disease: Diagnosis and Treatment)

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