Search Results (165)

Purpose: To review the current literature on the combined use of cataract surgery (or lensectomy) and vitrectomy in pediatric patients, with a focus on clinical indications, surgical techniques, outcomes, and complications across various pediatric ocular pathologies. Methods: A narrative review of published studies addressing the use of combined lensectomy and vitrectomy (LV) in pediatric patients was conducted. Conditions discussed include congenital cataracts, ectopia lentis, retinopathy of prematurity (ROP), retinal detachment (RD), and persistent fetal vasculature (PFV). Key surgical considerations, visual and anatomical outcomes, and postoperative complications were examined. Results: The literature search yielded a total of 160 articles, of which 43 met the inclusion criteria and were included in this review. Although lens-sparing vitrectomy (LSV) is preferred in many pediatric cases to preserve accommodation and reduce complications, combined LV is often necessary in advanced or complex diseases. Studies have shown that combined LV can achieve favorable anatomical outcomes, but functional visual recovery remains variable and is affected by factors such as patient age, baseline ocular anatomy, and disease severity. Postoperative complications such as glaucoma, visual axis opacification (VAO), and intraocular lens (IOL) dislocation are more frequent with combined procedures and require long-term follow-up and rehabilitation. Conclusions: Combined cataract surgery (or lensectomy) and vitrectomy may represent a valuable strategy in the management of complex pediatric ocular conditions, particularly when individualized to the clinical context. Tailored surgical approaches are essential to optimize anatomic and functional outcomes. Further prospective studies and harmonized multicenter registries are needed to develop evidence-based principles that can guide individualized surgical decision-making in this unique patient population. Full article

Background: Our study evaluated the correlation between internal carotid artery stenosis (ICAS) and retinal microvascular changes in patients with hypertensive retinopathy, dyslipidemia and ICAS. We analyzed vascular measurements provided by optical coherence tomography angiography (OCTA) and carotid Doppler ultrasonography (US) and linked OCTA parameters with carotid artery US measurements on the same side. Statistical differences in OCTA analysis among three groups (no stenosis, mild stenosis and moderate stenosis) were evaluated and correlated with carotid Doppler parameters. Our study aimed to evaluate whether OCTA can be proposed as a screening method in patients diagnosed with mild and moderate ICAS in order to improve the early detection of carotid changes, thus potentially reducing the rate of cardiovascular and cerebral complications of ICAS. Methods: We conducted a study on hypertensive patients with ICAS using six OCTA parameters in the analysis of the retinal vasculature and carotid Doppler US velocities of three carotid arteries and the vertebral artery (VA). Kruskal–Wallis and Dunn’s post hoc tests were used to determine whether there were statistically significant differences between the normal, mild and moderate stenosis groups. Spearman and Pearson correlation were used to obtain correlations among OCTA parameters such as the foveal avascular zone (FAZ), non-flow area (NFA), vascular flow area (VFA) and blood flow velocity on carotid Doppler US. Results: In the final analysis, 49 patients were included and 3 groups of stenosis were obtained, comprising 21 subjects with no stenosis, 19 with mild stenosis and 9 with moderate stenosis. Right eye and left eye groups were formed. In the right eye group with right ICAS, we found statistically significant results for FAZ circularity when comparing the normal stenosis group to the mild stenosis group (p = 0.025) and the mild stenosis group to the moderate stenosis group (p = 0.006). Statistically significant results were also observed for NFA when comparing the normal stenosis group to the moderate stenosis group (p = 0.004) and the mild stenosis group to the moderate stenosis group (p = 0.011). When comparing the FAZ area (p = 0.016) and VFA (p = 0.037) for the normal and moderate groups, statistically significant values were obtained. When comparing the normal and moderate stenosis groups with regard to the left eye, we found statistically significant results for VFA (p = 0.041), NFA (p = 0.045) and VFA (p = 0.029). When comparing the mild and moderate carotid artery stenosis groups, we obtained statistically significant results for NFA (p = 0.001), FAZ area (p = 0.007) and VFA (p = 0.013). In the right eye group, correlations between internal carotid artery (ICA) peak systolic velocity (PSV) and VFA (rho = −0.286), ICA end-diastolic velocity (EDV) and NFA (r = 0.365), external carotid artery (ECA) PSV and VFA (r = −0.288; rho = −0.317), common carotid artery (CCA) PSV and NFA (rho = −0.345), CCA EDV and NFA (rho = −0.292) and VA PSV and VFA (r = −0.327; rho = −0.379) were found. When analyzing OCTA parameters, we found statistically significant results for NFA and VFA (r = −0.374; rho = −0.288). Correlations were also found in the left eye group between ICA PSV and NFA (r = −0.351; rho = −0.313), ICA EDV and VFA (r = −0.421; rho = −0.314), ECA PSV and NFA (r = −0.412; rho = −0.457), CCA PSV and NFA (p = −0.288; rho = −0.339), and CCA EDV and NFA (r = −0.404; rho = −0.417). Conclusions: Our study found correlations between carotid Doppler velocities and OCTA vascular flow parameters; thus, OCTA may be used as a tool for monitoring the microvascular changes associated with carotid stenosis. OCTA can provide insights concerning the overall vascular condition of the patient, since it provides subjective data on vessel density and flow; therefore, by monitoring hypertensive patients with both OCTA and carotid Doppler US, we may be able to increase efficiency in screening and diagnosing patients with IACS. Full article

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM). Key drivers of DR include mitochondrial dysfunction, oxidative stress, and chronic inflammation, which lead to premature senescence of cells within the retinal vasculature. Senolytics improve outcomes in both animal models and in patients with severe forms of DR. In this review, we discuss (i) the role of endothelial senescence in each stage of DR pathogenesis, (ii) methods for detecting senescence in cultured endothelial cells and retinal vessels, and (iii) potential mechanistic explanations for how cells within retinal vessels resist DM-driven senescence. Full article

Background/Objectives: The aim of the current investigation was to assess the short-term changes in retinal-choroidal vasculature and the morphological complexity of non-exudative macular neovascularization (NE-MNV) using optical coherence tomography angiography (OCTA) and spectral-domain optical coherence tomography (SD-OCT). Methods: Sixteen eyes of 12 patients with NE-MNV underwent baseline and six-month follow-up examinations, including comprehensive ophthalmological assessment and imaging. Central macular thickness, foveal avascular zone, vessel density, flow area, and choroidal vascularity index were analyzed. NE-MNV morphology was quantitatively assessed for area, vessel characteristics, and fractal dimensions. Results: Significant changes in NE-MNV morphology were noted over six months, especially in fractal dimensions, vessel junctions, and vessel length (p-values: 0.01, 0.037, and 0.036, respectively). While there was an increase in the NE-MNV area, it did not reach statistical significance. No significant changes were shown regarding the standard SD-OCT and OCTA output parameters or choroidal measurements. Conclusions: The increase in NE-MNV fractal dimensions suggests rising complexity in the neovascular network and may indicate possible implications for clinical management. The correlation between baseline and follow-up measures underscores a trend toward complexity, pointing to the necessity for closer monitoring of patients with higher NE-MNV fractal dimensions. Full article

Background/Objectives: Diabetic retinopathy (DR) remains a leading cause of preventable blindness, with its global prevalence projected to rise sharply as diabetes incidence increases. Early detection and timely management are critical to reducing DR-related vision loss. Optical Coherence Tomography Angiography (OCTA) now enables non-invasive, layer-specific visualization of the retinal vasculature, facilitating more precise identification of early microvascular changes. Concurrently, advancements in artificial intelligence (AI), particularly deep learning (DL) architectures such as convolutional neural networks (CNNs), attention-based models, and Vision Transformers (ViTs), have revolutionized image analysis. These AI-driven tools substantially enhance the sensitivity, specificity, and interpretability of DR screening. Methods: A systematic review of PubMed, Scopus, WOS, and Embase databases, including quality assessment of published studies, investigating the result of different AI algorithms with OCTA parameters in DR patients was conducted. The variables of interest comprised training databases, type of image, imaging modality, number of images, outcomes, algorithm/model used, and performance metrics. Results: A total of 32 studies were included in this systematic review. In comparison to conventional ML techniques, our results indicated that DL algorithms significantly improve the accuracy, sensitivity, and specificity of DR screening. Multi-branch CNNs, ensemble architectures, and ViTs were among the sophisticated models with remarkable performance metrics. Several studies reported that accuracy and area under the curve (AUC) values were higher than 99%. Conclusions: This systematic review underscores the transformative potential of integrating advanced DL and machine learning (ML) algorithms with OCTA imaging for DR screening. By synthesizing evidence from 32 studies, we highlight the unique capabilities of AI-OCTA systems in improving diagnostic accuracy, enabling early detection, and streamlining clinical workflows. These advancements promise to enhance patient management by facilitating timely interventions and reducing the burden of DR-related vision loss. Furthermore, this review provides critical recommendations for clinical practice, emphasizing the need for robust validation, ethical considerations, and equitable implementation to ensure the widespread adoption of AI-OCTA technologies. Future research should focus on multicenter studies, multimodal integration, and real-world validation to maximize the clinical impact of these innovative tools. Full article

Objectives: The aim of this study was to investigate retinal and choroidal microvascular changes in patients with axial spondyloarthritis (axSpA) treated with long-term anti-TNF therapy and NSAIDs and in healthy control subjects using optical coherence tomography angiography (SS-OCT-A). Methods: A total of 162 eyes from 81 participants were included: 52 eyes from 26 axSpA patients treated with anti-TNF therapy (≥5 years), 44 eyes from 22 axSpA patients treated with NSAIDs, and 66 eyes from 33 healthy control subjects. SS-OCT-A imaging was used to assess retinal thickness, ganglion cell layer thickness, retinal nerve fiber layer thickness, and the vessel densities of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC). Disease activity was assessed with ASDAS-CRP. Results: Both axSpA subgroups showed a significant expansion of the foveal avascular zone and reduced SCP and DCP densities compared to the controls. The CC vessel density was higher in axSpA patients than in healthy subjects. The anti-TNF group had a lower CC vascular density than the NSAIDs group. The disease duration correlated with a decreased central DCP density and increased paracentral SCP and CC densities. Conclusions: SS-OCT-A revealed subclinical retinal and choroidal changes in axSpA patients, highlighting the impact of chronic inflammation on the retinal vasculature. While anti-TNF therapy effectively controls systemic inflammation, it cannot completely prevent microvascular changes. Further studies are needed to assess the clinical relevance of these results. Full article

Purpose: Proton irradiation is used to treat choroidal melanoma of the eye. The impact on non-malignant retinal cells is currently understudied. Therefore, we here report a mouse model to investigate the impact of proton irradiation on the retina. Methods: We performed a proton beam irradiation of 5–15 Cobalt-Gray-Equivalent (CGE) of the eyes of female C57Bl6/J (Cx3cr1^+/+), Cx3cr1^gfp/+ and Cx3cr1^gfp/gfp mice mimicking the clinical situation and evaluated the structure, function and cellular composition of the retina up to 24 weeks after irradiation. Results: Proton beam irradiation of the eye with 15 CGE leads to cataract formation after 24 weeks without affecting the gross anatomy of the retinal vasculature as shown by Fundus imaging in all genotypes respectively. However, 10 and 15 CGE, lead to a significant decrease in NG2 positive cell numbers and all three dosages induced an increase in GFAP immunoreactivity. At 24 weeks a dosage of 15 CGE resulted in functional impairment and a decrease of NG2 positive cells in both WT and Cx3cr1 animals. Iba1 cell immunoreactivity was increased in all genotypes. However, in the Cx3cr1 animals the invasion of Iba1 cells into the deep vascular layer was partially prevented. This was accompanied by a less severe functional impairment in the irradiated Cx3cr1^gfp/gfp vs. WT. Conclusions: Although the gross anatomy of the retina does not seem to be affected by proton beam irradiation, the cellular composition and retinal function changed significantly in both WT and Cx3cr1 mice reflecting the clinical situation. Moreover, cataract formation was one of the major long-term effects of irradiation. We conclude that the murine model (WT and Cx3cr1 genotype) can be used to investigate proton-beam associated side effects in vivo as well as to test prospective interventions. Moreover, the loss of Cx3cr1 seems to be partially protective. Full article

Diabetic retinopathy is the most common diabetic complication of the microvasculature and one of the leading causes of acquired vision loss worldwide. Yet, the current treatments for this blinding disease are futile to many diabetics. Accordingly, new biomarkers and therapeutics for diabetic retinopathy are needed. We discovered that STEAP4 (Six-Transmembrane Epithelial Antigen of the Prostate 4) is significantly increased in peripheral blood mononuclear cells of diabetics. STEAP4 expression was gradiently increased from low levels in diabetics without retinopathy to successively higher levels in diabetics with more severe disease. Although the role of STEAP4 in the diabetic retina is unclear, these results provide strong evidence that this metabolic enzyme could be a potential biomarker for diabetic retinopathy progression. Thus, the central goal of this study was to evaluate if this potential biomarker impacts the intrinsic pathologies that lead to the development of diabetic retinopathy. In diabetic mice, STEAP4 was significantly increased and co-localized with 4-Hydroxy-2-nonenal in the Müller glia and photoreceptor layers of the retina. STEAP4 inhibition significantly decreased reactive oxygen species in murine photoreceptor cells, human Müller glia, and retinas of diabetic mice. Administering an intravitreal injection of anti-STEAP4 to diabetic mice halted Occludin degradation in the retinal vasculature. Similarly, anti-STEAP4 treatment of human retina endothelial cells halted cell death mediated by diabetic donor sera. Collectively, our findings provide strong evidence that STEAP4 impacts the intrinsic pathologies that initiate the development of diabetic retinopathy. Suggesting that STEAP4 could be a novel biomarker and clinically relevant therapeutic target for this diabetic complication and blinding disease. Full article

The diagnosis of primary open-angle glaucoma (POAG) progression based on structural imaging such as color fundus photos (CFPs) is challenging due to the limited number of early biomarkers, as commonly determined by clinicians, and the inherent variability in optic nerve heads (ONHs) between individuals. Moreover, while visual function is the main concern for glaucoma patients, and the ability to infer future visual outcome from imaging will benefit patients by early intervention, there is currently no available tool for this. To detect glaucoma progression from ocular hypertension both structurally and functionally, and identify potential objective early biomarkers associated with progression, we developed and evaluated deep convolutional long short-term memory (CNN-LSTM) neural network models using longitudinal CFPs from the Ocular Hypertension Treatment Study (OHTS). Patients were categorized into four diagnostic groups for model input: healthy, POAG with optic disc changes, POAG with visual field (VF) changes, and POAG with both optic disc and VF changes. Gradient-weighted class activation mapping (Grad-CAM) was employed for the post hoc visualization of image features, which may be associated with the objective POAG biomarkers (rather than the biomarkers determined by clinicians). The CNN-LSTM models for the detection of POAG progression achieved promising performance results both for the structural and functional models, with an area under curve (AUC) performance of 0.894 for the disc-only group, 0.911 for the VF-only group, and 0.939 for the disc and VF group. The model demonstrated high precision (0.984) and F1-score (0.963) in the both-changes group (disc + VF). Our preliminary investigation for early POAG biomarkers with Grad-CAM feature visualization signified that retinal vasculature could serve as an early and objective biomarker for POAG progression, complementing the traditionally used optic disc features and improving clinical workflows. Full article

Macular telangiectasia type 2 (MacTel) is a slowly progressive macular disorder that is often diagnosed late due to the gradual onset of vision loss. Recent advances in diagnostic techniques have facilitated earlier detection and have shown that MacTel is more common than initially thought. The disease is genetically complex, and multiple variants contribute incrementally to the overall risk. The familial occurrence of the disease prompted the investigation of the genetic background of MacTel. To better understand the molecular milieu of the disease, a literature review of the clinical reports and publications investigating the genetic factors of MacTel was performed. To date, disease-associated variants have been found in genes involved in amino acid (glycine/serine) metabolism and transport, urea cycle, lipid metabolism, and retinal vasculature and thickness. Variants in genes implicated in sphingolipid metabolism and fatty acid/steroid/retinol metabolism have been found in patients with neurological disorders who also have MacTel. Retinal metabolism involves complex biochemical processes that are essential for maintaining the high energy requirements of the retina. Genetic alterations can disrupt key metabolic pathways, leading to retinal cell degradation and the subsequent vision loss that characterizes several retinal disorders, including MacTel. This review article summarizes genetic findings that may allow MacTel to be further investigated as an inherited retinal disorder. Full article

This comprehensive review examines the ocular vascular complications of cocaine use, focusing on its effects on retinal vasculature and inflammation. A rare case of bilateral frosted branch angiitis (FBA) in a 48-year-old man with a history of intranasal cocaine abuse is presented as an illustrative example to stimulate discussion. The case highlights severe retinal ischemia and vascular sheathing, with no identifiable infectious or autoimmune cause, ultimately complicated by systemic vascular events. Integrating this case with a review of the literature, we discuss cocaine’s vasoconstrictive and immunomodulatory effects and their role in retinal pathology, including vasculitis, vascular occlusions, hemorrhages, and optic neuropathy. Although often a diagnosis of exclusion, and with rare and poorly understood consequences, this review underscores the importance of considering cocaine abuse in the differential diagnosis of complex retinal presentations. Full article

Currently, research related to the visualization of cutaneous vascular changes to heat stress depending on age and gender is limited to methods such as laser Doppler flowmetry and plethysmography, which do not provide any spatially resolved information at high resolution. On the other hand, optical coherence tomography is a real-time, noninvasive, non-contact technique that can visualize internal structures at the level of a few microns and is widely used in ophthalmology to visualize retinal structures, for example. However, the use of OCT in the investigation of skin vasculature heat stress is limited, with no study being conducted with different genders and different age groups. In this study, we propose biospeckle optical coherence tomography (bOCT), which visualizes the structural changes along a temporal scale to visualize the dynamic changes within the skin under heat stress. Heat stress was applied by applying a USB hot pad (40 °C) for five minutes to the palmar forearm of the dominant hand. A swept-source OCT (SS-OCT) operating with a central wavelength of 1310 nm, a bandwidth of 125 nm, and a sweep frequency of 20 kHz was used to obtain OCT structural images at 12.5 fps. From the one hundred OCT structural images recorded for 8 s, the biospeckle image was calculated as a ratio of the standard deviation to the mean of the images. The biospeckle images were obtained before heating, soon after heating, and after 5 min of rest. A total of 20 subjects with an equal number of male and female participants, with 10 in their 20s and the other 10 in their 30s or older, participated in the experiments. The average biospeckle contrast results were compared for significant differences under the three different conditions of before heating, soon after heating, and after rest for different depths, age differences, and genders. With heating, across all subjects at shallow depths within 200 µm or so, possibly in the epidermis–dermis border region, a significant difference was observed in the average contrast between the before-heating and after-rest conditions, with no significant difference seen in the deeper regions. With respect to age groups irrespective of gender, there was only a significant difference in the average contrast between soon after heating and before heating for the younger group, while for the older group, there was significant difference between before heating and soon after heating as well as between before heating and after 5 min of rest. This result suggests that age plays a larger role in the control of vascular dynamics. With respect to gender and irrespective of age, there was significant difference between males and females for both soon after heating and after 5 min of rest, with no significant difference found for before heating. These differences could be explained by hormonal differences that play a larger role in the vascular dynamics of the control of skin under heat stress, though the clear mechanism behind the reason for these gender differences is not clearly understood yet. As for both gender and age, because of the smaller sample size for age and gender combined, more studies are needed to obtain statistically reliable results. In total, our results obtained using bOCT demonstrate that bOCT could be successfully implemented in the study of the environmental effects on skin tissue, and we believe this has potential implications in therapeutic use such warm water immersion. Full article

Background/Objectives: Retinal vascular occlusions are a significant cause of visual impairment in older adults, resulting in ischemic retinal damage and sudden vision loss. This study evaluates the retinal, optic nerve head (ONH), and choroidal capillary networks in chronic and acute-on-chronic hypoxia compared to normal controls using optical coherence tomography angiography (OCT-A). Methods: We evaluated a prospective study including twenty patients in the hypoxic group (mean age 61.2 ± 10.2) in two phases, chronic hypoxia and acute-on-chronic hypoxia, and 21 control subjects (mean age 59 ± 9.4 years). All patients underwent a comprehensive eye examination, OCT, and OCT-A imaging. The data were analyzed using OCT-A analysis software (Zeiss OCT-A software 2.1.0.55513) and Fiji software (1.51a). Vascular density of the retina and ONH, choriocapillaries, and foveal avascular zone (FAZ) size were measured. Results: The superficial peripapillary vascular density was higher for the control group (0.387 ± 0.03) compared to the hypoxic patients with (0.383 ± 0.03) and without O2 supplementation (0.383 ± 0.03; p = 0.018). No retinal angiographic differences were identified between the two study groups. The ganglion cell layer (GCL) was thinner in the hypoxic group. Both hypoxic subgroups demonstrated denser choriocapillaries (mean 13,073 ± 1812 and 12,689 ± 1815, with and without O2 supplementation, respectively) compared to the control group (mean 9749 ± 2881, p < 0.001 for both groups). Hypoxic patients demonstrated increased area size of choriocapillaries (+O2 supplementation—mean 44,347 ± 10,563; −O2 supplementation—mean 46,984 ± 12,822) compared to the control group (mean 30,979 ± 9635; p < 0.01 and p < 0.001, respectively). Conclusions: Chronic and acute-on-chronic hypoxia did not affect the retinal vascular network, most probably due to the strong autoregulation of vascular function of the retina. However, compared to the control group, GCL, ONH vasculature density, and most choriocapillaries indices were significantly altered among hypoxic patients. Full article

The development of fetal organs can be impacted by systemic changes in maternal circulation, with the placenta playing a pivotal role in maintaining pregnancy homeostasis and nutrient exchange. In clinical obstetrics, oxytocin (OXT) is commonly used to induce labor. To explore the potential role of OXT in the placental homeostasis of OXT, we compared OXT levels in neonatal cord blood among neonates (23–42 weeks gestation) whose mothers either received prenatal OXT or experienced spontaneous labor. Our previous research revealed that the oxytocin receptor (OXTR), essential in forming the blood–retina barrier, is expressed in the retinal pigment epithelium (RPE). We hypothesized that perinatal OXT administration might influence the development of the neural retina and its vasculature, offering therapeutic potential for retinal diseases such as retinopathy of prematurity (ROP). Plasma OXT levels were measured using a commercial OXT ELISA kit. Human fetal RPE (hfRPE) cells treated with OXT (10 µM) were assessed for gene expression via RNA sequencing, revealing 14 downregulated and 32 upregulated genes. To validate these differentially expressed genes (DEGs), hfRPE cells were exposed to OXT (0.01, 0.1, 1, or 10 µM) for 12 h, followed by RNA analysis via real-time PCR. Functional, enrichment, and network analyses (Gene Ontology term, FunRich, Cytoscape) were performed to predict the affected pathways. This translational study suggests that OXT likely crosses the placenta, altering fetal OXT concentrations. RNA sequencing identified 46 DEGs involved in vital metabolic and signaling pathways and critical cellular components. Our results indicate that the perinatal administration of OXT may affect neural retina and retinal vessel development, making OXT a potential therapeutic option for developmental eye diseases, including ROP. Full article

Dye-based angiography is the main imaging modality in evaluating the vasculature of the eye. Although most commonly used to assess retinal vasculature, it can also delineate normal and abnormal blood vessels in the anterior segment diseases—but is limited due to its invasive, time-consuming methods. Thus, anterior segment optical coherence tomography angiography (AS-OCTA) is a useful non-invasive modality capable of producing high-resolution images to evaluate the cornea and ocular surface vasculature. AS-OCTA has demonstrated the potential to detect and delineate blood vessels in the anterior segment with quality images comparable to dye-based angiography. AS-OCTA has a diverse range of applications for the cornea and ocular surface, such as objective assessment of corneal neovascularization and response to various treatments; diagnosis and evaluation of ocular surface squamous neoplasia; and evaluation of ocular surface disease including limbal stem cell deficiency and ischemia. Our review aims to summarize the new developments and clinical applications of AS-OCTA for the cornea and ocular surface. Full article