Search

To describe and assess the prognostic significance of subretinal transient hyporeflectivity (STHR) on a novel spectral domain optical coherence tomography (SD-OCT) in age-related macular degeneration.Consecutive patients with age-related macular degeneration (AMD) presenting STHR, defined as a small, well-defined, round subretinal, hyporeflective lesion, on SD-OCT and without exudative signs were included. Clinical examination and SD-OCT (SPECTRALIS, Heidelberg Engineering, Heidelberg, Germany) were analyzed at inclusion, 1 month before inclusion, and until the onset of exudative signs during the 12-month follow-up.Thirty-five STHR in 21 eyes of 20 patients were included. Among the 21 eyes, 2 eyes had early AMD, 1 eye had nonexudative asymptomatic macular neovascularization, and 18 eyes presented late AMD: 17 eyes neovascular AMD and 1 eye geographic atrophy. During the 2-month follow-up, 97.1% (34/35) of STHR disappeared. During the 12-month follow-up, 57.1% of eyes (12/21) developed exudative signs on 1 eye with early AMD and 11 eyes with neovascular AMD.Subretinal transient hyporeflectivity is a novel SD-OCT sign in patients with AMD. The eyes with isolated STHR should be closely monitored on a monthly basis to detect further exudation.

Purpose There is no widely accepted treatment for persistent/chronic central serous chorioretinopathy. The present study aimed to evaluate the efficacy, safety, and factors associated to treatment response to navigated micropulse laser in chorioretinopathy. Methods Retrospective observational case series including consecutive patients presenting with symptomatic persistent and chronic chorioretinopathy. All patients were treated with 5% navigated micropulse laser with the Navilas system (Navilas®, OD-OS GmBH, Teltwo, Germany), by overlying fluorescein angiography, indocyanine green angiography and/or spectral domain-optical coherence tomography images of visible leaking points and/or choroidal hyperpermeability/subretinal fluid to plan the laser treatment. Results Thirty-nine eyes of 36 consecutive patients (29 men and 7 women, with a mean age of 51.87 years) were included. Logarithm of the minimum angle of resolution (LogMar) best-corrected visual acuity increased from 0.39 ± 0.24 at baseline to 0.24 ± 0.22 at 3 months ( p Conclusion Navigated micropulse laser laser treatment was found to be effective and safe for the treatment of chorioretinopathy, with significant improvement in visual and anatomical outcomes, unaccompanied by any adverse event at 3 and 6 months follow-up. Factors associated to subretinal fluid resolution may allow a better selection of likely responders to navigated micropulse laser treatment.

Summary We report our experience in the surgical technique of sutureless intrascleral posterior chamber intraocular lens (PC IOL) fixation in patients with insufficient capsular support using a uniquely designed, foldable, acrylic Carlevale IOL. It is specifically designed for sutureless scleral fixation and is equipped with a small plug attached to each of two haptics to anchor the lens to the sclera with a self-retaining mechanism. This surgery does not require creation of a scleral tunnel or transscleral exposure or excessive manipulation of the haptics. The harpoon-like plugs provide great stability to this implant, which can be injected through a 2.2 mm incision . The characteristics of this IOL and the relative simplicity of this implantation technique makes it widely applicable in aphakic patients after previous complicated cataract surgery.

Introduction: To investigate choroidal thickness changes related to the clinical activity of inflammatory choroidal neovascularization in punctate inner choroidopathy/multifocal choroiditis as compared to myopic choroidal neovascularization. Materials and methods: Consecutive inflammatory choroidal neovascularization secondary to punctate inner choroidopathy/multifocal choroiditis, and myopic choroidal neovascularization were retrospectively reviewed. By means of enhanced-depth imaging optical coherence tomography, choroidal thickness was assessed at the same location before choroidal neovascularization development, at choroidal neovascularization onset (baseline), and after treatment. Results: Eleven eyes with inflammatory choroidal neovascularization and 11 eyes with myopic choroidal neovascularization were analyzed. Choroidal thickness beneath inflammatory choroidal neovascularization significantly increased at baseline and decreased after therapy (“Sponge sign”), reaching preclinical values. In particular, mean choroidal thickness under inflammatory choroidal neovascularization was 145 ± 85 µm at the preclinical stage, increased to 210 ± 103 µm at baseline (p = 0.006), and decreased to 136 ± 87 µm after treatment (p = 0.017). Conversely, no significant choroidal thickness changes were disclosed in myopic choroidal neovascularization eyes, under any location. Conclusion: Optical coherence tomography–based choroidal thickness evaluation may represent an additional useful tool to monitor inflammatory choroidal neovascularization activity. Moreover, choroidal thickness under choroidal neovascularizations could be used to discriminate the origin of choroidal neovascular membrane, either inflammatory or myopic, in doubtful cases and guide the therapeutic management.

Background and Objectives: The purpose of this study is to describe the effects of photobiomodulation on drusen regression with patients presenting with reticular pseudodrusen (RPD). Materials and Methods: This study is a retrospective observational case series study including patients presenting with RPD who underwent treatment by photobiomodulation. All patients underwent a complete ophthalmic examination and multimodal imaging prior to treatment, including spectral-domain optical coherence tomography (SD-OCT). Eyes were treated two times per week for six consecutive weeks. Best corrected-visual acuity (BVCA) was measured prior and after treatment for all patients. The number of RPD on the SD-OCT scans centered on the macula and stages of RPD was noted at baseline and 6 months after the first treatment session. Results: Five eyes of five patients were included in the study. Mean BCVA did not change 6 months after treatment compared to baseline. Mean number of RPD per eye was 112.60 +/− 48.33 RPD at baseline and 111.6 +/− 49.29 in the same area 6 months after treatment. Changes in RPD distribution according to RPD classification were observed before and after treatment with photobiomodulation. Changes in distribution mostly concerned stages 1 and 3 RPD: Total number of stage 1 RPD was 289 and increased to 324 after treatment. Total number of stage 3 RPD was 97 at baseline and decreased to 67 6 months after treatment. Percentage of stage 1 RPD increased from 46% to 56% after treatment. Percentage of stage 3 RPD decreased from 20% to 13% after treatment. Conclusions: Changes in RPD distribution were observed before and after treatment with photobiomodulation. The number of stage 3 reticular pseudodrusen decreased while number of stage 1 reticular pseudodrusen increased after treatment.

To investigate fellow eyes of newly diagnosed unilateral exudative Type 3 (T3) macular neovascularization (MNV) patients by assessing the presence and progression of a preclinical neovascular component during a 3-year follow-up.This is a longitudinal study involving three retinal referral centers. Patients affected by unilateral exudative treatment-naive T3 MNV were enrolled.Twenty-four eyes of 24 patients (79 ± 6 years old) were enrolled. Nine eyes (37%) displayed a nonexudative T3 MNV at baseline that developed exudation after a mean of 9 ± 9 months. Fifteen eyes that did not display a nonexudative Type 3 MNV at baseline. Five eyes (21%) did not display neovessels at baseline, but showed a nonexudative T3 after 13 ± 9 months, and exudation after 8 ± 3 months. Five eyes (21%) developed active exudative T3 MNV after 23 ± 9 months, with no detectable nonexudative stage at baseline. Five eyes (21%) did not show MNV, but progressed to geographic atrophy by 36 months of follow-up. Overall, T3 MNV in the fellow eye accounted for 79%, all developing exudation over 3 years of follow-up.The occurrence of a nonexudative T3 MNV is a frequent event in the fellow eye of patients newly diagnosed with unilateral exudative T3 MNV and it precedes the development of exudation over 3 years (prevalence of 37% and cumulative incidence of 79%). Optical coherence tomography angiography approach may be used to perform an early diagnosis and treatment of patients with T3 MNV.

Initial stages of Best vitelliform macular dystrophy (BVMD) and adult vitelliform macular dystrophy (AVMD) harbor similar blue autofluorescence (BAF) and optical coherence tomography (OCT) features. Nevertheless, BVMD is characterized by a worse final stage visual acuity (VA) and an earlier onset of critical VA loss. Currently, differential diagnosis requires an invasive and time-consuming process including genetic testing, electrooculography (EOG), full field electroretinogram (ERG), and visual field testing. The aim of our study was to automatically classify OCT and BAF images from stage II BVMD and AVMD eyes using a deep learning algorithm and to identify an image processing method to facilitate human-based clinical diagnosis based on non-invasive tests like BAF and OCT without the use of machine-learning technology. After the application of a customized image processing method, OCT images were characterized by a dark appearance of the vitelliform deposit in the case of BVMD and a lighter inhomogeneous appearance in the case of AVMD. By contrast, a customized method for processing of BAF images revealed that BVMD and AVMD were characterized respectively by the presence or absence of a hypo-autofluorescent region of retina encircling the central hyperautofluorescent foveal lesion. The human-based evaluation of both BAF and OCT images showed significantly higher correspondence to ground truth reference when performed on processed images. The deep learning classifiers based on BAF and OCT images showed around 90% accuracy of classification with both processed and unprocessed images, which was significantly higher than human performance on both processed and unprocessed images. The ability to differentiate between the two entities without recurring to invasive and expensive tests may offer a valuable clinical tool in the management of the two diseases.

Psoriasis is a chronic inflammatory skin disease with autoimmune pathogenic characteristics and is caused by chronic inflammation, which results in uncontrolled keratinocyte growth and defective differentiation. The link between the gut microbiota and immune system regulation opened a novel angle to understand the pathogenesis of many chronic multifactorial diseases, including psoriasis. Current evidence suggests that modulation of the gut microbiota, both through dietary approaches and through supplementation with probiotics and prebiotics, could represent a novel therapeutic approach. The present work aims to highlight the latest scientific evidence regarding the microbiome alterations of psoriatic patients, as well as state of the art insights in terms of microbiome-targeted therapies as promising preventive and therapeutic tools for psoriasis.

Background Berger’s IgA nephropathy (IgAN) is the most common primary glomerulonephritis. However, some rare cases of retinal manifestations have been described, with only two cases of retinal vasculopathy reported in the literature. Here we report an uncommon case of bilateral ischemic retinal vasculopathy associated with Berger IgAN, evaluated with complete multimodal imaging including ultra-wide field (UWF) imaging and swept source optical coherence tomography angiography (SS-OCTA). Case presentation A 51-year-old woman with a history of Berger’s IgA nephropathy complained of visual impairment in both eyes. Fundus examination showed bilateral peripapillary arterial attenuation and perivascular sheathing, associated to perifoveal telangiectatic lesions. There was a central scotoma in the perimetry of the right eye and peripheral visual field defect in the left eye. Full-field electroretinogram revealed significantly reduced oscillatory potentials. Spectral domain optical coherence tomography showed multiple focal areas of thinning of the inner retina, indicating long-lasting vascular occlusion lesions. UWF fluorescein angiography showed the presence of bilateral vasculitis, diffuse capillary leakage, macular ischemia and telangiectasia. SS-OCTA better highlighted the macular ischemia and vascular anomalies layer-by-layer. Conclusions Retinal vasculopathy is a very rare condition observed in IgA nephropathy. To our knowledge, this is the first report of complete multimodal functional and structural imaging. UWF imaging was very useful for accurate and comprehensive disease assessment, and OCTA was able to assess posterior pole vascular lesions.

Presumed solitary circumscribed retinal astrocytic proliferation (pSCRAP) is a rare, benign retinal tumor, typically presenting as a yellow-white, well-defined lesion. It was first qualified as astrocytic, but thanks to the development of optical coherence tomography (OCT), the lesion was identified as a deep glial lesion, as the nerve fiber layer appeared to be spared. Herein, the authors report the case of a 90-year-old man with inferopapillary pSCRAP who benefited from swept-source OCT angiography images. [ Ophthalmic Surg Lasers Imaging Retina. 2021;52:232–235.]

Purpose: To assess patient satisfaction regarding the sudden reorganization of care during the COVID-19 pandemic in the outpatient intravitreal injection (IVI) clinic. Methods: A survey of patients with ongoing IVIs for retinal diseases was carried out between April 23rd and May 12th, 2020. We designed a questionnaire to assess patient satisfaction concerning: personal protective equipment (PPE), social distancing, the perceived quality of care, and the total time spent in the department, using a Likert scale. We also collected the time spent per patients in the outpatient IVI clinic. Results: A hundred and twenty-seven eyes of 108 patients were included. The mean time spent in the IVI outpatient clinic was 31.87 +/− 16.61 min. In our survey, 99.1% of the patients were satisfied (highly satisfied or satisfied) with the new type of care provided, 89.8% with the duration of care, and 93.5% with the PPE. Satisfaction was associated with total time spent in hospital ( p = 0.005), with dissatisfied patients spending about 50% more time in the hospital than satisfied patients (43.91 min vs 30.50 min). Conclusion: Despite the crisis-related adjustment, our survey revealed high patient satisfaction with PPE, quality of care, and total time spent in outpatient IVI clinic.

Purpose: To analyze different clinical and anatomical features in treatment-naïve non-exudative macular neovascularizations (MNVs) secondary to age-related macular disease (AMD). Methods: In this retrospective longitudinal study with a minimum follow-up of 1 year, 31 eyes of 28 consecutive AMD patients (mean age 75 ± 9 years) with treatment-naïve non-exudative MNV were enrolled. Patients were divided in: short-term activated MNV group (exudation before 6-month) and quiescent MNV group (per definition no exudation during a minimum 6-month follow-up) showing no or late activation during follow-up (persistently quiescent and long-term activated MNV group, respectively). Results: During the follow-up (mean duration: 22 ± 9 months) four eyes (13%) showed exudation before 6-month follow-up (short-term activated MNV group), whereas 21 eyes (68%) did not develop signs of exudation (persistently quiescent group), and six eyes (19%) developed exudation after the minimum 6-month follow-up (long-term activated MNV group). Monthly MNV growth rate was significantly higher in the short-term activated MNV group (growth rate of 13.30%/month), vs persistently quiescent MNV group (0.64%/month, p Conclusion: We reported two different patterns for subclinical MNVs: subclinical MNVs characterized by short-term activation which could represent simply a pre-exudative stage in the development of an ordinary type 1 MNV, and quiescent MNVs characterized by low rate of growth and possible long-term activation. Analysis of OCT-A features may predict short-term activation for subclinical MNV but no features could predict the long-term activation.

To analyze the relationship between a focal increase of choroidal thickness (ChT) and exudative activity of macular neovascularization (MNV) secondary to pathologic myopia.Retrospective analysis including eyes with pathologic myopia presenting with a focally increased ChT underneath active MNV. All patients included were treated, and ChT was measured before and after each intravitreal injection by two experienced ophthalmologists.Fifty-two eyes of 52 patients with myopic MNV (19 men and 33 women) were included in this analysis. ChT at T-1 averaged 51.09 ± 33.56 μ m, whereas at the time of MNV activation (T0), ChT was significantly thicker: 85.11 ± 43.99 μ m ( P0.001). After a single intravitreal injection, the ChT significantly decreased to 53.23 ± 34.15 μ m ( P0.001).This study showed that focal ChT variations may be considered an interesting corollary sign of MNV in high myopic patients, indicating the activity of myopic neovascularization.

To compare acquisitions from single-volume Solix protocol (V1), multi-volume averaged Solix protocol (V4), and AngioVue in patients with diabetic retinopathy (DR) to assess differences in quantitative parameters introduced by high-speed scanning and averaging.Thirty-eight diabetic patients were divided into 4 groups showing either no sign, mild, moderate, or severe DR at fundus examination. For optical coherence tomography angiography (OCTA) acquisitions both AngioVue, Solix V1, and V4 were used on each patient. Outcome measures were macular perfusion density (PD), vessel length density (VLD), and vessel density index (VDI) for both superficial capillary plexus (SCP) and deep capillary plexus (DCP) and flow deficits (FD) in the choriocapillaris (CC).Our study revealed a good agreement in SCP parameters measured with all 3 devices. DCP measurements with Solix V1 showed moderate agreement with V4 and poor agreement with AngioVue measurements. Inter-device agreement in CC-FD assessment was relatively poor considering all 3 devices. The averaging process led to an underestimation of DCP and SCP parameters in all stages of DR (more evident in mild DR). AngioVue measurements compared to Solix V1 led to overestimation of SCP-PD (more pronounced in severe DR patients) and of DCP parameters (more evidently in moderate DR). The regression model derived from Solix V1 parameters was the best for categorization into the different stages.Averaging and high-speed scanning introduce changes in OCTA quantitative parameters in DR. Solix V1 is the most suitable for early diagnosis of DR, while averaged protocol could be the preferred choice in advanced stages of the disease.

Aims: To investigate alterations in deep retinal vascular complex (DVC) in patients with non-neovascular intermediate AMD (iAMD), treatment-naïve quiescent macular neovascularization (qMNV), exudative AMD (eAMD) by means of OCT angiography (OCTA). Methods: Patients with iAMD, qMNV, eAMD and healthy controls presenting in the Department of Ophthalmology of the Centre Hospitalier Intercommunal de Créteil between January 2016 and January 2018, were retrospectively included. 3 × 3-mm OCTA (AngioVue RTVue XR Avanti) perfusion density (PD) of DVC was computed in all groups at baseline and follow up (12.0 ± 1.1 months). Results: A total of 46 eyes of 45 patients were enrolled: 11/46 iAMD, 10/46 qMNV, 13/46 eAMD, 12/46 control eyes. PD showed a significant decrease during follow-up in qMNV ( p = 0.0059) and iAMD ( p = 0.0076) eyes. PD in eAMD and healthy controls didn’t show significant changes. Conclusion: PD decreases at the level of DVC in eyes with qMNV and iAMD, while in eAMD eyes, PD is stable throughout follow up, suggesting that repeated anti-vascular endothelial growth factor (VEGF) injections do not impact on the DVC PD.

Objective: The aim of this study was to evaluate the efficacy of a mix of carboxymethylcellulose and glycerin (Optive®) after intravitreal injection therapy (IVT) with anti-vascular endothelial growth factor for reducing ocular discomfort in patients. Methods: We prospectively included patients who were naive to any IVT. No artificial tear treatment was prescribed after the first IVT. After the second IVT, all patients instilled 3 drops per day of Optive® for 3 days. Every patient answered a questionnaire concerning the ocular discomfort at 72 h after both IVTs and a questionnaire about tolerance to treatment after the second IVT. Results: We included 45 patients (mean age 72.3 years [range 23–94], 25 females); 14 (34.1%) reported a feeling of grittiness after the first IVT but not after the second ( p = 0.01); 12 (29.3%) complained of global discomfort after the first IVT but not after the second ( p = 0.14); and 11 (26.8%) reported a watery eye after the first IVT but not after the second ( p = 0.21); 37/45 (82%) patients felt ocular discomfort after IVT. Conclusion: Most patients felt ocular discomfort after IVT. Instillation of Optive® significantly alleviated the feeling of grittiness for more than half of the patients.

Purpose: We intend to describe an uncommon presentation of X-linked juvenile retinoschisis (XLRS) in a 17-year-old boy showing a macular demarcation line in the right eye and an inferior peripheral bullous retinoschisis in both right and left eye, at his first ophthalmologic examination. Methods: The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination, ultra-wide-field retinography, spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, electroretinography, visual field test, and genetic molecular testing. Results: We report a rare case of genetically confirmed XLRS, presenting as a unilateral mildly-pigmented macular demarcation line (advanced sequel of unilateral spontaneous retinal reattachment of a previous retinal detachment or bullous retinoschisis) without foveoschisis in the fellow eye. Conclusion: XLRS is the most frequent cause of macular retinoschisis. The hallmark of XLRS is the evidence of a foveoschisis presenting with a characteristic spoke-wheel aspect in patients younger than 30 years of age. It is important to recognize uncommon presentations of XLRS so that the correct diagnosis is made, in order to provide the patients with appropriate genetic counseling and therapeutic care.

Purpose To describe the spectral-domain optical coherence tomography (OCT) features of fibrotic lesions associated with neovascular age-related macular degeneration (nAMD) and to outline the progression pathways from initial macular choroidal neovascular lesions (CNVs) to fibrosis. Methods Patients with nAMD were retrospectively included when macular subretinal fibrosis was present. Fibrosis was categorized using spectral-domain OCT with respect to retinal pigment epithelium (RPE) in 836 spectral-domain OCT slices from 44 eyes of 39 patients. In addition, in 47 distinct eyes, 4181 spectral-domain OCT slices were retrospectively reviewed to longitudinally assess progression from the initial lesion to the final fibrosis. Results Cross-sectional analysis classified fibrosis on spectral-domain OCT slices, as type A if located underneath the RPE, as type B if located above the RPE, and as type C if the remaining RPE was undistinguishable. The longitudinal analysis series revealed 3 progression pathways from the original CNV: 1) progression to type A, followed by RPE erosion and subretinal hyperreflective material, then type B and type C fibroglial lesion (FGL; 17/47 eyes); 2) progression to type B then type C FGL (17/47 eyes); and 3) persistence of type A with development of a flat, fibroatrophic lesion (13/47 eyes). Subretinal hyperreflective material, macular hemorrhage, or RPE tear occurred in 14 of 47, 13 of 47, and 10 of 47 eyes, respectively. Conclusion This spectral-domain OCT analysis identified various patterns of macular fibrosis in eyes with nAMD. Three pathways of progression to fibrosis were described including the well-established pathway of type 2 CNV progression to FGL and the progression of type 1 fibrovascular CNV to FGL or fibroatrophic lesion.

AimTo characterise macular neovascularisation (MNV) developing in eyes affected by geographic atrophy (GA).MethodsIn this multicentric longitudinal study involving three retina referral centres, patients previously affected by GA who developed an active MNV were included. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography and dye angiographies. Patients were treated with ProReNata antivascular endothelial growth factor (VEGF) injections and were revaluated after treatment.ResultsAmong 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm2) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 to 10.13, 95% CIs) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3 and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material with or without evidence of subretinal/intraretinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV.ConclusionsMNVs in GA showed different features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (ie, GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.

PURPOSE: To quantitatively analyze choriocapillaris alterations using swept-source optical coherence tomography angiography in eyes presenting with Type 3 macular neovascularization (MNV) and to compare these alterations with eyes presenting with intermediate AMD (iAMD). METHODS: Macular 3 × 3-mm swept-source optical coherence tomography angiography scans were retrospectively analyzed in eyes with Type 3 MNV and in eyes with iAMD. The choriocapillaris en face slabs were extracted from the swept-source optical coherence tomography angiography device after manual segmentation. En face choriocapillaris flow images were compensated with en face choriocapillaris structure images, followed by the Phansalkar local thresholding method using a window radius of 4 and 8 pixels. The percentage of flow deficits (FD%), the number, size, and total area of FDs were computed for comparison. A secondary analysis was performed in the four corners of the image to include equidistant regions in all eyes. RESULTS: Twenty-six Type 3 MNV eyes of 21 patients and 26 iAMD eyes of 17 patients were included. Compared with iAMD eyes, eyes with Type 3 MNV displayed a higher FD% (41.37% ± 14.74 vs. 19.80% ± 9.63 using radius 4 pixels [P < 0.001]; 45.24% ± 11.9 vs. 26.63% ± 8.96 using radius 8 pixels [P < 0.001]). The average size of FDs was significantly larger in Type 3 MNV eyes compared with iAMD eyes (P < 0.001), whereas the number of FDs was significantly lower in Type 3 MNV compared with iAMD eyes (P < 0.001). CONCLUSION: Type 3 MNV eyes present with increased choriocapillaris flow impairment compared with iAMD eyes. Reduced choriocapillaris perfusion may contribute to Type 3 MNV development and pathogenesis.

To provide a review of the salient histological and imaging features in neovascular age-related macular degeneration (AMD) that will be integrated in order to have a better comprehension of the pathogenesis and clinical aspects of this disease.A literature review of histology and imaging features in neovascular AMD was conducted.Histology has granted a detailed characterization of neovascular AMD ex vivo. In details, histological features in these eyes have offered important insights into the pathogenesis of neovascular AMD. In addition, histology donated a detailed characterization of the different types of macular neovascularization (MNV) that may complicate AMD. The introduction of optical coherence tomography angiography (OCTA) has enormously amplified our knowledge of neovascular AMD through in vivo assessment of the anatomical and pathological characteristics of this disease. New insights elucidating the morphological features of the choriocapillaris confirmed that this vascular structure plays a crucial role in the pathogenesis of neovascular AMD. OCTA also offered a detailed visualization of MNV complicating neovascular AMD.New imaging technologies offer a remarkable chance to build a bridge between histology and clinical findings in neovascular AMD.

The purpose of this study was to compare the performances of infrared (IR), fundus autofluorescence (FAF), and multicolor (MC) imaging in the characterization of geographic atrophy, with a focus on the possibility to detect incomplete retinal pigmented and outer retinal atrophy (iRORA) on en face imaging.The ground truth was established by two graders evaluating atrophy on spectral-domain optical coherence tomography (SD-OCT) images. A score for visibility of foveal sparing and margins of atrophy was attributed. Measurement of the atrophic area and the fovea-to-margin distance were performed. Accuracy of detection of foveal sparing was evaluated through comparison with B-scan images ground truth, with/without the inclusion of patients with foveal iRORA.Seventy patients were included in this study. Foveal sparing and atrophy's margins subjective visibility were significantly higher rated on MC images compared to IR and FAF (P0.005 and P0.001). Agreement with OCT B-scan assessed foveal sparing revealed a significantly higher area under receiver operating characteristic curves (AUROC) for MC images at the analysis performed both with (0.876) and without (0.853) inclusion of patients with foveal iRORA (P0.001 and P = 0.006). Quantitative measurements revealed lower atrophy extension (P = 0.026) and fovea-to-margin distance (P = 0.019) with MC imaging.MC imaging performed better at foveal sparing assessment, especially in the setting of foveal iRORA. MC also resulted in higher visibility of atrophy's margins, lower atrophy extension measurements, and lower distance from the fovea to atrophy's margins compared to both FAF and IR.MC rated significantly higher in foveal sparing and atrophy detection, higher visibility of atrophy's margins, lower atrophy extension measurements, and lower distance from the fovea to atrophy's margins, compared to FAF and IR.

Background and Objectives: The aim of this study was to report the characteristics of macular neovascularization (MNV) with undetectable flow on optical coherence tomography angiography (OCTA) in neovascular age related macular degeneration (nAMD), and compare them with the characteristics of detectable MNV. Materials and Methods: Patients with a diagnosis of nAMD who underwent dye imaging and OCTA in the same day were included and divided into two groups: undetectable and detectable flow on OCTA. Three OCTA devices were used, two with spectral-domain technology (AngioVue, RTVue 100xAvanti, Optovue, Freemont, CA, USA and Heidelberg OCT2 Beta Angiography Module, Heidelberg Engineering, Germany) and one swept-source OCTA (PlexElite 9000; Carl Zeiss Meditec, Inc., Dublin, CA, USA). We studied the demographics, neovascularization characteristics, and OCTA device and acquisition characteristics for both groups. Results: A global comparison between Group 1 and Group 2 was made, followed by an analysis of variables associated with (un)detectability for each OCTA device. A total of 108 eyes were included: 90 in the detectable group (Group 1) and 18 in the undetectable group (Group 2), corresponding to a global sensitivity of OCTA for the detection of MNV of 83.49%. There was a statistically significant difference between the two groups regarding MNV type (p = 0.02) and PED height (p = 0.017). For the three devices, detection sensitivity with automatic segmentation was significantly lower than with manual segmentation. For Heidelberg, PED Height and scan quality explained 68.3% of the undetectability. For AngioVue, PED Height and absence of hemorrhage explained 67.9% of undetectability. Conclusions: In this study, we found a global sensitivity of 83.49% for the three OCTA devices combined, with a range from 55.5% to 96.26% depending on the segmentation and OCTA device. This means that undetectable/undetected MNV can represent up to 45% of the examinations, eventually misdiagnosing choroidal neovascularization for 1 out every 2 patients.

PURPOSE To report the prevalence and treatment outcomes of eyes with sub-retinal pigment epithelium (sub-RPE) multilaminar hyperreflectivity at the onset/clinical detection of Type 3 macular neovascularization (MNV) secondary to exudative age-related macular degeneration. METHODS Retrospective analysis of consecutive patients diagnosed with Type 3 MNV secondary to age-related macular degeneration was performed. Eyes presenting with sub-RPE multilaminar hyperreflectivity on structural optical coherence tomography at the onset of Type 3 MNV were included in this study. An age-, sex-, and stage-matched control group was composed of eyes affected by Type 3 MNV without sub-RPE multilaminar hyperreflectivity. Prevalence and treatment outcomes after anti-vascular endothelial growth factor injections at 1-year follow-up were analyzed in both groups. RESULTS Nineteen treatment-naive eyes of 19 patients (8 men/11 women, mean age 83 ± 8 years old) presenting with sub-RPE multilaminar hyperreflectivity before or at the onset/clinical detection of Type 3 MNV were included from a cohort of 162 eyes with treatment-naive Type 3 MNV. This accounts for an estimated prevalence of 11.7% (5.8-15.2, 95% confidence intervals). No significant differences were disclosed between cases studied and the control group (143 eyes of 143 patients) in age, sex, best-corrected visual acuity at baseline, and number of injections. Best-corrected visual acuity did not improve during the 1-year follow-up in patients showing sub-RPE multilaminar hyperreflectivity (P = 0.45), whereas best-corrected visual acuity significantly increased in the control group (P < 0.001). The presence of sub-RPE multilaminar hyperreflectivity in the context of Type 3 MNV was significantly associated with regressive calcific drusen (P < 0.001) and multiple Type 3 lesions/eye (P < 0.001). CONCLUSION The detection of multilaminar hyperreflectivity at the onset/clinical detection of Type 3 MNV suggests that chronic exudation (i.e., the "onion-sign") in the sub-RPE space (i.e., focal sub-RPE neovascularization) may precede the onset/clinical detection of Type 3 MNV. Sub-retinal pigment epithelium multilaminar hyperreflectivity at the onset of Type 3 MNV may be an important predictor of poor visual outcome in these eyes.

PurposeTo investigate optical coherence tomography angiography (OCT-A) findings in recurrent type 3 macular neovascularisation (MNV).MethodsIn this retrospective cohort study, consecutive patients with type 3 MNV secondary to age-related macular degeneration underwent OCT-A at three different time points: baseline, after anti-vascular endothelial growth factor treatment with complete resolution of the exudative signs (ie, non-exudative stage) and at the recurrence of exudation (ie, recurrence stage). Demographics and clinical findings were analysed, including OCT-A features of type 3 MNV recurrence.ResultsTwelve eyes (12 patients, mean age 78±7 years) were included. Using OCT-A, at baseline all type 3 MNVs showed the presence of detectable flow downgrowing from the deep vascular complex (DVC) to the retinal pigment epithelium (RPE)/sub-RPE space. 6/12 eyes (50%) showed anomalous flow under the RPE, while the other 6 eyes showed flow reaching the RPE without anomalous flow in the sub-RPE space. At the non-exudative stage (after treatment), BCVA and CMT significantly improved (p=0.004 and p=0.036), and flow inside the retinal lesions reduced; interestingly the connection to the RPE/sub-RPE space regressed. At the time of recurrence, all type 3 MNVs showed the presence of intra/sub-retinal exudation with restoration of the flow deepening from the DVC to the RPE/sub-RPE space.ConclusionsDetectable flow deepening from the DVC to the RPE/sub-RPE space using OCT-A is mandatory to have a new exudation secondary to recurrent type 3 MNV. Early detection of type 3 MNV recurrence by OCT-A characterisation may prompt retreatment and potentially prevent progression to late stages of the disease.

BACKGROUND AND OBJECTIVE: To evaluate the anatomical and functional outcome of selective photocoagulation of capillary macroaneurysms (CMAs) by navigated focal laser. PATIENTS AND METHODS: Consecutive patients with solitary or secondary CMAs greater than 150 mm in diameter were included in this analysis. All patients were treated with navigated focal laser and received multimodal imaging. RESULTS: Seventeen eyes of 17 patients were retrospectively analyzed. Navigated laser photocoagulation of the CMAs successfully occluded 100% of the CMAs, inducing significative improvement in best-corrected visual acuity at 3 ( P = .002) and 6 months ( P = .001) and a decrease in central macular thickness (CMT) at 3 ( P = .0004) and 6 months ( P = .0004). CONCLUSIONS: Solitary or secondary CMAs arising from retinal capillaries are candidates for navigated laser treatment. Navigated focal treatment was able to close all CMAs in this series with an improvement in vision and CMT. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:366–373.]

Colorectal cancer (CRC) represents the third most diagnosed type of cancer worldwide with high mortality and an increased incidence rate. Bioactive dietary components such as curcumin and resveratrol have great therapeutic potential as they can modulate a plethora of signaling pathways related to colorectal carcinogenesis. Previous data have demonstrated that curcumin and resveratrol can induce apoptosis in different types of cancer cells. Considering the lack of data on the combinatorial effect of curcumin and resveratrol associated with the induction of apoptosis in colorectal pathology, the main objective of this study is to investigate the impact of single vs. combinatorial treatment of resveratrol and curcumin on their cytotoxic effects, as well as the modulation of several essential pro-apoptotic genes, on two colorectal cancer cell lines (DLD-1 and Caco-2) different in terms of chromosomal stability (MSI and MSS). The cytotoxic effects were evaluated by the MTT assay, the nature of the interaction between curcumin and resveratrol was assessed by the combination index method and the expression levels of key genes involved in the modulation of pro-apoptotic mechanisms were evaluated by RT-qPCR. Our data indicate that the combination treatment of curcumin and resveratrol is more effective in inhibiting the proliferation in a dose-dependent manner, with a synergistic effect for the DLD-1 cell line (CI < 1) and an additive effect for the Caco-2 cell line (CI ≥ 1). The IC50 values for the combination treatment were 71.8 μM (20.5 μM curcumin + 51.3 μM resveratrol) for the DLD-1 cell line and 66.21 μM (18.9 μM curcumin + 47.3 μM resveratrol) for the Caco-2 cell line, respectively. Our data pointed out, for the first time, that several genes involved in the modulation of apoptosis, including PMAIP1, BID, ZMAT3, CASP3, CASP7, and FAS, represent new targets of both singular and combinatorial treatments with resveratrol and curcumin, and also the combinatorial approach of curcumin and resveratrol exhibits a more powerful gene regulating effect compared to single treatment. Considering the beneficial aspects of the combinatorial approach with curcumin and resveratrol on colorectal cancer cells further studies should address the possible pharmacological benefits of using a combination of both dietary agents with different chemotherapeutic drug approaches.

Background and Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.

Purpose To automatically classify retinal atrophy according to its etiology, using fundus autofluorescence (FAF) images, using a deep learning model. Methods In this study, FAF images of patients with advanced dry age-related macular degeneration (AMD), also called geographic atrophy (GA), and genetically confirmed inherited retinal diseases (IRDs) in late atrophic stages [Stargardt disease (STGD1) and Pseudo-Stargardt Pattern Dystrophy (PSPD)] were included. The FAF images were used to train a multi-layer deep convolutional neural network (CNN) to differentiate on FAF between atrophy in the context of AMD (GA) and atrophy secondary to IRDs. Three-hundred fourteen FAF images were included, of which 110 images were of GA eyes and 204 were eyes with genetically confirmed STGD1 or PSPD. In the first approach, the CNN was trained and validated with 251 FAF images. Established augmentation techniques were used and an Adam optimizer was used for training. For the subsequent testing, the built classifiers were then tested with 63 untrained FAF images. The visualization method was integrated gradient visualization. In the second approach, 10-fold cross-validation was used to determine the model's performance. Results In the first approach, the best performance of the model was obtained using 10 epochs, with an accuracy of 0.92 and an area under the curve for Receiver Operating Characteristic (AUC-ROC) of 0.981. Mean accuracy was 87.30 ± 2.96. In the second approach, a mean accuracy of 0.79 ± 0.06 was obtained. Conclusion This study describes the use of a deep learning-based algorithm to automatically classify atrophy on FAF imaging according to its etiology. Accurate differential diagnosis between GA and late-onset IRDs masquerading as GA on FAF can be performed with good accuracy and AUC-ROC values.

To investigate the evolution of treatment-naive type 3 macular neovascularization (MNV) undergoing anti-vascular endothelial growth factor (VEGF) treatment through volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA).Retrospective observational study.Patients with type 3 MNV and age-related macular degeneration (AMD).Included subjects had three loading injections of an anti-VEGF agent. The OCTA volume data at baseline and follow-up were processed with a previously published algorithm in order to obtain a volume-rendered representation of type 3 MNV. Progressive changes in type 3 lesions were analyzed via 3D OCTA volume rendering.A total of 14 treatment-naive eyes with type 3 MNV from 11 AMD patients (7 females) were included. At both baseline and follow-up visits, a type 3 MNV complex was identifiable. Each complex was composed of a mean number of 2.5 ± 0.7 vascular branches at baseline and 1.4 ± 0.6 at the follow-up visit (p0.0001). The mean changes in central macular thickness and visual acuity were significantly correlated with modifications in the number of type 3 MNV branches (ρ = -0.533, p = 0.049, and ρ = -0.581, and p = 0.040, respectively).This study demonstrated that type 3 lesions do not disappear completely after loading treatment, as indicated previously by histopathologic studies. Importantly, quantitative volume changes in type 3 lesions are directly associated with treatment response.

Introduction: To evaluate the effects of the Navilas system guided by optical coherence tomography angiography for advanced macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Methods: Prospective case-series including nine eyes presenting with advanced MNV with persistence of exudative signs, no longer responding to anti-VEGF therapy, best-corrected visual acuity at least of 1.3 logMar. All patients were treated with Navilas guided by overlaid optical coherence tomography angiography (OCTA) images at the site of branching large neovascular trunks. Results: Occlusion of large neovascular trunks successfully occurred in all nine included patients. OCTA analysis revealed, at 1 month follow up, MNV total area decreasing from 6.2 ± 3.1 to 2.6 ± 3.4 mm2. At 6 months follow up, mean MNV area was 3.3 ± 3.4 mm2 ( p = 0.008). Conclusion: This preliminary study showed that Navilas treatment guided by OCTA may represent an attractive therapeutic option in advanced neovascular lesions secondary to AMD.

Purpose To describe the characteristics and natural history of quiescent choroidal neovascularization (CNV) in geographic atrophy (GA) secondary to nonexudative age-related macular degeneration (AMD) through multimodal imaging. Design Retrospective observational case series. Methods Patients diagnosed with quiescent CNV were analyzed in 2 high-volume referral centers. Imaging features obtained using fluorescein angiography (FA), indocyanine green angiography (ICGA), structural optical coherence tomography (OCT), and OCT angiography (OCT-A) were noted at first presentation and during the study period. Results Nineteen eyes of 19 patients were included. Mean (+SD) follow-up was 45.7 ± 14.7 months. Quiescent CNV appeared as an ill-defined hyperfluorescent lesion without leakage or pooling of dye in the late phase of FA. On ICGA, quiescent CNV appeared as a distinct area of hyperfluorescence (vascular network) in early to intermediate frames and as a hyperfluorescent plaque in the late frame (late plaque). OCT-A revealed a flow signal beneath the small irregular elevation of the retinal pigment epithelium at the site of the quiescent CNV visualized by structural OCT. During the study period, 5 of the 19 CNV patients developed exudation. The remainder showed specific alterations in both structural OCT and OCT-A imaging. At last follow-up, 92% of the quiescent CNV seemed to cover the area spared from atrophy. Conclusions The characteristics of the quiescent CNVs were very similar to those already described for intermediate AMD, although they had several specific features in the context of GA.

BACKGROUND AND OBJECTIVE: To investigate the progression of retinal atrophy in patients with retinal pigment epithelium (RPE) tears secondary to neovascular age-related macular degeneration. PATIENTS AND METHODS: In this retrospective case series, patients were analyzed at two high-volume referral centers. The extension of the areas without RPE was analyzed yearly from baseline to last examination through fundus autofluorescence (FAF) imaging using Region Finder (Heidelberg Engineering, Heidelberg, Germany). RESULTS: Sixteen eyes of 14 patients were included in the study. Mean follow-up was 70.11 months ± 15.5 months. The average area of atrophy was 6.89 mm 2 ± 5.4 mm 2 at baseline and 9.21 mm 2 ± 7.7 mm 2 at the last visit ( P < .0001). This accounts for a progression of 0.36 mm 2 ± 0.46 mm 2 /year. In all cases, FAF revealed centrifugal extension of retinal atrophy. CONCLUSIONS: In this series, the area of retinal atrophy enlarged over time. Atrophy enlargement is characterized by centrifugal extension from the base of the tear. [ Ophthalmic Surg Lasers Imaging Retina . 2017;48:705–710.]

Background: To describe the “dimple,” a previously unreported structural optical coherence tomography (OCT) finding in vascularized serous pigment epithelial detachment (PED) secondary to neovascular age-related macular degeneration (AMD). Methods: Retrospective, longitudinal, case series study. Clinical charts and multimodal imaging including OCT (structural and angiography) and dye-based angiography (fluorescein and indocyanine green) examinations of patients with dimple—defined as a localized invagination of the vascularized serous PED—were analyzed in 2 high-volume referral centers. Results: Nineteen eyes of 18 patients were included. Mean follow-up was at 64.1 ± 35.8months. The greater basal and height diameters of the vascularized serous PED were respectively 3425.8 ± 1049.6μm and 667.1 ± 279.9μm at baseline and 3076.2 ± 1649.9μm (p = 0.8) and 368.3 ± 295.1 at last follow-up (p = 0.0006). OCT analysis identified 2 phenotypes of dimple: type 1 or (“top denting”) (9 eyes) and type 2 (or “side denting”) (10 eyes). Both phenotypes are associated with hyper-reflective holding sub-retinal pigment epithelium (RPE) band encompassing the posterior face of the RPE and extending to the Bruch’s membrane. Hyper-reflective holding band is not correlated with angiographic signs of neovascular tissue in all cases. During follow-up, no case of RPE tear was observed. Conclusions: We describe the characteristics of the dimple and its association with hyper-reflective holding sub-RPE bands in the context of large vascularized serous PED in neovascular AMD. The presence of a dimple does not seem to be an additional risk factor for the development of RPE tearing in high-risk PED secondary to neovascular AMD.

Purpose To analyze the frequency and phenotypic variation of AMD in subjects with high myopia (HM), and to describe the clinical course and response to treatment of neovascularization (NV). Methods Patients with HM were identified at five retina tertiary referral centers. Inclusion criteria were myopic patients aged 55 years or more with axial lengths equal or greater than 25.5 mm. Results A total of 874 eyes from 442 HM subjects older than 55 years were identified and 104 eyes of 54 patients (72 ± 11 years) were included in the study and followed up for 23.5 ± 19.5 months. The estimated AMD frequency in HM subjects over 55 years was 11.9% (95% confidence interval; 9.8%-14.0%). A total of 34 of 104 eyes were diagnosed with drusen, 22 with reticular pseudodrusen (RPD), 28 with both drusen and RPD, and 20 with geographic atrophy. Neovascularization was detected in 52 eyes (50%), and type 1 was the most frequent form (39 eyes, 75%). Overall, NV was treated with 4.6 ± 2.6 anti-VEGF injections. Eyes with treatment-naive NV at baseline (n = 34) required 3.8 ± 1.5 anti-VEGF injections during the first year of treatment. This exceeded the injection number in the purely myopic population (1.8 to 3.6 injections for the first year). Conclusions This study provides evidence to suggest that older patients with HM are at a significant risk of the dry and neovascular forms of AMD. NV in eyes with HM and AMD required more injections in the first year compared to NV in HM eyes without AMD.

To compare widefield optical coherence tomography angiography (OCTA) to ultra-widefield fluorescein angiography (UWFA) in the assessment of nonperfusion in retinal vein occlusion (RVO).A cross-sectional study of 43 eyes of 43 patients with RVO examined using both widefield OCTA (PLEX Elite, Carl Zeiss Meditec, Dublin, CA) with a panoramic montage of five 12 × 12-mm images and UWFA (Optos, 200°). Qualitative analysis was performed according to nonperfusion areas (cutoff: three disk areas) on widefield OCTA. The quantitative analysis assessed the vascular density on the widefield OCTA and ischemic index on UWFA.The ischemic index on UWFA and vascular density in the superficial and deep plexus correlated significantly (P = 0.019, r = 0.357 and P0.013, r = 0.375, respectively). The qualitative classification on widefield OCTA and ischemic index on UWFA correlated significantly (P0.001, r = 0.618). For the detection of marked nonperfusion (ischemic index ≥ 25%), widefield OCTA had a sensitivity of 100% and a specificity of 64.9%.The presence of nonperfusion on UWFA correlated with widefield OCTA. Optical coherence tomography angiography could help to identify high-risk RVO patients who might benefit from a further evaluation using fluorescein angiography.

Purpose To evaluate the correspondence between macular atrophy (MA) progression and Type 1 macular neovascularization morphology during long-term anti-vascular endothelial growth factor treatment for exudative neovascular age-related macular degeneration. Methods Retrospective review of consecutive patients with complete retinal pigment epithelium and outer retina atrophy overlying or in the proximity of macular neovascularization. The assessment of MA was based on spectral domain optical coherence tomography, en-face near infra-red imaging and fundus autofluorescence. Macular neovascularization blood flow morphology was evaluated by swept-source optical coherence tomography-angiography. Qualitative features were categorized per ETDRS sector as: immature, mature; and hypermature pattern. An automatic analysis was designed in MATLAB coding language to compute MA per ETDRS. Measurements were compared between the baseline and the last follow-up visit. Results Twenty eyes from 20 patients were included; the mean age was 85.4 (8.3) years. The median follow-up was 1.85 (1.0-2.4) years and the median anti-vascular endothelial growth factor injection rate during follow-up was 4.0 (2.0-5.0) injections/year. During follow-up, sectors with persistence of an immature blood flow pattern had a lower MA growth rate than sectors with mature macular neovascularization flow patterns (P = 0.001). Conclusion The presence of an immature blood flow pattern on optical coherence tomography-angiography is associated with a lower progression rate of MA.

PURPOSE To evaluate vascular density (VD), fractal dimension, and skeletal density on optical coherence tomography angiography in eyes with idiopathic foveal hypoplasia (IFH). METHODS Patients presenting with IFH to Creteil University Eye Clinic between January 2015 and October 2018 and age-matched healthy controls were retrospectively evaluated. Vascular density, skeletal density, and fractal dimension analyses were computed on optical coherence tomography angiography superficial capillary plexa (SCP) and deep capillary plexa (DCP) images on the whole image using a custom algorithm. Vascular density on the central 1 mm and the peripheral 8 mm for the two groups was performed. RESULTS Thirty-six eyes of 21 patients (18 eyes with IFH and 18 control eyes) were included. A decrease of VD at the level of the SCP and DCP was found in eyes with IFH compared with healthy control eyes (P = 0.005 for VD at the level of the SCP and P = 0.003 for VD at the level of the DCP, respectively). On the central 1 mm, VD was decreased in healthy eyes (32.3% ± 4.8) at the level of the SCP compared to IFH eyes (55.6% ± 46.3) (P < 0.001). Skeletal density was decreased in IFH eyes in both SCP and DCP (P =< 0.001). Fractal dimension was lower in IFH eyes in both SCP and DCP (P < 0.001). CONCLUSION Vascular density, skeletal density, and fractal dimension are reduced at the level of SCP and DCP in patients with IFH compared with controls, reflecting a particular anatomical and vascular organization. Quantitative analysis using optical coherence tomography angiography could help to evaluate the severity of IFH.

PURPOSE To compare the morphological characteristics of subretinal fibrosis in late age-related macular degeneration using multicolor (MC) imaging, color fundus photography (CFP), and ultra-widefield CFP (UWFCFP). METHODS Thirty-two eyes of 31 patients diagnosed with subretinal fibrosis complicating exudative age-related macular degeneration were included. Included eyes were imaged by MC, CFP, and UWFCFP. The overall ability to visualize fibrosis, its margins, and dissimilarity with surrounding atrophy was graded using a score (0: not visible, 1: barely visible, 2: mostly visible, and 3: fully visible) by two readers. Area of fibrosis was calculated. Scaling, lesion colocalization on all three imaging techniques, and area measurements were performed using ImageJ. RESULTS Ninety-six images of 32 eyes were graded. The average area of fibrosis was 14.59 ± 8.94 mm for MC, 13.84 ± 8.56 mm for CFP, and 13.76 ± 8.79 mm for UWFCFP. Fibrosis was fully visible in 87.5% of cases using MC and 50% using CFP and UWFCFP. Fibrosis' margins were sharply defined in 40.6% of eyes with MC, 15.6% and 9.4% with CFP and UWFCFP, respectively. Multicolor imaging provided superior distinction between fibrosis and atrophy (100% for MC vs. 13.4% for CFP and 33.3% for UWFCFP). The inter- and intra-reader agreement was high for all measurements (P < 0.0001). CONCLUSION Multicolor technology allows for improved visualization and analysis of subretinal fibrosis when compared with CFP and UWFCFP, especially when surrounding atrophy is present.

ObjectiveTo assess the ability of a deep learning model to distinguish between diabetic retinopathy (DR), sickle cell retinopathy (SCR), retinal vein occlusions (RVOs) and healthy eyes using ultra-widefield colour fundus photography (UWF-CFP).Methods and AnalysisIn this retrospective study, UWF-CFP images of patients with retinal vascular disease (DR, RVO, and SCR) and healthy controls were included. The images were used to train a multilayer deep convolutional neural network to differentiate on UWF-CFP between different vascular diseases and healthy controls. A total of 224 UWF-CFP images were included, of which 169 images were of retinal vascular diseases and 55 were healthy controls. A cross-validation technique was used to ensure that every image from the dataset was tested once. Established augmentation techniques were applied to enhance performances, along with an Adam optimiser for training. The visualisation method was integrated gradient visualisation.ResultsThe best performance of the model was obtained using 10 epochs, with an overall accuracy of 88.4%. For DR, the area under the receiver operating characteristics (ROC) curve (AUC) was 90.5% and the accuracy was 85.2%. For RVO, the AUC was 91.2% and the accuracy 88.4%. For SCR, the AUC was 96.7% and the accuracy 93.8%. For healthy controls, the ROC was 88.5% with an accuracy that reached 86.2%.ConclusionDeep learning algorithms can classify several retinal vascular diseases on UWF-CPF with good accuracy. This technology may be a useful tool for telemedicine and areas with a shortage of ophthalmic care.

In this study, a dietary exposure assessment of mycotoxins was conducted for the Romanian population using the contamination data of a various categories of wheat-based products for direct human consumption. Wheat-based foods (n = 181) commercialized in Romania, including flour, bread, biscuits, breakfast cereals and pasta, were evaluated by GC-QqQ-MS/MS for the occurrence of deoxynivalenol (DON), 3-acetyldeoxynivalenol (3AcDON), 15-acetyldeoxynivalenol (15AcDON), fusarenon-X, nivalenol, HT-2 and T-2 toxins, diacetoxyscirpenol, neosolaniol and zearalenone (ZEA). DON and 15AcDON were detected in 63 and 5% of all the analyzed samples, whereas 13-AcDON, HT-2, T-2, NIV and ZEA were not detected. Exposure of Romanian adult population was assessed, the EDIs for the sum of DON+3AcDON+15AcDON were 669 ng kg−1 bw day−1 at low-bound estimation, and 690 ng kg−1 bw day−1 at upper-bound estimation, being lower than the TDI set (1000 ng kg−1 bw day−1).

PURPOSE: To characterize the features of choroidal neovascularization (CNV) secondary to angioid streaks (AS) with optical coherence tomography angiography (OCT-A) and to assess its sensitivity in CNV detection in this particular context. METHODS: Consecutive patients, both with treatment-naïve and recurrent CNV associated with angioid streaks were prospectively analyzed. All patients underwent macular imaging by fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain (SD)-OCT, and OCT-A (AngioVue, Optovue, Optovue Inc., Freemont, CA, USA). OCT-A detection rate of CNV associated to AS was evaluated by two independent observers. We studied the association between OCT-A feature and either exudative or active status using Fisher exact test. RESULTS: A total of 32 eyes of 18 consecutive patients were included in the analysis. OCT-A was able to detect CNV associated with angioid streaks in 87.5 % (28/32) eyes. OCT-A phenotypes of CNV were classified into interlacing pattern in 9 eyes, pruned vascular tree pattern in 7 eyes, and combined pattern in 12 eyes (Interuser agreement: 0.871 ± 0.071). CNV were not detectable in 4/32 eyes. There was a statistically significant association between the presence in OCT-A of densely ramified networks with both previous treatment status in the last 6 months (p

A review of the literature from 2014 to 2016 was conducted, focusing on the results of optical coherence tomography angiography in different chorioretinal diseases. In only 3 years, optical coherence tomography angiography has been shown to be an effective tool for diagnosing choroidal neovascularization complicating age-related macular degeneration, pathologic myopia, and inflammatory conditions. The technique has sometimes been considered superior to conventional multimodal imaging, for example, in choroidal neovascularization associated with chronic central serous chorioretinopathy or multifocal choroiditis. In retinal vascular diseases, optical coherence tomography angiography has helped to understand the condition described as paracentral acute middle maculopathy and has been considered highly effective for the analysis of retinal vascular macular changes secondary to retinal vein occlusion or macular telangiectasia. Changes in the foveal avascular zone, also reported in diabetic maculopathy, have been shown to occur before any angiographic signs. A reduction in capillary vascular density has been reported in the fovea of eyes with malignant melanoma, but not in eyes with choroidal nevus. However, optical coherence tomography angiography is a recent technique that probably needs refinements and further studies. Nevertheless, the first 3 years of optical coherence tomography angiography use suggest its clinical relevance and useful applications in daily clinical practice.

In terms of breastfeeding (BF) practices in Romania, there is a lack of up-to-date data. The aim of the present study was to assess current BF practices, and to investigate the factors associated with exclusive BF (EBF) under 6 months of age in northwestern Romania. A structured questionnaire was used to collect data among 1399 mothers of children aged 0–23 months, recruited between March and June 2019, from the community. BF practices were evaluated based on the World Health Organization indicators for assessing infant and young child feeding practices, whereas determinants of EBF were explored using logistic regression models. Almost all mothers (95.7%) breastfed their child at least once. The EBF rate was 46.7%, the continued BF rate at one year of age was 54.2%, and the continued BF rate at 2 years of age was 30.3%. The place of delivery and parental leave duration were strong determinants of EBF. The improving rates observed in this study for all the BF practices assessed suggest the continuation of efforts to develop effective national policies and programs for promoting, protecting, and supporting BF in Romania. Particular emphasis should be given to the creation in maternity hospitals of an environment that is supportive towards breastfeeding.

Purpose To describe structural features of eyes with adult-onset foveomacular vitelliform dystrophy (AFVD) on optical coherence tomography angiography (OCT-A) and to evaluate the ability to detect the presence of choroidal neovascularisation (CNV). Methods Consecutive patients presenting at the University Eye Clinic of Creteil with diagnosis of AFVD were included. All patients underwent a complete ophthalmological examination, including fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography and OCT-A by Optovue RTVue XR Avanti. Results Twenty-two eyes of 18 consecutive patients (8 women and 10 men; 68±12.8 years) were included. On OCT-A the presence of subretinal material leads to displacement of blood vessels at both the superficial and deep capillary plexuses of the retina. In one case, these vascular abnormalities were associated with long filamentous vessels running thorough the foveal avascular area. In all cases, a rarefaction of the choriocapillaris was also observed. In two eyes OCT-A distinctly disclosed the presence of a CNV secondary to AFVD while conventional imaging did not show clearly the neovascularisation due to masking effect of the subretinal vitelliform material. Conclusions In patients with AFVD, OCT-A showed vascular network rarefaction with less blood vessels at the superficial and deep capillary plexuses, and the choriocapillaris layer. These vascular abnormalities may play a role in the pathogenesis or simply represent a consequence of material accumulation and reabsorption in AFVD. In two cases, the conventional imaging did not show clearly the neovascularisation due to masking effect of the subretinal vitelliform material, while OCT-A showed distinctly the CNV.

Purpose To analyse the morphological characteristics of polypoidal choroidal vasculopathy (PCV) on optical coherence tomography angiography (OCT-A). Methods Prospective study with consecutive patients affected with PCV were included. All patients underwent a complete ophthalmological examination including fundus photography, fluorescein angiography, indocyanine green angiography, spectral-domain OCT and OCT-A. Results Twelve eyes of 12 patients (mean age 72.6±10.5 years; 4 men and 8 women) were included for analysis. In all eyes (12/12) the segmentation of the choriocapillaris layer on OCT-A revealed the branching vascular network (BVN) as a hyperflow lesion. OCT-A segmentation of the choriocapillaris layer in correspondence of the polypoidal lesion showed in 3/12 eyes (25%) a hyperflow round structure, surrounded by a hypointense halo, and in 9/12 eyes (75%) a hypoflow round structure. Conclusions The OCT-A is a non-invasive imaging modality allowing the visualisation of different structures in PCV. The BVN is constantly clearly detected. The hypoflow round structure appearance of the polyp in OCT-A, is probably due to an unusual blood flow inside the polypoidal lesions, contrasting with the BVN. Further improvement in OCT-A knowledge will provide information on the specificity of the different intensity characteristics in PCV.