Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography

·AIM:To evaluate optic nerve head(ONH)vessel density(VD)changes after cataract surgery using optical coherence tomography angiography(OCTA).·METHODS:This was a prospective observational study.Thirty-four eyes with mild/moderate cataracts were included.ONH scans were obtained before and 3mo after cataract surgery using OCTA.Radial peripapillary capillary(RPC)density,all VD,large VD and retinal nerve fiber layer thickness(RNFLT)in total disc,inside disc,and different peripapillary sectors were assessed and analyzed.Image quality score(QS),fundus photography grading and bestcorrected visual acuity(BCVA)were also collected,and correlation analyses were performed between VD change and these parameters.·RESULTS:Compared with baseline,both RPC and all VD increased in inside disc area 3mo postoperatively(from 47.5%±5.3%to 50.2%±3.7%,and from 57.87%±4.30%to 60.47%±3.10%,all P<0.001),but no differences were observed in peripapillary area.However,large VD increased from 5.63%±0.77%to 6.47%±0.72%in peripapillary ONH region(P<0.001).RPC decreased in inferior and superior peripapillary ONH parts(P=0.019,<0.001 respectively).There were obvious negative correlations between RPC change and large VD change in inside disc,superior-hemi,and inferior-hemi(r=-0.419,-0.370,and-0.439,P=0.017,0.044,and 0.015,respectively).No correlations were found between VD change and other parameters including QS change,fundus photography grading,postoperative BCVA,and postoperative peripapillary RNFLT.·CONCLUSION:RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract.No obvious VD changes are found in peripapillary area postoperatively.

Repeatability,interocular correlation and agreement of optic nerve head vessel density in healthy eyes:a sweptsource optical coherence tomographic angiography study

AIM:To assess the repeatability,interocular correlation,and agreement of quantitative swept-source optical coherence tomography angiography(OCTA)optic nerve head(ONH)parameters in healthy subjects.METHODS:Thir ty-three healthy subjects were enrolled.The ONH of both eyes were imaged four times by a swept-source-OCTA using a 3 mm×3 mm scanning protocol.Images of the radial peripapillary capillary were analyzed by a customized Matlab program,and the vessel density,fractal dimension,and vessel diameter index were measured.The repeatability of the four scans was determined by the intraclass correlation coefficient(ICC).The most well-centered optic disc from the four repeated scans was then selected for the interocular correlation and agreement analysis using the Pearson correlation coefficient,ICC and Bland-Altman plots.RESULTS:All swept-source-OCTA ONH parameters exhibited certain repeatability,with ICC>0.760 and coefficient of variation(CoV)≤7.301%.The obvious interocular correlation was observed for papillary vessel density(ICC=0.857),vessel diameter index(ICC=0.857)and fractal dimension(ICC=0.906),while circumpapillary vessel density exhibited moderate interocular correlation(ICC=0.687).Bland-Altman plots revealed an agreement range of-5.26%to 6.21%for circumpapillary vessel density.CONCLUSION:OCTA ONH parameters demonstrate good repeatability in healthy subjects.The interocular correlations of papillary vessel density,fractal dimension and vessel diameter index are high,but the correlation for circumpapillary vessel density is moderate.

Quantifying peripapillary vessel density and retinal nerve fibre layer in type 1 diabetic children without clinically detectable retinopathy using OCTA

AIM:To quantify changes in radial peripapillary capillary vessel density(ppVD)and the peripapillary retinal nerve fiber layer(pRNFL)in children with type 1 diabetes without clinical diabetic retinopathy by optical coherence tomography angiography(OCTA),providing a basis for early retinopathy in children with type 1 diabetes.METHODS:This was a retrospective study.A total of 30 patients(3–14y)with type 1 diabetes without clinical diabetic retinopathy(NDR group)were included.A total of 30 age-matched healthy subjects were included as the normal control group(CON group).The HbA1c level in the last 3mo was measured once in the NDR group.The pRNFL thickness and ppVD were automatically measured,and the mean pRNFL and ppVD were calculated in the nasal,inferior,temporal,and superior quadrants.The changes in ppVD and pRNFL in the two groups were analyzed.RESULTS:Compared with CON group,the nasal and superior ppVDs decreased in the NDR group(all P<0.01).The thickness of the nasal pRNFL decreased significantly(P<0.01),while the inferior,temporal and superior pRNFLs slightly decreased but not significant in the NDR group(all P>0.05).Person and Spearman correlation analysis of ppVD and pRNFL thickness in each quadrant of the NDR group showed a positive correlation between nasal and superior(all P<0.01),while inferior and temporal had no significant correlation(all P>0.05).There was no significant correlation between the HbA1c level and ppVD and pRNFL in any quadrant(all P>0.05).There was no significant correlation between the course of diabetes mellitus and ppVD and pRNFL in any quadrant(all P>0.05).CONCLUSION:ppVD and pRNFL decrease in eyes of children with type 1 diabetes before clinically detectable retinopathy and OCTA is helpful for early monitoring.

Peripapillary vessel density and retinal nerve fiber layer thickness changes in early diabetes retinopathy

·AIM:To perform a quantitative analysis of the peripapillary vessel density(VD)and retinal nerve fiber layer(RNFL)thickness changes in patients with early stage of diabetic retinopathy(DR).·METHODS:In this case-control study,swept-source optical coherence tomography angiography(SS-OCTA)imaging was used to examine diabetic and age-matched healthy subjects.The optic disc HD 6×6 mm^(2) blood flow imaging scan mode was selected.Automatic software was used to measure the peripapillary VD,capillary vessel density(CVD),and RNLF in an optic nerve head(ONH)filed based on the Garway-Heath map.In addition,the correlation between peripapillary VD,CVD,and RNFL was further investigated.·RESULTS:The cohort consisted of 32 healthy individuals and 72 patients with diabetes(34 eyes with no DR and 38 eyes with mild-moderate NPDR).Peripapillary VD decreased in the mild-moderate NPDR group compared to the control group in most regions(P<0.05).Peripapillary CVD and RNFL thickness were significantly lower in the mild-moderate NPDR group in the superior temporal(ST)quadrants(P=0.018.P=0.030).In the correlation analysis of each region,the RNFL thickness in the NS region was positively correlated with the peripapillary VD and CVD(r=0.233,P=0.05;r=0.288.P=0.015).In the TI region,the RNFL thickness was positively correlated with the peripapillary CVD(r=0.237,P=0.047).·CONCLUSION:The measurement based on the ONH topographic map may be helpful in detecting functional and structural impairments in DR.The peripapillary VD,CVD and RNFL decrease in early DR,and the RNFL thickness altered in association with the CVD or/and VD in some regions.

Structural measurements and vessel density of spectraldomain optic coherence tomography in early,moderate,and severe primary angle-closure glaucoma

AIM:To compare the macular ganglion cell-inner plexiform layer(GCIPL)thickness,retinal nerve fiber layer(RNFL)thickness,optic nerve head(ONH)parameters,and retinal vessel density(VD)measured by spectral-domain optical coherence tomography(SD-OCT)and analyze the correlations between them in the early,moderate,severe primary angle-closure glaucoma(PACG)and normal eyes.METHODS:Totally 70 PACG eyes and 20 normal eyes were recruited for this retrospective analysis.PACG eyes were further separated into early,moderate,or severe PACG eyes using the Enhanced Glaucoma Staging System(GSS2).The GCIPL thickness,RNFL thickness,ONH parameters,and retinal VD were measured by SD-OCT,differences among the groups and correlations within the same group were calculated.RESULTS:The inferior and superotemporal sectors of the GCIPL thickness,rim area of ONH,average and inferior sector of the retinal VD were significantly reduced(all P<0.05)in the early PACG eyes compared to the normal and the optic disc area,cup to disc ratio(C/D),and cup volume were significantly higher(all P<0.05);but the RNFL was not significant changes in early and moderate PACG.In severe group,the GCIPL and RNFL thickness were obvious thinning with retinal VD were decreasing as well as C/D and cup volume increasing than other three groups(all P<0.01).In the early PACG subgroup,there were significant positive correlations between retinal VD and GCIPL thickness(except superonasal and inferonasal sectors,r=0.573 to 0.641,all P<0.05),superior sectors of RNFL thickness(r=0.055,P=0.049).More obvious significant positive correlations were existed in moderate PACG eyes between retinal VD and superior sectors of RNFL thickness(r=0.650,P=0.022),and temporal sectors of RNFL thickness(r=0.740,P=0.006).In the severe PACG eyes,neither GCIPL nor RNFL thickness was associated with retinal VD.CONCLUSION:The ONH damage and retinal VD loss appears earlier than RNFL thickness loss in PACG eyes.As the PACG disease progressed from the early to the moderate stage,the correlations between the retinal VD and RNFL thickness increases.

Evaluation of macular vessel density changes after vitrectomy with silicone oil tamponade in patients with rhegmatogenous retinal detachment

AIM:To evaluate macular microvasculature changes in eyes after pars plana vitrectomy(PPV)and intraocular silicone oil(SO)tamponade for macula-off rhegmatogenous retinal detachment(RRD)using optical coherence tomography angiography(OCTA).METHODS:Totally 19 eyes(19 patients)with maculaoff RRD who underwent PPV and intraocular SO tamponade were retrospectively reviewed.The parafoveal superficial capillary plexus(SCP)vessel density(VD),deep capillary plexus(DCP)VD,choriocapillaris plexus(CCP)VD,and foveal macular thickness were evaluated using OCTA throughout 16 wk postoperatively.The values of healthy fellow eyes were used as control.RESULTS:The parafoveal SCP,DCP,and CCP VDs were significant increased over time in RRD eyes during the 12 wk postoperatively,then decreased at 16 wk postoperatively(all P<0.01).The ratios of RRD eyes and fellow healthy eyes(r/f ratios)of the SCP and DCP VDs were lower than those of the CCP VD postoperatively(all P<0.05).There were not significant differences in the r/f ratios between SCP and DCP VDs postoperatively(all P>0.05).CONCLUSION:The parafoveal SCP,DCP,and CCP VDs gradually recover over time after PPV surgery with SO tamponade.Long-time SO tamponade might decrease postoperative macular VDs.Compared to parafoveal CCP VD,the parafoveal SCP and DCP VDs were more vulnerable in RRD eyes postoperatively.

Changes of peripapillary vascular density and its correlation with nerve fiber layer thickness in patients with unilateral retinal vein occlusion

Objective:To observe the changes of peripapillary vascular density(VD)and its correlation with retinal nerve fiber layer(RNFL)thickness in patients with unilateral retinal vein occlusion(RVO)by optical coherence tomography angiography(OCTA).Methods:Prospective case-control study.Thirty-two patients(32 eyes)with RVO diagnosed at the Eye Hospital of China Academy of Chinese Medical Sciences from September 2020 to June 2021 were selected.Another 32 outpatients(32 eyes)with normal ocular examination were selected as the normal control group.Optic disc blood flow imaging was performed in all subjects using the OCTA to measure peripapillary RNFL thickness,peripapillary vessel density,optic disc area,and disc rim area.The correlation between peripapillary vascular density and RNFL,optic disc area and disc rim area in eyes with unilateral RVO was analyzed.Results:Compared with the normal control group,the prevalence of hypertension was higher in the unilateral RVO group,and the difference was statistically significant(P<0.05).Compared with the normal control group,the overall,inferior and temporal RNFL thickness around the optic disc was thinner in patients with unilateral RVO,and the difference was statistically significant(P<005).Compared with the normal control group,the overall VD,internal ring,external ring and inferior VD around the optic disc were slightly decreased in patients with unilateral RVO,and the differences were statistically significant(P<0.05).The results of Pearson correlation analysis indicated that RNFL thickness was positively correlated with peripapillary global VD(r=0.648,P<0.001),RNFL thickness was positively correlated with intrapapillary ring VD(r=0.427,P=0.015),and RNFL thickness was positively correlated with peripapillary VD(r=0.666,P<0.001).Conclusion:The results showed that the RNFL thickness around the optic disc was thinner in patients with unilateral RVO,especially in the inferior and temporal area,and the full area VD around the optic disc was decreased,especially in the internal ring,external ring and inferior area.In patients with unilateral RVO,peripapillary RNFL was positively correlated with peripapillary global,internal ring and external ring VD.

Correlation between macular blood flow density and stage of diabetic retinopathy

Objective:To investigate the association between the development of diabetic retinopathy and OCTA blood flow density.Methods:A total of 63 patients(100 eyes)diagnosed with type 2 diabetes in Eye Hospital of China Academy of Chinese Medical Sciences from September 2020 to July 2021 were selected,including 44 patients(72 eyes)with diabetic retinopathy and 19 patients(28 eyes)with type 2 diabetes without retinopathy(NDR).All patients underwent OCTA examination,and FAZ,PERIM,AI,FD,SVD,DVD and other indicators were counted.Results:(1)SVD,parafoveal SVD,DVD and parafoveal DVD gradually decreased with the progression of DR(P=0.000).There was no significant difference in SVD and DVD fovea(P>0.05).(2)The correlation coefficients between SVD,SVD,DVD,DVD and DR process were-0.525,-0.586,-0.323,-0.424,respectively(P<0.05),and all showed moderate negative correlation.(3)AI and FD gradually decreased with the progression of DR,and the differences were statistically significant(P=0.011,P=0.000),while FAZ and PERIM showed no significant difference with the progression of DR(P>0.05).(4)The correlation coefficients of FAZ,PERIM and DR progression were:-0.031,0.084(P>0.05),no correlation,AI,FD and DR process correlation coefficient were 0.307,-0.459(P<0.05),respectively,were moderately positive and negative correlation;(5)The correlation coefficients of FAZ,PERIM,AI,FD and age were-0.124,-0.052,0.113,-0.170(P>0.05),respectively.Conclusion:There is a moderate correlation between the progression of DR and the superficial and deep blood flow density of OCTA.It was moderately correlated with AI and FD.OCTA can assist in the assessment of DR disease progression.

OCTA characteristics in non-arteritic central retinal artery occlusion and correlation with visual acuity

AIM:To observe the retinal and choroidal circulations in patients with non-arteritic permanent central retinal artery occlusion(NA-CRAO)via optical coherence tomography angiography(OCTA)and analyze their correlation with visual acuity.METHODS:Sixty-two eyes with clinically confirmed acute NA-CRAO were included in the study and divided into:A type(mild n=29),B type(moderate n=27)and C type(severe n=6)based on the degree of visual loss,retinal edema,and arterial blood flow delay in fundus fluorescence angiography(FFA).Contralateral healthy eyes were used as the control group.Best-corrected visual acuity(BCVA),slit lamp microscopy,indirect ophthalmoscopy,fundus color photography,OCTA,and FFA were performed.Spearman’s correlation analysis was used to determine the correlations between retinal and choroidal vessels and visual acuity.RESULTS:There were no statistically significant differences in age,gender,and intraocular pressure among the three types and the control group(P>0.05).Vessel density in deep capillary plexus(VD-DCP)significantly decreased(P<0.05)in all three types of NA-CRAO patients compared to the control group.Vessel density in superficial vascular plexus(VD-SVP)significantly decreased(P<0.05)in type A patients and choriocapillaris flow area significantly decreased(P<0.05)in type B and type C patients compared to the control group;while outer retinal flow areas significantly increased in the type A(P<0.05)and decreased in type C patients(P<0.05).The retinal thickness significantly increased in type C group(P<0.05).The VD-SVP at fovea in the type A was significantly lower than both of type B and C.The VD-SVP at nasal parafovea in type A and B was significantly lower than type C(P<0.05).The logMAR BCVA of type A was significantly better than that of type B and C groups(P<0.05).Spearman’s correlation analysis showed that the logMAR BCVA was positively correlated with VD-SVP at fovea(r=0.679,P=0.031)and nasal parafovea(r=0.826,P=0.013).CONCLUSION:OCTA is valuable for assessing retinal ischemia,and evaluating visual impairment.Deep retinal vasculature is commonly affected in all NA-CRAO types.VDSVPs at fovea and nasal parafovea can serve as reliable markers of visual impairment in NA-CRAO.

Retinal microcirculation changes in prediabetic patients with shortterm increased blood glucose using optical coherence tomography angiography

BACKGROUND Retinal microcirculation alterations are early indicators of diabetic microvascular complications.Optical coherence tomography angiography(OCTA)is a noninvasive method to assess these changes.This study analyzes changes in retinal microcirculation in prediabetic patients during short-term increases in blood glucose using OCTA.AIM To investigate the changes in retinal microcirculation in prediabetic patients experiencing short-term increases in blood glucose levels using OCTA.METHODS Fifty volunteers were divided into three groups:Group 1[impaired fasting glucose(IFG)or impaired glucose tolerance(IGT)],Group 2(both IFG and IGT),and a control group.Retinal microcirculation parameters,including vessel density(VD),perfusion density(PD),and foveal avascular zone(FAZ)metrics,were measured using OCTA.Correlations between these parameters and blood glucose levels were analyzed in both the fasting and postprandial states.RESULTS One hour after glucose intake,the central VD(P=0.023),central PD(P=0.026),and parafoveal PD(P<0.001)were significantly greater in the control group than in the fasting group.In Group 1,parafoveal PD(P<0.001)and FAZ circularity(P=0.023)also increased one hour after glucose intake.However,no significant changes were observed in the retinal microcirculation parameters of Group 2 before or after glucose intake(P>0.05).Compared with the control group,Group 1 had a larger FAZ area(P=0.032)and perimeter(P=0.018),whereas Group 2 had no significant differences in retinal microcirculation parameters compared with the control group(P>0.05).Compared with Group 1,Group 2 had greater central VD(P=0.013)and PD(P=0.008)and a smaller FAZ area(P=0.012)and perimeter(P=0.010).One hour after glucose intake,Group 1 had a larger FAZ area(P=0.044)and perimeter(P=0.038)than did the control group,whereas Group 2 showed no significant differences in retinal microcirculation parameters compared with the control group(P>0.05).Group 2 had greater central VD(P=0.042)and PD(P=0.022)and a smaller FAZ area(P=0.015)and perimeter(P=0.016)than Group 1.At fasting,central PD was significantly positively correlated with blood glucose levels(P=0.044),whereas no significant correlations were found between blood glucose levels and OCTA parameters one hour after glucose intake.CONCLUSION A short-term increase in blood glucose has a more pronounced effect on retinal microcirculation in prediabetic patients with either IFG or IGT.

Detecting Pre and Early Retinal Changes in Patients with Type 2 Diabetes Mellitus Using Optical Coherence Tomography Angiography

Background: Studies conducted previously indicated that gradual vascular changes in diabetic retinopathy (DR) include reduction in retinal vascular density and choroidal thickness. One device that can be used to detect these early changes is optical coherence tomographic angiography (OCTA). Objective: To detect the pre and early diabetic retinal and choroidal microvascular changes in patients with type 2 diabetes mellitus using OCTA. Methods: A total of 188 eyes were included in the study that was conducted at Zhongnan Hospital of Wuhan University Ophthalmology Department. Participants were divided into three groups: controls (90 eyes), pre-DR (70 eyes) and early-DR (28 eyes). We evaluated the changes in vascular density of deep capillary plexus (DCP), intermediate capillary plexus (ICP), superficial vascular complex (SVP), choroidal thickness (CT) and choroidal vascular index (CVI). Results: Vessel density (VD) of deep capillary plexus (DCP) and intermediate capillary plexus (ICP) at 3 × 3 mm was not significant. However, superficial vascular plexus (SVP), was significant in superior quadrant, p = 0.033. In DCP layer at 6 × 6 mm, significant difference was noted superiorly, p = 0.023 and ANOVA p = 0.033. However, ICP layer showed significant changes temporaly and inferiorly in 1 - 3 mm and 1 - 6 mm retinal rings, p Conclusion: Our results reveal that although there were no clinical manifestations in the control group and the pre-DR group, changes in retinal and choroidal blood flow density had already occurred in the pre-DR group through OCTA detection, suggesting that early detection of the lesions provides an objective basis to prevent further retinal microvascular damage. Using OCTA parameters at 3 × 3 mm, 6 × 6 mm and 15 × 12 mm scan radius at different layers of the retina and choroid, we are able to detect early retinal microvascular and choroidal changes in patients with pre-DR and early-DR thereby saving the costs of dealing with advanced diabetic eye disease. OCTA therefore becomes a fundamental tool for the non-invasive diagnosis and prognosis of DR.

Immunohistochemical molecular markers as predictors of curability of endoscopically resected submucosal colorectal cancer

AIM: To clarify the usefulness of immunohistochemical molecular markers in predicting lymph node metastasis of submucosal colorectal cancer. METHODS: We examined microvessel density, lymphatic vessel density, the Ki-67 labeling index, expression of MUC1 and Matrix metalloproteinase-7 (MMP-7) in tumor cells, and expression of cathepsin D in stromal cells at the invasive front by immunostaining of samples resected from 214 patients with submucosal colorectal cancer. Pathologic features were assessed on hematoxylin-eosin- stained samples. We evaluated the relations between clinicopathologic/immunohistochemical features and lymph node metastasis. RESULTS: Lesions of the superficial type, with an unfavorable histologic grade, budding, lymphatic involvement, high microvessel density (≥ 40), high lymphatic vessel density (≥ 9), high Ki-67 labeling index (≥ 42), and positivity of MUC1, cathepsin D, and MMP-7 showed a significantly high incidence of lymph node metastasis. Multivariate analysis revealed that high microvessel density, unfavorable histologic grade, cathepsin D positivity, high lymphatic vessel density, superficial type, budding, and MUC1 positivity were independent risk factors for lymph node metastasis.A combined examination with four independent immunohistochemical markers (microvessel density, cathepsin D, lymphatic vessel density, and MUC1) revealed that all lesions that were negative for all markers or positive for only one marker were negative for lymph node metastasis. CONCLUSION: Analysis of a combination of immuno- histochemical molecular markers in endoscopically resected specimens of submucosal colorectal cancer allows prediction of curability regardless of the pathologic features visible of hematoxylin-eosin-stained sections.

Optical coherence tomography angiography of the peripapillary region and macula in normal,primary open angle glaucoma,pseudoexfoliation glaucoma and ocular hypertension eyes

AIM:To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma(POAG),pseudoexfoliation glaucoma(PXG),ocular hypertension(OHT)and normal eyes using optical coherence tomography angiography(OCTA).METHODS:A total of 114 POAG,PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included.The PXG,POAG,OHT,and control groups(aged 68.17±6.30 y,61.11±10.26 y,58.1±8.9 y,and 56.9±4.6 y,respectively)contained of 46,36,32,and 46 eyes,respectively.Measurements of vessel density(VD)in the peripapillary region and macula,average retinal inner thickness,and retinal nerve fiber layer thickness(RNFLT)were compared among groups.In order to test the accuracy of differentiation between eyes with and without glaucoma,the area was calculated under the receiver operating characteristic(ROC)curves.RESULTS:The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors(44.35%±6.78%vs 50.47%±1.83%,P<0.001),the superficial(44.08%±5.46%vs 51.28%±2.85%,P<0.001)and the deep(45.13%±8.55%vs 54.20%±5.44%,P<0.001)vascular plexus.There was a significant difference in peripapillary VD between glaucomatous and OHT eyes(44.35%±6.78%vs 49.86%±2.45%,P<0.001).The OHT group featured a lower superficial(48.06%±4.32%vs 51.28%±2.85%,P=0.027)and deep plexus(48.70%±5.99%vs 54.20%±5.44%,P=0.013)whole image vessel density(wiVD)than did the control group.The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG(42.22%±5.36%vs 46.54%±5.56%,P=0.046).CONCLUSION:OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT,and these results are correlated to functional and structural glaucomatous alterations.Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG.Furthermore,the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.

Analysis of macular microvasculature and thickness after ICL implantation in patients with myopia using optical coherence tomography

AIM:To investigate changes in macular vessels and thickness in myopic eyes after intraocular collamer lens(ICL)implantation using quantitative optical coherence tomography angiography(OCTA).METHODS:This retrospective included 73 myopic eyes of 73 patients(average age,27.53±6.16 y)who underwent ICL implantation(28 eyes were Toric ICL).Axial length(AL),uncorrected visual acuity(UCVA),refractive dioptre(RD),intraocular pressure(IOP)and OCTA were measured and compared with before and 1 wk,1,and 3 mo after surgery.OCTA was used to image vessel density(VD)and skeleton density(SD)in both the superficial(SCP)and deep capillary plexus(DCP).Central retinal thickness(CRT)and ganglion cellinner plexiform layer thickness(GCT)were also measured.Changes between pre-and postoperative measurements were analysed by repeated measures analysis of variance.RESULTS:Compared with preoperative data,postoperative data on UCVA revealed significant improvements in all patients(P<0.05).However,there was no significant difference in IOP.After the operation,CRT and GCT exhibited significant changes(P<0.05).Among these measures,CRT was significantly higher at one and three months postoperative(all P<0.01).GCT was significantly higher at 1 wk,1,and 3 mo postoperative(all P<0.01).Changes in VD and SD were nonsignificant in both the SCP and DCP.There was no difference in postoperative changes between the ICL and Toric ICL groups.CONCLUSION:ICL and Toric ICL implantation both have good efficacy and safety for myopic eyes,but macular area changes that occur after surgery need attention.

Relationship between the Expression of Vascular Endothelial Growth Factor C and Lymphangiogenesis in Human Pancreatic Cancer

Objective： To investigate the role the vascular endothelial growth factor C （VEGF-C） expression in lymphangiogenesis and lymph node metastasis in pancreatic cancer. Methods： The expression of VEGF-C in pancreatic cancer tissue of 42 cases and normal pancreatic tissue of 10 cases was detected by using immunohistochemical S-P method. The microlymphatic vessel density （MLVD） of both tissues was measured by enzyme-histochemical method at the same time. Results： The VEGF-C positive expression rate was significantly higher in pancreatic cancer tissue （64.3%） than in normal pancreatic tissue （20%, P〈0.05）. The MLVD was significantly higher in pancreatic cancer tissue （21.93±6.39） than that in normal pancreatic tissue （4.40±2.07, P〈0.001）. The VEGF-C positive expression rate, MLVD and lymph node metastasis had a positive correlation. Conclusion： The VEGF-C may play an important role in the lymphangiogenesis and lymph node metastasis of pancreatic cancer.

Identification of retinal thickness and blood flow in agerelated macular degeneration with reticular pseudodrusen

AIM:To investigate thickness characteristics and vascular plexuses in retinas with reticular pseudodrusen(RPD)as an early detection strategy for age-related macular degeneration(AMD).METHODS:This retrospective study included 24 subjects(33 eyes)with RPD and 25 heathy control subjects(34 eyes).The superficial capillary plexus(SCP)and the deep capillary plexus(DCP)of the retinal posterior poles were investigated with optical coherence tomography angiography(OCTA).Retinal thicknesses and vessel densities were analyzed statistically.RESULTS:The general retinal thicknesses of RPD eyes were significantly decreased(95%CI-14.080,-0.655;P=0.032).The vessel densities of DCP in RPD eyes were significantly increased in the global(95%CI 1.067,7.312;P=0.027),parafoveal(95%CI 0.417,5.241;P=0.022),and perifoveal(95%CI 0.181,6.842;P=0.039)quadrants.However,the vessel densities of the SCP were rarely increased in the eyes with RPD.CONCLUSION:The thinning of retinas in the RPD group suggests a reduction in the number of cells.Additionally,the increased vessel density of the DCP in retinas with RPD indicates a greater demand for blood supply,possibly due to the hypoxia induced RPD compensation caused by RPD in the outer retina.This study highlights the pathological risks associated with RPD and emphasizes the importance of early intervention to retard the progression of AMD.

Role of angiogenesis in oral squamous cell carcinoma development and metastasis: an immunohistochemical study

Although a few studies have shown that vascularity is increased from normal mucosa to dysplasia to carcinoma suggesting that disease progression in the oral mucosa is accompanied by angiogenesis. The role in lymph node metastasis in oral squamous cell carcinoma （OSCC） is equivocal. Role of angiogenesis in OSCC development and metastasis is evaluated in this study. This retrospective study of 50 samples consisted of 9 normal buccal mucosa, 22 leukoplakias, and 19 OSCC. Polyclonal antibodies to von-Willebrand factor were used to highlight the microvessels. Images were captured and morphometric image analysis was done for microvessel density （MVD）, area, and perimeter. Highest, as well as mean values of these three parameters were compared. MVD and perimeter, but not area, are significantly different between normal mucosa and OSCC, and leukoplakia and OSCC. There were no differences between normal mucosa and leukoplakia. MVD, area, and perimeter were not significantly different between the OSCC with and without lymph node metastasis. The highest and mean values of MVD are significantly correlated. In the development of OSCC, angiogenic phenotypic change occurs in carcinomas rather than in the pre-cancerous stage, and quantification of angiogenesis in OSCC does not predict the risk of lymph node metastasis.

A decrease in macular microvascular perfusion after retinal detachment repair with silicone oil

AIM:To observe whether silicone oil(SO)tamponade could decrease macular perfusion after retinal detachment repair.METHODS:A prospective observational case-control study.Patients diagnosed with primary macular off rhegmatogenous retinal detachment undergoing successful retinal repair surgery with vitrectomy were strictly selected.Optical coherence tomography angiography findings were compared between SO and air tamponade groups.Two postoperative visiting points were set(1 and 3 mo).RESULTS:Totally 29 patients(29 eyes)were enrolled.Twenty cases had SO tamponade while 9 cases were with air tamponade.At the first visiting point,superficial parafoveal vessel density(PFSVD)significantly decreased in the SO group(P=0.0403),especially in the superior quadrant or superior-hemi area(P=0.0089,0.0426,respectively).Parafoveal deep vessel density(PFDVD)had no difference between the two groups.At the second visiting point,all quadrants of PFSVD reduced significantly in the SO group(P=0.0256,0.0001,0.0031,<0.0001 in temporal,superior,nasal,and inferior area,respectively),but PFDVD remained no different.In the air group,all areas of PFSVD showed significantly improving from the first visit to the second one(P=0.0324,0.0001,0.0371,0.0026,in temporal,superior,nasal,and inferior area,respectively);however,almost all quadrants of PFDVD showed no changes during this period.In the SO group,both PFSVD and PFDVD showed no obvious changes between the two visiting points.Besides,parafoveal full retinal thickness in the SO group reduced significantly at both visiting points over the air tamponade,while the foveal avascular zone area showed no difference in the two groups.CONCLUSION:After retinal detachment surgery with vitrectomy and SO tamponade,superficial macular perfusion and full retinal thickness could decrease obviously when compared to air tamponade.This reduction process could persist throughout the tamponade period.

Analysis of retinal vasculature changes in indirect traumatic optic neuropathy using optic coherence tomography angiography

AIM:To assess the retinal vasculature alterations in indirect traumatic optic neuropathy(ITON)patients following craniofacial trauma by optic coherence tomography angiography(OCTA).METHODS:Patients diagnosed of monocular ITON were recruited from August 2016 to May 2020.OCTA was performed using the Angio Vue OCT-A system for two cube scans centered at the optic nerve head and fovea.OCTA data included thicknesses of peripapillary retinal nerve fiber layer(RNFL)and macular ganglion cell complex(GCC),as well as proportion of capillary perfusion and data were analyzed for correlation with post-injury timepoints:within 7,8-30,31-90,and 91-365d.RESULTS:A total of 73 ITON patients were studied.Significant thinning of RNFL and GCC layers and attenuation of microvascular perfusion were observed in ITON eyes as compared to contralateral unaffected eyes(for most of the analyzed sectors and quadrants,P<0.05).Without respect to surgical intervention and vision recovery,the decrease in retinal layer thicknesses and microvascular perfusion was time-dependent,and most significant within three months(P<0.001).CONCLUSION:ITON presents with time-dependent thinning of retinal layers and attenuation of microvasculature,indicating possible degeneration of retinal ganglion cells due to reduced retinal blood supply.

Retinal thickness and vascular parameters using optical coherence tomography in Alzheimer's disease:a meta-analysis

Examining the retinal tissue has the potential to provide a unique method and technique to quantify Alzheimer’s disease-related changes in participants at various stages of the disease.In this metaanalysis,we aimed to investigate the association of various optical coherence tomography parameters with Alzheimer’s disease and whether retinal measurements can be used to diffe rentiate between Alzheimer’s disease and control subjects.Scientific databases including Google Schola r,Web of Science,and PubMed were systematically searched for published articles that evaluated retinal nerve fiber layer thickness and retinal microvascular network in Alzheimer’s disease and control subjects.Seventy-three studies(5850 participants,including 2249 Alzheimer’s disease patients and 3601controls) were included in this meta-analysis.Relative to controls,Alzheimer’s disease patients had a significantly lower global retinal nerve fiber layer thickness(standardized mean difference [SMD]=-0.79,95% confidence intervals [CI]:-1.03 to-0.54,P <0.00001) as well as each quadrant being thinner in Alzheimer’s disease versus controls.Regarding macular paramete rs,values measured by optical coherence tomography were significantly lower in Alzheimer’s disease than controls for macular thickness(pooled SMD:-0.44,95% CI:-0.67 to-0.20,P=0.0003),foveal thickness(pooled SMD=-0.39,95% CI:-0.58 to-0.19,P <0.0001),ganglion cell inner plexiform layer(SMD=-1.26,95% CI:-2.24 to-0.27,P=0.01) and macular volume(pooled SMD=-0.41,95% CI-0.76 to-0.07,P=0.02).Analysis using optical coherence tomography angiography parameters revealed mixed results between Alzheimer’s disease and controls.Superficial vessel density(pooled SMD=-0.42,95% CI:-0.68 to-0.17,P=0.0001) and deep vessel density(pooled SMD=-0.46,95% CI:-0.75 to-0.18,P=0.001) were found to be thinner in Alzheimer’s disease patients whereas the foveal avascular zone(SMD=0.84,95% CI:0.17-1.51,P=0.01) was larger in controls.Vascular density and thickness of various retinal laye rs were decreased in Alzheimer’s disease patients compared to controls.Our results provide evidence for optical coherence tomography technology having the potential to detect retinal and microvascular changes in patients diagnosed with Alzheimer’s disease and aid in monito ring and early diagnosis methods.