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Systemic Lupus Erythematosus
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Vaneet K. Sandhu, Neha V. Chiruvolu, Daniel J. Wallace
Although many physicians embraced HCQ as off-label treatment for SLE for many years, some were wary of the lack of clinical trial data to prove its efficacy. Several investigators subsequently collaborated to form the Canadian Hydroxychloroquine Study Group, taking on the task of conducting a randomized, double-blind, placebo-controlled trial to study the effect of stopping HCQ treatment in forty-seven patients with clinically stable SLE. Despite the small sample size, they found that clinical flares occurred more frequently in the placebo group than in patients taking HCQ. Similarly, patients who discontinued HCQ had a 2.5-fold increased risk in recurrence of clinical manifestations or increase in disease severity.54 Since then, multiple studies have reaffirmed its efficacy, and it has remained a drug of choice in patients with SLE. A systemic review of literature published between 1982 and 2007 showed that there was high evidence of increase in survival and prevention of flares with HCQ.55 Furthermore, there was moderate protection against irreversible organ damage; hence, HCQ can be used in organ-involved disease as well.55 However, the medication risk of retinopathy remains of concern, and patients are advised to schedule regular follow-ups with eye specialists to monitor for these side effects.56 We are now finding that optical coherence tomography angiography can be used for early detection of retinal damage from HCQ at a stage when the damage is still reversible and when other imaging techniques cannot detect the damage.57
Optic Neuropathies Associated with Systemic Disorders And Radiation-Induced Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Optical coherence tomography angiography has been recently used to establish a putative grading system for RION, by characterizing effects on the radial peripherally capillary plexus (35). Findings may range from no detectable radial peripapillary capillary plexus abnormality to complete radial peripapillary capillary plexus dropout (35). Notably, more severe grades of peripapillary capillary injury correlate with worse visual acuity in affected eyes (35).
Photothermal Lasers
Published in Anita Prasad, Laser Techniques in Ophthalmology, 2022
OCT-A – optical coherence tomography angiography (non-invasive imaging technology, using motion contrast between moving erythrocytes in blood vessels, against static retina), provides topographic and structural information about retinal vessels (localized to superficial capillary plexus [SCP], or deep capillary plexus [DCP], and choriocapillaris or deep choroidal vessels). Identifies neovascularization (IRMA, NVD, NVE), DME, assesses macular perfusion, and can be used to monitor treatment response (regression of NV).Widefield OCT-A showing reduced macular and peripheral capillary density is predictive of severity and progression of DR.Choroidal circulation shows reduced thickness and vascular density and flow voids in the choriocapillaris in ischaemic vasculopathy.
Optical Coherence Tomography Angiography in Patients with Cone Dystrophy
Published in Seminars in Ophthalmology, 2022
Alper Can Yilmaz, Ali Hakan Durukan, Hayati Yilmaz, Umut Karaca
Optical coherence tomography angiography is a non-invasive technique that enables the visualization of the microvascular structure of the retina, choroid, and optic nerve head without the need for an intravenously injected dye. Studies on the repeatability and reliability of the quantitative data of different devices have been conducted in healthy individuals and have also started to find a place in clinical practice in many ocular pathologies.12–14 In this study, we evaluated retinal micro vascularity with OCTA to contribute to the understanding of the pathogenesis of cone dystrophy and directing treatment modalities. In the literature, there is a growing number of studies on the vascular process, especially retinitis pigmentosa, which aim to clarify the pathogenesis of hereditary fundus dystrophies that are relatively rare and have an unknown pathogenesis. The main purpose of the studies on the vascular process is to reveal the location of vascular support loss in pathogenesis and determine whether it is a cause or an effect.8,15 Although some information has been obtained from histopathological and genetic studies in most hereditary fundus dystrophies, the cause-effect relationship is not yet completed understood, and the pathogenesis has not been fully elucidated. Therefore, there are still no satisfactory treatments.
Retinal vascularity, nerve fiber, and ganglion cell layer thickness in thyroid eye disease on optical coherence tomography angiography
Published in Orbit, 2022
Tarjani Vivek Dave, Srujana Laghmisetty, Gayatri Krishnamurthy, Kavya Bejjanki, Anasua Ganguly, Ganesh Babu Jonnadula, Vivek Pravin Dave, Rajeev Reddy Pappuru
There has been recent literature on changes in peripapillary and macular vascular densities in cases with glaucomatous and ischemic optic neuropathies.9,10Also, optical coherence tomography angiography (OCTA) has been used to diagnose and monitor retinal microvascular changes by quantifying the density of vessels in the macula in eyes with diabetic retinopathy, central serous chorioretinopathy, glaucoma, and also to evaluate macular edema, age-related macular degeneration, and other macular pathology.11–13 Using customized image processing programs, including a split-spectrum amplitude-decorrelation angiography (SSADA) algorithm and enface scanning, the inner and outer retinal blood flows can be simultaneously visualized through the enface presentation of the volumetric OCTA. In the current communication, we report the macular and peri-papillary vascular densities in cases of active and inactive TED eyes and compare it with a normative dataset.
How to measure retinal microperfusion in patients with arterial hypertension
Published in Blood Pressure, 2021
Urszula Szulc, Edyta Dąbrowska, Janusz Pieczyński, Paweł Białkowski, Krzysztof Narkiewicz, Roland E. Schmieder, Joanna Harazny
Optical Coherence Tomography Angiography (OCTA) is a diagnostic imagining method that employs classical Optical Coherence Tomography technology together with motion-contrast imagining of volumetric blood flow. The measurement is based on motion contrast produced by moving RBCs visualised on series of repeated B-scans. This approach is an alternative for classic fluorescein or ICG angiography, which does not require dye injections and allows for the depth-resolved visualisation of retinal and choroidal vasculature [62,63]. The depth information of acquired flow data is one of the biggest advantages of this method [64]. A huge disadvantage of Optical Coherence Tomography Angiography is, however, a relatively long time of data acquisition, in which steady fixation of the eye is necessary to produce a high-quality image [65–67]. A recent study held by Holmen et al. [66] show that presence of at least one artefact can be expected in 97.3% images while severe artefacts can be found in 53.5% images. In another study Say et al. [67] assessed the prevalence of different types of artefacts showing that the most common major artefacts were following: loss of focus (55%), broad blink lines (37%), motion artefact (26%), specular dot (25%) and edge duplication (8%). Optical Coherence Tomography Angiography allows for measurements of retinal capillary density (RCD) and non-perfused areas (R-NPA), choriocapillaris flow area, optic nerve head capillary density.