Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: A review

Trivedi A., Katelaris C.

The uveitides are a heterogenous group of ocular inflammatory disorders that account for the third highest cause of blindness worldwide, responsible for 5-10% of visual impairment globally. Up to 35% of patients with uveitis can suffer significant vision loss. To prevent irreversible structural damage and blindness, it is important that the diagnosis and commencement of appropriate therapy occurs promptly. Management includes topical and systemic corticosteroid therapy and conventional immunomodulatory agents, including methotrexate, azathioprine, mycophenolate mofetil and cyclosporin. Significant progress has been made in the past decade in our understanding of the immunopathological pathways that drive intraocular inflammation, allowing the development of targeted therapy with biologic agents. These include TNF-α inhibitors, such as infliximab, adalimumab and etanercept; interleukin blockers, such as tocilizumab and daclizumab; and other targeted therapies, such as rituximab and abatacept. The efficacy of these agents has been studied in cases of severe uveitis that are refractory to conventional immunomodulatory agents and provide exciting results that have revolutionised uveitis management. Though the biologic era has provided a large armamentarium to treat uveitis, ongoing challenges and cases of recalcitrant uveitis remain, posing a challenge to internal medicine physicians. This comprehensive review aims to construct an updated summary on the existing evidence pertaining to the use of biologic agents in the treatment of uveitis. Methods include a systematic search for studies between 2000 and 2018 using PubMed, EMBASE, Ovid MEDLINE and Cochrane libraries.

Ağın A., Kadayıfçılar S., Sönmez H.E., Baytaroğlu A., Demir S., Sağ E., Özen S., Eldem B.

ObjectiveThe aim of this study was to conduct a detailed ophthalmological examination in children with systemic lupus erythematosus (jSLE), including choroidal thickness (ChT), choroidal vascularity index (CVI) and peripapillary retinal nerve fiber layer (RNFL).MethodsThe study included all jSLE patients ( n = 21) diagnosed according to the Systemic Lupus International Collaborating Clinics classification criteria between January 2017 and April 2017, and an age- and gender-matched control group ( n = 21). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to assess disease activity. After routine eye examinations, ChT at five points (750 µ and 1500 µ from the center of the fovea both in the temporal and nasal quadrants and under the fovea), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), CVI and RNFL thickness at the optic disc were evaluated.ResultsOne patient had active ocular involvement in the form of episcleritis. Another patient had corticosteroid-induced cataract. The median age of the patients was 16 years (6-19 years). ChT at five points, TCA, LA and SA were found to be higher in patients with jSLE, whereas RNFL thickness and CVI were similar to those of the healthy control individuals. No correlation was determined between optical coherence tomography findings, SLEDAI and the immunological parameters (antinuclear antibodies, anti-double-stranded DNA, complements 3 and 4, extracted nuclear antigen antibody, antiphospholipid antibody). Intraretinal and subretinal fluid was not present in any of the patients.ConclusionThe choroid was thicker in patients with jSLE than in the control group. The study results suggest that jSLE may affect the choroid. Ophthalmological evaluation is important in SLE patients, even in the absence of relevant complaints.

Chung Y., Cho E.H., Jang S., Lee S.Y., Lee E., Lee K.

NAKAYAMA L.F., BERGAMO V.C., CONTI M.L., BUENO L., MORAES N.S., AMBROGINI JR O.

ABSTRACT BACKGROUND: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment. OBJECTIVE: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature. METHODS: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy. RESULTS: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients. CONCLUSION: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.

Gökmen O., Yeşilırmak N., Akman A., Gür Güngör S., Yücel A.E., Yeşil H., Yıldız F., Sise A., Diakonis V.

Park J.Y., Kim B.G., Hwang J.H., Kim J.S.

To study the distribution of choroidal thickness (CT) in and outside of the vascular arcade, as well as at the fovea in healthy eyes using spectral-domain optical coherence tomography (OCT).Seventy healthy eyes were examined with OCT to obtain nine horizontal lines in and outside of the vascular arcade. Nine points including the central point of the line were chosen in 0.5-mm intervals to calculate CT. CT was measured at a total of 81 points in each patient to construct a map of CT distribution.Average subfoveal CT showed a significant relationship with age (P < 0.001) and axial length (P = 0.001). In all nine horizontal lines, CT showed a rough trend of being thickest at a particular point and decreasing thereafter. The aspect of CT distribution was different among the nine horizontal lines (P < 0.001), and the near superotemporal line displayed the thickest choroid among the lines. The difference of the trend between temporal vertical lines was significant as well (P < 0.001).The CT generally decreased with age, but it decreased much faster in old age than in relatively younger people. CT displayed large variations among different points in and outside of the vascular arcade. The thickest choroid was located at the point superior to the fovea, not the fovea itself. Such physiological variations should be considered when interpreting pathologic changes of the choroid.

Aydin E., Atik S., Koc F., Balikoglu-yilmaz M., Akin sari S., Ozmen M., Akar S.

Caramoy A., Heindl L.

Kal A., Duman E., Sezenöz A.S., Ulusoy M.O., Kal Ö.

To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values. We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed. Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT. Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.

Ahn S.J., Kim J.H., Lee B.R.

Purpose To evaluate choroidal changes in eyes with acute anterior uveitis associated with human leukocyte antigen (HLA)-B27 Methods In 44 patients with first-onset, unilateral, acute-onset (

Chhablani P.P., Ambiya V., Nair A.G., Bondalapati S., Chhablani J.

Imaging technology has advanced by leaps and bounds in the recent past and has resulted in a much greater understanding of ocular diseases. The aim of this review article is to summarize optical coherence tomography (OCT) findings of various systemic conditions.A systematic literature search of the Medline/PubMed database was performed. English articles up to April 2015 were included. Terms used for search included: Alzheimer's Disease; Multiple Sclerosis; Parkinson's Disease; Behçet's Disease; Schizophrenia; Migraine; Obstructive Sleep Apnea Syndrome; Neurofibromatosis; Sickle Cell Disease; Renal diseases; Lupus Retinopathy; Valsalva Retinopathy; Whiplash Retinopathy; Shaken-Baby Syndrome; Choroidal metastases; Intracranial Hypertension; Drug toxicity; Deferoxamine; Sildenafil; Tamoxifen; Hydroxychloroquine; Chloroquine; Ethambutol; Lead; Sickle Cell Disease; and Thalassemia along with OCT.Studies have shown that inner retinal thinning could be the earliest sign of neurological diseases and may help to differentiate individuals with abnormalities. Outer retinal damage was noted in cancer-related retinopathy and secondary to drug toxicity as a diagnostic sign. This review article summarizes the OCT findings and their importance in early diagnosis, treatment, and follow-up in a varying spectrum of systemic diseases including neurological diseases, hematological diseases, cancer-related retinopathies, and systemic drug toxicity.OCT findings are useful to predict the probability of a disease, to diagnose it early, to differentiate between healthy and unhealthy tissue, and to assess the effect of therapeutic interventions in many systemic diseases.

Malerbi F.K., Regatieri C.V., de Sa J.R., Morales P.H., Farah M.E., Dib S.A.

Univ Fed Sao Paulo, Dept Ophthalmol, Rua Jacques Felix 278-54, BR-04509001 Sao Paulo, SP, Brazil

Karadag A.S., Bilgin B., Soylu M.B.

Shulman S., Shorer R., Wollman J., Dotan G., Paran D.

Background Cognitive impairment is frequent in systemic lupus erythematosus. Atrophy of the corpus callosum and hippocampus have been reported in patients with systemic lupus erythematosus, and diffusion tensor imaging studies have shown impaired white matter integrity, suggesting that white matter damage in systemic lupus erythematosus may underlie the cognitive impairment as well as other neuropsychiatric systemic lupus erythematosus manifestations. Retinal nerve fiber layer thickness, as assessed by optical coherence tomography, has been suggested as a biomarker for white matter damage in neurologic disorders such as multiple sclerosis, Alzheimer’s disease and Parkinson’s disease. Retinal nerve fiber layer thinning may occur early, even in patients with mild clinical symptoms. Aim The objective of this study was to assess the association of retinal nerve fiber layer thickness, as a biomarker of white matter damage in systemic lupus erythematosus patients, with neuropsychiatric systemic lupus erythematosus manifestations, including cognitive impairment. Methods Twenty-one consecutive patients with systemic lupus erythematosus underwent neuropsychological testing using a validated computerized battery of tests as well as the Rey-Auditory verbal learning test. All 21 patients, as well as 11 healthy, age matched controls, underwent optical coherence tomography testing to assess retinal nerve fiber layer thickness. Correlations between retinal nerve fiber layer thickness and results in eight cognitive domains assessed by the computerized battery of tests as well as the Rey-Auditory verbal learning test were assessed in patients with systemic lupus erythematosus, with and without neuropsychiatric systemic lupus erythematosus, and compared to retinal nerve fiber layer thickness in healthy controls. Results No statistically significant correlation was found between retinal nerve fiber layer thickness in patients with systemic lupus erythematosus as compared to healthy controls. When evaluating by subgroups, no correlation was found between patients with or without neuropsychiatric systemic lupus erythematosus or cognitive impairment and retinal nerve fiber layer thickness. Conclusion Retinal nerve fiber layer thickness of systemic lupus erythematosus patients was not found to be statistically different compared to controls. Within systemic lupus erythematosus patients there was no correlation between retinal nerve fiber layer thickness and cognitive impairment or other neuropsychiatric systemic lupus erythematosus manifestations.

Bicer T., Celikay O., Kosker M., Alp M.Y., Ozisler C., Yesilyurt A., Kucuk Bicer B., Gurdal C.

We aimed to evaluate changes in retinal, choroidal, ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thicknesses in genetically diagnosed adult patients with familial Mediterranean fever (FMF).A total of 50 eyes of 50 genetically diagnosed patients with FMF and 50 eyes of controls were analyzed. Patients were recruited from the Genetic Diagnostic Center of Dışkapı Yıldırım Beyazıt Research and Training Hospital, Turkey. Retinal and choroidal thicknesses were obtained using spectral-domain optical coherence tomography from choroid, retina, GCC, and RNFL.Average baseline choroidal thickness was statistically significantly thinner in patients with FMF than controls at Ccenter (325.85 ± 30.8 µm and 338.97 ± 23.9 µm, respectively, p = 0.038), Cnasal500 (328.77 ± 31.6 µm and 349.00 ± 23.3 µm, respectively, p = 0.002), Cnasal1000 (324.97 ± 33.6 µm and 351.23 ± 23.8 µm respectively, p = 0.0001) and Cnasal1500 (324.75 ± 37.1 µm and 344.61 ± 27.3 µm, respectively, p = 0.008). However, there was no significant difference in temporal choroidal thickness (Ctemporal500, Ctemporal1000 and Ctemporal1500) in patients with FMF compared to controls (p > 0.05). There were no significant differences in retinal, GCC and RNFL thicknesses between the groups (p > 0.05).We hypothesize that the chronic inflammation seen in FMF could be the reason for the reduction seen in choroidal thickness in adult patients with FMF. Retinal, GCC and RNFL thicknesses did not differ from controls.

Burke J., Gibbon S., Low A., Hamid C., Reid‐Schachter M., Muniz‐Terrera G., Ritchie C.W., Dhillon B., O'Brien J.T., King S., MacCormick I.J., MacGillivray T.J.

AbstractINTRODUCTIONWe explored associations between measurements of the ocular choroid microvasculature and Alzheimer's disease (AD) risk.METHODSWe measured the choroidal vasculature appearing in optical coherence tomography (OCT) scans of 69 healthy, mid‐life individuals in the PREVENT Dementia cohort. The cohort was prospectively split into low‐, medium‐, and high‐risk groups based on the presence of known risk factors (apolipoprotein E [APOE] ε4 genotype and family history of dementia [FH]). We used ordinal logistic regression to test for cross‐sectional associations between choroidal measurements and AD risk.RESULTSChoroidal vasculature was progressively larger between ordinal risk groups, and significantly associated with risk group prediction. APOE ε4 carriers had thicker choroids and larger vascularity compared to non‐carriers. Similar trends were observed for those with a FH.DISCUSSIONSOur results suggest a potential link between the choroidal vasculature and AD risk. However, these exploratory findings should be replicated in a larger sample.Highlights Ocular choroidal microvasculature is of interest in relation to neurodegeneration due to its autonomic response to systemic, pathophysiological change. Choroidal changes in the prodromal stage of Alzheimer's disease (AD) are unexplored. The PREVENT Dementia cohort offers a unique, non‐invasive study of the microvasculature in mid‐life individuals at increased risk for developing AD. Significantly increased ocular choroidal vasculature was associated with increased risk (apolipoprotein E carrier and/or family history of dementia) for AD. These exploratory results suggest a potential association between the ocular choroidal vasculature and AD risk. However, findings should be replicated in a larger sample.

Raciborska A., Pieklarz B., Gińdzieńska-Sieśkiewicz E., Zonenberg A., Kowal-Bielecka O., Konopińska J., Dmuchowska D.A.

PurposeSystemic sclerosis (SSc) affects blood vessels, internal organs, and skin. In ophthalmology, SSc impacts the choroid. The choroidal vascularity index (CVI) measures the vascular component of the choroid and may serve as a biomarker for the disease staging and prognosis. Studies have reported reduced choroidal thickness and altered CVI in SSc, which supports the theory of vascular damage. This study aimed to examine interocular symmetry in choroidal parameters among SSc patients. It has provided the insight into the disease symmetry and assessed the representativeness of examining one eye.MethodsThis prospective single-center cross-sectional study included 33 patients with SSc and 40 healthy controls. The patients underwent ophthalmological examination (including refraction, visual acuity, IOP, biometry, slit-lamp biomicroscopy, dilated fundus examination, and spectral-domain optical coherence tomography) and rheumatological evaluation. Various parameters of the choroid in the macular and peripapillary regions were analyzed, including choroidal thickness, choroidal volume, and CVI. The interocular asymmetry in the choroidal parameters was quantified using signed and absolute differences. The correlation analysis between the left and right eyes was based on the intraclass correlation coefficient (ICC), Spearman’s correlation coefficient, and paired Wilcoxon test.ResultsThere were no significant differences in the macular and peripapillary choroidal parameters between fellow eyes in both SSc patients and controls (p &gt; 0.05). The parameter that showed the lowest correlation among those examined was CVI—in both groups, as well as in both examined areas. The interocular correlation of choroidal parameters was stronger in the peripapillary area than in the macular area in both groups. In general, the results were confirmed in subgroup analyses stratified according to sex, SSc subtype, Scl70 antibody positivity and previous and/or active digital ulcers.ConclusionThere is interocular symmetry of the choroidal parameters in patients with SSc and controls included in our study. The parameters from one eye are representative of the fellow eye of a given patient. This conclusion may contribute to the design and interpretation of future studies. It also broadens our knowledge of SSc pathophysiology.

Motamed Shariati M., Khazaei S., Yaghoobi M.

Abstract Background The choroid, a highly vascular structure within the eye, is significantly influenced by various systemic conditions. The advent of enhanced depth optical coherence tomography has improved our ability to evaluate choroidal pathophysiology. The choroidal vascularity index (CVI), a noninvasive and reliable tool, serves as an effective means of assessing the choroidal vascular structure. Recent studies have increasingly focused on exploring CVI alterations under different systemic conditions. This study aims to provide a comprehensive summary of the latest research findings in this area. Methods A systematic literature review was conducted on October 1, 2023, using two databases, MEDLINE (via PubMed) and Scopus. Search terms were tailored specifically for each database to ensure a thorough exploration of relevant literature. The studies identified were qualitatively assessed, with particular emphasis on outcomes related to CVI and choroidal thickness. Results A total of 48 studies were included in the review, encompassing a diverse range of systemic conditions such as diabetes, central nervous system disorders, cardiovascular diseases, autoimmune disorders, and infectious diseases. Notable reductions in CVI were observed in diabetic retinopathy, autoimmune diseases, and neurodegenerative disorders. Additionally, the review highlighted variations in CVI values related to the severity of systemic diseases, indicating its potential use as a biomarker for disease progression. Conclusion This review highlights the significant correlation between variations in the choroidal vascularity index and diverse systemic conditions affecting hemodynamics. An enhanced understanding of CVI provides deeper insights into the pathophysiological mechanisms underlying these disorders and positions CVI as a promising biomarker for early detection and monitoring. Nevertheless, its clinical utility warrants careful assessment. Future research should address the potential limitations of CVI to fully capitalize on its diagnostic and prognostic potential.

Yang Y., Wang J., Shi Y., Cao H., Wei L., Gao L., Liu M.

Microplastics (MPs) are ubiquitously dispersed in the environment, and undergoing the process of oxidation that alters their physical and chemical properties. Eyes, which directly interface with the external milieu, inevitably encounter MPs. Nonetheless, the ophthalmic toxicity of MPs towards organisms remains unclear. In this study, primary mouse corneal epithelial cells (MCECs), C57BL/6 mice, and CX3Crl

Zhou M., Wu D., Cai L., Wang C., Su Y., Li Y., Ke W., Chen T., Hong S., Xiao H., Wan P.

ObjectiveTo investigate the change in choroidal components of patients with Graves’ ophthalmopathy (GO) with different degrees of disease activity and severity by using the image binarisation method of optical coherence tomography (OCT).MethodsThis cross-sectional study included 151 eyes of 90 patients with GO. Patients were grouped according to the clinical activity score (CAS) and disease severity. Total choroidal area (TCA), luminal area, stromal area (SA) and choroidal vascularity index (CVI) were acquired by image binarisation of the OCT. Ocular parameters between groups were compared using generalised estimating equations, accounting for intereye correlation and adjusting for relevant factors.ResultsAs for the included eyes, 104 eyes were inactive GO and 47 eyes were active GO. Local choroidal thicknesses were thicker in active GO than in inactive GO. TCA and SA were significantly larger in active GO than in inactive GO group (3.44±0.91 mm2vs 3.14±0.88 mm2, p=0.046; 1.16 (1.03–1.50) mm2vs 1.10 (0.96–1.27) mm2, p=0.002, respectively). CAS was positively correlated with TCA (r=0.171, p=0.036) and SA (r=0.172, p=0.035), and negatively associated with CVI (r=−0.174, p=0.032). In multiple regression models, age, diopter and intraocular pressure (IOP) exhibited significant correlations with the SA (β=−0.006, p=0.010; β=0.076, p<0.001; β=0.015, p=0.010, respectively).ConclusionsThickened choroid was observed in active GO compared with inactive GO. The proportional increase of SA was augmented as the disease activity progressed. Age, diopter and IOP were independent factors that affected choroidal area and components in patients with GO. Multicentre prospective cohort studies with a large sample size are still needed.

Ermiş S., Özal E., Savur F., Karapapak M.

Akbarpour M., Jalali M.M., Alizadeh Y., Nemati S., Akbari M., Dourandeesh M.

Yesilirmak N., Kurt B., Aktas A., Behar-Cohen F., Bourges J.

To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls.

Wu Y., Fang P., Wang X., Shen J.

Pancreatic cancer (PC) is an extremely deadly cancer, with mortality rates closely tied to its frequency of occurrence. By the time of diagnosis, pancreatic cancer often presents at an advanced stage, and has often spread to other parts of the body. Due to the poor survival outcomes, PDAC is the fifth leading cause of global cancer death. The 5-year relative survival rate of pancreatic cancer was about 6% and the lowest level in all cancers. Currently, there are no established guidance for screening individuals at high risk for pancreatic cancer, including those with a family history of the pancreatic disease or chronic pancreatitis (CP). With the development of medicine, fundus maps can now predict many systemic diseases. Subsequently, the association between ocular changes and a few pancreatic diseases was also discovered. Therefore, our objective is to construct a deep learning model aimed at identifying correlations between ocular features and significant pancreatic ailments. The utilization of AI and fundus images has extended beyond the investigation of ocular disorders. Hence, in order to solve the tasks of PC and CP classification, we propose a brand new deep learning model (PANet) that integrates pre-trained CNN network, multi-scale feature modules, attention mechanisms, and an FC classifier. PANet adopts a ResNet34 backbone and selectively integrates attention modules to construct its fundamental architecture. To enhance feature extraction capability, PANet combines multi-scale feature modules before the attention module. Our model is trained and evaluated using a dataset comprising 1300 fundus images. The experimental outcomes illustrate the successful realization of our objectives, with the model achieving an accuracy of 91.50% and an area under the receiver operating characteristic curve (AUC) of 96.00% in PC classification, and an accuracy of 95.60% and an AUC of 99.20% in CP classification. Our study establishes a characterizing link between ocular features and major pancreatic diseases, providing a non-invasive, convenient, and complementary method for screening and detection of pancreatic diseases.

Fekrazad S., Hassanzadeh G., Salehi M.A., Mozafar M., Farahani M.S., Arevalo J.F.

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting various organs. Ocular involvement, particularly retinopathy, is common, emphasizing the significance of early detection. Optical coherence tomography angiography (OCTA), a non-invasive imaging technique, reveals microvascular changes, aiding SLE diagnosis and monitoring. This study evaluates OCTA's effectiveness in detecting SLE-related retinal alterations. A systemic search was undertaken across PubMed, Embase, and Scopus databases to identify studies presenting OCTA measurements in SLE patients compared to healthy controls. The meta-analysis, employing either fixed-effects or random-effects models based on heterogeneity levels, was conducted. Additionally, subgroup and sensitivity analyses, meta-regression, and quality assessments were carried out. Thirteen studies of 565 eyes in the SLE group and 560 eyes in the control group were included. The meta-analyses revealed that SLE patients had a significantly lower retinal vessel density in the superficial and deep capillary plexus layers, choriocapillaris flow area, and foveal avascular zone (FAZ) circularity index compared to healthy controls, but that there were no significant differences in the FAZ area and perimeter. These findings highlight how OCTA can provide a noninvasive assessment of SLE effects on the retinal microvasculature, potentially presenting a reliable biomarker for more precise detection of SLE and disease activity monitoring.

Burke J., Gibbon S., Low A., Hamid C., Reid-Schachter M., Muniz Terrera G., Ritchie C., Dhillon B., O'Brien J.T., King S., MacCormick I.J., MacGillivray T.J.

AbstractObjectiveTo explore associations between measurements of the ocular microvasculature in the choroid (a highly vascularised layer posterior to the retina) and genetic Alzheimer’s disease risk.MethodsWe measured the choroidal vasculature appearing in optical coherence tomography scans of 69 healthy, mid-life individuals in the PREVENT cohort. The cohort was prospectively split into low, medium, and high-risk groups based on the presence of known risk factors (APOE4 genotype and family history of dementia). We used ordinal logistic regression to test for cross-sectional associations between choroidal measurements and pre-determined risk of future Alzheimer’s disease.ResultsWe observed progressively increased choroidal vasculature between ordinal risk groups, and all choroidal measurements were significantly associated with risk group prediction. APOE4 carriers had significantly thicker choroids and larger vascular tissue compared to non-carriers. Similar trends were observed for those with a family history of dementia. In our sample, a 0.16 mm2increase in choroidal vascular area was associated with a 2-fold increase in the likelihood of having one or more markers of Alzheimer’s disease risk, compared with none.ConclusionsOur results suggest a potential link between the choroidal vasculature and risk of Alzheimer’s disease. However, these findings are exploratory and should be replicated in a larger, more diverse sample.

Akçal Ö., Suleymanzade M., Işık B., Ersöz M.G.

Purpose: Allergic rhinoconjunctivitis (ARC) is an allergic upper respiratory tract disease characterized by sneezing, runny nose, nasal congestion and ocular and nasal itching due to inflammation of the nasal and conjunctival mucosa. There are no studies evaluating both the choroidal and retinal areas in ARC patients. Our objective was to evaluate patients with ARC at the time of diagnosis and before initiating treatment using Optical Coherence Tomography (OCT). Material and methods: This prospective cross-sectional study included 30 patients with ARC who presented to the Pediatric Allergy &amp; Immunology Outpatient Clinic and 30 healthy control individuals. OCT scans were captured with Cirrus HD OCT-5000 (Carl Zeiss, Jena, Germany) in the enhanced depth imaging (EDI) mode. Results: Of the study population, 66.7% (n=20) of patient group and 56.6% (n=17) of control group were female. The mean age was 13±2.3 and 13.9±1.8 years in the patient and control groups, respectively. The temporal subfoveal choroidal thickness was statistically significantly thinner in ARC patients with asthma (p=0.032). A robust negative correlation was found between minimum ganglion cell-inner plexiform layer (GCIPL) thickness and absolute eosinophil count (AEC) in patients with ARC (r:-0.551, p&lt;0.0001). Conclusion: In our study, the GCIPL thickness was lower in ARC patients. Similarly, although it did not reach statistical significance, the minimum GCIPL thickness was lower in our patient group with asthma compared to those without asthma. Our results suggest that multiple allergen sensitization and elevated eosinophils may influence GCIP thickness. However, both choroidal and retinal tissue might be impacted during chronic followup. Further studies are needed to support these findings.

Zamorano Aleixandre M., Redondo Marcos I., González-López J.J.

Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes. La esclerosis sistémica (ES) es una enfermedad crónica, autoinmune y multisistémica que se caracteriza por una disfunción vascular, inflamación crónica y fibrosis generalizada. Aunque la afectación vascular se manifiesta comúnmente en la piel, también puede afectar otros órganos, incluyendo los ojos. La alteración vascular característica es una vasculopatía fibroproliferativa obliterante que conduce a la hipoxia e isquemia tisular. Presentamos un caso de edema macular (EM) bilateral en una paciente diagnosticada de ES como consecuencia de cambios vasculares retinianos y coroideos.

Zamorano Aleixandre M., Redondo Marcos I., González-López J.J.

La esclerosis sistémica (ES) es una enfermedad crónica, autoinmune y multisistémica que se caracteriza por una disfunción vascular, inflamación crónica y fibrosis generalizada. Aunque la afectación vascular se manifiesta comúnmente en la piel, también puede afectar otros órganos, incluyendo los ojos. La alteración vascular característica es una vasculopatía fibroproliferativa obliterante que conduce a la hipoxia e isquemia tisular. Presentamos un caso de edema macular (EM) bilateral en una paciente diagnosticada de ES como consecuencia de cambios vasculares retinianos y coroideos. Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes.

Niyousha M., Razmaray H., Mohammadi F., Hassanpoor N.

Abstract We aimed to evaluate choroidal thickness with optical coherence tomography (OCT) in patients with non-alcoholic fatty liver disease (NAFLD). Twenty-five patients diagnosed with grade 2 NAFLD between the ages of 20 and 40 along with 20 age and sex-matched healthy controls were recruited. After full ophthalmological examination, choroidal thickness (CT) at fovea, nasal 500, nasal 1000, temporal 500 and temporal 1000-micron distances was obtained for both eyes using enhanced depth imaging (EDI)-OCT. Mean ages of NAFLD patients and healthy controls were 34.25±2.00 and 33.41±2.00 respectively. Statistical analysis showed that in the measurements taken from 1000-micron nasal to the left fovea, CT was 320.25±36.16 μm in NAFLD group and 298.05±36.90 μm in healthy group which showed a significant difference between two groups (p=0.046). No other measurements were statistically significant between groups (p > 0.05 for all measurements). In concussion, Choroidal thickness was not affected in grade 2 NAFLD.