BackgroundThis study aimed to determine the relationship between image quality and measurement repeatability of optical coherence tomography angiography (OCTA) parameters in patients with non-proliferative diabetic retinopathy.MethodsA total of 100 eyes of 50 patients were included in the study. Three OCTA images were obtained consecutively during one session of imaging in all patients using the RTVue AngioVue OCTA device. We applied the signal strength index (SSI) provided by the RTVue system to define scan quality. Superficial vessel density (VD) in the central 3 × 3 mm macular and in the perifoveal region, as well as foveal avascular zone (FAZ) area were evaluated by the AngioAnalytics software for each scan from three consecutive measurements, whereby measurement repeatability of the OCTA parameters were calculated. The effect of SSI value on OCTA parameters, as well as on measurement errors was assessed.ResultsValues of SSI ranged from 30 to 85 with an overall mean of 61.79 ± 10.38. Mean SSI values showed significant positive correlation with the mean retinal capillary vessel density values, but not with non-flow area. Repeatability of OCTA parameters was generally improved with higher SSI values. We calculated a mean correction factor of 0.22% (95% CI 0.20–0.24 µm; p < 0.001) for VD at the 3 × 3 mm macular scan, 0.23% (95% CI 0.21–0.26%; p < 0.001) for perifoveal VD and − 0.001 mm2 (95% CI − 0.001 to 0.002; p = 0.001) for the non-flow area for each unit increase in SSI for the comparison of images with different SSI values.ConclusionsThe influence of image quality on OCTA metrics should be considered for image comparisons during follow-up to avoid misinterpretation of small changes in OCTA parameters in patients with diabetes.

Bevezetés: Az exsudativ időskori maculadegeneráció kezelésére alkalmazott intravitrealis ranibizumabinjekcióval szerzett eddigi tapasztalatok kedvezőek. Célkitűzés: A szerzők célul tűzték ki az intravitrealis ranibizumabterápia kétéves/ hosszú távú funkcionális és anatómiai eredményeinek felmérését. Módszer: Egycentrumú prospektív vizsgálatban 46 beteg (átlagéletkor: 75±9,1 év) adatait dolgozták fel. A kezelési protokoll szerint a betegek az első három hónap-ban havonta kaptak 0,5 mg ranibizumabinjekciót, majd szükség szerint (pro re nata). A legjobb korrigált visus, illetve a centrális retinavastagság változását követték. Eredmények: A legjobb korrigált látóélesség változása a követési idő végére sem a ke zelés előtti értékhez képest (p = 0,760), sem az első év végi eredményhez képest nem volt statisztikailag szignifi káns (p = 0,154). A centrális retinavastagság a kiindulási értékhez képest szignifi kánsan csökkent (p = 0,000001), az első év végi értékhez képest nem volt szignifi káns a változás (p = 0,875). Következtetések: Nedves tí-pusú maculadegene rációban szenvedő betegeknél pro re nata protokoll szerinti intravitrealis ranibizumabkezeléssel hosszú távon a látóélesség stabil marad, az exsudatio hatékonyan csökkenthető Orv. Hetil., 2013, 154(45), 1790-1797. Kulcsszavak: időskori maculadegeneráció, intravitrealis injekció, ranibizumab, optikai koherencia tomográfi a Long term intravitreal ranibizumab treatment for exsudative age-related macular degenerationIntroduction: The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time. Aim: To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment. Method: 46 patients (age: 75±9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the fi rst 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed. Results: The visus change at the end of the follow-up time was not statistically signifi cant compared to baseline (p = 0.760) and the at the end of the fi rst year (p = 0.154). Central retinal thickness decreased signifi cantly compared to baseline (p = 0.000001), but the change was not statistically signifi cant compared to the end of the fi rst year (p = 0.875). Conclusions: Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced effi ciently.

Background Anti-vascular endothelial growth factor (VEGF) therapy is currently the most effective therapy of exudative age-related macular degeneration (AMD). The aim of this study was to assess long-term benefits of intensive aflibercept and ranibizumab anti-VEGF therapy in patients with exudative AMD. Methods Two clinical trial sites recruited their original subjects for a re-evaluation 7 years after the baseline visit of the phase-3 Vascular Endothelial Growth Factor (VEGF) Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration (VIEW 2) trial. Forty-seven eyes of 47 patients with AMD originally treated with ranibizumab (14 eyes) or aflibercept (33 eyes) were included. Results Mean number of injections was 17.8 ± 3.0 during participation in the VIEW 2 trial. Fourteen of 47 (30%) eyes were given additional injections with a mean number of 5.7 ± 4.5 after the trial. At a mean follow-up time of 82 ± 5 months best corrected visual acuity (BCVA) remained stable or improved (≤ 10 letters lost) in 55% of patients in the entire study population, in 43% in the ranibizumab group and in 60% in the aflibercept group. In both groups combined mean BCVA was 54 ± 13 letters at baseline, 65 ± 17 letters at the end of the intensive phase and 45 ± 25 letters at the end of follow-up. There was no statistically significant difference in BCVA between the two groups at baseline (p = 0.88) and at the end of follow-up (p = 0.40). Macular atrophy was observed in 96% of eyes, average area was 7.22 ± 6.31 mm2 with no statistically significant difference between groups (p = 0.47). Correlation between BCVA at end-of-follow-up and the area of atrophy was significant (p < 0.001). At the end of follow-up, fluid was detected in 7 of 47 eyes (15%) indicating disease activity. Conclusion Long-term efficacy of aflibercept and ranibizumab was largely consistent. Following a two-year intensive therapy with as-needed regimen, BCVA was maintained or improved in almost half of the patients and in the ranibizumab group and more than half of the patients in the aflibercept group with very few injections. In a remarkable proportion of eyes, BCVA declined severely which underlines the need for long-term follow-ups and may indicate a more prolonged intensive therapy. Trial registrations VIEW 2 study: ClinicalTrials.gov ID: NCT00637377, date of registration: March 18, 2008. Long-term follow-up: IRB nr.: SE RKEB 168/2022, ClinicalTrials.gov ID: NCT05678517, date of registration: December 28, 2022, retrospectively registered.

Purpose To measure capillary vessel density (VD) using optical coherence tomography angiography (OCT‐A) in both eyes of diabetic patients and to evaluate its correlation with systemic risk factors. Methods A total of 103 eyes of 61 diabetic patients underwent OCT‐A imaging (RTVue‐XR Avanti; Optovue, Fremont, CA, USA). The control group included 92 eyes of 46 individuals without diabetes mellitus. In diabetic patients the duration of diabetes, insulin therapy, blood pressure, HbA1C, dyslipidemia and the presence of diabetic retinopathy was recorded. VD was examined in the central macula with a radius of 3 mm. The effect of risk factors on VD was assessed bilaterally using multivariable regression analysis. Results Vessel density was significantly decreased in diabetic patients compared to controls (47.26 vs. 50.88%; p < 0.001). In control subjects, VD significantly decreased with age (r = −0.54; p < 0.001), while in diabetic patients VD was associated only with the duration of diabetes among the risk factors (r = ‐0.15/year, p = 0.03). VD was also significantly decreased in diabetic patients without clinically detectable diabetic retinopathy compared to control subjects (48.19 vs. 50.88%, p < 0.001). Between‐eye difference in VD were significantly higher in diabetic patients with retinopathy (4.46±2.95%) and without retinopathy (4.19 ± 2.40%) in comparison to the controls (2.74 ± 2.24%; p = 0.02 for both comparisons). Conclusions Significantly decreased retinal vessel density and increased between‐eye asymmetry can be measured in diabetic patients compared to control subjects even before the presence of clinically detectable diabetic retinopathy. While in control subjects vessel density decrease with aging, in diabetic patients both vessel density and between‐eye asymmetry are significantly associated with the duration of diabetes.

Összefoglaló. A pseudoxanthoma elasticum (PXE, OMIM # 264800) egy autoszomális recesszív módon öröklődő multiszisztémás érintettséggel járó kórkép, melynek háttérében az ABCC6 gén mutációi állnak. A tünetek kialakulásának oka az ektópiás mineralizáció. Kalcium-só kristályok rakódnak le elsősorban a bőrben, a szem Bruch-membránjában és az erek endotheliumában, így a bőrelváltozások mellett a látás csökkenése és cardiovascularis eltérések is jelentkezhetnek. A klinikai tünetek változó súlyosságúak lehetnek, heterogén megjelenésűek. A betegek fenotípusának azonosítása, valamint gondozása multidiszciplináris feladat, bőrgyógyász, szemész, kardiológus és klinikai genetikus együttműködésén alapul. Célunk, hogy bemutassuk a betegségben előforduló tüneteket, melyek ismerete megkönnyíti a kórkép felismerését, illetve hogy felhívjuk a figyelmet a korai diagnózis fontosságára és ismertessük a korszerű diagnosztikai módszereket. A súlyos szisztémás tünetek kialakulása miatt rendkívüli jelentőséggel bír a társszakmák együttműködése, hogy a korai diagnózis által időben megfelelő gondozásban és terápiában részesülhessenek a betegek. Orv Hetil. 2022; 163(18): 702–711. Summary. Pseudoxanthoma elasticum (PXE, OMIM # 264800) is an autosomal recessive, multisystemic disorder, associated with mutations of the ABCC6 gene. Ectopic mineralization is in the background of the clinical manifestations of the disease. Calcium-salt crystals are deposited primarily in the skin, in the Bruch membrane of the eyes, and in the vascular endothelium. Thus, in addition to the skin lesions, visual impairment and cardiovascular involvement also occur. Clinical symptoms show varying severity and display heterogeneous appearance. The identification of the phenotype and care of the patients require a multidisciplinary perspective based on the collaboration of a dermatologist, ophthalmologist, cardiologist, and clinical geneticist. The aim of our work is to describe the development of symptoms of the disease, in order to facilitate the diagnosis. In addition, we aim to draw attention to the importance of early diagnosis of pseudoxanthoma elasticum, and to present modern diagnostic methods. Considering the development of severe systemic complications, the early diagnosis with the collaboration between related specialists is crucial to provide optimal clinical care and management of the patients. Orv Hetil. 2022; 163(18): 702–711.