Retinal Microvascular Changes in Patients With Acute Leukemia

Cicinelli, Maria Vittoria; Mastaglio, Sara; Menean, Matteo; Marchese, Alessandro; Miserocchi, Elisabetta; Modorati, Giulio; Bernardi, Massimo; Ciceri, Fabio; Bandello, Francesco

doi:10.1097/iae.0000000000003504

Cited by 8 publications

(11 citation statements)

References 32 publications

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“…This study evaluated changes in superficial retinal perfusion in patients with AML. We found that retinal perfusion in the macular region was significantly reduced in the acute phase of the disease, except for the central subfield, in patients with AML than in individuals with healthy eyes, which is consistent with the findings of Cicinelli et al ( 18 ); they also found lower VD in the SCP adjacent to the fovea in patients with acute leukemia, with no significant change in the fovea. This change was less pronounced in the central subfield, possibly because there are fewer vessels.…”

Section: Discussionsupporting

confidence: 92%

“…Contrary to our findings, Wechsler et al and Zhuang et al found a statistically significant association between retinal hemorrhage and thrombocytopaenia ( 16 , 17 ). A recent study of acute leukemia showed that patients with clinically visible leukemic retinopathy had higher WBC counts and fewer PLTs than did those without retinal signs ( 18 ). The sample size and classification of leukemia may be a result of differences in findings.…”

Section: Discussionmentioning

confidence: 99%

“…Abnormal retinal venous blood flow velocity was observed in patients with chronic myeloproliferative neoplasms which returned to normal levels after cytoreductive therapy ( 23 ). After leukemia remission, the perfusion of the capillaries in the macula and peripapillary areas improved ( 18 ), suggesting that the damage might be reversible. These studies revealed subclinical changes in the eyes of patients with acute leukemia, which can reflect the progression of systemic disease and may be helpful for the evaluation of patient efficacy and follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography

et al. 2023

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PurposeTo investigate changes in retinal circulation and the choroid in patients with acute myeloid leukemia (AML) in the acute and remission stages, to analyze the correlation between retinal circulation and laboratory parameters, and to assess risk factors associated with leukemic retinopathy.MethodsForty-eight patients (93 eyes) with AML were enrolled and divided into two groups according to fundus examination findings: the retinopathy and no retinopathy groups. Patients underwent eye measurements before treatment and after remission. Macular vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and choroidal thickness (ChT) were measured using optical coherence tomography angiography. Patients with healthy eyes were recruited as control participants.ResultsPatients with leukemic retinopathy had higher measurements of white blood cells (WBCs), circulating blasts, fibrin degradation products, and cross-linked fibrin degradation products (D-dimer) and a lower hemoglobin (HB) count (p < 0.05). In the acute phase of the disease, the VD and PD were lower and the ChT was thicker in patients with AML than in controls (p < 0.05), irrespective of the presence of leukemic retinopathy; however, the patients were partially recovered in the remission stage. The VD was lower in patients with higher WBC (r = −0.217, p = 0.036), D-dimer (r = −0.279, p = 0.001), fasting blood glucose (FBG) (r = −0.298, p = 0.004) and triglyceride (r = −0.336, p = 0.001) levels. The FAZ area was negatively correlated with HB (r = −0.258, p = 0.012).ConclusionPatients with AML appear to have subclinical retinal perfusion loss and choroidal thickening in the acute phase of the disease, but this is reversible. Injury to bone marrow function may cause a decrease in retinal perfusion. Leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography

et al. 2023

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“…None of the 14 patients had ocular symptoms, and the VA was 20/20 in all eyes. The cohort overlaps with a previous paper from our group investigating retinal circulation in AL (Cicinelli et al, 2022).…”

Section: Resultsmentioning

confidence: 74%

Imaging biomarkers of leukaemic choroidopathy

Menean

Apuzzo

Mastaglio

et al. 2023

Acta Ophthalmologica

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Purpose To longitudinally investigate choroidal and choriocapillaris perfusion metrics and the number of choroidal hyperreflective foci (HRF) in patients with acute leukaemia (AL) before and after disease remission and to correlate these metrics with systemic parameters during active disease. Methods Prospective, longitudinal study of 26 eyes of 14 AL patients. All patients underwent optical coherence tomography (OCT) and OCT‐angiography (OCTA) in the acute phase. Subfoveal choroidal thickness (CT), total, luminal and stromal choroidal area (TCA, LCA, SCA), choroidal vascularity index (CVI), choriocapillaris flow deficits (cFD) density, and choroidal HRF number were computed. In a subset, the measurements were repeated after AL remission. Age‐ and gender‐matched 26 healthy controls were recruited for cross‐sectional comparisons. Results Patient's mean age was 59 ± 12 years. The TCA, LCA, SCA and choroidal HRF number were significantly higher in patients than controls (p = 0.028, p = 0.044, p = 0.024 and p = 0.001, respectively). Lower haemoglobin levels were associated with lower CT (r = 0.58, p = 0.008). Higher D‐dimer values were associated with lower TCA (r = −0.52, p = 0.008), lower LCA (r = −0.50, p = 0.006), higher cFD density (r = 0.41, p = 0.044) and higher choroidal HRF number (r = 0.47, p = 0.008). The CT, TCA, SCA and choroidal HRF number significantly reduced after AL remission (p = 0.001, p = 0.047, p = 0.007 and p = 0.002 respectively). The CVI increased significantly compared to the active phase (p = 0.013). Conclusion The study demonstrates a subclinical choroidal involvement in patients with AL, with relative stromal thickening in the acute phase, and normalization after disease remission. Choroidal HRF were identified as a biomarker of leukaemic choroidopathy. Choriocapillaris and choroidal vascularity were inversely correlated with a systemic pro‐coagulant state.

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“…OCTA, a novel noninvasive technique, was recently adopted to quantitatively measure retinal and choroidal microvasculature in different ocular and systemic diseases, such as glaucoma (27,28), age-related macular degeneration (29-31), optic neuropathies (32-35), leukemia (36), diabetic retinopathy (37)(38)(39)(40), and TAO (14,19,20,41,42), and to evaluate the severity and prognosis of these diseases. Our study showed that the macular retinal VD was significantly decreased in the ODE and NODE groups compared with the normal group.…”

Section: Discussionmentioning

confidence: 99%

Decreased macular choriocapillaris in thyroid-associated ophthalmopathy: focusing on chorioretinal folds with and without optic disc edema

et al. 2023

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PurposeThe aim of this study was to evaluate the vessel density (VD) of the macular choriocapillaris (CC) and retina in thyroid-associated ophthalmopathy (TAO) patients with chorioretinal folds (CRFs) with and without optic disc edema (ODE) and the correlations of these characteristics with visual function.MethodThis was a cross-sectional study. Twenty TAO patients with CRFs (35 eyes) and 20 normal subjects (normal group, 40 eyes) were recruited at the Ophthalmology Department of the Sun Yat-sen Memorial Hospital from March 2018 to October 2022. Then, CRF patients were divided into two groups, the ODE and non-ODE groups (NODE), based on the presence or absence of ODE. All the patients underwent optical coherence tomography angiography (OCTA) and the VD of the macular CC and retina was computed. The correlation of VD and visual function was analyzed.ResultsCompared with the normal group, the macular whole-image VD in the retinal superficial layer (SLR-mwiVD: 49.82 ± 3.38 in the normal group, 42.44 ± 5.40 in the NODE group, and 42.51 ± 5.37 in the ODE group), deep layer (DLR-mwiVD: 51.05 ± 6.23 in the normal group, 45.71 ± 6.66 in the NODE group, and 46.31 ± 5.48 in the ODE group), and CC (CC-mwiVD: 70.23 ± 2.47 in the normal group, 68.04 ± 3.73 in the NODE group, and 63.09 ± 6.51 in the ODE group) was decreased in the NODE (all p < 0.05) and ODE group (all p < 0.01). There was no difference in these parameters except CC-mwiVD between the ODE and NODE groups. The CC-mwiVD in the ODE group (63.09 ± 6.51) was significantly reduced compared with that in the NODE group (68.04 ± 3.73, p = 0.004). All these VD parameters were negatively correlated with BCVA, VF-PSD, and P100 latency and positively associated with VF-MD, P100 amplitude, and HRR scores (all p < 0.05).ConclusionsThere was a significant decrease in the VD of the macular CC and retina of patients with CRFs with or without ODE, which was correlated with visual dysfunction. The VD of the macular CC in CRF patients with ODE was significantly reduced compared with that in the NODE group, but similar results were not observed in the retina.

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Retinal Microvascular Changes in Patients With Acute Leukemia

Cited by 8 publications

References 32 publications

Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography

Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography

Imaging biomarkers of leukaemic choroidopathy

Decreased macular choriocapillaris in thyroid-associated ophthalmopathy: focusing on chorioretinal folds with and without optic disc edema

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