Fully Automatic Retinal Vascular Tortuosity Assessment Integrating Domain-Related Information

[Abstract] The fundus of the eye is the only part of the human body that allows a direct non-invasive observation of the circulatory system. Retinal vascular tortuosity presents a valuable potential for diagnostic and treatment purposes of relevant vascular and systemic diseases. This work presents a computational metric for the tortuosity characterization that combines mathematical representations of the vessel segments with anatomical properties of the fundus image such as the vessel caliber, the distance to the optic disc, the distance to the fovea and the distinction between arteries and veins. The evaluation of the prognostic performance shows that the incorporation of the domain-related information allows a reliable characterization of the retinal vascular tortuosity that provides a better representation of the expert perception.This work is supported by the Instituto de Salud Carlos III, Government of Spain and FEDER funds of the European Union through the DTS18/00136 research projects and by the Ministerio de Ciencia, Innovación y Universidades, Government of Spain through the RTI2018-095894-B-I00 research projects; CITIC, Centro de Investigación de Galicia ref. ED431G 2019/01, receives financial support from Consellería de Educación, Universidade e Formación Profesional, Xunta de Galicia, through the ERDF (80%) and Secretaría Xeral de Universidades (20%)Xunta de Galicia; ED431G 2019/0

Neuroretinitis in Epstein Barr virus primary infection

Caso Clínico. Mujer de 36 años que acude a Urgencias por disminución de visión aguda en el OD. Se evidencia edema de papila bilateral con alteraciones significativas en los campos visuales realizados. El estudio sistémico demostró una seroconversión de Ig M para el Virus Epstein Barr. El cuadro se resolvió de forma espontánea con recuperación de la AV inicial. Discusión. La neurorretinitis es una enfermedad que puede ser de origen infeccioso, inflamatorio, autoinmune o vascular, pero a pesar de su etiología variada, suele presentarse con unos signos característicos, que facilitan su diagnóstico. El tratamiento variará dependiendo de la causa de la enfermedad.Case Report. We present the case of a 36 year-old woman who came to the Emergency Department due to loss visual acuity in the right eye. There was demostrate a bilateral papilledema with significative changes in visual fields. The systematic study was positive to Epstein Barr Virus with a seroconversion IgM. The case had a sponteneus resolution and the VA initial was recuperated. Conclusión. The neuroretinitis had multiple ethiology: infection, inflamatory, autoinmune or vascular, but there are some tipical signs which help the diagnosis. The treatment will change in function the disease's ethilogy

Effects of Oral Supplementation with Docosahexaenoic Acid (DHA) plus Antioxidants in Pseudoexfoliative Glaucoma: A 6-Month Open-Label Randomized Trial

Purpose: To assess the effects of antioxidant oral supplementation based on docosahexaenoic acid (DHA) in pseudoexfoliative (PEX) glaucoma. Patients and Methods: A prospective 6-month open-label randomized controlled trial was conducted in patients with PEX glaucoma and adequate intraocular pressure (IOP) control. Patients in the DHA group received a high-rich DHA (1 g) nutraceutical formulation. Ophthalmological examination, DHA erythrocyte membrane content (% total fatty acids), plasma total antioxidant capacity (TAC), plasma malondialdehyde (MDA), and plasma IL-6 levels were assessed. Results: Forty-seven patients (DHA group 23, controls 24; mean age 70.3 years) were included. In the DHA group, the mean IOP in the right eye decreased from 14.7 [3.3] mmHg at baseline to 12.1 [1.5] mmHg at 6 months (P=0.01). In the left eye, IOP decreased from 15.1 [3.3] mmHg at baseline to 12.2 [2.4] mmHg at 6 months (P=0.007). DHA erythrocyte content increased in the DHA group, with significant differences versus controls at 3 months and 6 months (8.1% [0.9] vs. 4.4% [0.7]; P < 0.0001). At 6 months and in the DHA group only, TAC levels as compared with baseline increased significantly (919.7 [117.9] vs. 856.9 [180.3] µM copper-reducing equivalents; P=0.01), and both MDA (4.4 [0.8] vs. 5.2 [1.1] nmol/mL; P  =  0.02) and IL-6 (2.8 [1.3] vs. 4.7 [2.3] pg/mL; P=0.006) levels were lower than in controls. Conclusions: Targeting pathophysiology mechanisms of PEX glaucoma by reducing oxidative stress and inflammation with a high-rich DHA supplement might be an attractive therapeutic approach. Despite the short duration of treatment, decrease in IOP supports the clinical significance of DHA supplementation.Propósito: Evaluar los efectos de la suplementación oral antioxidante basada en el ácido docosahexaenoico (DHA) en el glaucoma pseudoexfoliativo (PEX). Pacientes y métodos: Se realizó un ensayo controlado aleatorio prospectivo abierto de 6 meses en pacientes con glaucoma PEX y control adecuado de la presión intraocular (PIO). Los pacientes en el grupo de DHA recibieron una formulación nutracéutica de DHA (1 g) con alto contenido de riqueza. Se evaluaron el examen oftalmológico, el contenido de membrana de eritrocitos de DHA (% de ácidos grasos totales), la capacidad antioxidante total en plasma (TAC), el malondialdehído en plasma (MDA) y los niveles plasmáticos de IL-6. Resultados: Se incluyeron 47 pacientes (grupo 23 de DHA, controles 24; edad media 70,3 años). En el grupo con DHA, la PIO media en el ojo derecho disminuyó de 14.7 [3.3] mmHg al inicio del estudio a 12.1 [1.5] mmHg a los 6 meses (P = 0.01). En el ojo izquierdo, la PIO disminuyó de 15.1 [3.3] mmHg al inicio del estudio a 12.2 [2.4] mmHg a los 6 meses (P = 0.007). El contenido de eritrocitos de DHA aumentó en el grupo de DHA, con diferencias significativas en comparación con los controles a los 3 meses y 6 meses (8,1% [0,9] frente al 4,4% [0,7]; P <0,0001). A los 6 meses y solo en el grupo con DHA, los niveles de TAC en comparación con la línea base aumentaron significativamente (919.7 [117.9] vs. 856.9 [180.3] µM de equivalentes reductores de cobre; P = 0.01), y ambos MDA (4.4 [0.8] vs. 5.2 [1.1] nmol / mL; P = 0.02) e IL-6 (2.8 [1.3] vs. 4.7 [2.3] pg / mL; P = 0.006) los niveles fueron más bajos que en los controles. Conclusiones: Dirigirse a los mecanismos fisiopatológicos del glaucoma PEX mediante la reducción del estrés oxidativo y la inflamación con un suplemento rico en DHA puede ser un enfoque terapéutico atractivo. A pesar de la corta duración del tratamiento, la disminución de la PIO apoya la importancia clínica de la suplementación con DHA.Propósito: Avaliar os efectos da suplementación oral antioxidante baseada no ácido docosahexaenoico ( DHA) no glaucoma pseudoexfoliativo ( PEX). Pacientes e métodos: Realizouse un ensaio controlado aleatorio prospectivo aberto de 6 meses en pacientes con glaucoma PEX e control adecuado da presión intraocular ( PIO). Os pacientes no grupo de DHA recibiron unha formulación nutracéutica de DHA (1 g) con alto contido de riqueza. Avaliáronse o exame oftalmolóxico, o contido de membrana de eritrocitos de DHA (% de ácidos graxos totais), a capacidade antioxidante total en plasma ( TAC), o malondialdehído en plasma ( MDA) e os niveis plasmáticos de IL-6. Resultados: Incluíronse 47 pacientes (grupo 23 de DHA, controis 24; idade media 70,3 anos). No grupo con DHA, a PIO media no ollo dereito diminuíu de 14.7 [3.3] mmHg ao comezo do estudo a 12.1 [1.5] mmHg aos 6 meses ( P = 0.01). No ollo esquerdo, a PIO diminuíu de 15.1 [3.3] mmHg ao comezo do estudo a 12.2 [2.4] mmHg aos 6 meses ( P = 0.007). O contido de eritrocitos de DHA aumentou no grupo de DHA, con diferenzas significativas en comparación cos controis aos 3 meses e 6 meses (8,1% [0,9] fronte ao 4,4% [0,7]; P <0,0001). Aos 6 meses e só no grupo con DHA, os niveis de TAC en comparación coa liña basee aumentaron significativamente (919.7 [117.9] vs. 856.9 [180.3] µ M de equivalentes reductores de cobre; P = 0.01), e ambos os MDA (4.4 [0.8] vs. 5.2 [1.1] nmol / mL; P = 0.02) e IL-6 (2.8 [1.3] vs. 4.7 [2.3] pg / mL; P = 0.006) os niveis foron máis baixos que nos controis. Conclusións: Dirixirse aos mecanismos fisiopatológicos do glaucoma PEX mediante a redución da tensión oxidativo e a inflamación cun suplemento rico en DHA pode ser un enfoque terapéutico atractivo. A pesar da curta duración do tratamento, a diminución da PIO apoia a importancia clínica da suplementación con DHA

Computational assessment of the retinal vascular tortuosity integrating domain-related information

The retinal vascular tortuosity presents a valuable potential as a clinical biomarker of many relevant vascular and systemic diseases. Commonly, the existent approaches face the tortuosity quantification by means of fully mathematical representations of the vessel segments. However, the specialists, based on their diagnostic experience, commonly analyze additional domain-related information that is not represented in these mathematical metrics of reference. In this work, we propose a novel computational tortuosity metric that outperforms the mathematical metrics of reference also incorporating anatomical properties of the fundus image such as the distinction between arteries and veins, the distance to the optic disc, the distance to the fovea, and the vessel caliber. The evaluation of its prognostic performance shows that the integration of the anatomical factors provides an accurate tortuosity assessment that is more adjusted to the specialists' perception