Optical coherence tomography angiography (OCTA) has become increasingly established as a diagnostic procedure in clinical practice in recent years. In the field of medical retina in particular, it serves as a useful aid to the morphological assessment of vascular diseases such as neovascular age-related macular degeneration and diabetic retinopathy. Technically speaking, it is a further development of optical coherence tomography (OCT) and therefore offers the advantage of being non-invasive. Even though other imaging modalities still need to be used for certain clinical matters, OCTA offers a suitable alternative to invasive procedures in some situations or can be a helpful supplement in cases of unclear findings. In addition, OCTA has led to a better understanding of the pathophysiology and course of vascular diseases in a scientific context. Recent developments have already reduced or eliminated some of the limitations of OCTA and further improvements for use in clinical practice can be expected in the future.
Abstract:Less frequent retinal disorders associated with vascular alterations frequently present a diagnostic and therapeutic challenge. Vascular alterations may develop either at the posterior pole or peripheral of the vascular arcades, while subjective signs and visual function loss usually develop when the macula is involved. The differential diagnosis includes myopic macular neovascularisation, macular telangiectasia type 1, MacTel 2, pseudoxanthoma elasticum with angioid streaks, retinal arterial macroaneurysms, Coats disease and the combination of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN syndrome). Due to the low prevalence, early signs are often overlooked or misdiagnosed, and the diagnosis is established when secondary complications develop. Early detection is of high relevance for the affected patients: treatment in early stages may avert severe and permanent visual function loss. The development of multimodal retinal imaging techniques including optical coherence tomography, optical coherence tomography angiography, and widefield fluorescein angiography has markedly improved the early detection and differential diagnosis of these disorders. Differential diagnosis and definition of the disease stage is mandatory for a treatment according to current guidelines, recommendations or clinical experience. Larger studies to define optimal treatment regimens require multicenter cooperation and are not available for all disorders mentioned. The present review provides a concise overview of the early diagnosis, differential diagnosis and stage-related treatment regimens of these less frequent retinal vascular disorders.
The cornea plays a pivotal role in visual quality, accounting for most of the eye's refractive power. It is also frequently affected by a wide range of pathological conditions. Accurate diagnostics are therefore fundamental for making therapeutic decisions. This review provides an overview of established and emerging methods for examining the cornea, ranging from slit-lamp biomicroscopy and vital dyes to corneal topography, tomography, pachymetry, assessments of the endothelium and nerves, anterior segment optical coherence tomography, and biomechanical measurements.
The cornea plays a pivotal role in visual quality, accounting for most of the eye's refractive power. It is also frequently affected by a wide range of pathological conditions. Accurate diagnostics are therefore fundamental for making therapeutic decisions. This review provides an overview of established and emerging methods for examining the cornea, ranging from corneal pachymetry, assessments of the endothelium and nerves, anterior segment optical coherence tomography, and biomechanical measurements. Advances in high-resolution imaging and multimodal platforms have significantly improved the early detection of disease, risk stratification and monitoring. Furthermore, AI-supported multimodal approaches integrate topo-/tomography data for personalized risk assessment and mark the future of corneal diagnostics.
Retinal artery occlusion (RAO) remains one of the most vision-threatening conditions in ophthalmology. Most patients experience a dramatic, unilateral and painless loss of vision, which can lead to blindness. No causal therapy has yet been established, which is why there is currently no obligation to treat. Intravenous fibrinolysis therapy is currently being investigated in clinical trials and is the most promising option to date, but its benefits have not yet been proven. This therapy is established for ischaemic stroke but is based on the very narrow 4.5-hour time window which is comparable to stroke therapy. This time window has not yet been definitively established for RAV, but clinically every minute counts. Emergency admission to a neurological clinic is recommended, as there is an increased risk of further embolic and ischaemic events. Even though underlying giant cell arteritis (GCA) is rare, GCA must always be considered as a possible cause.
Wherever consumer fireworks are used, incidents with eye injuries do occur. In Germany, their number has increased in the past nine years, a clear overrepresentation of minors and bystanders is documented. Eyes are affected by a very individual combination of thermal, chemical and mechanical impact, resulting in minor to most complex injuries to adnexes, eye surface, iris, lens, sclera and/or posterior segment. Diagnostics may be complicated and require a structured approach, that is proposed here. Open globe injuries and intraocular foreign bodies necessitate early surgical intervention. In thermal and chemical burns early rinsing and antiphlogistic therapy is major for prevention of scarring and secondary glaucoma. The need for early or late replacement of limbal stem cells may yet emerge. Consequences of blunt trauma can be traumatic cataract, phakic or pseudophakic lens luxation, ruptures to all structures of the eye with long-term effects such as retinal detachment, choroidal or retinal pigment epithelial rupture and formation of choroidal neovascular membranes (CNV). Medical and surgical strategies are discussed. Despite all proven and innovative care strategies of therapy, functional and cosmetic outcome of fire work induced eye injuries might be impaired. In cases of severe injuries, social security coverage and rehabilitation must be considered early on.
