Ugo Introini

Vita-Salute San Raffaele University

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Francesco Bandello

IRCCS Ospedale San Raffaele

R. Brancato

University of Milan

Maurízio Battaglia Parodi

Vita-Salute San Raffaele University

Fabrizio Scotti

IRCCS Istituto Auxologico Italiano

Alfredo Pece

ASST Melegnano e della Martesana

Giuseppe Casalino

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Marco Setaccioli

Istituti di Ricovero e Cura a Carattere Scientifico

Luisa Pierro

Vita-Salute San Raffaele University

Maria Vittoria Cicinelli

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

G. Bolognesi

Azienda Sanitaria Locale Alessandria

Cooperative Institutions

Vita-Salute San Raffaele University

Istituti di Ricovero e Cura a Carattere Scientifico

San Raffaele University of Rome

Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

IRCCS Ospedale San Raffaele

University of Milan

University of Turin

University of Florence

University College London

Moorfields Eye Hospital

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MULTIZONAL OUTER RETINOPATHY AND RETINAL PIGMENT EPITHELIOPATHY (MORR)

Retina (2023)

Prithvi Ramtohul Alessandro Marchese Ugo Introini Debra A. Goldstein K. Bailey Freund

To describe specific clinical, multimodal imaging, and natural history features of an unusual variant of acute zonal occult outer retinopathy.Retrospective, observational, longitudinal, multicenter case series. Patients exhibiting this unusual clinical condition among cases previously diagnosed with acute zonal occult outer retinopathy were included. Multimodal imaging, laboratory evaluations, and genetic testing for inherited retinal diseases were reviewed.Twenty eyes from 10 patients (8 females and 2 males) with a mean age of 54.1 ± 13.3 years (range, 38-71 years) were included. The mean follow-up duration was 13.1 ± 5.3 years (range, 8-23 years). Presenting symptoms were bilateral in 7 patients (85% of eyes) and included scotomata and photopsia. All patients had bilateral lesions at presentation involving the peripapillary and far peripheral retina. Baseline optical coherence tomography showed alteration of the retinal pigment epithelium and photoreceptor layers corresponding to zonal areas of fundus autofluorescence abnormalities. Centrifugal and centripetal progression of the peripapillary and far-peripheral lesions, respectively, occurred over the follow-up, resulting in areas of complete outer retinal and retinal pigment epithelium atrophy.Initial alteration of photoreceptors and retinal pigment epithelium and a stereotypical natural course that includes involvement of the far retinal periphery, characterize this unusual condition. It may represent a variant of acute zonal occult outer retinopathy or may be a new entity. We suggest to call it multizonal outer retinopathy and retinal pigment epitheliopathy .

Occult

Fundus (uterus)

Outer nuclear layer

10.1097/iae.0000000000003927

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Citations (4)

Indocyanine green angiography in angioid streaks

Acta Ophthalmologica Scandinavica (1997)

Alfredo Pece P. Avanza Ugo Introini Rosario Brancato

To define the indocyanine green angiographic aspects of angioid streaks, peau d'orange and choroidal new vessels.Fifty-seven consecutive patients (112 eyes) with angioid streaks were evaluated by fluorescein angiography and indocyanine green angiography.Indocyanine green angiography showed angioid streaks in all eyes. We identified three different indocyanine green patterns of streaks (four groups): fluorescent (63%), hypofluorescent (8%), 'track-like' (19%) and mixed (10%). Angioid streaks were visualized better by indocyanine green angiography and red-free retinography than fluorescein angiography. Peau d'orange was seen better and found to be more widespread by indocyanine green angiography. Fluorescein angiography visualized choroidal neovascularization better, except for occult forms.Our findings show that angioid streaks have different indocyanine green angiography patterns. Considering that the hypofluorescent pattern was significantly observed in younger patients, indocyanine green angiography aspects might be correlated with different stages of the disease.

Indocyanine Green

Angioid streaks

Indocyanine green angiography

10.1111/j.1600-0420.1997.tb00769.x

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Clinical Course of Treated Choroidal Neovascularization in Eyes with Pre-existing Geographic Atrophy: Case Series and Reappraisal of the Literature

Current Eye Research (2020)

Giuseppe Casalino Alessandro Arrigo Ugo Introini Antonio Scialdone Michele Coppola

Purpose: To report the clinical course of choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) treatment in eyes with pre-existing geographic atrophy (GA).Material and Methods: Multicenter retrospective series. Electronic medical records, clinical notes, and multimodal retinal imaging of patients attending four tertiary referring centers with a diagnosis of unilateral CNV in the context of a pre-existing diagnosis of GA were included. GA was assessed on multimodal retinal imaging including spectral-domain optical coherence tomography (SD-OCT) scan with simultaneous near-infrared (NIR) reflectance imaging (OCT Spectralis, Heidelberg Engineering, Heidelberg, Germany) which was acquired at baseline and every follow-up visit. GA area was measured in treated eyes and fellow eyes using NIR.Results: Fifty-four eyes from 27 patients (23 females, mean age 80.89 ± 7.5) were included. The mean number of injections in the treated eyes was 5.52 ± 1.9 by month 12. From baseline to month 12, stabilization of best-corrected visual acuity (BCVA) and a significant decrease (P = .002) of central macular thickness (CMT) in the treated eyes were observed; there was a slight worsening of BCVA (-2 ETDRS letters) and a non-significant change (P = .4) of CMT in the fellow eyes. GA significantly increased in both treated and untreated eyes (P < .001 and P < .001, respectively) with a similar absolute increase (+2.68 mm2 and +2.59 mm2, respectively) and growth rate (0.4 and 0.34, respectively).Conclusions: In our study anti-VEGF treatment for CNV in eyes with pre-existing GA was effective in terms of decrease of exudative changes and stabilization of VA by month 12. A similar growth rate of GA between treated and untreated eyes does not support a causal relationship between anti-VEGF treatment and GA progression in this subset of patients. Further studies with a longer follow-up are mandatory to confirm these results.

10.1080/02713683.2020.1849730

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Citations (4)

Intravitreal Bevacizumab for Nonsubfoveal Choroidal Neovascularization Associated With Angioid Streaks

American Journal of Ophthalmology (2013)

Maurízio Battaglia Parodi Pierluigi Iacono Carlo La Spina Luigi Berchicci Fabrizio Scotti

Angioid streaks

10.1016/j.ajo.2013.10.015

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Citations (24)

Long-term Incidence and Risk Factors of Macular Fibrosis, Macular Atrophy, and Macular Hole in Eyes with Myopic Neovascularization

Ophthalmology Retina (2022)

Maria Vittoria Cicinelli Lamberto La Franca Elisabetta De Felice Alessandro Rabiolo Alessandro Marchese

10.1016/j.oret.2022.06.009

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Multimodal Imaging Study of Patients With Vitamin A Deficiency Retinopathy

Ophthalmic surgery, lasers & imaging retina (2023)

Francesco Pichi Shaikha Aljneibi Piergiorgio Neri Pukhraj Rishi Maria Vittoria Cicinelli

To describe multimodal imaging findings of vitamin A deficiency retinopathy.A retrospective study of patients with serum retinol < 0.3 mg/L. Fundus color photos, spectral domain-optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) were reviewed and, when available, electrophysiological tests were analyzed.Forty-five eyes (63.9 ± 15.7 years) were included. Ultra-widefield fundus photography showed drusen-like deposits (53.3%) and macular retinal pigment epithelium (RPE) mottling (40%). The deposits were hypoautofluorescent, and a perifoveal hyperautofluorescent ring was present in 8.9%. By SD-OCT, the ellipsoid zone had an irregular appearance (100%) and conical deposits anterior to the RPE (33.3%). Electroretinogram (ERG) (66.7%) showed a decrease in b-wave in the scotopic registers, and microperimetry (4.4%) showed decreased foveal sensitivity. After vitamin A supplementation, SD-OCT and FAF showed resolution of all findings. Forty percent of eyes had restoration of the scotopic registers in ERG and improved macular sensitivity by microperimetry (4.4%).Vitamin A deficiency causes a mild cone dysfunction in addition to the more severe absent rod response. [Ophthalmic Surg Lasers Imaging Retina 2023;54:330-336.].

Microperimetry

Erg

Fundus (uterus)

Scotopic vision

Fundus Photography

Electroretinography

Drusen

10.3928/23258160-20230513-01

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Citations (1)

Clinical Course of Autosomal Recessive Bestrophinopathy Complicated by Choroidal Neovascularization

Ophthalmic surgery, lasers & imaging retina (2018)

Ugo Introini Giuseppe Casalino Kamron Khan Chiara M. Eandi Camilla Alovisi

The authors report the clinical course of two cases of autosomal recessive bestrophinopathy (ARB) complicated by choroidal neovascularization (CNV). One patient presenting with a novel BEST1 mutation (c.658 C>T, p.Gln220*) underwent anti-vascular endothelial growth factor therapy. Response to treatment was documented on optical coherence tomography angiography (OCTA). Despite initial response to treatment, recurrent CNV exudation with progressive subretinal fibrosis was observed. In the second patient, the CNV was not treated and spontaneous regression was observed. This report indicates that the clinical course of CNV in ARB may vary considerably, ranging from spontaneous regression to progressive subretinal fibrosis despite intervention. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:888-892.].

10.3928/23258160-20181101-10

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Citations (7)

Consensus on the diagnosis, treatment and follow-up of patients with age-related macular degeneration eligible for ranibizumab

Expert Review of Ophthalmology (2012)

Alfredo Pece Claudio Azzolini Maurízio Battaglia Parodi Ferdinando Bottoni P. Danzi

Age-related macular degeneration (AMD) is an irreversible pathology that is the principal cause of serious loss of central vision and legal blindness among people over 60 years of age. There are two forms of AMD: the dry, or atrophic form, and the wet, neovascular form. The latter is less frequent but is the cause of approximately 80–90% of cases of serious loss of vision in a short time period. Early diagnosis is therefore essential to permit intervention as promptly as possible. Currently, the most effective therapy for neovascular AMD uses the new class of anti-VEGF drugs, and ranibizumab is today's 'gold standard' for this treatment. The Progetto LUCE (LUCE Project) consists of an advisory board of retinal disease specialists in Lombardy, Italy, whose task is to propose a consensus for the diagnosis, treatment and follow-up of neovascular AMD patients treated with ranibizumab on the basis of a review of the scientific evidence and Italian national health service regulations and the clinical experience of the advisory board members.

10.1586/eop.12.24

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Citations (9)

Indocyanine Green Angiography of Well-Defined Plaque Choroidal Neovascularization in Age-Related Macular Degeneration

Archives of Ophthalmology (2000)

Alfredo Pece G. Bolognesi Ugo Introini G. Pacelli Giliola Calori

To determine the natural course of well-defined plaque choroidal neovascularization (CNV) using indocyanine green angiography.Two ophthalmologists, experts in macular diseases and indocyanine green angiography, examined 40 eyes with exudative age-related macular degeneration and a well-defined plaque CNV using complete ophthalmoscopic evaluation, fluorescein angiography, and indocyanine green angiography. The increase in the size of the plaques was analyzed using multivariate analysis, in relation to the worsening of visual acuity, with adjustment for age, sex, and length of follow-up.Mean follow-up was 13.5 months (median, 11 months). Initial and final mean visual acuity were 20/46 (median, 20/50) and 20/65 (median, 20/100), respectively. The mean initial size of the plaque was 6.62 mm2 (median, 6.20 mm2), and the mean final size was 10.40 mm2 (median, 9.76 mm2). The enlargement was statistically significant (P<.001).We found that plaque CNV tends to become larger with time, the enlargement reaching about 40% in 1 year of follow-up. The resulting loss of visual acuity, however, is not significant, and is slightly correlated with the extension of the lesion; it also does not appear to be directly related to sex.

Indocyanine Green

Indocyanine green angiography

10.1001/archopht.118.5.630

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Citations (7)

Placoid lesions of the retina: progress in multimodal imaging and clinical perspective

British Journal of Ophthalmology (2021)

Alessandro Marchese Aniruddha Agarwal Stefano Erba Antonio Scialdone Elisabetta Miserocchi

Placoid lesions of the retina may be secondary to a wide spectrum of acquired inflammatory conditions that have been reported as single entities with different presentation and clinical course. These conditions include acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, serpiginous-like choroiditis, relentless placoid chorioretinitis and acute syphilitic posterior placoid chorioretinitis. In this article, we will group these conditions under the name of ‘placoids’. The recognition of the specific condition may be challenging in clinical practice, often resulting in diagnostic and therapeutic delay. Given the complex nature of placoids and their similarities, a systematic approach including differentiating between infectious and non-infectious aetiologies increases the chance of reaching the correct diagnosis. Detailed history and comprehensive clinical examination are the first steps to formulate a diagnostic hypothesis that should be corroborated by multimodal imaging and appropriate investigations. The advent of multimodal imaging has made it possible to extensively study placoids and revealed a constellation of specific findings that may help clinicians in the diagnostic process. The treatment of the conditions other than syphilis is complex and sometimes challenging. Our article is aimed at giving an overview of the individual entities associated with placoids and discussing the differential diagnosis. A practical and systematic approach is then proposed.

Chorioretinitis

Choroiditis

10.1136/bjophthalmol-2020-318337

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Citations (18)