Editor(s)
Prof. Jaffu Othniel Chilongola
Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Tumaini University, Tanzania.


ISBN 978-93-5547-605-0 (Print)
ISBN 978-93-5547-606-7 (eBook)
DOI: 10.9734/bpi/nhmmr/v5


This book covers key areas of  Medicine and Medical Research. The contributions by the authors include pregnancy, RBC indices, thyroid dysfunction, overt hypothyroidism, subclinical hypothyroidism, euthyroid, preeclampsia, asymptomatic bacteriuria, Hypothyroidism, thyroid dysfunction, thyroid stimulating hormone, cytotoxicity, heavy metals, ayurvedic method of detoxification, ayurveda medication, chronic illnesses, dying distress intervention, breast cancer, choriocapillaris flow, deep vascular plexus, foveoretinal detachment, high myopia, myopic foveoschisis, foveal avascular zone, myopic macular degeneration, myopic macular hole, myopic macular hole associated retinal detachment, myopic traction maculopathy, superficial vascular plexus, vessel density, coronary heart disease, hypercholesterolemia, low-density lipoprotein, nudge,  coronary artery disease, low density protein, ductal carcinoma, bleeding disorders, dental treatment, oral health, strongyloidiasis, gastritis, immunohistochemistry, human papillomaviruses. This book contains various materials suitable for students, researchers and academicians in the field of  Medicine and Medical Research.

 

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Chapters


Association and Correlation of Thyroid Hormones with Anaemia Types in Pregnant Women

Prabhavathi V, Prasad DKV

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 1-10
https://doi.org/10.9734/bpi/nhmmr/v5/1846B

The present study aimed   to measure the prevalence of thyroid dysfunction and to study their association with anaemia types in pregnant women.

In this study, Three hundred and eighty pregnant women with a gestational age of 12 weeks who had no history of thyroid dysfunction or anaemia were chosen. All pregnant women were divided into two groups: A, euthyroid, and B, thyroid dysfunction. According to the nature of the dysfunction, the B group was further subdivided into hypothyroid, subclinical hypothyroid (SCH), and hyperthyroid. Thyroid hormones and erythrocyte indices were measured in all subjects using 5 mL of blood. According to the findings, Out of 380 participants, 77.9% were found to be euthyroid, while the remaining 22.1 %had thyroid dysfunction. Hypothyroidism was detected in 7.9% of the cases, SCH in 13.9 %, and hyperthyroidism in 0.3 %of the cases. Anemia was found in 97 pregnant women (32.8 %) out of 296 euthyroid women, whereas it was found in 43 women out of 84 (51.2 %) in thyroid dysfunction women, that is significant statistically. There was no statistically significant difference between the thyroid dysfunction groups in Hb concentration, RBC count, MCV, MCH, and PCV between euthyroid and different thyroid dysfunction conditions (p<0.05). The correlation between fT4 and erythrocyte indices was found to be statistically significant. Because fT4 and TSH are correlated with erythrocyte indices, screening for thyroid dysfunction and vice versa is recommended to avoid the complications associated with anaemia and thyroid dysfunction.

The current study sought to determine the prevalence of thyroid dysfunction, particularly subclinical hypothyroidism (SCH), in children and adolescents in northern Andhra Pradesh, as well as its relationship with hyperlipidemia. Some  clinicians consider  SCH as a benign normal variation and thyroid hormone can be supplemented to lower the TSH levels and the exact cause of TSH elevation is unknown. A retrospective study of 600 subjects (Children=272, Adolescents=328) between 6-19 years of age were included and the following parameters were examined: age, sex, total triiodothyronine (tT3), total tetraiodothyronine (tT4), thyroid stimulating hormone (TSH), total cholesterol, triglycerides (TGL), LDL and HDL cholesterol. The subjects were divided into two groups based on their age (in years), with those aged 6 to 12 years in group I and those aged 12 to 19 years in group II.  Thyroid dysfunction was found to be prevalent in 9.9 percent and 10.4 percent of the 272 children and 328 adolescents studied, respectively. Subclinical hypothyroidism was found in 7.7 percent of children and 4.9 percent of adolescents. Females were more affected by thyroid dysfunction than males in both groups. When compared to euthyroid participants, SCH subjects had significantly higher serum levels of total cholesterol, TSH, and TGL (p<0.05).When compared to euthyroids, SCH had statistically significant reduced levels of HDL cholesterol (p<0.05). Between SCH and euthyroids, there was no difference in total T3, total T4, or LDL cholesterol levels. The prevalence of thyroid dysfunction in the study population was found to be 10.2 percent. SCH was found in 7.7 percent of children and 4.9 percent of adolescents, respectively. With a prevalence of 6.2 percent, subclinical hypothyroidism (SCH) was the most common thyroid dysfunction found in our study population (both children and adolescents).

The present study aimed to determine the prevalence of asymptomatic bacteriuria among antenatal women and its impact on perinatal and maternal outcomes.300 antenatal women at Anil Neerukonda Hospital were screened for ASB in this prospective study. Urine culture was performed on blood agar and Mac Conkey's agar for antibiotic sensitivity testing using the standardised Kirby-Bauer disc diffusion method. ASB was found to be present in 11.33 percent of the population. Out of 34 ASB positive instances, 8 (23.5%) were born with a birth weight of less than 2500 grammes, compared to 11 (4.1%) in unexposed cases (RR 5.68, 95 percent CI; 2.46-13.15; p<0.05). When compared to unexposed cases, preterm low birth was observed in 5 (14.7 percent) cases of ASB positive pregnant women (RR 1.5, 95 percent CI; 0.61-3.65, p=0.36). In terms of maternal outcomes, preterm labour was seen in 8 (23.5%) of ASB exposed women and 22 (8.3%) of non-exposed women (RR 2.84, 95 percent CI; 1.37-5.88, p=0.004). When comparing ASB positive and ASB negative cases, a considerable number of women developed hypertension (17.6%) and preeclampsia (8.8%). (4.9 percent and 2.3 percent respectively).In this investigation, ASB was found to be prevalent in 11.33 percent of the participants. Regular and repeated trimester wise screening need to be incorporated as a routine antenatal care for an integrated approach for safe motherhood and newborn health.

The current study sought to ascertain the prevalence of thyroid dysfunction and the need for universal screening in pregnant women. Three hundred and eighty pregnant women between the ages of 20 and 32, with gestational ages ranging from 8 to 36 weeks, were recruited. Chemiluminescence was used to measure the levels of free T3, free T4, and TSH in the blood. Based on the findings of the study, the pregnant women were divided into four groups: euthyroid, subclinical hypothyroid (SH), overt hypothyroid (OH), and overt hyperthyroid (OH).In this study, the mean ± SD age (in years) and BMI of all pregnant women was 23.9±3.9 and 22.9±1.6 respectively. The maternal age was statistically significant (p<0.05) in OH and overt hyperthyroidism. Similarly, women with a high BMI were more likely to develop OH than women with a normal BMI (p<0.05).Thyroid dysfunction was found to be prevalent in 18.7% of the population. Hypothyroidism was prevalent in 17.4% of the population, with the SH at 13.4% and overt hypothyroidism at 3.9 percent, but overt hyperthyroidism at 1.3 percent. TSH levels are higher with gestational age, rising from 2.72±1.85 IU/mL in the first trimester to 3.4±2.05 µIU/mL in the third trimester, with a statistically significant difference (p<0.05). Finally, it was discovered that the prevalence of elevated TSH in high-risk pregnant women was higher than in low-risk women (35.6 percent vs 5.1 percent), with a relative risk (RR) of 7.64, a 95 percent confidence interval (CI) of 4.62-12.65, and a p-value of 0.0001. However, 14 of the 51 people with SH (27.5 percent) were in the low-risk group.The results of this study found that 18.7% of pregnant women have thyroid dysfunction, emphasising the significance of screening all pregnant women for thyroid dysfunction, not just high-risk pregnant women, to avoid both maternal and foetal morbidity.

herbo-mineral drugs are unique Ayurvedic metallic preparations known in the Indian subcontinent for several centuries and have several benefits that have been instrumental in their widespread use in treatment of different disorders by traditional medicinal practitioners. These include better stability, lower dosage, ease of storability and sustained availability. In the herbo-metallic preparations, the particles used have a diameter of about 10–15 nm. Bhasma is now been considered Ayurvedic nanomedicine and provides opportunity for drug designing employing modern concept of nanomedicine. In order to combat the harmful effects produced as a result of single drug or formulations containing the metal, Ayurveda emphasizes a process, namely Shodhana (purification). It is stated in the various treatises that processing of the mineral drugs mentioned in Rasashastra (Indian Iatrochemistry) with classically prescribed traditional purification procedures consisting of medicinal herb juices/decoctions can help reduce poisonous effects and also potentiate their therapeutic value. Recently Pankajakasthuri formulated ZingiVir-H, a herbo-mineral Ayurvedic medicine targeted for managing various viral fevers, Bronchitis and Acute Respiratory tract infections. This medicine was formulated using five potent herbs and two purified heavy metals (Mercuric sulphide - HgS and Arsenic trisulphide - As2S3). The toxicity associated with metallic constituents used for preparing the medicine was removed by subjecting to various detoxifying processes as described in the century-old classical literatures of Ayurveda. However, one criticism levelled at Ayurvedic metal-derived drugs is a lack of empirical evidence for their claimed non-toxicity after detoxification. Given the widespread misconception, we intend to use MTT assay and ROS production to assess the cellular toxicity of ZingiVir-H and its two heavy metal ingredients (raw and at various stages of detoxification) in the L6 rat myoblast cell line. Purified HgS and As2S3 had significantly lower cellular toxicity in the MTT assay when compared to their raw forms. In the MTT assay, ZingiVir-H recorded non-toxicity when compared to that of raw heavy metals. Alternatively, purified HgS and As2S3 also recorded a significant reduction in ROS production when compared to that of raw HgS and As2S3. Finally, ZingiVir-H and the drug without its metal constituents recorded only 4.5±0.33% and 1.1±0.23% of ROS. These results established that the detoxification of HgS and As2S3 leads to a significant reduction of toxicity as well as the ROS production. Further, the quantitative analysis by X-ray diffractometer evidently revealed that the percentage of arsenic, mercury and sulphur was significantly reduced after the detoxification/purification of HgS and As2S3. By abiding the scientifically validated traditional purification techniques for poisonous medicinal plants and metals, it is possible to ameliorate their toxic effects and enhance their therapeutic efficacy. In addition to this, we conducted an oral toxicity study of ZingiVir-H in wistar rats. Treatment with ZingiVir-H daily for a continuous 28 days in experimental animals did not show any signs of toxicity. Histopathological examination of vital organs revealed normal architecture, suggesting no morphological alterations after ZingiVir-H treatment. These results demonstrated that ZingiVir-H did not possess the potential to induce any toxicity in the animals. Finally, the safety of ZingiVir-H tablets for the use of humans at a maximum dose of 1500 mg/ kg/day is scientifically established. Then we conducted a pilot clinical study to demonstrate the preliminary evaluation of the efficacy and safety of ZingiVir-H in hospitalized adults diagnosed with viral infection. Here in this study ZingiVir-H recorded a significant effect in managing viral infection. The Liver Function Test (LFT) and Renal Function Test (RFT) parameters before and after treatments were within the recommended clinical range, which established the hepato-renal safety of the ZingiVir-H in the study subjects. Thus, this study eventually proved that ZingiVir-H is highly effective and safe in managing viral fever in humans. Based on our findings, we hope that this research paper will attract widespread interest in order to confirm the toxicity threshold of herbomineral drugs and purified heavy metals according to Ayurvedic principles via cytotoxicity testing. Unambiguously, we can conclude that ZingiVir-H is nontoxic for human administration using scientific investigations such as in-vitro cytotoxicity assays, in-vivo animal toxicity experiments, and a pilot clinical study.

Study about Cancer and Potential Death: Updated Role of Mindfulness

A. M. Tacon

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 61-65
https://doi.org/10.9734/bpi/nhmmr/v5/2025B

Patients suffering with chronic progressive diseases like cancer must deal with the reality of loss practically on a daily basis as their condition worsens: as treatments and side effects take their toll; and death is a likely outcome. One intervention that holds promise in the combined area of thanatology (death) and cancer is mindfulness-based stress reduction. The objective  here is to provide an update as to mindfulness interventions that focus on death and loss-related  factors in those with cancer  A plethora of cancer studies indicates its effectiveness in producing beneficial outcomes, for example, reduction in scores for stress, anxiety, etc. While recent research advances the use of mindfulness interventions to include loved ones and caregivers, of those with cancer, future studies of mindfulness interventions also are needed for terminally ill where disease and death, loss and grief  intersect.

Determination of Quantitative Macular Perfusion Assessment in Surgical and Non-surgical Cases of Early-stage Myopic Traction Maculopathy

Miguel A. Quiroz-Reyes , Erick A. Quiroz-Gonzalez, Miguel A. Quiroz-Gonzalez, Virgilio Lima-Gomez

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 66-91
https://doi.org/10.9734/bpi/nhmmr/v5/2853C

The present study aimed to compare quantitative changes in macular perfusion in normal eyes, healthy highly myopic eyes, eyes with myopic foveoschisis (MF)/foveoretinal detachment (FRD) not treated surgically, and eyes with early stages of macular traction maculopathy (MTM) and fully resolved myopic FRD treated surgically.

This retrospective, consecutive, comparative, interventional, single-surgeon, case-control study was carried out on 118 eyes (104 individuals) between October 2015 and April 2021. Subjects included normal emmetropic eyes (control emmetropia, n = 25); healthy myopic eyes (control high myopia, n = 20); eyes with MF/FRD not treated surgically (non-surgical observational group, n = 28); and structurally fully resolved myopic eyes with FRD treated surgically (surgically treated group, n = 45). Spectral-domain optical coherence tomography (SD-OCT) and OCT angiography were used to assess long-term postoperative structural, functional, and perfusional outcomes.

According to the findings, In the surgical group, the mean evolution time of myopic FRD was 6.2 ± 3.6 months. The mean follow-up time was 25.9 ± 10.3 months. The mean time for the myopic FRD resolution was 4.6 ± 1.9 weeks. In the FRD surgical group, median best-corrected visual acuity increased from 0.90 logarithm of the minimum angle of resolution (logMAR; 0.60–1.00) to 0.30 logMAR (0.09–1.00), a highly significant improvement (p < 0.0001). The groups' quantitative vascular density (VD) evaluation results were considerably different (p < 0.001). The superficial foveal avascular zone (FAZ) area was significantly greater in the non-surgical group (p < 0.0001). Lower SD-OCT structural postoperative findings and higher VD quantification values were strongly connected with better final visual acuity results (p < 0.05). The observational group had a considerably higher central subfoveal thickness while the surgical group had a significantly lower central subfoveal thickness (both p<0.05).).

Our findings revealed that the surgical group had a higher rate of postoperative microstructural abnormalities on SD-OCT (91.4%) than the non-surgical group, as well as a high rate of statistically significant VD quantitative deficiencies and FAZ abnormalities, and marked improvement in VD and FAZ in the fully surgically resolved myopic FRD group (p < 0.05).

Reaching LDL-C Goals Using Nudges: A Review of Literatures

Reagan F. Cabahug

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 92-97
https://doi.org/10.9734/bpi/nhmmr/v5/15780D

To review literatures and analyse how nudges can help a physician attain patients’ LDL-C goals. Reduction in coronary events rates in high-risk patients is workable by modifying cardiovascular risk factors. Coronary heart disease is the leading cause of death in the United States and most European countries (CHD). The primary risk factor for coronary artery disease is hypercholesterolemia. High-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) are both significant risk factors for coronary heart disease (CHD). Hydroxymethylglutaryl-CoA (HMG-Co-A) inhibitors are the most effective treatment for lowering LDL-C levels and, as a result, lowering cardiovascular death and morbidity. A nudge occurs when a choice architecture is designed to predictably control behaviour without limiting an individual's choice.  The direction and force of a nudge should be consistent with professional standards in order for it to be effective. The article described how the actions of patients and physicians contributed to the rising prevalence of cardiovascular diseases. Nudges, whether digital or manual (using post-its), can be effective in persuading physicians to be proactive and in increasing patients' adherence to therapy. In order to achieve these objectives, trust between the patient and the physician is essential. Nudges can be an effective management tool for guiding correct behaviour among healthcare providers. The strategy is to persuade doctors that they are useful rather than annoying or controlling noodges. 

Current Management of Ductal Carcinoma in situ (DCIS)

Fernando Cordera, Rodrigo Arrangoiz

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 98-117
https://doi.org/10.9734/bpi/nhmmr/v5/1901B

Ductal carcinoma in situ (DCIS) is a non-invasive malignancy that develops within the breast ductal system's basement membrane. The natural history of DCIS is highly variable, with an estimated incidence of progression to invasive ductal carcinoma ranging from 20% to 53% ten years or more after the first diagnosis. DCIS surgical and adjuvant management has come a long way in the previous two decades. Despite this, surgeons, medical oncologists, and radiation oncologists, as well as their patients, continue to make management decisions based on traditional clinical and pathologic risk factors. The concurrence of DCIS and invasive carcinoma within one lesion suggests that DCIS is a precursor lesion to invasive carcinoma.  Long-term survival is great regardless of management method. The issue regarding DCIS revolves around avoiding either under- or over-treatment.   The objective of this chapter is to review the incidence and management options of DCIS. We will look at some of the current debates surrounding DCIS care, such as breast conserving surgery, the role of radiation in breast conserving surgery, sentinel node biopsy in DCIS, hormone therapy, risk classification, and the option of active surveillance for low-risk DCIS.

A Review on Endodontic Treatment in the Patients with Bleeding Disorders

Nawras Maher Mostafa, Shady Ahmed Moussa Aly

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 118-123
https://doi.org/10.9734/bpi/nhmmr/v5/3324E

Bleeding disorders remain an enigma to the dentist’s world over. The dental treatment of patients with bleeding disorders has been widely discussed in the literature with the aim of developing safe dental procedures. They not only challenge the skills of dental specialists but also raise the question of how these individuals should be managed emotionally as well as psychologically. The high incidence of dental problems is inducing bleeding during treatment which can even be life threatening in certain cases. With proper care, diligence and meticulous treatment planning, there is no dental treatment that cannot be performed in such patients. Mild bleeding disorder patients can be easily managed and can effectively undergo even surgical endodontic, however, severe bleeding disorder condition can pose significant health hazard and needs thorough preparation to meet any exigencies arising during the treatment. The majority of literature recommends how to deal with bleeding disorder patients in different cases during endodontic treatment. Non-surgical endodontic treatment of those patients totally safe and should be preferred over extraction as possible and can be done routinely, but for surgical endodontic treatment the consultation of the patient’s hematologist should be considered.

A Case Report on Gastroduodenal Strongyloidiasis Causing Protein Losing Enteropathy

S. Bharti, A. Singh, R. Kirti, . Navneet

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 124-130
https://doi.org/10.9734/bpi/nhmmr/v5/2034B

Strongyloidiasis is a widespread illness with a complicated life cycle that infects humans percutaneously. We discuss the case of a 46-year-old lady who arrived with abdominal pain and distention. She was on PPI for recurrent gastritis. She also discusses her steroid use for joint pain. A USG of the abdomen revealed significant ascites. Endoscopy of the upper gastrointestinal tract revealed diffuse erythematous gastric mucosa with a mild mosaic pattern, as well as edematous duodenal mucosa with patchy erythema. Strongyloides stercoralis was found to be infested in the stomach mucosal glands during histopathological investigation of a gastric sample. After a course of antihelmintic medication, the patient was entirely recovered.  This is a case report of gastroduodenal strongyloidiasis with presenting symptom of abdominal pain and ascites.

Breast Cancer: Immunohistochemical and Molecular Study of the HER-2 Oncoprotein in Congolese Women

Anicet Luc Magloire Boumba, Fabien Gaël Mouamaba, Sidney Frousse Christian Ngatali , Dimitry Moudiongui Mboungou Malanda, Donatien Moukassa, Jean Félix Peko

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 131-145
https://doi.org/10.9734/bpi/nhmmr/v5/2841C

Introduction: Breast cancer is a diverse disease with a wide range of morphological and molecular characteristics that influence treatment response.

Objective: The purpose of this study was to evaluate by immunohistochemistry and RT-PCR the overexpression of HER2 in breast cancer in women in the Republic of Congo.

Materials and Methods: An 8-month cross-sectional descriptive study was carried out. 25 paraffin biopsies were taken from breast cancer patients at the University Hospital of Brazzaville. The epidemiological, clinical, histological, immunohistochemical, and molecular aspects of the disease were investigated.

Results: The mean age of the patients was 49.64 ± 13.20 years (31-80 years). 60% of the patients had a right localization of the tumor. Invasive nonspecific type carcinoma was found in 76% of the patients. The T4b N1a M0 stage was the most common, accounting for 56% of the study population. Sixty percent of patients had SBR histopronostic grade 1. The percentages of positive oestrogen and progesterone receptors were 45 and 60%, respectively. The HER2 oncoprotein was found to be positive in 12% (3/25) of the 25 cases tested for IHC. With 32%, the luminal group was in the majority. RT-PCR analysis of the HER2 gene revealed overexpression in 60% (15/25) of cases, three of which were already positive for IHC. The "AmoyDx® HER2 Mutation Detection Kit" detected 12 mutations, 10 of which involved exon 20, accounting for 83.33 percent of cases, and 2 mutations involving exon 19, accounting for 16.67 percent of cases. The correlation of the overexpression of the HER2 gene showed a statistically significant difference between the two techniques, p <0.00003.

Conclusion: Because HER2 is a prognostic and predictive marker in breast cancer, it is a promising therapeutic target. However, IHC's highlighting remains time-consuming and prone to false negatives. As a result, when it comes to implementing targeted breast cancer therapies in Congo, molecular analysis could play a critical role in decision-making.

Human Papilloma Virus: Molecular Study in Congolese Women in the Departments of Niari and Bouenza

Luc Magloire Anicet Boumba, Parfait Christy Nganga, Sidney Frousse Christian Ngatali, Ghislain Loubano-voumbi , Donatien Moukassa

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 146-155
https://doi.org/10.9734/bpi/nhmmr/v5/3699E

Background: Human papillomaviruses (HPV) are the cause of many mucosal, benign, and malignant skin pathologies. Some so-called high-risk genotypes, particularly types 16 and 18, are implicated in the development of cervical cancer, one of the most common cancers in women.

Objective: To determine the prevalence of HPV infections and to identify oncogenic genotypes circulating in the departments of Niari and Bouenza.

Materials and Methods: A total of 207 cervical samples were analysed between 2019 and 2020. All samples were subjected to cervico vaginal smears for cytological investigation, and HPV DNA detection and genotyping were carried out using GeneXpert.

Results: The average age of the women who participated in this study was 43.67±12.31 years in Niari and 38.29 ± 10.52 in Bouenza with age intervals ranging from 18 to 80 years.

The following prevalences were discovered by cytological investigation of these samples: : Normal diagnosed in 89.58% (186/207) cases, ASCUS in 5.31% (11/207) cases, LSIL in 2.89% (6/207) cases, and ICC in 1.93% (4/207) cases.  The prevalence of HPV infection was detected in 83.54% (66/186) of women without lesions, 6.32% (5/11) of ASCUS women and 10.12% (8/10) of women with cytological abnormalities [5.06% (4/6) LSIL, and 5.06% (4/4) ICC].

In total, 79 of the 207 women in our study tested positive for one or more HPV-HR types, or 38.16%. In the Niari department, 37.5 percent (48/128) of women tested positive for HPV, whereas in the Bouenza department, 39.24 percent (31/79) of women tested positive for HPV. The number of HPV strains infected ranged from two to more than three. There was no statistically significant relationship between sociodemographic factors and genotyping (p>0.05). HPV-HR prevalence, on the other hand, differed greatly depending on cervical cytology (P 0.001).

Conclusion: The findings suggest that HPV 16 is more prevalent among women in these two departments of Congo.

A Brief Study about Choriocapillaris Vascular Density Changes: Healthy Vs. Advanced Exudative Age-related Macular Degeneration Previously Treated with Multiple Anti-VEGF Intravitreal Injections

Maria Cristina Savastano, Clara Rizzo, Gloria Gambini, Alfonso Savastano, Benedetto Falsini , Daniela Bacherini, Carmela Grazia Caputo, Raphael Kilian, Francesco Faraldi, Umberto De Vico, Stanislao Rizzo

New Horizons in Medicine and Medical Research Vol. 5, 11 April 2022, Page 156-174
https://doi.org/10.9734/bpi/nhmmr/v5/2016B

Purpose: The aim of our study was to highlight the differences between choriocapillaris VD in healthy ae-AMD eyes by OCT-A.

Introduction: The introduction of OCT-A in clinical practice, we have continued to gain considerable advancements in our knowledge regarding age-related macular degeneration, mostly for the exudative type (AMD).

Method: In this observational, cross-sectional study, 21 healthy and 21 ae-AMD eyes, already treated with anti-VEGF, were enrolled. Angio-View retina patterns centered on fovea (6.4 × 6.4 mm) were acquired for all participants using Solix full-range OCT (Optovue Inc., Freemont, CA, USA). The main outcome was to compare choriocapillaris VD between healthy and ae-AMD eyes. Automated measurements of whole image choriocapillaris VD (%) and fovea grid-based (%) were collected for the analysis. Angio-View patterns were used to assess the flow area (mm2) of macular neovascularization (MNV) by contour flow measure algorithm. Best-corrected visual acuity (BCVA) of both groups was also used for the statistical analysis.

Results: The mean age was 60.9 (±8.3) in healthy and 73.33 (±15.05) in ae-AMD eyes. The mean BCVA (ETDRS letters) was 98.47 (±1.50) in healthy and 7.04 (±5.96) in ae-AMD eyes. The Mann–Whitney test comparing choriocapillaries VD for whole and fovea healthy and ae-AMD eyes showed statistical significance (p < 0.0001 (t = 4.91; df = 40) and p < 0.0001 (t = 6.84; df = 40), respectively). Regarding, the correlation between MNV and VD of choriocapillaries, neither whole nor fovea areas were statistically significant (F = 0.38 (R2 = 0.01) and 1.68 (R2 = 0.08), respectively). Furthermore, this study noted greater choriocapillaris non-perfusion in type 3 MNV. Considering the pathogenesis of type 3 MNV, it is particularly interesting to study the choriocapillaris.

Conclusions: Choriocapillaris VD showed a statistically significant reduction in comparison to healthy eyes in ae-AMD eyes. Choriocapillaris impairment can be seen in the early phase of MNV pathogenesis. Future applications would be useful to assess choriocapillaris VD in different MNV such as Type 1, Type 2, Combined Type1-Type 2, retinal angiomatous proliferation (RAP), and polypoidal choroidal vasculopathy (PCV).