Clinical Significance of Retinal Vascular Occlusion in Moyamoya Disease

Seong, Hyo Jin; Lee, Ji Hwan; Heo, Ji Hoe; Kim, Do Kyung; Kim, Yong Bae; Lee, Christopher S.

doi:10.1097/iae.0000000000003181

Cited by 6 publications

(4 citation statements)

References 18 publications

(43 reference statements)

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“…10,[30][31][32][33] However, changes in the retinal vessels may not be significant in young individuals due to their ability to endure ischemic stress. 14 In addition, early signs of retinal vessel alterations due to MMD may be missed. 14 Nevertheless, challenges in retinal hemodynamics that accumulate before the onset of conditions, such as central retinal artery occlusion or central retinal vein occlusion, exert a strain on the retinal vascular structures, leading to microdamage.…”

Section: Discussionmentioning

confidence: 99%

“…14 In addition, early signs of retinal vessel alterations due to MMD may be missed. 14 Nevertheless, challenges in retinal hemodynamics that accumulate before the onset of conditions, such as central retinal artery occlusion or central retinal vein occlusion, exert a strain on the retinal vascular structures, leading to microdamage. 34 Tortuosity of retinal arteries and posterior segment neovascularization with venous dilatation in children are conditions that indicate significant hemodynamic stress on the retina.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple ocular conditions, such as morning glory optic disc anomaly, chorioretinal coloboma, anterior ischemic optic neuropathy, ocular ischemic syndrome, and retinal vascular occlusions, have all been associated with this disease. [9][10][11][12][13][14][15] Although these ophthalmic manifestations associated with MMD have sufficient diagnostic potential, they have not yet been adequately studied. This is due to the fact that minute changes are difficult to observe, while quantitative changes are difficult to measure.…”

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confidence: 99%

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Screening of Moyamoya Disease From Retinal Photographs: Development and Validation of Deep Learning Algorithms

Hong,

Yoon,

Shim

et al. 2024

Stroke

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BACKGROUND: Moyamoya disease (MMD) is a rare and complex pathological condition characterized by an abnormal collateral circulation network in the basal brain. The diagnosis of MMD and its progression is unpredictable and influenced by many factors. MMD can affect the blood vessels supplying the eyes, resulting in a range of ocular symptoms. In this study, we developed a deep learning model using real-world data to assist a diagnosis and determine the stage of the disease using retinal photographs. METHODS: This retrospective observational study conducted from August 2006 to March 2022 included 498 retinal photographs from 78 patients with MMD and 3835 photographs from 1649 healthy participants. Photographs were preprocessed, and an ResNeXt50 model was developed. Model performance was measured using receiver operating curves and their area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score. Heatmaps and progressive erasing plus progressive restoration were performed to validate the faithfulness. RESULTS: Overall, 322 retinal photographs from 67 patients with MMD and 3752 retinal photographs from 1616 healthy participants were used to develop a screening and stage prediction model for MMD. The average age of the patients with MMD was 44.1 years, and the average follow-up time was 115 months. Stage 3 photographs were the most prevalent, followed by stages 4, 5, 2, 1, and 6 and healthy. The MMD screening model had an average area under the receiver operating characteristic curve of 94.6%, with 89.8% sensitivity and 90.4% specificity at the best cutoff point. MMD stage prediction models had an area under the receiver operating characteristic curve of 78% or higher, with stage 3 performing the best at 93.6%. Heatmap identified the vascular region of the fundus as important for prediction, and progressive erasing plus progressive restoration result shows an area under the receiver operating characteristic curve of 70% only with 50% of the important regions. CONCLUSIONS: This study demonstrated that retinal photographs could be used as potential biomarkers for screening and staging of MMD and the disease stage could be classified by a deep learning algorithm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Screening of Moyamoya Disease From Retinal Photographs: Development and Validation of Deep Learning Algorithms

Hong,

Yoon,

Shim

et al. 2024

Stroke

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“…Of 14 patients, retinal vascular occlusion was the presenting sign of Moyamoya disease in 8 (57.1%) patients. Legal blindness occurred in 8 (57.1%) patients at final visits [5]. Vascular occlusion secondary to retrobulbar injection for ocular anesthesia is rare but can be vision threatening [6].…”

Section: Introductionmentioning

confidence: 99%

Retinal Vein Occlusion Treated with QIAPI 1™: Report of a Case

Herrera¹,

Arias²,

Arias

2022

JOJO

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Acute retinal vascular occlusions are frequent causes of visual impairment. Although both retinal artery occlusions and retinal vein occlusions are associated with increased age and cardiovascular risk factors, their pathophysiology, systemic implications, and management differ substantially. Retinal vascular events are perceived to be related to various cardiovascular complications. There is a positive association of retinal vascular events to mortality, stroke, and myocardial infarction. Retinal artery occlusion (RAO) and retinal vein occlusion (RVO) is associated with a higher risk of stroke. Given that RAO and RVO patients would generally present to ophthalmologists, their high cardiovascular risk should include a referral for cardiovascular assessment as part of their management protocol. This article reports the remarkable effects on tissues affected by retinal vascular events, when by pharmacological means, we restore the surprising ability to take energy directly from light, through the dissociation of water, as it happens in plants.

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