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Pachychoroid spectrum disease and choriocapillary flow analysis in patients with Cushing disease: an optical coherence tomography angiography study

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To investigate the presence of pachychoroid spectrum disease (PSD) in patients with Cushing disease (CD) and to evaluate subfoveal choroidal thickness (SFCT) and choriocapillary flow using spectral domain OCT (SD-OCT) with the enhanced depth imaging (EDI) and optical coherence tomography angiography (OCT-A).

Methods

Thirty-two patients with CD and 32 age- and sex-matched healthy volunteers were enrolled in this observational study. All participants had a complete ophthalmic examination including SD-OCT with EDI and OCT-A, and were subjected to the Perceived Stress Scale test (PSS). All patients with CD had hormone test including 24-h urinary-free cortisol (UFC) and plasma adrenocorticotropic hormone (ACTH). We compared SFCT and choriocapillary vessel density (CVD) between the two groups and evaluated the presence of PSD. We investigated the association of hormone level, SFTC, CVD with the presence of CD; the association between the hormone level, SFTC, CVD, the CD disease activity, and duration with the presence of PSD in CD patients; and the association between SFTC and CVD with the hormone level, the CD disease activity, and duration in CD patients.

Results

Higher values of SFCT and CVD were associated with CD (β: 0.028, 95% CI: 0.014; 0.041; β: 0.912, 95%CI: 0.205; 1.62, respectively). Twelve patients with CD (37.5%) reported a PSD in at least one eye, whereas no subject was found in control group (p < 0.001); in particular, 11 CD patients (34%) presented pachychoroid pigment epitheliopathy (PPE) and 1 CD patient (3%) presented polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization (PCV/AT1). In patients with CD, a significant positive association between SFCT and PSD was found (β: 0.010, 95% CI 0.001; 0.019).

Conclusion

A chronic state of hypercortisolism may have direct implications on the choroid. Patients with CD had higher SFCT values and a significant change in the choriocapillary flow compared to healthy controls. Moreover, PSD was observed only in CD patients.

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Authors and Affiliations

  1. Eye Clinic, AOU Ospedali Riuniti Ancona - Polytechnic University of Marche, via Conca 61, 60126, Ancona, Italy

    Nicola Vito Lassandro, Michele Nicolai, Alessandro Franceschi, Paolo Pelliccioni & Cesare Mariotti

  2. Division of Endocrinology, AOU Ospedali Riuniti Ancona - Polytechnic University of Marche, Ancona, Italy

    Giorgio Arnaldi

  3. Clinical Oncology, AOU Ospedali Riuniti Ancona - Polytechnic University of Marche, Ancona, Italy

    Luca Cantini

  4. Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic University of Marche, Ancona, Italy

    Rosaria Gesuita & Andrea Faragalli

Authors
  1. Nicola Vito Lassandro
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  2. Michele Nicolai
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  3. Giorgio Arnaldi
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  4. Alessandro Franceschi
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  5. Paolo Pelliccioni
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  6. Luca Cantini
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  7. Rosaria Gesuita
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  8. Andrea Faragalli
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  9. Cesare Mariotti
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Contributions

Nicola Vito Lassandro was involved in the study conception and design. Material preparation, data collection, and analysis were performed by Nicola Vito Lassandro, Michele Nicolai, Luca Cantini, Alessandro Franceschi, Rosaria Gesuita, and Andrea Faragalli. The first draft of the manuscript was written by Nicola Vito Lassandro and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alessandro Franceschi.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ospedali Riuniti of Ancona Local Scientific committee.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

Conflict of interest

The authors declare no competing interests.

Disclaimer

The principal investigator, Dr. Lassandro Nicola Vito had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis.

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Lassandro, N.V., Nicolai, M., Arnaldi, G. et al. Pachychoroid spectrum disease and choriocapillary flow analysis in patients with Cushing disease: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 260, 1535–1542 (2022). https://doi.org/10.1007/s00417-021-05524-2

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  • DOI: https://doi.org/10.1007/s00417-021-05524-2

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