Quantitative assessment of intervortex anastomosis in central serous chorioretinopathy and fellow eyes: Does the size of anastomotic vessels matter for the diagnosis?

PURPOSE: To evaluate the frequency and size of intervortex anastomosis at the posterior pole on en-face spectral domain optical coherence tomography (SD-OCT) images in central serous chorioretinopathy (CSC) cases and their fellow eyes and its associations with choroidal morphology. METHODS: Sixty-five treatment-naive eyes of 65 patients with CSC, 65 fellow eyes, and 55 eyes of healthy age-matched participants were included. The presence of intervortex anastomosis at the watershed zone and asymmetry of the choroidal vessels between the superior and inferior macula were evaluated using 6 × 6 mm en-face SD-OCT. The diameter of the widest Haller vessel and the diameter of the widest anastomotic Haller vessel passing through the watershed zone were measured on en-face SD-OCT images. The choroidal vascularity index (CVI) was assessed using ImageJ software. RESULTS: Intervortex vein anastomosis on the horizontal watershed zone was detected in 75.4% diseased eyes, 61.5% in fellow eyes, and 36.4% in healthy age-matched controls (p < 0.001). The mean CVI was significantly higher in both diseased (74.3 ± 2.3%) and fellow (73.8 ± 2.2%) eyes of CSC cases than in healthy controls (72.5 ± 2.3%) (p = 0.002, p = 0.013, respectively). In the cases with intervortex vein anastomosis, the diameter of the widest anastomotic Haller vessel passing through the watershed zone was 0.40 ± 0.10 mm in diseased eyes, 0.35 ± 0.11 mm in fellow eyes, and 0.30 ± 0.09 mm in healthy age-matched controls (p = 0.001). CONCLUSIONS: Intervortex anastomosis might be seen as a variation in normal eyes, however, its frequency and the size of anastomotic vessels are significant higher in not only CSC but also in fellow eyes.

Qualitative and quantitative comparisons of type 1 macular neovascularizations between pachychoroid neovasculopathy and neovascular age-related macular degeneration using optical coherence tomography angiography.

OBJECTIVES: To compare qualitative and quantitative features of type 1 macular neovascularizations (MNV) in pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD). METHODS: Forty-three treatment-naive eyes of 41 PNV patients and 40 treatment-naive eyes of 38 patients with nAMD were included. The patients were classified as PNV or nAMD according to the presence of pachychoroid features and soft/reticular drusen. Presence of central trunk and maturity of the MNV were evaluated on optical coherence tomography angiography (OCTA) images. MNV area, vessel density (VD), total vessel length (VL), number of intersection points (IPs), fractal dimension (FD), and lacunarity (LAC) were calculated using ImageJ software and FracLac plugin. RESULTS: The mean age was 56.8 ± 8.7 years in PNV and 70.4 ± 8.8 years in neovascular AMD groups (p < 0.001). Compared to nAMD, the presence of central trunk was less frequent in PNV (48.8% vs 77.5%, p = 0.007). Immature MNV pattern was observed more frequently in PNV eyes than nAMD (41.9% vs 20.0%, p = 0.009). PNV cases had significantly lower median MNV area [0.913(1.115) vs 2.542(3.273) mm²], total VL [14.84 (20.46) vs 36.34 (44.68) mm], number of IPs [104(140) vs 335(417.3)], and FD [1.56(0.10) vs 1.59(0.11)] comparing to nAMD cases (p < 0.001, p = 0.001, p < 0.001, p = 0.043 respectively). However, the mean VD (42.4 ± 6.8 vs 42.9 ± 9.0%) and the median LAC values [0.42 (0.09) vs 0.42 (0.09)] did not differ significantly between groups (p = 0.776, p = 0.526, respectively). CONCLUSION: Morphological and quantitative differences exist in type 1 neovascular lesions. Type 1 MNVs in the PNV group are characterized by a smaller and less complex structure.

The longitudinal follow-up of a newly proposed OCTA imaging finding (SSPiM) and the importance of it as a new biomarker for treatment response in diabetic macular edema.

PURPOSE: This study aimed to evaluate the frequency of SSPiM (suspended scattering particles in motion), systemic risk factors, ocular findings, progression characteristics, and treatment response in diabetic retinopathy (DR) patients. METHODS: In this prospective study, a total of 109 eyes of 109 patients with diabetic macular edema (DME) were included. Demographic characteristics and systemic data of the patients were recorded. In addition to a detailed ophthalmological examination, optical coherence tomography (OCT) and OCT angiography (OCTA) imaging were performed. According to the OCTA images, the patients were divided into two categories: SSPiM detected (SSPiM +) and undetected (SSPiM -). The patients were followed up at 0, 3, and 6 months. Treatment responses at 6 months in treatment-administered patients with and without SSPiM were examined. RESULTS: The frequency of SSPiM in DME cases was found to be 34.9%. No significant correlation was found between SSPiM and demographic characteristics, systemic, and biochemical parameters (p > 0.05). It was observed that SSPIM was most frequently localized in the outer nuclear layer adjacent to the outer plexiform (81.6%). SSPiM appearance disappeared in 7 (19.4%) of 36 patients with SSPiM who had regular follow-up for 6 months. In 4 (11.1%) of these seven patients, hard exudate plaques developed in the areas where SSPiM disappeared. Regarding treatment response at 6 months, the decrease in CMT was statistically significantly lower in the SSPiM group compared to cases without SSPiM. CONCLUSION: SSPiM is a finding seen in approximately one-third of DME patients and may adversely affect the response to the treatment.

Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life.

Purpose: The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). Methods: The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. Results: In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Conclusions: Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.

Clinical Use of Optical Coherence Tomography Angiography in Retinal Diseases.

The advent of optical coherence tomography angiography (OCTA) is one of the cornerstones of fundus imaging. Essentially, its mechanism depends on the visualization of blood vessels by using the flow of erythrocytes as an intrinsic contrast agent. Although it has only recently come into clinical use, OCTA has become a non-invasive diagnostic tool for the diagnosis and follow-up of many retinal diseases, and the integration of OCTA in multimodal imaging has provided a better understanding of many retinal disorders. Here, we provide a detailed overview of the current applications of OCTA technology in the diagnosis and follow-up of various retinal disorders.

Retinal Vascular Tortuosity Index Change after Idiopathic Epiretinal Membrane Surgery: Does Internal Limiting Membrane Peeling Affect Retinal Vascular Tortuosity?

BACKGROUND: Idiopathic epiretinal membrane (iERM) surgery is one of the most commonly performed vitreoretinal surgeries, and the issue of internal limiting membrane (ILM) peeling in ERM surgery is still controversial. The aims of this study are to evaluate the changes in retinal vascular tortuosity index (RVTI) after pars plana vitrectomy for the iERM using optical coherence tomography angiography (OCTA) and to assess whether ILM peeling has an additional effect on RVTI reduction. METHODS: This study included25 eyes of 25 iERM patients who underwent ERM surgery. The ERM was removed without ILM peeling in 10 eyes (40.0%), and the ILM was peeled in addition to the ERM in 15 eyes (60.0%). The existence of the ILM after ERM peeling was checked with second staining in all eyes. Best corrected visual acuity (BCVA) and 6 × 6 mm en-face OCTA images were recorded before surgery and at the first month postoperatively. A skeleton model of the retinal vascular structure was created following Otsu binarization of en-face OCTA images using ImageJ software (1.52U). RVTI was calculated as the ratio of each vessel length to its Euclidean distance on the skeleton model using the Analyze Skeleton plug-in. RESULTS: The mean RVTI declined from 1.220 ± 0.017 to 1.201 ± 0.020 (p = 0.036) in eyes with ILM peeling and from 1.230 ± 0.038 to 1.195 ± 0.024 in eyes without ILM peeling (p = 0.037). There was no difference between the groups in terms of postoperative RVTI (p = 0.494). A statistically significant correlation was found between postoperative RVTI and postoperative BCVA (rho = 0.408, p = 0.043). CONCLUSIONS: The RVTI is an indirect indicator of the traction created by the iERM on retinal microvascular structures, and it was effectively reduced after iERM surgery. The postoperative RVTIs were similar in cases who underwent iERM surgery with or without ILM peeling. Therefore, ILM peeling may not have an additive effect on the loosening of microvascular traction and thus may be reserved for recurrent ERM surgeries.

An Atypical Case of Exogeneous Endophthalmitis after Intravitreal Injection Presenting with Roth Spots.

PURPOSE: To report an atypical case of exogeneous endophthalmitis presenting with Roth spots. CASE: A 67-year-old man presented with decreased vision, mild pain, and discomfort in his left eye 12 days after an intravitreal aflibercept injection. Best-corrected visual acuity was 20/200, and there were +3 anterior chamber cells. On fundus examination, multiple intraretinal hemorrhages with a central white core resembling a Roth spot were observed. Intravitreal antibiotic injections were performed, and a vitreous sample was taken. Although post-intravitreal injection history was available, full systemic screening was planned to rule out endogenous endophthalmitis because of the presence of these Roth spots. Vitrectomy was performed and methicillin-sensitive coagulase-negative Staphylococcus was detected on culture. CONCLUSION: Although the presence of Roth spots is an unexpected finding in post-injection endophthalmitis, it was nevertheless demonstrated in our case. For this reason, it should be kept in mind that Roth spots can be encountered in bacterial endophthalmitis.

Choroidal structural features of acquired vitelliform lesions in non-exudative age-related macular degeneration.

PURPOSE: To define the choroidal morphological characteristics of non-exudative age-related macular degeneration (AMD) cases associated with acquired vitelliform lesions (AVLs). METHODS: This retrospective study included intermediate AMD patients with AVLs (Group1, 21eyes) and without AVLs (Group2, 21eyes). A healthy control group was (Group3, 23eyes) also included. Subfoveal choroidal thickness (SFCT), greatest basal diameter (GBD), and maximum height (MH) of the largest PED were measured on spectral domain optical coherence tomography. Internal reflectivity of PEDs and total choroidal area (TCA) were measured using ImageJ software. The TCA was binarized to the luminal area (LA) and stromal area. The choroidal vascularity index (CVI) was assessed. RESULTS: The mean SFCT, TCA, and LA were higher in Group 1 (290.3 ± 86.8 µm, 0.840 ± 0.302 mm2, 0.602 ± 0.227 mm2) than in Group 2 (215.6 ± 85.0 µm, 0.594 ± 0.183 mm2, 0.429 ± 0.139 mm2) (p = 0.014, p = 0.017, p = 0.020, respectively). There was no significant difference in the CVI measurements between Group 1 and Group 2 (p = 1.000). The mean GBD and MH of the PED was higher in Group 1 (1443 ± 595 µm, 188 ± 86 µm) than in Group 2 (851 ± 368 µm, 119 ± 38 µm) (p = <0.001, p = 0.001, respectively). Internal PED reflectivity was significantly lower in Group 1 (0.44 ± 0.21) than in Group 2 (0.66 ± 0.17) (p = <0.001). Internal PED reflectivity showed negative correlation with GBD and MH of the PED in Group 1 (r = -0.587, p = 0.005; rho = -0.448, p = 0.042, respectively). In Group 2, internal PED reflectivity had a negative correlation with MH of the PED (rho = -0.511, p = 0.018). CONCLUSION: Non-exudative AMD patients with AVLs are more prone to have a thick choroid and large hyporeflective PEDs as compared to the those without AVLs.

Seroreactivity against retinal proteins in a case of POC1B gene associated cone dystrophy with normal funduscopic appearance: a systematic approach to diagnosis.

PURPOSE: To report a case of cone dystrophy, associated with autosomal recessive homozygote POC1B gene variant, mimicking autoimmune retinopathy. CASE: A 45-year-old female presented with a complaint of decreased vision in both eyes. Her best corrected visual acuity was 20/32 in the right eye and 20/50 in the left eye. Anterior segment and dilated fundus examinations were unremarkable. Spectral domain optical coherence tomography showed a subfoveal blurred dome-shaped ellipsoid zone and an extinguished interdigitation zone affecting the entire macula. Full field electroretinography revealed reduced cone responses. The differential diagnosis included inflammatory chorioretinopathies, autoimmune retinopathies (paraneoplastic or nonparaneoplastic), and hereditary retinal dystrophies. No remarkable finding was observed on combined fluorescein and indocyanine green angiographies. Paraneoplastic autoimmune antibody panel revealed nothing; however, aldolase, enolase, pyruvate kinase M2, and glyceraldehyde-3-phosphate dehydrogenase antibodies were positive on autoimmune retinopathy panel. To exclude hereditary retinal dystrophies, whole-exome sequencing (WES) was applied. WES identified an autosomal recessive homozygote POC1B gene variant (c.680A>G, p.His227Arg). Cone dystrophy diagnosis was given. CONCLUSION: Cone dystrophy associated with POC1B gene variant may present without visible fundus abnormalities. It should be kept in mind that retinal autoantibodies may be positive in such a hereditary dystrophy case due to long-term exposure of the immune system to self-antigens. Therefore, autoimmune retinopathy is a diagnosis of exclusion and should not be diagnosed until all other causes, including hereditary dystrophies, have been ruled out.

Pediatric Uveitis in Turkey: The National Registry Report II.

PURPOSE: To report demographic and clinical profiles of children with uveitis in theTurkishpopulation. METHODS: The data of the pediatric uveitis cases in the nation wide uveitis database were analyzed. RESULTS: The study included 697 eyes of 442 patients with a meanage of 10.8 ± 3.8 years. There were 333 patients (75.3%) with non-infectious uveitis and 69 patients (15.6%) with infectious uveitis. Pars planitis (20.1%) was leading clinical form followed by idiopathic cases with uveitis other than pars planitis (18.8%), juvenile idiopathic arthritis(JIA) related uveitis (12.4%), Behçet uveitis (9.3%) and toxoplasma retinochoroiditis (7.9%). Ocular involvement was unilateral in 187 patients (42.3%) and bilateral in 255 patients (57.7%). The most common anatomiclocation of uveitis was anterior uveitis (39.1%), followed by intermediate uveitis (29.4%), panuveitis (16.1%) and posterior uveitis (15.4%). CONCLUSION: The most common systemic association was JIA in the younger children and Behçet disease in the older children.

Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study.

PURPOSE: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. METHODS: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. RESULTS: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.

Association Between Optical Coherence Tomography Angiography Findings and Inner Retinal Thickness in Diabetic Patients.

Objectives: To investigate the association between optical coherence tomography angiography (OCTA) findings and inner retinal thickness (IRT) in diabetic patients. Materials and Methods: This retrospective study included 23 eyes of 23 diabetic patients with retinopathy (group 1), 30 eyes of 30 diabetic patients without retinopathy (group 2), and 27 eyes of 27 non-diabetic age-matched controls (group 3). Foveal avascular zone (FAZ) area (mm2), average vessel density (%) in the parafoveal region, and average IRT in the parafoveal region (µm) were calculated using 6x6 mm OCTA images. Correlations between IRT and OCTA findings were analyzed. Results: The mean FAZ area was 0.32±0.11 mm2 in group 1, 0.29±0.08 mm2 in group 2, and 0.22±0.09 mm2 in group 3. There were statistically significant differences between groups 1 and 3 (p<0.001) and between groups 2 and 3 (p=0.001). Average IRT was 108.02±9.42 µm in group 1, 110.12±11.01 µm in group 2, and 114.41±5.21 µm in group 3, with statistically significant differences between groups 1 and 3 (p=0.003) and between groups 2 and 3 (p=0.014). In both group 1 and group 2, average IRT was correlated with FAZ area (r=-0.320 and -0.512, respectively). Conclusion: The inner retina is significantly thinner in diabetic patients with and without retinopathy compared to controls. Quantitative OCTA findings and IRT are correlated in diabetic patients, suggesting that both structures are compromised in patients with diabetes with or without retinopathy. Microvascular changes in FAZ detected by OCTA might precede neurodegenerative changes.

A Case of Rhegmatogenous Retinal Detachment With an Unpredictable Macular Tear Treated With Autologous Retinal Graft.

A 40-year-old male presented with decreased vision following trauma from a stone. The view of the posterior segment was precluded due to cortex material. Ocular ultrasonography detected total retinal detachment. During 25-G pars plana vitrectomy, a large macular tear was observed. Because this finding was not expected, autologous retinal graft was the only possible surgical option to close this macular tear. A retinal graft was taken from the periphery and spread over the macula. At the postoperative period, the retinal graft was in place and integrated with the tear. An autologous retinal graft may be an effective surgical option in the presence of macular tear. [Ophthalmic Surg Lasers Imaging Retina 2022;53:575-578.].

A Comparative Study of Short-Term Vascular and Stromal Alterations of the Choroid Following Half-Fluence Photodynamic Therapy in Pachychoroid Neovasculopathy and Chronic Central Serous Chorioretinopathy.

Background: Central serous chorioretinopathy (CSCR) and pachychoroid neovasculopathy (PNV) are among the pachychoroid spectrum diseases (PSDs). Half-fluence photodynamic therapy (hf-PDT) is one of the effective treatment methods for both diseases. The aim of this study was to compare the effect of hf-PDT on the choroidal structure in CSCR and PNV. Methods: This study included 35 patients with chronic CSCR and 18 patients with PNV. The hf-PDT protocol was applied to all eyes. Before and 3 months after hf-PDT, enhanced-depth optical coherence tomography images were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Results: Compared with baseline values, 3 months after hf-PDT, the mean CA reduced from 1.398 to 1.197 mm2 (p < 0.001) in the CSCR group and the total CA reduced from 1.050 to 1.000 mm2 (p < 0.021) in the PNV group. The mean percentage changes in CA, LA, and SA values were statistically higher in the chronic CSCR group (13.86%, 13.53%, and 14.11%, respectively) than those in the PNV group (4.61%, 4.02%, and 5.74%; p = 0.001, p = 0.002, and p = 0.031, respectively). Conclusion: CSCR and PNV are thought to be PSDs. However, they differ in choroidal morphological response after hf-PDT, which might be a result of the different structural components of the PNV lesions.

Visualization of Type-1 Macular Neovascularization Secondary to Pachychoroid Spectrum Diseases: A Comparative Study for Sensitivity and Specificity of Indocyanine Green Angiography and Optical Coherence Tomography Angiography.

BACKGROUND: The aim of this study was to compare optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA) in detecting type-1 macular neovascularization (MNV) in pachychoroid spectrum diseases. METHODS: Patients with pachychoroid characteristics who had undergone ICGA and OCTA imaging at the same visit, were recruited. The diagnosis of MNV was made by a senior retina specialist using multimodal imaging techniques. Afterward, both ICGA and OCTA images were separately reviewed by a masked-independent senior retina specialist with regard to the presence of MNV. The specificity, sensitivity, positive, and negative predictive values of ICGA and OCTA were analyzed. RESULTS: OCTA was able to detect MNV with 97.2% sensitivity, failing to detect MNV only in one eye. The sensitivity of ICGA to detect MNV was 66.76%. The negative predictive value of OCTA was 94.7%; however, this value was 60% for ICGA. Multimodal imaging and OCTA were in almost perfect agreement (kappa coefficient = 0.95). CONCLUSION: OCTA shows greater sensitivity when detecting type-1 MNV than ICGA in pachychoroid neovasculopathy cases. OCTA is a non-invasive and quick imaging modality that can be preferred to dye angiography in the visualization of type-1 MNV in pachychoroid neovasculopathy.

Choroidal structural alterations in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy.

PURPOSE: To assess choroidal structural changes in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. METHODS: This retrospective cross-sectional study included treatment-naive patients with non-proliferative DR (NPDR) (group 1), diabetic patients without DR (group 2), and healthy subjects (group 3). Patients were also grouped according to the duration of diabetes: long-term group (> 15 years, n = 32) and short-term group (˂ 15 years, n = 28). The choroidal thickness was measured at three points; subfoveal, 1500 µm nasal, and 1500 µm temporal to the fovea. The choroidal area, stromal area, luminal area (LA), and choroidal vascularity index (CVI) were quantified using ImageJ. Partial correlation analysis and one-way analysis of covariance test were performed for statistical analysis. RESULTS: The study included 30 eyes of 30 treatment-naive patients with NPDR (group 1), 30 eyes of 30 diabetic patients without DR (group 2), and 30 eyes of 30 healthy persons (group 3). The mean subfoveal, nasal, and temporal choroidal thicknesses were decreased in group 1 in comparison with controls (p < 0.001, p = 0.035, and p = 0.005, respectively). The mean LA in group 1 and group 2 were both significantly lower compared to group 3 (group 1 vs. group 3, p = 0.004; group 2 vs. group 3, p = 0.020). CVI was significantly lower in group 1 and group 2 than in controls (group 1 vs. group 3, p = 0.019; group 2 vs. group 3, p = 0.025). CVI was significantly lower in the long-duration group than in the short-duration group (p < 0.001). A moderate negative correlation was found between the duration of diabetes and CVI (r = - 0.467, p < 0.001). A moderate negative correlation was found between HbA1c level and luminal area and CVI (r = - 0.466, p < 0.001, and r = - 0.425, p < 0.001, respectively). CONCLUSION: Choroidal structure and CVI are altered even in the absence of clinically confirmed retinopathy and these alterations are related to the duration of diabetes.

Atypical Chronic Central Serous Chorioretinopathy Mimicking Vogt-Koyanagi-Harada Disease: Full Therapeutic Response to Half-Fluence Photodynamic Therapy

The aim of this case report is to describe a case of atypical central serous chorioretinopathy (CSCR) definitively diagnosed after 8 years. A 44-year-old woman presented with reduced visual acuity in her left eye. Her visual acuity was light perception with projection in the right eye and 0.15 in the left. She described a similar decline in vision in her right eye 8 years ago. At that time, she had exudative retinal detachment and was treated with systemic immunosuppressive therapy for a presumed diagnosis of Vogt-Koyanagi-Harada disease. Despite resolution of the exudative retinal detachment, macular scarring developed. Eight years later, she developed inferior exudative retinal detachment in the left eye. A diagnosis of atypical CSCR was made with the help of multimodal imaging and her left eye was successfully treated with eplerenone and half-fluence photodynamic therapy (hf-PDT). In conclusion, early diagnosis and treatment of atypical CSCR may prevent subretinal fibrosis formation and permanent vision loss. Hf-PDT and eplerenone are successful treatment options for atypical CSCR.

Treatment outcomes of photodynamic therapy and findings predicting treatment success in pachychoroid-associated neovascularization.

PURPOSE: To investigate the treatment outcomes and predictive factors affecting treatment success of half-fluence photodynamic therapy (hf-PDT) in pachychoroid-associated neovascularization (PNV). METHODS: Twenty-four eyes of 23 PNV patients who underwent hf-PDT were included in this study. The results of optical coherence tomography (OCT) and OCT-angiography imaging were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Baseline characteristics of the eyes showing complete response (group 1) and the eyes with partial response or unresponsive to hf-PDT (group 2) were compared. RESULTS: The mean age of the patients was 54.2±9.6 years. The mean follow-up time after hf-PDT was 20.7 ± 13.6 months. Three months after hf-PDT, the subretinal fluid had completely regressed in 18 eyes (75.0%), partial resolution was observed in 3 eyes (12.5%), and 3 eyes (12.5%) were unresponsive to hf-PDT. When the baseline characteristics before hf-PDT were evaluated between the groups, the mean central choroidal thickness (411.5 ± 115.1 µm vs 284.8 ± 69.4 µm), the mean CA (1.082 ± 0.315 mm2 vs 0.795 ± 0.242 mm2) and the mean LA (0.795 ± 0.234 mm2 vs 0.578 ± 0.200 mm2) was significantly higher in group 1 compared to group 2 (p = 0.019, p = 0.018, p = 0.018, respectively). CONCLUSION: Hf-PDT is an effective treatment method usually providing total resolution of subretinal fluid in PNV cases. A high baseline central choroidal thickness and large luminal area may be positive predictive factors in terms of full anatomical response to hf-PDT. It may be possible to plan a more effective treatment strategy by keeping these factors in mind.

A Comparative Study of Choroidal Vascular and Structural Characteristics of Typical Polypoidal Choroidal Vasculopathy and Polypoidal Choroidal Neovascularization: OCTA-Based Evaluation of Intervortex Venous Anastomosis.

BACKGROUND: The aim of this study was to compare the choroidal characteristics of typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV) cases, and to investigate the presence of intervortex venous anastomoses in these PCV subtypes by using en face optical coherence tomography angiography (OCTA). METHODS: A total of 35 eyes of 33 PCV cases were included. The PCV cases were divided into T-PCV and P-CNV groups. The choroidal vascularity index (CVI) was calculated. En face OCTA images were evaluated for the presence of intervortex venous anastomoses. The diameter of the largest anastomotic Haller vessel was measured. RESULTS: T-PCV cases had significantly higher mean CVI values (73.9 ± 3.7 vs. 70.8 ± 4.5%) than P-CNV cases (p = 0.039). Intervortex venous anastomoses were observed in 85.7% of T-PCV eyes and in 91.7% of P-CNV eyes on en face OCTA (p = 1.000). In the cases with intervortex venous anastomosis, the mean diameter of the largest anastomotic vessel on en face OCTA was 341.2 ± 109.1 µm in the T-PCV and 280.4 ± 68.4 µm in the P-CNV group (p = 0.048). CONCLUSIONS: The higher CVI value in T-PCV may be an important feature concerning the pathogenesis and classification of PCV. Although there was no difference between the two subtypes in terms of intervortex anastomosis, more dilated anastomotic vessels were observed in the T-PCV.

Vascular and structural alterations of the choroid evaluated by optical coherence tomography angiography and enhanced-depth imaging optical coherence tomography in eyes with reticular pseudodrusen and soft drusen.

BACKGROUND: To assess the vascularity of choriocapillaris and structural choroidal differences in eyes with reticular pseudodrusen (RPD) and soft drusen. METHODS: 21 eyes with RPD (group 1), 17 eyes with soft drusen (group 2), and 19 eyes as a control group (group 3) were included in this study. Choriocapillaris vascular density and flow area were measured by optical coherence tomography angiography. Total choroidal area, luminal area, stromal area, and lumen/stroma ratios were measured on optical coherence tomography B-scans converted to binary images. RESULTS: Mean choriocapillaris vascular density was higher in group 3 than other groups (group 1 vs 3, p = 0.001; group 2 vs 3, p = 0.003). Mean flow area in choriocapillaris was higher in group 3 than other groups (group 1 vs 3, p = 0.001; group 2 vs 3, p = 0.001). Mean luminal, stromal, and total choroidal areas decreased in group 1 and group 2 compared to controls (p < 0.001, p < 0.001, and p < 0.001, respectively). The stroma ratio decreased in group 1 compared to group 3 (p = 0.013). The lumen ratio and lumen/stroma ratio increased in group 1 compared to group 3 (p = 0.012 and p = 0.008, respectively). CONCLUSIONS: The choroid of eyes with RPD and soft drusen was affected in both choriocapillaris and whole choroid layer.