Fluorescein versus Indocyanine Green Angiography Guided Half-Dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy.

Purpose: To compare the outcomes of fluorescein angiography (FA)-guided and indocyanine green angiography (ICGA)-guided half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC). Methods: In this retrospective comparative study, medical records of eyes with chronic CSC who underwent half-dose PDT were reviewed. A retina specialist performed FA-guided half-dose PDT, and the other performed ICGA-guided treatment. The success of applying PDT in the resolution of subretinal fluid was compared between the FA- and ICGA-guided methods. Results: Eighty-two eyes of 73 patients (41 eyes in each group) received half-dose PDT. After half-dose PDT, a significant improvement in the best-corrected visual acuity (BCVA) was found at the time of the last follow-up in both groups (both P < 0.001), with no significant intergroup difference. Central subfield and subfoveal choroidal thicknesses decreased significantly in both groups at the last follow-up (all P < 0.05), with no significant differences between the groups. Subretinal fluid (SRF) resolved in all eyes, and no persistent SRF was detected during the follow-up period. Conclusion: FA-guided and ICG-guided half-dose PDT may have similar efficacy for the treatment of chronic CSC.

Evaluating the Efficacy and Safety of Aflibercept Biosimilar (P041) Compared with Originator Product in Patients with Neovascular Age-Related Macular Degeneration.

OBJECTIVE: To assess the noninferiority of biosimilar aflibercept (P041, CinnaGen) to the originator aflibercept (AFL, Regeneron) in terms of efficacy, safety, and immunogenicity. DESIGN: This was a phase Ш, 52-week, multicenter, randomized, double-masked, and active control trial involving eyes in a 1:1 ratio. SUBJECTS: Patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration randomized into the 2 groups of P041 and AFL. METHODS: Patients received an injection of aflibercept every 4 weeks for 3 doses, followed by administration every 8 weeks up to week 48. MAIN OUTCOME MEASURES: The primary outcome was the noninferiority analysis of eyes maintaining vision at week 52. Secondary outcomes included the changes in visual acuity and retinal thickness, safety evaluation, and immunogenicity during the study. RESULTS: In total, 168 eyes of 168 patients were included. At week 52, the proportion of patients maintaining vision was 94.44% in the P041 group compared with 94.52% in the AFL group. The 95% confidence interval (CI) for the difference of maintaining vision from baseline did not exceed the predefined noninferiority margin of 10% (difference, -0.0008; 95% CI, -0.074 to 0.074; P = 0.98). Secondary outcomes indicated similar results in both arms (all P > 0.05). Safety measured outcomes and immunogenicity were similar between the 2 study groups. CONCLUSIONS: Biosimilar aflibercept was noninferior to AFL in eyes with neovascular age-related macular degeneration. Other efficacy and safety findings also indicated the similarity of 2 products. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Neurodegeneration with Brain Iron Accumulation Disorders and Retinal Neurovascular Structure.

BACKGROUND: The unique neurovascular structure of the retina has provided an opportunity to observe brain pathology in many neurological disorders. However, such studies on neurodegeneration with brain iron accumulation (NBIA) disorders are lacking. OBJECTIVES: To investigate NBIA's neurological and ophthalmological manifestations. METHODS: This cross-sectional study was conducted on genetically confirmed NBIA patients and an age-gender-matched control group. The thickness of retinal layers, central choroidal thickness (CCT), and capillary plexus densities were measured by spectral domain-optical coherence tomography (SD-OCT) and OCT angiography, respectively. The patients also underwent funduscopy, electroretinography (ERG), visual evoked potential (VEP), and neurological examination (Pantothenate-Kinase Associated Neurodegeneration-Disease Rating Scale [PKAN-DRS]). The generalized estimating equation model was used to consider inter-eye correlations. RESULTS: Seventy-four patients' and 80 controls' eyes were analyzed. Patients had significantly decreased visual acuity, reduced inner or outer sectors of almost all evaluated layers, increased CCT, and decreased vessel densities, with abnormal VEP and ERG in 32.4% and 45.9%, respectively. There were correlations between visual acuity and temporal peripapillary nerve fiber layer (positive) and between PKAN-DRS score and disease duration (negative), and scotopic b-wave amplitudes (positive). When considering only the PKAN eyes, ONL was among the significantly decreased retinal layers, with no differences in retinal vessel densities. Evidence of pachychoroid was only seen in patients with Kufor Rakeb syndrome. CONCLUSION: Observing pathologic structural and functional neurovascular changes in NBIA patients may provide an opportunity to elucidate the underlying mechanisms and differential retinal biomarkers in NBIA subtypes in further investigations. © 2023 International Parkinson and Movement Disorder Society.

Stem Cell Therapy in Stargardt Disease: A Systematic Review.

This article aimed to review current literature on the safety and efficacy of stem cell therapy in Stargardt disease. A comprehensive literature search was performed, and two animal and eleven human clinical trials were retrieved. These studies utilized different kinds of stem cells, including human or mouse embryonic stem cells, mesenchymal stem cells, bone marrow mononuclear fraction, and autologous bone marrow-derived stem cells. In addition, different injection techniques including subretinal, intravitreal, and suprachoroidal space injections have been evaluated. Although stem cell therapy holds promise in improving visual function in patients with Stargardt disease, further investigation is needed to determine the long-term benefits, safety, and efficacy in determining the best delivery method and selecting the most appropriate stem cell type.

Optical Coherence Tomography Angiography Findings after Acute Intraocular Pressure Elevation in Patients with Diabetes Mellitus versus Healthy Subjects.

Purpose: To assess the changes in optic nerve head and macular microvascular networks after acute intraocular pressure (IOP) rise in healthy eyes versus the eyes of diabetic patients. Methods: In this prospective, interventional, comparative study, 24 eyes of 24 adults including 12 eyes of healthy nondiabetic subjects and 12 eyes with mild or moderate non-proliferative diabetic retinopathy (NPDR) were enrolled. IOP elevation was induced by a suction cup attached to the conjunctiva. IOP and optical coherence tomography angiographic (OCTA) images of the optic disc and macula were obtained before and immediately after the IOP rise. Results: Baseline and post-suction IOPs were not significantly different between the two groups (all P > 0.05). The mean IOP elevation was 13.93 ± 3.41 mmHg among all eyes and was statistically significant as compared to the baseline in both groups (both P < 0.05). After IOP elevation, healthy eyes demonstrated a reduction in the vessel density in the whole image deep and superficial capillary plexuses and parafoveal deep capillary plexus (DCP) (all P < 0.05). In diabetic retinopathy, foveal vessel density at DCP decreased significantly following IOP rise (P = 0.003). In both groups, inside disc vessel density decreased significantly after IOP rise (both P < 0.05), however, no significant change was observed in peripapillary vessel density (both P > 0.05). Conclusion: Acute rise of IOP may induce different levels of microvascular changes in healthy and diabetic eyes. Optic disc microvasculature originating from the posterior ciliary artery may be more susceptible to IOP elevation than that of retinal microvasculature.

"Inverted Snowing-Cloud" Sign in Endogenous Candida Endophthalmitis.

Candida spp. is the most common cause of endogenous fungal endophthalmitis. The diagnosis of this rare disease is based on clinical findings supported by positive blood culture. Recently, it has been shown that optical coherence tomography (OCT) characteristic findings are beneficial in making a correct diagnosis of fungal infection in cases with endogenous endophthalmitis. The current photo-essay aims to highlight the role of OCT in diagnosis of Candida endogenous endophthalmitis where OCT imaging of one of the retinal lesions disclosed a pre-retinal hyper reflective lesion with overlying punctate vitreous opacities. We propose "inverted snowing-cloud" sign for this OCT pattern considering the resemblance of the vitreous opacities to snowflakes.

Correlation between global prevalence of vision impairment and depressive disorders.

PURPOSE: To assess the correlation of the worldwide prevalence of visual impairment and depressive disorders. METHODS: This is an ecologic study on Global Burden of Disease 2019 data. Global and national prevalence numbers and rates of vision impairment (VI) and depressive disorders were obtained from database. The human development index (HDI) and socio-demographic index (SDI) were derived from international open databases. Main outcome measures were the correlation of the VI and depressive disorders in total and different age, sex, and socioeconomic subgroups. RESULTS: In 2019, the worldwide prevalence of total VI and total depressive disorders were 9.6% (95% Uncertainty Interval (UI): 8.0-11.3) and 3.8% (95% UI: 3.4-4.2), respectively. The prevalence rates of total VI (r = 0.38, P < 0.001) as well as cataract (r = 0.43, P < 0.001), age-related macular degeneration (AMD) (r = 0.32, P < 0.001), refractive disorders (r = 0.19, P < 0.001) and near vision loss (r = 0.33, P < 0.001) correlated, positively, with dysthymia. In addition, the prevalence rates of glaucoma (r for total depressive disorders = 0.37, P < 0.001 and r for major depressive disorders (MDD) = 0.38, P < 0.001) and AMD (r for total depressive disorders = 0.37, P < 0.001 and r for MDD = 0.28, P < 0.001) had a positive correlation with MDD and total depressive disorders. The correlations remained significant in sociodemographic subgroups. CONCLUSION: There was a significant correlation between national prevalence rates of VI and ocular disabilities with depressive disorders, worldwide.

The effect of intravitreal recombinant tissue plasminogen activator injection on diabetic tractional fibrovascular membranes: Proposed criteria using optical coherence tomography.

PURPOSE: To evaluate the effect of intravitreal recombinant tissue plasminogen activator (tPA) on diabetic tractional fibrovascular membranes (FVM) using proposed optical coherence tomography (OCT) criteria. METHODS: This prospective, interventional case series enrolled eyes with tractional retinal detachment who were candidates for pars plana vitrectomy. OCT images were obtained to evaluate the border of the attached-detached retina and overlying FVP at baseline and 1 week post-intravitreal tPA injection using the follow-up scan acquisition protocol. Two independent graders assessed retinal detachment (RD) height, FVM height, and retinal thickness at the site of membrane attachment. RESULTS: Thirteen eyes from 13 individuals were included. Assessment of RD height, FVM height, and retinal thickness at membrane attachment point were feasible at both visits in 10/13 (77%), 10/13 (77%), and 8/13 (62%) of eyes, respectively. There was excellent agreement between the two graders for all measurements (all ICC > 0.94). Release of the retina-membrane attachment point was not observed in any eyes. No statistically significant change was found in any of the measured parameters. CONCLUSIONS: Excellent agreement was achieved between the graders for quantitative assessment of diabetic FVM using our proposed OCT criteria. We did not observe a significant change in the FVM measurements, 1-week after intravitreal tPA injection.

Choroidal thickness after phacoemulsification: nonrandomized comparison of postoperative topical ketorolac vs dexamethasone vs combination of ketorolac-dexamethasone eyedrops.

PURPOSE: To compare the effect of topical dexamethasone vs ketorolac vs combined dexamethasone-ketorolac after phacoemulsification on choroidal thickness (CT). SETTING: Tertiary university-based hospital. DESIGN: Prospective nonrandomized comparative case series. METHODS: Ninety-two eyes of 92 patients were assigned to the 3 groups after uneventful phacoemulsification: Group 1, dexamethasone; Group 2, ketorolac; Group 3, combined dexamethasone-ketorolac applied topically. CT at subfoveal (SFCT), nasal, and temporal as primary and central retinal thickness (CRT) as secondary outcomes were measured preoperatively and at 1 month, 3 months, and 6 months postoperatively using enhanced depth-imaging optical coherence tomography. RESULTS: Preoperative CT was similar between the groups (all P > .05). The groups differed in pattern of changes in nasal and temporal CT (both P < .001) although their changes of CRT (P = .13) and SFCT (P = .55) over time were similar. The mean of SFCT at 1 month, 3 months, and 6 months was significantly higher than baseline in dexamethasone (P < .001 for all follow-ups) and combined (P < .001 for both 1 month and 3 months and P = .03 for 6 months) groups, whereas it was not statistically significant in the ketorolac group (P = .07). There was an increase in the nasal and temporal CT in 3 groups, persisted at 6 months in dexamethasone (both P < .001) and ketorolac (both P < .001) groups, whereas the change was not statistically significant at 6 months in the combined group. Choroidal thickness measurements were performed in 31 eyes of 31 patients in group 1, 29 eyes of 29 patients in group 2, and 32 eyes of 32 patients in group 3. CONCLUSIONS: Dexamethasone and combined groups had statistically significant changes of SFCT after phacoemulsification; however, the ketorolac group did not. The pattern of SFCT changes was similar between 3 groups.

Quantitative analysis of optical coherence tomography angiography metrics in diabetic retinopathy.

PURPOSE: To evaluate the correlation of the visual acuity and diabetic retinopathy stage using optical coherence tomography and optical coherence tomography angiography metrics. METHODS: In this prospective study, optical coherence tomography and optical coherence tomography angiography images of patients with different stages of diabetic retinopathy were obtained. In optical coherence tomography angiography images, the size of foveal avascular zone, central macular thickness, and vessel density at superficial and deep capillary layers of the macula were measured. In optical coherence tomography images, the presence of intraretinal cyst, disorganization of retinal inner layer, and ellipsoid zone and external limiting membrane disruption were evaluated. The associations between the variables with visual acuity and diabetic retinopathy stage were analyzed. RESULTS: In total, 68 eyes of 38 patients with a mean age of 58.96 ± 10.59 years were included. In total, 34 eyes were categorized as non-proliferative diabetic retinopathy, 14 as active, and 20 as regressed proliferative diabetic retinopathy. Univariate analysis showed deep parafoveal vessel density, central macular thickness, ellipsoid zone disruption, disorganization of retinal inner layer, and external limiting membrane disruption had a significant relationship with visual acuity. However, in multivariate analysis, only central macular thickness and ellipsoid zone disruption had significant association with visual acuity (p = 0.02 and p = 0.01, respectively). There was a significant difference in deep parafoveal vessel density (p = 0.04), but not in foveal avascular zone area, between different stages of diabetic retinopathy. CONCLUSION: In this study, the foveal avascular zone area did not correlate with visual acuity and different stages of diabetic retinopathy. Structural abnormalities on optical coherence tomography images with especial focus on outer retinal disruption provided more reliable predictors for visual acuity outcomes in patients with diabetic retinopathy.

Stepwise segmentation error correction in optical coherence tomography angiography images of patients with diabetic macular edema.

AIM: To determine the minimum number of optical coherence tomography B-scan corrections required to provide acceptable vessel density measurements on optical coherence tomography angiography images in eyes with diabetic macular edema. METHODS: In this prospective, noninterventional case series, the optical coherence tomography angiography images of eyes with center-involving diabetic macular edema were assessed. Optical coherence tomography angiography imaging was performed using RTVue Avanti spectral-domain optical coherence tomography system with the AngioVue software (V.2017.1.0.151; Optovue, Fremont, CA, USA). Segmentation error was recorded and manually corrected in the inner retinal layers in the central foveal, 100th and 200th optical coherence tomography B-scans. The segmentation error correction was then continued until all optical coherence tomography B-scans in whole en face image were corrected. At each step, the manual correction of each optical coherence tomography B-scan was propagated to whole image. The vessel density and retinal thickness were recorded at baseline and after each optical coherence tomography B-scan correction. RESULTS: A total of 36 eyes of 26 patients were included. To achieve full segmentation error correction in whole en face image, an average of 1.72 ± 1.81 and 5.57 ± 3.87 B-scans was corrected in inner plexiform layer and outer plexiform layer, respectively. The change in the vessel density measurements after complete segmentation error correction was statistically significant after inner plexiform layer correction. However, no statistically significant change in vessel density was found after manual correction of the outer plexiform layer. The vessel density measurements were statistically significantly different after single central foveal B-scan correction of inner plexiform layer compared with the baseline measurements (p = 0.03); however, it remained unchanged after further segmentation corrections of inner plexiform layer. CONCLUSION: Multiple optical coherence tomography B-scans should be manually corrected to address segmentation error in whole images of en face optical coherence tomography angiography in eyes with diabetic macular edema. Correction of central foveal B-scan provides the most significant change in vessel density measurements in eyes with diabetic macular edema.

Optical coherence tomography angiography (OCTA) applications in ocular oncology.

Optical coherence tomography angiography (OCTA) is a revolutionary method in the visualization of the vascular system in different retinal and choroidal layers. During the last 4 years since the commercial availability of different OCTA devices, attempts have been made to utilize this technology in various aspects of ocular oncology from the differentiation of benign and malignant lesions to assisting in evaluation of post-treatment complications, such as radiation retinopathy. However, current OCTA technology is restricted by various artefacts and inherent limitations, some of which are more pronounced in the presence of elevated tumoural lesions. Imminent advancements in OCTA systems and image acquisition processes promise a great potential for application of OCTA in ocular oncology.

Effect of segmentation error correction on optical coherence tomography angiography measurements in healthy subjects and diabetic macular oedema.

PURPOSE: To evaluate the impact of segmentation error on vessel density measurements in healthy eyes and eyes with diabetic macular oedema (DMO). METHODS: In this prospective, comparative, non-interventional study, enface optical coherence tomography angiography (OCTA) images of the macula from healthy eyes and eyes with DMO were acquired. Two expert graders assessed and corrected the segmentation error. The rate of segmentation error and the changes in vessel density and inner retinal thickness after correction of the segmentation error were recorded and compared between the two groups. RESULTS: 20 eyes with DMO and 24 healthy eyes were evaluated. Intergrader agreement was excellent (intraclass correlation coefficient ≥0.9) for all parameters in both groups. The rate of segmentation error was 33% and 100% in healthy and diabetic eyes, respectively (p<0.001). Nine healthy eyes (37.5%) and all eyes with DMO (100%) were noted to exhibit a change in at least one of the foveal or parafoveal vessel density measurements. The rate of any change in foveal and parafoveal vessel densities in both the superficial and deep capillary plexus was statistically significantly higher in the diabetic group (all p<0.001). No statistically significant change was observed in mean vessel density (superficial and deep capillary plexuses) after correction of the segmentation error in healthy and DMO eyes (All p>0.05). However, the mean absolute change in the vessel density measurements was statistically significantly higher in the diabetic group (all p<0.05). The mean absolute change in superficial and deep inner retinal thickness was statistically significantly higher in DMO (p=0.02 and p=0.002, respectively). CONCLUSIONS: In this study, misidentification of retinal layers and consequent vessel density measurement error occurred in all eyes with DMO and in one-third of healthy eyes. The segmentation error should be checked and manually corrected in the OCTA vessel density measurements, especially in the presence of macular oedema.

Surgical Removal of Submacular Perfluorocarbon Liquid Using a 41-Gauge Extendible Subretinal Injection Needle.

Submacular perfluorocarbon liquid (PFCL) retention is a well-known complication of vitreoretinal surgeries; however, the optimal surgical technique for the removal of subfoveal PFCL is yet to be determined. We describe a novel surgical technique for the removal of retained submacular PFCL by performing a retinotomy adjacent to the inferotemporal arcade using a 41-gauge extendible subretinal injection needle and inducing a therapeutic retinal detachment. Through the same retinotomy, the bent 41-gauge needle was advanced into the subretinal space to reach the PFCL bubble. Subsequently, active aspiration of PFCL was performed. The surgical procedure was successfully performed in two patients. This technique appears to be an effective surgical approach for removing retained submacular PFCL bubble.

Optical coherence tomography angiography features of optic nerve head drusen and nonarteritic anterior ischemic optic neuropathy.

OBJECTIVE: To evaluate the optic disc microvasculature in optic nerve head drusen (ONHD) vasculature in comparison to acute nonarteritic anterior ischemic optic neuropathy (NAION) and normal eyes using optical coherence tomography angiography (OCT-A). METHODS: Ten eyes with ONHD, 10 eyes with acute NAION, and 10 healthy eyes were included in this prospective, comparative, observational case series. OCT-A imaging was performed on the optic discs. Qualitative grading was performed for dilation and tortuosity of the peripapillary vessels by 3 graders. Quantitative comparison was performed for peripapillary and inside disc vessel densities in nerve head (NH) and retinal peripapillary capillary (RPC) slabs. RESULTS: The intergrader agreement for dilation and tortuosity of the peripapillary vessels was poor (0.313 and 0.182 for vascular dilation in nerve head and radial peripapillary capillary enface images, respectively, and 0.478 and 0.490 for vascular tortuosity in nerve head and radial peripapillary capillary enface images, respectively). In NH en face images, the vessel density measurements were statistically significantly different between the 3 groups (all p < 0.05). In RPC en face images, the vessel density measurements were statistically significantly different between the 3 groups (all p < 0.05) except for nasal peripapillary sector (0.08). CONCLUSION: Despite poor intergrader agreement in qualitative analysis, quantitative OCT-A evaluation may differentiate optic disc edema due to NAION from pseudodisc edema due to ONHD.

Ultra-Wide-Field Fluorescein Angiography-Guided Normalization of Ischemic Index Calculation in Eyes With Retinal Vein Occlusion.

Purpose: The purpose of this study was to compare the use of central and montaged ultra-wide-field fluorescein angiography (UWFFA) images for calculating the area of nonperfusion (NP) and ischemic index (ISI) in patients with retinal vein occlusion (RVO) and macular edema (ME) and to correlate these measurements with best-corrected visual acuity (BCVA) and central macular thickness (CMT). Methods: Thirty eyes of 30 RVO patients with recurrent ME were enrolled. Baseline UWFA images were sent to the Doheny Image Reading Center for quantitative analysis by certified graders. The association between ISI from the various zones and BCVA and CMT was examined by Spearman rank correlation and compared. Generalized linear models (GLMs) were used to analyze associations between BCVA and disease status. Results: The NP area and ISI for central and montaged images were not significantly different for any retinal zone. A modest but statistically significant negative linear correlation was observed between BCVA and ISI, ranging from r = -0.3825 in the perimacular area (PMA) to r = -0.584 in the far peripheral area (FPA). On GLM analysis, both PMA (ß = -1.059; 95% confidence interval: -1.74 to -0.378) and FPA (ß = -0.505; 95% confidence interval: -0.988 to -0.021) were significant independent predictors of BCVA. We found no correlation between ISI from the various zones and CMT in this cohort. Conclusions: Montaging of UWFFA images may not be required to adequately quantify and represent areas of NP in eyes with RVO. NP in both the PMA and peripheral retina appear relevant to visual function, highlighting the importance of evaluating the retinal periphery in these individuals.

Resident-performed neodymium:YAG laser posterior capsulotomy.

OBJECTIVE: To investigate the outcomes of resident-performed Nd:YAG laser posterior capsulotomy. DESIGN: Combined retrospective and prospective study. PARTICIPANTS: Patients (N = 301) who underwent Nd:YAG capsulotomy by ophthalmology residents at Rassoul Akram Hospital, Tehran, Iran. METHODS: Assessment of visual outcomes and complications and the results of second- and third-year residents. RESULTS: In the retrospective arm, 131 eyes of 129 patients were enrolled. Mean best-corrected visual acuity (BCVA) improved significantly from 1.15 ± 0.26 to 0.54 ± 0.39 logMAR (p < 0.001). Mean intraocular pressure (IOP) before capsulotomy and at the final visit was 13.1 ± 2.34 mm Hg and 13.6 ± 2.17 mm Hg, respectively (P = 0.30). Retinal detachment occurred in 2 eyes (1.5%). No case of intraocular lens decentration or endophthalmitis was detected. In the prospective arm on 173 eyes of 172 patients, mean pre-YAG BCVA was 1.14 ± 0.25 logMAR and increased to 0.51 ± 0.37 logMAR after surgery (p < 0.001). There was no significant difference between pre-laser IOP measurements compared with the 1-month IOP measurements (P = 0.32). The postoperative changes in mean BCVA and IOP between the second- and third-year residents were not significant; however, the applied laser power, the number of laser spots, rate of incomplete capsulotomies, and the amount of total and central laser-induced IOL pits were significantly higher among the second-year residents. CONCLUSIONS: Resident-performed capsulotomy appears to be effective with a low complication profile. Despite the lower levels of surgical skills, second-year residents could achieve good visual outcomes. The laser parameters and IOL-related complications improved with increasing surgical experience.

Swept-source OCT angiography imaging of the macular capillary network in glaucoma.

PURPOSE: To evaluate the macular capillary network density of superficial and deep retinal layers (SRL/DRL) by swept-source optical coherence tomography angiography (OCTA) in patients with primary open angle glaucoma (POAG) and to compare the results with those of normal subjects. METHOD: In this prospective study, 24 eyes of 24 normal individuals and 24 eyes of 24 patients with mild to moderate POAG underwent fovea centred 6×6 mm cube macular OCTA imaging by a swept-source OCTA device (Triton, Topcon, Tokyo, Japan). Quantitative analysis of the retinal vasculature was performed by assessing vessel density (VD) as the ratio of the retinal area occupied by vessels at the SRL and DRL. RESULTS: The mean VD (ratio) at the SRL and DRL was statistically significantly lower in patients with POAG (SRL, p<0.001; DRL, p<0.001). In the SRL, the mean±SD VD ratio was 0.34±0.05 in patients with POAG and 0.40±0.02 in normal individuals (p<0.001). In the DRL, the mean (SD) ratio was 0.37±0.05 in patients with POAG and 0.43±0.02 in normal individuals (p<0.001). The mean VD at the SRL was significantly correlated with ganglion cell inner plexiform layer thickness (r=0.42, p=0.04) but not with visual field mean deviation (r=0.4, p=0.06) and retinal nerve fibre layer thickness (r=0.5, p=0.06). The mean VD at the DRL did not show significant correlation with any other glaucoma parameter (p>0.05). CONCLUSION: The assessment of macular VD by swept-source OCTA may offer additional information for detection of glaucoma.

Ultra-wide-field imaging in diabetic retinopathy.

Since 1991, 7-field images captured with 30-50 degree cameras in the Early Treatment Diabetic Retinopathy Study were the gold standard for fundus imaging to study diabetic retinopathy. Ultra-wide-field images cover significantly more area (up to 82%) of the fundus and with ocular steering can in many cases image 100% of the fundus ("panretinal"). Recent advances in image analysis of ultra-wide-field imaging allow for precise measurements of the peripheral retinal lesions. There is a growing consensus in the literature that ultra-wide-field imaging improves detection of peripheral lesions in diabetic retinopathy and leads to more accurate classification of the disease. There is discordance among studies, however, on the correlation between peripheral diabetic lesions and diabetic macular edema and optimal management strategies to treat diabetic retinopathy.

Distribution of Nonperfusion Area on Ultra-widefield Fluorescein Angiography in Eyes With Diabetic Macular Edema: DAVE Study.

PURPOSE: To explore the distribution of nonperfusion area (NPA) in eyes with diabetic macular edema (DME) and its relationship with the severity of DME. DESIGN: Prospective, observational case series. METHODS: Forty eyes of 29 patients with treatment-naïve DME who participated in the DAVE study (NCT01552408) were included. Ultra-widefield fluorescein angiography images were sent to the Doheny Image Reading Center, where they were montaged and corrected using stereographic projection to adjust for peripheral distortion. Two experienced, independent/masked certified graders manually segmented the NPA and the total visible retinal area (TRA), and computed the NPA and TRA in square millimeters (mm2). The ischemic index (ISI) was calculated. The distributions of NPA and ISI within different retinal zones were correlated with the severity of DME. RESULTS: In 40 eyes with treatment-naïve DME (mean age, 55.8 years) visual acuity (VA) (mean 59.6 EDTRS letters) was correlated with central macular thickness (CMT) (mean 536.9 µm, R = -0.418, P = .008) and macular volume (MV) (mean 11.9 mm3, R = -0.449, P = .004). The NPA and ISI among the different retinal zones were significantly different (NPA: P < .001; ISI: P = .005). The NPA and ISI in the midperiphery were negatively associated with CMT (NPA: P = .04; ISI: P = .02). However, the global NPA and ISI for the entire retina were not associated with CMT or MV (P > .05). CONCLUSION: In eyes with DME, the ISI increases with increasing distance from the fovea. The severity of DME does not appear to correlate with global NPA and ISI.