An Update on Multimodal Ophthalmological Imaging of Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome.

Sturge-Weber syndrome (SWS) is characterized by facial port-wine stains, leptomeningeal hemangiomas, and prominent ocular manifestations such as glaucoma and diffuse choroidal hemangiomas (DCHs). Imaging modalities are critical for diagnosing and longitudinally monitoring DCHs in SWS. Fundus photography is fundamental in assessing both eyes simultaneously, fluorescein angiography and indocyanine green angiography effectively map the retinal and choroidal circulation, and ultrasonography offers essential structural insights into the choroid and retina. NIR imaging reveals subtle retinal pigment changes, often overlooked in standard fundus examination. Enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT) and swept-source OCT (SSOCT) improve the visualization of the choroidal-scleral boundary, essential for DCH characterization. The potential of OCT angiography (OCTA) is under exploration, particularly its role in predicting signs of disease progression or worsening, as well as potential new biomarkers such as the choroidal vascularity index (CVI). The present review aims to provide an update on multimodal imaging of DCHs in SWS.

Retinal and Choroidal Changes Following Implantable Collamer Lens V4c Implantation in High Myopia Patients-A 1-Year Follow-Up Study.

This prospective study aimed to evaluate the impact of Visian Implantable Collamer Lens (ICL) V4c implantation on retinal and choroidal morphology in patients with high myopia. A total of 97 eyes from 52 high myopic patients who underwent ICL V4c implantation were followed up for 12 months. Preoperative and postoperative evaluations included comprehensive ophthalmic assessments and enhanced depth imaging optical coherence tomography (EDI-OCT) to analyze changes in central retinal thickness (CRT), retinal volume (CRV), choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), and choroidal vascular index (CVI). Repeated measures mixed-effects models were used for comparing pre- and postoperative measurement variables and exploring relationships among age, axial length (AL), spherical equivalent refraction (SER), and postoperative retinal and choroidal changes, with statistical significance set at p < 0.05. Follow-up assessments were conducted at various time points, with participation rates ranging from 21% to 98%. Baseline characteristics showed a median age of 26.7 years, -10.14 diopters of SER, and an AL of 27.44 mm. Throughout the 12-month follow-up, CRT and 3.0 mm CRV consistently increased compared to the baseline, with statistically significant rises observed at postoperative day 1, week 1, and month 12. Most ChT measurements, including subfoveal ChT, declined over the 12 months, except at postoperative 6 months. Horizontal and vertical TCA and LA values significantly increased throughout the follow-up, except for month 6. After surgery, both horizontal and vertical CVI parameters exhibited an increase compared to the baseline, with some changes reaching statistical significance. Correlation analysis performed by repeated measures mixed-effects models showed that no relationship was found between age, AL, and SER and changes in postoperative retinal parameters and CVI parameters. However, postoperative changes in ChT and choroidal area parameters showed a negative correlation with AL and a positive correlation with SER. Our research demonstrated that ICL V4c implantation resulted in noteworthy alterations in retinal and choroidal morphology over a 1-year follow-up period. Moreover, in patients with high myopia, individuals with longer AL and higher degrees of myopia exhibited more pronounced postoperative changes in the choroid and retina. Further studies with extended follow-up durations are necessary to comprehensively understand the long-term effects of ICL implantation on retinal and choroidal morphology and function.

The Effects of Uneventful Phacoemulsification on Subfoveal Choroidal Thickness.

INTRODUCTION: To evaluate the impacts of phacoemulsification preoperative and intraoperative factors on postoperative subfoveal choroidal thickness (SFCT). METHODS: This prospective interventional study was conducted on patients undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation at the private clinic Ophthalmica Eye Institute, in Thessaloniki, Greece. Forty-six eyes of 46 patients were included in the study. Operative time (OT), phacoemulsification time (PT), effective phacoemulsification time (EPT) and phacoemulsification power (PP) were recorded for each patient. All patients received dexamethasone and nepafenac drops for 4 weeks postoperatively. Choroidal thickness (CT) at five anatomical locations was measured preoperatively and at 1 week, 1 month and 3 months postoperatively. RESULTS: Subfoveal choroidal thickness significantly increased over baseline thickness at 1 week postoperatively, returned to preoperative levels at 1 month and increased again at 3 months. Changes at 1 week and 3 months postoperatively correlated to baseline choroidal thickness (p = 0.023 and p = 0.011, respectively). Spherical equivalent (SE) inversely correlated to SFCT throughout the entire follow-up period (baseline p = 0.044, 1-week p = 0.011, 1-month p = 0.013, 3-month p = 0.018). EPT was the most significant determinant of increased SFCT at all time points (1-week p = 0.011, 1-month p = 0.01, 3-month p = 0.015). PT and PP significantly correlated to the SFCT increase at 3 months postoperatively (p = 0.033 and p = 0.043, respectively). OT was not associated with a change in SFCT at any time point (p > 0.05). CONCLUSION: Phacoemulsification can alter choroidal thickness until at least 3 months after surgery. Preoperative and intraoperative factors, notably SE, baseline SFCT, PT, PP and especially EPT, can influence postoperative CT increase.

Optical Coherence Tomography in Inflammatory and Neoplastic Lesions Deforming the Choroidal Profile.

The choroid is the main part of the uvea, the vascular layer of the eye that lies between the retina and the sclera. The high vascular component of the choroid makes this structure susceptible to inflammation in multisystemic diseases, as well as the most common site of metastasis in the eye. Therefore, the choroid is involved in many pathological conditions, from uveitis to intraocular tumors. Differentiating between inflammatory and neoplastic lesions deforming the choroidal profile can sometimes be challenging. In addition, scleral disorders can also deform the choroidal profile. Choroidal imaging includes ophthalmic ultrasonography, indocyanine green angiography, and optical coherence tomography (OCT). Recent advances in choroidal imaging techniques, such as enhanced depth imaging optical coherence tomography (EDI-OCT) and swept-source optical coherence tomography (SS-OCT), have facilitated an in-depth analysis of the choroid. The purpose of this review article is to report on and highlight the most common OCT findings to help in the differential diagnosis between inflammatory and neoplastic lesions deforming the choroidal profile.

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors.

AIM: To characterize spectral-domain optical coherence tomography (SD-OCT) features of chorioretinal folds in orbital mass imaged using enhanced depth imaging (EDI). METHODS: Prospective observational case-control study was conducted in 20 eyes of 20 patients, the uninvolved eye served as a control. All the patients underwent clinical fundus photography, computed tomography, EDI SD-OCT imaging before and after surgery. Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5; the remaining patients underwent tumor excision. Patients were followed 1 to 14mo following surgery (average follow up, 5.8mo). RESULTS: Visual acuity prior to surgery ranged from 20/20 to 20/200. Following surgery, 5 patients' visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10 (range 4 to 26 letters). Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery. Following surgical excision, photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients. CONCLUSION: Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis. Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.

Insights into the underlying choroid in different stages of idiopathic epiretinal membranes after Viteromacular surgery.

PURPOSE: The purpose of the study was to longitudinally investigate the correlation between choroidal morphologic and vascular parameters and postoperative visual outcome in different stages of idiopathic epiretinal membranes (iERMs). METHODS: A prospective, observational, institutional case series of 102 consecutive patients diagnosed with unilateral iERMs were recruited at Peking University Third Hospital and were followed up for 12 months after surgical treatment with vitrectomy. Participants were classified into four stages according to current staging scheme. All eligible subjects underwent standardized imaging evaluation of choroidal parameters including subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), and choroidal capillary perfusion (CCP) at baseline and each follow-up by enhanced depth optical coherence tomography (EDI-OCT) and OCT angiography (OCTA). Longitudinal follow-up of choroidal parameters over 12 months was analysed, and their correlations with best-corrected visual acuity (BCVA) were also assessed for predictive prognostic value. RESULTS: CVI and CCP were significantly correlated with BCVA at each follow-up examination (all p < 0.05). However, SFCT exhibited no variation among different stages of iERMs at baseline (p = 0.981) or during follow-up (p = 0.520). The preoperative CVI correlated with 12-month postoperative BCVA (p < 0.001) and its predictive prognostic effect on BCVA was validated in multiple regression analysis (p = 0.006). CONCLUSION: CVI varied among different stages of iERM and was significantly correlated with visual outcomes after the surgery. CVI could serve as a predictive prognostic marker in iERMs, which further indicates the underlying choroid should be taken into consideration in clinical evaluation of iERMs.

Comparison of Choroidal Thickness, Foveal Avascular Zone, and Macular Capillary Density in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Ranibizumab or Aflibercept-A Prospective Study.

This prospective comparative case series aims to compare best-corrected visual acuity (BCVA), retinal microvasculature, and retinal structural changes in patients treated with either ranibizumab or aflibercept for macular edema (ME) secondary to treatment-naïve branch retinal vein occlusion (BRVO) by optical coherence tomography angiography (OCTA). Ten patients were enrolled with macular capillary density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and foveal avascular zone (FAZ) measured in both eyes before and after treatment. Final central retinal thickness and BCVA improved significantly (p < 0.05), and densities of SCP and DCP of BRVO sectors were significantly lower at baseline than fellow eye counterparts and remained persistently lower during treatment, particularly in the aflibercept group (p < 0.05). SCP density, DCP density of both BRVO sectors (p = 0.0001, p < 0.0001), and non-BRVO sectors (p < 0.0001, p < 0.0001) were significantly correlated with final BCVA for diseased eyes. Using multivariate general linear model analysis, and including OCTA parameters only, but not all of the available clinical data, DCP density of BRVO sectors in both eyes was the most predictive factor for final visual outcome (probability p < 0.0001). OCTA offered further qualitative and quantitative evaluation of treatment-naïve BRVO. Judging by OCTA parameters, not only in the diseased eye but also in the fellow eye, DCP density of BRVO sectors was the most predictive factor of final visual outcome.

Retinal Optical Coherence Tomography Angiography Findings following Retinoblastoma Treatment by Chemotherapy.

Purpose: To investigate the macular microvascular changes after different kinds of chemotherapy in patients with extramacular retinoblastoma (RB). Methods: In this study, 28 eyes of 19 patients with bilateral RB treated with intravenous systemic chemotherapy (IVSC group) and 12 eyes of 12 patients with unilateral RB treated with intra-arterial chemotherapy (IAC group) were compared with 6 normal fellow eyes of 6 patients with unilateral RB treated with IVSC (IVSC fellow eye group), and 7 normal fellow eyes of 7 unilateral RB patients treated with IAC (IAC fellow eye group), as well as 12 age-matched normal eyes. Enhanced depth imaging optical coherence tomography measurements of central macular and subfoveal choroidal thickness (CMT and SFCT) as well as optical coherence tomography angiography measurements such as retinal superficial capillary density (SCD), deep capillary density (DCD), and choriocapillaris density were documented. Results: Images of 2 eyes in the IVSC group and 8 eyes in the IAC group were excluded from the final image analysis due to severe retinal atrophy. Overall, 26 eyes with bilateral RB treated with IVSC and 4 eyes of 4 patients with unilateral RB treated with IAC were compared with the mentioned control groups. Best-corrected visual acuity was 1.03 logMAR in the IAC patients compared to 0.46 logMAR in the IVSC group at the time of imaging. While the CMT and SFCT were lower in the IAC group in comparison with the IAC fellow eye and normal groups (P < 0.05 for all), no remarkable difference was observed between the IVSC group and the control groups based on the mentioned parameters. Although the SCD showed no significant difference between the IVSC and control groups, this parameter was significantly lower in the eyes receiving IAC relative to the corresponding fellow eye group (P = 0.042) and normal control eyes (P = 0.047). The mean DCD was considerably lower in both the treatment groups compared to the control groups (P < 0.05 for all). Conclusion: Our study showed a substantial decrease in SCD, DCD, CMT, and choroidal thickness in the IAC group, which may explain the lower visual outcome in this group.

Corneal cross-linking for keratoconus: Evaluation of the retina and choroid.

PURPOSE: To investigate the possible structural changes of the central choroid and retina after collagen cross-linking (CXL) in patients with progressive keratoconus (KCN). METHODS: Twenty-five eyes of 25 patients were included in this study. Patients underwent enhanced depth imaging optical coherence tomography (EDI-OCT) before and 1 month after CXL. The values for central macular thickness (CMT), subfoveal choroidal thickness (CHT), and choroidal volume (CHV) were evaluated. RESULTS: CMT before and after CXL was 263.24 ± 16.25 µm and 263.20 ± 16.51 µm, respectively (p = 0.98). CHT was 362.08 ± 36.80 µm and 367.84 ± 33.67 µm before and after CXL, respectively (p = 0.26). CHV was 8.74 ± 0.33 mm3 and 8.68 ± 0.36 mm3 before and after CXL, respectively (p = 0.11). There was no significant difference in the corrected distance visual acuity before and after CXL (0.06 ± 0.05 and 0.05 ± 0.05 logMAR, respectively, p = 0.65). CONCLUSION: Central retinal and choroidal thicknesses are not changed after corneal cross- linking.

Expanded Spectrum of Optical Coherence Tomography Findings in Patients with Ocular Toxoplasmosis.

PURPOSE: To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity. METHODS: Observational case series. RESULTS: A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature 'hourglass configuration'. CONCLUSION: Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.

Unusual case of enlarged choroidal vessels in neurofibromatosis type 1 observed with near-infrared reflectance and spectral domain optical coherence tomography.

ABSTRACT: The cardinal diagnostic signs of neurofibromatosis type 1 (NF1) are Lisch nodules of the iris and optic pathway gliomas. Retinal mi-crovascular alterations have been described but with uncertain signi-ficance. Choroidal nodules, detectable with near-infrared reflectance (NIR) imaging, are present in most cases and have been proposed as a new diagnostic criterion. Recently, a study reported the presence of unusual dilated choroidal vessels, visible through NIR examination. We report a case of a 65-year-old patient with NF1. Best-corrected visual acuity was 20/20 with a refractive error of +2.75 diopters in both eyes. Anterior segment examination revealed Lisch nodules in both eyes. At NIR imaging the patient presented typical choroidal alterations in both eyes. No retinal vessel anomalies were detected. The patient presented enlarged choroidal vessels in the left eye, first detected by NIR and then analyzed through enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT). These vessels extended from the choroidal-scleral junction to the outer border of the retinal pigment epithelium/Bruch's layer. The choriocapillaris layer was absent above the dilated vessels. The presence of enlarged choroidal vessels may be considered as a novel distinctive ophthalmologic aspect of NF1, but further studies are necessary.

Suprachoroidal hemorrhage due to Valsalva maneuver, importance of enhanced depth imaging optical coherence tomography in differential diagnosis.

We describe a case report of a spontaneous suprachoroidal hemorrhage, in which the enhanced depth imaging optical coherence tomography (OCT-EDI) is extremely useful in establish the differential diagnosis with a choroidal tumor. A 70 year-old woman was referred with a central scotoma after a Valsalva maneuver. In the posterior pole we observed a grey bilobed subretinal mass with the appearance of a choroidal tumor. OCT-EDI revealed an optically dark region with a scalloped anterior tumor contour and subretinal fluid, the choroicapillaris appeared to be intact and displaced anteriorly. The diagnosis was a suprachoroidal hemorrhage and it resolved in 12 weeks. Spontaneous suprachoroidal hemorrhage is a rare condition and it can resemble choroidal tumor. OCT-EDI is a very valuable tool in the differentiation of hemorrhage from tumors.

Current concepts on diffuse choroidal hemangioma in Sturge Weber syndrome.

Background: Diffuse choroidal hemangioma (DCH) is a benign vascular tumor that is characteristically found in the Sturge-Weber syndrome (SWS). Recent genetic discoveries demonstrate that DCH occurs sporadically from an activating mutation in GNAQ at codon R183. Mutations in GNAQ or GNA11 result in dysregulation of the mitogen-activated protein kinase, which influences gene transcription and results in cellular proliferation. DCH may not always be readily detected on routine ophthalmological examination, consequently diagnosis and multidisciplinary referral are often delayed.Purpose: A literature search was performed through April 2020 without a lower date limit. This review will summarize the pathogenesis, diagnosis and management of DCH.Discussion: Multimodal imaging facilitates early detection of the condition. In particular, enhanced depth imaging spectral domain optical coherence tomography enables non-invasive, high-resolution visualization of the choroid to even detect mild choroidal thickening. Management of symptomatic DCH is generally difficult and results in poor visual outcome, thus, treatment is generally unwarranted, unless the hemangioma complicated by serous retinal detachment. The main treatment method is radiation therapy with external beam radiation therapy, proton beam therapy, plaque brachytherapy, and gamma knife surgery where low doses of radiation entail fewer complications. One method of alternative management is with photodynamic therapy that, although less invasive with a lower rate of complications, is not always feasible or effective in cases with extensive exudative retinal detachment.Conclusions: Multimodal ophthalmological imaging facilitates diagnosis of DCH and lifelong surveillance is essential in patients.

Hyperpigmented spots at fundus examination: a new ocular sign in Neurofibromatosis Type I.

BACKGROUND: Neurofibromatosis Type I (NF1), also termed von Recklinghausen disease, is a rare genetic disorder that is transmitted by autosomal dominant inheritance, with complete penetrance and variable expressivity. It is caused by mutation in the NF1 gene on chromosome 17 encoding for neurofibromin, a protein with oncosuppressive activity, and it is 50% sporadic or inherited. The disease is characterized by a broad spectrum of clinical manifestations, mainly involving the nervous system, the eye and skin, and a predisposition to develop multiple benign and malignant neoplasms. Ocular diagnostic hallmarks of NF1 include optic gliomas, iris Lisch nodules, orbital and eyelid neurofibromas, eyelid café-au-lait spots. Choroidal nodules and microvascular abnormalities have recently been identified as additional NF1-related ocular manifestations. The present study was designed to describe the features and clinical significance of a new sign related to the visual apparatus in NF-1, represented by hyperpigmented spots (HSs) of the fundus oculi. RESULTS: HSs were detected in 60 (24.1%) out of 249 patients with NF1, with a positive predictive value of 100% and a negative predictive value of 44.2%. None of the healthy subjects (150 subjects) showed the presence of HSs. HSs were visible under indirect ophthalmoscopy, ultra-wide field (UWF) pseudocolor imaging and red-only laser image, near-infrared reflectance (NIR)-OCT, but they were not appreciable on UWF green reflectance. The location and features of pigmentary lesions matched with the already studied NF1-related choroidal nodules. No significant difference was found between the group of patients (n = 60) with ocular HSs and the group of patients (n = 189) without ocular pigmented spots in terms of age, gender or severity grading of the disease. A statistically significant association was demonstrated between the presence of HSs and neurofibromas (p = 0.047), and between the presence of HSs and NF1-related retinal microvascular abnormalities (p = 0.017). CONCLUSIONS: We described a new ocular sign represented by HSs of the fundus in NF1. The presence of HSs was not a negative prognostic factor of the disease. Following multimodal imaging, we demonstrated that HSs and choroidal nodules were consistent with the same type of lesion, and simple indirect ophthalmoscopy allowed for screening of HSs in NF1.

Distribution of Choroidal Thickness and Choroidal Vessel Dilation in Healthy Japanese Individuals: The Nagahama Study.

Purpose: To report fundamental epidemiologic data for choroidal parameters such as choroidal thickness and index of choroidal vascularity in Japanese individuals and to evaluate their correlations with age, sex, systemic parameters, and other ocular parameters. Design: Population-based cohort study. Participants: A total of 9850 individuals participated in the first follow-up of the Nagahama Prospective Cohort for Comprehensive Human Bioscience (the Nagahama Study) conducted between 2013 and 2016. Methods: All participants underwent standardized ophthalmic examinations, including OCT with enhanced depth imaging (EDI; RS-3000 Advance; Nidek). We manually segmented the choroidoscleral interface to measure subfoveal choroidal thickness (SFCT) and calculated the normalized choroidal intensity obtained with EDI (NCIEDI) and choroidal vascularity index (CVI). These are indices of choroidal brightness in OCT and reportedly represent the dilation of choroidal vessels. After summarizing the age-sex stratified distributions of SFCT, NCIEDI, and CVI, their associations with age, sex, axial length (AL), and spherical equivalent (SE) were evaluated using linear regression analysis with adjustments for possible confounders. Main Outcome Measures: Distribution of SFCT, NCIEDI, and CVI in the healthy Japanese population and their characteristics. Results: Age-sex standardized SFCT, NCIEDI, and CVI were 291.2 µm, 0.653, and 66.88%, respectively. In both men and women, SFCT was associated negatively with age (P < 0.001) and NCIEDI was associated positively with age (P < 0.001). Although both SFCT and NCIEDI did not differ significantly between men and women overall (P = 0.87 and P = 0.21, respectively), among younger participants (35-50 years of age), men showed significantly greater SFCT than women (P < 0.001). Only in men was CVI associated positively with age (P < 0.001). In the multivariable analysis, SFCT was associated significantly with age, sex, AL, SE, and the interaction term of age and sex (P < 0.001). Independent of SFCT, NCIEDI and CVI were associated significantly with age (P < 0.001). Conclusions: We report normative Japanese SFCT, NCIEDI, and CVI data using a large general Japanese cohort. The association analysis of SFCT with NCIEDI and CVI suggested that younger individuals have a more lumen-rich choroid for their choroidal thickness than older individuals.

Multimodal Imaging in Choroidal Metastasis.

BACKGROUND: Choroidal metastasis represents the most common malignant intraocular tumours. OBJECTIVES: The objective of this study is to detect the structural and vascular features of choroidal metastasis by multimodal imaging. METHODS: Sixteen eyes of 16 patients with choroidal metastasis were enrolled in this prospective study. The multimodal imaging was performed in all patients: fluorescein angiography, indocyanine green angiography, enhanced depth imaging optical coherence tomography (EDI-OCT), OCT angiography (OCTA), and ultrasonography. RESULTS: The choroidal metastasis was located in the macula region in 9 eyes (57%) and in the extramacular region in 7 eyes (43%). EDI-OCT showed a mean thickness of 950 ± 246 µm, a smooth anterior tumour surface in 5 eyes (31%), and a lumpy bumpy appearance in 11 eyes (69%). The most frequent EDI-OCT features were represented by choriocapillaris thinning (100%), shaggy photoreceptors (82%), subretinal fluid with speckles (69%), subretinal lipofuscin pigment (6%), absence of drusen (100%), optical shadowing (94%), low-internal optical reflectivity (75%), and retinal pigment epithelium alterations (43%). OCTA revealed an absence of intratumoral vascular network in all cases. CONCLUSIONS: The multimodal imaging contributed to greater insights into the anatomical and vascular features of choroidal metastasis. It allows for the collection of useful information to establish an appropriate diagnosis and follow-up.

Evaluation of Peripapillary and Subfoveal Choroid Thickness in Asymptomatic Carotid Artery Stenosis.

OBJECTIVE: In this study, it aims to investigate the effect of asymptomatic carotid artery stenosis on peripapillary and subfoveal choroid thickness using enhanced depth imaging optical coherence tomography. PATIENTS AND METHODS: While investigating for coronary artery disease, 76 patients with asymptomatic carotid artery stenosis and 35 patients with normal carotid artery (total = 111) were evaluated. Patients according to the degree of stenosis were divided into four categories as non-stenosis (n = 35), mild (n = 26), moderate (n = 27) and severe stenosis (n = 23). Subfoveal and peripapillary choroid thickness, ocular perfusion and intraocular pressures of all patients were measured using a Fourier-domain optical coherence tomography after general ophthalmological examination. In addition, hypertension, hyperlipidemia, and whether there is a relationship between smoking status and choroid thickness was compared. RESULTS: As the degree of carotid artery stenosis increased, subfoveal and peripapillary choroidal thickness decreased significantly. However, no changes were detected in ocular perfusion and intraocular pressure values (p=0.935, p=0.519). Decrease in peripapillary and subfoveal choroid thickness values was found to be particularly between the group with severe stenosis and the group with control and mild stenosis (p = 0.003, p = 0.001). In addition, as the degree of carotid stenosis increased in patients with hypertension and smoking, peripapillary choroid thickness was found to be thinner (p=0.003). CONCLUSION: We believe that the possibility of carotid artery stenosis should be considered in cases with decreased choroid thickness. In addition, we think that even if it is asymptomatic, in cases with severe carotid stenosis, in the presence of choroidal thinning, a chance of surgical intervention should be given to the stenosis.

[Optical coherence tomography in diagnostics of small choroidal melanoma]. / Opticheskaia kogerentnaia tomografiia v diagnostike nachal'noi melanomy khorioidei.

PURPOSE: To determine signs of small choroidal melanoma with different pigmentation using enhanced depth imaging optical coherence tomography (EDI-OCT). MATERIAL AND METHODS: The study included 344 patients with small choroidal melanoma with different pigmentation examined using EDI-OCT: 1st group - pigmented melanoma (228 eyes), 2nd group - low pigmented (65 eyes), and 3rd group - amelanotic (51 eyes). RESULTS: In pigmented small choroidal melanomas - elevation of choroidal profile towards vitreous, compression of choriocapillaries with a narrow even 'belt' and a 'shadow' effect; thinning, defects in Bruch's membrane; thickening of the retina above the tumor, lobulated photoreceptors; intra- and subretinal exudate (diffuse, cystic edema, neuroepithelial detachment); defects and detachment of pigment epithelium with hyperreflective foci, disorganization of the pigment with the formation of hyperreflective foci at different retinal levels. In low-pigmented small choroidal melanomas - elevation of choroidal profile towards vitreous, visualized inner surface of the sclera, 'excavation' of the choroid, enlarged choriocapillaries, contour of tumor; thickening of the retina, accumulation of intra- and subretinal exudate (local neuroepithelial detachments); disorganization of the pigment in pigment epithelium with hyperreflective foci in the outer retinal layers. In amelanotic small choroidal melanomas - elevation of choroidal profile towards vitreous, visualized inner surface of the sclera, 'excavation' of the choroid; contouring of choriocapillaries, longitudinal hyperreflective bands in the tumoral stroma, smoothness of the Bruch`s membrane, structural losses of photoreceptors; thickening of the retina (neuroepithelial detachment, diffuse edema); uneven thickening of pigment epithelium. CONCLUSION: EDI-OCT can help identify microstructural changes in the choroid and adjacent retina in small choroidal melanomas with different degrees of pigmentation, suggesting at the early stages a more aggressive course of the tumoral process affecting the prognosis of the disease. In addition, identification of the microstructure and degree of pigmentation of initial choroidal melanomas is necessary for planning an organ-preserving treatment.

Increased choroidal thickness: a new indicator for monitoring diabetic macular oedema recurrence.

PURPOSE: The aim of this study was to determine whether choroidal thickness (CT) increases at the time of exudative recurrence in diabetic patients with unilateral diabetic macular oedema (DME) treated with intravitreal injections of anti-VEGF or dexamethasone. METHODS: A real-life, prospective, two-centre study was conducted over a 9-month period investigating diabetic patients presenting with unilateral DME treated with anti-VEGF or dexamethasone intravitreal injections, and CT was measured manually, using the enhanced depth imaging module of the spectral domain optical coherence tomography. Choroidal thickness (CT) was measured in the morning, in both the affected and healthy eye of each patient at two timepoints: when the macula was 'dry' (T0) and at the time of exudative recurrence (T1). RESULTS: A total of 51 patients with unilateral DME were included. Mean CT in the affected eye was significantly thicker at the time of exudative recurrence (210.8 ± 44.1 µm at T0 versus 238.0 ± 49.0 µm at T1, p < 0.001). There was no significant variation in CT in the fellow eye (214.4 ± 52.3 µm at T0 versus 218.9 ± 53.4 µm at T1, p = 0.53). The type of intravitreal injection, the number of injections and the CT at T0 had no influence on the change in CT. CONCLUSION: This study found that CT increased significantly in the affected eye at the time of recurrence of DME treated with anti-VEGF or dexamethasone injections. Choroidal thickness (CT) could constitute an interesting new indicator for monitoring patients with DME.