Quantitative evaluation of OCT angiography images in healthy and glaucomatous subjects through a novel approach: exploring inter-image variability.

PURPOSE: This study aims to investigate inter-image intra-observer variability of macular, and optic disc (ONH) microvasculature measurements of glaucomatous and normal subjects using Swept-Source Optical Coherence Tomography Angiography (OCT-A) (OCT Topcon ImageNet 6; DRI OCT Triton, Topcon Corporation, JAPAN) - based imaging data analysis and processing with a newly made quantitative approach. METHODS: A total of 20 glaucomatous and 20 healthy eyes underwent three OCT-A scanning of the ONH and macula. Macular and papillary and peripapillary vascular networks were calculated. For each eye, eighteen scans were analyzed using a novel approach: custom MATLAB 2021b scripts were employed for imaging analyses. Grayscale distribution was performed using the histcounts MATLAB function with 51 bins. For all layers, the vascular layer coefficient of variation (vl CoV) of the three measures were performed. The vl CoV difference between the two groups was analyzed by Student t-test. RESULTS: In glaucomatous eyes, the vl CoV ranged from 4.49% to 8.54%, while in the control group from 3.58% to 8.32%. Both groups exhibited higher CoVs when assessing the optic disc. The papillary and macular microvasculature reproducibility was comparable between groups. CONCLUSIONS: Utilizing Swept-Source OCT-A images our study has identified an easy and reproducible method that appears to be fast and can assist physicians in assessing macular and ONH perfusion with less inter-image variability, particularly in the 70 µm superficial area of the optic disc. The high reliability obtained suggested that this method could be useful as early clinical biomarker.

A Case of Bilateral Choroidal Effusion after XEN Gel Stent Implantation.

PURPOSE: This study aimed to describe a rare case of bilateral choroidal effusion following a XEN45 implantation. CASE REPORT: An 84-year-old man with primary open-angle glaucoma underwent uneventful ab interno XEN45 device implantation in the right eye. The immediate postoperative period was complicated by hypotony and serous choroidal detachment, which were treated and resolved using steroids and cycloplegic drops. Eight months later, the fellow eye underwent the same surgery, which was followed by choroidal detachment that required transscleral surgical drainage. CONCLUSIONS: This case highlights the importance of a careful postoperative follow-up and a timely intervention in the context of XEN45 implantation, and suggests that choroidal effusion in one eye may be a risk factor for choroidal effusion in the other eye when undergoing the same type of surgery.

Bilateral Choroidal Osteomas in an Elderly Woman: A Case Report.

Choroidal osteoma is a rare clinical entity of unknown etiology. It is a benign ossifying tumor characterized by mature bone replacing choroid. It typically affects young females, unilaterally. Vision loss occurs mainly due to photoreceptor degeneration secondary to decalcification and/or development of choroidal neovascularization, especially if located near the macular area. We present a case of an old woman with bilateral choroidal osteomas identified incidentally. An 84-year-old Caucasian woman who was asymptomatic, without clinical features suggestive of choroidal osteoma, was referred to our hospital for a follow-up visit. On the fundus examination, both eyes showed a suspected lesion. B-scan ultrasound demonstrated bilateral highly reflective calcified lesions within the choroid, with an evident cone of shadow, suggestive of choroidal osteoma. Further investigations have performed to confirm the diagnosis. Although the literature reports a more common one-sidedness and typical manifestation of choroidal osteoma in the teenage years, our case report refers to bilateral choroidal osteomas in an elderly woman.

Blood Reflux Through a PreserFlo MicroShunt Device After Needling.

INTRODUCTION: To report a case of hyphema after a bleb needling revision in a PreserFlo MicroShunt implantation. CASE DESCRIPTION: An 87-year-old man suffering from bilateral open angle glaucoma was referred to our hospital with a diagnosis of unsatisfactory intraocular pressure (IOP) control in the right eye, despite the maximally tolerated medical therapy. The patient underwent PreserFlo MicroShunt implantation in his right eye. About 2 months after the surgical procedure, the IOP was raised because of bleb failure for subconjunctival scarring. A needling revision was performed at the slit lamp. During the procedure blood reflux through a PreserFlo MicroShunt device from a filtering bleb to the anterior chamber was observed, causing an IOP rise. Treatment with oral acetazolamide, topical steroid, and antibiotic resulted in the complete resolution of the hyphema in 2 weeks and a significant lowering in IOP. CONCLUSIONS: This is the first reported case of blood reflux to the anterior chamber through a PreserFlo MicroShunt implant after a needling procedure.

Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study.

BACKGROUND: The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). METHODS: DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. RESULTS: The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (-2.6 ± 3.5 letters vs -8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 µm CST worsening in eyes from both groups. CONCLUSION: Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.

A 2-year prospective multicenter study of ultrasound cyclo plasty for glaucoma.

Ultrasound cyclo plasty (UCP) is a recently developed surgical technique for glaucoma allowing a selective and controlled coagulation of the ciliary body. We herein investigated the long-term efficacy and safety of UCP for the treatment of glaucoma. This prospective study included patients with primary and secondary glaucoma. All surgeries were performed using the EyeOP1 device (Eye Tech Care, Rillieux-la-Pape, France). Sixty-six patients were included, and 60 completed regularly the 2-year follow-up. Preoperative IOP was 28.5 ± 9.6 mmHg and significantly decreased to 17.0 ± 5.4 at 2 years (p < 0.001). The daily number of both hypotensive eye drops and acetazolamide tablets decreased significantly (respectively, from 2.6 ± 1.1 to 1.7 ± 1.2 and from 0.7 ± 0.8 to 0.2 ± 0.5; both p < 0.001). At 2 years, 68.1% of patients met the definition of qualified success (IOP < 21 mmHg regardless of glaucoma medications) and 10.3% of patients met the definition of complete success (IOP < 21 mmHg without glaucoma medications). No major intra- or postoperative complications occurred; however, 15 eyes required additional glaucoma surgery. These results suggest that UCP is an effective and safe procedure to reduce IOP in glaucoma patients through a 2-year follow-up period.