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BACKGROUND: To compare different clinical and Spectral-Domain Optical Coherence Tomography (SD-OCT) features of high myopic eyes with Stickler syndrome (STL) with matched controls. METHODS: Patients with genetically confirmed STL with axial length ≥ 26 mm and controls matched for axial length were included. The following data were obtained from SD-OCT scans and fundus photography: choroidal and retinal thickness (respectively, CT and RT), peripapillary atrophy area (PAA), presence of posterior staphyloma (PS). RESULTS: Twenty-six eyes of 17 patients with STL and 25 eyes of 19 controls were evaluated. Compared with controls, patients with STL showed a greater CT subfoveally, at 1000 µm from the fovea at both nasal and temporal location, and at 2000 and 3000 µm from the fovea in nasal location (respectively, 188.7±72.8 vs 126.0±88.7 µm, 172.5±77.7 vs 119.3±80.6 µm, 190.1±71.9 vs 134.9±79.7 µm, 141.3±56.0 vs 98.1±68.5 µm, and 110.9±51.0 vs 67.6±50.7 µm, always P< 0.05). Furthermore, patients with STL showed a lower prevalence of PS (11.5% vs 68%, P< 0.001) and a lower PAA (2.2±2.1 vs 5.4±5.8 mm2, P=0.03), compared with controls. CONCLUSIONS: This study shows that high myopic patients with STL show a greater CT, a lower PAA and a lower prevalence of PS, compared with controls matched for axial length. These findings could be relevant for the development and progression of myopic maculopathy in patients with STL.
Subject(s)
Arthritis , Connective Tissue Diseases , Hearing Loss, Sensorineural , Retinal Detachment , Choroid , Connective Tissue Diseases/complications , Humans , Retinal Detachment/diagnosis , Retinal Detachment/etiology , Tomography, Optical CoherenceABSTRACT
PURPOSE: To assess preoperative optical coherence tomography (OCT) findings of foveal-splitting retinal detachment (RD) and determine postoperative outcomes. METHODS: Consecutive patients who underwent RD surgery over a 1-year period were included. Patients diagnosed with a detachment extending to the edge of the fovea on fundus examination (i.e., macula-On/Off) underwent macular OCT scanning. Visual acuity (VA) after 1 year of macula-On/Off, macula-On, and macula-Off eyes was compared. RESULTS: A total of 85 eyes were included, 8 of which had a macula-On/Off RD. On preoperative OCT, all macula-On/Off RD eyes had foveal detachment extending beyond the foveal center over a median distance of 632 µm. Mean VA of the macula-On/Off eyes had improved from 20/160 to 20/40 at 1 year postoperatively (p = 0.035). The preoperative VA of macula-On/Off eyes was significantly better than macula-Off eyes (p = 0.032) and lower than macula-On eyes (p = 0.004). At 1 year, the VA of macula-On/Off eyes was no different from that of the macula-On eyes (p = 0.320), and tended to be better than that of the macula-Off eyes (p = 0.062). CONCLUSION: Preoperative OCT revealed a shallow RD extending beyond the foveal center in eyes with clinical foveal-splitting RD. These eyes, termed macula-On/Off RD eyes, had a preoperative VA between macula-On and macula-Off eyes, while their final VA was close to those with macula-On RD.
Subject(s)
Macula Lutea , Retinal Detachment , Fovea Centralis , Humans , Retinal Detachment/diagnosis , Retinal Detachment/surgery , Retrospective Studies , Tomography, Optical Coherence , VitrectomyABSTRACT
PURPOSE: To determine the preoperative factors influencing visual recovery after vitrectomy for myopic foveoschisis. METHODS: Sixty-six eyes of 65 consecutive patients operated on for myopic foveoschisis were retrospectively included. All eyes underwent a preoperative ocular examination including best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography with central foveal thickness measurement and foveal status classification: simple foveoschisis, foveal detachment, or macular hole. To study the impact of preoperative visual acuity, 4 visual acuity groups separated by quartile ranges were defined. Postoperative visits at 1, 3, or 12 months including BCVA measurement and optical coherence tomography were recorded. RESULTS: Mean refraction was -15.90 diopters, mean axial length was 30.30 mm, mean central foveal thickness was 590 µm, and mean baseline logarithm of the maximum angle of resolution visual acuity was 0.68 (Snellen equivalent of 20/96). The final BCVA improved significantly from 3 months after surgery until the last follow-up visit; the mean logarithm of the maximum angle of resolution visual acuity at last follow-up was 0.43 (Snellen equivalent of 20/54). Mean central foveal thickness decreased significantly as soon as the first postoperative month (P < 0.0001). The preoperative BCVA was the only independent factor significantly correlated with the final BCVA as opposed to the foveal status (P < 0.0001). The mean BCVA and mean visual gain at the last follow-up visit were significantly different between the four visual acuity groups (P < 0.0001 and P = 0.017, respectively). CONCLUSION: The main factor influencing the postoperative visual acuity is the preoperative visual acuity. Although the preoperative anatomical status seemed important in surgeon decision making, once normalized on visual acuity, it no longer influenced the postoperative visual acuity.
Subject(s)
Retinoschisis , Visual Acuity/physiology , Vitrectomy , Adult , Aged , Female , Fovea Centralis/pathology , Humans , Male , Middle Aged , Retinoschisis/physiopathology , Retinoschisis/surgery , Retrospective StudiesABSTRACT
PURPOSE: To report the feasibility and information provided by intraoperative optical coherence tomography (iOCT) during vitreomacular surgery in highly myopic eyes. METHODS: Retrospective observational case series on consecutive highly myopic eyes that underwent vitreomacular surgery with iOCT for epiretinal membrane (ERM), macular hole, and myopic foveoschisis. The main outcome was the qualitative and quantitative assessment of retinal changes: detection of persistent epiretinal structures, new openings, central macular thickness, and macular hole diameters after each step of the surgical procedure. Quantitative measurements (in pixels) were manually obtained on iOCT video screen captures. RESULTS: Twenty-two eyes were included: six ERMs, 10 macular holes, and 6 with myopic foveoschisis. An unsuspected postpeeling macular opening was detected by iOCT in 2/22 eyes. Intraoperative optical coherence tomography also allowed for detecting the presence of residual fragments of the vitreous cortex in 6/12 eyes after surgically induced posterior vitreous detachment. Intraoperative optical coherence tomography detected residual fragments of the internal limiting membrane in 5/21 eyes after internal limiting membrane peeling, and residual fragments of ERM in 3/15 eyes with ERM. Quantitative analysis did not find any significant change in central macular thickness and macular hole diameters before and after ERM and internal limiting membrane peeling. CONCLUSION: In highly myopic eyes, iOCT could help assess undetected macular openings and otherwise posterior vitreous status and epiretinal structure peeling.
Subject(s)
Epiretinal Membrane/surgery , Myopia, Degenerative/surgery , Retinal Perforations/surgery , Retinoschisis/surgery , Tomography, Optical Coherence/methods , Vitrectomy/methods , Adult , Aged , Feasibility Studies , Female , Humans , Intraoperative Period , Male , Middle Aged , Myopia, Degenerative/complications , Retrospective StudiesABSTRACT
PURPOSE: To determine the rate of macular holes (MH) occurring in the fellow eyes of eyes with MH depending on the vitreomacular interface at baseline. METHODS: This was a retrospective study of patients operated on for idiopathic MH, with persistent vitreofoveal attachment in the fellow eye assessed by spectral-domain optical coherence tomography (SD-OCT). Follow-up lasted 6 months or more, and the main outcome was the occurrence of an MH. RESULTS: The 77 fellow eyes included had a mean follow-up of 34.11 ± 22.3 months (6-78.4). At baseline, 31 eyes had vitreomacular traction (VMT), 35 vitreomacular adhesion, and 11 no posterior vitreous detachment. MH occurred in 19.5% of the cases (15/77). The rate of MH was significantly higher among the eyes with VMT than among the eyes without VMT at baseline (35.5 vs. 8.7%; p = 0.009). CONCLUSION: One-third of eyes with VMT at baseline identified by SD-OCT will develop an MH in the following 5 years.
Subject(s)
Retinal Detachment/complications , Retinal Perforations/epidemiology , Vitreous Detachment/complications , Aged , Aged, 80 and over , Cell Adhesion , Female , Humans , Incidence , Macula Lutea/metabolism , Male , Middle Aged , Retinal Perforations/diagnostic imaging , Retinal Perforations/surgery , Retrospective Studies , Risk Factors , Tomography, Optical Coherence , Vitreous Body/metabolismABSTRACT
PURPOSE: To assess the rate of complete posterior vitreous detachment (PVD) in highly myopic eyes requiring vitreoretinal surgery based on intraoperative observations. METHODS: Monocentric retrospective observational case series of consecutive highly myopic patients whose eyes underwent 25 G 3-port pars plana vitrectomy between 2009 and 2012. Patients were operated on for rhegmatogenous retinal detachment, epiretinal membrane, macular hole with retinal detachment, myopic foveoschisis, and myopic macular hole. Patient records were reviewed focusing on the intraoperative assessment of PVD which was assisted in most cases by a visualization agent. RESULTS: Ninety-six eyes of 95 patients whose mean age was 62.15 ± 12.4 years (29-95) were included. Complete PVD was observed in 52.1% of eyes. The PVD rate varied depending on the disease (P < 0.0001). It was high in retinal detachment and epiretinal membrane (85 and 74.2%, respectively) and low in myopic foveoschisis and myopic macular hole (14.3 and 10%, respectively). Complete PVD was found in 42.9% of macular hole with retinal detachment. CONCLUSION: In highly myopic eyes, the rate of complete PVD varied widely depending on the vitreoretinal disease operated on. The posterior vitreous cortex was often detached from the retina in retinal detachment and epiretinal membrane but was most often attached in myopic foveoschisis and macular hole.
Subject(s)
Intraoperative Complications , Myopia, Degenerative/complications , Retinal Detachment/surgery , Retinal Perforations/surgery , Retinoschisis/surgery , Vitrectomy , Vitreous Detachment/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Visual Acuity/physiology , Vitreoretinal Surgery , Vitreous Detachment/diagnosis , Vitreous Detachment/surgeryABSTRACT
Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.
Subject(s)
Retinal Detachment , Humans , Retinal Detachment/surgery , Retinal Detachment/diagnosis , Retinal Detachment/etiology , Quality of Life , Scleral Buckling/adverse effects , Vitrectomy/adverse effects , Treatment OutcomeABSTRACT
PURPOSE: To describe the retinal and vitreous changes in eyes showing myopic macular schisis (MMS) improvement when vitrectomy was not performed and identify triggering factors. DESIGN: Retrospective observational study. SUBJECTS: Patients with nonoperated MMS. METHODS: The records of patients with MMS who were followed without performing surgery for >6 months were retrospectively reviewed, and the eyes showing an anatomic improvement were included. Myopic macular schisis evolution was analyzed quantitatively (central foveal thickness [CFT], parafoveal thickness, maximum height) and qualitatively (presence/absence of foveal detachment, lamellar hole, epiretinal membrane, choroidal neovascularization, inner and outer retinoschisis, vitreous status) at baseline and at the final visit. An anatomic improvement was defined as a decrease in CFT by ≥50 µm. MAIN OUTCOME MEASURES: The rate of anatomic improvement of MMS without performing vitrectomy and the morphological changes observed in these cases. RESULTS: In a cohort of 74 nonoperated eyes with MMS, MMS improved in 14 eyes (19%) after a mean follow-up of 55 ± 38 months (range, 8-138). In these improved cases, the mean decrease in CFT was 153 ± 166 µm (range, 24-635; P = 0.005) and a complete resolution of MMS was observed in 9 eyes (64%). In 9 eyes (64%), the improvement was associated with visible vitreous changes in the macular area on the OCT scans. The mean visual acuity, which was already good at baseline (20/50, 0.4 ± 0.2 logarithm of the minimum angle of resolution), increased at the last visit (20/40, 0.3 ± 0.3 logarithm of the minimum angle of resolution) but without reaching significance. CONCLUSIONS: This long-term follow-up analysis showed that almost 20% of MMS in eyes without indication for surgery could improve over time. In most cases, the improvement was associated with an apparent resolution of vitreous tensions. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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PURPOSE: To assess the sequence of anatomical resolution of myopic foveoschisis (MFS) after vitrectomy. DESIGN: Monocentric retrospective observational case series. SUBJECTS: The files of consecutive patients with MFS who underwent vitreoretinal surgery and were followed postoperatively for at least 6 months were reviewed. METHODS: Patients underwent pars plana vitrectomy for MFS. The central foveal thickness (CFT) was measured. The presence of a foveal involvement, and/or outer retinoschisis (ORS), with or without inner retinoschisis (IRS), and foveal detachment (FD) were analyzed. Anatomical success was defined as the resolution of foveal ORS and FD. MAIN OUTCOME MEASURES: The main outcome was the time to resolution of the different morphologic features of MFS after surgery. RESULTS: Thirty-nine eyes of 36 patients were included in the analysis. The mean follow-up was 14.8 ± 12.9 months (range, 6-84 months). Anatomical success was achieved in 82% of cases at the end of the follow-up and in > 80% of cases during the first year. The CFT was significantly decreased in 79% of cases at 3 months. Inner retinoschisis, present in 18 eyes (46%), resolved in all cases after a median time of 1 month. Foveal ORS, present in all cases, resolved in 82% of cases after a median time of 3 months. The FD, present in 23 eyes (59%), resolved in 91% of cases after a median time of 6 months. Extrafoveal ORS resolved in 59% of cases after a median time of 12 months. The mean best-corrected visual acuity significantly improved from 0.80 ± 0.64 logarithm of the minimum angle of resolution (logMAR) (Snellen Eq 20/148) to 0.48 ± 0.52 logMAR (Snellen Eq 20/70). CONCLUSIONS: Most MFS (80%) are completely resolved during the first year. The decrease in CFT and early resolution of IRS could be used as early biomarkers of surgical success.
Subject(s)
Myopia, Degenerative , Retinoschisis , Humans , Basement Membrane/surgery , Fovea Centralis , Myopia, Degenerative/complications , Myopia, Degenerative/diagnosis , Myopia, Degenerative/surgery , Retinoschisis/diagnosis , Retinoschisis/surgery , Retrospective Studies , Tomography, Optical Coherence , VitrectomyABSTRACT
AIMS: To analyse the prevalence and postoperative outcomes of a particular form of epiretinal membrane (ERM) with foveoschisis-like stretched hyporeflective spaces in emmetropic eyes. METHODS: A retrospective study of all consecutive eyes operated for primary ERM over a 46-month period was conducted. The presence of foveoschisis-like stretched hyporeflective spaces was assessed on the preoperative optical coherence tomography B-scan in all eyes. Highly myopic eyes were excluded. Preoperative and postoperative characteristics of eyes with foveoschisis were compared with those of a control group of 100 consecutive eyes with primary ERM without cystoid spaces. RESULTS: Of 544 eyes with primary ERM, 17 had foveoschisis, corresponding to a prevalence of 3.1%. After a mean postoperative follow-up of 17.9±10.9 months, the foveoschisis had completely resolved in 76.5% of eyes (n=13/17). In the four eyes (23.5%) with persistent foveoschisis, the remaining hyporeflective cystoid spaces were located exclusively in the inner nuclear layer. The postoperative visual acuity and central macular thickness did not differ between both groups at the final visit. However, an acute postoperative macular oedema occurred in 24% (n=4/17) of cases (vs 3% in the control group; p=0.0084). CONCLUSION: Foveoschisis was found in about 3% of eyes with idiopathic ERM. After peeling, the foveoschisis usually resolves completely with functional outcomes similar to those achieved with other primary ERM. However, this feature was associated with a higher risk of postoperative macular oedema (in 1/4 of cases).
Subject(s)
Epiretinal Membrane , Macular Edema , Retinoschisis , Epiretinal Membrane/surgery , Humans , Macular Edema/surgery , Retinoschisis/surgery , Retrospective Studies , Tomography, Optical Coherence/methods , Vitrectomy/methodsABSTRACT
AIM: To analyse the choroidal thickness (CT) and vessel pattern of myopic patients with dome-shaped macula (DSM) and their association with the DSM axis and serous retinal detachment (SRD). METHODS: Retrospective study. The CT and vessel pattern were assessed on optical coherence tomography (OCT), OCT-angiography and ultra-wide-field photography. RESULTS: 27 eyes of 18 subjects (mean age: 65 years) were included. Compared with the 11 eyes (41%) with horizontal DSM, the 16 eyes (59%) with vertical DSM had a shorter axial length (25.8±2 mm vs 28.3±2.5 mm; p=0.01), a higher mean macular bulge height (624.4±207 µm vs 255.4±160.3 µm; p=0.0001) and a thicker CT (183.1±91.1 µm vs 72±38.3 µm; p<0.001). Large choroidal vessels crossed the macular area in 75% of eyes with vertical DSM vs 27% of eyes with horizontal DSM (p=0.02), whereas a watershed zone framing the macula was more often seen in horizontal DSM (72% vs 25%, p=0.02). Thirteen eyes (48%) had an SRD that was not associated with the DSM axis, the mean bulge height, the CT or the vessel pattern. CONCLUSION: The presence of an SRD did not correlate with the DSM axis, the CT or the vessel pattern. However, the rate of large choroidal vessels crossing the macula was higher in vertical DSM than in horizontal DSM.
Subject(s)
Macula Lutea , Myopia , Retinal Detachment , Humans , Aged , Fluorescein Angiography , Retrospective Studies , Visual Acuity , Choroid , Myopia/complications , Tomography, Optical Coherence/methods , Retinal Detachment/complicationsABSTRACT
BACKGROUND: To compare imaging modalities for visualizing primary epiretinal membrane (ERM) with each other and with intraoperative digital images (IDI) after blue staining. METHODS: The records of consecutive patients operated for primary ERM over a 12-month period were retrospectively reviewed. Preoperative imaging included color fundus photography (CFP), En Face spectral-domain optical coherence tomography (OCT), 45° infrared- (IR) and blue-reflectance (BR) scanning laser ophthalmoscopy. All images were qualitatively analyzed and scored from 0-4 according to the ability to visualize ERM details (0 = no visible ERM or vessel contraction, 1 = vessel contraction, 2 = retinal folds, 3 = ERM limits, 4 = elevated ERM edge). The preoperative ERM morphology was then compared to that seen on the IDI acquired after 1-min blue dye staining when available. RESULTS: Seventy eyes were included. The highest score for ERM visualization was obtained on BR and En Face OCT. A score of 3 or 4 was obtained in 68.5%, 62.1%, 17.9% and 13.6% of cases on En Face OCT, BR, CFP and IR images, respectively. IDI were available for 20 eyes, and showed a similar ERM morphology compared to preoperative images in most cases: a negative staining pattern corresponded to a plaque on En face OCT in 91% of eyes. However, IDI failed to show the ERM edges in 37.5% of cases. CONCLUSION: ERM morphology was better visualized preoperatively by BR and En Face OCT, in a similar way to the IDI after staining. Future intraoperative visualization systems could integrate both imaging modalities overlaid with the IDI for guiding ERM removal instead of staining.
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PURPOSE: The surgical indication for lamellar macular holes (LMH) is controversial due to a misclassification of different macular diseases. A consensus based on an optical coherence tomography (OCT) definition has recently been suggested. The aim of this study was to investigate the surgical outcomes of patients with LMH selected based on this OCT-based consensus definition. METHODS: Retrospective review of patients who underwent surgery for LMH with a follow-up of at least 3 months. Anatomical OCT criteria for the diagnosis of LMH were the presence of an irregular foveal contour with foveal cavitation and a loss of retinal tissue. Cases of macular pseudoholes and epiretinal membrane foveoschisis were excluded. Surgery consisted in pars plana vitrectomy with centripetal peri-hole peeling of epiretinal proliferation and internal limiting membrane. Pre- and postoperative visual acuities (VA) were compared, and changes in OCT anatomical features, including the restoration of the foveal profile and outer retinal layers, were assessed. RESULTS: Eleven eyes of 11 patients were included, of which 9 eyes (81.8%) showed proliferation on preoperative OCT. The mean VA improved from 0.44 ± 0.19 LogMAR (20/55 Snellen equivalent) to 0.16 ± 0.08 LogMAR (20/28 Snellen equivalent), after a mean follow-up of 7.2 ± 2.9 months (P = 0.02). Postoperatively, all eyes showed a restored foveal profile. The mean central foveal thickness increased from 127.6 ± 29.9 µm to 209.0 ± 44.0 µm (P = 0.001). At baseline, ellipsoid zone disruption and external limiting membrane disruption were found in 9 and 7 eyes, respectively. Postoperatively, the ellipsoid zone and external limiting membrane were restored in respectively 6/9 eyes (66.7%) and 5/7 eyes (71.4%). No cases of postoperative full-thickness macular hole were found. CONCLUSION: In patients with LMH carefully selected based on the recent OCT-based criteria and showing a loss of retinal tissue, the foveal architecture was restored and the VA was improved after vitrectomy with peri-hole peeling for epiretinal proliferation.
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PURPOSE: To determine the mechanism behind macular bulge height increase in eyes with dome-shaped macula (DSM). DESIGN: Retrospective, observational case series. METHODS: Eyes presenting with DSM followed up for a minimum of 1 year were examined using ocular biometry and spectral-domain optical coherence tomography at baseline and at end of follow-up. Axial length (AL), DSM bulge height, and central and peripheral choroidal thickness (nasal, temporal, superior, and inferior quadrants) were reported. Eyes were categorized into 2 groups for comparison: the "mini-DSM" group (DSM < 100 µm) and the "classic" DSM group (DSM > 100 µm). RESULTS: Fifty-eight eyes (33 patients) were studied: 32 (55%) were classic DSM and 26 (45%) mini-DSM. During the mean follow-up of 51.76 ± 36.01 months, mean AL increased from 26.99 ± 2.94 mm to 27.12 ± 3.09 mm (P = .010) and mean macular bulge height increased from 235.88 ± 282.47 µm to 262.34 ± 317.15 µm (P < .001). DSM height change was significantly higher than AL change (P < .001). Mean peripheral choroidal thickness significantly decreased nasally (P = .008), temporally (P = .026), and inferiorly (P < .001). Mini-DSM eyes exhibited shorter AL (26.17 vs 27.66 mm; P = .027), greater visual acuity (0.169 vs 0.437 logMAR; P = .002), and fewer macular complications compared to classic DSM eyes. CONCLUSIONS: Macular bulge increase in DSM is associated with eye elongation and overall thinning of the peripheral choroid. DSM might result from differential elongation of the eye predominant in the peri-dome region. Mini-DSM (ie, inferior to 100 µm) are characterized by slower evolution, better visual prognosis, and fewer complications compared to "classic" DSM.
Subject(s)
Axial Length, Eye/pathology , Macula Lutea/pathology , Retinal Diseases/etiology , Adult , Aged , Biometry , Choroid/pathology , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/etiology , Dilatation, Pathologic/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myopia, Degenerative/complications , Retinal Diseases/diagnostic imaging , Retinal Diseases/physiopathology , Retrospective Studies , Slit Lamp Microscopy , Tomography, Optical Coherence , Visual Acuity/physiologyABSTRACT
Purpose: To assess topographic variations of choroidal thickness (CT) in the fovea and beyond in healthy eyes. Methods: This cross-sectional study included healthy subjects ≤ 55 years of age with axial lengths (22-26 mm) and refractive error margins (-4D, +4D) in normal ranges. Images were acquired using swept-source optical coherence tomography angiography (OCT-A). Corneal thickness (CT) maps from 12 × 12-mm radial scans and 9 × 9-mm OCT-A B-scans were analyzed. Results: The study included 64 eyes of 33 subjects (mean age, 37 years). Mean CT was >300 µm in all locations except the nasal outer macula. The subfoveal CT was >395 µm in 30% of cases; in 38.7% of cases, >50% of the CT map was thicker than 395 µm. The mean thickest choroidal point was 395.2 µm (range, 164-548 µm), located superior and temporal to the macula in 72.2% of cases and subfoveally in 1.8% of cases. The CT pattern was symmetrical (58%) or asymmetrical (42%) along a horizontal axis correlating with choroidal vein distribution. Half of the asymmetrical patterns were thicker in the inferior quadrants, with an oblique temporal watershed of venous drainage, and the other half were thicker superiorly. The mean vascularity index was â¼75% regardless of the mean CT. Conclusions: One-third of healthy eyes of patients younger than age 55 had a thick choroid (>395 µm). In these normal eyes, the thickest choroidal point was not subfoveal, CT symmetry above and below the fovea depended on choroidal vein distribution, and choroidal vascularity index was independent from CT. No patients demonstrated fundus autofluorescence abnormalities, and the choriocapillaris remained visible even in thick choroids. These features could be interesting when differentiating normal versus pathological states.
Subject(s)
Choroid/anatomy & histology , Tomography, Optical Coherence , Adult , Axial Length, Eye/anatomy & histology , Choroid/blood supply , Choroid/diagnostic imaging , Cross-Sectional Studies , Female , Fovea Centralis , Healthy Volunteers , Humans , Male , Middle Aged , Organ Size , Prospective Studies , Reference Values , Young AdultABSTRACT
AIMS: In longstanding diabetic macular oedema (DME) or retinal vein occlusion (RVO), capillary macroaneurysms may develop. Indocyanine green angiography (ICGA) has been shown to optimise their detection. Here, we report the anatomical and functional outcome of the elective photocoagulation of capillary macroaneurysms. METHODS: A retrospective, interventional, two-centre study. In eyes with chronic macular oedema and severe hard exsudates due to diabetic retinopathy or RVO, the presence of capillary macroaneurysms (defined by a diameter larger than 150â µm) was assessed by ICGA and optical coherence tomography (OCT). Capillary macroaneurysms were selectively photocoagulated, the presence of photothrombosis within the lumen being assessed by immediate OCT. RESULTS: Four eyes from three patients with DME and five eyes from five patients with RVO were included. The median duration of visual loss was 4â years. Median initial visual acuity (VA) was 20/200. The median number of capillary macroaneurysms per eye was 2 (range, 1-8) and their median size was 410â µm (range, 154-603). Six months after photocoagulation, there was a significant reduction in macular thickness (mean±SD, 528â µm±200 vs 271â µm±152, p<0.05) and improvement of VA (mean log MAR, 0.82 vs 0.58, p<0.05). CONCLUSIONS: During macular oedema with severe hard exsudates due to DME or RVO, systematic detection of capillary macroaneurysms by ICGA followed by their OCT-controlled photocoagulation may be of interest. These results may contribute to re-evaluate the role of photocoagulation in the management of longstanding macular oedema.
Subject(s)
Aneurysm/surgery , Laser Coagulation/methods , Macular Edema/surgery , Adult , Aged , Capillaries/surgery , Diabetic Retinopathy/complications , Female , Fluorescein Angiography/methods , Humans , Indocyanine Green/administration & dosage , Macular Edema/diagnosis , Macular Edema/pathology , Male , Middle Aged , Pilot Projects , Retinal Vein Occlusion/complications , Retinal Vessels/surgery , Retrospective StudiesABSTRACT
PURPOSE: To study the relationship between the size of primary full-thickness macular hole (MH) and the vitreomacular attachment status. DESIGN: Single-centre retrospective observational case series. METHODS: The records of 100 consecutive eyes operated for primary full-thickness MH were retrospectively reviewed. The vitreous status and MH diameter were assessed on the preoperative optical coherence tomography scans. MH were classified depending on the presence or absence of vitreomacular traction (VMT) and their size as small (<250â µm), medium (250-400â µm) and large (>400â µm), as suggested in the International VMT Study Group Classification. RESULTS: 22% of MH had VMT and 13% had both VMT and a diameter <400â µm. The MH diameter was not significantly different depending on the presence or absence of VMT (respectively, 339±134 and 423±191â µm (p=0.094)), with large overlap between groups. Small, medium and large MH were similarly distributed regardless of the presence or absence of VMT (p=0.69). CONCLUSIONS: Our series of 100 MH did not reveal any significant relationship between the MH size and the presence or absence of VMT. Only 13% of MH had VMT and a diameter <400 mm, then were eligible for intravitreal ocriplasmin as a possible treatment.