Quantitative Assessment of Retinal and Choroidal Microvasculature in Asymptomatic Patients with Carotid Artery Stenosis.

SIGNIFICANCE: Carotid disease contributes to 15 to 20% of all ischemic strokes, one of the leading causes of permanent disabilities and mortality globally. With its growing prevalence and the inflicted disability rates, screening for anomalies that precede the onset of its serious complications is of crucial global significance. PURPOSE: This study aimed to assess the relationship between retinal and choroidal perfusion changes with the degree of stenosis using quantitative swept-source optical coherence tomography angiography in patients with internal carotid artery stenosis. METHODS: A retrospective cohort study was conducted in 72 eyes with carotid stenosis. According to the degree of stenosis, the participants were divided into a healthy group (group 1: 34 eyes), a mild-moderate stenosis group (group 2: 22 eyes), and a severe stenosis group (group 3: 16 eyes). Swept-source optical coherence tomography angiography was performed to scan macular fovea. Capillary density values in the different retinal and choroidal layers were the major measurements for our study. RESULTS: Mean vessel density in the midchoroid layer was significantly higher in groups 2 and 3 compared with group 1. Deep choroid disclosed significantly superior vascular density values in group 3 compared with groups 2 and 1. Superficial and deep capillary plexus showed decreased vascular density values when comparing group 3 with groups 1 and 2, although they were not significant. CONCLUSIONS: Our report provides the first evidence that choroidal microvascular changes were correlated with severity of carotid artery stenosis. Optical coherence tomography angiography can sensitively detect subtle, early changes in the ocular blood in carotid disease representing a useful, noninvasive, and objective approach to the retinal microvasculature.

Optical coherence tomography biomarkers in patients with macular edema secondary to retinal vein occlusion treated with dexamethasone implant.

PURPOSE: To evaluate the impact of optical coherence tomography (OCT) biomarkers on intravitreal dexamethasone (DEX) implant clinical outcomes in patients with macular edema secondary to retinal vein occlusion (RVO-ME). METHODS: Retrospective study conducted on a cohort of patients with RVO-ME, either naïve or previously treated, who underwent treatment with DEX implant and had a follow-up of 6 months. Anatomic success was defined as a central retinal thickness (CRT) < 250 µm or a relative reduction of CRT ≥10% from baseline. The primary endpoint was the mean change in CRT from baseline to month-6. Secondary end-points included changes in BCVA, the impact of baseline OCT biomarkers on functional and anatomic outcomes; and the impact of treatment on the different OCT biomarkers. OCT biomarkers associated with functional and anatomic outcomes were estimated using a logistic regression model. RESULTS: Fifty-seven eyes were included in the study. Baseline CRT was significantly decreased from 567.6 ± 226.2 µm to 326.9 ± 141.0 µm at month-6 (p < 0.0001). Baseline BCVA was significantly lower in the eyes with disrupted external limiting membrane (ELM) (mean 40.3 ± 21.3 letters) than in those with non-disrupted (mean 68.6 ± 10.7 letters) or partially-disrupted ELM (mean 59.6 ± 13.2 letters), p = 0.0001 and p = 0.0011, respectively. Baseline BCVA was significantly lower in eyes with > 20 hyperreflective foci (HRF) than in those with < 10 HRF (p = 0.0388). The eyes with disorganization of the retinal inner layers (DRIL) had lower baseline BCVA than those without DRIL (Hodges-Lehmann median difference: - 12.0 letters, 95% CI: - 25.0 to - 5.0 letters, p = 0.0042). At month-6, 26 (45.6%); 24 (42.1%), and 20 (35.1%) eyes achieved a BCVA improvement ≥5, ≥10, and ≥ 15 letters respectively. Forty (70.2%) eyes were classified as anatomic success at month-6. Logistic regression analysis found none factor significantly associated with success in the multivariate analysis. CONCLUSIONS: The results of this study suggested a positive impact of DEX on CRT and BCVA in eyes with RVO-ME. No OCT-biomarkers were identified as predictors of clinical-outcomes. Additionally, presence of DRIL, presence of HRF (> 20), or disrupted ELM were significantly associated with worse baseline BCVA.

Case Report: Multimodal Imaging Features of an ABCA4 Cone Dystrophy.

SIGNIFICANCE: Cone dystrophies and cone-rod dystrophies are a group of rare inherited pathologies characterized by degeneration of cone photoreceptors and subsequent rod involvement. The identification of causative genes is essential for diagnosis, and advanced imaging is acquiring great value in the characterization of the different phenotypic expressions. PURPOSE: We describe genotype-phenotype associations of an autosomal recessive ABCA4-associated cone dystrophy using multimodal imaging. CASE REPORT: A 34-year-old woman presented with progressive visual acuity decay. Visual acuity was 20/32 for her right eye and 20/25 for her left eye. A central scotoma was detected on a 10-2 Humphrey visual field in both eyes. Funduscopy revealed perifoveal retinal pigment epithelial changes, and fundus autofluorescence using blue excitation light showed decreased autofluorescence in the central fovea of both eyes with surrounding annular ring of increased autofluorescence in the perifoveal zone; green excitation light fundus autofluorescence was more accurate in the characterization of the size, perimeter, and circularity of central hypofluorescent lesions. Optical coherence tomography revealed an incomplete focal cavitation in both foveas, and optical coherence tomography angiography images showed a reduction in the superficial and deep capillary plexus density, an increased foveal avascular area, and subtle voids in choriocapillaris blood flow. Electroretinography was consistent with cone dystrophy, and molecular testing revealed the alteration of the ABCA4 gene. CONCLUSIONS: The identification of an incomplete focal cavitation could alert the clinician to consider early ABCA4 central cone dystrophy. The patient in this case also exhibited reduced vessel density in the foveal area. Both of these characteristics could be important features related to the underlying genetic mutation.

Effect of Dexamethasone Intravitreal Implant on Visual Acuity and Foveal Photoreceptor Integrity in Macular Edema Secondary to Retinal Vascular Disease.

PURPOSE: The aim of this study was to evaluate the effect of the dexamethasone intravitreal (DEX) implant on the external limiting membrane (ELM) and ellipsoid zone (EZ) integrity in treatment-naïve patients with macular edema (ME) secondary to retinal vascular disease (RVD). METHODS: This is a retrospective study conducted on patients with ME secondary to RVD, who underwent a DEX implant. RESULTS: One-hundred eyes were included. Mean age was 70.3 ± 11.1 years. Mean ELM integrity significantly improved from 1,575.9 ± 285.9 µm at baseline to 1,711.7 ± 244.0 µm at month 3 (p < 0.0001). Similarly, there was a significant improvement in EZ integrity from baseline to month 3 (1,531.5 ± 317.1 vs. 1,694.3 ± 252.8 µm, respectively, p < 0.0001). At month 3, mean visual acuity (VA) gain was 9.9 ± 14.1 letters (p < 0.0001). Mean central retinal thickness (CRT) significantly decreased by -193.2 ± 185.7 µm from baseline to month 3 (p < 0.0001). Mean changes in VA and CRT were significantly correlated with baseline ELM integrity (p = 0.0065 and p = 0.0046, respectively) and EZ integrity (p = 0.0300 and p = 0.0035, respectively). At month 3, the proportion of eyes which had an intact ELM (mean difference 16.0%, 95% CI 5.4-26.4%, p = 0.0033) and EZ (mean difference 12.0%, 95% CI 1.8-22.1%, p = 0.0210) was significantly higher than at baseline. CONCLUSIONS: DEX implant was able to significantly improve ELM and EZ integrity in naïve patients with ME.

Case Report: Tapioca Iris Melanoma: An Uncommon Presentation of an Uncommon Tumor.

SIGNIFICANCE: Iris tumors are rare conditions, and there is a relative paucity of recent published data on its broad clinical spectrum. Tapioca iris melanoma is a rarer yet devastating form with wide and challenging differential diagnoses because of its amelanotic nodular appearance. PURPOSE: This study aimed to report the challenging presentation of an uncommon iris melanoma, describing the clinical and histological findings and comparing them with the existing published data. CASE REPORT: An uncommon clinicopathological report on the tumor unusual localization, patient age, absence of elevated IOP and heterochromia, and negative S-100 stain that caused diagnostic uncertainty is presented. The patient remains free of metastatic disease 7 years after a complete tumor full-thickness excision. CONCLUSIONS: Tapioca iris melanomas are uncommon tumors with a presentation/surgical management that differs from other malignant tumors. Ophthalmologists should consider it among the vast differential diagnoses when observing amelanotic lesions, even without the hallmark signs being evident.

Intravitreal dexamethasone implant Ozurdex® in naïve and refractory patients with different subtypes of diabetic macular edema.

BACKGROUND: Diabetic macular edema (DME) can be treated with different alternatives, among them Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) has demonstrated that may improve both central macular thickness (CMT) and best corrected visual acuity (BCVA). This study aimed to evaluate the effect of the intravitreal dexamethasone implant Ozurdex® in patients with different subtypes of diabetic macular edema over a 6-month follow-up period. METHODS: Eighty-four (29 naïve and 55 previously treated) eyes were included in this retrospective study. For each patient, the BCVA [Early Treatment Diabetic Retinopathy Study (ETDRS) charts] and macular thickness on optical coherence tomography (OCT) at baseline visit and within the 2nd, 4th, and 6th months of follow-up were obtained. The main outcomes measurements were the mean change in BCVA and in CMT with respect to the baseline value. The percentage of patients gaining ≥5 letters and ≥ 10 letters in BCVA was also analyzed. RESULTS: A total of 84 eyes, 29 (34.5%) naïve and 55 (65.5%) non-naïve, from 69 patients were included in the study. BCVA at baseline was 58.8 (16.4) and 61.8 (11.6) in naïve and refractory patients, respectively, p = 0.4513. At every visit, BCVA significantly improved from baseline in naïve and non-naïve eyes (p < 0.0001 and p = 0.0003, respectively; Friedman rank sum test). At baseline, the mean CMT was 466.2 (189.7) µm and 448.1 (110.7) µm in the naïve and non-naïve patients, respectively (p = 0.5830); and decreased to 339.3 (92.5) µm and 357.5 (79.1) µm, respectively (p = 0.0004 and p < 0.0001, respectively, Wilcoxon signed-rank test). The proportion of patients gaining ≥10 letters was significantly greater in the naïve group, p = 0.0199. CONCLUSION: The intravitreal dexamethasone implant (Ozurdex) is effective for the treatment of diabetic macular edema, even in refractory cases that have failed to respond to previous therapies.

Sequential Dexamethasone and Aflibercept Treatment in Patients with Diabetic Macular Edema: Structural and Functional Outcomes at 52 Weeks.

OBJECTIVE: The aim of this paper is to compare intravitreous aflibercept versus dexamethasone implant followed by aflibercept (sequential treatment group) in patients with diabetic macular edema (DME). METHODS: We conducted an observational retrospective study in naïve DME patients, 15 treated only with aflibercept (a monthly injection for the first 5 consecutive doses, followed by an injection every 2 months), and 15 treated with a single dexamethasone implant followed by bimonthly aflibercept. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and qualitative features as well as adverse events were assessed at baseline and at 2, 6, and 12 months. RESULTS: BCVA increased from 70.8 ± 4.1 to 83.5 ± 2.7 letters with aflibercept and from 75.6 ± 2.7 to 86.5 ± 2.5 with sequential treatment (p = 0.551). CMT decreased from 411 ± 26.1 to 288.1 ± 10.5 with aflibercept and from 411.4 ± 24.3 to 260.8 ± 17.9 in the sequential treatment group. The differences between the 2 groups, in terms of visual gain and decreased MT, were not statistically significant (p > 0.05). Nine and 6 injections and 9 and 7 monitoring visits were performed. CONCLUSION: Sequential treatment in DME, starting with dexamethasone and followed by aflibercept, is a promising alternative that can reduce the treatment burden in the first year without statistically significant differences in terms of visual gain and decreased MT compared to aflibercept only.

One-Year Outcomes of the Treat-and-Extend Approach with Aflibercept in Age-Related Macular Degeneration: Effects on Typical Choroidal Neovascularization and Retinal Angiomatous Proliferation.

OBJECTIVE: To investigate functional/morphological outcomes of the treat-and-extend regimen (TER) with aflibercept in typical choroidal neovascularization (CNV) and retinal angiomatous proliferation (RAP) secondary to exudative age-related macular degeneration (AMD). METHODS: This was a retrospective study of 37 eyes treated with 2 mg aflibercept according to a TER protocol. Examinations included best corrected visual acuity (BCVA), numbers of injections, and visits needed. Additionally, quantitative/qualitative analyses with fluorescein angiography and spectral- domain optical coherence tomography were conducted at baseline as well as at 3, 6, and 12 months. RESULTS: BCVA significantly improved from 0.6 ± 0.27 to 0.4 ± 0.34 logMAR. The final mean numbers of injections were 8.03 ± 1.27 and 7.28 ± 0.75 and the numbers of visits 6.5 ± 1.09 and 7.14 ± 1.57 in typical CNV and in RAP or atypical CNV, respectively, and they did not differ between the different subtypes of CNV (p > 0.05). CONCLUSIONS: Aflibercept in TER is effective for all exudative AMD subtypes. The patient's visual gain, the mean number of injections, and the number of visits needed did not depend on the subtype of CNV.

Repeatability of swept-source optical coherence tomography angiography automated macular vessel density.

INTRODUCTION: Optical Coherence Tomography Angiography Ratio Analysis (OCTARA) is capable of visualizing inner and outer retinal vascular plexuses, choriocapillaris, and larger choroidal vasculature in vivo without contrast injection. The aim of this study was to assess the intrasession repeatability of automated vessel density measurements using Triton Swept-Source Optical Coherence Tomography Angiography (OCTA) innovative algorithm OCTARA in retinal and choroidal vasculature. METHODS: To study population between 65-90 years old with no eye diseases. For each subject measurements were performed four times. The intraclass correlation coefficient and the coefficient of variation were calculated to analyze repeatability of the OCTARA automatically generated vessel density measurements. RESULTS: A total of 35 eyes were included in the study. The intraclass correlation coefficient of the global vessel density in the superficial capillary plexus and the deep capillary plexus were 0.963 and 0.975, respectively, and the coefficient of variation were 5.4% and 4.4%, respectively. The intraclass correlation coefficient of the rest of the global measurements was indicative of good reliability with the exception of the deep choroid layer with an intraclass correlation coefficient of 0.6 indicative of moderate reliability. CONCLUSIONS: Our results proved excellent repeatability of automated vessel density measurements in the superficial and deep capillary plexus layers in our cohort using a OCTARA algorithm indicating that it may be a reliable diagnostic tool. It also showed good reliability in choriocapillary and mid choroid layer. These findings may be of value in assessing the significance of differences in capillary density measurements over time and across different settings.

The contribution of indocyanine green angiography in a case of unilateral retinal pigment epithelium dysgenesis.

PURPOSE: To further enhance understanding of the expanded clinical spectrum of unilateral retinal pigment epithelium dysgenesis (URPED) via numerous imaging modalities including novel markers of highly detailed indocyanine green angiography (ICGA) features. METHODS: Retrospective, observational, case report. RESULTS: URPED in this patient is expressed as a solitary, flat and pigmented lesion in the posterior pole with RPE hyperplasia and atrophic changes. An epiretinal membrane (ERM) causing fine, tortuous retinal vessels and retinal folds was observed. Green and blue excitation light fundus autofluorescence showed a biphasic appearance with hypoautofluorescent rounded lesions and a reticular configuration of normal RPE. Fundus fluorescein angiography revealed diffuse hypofluorescence and hyperfluorescent wisps of leakage in late-phases. Early-phase of ICGA evidenced diffuse hypocianescence and a delineated hypercianescent scalloped margin appeared in the late-phase, together with focal hypocianescent spots. SD-OCT demonstrated irregularity of the RPE with fibrosis and hyperplastic changes combined with atrophic areas. Flat RPE detachments intermingled with healthy-appearing RPE were also observed together with thinning of the outer retina. ERM with thickening and disorganization involving the whole retina was present. Optical coherence tomography angiography (14 × 14 mm) revealed an oval shape foveal avascular zone and vascular anomalies such as tortuosity and looping. CONCLUSION: URPED is an extremely rare clinical entity with only a few cases reported. In this case the almost pathognomonic differential features of URPED were best appreciated with ICGA imaging. To our knowledge, this is the first reported case of URPED with these abnormal findings on ICGA meaning it could be part of the spectrum of the disease.

Twelve-year follow up of a case of autosomal recessive bestrophinopathy with transient resolution of retinal edema in one eye.

PURPOSE: To report 12-year follow-up of a patient with ARB. CASE REPORT: A 25-year-old man presented with blurred vision in his both eyes (OU). Best-corrected visual acuity (BCVA) was 20/63 Snellen equivalent in the right eye (OD) and 20/32 Snellen equivalent in the left eye. The intraocular pressures and anterior segment examination were unrevealing in OU. Posterior segment examination revealed multiple yellowish flecks and dots in the posterior pole in OU. Optical coherence tomography (OCT) showed subretinal fluid (SRF), intraretinal hyporeflective spaces, elongated and shaggy photoreceptors and outer retinal defects. Fundus autofluorescence demonstrated mottling hyperautofluorescence and hypoautofluorescence in the posterior pole in OU. Fluorescein angiography illustrated hyperfluorescence in the posterior pole and surrounding the arcades in OU. Multifocal electroretinography objectified mild to markedly abnormal responses in all ring areas in OU. Molecular genetic testing confirmed two heterozygous sequence variations in the BEST1 gene. At 4 years of follow-up, OCT revealed a complete resolution of SRF and a partial resolution of intraretinal hyporeflective spaces in the OD with corresponding improvement in the BCVA to 20/23 Snellen equivalent in the OD, even though outer retinal defects persisted. Our patient denied recent changes in his alimentary habits and medical history at that time. Posteriorly, SRF and intraretinal hyporeflective spaces reappeared in the OD. CONCLUSION: To the best of our knowledge, this is the first case report of ARB with a transient resolution of retinal edema in one eye without medical treatment and dietary therapy.

Optical coherence tomography angiography quantitative analysis of retinal and choroidal microvasculature in patients with dyslipidemia.

INTRODUCTION: The purpose of this investigation was to report swept source-optical coherence tomography angiography (SS-OCTA) quantitative information of retinal and choroidal microvascularization in patients with dyslipidemia (DL). METHODS: We performed a retrospective study. The study enrolled 37 eyes of 20 patients with DL and 40 eyes of 23 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP) and choriocapillaris (CC)) in 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes were recorded. RESULTS: No differences in VD in SCP, MCP and DCP were demonstrated between DL group and control group (p > 0,05). Conversely, VD in the central region at CC was diminished in patients with DL in both cubes (p < 0,05). Moreover, total VD in CC was decreased in the DL group in 6 mm × 6 mm cube (p < 0,05). Regarding FAZ area, we demonstrated and enlargement of FAZ in each retinal capillary plexus, but it did not reach statistical significance (p > 0,05). CONCLUSION: We objectified a diminution of VD in the CC, suggesting that DL mainly affects the choroidal microvasculature. Nonetheless, further studies with a larger population are needed.

Swept-source optical coherence tomography angiography automatic analysis of microvascular changes secondary to systemic hypertension.

INTRODUCTION: The aim of our study is to report swept-source optical coherence tomography angiography (SS-OCTA) quantitative parameters of retinal and choroidal microvasculature in patients with systemic hypertension (HTN) using a built-in software of SS-OCTA. METHODS: We performed a retrospective study. This study enrolled 93 eyes of 51 subjects with HTN and 71 eyes of 38 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP), total capillary plexus (TCP) and choriocapillaris (CC)) of the OCTA cube of 4,5 mm × 4,5 mm were recorded. RESULTS: A decrease of parafoveal VD in CC, DCP and TCP were demonstrated between HTN group and control group (p < 0,05). Conversely, no differences were demonstrated in parafoveal VD of SCP and MCP (p > 0,05). Subgroup analysis revealed a diminution of central VD at SCP, DCP and TCP in patients taking one antihypertensive drug compared to patients treated with two medications (p < 0,05). Correlation analysis showed a significant, albeit weak, negative correlation between HTN duration, and parafoveal VD in the SCP and FAZ area at SCP, DCP and TCP (p < 0,05 and r < 0,300). CONCLUSION: When normative data are available, OCTA might be used as a potential tool in the prevention and follow-up of end-organ damage secondary to HTN. Nonetheless, further studies are needed to confirm this hypothesis.

Two-Year Results of a Treat and Extend Regimen with Aflibercept in Caucasian Patients with Pachychoroid Neovasculopathy.

INTRODUCTION: There are few reports evaluating the treatment of pachychoroid neovasculopathy (PNV) in white patients. The purpose of this study is to analyze the results of a treat and extend regimen with aflibercept in white patients with PNV after 2 years of follow-up. METHODS: We performed a retrospective study in 31 eyes of 26 patients with PNV treated with a treat an extend regimen of intravitreal aflibercept. The mean age was 63,84 ± 7.92 years. There were 9 males (35%) and 17 females (65%). Best-corrected visual acuity (BCVA), central macular thickness (CMT), choroidal subfoveal thickness (CST), choroidal thickness (CT) under type 1 choroidal neovascularization (CNV), pigment epithelium detachment (PED) height, and presence of subretinal fluid (SRF), intraretinal fluid (IRF) and wet macula, were evaluated at baseline and after 3, 6, 12, and 24 months. RESULTS: BCVA remained stable during the follow-up (p 0.161). A significant diminution of CMT was found (p 0.001). Conversely, PED height diminution was not significative (p 0.260). CST and CT under type 1 CNV improved significantly during the follow-up (p 0.005 and 0.009, respectively). Also, wet macula improved after 24 months (p < .001). The average number of intravitreal injections was 12.34 ± 6.01. CONCLUSION: Treat and extend regimen with intravitreal aflibercept in white patients with PNV may be effective for improving CMT, CST, CT under type 1 CNV and wet macula, and to stabilize vision, with a personalized regimen of intravitreal injections.

Peripapillary pachychoroid neovasculopathy: A novel entity.

PURPOSE: Peripapillary pachychoroid syndrome is a new variant of pachychoroid disease recently described. It is important to establish the features and pathogenic mechanisms of this novel entity and its possible association with type 1 neovascularization. The aim of this study is to report a case of peripapillary pachychoroid neovasculopathy, a novel entity of pachychoroid spectrum disease. CASE REPORT: A 51-year-old woman was referred to our macula service due to macular pigmentary changes in her right eye. On examination, best corrected visual acuity was 20/20 Snellen equivalent in both eyes. Funduscopy revealed pigmentary changes in the papillonasal bundle in her right eye with mottled autofluorescence in the same area where pigmentary changes. Spectral-domain optical coherence tomography illustrated a shallow irregular pigment epithelium detachment (PED) which appears as "double layer sign" overlying pachyvessels, with hyper-flow signal beneath it and a large network of neovascularization revealed by cross-sectional optical coherence tomography angiography. Indocyanine green angiography confirmed the pachyvessels and choroidal hyper-permeability in the peripapillary region. A diagnosis of peripapillary pachychoroid neovasculopathy was made and good visual and anatomical outcomes were achieved with a treat-and-extend regimen with intravitreal aflibercept. CONCLUSION: We report a novel entity within the pachychoroid spectrum disease, the peripapillary pachychoroid neovasculopathy, which could improve our understanding of the pathogenic mechanism of choroidal neovascularization in pachychoroid disorders.

Optical coherence tomography angiography analysis of aneurismal type 1 neovascularization in a cohort of white patients.

INTRODUCTION: To evaluate the detection rate of aneurysmal type 1 neovascularization (AT1) in Caucasian patients using optical coherence tomography angiography (OCTA) and to describe OCTA characteristics of AT1 in a cohort of white patients. METHODS: We conducted an observational retrospective study in 44 eyes of 43 patients with AT1. All patients underwent a complete ophthalmologic examination, including fundus imaging, indocyanine green angiography, optical coherence tomography, and OCTA. Branching vascular network (BVN) and polyp detection rates by OCTA were evaluated. Furthermore, we described BVN and polyp morphologies on en face OCTA and flow of polyps on B-scan OCTA. RESULTS: En face OCTA revealed BVN in 84.09% of cases and polypoidal lesions in 86.36% of cases. B-scan OCTA showed BVN and polyps in 95.45% and 93.18% of the patients, respectively. "Trunk" BVNs (51.35%) and "ring" polyps (47.37%) were the most frequent morphologies observed in our cohort, and "patchy hyperflow" (80.49%) signal was the most common visualized in our patients. Regarding OCT parameters, CT under polyps was higher in patients with positive detection of polyps on B-scan OCTA. CONCLUSION: OCTA is a possible diagnosis tool in Caucasian patients with AT1. To the best of our knowledge, this is the largest study performed in Caucasian patients regarding OCTA diagnostic abilities and features.

Multimodal imaging of two cases of retinal vein occlusion secondary to Waldenstrom macroglobulinemia.

PURPOSE: To report multimodal imaging characteristics of two cases of retinal vein occlusion (RVO) secondary to Waldenstrom macroglobulinemia (WM). CASE REPORT: Case 1: An 82-year-old woman presented with vision loss. She had a history of WM. Best-corrected visual acuity (BCVA) was 20/100 Snellen equivalent in the right eye (OD) and 20/63 in the left eye (OS). Fundoscopy showed bilateral hemorrhages in posterior pole and along superotemporal arcade. Fluorescein angiography illustrated no macular leakage. Optical coherence tomography (OCT) revealed macular edema (ME). Optical coherence tomography angiography (OCTA) demonstrated abnormalities in choriocapillaris. A diagnosis of bilateral branch RVO was made and ME was treated with intravitreal dexamethasone, achieving stability. Case 2: A 65-year-old man presented with venous dilation, tortuosity, and intraretinal hemorrhages. BCVA was 20/20 in both eyes (OU). OCT showed ME and hyperreflective dots in choroid. A diagnosis of bilateral central RVO was made. Laboratory evaluation and bone narrow biopsy confirmed a diagnosis of WM. After that, our patient consulted because of vision loss. BCVA was 20/400 in OU. Fundoscopy and OCT demonstrated a worsening of the intraretinal hemorrhages and the ME. OCTA showed damage of choriocapillaris. Thus, intravitreal dexamethasone and plasmapheresis was advised. Two months after, BCVA was 20/40 in the OD and 20/32 in the OS. Also, fundoscopy and OCT improved. CONCLUSION: Early treatment of WM is truly important, with the aim of achieving a decrease in IgM levels in order to avoid toxic effect over the RPE that results in refractory ME.

Two-year results of a treat and extend regimen with aflibercept in Caucasian patients with aneurysmal type 1 neovascularization.

INTRODUCTION: There are a few reports investigating the treatment of aneurysmal type 1 neovascularization (AT1) in Caucasian patients. The aim of this study is to evaluate the 2-year results of a treat and extend regimen with aflibercept in Caucasian patients with AT1. METHODS: We conducted an observational retrospective study in 28 eyes of 26 patients with naïve AT1 treated with a treat an extend regimen of intravitreal aflibercept. Best corrected visual acuity (BCVA), central macular thickness (CMT), pigment epithelium detachment (PED) height, presence of dry macula, and regression rate of polypoidal lesions were assessed at baseline and at 12 and 24 months. RESULTS: BCVA was significantly increased by 9.03 ± 16 letters (p < 0.01) and 9.2 ± 16.87 letters (p < 0.01) after the 12 and 24 months follow-up. A significant decrease of CMT was found at 12 and 24 months (p < 0.01). Nevertheless, significant changes in PED height were not observed (0.1 < p > 0.05). At 12 and 24 months of follow-up, dry macula was achieved in a total of 10 eyes (35.71%) and 15 eyes (53.57%). The regression rate of polypoidal lesions was 25% (7 eyes) and 35.71% (10 eyes) after 12 and 24 months. The mean number of intravitreal injections was 7.81 ± 3.20 the first year and 6.11 ± 3.49 the second year. CONCLUSION: To the best of our knowledge, treat and extend regimen with intravitreal aflibercept in Caucasian patients may be effective for improving BCVA, CMT, wet macula, and regression rate of polypoidal lesions.

Quantitative analysis of retinal and choroidal vasculature in patients with chorioretinal folds secondary to hyperopia.

INTRODUCTION: There is a lack of information on quantitative parameters of optical coherence tomography angiography (OCTA) in cases of chorioretinal folds (CRF). The aim of this study was to compare OCTA retinal and choriocapillary vessel density (VD) between normal subjects and patients with CRF. METHODS: We conducted an observational retrospective study. A total of 16 eyes of eight patients were recruited (eight eyes with CRF and eight control eyes). Data on best-corrected visual acuity (BCVA), refractive error, central macular thickness (CMT), central subfoveal thickness (CST), and OCTA findings (VD and foveal avascular zone (FAZ) area in superficial capillary plexus (SCP), middle capillary plexus (MCP), and deep capillary plexus (DCP), and VD in choriocapillaris (CC)) were recorded in each eye. RESULTS: Compared with control group, CRF group showed decreased VD in the foveal region of SCP and MCP (p value 0.003 and 0.001), and increased VD in nasal region of SCP and MCP (p value 0.02 and 0.001), and in parafoveal area of MCP (p value 0.005). No differences were found in DCP and CC layers. Furthermore, we observed an enlargement of FAZ in CRF group at SCP and MCP slabs (p value <0.001 and 0.015). Respect to optical coherence tomography parameters, we demonstrated a thicker choroid in the CRF group (p value 0.002). CONCLUSION: To the best of our knowledge, this is the first study reported in the literature quantifying VD of retinal capillary plexus and CC in a group of patients with a diagnosis of CRF secondary to hyperopia.