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PURPOSE: To evaluate the frequency and size of intervortex anastomosis at the posterior pole on en-face spectral domain optical coherence tomography (SD-OCT) images in central serous chorioretinopathy (CSC) cases and their fellow eyes and its associations with choroidal morphology. METHODS: Sixty-five treatment-naive eyes of 65 patients with CSC, 65 fellow eyes, and 55 eyes of healthy age-matched participants were included. The presence of intervortex anastomosis at the watershed zone and asymmetry of the choroidal vessels between the superior and inferior macula were evaluated using 6 × 6 mm en-face SD-OCT. The diameter of the widest Haller vessel and the diameter of the widest anastomotic Haller vessel passing through the watershed zone were measured on en-face SD-OCT images. The choroidal vascularity index (CVI) was assessed using ImageJ software. RESULTS: Intervortex vein anastomosis on the horizontal watershed zone was detected in 75.4% diseased eyes, 61.5% in fellow eyes, and 36.4% in healthy age-matched controls (p < 0.001). The mean CVI was significantly higher in both diseased (74.3 ± 2.3%) and fellow (73.8 ± 2.2%) eyes of CSC cases than in healthy controls (72.5 ± 2.3%) (p = 0.002, p = 0.013, respectively). In the cases with intervortex vein anastomosis, the diameter of the widest anastomotic Haller vessel passing through the watershed zone was 0.40 ± 0.10 mm in diseased eyes, 0.35 ± 0.11 mm in fellow eyes, and 0.30 ± 0.09 mm in healthy age-matched controls (p = 0.001). CONCLUSIONS: Intervortex anastomosis might be seen as a variation in normal eyes, however, its frequency and the size of anastomotic vessels are significant higher in not only CSC but also in fellow eyes.
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OBJECTIVES: To compare qualitative and quantitative features of type 1 macular neovascularizations (MNV) in pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD). METHODS: Forty-three treatment-naive eyes of 41 PNV patients and 40 treatment-naive eyes of 38 patients with nAMD were included. The patients were classified as PNV or nAMD according to the presence of pachychoroid features and soft/reticular drusen. Presence of central trunk and maturity of the MNV were evaluated on optical coherence tomography angiography (OCTA) images. MNV area, vessel density (VD), total vessel length (VL), number of intersection points (IPs), fractal dimension (FD), and lacunarity (LAC) were calculated using ImageJ software and FracLac plugin. RESULTS: The mean age was 56.8 ± 8.7 years in PNV and 70.4 ± 8.8 years in neovascular AMD groups (p < 0.001). Compared to nAMD, the presence of central trunk was less frequent in PNV (48.8% vs 77.5%, p = 0.007). Immature MNV pattern was observed more frequently in PNV eyes than nAMD (41.9% vs 20.0%, p = 0.009). PNV cases had significantly lower median MNV area [0.913(1.115) vs 2.542(3.273) mm²], total VL [14.84 (20.46) vs 36.34 (44.68) mm], number of IPs [104(140) vs 335(417.3)], and FD [1.56(0.10) vs 1.59(0.11)] comparing to nAMD cases (p < 0.001, p = 0.001, p < 0.001, p = 0.043 respectively). However, the mean VD (42.4 ± 6.8 vs 42.9 ± 9.0%) and the median LAC values [0.42 (0.09) vs 0.42 (0.09)] did not differ significantly between groups (p = 0.776, p = 0.526, respectively). CONCLUSION: Morphological and quantitative differences exist in type 1 neovascular lesions. Type 1 MNVs in the PNV group are characterized by a smaller and less complex structure.
Subject(s)
Choroidal Neovascularization , Fluorescein Angiography , Tomography, Optical Coherence , Wet Macular Degeneration , Humans , Tomography, Optical Coherence/methods , Male , Female , Aged , Middle Aged , Fluorescein Angiography/methods , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/drug therapy , Choroidal Neovascularization/diagnostic imaging , Choroidal Neovascularization/diagnosis , Visual Acuity/physiology , Retinal Vessels/diagnostic imaging , Retinal Vessels/pathology , Retrospective Studies , Choroid/blood supply , Choroid/diagnostic imaging , Aged, 80 and overABSTRACT
PURPOSE: This study aimed to evaluate the frequency of SSPiM (suspended scattering particles in motion), systemic risk factors, ocular findings, progression characteristics, and treatment response in diabetic retinopathy (DR) patients. METHODS: In this prospective study, a total of 109 eyes of 109 patients with diabetic macular edema (DME) were included. Demographic characteristics and systemic data of the patients were recorded. In addition to a detailed ophthalmological examination, optical coherence tomography (OCT) and OCT angiography (OCTA) imaging were performed. According to the OCTA images, the patients were divided into two categories: SSPiM detected (SSPiM +) and undetected (SSPiM -). The patients were followed up at 0, 3, and 6 months. Treatment responses at 6 months in treatment-administered patients with and without SSPiM were examined. RESULTS: The frequency of SSPiM in DME cases was found to be 34.9%. No significant correlation was found between SSPiM and demographic characteristics, systemic, and biochemical parameters (p > 0.05). It was observed that SSPIM was most frequently localized in the outer nuclear layer adjacent to the outer plexiform (81.6%). SSPiM appearance disappeared in 7 (19.4%) of 36 patients with SSPiM who had regular follow-up for 6 months. In 4 (11.1%) of these seven patients, hard exudate plaques developed in the areas where SSPiM disappeared. Regarding treatment response at 6 months, the decrease in CMT was statistically significantly lower in the SSPiM group compared to cases without SSPiM. CONCLUSION: SSPiM is a finding seen in approximately one-third of DME patients and may adversely affect the response to the treatment.
Subject(s)
Angiogenesis Inhibitors , Diabetic Retinopathy , Fluorescein Angiography , Fundus Oculi , Intravitreal Injections , Macular Edema , Tomography, Optical Coherence , Visual Acuity , Humans , Macular Edema/diagnosis , Macular Edema/etiology , Macular Edema/drug therapy , Tomography, Optical Coherence/methods , Diabetic Retinopathy/diagnosis , Male , Female , Prospective Studies , Follow-Up Studies , Fluorescein Angiography/methods , Middle Aged , Angiogenesis Inhibitors/therapeutic use , Angiogenesis Inhibitors/administration & dosage , Aged , Macula Lutea/pathology , Macula Lutea/diagnostic imaging , Biomarkers , Disease Progression , Time FactorsABSTRACT
Vision plays an important role in an athletes' success. In sports, nearly 80% of perceptual input is visual, and eye health and sports medicine are closely intertwined fields of utmost importance to athletes. The physical nature of sports activities renders individuals more prone to various eye injuries than the general population. Ocular trauma can lead to lifelong sequelae, and impaired vision requires careful follow-up and management. Apart from injuries, athletes may also experience vision problems that can hamper their performance, including blurred vision, double vision, and light sensitivity. The interdisciplinary nature of sports medicine necessitates collaboration between sports medicine professionals and ophthalmologists. Through such collaborations, athletes can receive appropriate eye care, education on proper eye protection and guidance on adopting good eye health practices. If any inconspicuous symptoms are not detected and treated promptly, athletes may acquire systemic injuries because of defective vision, preventing them from achieving high level athletic performance in competitions. The protection of the elite athlete is the responsibility of all of us in sports medicine. To advance a more unified, evidence-informed approach to ophthalmic health assessment and management in athletes and as relevant for sports medicine physicians, the International Olympic Committee Consensus Group aims for a critical evaluation of the current state of the science and practice of ophthalmologic issues and illness in high-level sports, and present recommendations for a unified approach to this important issue.
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The advent of optical coherence tomography angiography (OCTA) is one of the cornerstones of fundus imaging. Essentially, its mechanism depends on the visualization of blood vessels by using the flow of erythrocytes as an intrinsic contrast agent. Although it has only recently come into clinical use, OCTA has become a non-invasive diagnostic tool for the diagnosis and follow-up of many retinal diseases, and the integration of OCTA in multimodal imaging has provided a better understanding of many retinal disorders. Here, we provide a detailed overview of the current applications of OCTA technology in the diagnosis and follow-up of various retinal disorders.
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BACKGROUND: Idiopathic epiretinal membrane (iERM) surgery is one of the most commonly performed vitreoretinal surgeries, and the issue of internal limiting membrane (ILM) peeling in ERM surgery is still controversial. The aims of this study are to evaluate the changes in retinal vascular tortuosity index (RVTI) after pars plana vitrectomy for the iERM using optical coherence tomography angiography (OCTA) and to assess whether ILM peeling has an additional effect on RVTI reduction. METHODS: This study included25 eyes of 25 iERM patients who underwent ERM surgery. The ERM was removed without ILM peeling in 10 eyes (40.0%), and the ILM was peeled in addition to the ERM in 15 eyes (60.0%). The existence of the ILM after ERM peeling was checked with second staining in all eyes. Best corrected visual acuity (BCVA) and 6 × 6 mm en-face OCTA images were recorded before surgery and at the first month postoperatively. A skeleton model of the retinal vascular structure was created following Otsu binarization of en-face OCTA images using ImageJ software (1.52U). RVTI was calculated as the ratio of each vessel length to its Euclidean distance on the skeleton model using the Analyze Skeleton plug-in. RESULTS: The mean RVTI declined from 1.220 ± 0.017 to 1.201 ± 0.020 (p = 0.036) in eyes with ILM peeling and from 1.230 ± 0.038 to 1.195 ± 0.024 in eyes without ILM peeling (p = 0.037). There was no difference between the groups in terms of postoperative RVTI (p = 0.494). A statistically significant correlation was found between postoperative RVTI and postoperative BCVA (rho = 0.408, p = 0.043). CONCLUSIONS: The RVTI is an indirect indicator of the traction created by the iERM on retinal microvascular structures, and it was effectively reduced after iERM surgery. The postoperative RVTIs were similar in cases who underwent iERM surgery with or without ILM peeling. Therefore, ILM peeling may not have an additive effect on the loosening of microvascular traction and thus may be reserved for recurrent ERM surgeries.
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PURPOSE: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. METHODS: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. RESULTS: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.
Subject(s)
Diabetes Mellitus , Diabetic Retinopathy , Macular Edema , Humans , Macular Edema/diagnosis , Macular Edema/drug therapy , Macular Edema/etiology , Dexamethasone , Angiogenesis Inhibitors/therapeutic use , Delphi Technique , Turkey , Vascular Endothelial Growth Factor A , Drug Implants/therapeutic use , Intravitreal Injections , Glucocorticoids , Treatment Outcome , Diabetes Mellitus/drug therapyABSTRACT
PURPOSE: To report an atypical case of exogeneous endophthalmitis presenting with Roth spots. CASE: A 67-year-old man presented with decreased vision, mild pain, and discomfort in his left eye 12 days after an intravitreal aflibercept injection. Best-corrected visual acuity was 20/200, and there were +3 anterior chamber cells. On fundus examination, multiple intraretinal hemorrhages with a central white core resembling a Roth spot were observed. Intravitreal antibiotic injections were performed, and a vitreous sample was taken. Although post-intravitreal injection history was available, full systemic screening was planned to rule out endogenous endophthalmitis because of the presence of these Roth spots. Vitrectomy was performed and methicillin-sensitive coagulase-negative Staphylococcus was detected on culture. CONCLUSION: Although the presence of Roth spots is an unexpected finding in post-injection endophthalmitis, it was nevertheless demonstrated in our case. For this reason, it should be kept in mind that Roth spots can be encountered in bacterial endophthalmitis.
Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Male , Humans , Aged , Intravitreal Injections , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Vitreous Body/microbiology , Vitrectomy/adverse effects , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/etiology , Anti-Bacterial Agents/therapeutic useABSTRACT
PURPOSE: To report a case of cone dystrophy, associated with autosomal recessive homozygote POC1B gene variant, mimicking autoimmune retinopathy. CASE: A 45-year-old female presented with a complaint of decreased vision in both eyes. Her best corrected visual acuity was 20/32 in the right eye and 20/50 in the left eye. Anterior segment and dilated fundus examinations were unremarkable. Spectral domain optical coherence tomography showed a subfoveal blurred dome-shaped ellipsoid zone and an extinguished interdigitation zone affecting the entire macula. Full field electroretinography revealed reduced cone responses. The differential diagnosis included inflammatory chorioretinopathies, autoimmune retinopathies (paraneoplastic or nonparaneoplastic), and hereditary retinal dystrophies. No remarkable finding was observed on combined fluorescein and indocyanine green angiographies. Paraneoplastic autoimmune antibody panel revealed nothing; however, aldolase, enolase, pyruvate kinase M2, and glyceraldehyde-3-phosphate dehydrogenase antibodies were positive on autoimmune retinopathy panel. To exclude hereditary retinal dystrophies, whole-exome sequencing (WES) was applied. WES identified an autosomal recessive homozygote POC1B gene variant (c.680A>G, p.His227Arg). Cone dystrophy diagnosis was given. CONCLUSION: Cone dystrophy associated with POC1B gene variant may present without visible fundus abnormalities. It should be kept in mind that retinal autoantibodies may be positive in such a hereditary dystrophy case due to long-term exposure of the immune system to self-antigens. Therefore, autoimmune retinopathy is a diagnosis of exclusion and should not be diagnosed until all other causes, including hereditary dystrophies, have been ruled out.
Subject(s)
Autoimmune Diseases , Cone Dystrophy , Retinal Dystrophies , Female , Humans , Middle Aged , Cone Dystrophy/diagnosis , Retina , Retinal Cone Photoreceptor Cells , Retinal Dystrophies/diagnosis , Retinal Dystrophies/genetics , Electroretinography , Tomography, Optical Coherence/methods , Fluorescein Angiography , Cell Cycle Proteins/geneticsABSTRACT
PURPOSE: To define the choroidal morphological characteristics of non-exudative age-related macular degeneration (AMD) cases associated with acquired vitelliform lesions (AVLs). METHODS: This retrospective study included intermediate AMD patients with AVLs (Group1, 21eyes) and without AVLs (Group2, 21eyes). A healthy control group was (Group3, 23eyes) also included. Subfoveal choroidal thickness (SFCT), greatest basal diameter (GBD), and maximum height (MH) of the largest PED were measured on spectral domain optical coherence tomography. Internal reflectivity of PEDs and total choroidal area (TCA) were measured using ImageJ software. The TCA was binarized to the luminal area (LA) and stromal area. The choroidal vascularity index (CVI) was assessed. RESULTS: The mean SFCT, TCA, and LA were higher in Group 1 (290.3 ± 86.8 µm, 0.840 ± 0.302 mm2, 0.602 ± 0.227 mm2) than in Group 2 (215.6 ± 85.0 µm, 0.594 ± 0.183 mm2, 0.429 ± 0.139 mm2) (p = 0.014, p = 0.017, p = 0.020, respectively). There was no significant difference in the CVI measurements between Group 1 and Group 2 (p = 1.000). The mean GBD and MH of the PED was higher in Group 1 (1443 ± 595 µm, 188 ± 86 µm) than in Group 2 (851 ± 368 µm, 119 ± 38 µm) (p = <0.001, p = 0.001, respectively). Internal PED reflectivity was significantly lower in Group 1 (0.44 ± 0.21) than in Group 2 (0.66 ± 0.17) (p = <0.001). Internal PED reflectivity showed negative correlation with GBD and MH of the PED in Group 1 (r = -0.587, p = 0.005; rho = -0.448, p = 0.042, respectively). In Group 2, internal PED reflectivity had a negative correlation with MH of the PED (rho = -0.511, p = 0.018). CONCLUSION: Non-exudative AMD patients with AVLs are more prone to have a thick choroid and large hyporeflective PEDs as compared to the those without AVLs.
Subject(s)
Macular Degeneration , Humans , Retrospective Studies , Visual Acuity , Macular Degeneration/diagnosis , Macular Degeneration/pathology , Choroid/pathology , Tomography, Optical Coherence/methodsABSTRACT
A 40-year-old male presented with decreased vision following trauma from a stone. The view of the posterior segment was precluded due to cortex material. Ocular ultrasonography detected total retinal detachment. During 25-G pars plana vitrectomy, a large macular tear was observed. Because this finding was not expected, autologous retinal graft was the only possible surgical option to close this macular tear. A retinal graft was taken from the periphery and spread over the macula. At the postoperative period, the retinal graft was in place and integrated with the tear. An autologous retinal graft may be an effective surgical option in the presence of macular tear. [Ophthalmic Surg Lasers Imaging Retina 2022;53:575-578.].
Subject(s)
Macula Lutea , Retinal Detachment , Retinal Perforations , Adult , Humans , Male , Retina , Retinal Detachment/diagnosis , Retinal Detachment/etiology , Retinal Detachment/surgery , Retinal Perforations/diagnosis , Retinal Perforations/etiology , Retinal Perforations/surgery , Retrospective Studies , Visual Acuity , Vitrectomy/methodsABSTRACT
Background: Central serous chorioretinopathy (CSCR) and pachychoroid neovasculopathy (PNV) are among the pachychoroid spectrum diseases (PSDs). Half-fluence photodynamic therapy (hf-PDT) is one of the effective treatment methods for both diseases. The aim of this study was to compare the effect of hf-PDT on the choroidal structure in CSCR and PNV. Methods: This study included 35 patients with chronic CSCR and 18 patients with PNV. The hf-PDT protocol was applied to all eyes. Before and 3 months after hf-PDT, enhanced-depth optical coherence tomography images were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Results: Compared with baseline values, 3 months after hf-PDT, the mean CA reduced from 1.398 to 1.197 mm2 (p < 0.001) in the CSCR group and the total CA reduced from 1.050 to 1.000 mm2 (p < 0.021) in the PNV group. The mean percentage changes in CA, LA, and SA values were statistically higher in the chronic CSCR group (13.86%, 13.53%, and 14.11%, respectively) than those in the PNV group (4.61%, 4.02%, and 5.74%; p = 0.001, p = 0.002, and p = 0.031, respectively). Conclusion: CSCR and PNV are thought to be PSDs. However, they differ in choroidal morphological response after hf-PDT, which might be a result of the different structural components of the PNV lesions.
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BACKGROUND: The aim of this study was to compare optical coherence tomography angiography (OCTA) and indocyanine green angiography (ICGA) in detecting type-1 macular neovascularization (MNV) in pachychoroid spectrum diseases. METHODS: Patients with pachychoroid characteristics who had undergone ICGA and OCTA imaging at the same visit, were recruited. The diagnosis of MNV was made by a senior retina specialist using multimodal imaging techniques. Afterward, both ICGA and OCTA images were separately reviewed by a masked-independent senior retina specialist with regard to the presence of MNV. The specificity, sensitivity, positive, and negative predictive values of ICGA and OCTA were analyzed. RESULTS: OCTA was able to detect MNV with 97.2% sensitivity, failing to detect MNV only in one eye. The sensitivity of ICGA to detect MNV was 66.76%. The negative predictive value of OCTA was 94.7%; however, this value was 60% for ICGA. Multimodal imaging and OCTA were in almost perfect agreement (kappa coefficient = 0.95). CONCLUSION: OCTA shows greater sensitivity when detecting type-1 MNV than ICGA in pachychoroid neovasculopathy cases. OCTA is a non-invasive and quick imaging modality that can be preferred to dye angiography in the visualization of type-1 MNV in pachychoroid neovasculopathy.
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PURPOSE: To assess choroidal structural changes in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. METHODS: This retrospective cross-sectional study included treatment-naive patients with non-proliferative DR (NPDR) (group 1), diabetic patients without DR (group 2), and healthy subjects (group 3). Patients were also grouped according to the duration of diabetes: long-term group (> 15 years, n = 32) and short-term group (Ë 15 years, n = 28). The choroidal thickness was measured at three points; subfoveal, 1500 µm nasal, and 1500 µm temporal to the fovea. The choroidal area, stromal area, luminal area (LA), and choroidal vascularity index (CVI) were quantified using ImageJ. Partial correlation analysis and one-way analysis of covariance test were performed for statistical analysis. RESULTS: The study included 30 eyes of 30 treatment-naive patients with NPDR (group 1), 30 eyes of 30 diabetic patients without DR (group 2), and 30 eyes of 30 healthy persons (group 3). The mean subfoveal, nasal, and temporal choroidal thicknesses were decreased in group 1 in comparison with controls (p < 0.001, p = 0.035, and p = 0.005, respectively). The mean LA in group 1 and group 2 were both significantly lower compared to group 3 (group 1 vs. group 3, p = 0.004; group 2 vs. group 3, p = 0.020). CVI was significantly lower in group 1 and group 2 than in controls (group 1 vs. group 3, p = 0.019; group 2 vs. group 3, p = 0.025). CVI was significantly lower in the long-duration group than in the short-duration group (p < 0.001). A moderate negative correlation was found between the duration of diabetes and CVI (r = - 0.467, p < 0.001). A moderate negative correlation was found between HbA1c level and luminal area and CVI (r = - 0.466, p < 0.001, and r = - 0.425, p < 0.001, respectively). CONCLUSION: Choroidal structure and CVI are altered even in the absence of clinically confirmed retinopathy and these alterations are related to the duration of diabetes.
Subject(s)
Diabetes Mellitus , Diabetic Retinopathy , Retinal Diseases , Humans , Glycated Hemoglobin , Diabetic Retinopathy/diagnosis , Tomography, Optical Coherence , Retrospective Studies , Cross-Sectional Studies , ChoroidABSTRACT
The aim of this case report is to describe a case of atypical central serous chorioretinopathy (CSCR) definitively diagnosed after 8 years. A 44-year-old woman presented with reduced visual acuity in her left eye. Her visual acuity was light perception with projection in the right eye and 0.15 in the left. She described a similar decline in vision in her right eye 8 years ago. At that time, she had exudative retinal detachment and was treated with systemic immunosuppressive therapy for a presumed diagnosis of Vogt-Koyanagi-Harada disease. Despite resolution of the exudative retinal detachment, macular scarring developed. Eight years later, she developed inferior exudative retinal detachment in the left eye. A diagnosis of atypical CSCR was made with the help of multimodal imaging and her left eye was successfully treated with eplerenone and half-fluence photodynamic therapy (hf-PDT). In conclusion, early diagnosis and treatment of atypical CSCR may prevent subretinal fibrosis formation and permanent vision loss. Hf-PDT and eplerenone are successful treatment options for atypical CSCR.
Subject(s)
Central Serous Chorioretinopathy , Photochemotherapy , Retinal Detachment , Uveomeningoencephalitic Syndrome , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/drug therapy , Child , Eplerenone/therapeutic use , Female , Humans , Retinal Detachment/etiology , Uveomeningoencephalitic Syndrome/complications , Uveomeningoencephalitic Syndrome/diagnosis , Uveomeningoencephalitic Syndrome/drug therapyABSTRACT
PURPOSE: To evaluate the effects of Fabry disease (FD) on the retinal microvasculature and choroidal vascular and structural characteristics. METHODS: This study included 10 patients with FD and 10 age-matched healthy controls. Binarized enhanced depth imaging optical coherence tomography (OCT) images were used to measure the total choroidal area, luminal area, and stromal area with ImageJ software. The choroidal vascularity index (CVI) was assessed. The vessel densities (VD) of the retinal capillary plexuses and foveal avascular zone (FAZ) area were measured with OCT-angiography. RESULTS: The most common anterior segment finding was cornea verticillata (60.0%) and the most frequent posterior segment finding was vascular tortuosity (50.0%). Intraretinal hyperreflective foci on B-scan OCT was observed in 50.0% of the cases. In Fabry cases, a linear mixed model with random intercept revealed that 1% change in CVI was related to -0.009 mm2 (p = .015) change in FAZ area and -0.047 mm change, (p = .024) in FAZ perimeter. In the presence of retinal vascular tortuosity, 1% change in CVI was related to -0.013 mm2 (p = .002) change in FAZ area and -0.052 mm change (p = .004) in FAZ perimeter. In the presence of hyperreflective foci, 1% change in CVI was related to -0.014 mm2 (p = .004) change in FAZ area and -0.064 mm change (p = .003) in FAZ perimeter. CONCLUSION: The significant negative associations between FAZ measurements and CVI suggest a possible interaction between the choroidal and retinal microvasculature of patients with FD. These alterations were more pronounced in the presence of hyperreflective foci and retinal vascular tortuosity.
Subject(s)
Fabry Disease , Macula Lutea , Choroid , Fabry Disease/complications , Fluorescein Angiography/methods , Humans , Retinal Vessels , Tomography, Optical Coherence/methodsABSTRACT
PURPOSE: To investigate the treatment outcomes and predictive factors affecting treatment success of half-fluence photodynamic therapy (hf-PDT) in pachychoroid-associated neovascularization (PNV). METHODS: Twenty-four eyes of 23 PNV patients who underwent hf-PDT were included in this study. The results of optical coherence tomography (OCT) and OCT-angiography imaging were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Baseline characteristics of the eyes showing complete response (group 1) and the eyes with partial response or unresponsive to hf-PDT (group 2) were compared. RESULTS: The mean age of the patients was 54.2±9.6 years. The mean follow-up time after hf-PDT was 20.7 ± 13.6 months. Three months after hf-PDT, the subretinal fluid had completely regressed in 18 eyes (75.0%), partial resolution was observed in 3 eyes (12.5%), and 3 eyes (12.5%) were unresponsive to hf-PDT. When the baseline characteristics before hf-PDT were evaluated between the groups, the mean central choroidal thickness (411.5 ± 115.1 µm vs 284.8 ± 69.4 µm), the mean CA (1.082 ± 0.315 mm2 vs 0.795 ± 0.242 mm2) and the mean LA (0.795 ± 0.234 mm2 vs 0.578 ± 0.200 mm2) was significantly higher in group 1 compared to group 2 (p = 0.019, p = 0.018, p = 0.018, respectively). CONCLUSION: Hf-PDT is an effective treatment method usually providing total resolution of subretinal fluid in PNV cases. A high baseline central choroidal thickness and large luminal area may be positive predictive factors in terms of full anatomical response to hf-PDT. It may be possible to plan a more effective treatment strategy by keeping these factors in mind.
Subject(s)
Central Serous Chorioretinopathy , Photochemotherapy , Porphyrins , Adult , Central Serous Chorioretinopathy/drug therapy , Fluorescein Angiography/methods , Humans , Middle Aged , Photochemotherapy/methods , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Retrospective Studies , Tomography, Optical Coherence/methods , Treatment Outcome , Visual AcuityABSTRACT
BACKGROUND: The aim of this study was to compare the choroidal characteristics of typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV) cases, and to investigate the presence of intervortex venous anastomoses in these PCV subtypes by using en face optical coherence tomography angiography (OCTA). METHODS: A total of 35 eyes of 33 PCV cases were included. The PCV cases were divided into T-PCV and P-CNV groups. The choroidal vascularity index (CVI) was calculated. En face OCTA images were evaluated for the presence of intervortex venous anastomoses. The diameter of the largest anastomotic Haller vessel was measured. RESULTS: T-PCV cases had significantly higher mean CVI values (73.9 ± 3.7 vs. 70.8 ± 4.5%) than P-CNV cases (p = 0.039). Intervortex venous anastomoses were observed in 85.7% of T-PCV eyes and in 91.7% of P-CNV eyes on en face OCTA (p = 1.000). In the cases with intervortex venous anastomosis, the mean diameter of the largest anastomotic vessel on en face OCTA was 341.2 ± 109.1 µm in the T-PCV and 280.4 ± 68.4 µm in the P-CNV group (p = 0.048). CONCLUSIONS: The higher CVI value in T-PCV may be an important feature concerning the pathogenesis and classification of PCV. Although there was no difference between the two subtypes in terms of intervortex anastomosis, more dilated anastomotic vessels were observed in the T-PCV.
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BACKGROUND: To assess the vascularity of choriocapillaris and structural choroidal differences in eyes with reticular pseudodrusen (RPD) and soft drusen. METHODS: 21 eyes with RPD (group 1), 17 eyes with soft drusen (group 2), and 19 eyes as a control group (group 3) were included in this study. Choriocapillaris vascular density and flow area were measured by optical coherence tomography angiography. Total choroidal area, luminal area, stromal area, and lumen/stroma ratios were measured on optical coherence tomography B-scans converted to binary images. RESULTS: Mean choriocapillaris vascular density was higher in group 3 than other groups (group 1 vs 3, p = 0.001; group 2 vs 3, p = 0.003). Mean flow area in choriocapillaris was higher in group 3 than other groups (group 1 vs 3, p = 0.001; group 2 vs 3, p = 0.001). Mean luminal, stromal, and total choroidal areas decreased in group 1 and group 2 compared to controls (p < 0.001, p < 0.001, and p < 0.001, respectively). The stroma ratio decreased in group 1 compared to group 3 (p = 0.013). The lumen ratio and lumen/stroma ratio increased in group 1 compared to group 3 (p = 0.012 and p = 0.008, respectively). CONCLUSIONS: The choroid of eyes with RPD and soft drusen was affected in both choriocapillaris and whole choroid layer.
Subject(s)
Photochemotherapy , Tomography, Optical Coherence , Choroid/diagnostic imaging , Fluorescein Angiography , Photochemotherapy/methods , Photosensitizing Agents , Retrospective StudiesABSTRACT
PURPOSE: To determine the cut-off levels for choroidal thickness and choroidal vascularity index (CVI) to differentiate among pachychoroid spectrum diseases. STUDY DESIGN: A retrospective comparative study METHODS: A total of 143 eyes were included. Of these 29 had uncomplicated pachychoroid (UCP), 29 had pachychoroid pigment epitheliopathy (PPE), 25 had pachychoroid neovasculopathy (PNV), 30 had central serous chorioretinopathy (CSC), and 30 had polypoidal choroidal vasculopathy (PCV). The choroidal areas were measured with ImageJ software. The CVI, the proportion of the luminal area to the total choroidal area, was assessed. RESULTS: The cut-off points of central choroidal thickness were determined as 360 µm for the PPE and PCV group pair (p < 0.001), 422 µm for the PNV and CSC group pair (p = 0.026), 271 µm for the PNV and PCV group pair (p < 0.001), and 341 µm for the CSC and PCV group pair (p < 0.001). The cut-off points of CVI were 72.7 for the PPE and PCV group pair (p < 0.001), 74.7 for the PNV and CSC group pair (p = 0.005), 72.6 for the PNV and PCV group pair (p = 0.001), and 73.6 for the CSC and PCV group pair (p < 0.001). CONCLUSION: Pachychoroid spectrum may be composed of a combination of distinct choroidal diseases with different vascular and structural characteristics.