Structural alterations of the choroid evaluated using enhanced depth imaging optical coherence tomography in patients with coronavirus disease / Alterações estruturais da coroide avaliadas por imagens de tomografia de coerência óptica com profundidade realçada em pacientes com COVID-19

ABSTRACT Purpose: To assess choroidal changes using enhanced depth imaging optical coherence tomography in coronavirus disease (COVID-19). Methods: Thirty-two patients with moderate COVID-19 and 34 healthy subjects were included in the study. Choroidal thickness was measured at 3 points as follows: at the subfovea, 1500 mm nasal to the fovea, and 1500 mm temporal to the fovea. The total choroidal area, luminal area, stromal area, and choroidal vascular index were measured with Image-J. All the measurements were performed during the disease and at 4 months after remission. Results: In the patient group, the subfoveal, nasal, and temporal choroidal thicknesses were decreased as compared with those in the controls, but without statistically significant differences (p=0.534, p=0.437, and p=0.077, respectively). The mean total choroidal, stromal, and luminal areas and choroidal vascular index were statistically significantly decreased in the patient group (p<0.001, p=0.001, p=0.001, and p=0.003; respectively). At 4 months after remission, the choroidal structural parameters and choroidal vascular index revealed statistically significant increases as compared with the baseline measurements in the patients with COVID-19 (all p<0.001 and p=0.047, respectively). Conclusion: The choroidal vascular and stromal parameters showed significant transient decreases during the disease course of COVID-19.

RESUMO Objetivo: Avaliar alterações da coroide através de imagens de tomografia de coerência óptica (OCT) com pro fundidade realçada na doença por coronavírus de 2019 (COVID-19). Métodos: Foram incluídos no estudo 32 pacientes com COVID-19 moderada e 34 indivíduos saudáveis. A espessura da coroide foi medida em 3 pontos: subfoveal, a 1500 mm da fóvea na direção nasal e a 1500 mm da fóvea na direção temporal. A área total da coroide, a área luminal, a área estromal e o índice vascular da coroide foram medidos com o programa ImageJ. Todas as medições foram feitas durante a doença ativa e 4 meses após a remissão. Resultados: No grupo de pacientes, as espessuras subfoveal, nasal e temporal da coroide mostraram-se reduzidas em comparação com os controles. A diferença não foi estatisticamente significativa (respectivamente, p=0,534, p=0,437 e p=0,077). As médias das áreas total da coroide, estromal e luminal, bem como o índice vascular da coroide, mostraram-se diminuídos com significância estatística no grupo de pacientes (respectivamente, p<0,001, p=0,001, p=0,001 e p=0,003). Aos 4 meses após a remissão, os parâmetros estruturais e o índice vascular da coroide revelaram um aumento estatisticamente significativo em pacientes com COVID-19, em comparação com as medidas iniciais (todos os valores de p<0,001 para os parâmetros estruturais e p=0,047 para o índice vascular da coroide). Conclusão: Os parâmetros vasculares da coroide e do estroma mostraram uma diminuição transitória, mas significativa em pacientes com COVID-19 durante a doença.

Choroidal vascularity index after a single dose of intravitreal dexamethasone implant in patients with refractory diabetic macular oedema.

PURPOSE: To evaluate choroidal vascularity index (CVI) after a single dose of intravitreal dexamethasone implant in refractory diabetic macular oedema (DME). METHODS: Total choroidal area, luminal area, and CVI were measured at baseline, 1st month, and at 3rd month after dexamethasone implant using binarization of enhanced depth imaging optical coherence tomography (EDI-OCT) images. RESULTS: A total of 25 eyes of 25 patients (mean age: 61.4 ± 8.3 years; 12 males, 13 females), were enroled in the study. All eyes had been previously treated with intravitreal aflibercept injections (mean number of injections 4.6 ± 2.5). Mean CVI was 70.3 ± 8.1 prior to intravitreal dexamethasone treatment. It was decreased to 66.1 ± 9.3 at 1 month and 63.5 ± 10.1 at 3 months after treatment. The mean CVI was significantly decreased at 3 months compared with pre-treatment measures (p = 0.033). CONCLUSION: CVI was found to be decreased in patients who responded to intravitreal dexamethasone implant.

Analysis of choroidal vascularity index in multiple sclerosis patients without optic neuritis attack.

BACKGROUND: To evaluate the choroidal structural changes in multiple sclerosis (MS) patients without previous optic neuritis (ON) attacks. METHODS: Forty eyes of 20 MS patients without a history of ON and 40 eyes of 20 age-matched healthy volunteers were included in this study. The choroidal thickness (CT) was measured at three points; subfoveal, 1500 µm nasal to the fovea, and 1500 µm temporal to the fovea. Choroidal area (CA), luminal area (LA), and choroidal vascularity index (CVI) were calculated using ImageJ. RESULTS: The mean subfoveal, nasal and temporal CT were decreased in MS patients compared to controls (for all, p < 0.001). The mean LA was 0.572 ± 0.113 mm2 in MS group, and 0.729 ± 0.188 mm2 in controls (p = 0.002). The mean CVI was decreased in the MS group (69.38% ± 4.87) in comparison to the controls (73.41% ± 5.18) (p = 0.034). CONCLUSION: The current study demonstrated significant anatomical alterations of the choroid in the eyes of patients with MS.

Short-term effect of angiotensin-converting enzyme inhibitor on retinal vessel diameter in patients with systemic hypertension.

PURPOSE: To determine the retinal vessel diameter changes after angiotensin-converting enzyme (ACE) inhibitor treatment in a group of hypertensive patients. METHODS: This study included 60 treatment-naive hypertensive patients who were treated with ACE inhibitor. Sixty healthy volunteers served as control group. An optical coherence tomography scan protocol including the measurement of peripapillary retinal vessel diameters was performed at baseline and at 1st month. The diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV), superior nasal artery (SNA), inferior nasal artery (INA), superior nasal vein (SNV) and inferior nasal vein (INV) were statistically compared. RESULTS: The baseline diameters of the STA, ITA, SNA, and INA were significantly decreased in the patient group compared with the control group (all p < 0.05). There was a significant increase at 1st month after the treatment in comparison to baseline measurements (all p < 0.05). When compared with the controls, only the diameter of SNV showed a significant decrease at baseline (p = 0.031). After the treatment, the diameters of SNV and INV were significantly increased compared with baseline measurements (p = 0.049 and p = 0.035, respectively). There were no significant differences between the control group and the patient group at 1st month (all p > 0.05). CONCLUSION: Short-term treatment with ACE inhibitor led to a significant improvement in the retinal vessel diameters of patients with hypertension.

Factors effecting the choroidal vascularity index in children with mild to moderate myopia.

PURPOSE: To measure the choroidal structural parameters in a population of myopic children and determine the factors effecting the choroidal vascularity index (CVI). METHODS: In total, 200 eyes of 200 children (100 females, 100 males) with a mean age of 11.5 ± 1.6 years were included in the study. Macular imaging was performed using EDI mode of spectral domain-optical coherence tomography. Binarization of the choroidal area was performed with ImageJ software. Total choroidal area, luminal area (LA), stromal area (SA), and CVI were automatically calculated. RESULTS: The mean choroidal, stromal and luminal areas were measured as 0.952 ± 0.127 mm2, 0.626 ± 0.103 mm2 and 0.325 ± 0.076 mm2, respectively. The mean CVI was 65.81% ± 6.56. Age and the axial length (AL) of the participants were not found to be associated with the LA and the CVI. (r=-0.078, p=0.274, r=0.017, p=0.808, and r=0,051, p=0.474 and r=-0.128, p=0.071, respectively). There was a statistically significant strong association between the LA and CVI measurements and SE of the participants (r=0.736, p=0.001, and r=-0.605; p=0.001). CONCLUSION: Age and AL were not associated with the CVI, but SE was significantly associated with the CVI.

Structural alterations of the choroid evaluated using enhanced depth imaging optical coherence tomography in patients with coronavirus disease.

PURPOSE: To assess choroidal changes using enhanced depth imaging optical coherence tomography in coronavirus disease (COVID-19). METHODS: Thirty-two patients with moderate COVID-19 and 34 healthy subjects were included in the study. Choroidal thickness was measured at 3 points as follows: at the subfovea, 1500 mm nasal to the fovea, and 1500 mm temporal to the fovea. The total choroidal area, luminal area, stromal area, and choroidal vascular index were measured with Image-J. All the measurements were performed during the disease and at 4 months after remission. RESULTS: In the patient group, the subfoveal, nasal, and temporal choroidal thicknesses were decreased as compared with those in the controls, but without statistically significant differences (p=0.534, p=0.437, and p=0.077, respectively). The mean total choroidal, stromal, and luminal areas and choroidal vascular index were statistically significantly decreased in the patient group (p<0.001, p=0.001, p=0.001, and p=0.003; respectively). At 4 months after remission, the choroidal structural parameters and choroidal vascular index revealed statistically significant increases as compared with the baseline measurements in the patients with COVID-19 (all p<0.001 and p=0.047, respectively). CONCLUSION: The choroidal vascular and stromal parameters showed significant transient decreases during the disease course of COVID-19.

Assessment of choroidal vascularity index during the menstrual cycle.

PURPOSE: To explore the effect of menstrual cycle on choroidal vascularity index (CVI). METHODS: Thirty six eyes of 36 healthy women were included in this prospective study. The menstrual cycles were regular and ranged from 28 to 30 days in length. Optical coherence tomography images were obtained in 3 different phases of the menstrual cycle. The choroidal thickness (CT), total choroidal area, luminal area, stromal area, and CVI were quantified. RESULTS: Mean subfoveal, nasal and temporal CT were significantly changed in mid-luteal phase in comparison to early follicular (p = 0.018, p = 0.006 and p = 0.001, respectively) and ovulatory phases (p = 0.037, p = 0.037, and p = 0.035, respectively). Mean CVI showed a significant change in mid-luteal phase when compared with early follicular (p = 0.001) and ovulatory phases (p = 0.036). CONCLUSION: CVI seemed to be affected in mid-luteal phase of menstrual cycle. This should be considered while analyzing choroidal structure in otherwise healthy women.

Choroidal vascularity index in obstructive sleep apnea syndrome.

BACKGROUND: There is growing evidence supporting an association between obstructive sleep apnea syndrome (OSAS) and systemic vascular disorders. However, the data on choroidal microvasculature are limited. In recent years, choroidal thickness (CT) and choroidal vascularity index (CVI) have been of considerable interest as objective markers of choroidal vascularity. We hypothesized that the imbalance of vascular regulation in OSAS may adversely affect the CT and CVI and may help to assess the vascular risk in these patients. PURPOSE: This study aimed to evaluate the choroidal morphology in patients with OSAS. MATERIALS AND METHODS: Patients with moderate OSAS were included to this study. The subfoveal, nasal, and temporal CT were calculated. The choroidal area (CA) was binarized to the luminal area (LA) and stromal area (SA) using ImageJ software. The CVI was calculated as the proportion of the LA to the total CA. RESULTS: Of 40 eyes of 40 patients, the mean subfoveal CT was significantly decreased in the OSAS group in comparison to the controls (p = 0.032). The mean CA, LA, and SA were decreased in the OSAS group compared with the controls, but the differences did not reach a statistical significance (p = 0.132, p = 0.104, and p = 0.184, respectively). The CVI was not significantly changed in patients with OSAS (p = 1.000). CONCLUSION: Unlike CT, there were no significant differences in choroidal structural parameters and CVI in patients with OSAS.

Choroidal structural changes and choroidal vascularity index in patients with systemic hypertension.

PURPOSE: To assess the impact of systemic hypertension on the choroidal structure and choroidal vascularity index (CVI). METHODS: This prospective cross-sectional study comprised 50 eyes of 50 treatment-naive hypertensive patients and 50 eyes of 50 healthy subjects. Choroidal thickness (CT) was measured in the subfoveal region, 1500 µm nasal to the fovea, and 1500 µm temporal to the fovea. Binarization of the enhanced depth-optical coherence tomography images was performed with Image-J software. The CT, choroidal area (CA), luminal area (LA), and CVI were compared statistically. RESULTS: The mean subfoveal, nasal, and temporal CT were decreased in the patient group (p 0.003, 0.026, and 0.001, respectively). The mean CA, LA, and CVI were decreased in the patient group in comparison to controls (p = 0.047, 0.009, and 0.016 respectively). The correlation between the subfoveal CT and systolic blood pressure was significant (r = -0.450, p < 0.001). There was a significant correlation between the systolic blood pressure and CVI (r = -0.401, p < 0.001). CONCLUSION: The significant decrease in the structural parameters and CVI show that choroid is affected in patients with treatment-naive hypertension.

Association of choroidal structure and body mass index in an adult population.

PURPOSE: To determine the relation of choroidal structural parameters and body mass index (BMI) in an adult population. METHODS: About 144 eyes of 144 healthy individuals were incorporated. There were four groups according to BMI values: Group 1 (⩽18.5), group 2 (18.6-24.9), group 3 (25.0-29.9), and group 4 (30.0-34.9). The enhanced depth imaging optical coherence tomography images were binarized using Image-J software. Choroidal thickness (CT), circumscribed choroidal area (CCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were calculated. RESULTS: Mean subfoveal, nasal, and temporal CT were lower in group 4 rather than group 1 (p = 0.032, p = 0.001, and p < 0.001, respectively). Mean nasal and temporal CT also showed a decrease in group 4 as compared to group 2 (p = 0.04 and p = 0.039). Mean CCA and LA were decreased in group 4 in comparison to group 3 (p = 0.001 and p = 0.001), group 2 (p < 0.001 and p < 0.001), and group 1 (p = 0.001 and p < 0.001). Mean SA showed a decrease only in group 3 rather than group 2 (p = 0.021) and group 1 (p = 0.008). Mean CVI was decreased in group 3 and group 4 in comparison to group 1 (p < 0.001 and p < 0.001) and group 2 (p = 0.002 and p < 0.001). CONCLUSION: Increased BMI percentile was associated with a decrease in CT and structural parameters.