An OCT-A Analysis of the Importance of Intermediate Capillary Plexus in Diabetic Retinopathy: A Brief Review.

Optical coherence tomography-angiography is a technique that allows us to non-invasively study in vivo the different retinal vascular networks. This allows a deeper understanding of retinal capillary anatomy and function, in addition to the pathophysiologic changes encountered in diverse diseases. The four retinal capillary layers have different anatomies and functions, implying distinct adaptation and roles in the course of the diseases. Diabetic retinopathy is the leading cause of blindness in working-age adults. Several studies have evaluated how each retinal capillary layer is specifically affected according to the stage of the disease. Unfortunately, too few studies have considered the intermediate capillary plexus as a separate layer, as it has often been incorporated in another layer. In this review, we shed light on the potential role the intermediate capillary plexus plays in the physiopathology of diabetic retinal disease as well as its potential use in grading diabetic retinopathy and its clinical added value in estimating the disease prognosis.

Cataract surgery and environmental sustainability: a comparative analysis of single-use versus reusable cassettes in phacoemulsification.

OBJECTIVE: To compare sustainability, financial implications and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones. METHODS: Observational study involving retrospective cataract surgery data collection at the Centre Médical de l'Alliance, Braine-l'Alleud, Belgium, a tertiary eye care centre. Information on cassette weight, quantities and transport volume was obtained from routine procedures and purchasing records. The costs for each machine were calculated by reviewing the invoices received from the accounting department. RESULTS: We found significant differences across comparisons. The reusable cassette machine, when compared with the single-use machine, used 306.7 kg less plastic (75.3% reduction), required 2494 m3 less storage per 1000 surgeries (67.7% decrease) and cost €54.16 less per 10 procedures (16.9% reduction). The machine with daily reusable cassettes also exhibited a 7-minute priming time advantage for 10 procedures, reducing downtime between cases. CONCLUSIONS: Our findings underscore the benefits of adopting reusable cassette systems: reduced plastic consumption, storage volume and priming time, as well as enhanced efficiency and cost-savings. Healthcare professionals and institutions are encouraged to embrace environmentally conscious initiatives. The use of reusable cassette systems for cataract surgeries offers a pathway to sustainable practices.

Intense Pulsed Light Therapy in the Treatment of Dry Eye Diseases: A Systematic Review and Meta-Analysis.

BACKGROUND: Intense pulsed light therapy (IPL) is a recently developed way of treating dry eye disease (DED). During the last decade, there was a multiplication of trials studying IPL efficacy. The goal of this review is to summarize the most important and significant results of these trials estimating effect sizes. METHODS: The PubMed and sciencedirect databases were searched using a PICO model-based approach. Randomized controlled trials including at least 20 patients with DED and no other eye condition, with a control group and break-up time or symptom scores data available for extraction were included in this review. Statistical analysis evaluated the tear break-up time (TBUT), non-invasive break-up time (NIBUT), ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED). Three comparisons were carried on for each outcome: longest follow-up values vs. baseline in the treatment group, longest follow-up values in the treatment group vs. control group, and changes from baseline in the treatment group vs. control group. A subgroup analysis was carried on. RESULTS: Eleven randomized controlled trials, published between 2015 and 2021 were included in this systematic review with 759 patients in total. The longest follow-up values vs. baseline in the treatment group analyses were significantly in favor of IPL for all the parameters studied for instance: NIBUT (effect size (ES), 2.02; 95% confidence interval (CI), (1.43; 2.62)), TBUT (ES, 1.83; 95% CI, (0.96; 2.69)), OSDI (ES, -1.38; 95% CI, (-2.12; -0.64)) and SPEED (ES, -1.15; 95% CI, (-1.72; -0.57)). The longest follow-up values in the treatment group vs. control group analyses, and, the change from baseline in the treatment group vs. control group analyses, were both significantly in favor of IPL for NIBUT, TBUT, and SPEED but not for OSDI. CONCLUSIONS: IPL seems to have a positive effect on tear stability evaluated by the break-up times. However, the effect on DED symptoms is less clear. Some confounding factors such as the age and the IPL device used influence the results indicating that the ideal settings still need to be found and personalized for the patient.

Experimental Models to Study Epithelial-Mesenchymal Transition in Proliferative Vitreoretinopathy.

Proliferative vitreoretinal diseases (PVDs) encompass proliferative vitreoretinopathy (PVR), epiretinal membranes, and proliferative diabetic retinopathy. These vision-threatening diseases are characterized by the development of proliferative membranes above, within and/or below the retina following epithelial-mesenchymal transition (EMT) of the retinal pigment epithelium (RPE) and/or endothelial-mesenchymal transition of endothelial cells. As surgical peeling of PVD membranes remains the sole therapeutic option for patients, development of in vitro and in vivo models has become essential to better understand PVD pathogenesis and identify potential therapeutic targets. The in vitro models range from immortalized cell lines to human pluripotent stem-cell-derived RPE and primary cells subjected to various treatments to induce EMT and mimic PVD. In vivo PVR animal models using rabbit, mouse, rat, and swine have mainly been obtained through surgical means to mimic ocular trauma and retinal detachment, and through intravitreal injection of cells or enzymes to induce EMT and investigate cell proliferation and invasion. This review offers a comprehensive overview of the usefulness, advantages, and limitations of the current models available to investigate EMT in PVD.

Intravitreal methotrexate in vemurafenib-induced uveitis.

PURPOSE: Vemurafenib, a BRAF inhibitor, has revolutionized the prognosis of late-stage melanoma patients, rising at the same time concerns about its potential adverse effects. Here is a case of vemurafenib-induced uveitis, peculiar in both its presentation and management. METHODS: Case report, diagnostic and therapeutic challenge. RESULTS: Uveitis is a known side effect of vemurafenib. It is generally bilateral, moderate, manageable with topical steroids and does not require cancer therapy cessation. We present a patient who suffered from a unilateral, severe uveitis following vemurafenib treatment that fully recovered thanks to intravitreal methotrexate injections, as conventional corticosteroid therapy was contraindicated. CONCLUSION: Uveitis can be a serious ocular adverse effect of vemurafenib, while its risks factors and mechanisms remain unknown. As BRAF inhibitors are now used on a regular basis, it is important for clinicians to be aware of this potentially sight-threatening side effect. Intravitreal methotrexate injections may be considered as an effective treatment choice in severe targeted agents-induced uveitis.

Active Ocular Toxoplasmosis Associated with Simultaneous Multiple Evanescent White Dot Syndrome.

PURPOSE: We describe the association between active ocular toxoplasmosis and Multiple Evanescent White Dot Syndrome (MEWDS). PATIENTS AND METHODS: Retrospective observational case report of a patient who presented with concomitant ocular toxoplasmosis and MEWDS (Erasmus University Hospital, Brussels, Belgium). Clinical record and multimodal imaging including fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. RESULTS: Multimodal imaging of a 25-year-old-woman that presented with concomitant active ocular toxoplasmosis and MEWDS is described. Both clinical entities regressed completely after 8 weeks under steroidal anti-inflammatory drugs and antibiotics. CONCLUSION: Active ocular toxoplasmosis can be associated with simultaneous multiple evanescent white dot syndrome. Further reports are needed to precise and characterize this clinical relationship and its management.Abbreviations: MEWDS: Multiple Evanescent White Dot Syndrome; Fundus Autofluorescence FAF; BCVA: Best-corrected Visual Acuity; FA: Fluorescein Angiography; ICGA: Indocyanine Green Angiography; SD-OCT: Spectral Domain Optical Coherence Tomography; IR: Infrared.

Correlations Between Different Choriocapillaris Flow Deficit Parameters in Normal Eyes Using Swept Source OCT Angiography.

PURPOSE: Choriocapillaris (CC) imaging of normal eyes with swept-source optical coherence tomographic angiography (SS-OCTA) was performed, and the percentage of CC flow deficits (FD%) and the average area of CC flow deficits (FDa) were compared within the given macular regions. DESIGN: A prospective, cross-sectional study. METHODS: Subjects with normal eyes ranging in age from their 20s through their 80s were imaged with SS-OCTA (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, California, USA) using both 3×3-mm and 6×6-mm macular scan patterns. The CC images were generated using a previously published and validated algorithm. In both 3×3-mm and 6×6-mm scans, the CC FD% and FDa were measured in circular regions centered on the fovea with diameters as 1 mm and 2.5 mm (C1 and C2.5). In 6×6-mm scans, the FD% and FDa were measured within an additional circular region with diameter as 5 mm (C5). The correlations between FD% and FDa from each region were analyzed with Pearson correlation coefficients. RESULTS: A total of 164 eyes were analyzed. There was excellent correlation between CC FDa and FD% measurements from each region. In the 3×3-mm scans, the correlations in the C1 and C2.5 regions were 0.83 and 0.90, respectively. In the 6×6-mm scans, the correlations in C1, C2.5, and C5 regions were 0.90, 0.89, and 0.89, respectively. CONCLUSIONS: When measuring CC FDs, we found excellent correlations between FDa and FD% in regions from 3×3-mm and 6×6-mm scans. Further studies are needed to determine if one parameter is more useful when studying diseased eyes.

Widefield Swept-Source Optical Coherence Tomography Angiography of Proliferative Diabetic Retinopathy.

BACKGROUND AND OBJECTIVE: To demonstrate the utility of widefield swept-source optical coherence tomography angiography (SS-OCTA) for the diagnosis and management of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Consecutive patients with vision-threatening diabetic retinopathy were imaged with widefield SS-OCTA using the 12 mm × 12 mm scan pattern. RESULTS: Twenty-four eyes of 12 patients underwent SS-OCTA imaging. In all 24 eyes, the en face total retinal flow images detected areas of decreased retinal perfusion, and the en face vitreoretinal interface (VRI) slabs detected foci of retinal neovascularization (NV). NV was treated and followed using the VRI images. CONCLUSIONS: Widefield SS-OCTA is a useful, noninvasive technology for the detection and monitoring of NV in PDR. Features of interest, such as areas of decreased retinal perfusion, increased retinal thickness, and NV, can be identified from different en face slabs extracted from a single 12 mm × 12 mm scan. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:474-484.].

Two-Year Risk of Exudation in Eyes with Nonexudative Age-Related Macular Degeneration and Subclinical Neovascularization Detected with Swept Source Optical Coherence Tomography Angiography.

PURPOSE: Swept source optical coherence tomography angiography (SS-OCTA) was used to study the prevalence, incidence, and natural history of subclinical macular neovascularization (MNV) in eyes with unilateral nonexudative age-related macular degeneration. DESIGN: Prospective cohort study. METHODS: Patients were imaged using 3- × 3-mm and 6- × 6-mm SS-OCTA scan patterns. MNV was detected using the outer retina to choriocapillaris en face slab. Prevalence and incidence of subclinical MNV, Kaplan-Meier cumulative estimates for the overall risk of exudation, and the association between neovascular lesion size and the risk of exudation were assessed through 2 years. RESULTS: From August 2014 through March 2018, 227 patients (154 intermediate and 73 late age-related macular degeneration eyes) underwent SS-OCTA imaging. Thirty eyes (13.2%) had subclinical MNV at first imaging and 12 eyes (8.9%) developed subclinical MNV during follow-up. Of the 191 eyes with >1 visit, 19 developed exudation. Fourteen of these eyes had pre-existing subclinical MNV. The incidence of exudation from the time of first detection of any subclinical MNV was 34.5%. The relative risk of exudation after detection of subclinical MNV was 13.6 times greater (95% confidence interval 4.9-37.7) than in the absence of subclinical MNV (P < .001). There was no significant risk of exudation based on lesion size alone (P = .91). CONCLUSIONS: By 24 months, the risk of exudation was 13.6 times greater for eyes with subclinical MNV detected by SS-OCTA compared with eyes without subclinical MNV. For eyes with subclinical MNV in the absence of symptomatic exudation, we recommend close follow-up without treatment.

Multimodal Imaging of Punctate Outer Retinal Toxoplasmosis.

BACKGROUND AND OBJECTIVE: To describe the multimodal imaging characteristics associated with punctate outer retinal toxoplasmosis (PORT). PATIENTS AND METHODS: Multicenter, retrospective, observational case series of three patients who presented with PORT. Multimodal imaging was reviewed including optical coherence tomography (OCT), fundus autofluorescence, optical coherence tomography angiography, and conventional dye-based angiography. RESULTS: Patient ages ranged from 13 years to 55 years. Each patient had multiple white, punctate outer retinal lesions in the affected eye at initial diagnosis. OCT showed both inner and outer retinal changes, including disruption of the ellipsoid and interdigitation zones and retinal pigment epithelium/Bruch's membrane complex, as well as punctate, preretinal, hyperreflective lesions at the vitreoretinal interface, which regressed with treatment. CONCLUSION: Multimodal imaging is useful in diagnosing and monitoring treatment response in PORT, an uncommon presentation of ocular toxoplasmosis that must be differentiated from white dot syndromes or other causes of unilateral retinitis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:281-287.].

Predictive Value of the OCT Double-Layer Sign for Identifying Subclinical Neovascularization in Age-Related Macular Degeneration.

PURPOSE: Structural OCT images from eyes with nonexudative age-related macular degeneration (AMD) were graded for the presence of a double-layer sign to determine if the double-layer sign predicted subclinical macular neovascularization (MNV). DESIGN: Prospective, observational study. PARTICIPANTS: Nonexudative AMD patients with and without subclinical MNV identified by swept-source (SS) OCT angiography (OCTA). METHODS: Participants were enrolled prospectively into an SS OCTA imaging study. A set of test scans with and without subclinical MNV was compiled to assess the ability of trained graders to identify nonexudative type 1 MNV. The graders evaluated only the structural OCT B-scans of those eyes. The presence of a double-layer sign was used as a predictive sign for subclinical type 1 MNV. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from 2 separate gradings were calculated and compared. MAIN OUTCOME MEASURES: The association between the presence of a double-layer sign and subclinical type 1 MNV. RESULTS: One hundred eyes with nonexudative AMD from 94 patients were used for this study. The test set contained 64 eyes with intermediate AMD, which included 20 eyes with subclinical MNV, and 36 eyes with late AMD, which included 13 eyes with subclinical MNV. Two junior graders read the scans separately then reached a consensus grading. They detected a double-layer sign in 24 of 33 eyes with subclinical MNV and did not detect a double-layer sign in 56 of 67 eyes without MNV. Their sensitivity, specificity, PPV, and NPV were 73%, 84%, 69%, and 86%, respectively. The senior grader detected a double-layer sign in 29 of 33 eyes with subclinical MNV and did not detect a double-layer sign in 58 of 67 eyes without MNV, achieving a sensitivity, specificity, PPV, and NPV of 88%, 87%, 76%, and 94%, respectively. For all graders, there were statistically significant associations between type 1 MNV and presence of the double-layer sign (P < 0.001). CONCLUSIONS: Presence of the double-layer sign on structural OCT B-scans was associated with subclinical type 1 MNV and can be used to identify these lesions with good predictive values in eyes with nonexudative AMD.

En Face Imaging of Geographic Atrophy Using Different Swept-Source OCT Scan Patterns.

PURPOSE: Different swept-source (SS) OCT scan patterns were used to image geographic atrophy (GA) to determine if they provided similar area and enlargement measurements in eyes with age-related macular degeneration (AMD). DESIGN: Prospective, observational case series. PARTICIPANTS: Patients with GA secondary to nonexudative AMD. METHODS: Patients were imaged using SS OCT (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, CA), with follow-up imaging performed after 6 months and 1 year. Both the 6×6 mm and 12×12 mm scan patterns were obtained at each visit. Area measurements of GA were obtained from the en face images generated from a slab with boundaries extending 64 to 400 µm beneath Bruch's membrane. MAIN OUTCOME MEASURES: Comparison of area measurements and enlargement rates (ERs) measurements between the 6×6 mm and 12×12 mm scan patterns. RESULTS: Thirty-two eyes of 25 patients with GA secondary to nonexudative AMD were enrolled. The mean lesion area measurements at baseline were 3.81 mm2 for the 6×6 mm scan and 3.75 mm2 for the 12×12 mm scan. At baseline and over 1 year, the lesion area measurements between the 6×6 mm and the 12×12 mm scan patterns were comparable for all eyes (0.04 mm2; P < 0.001, analysis of variance). The annual ER measurements from the 6×6 mm and 12×12 mm scan patterns were similar (Pearson r = 0.99), with an average ER using the square root transformation strategy of 0.3 mm/year. CONCLUSIONS: Both the 6×6 mm and the 12×12 mm scan patterns resulted in similar area and ER measurements for GA when visualized using the en face images. With the 12×12 mm scan pattern, which represents a 40° field of view (FOV), the measurement of GA using OCT en face imaging is no longer limited by the 6×6 mm FOV. Since macular GA can extend beyond the 6×6 mm FOV, the 12×12 mm FOV can now image all macular GA. With a FOV now similar to autofluorescence and color fundus imaging, SS OCT imaging can be used as the sole imaging method for the detection, measurement, and ER assessment of all GA associated with AMD in clinical practice and in clinical trials.

Imaging of Epiretinal Membranes Using En Face Widefield Swept-Source Optical Coherence Tomography.

BACKGROUND AND OBJECTIVE: Swept-source optical coherence tomography (SS-OCT) imaging was performed on eyes with epiretinal membranes (ERMs), and the extent of the ERMs were compared between the 12 mm × 12 mm scans and the more routine 6 mm × 6 mm field of view (FOV). PATIENTS AND METHODS: Eyes containing ERMs were imaged using a 12 mm × 12 mm SS-OCT scan. En face images derived from vitreoretinal interface (VRI) slabs were reviewed to assess the full extent of the ERM. RESULTS: En face VRI slab images from 12 mm × 12 mm scans could visualize the full extent in eyes with ERMs. CONCLUSIONS: The use of 12 mm × 12 mm SS-OCT scans and en face VRI slabs provided better visualization of large ERMs compared with a 6 mm × 6 mm FOV. This strategy can be useful in identifying the full extent of tractional forces and may help with preoperative surgical planning in selected cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:106-112.].

Age-dependent Changes in the Macular Choriocapillaris of Normal Eyes Imaged With Swept-Source Optical Coherence Tomography Angiography.

PURPOSE: Swept-source optical coherence tomography angiography (SS-OCTA) was used to measure the age-dependent changes in macular choriocapillaris (CC) flow deficits (FDs) in normal eyes. DESIGN: A prospective, cross-sectional study. METHODS: Subjects with normal eyes ranging in age from their 20s to their 80s were imaged using a 100-kHz SS-OCTA instrument (PLEX Elite 9000, Carl Zeiss Meditec, Dublin, California, USA). Both 3 × 3-mm and 6 × 6-mm scans were used to image the macular CC. Visualization of the CC and quantification of FDs were performed using a previously validated algorithm. The percentage of FDs (FD%) in the central 1-mm circle (C1), 1.5-mm rim (R1.5), and 2.5-mm circle (C2.5) from the 3 × 3-mm and 6 × 6-mm scans and FD% in the 2.5-mm rim (R2.5) and 5-mm circle (C5) from the 6 × 6-mm scans were measured and correlated with age and axial length. RESULTS: A total of 164 subjects were enrolled, with at least 10 subjects from each decade of life. No meaningful correlations were found between FD% and axial length (|r| < 0.30). FD% in all fields increased with increasing age (all r > 0.50; all P < .001); however, the greatest increases were found in the central macula C1 regions and the smallest increases in the peripheral macula R2.5 regions. CONCLUSIONS: In normal aging, the FD% increased with age across the central 5 mm of the macula, but the greatest increase was found in the central 1-mm region of the macula.

Swept-Source Optical Coherence Tomography Angiography of an Amalric Choroidal Infarction in a Rare Presentation of Giant Cell Arteritis With Bilateral Corneal Edema.

A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache. Multimodal imaging revealed an Amalric choroidal infarct in the left eye visualized by widefield indocyanine green angiography and swept-source optical coherence tomography angiography (SS-OCTA). Prompt intravenous corticosteroid treatment resulted in 20/20 vision, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy. The case underscores the use of widefield SS-OCTA as a non-invasive test to aid in the diagnosis of GCA, as well as bilateral cornea edema as a rare presentation of GCA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e157-e160.].

Anatomic Localization of Type 1 and Type 2 Macular Neovascularization Using Swept-Source OCT Angiography.

BACKGROUND AND OBJECTIVE: Swept-source optical coherence tomography angiography (SS-OCTA) and different boundary-specific segmentation strategies were used to distinguish type 1 macular neovascularization (MNV) from type 2 MNV in eyes with exudative age-related macular degeneration (AMD). PATIENTS AND METHODS: Eyes with exudative AMD were enrolled in a prospective study. Segmentation strategies included a slab from the outer retina (OR) to the choriocapillaris (CC) for the entire MNV, a slab from the retinal pigment epithelium (RPE) to the CC for the type 1 MNV, and a slab from the OR to the RPE for the type 2 MNV. RESULTS: In 13 eyes, SS-OCTA B-scans and en face images using different segmentation strategies were able to identify type 1 and type 2 components of the MNV. CONCLUSION: In eyes with exudative AMD, SS-OCTA imaging and commercially available boundary-specific segmentation strategies were used to distinguish between type 1 and type 2 MNV. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:878-886.].

Accurate estimation of choriocapillaris flow deficits beyond normal intercapillary spacing with swept source OCT angiography.

BACKGROUND: To estimate choriocapillaris flow deficits beyond normal intercapillary distance with swept source optical coherence tomography angiography (SS-OCTA). METHODS: Subjects were enrolled and repeated SS-OCTA scans were performed using the 3 mm × 3 mm scan pattern. Blood flow was identified using the complex optical microangiography (OMAGc) algorithm. The choriocapillaris (CC) was defined as a 20 µm slab of the flow volume beneath the outer boundary of Bruch's membrane (BM) and was compensated with the corresponding structural image for flow deficits measurement. Flow deficits were segmented based on one mean standard deviation from a normal database. A histogram based thresholding method was developed to remove small flow deficits that were determined by examining intercapillary spacing within normal CC networks. A registration method based on affine and B-spline transformation was utilized for the CC angiogram averaging. Four repeated scans were averaged, and results were compared with and without removal of small flow deficits after averaging a different number of scans (N=1, group 1; N=2, group 2; N=3, group 3 and N=4, group 4). RESULTS: Seven normal subjects were enrolled. Intercapillary distance was found to be 24 µm for the CC networks under OCTA, which was used as the threshold to exclude small flow deficits for CC quantification. After averaging, significant reduction in background noise and improvement in continuity of blood vessel networks were observed both on retinal and choriocapillaris angiograms. Flow deficit percentages of the choriocapillaris were significantly reduced with averaging (group 1 vs. group 2: P<0.0001; group 2 vs. group 3: P<0.001; group 3 vs. group 4: P<0.001). The flow deficit percentages were also significantly reduced after removing the small flow deficits (≤24 µm in diameter) in all groups (P<0.01). A statistically significant difference was found after removing small flow deficits (≤24 µm in diameter) between group 1 and group 2 (P<0.001), between group 2 and group 3 (P<0.05), and between group 3 and group 4 (P<0.05). However, the significance was decreased compared to that without small flow deficits removal. CONCLUSIONS: A method was developed to improve the robust estimation of choriocapillaris flow deficits by removing the small flow deficits corresponding to normal intercapillary spacing. After the removal of small flow deficits, fewer repeats were required for image averaging to achieve comparable accuracy of flow deficit measurements with SS-OCTA.

OCT Angiography Helps Distinguish Between Proliferative Macular Telangiectasia Type 2 and Neovascular Age-Related Macular Degeneration.

BACKGROUND AND OBJECTIVE: To demonstrate the advantage of optical coherence tomography angiography (OCTA) for the diagnosis and management of proliferative macular telangiectasia type 2 (MacTel2) masquerading as neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: This is an observational cases series. Three patients referred with the diagnosis of neovascular AMD were identified in this retrospective study. In addition to color fundus, fluorescein angiography, and spectral-domain OCT (SD-OCT) imaging, SD-OCTA (AngioPlex; Carl Zeiss Meditec, Dublin, CA) was performed. RESULTS: SD-OCTA revealed bilateral parafoveal retinal microvascular changes in three patients and unambiguously confirmed the diagnosis of MacTel2. CONCLUSION: OCTA is an important tool for the correct diagnosis of MacTel2 in older patients with the concomitant or masquerading diagnosis of AMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:303-312.].

Swept-Source OCT Angiography Identifies Choroidal Neovascularization Arising From a Choroidal Nevus.

Swept-source optical coherence tomography angiography (SS-OCTA) was used to diagnose choroidal neovascularization (CNV) arising from a choroidal nevus. A 61-year-old woman initially presented with submacular hemorrhage. She was diagnosed with neovascular age-related macular degeneration (AMD) and received three injections of bevacizumab (Avastin; Genentech, South San Francisco, CA). At a follow-up visit, SS-OCTA showed that the CNV appeared to arise from an adjacent choroidal nevus. This is the first report of using SS-OCTA to diagnose CNV associated with a choroidal nevus masquerading as neovascular AMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:360-363.].

Swept-Source OCT Angiographic Imaging of a Central Retinal Vein Occlusion During Pregnancy.

To avoid fluorescein angiography in a pregnant woman diagnosed with a central retinal vein occlusion (CRVO), swept-source optical coherence tomography angiography (SS-OCTA) was performed and showed no evidence of decreased central retinal perfusion leading to the diagnosis of a nonischemic CRVO. Five months after an intravitreal injection of steroid, both her vision and the retinal appearance had returned to normal. This case demonstrates how a noninvasive, safe, 12 mm × 12 mm SS-OCTA image of a CRVO is useful in evaluating the retinal perfusion at presentation and follow-up during pregnancy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:206-208.].