Short-term Effect of Strabismus Surgery on Choroidal Vasculature.

PURPOSE: To investigate the effect of strabismus surgery on choroidal structure using the binarization method. METHODS: Forty-two eyes of 27 patients who had surgery for horizontal strabismus were included in the study. Optical coherence tomography (OCT) images of the patients before the operation and at 1 day and 1 week after the operation were binarized. Total choroidal area (TCA), stromal area (SA), luminal area (LA), and choroidal vascularity index (CVI) were calculated and compared. RESULTS: The mean age of the patients was 16.7 ± 13.5 years; 12 were female, and 15 were male. The mean spherical equivalent was 0.125 ± 0.50 diopters (D). The mean axial length value was 23.3 ± 1.3 mm. Preoperative TCA was 599686 ± 113451, LA was 394259 ± 67259, SA was 209180 ± 47723, and CVI was 0.66 ± 0.02. At 1 day postoperatively, TCA was 615575 ± 103686, LA was 395364 ± 60314, SA was 218418 ± 45620, and CVI was 0.65 ± 0.02. At 1 week postoperatively, TCA was 610997 ± 110578, LA was 394002 ± 65186, SA was 214995 ± 46481, and CVI was 0.66 ± 0.04. A statistically significant decrease in CVI and increase in TCA and SA were observed on the first postoperative day; these changes were observed as returning to preoperative values at 1 week postoperatively. CONCLUSIONS: Strabismus surgery temporarily decreases the CVI by increasing the SA of the choroidal layer, possibly due to hemodynamic changes and/or inflammatory causes in the early period. [J Pediatr Ophthalmol Strabismus. 2024;61(2):114-119.].

Evaluation of peripapillary and subfoveal choroidal vascularity index in patients with multiple sclerosis.

PURPOSE: To evaluate the changes in the peripapillary choroidal vascularity index (PCVI) and subfoveal choroidal vascularity index (SFCVI) in multiple sclerosis (MS) patients and healthy subjects. METHODS: A total of 145 eyes of 73 patients were investigated in this cross-sectional study. 78 eyes of 39 MS patients (Group 1) and 67 eyes of 34 healthy subjects (Group 2) were evaluated. MS patients with a history of optic neuritis (ON) constituted Group 1a, those without a history of ON constituted Group 1b. RESULTS: The mean PCVI was significantly lower in Group 1 than Group 2 (61,39 ± 3,00% vs 64,49 ± 2,29%, respectively, p < 0.001). The mean SFCVI scores of Group 1 was significantly lower than Group 2 (64,01 ± 2,66% vs. 66,87 ± 2,14%, respectively, p < 0.001). The mean PCVI of Group 1a (59,26 ± 2,85%) was significantly lower compared to Group 1b (62,87 ± 2,08%) and Group 2 (64,49 ± 2,29%, p1 < 0.001, p2 < 0.001). The mean SFCVI of Group 1a was significantly lower than Group 2 (64.26 ± 2.75% vs. 66.87 ± 2.14%, respectively, p < 0.001). CONCLUSION: PCVI and SFCVI scores were significantly lower in MS patients compared to healthy controls. PCVI scores of MS patients who had a history of ON were significantly lower than those of patients without a previous ON attack, as were SFCVI scores. We consider that evaluation of PCVI and SFCVI might be useful for monitoring ocular involvement in patients with MS.

Features of the Choroidal Structure in Children With Anisometropic Amblyopia.

PURPOSE: To examine the choroidal structure in children with anisometropic amblyopia using the binarization method. METHODS: Thirty children with unilateral anisometropic amblyopia and 30 healthy age- and sex-matched controls were included in the study. Choroidal thickness was measured with optical coherence tomography. The choroidal layer was examined with the binarization method using ImageJ software (National Institutes of Health). The total choroidal area, stromal area, luminal area, luminal area to stromal area ratio, and choroidal vascular index were calculated. The values were compared by correlating the spherical equivalent (SE) (determined by an autorefractometer) with anterior chamber depth, axial length, central corneal thickness (measured by optical biometry), and choroidal thickness values. RESULTS: Mean SE values were 3.75 ± 2.16 diopters (D) in the amblyopic eyes, 2.39 ± 2.09 D in the fellow eyes, and -0.27 ± 0.53 D in the control eyes. Best corrected visual acuity (BCVA) was 0.29 ± 0.11 logarithm of the minimum angle of resolution (logMAR) in the amblyopic eyes, 0.02 ± 0.04 logMAR in the fellow eyes, and 0 ± 0 logMAR in the control eyes. Choroidal thickness values were 351 ± 47 µm in the amblyopic eyes, 333 ± 55 µm in the fellow eyes, and 324 ± 51 µm in the control eyes. Luminal area to stromal area ratio values were 1.73 ± 0.13 in the amblyopic eyes, 1.76 ± 0.15 in the fellow eyes, and 2.02 ± 0.25 in the control eyes. Choroidal vascular index values were 63% ± 0.02 in the amblyopic eyes, 64% ± 0.02 in the fellow eyes, and 66% ± 0.03 in the control eyes. BCVA, SE, choroidal thickness, luminal area to stromal area ratio, and choroidal vascular index were significantly different in each group. The total choroidal area, luminal area, and stromal area were similar in all eyes. No correlation was found between choroidal vascular index and choroidal thickness, anterior chamber depth, axial length, and central corneal thickness. CONCLUSIONS: In children with anisometropic amblyopia, the total choroidal area was relatively larger in both the amblyopic and the fellow eyes compared to the control eyes. Due to the higher stromal area and lower luminal area, both the amblyopic and the fellow eyes also had lower choroidal vascular index values than control eyes. [J Pediatr Ophthalmol Strabismus. 2022;59(5):320-325.].

The effect of branch retinal vein occlusion on the vascular structure of the choroid.

OBJECTIVE: Our aim is to examine choroidal structural changes in eyes with branch retinal vein occlusion (BRVO). MATERIAL AND METHOD: This retrospective, comparative study included 34 newly diagnosed unilateral BRVO patients and 40 healthy controls. Subfoveal choroidal thickness (SFCT) measurement was performed with enhanced depth imaging optical coherence tomography (EDI-OCT). The images were binarized using the ImageJ software program. Total choroidal area (TCA), stromal area (SA), and luminal area (LA) were calculated from the 1500 µm area. The choroidal vascular index (CVI) was determined as the LA/TCA ratio. All parameter values were compared between the BRVO eye and the fellow eye, and the control group eyes. RESULTS: Eyes with BRVO had a greater SA compared to both fellow and control eyes; hence, the CVI was lower (p < 0.001). LA did not differ between eyes. TCA, although not statistically significant, was larger in eyes with BRVO than in both fellow and control eyes. SFCT was also greater in eyes with BRVO. No correlation was observed between CVI and SFCT and best-corrected visual acuity (BCVA). CONCLUSION: BRVO affects the stromal part of the choroid rather than its vascular structure. SA increases due to choroidal exudation that occurs in response to retinal ischemia, and CVI decreases accordingly.

Long-term effect of intravitreal aflibercept treatment on choroidal vascularity index in neovascular age-related macular degeneration.

BACKGROUND: Our aim is to examine the effect of intravitreal aflibercept treatment on the choroidal vascularity index in eyes with neovascular age-related macular degeneration (nARMD) using the binarization method. METHODS: Included in the study were the 38 eyes of 38 patients diagnosed with nARMD and treated with intravitreal aflibercept at our clinic. The patients' 12-month records were reviewed retrospectively. Patients' choroidal thickness (CT) was measured at baseline, 3rd month, 6th month, and 12th month on EDI-OCT images. We calculated luminal area (LA), stromal area (SA), total choroidal area (TCA), and choroid vascular index (CVI) values using binarization. RESULTS: The mean age of the patients was 70,1 ± 8 years. The mean of injections over 12 months was 5.6 ± 2. Baseline values were CT 224 µm, LA 0,214 mm2, SA 0,119mm2, TCA 0,333 mm2, and CVI 64% respectively. At the 3rd month, values were CT 223 µm, LA 0,212 mm2, SA 0,121 mm2, TCA 0,332 mm2, and CVI 64%, respectively. The 6th-month values were CT 221 µm, LA 0,204 mm2, SA 0,116 mm2, TCA 0,320 mm2, and CVI 64%, respectively, and 12-month values were CT 218 µm, LA 0,204 mm2, SA 0,112 mm2, TCA 0,318 mm2, and CVI 64%, respectively. According to LogMAR, BCVA was 0.59 at baseline, 0.56 at 3 months, 0.52 at 6 months, and 0.51 at 12 months. At the end of month 12, we observed a statistically significant decrease in CT. No significant changes were observed in other parameters. When the number of injections was correlated with CVI, CT, and BCVA, a significant negative correlation was observed with CVI CONCLUSIONS: Aflibercept treatment reduces CT by affecting not only luminal but also stromal areas of the choroid in the long term but does not change the CVI. However, as the number of injections increases, CVI decreases.

Choroidal vascularity index in adults with different refractive status.

AIM: We aimed to perform structural analysis of the choroid in adults with different refractive status. MATERIALS AND METHODS: A prospective, comparative study of 100 right eyes of 100 patients ages 18-40 years was conducted. The patients were divided into four groups according to spherical equivalent (SE): Group 1: -0.5 and above, low-to-moderate myopia; Group 2: -6 and above, high myopia; Group 3: +0.5 and above, hyperopia; Group 4: +/- 0.5, emmetropia. With the images obtained using enhanced depth imaging optical coherence tomography (EDI-OCT), the total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascular index (CVI) were calculated using the binarization method. The anterior chamber depth (ACD), axial length (AL), and central corneal thickness (CCT) values were measured by optical biometry. All parameters were compared between groups. The correlation of biometric parameters with CVI was examined. RESULTS: Parameters were found to be statistically different between the four groups. TCA, LA, and SA values were the highest in Group 3 and lowest in Group 2. L/S ratio and CVI values in Group 3 were significantly lower than in the other groups. There was a negative correlation between AL with SE and CT, and no correlation between the CVI and other parameters. CONCLUSION: CVI decreases when emmetropization is disrupted and changes to hypermetropia or myopia. The reason for the decrease in myopia is the reduction of the luminal area, while in hyperopia it is due to an increase in the stromal area. When there is a shift toward myopia, there is a decrease in the TCA, but the CVI does not change significantly. Unlike CT, the CVI is not affected by factors such as SE and AL; therefore, the CVI can be a useful parameter for examining choroidal changes in refractive errors.

Compatibility of Pupil Size Measured with Nidek ARK-1a Table Top Autorefractometer and Plusoptix A12C Photoscreener.

Aim: To evaluate the differences in pupil size measured with and without cycloplegia by a table top autorefractometer, ARK-1a Auto Ref/Keratometer, Nidek, Japan, 2014 release, compared to handheld photoscreener, Plusoptix A12C, software 6.1.12, under monocular and binocular conditions.Materials and Methods: In the study, 100 eyes of 100 patients ages 18-55 years were included. The patients' pupil sizes were measured with a table top autorefractometer, Nidek ARK 1a without cycloplegia, and then the pupils were remeasured under monocular and binocular conditions with a photoscreener, Plusoptix A12C, respectively. After that the measurements with cycloplegia were repeated in the same order. The values obtained with both devices were compared.Results: In the measurement results without cycloplegia, the pupil size measured by Nidek ARK 1a was found to be significantly different than that measured by Plusoptix A12C under both monocular and binocular conditions. Pupil size measured with Plusoptix A12C under monocular conditions was also different than pupil diameter measured under binocular conditions. In the measurements with cycloplegia, it was observed that the pupil size measured with Plusoptix A12C under monocular and binocular conditions was not different from the diameter measured with Nidek ARK 1a.Conclusion: Pupil sizes measured with Nidek ARK 1a and Plusoptix A12C in monocular and binocular conditions without cycloplegia are different, but measurements with cycloplegia are similar. We believe that pupil size measurement with Plusoptix A12C under binocular conditions without cycloplegia will be more appropriate when necessary as a screening device in clinical settings.

Influence of one or two horizontal muscle surgeries on OCT findings.

We investigate the effects of differences between one or two horizontal rectus muscle surgeries (recession ± resection) on the central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and retinal nerve fiber layer (RNFL). Measurements of the CMT, SFCT, and RNFL in patients who underwent horizontal rectus muscle surgery were obtained using optical coherence tomography (OCT). Patients were grouped as those who had undergone rectus muscle recession surgery (Group 1) and those who had undergone rectus muscle recession + resection surgery (Group 2). The CMT, SFCT, and RNFL in patients were measured preoperatively and 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. A total of 65 eyes of 50 patients were analyzed retrospectively. The average age of the 25 patients in Group 1 was 8.96 ± 7.966 years (min 3, max 38). The average age of the 25 patients in Group 2 was 15.17 ± 6.806 years (min 2, max 34). The comparison of the preoperative and the 1-day and 1-week postoperative values revealed an increase in CMT and SFCT in Group 1 and Group 2. There were no significant differences between the two groups. It was observed that this increase reached the preoperative values after 1-3 months and 6 months in both groups. There was no statistically significant change in the RNFL. Rectus muscle surgery (recession±resection) caused an increase in CMT and SFCT in the early stage, which was possibly caused by the altered choroidal microcirculation resulting from mechanical traction during surgery and by postoperative inflammation. There was no difference between one or two muscle surgeries.

Does exotropia surgery have a long-term effect on choroidal vasculature?

OBJECTIVE: To investigate the long-term effect of exotropia surgery on the choroidal structure. MATERIAL AND METHOD: The study included 18 patients treated with medial rectus resection and lateral rectus recession for exotropia and 18 healthy patients as a control group. Demographic and clinical characteristics as well as enhanced depth imaging optical coherence tomography (EDI-OCT) scans were collected retrospectively. Images were binarized using ImageJ software; total choroidal area along with luminal and stromal areas (TCA, LA, and SA) were segmented, and CVI was computed as the ratio of LA/TCA. In addition, choroidal thickness (CT) was evaluated. RESULTS: No significant differences were found between operated eyes, fellow eyes, and control group eyes in terms of CT, TCA, LA, SA, and CVI. CONCLUSION: Strabismus surgery does not appear to negatively effect the choroidal layer in the long term. We recommend that this surgery be performed without delay as it positively affects the psychological health of the patient and improves quality of life.

Transient Retinal Artery Occlusion After Uncomplicated Rhinoplasty.

PURPOSE: Loss of vision is an extremely rare and unexpected complication following a routine uncomplicated nasal surgery. In majority of patients, visual loss has attributed to retinal emboli which occur with retrograde flow of the intra-arterially injected agents into the nasal cavity or direct trauma to the optic nerve. In this report, the authors present a patient with unilateral decreased vision due to branch retinal artery occlusion soon after a routine nasal surgery. METHODS: Clinical report. RESULT: A 32-year-old female patient admitted to the author' clinic with the complaints of decreased visual acuity in the left eye. She stated that she had undergone rhinoplasty operation 1 week ago and vision loss started immediately after the surgery.In the ophthalmological examination, the best corrected visual acuity with Snellen chart was 1.0 in the right eye and 0.3 in the left eye. In the fundoscopic examination of left eye there was a pale area in the inferior part of the macula. Fundus fluorescein angiography showed no evidence of nonperfusion in the right and left eyes and vascular structure was normal. On the optic coherence tomography, hyperreflectivity and increased thickness were observed in the inner retinal layers of the left eye. In the visual field test, there was a loss of the visual field which corresponds to the pale area on the left eye. Hyperbaric oxygen therapy was recommended. The ophthalmologic examination carried out 2 months later revealed a best corrected visual acuity of the left eye 0.9. In the fundoscopy pale area was regressed in the left eye. Fundus fluorescein angiography showed a good perfusion. There was a little progression in the visual field test. CONCLUSION: Direct mechanical trauma and vasoplastic/embolic vascular events are thought to be possible mechanisms. The authors think in this case, there was a retrograde flow of agents used during the surgery through ophthalmic artery to retinal arteries and vasospasm by epinephrin worsened the situation. Although rare retinal artery occlusion may develop after rhinoplasty, vision loss as a result of a surgery, if done for aesthetic purposes is not acceptable.

Surgically induced astigmatism following medial rectus recession: short-term and long-term outcomes.

PURPOSE: The current study aimed to investigate short- and long-term postoperative ocular refractive effects of medial rectus recession on the involved eye and to describe the detectable effects in detail by the results of vector analysis. METHODS: Data of patients in whom medial rectus recession was performed between 2010 and 2012 were retrospectively evaluated. The study included 52 eyes of 32 patients. Patients with a history of previous ocular surgery, congenital or progressive corneal disease, familial or acquired posterior segment disease, glaucoma, a history of ocular trauma, or any neurological or systemic disease were excluded. Best-corrected and uncorrected visual acuities and refraction examination findings of the patients were recorded before the surgery and at the postoperative first month and first year. A vector analysis program was used to analyze surgically induced astigmatism. RESULTS: Significant myopic shift and astigmatic change were determined in the spherical equivalent refraction in the early postoperative period (first month); however, these changes disappeared in the long term (at the postoperative first year). A positive correlation was not observed between the amount of surgical recession and the results of ophthalmic examination at the postoperative first month and first year. CONCLUSIONS: Only postoperative first month spherical equivalent showed a positive correlation with the amount of surgical recession; however, this correlation disappeared at the postoperative first year.