Evaluation of focal choroidal excavation in the macula using swept-source optical coherence tomography.

PURPOSE: To evaluate imaging findings of patients with focal choroidal excavation (FCE) in the macula using swept-source optical coherence tomography (SS-OCT) and correlate it clinically. METHODS: Prospective observational case series. Eleven consecutive patients (12 eyes) with FCE were described. Data on demographics and clinical presentation were collected and imaging findings (including color photography, fundus autofluorescence imaging, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and SS-OCT) were analyzed. RESULTS: The primary diagnosis was epiretinal membrane (two eyes), choroidal neovascularization (one eye), polypoidal choroidal vasculopathy (three eyes), central serous chorioretinopathy (one eye), and dry age-related macular degeneration (two eyes). Eleven out of 12 of the lesions were conforming. One presented with a non-conforming lesion that progressed to a conforming lesion. One eye had multiFCE and two had two overlapping choroidal excavations. Using the SS-OCT, we found the choroid to be thinned out at the area of FCE but sclera remained normal. The choroidal tissue beneath the FCE was abnormal, with high internal reflectivity and poor visualization of choroidal vessels. There was loss of contour of the outer choroidal boundary that appeared to be pulled inward by this abnormal choroidal tissue. A suprachoroidal space was noted beneath this choroidal tissue and the choroidal-scleral interface was smooth. Repeat SS-OCT 6 months after presentation showed the area of excavation to be stable in size. CONCLUSION: FCE can be associated with epiretinal membrane, central serous chorioretinopathy, and age-related macular degeneration. The choroid was thinned out in the area of FCE.

Automatic glaucoma diagnosis from fundus image.

Glaucoma is currently diagnosed by glaucoma specialists using specialized imaging devices like HRT and OCT. Fundus imaging is a modality widely used in primary healthcare. An automatic glaucoma diagnosis system based on fundus image can be deployed to primary healthcare clinics and has potential for early disease diagnosis. A mass glaucoma screening program can also be facilitated using such a system. We present an automatic fundus image based cup-to-disc ratio measurement system; and demonstrate its potential for automatic objective glaucoma diagnosis and screening. It provides strong support to use fundus image as the modality for automatic glaucoma diagnosis.

Intelligent fusion of cup-to-disc ratio determination methods for glaucoma detection in ARGALI.

Glaucoma is a leading cause of permanent blindness. ARGALI, an automated system for glaucoma detection, employs several methods for segmenting the optic cup and disc from retinal images, combined using a fusion network, to determine the cup to disc ratio (CDR), an important clinical indicator of glaucoma. This paper discusses the use of SVM as an alternative fusion strategy in ARGALI, and evaluates its performance against the component methods and neural network (NN) fusion in the CDR calculation. The results show SVM and NN provide similar improvements over the component methods, but with SVM having a greater consistency over the NN, suggesting potential for SVM as a viable option in ARGALI.

Giant retinal tear management: an Asian experience.

PURPOSE: To report the management of giant retinal tears (GRT). METHODS: Retrospective review of all patients who underwent surgery for GRT with at least 6 months follow-up. RESULTS: A total of 124 patients with 128 eyes were managed for GRT between 1991 and 2005. Of them, 99 eyes of 96 patients with at least 6 months follow-up were reviewed (mean follow-up 63.38 months). There were 113 men and the mean age was 39.6 years (8-72 years). Myopia was present in 81 eyes (63.3%) with mean myopia -7.56 dioptres sphere, DS (-1.00 to -27.00 DS). All eyes underwent pars plana vitrectomy. Scleral buckling was done in 90 eyes (70.3%) and lens removal in 49 of 95 phakic eyes (51.2%). Total 84 eyes (84.8%) were re-attached at 6 months after vitrectomy. This was achieved with one surgery in 71 eyes (71.7%). The mean number of surgeries for reattachment was 1.19 surgeries. At 6 months, 41 eyes (41.4%) regained 20/40 or better vision. A total of 47 vitreoretinal pathologies were seen in the fellow eyes of the 124 patients, including 4 with GRTs. CONCLUSION: Surgical success for GRT can be achieved with good visual outcome in 84.8% after a mean of 1.19 surgeries. The fellow eyes are however at risk of pathologies and should be followed-up in the long term.