Choroidal morphologic features in central serous chorioretinopathy using ultra-widefield optical coherence tomography.

PURPOSE: To analyze the choroidal morphological changes in central serous chorioretinopathy (CSC) using ultra-widefield (UWF)-optical coherence tomography (OCT). METHODS: This single-center, case-control study included 65 CSC eyes (52 males; age, 55.6 ± 13.0 years) and 65 healthy eyes (50 males; age, 57.1 ± 17.9 years). UWF-OCT (viewing angle, 200°) with real-shape correction was used to create an automated choroidal thickness (CT) map. The CT map had three sub-areas: the central (0-30°), middle (30-60°), and peripheral areas (60-100°), and was divided by vertical and horizontal lines. Differences in the CT and the CT change rate (CTCR) from the central to peripheral areas were examined between the CSC and control groups after adjusting for subjects' demographic and clinical factors. Furthermore, we assessed the vortex veins dilation patterns (VVDP) in the macula and examined the CT and the CTCR differences between CSC patients and controls for each VVDP. RESULTS: CSC patients had greater CT than those of the controls in all sectors (CSC vs. controls, the peripheral area: supratemporal 284.4 ± 71.2 µm vs. 220.4 ± 71.2 µm, infratemporal 263.3 ± 69.2 µm vs. 195.3 ± 52.3 µm, supranasal 251.9 ± 70.3 µm vs. 189.5 ± 58.1 µm, infranasal 193.6 ± 71.2 µm vs. 146.3 ± 48.9 µm, P < 0.0001 for all sectors). The CTCR was apparently larger in CSC eyes than controls only for the upper-dominant type of VVDP (CSC patients vs. controls, supratemporal 32.1 ± 9.9% vs. 4.6 ± 23.1%, infratemporal 44.0 ± 11.2% vs. 25.6 ± 16.8%, supranasal 42.6 ± 9.8% vs. 22.2 ± 19.4%, infranasal 57.6 ± 41.2% vs. 41.2 ± 13.9%, P < 0.0001 for all sectors). CONCLUSIONS: CSC has a thicker choroid, even in the peripheral areas, and the macular choroidal thickening was more severe in the upper-dominant type of VVDP. VVDP may affect the location of excessive fluid.

NORMAL PERIPHERAL CHOROIDAL THICKNESS MEASURED BY WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: Choroidal stasis plays an important role in the pathogenesis of many conditions and leads to choroidal thickening. However, the normal peripheral choroidal thickness (PCT) pattern remains unknown. This study investigated PCT and associated factors using ultrawidefield optical coherence tomography in healthy eyes. METHODS: This cross-sectional study included 120 healthy eyes (57 males; age, 52.0 ± 20.5 years). We used choroidal thickness maps created by ultrawidefield optical coherence tomography (viewing angle, 200°) with real-shape correction. The peripheral area was defined from 60° to 100° and further separated vertically and horizontally. The PCT and the correlations between PCT and subjects' characteristics were examined. RESULTS: The PCT were 227.1 ± 57.0 µ m, 199.6 ± 53.9 µ m, 196.6 ± 57.1 µ m, and 148.0 ± 38.2 µ m in supratemporal, infratemporal, supranasal, and infranasal areas, respectively. The thickest peripheral sector was most frequently observed in supratemporal (69.2%). The PCT negatively correlated with age in all regions ( P -values < 0.001) and axial length in supratemporal, supranasal, and infranasal areas ( P -values ≤ 0.003). The temporal PCT was thicker on the side contiguous with the posterior pole Haller's vessels ( P -values ≤ 0.020). CONCLUSION: The PCT is associated with age, axial length, and the running pattern of Haller's vessels.

OCULAR FACTORS RELATED TO PREOPERATIVE ENLARGEMENT OF IDIOPATHIC MACULAR HOLE DIAMETER.

PURPOSE: To determine the preoperative factors that are significantly correlated with an enlargement of an idiopathic macular hole (MH) during the one-month preoperative period. METHODS: This was a retrospective cross-sectional study of patients with MH who had undergone vitrectomy in the Kagoshima University Hospital. The stage of the MH was determined by using spectral domain optical coherence tomography. Patients who had optical coherence tomography images at two time points more than 14 days apart before the vitrectomy were studied. RESULTS: The MH participants were at Stage 2 in 44 eyes, at Stage 3 in 58 eyes, and at Stage 4 in 38 eyes. The rate of increase of the hole diameter was 26.0 ± 42.3% at Stage 2, 5.52 ± 15.5% at Stage 3, and 8.04 ± 18.7% at Stage 4. The rate of change at Stage 2 was significantly greater than that at Stage 3 and Stage 4 (both P < 0.01). In Stage 2, the MH diameter at the initial visit was significantly and negatively correlated with the rate of MH enlargement (r = -0.35, P = 0.021). CONCLUSION: Patients with Stage 2 MHs, especially eyes with small hole diameter, should be considered for early surgery.

QUANTIFICATION OF VESSELS OF HALLER'S LAYER BASED ON EN-FACE OPTICAL COHERENCE TOMOGRAPHY IMAGES.

PURPOSE: To quantify the vessels of Haller's layer of normal subjects in en-face optical coherence tomographic images. METHODS: One hundred and seventy-two normal eyes were studied. En-face images of the top 25% slab of Haller's layer was analyzed. The vessel area, vessel length, and mean vessel diameter were calculated. The vessel running pattern was quantified for the degree of symmetry and designated as the "symmetry index." The coefficient of correlation between each choroidal parameter and the age, sex, axial length, and central choroidal thickness was determined. RESULTS: The vessel area was 23.4 ± 3.6 mm2, vessel length was 164.6 ± 24.1 mm, mean vessel diameter was 0.143 ± 0.019 mm, and the symmetry index was 58.6 ± 6.1%. Multiple regression analysis showed that the vessel area was significantly correlated with the age (R = -0.421, P < 0.001) and central choroidal thickness (R = 0.315, P < 0.001). The vessel length was significantly correlated with the age (R = -0.391, P = 0.024) and central choroidal thickness (R = -0.410, P < 0.001). The mean vessel diameter was significantly correlated with the age (R = -0.107, P = 0.024) and central choroidal thickness (R = 0.775, P < 0.001). The correlation between the symmetry index and any clinical findings was not significant. CONCLUSION: Quantification of en-face images of Haller's layer provide new biomarkers of the choroid.

MORE EFFECTIVE SCREENING FOR EPIRETINAL MEMBRANES WITH MULTICOLOR SCANNING LASER OPHTHALMOSCOPE THAN WITH COLOR FUNDUS PHOTOGRAPHS.

PURPOSE: To assess the ability of the multicolor scanning laser ophthalmoscope (MC-SLO) to screen for epiretinal membranes (ERMs). METHODS: A retrospective cross-sectional study of 35 eyes of 32 patients with an ERM detected by optical coherence tomography and 46 eyes of 23 healthy volunteers. The detection of the ERM was graded into three visibility scores-1, not visible, 2, barely visible, and 3, clearly visible-by retina specialists or by ophthalmology residents. The sensitivity and specificity of the detection with the merged image of the MC-SLO or color fundus photographs (CFPs) were calculated. RESULTS: The sensitivity for ERM detection in the MC-SLO and CFP were 91.4% and 65.7% by specialists and 97.1% and 60.0% by residents. The specificity for both devices was 100% by specialists and residents. The visibility score for the MC-SLO images were significantly higher than that for the CFP by both specialists and residents. In addition, the visibility score for the MC-SLO determined by residents was significantly higher than that for the CFP by specialists. CONCLUSION: The detection of an ERM is better with the MC-SLO images than with CFP. Furthermore, the ERM detection in the MC-SLO images by residents was comparable to that by specialists.

Running pattern of choroidal vessel in en face OCT images determined by machine learning-based quantitative method.

PURPOSE: To evaluate the new method to quantitate the running pattern of the vessels in Haller's layer in en face optical coherence tomographic (OCT) images using the new algorithm. METHODS: A retrospective and cross-sectional study. The en face image of top 25% slab of Haller's layer was analyzed. The vascular area in these images was calculated after binarization. Then, the vessels were thinned, and the total length of the vessels and the mean vessel diameter were calculated. Based on the angle of vessel running, "natural oblique vessel" was defined. The ratio of the natural oblique vessel to the whole vessels was defined as the "symmetry index". To examine the reproducibility of the software, the images obtained on two different examination dates of the same subject (25 eyes of 25 healthy subjects) were analyzed. Also, to compare the symmetry index and subjective evaluations, 180 eyes and 180 healthy subjects were analyzed. The subjective evaluations classified the images into 3 groups, the Symmetrical, Semi-symmetrical, and Asymmetrical types. Symmetry index was compared in each group. RESULTS: The inter-measurement correlation coefficient (ICC) of the vessel area, vessel length, and vessel diameter were 0.955, 0.934, and 0.954, respectively. The ICC of the symmetry index was 0.926. The symmetry index of the Symmetrical type was 60.4 ± 7.2%, that of the Semi-symmetry type was 56.2 ± 4.6%, and that of the Asymmetry type was 52.6 ± 5.2%. CONCLUSIONS: The present algorithm can analyze vessels in Haller's layer of the en face images of choroid in an objective manner with good repeatability.

Ability of MultiColor scanning laser ophthalmoscope to detect non-glaucomatous retinal nerve fiber layer defects in eyes with retinal diseases.

PURPOSE: To compare the ability of ocular fundus images obtained by Spectralis MultiColor scanning laser ophthalmoscope (MC-SLO) to that obtained by conventional color fundus images (CF) in detecting non-glaucomatous nerve fiber layer defects (NFLDs). METHODS: A cross-sectional, retrospective study. Patients with retinal diseases who had ocular examination with both the MC-SLO and CF instruments at the Kagoshima University from December 2016 to February 2017 were studied. Eyes that had NFLDs with non-glaucomatous optic discs were analyzed. The visibility of the NFLDs was classified into three grades: grade 0, not visible; grade 1, barely visible; and grade 2, clearly visible. The NFLD grade for blue, green, and red scanning lights of the MC-SLO, merged images with three wavelengths and the color and red-free images were determined by two ophthalmologists. These scores were compared by Steel-Dwass tests. RESULTS: Thirty-one eyes of 26 patients with a mean age of 63.1 ± 11.2 years were studied. There were 14 eyes with diabetic retinopathy, 11 eyes with age-related macular degeneration, 3 eyes with a branch retinal vein occlusion, and 3 eyes with an epiretinal membrane/macular hole. Both the intra-rater (0.631-0.790) and inter-rater (0.637-0.733) agreements were good. NFLDs were detected by the blue wavelength in all cases and by green wavelength and merged wavelengths in 90.3% of the images. The mean NFLD grade was 1.58 ± 0.49 for blue light images, 1.13 ± 0.54 for green light images, 0.07 ± 0.24 for red light images, and 1.16 ± 0.56 for merged images. The NFLD score for blue wavelength was significantly higher than that for green and red wavelength images (P < 0.05 and P < 0.01) but not significantly higher than that for the merged images. NFLDs were detected in 12 eyes (38.7%) in the color images and 16 eyes (51.6%) in the red-free images. The NFLD score for the CF and the red-free image was 0.41 ± 0.55 and 0.70 ± 0.67 which is significantly lower than that of blue MC-SLO images. CONCLUSION: The images obtained by MC-SLO are superior to that obtained by CF in detecting NFLDs in eyes with retinal diseases. We recommend MC-SLO imaging to screen for NFLDs in eyes with retinal diseases.

Effect of fluid-air exchange on reducing residual silicone oil after silicone oil removal.

PURPOSE: Our purpose was to determine the effect of fluid-air exchange on the amount of silicone oil (SO) droplets remaining in the vitreous cavity after removal of the main body of the SO. METHODS: This was a retrospective comparative study of 56 eyes of 56 patients that had undergone vitrectomy with SO tamponade. Fluid-air exchange was performed during surgery in 30 eyes [Air Ex(+) group] and was not done in 26 eyes [Air Ex(-) group]. All of the eyes were examined by ultrasonography, and the images were converted to binarized image. The amount of residual SO droplets/vitreal area in the images was expressed as the, "silicone oil index (SOI)". The correlations between SOI and clinical findings were determined. RESULTS: The SOI was significantly correlated with the axial length (AL, R = 0.444, P = 0.023). The SOI in the Air Ex(+) group was significantly higher (7.4 ± 2.6%) than in the Air Ex(-) group (4.9 ± 3.4%; P = 0.004). Multiple linear regression analyses showed that the SOI was independently and significantly correlated with the AL and the Air Ex(+) group (P = 0.003, P = 0.006, respectively). CONCLUSIONS: Fluid-air exchange during vitrectomy to remove residual SO is not effective. Our findings indicate that it may increase the amount of residual SO droplets.

AMOUNT OF RESIDUAL SILICONE OIL IN VITREOUS CAVITY IS SIGNIFICANTLY CORRELATED WITH AXIAL LENGTH.

PURPOSE: To determine the parameters of the eye that are significantly correlated with the amount of residual silicone oil remaining after most of it is removed by vitrectomy. METHODS: Nineteen eyes of 19 patients who had silicone oil removed were studied. The day after the surgery for silicone oil removal, B-scan ultrasonography was performed, and the residual silicone oil droplets were observed as hyperechoic particles in the ultrasonographic images. The images of the vitreous cavity were binarized, and the ratio of area of hyperechoic particles to the total vitreous area was quantified and named the silicone oil index (SOI). The correlations between SOI and clinical findings were determined. RESULTS: The SOI was significantly and positively correlated with the axial length (AL) and the preoperative intraocular pressure (AL, R = 0.676, P = 0.002; preoperative intraocular pressure, R = 0.771, P < 0.001). Partial correlation analysis showed that the AL remained significantly correlated with the SOI but the preoperative intraocular pressure was not (AL, R = 0.734, P = 0.001; preoperative intraocular pressure, R = 0.417, P = 0.096). None of the other clinical factors was significantly correlated with the SOI. CONCLUSION: Considering the significant correlation between the amount of residual silicone oil and the AL of the eye, myopic eyes should be carefully scrutinized for residual silicone oil.

Evaluating photodynamic therapy versus brolucizumab as a second-line treatment for polypoidal choroidal vasculopathy.

BACKGROUND: To compare the one-year outcomes between intravitreal brolucizumab (IVBr) monotherapy and photodynamic therapy (PDT) as a second-line treatment in patients with polypoidal choroidal vasculopathy (PCV) who did not respond to first-line therapy. METHODS: This case-control study included eyes with PCV that do not respond to aflibercept or ranibizumab. The patients were retrospectively registered. We compared outcomes, including best-corrected visual acuity (BCVA), anatomical results, and the need for additional treatments, between IVBr and a combination therapy using PDT as second-line treatments for refractory PCV, after adjusting for potential confounders. We analyzed E-values to evaluate the robustness of the results against unmeasured confounders. RESULTS: Twenty-two eyes received IVBr, and twenty-four underwent PDT. No apparent differences were observed in BCVA and central macular thickness (CMT) changes from baseline between the groups (IVBr vs. PDT: BCVA, 0.01 ± 0.47 logMAR vs. 0.04 ± 0.18 logMAR, P-value = 0.756; CMT: - 36.3 ± 99.4 µm vs. - 114.7 ± 181.4 µm, P-value = 0.146). Only in the PDT group, five eyes (20.8%) did not require additional treatment after the second-line treatment, the adjusted odds ratio indicating no further treatment needed was 11.98 (95% confidence interval: 1.42-2070.07, P-value = 0.019). The E-value for the adjusted odds ratio was 23.44. CONCLUSIONS: Both second-line treatments for PCV exhibited similar visual and anatomical outcomes. Only in the PDT-treated eyes were there some patients who did not require further treatment after second-line therapy.

Sex differences in choroidal vessels using novel wide-field choroidal en-face images from optical coherence tomography.

This study aims to develop a method to quantify choroidal vessels in normal eyes using wide-field optical coherence tomography (OCT) en-face images. The study included participants with normal eyes in whom wide-angle OCT images were acquired to generate planarized choroidal en-face and thickness map images. The images were segmented into central, midperipheral, and peripheral areas, and the midperipheral and peripheral areas were further segmented into supratemporal, infratemporal, supranasal, and infranasal sectors. The mean planarized choroidal-vessel density (p-CVD), planarized choroidal-vessel size (p-CVS), and choroidal thickness (CT) were calculated in each sector. Sex differences were analyzed using the Mann-Whitney U test. The study included 162 participants comprising 84 female (mean age, 43.5 years; axial length, 24.0 mm) and 78 male (mean age, 44.4 years; axial length, 24.2 mm) participants with no significant differences in demographics (P ≥ 0.107). Men had a higher mean p-CVD in all regions (P < 0.001). The mean p-CVS was greater in men in all regions except for the supratemporal sector (P < 0.001). No significant differences in sex in the mean CT were observed in all regions (P ≥ 0.106). The p-CVD and p-CVS in normal eyes differ between sexes. This finding may contribute to the understanding of the pathophysiology of choroidal diseases.

A Photodynamic Therapy Index for Central Serous Chorioretinopathy to Predict Visual Prognosis Using Pretreatment Factors.

PURPOSE: This study aimed to establish a treatment index based on functional outcomes of photodynamic therapy (PDT) for central serous chorioretinopathy (CSC). DESIGN: A retrospective clinical case-control study. METHODS: This was a single-institute study. Eighty (80) eyes with CSC, who were treated by PDT and whose subretinal fluid resolves within 6 months were divided into two groups: those with poor visual outcome (PVO) (best-corrected visual acuity [BCVA] ≤ 0.5 6 months post-PDT), and the remaining eyes (better visual outcome [BVO]). The areas under the curve (AUC) and cutoff values from receiver operating characteristic curves were examined. These was used to predict the groups using pretreatment BCVA and the thickness of each retinochoroidal layer. RESULT: Twenty-one (21) eyes were in the PVO group and 59 eyes in the BVO group were included. The AUCs were 0.959 for BCVA, 0.959 for the thickness from the internal limiting membrane to the external limiting membrane (IET), 0.820 for the thickness from the external limiting membrane to the photoreceptor outer segment layer, 0.715 for the subfoveal retinal thickness, and 0.515 for the subfoveal choroidal thickness. The BCVA and IET cut-off values were 0.267 logMAR and 71.5 µm, respectively. Using the combination of the cutoff values of BCVA and IET, the highest values for the sensitivity, specificity, positive predictive value, and negative predictive value were 95.2%, 94.9%, 85.0%, and 98.0%, respectively. CONCLUSION: The combination of pre-PDT BCVA and IET in CSC can accurately predict the post-treatment visual prognosis. These values could be used as a treatment index of PDT for CSC.

Characteristics Related to Visual Acuity Loss After Successful Photodynamic Therapy for Eyes With Central Serous Chorioretinopathy.

PURPOSE: This study aimed to examine baseline characteristics for identifying factors associated with vision loss (VL) in patients with central serous chorioretinopathy (CSC) who successfully responded to photodynamic therapy (PDT). DESIGN: A retrospective, clinical case-control study. METHODS: This study included 85 eyes with CSC, which underwent PDT, and resolved serous retinal detachment. These eyes were classified into 2 groups: the VL group (best-corrected visual acuity 6 months after PDT was worse than that at baseline) and the vision maintenance or improved group (the others). Baseline factors were analyzed to determine the characteristics of the VL group and assess the diagnostic potential of these factors. RESULT: Seventeen eyes were included in the VL group. The mean values of the neurosensory retinal (NSR) thickness, the internal limiting membrane-external limiting membrane thickness (IET), and the external limiting membrane-photoreceptor outer segment thickness (EOT) in the VL group were significantly thinner than those in the vision maintenance or improved group (NSR thickness, 123.2 ± 39.7 µm vs 166.3 ± 49.6 µm, P < .001; IET, 63.1 ± 17.0 µm vs 88.0 ± 25.4 µm, P < .001; EOT, 60.1 ± 28.6 µm vs 78.3 ± 33.1, P = .041). The sensitivity, specificity, and positive and negative predictive values for predicting VL were 94.1%, 50.0%, 32.0%, and 97.1% for NSR thickness; 94.1%, 51.5%, 32.7%, and 97.2% for IET; and 94.1%, 30.9%, 25.4%, and 95.5% for EOT, respectively. CONCLUSIONS: Pretreatment sensory retinal layer thickness could predict VL after PDT for CSC and may be a helpful reference for PDT.

Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic.

BACKGROUND/AIMS: To determine the incidence and causative pathogens of endophthalmitis after vitrectomy during strict face mask wearing in the COVID-19 period. METHODS: This was a retrospective multicentre study including 31 ophthalmological institutions of the Japanese Retina and Vitreous Society or Japan-Clinical Retina Study group. Patients who had undergone vitrectomy during 2019, the pre-COVID-19 period, and from July 2020 to June 2021, the COVID-mask period, were studied. The results of cataract surgery were used as a control. The total number of vitrectomies and the total number of postoperative endophthalmitis were determined. Then, the differences in the incidence of postoperative endophthalmitis between the pre-COVID-19 period and the COVID-mask period, and the type of pathogens causing the endophthalmitis were studied. RESULTS: The incidence of postvitrectomy endophthalmitis was significantly lower in the pre-COVID-19 period with 16 568 surgeries and 18 endophthalmitis cases (0.11%) than in the COVID-mask period of 14 929 surgeries and 31 endophthalmitis cases (0.21%; p=0.031, OR=1.913, 95% CI 1.078 to 3.394). In the pre-COVID-19 period, 4 of the 18 eyes were culture positive, and all were of the Staphylococcus family. In the COVID-mask period, 9 of the 31 eyes were culture positive, and 4 cases were related to oral commensals including Streptococcus spp, which are reportedly very rare in endophthalmitis after vitrectomy. CONCLUSIONS: It is necessary for physicians to be aware of the higher incidence of postvitrectomy endophthalmitis during the COVID-mask period, and to treat their patients appropriately.

Effect of the macular shape on hole findings in idiopathic macular hole differs depending on the stage of the macular hole.

This study aimed to investigate the relationship between macular shape and idiopathic macular hole (MH) findings using an objective method. We present retrospective observational case series on patients with MH. The shape of the macular area was quantified using quadratic equations, and the ocular shape (OS) index was calculated. The correlation between the OS index and macular hole findings for each stage was evaluated. Pearson's correlation coefficient showed a significant correlation between the OS index and horizontal hole diameter (p = 0.044), bottom diameter (p = 0.006), and vertical bottom diameter (p = 0.024) in stage 2. For stage 4, there was a negative and significant correlation between the OS index and age (p = 0.037), and horizontal (p = 0.021) and vertical (p = 0.027) bottom diameter. Multiple regression analysis showed that the horizontal (p = 0.0070) and vertical (p = 0.031) bottom diameter and OS index were independently and positively correlated in stage 2. In stage 4, the OS index was independently and negatively correlated with the horizontal (p = 0.037) and vertical (p = 0.048) bottom diameter. The ocular shape of the macula affects MH findings, and its impact depends on its stage.

Sex- and Age-Dependent Wide-Field Choroidal Thickness Differences in Healthy Eyes.

In this study, we aimed to map and characterize the choroidal thickness over a wide area from the posterior pole to the vortex vein in normal eyes. This observational study included 146 healthy eyes (63 male). Three-dimensional volume data were acquired to create a choroidal thickness map using swept-source optical coherence tomography. The map was classified as type A if an area with a choroidal thickness >250 µm in the vertical direction from the optic disc, and the area corresponding to the watershed was not observed, or as type B if such an area was observed. The relationship between the ratio of groups A to B and age was compared by classifying the age for three age groups: <40, 40-60, and >60 years in men and women. In men and women, 69.8% and 49.4% were classified as type A, respectively, with significant sex differences (p = 0.013). The proportion of type B decreased with increasing age in both the sexes. There was a significant difference between ≤60 and >60 years in men and between ≤40 and >40 years in women (p < 0.05). To conclude, the wide-area choroidal thickness and the age-dependent changes in healthy eyes differed between the sexes.

Effect of photodynamic therapy on choroid of the medial area from optic disc in patients with central serous chorioretinopathy.

PURPOSE: To explore the effect of photodynamic therapy (PDT) on the choroid of medial area from optic disc and factors correlated with treatment outcomes, we evaluated choroidal changes using ultra-widefield optical coherence tomography (UWF-OCT) after PDT for central serous chorioretinopathy (CSC). METHODS: In this retrospective case-series, we included CSC patients who received a standard-dose of full-fluence PDT. UWF-OCT were examined at baseline and 3 months after treatment. We measured choroidal thickness (CT), classified into central, middle, and peripheral sectors. We examined CT changes after PDT by sectors and treatment outcome. RESULTS: Twenty-two eyes of 21 patients (20 males; mean age 58.7 ± 12.3 years) were included. CT reduction after PDT was significant in all sectors, including peripheral areas: supratemporal, 330.5 ± 90.6 µm vs. 237.0 ± 53.2 µm; infratemporal, 240.0 ± 89.4 µm vs. 209.9 ± 55.1 µm; supranasal, 237.7 ± 59.8 vs 209.3 ± 69.3 µm; infranasal, 172.6 ± 47.2 µm vs. 155.1 ± 38.2 µm (P < 0.001, for all). In patients with retinal fluid resolution, despite no apparent difference in baseline CT, there was more significant reduction after PDT in supratemporal and supranasal peripheral sectors, compared with patients without resolution: supratemporal, 41.9 ± 30.3 µm vs. -1.6 ± 22.7 µm; supranasal, 24.7 ± 15.3 µm vs. 8.5 ± 3.6 µm (P < 0.019, for both). CONCLUSIONS: Whole CT decreased after PDT, including in medial areas from optic disc. This may be associated with the treatment response of PDT for CSC.

Vortex Veins in Eyes With Pachychoroid Spectrum Disorders Evaluated by the Adjusted Reverse 3-Dimensional Projection Model.

Purpose: To compare the distribution of vortex vein ampulla (VVA) between pachychoroid spectrum disorder (PSD) and controls. Design: A single-center, case-control study. Participants: This study included 75 PSD, 35 fellow, and 65 control eyes. Methods: We quantified VVA distribution using a 3-dimensional reverse projection model corrected for image distortion. We investigated the distribution of major drainage veins (MDV), in which macular Haller's vessels directly influx. Main Outcome Measures: The mean distances from the optic disc to VVAs and the mean angles between VVAs and the fovea-disc line. Results: The PSD group had significantly fewer VVA in infranasal sector (PSD, fellow, control; 1.6 ± 0.6, 1.8 ± 0.6, 1.9 ± 0.6, respectively, P = 0.026). In supralateral sector, for PSD, fellows, and controls, the mean distances from the optic disc to VVAs were 14.1 ± 1.0 mm, 14.1 ± 1.1 mm, and 13.6 ± 1.4 mm, respectively, and were significantly farther in PSD than in controls (P = 0.023). The mean angles between VVAs and the fovea-disc line were 64.8 ± 5.9°, 66.4 ± 6.4°, and 61.7 ± 6.4°, respectively, and were significantly higher in PSD and fellows than in controls (P = 0.008). The mean distances from the optic disc to MDV in supratemporal sector were 14.1 ± 1.2 and 13.7 ± 1.2 in eyes whose Haller's vessels extended beyond the fovea-disc line (asymmetry), and those that did not, respectively, with the asymmetric eyes significantly farther (P = 0.016). Conclusions: The VVA position in supralateral sector was farther and higher in PSD than in controls, suggesting that the distribution of VVA may be associated with the development of PSD. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Colour tone of retinal arterioles imaged with a colour scanning laser ophthalmoscope can be an indicator of systemic arterial stiffness.

OBJECTIVE: Colour scanning laser ophthalmoscope (cSLO) offers several advantages, including improved image quality and better visualisation of the retinal structures compared with colour fundus photograph (CFP). This study aimed to identify whether cSLO could be used to predict systemic arterial stiffness. METHODS AND ANALYSIS: We retrospectively analysed the data of 54 patients with 103 eyes. In addition to blood pressure and blood data, all patients had cardio-ankle vascular index (CAVI) measurements, as well as images of the fundus acquired using cSLO and CFP. We determined the retinal artery sclerosis (RAS) index from the colour of the retinal artery in cSLO images, the ratio of arterial to venous diameter (A/V ratio), and Scheie's classification in CFP images. The correlation between each parameter and CAVI was examined using Spearman's rank correlation coefficient, and the correlation between Scheie's classification and CAVI was examined using Steel-Dowass tests. RESULTS: CAVI showed a significant positive correlation with the RAS index (r=0.679, p<0.001) but not with the A/V ratio or Scheie's classification. Multiple regression analysis showed that the RAS index was significantly and independently correlated with CAVI. CONCLUSION: cSLO is a non-invasive imaging modality that has the potential to accurately and instantaneously detect early systemic arterial stiffness.

Wayfinding artificial intelligence to detect clinically meaningful spots of retinal diseases: Artificial intelligence to help retina specialists in real world practice.

AIM/BACKGROUND: To aim of this study is to develop an artificial intelligence (AI) that aids in the thought process by providing retinal clinicians with clinically meaningful or abnormal findings rather than just a final diagnosis, i.e., a "wayfinding AI." METHODS: Spectral domain optical coherence tomography B-scan images were classified into 189 normal and 111 diseased eyes. These were automatically segmented using a deep-learning based boundary-layer detection model. During segmentation, the AI model calculates the probability of the boundary surface of the layer for each A-scan. If this probability distribution is not biased toward a single point, layer detection is defined as ambiguous. This ambiguity was calculated using entropy, and a value referred to as the ambiguity index was calculated for each OCT image. The ability of the ambiguity index to classify normal and diseased images and the presence or absence of abnormalities in each layer of the retina were evaluated based on the area under the curve (AUC). A heatmap, i.e., an ambiguity-map, of each layer, that changes the color according to the ambiguity index value, was also created. RESULTS: The ambiguity index of the overall retina of the normal and disease-affected images (mean ± SD) were 1.76 ± 0.10 and 2.06 ± 0.22, respectively, with a significant difference (p < 0.05). The AUC used to distinguish normal and disease-affected images using the ambiguity index was 0.93, and was 0.588 for the internal limiting membrane boundary, 0.902 for the nerve fiber layer/ganglion cell layer boundary, 0.920 for the inner plexiform layer/inner nuclear layer boundary, 0.882 for the outer plexiform layer/outer nuclear layer boundary, 0.926 for the ellipsoid zone line, and 0.866 for the retinal pigment epithelium/Bruch's membrane boundary. Three representative cases reveal the usefulness of an ambiguity map. CONCLUSIONS: The present AI algorithm can pinpoint abnormal retinal lesions in OCT images, and its localization is known at a glance when using an ambiguity map. This will help diagnose the processes of clinicians as a wayfinding tool.