[Capabilities of optical coherence tomography in examination of senile scleral plaques]. / Vozmozhnosti opticheskoi kogerentnoi tomografii v otsenke senil'noi skleral'noi blyashki.

Senile scleral plaque (SSP) is a degenerative disease of the sclera manifested by the appearance of gray spots with clearly defined borders anteriorly from the insertion site of horizontal rectus muscles. Even with minimal changes over time changes over time are minor, SSP weakens the structural function of the sclera and creates a risk of a complicated course associated with scleromalacia. Interest in the study of SSP is increasing due to the growing number of transscleral intravitreal injections. PURPOSE: To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT). MATERIAL AND METHODS: The study examined 13 patients (21 eyes) with average age of 77.1±6.3 years. OCT scanning was performed to determine OCT signs of SSP, the length (parallel to the limb), the width and height of the SSP, as well as the depth and thickness of the overlying sclera. RESULTS: A combination of nasal and temporal SSP was observed in 14 eyes, and nasal only SSP was detected in 6 eyes. In all cases, OCT presented a characteristic picture of SSP observed as an intrascleral cavity with hyperreflective content with lower reflectivity than the surrounding tissues, and clear borders represented by unchanged scleral fibers. The length of the SSP parallel to the limb was 3296±820 µm, the width - 2312±436 µm, the height of the SSP cavity - 482±89 µm. The depth of SSP site was 213±36 µm, the thickness of the overlying sclera - 125±29 µm. CONCLUSION: Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.

CORRELATION BETWEEN POSTERIOR STAPHYLOMA AND DOME-SHAPED MACULA IN HIGH MYOPIC EYES.

PURPOSE: To investigate the relationship between posterior staphyloma and dome-shaped macula (DSM) in highly myopic eyes. METHODS: The clinical data were collected from patients with high myopia: diopter, best-corrected visual acuity, axial length, fundus images, optical coherence tomography, and 3D magnetic resonance imaging. A DSM was defined as a convex curvature of the macula in one or both of the vertical and horizontal optical coherence tomography scans. The relationship between DSM and posterior staphyloma was evaluated. RESULTS: A total of 123 eyes were included. Dome-shaped macula was found in 18 eyes (14.63%). Twelve eyes with DSM had positive 3D magnetic resonance imaging findings. Nine eyes had horizontal oval-shaped dome, and a band-shaped inward convexity that extended horizontally from the optic disc through the fovea could be seen. Three eyes had round dome, and 3D magnetic resonance imaging showed a round inward convexity of the macular area. Five inward convexities were the border of multiple staphylomas, five were the boundary of one staphyloma, and two were within a single staphyloma. CONCLUSION: The formation of highly myopic DSM is related to the morphological change of the entire posterior segment.

Reaction on "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma".

BACKGROUND: In the recently published article entitled "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma" Jacobsen et al. describe a case in which a hyper-intense extra-ocular lesion on MRI was erroneously diagnosed as an extrascleral extension of the tumor. Based upon this the authors conclude "the superiority of ocular ultrasound in the diagnostic management of extra scleral extension in choroidal melanoma". In our view, there are numerous flaws in the investigation that cast doubt on this message. MAIN: First of all, this is quite a bold statement when only one patient has been evaluated. Secondly, the manuscript only presents a post-contrast T1-weighted image, whereas multiple MRI-sequences need to be included to determine if a hyperintense region is an extrascleral invasion. Moreover, no modern MRI-techniques such Dynamic Contrast Enhanced (DCE) or Diffusion Weighted Imaging (DWI) have been included in the evaluation of this patient, making it hard to use this single case to compare the efficacy of MRI and Ultrasound. The presented data do, however, give clear clues that the hyperintense lesion is likely to be inflammatory. CONCLUSION: Although the study falls short in providing a comprehensive comparison between current MRI techniques and ultrasound, it does show that the evaluation of ocular MR-images should be made in a multi-disciplinary setting involving both ophthalmologist and radiologists, since the field of ocular MRI is continuously progressing.

[Relation between ultrasonographic characteristics of pathologic myopia posterior staphyloma and retinoschisis].

Objective: To study the ultrasonographic characteristics of pathologic myopia posterior staphyloma and the relation with retinoschisis. Methods: Retrospective case series study. Eighty-seven eyes of 66 pathologic myopia patients with posterior staphyloma were included. Staphyloma morphology and anteroposterior axis of the eyeball were observed by B-scan ultrasonography. Optical coherence tomography was used to explore the retinoschisis. Results: Arc-shaped (10.35%), cone-shaped (22.99%), wedge-shaped (33.33%) and rectangle-shaped (33.33%) posterior staphylomas were found by B-scan ultrasonography. Posterior pole or macular retinoschisis was found by optical coherence tomography in 65 eyes (74.71%), 56 of which (86.15%) were observed to have a rough posterior ocular wall or membranoid attachment by ultrasonography. The anteroposterior axis of arc-shaped posterior staphyloma was shorter than that of staphylomas in the other shapes. Posterior staphyloma morphology was related to retinoschisis(r=0.385, 0.406. P<0.01). The retinoschisis was at the macula in 80.00% of cone-shaped posterior staphyloma, at the wedge-shaped corner in 75.00% of wedge-shaped posterior staphyloma and at the rectangle-shaped corner in 62.50% of rectangle-shaped posterior staphyloma. Conclusions: It is hard to discover retinoschisis of pathologic myopia posterior staphyloma by ophthalmoscopy. Morphologic characters of posterior staphyloma and conditions of posterior eyewall can be showed directly under ultrasonographic examination. B-scan ultrasonography may provide a diagnostic basis for pathologic myopia retinoschisis. (Chin J Ophthalmol, 2017, 53: 46-52).

Idiopathic sclerochoroidal calcification.

PURPOSE: Sclerochoroidal calcification is a rare ocular condition characterized by multifocal, yellow-white elevated fundus lesions typically located in the superotemporal quadrant along the superior arcades. The pathology of calcification can be classified as dystrophic, metastatic, or idiopathic. Vision-threatening complications may arise, such as choroidal neovascular membrane and serous retinal detachment. The pathogenesis of sclerochoroidal calcification remains unclear. CASE REPORT: A 72-year-old Caucasian male patient presented to the clinic for routine examination. Fundus evaluation revealed bilateral, multifocal, pale yellow elevated lesions in the superotemporal fundus. Ultrasonography showed a focal area of hyper-reflectivity located in the posterior retina of both eyes, and optical coherence tomography showed an intact retina overlying the elevated lesions in the choroid. Systemic evaluation for dystrophic and metastatic calcification was negative, and the patient was diagnosed with idiopathic sclerochoroidal calcification. CONCLUSIONS: It is important to distinguish sclerochoroidal calcification from other conditions to prevent unnecessary intervention. Calcification of body tissues warrants a systemic evaluation, including screening for calcium and phosphorous levels, to rule out underlying systemic disease. If a biochemical abnormality is discovered, it can be appropriately treated with supplements. If calcification is deemed idiopathic, then annual dilated examinations are recommended to monitor the fundus lesions. Visual prognosis for sclerochoroidal classification is good, as the lesions are typically located away from the macula and foveal encroachment is rare.

Multimodal and retro-mode imaging in sclerochoroidal calcification: A case report.

We present a case report on sclerochoroidal calcification (SCC), a rare condition involving calcium pyrophosphate deposits in the posterior pole of the eye in a 70-year-old patient. We provide an account of the clinical presentation and its appearance in multimodal images, using color fundus photography, swept-source optical coherence tomography (SS-OCT), ocular ultrasound, and the novel retro-mode imaging (RMI) technique. Visual acuity was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). Color fundus photography revealed yellowish deposits located in the upper temporal arcade of both eyes. SS-OCT demonstrated masses of scleral origin. Ocular ultrasounds confirmed the calcification of these masses. RMI detected hyper-reflective images with marked superficial elevation. Systemic laboratory results did not detect any abnormalities, leading to the diagnosis of bilateral idiopathic SCC.

Automated Posterior Scleral Topography Assessment for Enhanced Staphyloma Visualization and Quantification With Improved Maculopathy Correlation.

Purpose: To quantitatively characterize the posterior morphology of high myopia eyes with posterior staphyloma. Methods: Surface points of the eyeball were automatically extracted from magnetic resonance imaging scans using deep learning. Subsequently, the topography of posterior staphylomas was constructed to facilitate accurate visualization and quantification of their location and severity. In the three-dimensional Cartesian coordinate system established with surface points, measurements of distances (D) from each point to the hypothetical pre-elongation eye center within the eyeball and local curvatures (C) at each point on the posterior sclera were computed. Using this data, specific parameters were formulated. The concordance of these parameters with traditional staphyloma classification methods and their association with myopic traction maculopathy (MTM) grades based on the ATN classifications were investigated. Results: The study included 102 eyes from 52 participants. The measured parameters, particularly the variance of distance (Dvar) and the maximum value of the curvature and distance product (C · Dmax), demonstrated efficacy in differentiating various types of posterior staphyloma and exhibited strong correlations with the grades of MTM. Conclusions: The automated generation of the posterior scleral topography facilitated visualization and quantification of staphyloma location and severity. Simple geometric parameters can quantify staphyloma shape and correlate well with retinal complications. Future works on expanding these measures to more imaging modalities could improve their clinical use and deepen insights into the link between posterior staphyloma and related retinal diseases. Translational Relevance: This work has the potential to be translated into clinical practice, allowing for the accurate assessment of staphyloma severity and ultimately improving disease management.

Imaging characteristics of idiopathic scleroma: a retrospective case series and review of the literature.

BACKGROUND: Idiopathic scleroma (previously coined solitary idiopathic choroiditis or focal scleral nodule) is an innocuous lesion affecting the sclera with intraocular manifestations. It is often the basis of many misdiagnoses such as amelanotic choroidal melanoma, osteoma or metastatic lesions. Patients are often asymptomatic and the course is benign. With increasing use of community based imaging, more of such cases are being identified. This paper is a retrospective case series investigating the multi-modal imaging findings of idiopathic scleroma. METHODS: A retrospective analysis of prospectively collected data were analysed. Over the course of January 2008-January 2022, 44 patients diagnosed with idiopathic scleroma and imaged with wide-field colour fundus photography, fundus autofluorescence, ocular coherence tomography (OCT) and B-scan ultrasonography. Due to a poor image, only 43 images were included for OCT review. We also reviewed our patient's demographics, symptoms and baseline ophthalmic characteristics upon presentation. RESULTS: The mean age was 52 years (range 32-79) and there was no predilection towards gender. All lesions were post equatorial with the most common location being inferotemporal (n = 16, 36%); 32 lesions (73%) were yellow on fundus photography. 82% (n = 36/44) of lesions exhibited hyperautoflourescence and 43 lesions (98%) showed hyperechogenicity on B-scan ultrasonography. 100% of lesions originated from the sclera with no lesions showing active inflammation. 20 (47%) lesions had associated blood vessels overlying them on OCT. DISCUSSION: Idiopathic scleroma is a yellow, hyperautofluorescent, hyperechogeneic scleral lesion that has no signs of active inflammation. These characteristics help define them from other more sinister cause of amelanotic fundal lesions.

Idiopathic orbital pseudotumour.

Idiopathic orbital pseudotumour (IOP) is a benign inflammatory condition usually confined to the orbit. This may involve single or multiple intraorbital structures. Extraorbital extension can also occur. The imaging appearances often mimic other orbital diseases. Both computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used to investigate orbital diseases, and it is important for radiologists to be aware of the variety of imaging appearances that occur in IOP. We present the imaging appearances in histopathologically confirmed cases of IOP and discuss the clinical features, natural history, and differential diagnosis of this condition.

Sclerochoroidal calcification as casual finding. / Calcificaciones esclerocoroideas como hallazgo casual.

Sclerochoroidal calcification (SCC) is uncommon and benign. It is usually detected in a routine examination, finding multiple yellow-white lesions in the upper temporal region of the retina in middle-aged and elderly men. A case report is presented of a 79 year-old male patient, who during a routine examination with a pseudoexfoliative glaucoma in the right eye, as well as raised white-yellow subretinal lesions in the upper temporal region in both eyes. After establishing hypotensive treatment and performing autofluorescence, optical coherence tomography (OCT), ultrasound, ocular computed tomography (CT) and complete laboratory analysis, idiopathic SCC was diagnosed. SCC requires a complete ophthalmological and systemic study as it can be associated with endocrine disease. Periodic follow-up is also recommended, as well as to rule out possible complications, such as atrophy of the overlying pigment epithelium, serous detachment, or the appearance of neovascularization. The differential diagnosis should be made of benign and malignant lesions, in order to avoid unnecessary treatment.

Episcleral racemose hemangioma.

Racemose hemangioma is a rare, benign vascular malformation. In the episclera, it appears as dilated, tortuous blood vessels that pass from the fornix over the globe surface to the limbal area, without capillary architecture, and then loop backward into the fornix. Fluorescein angiogram reveals the vascular malformation with rapid flow and confirms the episcleral vessels to be large in caliber and with a curvilinear, twisted configuration. We report the case of a 22-year-old man with nonhemorrhagic, coincidental racemose hemangioma of the episclera.

Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography.

PURPOSE: To determine the early signs of posterior staphylomas in highly myopic eyes of younger subjects by swept-source ultra-widefield optical coherence tomography (WF-OCT). METHODS: This was an observational case series study. Highly myopic subjects younger than 20 years old who were examined consecutively by prototype WF-OCT were studied. High myopia was defined according to the Ministry of Health and Welfare, Japan classification. A posterior displacement of the sclera and two OCT features indicating the staphyloma edges were used as markers of a staphyloma. RESULTS: Fifty-five eyes of 30 patients with the mean age of 12.3 years, and the mean axial length of 27.9 mm were studied. Seven of the 55 eyes (12.7%) had a posterior displacement of the sclera and were diagnosed as having a staphyloma. Among the two OCT features of the staphyloma edges, a gradual thinning of the choroid toward the staphyloma edge and gradual re-thickening of choroid from the staphyloma edge toward the posterior pole were found in these 7 eyes. However, the other feature of an inward protrusion of the sclera at the staphyloma edge, was obvious in only 2 eyes. The subfoveal choroid and choroid nasal to the optic disc were significantly thinner in eyes with a staphyloma than those without it. CONCLUSIONS: The changes of the choroidal thickness toward the staphyloma edge with the posterior displacement of the sclera were considered an early sign which precedes an inward protrusion of sclera at the staphyloma edge.

Rectus Extraocular Muscle Paths and Staphylomata in High Myopia.

PURPOSE: To investigate the relationship between displacement of extraocular muscles (EOMs) and staphyloma in high myopia using magnetic resonance imaging (MRI). DESIGN: Retrospective case-control study. METHODS: Setting: Institutional study. POPULATION: Twenty-nine highly myopic patients (46 eyes), 11 age-matched healthy control subjects (21 eyes), and 34 patients (66 eyes) with sagging eye syndrome. PROCEDURES: MRI was analyzed for aspect ratio (AR) of the ocular cross section, locations of staphylomata and EOMs, and status of superior rectus to lateral rectus (SR-LR) band ligament. MAIN OUTCOME MEASURES: Association between staphylomata with EOM paths and the LR-SR band. RESULTS: Several associations of staphylomata were statistically significant (P < .05). Most staphylomata were superotemporal. Myopic patients with staphyloma had larger ARs in quasi-coronal images than in myopic subjects without staphyloma or normal controls. Compared to patients with high myopia without staphyloma and normal controls, when staphyloma was present, there was more inferior LR displacement, larger LR-globe angle, and larger SR-LR displacement angle than in myopic subjects without staphyloma. Staphyloma in the superotemporal quadrant was associated with greater SR-LR angle than in other quadrants. There were significantly more ruptures of SR-LR band ligament in highly myopic patients with staphyloma than in those without staphyloma. CONCLUSIONS: Local staphylomata in high myopia reflect ocular asphericity and correlate with EOM paths. Myopic staphylomata are associated with inferior displacement of LR path and defect of the LR-SR band ligament.

En face optical coherence tomography of the posterior pole in high myopia.

PURPOSE: To evaluate a large series of patients affected by high myopia using multiplanar imaging provided by en face optical coherence tomography (OCT). DESIGN: Observational cross-sectional study. METHODS: En face OCT longitudinal cross-sectional B scans and coronal C scans were obtained in 200 eyes of 100 patients with myopia greater than -6 diopters and evidence of posterior staphyloma at fundus examination and at ultrasound B-scan evaluation. RESULTS: A macular hole was present in three eyes (1.5%). We detected posterior retinal detachment in 37 cases (18.5%). In 15 eyes (7.5%) detachment was associated with a macular hole. In the remaining 22 eyes (11%), the detachment was located in the area of the staphyloma, and was associated with vitreoretinal traction in four eyes (18.2%) of 22 eyes. There was evidence of detachment of the internal limiting membrane (ILM) in 12 eyes (6%) and retinoschisis in 27 (13.5%) of 200 eyes. Retinal vascular microfolds were detected in 40 eyes (20%), and occurred in all cases of peripapillary retinal detachment, ILM detachment, and retinoschisis. Paravascular microcysts occurred in three eyes (1.5%), and peripapillary detachment of the pigment epithelium in 10 eyes (5%). CONCLUSIONS: En face OCT provides accurate imaging of retinal abnormalities in high myopia and allows width measurement and point-to-point localization of alterations. Thus, it can represent a noninvasive way to detect minimal changes during follow-up. Posterior detachment in the absence of a macular hole seems to be related to vitreoretinal traction, staphyloma, and inward forces exerted by rigid retinal vessels and ILM. En face OCT-assisted surgery of macular holes could help to plan removal of premacular tractional structures.

ENLARGEMENT OF SCLEROCHOROIDAL CALCIFICATIONS: MULTIMODAL IMAGING UPDATE.

PURPOSE: To report the multimodal imaging and enlargement of sclerochoroidal calcifications over a 10-year period. METHODS: Case report of a 74-year-old white man who presented for routine follow-up and was found to have yellow chorioretinal lesions in the right eye. RESULTS: Multimodal imaging was performed and confirmed sclerochoroidal calcifications. Comparison of fundus photography over a 10-year period demonstrated growth of preexisting lesions and the development of new lesions in the right eye. CONCLUSION: Over time, this patient developed new sclerochoroidal calcifications and enlargement of preexisting calcifications. We, therefore, recommend regular follow-up with periodic multimodal imaging for these patients.

Knobby Eye Syndrome.

INTRODUCTION: A spherical globe is traditionally assumed, but this study employed magnetic resonance imaging (MRI) to demonstrate frequent occurrence of non-spherical staphylomata in strabismic patients. METHODS: High-resolution, surface coil MRI was obtained in multiple image planes in 21 highly myopic subjects (36 eyes) and compared with 17 normal controls (33 eyes). Images were analyzed for axial length, aspect ratio of eye shape, and deflection of muscle paths. RESULTS: All but two high myopes had strabismus. While myopic globes were generally spherical in 10 myopic eyes including both orthotropic subjects, 15 globes exhibited diffuse posterior staphylomata, 16 equatorial staphylomata, and 4 both posterior and equatorial staphylomata. Equatorial scleral ectasias were positioned to contact and elongate paths of horizontal rectus muscles in some gaze positions. Axial length in myopes averaged 28.8 ± 3.8 (SD) mm and did not differ significantly between regular vs. irregular staphylomata. Globe aspect ratios in the coronal, axial, and sagittal planes were significantly greater than normal in myopes (P < 0.005), but correlated significantly with axial length only in the axial and sagittal planes (P < 0.03). While myopes with irregular staphylomata were older at 57 ± 11 years than subjects with spherical globes at 24 ± 8 years (P < 0.0005), other clinical features were similar. CONCLUSION: Irregular equatorial or posterior staphylomata are common in strabismic axial high myopes, acting, like "cams" affixed to the normally spherical globe so that they may have no mechanical effect until rotating eccentrically against muscles. After rotational contact, staphylomata would nonlinearly increase muscle tension with further duction. Imaging may be clinically informative about this "knobby eye syndrome."

High-frequency ultrasound of extranodal limbal Rosai-Dorfman disease: affecting the conjunctiva, sclera, and cornea.

PURPOSE: To correlate the clinical, high-frequency ultrasound, and pathology characteristics of an epibulbar Rosai-Dorfman tumor. METHODS: We report a case of a steroid-resistant yellow perilimbal epibulbar tumor referred for ophthalmic oncology evaluation. It was documented by slit-lamp photography and evaluated by high-frequency ultrasound. A hematology-oncology evaluation and excisional biopsy were performed. RESULTS: Ophthalmic examination revealed a solitary yellow perilimbal epibulbar tumor. High-frequency ultrasound imaging revealed low internal reflectivity and partial-thickness scleral and corneal invasion with no extension into the anterior segment. Primary excision was performed. Although histopathology revealed large atypical histiocytes, immunochemistry found them to be both S-100 positive and CD1a negative (diagnostic of Rosai-Dorfman disease). Hematology-oncology evaluation revealed no systemic disease or links to human herpesvirus. Local control required cryotherapy and sub-Tenon steroid injection. CONCLUSIONS: Epibulbar Rosai-Dorfman tumors can invade the sclera and are often treated by surgical excision. High-frequency ultrasound imaging should be used to determine the presence or extent of invasion before surgery.

Invasive spindle cell carcinoma of the conjunctiva managed by full-thickness eye wall resection.

PURPOSE: To describe an invasive spindle cell carcinoma of the conjunctiva managed by full-thickness eye wall resection. METHODS: A 51-year-old man developed a conjunctival mass that was excised and proved to be a spindle cell carcinoma. A tumor recurrence 20 months later was evaluated by ultrasound biomicroscopy (UBM) and managed by full-thickness eye wall resection and scleral graft. RESULTS: UBM depicted an epibulbar mass with deep invasion through the limbus to Descemet membrane. The tumor was removed by full-thickness eye wall resection and scleral graft. CONCLUSIONS: Deep scleral invasion of conjunctival spindle cell carcinoma can sometimes be managed by local resection rather than irradiation or enucleation.