Search

Competing Interests: Competing interests: None declared.

Background: To identify and analyse the character and relationship between flat irregular pigment epithelial detachment feature (FIPED), choroidal thickness and choroidal neovascularisation (CNV) network seen on optical coherence tomography angiography (OCTA) in eyes with central serous chorioretinopathy (CSCR) in Chinese patients., Method: In the present study, 152 eyes of 144 Chinese patients, who were previously diagnosed with CSCR, were retrospectively studied. Patients' baseline characteristics, the course of CSCR, best-corrected visual acuity, the pattern of CNV on OCTA, FIPED and choroidal thickness detected by enhanced depth imaging-OCT (EDI-OCT) were analysed., Results: It was disclosed that 7.23% of CSCR patients had CNV. Age and the course of CSCR were found to be correlated with the occurrence of CNV. Among the eyes with CNV network (11 eyes), 100% of them had FIPED, whereas, among the eyes without CNV (141 eyes), 18.04% had FIPED. The maximum width and en-face area of PED were greater in the CNV group compared with that in the non-CNV group (p<0.001). It also was revealed that female gender and a poor vision were risk factors for CNV in eyes with CSCR. The choroidal thickness detected by EDI-OCT was also statistically significant between eyes with CNV and eyes without CNV. The patients who have CNV complicated with FIPED are susceptible to have low vision., Conclusion: The present research demonstrated that the majority of CNV cases were linked to FIPED, and the thinner thickness of choroid. The greater width and en-face area of PED may point towards the presence of an underlying CNV network., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate optical coherence tomography angiography (OCT-A) findings in recurrent type 3 macular neovascularisation (MNV)., Methods: In this retrospective cohort study, consecutive patients with type 3 MNV secondary to age-related macular degeneration underwent OCT-A at three different time points: baseline, after anti-vascular endothelial growth factor treatment with complete resolution of the exudative signs (ie, non-exudative stage) and at the recurrence of exudation (ie, recurrence stage). Demographics and clinical findings were analysed, including OCT-A features of type 3 MNV recurrence., Results: Twelve eyes (12 patients, mean age 78±7 years) were included. Using OCT-A, at baseline all type 3 MNVs showed the presence of detectable flow downgrowing from the deep vascular complex (DVC) to the retinal pigment epithelium (RPE)/sub-RPE space. 6/12 eyes (50%) showed anomalous flow under the RPE, while the other 6 eyes showed flow reaching the RPE without anomalous flow in the sub-RPE space. At the non-exudative stage (after treatment), BCVA and CMT significantly improved (p=0.004 and p=0.036), and flow inside the retinal lesions reduced; interestingly the connection to the RPE/sub-RPE space regressed. At the time of recurrence, all type 3 MNVs showed the presence of intra/sub-retinal exudation with restoration of the flow deepening from the DVC to the RPE/sub-RPE space., Conclusions: Detectable flow deepening from the DVC to the RPE/sub-RPE space using OCT-A is mandatory to have a new exudation secondary to recurrent type 3 MNV. Early detection of type 3 MNV recurrence by OCT-A characterisation may prompt retreatment and potentially prevent progression to late stages of the disease., Competing Interests: Competing interests: RS, EB and VC are consultants for ZEISS (Dublin, USA). FB is a consultant for: Alcon (Fort Worth,Texas,USA), Alimera Sciences (Alpharetta, Georgia, USA), Allergan Inc (Irvine, California, USA), Farmila-Thea (Clermont-Ferrand, France), Bayer Shering-Pharma (Berlin, Germany), Bausch + Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), Novagali Pharma (Évry, France), Novartis (Basel, Switzerland), Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee,Belgium), Zeiss (Dublin, USA). EHS is a consultant for: Allergan Inc (Irvine, California, USA), Bausch + Lomb (Rochester, New York, USA), Bayer Shering-Pharma (Berlin, Germany), Novartis (Basel, Switzerland). GQ is a consultant for: Alimera Sciences (Alpharetta, Georgia, USA), Allergan Inc (Irvine, California, USA), Amgen (Thousand Oaks, USA), Bayer Shering-Pharma (Berlin, Germany), Heidelberg (Germany), KBH (Chengdu; China), LEH Pharma (London, UK), Lumithera (Poulsbo, USA), Novartis (Basel, Switzerland), Sandoz (Berlin, Germany), Sifi (Catania, Italy), Sooft-Fidea (Abano, Italy), ZEISS (Dublin, USA)., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Aims: This study aimed to report the 3-year follow-up results of the clinical course and structural changes of choroidal neovascularisation (CNV) by optical coherence tomography angiography (OCT-A) in eyes with a history of chronic central serous chorioretinopathy (CSC)., Methods: This is a retrospective study of patients with chronic CSC complicated with CNV. Patients were recorded of best-corrected visual acuity (BCVA) and treatment modalities. OCT was used to evaluate the presence of subretinal fluid (SRF), type of CNV, changes in central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT). Changes in the size, vessel density (VD) and morphology of CNV were evaluated by OCT-A. Comparison between baseline and final parameters was made., Results: A total of 30 eyes in 26 patients, most of whom had previous treatment for chronic CSC, were included with a mean follow-up period of 40.37±4.11 months. No changes in BCVA were noted (p=0.562). During the 3-year follow-up period with OCT-A, five eyes had SRF noted. The other 25 eyes remained SRF free throughout the course. Regarding the morphological changes, the size of CNV enlarged significantly (p<0.01); VD of CNV decreased significantly (p=0.01); and the number of CNV with visible core vessel significantly increased (p<0.01). A significant reduced SFCT was noted (p=0.02), while the CRT remained unchanged (p=0.855)., Conclusion: For most eyes infected with chronic CSC receiving previous treatment for the activity of chronic CSC, with CNV subsequently found on OCT-A, a midterm stable clinical course up to 3 years was noted, despite significant structural changes of CNV evaluated by OCT-A., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aimed to describe the characteristics of microvascular retinal alterations in eyes with chronic central serous chorioretinopathy (CSC) employing optical coherence tomography angiography (OCTA) analysis., Methods: We collected data from 472 eyes with chronic CSC from 336 patients who had OCTA obtained. Each OCTA image was graded by two readers to assess the presence of microvascular retinal alterations, including regions of vascular rarefaction/retinal hypoperfusion, enlargement of the foveal avascular zone (FAZ) and presence of telangiectasias or microaneurysms. Volume spectral domain optical coherence tomography (SD-OCT) scans were obtained through the macula and the OCT was correlated with the OCTA findings in eyes with retinal vascular alterations., Results: OCTA displayed microvascular retinal alterations in 18 out of 474 eyes (3.6%) from 14 patients (13 male and 1 female; mean±SD age was 54.7±11.1 years). One eye displayed the presence of retinal telangiectasias, while 17 out of 18 eyes were graded as having areas of retinal vascular rarefactions, and 3 out of 17 eyes were also characterised by an enlargement of the FAZ. The parafoveal region was the location most involved by retinal vascular changes (66,7%), followed by foveal (22,2%) and perifoveal (11.1%) regions, respectively., Conclusion: Although CSC is known to represent a choroidal disorder, retinal vascular alterations may be present in these eyes and OCTA may represent a useful tool to identify and describe them., Competing Interests: Competing interests: FB is a consultant for Alcon (Fort Worth, Texas, USA), Alimera Sciences (Alpharetta, Georgia, USA), Allergan (Irvine, California, USA), Farmila-Thea (Clermont-Ferrand, France), Bayer Shering-Pharma (Berlin, Germany), Bausch And Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), NovagaliPharma (Évry, France), Novartis (Basel, Switzerland), Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee, Belgium), Zeiss (Dublin, USA), outside the submitted work. GQ is a consultant for Alimera Sciences (Alpharetta, Georgia, USA), Allergan (Irvine, California, USA), Heidelberg (Germany), Novartis (Basel, Switzerland), Bayer Shering-Pharma (Berlin, Germany), Zeiss (Dublin, USA), outside the submitted work. MP reports personal fees from Allergan, personal fees from Bayer, personal fees from Novartis, outside the submitted work. Other authors: none. Other acknowledgements: The research for this paper was in part financially supported by the Italian Ministry of Health and Fondazione Roma. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To investigate the relationship between the ophthalmic and systemic phenotypes in patients with hereditary transthyretin amyloidosis with the S77Y mutation (ATTRS77Y)., Methods: In this cross-sectional study, patients with genetically confirmed ATTRS77Y amyloidosis were enrolled. All patients underwent complete neurological examination, including staging with the Neuropathy Impairment Score (NIS), Polyneuropathy Disability (PND) score; complete cardiological evaluation, including echocardiography, cardiac MRI and/or cardiac scintigraphy and complete ophthalmic evaluation, including slit lamp examination and fundus examination. Ocular ancillary tests (fluorescein and indocyanine green angiography, and anterior segment optical coherence tomography) were performed in cases with abnormal findings. The Kruskal-Wallis test was used for quantitative outcomes and Fisher's exact test for qualitative outcomes. Statistical significance was indicated by p<0.05 (two tailed)., Results: The study sample was composed of 24 ATTRS77Y patients. The mean patient age was 58.4±12.4 years. None of the patients presented with amyloid deposits in the anterior chamber, secondary glaucoma or vitreous amyloidosis. Retinal angiopathy was observed in four patients, complicated with retinal ischaemia in one patient. Conjunctival lymphangiectasia (CL) was detected in 13 patients (54%), associated with perilymphatic amyloid deposits. The presence of CL was statistically associated with more severe neurological disease (NIS=43.3±31.9 vs 18.9±20.4; PND=2.6±1.0 vs 1.4±0.7 in patients with and without CL, respectively; both p<0.05) and amyloid cardiomyopathy (p=0.002)., Conclusion: In ATTRS77Y patients, CL is common and could serve as a potential biomarker for severe systemic disease. There were neither anterior chamber deposits, secondary glaucoma nor vitreous deposits in ATTRS77Y patients., Competing Interests: Competing interests: ML has been an occasional consultant on subjects outside the scope of this work for Alcon, Allergan, Baush and Lomb, Dompe, Horus, MSD, Novartis, Santen, Shire and Thea. CC reports personal fees from Pfizer, outside the submitted work. CL and VA report personal fees from Pfizer, outside the submitted work. MS reports personal and consulting fees from Pfizer and Alnylam, outside the submitted work. DA reports personal fees from Pfizer Europe, personal fees from Pfizer, personal fees from Alnylam, and personal fees from GSK, outside the submitted work. AR has been an occasional consultant on subjects outside the scope of this work for Alcon, Novartis, Allergan, Pfizer, Shire, Horus and Thea., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background/aims: To describe the risk factors for the development of retinal pigment epithelial (RPE) atrophy following intravitreal anti-vascular endothelial growth factor (VEGF) injection treatment for polypoidal choroidal vasculopathy (PCV)., Methods: We retrospectively included 162 eyes of 162 treatment-naïve patients with PCV in this study. All patients were treated with an initial series of three monthly loading doses of anti-VEGF injections, followed by further injections as required. Baseline ocular characteristics and lesion features were assessed using fluorescein angiography, indocyanine green angiography and spectral domain optical coherence tomography, to determine and evaluate the potential risk factors for RPE atrophy through 2 years of follow-up., Results: RPE atrophy had developed in 17 of 162 eyes (10.5%) after 2 years of anti-VEGF treatment. Nine cases (53.0%) of RPE atrophy occurred at branching vascular networks, and eight (47.0%) developed at locations with polyp or polyp-associated pigment epithelial detachment. Among the baseline characteristics, the mean subfoveal choroidal thickness was significantly thinner (192±98 vs 288±152; p=0.009) and presence of subretinal drusenoid deposits was significantly more frequent in eyes with RPE atrophy (11.8% vs 2.1%; p=0.028). Using multiple logistic regression analysis, the mean subfoveal choroidal thickness (OR 0.975; 95% CI 0.929 to 1.324; p=0.002) was identified as a significant risk factor for the development of RPE atrophy., Conclusions: Approximately one-tenth of the patients with PCV developed RPE atrophy during the 24 months after intravitreal anti-VEGF injections. Subfoveal choroidal thinning at baseline is associated with increased risk of post-treatment RPE atrophy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Biallelic ABCC6 mutations cause pseudoxanthoma elasticum, a systemic disease characterised by calcification of elastic tissue and a specific retinal phenotype. In this study, we investigated if monoallelic ABCC6 mutations are also associated with retinal alterations., Methods: In this prospective, cross-sectional, monocentre case-control study, carriers of monoallelic ABCC6 mutations were investigated and compared with age-matched controls. The retinal phenotype was characterised using fundus photography, fundus autofluorescence, confocal near-infrared reflectance imaging, spectral domain optical coherence tomography and in selected cases late-phase indocyanine green angiography., Results: Thirty-eight subjects carrying monoallelic ABCC6 mutations (mean age 70.2 years, range 50-90, 26 female) were examined and compared with 77 age-matched controls (mean age 69.9 years, range 50-93, 43 female). Retinal alterations were more frequently found in carriers of monoallelic ABCC6 mutations compared with controls (50% vs 33.8%, p=0.107) with increasing prevalence at older age. Typical findings were peripapillary atrophy (37% vs 23%, p=0.184), pattern dystrophy-like changes (24% vs 12%, p=0.109), reticular pseudodrusen (21% vs 5%, p=0.019), small angioid streaks (8% vs 1%, p=0.105), choroidal neovascularisations and atrophic lesions (both 8% vs 0%, p=0.034). Late-phase indocyanine green angiography showed a reduced cyanescence centred to the posterior pole in 11 of 14 examined subjects with monoallelic ABCC6 mutations., Conclusion: The findings of this study indicate a possible ocular ABCC6 haploinsufficiency phenotype. Due to its late-onset and phenotypic similarities, misinterpretation as age-related macular degeneration is possible., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aim: There is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV., Methods: Eyes with iCNV treated with anti-VEGF injections were divided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups., Results: Eighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 57.3 (15.8) letters in the LOADING vs 60.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p<0.001). At 24 months, there was no difference in VA between the LOADING and PRN group (72.3 (14.0) vs 74.7 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1-Q3)) than the PRN (4.5 (3-7) vs 2.5 (2-3.2), p<0.0001). The iCNV recurrences were similar in both groups., Conclusions: iCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment., Competing Interests: Competing interests: AI: Allergan (financial support), Novartis (consultant), Bayer (consultant). FP: Zeiss (consultant), Bayer (speaker), Novartis (speaker), Allergan (consultant), AbbVie (consultant). LC: Abbvie Code C (consultant), Santen Code C (consultant). MCG: Novartis (consultant), Bayer (recipient), Ophtea (consultant), Novartis (recipient), Allergan (consultant), Allergan (recipient), Bayer (consultant), Ophtea (recipient). PJM: AbbVie (financial support), AbbVie (consultant), AbbVie (recipient), Allergan (financial support), Allergan (consultant), Allergan (recipient), Shire (consultant), Shire (recipient), Zeiss (financial support)., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To describe clinical and imaging characteristics of patients presenting with diabetic retinopathy (DR) with coexisting acute or chronic central serous chorioretinopathy (CSCR)., Methods: This was a cross-sectional study which included 54 eyes of 27 patients with coexisting DR and CSCR. Demographic details, prior history of laser, best-corrected visual acuity (BCVA), central macular thickness (CMT), height of neurosensory detachment (NSD), subfoveal choroidal thickness (SFCT), subfoveal large choroidal vessel layer thickness (SF-LCVT), fluorescein angiography and indocyanine green angiography features were recorded. Subanalysis was done for patients with unilateral CSCR. Data was evaluated using Student t-test for quantitative data and χ 2 test for qualitative data. CSCR between different grades of DR was analysed using analysis of variance., Results: Prevalence of coexistent CSCR in eyes with DR was 0.4%. Mean age was 53.96±8.79 years, with 25 males. Mean CMT was 349.2±258 μm. Mean SFCT and SF- LCVT of 38 eyes were 376.40±86 μm and 178.80±62.8 μm, respectively. Fifteen eyes had centre involving diabetic macular oedema. Subanalysis of patients with unilateral CSCR showed that the loss of inner segment-outer segment (IS-OS) integrity (p=0.001), photoreceptor footplates at the NSD roof (p=0.001) on optical coherence tomography and dilated choroidal vessels (p=0.05) on indocyanine green angiography were found more often in the CSCR eyes compared with their fellow eyes. Features of CSCR among the different grades of DR were not significantly different between the groups., Conclusion: Our study describes features of a unique subset of patients presenting with coexistent DR and CSCR. Such coexistent nature needs special attention by the clinicians as this may change the treatment approach and alter outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The aim of this study was to evaluate the effect of anti-vascular endothelial growth factor (VEGF) therapy on choroidal neovascularisation (CNV) complicating central serous chorioretinopathy (CSC) using multimodal imaging, and to identify possible predictive factors of the treatment response., Design: Retrospective study., Methods: Data of 27 eyes with CNV complicating CSC treated with anti-VEGF therapy (either ranibizumab or aflibercept) were reviewed. Response to anti-VEGF treatment was evaluated by change in visual acuity, intra/subretinal fluid modifications and CNV changes on optical coherence tomography angiography (OCTA). Univariate and multivariate analyses were performed to identify predictive factors for central retinal thickness (CRT) change and for the relative degree of treatment response (complete, incomplete or absent fluid reduction)., Results: CRT was significantly reduced at 32±15 days after 2.8±1.3 injections (p=0.0004) as was the subretinal fluid (p=0002). Complete fluid resorption was observed in 45% of cases. Best corrected visual acuity did not significantly improve (p=0.18). CNV area (p=0.09) and CNV flow area (p=0.07) did not significantly decrease. No changes in CNV pattern were noted. Univariate analysis identified greater CRT at baseline (p<0.0001), greater amount of subretinal fluid (p<0.0001), a shorter period of retinal fluid (p=0.04) and female gender (p=0.04) as predictors for CRT reduction. After multivariate analysis the factor of greater CRT at baseline (p<0.0001) proved independent. The degree of treatment response was dependent on the size of CNV surface (p=0.05) and flow area (p=0.05) on OCTA in the univariate analysis, and the latter independent after multivariate analysis. In addition, a shorter time period of retinal fluid appeared to play a role (p=0.01 multivariate, p=0.19 univariate)., Conclusion: The anti-VEGF response was highly variable and often incomplete, suggesting that CNV was not solely responsible for the fluid accumulation. Predictive factors may guide indication for anti-VEGF in CNV associated with CSC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: During diabetic macular oedema (DME), a spectrum of capillary abnormalities is commonly observed, ranging from microaneurysms to large microvascular abnormalities. Clinical evidence suggests that targeted photocoagulation of large microvascular abnormalities may be beneficial, but their detection is not done in a routine fashion. It was reported that they are better identified by indocyanine green angiography (ICGA) than by fluorescein angiography. Here, we investigated the prevalence and ICGA and optical coherence tomography (OCT) features of retinal microvascular abnormalities in a group of patients with DME., Methods: Observational study. The fundus photographs, ICGA and structural and angiographic OCT charts of 35 eyes from 25 consecutive patients with DME were reviewed., Results: 22 eyes (63%) had at least one focal area of microvascular abnormalities showing prolonged indocyanine green (ICG) staining (ie, beyond 10 mins after injection). In particular, all eyes (n=9) with circinate hard exudates showed foci of late ICG staining. These areas were either isolated globular capillary ecstasies or a cluster of ill-defined capillary abnormalities. They were located at a median distance of 2708 µm from the fovea (range: 1064-4583 µm). Their diameter ranged from 153 to 307 µm. During ICGA, 91% showed increased their contrast and apparent size in late frames, whereas 79% of microaneurysms showed reduced contrast on late frames. OCT angiography was not contributive for the detection of these lesions., Conclusion: Late ICG staining revealing large microvascular abnormalities is commonly observed during DME. Because of their specific angiographic and OCT features relative to microaneurysms, we propose to name them telangiectatic capillaries (TelCaps)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To discover whether retinal vessel oxygen metabolism is affected in uveitis associated with Vogt-Koyanagi-Harada (VKH) disease., Methods: 41 patients with VKH disease (82 eyes) and 12 healthy subjects (24 eyes) matched in age and gender were prospectively evaluated. Retinal oxygen saturation and vessel calibre were measured with a non-invasive spectrophotometric retinal oximeter (Oxymap T1)., Results: In healthy controls, mean arteriolar oxygen saturation (%) was 93.8±5.9 and venular saturation was 60.1±5.8. In acute VKH uveitic phase associated with exudative retinal detachment (n=12), arteriolar and venular oxygen saturation values were 104.7±7.8 and 67.9±7.7, respectively, and both are significantly higher than the healthy group (p<0.001; p=0.001, respectively). In patients with VKH disease who recovered after immunosuppressive therapy and restored normal anatomy without 'sunset glow fundus' (n=13), oximetry values were 96.4±9.6 and 61.6±7.5, respectively, similar to healthy controls. In patients with 'sunset glow fundus' and chorioretinal atrophy (n=16), saturation levels were 88.6±7.8 and 50.0±13.1, respectively, significantly lower than healthy controls (p=0.02; p=0.003, respectively). These patients also had significantly smaller diameter of retinal arterioles and venules compared with controls (p=0.035; p=0.001, respectively)., Conclusions: Retinal oxygen metabolism is altered in uveitis associated with VKH disease. Oxygen saturation profile is abnormal in acute uveitic phase of the disease and returns to normal in those who recover with normal fundus appearance, but not in eyes that suffer permanent anatomical damage with 'sunset glow fundus' and chorioretinal atrophy. Retinal oximetry may be of value in evaluating vascular and metabolic aspects of posterior uveitis., Competing Interests: Competing interests: A. M. Abu El-Asrar, None; A. F. AlBloushi, None; P. W. Gikandi, None; S.H. Hardarson, Oxymap ehf. (C, I), P; E. Stefánsson, Oxymap ehf. (I, S). E. Stefánsson and S.H. Hardarson have financial interests in the retinal oximeter used in the study., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate the choroidal thickness (CT) and choroidal vascular densities (CVD) of patients with macular telangiectasia type 2 (MacTel2) and their association with other multimodal imaging features, using swept-source optical coherence tomography (SS-OCT)., Methods: Prospective, cross-sectional study. Consecutive patients with MacTel2 along with controls without any macular disease were included. Fundus photography, confocal blue reflectance, near-infrared reflectance, autofluorescence, fluorescein angiography, spectral domain OCT and SS-OCT were performed. Images were independently analysed by two graders, and CVD was calculated from binarised en face SS-OCT images. CT was obtained from the SS-OCT platform via built-in automated segmentation. Multilevel mixed-effects models were used for statistical analysis., Results: Thirty-nine eyes of 20 patients with MacTel2 and 29 eyes of 15 control patients were included. Average CT and perifoveal temporal CT did not differ significantly between eyes with MacTel2 and control eyes (p≥0.350), when accounting for confounding factors. Overall and temporal CVD also did not significantly differ between the two groups (p≥0.490)., Conclusion: CT and CVD did not significantly differ between MacTel2 and control eyes in this study using SS-OCT. Even though MacTel2 may include abnormalities involving the choroid, these are likely minor in comparison to the predominant retinal changes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To characterise the clinical and topographical features of circumscribed choroidal haemangioma (CCH) and to visualise the patterns of tumour extent in the ocular fundus., Methods: Data on the size, shape and location of 113 CCH were converted into a database of two-dimensional retinal charts by means of computer drawing software. The extent of the tumours was visualised by merging the charts and displaying the number of overlapping tumours on colour-coded maps., Results: The mean largest tumour diameter was 7.2 mm (range, 2.5-11.0 mm), mean tumour height was 2.4 mm (range, 0.7-4.6 mm) and mean diameter/height ratio was 3.2 (range, 2.1-6.0). The mean distance from the posterior tumour margin to the foveola and optic disc margin was 1.7 mm (range, 0-15 mm) and 2.4 mm (range, 0-11 mm), respectively. The hemispheric location of the tumour centroid was temporal in 75 eyes (66%) and nasal in 38 (34%) (p=0.0005) and the distribution between the superior and inferior hemispheres was 68 (60%) and 45 (40%), respectively (p=0.03). The presence of subretinal fluid (SRF) was significantly associated with young age at diagnosis (p=0.0002), low tumour diameter/height ratio (p=0.0004), nasal hemisphere location (p=0.006) and close proximity to the optic disc (p=0.004)., Conclusions: The superotemporal quadrant close to the macula is the most frequent location of CCH. The tumours are generally characterised by a diameter/height ratio of >2. Tumours in young patients, with marked elevation, in nasal hemisphere and in proximity to the optic disc are associated with SRF exudation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH., Methods: Pars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared., Results: The anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001)., Conclusions: These findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Background and Objective: To demonstrate the coexistence of polypoidal choroidal vasculopathy (PCV) with type 2 neovascularisation (NV), we used multimodal imaging, including spectral-domain optical coherence tomography angiography (SD-OCTA), to identify both types of lesions in the same eye., Study Design: This retrospective case series reviewed patients with PCV diagnosed with indocyanine green angiography (ICGA), fluorescein angiography (FA), SD-OCT and SD-OCTA., Results: 15 eyes of 14 patients were imaged and diagnosed with PCV by ICGA. ICGA identified polyps in all these eyes, while SD-OCTA imaging identified polypoidal lesions in only 11 (73%) of these eyes with PCV. Branching vascular networks (BVNs) were detected in 12 eyes (80%) by ICGA and SD-OCTA. Type 2 NV was detected in four eyes (27%) by FA and SD-OCTA. In these eyes, a combination of polyps, BVNs and type 2 NV were detected using FA, ICGA and SD-OCTA., Conclusion: BVN and type 2 NV can coexist in the same PCV eye and communicate with each other. This suggests that polyps may represent a structural variant of neovascular tissue rather than a distinct pathogenic process in NV., Competing Interests: Competing interests: PJR receives research support and consulting fees from Carl Zeiss Meditec, Dublin, California, USA., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Multiple evanescent white dot syndrome (MEWDS) is an inflammatory disease that can be associated with choroidalneovascularisation (CNV). However, few studies in the literature have described the occurrence of MEWDS in association with CNV. This paper discusses whether CNV can trigger MEWDS in a predisposed eye., Methods: A retrospective multicentric case series of six eyes in six patients with acute onset of MEWDS and evidence of previous CNV was conducted between January 2015 and January 2017. All patients underwent ophthalmic examination including multimodal imaging at baseline and during follow-up., Results: The mean age was 32.2±12.2 years. The majority of patients were women (5/1). In each case, MEWDS was diagnosed during a recurrence or occurrence of CNV secondary to choriocapillaritis, central serous chorioretinopathy or atrophic scar, presumably due to congenital toxoplasmosis. All patients were treated with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) with good anatomical and functional responses (mean gain of 0.3±0.31logMAR). The mean duration of follow-up was 13.5±10.65 months., Conclusion: This study highlights a sequence in the development of MEWDS, following the occurrence or recurrence of CNV. CNV may trigger MEWDS, possibly due to the proinflammatory environment created by the retinal tissue surrounding the CNV., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aim: To report the complications observed in a consecutive large series of cases treated with keratopigmentation (KTP)., Methods: KTP was performed in 234 eyes of 204 patients for therapeutic and cosmetic reasons. From them, 50 eyes of 29 patients suffered complications. Different KTP techniques and three generations of pigments (GP) were used. The follow-up period ranged from 4 months to 12 years. Light sensitivity (LS), visual field (VF) limitations and MRI alterations were considered functional complications. Organic complications were described as change in colour, colour fading and neovascularisation., Results: The percentage of complications was 12.82%. Most patients complained of LS (49%), then colour fading and change in colour (19%). Neovascularisation, VF limitations and MRI complications constituted 7%, 4% and 2%, respectively. Organic complications were observed with the previous GP but resolved with the latest third GP with CE mark certification (Conformité Européene). Although LS remained with the corneal-specific pigments, it gradually disappeared in most of the patients (81.81%) 6 months postoperatively., Conclusion: To the best of our knowledge this is the first time a study systematically and comprehensively approaches and reports KTP complications. KTP with third GP provides better results and fewer complications than previous ones. It is a modern, minimally invasive technique that helps solve several functional ocular problems and improves cosmetic appearance of the patients. Dermatological pigments should not be used as they lead to complications; instead pigments specifically tested for the eye in terms of toxicity and teratogenicity should be used., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To describe a new stage of multiple evanescent white dot syndrome (MEWDS), occurring at a very early phase of the disease., Methods: Retrospective analysis of clinical, angiographic and tomographic findings in four patients with 'hyper-early' stage MEWDS., Results: In four patients seen within 1 week of the onset of symptoms, fundus analysis revealed macular granity and the classic yellow-white dots, some having no corresponding hyperautofluorescent pattern. Spectral-domain optical coherence tomography (SD-OCT) showed central foveal disruption of the ellipsoid zone (EZ) and interdigitation layer with a hyper-reflective dome-shaped lesion. In two patients, fluorescein angiography (FA) revealed an intermediate hypofluorescent perimacular halo, whereas late indocyanine green angiography (ICGA) showed a hyperfluorescent halo as well as the classic MEWDS features. After a few days, the EZ disruption appeared complete on OCT and fundus autofluorescence (FAF) in all patients. Visual acuity, OCT and FAF findings had fully recovered within 3 months., Conclusions: We have shown a new feature of MEWDS on FAF, OCT, FA and ICGA, corresponding to a very early stage of the disease., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Aims: To investigate the relationship between idiopathic choroidal neovascularisation (CNV) and choroidal watershed zones (CWZs) using indocyanine green angiography (ICGA)., Design: Multicentre, retrospective, interventional case series., Methods: The medical records and ICGA findings of 44 patients (44 eyes) diagnosed with idiopathic CNV were reviewed. CWZs, defined as hypofluorescence that disappeared during the early phase of ICGA, were classified, and the findings were compared with those of a control group of 30 eyes. The topographical relationship between CWZs and CNV was evaluated. Visual acuity and recurrence were analysed according to the CWZ classification., Results: The CNV lesion was subfoveal in 16 eyes, juxtafoveal in 12 eyes and extrafoveal in 16 eyes. The most common types of CWZs were stellate (23 eyes, 52.3%) and vertical (19 eyes, 43.2%). CWZs involving the fovea were seen in more patients with idiopathic CNV (37 eyes, 84.1%) than in the control group (11 eyes, 36.7%, p<0.001). The topographical relationship between CWZs and CNV was determined in 42 eyes (95.5%), with the CNV located within the CWZ in 39 eyes and at the margin in 3 eyes. Extrafoveal CNV was within the CWZ in all 16 affected eyes. At 6 months, visual acuity was significantly worse in patients with subfoveal CNV (p=0.028) or stellate CWZs (p=0.039)., Conclusions: The findings of a CWZ were related to the location and functional outcome of idiopathic CNV. Our results suggest that choroidal circulation is a predisposing factor for the development of CNV in young patients., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Conjunctival oedema is commonly observed in patients with allergic conjunctivitis and can be induced by histamine. In animal models of allergic conjunctivitis, conjunctival oedema is generally evaluated by measuring the extravasation of Evans blue dye into the conjunctiva. A limitation of this method is that it only allows evaluation at a single time point. The aim of the present study was to investigate kinetic changes in histamine-induced bulbar oedema., Methods: Evans blue dye was injected intravenously into male guinea pigs. Histamine eye-drops were administered 30 min later. One group of animals received levocabastine (an antihistamine) eye-drops 10 min before histamine challenge. A digital camera was used to obtain images of the bulbar conjunctiva at 1 min intervals until 30 min after histamine challenge. The conjunctivas were then harvested, and the concentration of Evans blue was measured. The ImageJ software was used to analyse the images by counting the number of absolute pixel values., Results: The degree of conjunctival oedema increased progressively until 20 min after histamine challenge and then stabilised. Correspondingly, the number of absolute pixel values increased significantly until 5 min after histamine challenge, then increased gradually until the 20 min time point and finally plateaued. Pixel values were significantly lower in animals treated with levocabastine than in control animals. A significant correlation was observed between the pixel values of the conjunctival images and the concentration of Evans blue in the conjunctiva., Conclusions: This is the first study to have quantitatively evaluated kinetic changes in histamine-induced bulbar oedema by means of image analysis.