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3-D assessing of intracanal anatomy in the clinical endodontic practice is always challenging. Although computed tomography could visualize intracanal anatomy but, they all use harmful ionized radiation and presented low sensitivity in detection of fine canal anatomy images. Optical coherence tomography (OCT) is a high-resolution imaging technique that allows micrometer scale imaging of biologic tissues over small distances, uses infrared light waves that reflect off the internal microstructure within the biologic tissues and gives high resolution images. In studies OCT has previously been shown to be a valuable tool in assessing intracanal anatomy, cleanliness of the canal after preparation, and even perforations. Aim: To evaluate the ability of optical coherence tomography (OCT) to image root canal walls, and to identify confounding factors in root canal treatment. Histological validation of data acquisition for root canal lumen dimensions (area and diameter) obtained from OCT scan. Methodology: Maxillary incisors with poor prognosis for endodontic treatment outcome were scanned for canal lumen dimension using Intra coronary OCT probe modality. The same tooth were extracted, was sectioned to get a total number of 20 slices (n=20). Root canal lumen dimension of each slice was validated and compared histologically, double blindedly using Nikon digital microscope software (NIKON DS -Ri2) with dimensions obtained by OCT scan. The mean data acquired by OCT were correlation with histological slices using co-relation regression test. Results: A strong correlation was found between the data acquired by using OCT and histology for area of canal lumen r (area) = 0.97, max and min diameter r= 0.95, 0.93 respectively. Conclusion: Optical coherence tomography is a non-invasive and non-destructive technique for endodontic imaging. It proved to be suitable for analysing the anatomy and cleanliness of root canal walls, and has a high sensitivity and specificity for detection of internal anatomy of canals. OCT generates high-resolution, real-time, intra-canal microscopic images, and holds great potential for in-vivo application. [ABSTRACT FROM AUTHOR]

The major facilitator superfamily domain-containing protein 8 (MFSD8) pathogenic variants are classically associated with autosomal recessive neuronal ceroid lipofuscinosis-7. Case reports have recently demonstrated an association of MFSD8 variants causing autosomal recessive macular dystrophy with central cone involvement without neurologic sequelae. We report a patient with a novel ocular phenotype associated with MFSD8 pathogenic variants causing macular dystrophy without systemic findings. A 37-year-old female presented with a 20-year history of progressive bilateral vision loss. Fundus examination was notable for a slight pigmentary ring around the fovea in both eyes. Optical coherence tomography (OCT) of the macula showed bilateral subfoveal ellipsoid zone loss without outer retinal changes. Fundus autofluorescence (FAF) demonstrated foveal hypo-autofluorescence (AF) in both eyes as well as hyper-AF nasally to the optic nerve in the perifoveal area. Full-field and multifocal electroretinography demonstrated cone dysfunction with diffuse macular changes in both eyes. Subsequent genetic testing identified two pathogenic MFSD8 variants. The patient had no neurologic symptoms consistent with variant-late infantile neuronal ceroid lipofuscinosis. MFSD8 pathogenic variants are known to cause macular dystrophies. We report a novel MFSD8-associated macular dystrophy phenotype demonstrating foveal-limited disease with cavitary changes on OCT without inner retinal atrophy and foveal-specific changes on FAF. A threshold model can explain how a hypomorphic missense variant heterozygous with a loss-of-function nonsense variant can lead to a predominantly ocular phenotype with preserved neurologic function. We recommend careful monitoring of these patients for future signs of both retinal and systemic disease progression. [ABSTRACT FROM AUTHOR]

The objective grading of anterior chamber inflammation (ACI) has remained a challenge in the field of uveitis. While the grading criteria produced by the Standardization of Uveitis Nomenclature (SUN) International Workshop have been widely adopted, limitations exist including interobserver variability and grading confined to discrete categories rather than a continuous measurement. Since the earliest iterations of optical coherence tomography (OCT), ACI has been assessed using anterior segment OCT and shown to correlate with slit-lamp findings. However, widespread use of this approach has not been adopted. Barriers to standardization include variability in OCT devices across clinical settings, lack of standardization of image acquisition protocols, varying quantification methods, and the difficulty of distinguishing inflammatory cells from other cell types. Modern OCT devices and techniques in artificial intelligence show promise in expanding the clinical applicability of anterior segment OCT for the grading of ACI. [ABSTRACT FROM AUTHOR]

Purpose To describe the association between morphologic features on fundus photography (FP), fluorescein angiography (FA), and optical coherence tomography (OCT) and visual acuity (VA) in the second year of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Design Prospective cohort study within a randomized clinical trial. Participants Participants in the CATT. Methods Study eye eligibility required angiographic and OCT evidence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and VA between 20/25 and 20/320. Treatment was assigned randomly to ranibizumab or bevacizumab with 3 different dosing regimens over a 2-year period. Main Outcome Measures Fluid type, location, and thickness; retina and subretinal tissue complex thickness on OCT; size and lesion composition on FP and FA; and VA. Results Among 1185 CATT participants, 993 (84%) had fluid on OCT at baseline and completed 2 years of follow-up. At 2 years, intraretinal fluid (IRF), subretinal fluid (SRF), sub–retinal pigment epithelium (RPE) fluid, and subretinal tissue complex thickness decreased in all treatment groups. Ranibizumab monthly was best able to resolve each type of fluid. Eyes with SRF in the foveal center on OCT had better mean VA than eyes with no SRF (72.8 vs. 66.6 letters; P = 0.006). Eyes with IRF in the foveal center had worse mean VA than eyes without IRF (59.9 vs. 70.9 letters; P < 0.0001). Eyes with retinal thickness <120 μm had worse VA compared with eyes with retinal thickness 120 to 212 and >212 μm (59.4 vs. 71.3 vs. 70.3 letters; P < 0.0001). At 2 years, the mean VA (letters) of eyes varied substantially by the type of subfoveal pathology on FP and FA: 70.6 for no pathology; 74.1 for fluid only; 73.3 for CNV or pigment epithelial (RPE) detachment; 68.4 for nongeographic atrophy; and 62.9 for geographic atrophy, hemorrhage, RPE tear, or scar ( P < 0.0001). Conclusions The associations between VA and morphologic features identified through year 1 were maintained or strengthened during year 2. Eyes with foveal IRF, abnormally thin retina, greater thickness of the subretinal tissue complex on OCT, and subfoveal geographic atrophy or scar on FP/FA had the worst VA. Subretinal fluid was associated with better VA. [ABSTRACT FROM AUTHOR]

Purpose This study was designed to determine the feasibility of anterior segment optical coherence tomography (AS-OCT) to objectively image and quantify the degree of AC inflammation. Design Prospective evaluation of a diagnostic test. Participants Patients with anterior segment involving uveitis. Methods Observational case series of patients with uveitis. Single-line and 3-dimensional (3D) volume AS-OCT scans were manually graded to evaluate for the presence or absence of cells in the AC. Clinical grading scores were correlated to the number of cells seen in each line scan. An automated algorithm was developed to measure the number of cells seen in the 3D volume scan and compared with manual measurements and clinical grading scores. Main Outcome Measures Degree of anterior segment inflammation. Results A total of 114 eyes from 76 patients were imaged, 83 eyes with line scans and 31 eyes with volume scans. The average number of cells on line scans was 0.13 for grade 0, 1.2 for grade 1/2+, 2.6 for grade 1+, 5.7 for grade 2+, 15.5 for grade 3+, and 41.2 for grade 4+. Spearman correlation coefficient comparing clinical grade with the individual AS-OCT line scans was 0.967 ( P < 0.0001). The range of cells in the automated cell count of 3D volume scans was 13.60 to 1222; the range for manual cell counts was from 9.2 to 2245. The Spearman correlation coefficients were r = 0.7765 ( P < 0.0001) and r = 0.7484 ( P < 0.0001) comparing the manual and automated cell counts with the clinical grade, respectively. Spearman correlation coefficient comparing the automatic cell counts with manual cell count in the 3D volume scan was 0.997 ( P < 0.0001). Conclusions Anterior segment OCT can be used to image and grade the degree of AC inflammation. Clinical grading strongly correlates with the number of cells on AS-OCT line scans and volume scans. The automated algorithm to measure cell count had a high correlation to manual measurement of cells in the 3D volume scans. This modality could be used to objectively grade response to treatment. [ABSTRACT FROM AUTHOR]

Background Spectral domain optical coherence tomography (SDOCT) allows for higher resolution scans and higher scanning speeds compared to time domain OCT (TDOCT). The purpose of this study is to compare the pathology detection rates of various SDOCT devices to the Stratus TDOCT. Methods Patients with neovascular age-related macular degeneration were imaged on the Stratus and one of four SDOCT devices. The images were then analysed in a masked manner evaluating for the presence of epiretinal membrane (ERM), pigment epithelial detachment (PED) and subretinal fluid (SRF). After determining that low scan density with one of the devices was likely the cause of missed PED and SRF compared to the other SDOCT devices the study was repeated with a higher scan density. Results 60 eyes from 60 patients with neovascular macular degeneration were imaged on each SDOCT device, for a total of 240 eyes from 240 patients imaged on Stratus. There were no instances where pathology was visible on Stratus but was missed on SDOCT. The highest incidence of missed pathology was with SRF, followed by ERM and PED. Conclusions The increased resolution and image quality of SDOCT devices over TDOCT allows for finer discrimination of retinal structures. The increased speed of SDOCT allows for dense coverage of the macula resulting in the ability to see smaller areas of PED and SRF. There was a critical threshold for the distance between B-scans in the three-dimensional cube scan for detection of pathology. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether intravitreal fluocinolone acetonide (FA) implantation (Retisert) leads to scleral thinning. Methods: Scleral thickness was measured at the pars plana region (4 quadrants) with anterior segment OCT (Visante) in FA implanted eyes (18) with noninfectious posterior uveitis in comparison to eyes with prior vitrectomy (8), and normal eyes without prior surgery (30). Results: Mean scleral thickness in normal (nonsurgical) eyes was 0.99/0.93/0.88/0.86, and 0.92 mm in the inferonasal/inferotemporal/superotemporal/superonasal quadrants, and overall, respectively. Sclera was thinner in each quadrant of the FA implanted eyes compared to the fellow or nonsurgical eyes, although none reached statistical significance, as the differences were small. However, a few FA implanted eyes demonstrated more dramatic scleral thinning than others. Conclusions: FA implant appears to lead to statistically nonsignificant scleral thinning overall with few exceptions. Clinicians should be aware of potential scleral thinning in select cases, important for reimplantation and long-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To compare retinal thickness (RT) measurements between traditional 6 radial line scans and three-dimensional (3D) scans using spectral-domain optical coherence tomography (SD-OCT). Design: Prospective, consecutive case series. Methods: Twenty eyes of 17 patients with macular diseases and 8 healthy subjects were scanned using 2 different methods (3D scan and 6 radial line scan) using 2 different SD-OCT devices (Topcon OCT-1000 [Topcon Inc, Paramus, New Jersey, USA] and Canon SPOCT [(Canon/Optopol Inc, Depew, New York, USA]) by an experienced OCT operator. In 16 eyes, the data of TD-OCT were also obtained for comparison. The RT in 9 regions based on Early Treatment Diabetic Retinopathy Study areas were analyzed and compared. Bland-Altman plots were used to evaluate agreement. Results: In the eyes with macular diseases, there was no significant difference in the RT between 3D and 6 radial line scans except the center subfield (P = .011) on the Topcon OCT-1000, and inner inferior (P = .031) and outer nasal (P = .014) areas on the Canon SPOCT. In the healthy subjects, there was no significant difference between the different scans on both SD-OCT devices. The 95% limit of subjects was 3.2 to 30.6 μm and 16.7 to 28.3 μm in the eye with macular diseases on OCT-1000 and SPOCT, respectively, and 6.7 to 13.6 μm and 10.8 to 32.3 μm in healthy subjects on OCT-1000 and SPOCT, respectively. Conclusions: Preliminary results suggest the RT obtained by the 2 different scan patterns, 3D scan and 6 radial line scan, did not differ significantly on SD-OCT. [Copyright &y& Elsevier]

Purpose: To compare automated retinal thickness values generated by the fast macular thickness maps (FMTM) and customized 6-radial line scans (RLS) versus manual retinal measurements on Stratus optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA). Design: Prospective, observational case series. Participants: Patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD), diabetic macular edema (DME), or branch/central retinal vein occlusion (RVO). Methods: Patients were prospectively imaged using the FMTM and customized RLS patterns on Stratus OCT at the same sitting. Each scan was evaluated for errors in retinal segmentation (i.e., correct retinal boundaries [CRB]). Automated values were recorded while central retinal thickness measurements were determined manually for both patterns. The presence or absence of epiretinal phenomenon, cystoid spaces, pigment epithelial detachment, and subretinal fluid was also noted. Main Outcome Measures: Errors in retinal segmentation at and outside the fovea (i.e., CRB) and percentage of automated values within a clinically acceptable margin (±25 μm) of the manual central retinal thickness. Results: A total of 147 eyes of 147 patients (95 eyes with exudative AMD, 41 eyes with DME, and 11 eyes with macular edema caused by RVO) were included. For wet AMD, the total number of CRB at the fovea and outside the fovea was 363 (63.7%) and 360 (63.2%), respectively, in FMTM and 428 (75.1%) and 426 (74.7%), respectively, in RLS (P<0.0001 for both). For DME and RVO, the total number of CRB at the fovea and outside the fovea was 274 (87.8%) and 256 (82.1%), respectively, in FMTM and 287 (92.0%) and 270 (86.5%), respectively, in RLS (P = 0.11, P = 0.15, respectively). Some 40% and 56% of automated foveal center point thicknesses on FMTM and RLS, respectively, were within ±25 μm of the manual central retinal thickness for AMD (P = 0.042), versus 94% and 81% for DME and RVO, respectively (P = 0.07). Conclusions: For exudative AMD, the RLS protocol provides fewer segmentation errors than the FMTM protocol, and its automated retinal thickness values (e.g., foveal center point, central subfield) correlate better with manual retinal thickness measurement than FMTM. In DME and RVO, however, both protocols provide similar and low segmentation errors, and their automated results are close to manual measurements. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To compare the ability to delineate and detect patterns of choroidal neovascularization (CNV) activity in patients with exudative age-related macular degeneration (AMD) after ranibizumab treatment between time-domain optical coherence tomography (TD-OCT) and 4 different spectral-domain optical coherence tomography (SD-OCT) devices. Design: Prospective, consecutive case series. Participants: Sixty-one eyes of 58 patients with exudative AMD after ranibizumab treatment were included in this study. Methods: All patients were imaged with TD-OCT and at least 1 of 4 different SD-OCT devices at the same visit after ranibizumab treatment. The OCT images were analyzed in a masked fashion by 2 independent graders (KS, TY) to delineate and detect the presence of CNV activity defined as the presence of subretinal fluid, intraretinal cysts, intraretinal fluid, sub–retinal pigment epithelium (sub-RPE) fluid, or a combination thereof. The automated evaluation of retinal thickness also was analyzed between devices. Main Outcome Measures: Evidence of CNV activity on linear B-scans and 3-dimensional so-called cube scans on SD-OCT and linear B-scan on TD-OCT. Results: In linear B-scan mode, all 4 SD-OCT devices were superior in their ability to delineate sub-RPE fluid compared with TD-OCT (P<0.05). Three of 4 SD-OCT devices were superior in delineating intraretinal fluid, and 2 of 4 SD-OCT devices were superior in delineating subretinal fluid and intraretinal cysts (P<0.05). In the 3-dimensional so-called cube mode, all 4 SD-OCT devices were superior in detecting subretinal fluid and 2 of 4 SD-OCT devices were superior in detecting sub-RPE and intraretinal fluid (P<0.05). There were significant correlations in center point thickness between all SD-OCT devices and TD-OCT (P<0.01), and 3 of 4 and 1 of 3 SD-OCT devices showed significant differences from TD-OCT in center point thickness (P<0.01) and center subfield thickness (P<0.001), respectively. Conclusions: SD-OCT is superior to TD-OCT in evaluating for CNV activity in patients with wet AMD after ranibizumab injection. Retinal thickness measurements between SD-OCT and TD-OCT also were significantly different. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To investigate the in vivo real-time wound morphology of fresh 23-gauge sutureless oblique sclerotomy wounds with anterior segment optical coherence tomography (OCT). Design: Prospective, observational case series. Methods: Subjects underwent three-port pars plana vitrectomy with a 23-gauge trocar/cannula microincision surgical system at the Cole Eye Institute. All incisions were created in an oblique (aka beveled or angled) fashion. The incisions were imaged with the Visante OCT (Carl Zeiss Meditec, Dublin, California, USA) device on postoperative days 1 and 8. The main outcome measure was wound structure (eg, presence of gaping) as evaluated with OCT. Surgical and ocular parameters were also recorded. Results: Fourteen patients were investigated. Gross clinical examination revealed no evidence of leakage. OCT demonstrated closed wounds in all eyes on postoperative days 1 and 8. The external (entry) site of the incision was occasionally seen as a gape; however the rest of the wound was closed. One patient with closed wounds had transient hypotony along with shallow peripheral choroidals noted on postoperative day 1, which resolved on their own. Conclusions: Oblique incisions have been proposed for microincision sutureless vitrectomy to prevent wound leakage, hypotony, and the secondary risk of endophthalmitis. This study demonstrates that oblique incisions provide adequate wound apposition as shown by OCT even on postoperative day 1. [Copyright &y& Elsevier]

The article presents a case study of a 76-year-old woman with closed macular hole (MH) after undergoing an indocyanine green (ICG) assisted internal limiting membrane (ILM) peeling. It reveals that the woman lost her sight in the left eye after one month of the operation and that her visual ability was rated as 20/400. Results show that intraretinal changes were determined after the ICG assisted ILM peeling was applied during the MH surgery.

Purpose: To investigate the in vitro dynamic wound morphology of fresh 25- and 23-gauge sutureless sclerotomy wounds. Design: Experimental study; laboratory investigation. Participants: Sixteen eyes of New Zealand white rabbits. Methods: Eight cadaver heads were obtained, and the eyes were enucleated with their conjunctiva intact to simulate an intact globe. Four eyes were analyzed using 4 different wound types and cannula sizes: 25-gauge straight incision (group a); 25-gauge angled incision (group b); 23-gauge straight incision (group c); and 23-gauge angled incision (group d). Three incisions were created in each eye using either a 25- or 23-gauge trocar/cannula system. Intraocular pressure (IOP) was controlled with intraocular balanced salt solution infused through the infusion cannula. The incisions were imaged with a prototype, anterior segment spectral domain optical coherence tomography device under variable IOP to simulate successive blinks or rubbing of the eye and to evaluate the wounds in a dynamic state. Finally, India ink was applied to the surface of the eye under variable IOP to evaluate for wound leakage and potential ink ingress. The eyes were then analyzed by frozen section. Main Outcome Measures: Wound gaping as evaluated with optical coherence tomography (OCT) and presence of India ink particles in incisions evaluated by histology. Results: Gross examination revealed obvious leakage of intraocular fluid in groups A and C (straight incisions) under variable IOP, with some even developing conjunctival blebs. Groups B and D (angled incisions) demonstrated minimal to no clinical leakage. Spectral domain optical coherence tomography demonstrated open wounds in straight incisions under all IOP conditions, with a slightly larger open wound under high IOP. Angled incisions demonstrated less wound gap overall and better wound apposition under high IOP versus low IOP. Histologic examination revealed India ink particles in all straight incisions with penetration across the whole incision in some wounds, whereas no ink particles were observed in angled incisions. Conclusions: Angled incisions have been proposed for sutureless vitrectomy to prevent wound leakage, hypotony, and the secondary risk of endophthalmitis. This study demonstrates that angled incisions provide better wound apposition under dynamic IOP conditions immediately after formation that simulate real-world situations: blinking, squeezing, or even rubbing of the eye. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Objective: To evaluate the visual outcomes for intravitreal ranibizumab administered on an as-needed basis for exudative age-related macular degeneration (AMD) and to investigate the relationship between injection frequency and visual outcome in this setting. Design: Retrospective, interventional case series. Participants: A total of 131 eyes with treatment-naïve, exudative AMD undergoing ranibizumab monotherapy. Methods: Intravitreal ranibizumab was administered on an as-needed basis guided by clinical examination and optical coherence tomography (OCT). The OCT scans were evaluated by the treating physicians for the presence of intraretinal fluid, subretinal fluid, intraretinal cysts, or increasing pigment epithelial detachment size. Clinical data including visual acuity (VA), choroidal neovascularization lesion morphology, and treatment course were collected retrospectively for analysis. Main Outcome Measures: Mean change in best-corrected Snellen VA. Results: The mean age was 81.3 years, mean follow-up was 12±4.3 months (minimum 6 months, median 12 months), and mean number of injections was 5.2±2.8. Mean baseline Snellen VA for the entire population was 20/110 and significantly improved at 6 months (20/80; P = 0.0002) and at last follow-up (20/90; P = 0.0066). At 6 months, 31% of eyes had gained at least 3 lines of VA and 90.5% had avoided loss of 3 lines. On average, it took 3.0 injections and 3.5 months to achieve a “dry” or “flat” macula on OCT after initiating treatment. Resolution of intra- and subretinal fluid on OCT did not correlate with the degree of vision improvement. Eyes receiving more frequent injections (defined as <2 months mean inter-injection interval) gained more vision (+2.3 lines at 6 months) than eyes receiving injections less frequently (+0.46 lines at 6 months; P = 0.012). At 6 months, 3.1% of those in the more frequent injection group lost >3 lines of vision compared with 15.9% in the >2 months interval group (P = 0.011). Conclusions: In a population receiving as-needed injections of ranibizumab for exudative AMD, visual improvement was related to the frequency of injections received but not to the resolution of fluid by OCT. Treatment with ranibizumab on a strictly as-needed basis may result in undertreatment and significantly less visual gain. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]