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Background: To compare the visual and anatomical outcomes of pneumatic displacement (PD) combined with anti-vascular endothelial growth factor (VEGF) therapy versus anti-VEGF monotherapy in treatment-naive eyes with submacular haemorrhage (SMH) secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy., Methods: In a retrospective comparative interventional study of 57 eyes, the changes in logMAR visual acuity (VA), and SMH height and area at baseline at months 1, 3 and 12 were compared between the PD and non-PD groups., Results: There was no significant difference in mean VA in the PD versus non-PD group at month 12 (1.1 versus 0.7, p = 0.09). At baseline, the PD group, compared to the non-PD group, had significantly larger SMH area (35.9 versus 26.9 mm 2 , p = 0.04) and SMH height at the fovea (733.7 versus 503.6 µm, p < 0.01). The greatest reduction in SMH height and area occurred between baseline and month 1 in the PD group, which was faster than between month 1 and month 3 in the non-PD group, with similar findings in the matched pair analysis matched for SMH height and area. In the multivariable analysis, only baseline VA was associated with VA outcomes (month 1: β = -0.46, 95% [confidence interval] CI = -0.78 to -0.14, p = 0.006; month 3: β = -0.52, 95% CI = -0.86 to -0.18, p = 0.004; and month 12: β = -0.78, 95% CI = -1.16 to -0.39, p < 0.001)., Conclusions: The visual outcome of SMH at month 12 in nAMD and PCV is poor regardless of whether PD is performed in addition to anti-VEGF therapy, although a more rapid resolution of SMH can be expected., Competing Interests: Competing interests: CMGC and KYCT are members of the Eye editorial board., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To identify the role of systemic arterial stiffness and choroidal microvascular insufficiency on structural progression of normal-tension glaucoma (NTG)., Design: Retrospective cohort study., Methods: A total of 107 early NTG eyes of 88 patients, who underwent pulse wave velocity (PWV) measurements and optical coherence tomography (OCT) angiography (OCT-A) at baseline, were categorized depending on the presence of peripapillary choroidal microvasculature dropout (MvD) and PWV. Differences in glaucomatous progression were analyzed. Structural progression rates were determined using the trend-based analysis of Cirrus OCT., Results: Thirty-two eyes displayed choroidal MvD (62.7 [95% CI 58.4-67.0] years old, 53.6% males), and 70 eyes did not show any MvD (59.9 (95% CI 57.1-62.6) years old, 53.3% males) at baseline. Patients were followed for 48.4 (95% CI 40.0-56.8) months. When they were further divided based on PWV (high PWV ≥ 1400 cm/sec), those with choroidal MvD and high PWV showed significantly faster thinning in macular ganglion cell-inner plexiform layer (GCIPL; P = .023). In comparison to those with low PWV and no MvD, eyes with high PWV and MvD in the peripapillary area were likely to show fast structural progression (≤-1.2 µm/year) in the macular GCIPL by odds of 6.019 (95% CI 1.619-38.531, P = .025)., Conclusions: In NTG eyes, GCIPL thinning was faster when choroidal MvD and high systemic arterial stiffness were present. The simultaneous presence of regional and systemic vascular insufficiency may be associated with rapid glaucoma structural progression in eyes with low baseline intraocular pressure., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The association between the total macular burden of hyperreflective foci (HRF) in eyes with intermediate AMD (iAMD) and the onset of persistent choroidal hypertransmission defects (hyperTDs) was studied using swept-source optical coherence tomography (SS-OCT)., Design: Post hoc subgroup analysis of a prospective study., Methods: A retrospective review of iAMD eyes from subjects enrolled in a prospective SS-OCT study was performed. All eyes underwent 6×6 mm SS-OCT angiography (SS-OCTA) imaging at baseline and follow-up visits. En face sub-retinal pigment epithelium (subRPE) slabs with segmentation boundaries positioned 64 to 400 µm beneath Bruch's membrane (BM) were used to identify persistent choroidal hyperTDs. None of the eyes had persistent hyperTDs at baseline. The same subRPE slab was used to identify choroidal hypotransmission defects (hypoTDs) attributable to HRF located either intraretinally (iHRF) or along the RPE (rpeHRF) based on corresponding B-scans. A semiautomated algorithm was used by 2 independent graders to validate and refine the HRF outlines. The HRF area and the drusen volume within a 5 mm fovea-centered circle were measured at each visit., Results: The median follow-up time for the 171 eyes from 121 patients included in this study was 59.1 months (95% CI: 52.0-67.8 months). Of these, 149 eyes (87%) had HRF, and 82 (48%) developed at least one persistent hyperTD during the follow-up. Although univariable Cox regression analyses showed that both drusen volume and total HRF area were associated with the onset of the first persistent hyperTD, multivariable analysis showed that the area of total HRF was the sole significant predictor for the onset of hyperTDs (P < .001). ROC analysis identified an HRF area ≥ 0.07 mm² to predict the onset of persistent hyperTDs within 1 year with an area under the curve (AUC) of 0.661 (0.570-0.753), corresponding to a sensitivity of 55% and a specificity of 74% (P < .001)., Conclusions: The total macular burden of HRF, which includes both the HRF along the RPE and within the retina, is an important predictor of disease progression from iAMD to the onset of persistent hyperTDs and should serve as a key OCT biomarker to select iAMD patients at high risk for disease progression in future clinical trials., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims: To describe the clinical features, multimodal imaging, treatments and natural course of acute spontaneous vortex vein occlusion., Methods: Clinical data were collected on nine patients with acute vortex vein occlusion. The symptoms and signs, multimodal imaging, treatments and follow-up results were summarised., Results: Six patients (66.7%) were men and three (33.3%) were women. The mean age was 47.8±15.4 years. Patients were initially misdiagnosed as having choroidal tumour (66.7%), scleritis (22.2%) and peripheral exudative haemorrhagic chorioretinopathy (11.1%). The related clinical characteristics included choroidal pseudo-tumour (100%), anterior segment injection (88.9%), acute ocular pain (77.8%), transient blurred vision (66.7%) and subsequent scleral icterus (66.7%). Six patients (66.7%) experienced a definite Valsalva manoeuvre prior to the onset. In acute phase, ultrasonography showed a low-to-medium reflective lesion without inside blood flow signal (mean thickness, 2.7±0.6 mm). Swept-source optical coherence tomography angiography (SS-OCTA) demonstrated the dilated vortex veins and ampulla with suprachoroidal haemorrhage and exudation. Indocyanine green angiography (ICGA) demonstrated choroidal circulation abnormalities in the affected quadrant. MRI showed a well-defined mass with enhancement. The main treatment was medical observation (44.5%). The choroidal pseudo-tumour spontaneously resolved with a mean course of 4.1±1.9 weeks., Conclusions: Acute vortex vein occlusion is a rare condition and initial misdiagnosis is not uncommon. It is mainly identified as an evanescent choroidal pseudo-tumour with acute pain, red eye and blurred vision. Widefield ICGA and SS-OCTA can offer valuable diagnostic clues. Medical observation may be a treatment option., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study aims to evaluate the two-year outcomes of polypoidal choroidal vasculopathy (PCV) treated with conbercept and to investigate the predictive response factors., Methods: Consecutive patients with PCV who received three-loading intravitreal conbercept, followed by as-needed reinjections, were studied retrospectively. The best corrected visual acuity (BCVA), central retinal thickness (CRT) and polyps were evaluated. Patients who achieved dry maculae in month 6 were categorised into the dry group, or otherwise, into the non-dry group. The predictive factors for a dry macula were evaluated., Results: A total of 25 eyes from 25 patients (17 males; mean age: 62.8 ± 6.4 years) were included. At month 24, the average BCVA increased significantly from 49.9 ± 15.0 letters to 57.2 ± 16.0 letters (p = 0.040); the average CRT decreased significantly from 430.16 ± 166.55 μm to 278.31 ± 157.34 μm (p = 0.00), and 88% of the eyes achieved dry maculae. The number of polyps changed from 55 to 20 (fading rate: 63.6%; p < 0.001). The mean number of intravitreal injections was 8.6 ± 5.4. The dry group (10 eyes, 40%) was more likely to have higher branching vascular network vessel density (BVN VD; p = 0.021), submacular haemorrhages (p = 0.011) but lack polyp-related serous pigmented epithelial detachment (PED) (p = 0.037)., Conclusions: Conbercept was effective in eyes with PCV at maintaining functional and anatomical improvement. Baseline characteristics, including BVN VD, the presence of polyps with serous PED and submacular haemorrhage, seemed to be related to the response to conbercept., (© 2024. The Author(s).)

Purpose: High Magnification Module (HMM™, Heidelberg Engineering, Heidelberg, Germany) imaging is a novel technique, designed to visualize the retina at a cellular level. To assess the potential of HMM™-based metrics as endpoints for future trials, we evaluated correlations between structural HMM™ cone metrics, spectral-domain OCT (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) and retinal sensitivity on microperimetry (MP, MAIA, CenterVue, Padova, Italy) in healthy subjects and p.(Arg142Trp) PRPH2-associated Central Areolar Choroidal Dystrophy (CACD) patients., Methods: We projected a default 10° MP grid on composite HMM™ images and performed automated cone density (CD), intercell distance (ICD) and nearest neighbour distance (NND) analysis at stimuli located at 3° and 5° retinal eccentricity. We manually measured intrasubject outer retinal thickness on SD-OCT in absolute and relative scotomas, located outside of focal atrophy., Results: We included 15 CACD patients and five healthy subjects. We found moderate-to-strong correlations of HMM™ metrics and MP sensitivity at 3° eccentricity from the fovea. We found the outer retina at the locations of absolute scotomas to be statistically significant thinner (p = 0.000003, one-sample t-test), as the outer retinal thickness at locations of relative scotomas. Interestingly, HMM™ metrics of these areas did not differ significantly., Conclusions: We found significant correlations between structural photoreceptors metrics on HMM™ imaging and retinal sensitivity on MP in healthy subjects and CACD patients. A multimodal approach, combining SD-OCT, MP and HMM™ imaging, allows for detailed mapping of retinal photoreceptor integrity and restitution potential, important data that could serve as biomarkers in future clinical trials., (© 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the imaging and clinical features of polypoidal choroidal vasculopathy (PCV) with pulsation., Methods: The PCV eyes were classified into pulsatile and nonpulsatile PCV groups according to the pulsation on indocyanine green angiography. Imaging features including the dye filling time of the polyp and clinical features were compared., Results: A total of 75 eyes were classified into the pulsatile PCV (30 eyes) and the nonpulsatile PCV (45 eyes) groups. The initial filling time and complete filling time of the polyp of the pulsatile PCV group (2.59 ± 0.93 and 8.33 ± 3.42 seconds) were shorter than those of the nonpulsatile PCV group (4.11 ± 1.87 and 10.63 ± 3.81 seconds, P < 0.001 and P = 0.010, respectively). The pigment epithelial detachment height of the pulsatile PCV group (414.90 ± 377.15 µ m) was greater than that of the nonpulsatile PCV group (247.81 ± 164.07 µ m, P = 0.030). The pulsatile PCV group showed a higher prevalence of subretinal hemorrhage (43.33%) after intravitreal injection than the nonpulsatile PCV group (13.95%, P = 0.005) during 12 months. The mean number of injections during 12 months of the pulsatile PCV group (5.48 ± 1.46) was greater than that of the nonpulsatile PCV group (4.09 ± 1.21, P < 0.001)., Conclusion: Eyes with pulsatile PCV showed shorter filling time of the polyp, greater pigment epithelial detachment height, higher prevalence of subretinal hemorrhage, and more intravitreal injection numbers during 12 months. These might suggest that PCV has distinct imaging and clinical features according to the polyp pulsation.

Purpose: Widefield swept-source optical coherence tomography (OCT) imaging was used to characterize choroidal thickness and vascularity at baseline in proliferative diabetic retinopathy (PDR) and longitudinally after panretinal photocoagulation (PRP)., Methods: Patients with treatment-naive PDR were imaged at baseline and at 1 week, 1 month, and 3 months after PRP. Previously validated algorithms were used to calculate the mean choroidal thickness (MCT) and choroidal vascularity index (CVI) in 5 regions of 12 mm × 12 mm scans., Results: Fourteen PDR eyes were included. Baseline MCT in PDR eyes did not differ significantly from normal eyes, but CVI measurements in PDR eyes were lower in all regions (P < 0.001-0.008). After PRP, MCT measurements in PDR eyes were significantly lower at 1 month and 3 months in all regions (P < 0.001-0.005) except the fovea (P = 0.074). However, CVI measurements did not change over time in any region after PRP., Conclusion: The choroid in PDR eyes has a smaller CVI than that in normal eyes. After PRP, the choroidal thickness decreases outside the fovea, but the CVI remains constant, which suggests that a relative decrease in choroidal vascularity persists. These widefield swept-source OCT results are consistent with choroidal alterations found in histopathological reports of diabetic choroidopathy.

Purpose: To evaluate associations between choroidal thickness and features of polypoidal choroidal vasculopathy (PCV) lesions based on multimodal imaging., Methods: This cross-sectional analysis included treatment-naive PCV eyes from a prospectively recruited observational cohort. Associations between of subfoveal choroidal thickness (SFCT) and qualitative and quantitative morphologic features of PCV lesions on color fundus photographs, indocyanine green and fluorescein angiography, and spectral-domain optical coherence tomography were evaluated., Results: We included 100 eyes with indocyanine green angiography-proven PCV. Subfoveal choroidal thickness showed a bimodal distribution with peaks at 170 µm and 350 µm. There was a significant linear increase in the total lesion area (P-trend = 0.028) and the polypoidal lesion area (P-trend = 0.030 and P-continuous = 0.037) with increasing SFCT. Pairwise comparisons between quartiles showed that the total lesion area (4.20 ± 2.61 vs. 2.89 ± 1.43 mm2, P = 0.024) and the polypoidal lesion area (1.03 ± 1.01 vs. 0.59 ± 0.45 mm2, P = 0.042) are significantly larger in eyes in Q4 (SFCT ≥ 350 μm) than eyes in Q1 (SFCT ≤ 170 μm). Although there was no significant linear trend relating SFCT to best-corrected visual acuity, pairwise comparisons showed that eyes in Q4 (SFCT ≥ 350 μm) have significantly worse vision (0.85 ± 0.63 vs. 0.55 ± 0.27 logMAR, P = 0.030) than eyes in Q2 (SFCT 170-260 μm)., Conclusion: Total lesion areas and polypoidal lesion areas tend to be larger in eyes with increasing SFCT. Choroidal background may influence the phenotype or progression pattern of PCV.

Purpose: To investigate the effect of blood flow in the temporal optic nerve head (ONH) and peripapillary chorioretinal atrophy (PPA) zone on central visual field (VF) defects and progression in eyes with open-angle glaucoma (OAG) and myopic disc., Design: Retrospective longitudinal medical chart review., Participants: This study comprised 366 eyes of 245 OAG patients with myopic disc, followed for at least 2 years with at least 5 reliable VF tests. OCT and laser speckle flowgraphy (LSFG) were performed at baseline., Methods: We analyzed the relationship between temporal ONH-tissue mean blur rate (MBR), temporal PPA-tissue MBR, total deviation (TD)-central, and TD-central slope with a linear mixed-effects model. Additionally, we investigated background factors influencing temporal PPA-tissue MBR. Main outcome measures were basic ophthalmic and systemic variables, baseline ONH-tissue MBR, baseline PPA-tissue MBR, baseline TD, and TD slope., Results: Lower temporal ONH-tissue MBR was associated with both worse TD-central and faster TD-central slope (β = 0.30, P < 0.001; β = 0.18, P = 0.001, respectively). However, lower temporal PPA-tissue MBR was only associated with faster TD-central slope (β = 0.15, P = 0.005). Lower ONH-tissue MBR and lower PPA-tissue MBR were significant independent contributors to worse TD-central slope, after adjusting for potential confounding factors (β = 0.12 to 0.15, P < 0.05). The multivariate analysis showed that lower pulse rate, larger temporal PPA area, and lower circumpapillary retinal nerve fiber layer thickness were associated with lower PPA-tissue MBR (P < 0.05)., Conclusions: Measurement of systemic variables and LSFG analysis might help clinicians to predict central VF defect severity and progression in OAG eyes with myopic disc., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Optical coherence tomography angiography (OCTA) can visualize the vascular status of the choriocapillaris noninvasively and separately from the other vascular beds. We describe focal ischemia in the choriocapillaris and reperfusion of the area in hypertensive choroidopathy using en-face OCTA., Case: A 32-year-old woman diagnosed with pregnancy-induced hypertension presented with acute anorthopia in the right eye after delivery via Caesarian section. Fundus examination showed an Elschnig's spot and serous retinal detachment (SRD) in the inferior perifoveal region. Early-phase fluorescein angiography and indocyanine green angiography images showed focally delayed choroidal perfusion, i.e., regional absence of choroidal flush. OCTA also showed a focal dark area in a slab of the choriocapillaris corresponding to the angiographic observation. After oral antihypertensive treatment, the dark area on the OCTA image of the choriocapillaris resolved over time in association with the resolving SRD., Conclusion: En-face OCTA is a useful technology to follow noninvasively the circulatory status of the choriocapillaris in hypertensive choroidopathy.

Purpose: To investigate the characteristic appearances of fundus autofluorescence (FAF) in patients with treatment-naive and active polypoidal choroidal vasculopathy (PCV)., Method: Cases with the diagnosis of treatment-naive and active PCV from November 2012 to May 2017 at Peking Union Medical College Hospital were retrospectively reviewed. All patients underwent comprehensive ophthalmologic examination. Autofluorescence (AF) findings were described at the retinal sites of the corresponding lesions identified and diagnosed using indocyanine green angiography and spectral-domain optical coherence tomography., Results: One hundred seventy patients with 192 affected eyes were included. The logMAR BCVA of the patients were 0.53 ± 0.28. The six AF patterns of 243 polypoidal lesions were confluent hypo-AF with hyper-AF ring (49.8%), confluent hypo-AF (22.6%), hyper-AF with hypo-AF ring (3.7%), granular hypo-AF (7.0%), blocked hypo-AF due to hemorrhage (8.6%), and polyps without apparent AF changes (8.2%). For 146 branching vascular networks (BVNs), 97.3% were granular hypo-AF, and others were blocked hypo-AF due to hemorrhage., Conclusion: In eyes with treatment-naive and active PCV, the polypoidal lesions and BVNs induce characteristic FAF changes. FAF images provide reliable adjunct reference for the diagnosis of PCV.

Purpose: The purpose of this study was to evaluate retinal and choroidal thickness in patients with Parkinson's disease (PD) using spectral domain-optical coherence tomography (SD-OCT)., Material and Methods: Participants in our study were 31 PD patients and 25 age-matched healthy controls. All participants underwent best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, dilated fundoscopy, and SD-OCT. Macular and retinal nerve fiber layer (RNFL) thickness and choroidal thickness in all quadrants were recorded., Results: There was a statistically significant reduction in average, superior, and temporal RNFL thickness, average ganglion cell complex, and choroidal thickness in the subfoveal area and in all quadrants between patients with PD and controls., Conclusions: The role of the choroidal vasculature in the pathophysiology of PD should be further scrutinized.

Importance: Investigating the quantitative 3-dimensional (3-D) anatomy of polypoidal complex is important for a better understanding of the pathogenesis of polypoidal choroidal vasculopathy (PCV)., Objective: To quantitatively evaluate the 3-D characteristics of polypoidal structures, branching vascular networks (BVNs), and origin of PCV using optical coherence tomography angiography (OCTA) and multiple image systems., Design, Setting, and Participants: A prospective, observational study was conducted in 47 consecutive Taiwanese patients (47 eyes) from May 21, 2015, to April 30, 2017. All participants were scanned with the Optovue-RTVue-XR-Avanti OCTA system. Patients in whom PCV was identified on OCTA were examined to define characteristics and structures of the original spouting vessels (stalks) from the choroid, polypoidal structures, and BVNs on OCTA., Main Outcomes and Measures: Quantitative analysis of 3-D structures of the polypoidal complex., Results: Among the 47 patients, the mean (SD) patient age was 68.9 (8.0) years, and 28 (59.6%) men were included. Clear images of polypoidal structures could be detected in 17 eyes (36.2%, 22 polypoidal structures), BVNs in 26 eyes (55.3%, 26 tufts of BVNs), and stalks of origin from the choroid in 26 eyes (55.3%, 26 stalks) on the en face plane on OCTA. All polypoidal structures were found at a mean (SD) height of 45.3 (36.1) μm above the retinal pigment epithelium (RPE) reference plane that was preset by the machine, while the BVNs were found at a mean (SD) depth of 28.6 (14.2) μm below the RPE reference plane and the choroidal stalks at 80.4 (24.4) μm below RPE reference plane. The mean (SD) thickness of polypoidal structures was 38.4 (15.5) μm and of BVNs, 60.2 (25.0) μm. The polypoidal structures were all above the Bruch membrane within the dome of the RPE detachment, the choroidal stalks were all in the choroid layer. The BVNs could be either above (up to 18 μm), within, or below (up to 28 μm) the Bruch membrane and were in proximity to the double layers of flattened RPE detachment., Conclusions and Relevance: These results demonstrate a 3-D architecture of PCV that may be helpful for a better understanding of the anatomy, pathophysiology, and pathogenesis of PCV.

Purpose: To report 3 cases of ocular chorioretinal folds from different etiologies and their aspect with the new imaging technology of optical coherence tomography (OCT) angiography (OCT-A)., Methods: Baseline data, investigational process on etiology, and follow-up data of patients referred for chorioretinal folds to the Medical Retina & Imaging Unit of San Raffaele Hospital in the period January-March 2016 were collected. Multimodal imaging evaluation, comprehensive of infrared, fundus autofluorescence, multicolor, spectral-domain OCT, and OCT-A, was performed on all patients., Results: Four eyes of 3 men, 65, 46, and 50 years of age, showed chorioretinal folds secondary to central serous chorioretinopathy, postoperative hypotony (after deep sclerectomy), and anisometropia with unilateral hyperopia, respectively. In all cases, OCT-A imaging showed a signal reduction in the choriocapillaris layer in correspondence of the folds. Due to this signal reduction, the en face reconstruction of choriocapillaris layer showed, in all cases, a peculiar tigroid aspect. The aspect of the folds at OCT-A remained unchanged during the 3-month follow-up in all patients., Conclusions: Optical coherence tomography angiography shows a typical linear signal reduction in the choriocapillaris layer in correspondence of the fold with a tigroid pattern. We hypothesize this aspect could be explained by blood flow alteration at the choriocapillaris level in correspondence of the fold.

Purpose: To detect choriocapillaris changes by enhanced depth imaging optical coherence tomography (EDI-OCT) in areas of choriocapillaris hypoperfusion visualized on indocyanine green angiography., Methods: Combined indocyanine green angiography and EDI-OCT from patients diagnosed with inflammatory choriocapillaris hypoperfusion were retrospectively analyzed. The EDI-OCTs were compared with indocyanine green angiography to detect choriocapillaris changes suggestive of choriocapillaris hypoperfusion in both active stage (AS) and inactive stage of the disease. The EDI-OCT was graded by two independent observers for choriocapillaris pattern (normal/altered) and reflectivity (hyper/hypo/isoreflective) changes. Manual measurements of choriocapillaris thickness were obtained. Interobserver agreement was assessed using Cohen's kappa, and differences in groups were assessed using McNemar's test., Results: Forty-two lesions from 11 eyes (8 patients, 3 males) were analyzed. Three patients (4 eyes, 17 lesions) were diagnosed with serpiginous choroiditis, and 5 patients (7 eyes, 25 lesions) were diagnosed with acute posterior multifocal placoid pigmented epitheliopathy. All the lesions demonstrated choriocapillaris hyporeflectivity on EDI-OCT during AS and isoreflectivity during inactive stage. The characteristic choriocapillaris dotted pattern was absent during AS. Choriocapillaris thickness at the sites of hypoperfusion was significantly higher during AS (63.07 ± 16.47 μm) than in inactive stage (22.92 ± 7.65 μm) (P < 0.001). Disruption of retinal pigment epithelium during AS was strongly associated with choriocapillaris atrophy during follow-up (P < 0.001)., Conclusion: The EDI-OCT shows characteristic choriocapillaris changes suggestive of choriocapillaris hypoperfusion that correlate with ischemia on indocyanine green angiography during both AS and inactive stage of the disease.

Purpose: To perform a quantitative analysis of choroidal thickness in patients with Fuchs Uveitis Syndrome (FUS) using enhanced depth imaging optical coherence tomography (EDI-OCT)., Methods: All patients underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, applanation tonometry, axial length measurements with a swept-source biometer (IOLMaster 700, Carl Zeiss Medic AG, Jena, Germany) and macular 30° linear EDI- B-scan SD-OCT section (Spectralis HRAII+OCT, Heidelberg Engineering, Heidelberg, Germany) in both eyes. Analysis of choroidal thickness was performed at three different locations: subfoveally, 750 μm nasally, and 750 μm temporally to the fovea. Patients having received any surgery or intravitreal injections in the last 12 months and with axial length variance ≥ 1 mm between both eyes were excluded., Results: Sixteen eyes of eight consecutive patients with unilateral FUS were included. Segmented analysis of the choroid, separately considering Haller's layer and Sattler's-choriocapillaris layers, showed statistically significant lower values (p < 0.05) in affected eyes (FEs) compared to fellow eyes (NFEs). In NFEs, total choroidal thickness mean values ranged from 305.62 ± 92.96 μm to 347.50 ± 91.55 μm; in FEs those values were significantly lower (p < 0.05), ranging from 232.62 ± 89.33 μm to 255.62 ± 89.33 μm., Conclusion: Diffuse and full-thickness choroidal thinning in FEs was observed. Considering the absence of significant axial length differences between FEs and NFEs in our patient series, these data seem to suggest that the full-thickness choroidal thinning in FEs may be due to the inflammatory process. In that way, FUS might be regarded as an inflammatory condition involving the whole uveal tunic, even the posterior part of it, definitively supplanting the early definition of "heterochromic iridociclytis".

Purpose: We observed and analyzed the morphologic characteristics of polypoidal lesions and abnormal branching vascular network (BVN) in patients with polypoidal choroidal vasculopathy (PCV) by optical coherence tomography angiography (OCTA)., Methods: A retrospective observational case series was done of patients with PCV. All patients were scanned with a 70-kHz spectral-domain OCT system using the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm to distinguish blood flow from static tissue. The OCTA images of these patients were compared to those from indocyanine green angiography (ICGA). Semiautomated segmentation was used to further analyze the polypoidal lesion and the BVN., Results: We studied 13 eyes of 13 patients 51 to 69 years old. A total of 11 patients were treatment-naive. Two patients had multiple anti-VEGF injections and one underwent photodynamic therapy (PDT). Optical coherence tomography angiography was able to detect the BVN in all cases. Using cross-sectional OCTA, BVN locations were shown to be in the space between the RPE and Bruch's membrane. Using en face OCTA, the BVN vascular pattern could be shown more clearly than by ICGA. Polypoidal lesions showed high flow signals in different patterns in 12 cases in the outer retina slab. Using cross-sectional OCTA, the polyps were shown to be just below the top of the pigment epithelial detachment (PED). In one case, the polypoidal lesion was not detectable at the outer retina slab., Conclusions: Optical coherence tomography angiography is a noninvasive imaging tool for detecting vascular changes in PCV. Branching vascular networks showed more clearly on OCTA than on ICGA. Polypoidal lesions had variable patterns on OCTA and were not always detected. The OCTA patterns of the polypoidal lesions and the BVN are helpful in understanding the pathology of PCV.

Purpose: To evaluate the efficacy of an optical coherence tomography (OCT)-based diagnosis of polypoidal choroidal vasculopathy (PCV) in Korean patients., Methods: This retrospective, observational case series included 263 eyes of 263 patients (147 eyes with PCV and 116 eyes with typical exudative, age-related macular degeneration [AMD]) who had been diagnosed with treatment naïve exudative AMD. Eyes with three or more of the following OCT findings were diagnosed with PCV: multiple retinal pigment epithelial detachment (RPED), a sharp RPED peak, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates. The OCT-based diagnosis was compared with the gold-standard indocyanine green angiography-based method. The sensitivity and specificity of the OCT-based diagnosis was also estimated. An additional analysis was performed using a choroidal thickness criterion. Eyes with a subfoveal choroidal thickness greater than 300 µm were also diagnosed with PCV despite having only two OCT features., Results: In eyes with PCV, three or more OCT features were observed in 126 of 147 eyes (85.7%), and the incidence of typical exudative AMD was 16 of 116 eyes (13.8%). The sensitivity and specificity of an OCT-based diagnosis were 85.7% and 86.2%, respectively. After applying the choroidal thickness criterion, the sensitivity increased from 85.7% to 89.8%, and the specificity decreased from 86.2% to 84.5%., Conclusions: The OCT-based diagnosis of PCV showed a high sensitivity and specificity in Korean patients. The addition of a choroidal thickness criterion improved the sensitivity of the method with a minimal decrease in its specificity.

Purpose: To describe image artifacts of optical coherence tomography (OCT) angiography and their underlying causative mechanisms. To establish a common vocabulary for the artifacts observed., Methods: The methods by which OCT angiography images are acquired, generated, and displayed are reviewed as are the mechanisms by which each or all of these methods can produce extraneous image information. A common set of terminology is proposed and used., Results: Optical coherence tomography angiography uses motion contrast to image blood flow and thereby images the vasculature without the need for a contrast agent. Artifacts are very common and can arise from the OCT image acquisition, intrinsic characteristics of the eye, eye motion, image processing, and display strategies. Optical coherence tomography image acquisition for angiography takes more time than simple structural scans and necessitates trade-offs in flow resolution, scan quality, and speed. An important set of artifacts are projection artifacts in which images of blood vessels seem at erroneous locations. Image processing used for OCT angiography can alter vascular appearance through segmentation defects, and because of image display strategies can give false impressions of the density and location of vessels. Eye motion leads to discontinuities in displayed data. Optical coherence tomography angiography artifacts can be detected by interactive evaluation of the images., Conclusion: Image artifacts are common and can lead to incorrect interpretations of OCT angiography images. Because of the quantity of data available and the potential for artifacts, physician interaction in viewing the image data will be required, much like what happens in modern radiology practice.

Purpose: The effect of hypothyroidism on the choroidal thickness (CT) was investigated in patients with subclinical hypothyroidism and overt hypothyroidism, and biochemically and clinically euthyroid patients receiving levothyroxine treatment. The patients were compared with healthy subjects., Materials and Methods: One eye of 71 hypothyroid and 22 healthy subjects between 20 and 40 years of age were included in this study. CT measurements were taken at the fovea and at 2 points that were 1500 μm nasal and temporal to the fovea using spectral-domain optical coherence tomography. Independent sample t-test's and was used for statistical analysis of the data., Results: The CT was significantly thicker in hypothyroid patients compared to healthy subjects (P values were 0.013 for subfoveal, 0.015 for temporal and 0.020 for nasal segments). The intraocular pressure (IOP) and body mass index (BMI) were also significantly higher in hypothyroid patients (P values were 0.021 and 0.003, respectively). There was not a statistically significant difference in the BMI and IOP measurements between healthy subjects and euthyroid patients (P > 0.05). However, there was a statistically significant difference in the subfoveal, temporal and nasal CT measurements between healthy subjects and euthyroid patients (P values were 0.006, 0.031 and 0.013, respectively)., Conclusions: All subgroups of hypothyroid patients had thicker CT compared to healthy subjects. Euthyroid patients receiving levothyroxine treatment had lower IOP, BMI levels, and serum lipid levels than patients with subclinical hypothyroidism and overt hypothyroidism.

Purpose: To improve our understanding of hyperacuity defects measured with preferential hyperacuity perimetry (PHP) by correlating PHP findings with the retinal microstructural changes visible on spectral-domain optical coherence tomography (OCT) in patients with polypoidal choroidal vasculopathy (PCV)., Materials and Methods: Twenty-eight eyes of 28 patients with PCV were retrospectively reviewed. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (logMAR) testing, PHP, and OCT. The functional 'PHP test score' and 'total volume of hyperacuity defect zone' were also analyzed., Results: Patients were classified based on the hyperacuity defect by PHP, as follows: Hyperacuity defect (n = 17 eyes) group and hyperacuity intact (n = 11 eyes) group. The mean best-corrected visual acuity in the hyperacuity intact group (0.46 ± 0.39) was better than that in the hyperacuity defect group (0.82 ± 0.37) (P = 0.014). The presence of serous retinal detachment and retinal pigment epithelial detachment did not differ significantly between groups (P = 0.120 and P = 0.689, respectively). A disrupted photoreceptor layer was more common in the hyperacuity defect group compared with the hyperacuity intact group (P = 0.0001). Among 17 eyes with a hyperacuity defect, 9 eyes showing intra-retinal pathology (intra-retinal cyst or hard exudates) and had a significantly higher PHP test score and larger total volume of the hyperacuity defect zone than 8 eyes without intra-retinal pathology (P = 0.006 and P = 0.021, respectively)., Conclusion: A hyperacuity defect in PCV was associated with photoreceptor disarrangement. Furthermore, PCV lesions on the inner retina that invaded the photoreceptor layer were associated with a more severe hyperacuity defect.

Purpose: To report choroidal thickness and volume in healthy eyes using swept source optical coherence tomography (SS-OCT)., Methods: A prospective observational study of 122 patients examined with swept source OCT (DRI-OCT, Topcon, Japan). In each eye, we performed 256 horizontal scans, 12 mm in length and centered on the fovea. We calculated choroidal thickness manually with a built-in caliper and automatically using DRI-OCT mapping software. Choroidal volume was also automatically calculated. We measured axial length with optical low-coherence reflectometry (Lenstar LS 900, Haag-Streit, Switzerland)., Results: The choroid has focally increased thickness under the fovea. Choroid was thinnest in the outer nasal quadrant. In stepwise regression analysis, age was estimated as the most significant factor correlating with decreased choroidal thickness (F=23.146, P<0.001) followed by axial length (F=4.902, P=0.03). Refractive error was not statistically significant (F=1.16, P=0.28)., Conclusions: SS-OCT is the first commercially available system that can automatically create choroidal thickness and volume maps. Choroidal thickness is increased at the fovea and is thinnest nasally. Age and axial length are critical for the estimation of choroidal thickness and volume. Choroidal measurements derived from SS-OCT images have potential value for objectively documenting disease-related choroidal thickness abnormalities and monitoring progressive changes over time.

Purpose: To describe the pathoanatomy of diabetic choroidopathy (DC) in pre-diagnosed diabetic retinopathy (DR) cases and to provide angiographic and optical evidence for DC using indocyanine green angiography (ICGA) and enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT)., Methods: A retrospective analysis of 80 eyes from 40 DR patients was conducted. In Group One, choroidal vascular abnormalities were evaluated by comparing angiographic findings from simultaneous ICGA with those from fundus fluorescein angiography (FFA). In Group Two, EDI SD-OCT was used to evaluate the subfoveal choroidal thickness (SFCT) and define the choroid boundary in order to acquire the bilateral and symmetric choroidal area (CA). Data were then analyzed by Image Pro Plus 6.0., Results: In Group One, choroidal abnormalities that were evident using ICGA but not FFA included early hypofluorescent spots in 47 eyes (75.81%), late hyperfluorescent spots in 37 eyes (59.68%), and late choroidal non-perfusion regions in 32 eyes (51.61%). In particular, a significant difference between proliferative DR (PDR) in 17 of 23 eyes (73.91%) and non-PDR in 16 of 39 eyes (41.03%) was observed in late choroidal non-perfusion regions. Eighteen of 31 eyes (58.06%) also exhibited "inverted inflow phenomena." In Group Two, both the SFCT and CA of eyes with diabetic macular edema and serous macular detachment were significantly greater than those in the other eyes. The CA in panretinal photocoagulation (PRP) treated cases was also greater than that in non-PRP treated cases., Conclusions: Early hypofluorescent spots, late choroidal non-perfusion regions, inverted inflow phenomena, higher SFCT, and larger CA are qualitative and quantitative indexes for DC. Moreover, the late choroidal non-perfusion region is a risk factor for DC with DR. Our study suggests that the supplemental use of ICGA and EDI SD-OCT with FFA is a better choice for DR patients.

Seventy percent of the blood flow to the eye goes to the choroid, a structure that is vitally important to the function of the retina. The in vivo structure of the choroid in health and disease is incompletely visualized with traditional imaging modalities, including indocyanine green angiography, ultrasonography, and spectral domain optical coherence tomography (OCT). Use of new OCT modalities, including enhanced depth imaging OCT, image averaging, and swept-source OCT, have led to increased visualization of the choroidal anatomy. The correlation of these new anatomical findings with other imaging modalities results increases understanding of many eye diseases and recognises of new ones. The status of the choroid appears to be a crucial determinant in the pathogenesis of diseases such as age-related choroidal atrophy, myopic chorioretinal atrophy, central serous chorioretinopathy, chorioretinal inflammatory diseases, and tumors. Extension of these imaging techniques has provided insights into abnormalities of the sclera and optic nerve. Future developments will include blood flow information, 3D rendering of various ocular structures, and the ability to evaluate changes in 3D structural information over time (4D imaging)., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To evaluate subfoveal choroidal thickness changes in cases with recurrent polypoidal choroidal vasculopathy (PCV) after combination therapy with intravitreal ranibizumab and photodynamic therapy (PDT)., Design: Retrospective observational case series study., Methods: We measured subfoveal choroidal thickness in PCV using optical coherence tomography (OCT) before and after PDT. In recurrent cases, the choroidal thickness was measured at the time of the recurrence. In nonrecurrent cases, choroidal thickness was measured 1 year after PDT., Results: Combination therapy was performed in 27 eyes (27 patients). Polypoidal lesions regressed within 3 months after initial treatment in all eyes. Retreatment was needed in 10 of 27 eyes (37.0%) after more than 3 months of follow-up. In recurrent cases, subfoveal choroid decreased from 188 μm at baseline to 157 μm 3 months after PDT (P < .01); however, choroidal thickness increased to 179 μm with recurrence (P = .54 compared to baseline; average, 8.0 months). In nonrecurrent cases, subfoveal choroid decreased from 257 μm at baseline to 210 μm 3 months after PDT and 212 μm 1 year after PDT (P < .01, respectively)., Conclusion: Subfoveal choroidal thickness in PCV at the time of recurrence returned to the baseline level after choroidal thinning as a result of PDT treatment. Choroidal thickness changes after PDT examined using OCT may reflect disease activity in PCV., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Idiopathic panuveitis is a diagnosis of exclusion that lacks distinguishing features on fluorescein and indocyanine green angiography. Choroidal hypoperfusion or ischaemia has been implicated in panuveitis of different aetiologies. In this study, we use enhanced depth imaging optical coherence tomography (OCT) to examine the choroid and its vasculature in patients with this disease., Methods: In this retrospective, cross-sectional study, OCT-derived measurements of retinal and choroidal thickness were obtained after manual segmentation using custom software. Choroidal measurements were further subdivided into Haller's large vessel layer (HLVL) and Sattler's medium vessel layer (SMVL), and correlated with clinical parameters., Results: Twenty-one eyes from 21 patients were included. A reduction in hypo-reflective spaces, corresponding to vascular lumens, was observed in HLVL. The mean thickness of both the choroid (233.7 ± 73.3 μm), and HLVL (167.8 ± 53.7 μm), was less than that previously reported for normal eyes. Choroidal thickness expressed as a ratio to retina thickness showed significant correlation to visual acuity (r = 0.58, p = 0.006). This correlation was maintained in the ratio between HLVL and retinal thickness (r = 0.56, p = 0.009), but not in SMVL to retinal thickness (r = 0.352, p = 0.12)., Conclusions: This study reports novel OCT-derived parameters in patients with idiopathic panuveitis. We noted loss of hyporeflectivity in HLVL, and thinning of both HLVL and the choroid as a whole. The observed correlation between visual acuity and the ratio of choroidal to retinal thickness is a strong enhanced depth imaging (EDI)-OCT derived candidate for prospective validation in future studies.

Purpose: To evaluate the clinical features of peripapillary choroidal cavitation (PCC) detected by optical coherence tomography (OCT)., Design: Retrospective, observational case series., Participants: One hundred twenty-two eyes from 83 patients diagnosed with PCC by OCT database review were included in this study., Methods: Stereoscopic color fundus photographs from eyes with PCC were reviewed by 2 independent ophthalmologists. They were masked to the refractive error, axial length, and OCT findings., Main Outcome Measures: Chart review and data analysis included gender, age, best-corrected visual acuity (BCVA), refractive error, axial length, clinical appearance of the peripapillary area, and associated funduscopic abnormalities., Results: One hundred twenty-two eyes with PCC from 83 patients were analyzed. Among the patients, 41.8% were men and 58.2% were women. The mean age was 48.2 ± 12.6 years and mean BCVA in logarithm of the minimum angle of resolution units was 0.23 ± 0.43. The mean refractive error in spherical equivalent was -9.03 ± 5.11 diopters (D) and mean axial length (AL) was 27.36 ± 2.09 mm. With respect to refractive error, 90 eyes (73.8%) were highly myopic (≥-6.00 D), 24 eyes (19.7%) had low myopia (<-6.00 D), 5 eyes (4.1%) were emmetropic (1.00 to -1.00 D), and 3 eyes (2.6%) were hyperopic (>1.00 D). Forty eyes (32.8%) with PCC had AL of less than 26.50 mm (mean, 25.11 ± 1.07 mm; range, 22.51-26.42 mm). Patients with eyes with PCC that had low myopia, were emmetropic, and were hyperopic also were significantly older than patients with highly myopic eyes (P<0.05). Stereoscopic fundus photographs demonstrated a yellow-orange, localized, well-circumscribed peripapillary lesion in 57 (46.7%) eyes with PCC. A PCC with opening was observed in 14 (26.4%) of 53 eyes with excavated myopic conus and in 5 (7.2%) of 69 eyes without excavated myopic conus (P<0.05)., Conclusions: This study demonstrated that peripapillary choroidal cavitation is common and not exclusive to highly myopic eyes. The funduscopic finding of a yellow-orange peripapillary abnormality may not be evident in all eyes with demonstrable PCC by OCT. Although its pathogenesis and pathologic significance require further investigation, PCC may be a degenerative change in aging eyes., (Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate macular atrophy by frequency-domain optical coherence tomography (OCT) in patients with birdshot retinochoroidopathy and to compare the resulting thickness measures with visual acuity and multifocal electroretinography (mfERG)., Methods: Measures were obtained from 14 eyes of 7 patients with birdshot retinochoroidopathy and 23 normal eyes. Optical coherence tomography-3 measures of macular thinning were related to visual acuity, mfERG response density, and time since diagnosis. Horizontal midline frequency-domain OCT scans identified which layers of the retina were primarily responsible for macular thinning., Results: All eyes with a history of birdshot retinochoroidopathy for >10 years had abnormal mfERG response densities. Compared with those without anatomic thinning (n = 8), eyes with anatomic thinning (n = 6) had significantly lower visual acuity (P = 0.0006), foveal response density (P = 0.006), and overall mfERG response density (P = 0.009). Segmentation of retinal layers on frequency-domain OCT scans showed that anatomic thinning was as a result of reduction in the receptor 1 layer (REC+), the thickness of the segment extending from the proximal border of the outer plexiform layer to the Bruch membrane-choroid interface., Conclusion: Macular atrophy, as reflected in OCT evidence of macular thinning and mfERG evidence of macular function, occurs in patients with long-standing birdshot retinochoroidopathy. Measures of retinal layer thicknesses by frequency-domain OCT suggest that the atrophy occurs primarily in the outer retina.

The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments.

Purpose: To evaluate central serous chorioretinopathy (CSCR) by means of optical coherence tomography (OCT) and multifocal electroretinogram (mf-ERG) at presentation and after resolution of the acute phase., Design: Prospective comparative observational case series with a normal sample., Patients and Method: Twenty-one eyes of 21 patients with unilateral CSCR were examined. Both eyes underwent complete ophthalmological examination, which included measurement of best-corrected visual acuity, fluorescein angiography, OCT and mf-ERG recording. Our results were compared with the corresponding findings of 33 normal volunteers of the same age., Results: At presentation, the averaged mean retinal thickness of the fovea, measured by OCT, was 303 mum in the affected eyes, 69.3% higher compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 11.29 nV/degree(2), 50.8% lower compared to the normal controls (p < 0.001). After regression of CSCR, the averaged mean retinal thickness of the fovea was 213 microm in the affected eyes, 19.3% greater compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 16.05 nV/degree(2), 30.1% lower compared to normal controls (p < 0.001). It is interesting that 6 of 21 fellow nonaffected eyes showed abnormal values, with an averaged mean retinal thickness of OCT (246 mum) and an averaged mean retinal response density of mf-ERG in area 1 (12 microV/degree(2)). In the remaining 15 eyes, the OCT and the mf-ERG values were within normal limits., ((c) 2007 S. Karger AG, Basel.)

Purpose: To report the presence and disappearance of subretinal fibrinous exudate in pregnancy-induced central serous chorioretinopathy studied with optical coherence tomography (OCT)., Methods: Case report. A 32-year-old woman was referred for ophthalmoscopic evaluation in her 32nd week of pregnancy, complaining of reduced vision in her right eye., Results: The funduscopic examination revealed a serous detachment of the macula with subretinal exudative deposits in the right eye and a peripapillary serous detachment in the left eye. OCT sections through the right macula demonstrated serous elevation of the retina and the presence of highly reflective material in the subretinal space. Two weeks after delivery, OCT showed resolution of subretinal fluid and the disappearance of submacular exudate in the right eye., Conclusion: During pregnancy and immediately after delivery, OCT may provide information reflecting the relationship between the retina, subretinal space, and retinal pigment epithelium without any known adverse effects to the infant. In a patient with pregnancy-associated central serous chorioretinopathy, a highly reflective material, presumably fibrin, was detected spanning the subretinal space that was subsequently shown to disappear. This information may help us better understand the pathological retinal changes that may occur during pregnancy.