Search

Purpose: To report a case of punctate inner choroiditis (PIC) and subsequent choroidal neovascular membrane (CNVM) development in a young, high myope following vitreoretinal surgery for rhegmatogenous retinal detachment., Case Description: A 44-year-old male with high myopia underwent pars plana vitrectomy for subtotal retinal detachment in the left eye, followed by cataract extraction and silicone oil removal. Three years postoperatively, he presented with blurred vision, and fundus examination revealed PIC lesions at the posterior pole. Spectral-domain optical coherence tomography (SD-OCT) showed characteristic features of PIC, including hyperreflective nodule-like elevations, disrupted ellipsoid and interdigitation zones, retinal pigment epithelium (RPE) elevations and increased choroidal hyper transmission signals., Results: Initially, no treatment was initiated, and the patient was monitored. Three years later, the patient experienced further vision loss, and fundus examination showed progression of PIC lesions and new CNVM formation in the left eye. The patient was treated with systemic corticosteroids and an intravitreal anti-VEGF injection (Razumab ® 0.5 mg/0.05 ml). Three weeks after the intervention, SD-OCT showed regression of the CNVM, and the patient's visual symptoms improved., Conclusion: This case underscores the importance of long-term follow-up and timely intervention in managing PIC, especially in high myopes post-retinal surgery. Early identification and treatment with systemic corticosteroids and anti-VEGF therapy are crucial to preserving visual function and preventing severe complications like CNVM., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To describe idiopathic multifocal choroiditis with chorioretinal atrophy developing choroidal flow voids on optical coherence tomography angiography that preceded a recurrence of the disease., Methods: Case report., Results: A 24-year-old woman presented with visual field changes and occasional photopsias. Systemic workup for syphilis, tuberculosis, and sarcoidosis was negative. Clinical findings and multimodal imaging were consistent with idiopathic multifocal choroiditis with chorioretinal atrophy, complicated by inactive choroidal neovascularization in her right eye. She was treated with systemic corticosteroids with a taper over 3 months without change in her examination. She was then stable for 2 years. At that point, the patient experienced increased photopsias, but her examination result was unchanged. Optical coherence tomography angiography showed multiple flow voids in the choroid that were not present 6 months ago. No lesions were seen on other imaging modalities. Structural optical coherence tomography showed some subtle hyperreflectivity throughout the choroid that was previously absent. Given the unknown significance of these flow voids, the patient was asked to return for follow-up in 1 month. Her photopsias improved, and her vision remained normal. On repeat examination after 1 month, the patient had developed a few subtle yellow lesions in the superonasal quadrant of the left eye. There were no macular lesions. The repeat optical coherence tomography angiography revealed that the flow voids were fading., Conclusion: Imaging findings using optical coherence tomography angiography in our patient with idiopathic multifocal choroiditis showed choroidal flow voids that preceded clinical recurrence, not detected by other imaging modalities. Future studies should determine whether optical coherence tomography angiography can be used to detect subclinical lesions preceding clinical recurrences of idiopathic multifocal choroiditis.

Purpose: This retrospective case series aimed to assess the concordance between clinical diagnoses of punctate inner choroidopathy and multifocal choroiditis and panuveitis (MCP) using the 2021 Standardization of Uveitis Nomenclature Working Group criteria., Methods: Using the medical records of the patients, the authors reevaluated 100 eyes of 75 patients with idiopathic multifocal chorioretinal inflammatory lesions based on Standardization of Uveitis Nomenclature criteria and compared the result with the clinical diagnosis., Results: Of 100 eyes, 29 eyes (29%) were diagnosed as punctate inner choroidopathy and 15 eyes (15%) were diagnosed as MCP using Standardization of Uveitis Nomenclature criteria, and 56 (56%) eyes could not be diagnosed as either. Clinically diagnosed punctate inner choroidopathy eyes were significantly more myopic than the clinically diagnosed MCP eyes (mean spherical equivalent -6.65 ± 4.63 vs. -3.85 ± 2.31, P = 0.01). Sixteen eyes with vitreous inflammation were all clinically diagnosed as MCP, but four (25%) could not be diagnosed as MCP using Standardization of Uveitis Nomenclature criteria., Conclusion: The existing diagnostic criteria showed limitations in capturing all clinical cases of punctate inner choroidopathy or MCP, and adding or revising criteria on features such as vitreous inflammation or myopia could be considered to enhance diagnostic accuracy.

Purpose: To investigate peripapillary atrophy and macular chorioretinal scars in eyes affected by multifocal choroiditis and panuveitis., Methods: This retrospective cohort study reviewed the medical records, fundus photographs, and spectral-domain optical coherence tomographic scans of 31 eyes from 19 patients., Results: Patients had a mean age of 45 years (range 24-69 years). The average follow-up duration was 7 years (range, 2.5-14.5 years), with 14 patients undergoing immunosuppressive treatment. In the group of 31 eyes, 20 showed peripapillary plumes of ill-defined hyperreflectivity at the termination border of the retinal pigment epithelium. These plumes, extending from bare Bruch membrane to the outer nuclear layer, sometimes undermined the adjacent retinal pigment epithelium. They responded to corticosteroid treatment and resembled the material under the retinal pigment epithelium in acute lesions. Among 20 eyes with these peripapillary inflammatory lesions, 16 (80%) experienced increased atrophy, in contrast to none in the eyes without these lesions ( P < 0.001). Similar patterns were observed at the edges of macular chorioretinal atrophy. This observation occurred in patients using immunosuppressive medication who were otherwise thought to be under adequate control., Conclusion: In patients with multifocal choroiditis and panuveitis, previously unrecognized plumes of smoldering inflammatory activity at the borders of chorioretinal atrophy appears to be linked to atrophy expansion. The recognition of this phenomenon may require a reappraisal of treatment of multifocal choroidopathies to help mitigate the expansion of atrophy in these eyes.

Purpose: The aim is to analyze automated quantification of choriocapillaris flow deficit (CCFD) on swept-source (SS)-optical coherence tomography angiography (OCTA) in tubercular serpiginous-like choroiditis (TBSLC)., Methods: In this prospective study, automated CCFD calculations were performed on SS-OCTA and compared with CCFD areas on indocyanine green angiography (ICGA). Patients were divided into two groups based on the occurrence of paradoxical worsening (PW)., Results: Twenty-nine eyes (29 subjects; 18 males; mean age: 33±12 years) were included. The mean CCFD at baseline was 34.9 ± 4.3% on OCTA in eyes without PW and 35.4 ± 5.0% on SS-OCTA with PW (p = .77). At 4 and 12 weeks, CCFD on SS-OCTA improved to 30.6 ± 3.9% and 28.0 ± 4.2% (p < .001) without PW, respectively, and increased to 42.9 ± 4.4% and 48.8 ± 4.1% (p < .001) with PW, respectively. The SS-OCTA CCFD correlated well with ICGA (r = 0.48; p < .001)., Conclusions: Automated quantitative serial assessment of CCFD on SS-OCTA can serve as a useful biomarker of disease activity in eyes with TBSLC.

Purpose: To assess the effect of corticosteroids (CS) on choroidal neovascularization (CNV) occurrence and recurrence of activity over 2 years in patients with punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC)., Methods: Retrospective longitudinal study. Previous use of CS was analyzed between group without CNV and group with CNV occurrence and recurrence., Results: Thirty-six patients were included. Patients with CNV were less likely to have received CS in the 6 months following PIC or MFC diagnosis (17% versus 65%, p-value = 0.01). Patients with CNV who had a recurrence of neovascular activity were less likely to have received a previous CS therapy (20% versus 78%; odds ratio = 0.08, p-value = 0.005)., Conclusions: This study suggests that patients with PIC and MFC should be treated by CS to prevent CNV development and decrease CNV recurrences.

Purpose: To evaluate the influence of immunomodulatory therapy (IMT) on visual and treatment outcomes of inflammatory choroidal neovascularization (iCNV) in patients affected by multifocal choroiditis (MFC), and to compare them to patients treated with steroids as needed., Design: Multicenter retrospective matched cohort study., Methods: Patients affected by MFC with iCNV were divided into a IMT group and a "steroids as needed" group and matched according to the time between diagnosis and beginning of systemic treatment. Visual acuity (VA), number of anti-vascular endothelial growth factor (VEGF) intravitreal injections, and number of iCNV reactivations during 2 years of follow-up after treatment initiation were compared between the 2 groups., Results: A total of 66 eyes of 58 patients were included, equally divided into the 2 groups. Patients in the IMT group had a lower relative risk (RR) of iCNV reactivation (0.64, P = .04) and of anti-VEGF intravitreal injection retreatment (0.59, P = .02). Relapses of MFC-related inflammation were independently associated with a higher RRs of iCNV reactivation (1.22, P = .003). Final VA was higher in the IMT compared to the steroids as needed group (mean [SD], 69.1 [15.1] vs 77.1 [8.9] letters, P = .01), and IMT was associated with greater VA gains over time (+2.5 letters per year, P = .04)., Conclusions: IMT was associated with better visual and treatment outcomes in MFC complicated by iCNV compared to steroids as needed. The better outcomes of the IMT group and the association between MFC-related inflammation and iCNV reactivations highlight the need for tighter control of inflammation to prevent iCNV relapses and visual loss., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the clinical course of idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and the efficacy and safety of treatment options during pregnancy., Methods: Patients with MFC or PIC and a pregnancy in 2011-2019 from two academic centres were enrolled. For the most recent pregnancy, data on best-corrected visual acuity (BCVA) before and after pregnancy, relapse rate in pregnancy and postpartum period and obstetric, maternal and neonatal outcomes were collected. Treatment regimens consisted of a wait-and-see regime and an immunosuppressive treatment regime with systemic corticosteroids and/or azathioprine, both combined with intravitreal antivascular endothelial growth factor injections when indicated., Results: Sixteen women (26 affected eyes) were included. Median Snellen BCVA was 20/19 before pregnancy and 20/18 after delivery. In seven pregnancies a wait-and-see regime and in nine pregnancies an immunosuppressive treatment regime was carried out. Fourteen intravitreal anti-VEGF injections were given in six pregnancies. The relapse rate during pregnancy was 44% and in the postpartum period 31%. Maternal/obstetrical and fetal complications occurred in 31% and 13% of the pregnancies, respectively. Fifteen healthy children were born and one pregnancy ended in a stillbirth in a patient with a complicated obstetrical history. One patient treated with azathioprine developed intrahepatic cholestasis of pregnancy (ICP)., Conclusions: Among women with MFC and PIC BCVA remained stable during pregnancy despite a relapse rate of 44% in pregnancy. No major maternal, obstetric and fetal complications occurred in pregnant patients treated with systemic corticosteroids, azathioprine or intravitreal anti-VEGF injections, though one patient developed ICP while treated with azathioprine., (© 2021 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate the choriocapillaris and choroidal characteristics of focal choroidal excavation (FCE) to establish pathomechanisms of the disease., Methods: Thirty eyes with FCE, 26 eyes with pachychoroid neovasculopathy (PNV), and 25 participants without any conditions (control group) were analyzed retrospectively. The thickness of both choriocapillaris equivalent and whole choroid was measured at three different points: under the lesion (excavation or neovascularization), in the normal retina, and in the fovea of fellow eye. Indocyanine green angiographic images were collected to confirm choriocapillaris ischemia and the presence of choroidal inflammation., Results: In both FCE and PNV, choriocapillaris-equivalent attenuation was observed under the lesion compared with other region of the retina (28.1 ± 11.3 μm vs. 69.4 ± 20.0 μm in FCE; 23.5 ± 9.7 μm vs. 62.3 ± 14.7 μm in PNV; both P < 0.001). We also observed focal thinning of the whole choroid under the lesion (149.7 ± 88.7 μm vs. 296.6 ± 83.2 μm; P < 0.001) in FCE but not in PNV. Pachyvessels distribution on optical coherence tomography and numerous dark areas on indocyanine green angiography implied that choroidal inflammation was related to the FCE occurrence., Conclusion: Choriocapillaris ischemia was related to both FCE and PNV. The choroidal thinning under the excavation and adjacent pachyvessels observed in FCE suggested that focal inflammation and scarring may contribute to choriocapillaris ischemia and eventual retinal pigment epithelium retraction with dysfunction in the pathomechanism.

Background: To describe the clinical course of an active solitary idiopathic choroiditis (focal scleral nodule) that nearly resolved over six weeks without intervention., Case Presentation: An 18-year-old man presented to the emergency department with headaches and new onset central scotoma in the right eye. Visual acuity was 20/20 in both eyes. Fundus examination revealed an amelanotic choroidal lesion with associated shallow subretinal fluid. It measured 6.1 × 6.3 × 1.4mm on A- and B-scan. Evaluation for systemic inflammatory and infectious diseases was negative. A week later, the lesion remained stable, and a month later, there was improvement of the lesion with a decrease in size on OCT and exam and resolution of the subretinal fluid suggesting that the lesion had become inactive., Conclusions: Solitary idiopathic choroiditis (Focal scleral nodule) is a rare condition characterized by inflammatory granulomatous reaction. This case report sheds light on the unknown natural course of a solitary idiopathic choroiditis (focal scleral nodule).

Purpose: To assess the visualization of choroidal granulomas with swept-source optical coherence tomography angiography (OCTA)., Methods: Consecutive patients with granulomatous choroiditis due to tuberculosis, sarcoidosis, or Vogt-Koyanagi-Harada disease underwent baseline OCTA images using a 12 × 12-mm field of view, and the choroidal slabs were analyzed by two independent examiners who counted the oval areas of flow void. Simultaneously, indocyanine green angiography (ICGA) and enhanced-depth imaging OCT were performed to mark visible choroidal changes corresponding to granulomatous lesions. The lesion areas on OCTA and ICGA were assessed using the in-built caliper tool., Results: Three hundred and one round-shaped areas of flow void on OCTA, 209 hypofluorescent round lesions on ICGA, and 42 hyporeflective choroidal lesions on enhanced-depth imaging OCT were identified in 23 eyes from 14 patients. Of the 209 ICGA granulomas, 197 (94.3%) had a corresponding round area of flow void on OCTA that was interpreted as a granuloma. One hundred and four additional round flow voids were identified on OCTA that did not correspond to any hypofluorescent lesion on ICGA. The mean area of the 197 granulomas detected with both imaging modalities was significantly larger on ICGA (mean 0.33 mm2) than that on OCTA (mean 0.28 mm2)., Conclusion: Optical coherence tomography angiography seems to be an optimal imaging method for the visualization of choroidal granulomas.

Purpose: To analyze baseline clinical and imaging risk factors associated with poor outcome in patients with tubercular serpiginous-like choroiditis (TB SLC)., Design: Retrospective clinical study., Methods: Charts and fundus photographs of consecutive patients with active TB SLC seen at a single tertiary referral center with 6 months follow-up after initiation of treatment were reviewed. Logistic mixed models were performed to determine the clinical and imaging factors associated with the response to therapy, including the opacity of choroiditis graded according to a 3-point scale., Results: This study included 203 eyes of 183 patients with active TB SLC. Poor initial best-corrected visual acuity (BCVA) and foveal and optic disc involvement were associated with poor response to therapy at 6 months (odds ratio [OR] 4.489, 95% confidence interval [CI]: 1.92-10.47; P = .001; OR 2.892, 95% CI: 1.23-6.81; P = .015; OR 11.633, 95% CI: 3.17-42.71; P < .001, respectively). The high opacity grades (2 and 3) were also associated with poor outcomes OR 9.541; 95% CI: 2.94-30.91; P = .001). Poor baseline BCVA and high grade of opacity of the lesions were the composite risk factors for paradoxical worsening of TB SLC (OR 7.555, 95% CI: 1.78-32.02; P = 0.006; OR 7.434, 95% CI: 1.34-41.18; P =0.021, respectively)., Conclusions: TB SLC with higher grades of lesion opacity at baseline may be associated with greater risk of poor therapeutic response and paradoxical worsening. Grading of baseline lesion opacity may be used in future prospective studies to predict the biological behavior of the lesions and may serve as a guide to therapeutic interventions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To evaluate multimodal imaging findings of solitary idiopathic choroiditis (SIC; also known as unifocal helioid choroiditis) to clarify its origin, anatomic location, and natural course., Design: Multicenter retrospective observational case series., Participants: Sixty-three patients with SIC in 1 eye., Methods: Demographic and clinical data were collected. Multimodal imaging included color fundus photography, OCT (including swept-source OCT), OCT angiography (OCTA), fundus autofluorescence, fluorescein and indocyanine green angiography, and B-scan ultrasonography., Main Outcome Measures: Standardized grading of imaging features., Results: Mean age at presentation was 56 ± 15 years (range, 12-83 years). Mean follow-up duration in 39 patients was 39 ± 55 months (range, 1 month-25 years). The lesions measured a mean of 2.4 × 2.1 mm in basal diameter, were located inferior (64%) or nasal to the optic disc, and appeared yellow (53%). No systemic associations were found. The lesions all appeared as an elevated subretinal mass, with OCT demonstrating all lesions to be confined to the sclera, not the choroid. On OCT, the deep lesion margin was visible in 12 eyes with a mean lesion thickness of 0.6 mm. Overlying choroidal thinning or absence was seen in 95% (mean choroidal thickness, 28 ± 35 μm). Mild subretinal fluid was observed overlying the lesions in 9 patients (14%). Retinal pigment epithelial disruption and overlying retinal thinning was observed in 56% and 57%, respectively. OCT angiography was performed in 13 eyes and demonstrated associated choroidal and lesional flow voids. Four lesions (6%) were identified at the macula, leading to visual loss in 1 patient. One lesion demonstrated growth and another lesion showed spontaneous resolution., Conclusions: In this largest series to date, multimodal imaging of SIC demonstrated a scleral location in all patients. The yellow and white clinical appearance may be related to scleral unmasking resulting from atrophy of overlying tissues. Additional associated features included documentation of deep margin on swept-source OCT, trace subretinal fluid in a few patients, and OCTA evidence of lesional flow voids. Because of the scleral location of this lesion in every patient, a new name, focal scleral nodule, is proposed., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe a novel spectral-domain (SD) OCT finding of a double-layer sign at the site of activity in tubercular serpiginous-like choroiditis (SLC) and how this sign can be used to assess treatment response in these eyes., Design: Retrospective, observational case series., Methods: We retrospectively reviewed simultaneous fundus photographs and SD OCT and fundus autofluorescence (FAF) images of eyes affected with tubercular SLC from the acute stage until resolution of lesions using the Heidelberg Spectralis HRA and OCT system (Heidelberg Engineering, Heidelberg, Germany)., Main Outcome Measures: Occurence of the double layer sign (DLS) during activity; reduction in the double layer sign (DLS) with resolution of choroidal and retinal inflammation; correlation of SD OCT and FAF findings., Results: Five eyes of 5 patients were studied in detail. Spectral-domain OCT findings included choroidal elevation and a double-layer sign (separation of hyperreflective retinal pigment epithelium [RPE] from Bruch's membrane, with the gap between them showing moderate reflectivity) at the site of activity. This correlated with hyperautofluorescence with indistinct borders on FAF imaging. Reduction in the double-layer sign became evident as the lesions began to resolve, and eventually this area was replaced by hyperreflective, irregular, knobbly elevations of the RPE. In eyes with severe inflammation and increased choroidal elevation on OCT, the double-layer sign was very prominent. As the choroidal elevation decreased on OCT, increased reflectance from the choroidal layers was evident. As the lesions resolved, the lesions became predominantly hypoautofluorescent on FAF and loss of RPE, ellipsoid zone, and external limiting membrane on SD OCT scan became evident. Good correlation was found between the resolution of the double-layer sign on SD OCT and FAF findings., Conclusions: The double-layer sign on SD OCT may be a useful finding in monitoring the activity in tubercular SLC. The OCT changes can be correlated with FAF imaging in these eyes., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Serpiginous choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like choroiditis (SLC) and multifocal serpiginoid choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC., Competing Interests: None

Background and Objectives: To analyze the panorama optical coherence tomography angiography (P-OCTA) characteristics of serpiginous-like choroiditis (SLC) and to correlate these findings with indocyanine green angiography (ICGA)., Patients and Methods: Prospective, observational study of 32 eyes of 24 patients. Twenty-seven eyes of 16 patients who met inclusion criteria were included in the final study. Multimodal imaging was performed using P-OCTA, OCT, fundus autofluorescence, fluorescein angiography, and ICGA. Morphologic features at the site of lesions were analyzed using P-OCTA and correlated with ICGA., Results: P-OCTA in active phase revealed areas of large flow void, which correlated with hypofluorescent areas on ICGA. Healing phase revealed appearance of vascular network due unmasking of choriocapillaris that corresponded to reduced hypofluorescence on ICGA., Conclusion: P-OCTA as a noninvasive tool provides widefield and high-resolution images that can be used as an complementary tool to ICGA for diagnosis of SLC cases. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:859-869.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To present a single case of bilateral multiple evanescent white dot syndrome (MEWDS)., Methods: A single case with three months of follow-up using imaging studies including fundus color photography (FP), fluorescein angiography (FA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), en face SD-OCT and optical coherence tomography angiography (OCTA) is presented., Results: The patient presented with bilateral MEWDS, ultimately with complete resolution of symptoms. FP revealed foveal granularity and white punctate deep retinal spots, FA found early wreath-like hyperfluorescence, while ICGA showed hypofluorescent dots and spots in the early and late stages. FAF showed areas of hyperautofluorescence. SD-OCT revealed disruption of the ellipsoid zone (EZ) and accumulation of hyperreflective material of variable size and shape. En face SD-OCT demonstrated hyporeflective areas corresponding to areas of EZ disruption as well as hyperreflective dots in the outer nuclear layer. OCTA showed areas of photoreceptor slab black-out corresponding to areas of EZ disruption and light areas of flow void or flow disturbance in the choriocapillaris slab., Conclusions: This case represents an unusual case of bilateral MEWDS with complete resolution within three months.

Purpose: To analyze the ability of optical coherence tomography angiography to identify choroidal neovascularization in multifocal choroiditis and to describe active and inactive choroidal neovascularization findings., Methods: Retrospective study of consecutive patients with multifocal choroiditis and choroidal neovascularization examined between January and November 2016. In addition to usual exams, optical coherence tomography angiography (AngioPlex™ CIRRUS™ HD-OCT model 5000; Carl Zeiss Meditec, Inc., Dublin, CA, USA) images were assessed for morphological analysis: choroidal neovascularization size, choroidal neovascularization margin (well or poorly circumscribed), choroidal neovascularization shape (tangled or interlacing), choroidal neovascularization core (feeder vessel) and dark ring around the choroidal neovascularization., Results: A total of 10 eyes were included. Optical coherence tomography angiography identified all choroidal neovascularization. Active choroidal neovascularization had well-circumscribed margins (67%), interlacing shape (83%), and a surrounding dark ring (83%). Inactive choroidal neovascularization had rather poorly circumscribed margins (75%), tangled shape, and "dead tree" appearance (50%) with less frequently a surrounding dark ring (50%)., Conclusion: Optical coherence tomography angiography is adapted to confirm the diagnosis of choroidal neovascularization complicating multifocal choroiditis, but it is still insufficient to differentiate active and inactive lesions.

Background/aims: To analyse choroidal vascular density of affected and non-affected areas in active and inactive serpiginouschoroiditis (SC) by means of optical coherence tomography angiography (OCT-A)., Methods: In this cross-sectional and observational study, 22 eyes of 11 patients diagnosed with SC were included. All patients underwent blue-light fundus autofluorescence (spectralis Heidelberg retinalangiography+OCT) and swept-source OCT-A (AngioPlex Elite 9000 SS-OCT, Carl Zeiss Meditech) to analyse qualitative features and choroidal vessel density of areas considered affected, and the inner and the outer border of the lesions. Unaffected areas of otherwise healthy retina have also been studied., Results: All inactive inflammatory lesions were characterised by atrophy of choriocapillaris with an impairment of its detectable flow and greater visibility of choroidal vessels. On the other hand, all active inflammatory lesions showed an area of complete absence of decorrelation signal. The pathological border was characterised by a statistically significant lower choroidal vessel density compared with both the outer border and the unaffected area (0.650±0.113 vs 0.698±0.112, (p<0.001)). Although not statistically significant, vessel density of the outer border of inactive lesions was lower than vessel density of unaffected areas (0.650±0.113 vs 0.698±0.112, p=0.441). Active inflammatory lesions showed an area of complete absence of decorrelation signal at the level of the choriocapillaris and whole choroid., Conclusion: OCT-A represents a new imaging technique that provides useful information about the leading changes of choroidal vascular network in active and inactive lesions of SC., 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.)

Purpose: To characterize the macular lesions in multifocal choroiditis using multimodal imaging (MMI) and to evaluate optical coherence tomography angiography (OCTA) in distinguishing neovascular from inflammatory lesions., Methods: Retrospective review of medical records of consecutive patients diagnosed with multifocal choroiditis and macular involvement, between September 2014 and May 2016, were included. All patients underwent standard examination and MMI, including fundus color photography, fundus autofluorescence, fluorescein angiography, and spectral domain optical coherence tomography. They also underwent OCTA examination. Multimodal imaging and OCTA characteristics of inflammatory lesions and choroidal neovascularization (CNV) were compared., Results: Eighteen eyes of 13 patients (11 females) were analyzed. The mean age was 42.9 ± 13.4 years. The lesions were first categorized as active or inactive CNV and active or inactive inflammatory lesions through conventional MMI. Using OCTA, an abnormal blood flow was observed in all active CNV (9/9) and most inactive CNV (5/6), but also in 2 of 14 lesions previously classified as active inflammatory lesions. On the contrary, no case of inactive inflammatory lesions showed abnormal blood flow. Therefore, the use of OCTA allowed a diagnosis of CNV that was not made through conventional MMI in 14% of cases of active inflammatory lesions., Conclusion: The combined findings of conventional imaging and OCTA demonstrate distinctive features of inflammatory lesions and CNV in multifocal choroiditis, allowing an appropriate management of these sight-threatening lesions. However, OCTA alone did not distinguish between active and inactive CNVs and should be integrated into an MMI approach.

Purpose: To evaluate retinal and choroidal changes in patients with non-granulomatous choroiditis using the multimodality imaging (MMI)., Methods: Eight eyes of four patients were analyzed. Three patients (six eyes) were diagnosed with serpiginous choroiditis (SC) and one patient (two eyes) with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). The patients were imaged on the same day using the RTVue Avanti XR instrument OCT/OCTA (Optovue Inc, Fremont, CA), Heidelberg Retina Angiograph 2 FAF and FA (Heidelberg Engineering, Germany), and TRC50DXi Topcon FP (Topcon Medical Systems, Oakland, NJ)., Results: OCT angiography (OCTA) showed hypoperfusion in all the cases, reperfusion in choriocapillaris in two eyes after treatment and identified a choroidal neovascularization (CNV), which was not detected on the fluorescein angiography (FA)., Conclusions: OCTA may be an effective noninvasive image modality to follow up these patients and may provide further information to help us to understand the pathophysiology and complications of these diseases.

Purpose: To assess choroidal vascular changes among patients with tubercular multifocal serpiginoid choroiditis (TB MSC) using previously validated techniques., Methods: Patients with TB MSC (n = 18) and healthy controls (n = 30) underwent enhanced-depth imaging optical coherence tomography (EDI-OCT) imaging. Using previously validated algorithm of image binarization, EDI-OCT scans were segmented to derive total choroidal area, luminal area, stromal area, and choroidal vascularity index (CVI)., Results: There was a statistically significant difference in the CVI between controls (66.90 ± 1.77%) and TB MSC patients (65.46 ± 2.53%; p < 0.001). There was significant reduction in CVI at follow-up (3 months) (63.77 ± 3.91%; p = 0.05). The choroidal thickness was higher in TB MSC compared to controls (278.90 ± 57.84 µm versus 329.33 ± 27.69 µm; p = 0.001)., Conclusions: CVI provides insight into structural changes in choroid in TB MSC. During the active disease, there is relative decrease in choroidal vascularity. As the lesions heal, choriocapillaris atrophy occurs with remodeling of choroid.

Purpose: To investigate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE)., Methods: A retrospective observational case series using multimodal imaging including optical coherence tomography (OCT) angiography., Results: Five patients with APMPPE were included. In most acute lesions, OCT angiography revealed outer retinal and retinal pigment epithelium (RPE) hyperreflective lesions with attenuated OCT signal in the underlying choroid, but careful examination allowed us to identify a single lesion with decreased choriocapillaris flow outside the signal attenuation. Optical coherence tomography angiography obtained after healing of lesions revealed areas of hypointense circular flow voids clustered in groups surrounded by either isointense or hyperintense signal background. Point-by-point evaluation revealed these flow voids did not correspond to areas of RPE thickening or focal pigmentary changes. Larger hypointense lesions were observed and did correlate with pigmentary changes., Conclusion: Our case series demonstrates choriocapillaris flow abnormalities in acute APMPPE extending beyond the OCT lesions, and distinct residual vascular abnormalities in healed APMPPE lesions on OCT angiography. Our findings support a primary ischemic insult to the photoreceptors and RPE, but choriocapillaris flow abnormalities could be secondary to (OCT invisible) retinal and RPE involvement. The lack of understanding of the etiology along with the inability to visualize most of the choroid in acute lesions precludes definite conclusions about the true pathogenesis of APMPPE.

PurposeThe aim of this study was to determine a sequence of structural changes in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography-angiography (OCT-A) and comparing with other imaging modalities.Patients and methodsPatients with a new diagnosis of acute-onset APMPPE referred to a regional specialist centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included the following: fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain-OCT (SD-OCT), and OCT-A. All non-invasive imaging processes were repeated during follow-up.ResultsTen eyes of five patients were included in the study, three males and two females, with a mean age of 26.2 years (range: 21-32) and a mean follow-up of 6.4 months (range: 2.6-13.3). All patients presented with bilateral disease and macular involving lesions. OCT-A imaging of the choriocapillaris was supportive of hypoperfusion at the site of APMPPE lesions during the acute phase of this condition with normalisation of choroidal vasculature during follow-up. Multimodal imaging consistently highlighted four sequential phases from presentation to resolution of active disease.ConclusionsMultimodal imaging in patients with APMPPE in acute and long-term follow-up demonstrates a reversible choroidal hypoperfusion supporting the primary inciting pathology as a choriocapillaritis. The evolution shows resolution of the ischaemia through a defined sequence that results in persistent changes at the level of the retinal pigment epithelium and outer retina. OCT-A was able to detect preclinical changes and chart resolution at the level of the choriocapillaris.

The aim of the study was to report the clinical utility of optical coherence tomography angiography (OCT-A) in characterizing and differentiating inflammatory lesions and choroidal neovascularization (CNV) in multifocal choroiditis (MFC). A patient affected by MFC complaining central visual loss and scotoma in his left eye was fully investigated with dye-based angiographies, structural OCT and OCT-A. A reactivation of macular CNV was initially suspected, while OCT-A revealed the absence of any decorrelation signal both over the retinal pigment epithelium (RPE) and between RPE and Bruchs' membrane. OCT-A is a promising tool in detecting inflammatory CNV and in differentiating CNV from primitive inflammatory damage. Finely characterizing the aspect of a lesion allows us to choose the best therapeutic strategy for managing these potentially blinding diseases.

Purpose: To evaluate the spectrum of macular chorioretinal lesions occurring in idiopathic multifocal choroiditis using optical coherence tomography angiography (OCTA) to evaluate those showing neovascular flow., Methods: This was a descriptive, retrospective study of 18 eyes of 14 patients with multifocal choroiditis. Macular lesions were characterized as subretinal pigment epithelium, subretinal, or mixed and evaluated during active and presumed inactive states of multifocal choroiditis. Correlations between structural optical coherence tomography and OCTA were performed. In select cases, correlations between OCTA, fluorescein angiography, and fundus autofluorescence were evaluated. In 5 eyes, quantitative measurements of neovascular lesions were compared at baseline and following intravitreal anti-vascular endothelial growth factor therapy., Results: Mean patient age was 48 years (SD: 13.8; 86% women). Optical coherence tomography angiography flow signatures consistent with neovascularization were identified in 83% of eyes, including in 0% of subretinal pigment epithelium, 91% of subretinal, and 100% of mixed lesions. Lesions that did not demonstrate definitive signs of fluorescein angiography leakage were frequently found to have neovascularization using OCTA. There was no change in quantitative measurements of neovascular lesions after anti-vascular endothelial growth factor therapy (all tested variables P > 0.05)., Conclusion: Optical coherence tomography angiography may be a useful imaging modality for understanding the pathophysiology of multifocal choroiditis and monitoring its clinical course.

Two patients (a 37-year-old man and a 28-year-old woman) who had choroidal neovascular membrane (CNVM) secondary to inactive toxoplasma retinochoroiditis scarring were evaluated. Multimodal imaging including fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA) was used. CNVM secondary to inactive toxoplasma retinochoroiditis scarring was detected. Representative images of CNVM were demonstrated in the outer retinal layer and choriocapillary layer on OCTA. OCTA, a relatively new technique, is useful in the diagnosis of the CNVMs secondary to retinochoroiditis. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:509-511.]., (Copyright 2017, SLACK Incorporated.)

Few cases have been reported describing choroidal vasculature in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography (OCT) angiography. We report choroidal vasculature changes in an APMPPE patient with the clinical course characterized by OCT angiography. A 39-year-old female was referred to us for bilateral multiple white spots in bilateral fundus. The best-corrected visual acuity was 20/20 in the right eye and 20/50 in the left eye. Multiple yellowish-white placoid lesions were observed in bilateral fundus, and fluorescein angiography showed a "block early, stain late" pattern at the placoid lesions characteristic of APMPPE. The placoid lesion represented vascular rarefaction at the choriocapillaris in the OCT angiography en face view. While the clinical course of symptoms and most of the low vascular rarefaction lesions regressed in 6 months, some new lesions were subclinically noted. Blurred vision recurred at 9 months from the first visit, and the vascular rarefaction lesions developed in different areas than those observed in the initial visit. Multiple yellowish-white placoid lesions in an APMPPE patient represented vascular rarefaction at the choriocapillaris in OCT angiography. The vascular rarefaction recovered and then recurred during the clinical course. OCT angiography can visualize changes of the choroidal vessels during APMPPE.

Punctate inner choroidopathy (PIC), an idiopathic inflammatory multifocal chorioretinopathy that predominantly affects young myopic women, appears to be relatively rare, but there are limited data to support accurate estimates of prevalence, and it is likely that the condition is underdiagnosed. The etiological relationship between PIC and other conditions within the "white dot syndromes" group remains uncertain. We, like others, would suggest that PIC and multifocal choroiditis with panuveitis represent a single disease process that is modified by host factors (including host immunoregulation) to cause the range of clinical phenotypes seen. The impact of PIC on the patient is highly variable, with outcome ranging from complete spontaneous recovery to bilateral severe sight loss. Detection and monitoring have been greatly facilitated by modern scanning techniques, especially optical coherence tomography and autofluorescence imaging and may be enhanced by coregistration of sequential images to detect change over time. Depending on the course of disease and nature of complications, appropriate treatment may range from observation to systemic immunosuppression and antiangiogenic therapies. PIC is a challenging condition where treatment has to be tailored to the patient's individual circumstances, the extent of disease, and the risk of progression., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To report a case of atypical serpiginous choroiditis with previously unreported findings on optical coherence tomographic angiography., Case Report: A 35-year-old otherwise healthy man had a 1-week history of vision loss in his right eye. The visual acuity in right eye was counting fingers at 1 meter. Fundoscopy showed a classic peripapillary serpiginous lesion and a solitary macular lesion. Fundus fluorescein angiography revealed early hypofluorescence of active lesions with gradual increase in fluorescence across the phase of angiogram. Optical coherence tomography showed hyperreflectivity in outer retinal layers and loss of ellipsoid zone band. The patient was treated with oral prednisone and visual acuity returned to near normal. The inflammation recurred once the patient discontinued corticosteroid therapy. The flare-up was treated with intravenous methylprednisolone followed by oral steroids. Oral azathioprine was added as a steroid-sparing agent and oral prednisone was tapered slowly and discontinued. The visual acuity returned to normal with settlement of all lesions after initiating azathioprine. Optical coherence tomography showed reintegration of retinal anatomy. No recurrence was seen after discontinuation of corticosteroids. Optical coherence tomographic angiography in resolved serpiginous choroiditis was consistent with loss of choriocapillaris homogeneity., Conclusions: Serpiginous choroiditis may manifest with multifocal lesions and may be confused with relentless placoid chorioretinitis. However, it ends up in a typical geographic scar. Optical coherence tomography can be used to monitor the changes in retinal structure. Choriocapillaris changes as seen on optical coherence tomographic angiography may be a possible mechanism behind the development of choroidal neovascularization in later stages of the disease.

Two women with unilateral vision loss from multiple evanescent white dot syndrome were imaged serially with swept-source optical coherence tomography (SS-OCT). En face wide-field structural images revealed peripapillary outer photoreceptor disruption better than conventional fundus autofluorescence imaging. OCT angiography (OCTA) imaging showed preservation of flow within the retinal vasculature and choriocapillaris. As OCTA imaging of the choriocapillaris continues to evolve, these images may lay the groundwork for future investigation. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:69-74.]., (Copyright 2017, SLACK Incorporated.)

Punctate inner choroidopathy (PIC) is a relatively uncommon inflammatory multifocal chorioretinopathy that predominantly affects young, myopic women. Subfoveal choroidal neovascularization (CNV) often leads to rapid loss of sight. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) remain the existing gold standards for CNV diagnosis. However, these methods are invasive and time-consuming. Recently, optical coherence tomography angiography (OCTA) has been used more frequently as an adjunct to FA/ICGA. In this report, a 38-year-old woman with PIC and idiopathic CNV presented with blurred vision despite 18/20 visual acuity. FA revealed positive staining and possible leakage, but did not provide clear evidence of CNV. OCTA detected abnormal flow in the outer retina, corresponding to type 2 CNV, that decreased following intravitreal anti-vascular endothelial growth factor (VEGF) therapy. Furthermore, OCTA could show remodeling of the choroidal capillaries after the treatment. OCTA may be helpful in the detection, follow-up, and evaluation of therapeutic strategies to treat CNV secondary to PIC. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1157-1161.]., (Copyright 2016, SLACK Incorporated.)

This report describes a 19-year-old patient with the rare association of multiple evanescent white dot syndrome (MEWDS) and choroidal neovascularization (CNV). Despite the initial diagnosis of MEWDS, her vision significantly decreased. Fluorescein angiography showed dye leakage and pooling at the macula, whereas optical coherence tomography (OCT) showed cystoid macular edema and serous neuroepithelial elevation. The dye leakage and pooling made it impossible to diagnose CNV. However, OCT angiography (OCTA) revealed a vascular structure in the outer retina, thereby leading to the CNV diagnosis. Visual acuity improved after an anti-vascular endothelial growth factor injection. OCTA proved to be useful in the diagnosis of CNV. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:580-584.]., (Copyright 2016, SLACK Incorporated.)

Purpose: To use optical coherence tomography angiography (OCTA) to characterize the effects of anti-VEGF injections on treatment-naive choroidal neovascularization (CNV)., Methods: From August 2014 to May 2015, treatment-naive eyes with CNV were scanned using a prototype OCTA system on a commercially available SD-OCT device (Optovue Inc, Fremont, CA). Optical coherence tomography angiography scans were obtained before anti-VEGF injection and at follow-up visits. The CNV area and greatest linear dimension (GLD) were measured along with the maximum retinal pigment epithelial detachment (RPED) height. Changes in subretinal and/or intraretinal fluid were also assessed., Results: Six eyes of six patients with treatment-naive CNV were included. Diagnoses included neovascular age-related macular degeneration, idiopathic polypoidal choroidal vasculopathy, CNV secondary to central serous chorioretinopathy and multifocal choroiditis, and macular telangiectasia Type 2 with subretinal neovascularization. After treatment, all patients with fluid on OCT initially showed a decrease in the amount of fluid. Five of six patients demonstrated decreases in CNV GLD and area with an average reduction of 23.6% and 29.8% respectively., Conclusion: Both CNV greatest linear dimension and area measured using OCTA decreased after anti-VEGF treatment in most patients. Optical coherence tomography angiography may be a useful tool for monitoring and quantifying the response of CNV to treatment.

Purpose: To assess the longitudinal development of choroidal neovascularization (CNV) Type 2 after intravitreal anti-vascular endothelial growth factor by optical coherence tomography-angiography (OCT-A)., Methods: Five eyes of five patients with naive CNV Type 2 were assessed by OCT-A in this observational longitudinal study. To perform, the OCT-A used an 840-nm wavelength OCT device (XR-Avanti, Freemont; Optovue) based on split-spectrum amplitude-decorrelation angiography algorithm. The timing of analysis was after 24 hours, between 7 days and 10 days, between 12 days and 18 days, and 30 days after the intravitreal anti-vascular endothelial growth factor injections. The protocol of analysis was 3-mm  × 3-mm OCT angiograms centered at the macula. The day after the injection, OCT-A showed the decrease of neovascularization, with apparent vessel fragmentation. The CNV area was reduced with pruning of thinner anastomoses and loss of smaller vessels. Decrease of dimensions of CNV area, microvascular rarefaction, and vessels narrowing was observed between 7 days and 10 days, between 12 days and 18 days because of the further loss of smaller capillaries. Residual flow was always visible to the afferent trunk over the time., Results: The mean age of patients was 72.6 (SD ±16.22) years. All were women, naive cases, and followed from 5 months to 14 months. Over that time, they had a mean number of 5.5 intravitreal injections (from 3 to 8) and a mean number of 11 OCT-A examinations each (from 8 to 26). The most salient result emerging from this study is the consistency in the patterns of cyclic CNV variations after treatment in different patients. This CNV cycle was approximately 62 days long., Conclusion: This study suggests that OCT-A is able to detect the Type 2 CNV developments. This new method allows noninvasive analysis of CNV networks remodeling during anti-vascular endothelial growth factor follow-up. In conclusion, OCT-A provides a useful approach for monitoring the CNV Type 2 over the time.

Purpose: To describe the spectral-domain optical coherence tomographic (SD-OCT) features of inflammatory choroidal neovascular membranes (iCNV) in multifocal choroiditis and punctate inner choroidopathy, and to compare them to those of the acute inflammatory lesions in the same underlying diseases. This is a retrospective, consecutive, observational case series., Methods: Each patient underwent a comprehensive eye examination, fundus photography, and fluorescein angiography (FA) on the initial visit. SD-OCT features of iCNV were reviewed at presentation and 4 weeks later, and were compared to SD-OCT features of the inflammatory lesions. There were ten eyes with iCNV and eight eyes with the acute lesions of chorioretinitis., Results: All iCNV had a sub-retinal pigment epithelium (sub-RPE) component and a subretinal or retinal component that infiltrated the outer retinal layers to different extents. All iCNV had associated fluid exudation, and all showed RPE and inner segment/outer segment junction layer (IS/OS) disruption. On the other hand, approximately half of the inflammatory lesions were confined between Bruch's membrane and RPE; the rest showed infiltration into the outer retinal layers in a pattern similar to iCNV, with no fluid exudation but with associated choroidal hyperreflectivity. In most of them, disruption of RPE and IS/OS was also noted., Conclusions: The acute lesions of chorioretinitis can be difficult to distinguish from iCNV based on clinical examination and FA. However, iCNV demonstrate characteristic SD-OCT features not seen with the inflammatory lesions. These findings may help to differentiate these two entities that typically require different treatments.

Purpose: To describe fundus autofluorescence (FAF) imaging and its correlation to spectral-domain optical coherence tomography (SD-OCT) in retinal areas that appear clinically noninvolved in patients with multifocal choroiditis/punctate inner choroidopathy (MFC/PIC)., Methods: Six patients with MFC or PIC were evaluated during the disease course with multimodal imaging, which included fluorescein angiography, FAF imaging, indocyanine green angiography, and SD-OCT., Results: Five patients had acute and/or scarred chorioretinal spots at presentation. Five patients had choroidal neovascularization. FAF imaging in all patients disclosed diffuse peripapillary and/or posterior-pole hyperautofluorescent plaques in areas that appeared clinically to be noninvolved. Corresponding SD-OCT scans revealed severe disruption of the inner segment/outer segment junction. Findings resolved with corticosteroid treatment Conclusions: FAF imaging of patients with MFC/PIC reveals extensive pathology beyond the clinically apparent spots. FAF findings highlight the areas of corresponding anatomic disruption of the photoreceptor-retinal pigment epithelium complex.

Purpose: To describe the findings of optical coherence tomography and clinical characteristics in patients of zonal outer retinopathy associated with punctuate inner choroidopathy., Method: Review of consecutive cases on fundus photographs, spectral domain ocular coherence tomography, fluorescein angiography, indocyanine green angiography, visual field, and electrophysiological studies of patients with punctate inner choroidopathy and associated zonal outer retinopathy., Results: This study involves 4 patients suffering visual field defect far beyond the area corresponding to punctate inner choroidopathy lesions. Findings in optical coherence tomography include attenuated signals of photoreceptor inner/outer segment areas corresponding to visual field defect, and increased choroidal thickness. After treatment with immunosuppressive agents, improvements are noted in all 4 patients., Conclusion: Optical coherence tomography is helpful in the diagnosis of patients suffering zonal ocular outer retinopathy associated with punctate inner choroidopathy. All those patients responded well to immunosuppressive agents.

Introduction: Multiple evanescent white dot syndrome (MEWDS) is a rare, usually unilateral, retinal disease associated with transient loss of vision. Its pathogenesis remains elusive. The purpose of this study was to determine the spatial location of the lesions in the neurosensory retina of a patient with MEWDS, using a new technology, i.e. "en face" optical coherence tomography ("en face" OCT)., Methods: A 21-year-old woman presenting with bilateral MEWDS underwent Cirrus(®) OCT with advanced "en face" reconstructions of the various retinal layers and inner choroid, fluorescein angiography, and infracyanine green angiography (ICGA)., Results: During the acute stage of MEWDS, advanced "en face" visualization mode of the IS/OS photoreceptor junction and the inner choroid showed areas of strong signal attenuation, forming a spot pattern identical to that of the hypofluorescent IGCA dots. One month later, visual acuity returned to 20/25 in both eyes and the reflectivity map of the IS/OS junction and inner choroid displayed no areas of signal attenuation., Conclusion: "En face" OCT is a new, noninvasive technology, capable of visualizing specific attenuation of the IS/OS junction in MEWDS, which form a spot pattern identical to those revealed by ICGA., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Purpose: To compare the spectral-domain optical coherence tomography (SD-OCT) findings of the acute lesions of multifocal choroiditis (MFC) with those of new-onset myopic choroidal neovascularization (CNV)., Methods: Observational case series. A retrospective review comparing the SD-OCT findings of the acute lesions of MFC with those of early myopic CNV. Spectral-domain optical coherence tomography findings in two female patients and one male patient presenting with acute inflammatory lesions of MFC were compared with those of new-onset CNV in three patients with myopic macular degeneration. Each patient underwent a comprehensive eye examination, fundus photography, and fluorescein angiography on the initial visit. The patients underwent SD-OCT scanning at baseline and at follow-up visits using image registration and eye tracking., Results: Spectral-domain optical coherence tomography imaging of the acute lesions of MFC showed drusenlike material between the retinal pigment epithelium and the Bruch membrane, presumed vitreous cells, and localized choroidal hyperreflectivity below the subretinal pigment epithelial material. These SD-OCT findings were not usually present in the eyes with myopic CNV. The subretinal pigment epithelial material corresponded to acute lesions found on color photographs and fluorescein angiography. The subretinal pigment epithelial material and choroidal hyperreflectivity appeared to improve after treatment with antiinflammatory or anti-vascular endothelial growth factor therapy. In contrast, SD-OCT in the patients with myopic CNV showed a very thin choroid, a posterior staphyloma, and a Type 2 (subretinal) neovascular pattern., Conclusion: The acute lesions of MFC can be difficult to distinguish from myopic CNV based on clinical examination and fluorescein angiography. However, the inflammatory lesions of MFC can demonstrate characteristic SD-OCT findings not seen with myopic CNV. These SD-OCT findings may help to differentiate these two entities that typically require different treatments.

Purpose: To report fundus autofluorescence (FA) and spectral domain optical coherence tomography (SDOCT) findings in serpiginous choroiditis., Design: Case report., Methods: SDOCT and FA imaging of a 37-year-old woman with bilateral recurrent serpiginous choroiditis., Results: Active new lesions disclosed hyperautofluorescence, in contrast to hypoautofluorescent scarred lesions. SDOCT showed increased reflectance of the choroid and deeper retinal layers, along with disruption of the photoreceptor inner and outer segment junction in both active and inactive lesions., Conclusion: Autofluorescence imaging and SDOCT are useful noninvasive methods for the evaluation of serpiginous choroiditis. Autofluorescence imaging allows identification of recurrences and retinal pigment epithelium involvement in the follow-up of this disease.

A single case of multifocal choroiditis with panuveitis (MFCPU) was investigated by a three-dimensional (3-D) high-penetration optical coherence tomography. The HP-OCT is based on a swept-source OCT technology, uses a probe beam with a center wavelength of 1060 nm, and possesses a depth resolution of 10.4 micromin tissue. Two eyes of an MFCPU patient were involved in this study. The eyes were also examined by color fundus photograph, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Findings in these four modalities are comparatively discussed. The OCT scans revealed the following characteristic properties of the lesion sites. Thinning of the retina, destructuring of the retinal layers, and disappearance of the junction of the inner and outer segments of the photoreceptor (IS/OS). Due to the high penetration of this OCT system, the following characteristic properties of the lesions were also observed: localized thinning of the choroid, occlusion of the choroidal vessels, and localized hyper-reflectivity that may represent hyper-pigmentation of the choroid.

Purpose: To describe choroiditis in multiple sclerosis (MS)., Design: Case report., Methods: Clinical findings, fluorescein angiography, optical coherence tomography, and treatment are presented. A 50-year-old man with MS presented with vitritis and multiple choroidal lesions in the fovea and periphery in both eyes. Fluorescein angiography (FA) revealed early hyperfluorescence and late leakage of the lesions. Optical coherence tomography showed subretinal fluid in the right eye. One month post-treatment, visual acuity returned to the baseline with complete resolution of subretinal fluid and decreased leakage on FA., Conclusions: Choroiditis might be related to MS, but may also be a chance occurrence.

Aim: To describe the different retinal morphological characteristics that can present on optical coherence topography (OCT) in a spectrum of uveitic diseases., Methods: We reviewed the literature and our own OCT image archive for characteristic features that may be suggestive of a particular disease process., Results: OCT demonstrates a variety of characteristic morphological changes, some that may point towards a specific disease process. We describe the various forms of macular oedema found in uveitis as well as OCT features typically found in multifocal choroiditis, serpiginous chorioretinitis, toxoplasma chorioretinitis, Vogt-Koyanagi-Harada, sympathetic ophthalmia and the vitreomacular traction syndrome., Conclusion: Ophthalmologists should be aware of the variety of retinal morphological characteristics that can present on OCT in uveitic disease. Recognition may aid in the diagnostic process, which is complementary to conventional fundal photography and fluorescein angiography. This can facilitate earlier diagnosis and, more importantly, the initiation of specific treatment.