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To highlight the importance of swept-source anterior segment optical coherence tomography (SS-ASOCT) in the peri-surgical management of cataract in uveitis. To describe a case of fibrinoid syndrome in uveitis treated with recombinant tissue plasminogen activator (rtPA). SS-ASOCT was performed at each follow-up before and after cataract surgery to assess anterior chamber inflammation and assist the clinical management of the patient. A patient with idiopathic autoimmune uveitis was scheduled for cataract surgery. SS-ASOCT allowed to correctly plan the surgery timing. The patient developed a severe fibrinoid syndrome. Postsurgical SS-ASOCT allowed to distinguish between anterior chamber cells and fibrin thus guiding the timing for rtPA intracameral injection. Visual acuity improved from 20/400 the day after the surgery to 20/40. SS-ASOCT allowed a precise assessment of the inflammatory components (cellular vs fibrinoid) after cataract surgery. Intracameral rtPA was safe and effective in the treatment fibrinoid syndrome in uveitis. [ABSTRACT FROM AUTHOR]

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To report a case of iris ischemia in an eye affected by Cytomegalovirus (CMV)-related Chronic Retinal Necrosis (CRN) with partial reperfusion after antiviral therapy demonstrated by optical coherence tomography angiography (OCTA). Retrospective case report. Multimodal imaging was performed at each follow-up visits. At baseline, the clinical findings and PCR on aqueous confirmed the diagnosis of CMV-induced CRN, while OCTA and Fluorescein Angiography showed multi-sectoral retinal and iris non-perfusion. After three weekly intravitreal injections of Foscarnet and retinal photocoagulation, the clinical and angiographic picture improved, with partial reperfusion of both retinal and iris vasculature. Retinal and iris non-perfusion in CRN can be partially reversible, if prompt treatment is administered. OCTA of the anterior segment allowed an accurate follow-up of the iris vasculature and its perfusion. [ABSTRACT FROM AUTHOR]

To report a case of intraretinal tubercular granuloma successfully treated with photodynamic therapy (PDT). Retrospective case report. Multimodal imaging was performed at each follow-up visit. The tuberculoma did not regress and did not significantly reduce its exudation after anti-tubercular therapy (ATT), systemic steroid therapy and intravitreal anti-VEGF. Second line treatment with PDT was attempted. The lesion showed a regression with reduced sub-retinal fluid and intra-retinal exudates. A second PDT was performed for reactivation of the lesion 5 months after the first treatment. Further regression of the lesion was observed. PDT may be a valuable second-line therapeutic approach for vascularized intraretinal granulomas. [ABSTRACT FROM AUTHOR]

To compare Indocyanine Green (ICGA) and fundus fluorescein angiography (FFA) with Optical Coherence Tomography Angiography (OCTA) findings in toxoplasmic chorioretinitis (TCR). Patients affected by active TCR were included. FFA, ICGA, and OCTA images were analyzed and lesions were compared between different modalities. Satellite dark dots (SDD) were compared between modalities. Fifteen patients were enrolled. The mean lesion area was similar between fundus photography (FP), FFA, and OCTA-Retina. The mean lesion area was similar between ICGA and OCTA-Choroid slab. ICGA and OCTA-Choroid showed a larger extension of the lesion compared to FP, FFA, and OCTA-Retina (p =.01, 0.0001, and 0.0002 for ICG angiography and p =.03, 0.008, and 0.0002 for OCTA-Choroid, respectively). On OCTA B-scans, the retinal flow defects were smaller than the underlying choroidal non-perfusion. The number of SDD was similar between ICGA and OCTA. OCTA is a reliable method to assess retinal and choroidal involvement in TCR. OCTA confirmed a wider involvement of the choroid than the retina. [ABSTRACT FROM AUTHOR]

Purpose: To analyse vitreous anatomy patients with anterior uveitis (AU) using swept source optical coherence tomography (SS‐OCT). Methods: Patients with newly diagnosed AU and healthy participants were scanned using 16‐mm SS‐OCT B‐scans and 12 × 12 mm cube centred at the fovea. Linear SS‐OCT scans were evaluated to identify the premacular bursa (PB) above the macula and the Cloquet's canal above the optic disc. A dynamic evaluation of the 12 × 12 mm cube enabled en face measurement of the vertical and horizontal diameters of the PB and the presence/absence of communication between the PB and Cloquet's canal. Results: One hundred and thirty‐five subjects were included in the study. Forty‐five patients were healthy (mean age 33.47 years). En face measurements of the horizontal and vertical PB mean diameters were 5.2 mm and 4.7 mm. In 90 subjects with AU (mean age 30.10 years), the mean horizontal and vertical diameter of the PB were significantly larger (p < 0.01). Thirty‐seven eyes with AU presented with cystoid macular oedema (CME). The mean diameters of the PB in this subgroup were significantly larger (p < 0.01). In 75% of the entire cohort (51% of eyes in the control group, 87% of eyes with AU and 100% of eyes with AU and CME), a channel connecting the PB and Cloquet's canal could be identified. Conclusions: SS‐OCT identification of a connecting channel between the PB and the Cloquet's canal suggests that inflammatory cytokines may drain from the anterior chamber through this system of channels, thus increasing the risk of CME. [ABSTRACT FROM AUTHOR]

Aims To study widefield imaging features, analyse risk factors for progression and compare treatment modalities of peripheral exudative haemorrhagic chorioretinopathy (PEHCR). Methods Clinical and imaging data from each visit were collected, including near-infrared reflectance, fluorescein angiography, indocyanine green angiography, optical coherence tomography using the Spectralis platform (Heidelberg Engineering). Clinical features and treatment performed were recorded. Lesions were classified according to treatments used and according to the prognostic index of macular involvement (MI) and intravitreal bleeding (IVB). Results 50 eyes of 35 patients were retrospectively enrolled. Using widefield imaging, peripheral subretinal fluid (SRF) was detected in 31 (62%) eyes and peripheral neovascular networks were detected in 42 (84%) eyes and graded as focal, diffuse and subtotal in 22 (44%), 17 (34%) and 11 (22%) eyes, respectively. MI secondary to PEHCR during the follow-up was documented in 17 (34%) eyes, while IVB occurred in 7 (14%) eyes. Both MI and IVB correlated with peripheral SRF and lesion grade. Active treatment included anti-vascular endothelial growth factor (anti-VEGF) injections, photodynamic therapy (PDT) and combined anti-VEGF and PDT for 13 (26%), 1 (2%) and 18 (36%) eyes, respectively. In eyes with risk factors, anti-VEGF and combined treatment inversely correlated with MI incidence. Conclusions In our series, peripheral subretinal exudation and the extension of peripheral involvement represented risk factors for MI in eyes with PEHCR. In those high-risk eyes, active treatment is warranted. [ABSTRACT FROM AUTHOR]

Background To compare fluorescein angiography (FA) and five different optical coherence tomography angiography (OCTA) devices and to test their reproducibility in the evaluation of retinal microaneurysms (MAs) secondary to diabetic retinopathy (DR). Methods On the same day, patients with DR were imaged with FA and five OCTA devices: prototype Spectralis OCTA, prototype PlexElite, RTVue XR Avanti, AngioPlex and DRI OCT Triton. For all OCTA devices, a 3×3 volume scan pattern was performed. MAs were evaluated for the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results Twenty eyes of 15 patients with DR were included. FA counted a significantly higher number of MAs compared to OCTA devices. Spectralis OCTA obtained a significantly higher number of MAs compared to PlexElite, RTVue XR Avanti, AngioPlex and DRI OCT Triton (p<0.0001). PlexElite and AngioPlex showed a greater number of MAs in the SCP, Spectralis OCTA, RTVue XR Avanti and DRI OCT Triton in the DCP. Higher sensitivity (43.3%) but lowest specificity (54.4%) was observed for Spectralis OCTA compared to other devices. The higher specificity (78.5%) and positive predictive value (83.3%) were observed for DRI OCT Triton. Conclusions FA remains the best imaging modality to visualise retinal MAs. Spectralis OCTA was able to detect more MAs compared to other devices, likely due to the higher number of B-scans in the scanned area as well as due to the higher number of repeated B-scans. The high variability between OCTA devices should be taken into account for future clinical trials as in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate choroidal structural changes in patients with multiple evanescent white dot syndrome (MEWDS) during the acute and recovery stages.Methods: Enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of 16 patients with unilateral MEWDS were acquired during the acute and recovery stages in both eyes. Images were binarized with the ImageJ software to measure subfoveal choroidal thickness (CT), total choroid area, luminal area and choroidal vascularity index (CVI).Results: In the acute stage, subfoveal CT, total choroidal area and CVI were significantly higher in eyes with MEWDS compared to fellow eyes (371.2 ± 101.8 vs 317.1 ± 90.3 µm, p = .001; 2.826 ± 0.686 vs 2.524 ± 0.674 mm2, p = .014; 69.49 ± 3.51 vs 68.27 ± 3.41%, p = .044, respectively). In the recovery stage, subfoveal CT, total choroidal area and CVI in eyes with MEWDS significantly decreased to respectively 333.4 ± 90.5 µm, p = .007, 2.592 ± 0.570 p = .002, and 67.31 ± 2.74%, p = .014.Conclusions: Choroidal thickness and vascularity are significantly increased during the acute stage of MEWDS. [ABSTRACT FROM AUTHOR]

The clinical grading of vitreous haze presents some limitations such as subjectivity and intra-grader variability. On the other hand the proposed OCT-based methods only explore the posterior part of the vitreous. Here we describe the inflammatory changes affecting the anterior vitreous imaged by Anterior Segment Optical Coherence, Tomography (AS-OCT) from patients affected by uveitis. The AS-OCT (Anterion, Heidelberg Engineering, Heidelberg, Germany) detected vitreous sheets, vitreous lacunae, and formations resembling inflammatory cells, providing an objective characterization of the inflammatory changes in the anterior vitreous as well as their relationships with the other ocular structures. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the pathogenesis of Multiple Evanescent White Dot Syndrome (MEWDS) using multimodal imaging (MMI).Methods: Retrospective case series of 7 patients with acute MEWDS. Each patient underwent: near-infrared reflectance (IR), blue and near-infrared autofluorescence (FAF and NIRAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), enhanced depth imaging optical coherence tomography (EDI-OCT) on Spectralis, and optical coherence tomography angiography on OCTA Spectralis, XR Avanti or Plex Elite 9000.Results: OCTA and FA findings of early hyperfluorescence depict an unaffected choriocapillaris. On ICGA early to late hypofluorescent lesions corresponded to the hyporeflectivity on IR, consistent with altered reflectivity of the RPE. The SDI-OCT showed ellipsoid zone disruption as confirmed by FAF hyperautofluorescence. Some lesions showed a hypertransmission sign underneath the RPE, possibly due to changes in RPE intracellular melanin as suggested by NIRAF hypoautofluorescence.Conclusions: The MMI findings of MEWDS are secondary to RPE reflectivity changes, suggesting its pivotal role. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo assess inflammatory changes in the anterior vitreous (AV) using a swept source anterior segment optical coherence tomography (SS-ASOCT) and to correlate them with uveitis features and clinical grading of intraocular inflammation.140 eyes from 96 patients were included in this observational, cross-sectional study: 40 ACTIVE uveitis, 40 INACTIVE uveitis and 60 CONTROLS. All eyes underwent intraocular inflammation clinical grading (anterior chamber (AC) cells counting and vitreous haze evaluation) and AV imaging with SS-ASOCT. Cells seen in the AV on OCT were manually counted using imageJ. Vitreous reflectivity variation was indirectly measured by calculating the vitreous/iris pigment epithelium (VIT/IPE) relative intensity. These OCT-based parameters were compared across the groups and correlated with inflammation clinical grading.The mean [SD] number of AV OCT cells was significantly higher (both p < 0.001) in ACTIVE uveitis (12[9.8]) compared to INACTIVE uveitis (4.5[3.5]) and CONTROLS (4[3.1]). In ACTIVE uveitis the number of AV OCT cells was significantly and positively correlated with the AC cells (p = 0.04), the VIT/IPE relative intensity (p = 0.0002), the uveitis anatomical classification (INTERMEDIATE UVEITIS, p = 0.02) and the vitreous haze clinical grading (p < 0.0001). The mean[SD] VIT/IPE relative intensity of the AV increased from CONTROLS (0.12[0.01]) to INACTIVE uveitis (0.15[0.01]) to ACTIVE uveitis (0.17[0.02]), but with no statistically significant differences.We were able to visualize and objectively evaluate changes occurring in the AV in eyes with uveitis by means of a commercially available SS-ASOCT. OCT-cells in the AV could represent an adjunctive tool in the objective evaluation of intraocular inflammation. [ABSTRACT FROM AUTHOR]