Choriocapillaris Layer Research Articles

Evaluation of Retinal and Choroidal Microvascularity in Patients with Benign Essential Blepharospasm

Purpose To assess the retinal and choroidal microvascular changes in patients with benign essential blepharospasm (BEB) and to investigate the factors that may be effective on microvascularity. Methods This study included patients with BEB and healthy controls. All participants underwent a comprehensive examination followed by optical coherence tomography angiography (OCTA). Macular vascular perfusion density (VPD), foveal avascular zone (FAZ), and subfoveal choroidal thickness (CT) were measured. The clinical findings of the BEB group and the administration of botulinum toxin A (BTx-A) prior to OCTA imaging were recorded retrospectively from the medical records. Results A total of 16 patients with BEB and 20 healthy controls were included in this study. VPD values in all quadrants of the superficial and deep macular capillary plexus were significantly different in the BEB group compared to the control group (each p-value <0.05). In the choriocapillaris layer, VPD was significantly higher in the superior, nasal, and temporal quadrants compared to the control group (each p-value <0.05). The BEB group exhibited significantly smaller superficial and deep FAZ values compared to the control group, consistent with the observed increase in vascular density (each p-value <0.05). CT was thinner in the BEB group, although not statistically significant (p = 0.138). No correlation was found between the total dose of BTx-A administered to the BEB group and OCTA parameters (each p-value >0.05) Conclusion Benign essential blepharospasm may be associated with increased retinal vascular density in the superficial and deep capillary plexus and decreased FAZ area.

Optical coherence tomography angiography analysis of choriocapillaries in patients with diabetic macular edema versus diabetics without macular edema

Background Diabetic macular edema (DME) is a prevalent and potentially vision-threatening condition in individuals with diabetes mellitus (DM). Aim This study aimed to investigate the possible association between choriocapillaris (CC) and the incidence of DME using (OCTA) and elucidate any underlying processes by which CC could contribute to the development of DME. Patients and methods This research was conducted on 30 diabetic eyes with DME that no had therapy before, and 30 eyes without DME. The participants were over 18 years old and had clear media that allowed for accurate imaging. Results There was no significant difference in vascular density (VD) in the superficial capillary plexus (SCP) between both groups that were analyzed. VD in both the CC and deep capillary plexus (DCP) had a substantial decline. A direct relationship exists between VD and age in the SCP of the DME groups. A negative connection was observed between VD and uncorrected visual acuity in the DCME groups. A significant connection appeared between the duration of VD and DME in the diabetic patients without macular edema subgroup of the study. A negative association was seen between the length of DM and VD in SCP, as well as between uncorrected visual acuity and CC. Conclusion OCTA showed decrease in VD in DCP and CC layers in presence of DME and the lowering of VD was more in CC layer than DCP. Using OCTA helps in understanding micro vascular changes in DME.

Evaluating choroidal vascular changes in young adults with high myopia utilizing swept source optical coherence tomography angiography.

Utilizing Swept source optical coherence tomography angiography (SS-OCTA) investigates the changes in the vascular characteristics of the choriocapillaris and larger vascular layers, including Sattler's and Haller's layers, in the macular region of young myopia patients, in order to Enhance our comprehension of the underlying mechanisms of the pathogenesis of myopia. A retrospective analysis was performed on 103 young adults (154 eyes) that underwent SS-OCTA. Axial lengths (AL) were measured, 64 eyes with AL < 26.5 mm as non-high myopia (NHM) and 90 eyes with AL ≥ 26.5 mm as high myopia (HM). Macular superficial capillary plexuses (SCP), deep capillary plexuses (DCP), choriocapillaris (CC) density, choroidal Sattler's and Haller's layers (CSHL) density, foveal avascular zone area (FAZ area), and subfoveal choroidal thickness (SFCT) were assessed. Multivariate regression analysis was employed to assess the effect of age,spherical equivalent(SE), axial length(AL),and SFCT on OCTA parameters. SCP and DCP densities in the foveal retina of NHM group were significantly lower than those in HM group(SCP 20.09 ± 4.30 vs. 21.54 ± 4.52, p = 0.043;DCP14.73 ± 3.93 vs. 16.21 ± 4.07, p = 0.024). Also, CC density subfoveal was significantly lower in NHM group compared to HM group(55.02 ± 2.39 vs. 56.37 ± 2.76, p = 0.0001); CSHL density subfoveal and parafoveal temporal were also significantly lower in NHM than HM(subfoveal 55.78 ± 4.67 vs. 58.17 ± 4.41, p = 0.002;parafoveal temporal 52.10 ± 3.48 vs. 54.06 ± 4.12, p = 0.002). In the multiple linear regression analysis, density of SCP in the foveal retina was increased with higher myopia(sβ=0.226, p = 0.047)and decreased with aging(sβ=-0.304, p = 0.001). Moreover, gradual decrease of the DCP was observed with aging(sβ=-0.227, p = 0.004). CSHL density subfoveal increased with the increase in AL(sβ=0.318, p = 0.007). Age primarily influenced retinal vessel density, whereas axial length significantly affected Sattler's and Haller's layers. This also indicates that the subfoveal and parafoveal temporal CSHL densities are crucial for monitoring changes during myopia progression. Additionally, there appears to be a compensatory mechanism for high myopia to sustain visual function.

Detection of Retinal and Choriocapillaris Microvascular Changes in Retinal Vein Occlusion and Fellow Eyes by Optical Coherence Tomography Angiography: A Systematic Review and Meta-Analysis.

This study aims to summarize the retinal and choroidal microvascular features detected by optical coherence tomography angiography (OCTA) in the affected and fellow eyes of patients with retinal vein occlusion (RVO). A comprehensive search of the PubMed, Embase, and Ovid databases was conducted to identify studies comparing OCTA metrics among RVO, RVO-fellow, and control eyes. Outcomes of interest included parameters related to foveal avascular zone (FAZ) and fovea- and optic nerve head (ONH)-centered perfusion measurements of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris layer. Pooled results were presented as mean differences or standardized mean differences with 95% confidence intervals. Fifty-three studies, comprising 2119 RVO, 1393 fellow, and 1178 control eyes, were included in the quantitative meta-analysis. RVO eyes exhibited larger FAZ areas, increased FAZ acircularity, and reduced macular retinal and choriocapillaris perfusion compared to RVO-fellow and control eyes (P < 0.05). RVO eyes also demonstrated significantly lower perfusion density (PD) in the inside-disk and peripapillary regions of the radial peripapillary capillary layer (RPC), as well as lower retinal and choriocapillaris PD in the 4.5 × 4.5mm2 field of view (FOV) of ONH-centered scans (P < 0.05). RVO-fellow eyes showed decreased SCP-PD and DCP-PD in theparafoveal region and the 3 × 3mm2 FOV, reduced inside-disk and 4.5 × 4.5mm2 FOV RPC-PD (P < 0.05), and a diminished choriocapillaris flow area in the 3 × 3mm2 FOV (P < 0.05). Both RVO-affected and RVO-fellow eyes exhibited retinal and choriocapillaris microvascular impairment around the fovea and ONH. OCTA represents a promising tool for comprehensively assessing vascular alterations in RVO and providing evidence of fellow eye involvement.

Prevalence and associated factors of choroidal caverns in patients with type 2 diabetes mellitus.

To study the prevalence of choroidal caverns (CCs) in patients with type 2 diabetes (T2DM) and their association with demographic and clinical data. We included patients with T2DM and nondiabetic controls in a cross-sectional, monocenter study. The main outcome measure was the presence of CCs. Exploratory variables included age, sex, diabetic retinopathy (DR) status, duration of T2DM, visual acuity, arterial hypertension (aHT), hyperlipidemia, HbA1c, choroidal thickness (CT) and choroidal vascularity index (CVI). Group differences between eyes with and without CCs and associations with demographic and clinical variables were assessed. After including a total of 205 eyes of 116 patients, the prevalence of CCs was 25% in the control, 28% in the T2DM without DR and 9.5% in the DR groups. The locations of the caverns were: choriocapillaris (N=2, 4.2%), Sattler's (N=29, 60.4%) and Haller's layer (N=17, 35.4%). 34.3% of patients had caverns in both eyes. We found no significant differences in systemic conditions (including aHT, hyperlipidemia, HbA1c or T2DM disease duration). CVI was the only parameter independently associated with the presence of choroidal caverns (OR 1.37). We found choroidal caverns in almost a quarter of patients with and without T2DM. CCs were mainly located in the Sattler's layer. CVI was independently associated with the presence of CCs. These findings suggest that the presence of CCs may be a sign of a higher metabolic activity within the choroidal microenvironment, irrespective of T2DM status.

Changes in choroidal thickness and blood flow in response to form deprivation-induced myopia and repeated low-level red-light therapy in Guinea pigs.

To evaluate ocular refractive development, choroidal thickness (ChT) and changes in choroidal blood flow in form-deprived myopia (FDM) Guinea pigs treated with repeated low-level red-light (RLRL) therapy. Twenty-eight 3-week-old male tricolour Guinea pigs were randomised into three groups: normal controls (NC, n = 10), form-deprived (FD, n = 10) and red light treated with form-deprivation (RLFD, n = 8). Interocular refraction and axial length (AL) changes were monitored. Optical coherence tomography angiography (OCTA) measured choroidal thickness, vessel area density, vessel skeleton density and blood flow signal intensity (flux) in the choriocapillaris and medium-large vessel layers. The experimental intervention lasted 3 weeks. At week 3, the FD group had higher myopia and longer axial length than the NC group (all p < 0.001). The RLFD group had higher hyperopia and shorter axial length than the FD group (all p < 0.001). At week 1, the NC group had a thicker choroidal thickness than the FD group (p < 0.05). At weeks 2 and 3, the RLFD group had a thicker choroidal thickness than the FD group (p = 0.002, p < 0.001, respectively). Additionally, the NC group had higher vessel area density, vessel skeleton density and flux in the choriocapillaris layer than the FD group at the three follow-up time points (all p < 0.05). At week 3, the vessel skeleton density and flux were higher in the RLFD group than in the FD group (all p < 0.05). Correlation analysis results showed that weekly changes in refraction and choroidal thickness were negatively correlated with changes in axial length (all p < 0.05). Choroidal thickness changes were positively correlated with alterations in the vessel area density, vessel skeleton density and flux in the choriocapillaris layer, as well as vessel skeleton density and flux changes in the medium-large vessel layers (all p < 0.05). Repeated low-level red-light (RLRL) therapy retards FDM progression in Guinea pigs, potentially through increased choroidal blood flow in the choriocapillaris layer.

Myopic Maculopathy Stabilization in a Child with Progressive Complicated Myopia and Underlying Connective Tissue Dysplasia via Optical Therapy with HAL Spectacle Lenses Inducing Retinal Peripheral Defocus: Clinical Case

Background. Myopia is a serious medical and social problem specifically due to the high risk of such complications as cataracts, myopic maculopathy, glaucoma, and retinal detachment. Children with connective tissue dysplasia (CTD) syndrome are most subjected to myopia. Prevention of myopia progression in children remains the only effective way to prevent myopic maculopathy. Significant progress in this field has been achieved via optical technologies developed on the basis of peripheral defocus theory. Clinical case description. Patient, 10 years old, with CTD, mild myopia of both eyes with rapid progression, myopic maculopathy, grade 1. Ophthalmic status: spheroequivalent refraction — right eye (–)1.5 diopters / left eye (–)1.75 diopters; vision acuity with monocular correction — 1.0. Fundoscopy: optic disc is pale pink, with clear borders, arteries and veins are well-proportioned, their courses and calibers are intact; choriocapillary layer attenuation in the macular and paramacular zones, “parquet fundus”; areas of pigment redistribution on peripheral retina; no atrophic foci detected; anterior-posterior axis of the right and left eyes — 26.2 and 26.3 mm, respectively. Optical coherence tomography (OCT) has revealed retinal thinning in the upper and nasal sectors in the right eye during the first assessment. The left eye has demonstrated losses of retinal thickness within the middle parafoveal zone and significant thinning in the upper segment. Optical therapy with HAL spectacle lenses (inducing volumetric myopic peripheral defocus) was assigned to control myopia to slow down the pathological axial growth of the child's eyes and to stabilize refraction. 4 months of wearing glasses with HAL lenses has led to the stabilization of dystrophic changes in retina, signs of improvement in several sectors by were observed on OCT. No negative changes were revealed in all parafoveal segments of the left eye. The child was recommended to continue wearing glasses with HAL lenses with dynamic follow-up every 3 months. Conclusion. CTD in children is associated with high risk of complications in case of myopia progression, moreover, retinal pathology can occur even with mild myopia. Optical therapy with HAL spectacle lenses is effective and safe first treatment of choice in the control of myopia in children with CTD, and opens new opportunities in prevention of progressive myopia disabling complications in children, whose treatment results were not previously sufficient.

Assessment of Changes in Vascular Density in the Layers of the Eye in Patients With Parkinson's Disease.

The retina is affected by Parkinson's disease (PD). We aimed to assess the anatomical and vascular deterioration of the retina in PD. Sixty-six patients with PD and 66 healthy volunteers were evaluated in this study. Choriocapillaris vessel density (CCVD), superficial vascular density (SVD), deep vascular densities (DVD), central macular thickness (CMT), retinal nerve fibre layer (RNFL), ganglionic cell layer (GCL), and choroidal thickness (CT) were assessed. RNFL, GCL, CMT, and CT were thinner than in HC, and also the differences between the groups were statistically significant (P < .05). SVD and DVD were not statistically different between the groups (P > .05). There was a decrease in vascular density in all quadrants of the choriocapillary layer. The decrease in vascular density was statistically significant in the nasal, inferior and central quadrants (P < .05). These results supported vascular thinning in the choroidal layer. Also showed that vascular and neural layers were affected together. It could help clinicians in the follow-up of Parkinson's patients.

Non-endothelial expression of endomucin in the mouse and human choroid

Endomucin (EMCN) is a 261 amino acid transmembrane glycoprotein that is highly expressed by venous and capillary endothelial cells where it plays a role in VEGF-mediated angiogenesis and regulation of immune cell recruitment. However, it is better known as a histological marker, where it has become widespread due to the commercial availability of high-quality antibodies that work under a wide range of conditions and in many tissues. The specificity of EMCN staining has been well-validated in retinal vessels, but while it has been used extensively as a marker in other tissues of the eye, including the choroid, the pattern of expression has not been described in detail. Here, in addition to endothelial expression in the choriocapillaris and deeper vascular layers, we characterize a population of EMCN-positive perivascular cells in the mouse choroid that did not co-localize with cells expressing other endothelial markers such as PECAM1 or PODXL. To confirm that these cells represented a new population of EMCN-expressing stromal cells, we then performed single cell RNA sequencing in choroids from adult wild-type mice. Analysis of this new dataset confirmed that, in addition to endothelial cells, Emcn mRNA expression was present in choroidal pericytes and a subset of fibroblasts, but not vascular smooth muscle cells. Besides Emcn, no known endothelial gene expression was detected in these cell populations, confirming that they did not represent endothelial-stromal doublets, a common technical artifact in single cell RNA seq datasets. Instead, choroidal Emcn-expressing fibroblasts exhibited high levels of chemokine and interferon signaling genes, while Emcn-negative fibroblasts were enriched in genes encoding extracellular matrix proteins. Emcn expressing fibroblasts were also detected in published datasets from mouse brain and human choroid, suggesting that stromal Emcn expression was not unique to the choroid and was evolutionarily conserved. Together, these findings highlight unique fibroblast and pericyte populations in the choroid and provide new context for the role of EMCN in the eye.

Hyperreflective choroidal foci in diabetic eyes with and without macular edema: Novel insights on diabetic choroidopathy

Histopathologic studies of diabetic choroid suggest that diabetic choroidopathy is a key aspect secondary to diabetes. Recently, hyperreflective choroidal foci (HCF) have been introduced as novel optical coherence tomography (OCT) parameter. The aim of this study was to identify and quantify HCF in diabetic subjects with retinopathy, with or without diabetic macular edema (DME). Eighty-five diabetic subjects with different degrees of DR were enrolled: 37 without DME and 48 with DME. All subjects underwent full ophthalmologic examination including spectral domain optical coherence tomography (OCT). OCT images were analyzed to quantify and localize HCF. Each image was analyzed by two independent, masked examiners. OCT images showed that all subjects (100%) had HCF in the different layers of the choroid. The number of HCF was significantly higher in diabetics with DME versus those without DME (p < 0.0001). HCF showed variable size, shape and location inside the choroid. They were mainly located in choriocapillaris and Sattler's layer, on the edges of blood vessels. The intraobserver and interobserver agreement was almost perfect (ICC >0.9). This study suggests that hyperreflective foci in the choroid of subjects with DR may be accurately identified with structural OCT. Their number significantly increases with the progression of DME. These HCF may represent, as in the retina, a sign of infiltration of inflammatory cells (mainly migrating microglia) into the choroid, according to the hypothesis raised by Jerry Lutty. HCF may confirm in vivo the histopathologic findings suggesting that diabetic choroidopathy may be primarily a neuroinflammatory disorder.

Quantitative optical coherence tomography angiography assessments in the fellow eyes of those with central serous chorioretinopathy

BackgroundTo analyze the vessel density (VD) of the retina and choriocapillaris (CC) layer and the structure of the foveal avascular zone (FAZ) in the fellow eyes of central serous chorioretinopathy (CSC) patients by using optical coherence tomography angiography (OCTA).MethodsThis was a case–control study. Unilateral CSC patients and age-matched healthy subjects were recruited from the Affiliated Eye Hospital of Wenzhou Medical University between July 2016 and July 2021. All eyes were divided into three groups: acute CSC (aCSC), chronic CSC (cCSC), and healthy controls. Both aCSC and cCSC were again divided into two subgroups: the affected eyes and the fellow eyes. In this study, all parameters of VD and FAZ were measured by self-software of OCTA.ResultsA total of 231 eyes of 137 subjects were included, with 47 aCSC patients, 47 cCSC patients, and 43 healthy controls. In the fellow eyes of CSC, the retinal VD was significantly lower (all P < 0.05), and the FAZ was significantly larger (all P < 0.05) in the cCSC group than in healthy controls, while no difference was detected in the CC layer. There was no significant difference between the aCSC group and healthy controls in all OCTA parameters. In the affected eyes of CSC, the superficial retinal vessel density (SRVD) was significantly higher (all P < 0.05) in healthy controls than in the aCSC and cCSC groups, while the deep retinal vessel density (DRVD) was significantly lower (all P < 0.05) and the FAZ was larger (all P < 0.05) in the cCSC group than in the aCSC group and healthy controls. A liner regression equation was established: Y (BCVA, best corrected visual acuity) = 3.692–0.036✱X1 (DRVD-Fovea)-0.031✱X2 (FD-300, vessel density around the 300 μm width of the FAZ), R2 = 0.427.ConclusionBased on OCTA measurements, this study revealed that the retinal microvascular network was impaired even in the fellow eyes of those with cCSC, which should arouse attention to the observation of unilateral CSC.

Chorio-retinal vessel density in women affected by functional hypothalamic amenorrhea: a monocentric observational cross-sectional study to evaluate the impact of hypoestrogenism on chorio-retinal vascularization

PurposeFunctional hypothalamic amenorrhea (FHA) is characterized by an estrogen deficiency which in turn can cause vascular dysfunction. The aim of this study is to evaluate any changes in the chorio-retinal circulation in patients affected by FHA. 24 patients with FHA and 24 age-matched controls underwent a gynecological evaluation and an OCT angiography (OCTA) to study chorio-retinal vascularization.ResultsOCTA in FHA patients showed an increase in vessel density in the choriocapillaris (CC) layer (both in the fovea area, at 5% p value = 0.037 and in the whole area, at 5% p value = 0.028) and an increase in vascular density in the deep fovea (DVP) (at 10% p value = 0.096) in the whole district compared to controls. Simple linear regressions show a significant negative association between CC vessel density and insulin (p = 0.0002) and glucose values (p = 0.0335) for the fovea district and a negative association between DVP vessel density and endometrial thickness (at 10%, p value: 0.095) in the whole district.ConclusionOur study shows that CC vessel density is increased in women affected by FHA. This could represent a compensation effort to supply the vascular dysfunction caused by estrogen deficiency. We also found an increasing trend in vascular density in DVP associated with the decrease of endometrial thickness, an indirect sign of estrogenization. Considering that these changes occur in absence of visual defects, they could be used as a biomarker to estimate hypoestrogenism-induced microcirculation changes before clinical appearance.

Multimodal Imaging Characteristics and Diagnostic Value of Choroidal Nodules in Patients with Neurofibromatosis Type 1.

Yasunari nodules are choroidal lesions observed in patients diagnosed with neurofibromatosis type 1 (NF-1) and characterized by relatively irregular dome-shaped, plaque-like, or patchy boundaries. The present study examines the multimodal imaging characteristics of Yasunari nodules and their value in the diagnosis of NF-1. Medical records including optical coherence tomography (OCT), enhanced depth imaging OCT, infrared reflectance (IR) imaging, OCT angiography, and color fundus images of NF-1 patients who were examined at the Department of Ophthalmology in Dokuz Eylül University Faculty of Medicine between January 2022 and December 2023 were retrospectively reviewed for the presence of Yasunari nodules. A total of 54 eyes of 27 patients were included in the study. At least one choroidal nodule was detected on IR imaging in 52 eyes (96.3%). In 31 (72.1%) of the 43 eyes (79.6%) with available high-quality OCT angiography images, choroidal nodules were observed as areas showing a flow deficit in the choriocapillaris layer. Of the total 54 eyes included, Lisch nodules without choroidal nodules were observed in 2 eyes (3.7%). In 16 eyes (29.6%), Lisch nodules were not detected despite the presence of choroidal nodules. Both Lisch nodules and choroidal nodules were detected in the other 36 eyes (66.7%). Yasunari nodules are frequently observed in NF-1 cases and can be easily detected with multimodal imaging techniques, especially IR imaging. The ability to visualize choroidal nodules before the appearance of Lisch nodules demonstrates the importance of Yasunari nodules in the diagnosis of NF-1.

Microstructural changes in the retina in children with retinopathy of prematurity according to optical coherence tomography. Literature review

Retinopathy of prematurity (ROP) is a crucial problem in modern ophthalmology. ROP is a vasoproliferative disease of the eyes in premature infants. Approximately 50,000 children worldwide have become blind because of ROP. The determining indicator in the development of visual acuity is the morphofunctional state of the macula, structural changes of which can lead to disturbances in its functions and, consequently, decreased vision. The present review analyzed available OCT (optical coherence tomography) data on the morphometric and structural state of the retina in children with ROP. Morphometric features of the macular zone in children in the scar period of ROP can be presented by an increase in retinal thickness in the center of the fovea and changes in the profile of the macula by smoothness or absence of foveal depression. These are more pronounced in children after laser coagulation of the retina in the active phase of ROP and in very premature babies. In some cases with increased retinal thickness in the center of the fovea, the presence of internal layers and an increase in the thickness of the outer nuclear layer are noted. Structural features of the macula with favorable outcomes of RP can be expressed by traction displacement of the foveola, photoreceptor layer thinning and pigment epithelium unevenness, intra and epiretinal fibrosis, choriocapillaris layer atrophy, discontinuity of the connection of the outer and internal segments of the photoreceptors and the pigment epithelium–choriocapillaris complex, and central retinoschisis. Furthermore, this review presents mixed results from studies on the impact of structural changes in the macula in cicatricial ROP on visual function.

Torpedo Maculopathy: Case Series of an Underdiagnosed and Rare Condition Using Multimodal Imaging.

Background: Torpedo maculopathy is a rare benign congenital anomaly of the retinal pigment epithelium (RPE) mostly asymptomatic throughout life. The clinical presentation is very typical displaying an ovoid cleft of the RPE typically located in the temporal zone of the macula. Despite this pathognomonic feature, patients are often referred to retina clinics for secondary opinions. The aim of this case series is to raise awareness of this rare condition among ophthalmologists and to explore the added value of multimodal imaging, in particular OCT angiography (OCTA), to increase its identification. History and Signs: 5 patients between 11 and 73 years-old were referred in our institution for further evaluation of an unilateral yellowish hypopigmented torpedo-shaped flat lesion in the temporal sector of the macula. Lesions varied in size and distance from the fovea. 3 patients were asymptomatic and 2 patients complained of decreased vision. Of these two, only one had a decrease in visual acuity in the affected eye as measured at the consultation. Therapy and Outcome: Spectral domain OCT (SD-OCT) revealed in all cases a thinned RPE combined with hyper-reflectivity of the adjacent choroid on the ovoid lesion while the foveal region remained normal. Infrared Reflectance showed a heterogeneous hyperreflective area deliminated with a hyporeflective ring. On fundus blue light autofluorescence (FAF) exam, the lesions appeared hypoautofluorescent with a hyperautofluorescent perimeter. In all cases, OCTA of torpedo lesions identified choriocapillary remodeling with different phenotypes reflecting a possible disappearance of the choriocapillary layer with window effect. The superficial and deep capillary plexus layers (SCP and DCP) were in most cases comparable to the adjacent retina, and no differences were found in the quantitative analysis of SCP and DCP vascular density measured in each eye. Conclusion: Torpedo maculopathy is a rare well described clinical condition that displays pathognomonic features on regular fundoscopy examination. Our case series showed that the use of multimodal imaging, including SD-OCT, FAF and OCTA, seems to be of little value in increasing its recognition thus confirming the importance of its typical clinical appearance among ophthalmologists. Interestingly, SD-OCT and OCTA demonstrated no abnormalities of the adjacent macula of the affected eye, which seems to confirm its isolated local unilateral ophthalmic condition.

Chorioretinal biomarkers in hypothalamic amenorrhea

PurposeThe aim of our study was to evaluate changes in the retinal and choriocapillaris circulations in patients with hypothalamic amenorrhea.MethodsProspective, cross-sectional observational study on 25 patients (50 eyes) diagnosed with hypothalamic amenorrhea and 25 age-matched healthy women. Optical coherence tomography angiography (OCTA) was used to evaluate the vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris VD layers in whole 6.4 × 6.4-mm image and in fovea grid-based image. In patients’ group, systemic parameters were collected: body mass index (BMI), endometrial rhyme thickness, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, insulin, and cortisol.ResultsSCP and DCP did not show any statistical difference when comparing patients and controls (all p > 0.05). Differently, choriocapillaris VD in the whole region showed a non-significant tendency toward higher values in the patients group in both eyes (p = 0.038 for right eye [RE], p = 0.044 for left eye [LE]). Foveal choriocapillaris VD was higher in hypothalamic amenorrhea women vs. healthy controls (66.0 ± 2.4 vs. 63.7 ± 6.6%, p = 0.136 for RE; 65.0 ± 2.4 vs. 61.6 ± 7.0%, p = 0.005 for LE). Focusing on correlation with systemic parameters, SCP and DCP foveal density had a medium/high effect size with endometrial rhyme, along with DCP in the fovea area vs. cortisol and SCP in the whole area vs. FSH.ConclusionWhen comparing hypothalamic amenorrhea patients to healthy subjects, OCTA detected changes in the choriocapillaris layer, showing increased VD in the early stage of the systemic pathology, suggesting that microvascular “compaction” could be a first phase of hypoestrogenism adaptation.

Repeatability of swept-source optical coherence tomography angiography automated macular vessel density.

Optical Coherence Tomography Angiography Ratio Analysis (OCTARA) is capable of visualizing inner and outer retinal vascular plexuses, choriocapillaris, and larger choroidal vasculature in vivo without contrast injection. The aim of this study was to assess the intrasession repeatability of automated vessel density measurements using Triton Swept-Source Optical Coherence Tomography Angiography (OCTA) innovative algorithm OCTARA in retinal and choroidal vasculature. To study population between 65-90 years old with no eye diseases. For each subject measurements were performed four times. The intraclass correlation coefficient and the coefficient of variation were calculated to analyze repeatability of the OCTARA automatically generated vessel density measurements. A total of 35 eyes were included in the study. The intraclass correlation coefficient of the global vessel density in the superficial capillary plexus and the deep capillary plexus were 0.963 and 0.975, respectively, and the coefficient of variation were 5.4% and 4.4%, respectively. The intraclass correlation coefficient of the rest of the global measurements was indicative of good reliability with the exception of the deep choroid layer with an intraclass correlation coefficient of 0.6 indicative of moderate reliability. Our results proved excellent repeatability of automated vessel density measurements in the superficial and deep capillary plexus layers in our cohort using a OCTARA algorithm indicating that it may be a reliable diagnostic tool. It also showed good reliability in choriocapillary and mid choroid layer. These findings may be of value in assessing the significance of differences in capillary density measurements over time and across different settings.

Vessel density on optical coherence tomography angiography is prognostic for future disease course in intermediate uveitis.

As most rare diseases, intermediate uveitis lacks reliable endpoints necessary for randomized clinical trials. Therefore, we investigated longitudinal changes of retinal and choriocapillaris perfusion on optical coherence tomography angiography (OCT-A) in intermediate uveitis and their prognostic value for future best corrected visual acuity (BCVA) and central retinal thickness (CRT). In this retrospective, longitudinal cohort study eyes of patients with intermediate uveitis were imaged by swept-source OCT-A (macula-centered 3 × 3mm; PLEX Elite 9000, Zeiss) and stratified into clinically stable, worsened and improved based on changes in clinical parameters. Superficial (SRL) and deep retinal layers (DRL) were automatically analyzed for vessel density (VD) and choriocapillaris layer for non-perfused area (CCNPA) using ImageJ. Mixed-effects regression analysis controlling for age, sex, and OCT-A signal strength index (SSI) was used to evaluate the prognostic value of OCT-A parameters. 91 eyes (62 stable, 12 worsened, and 17 improved) were included in the analysis and mean follow-up time was 296 days. Longitudinal changes of VD were different between all three groups (p = 0.002 for SRL and p = 0.017 for DRL). Clinically worsened eyes showed a decrease in VD (- 0.032 ± 0.055 for SRL and - 0.027 ± 0.025 for DRL), whereas clinically improved eyes showed an increase in VD (0.037 ± 0.039 for SRL and 0.001 ± 0.023 for DRL). No difference was found for CCNPA. When controlling for age, sex, and SSI, observed differences held true in clinically worsened eyes for DRL (p = 0.011) and in clinically improved eyes for SRL (p = 0.002). An increase of CCNPA in clinically worsened eyes (p = 0.03) compared to clinically stable and improved eyes was evident. Predictive analysis revealed an association of VD in SRL and DRL at baseline with BCVA at follow-up (p = 0.039 and p = 0.047, respectively) and of VD in SRL at baseline with CRT at follow-up (p = 0.046). Alterations in retinal perfusion on OCT-A in intermediate uveitis are partly reversible and OCT-A VD may serve to predict future BCVA and CRT. Thus, perfusion parameters on OCT-A might aid monitoring and serve as prognostic imaging-biomarker.

Choriocapillaris, photoreceptor and inner retinal layers in spatial relationship to parapapillary alpha, beta, gamma and delta zone

Aims/Purpose: To examine the spatial relationships between the choriocapillaris, retinal layers and retinal pigment epithelium (RPE) in the parapapillary region.Methods: Human eyes enucleated due to uveal melanomas or secondary angle‐closure glaucoma were histomorphometrically examined.Results: The investigation consisted of 100 globes. In non‐highly myopic non‐glaucomatous eyes, the photoreceptor layer, choriocapillaris and retinal inner nuclear layer (INL) ended approximately at the end of the RPE layer, with no significant (all p ≥ 0.10) difference between the layers. In the non‐highly myopic, glaucomatous eyes and the highly myopic eyes, the photoreceptor layer, choriocapillaris and inner nuclear layer ended in the majority of eyes beyond the RPE‐end in direction to the optic disc border, with the INL extending beyond the RPE‐end significantly more than the photoreceptor layer (non‐highly myopic non‐glaucomatous group: 133 ± 183 μm versus 66.5 ± 96.8 μm; p = 0.001; highly myopic glaucomatous eyes: (266 ± 395 μm vs. 211 ± 286 μm; p = 0.03). A larger extension of the photoreceptor layer, choriocapillaris and INL beyond the RPE‐end correlated with longer axial length (beta: 0.50; B: 32.2; 95% CI: 21.6, 42.8) and wider beta zone (beta: 0.28; B: 0.10; 95% CI: 0.04, 0.16), with longer axial length (beta: 0.24; B: 23.0; 95% CI: 1.6, 44.5) and longer beta zone (beta: 0.59; B: 0.32; 95% CI: 0.22, 0.41; p &lt; 0.001), and with longer axial length (beta: 0.34; B: 43.7; 95% CI: 11.6, 75.7), longer gamma zone (beta: 0.52; B: 0.28; 5% CI: 0.15, 0.41) and diagnosis of non‐highly myopic glaucoma (beta: 0.28; B: 267; 95% CI: 80.8, 454), respectively.Conclusions: Non‐glaucomatous non‐highly myopic eyes differ from highly myopic eyes and glaucomatous eyes in the spatial relationship of the parapapillary tissue layers. The findings support the notion of an axial elongation‐associated shifting of the parapapillary RPE and Bruch's membrane for development of myopic beta zone, and an RPE‐cell loss for development of glaucomatous beta zone.

Association between functional parameter and structural, and vascular parameters in advanced glaucoma

Aims/Purpose: We aimed to evaluate the function‐vasculature, and function–structure relationships in advanced glaucoma patients.Methods: This cross‐sectional study included 29 eyes of 24 advanced glaucoma patients. Advanced glaucoma was classified as visual fields (VFs) with a mean deviation (MD) below ‐12 dB according to Hodapp‐Parrish‐Anderson classification system. The structural parameters, cup/disc area ratio, cup/disc vertical ratio, cup/disc horizontal ratio, rim area, disc area, cup volume, retinal nerve fibre layer thickness, macular ganglion cell complex (GCC) thickness, were measured using optical coherence tomography (OCT, Optovue, Fremont, CA). The vessel density of superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), outer retina (OR), and choriocapillaris (CC) were analysed by optical coherence tomography angiography (OCTA, DRI OCT Triton Plus, Topcon, Tokyo, Japan). For all layers, the average vessel density of the area between 1 mm and 3 mm diameter circles was calculated, assuming the 1 mm diameter area centered on the fovea as the central region. Relationships between 10–2 VF MD values, and structural and vascular parameters were assessed by Pearson's correlation coefficients. p &lt; 0.05 was considered statistically significant.Results: The mean ± SD age of all patients was 61.9 ± 15.8 years and 75% were male. For structural parameters, there was a positive correlation between the MD and GCC thickness values (p = 0.001, r = 0.617), while none of the parameters of the optic disc were related to the MD value. There were significant positive correlations with the vessel densities of the SRCP and CC layers (p = 0.001, r = 0.593 and p = 0.002, r = 0.541, respectively).Conclusions: Decreased vessel densities of the SRCP and CC were significantly associated with severity of visual field damage. This study showed that OCTA can be a promising method in daily use for monitoring advanced glaucoma.