Enhanced Depth Imaging Spectral-domain Optical Coherence Tomography Research Articles

Macular choroidal thickness, volume, and vascularity index in patients with systemic sclerosis.

The aim of this study was to investigate choroidal parameters in patients with systemic sclerosis (SSc) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT) and to determine their relationships with clinical variables and ocular features. Thirty-three patients with SSc and 40 controls were enrolled. The groups did not differ with regard to age, sex, and axial length. The mean choroidal thickness and volume were obtained in each conventional Early Treatment of Diabetic Retinopathy Study grid subfield. The choroidal vascularity index (CVI), which provides a quantitative analysis of vasculature by calculating the proportion of the luminal area (LA) to the total choroidal area (TCA), was determined. Lower choroidal thickness and volume were observed in the SSc group. The CVI was significantly higher in SSc patients, whereas the TCA, LA, and stromal area were significantly lower in the SSc group; however, the significant difference of the stromal component was more pronounced than that of the luminal component. Regression analyses did not identify any clinical factors associated with the CVI (except Ca-blocker use), central macular thickness, or volume. No significant differences in choroidal parameters were found within the SSc subtypes (diffuse cutaneous systemic sclerosis (dcSSc) vs. limited cutaneous systemic sclerosis (lcSSc)), or between eyes stratified according to SSc pattern (early, active, or late) using nailfold capillaroscopy (p > 0.05 for all). Our results, with notably higher CVI values, may shed new light on choroidal impairment in patients with SSc. Stromal involvement appeared to dominate the vascular component.

An Update on Multimodal Ophthalmological Imaging of Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome.

Sturge-Weber syndrome (SWS) is characterized by facial port-wine stains, leptomeningeal hemangiomas, and prominent ocular manifestations such as glaucoma and diffuse choroidal hemangiomas (DCHs). Imaging modalities are critical for diagnosing and longitudinally monitoring DCHs in SWS. Fundus photography is fundamental in assessing both eyes simultaneously, fluorescein angiography and indocyanine green angiography effectively map the retinal and choroidal circulation, and ultrasonography offers essential structural insights into the choroid and retina. NIR imaging reveals subtle retinal pigment changes, often overlooked in standard fundus examination. Enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT) and swept-source OCT (SSOCT) improve the visualization of the choroidal-scleral boundary, essential for DCH characterization. The potential of OCT angiography (OCTA) is under exploration, particularly its role in predicting signs of disease progression or worsening, as well as potential new biomarkers such as the choroidal vascularity index (CVI). The present review aims to provide an update on multimodal imaging of DCHs in SWS.

Tamoxifen related chorioretinal structural changes

Purpose To evaluate the vascular structure of the choroid and each retinal layer in patients with breast cancer on tamoxifen therapy and compare them with healthy subjects. Materials and Methods 124 eyes of 62 patients with breast cancer who were on tamoxifen therapy (group 1) and 80 eyes of 40 healthy controls (group 2) were included in this prospective cohort study. The structure of the choroid was evaluated using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and choroidal binarisation. Spectral-domain OCT (SD-OCT) was performed to analyse the peripapillary nerve fibre layer thickness (pRNFL) and each retinal layer thickness. A subgroup analysis was performed based on chemotherapy history in Group 1. All parameters were compared between Group 1 and the healthy controls and between the subgroups of Group 1. Results The subfoveal choroidal thickness and temporal and nasal directions were increased in Group 1 when compared with Group 2 (p < 0.05, each comparison). Choroidal vascularity index was significantly decreased in Group 1 compared with Group 2 (63.15 ± 3.11% and 65.37 ± 4.63%, p < 0.001). There were no significant differences in each retinal layer, pRNFL thickness, and choroid structural parameters between the subgroups of Group 1. Conclusions Increased choroidal thickness may be the initial finding of subclinical tamoxifen-induced retinopathy. Patients with breast cancer undergoing tamoxifen therapy may be screened prior to tamoxifen therapy and followed during treatment by SD-OCT.

Optical coherence tomography enhanced depth imaging of chorioretinal folds in patients with orbital tumors.

To characterize spectral-domain optical coherence tomography (SD-OCT) features of chorioretinal folds in orbital mass imaged using enhanced depth imaging (EDI). Prospective observational case-control study was conducted in 20 eyes of 20 patients, the uninvolved eye served as a control. All the patients underwent clinical fundus photography, computed tomography, EDI SD-OCT imaging before and after surgery. Two patients with cavernous hemangiomas underwent intratumoral injection of bleomycin A5; the remaining patients underwent tumor excision. Patients were followed 1 to 14mo following surgery (average follow up, 5.8mo). Visual acuity prior to surgery ranged from 20/20 to 20/200. Following surgery, 5 patients' visual acuity remained unchanged while the remaining 15 patients had a mean letter improvement of 10 (range 4 to 26 letters). Photoreceptor inner/outer segment defects were found in 10 of 15 patients prior to surgery. Following surgical excision, photoreceptor inner/outer segment defects fully resolved in 8 of these 10 patients. Persistence of photoreceptor inner/outer segment defects caused by compression of the globe by an orbital mass can be associated with reduced visual prognosis. Our findings suggest that photoreceptor inner/outer segment defects on EDI SD-OCT could be an indicator for immediate surgical excision of an orbital mass causing choroidal compression.

Cortisol awake response imbalance as an indicator of acute central serous chorioretinopathy: Relationship with choriocapillaris and choroidal features.

The purpose of the present study was to measure in central serous chorioretinopathy (CSC) the salivary cortisol awake response (CAR) delta percentage (Δ%) variation, a distinct and robust indicator of cortisol rhythm during wakefulness, commonly proposed as a marker of hypothalamic-pituitary adrenal (HPA) axis activity, whose alteration is frequently associated with several adverse health outcomes. In the present cross-sectional observational study, salivary CAR Δ% variation was assessed in 17 adult male subjects affected by acute naïve CSC and compared to 17 matched healthy controls. Choroid vasculature metrics were assessed in the study population by measuring the subfoveal choroidal thickness (FCT) and the choroidal vascularity index (CVI) by the imaging technique of enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Furthermore, flow signal void area features of the choriocapillaris were evaluated in the study population using OCT angiography (OCTA). Both the control and CSC groups showed a physiological cortisol increase that occurred during the first 30 min after awaking. However, CSC adult male patients showed remarkably blunted CAR Δ% variation in comparison with controls, which might reflect a CSC-related imbalance of HPA axis activity. Statistically significant correlations were shown by Pearson's correlation test between salivary CAR Δ% and the selected choroidal and choriocapillaris imaging biomarkers (FCT, CVI, and flow signal void area) in the study population. In conclusion, alterations of the CAR Δ% increase, associated with choroidal-retinal metrics, might provide a window into the physiopathology of acute CSC, suggesting a possible common factor to explain the association between stress and CSC.

Effect of nasal septum deviation on choroidal thickness

Objectives: This study aimed to investigate the choroidal thickness in patients with nasal septum deviation using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). Patients and Methods: The prospective case-control study included 106 eyes of 53 patients (29 males, 24 females; mean age: 31.2±10.6 years; range, 18 to 50 years) who were detected to have nasal septum deviation by anterior rhinoscopy and nasal endoscopy between April 2020 and July 2020. Seventy-two eyes of 36 healthy participants (20 males, 16 females; mean age: 28.3±10.1 years; range, 18 to 50 years) were included in the control group. The degree of deviation of patients with septum deviation was graded with the nasal obstruction symptom evaluation (NOSE) scale. Choroidal thickness measurements were performed at subfoveal, temporal, and nasal regions using the EDI-OCT and compared in patients with and without deviation. In addition, the relationship between the severity of septal deviation and choroidal thickness measurements was examined. Results: The mean subfoveal, nasal, and temporal choroidal thicknesses in the nasal septum deviation group were 361.0±99.4 μm, 334.5±101.1 μm, and 349.7±93.6 μm, respectively. The mean subfoveal, nasal, and temporal choroidal thicknesses in the control group were 381.2±75.5 μm, 345.5±72.8 μm, and 368.6±79.2 μm, respectively. There was no significant difference in choroidal thickness measurements between the groups (p&gt;0.05). However, it was observed that choroidal thickness decreased as the NOSE scale grade increased (p&lt;0.05). Conclusion: This study shows that choroidal thickness measurements are similar between patients with nasal septal deviation and healthy participants and demonstrates a negative correlation between the severity of septum deviation and choroidal thickness.

Choroidal Thickness in Different Patterns of Diabetic Macular Edema.

This observational study investigated the changes in choroidal thickness (ChT) in different patterns of diabetic macular edema (DME) based on image processing using enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Participants with ocular conditions affecting the fundus view, including retinal diseases, were excluded. After observing the patient’s medical record, multicolor fundus photos, thickness maps, and subtypes of DME were diagnosed according to the criteria reported by the Early Treatment Diabetic Retinopathy Study (ETDRS). Edema was classified as focal or diffuse and was subdivided into cystic macular edema (CME), CME with subretinal fluid (CME+), and spongy macular edema (SME). Image processing was performed on the B-scan images from SD-OCT to segment the choroid layer and obtain the choroid thickness. A total of 159 eyes of 81 patients (46 males and 35 females; 57.53 ± 9.78 years of age), and 57 eyes of 30 healthy individuals (age 57.34 ± 8.76 years) were enrolled in this study. Out of 159 eyes, 76 had focal macular edema (FME), 13 exhibited SME, and 51 presented CME. Among those with cystic macular edema, 19 eyes showed subretinal fluid (CME+). The average choroidal thickness in FME, diffuse SME, CME, and CME+ was 216.95 ± 52.94 µm, 243.00 ± 46.34 µm, 221.38 ± 60.78 µm, and 249.63 ± 53.90 µm, respectively. The average choroidal thickness in age-matched controls was 213.88 ± 45.60 µm. Choroidal thickness increases with the severity of edema; choroidal thickness was higher in diffuse macular edema than in FME. However, choroidal thickness increased in cystic macular edema with subretinal fluid (CME+).

Choroidal Thickness in Emmetropia: An Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography-Based Study.

Objectives:To investigate and determine the choroidal thickness (CT) in healthy emmetropic Turkish subjects aged between 20 and 40 years using Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography (EDI-OCT).Methods:This study included 194 eyes of 194 healthy emmetropic subjects. All participants underwent a detailed ophthalmologic examination. Axial length (AL) was measured with optical biometry. CT measurements were performed at subfoveal, 1.0 mm temporal, and 1.0 mm nasal using the EDI-OCT. Central macular thickness (CMT) measurements were also performed at the same time. Participants were divided into two groups; Group 1 (age between 20 and 30 years) and Group 2 (age between 31 and 40 years). CT and CMT were compared among two groups.Results:The mean age of all the subjects was 26.61±6.08 years, the mean AL was 23.44±0.72 mm, and the mean spherical equivalent was −0.11±0.28 Diopter. The mean subfoveal, nasal, and temporal CT was 389.27±86.61 μm, 354.54±86.86 μm, and 368.25±78.69 μm, respectively. Subfoveal and nasal CT of female participants were found thinner than male participants (p=0.013 and p=0.008, respectively). CT and CMT were found similar between Group 1 and Group 2.Conclusion:This study showed that mean subfoveal CT and CMT was 389.27±86.61μm and 268.17±18.76 μm, respectively, among healthy emmetropic Turkish subjects. Females had thinner CT in subfoveal and nasal quadrants. In addition, age did not affect CT between 20 and 40 years.

Relationship of Choroidal Vasculature and Choriocapillaris Flow With Alterations of Salivary α-Amylase Patterns in Central Serous Chorioretinopathy.

PurposeAn abnormality in choroidal vasculature is a known factor in the pathogenesis of central serous chorioretinopathy (CSC), a chorioretinal disease affecting mostly middle-aged males. The purpose of the present study was to investigate the role of the autonomic nervous system (ANS) in the pathophysiology of CSC.MethodsThis was a cross-sectional observational study in which characteristic choroidal vasculature metrics were assessed by measuring the subfoveal choroidal thickness (FCT) and the choroidal vascularity index (CVI) using the imaging technique of enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Furthermore, flow signal void area features were also evaluated in the study population using OCT angiography (OCTA). Diurnal patterns of salivary α-amylase (a-AMY) production, proposed as a marker of autonomic activity, were assessed in an adult male study population affected by acute naïve CSC in comparison with matched healthy controls.ResultsResults include an overall higher diurnal output of salivary a-AMY production, which is in line with the phenomenon of a sympathetic “drive” playing a role in the pathophysiology of CSC, and a flattened diurnal percentage variation in α-AMY in CSC-affected subjects. Furthermore, Pearson's coefficient test revealed statistically significant correlations between salivary α-AMY diurnal percentage variation and selected choroidal imaging biomarkers (FCT, CVI, and flow signal void area). Finally, multiple linear regression analysis identified salivary α-AMY diurnal percentage production as the sole predictor of the CVI and flow signal void area in the study population.ConclusionsAutonomic nervous system dysregulation was highlighted in CSC patients.

Peripapillary choroidal thickness assessed by spectral-domain optical coherence tomography in normal Japanese.

To investigate peripapillary choroidal thickness (PPCT) in normal Japanese subjects by using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) technique and evaluate its association with ocular and systemic factors. Cross-sectional study. This study included 85 eyes of 85 normal Japanese subjects. Normal subjects were defined as those without retinal and optic nerve disorders of any kind. The PPCT was measured at the location of 3.4mm diameter peripapillary circle centered on the optic nerve head. It was measured as the distance between the retinal pigment epithelium and scleral-choroidal interface at the following six sectors; temporal, supra-temporal, supra-nasal, nasal, infero-nasal, and infero-temporal. Global PPCT was calculated based on these sectorial data. In addition, association between the PPCT and ocular and systemic factors were evaluated. Among the included subjects, 39 (45.9%) were men and mean age was 51.4 ± 17.6years. The mean global PPCT was 135.8 ± 40.6µm. The infero-nasal and infero-temporal sectors were significantly thinner than other sectors (all, P < 0.05). In multiple regression analysis, thinner global PPCT was significantly associated with older age (P < 0.0001) and female sex (P = 0.0330) after considering effects of other confounders. This study provided global PPCT and its profile in normal Japanese subjects by using EDI SD-OCT. These results may be used as a reference in the assessment of normal status of the PPCT. The age and sex of the subjects should be considered in interpreting the PPCT data.

Changes in Choroidal Thickness and Axial Length with Intraocular Pressure Changes After Trabeculectomy

Background: Trabeculectomy is commonly performed in patients with chronic open angle glaucoma when medical therapy fails to control intraocular pressure (IOP). Objective: The aim of the current work was to evaluate choroidal thickness (C.T) changes with Enhanced Depth Imaging-Optical Coherence Tomography (EDI-OCT) & axial length (AXL) with ophthalmic A-Scan ultrasound after reduction of intraocular pressure (IOP) following trabeculectomy. Patients and Methods: The study was included 20 patients with open-angle glaucoma. The choroidal thickness was measured using enhanced depth imaging spectral domain optical coherence tomography (EDI-SD-OCT) and AXL of eye was measured using A-scan ultrasound before trabeculectomy and 1 month, 3 and 6 months postoperatively. Results: The changes of choroidal thickness before and after 1, 3 and 6 months of the operation found to have high statistically significant increase in SFCT-V, SFCT-V, NCT, TCT, SCT and ICT in 1st month postoperative with mean (217.65±27.03, 218±21.09, 216.9±28.86, 190.35±34.3, 223.1±24.82 and 244.8 ± 23.77) respectively, then they decreased in the 3rd month with mean (198.85 ±27.8, 197.8±23.3, 200.15±27.5, 178.35 ±31.9, 208.75±23.3 and 233.5±21.05) respectively, but it was not less than preoperative, and continued in decreasing in the 6th month with mean (187.3 ± 29.02, 186.95 ± 25.82, 188.95±27.47, 166.45±26.38, 197.7± 23.05 and 223.5±22.66) respectively, but it was not also less than preoperative. Conclusion: It could be concluded that intraocular pressure (IOP) reduction after trabeculectomy caused an increase in choroidal thickness (CT) this reduction of IOP was negatively correlated only with the increase in nasal, temporal, inferior and superior CT 3 mm away from the fovea.

Effects of age and binarising area on choroidal vascularity index in healthy eyes: an optical coherence tomography study.

To investigate the changes in the choroidal vascularity index (CVI) with age and to compare the effect of the binarised area on CVI in healthy eyes using spectral-domain optical coherence tomography (SD-OCT). Two hundred and twenty-four eyes of 224 healthy subjects were included in this prospective cross-sectional study.The eyes were divided into different age groups to analyse the possible age-related choroidal structural changes. Subfoveal choroidal thickness (SFCT), CVI, total choroidal area (TCA), stromal area (SA), luminal area (LA), and CVI within the central 1500µm of the macula were analysed using enhanced depth imaging SD-OCT. The CVI was defined as the proportion of the LA to the TCA, and its values for the two binarised areas were compared (CVItotal vs. CVI1500). The mean age was 34.77 ± 20.97 (range: 5-70) years. The mean CVItotal was statistically lower (66.71 ± 2.58%) than the mean CVI1500 (67.54 ± 3.13%, p = 0.008) among all the healthy participants. TCA, LA, CVItotal, and CVI1500 were statistically higher in the ≤ 18-year-old group compared to the > 18-year-old group (p < 0.05), but SA was not significantly different between the groups (p = 0.327). Similarly, TCA, LA, CVItotal, and CVI1500 between the five studied age groups were statistically different (p < 0.001), showing larger figures in the 0-10-year-old group. However, this was not true for the stromal region (p = 0.139). CVItotal exhibited a very strong positive correlation with CVI1500. No significant gender-related difference was observed in CVI. Decreased LA, TCA, and CVI were observed in healthy eyes with increasing age. CVI1500 was higher than CVItotal in a single B scan OCT. This result may provide valuable information about the choroid under different conditions, such as its physiological changes and disease pathophysiology.

Lamina Cribrosa Moves Anteriorly After Trabeculectomy in Myopic Eyes.

PurposeThe purpose of this study was to investigate changes in lamina cribrosa (LC) depth after trabeculectomy in myopic eyes using enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT).MethodsSerial horizontal B-scans of the optic nerve head of 41 myopic eyes with primary open-angle glaucoma (POAG) were obtained before and 3 months after trabeculectomy using EDI SD-OCT. LC depth, defined as the distance from the opening plane of Bruch's membrane to the level of the anterior LC surface, was measured before and 3 months after trabeculectomy at 7 locations spaced equidistantly across the vertical optic disc diameter on B-scan images. The mean of the measurements at these seven planes was defined as the average LC depth. Factors associated with changes in LC depth were identified by linear regression.ResultsIntraocular pressure (IOP) decreased from 26.3 ± 9.3 millimeters of mercury (mm Hg) preoperatively to 10.6 ± 3.5 mm Hg 3 months after trabeculectomy. LC depth was significantly lower 3 months after trabeculectomy than preoperatively (P < 0.001, all planes). The magnitude of LC depth reduction was significantly associated with younger age, higher preoperative LC depth, and greater magnitude of IOP reduction (all P ≤ 0.016).ConclusionsLC depth reduction was observed after trabeculectomy in myopic eyes. The degree of LC depth reduction was not related to the degree of myopia.

Clinical Assessment of Scleral Canal Area in Glaucoma Using Spectral-Domain Optical Coherence Tomography

To investigate anterior scleral canal (ASC) area in the eyes with glaucoma using spectral-domain optical coherence tomography (SDOCT). Cross-sectional study. This study included 206 eyes of 103 patients with glaucoma, classified as 66 eyes of 33 patients with unilateral glaucoma and 140 eyes of 70 patients with bilateral glaucoma. Radial scan enhanced depth imaging SDOCT centered on the optic disc was performed, and parameters that present ASC area such as ASC opening and the largest ASC area were obtained in each eye. The largest ASC area was the largest cross-sectional area of the ASC region identified between the ASC opening and anterior lamina cribrosa insertion. These parameters were compared between eyes with and without glaucoma in unilateral glaucoma, and eyes with worse and better visual field defect (VFD) in bilateral glaucoma. In the patients with unilateral glaucoma, ASC opening and largest ASC area were significantly larger in the eyes with glaucoma than in those without glaucoma (both P < .001). In bilateral glaucoma, these parameters were significantly larger in the eyes with worse VFD than in those with better VFD (P= .0080 and P= .0018, respectively). Intereye differences of the ASC parameters in the glaucoma patients were significantly greater than that in the normal subjects. Significantly larger ASC area was first observed in the living human eyes with glaucoma compared to the normal eyes. Further longitudinal studies are required to determine if the ASC area is useful in the prevention and treatment of glaucoma.

Can subfoveal choroidal thickness replace subjective tests in patients using tadalafil to treat erectile dysfunction?

We aimed to determine the effect on choroidal thickness of daily 5mg tadalafil use in patients with erectile dysfunction (ED) and to evaluate agreement between short form of International Index of Erectile Function (IIEF 1-5, 15) scores and choroidal thickness during follow-up. Enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) was used to measure full choroidal thickness in the subfoveal area, choroidal thickness (CT) and small-choroidal-vessel-layer (SCVL) thickness. Thirty of the 45 patients included complete their follow-ups and exhibited medication continuity. Patients were divided into two groups, five (16.7%) with ED at any level at third-month follow-up, and 25 (83.3%) with no ED, and subgroup analysis was then performed. Median changes in SCVL thickness at first- and sixth-month follow-ups were 20.5µm versus 9.0μm (p=.001) and 23.5µm versus 12.5µm (p=.005) in patients without and with ED respectively. The SCVL thickness increased by 20μm compared with the baseline level, indicating an improvement in the patient's complaints of erectile dysfunction. The level of increase in SCVL thickness can be a useful and objective guide to clinicians if they cannot be present when the IIEF questionnaire is administered.

The clinical features of posterior scleritis with serous retinal detachment: a retrospective clinical analysis.

To summarize the clinical features, systemic associations, risk factors and choroidal thickness (CT) changing in posterior scleritis (PS) with serous retinal detachment. This retrospective study included 23 patients diagnosed PS with retinal detachment from August 2012 to July 2017. All patients' medical history and clinical features were recorded. The examinations included best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination, and routine eye examinations. Posterior coats thickness (PCT) was determined by B-scan ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and clinical data were compiled and analyzed. After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5±9.24 years old. Ocular pain and blurred vision were the two most common complained symptoms by patients. Anterior scleritis occurred in 12 patients, which was confirmed by ultrasound biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular area. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with fluid in Tenon's capsule demonstrated as a typical T-sign. The average PCT was 2.51±0.81 mm in the PS-affected eyes and only 1.09±0.29 mm in the unaffected eye (P<0.0001). The subfoveal CT was 442.61±55.61 µm, which correlated with axis length (r=-0.65, P=0.001) and PCT (r=0.783, P<0.001). The BCVA and IOP did not correlate with either CT or PCT. PS with serous retinal detachment presented a variety of symptoms, such as pain, visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound is a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

Relationship Between Optical Coherence Tomography Angiography Peripapillary Vessel Density and Lamina Cribrosa Depth.

To investigate the global and regional relationship between the pVD assessed by OCT-A and LCD assessed by enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT). A total of 38 eyes of 38 healthy subjects and 38 eyes of 38 glaucoma patients were included. Peripapillary microvasculature and lamina cribrosa were imaged by OCT-A and enhanced depth imaging SD-OCT, respectively. The pVD and LCD were measured at temporal, superotemporal, superonasal, nasal, inferonasal, and inferotemporal sectors. Global and regional correlations between pVD and LCD were evaluated in all subjects. The pVD (59.0±2.6 vs. 54.4±5.4%) and LCD (318.5±76.4 vs. 404.6±92.5 μm) were significantly different between healthy and glaucoma subjects. The average pVD assessed by OCT-A was not significantly correlated with average LCD assessed by SD-OCT (r=-0.160, P=0.167). Regional correlation between pVD and LCD was statistically significant only in the inferotemporal sector (r=-0.301 and P=0.008). In the linear regression analysis, reduced pVD was independently associated with decreased visual field mean deviation and peripapillary retinal nerve fiber layer thickness but not with increased LCD. Global and regional correlations between pVD and LCD were poor except for the inferotemporal sector. This finding suggests that peripapillary microvascular impairment may not result directly from posterior lamina cribrosa displacement.

CHANGES IN CHOROIDAL THICKNESS IN CLINICALLY SIGNIFICANT PSEUDOPHAKIC CYSTOID MACULAR EDEMA.

To investigate choroidal thickness in eyes with clinically significant pseudophakic cystoid macular edema (PCME) during the acute phase and following resolution of the edema, using enhanced depth imaging spectral domain optical coherence tomography (EDI-OCT). This is a retrospective, observational clinical study. Patients' records were reviewed for cases of clinically significant PCME after uneventful phacoemulsification surgery. Choroidal thickness was measured at time of PCME diagnosis in both eyes and after CME resolution in the affected eye using enhanced depth imaging spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering). Measurements were taken subfoveal and 1.5 mm nasal, temporal, inferior, and superior from the center of the fovea. Statistical analysis was performed using paired t-test and Pearson correlation. Mean subfoveal choroidal thickness in 34 eyes with PCME measured 258 ± 83 μm at baseline and decreased to 215 ± 79 μm after CME resolution (P < 0.001). Mean subfoveal choroidal thickness measured at baseline in fellow eyes was significantly lower (194 ± 77 μm) compared to acute PCME (P < 0.001) and after CME resolution (P = 0.011). Choroidal thickness is increased in eyes with PCME and decreases following edema resolution. These findings may strengthen the hypothesis of an inflammatory pathogenesis in PCME.

THREE-DIMENSIONAL ANALYSIS OF SUBMACULAR PERFORATING SCLERAL VESSELS BY ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY.

To analyze submacular perforating scleral vessels (PSVs) using enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT). Twenty-two eyes of 11 healthy women were included in this retrospective study. Central EDI-SDOCT scans (3 × 4.5 × 1.9 mm, 13.5 mm scan area) were acquired and postprocessed by denoising, manual sclera segmentation, and PSV investigated by five graders. Mean age was 22.4 ± 6.2 years. Mean refractive error was -0.44 ± 0.8 diopters. Mean axial length was 23.08 ± 0.63 mm. The coefficient of agreement for grading was good. Mean number of submacular PSVs was 0.33 ± 0.2 per mm (range from 0 to 9 per eye). Subfield analysis showed 0.2 ± 0.5 (range 0-2) and 2.1 ± 1.8 (range 0-7) vessels, respectively, for central 1-mm diameter and 3-mm diameter. Quadrant analysis showed 0.7 ± 0.9, 0.5 ± 0.9, 0.3 ± 0.6, and 0.4 ± 0.6 vessels, respectively for superior, inferior, nasal, and temporal quadrants. Total number of PSV showed no significant side difference (median difference 0.5, confidence interval -3.0 to 3.0, P = 0.94) or an influence of axial length (P = 0.16). This is the first description of three-dimensional EDI-SDOCT visualization of submacular PSV in healthy eyes. This method allows for in vivo imaging of a critical component of outer retinal perfusion at the posterior pole.

Choroidal perfusion abnormalities associated with Acute Posterior Multifocal Placoid Pigment Epitheliopathy: a case report

BackgroundIndocyanine Green Angiography (ICG-A) and Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography (EDI-OCT) are essential imaging techniques for diagnosis, management and understanding of the pathophysiology of many chorioretinal diseases. Herein, we report the ICG-A and EDI-OCT findings from a case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE), in which these imaging techniques enable the visualization of more diagnostic details than those observable with other widely used diagnostic tools.Case presentationA 60-year-old white female presented with bilateral blurred vision for few days. Fundus examination showed multiple, yellow-white placoid lesions at the posterior pole of both eyes. The placoid lesions were also evident on Spectral-Domain Optical Coherence Tomography (SD-OCT), Fluorescein Angiography (FA), Fundus Autofluorescence (AF), and ICG-A. A complete ophthalmologic examination was performed and the diagnosis of APMPPE was made based on imaging and clinical features. Notably, all the lesions detected by FA, AF and OCT corresponded to focal areas of hypofluorescence seen on ICG-A, whereas several additional hypofluorescent areas that were not associated with FA, AF or OCT abnormalities, were also detected with ICG-A. On follow-up, the regression of outer retinal abnormalities detected on OCT preceded the restoration of choroidal perfusion abnormalities in the corresponding locations on ICG-A. This long-standing choroidal perfusion defect could not be detected with OCT. EDI-OCT scans revealed characteristic choriocapillaris changes beneath the placoid lesions and an increase in choroidal thickness during the acute phase, with subsequent decrease in the inactive stage of the disease.ConclusionOur findings show that ICG-A and EDI-OCT provide detailed morphologic information of choroidal abnormalities in APMPPE and allow accurate evaluation of definitive resolution of the lesions. Moreover, they support the acute choroidal hypoperfusion as the primary mechanism overlying the pathogenesis of the disease, and suggest that the non-perfused areas may extend beyond the damage of the outer retina.