Large Choroidal Vessels Research Articles

A novel multi-scale and fine-grained network for large choroidal vessels segmentation in OCT

Accurate segmentation of large choroidal vessels using optical coherence tomography (OCT) images enables unprecedented quantitative analysis to understand choroidal diseases. In this paper, we propose a novel multi-scale and fine-grained network called MFGNet. Since choroidal vessels are small targets, long-range dependencies need to be considered, therefore, we developed a two-branch fine-grained feature extraction module that can mix the long-range information extracted by TransFormer with the local information extracted by convolution in parallel, introducing information exchange between the two branches. To address the problem of low contrast and blurred boundaries of choroidal vessels in OCT images, we developed a large kernel and multi-scale attention module, which can improve the features of the target area through multi-scale convolution kernels, channel mixing and feature refinement. We quantitatively evaluated the MFGNet on 800 OCT images with large choroidal vessels manually annotated. The experimental results show that the proposed method has the best performance compared to the most advanced segmentation networks currently available. It is noteworthy that the large choroidal vessels were reconstructed in three dimensions (3D) based on the segmentation results and several 3D morphological parameters were calculated. The statistical analysis of these parameters revealed significant differences between the healthy control group and the high myopia group, thereby confirming the value of the proposed work in facilitating subsequent understanding of the disease and clinical decision-making.

Choroidal thickness and vascular density after rhegmatogenous retinal detachment.

To study choroidal thickness (CT) and luminal areas of choroidal vessels in the setting of fovea-off rhegmatogenous retinal detachment (RRD). Twenty-seven eyes with RRD were prospectively studied before and after pars plana vitrectomy and SF6 tamponade, using swept-source optical coherence tomography (SS-OCT). CT was measured pre- and postoperatively both subfoveally and in attached macular areas. Postoperatively, the CT in previously detached or attached Early Treatment Retinopathy Diabetic Study (ETRDS) macular areas and the choroidal luminal areas were assessed. The preoperative median subfoveal CT of 260 μm (interquartile range (IQR) = 151) was significantly reduced to 200 μm (IQR = 110) 1 month postoperatively (p < 0.001). Corresponding to attached macular areas, the preoperative median CT of 184 μm (IQR = 116) was significantly reduced to 155 μm (IQR = 103) 1 month postoperatively (p = 0.03). No significant changes in CT occurred from 1 to 12 months postoperatively, either in previously detached, median 163 μm (IQR = 74) to 173 μm (IQR = 127), (p = 0.484), or in attached, 148 μm (IQR = 110) to 159 μm (IQR = 142), (p = 0,766) EDTRS areas. Median luminal areas of inner choroidal microvasculature and large choroidal vessels were 58.5% (IQR = 1.4) and 61.4% (IQR = 2.2) at 1 month, respectively, and stayed unchanged until 12 months postoperatively. CT reduction 1 month after vitrectomy for fovea-off RRD was more pronounced subfoveally than beneath attached macular areas. This finding could represent a normalization of a subfoveal choroidal swelling due to increased fluid absorption during RRD. From 1 month and onwards, the CT and luminal areas remained unchanged.

Ultra‐widefield retinal and choroidal vascular architecture in mild cognitive impairment and normal cognition

AbstractBackgroundMild cognitive impairment (MCI) is currently a clinical diagnosis characterized by decline in memory and daily cognitive function from baseline. Exploratory studies using optical coherence tomography angiography have reported alterations in the retinal capillary plexus vessel density and attenuation of the retinal nerve fiber layer, but these results appear to be mixed. We used ultra‐widefield (UWF) imaging to evaluate retinal and choroidal vasculature and structure in individuals with mild cognitive impairment (MCI) compared to controls with normal cognition.MethodA cross‐sectional comparison of patients with MCI compared to cognitively normal controls. Scanning laser ophthalmoscopy (SLO) (California, Optos Inc, Marlborough, MA) was used to obtain UWF fundus color images. Images were analyzed with the Vasculature Assessment Platform for Images of the Retina (VAMPIRE) software. Measured metrics included vessel width gradient, vessel width intercept, large vessel choroidal vascular density, vessel tortuosity, and vessel fractal dimension.Result131 eyes of 82 MCI patients and 231 eyes of 133 cognitively normal participants were analyzed. Both retinal artery and vein width gradients were less negative in MCI vs. controls, demonstrating decreased rates of vessel thinning towards the periphery (p &lt; 0.001, p = 0.027). Retinal artery and vein width intercepts, a metric that extrapolates vessel width at the center of the optic disc, were smaller in MCI patients vs controls (p &lt; 0.001, p = 0.017). The large vessel choroidal vascular density was greater in MCI patients vs controls (p = 0.025).ConclusionWhen compared to controls with normal cognition, MCI patients had overall thinner retinal vasculature manifested in both the retinal arteries and veins. Furthermore, in MCI, these thinner arteries and veins attenuated at a lower rate when traveling towards the periphery, when compared to controls, perhaps because they were already more attenuated posteriorly. MCI patients also had increased choroidal vascular density.

Retromode Infrared Scanning Laser Ophthalmoscopy in Vogt-Koyanagi-Harada Disease.

This study examined six patients with Vogt-Koyanagi-Harada (VKH) disease using retromode infrared scanning laser ophthalmoscopy (RMI-SLO). We conducted a single-center retrospective review of the medical records of six patients diagnosed with VKH disease. The RMI-SLO images were compared to those obtained using color fundus photography, optical coherence tomography (OCT), and dye-based retinal angiography. In the acute phase of VKH disease, RMI-SLO revealed pseudo-three-dimensional (3D) regions and wavy patterns. These observations corresponded to the areas of serous retinal detachment (sRD) and choroidal folds identified on OCT. Notably, the detection of pseudo-3D regions by RMI-SLO proved to be more effective than color fundus photography in identifying sRDs. Hyper-reflective lines inside the sRDs were observed in the RMI-SLO images and were consistent with the fibrinous membranes observed in the OCT images. The hyper-reflective choroidal vasculature in RMI-SLO images was notably absent, a finding like the fuzzy pattern of large stromal choroidal vessels observed in indocyanine green angiography images. Following steroid treatment, these abnormal findings reverted to normal. RMI-SLO imaging could serve as an alternative option for both pre- and post-treatment assessments in VKH disease. Moreover, it has the potential to reduce the need for retinal angiography. What is known Optical coherence tomography (OCT) and indocyanine green angiography (ICGA) are essential for the diagnosis of Vogt-Koyanagi-Harada (VKH) disease. However, it is difficult to visualize a wide area of the fundus with OCT, and ICGA carries risks of allergic reactions or shock. What is new Retromode infrared scanning laser ophthalmoscopy (RMI-SLO) can demonstrate pseudo-three-dimensional regions and wavy patterns corresponding to serous retinal detachment and choroidal folds in the acute stage of VKH disease. Hyper-reflective choroidal vasculature was absent in the acute stage of VKH disease on RMI-SLO and may correlate with choroidal thickening. RMI-SLO could be an alternative option for the assessment of VKH disease and has the potential to reduce the need for dye-based retinal angiography.

Asymmetric choroidal vascular pattern in tilted disc syndrome.

To observe the choroidal vasculature in patients with tilted disc syndrome (TDS) using en face optical coherence tomography (OCT) and to evaluate the symmetry of the choroidal vascular pattern in the macular area. En face OCT was performed using a Plex Elite 9000 (Zeiss) with a 12 × 12mm image of the macula, which was flattened with retinal pigment epithelium and segmented into choroidal layers. The middle/large choroidal vessels were evaluated for vertical symmetry qualitatively by the retina specialist coauthors and quantitatively by binarization analysis of choroidal vessel density and mean vessel diameter. The 2 cases and 4 eyes (19.0%) that were difficult to segment due to the severe slope of the macular area were excluded. Of the 17 eyes in the remaining 13 cases, asymmetric middle/large choroidal vessels were observed in all eyes. Vessel density (P = 0.01) and mean vessel diameter (P < 0.01) of the choroidal middle/large vessels were significantly higher in the superior than in the inferior choroidal segmentation. Serous retinal detachment was observed in 4 eyes, all asymmetric cases. Vertical asymmetry of the middle and large choroidal vessels is observed in most TDS patients. Circulatory imbalance due to choroidal vascular abnormalities in TDS may be one of the causes of serous retinal detachment. What is known: Tilted disc syndrome is the congenital disease with ocular morphologic abnormalities associated with incomplete closure of the embryonic fissure of the eye at the inferior optic nerve head Vertical cross-sectional optical coherence tomography images revealed that the choroid above the macula in tilted disc syndrome is relatively thickened, whereas the choroid within the inferior staphyloma is thinning. Evaluation of choroidal vascularity in tilted disc syndrome by en face optical coherence tomography revealed qualitatively and quantitatively highly dense choroidal vessels in the superior region, with larger diameter choroidal vessels than in the inferior region, and vertical asymmetry with an upward predominance. Choroidal circulatory imbalance due to vertical asymmetry of the choroidal vessels may be one of the causes of serous retinal detachment in tilted disc syndrome.

Decreased Choriocapillaris Vessel Density in the Ipsilateral Eye after Carotid Artery Revascularization Detected by Widefield Swept-Source OCT Angiography

ObjectiveTo investigate the short-term blood flow changes and image features of the retina and choroid in patients undergo carotid artery revascularization (CAR) for severe carotid artery stenosis (SCAS) using widefield swept-source optical coherence tomography angiography (SS-OCTA). DesignProspective study. ParticipantsThis prospective study included 112 eyes (56 eyes of the ipsilateral side and 56 eyes of the contralateral side) of 56 participants with severe carotid artery stenosis. MethodsParticipants were examined using widefield SS-OCTA covering an area of 16*16mm centered on the fovea before and after carotid artery revascularization. Retinal parameters including central macular thickness (CMT), vessel density of the retinal superficial vascular complex (VDRSVC), vessel density of the retinal deep vascular complex (VDRDVC), and vessel density of the retina (VDR) and choroidal parameters including central choroidal thickness (CCT), vessel density of the choriocapillaris (VDCC), vessel density of the medium and large choroidal vessels (VDMLC), choroidal vessel volume ratio (CVV/a), and three-dimensional choroidal vascularity index (3D-CVI) were measured. Besides, preoperative and postoperative OCTA images were screened and compared. Main Outcome MeasuresRetinal and choroidal parameters obtained from SS-OCTA. ResultsIn the ipsilateral eye (56 eyes), increase of VDRSVC, VDR, CVV/a, CCT, and 3D-CVI and decrease of VDCC was found after CAR. 13 patients were identified with postoperative ipsilateral choriocapillaris flow voids (PICCFVs) with OCTA images, and presence of PICCFVs was associated with greater postoperative VDCC decrease. In the contralateral eye (56 eyes), we found increase of VDRSVC, VDRDVC, VDR, while no difference of choroidal parameters after CAR and no findings of PICCFVs. ConclusionsFindings of this study suggest that ocular microvascular perfusion is improved after CAR in the ipsilateral eye and the contralateral eye within a wide field of the fundus. The VDCC is decreased in the ipsilateral eye, which may indicate infarctions of choriocapillaris or ischemia-reperfusion injury of the choriocapillaris after CAR.

Role of multimodal imaging in the diagnosis of choroidal neovascularization overlying a choroidal macrovessel

A 66-year-old female presented with complaints of blurred vision in the left eye for 6 months. Fundus examination showed an orange lesion with a tail-like projection at the center of the macula. However, indocyanine green angiography, optical coherence tomography (OCT), and OCT angiography showed the presence of a large choroidal vessel, neovascular network within the pigment epithelial detachment and subretinal fluid. A diagnosis of type 1 choroidal neovascularization overlying a choroidal macrovessel was made. This case report illustrates the role of multimodal imaging in the diagnosis of choroidal neovascularization overlying a choroidal macrovessel.

Sodium-iodate injection can replicate retinal and choroid degeneration in pigmented mice: Using multimodal imaging and label-free quantitative proteomics analysis

Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss in the elderly population. Sodium iodate (NaIO3), a stable oxidizing agent, has been injected to establish a reproducible model of oxidative stress-induced RPE and photoreceptor death. The aim of our study was to evaluate the morphological and molecular changes of retina and retinal pigment epithelium (RPE)-choroid in NaIO3-treated mouse using multimodal fundus imaging and label-free quantitative proteomics analysis. Here, we found that following NaIO3 injection, retinal degeneration was evident. Fundus photographs showed numerous scattered yellow-white speckled deposits. Optical coherence tomography (OCT) images indicated disruption of the retinal layers, damage of the RPE layer and accumulation of hyper-reflective matter in multiple layers of the outer retina. Widespread foci of a high fundus autofluorescence (FAF) signal were noticed. Fundus fluorescein angiography (FFA) revealed diffuse intense transmitted fluorescence mixed with scattered spot-like blocked fluorescence. Indocyanine green angiography (ICGA) presented punctate hyperfluorescence. Due to the atrophy of the RPE and Bruch's membrane and choroidal capillary complex, the larger choroidal vessels become more prominent in ICGA and optical coherence tomography angiography (OCTA). Transmission electron microscope (TEM) illustrated abnormal material accumulation and damaged mitochondria. Bioinformatics analysis of proteomics revealed that the differentially expressed proteins participated in diverse biological processes, encompassing phototransduction, NOD-like receptor signaling pathway, phagosome, necroptosis, and cell adhesion molecules. In conclusion, by multimodal imaging, we described the phenotype of NaIO3-treated mouse model mimicking oxidative stress-induced RPE and photoreceptor death in detail. In addition, proteomics analysis identified differentially expressed proteins and significant enrichment pathways, providing insights for future research, although the exact mechanism of oxidative stress-induced RPE and photoreceptor death remains incompletely understood.

The effect of heart rate variability on the choroidal vascularity of the optical coherence tomography and angiography in central serous chorioretinopathy.

To investigate the correlation between the autonomic nervous system and choroidal vascularity in patients with central serous chorioretinopathy (CSC), using heart rate variability (HRV) analysis, optical coherence tomography (OCT) and OCT angiography (OCTA). We retrospectively analyzed data of 25 patients with unilateral CSC (50 eyes, including the unaffected fellow eyes) and 25 healthy controls. The assessment involved a 5-minute HRV analysis encompassing both frequency and time domains, especially low frequency (LF), high frequency (HF), and LF/HF ratio. In OCT (12 × 9mm) and en-face OCTA (3 × 3mm) scans, we measured parameters including choroidal vascularity index (CVI), choroidal vessel density in the middle and deep layers, and choriocapillaris flow void. Regression analysis was conducted to elucidate the associations between HRV parameters and OCT/OCTA measurements. Normalized LF(LFnorm) and LF/HF ratios were higher in patients with CSC than in healthy controls. LFnorm and the log-transformed ratio of LF to HF [log(LF/HF)] demonstrated a significant and borderline correlation with CVI in the linear regression analysis (P = 0.040, R2 = 0.171, and P = 0.059, R2 = 0.147, respectively). Both CVI and deep choroid vessel density showed a more significant association with LFnorm and log (LF/HF) in the non-linear quadratic regression analysis than in the linear analysis (all, P < 0.04, R2 > 0.25). The frequency-domain parameters of HRV, including LFnorm and log (LF/HF), demonstrated a significant association with indicators reflective of large choroidal vessel luminal area on macular OCT/OCTA scans. This observation implies complicated modulation of choroidal blood flow by the autonomic nervous system in CSC.

Initial Factors Associated with Resistance to Intravitreal Aflibercept Injection in Polypoidal Choroidal Vasculopathy

Purpose: To identify initial factors contributing to the resistance against intravitreal aflibercept treatment in polypoidal choroidal vasculopathy (PCV) patients.Methods: This study included PCV patients initially treated with aflibercept. Resistance was defined when treatment did not reduce subretinal fluid (SRF) or intraretinal fluid (IRF) by 100 μm or more after three consecutive 4-week intervals, and the treatment interval could not be extended beyond 8 weeks. To identify initial factors associated with resistance to aflibercept treatment, we examined visual acuity and central choroidal thickness before initial treatment and after three treatments. Choroidal thickness was divided into the thickness of the large choroidal vessel layer and the layer that includes choriocapillaris and medium choroidal vessel thickness (termed medium choroidal vessel/choriocapillaris layer thickness, MCCT). Additionally, the volume of SRF, IRF, subretinal hyperreflective material, and pigment epithelial detachment in optical coherence tomography (OCT) images was investigated. The statistical significance of each factor was assessed through logistic regression analysis.Results: The study included 39 eyes showing no resistance to aflibercept and 37 eyes that exhibited resistance. Multiple logistic regression analysis, adjusted for age and sex, indicated that a lower initial ratio of MCCT to choroidal thickness at the fovea was associated with resistance to aflibercept.Conclusions: In patients with PCV treated with aflibercept, early OCT anatomical structures, such as the initial MCCT-choroidal thickness ratio at the fovea, may predict response to treatment injections.

Choroidal Layer Analysis in OCT images via Ambiguous Boundary-aware Attention

Optical Coherence Tomography (OCT) is a commonly used retina imaging technique, and it is capable of revealing the morphology of the choroid. However, the segmentation and quantitative analysis of the sublayers and vessels in choroid are rarely explored, primarily due to the indistinct boundaries of choroidal sublayers, and imbalanced distribution of vessels observed in OCT imagery. In this paper, we propose a novel two-stage architecture called Choroidal Layer Analysis network (CLA), that may be considered the first attempt in this research community for joint segmentation of choroidal sublayers and choroidal vessels in OCT images. CLA employs the encoder–decoder network with the residual U-shape module as the backbone. In order to empower the ability of the segmentation model to identify the inconspicuous boundaries of choroidal sublayers, we introduce an Ambiguous Boundary Attention block (ABA) into the bottleneck of the encoder–decoder network in the first stage. For more accurate segmentation of large choroidal vessels with ambiguous contours and imbalanced spatial distribution, the second stage introduces an active contour-based loss to refine the contours of choroidal vessels simultaneously with precise identification of each vessel via contextual modeling. To train, test and validate the proposed model, we conducted a choroidal segmentation dataset containing 800 OCT images, with their sublayers and large choroidal vessels manually annotated. Experimental results demonstrate the superiority of the proposed approach compared with other state-of-the-art segmentation networks in large margins. It is worth noting that we also reconstructed the large choroidal vessels in three-dimensional (3D) based on the segmentation results, and multiple 3D morphological parameters were calculated. The statistical analysis of these parameters demonstrates significant differences between the healthy control and high myopia group, and this further confirms the proposed work may facilitate subsequent disease understanding and clinical decision-making.

Quantitative assessment of choroidal parameters and retinal thickness in central serous chorioretinopathy using ultra-widefield swept-source optical coherence tomography: a cross-sectional study

ObjectiveIn this study, we used ultra-wide field swept-source optical coherence tomography angiography (UWF SS-OCTA) to assess changes in retinal thickness (RT) and choroidal parameters in individuals who had received a diagnosis of central serous chorioretinopathy (CSC).MethodsThe study encompassed the evaluation of 59 eyes from 47 patients with a diagnosis of CSC, alongside 33 fellow eyes and 31 eyes from healthy individuals (controls). The parameters assessed included RT, choroidal thickness (CT), choriocapillaris density, vascular density of the large choroidal vessel layer, three-dimensional choroidal vascularity index (3D-CVI), choroidal vessel volume per unit area (mCVV/a), and choroidal stroma volume per unit area (mCSV/a).ResultsMetrics including mCVV/a, mCSV/a, 3D-CVI, CT, and RT exhibited significantly elevated values in the eyes affected by CSC compared to those of the control group across nine subfields. Moreover, a substantial number of the subfields in both CSC-affected and fellow eyes exhibited increased values for mCVV/a, mCSV/a, 3D-CVI, CT, and RT when compared with the control group. Additionally, acute and chronic CSC subfields demonstrated significantly elevated values for mCVV/a, mCSV/a, 3D-CVI, CT, and RT in comparison to healthy control eyes. Notably, specific subfields associated with complex and atypical forms of CSC revealed higher metrics compared to those of the control group.ConclusionIn conclusion, the UWF SS-OCTA proved to be a valuable tool for exploring the anatomical etiology and clinical classification and diagnosis of CSC.

Дифференциальная диагностика невусов и меланом хориоидеи по данным ОКТ

The article presents the study results of 64 patients with suspicious (progressive) nevi (n = 42) and initial choroid melanomas (n = 22, of which n = 3 had anamnesis of choroid nevus). Ultrasound examination, digital photoregistration of the fundus and OCT were done for all patients. According to the OCT data it was possible to identify diagnostic criteria that help distinguish of suspicious nevi including those with a high risk of malignant transformation from initial choroid melanomas. First of all these are the preservation of the Bruch membrane and the presence of druses. While malignant transformation of suspicious nevi was characterized by shape asymmetry of the enlarged “choroidal complex”, dilation of large choroidal vessels around the nevus, the presence of RPE detachment and the presence of hyperreflective intraretinal inclusions. Criteria of initial choroid melanomas were violation of the integrity of the Bruch membrane, rounded cavities in the inner layers of the choroid, deposits at the level of RPE, edema and/or rupture of the photoreceptor layer. Keywords: suspicious choroid nevus, choroid melanoma, OCT

Central and Peripheral Changes in Retinal Vein Occlusion and Fellow Eyes in Ultra-Widefield Optical Coherence Tomography Angiography.

To explore the central and peripheral retinal and choroidal changes in retinal vein occlusion (RVO) and fellow eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA). Fifteen ischemic central RVO (CRVO), 15 branch RVO (BRVO), and 15 age-matched healthy controls were prospectively recruited. Retinal and choroidal parameters, including retinal vessel flow density (VFD) and vessel linear density (VLD), choroidal vascularity volume (CVV), choroidal vascularity index (CVI), and VFD in the large and medium choroidal vessels (LMCV-VFD), were measured in the central and peripheral regions of the 24 × 20-mm UWF-SS-OCTA images. Ischemic CRVO and BRVO eyes showed increased foveal avascular zone area, perimeter, and acircularity index (AI) compared to their fellow eyes and healthy control eyes, and RVO fellow eyes also had larger AI values than controls (P < 0.05). For ischemic CRVO and BRVO eyes versus control eyes, VFD, VLD, CVV, CVI, and LMCV-VFD decreased, but retinal thickness and volume in the superficial capillary plexus, deep capillary plexus, and whole retina increased (P < 0.05). Moreover, RVO fellow eyes also showed significantly decreased retinal VFD, LMCV-VFD, and CVI, as well as increased retinal thickness and volume, compared with control eyes (P < 0.05). Alterations were not consistent throughout the retina, as they involved only the peripheral or central regions in some cases. The affected and unaffected fellow eyes of RVO patients both demonstrated central and/or peripheral structural and vascular alterations in the retina and choroid. Because UWF-SS-OCTA enables visualization and evaluation of the vasculature outside the posterior pole, it presents a promising approach to more fully characterize vascular alterations in RVO.

Analysis of the Retinal and Choroidal Vasculature Using Ultrawidefield Fundus Imaging in Mild Cognitive Impairment and Normal Cognition

PurposeTo utilize ultra-widefield (UWF) imaging to evaluate retinal and choroidal vasculature and structure in individuals with mild cognitive impairment (MCI) compared to controls with normal cognition. DesignProspective cross-sectional study ParticipantsOne hundred thirty-one eyes of 82 MCI patients and 231 eyes of 133 cognitively normal participants from the Eye Multimodal Imaging in Neurodegenerative Disease (iMIND) Study. MethodsA scanning laser ophthalmoscope (SLO) (California, Optos Inc, Marlborough, MA) was used to obtain UWF fundus color images. Images were analyzed with the Vasculature Assessment Platform for Images of the Retina UWF (VAMPIRE-UWF 2.0, Universities of Edinburgh and Dundee, United Kingdom) software. Main outcome measuresImaging parameters included vessel width gradient, vessel width intercept, large vessel choroidal vascular density, vessel tortuosity, and vessel fractal dimension. ResultsBoth retinal artery and vein width gradients were less negative in MCI patients compared to controls, demonstrating decreased rates of vessel thinning at the periphery (p < 0.001, p = 0.027). Retinal artery and vein width intercepts, a metric that extrapolates the width of vessel at the center of the optic disc, were smaller in MCI patients compared to controls (p < 0.001, p = 0.017). The large vessel choroidal vascular density, which quantifies the vascular area versus total choroidal area, was greater in MCI patients compared to controls (p = 0.025). ConclusionsWhen compared to controls with normal cognition, MCI patients had thinner retinal vasculature manifested in both the retinal arteries and in the veins. In MCI, these thinner arteries and veins attenuated at a lower rate when traveling towards the periphery. MCI patients also had increased choroidal vascular density.

Integrity of the Hyperreflective Layer in the Inner Choroid in Eyes with Drusen.

This study aimed to compare the integrity of the hyperreflective layer of the inner choroid in eyes with and without drusen. Swept-source optical coherence tomography images of patients with drusen and normal controls were reviewed. Using a line plot of ImageJ, choroidal reflectivity was measured at the subfovea, and the integrity of the hyperreflective layer of the inner choroid was determined. In total, 63 eyes with drusen and 30 control eyes without drusen were included. The integrity of the hyperreflective layer of the inner choroid was preserved in 81.0% of eyes with drusen and 93.3% of normal controls. The proportion of eyes with the hyperreflective layer did not differ between eyes with and without drusen. Of the 63 subjects with drusen, this hyperreflective layer was observed in all 28 eyes (100%) with pachydrusen but only in 68.6% of the 35 eyes with soft drusen, and its prevalence was significantly different (P = 0.001). The prevalence of the hyperreflective layer between the choriocapillaris and medium or large choroidal vessels in eyes with soft drusen differed from that in eyes with pachydrusen. These findings support the suggestion that changes within the choroidal stroma may be involved in the pathogenesis of age-related macular degeneration.

Hyperviscosity Syndrome-related Retinopathy in a Patient with Waldenström Macroglobulinemia

Purpose: We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved.Conclusions: In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

The Association Between Choroidal Thickness and Meniere's Disease: A Cross-Sectional Study.

To evaluate and compare choroidal thickness (CT) between patients with Meniere's disease (MD) and a control group. This case-control analytical study was conducted on 37 subjects with MD and 37 healthy subjects. Subfoveal CT (SCT), large choroidal vessel (LCV) layer thickness, and mean subfoveal LCV thickness/mean SCT ratio were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) in the eyes on the MD side (ipsilateral), the contralateral eyes, and the control group. A statistically significant difference was observed in the mean SCT values between the ipsilateral and control groups after adjustment for age, sex, and migraine (p = 0.04). Moreover, there was a statistically significant difference between the mean subfoveal LCV thickness values and the mean subfoveal LCV thickness/mean SCT ratio between the ipsilateral and control groups (p = 0.006, and p < 0.001, respectively). Patients with a duration of disease over three years had a greater mean subfoveal LCV thickness/mean SCT ratio (67.35 ± 11.56 and 60.66 ± 11.27, respectively), which was statistically insignificant (p = 0.08). We found a thicker choroid and Haller layer, and a greater subfoveal LCV thickness/SCT ratio on the MD side compared to the controls. Furthermore, patients with a greater duration of disease had a lower subfoveal LCV thickness/SCT ratio. These findings may reflect the role of the trigeminal vascular system (TVS) and neurovascular pathophysiology in MD patients. More extensive studies are required to reach more definitive conclusions about the association between CT and MD. 4 Laryngoscope, 134:1889-1893, 2024.

Changes in the choroid detected by ultrawide-field optical coherence tomography angiography in type 2 diabetes mellitus patients without diabetic retinopathy

AimThe study objective was to investigate the choroidal changes in type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR). MethodsThis was a cross-sectional study. Controls without diabetes and T2DM patients without DR (NDR) were included. Ultrawide-field (24 × 20 mm2) optical coherence tomography angiography (OCTA) was performed to analyse choroidal thickness and vessel density. All OCTA images were divided into 3 × 3 grids. The grid centre was considered the central area, while the rest was defined as the peripheral area. ResultsNo differences between groups were observed in the flow density of the choriocapillaris (CC), choroidal thickness (ChT) and choroidal vascular index (CVI) of the large and medium choroidal vessel (LMCV) in the central area. In the eight peripheral areas, the mean flow density of the CC did not differ between the groups, while the mean CVI and ChT were decreased in the NDR group (P< 0.05). In each peripheral area, the mean CVI and ChT were decreased in the NDR group (P< 0.05, except in the infratemporal area and nasal area for ChT and in the infratemporal area for CVI). In the correlation analysis, both mean peripheral CVI and ChT correlated with age and the duration of diabetes. ConclusionEarly choroidal lesions tended to be peripheral in the LMCV in patients with diabetes without DR and correlated with age and the duration of diabetes.

Serous Maculopathy Due to Aspecific Choroidopathy (SMACH).

Serous Maculopathy Due to Aspecific Choroidopathy (SMACH).