Spectral-domain Optical Coherence Tomography Features Research Articles

Characteristics of fundus image in macular telangiectasia type 2

Objective To observe the fundus image characteristics of macular telangiectasia type 2 (MacTel type 2) patients. Methods A total of 8 patients (16 eyes) diagnosed of MacTel type 2 were included in this study. There were 4 males and 4 females, age ranged from 44 to 69 years old with a median age of (59.88±7.85) years. All patients received examination of best-corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus color photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (OCT) and macular pigment optical density (MPOD). Four eyes of 2 patients received OCT angiography examination at the same time. Classification was made according to the Gass and Blodi′s criteria. The follow-up time was from 1 to 19 months with the average time of (11.00±8.91) months. The clinical characteristics were observed and analyzed. Results The BCVA was 0.07 - 0.8. There were 1 eye in stage 1, 1 eye in stage 2, 6 eyes in stage 3, 8 eyes in stage 4. The disease showed a bilateral appearance with a low progression. Fundus features included loss of retinal transparency (14 eyes, 87.5%), blunted retinal venule (15 eyes, 93.75%), pseudo-lamellar hole (5 eyes, 31.25%), pigment proliferation (9 eyes, 56.25%). FFA findings were telangiectatic capillaries predominantly temporal to the foveola in the early phase and a diffuse hyperfluorescence in the late phase. Spectral domain OCT features included depletion of the retinal inner, outer structures, cavity (7 eyes, 43.75%), and atrophy of the neurosensory retina (9 eyes, 56.25%). On AF, reduced foveal masking due to loss of macular pigment can be observed. The loss of macular pigment could also be seen on MPOD. OCTA showed the increased intervascular spaces, broken regular network of foveal avascular zone (FAZ), right-angled vessel dipping, dilatations, traction of superficial and deep capillary layers in both the superficial and deep layers, especially in the deep layer. Only one eye of one patient proceeded from stage 4 to stage 5. Conclusions Characteristic features of MacTel type 2 included cavities and outer retina atrophy on OCT; loss of MP on MPOD; broken regular network of FAZ, morphological and structural abnormalities of superficial and deep layers of perifoveal capillary network on OCTA. Key words: Retinal Diseases/diagnosis; Macula lutea/injuries; Disease attributes

Predictors of Outcome in Patients with Neovascular Age-Related Macular Degeneration Switched from Ranibizumab to 8-Weekly Aflibercept

The purpose of this study was to evaluate the outcomes over 12 months in patients with neovascular age-related macular degeneration (nAMD) with insufficient response to ranibizumab who were switched directly to 8-weekly fixed dosing of aflibercept without a loading phase. Retrospective interventional study. Consecutive patients with nAMD who were switched from pro re nata (PRN) intravitreal ranibizumab to 8-weekly fixed aflibercept because of persistent disease activity from November 1, 2013, to September 30, 2014, were included. Demographic data, visual acuity (VA), and spectral-domain optical coherence tomography characteristics over time were evaluated to determine the prognostic indicators of final visual outcome at 12 months. The VA, central subfield thickness (CST), presence of macular fluid at month 12 compared with baseline, and the definition of prognostic indicators of final visual outcome at month12. A total of 431 patients (447 eyes) were included in this study. There was no statistically significant difference in VA between baseline and month 12 (P= 0.79), whereas the CST significantly decreased at month 12 compared with baseline (P < 0.001). At the 12-month follow-up, 48.3% of eyes had no macular fluid compared with 8.5% at baseline. The mean number of injections at month 12 was 6.8±1.75. Poor prognostic indicators included increasing age, increasing CST, the presence of intraretinal fluid, pigment epithelial detachment, and subfoveal thickening. Patients who have not yet "responded" to PRN ranibizumab seem to exhibit retinal dehydration after switching to aflibercept, whereas there was no demonstration of VA benefit. Baseline features at the point of switching can independently predict outcomes.

Optical Coherence Tomography Features Of Active And Inactive Retinal Neovascularization In Proliferative Diabetic Retinopathy.

To describe spectral domain-optical coherence tomography features of retinal neovascularization in proliferative diabetic retinopathy and thus to identify novel signs of new vessel activity. Retrospective, cross-sectional study. Data were collected over a 9-month period. Spectral domain optical coherence tomography scans were performed over areas of new vessel complexes (NVC) in both the disk and elsewhere, and were qualitatively graded by two masked observers. New vessel complexes activity was determined using clinical and angiographic criteria and correlated with spectral domain optical coherence tomography features. Forty-three eyes of 30 patients with proliferative diabetic retinopathy were included. Sixty-one NVC lesions (neovascularization of the disk-37.7%, neovascularization elsewhere-62.3%) were captured by spectral domain-optical coherence tomography and analyzed. Among them, 63.9% were classified as active and 36.1% as quiescent. Five distinctive features were identified as significantly different between active and quiescent NVC: the presence of vitreous hyperreflective dots in active NVC (P = 0.002) and the presence of epiretinal membrane (P = 0.04), inner retinal tissue contracture (P = 0.03), vitreous invasion (P = 0.02), and protrusion towards vitreous (P = 0.002) in quiescent NVC. In this exploratory study, the presence of vitreous hyperreflective dots, epiretinal membrane, inner retinal tissue contracture, vitreous invasion, and vitreous protrusion were identified as distinct signs of disease activity. Such parameters may be useful as a noninvasive imaging modality in eyes undergoing treatment for proliferative diabetic retinopathy.

Tomographic features of idiopathic polypoidal choroidal vasculopathy using spectral domain OCT

Purpose: To study the tomographic features of idiopathic polypoidal choroidal vasculopathy (IPCV) diagnosed on indocyanine green (ICG) angiogram using spectral domain optical coherence tomography (SDOCT). Design: This was a retrospective observational case series. Materials and Methods: Spectral domain optical coherence tomography (SD OCT) features of 50 eyes of 50 consecutive patients diagnosed as idiopathic polypoidal choroidal vasculopathy (IPCV) between January 2013 to January 2015 on ICG angiograms were studied. A qualitative analysis based on various tomographic features corresponding to the polypoidal lesions and branching vascular network on Spectrailis OCT was studied. Polyps were localized to subfoveal and juxtafoveal areas. These were later compared with SDOCT features of 15 eyes of 15 consecutive patients newly diagnosed as occult choroidal neovascular membrane (CNVM) on FFA/ICG. Results: Of the 50 eyes, sharp peak pigment epithelial notch (PED) was present in 49 eyes (98%); PED notch in 49 eyes (98%); a visible hyporeflective lumen with hyperreflective lesions adherent to the outer surface of the RPE in 48 eyes (96%), multiple PED in 44 eyes (80%), and diffuse PED in 44 eyes (80%); intraretinal hyperreflective dots representing hard exudates were seen in 44 eyes (88%). Surrounding OCT features such as intraretinal hyperreflective dots represent hard exudates, Cystoid macular edema and subretinal fluid were seen in 44 eyes (88%). Sub-RPE features such as PED with sheaths of internal reflectivity – branching vascular network in 19 eyes (38%) and prominent Bruchs membrane and surfacing of choroidal vessels was seen in 18 eyes (36%). At least 3 of the abovementioned OCT features were seen in all of the eyes diagnosed as PCV. The height of the PED ranged from 138–1300 μ (median = 422.2 μ). Of the 15 eyes, 80% showed presence of FVPED; multiple PED were seen in 33.3%; intraretinal hard exudates in 66.7%, and notch PED in 6.7%. Hyporeflective lumen with hyperreflective lesion under RPE was not seen in any of the eyes. The height of PED ranged from 118–339 μ (median = 164.28 μ). Conclusions: SDOCT-based features mentioned above allows detection of IPCV and differentiate it from occult CNVM. Our results suggest that SDOCT may be a useful noninvasive tool compared to ICG in detecting PCV, especially in places where ICG is not available or is contraindicated.

Correlation between visual acuity changes and optical coherence tomography morphological findings in idiopathic epiretinal membranes.

To analyze the influence of spectral-domain optical coherence tomography (SD-OCT) features on visual acuity changes in patients with idiopathic epiretinal membranes (ERMs). Seventy-nine eyes of 71 patients were included in this study. SD-OCT was performed for all patients; data were collected upon ERM diagnosis and at the final visit. The patients were divided into subgroups based on their SD-OCT features. The initial best corrected visual acuity (BCVA) and changes in BCVA for each subgroup were compared. A multivariate analysis was performed to assess the factors associated with changes in BCVA. During a mean follow-up period of 20.78 months, the mean change in logMAR visual acuity was 0.052 ± 0.089. Eyes with inner segment/outer segment (IS/OS) junction disruption and cystoid macular edema (CME) had a significantly lower mean initial BCVA than those without disruption and CME (P = 0.036 and P = 0.012, respectively). However, only eyes with CME had significant changes in BCVA (P = .034). Multivariate analysis revealed the presence of CME as the only factor that had a significant correlation with VA changes. In patients with idiopathic ERMs, the presence of CME and IS/OS disruption detected by OCT correlated with a poorer initial BCVA. Most patients' visual acuity remained stable during follow-up. The presence of CME with OCT represented a predictor of the progression of visual acuity. These results may provide valuable clinical information regarding the management of patients with idiopathic ERMs. We demonstrated that the presence of CME and IS/OS disruption detected with OCT correlated with a poorer BCVA in idiopathic ERMs. The visual acuity of most patients was stable during the follow-up period. The presence of CME in OCT represented a predictor of vision deterioration for patients with idiopathic ERMs.

Relationship of retinal morphology and retinal sensitivity in the treatment of neovascular age-related macular degeneration using aflibercept.

To relate the functional response to distinct morphological features of the retina during aflibercept treatment for neovascular AMD (nAMD). A total of 726 retinal locations in 22 consecutive eyes presenting with treatment-naive nAMD underwent a standardized examination with spectral-domain optical coherence tomography (SD-OCT) and topographic microperimetry (MP) at baseline, after 3 and 12 months of continuous intravitreal aflibercept therapy. The retinal sensitivity at each stimulus location was registered to the corresponding location on SD-OCT morphology. Subsequently, the microperimetric responses were evaluated with respect to the following underlying SD-OCT features: neovascular complex (NVC), subretinal fluid (SRF), intraretinal fluid (IRF), intraretinal cystoid space (IRC), serous pigment epithelium detachment (sPED), and fibrovascular pigment epithelium detachment (fPED). Baseline sensitivity was reduced to mean values of 1.8 dB in NVC, 2.2 dB in IRC, 2.8 dB in IRF, 2.6 dB in sPED, 3.6 dB in SRF, and 4.6 dB in fPED. Improvements in retinal sensitivity were most pronounced during the initial 3-month interval, when significant recovery was documented for SRF and sPED with +4.0/5.5 dB (P < 0.0001) and to a lesser extent for IRF, IRC, fPED, with +1.1, 1.7, 2.3 dB, respectively. From month 3 to 12, the additional benefit ranged from 0.3 to 1.0 dB (P > 0.05 for each category). Significant functional benefits following intravitreal aflibercept treatment could be detected over all defined morphological pathologies. The level of improvement varied dependent on the associated feature with the best prognosis for visual improvement in SRF and sPED and least with intraretinal fluid and particularly intraretinal cysts.

Spectral-Domain Optical Coherence Tomography Staging and Autofluorescence Imaging in Achromatopsia

IMPORTANCE Evidence is mounting that achromatopsia is a progressive retinal degeneration, and treatments for this condition are on the horizon. OBJECTIVES To categorize achromatopsia into clinically identifiable stages using spectral-domain optical coherence tomography and to describe fundus autofluorescence imaging in this condition. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was performed between 2010 and 2012 at the Edward S. Harkness Eye Institute, New York-Presbyterian Hospital. Participants included 17 patients (aged 10-62 years) with full-field electroretinography-confirmed achromatopsia. MAIN OUTCOMES AND MEASURES Spectral-domain optical coherence tomography features and staging system, fundus autofluorescence and near-infrared reflectance features and their correlation to optical coherence tomography, and genetic mutations served as the outcomes and measures. RESULTS Achromatopsia was categorized into 5 stages on spectral-domain optical coherence tomography: stage 1 (2 patients [12%]), intact outer retina; stage 2 (2 patients [12%]), inner segment ellipsoid line disruption; stage 3 (5 patients [29%]), presence of an optically empty space; stage 4 (5 patients [29%]), optically empty space with partial retinal pigment epithelium disruption; and stage 5 (3 patients [18%]), complete retinal pigment epithelium disruption and/or loss of the outer nuclear layer. Stage 1 patients showed isolated hyperreflectivity of the external limiting membrane in the fovea, and the external limiting membrane was hyperreflective above each optically empty space. On near infrared reflectance imaging, the fovea was normal, hyporeflective, or showed both hyporeflective and hyperreflective features. All patients demonstrated autofluorescence abnormalities in the fovea and/or parafovea: 9 participants (53%) had reduced or absent autofluorescence surrounded by increased autofluorescence, 4 individuals (24%) showed only reduced or absent autofluorescence, 3 patients (18%) displayed only increased autofluorescence, and 1 individual (6%) exhibited decreased macular pigment contrast. Inner segment ellipsoid line loss generally correlated with the area of reduced autofluorescence, but hyperautofluorescence extended into this region in 2 patients (12%). Bilateral coloboma-like atrophic macular lesions were observed in 1 patient (6%). Five novel mutations were identified (4 in the CNGA3 gene and 1 in the CNGB3 gene). CONCLUSIONS AND RELEVANCE Achromatopsia often demonstrates hyperautofluorescence suggestive of progressive retinal degeneration. The proposed staging system facilitates classification of the disease into different phases of progression and may have therapeutic implications.

Three-Dimensional Assessment of Vascular and Perivascular Characteristics in Subjects with Retinopathy of Prematurity

To study vascular features detected with spectral domain optical coherence tomography (SD-OCT) in subjects undergoing retinopathy of prematurity (ROP) screening. Cross-sectional study. Fifty-seven premature neonates, 10 with plus disease in at least 1 eye and 47without plus disease. Bedside noncontact SD-OCT imaging was performed after obtaining parental consent on 97 consecutive infants between January 2009 and September 2012. Fifty-seven subjects (31-49 weeks' post-menstrual age) who had an SD-OCT scan in at least 1 eye showing the edge of the optic nerve and at least 1 major retinal vascular arcade were included. One eye per subject was randomly selected for analysis. Two masked graders evaluated scans for (1) retinal vessel elevation, (2) scalloped retinal layers, (3) hyporeflective vessels, and (4) retinal spaces. To coalesce the weight of these features, a Vascular Abnormality Score by OCT (VASO) was created. For quantitative assessment of vessel elevation, retinal surface maps were created. Prevalence of SD-OCT vascular abnormalities, the VASO, intergrader agreement, and presence of elevation on surface maps. From among 67 SD-OCT characteristics that were recorded, the most common characteristics found were vessel elevation (44%), hyporeflective vessels (40%), scalloped layers (22%), and retinal spaces (11%). Features significantly associated with plus disease were vessel elevation (P= 0.01), hyporeflective vessels (P= 0.04), and scalloped retinal layers (P= 0.006). Intragrader agreement was between 74% and 90% for all features. The VASO was significantly higher in subjects with plus disease (P= 0.0013). On 3-dimensional SD-OCT volumes, eyes with plus disease had greater retinal surface elevation that more often matched en face retinal vascular patterns. We present a novel 3-dimensional analysis of vascular and perivascular abnormalities identified in SD-OCT images of eyes with ROP. The SD-OCT characteristics that are more common in eyes with plus disease provide the first invivo demonstration of the effects of vascular dilation and tortuosity on perivascular tissue. The VASO and surface maps also delineate the severity of vascular pathology in plus disease. Further studies evaluating these findings in eyes with pre-plus versus normal posterior pole vessels may determine the usefulness of SD-OCT in the early detection of vascular abnormalities in ROP.

Spectral-Domain Optical Coherence Tomography Features in Fellow Eyes of Patients with Idiopathic Macular Hole

To describe the vitreomacular interface and foveal structural changes in fellow eyes of patients with idiopathic macular holes using spectral-domain optical coherence tomography (SD-OCT). Retrospective analysis of consecutive medical records and SD-OCT images of the fellow eyes of patients with macular hole was done. Changes of the vitreoretinal interface and foveal structures on SD-OCT scan of the 101 fellow eyes of 101 subjects with full-thickness macular hole were studied and compared with 101 eyes of 101 age-matched healthy subjects. Sixty-four patients (57.65%) were female. Mean age at presentation was 60.44 ± 12.17 years. The best-corrected visual acuity (BCVA) in eyes with macular hole was 0.86 logMAR units and in fellow eyes was 0.41 logMAR units. Seven eyes had macular hole in the fellow eye at the time of presentation. The majority of the fellow eyes (87/101, 78.37%) were phakic. The average base diameter of macular hole was 1105 ± 451.63 µm. Incidence of vitreomacular traction, epiretinal membrane, lamellar hole, and inner foveal split was more common (<0.05) in fellow eyes in comparison to healthy eyes. In contrast, posterior vitreous detachment (PVD) and perifoveal PVD was more common in age-matched control eyes. There was no statistically significant correlation between foveal abnormalities of fellow eyes with base diameter of eyes with macular hole, BCVA, and duration of symptoms. Fellow eyes of patients with idiopathic macular hole have a high frequency of abnormal vitreoretinal interface and foveal abnormalities, which predisposes to formation of macular hole.

Enhanced depth imaging optical coherence tomography findings associated with serous retinal detachment in preeclampsia

Preeclampsia is characterized by hypertension, proteinuria, and edema occurring in the second half of pregnancy. The main ocular manifestations are related to dysfunction of both retinal and choroidal circulation [1, 2]. Similarly to hypertensive retinopathy, cotton wool spots, hemorrhages, edema, papilloedema, serous retinal detachment and lesions of the retinal pigment epithelium (RPE) may develop in preeclampsia. Fluorescein angiography shows areas of choroidal hypoand nonperfusion (Elschnig spots) in preeclamptic women with serous retinal detachment [3, 4]. It has been proposed that intense spasm of the choroidal arterioles may be responsible for choroidal ischemia, resulting in increased vascular permeability, and subsequently, accumulation of serous fluid in the subretinal space [4]. We investigate the changes in the outer retina and choroid by means of enhanced depth imaging (EDI) [5] spectral-domain optical coherence tomography (SD-OCT) in a preeclamptic women with serous retinal detachment. A 38-year-old woman developed hypertension (190/ 110 mmHg), proteinuria, and generalized edema in the 35th week of pregnancy. Two days after undergoing a cesarean section, the patient was referred to our department for impairment of vision in both eyes. Best-corrected visual acuity was 20/25 in the right eye (RE) and 20/80 in the left eye (LE). Fundus biomicroscopy showed a peripapillary serous retinal detachment bilaterally, with involvement of the LE macula. Blue fundus autofluorescence (b-FAF) showed inhomogeneous increased autofluorescence in the peripapillary area, while near-infrared fundus autofluorescence (nirFAF) revealed peripapillary areas of hypoautofluorescence together with focal points of intensely decreased nir-FAF (Fig. 1). EDI SD-OCT scans through the areas of abnormal autofluorescence and the macula showed peripapillary serous retinal detachment bilaterally with focal RPE elevations, and serous macular detachment in the LE (Fig. 2). Choroidal thickness in the scan passing through the macula was 475 lm RE, 361 lm LE subfoveally, and 263 lm RE, 367 lm LE in the peripapillary area (Fig. 2) (increased compared with reference values) [5]. Two weeks later, BCVA improved to 20/20 in both eyes, and fundus biomicroscopy revealed disappearance of serous retinal detachment. b-FAF still showed increased autofluorescence in the peripapillary area, while nir-FAF revealed almost complete disappearance of both peripapillary areas of hypoautofluorescence and focal points of decreased nir-FAF (Fig. 1). EDI SD-OCT scans confirmed the disappearance of serous retinal detachment in both eyes, and showed persistence of focal RPE elevations (Fig. 2). Choroidal thickness in the scan passing through the macula was unchanged subfoveally, while decreased to 186 lm RE, 284 lm LE in the peripapillary area (Fig. 2). Previous reports have documented, by time domain OCT, the presence of serous retinal detachment in preeclamptic women [6]. To the best of our knowledge this is the first case study to describe the SD-OCT features of serous retinal detachment in preeclampsia. SD-OCT revealed focal RPE elevations in the peripapillary areas of abnormal FAF (both b-FAF and nir-FAF) suggesting compromised fluid transport (choroid-RPE-retina) in the acute phase of the disease, which persisted also after the resolution of both serous retinal detachment and focal L. Querques G. Querques (&) F. Loperfido R. Lattanzio F. Bandello Department of Ophthalmology, University Vita Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy e-mail: giuseppe.querques@hotmail.it

SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY OF EARLY ONSET LARGE COLLOID DRUSEN

Large colloid drusen (LCD) are a subgroup of early onset drusen recently reported. The aim of this study was to describe morphologic features in patients affected with LCD using high-resolution spectral-domain optical coherence tomography (SD-OCT). A complete ophthalmologic examination including SD-OCT was performed in 22 eyes of 11 consecutive patients. Mean age was 35 years old at diagnosis, and mean visual acuity was 20/25. In all eyes, SD-OCT showed multiple dome-shaped retinal pigment epithelium detachments corresponding to the drusen. Mean height of drusen was 199 μm (range, 108-316 μm) and mean width was 419 μm (range, 190-681 μm). Indocyanine green angiography hypofluorescent LCD were larger and more reflective on SD-OCT than indocyanine green angiography hyperfluorescent LCD. All drusen appeared convex with medium and homogeneous internal reflectivity. Retina overlying LCD appeared wavy and overall thinned. Prominent diffuse hyperreflective haze in the Henle fiber layer over drusen was noted in 73% of the eyes. No geographic atrophy or choroidal neovascularization was observed. The peculiar SD-OCT features reported in the current series give insight on the ultrastructure of LCD. Further studies with follow-up evaluation and possibly histologic evaluation are needed to clarify the clinical significance of LCD.

The Posterior Pole and Papillomacular Fold in Posterior Microphthalmos: Novel Spectral-Domain Optical Coherence Tomography Findings

To report and analyze the spectral-domain optical coherence tomography (SD-OCT) features of the posterior pole and papillomacular fold (PMF) in posterior microphthalmos (PM) in relation to axial length of the globe and corneal power. Comparative case series. Forty eyes of 20 PM patients and 70 eyes of 35 age-matched controls. All PM and control eyes underwent a full biometric evaluation, including axial length and corneal power measurements, and macular SD-OCT. In addition, a novel SD-OCT marker of the posterior pole curvature, termed the posterior pole curvature index (PPCI), was measured along both the vertical and horizontal meridians. The OCT characteristics of the PMF were analyzed and the PPCIs were compared and correlated with the axial length and corneal power in both groups of eyes, and with the PMF severity in PM eyes. We considered the SD-OCT features of the PMF, the PPCI in PM eyes and controls, and the correlations between PPCI and PMF severity and axial length. All PMFs were predominantly horizontal and partial thickness, sparing the outer retina except the outer plexiform layer. The PPCI in PM eyes (mean ± standard deviation, 145±40.3 microns; median, 144) was significantly larger than that of controls (14±12.8 microns; median, 14; P<0.0001). In addition, the vertical PPCI in PM eyes, but not in controls, was notably larger than the horizontal PPCI (mean difference, 55±30.4 microns; P<0.0001). In PM eyes, the PPCI strongly correlated with PMF height (R = 0.68; P<0.0001), inverse axial length (R = -0.71; P<0.0001), and corneal power (R = 0.49; P = 0.002), and the PMF height correlated strongly and inversely with the axial length (R = -0.62; P<0.0001). The PMF in PM eyes has characteristic morphologic SD-OCT features. The increased posterior pole curvature in PM and its significant correlation with the axial length, the PMF severity and keratometry established in this study suggest that PM eyes are not only shorter than normal, but seem to be abnormally shaped posteriorly, particularly along the vertical meridian. This factor may play a role in the pathogenesis and morphology of the PMF. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Progression of Intermediate Age-related Macular Degeneration with Proliferation and Inner Retinal Migration of Hyperreflective Foci

Drusen and migrating retinal pigment epithelium have been associated with hyperreflective foci (HF) detected by spectral-domain optical coherence tomography (SD-OCT). This study sought to quantify the change in intraretinal HF distribution and its correlation with age-related macular degeneration (AMD) disease progression. Prospective observational study from the multicenter Age-Related Eye Disease Study 2 (AREDS2) Ancillary SD-OCT Study. Patients (n=299) with 1 enrolled eye with intermediate AMD and baseline SD-OCT, followed by SD-OCT imaging at 1-year and 2-year visits. The number and location of HF were scored in SD-OCT scans of all 299 eyes. The change in transverse (horizontal) and axial (vertical) distribution of HF in the macula were evaluated with pairwise signed-rank tests. Two-year inner retinal HF migration was determined by the change in HF-weighted axial distribution (AxD) score calculated for each eye. The correlation of HF with SD-OCT features of AMD progression was evaluated with logistic regression analysis. The mean change in number of HF, transverse and axial distribution of HF in the macula, and AxD per eye. In 299 study eyes, the 2-year increase in the number of HF (P<0.001) and the AxD (P<0.001) per eye represented longitudinal proliferation and shift to inner retinal layers, respectively. Eyes with geographic atrophy (GA) at 2 years were correlated with the presence of baseline HF (P<0.001; odds ratio [OR], 4.72; 95% confidence interval [CI], 2.43-9.80), greater number of baseline HF (P<0.001; OR, 1.61 per HF; 95% CI, 1.32-2.00), and greater baseline AxD (P<0.001; OR, 1.58 per AxD point; 95% CI, 1.29-1.95). Proliferation and inner retinal migration of SD-OCT HF occurred during follow-up in eyes with intermediate AMD. These characteristics were associated with greater incidence of GA at year 2; therefore, SD-OCT HF proliferation and migration may serve as biomarkers for AMD progression. Proprietary or commercial disclosure may be found after the references.

Predictive Value of Spectral-Domain Optical Coherence Tomography Features in Assessment of Visual Prognosis in Eyes With Neovascular Age-Related Macular Degeneration Treated With Ranibizumab

To determine whether pretreatment (baseline) optical coherence tomography (OCT) features can be used as predictors of visual acuity outcome at 12 months in eyes with neovascular age-related macular degeneration treated with intravitreal ranibizumab and to assess whether baseline OCT features can predict a change in visual acuity from baseline to 12 months. Retrospective, observational study. We retrospectively evaluated the serial cross-sectional images of the macula obtained using the Spectralis OCT (HRA+OCT; Heidelberg Engineering) in 100 eyes of 94 patients attending a single center and undergoing treatment with intravitreal ranibizumab for neovascular age-related macular degeneration. The baseline OCT characteristics and visual acuity were correlated to the final visual acuity (Early Treatment Diabetic Retinopathy Study letters) and change in visual acuity after 12 months of monitoring and treatment. Univariate and multivariate analyses were carried out to correlate these morphologic features with the final visual acuity and the change in visual acuity. Intact ellipsoid zone (P = .0001) and external limiting membrane in the subfoveal area (P < .0001) at baseline were the only 2 independent good prognostic indicators of final visual acuity at 12 months. However, none of the morphologic features at baseline could predict the change in visual acuity by 12 months. The results suggest that integrity of the outer retinal layers at baseline is crucial for determining final visual acuity at 12 months in eyes undergoing treatment with ranibizumab for neovascular age-related macular degeneration.

Spectral-domain Optical Coherence Tomography Characteristics of Chorioretinal Folds

Purpose: To describe the spectral-domain optical coherence tomography features of chorioretinal folds of various etiology. Materials and methods: Cross-sectional observational case series of consecutive patients with chorioretinal folds. All patients underwent enhanced depth imaging optical coherence tomography over a two-month study period. Clinical variables and imaging features including subfoveal choroidal thickness and chorioretinal fold morphology were analysed. Results: 11 of 628 patients evaluated presented with chorioretinal folds. Diagnoses included hyperopia, uveal effusion, and secondary to surgery or medications. 22 patients presented with lesions simulating chorioretinal folds on ophthalmoscopy but were found not to be true chorioretinal folds with optical coherence tomography. Subfoveal choroidal thickness was diffusely thick in hyperopia, uveal effusion, hypotony, and topiramate, and normal in cases following scleral buckle and trauma. Lesions simulating chorioretinal folds occurred in age-related choroidal atrophy, and demonstrated chorioretinal contour changes involving specific choroidal vessels in an overall thin choroid. Conclusion: Chorioretinal folds occurred in the context of a diffusely thick choroid in high hyperopia and hypotony, and with a normal choroidal thickness following scleral buckle or trauma. Enhanced depth imaging OCT is helpful in differentiating chorioretinal folds from various etiologies and from simulating lesions.

Correlation of SD-OCT Features and Retinal Sensitivity in Neovascular Age-Related Macular Degeneration

To correlate retinal sensitivity in patients with neovascular age-related macular degeneration (AMD) with specific characteristics of retinal morphology. Thirty eyes of 30 patients presenting with active choroidal neovascularization were examined by spectral domain optical coherence tomography (SD-OCT) and microperimetry (MP-1). Image-processing software was used to match a fundus photographic (FP) MP-1 image with an infrared+OCT SD-OCT image. Each MP test point for retinal sensitivity was positioned at the corresponding SD-OCT location, and the microperimetric results were evaluated. An intact retinal configuration was associated with a median retinal sensitivity of 15.5 dB (quartiles: 12 dB, 18 dB). The median retinal sensitivities were 0 dB (quartiles: 0 dB, 1 dB) for the neovascular complex, 4 dB (0 dB, 9 dB) for the subretinal fluid, 1 dB (0 dB, 6 dB) for the intraretinal fluid, and 0 dB (0 dB, 3 dB) for intraretinal cysts. Pigment epithelium detachment was associated with a median retinal sensitivity of 3 dB (0 dB, 8 dB), and subretinal drusen had a median value of 8 dB (5 dB, 12 dB). Deep retinal layer analyses gave low median retinal sensitivities of 0 dB (0 dB, 3 dB) for an absent retinal pigment epithelium layer and 1 dB (0 dB, 5 dB) for an absent photoreceptor layer. Superimposition of morphological SD-OCT features and microperimetric retinal sensitivity allowed exact determination of the differential impact of retinal alteration on the corresponding sensitivity. Individual OCT-related indicators of neurosensory integrity were distinctly correlated with visual function. "Morphofunctional" findings could be relevant as prognostic factors and for (re)treatment decisions. (https://www.clinicaltrialsregister.eu/ number, 2006-005684-26.).

Spectral-Domain Optical Coherence Tomography Characteristics of Intermediate Age-related Macular Degeneration

Describe qualitative spectral-domain optical coherence tomography (SD-OCT) characteristics of eyes classified as intermediate age-related macular degeneration (nonadvanced AMD) from Age-Related Eye Disease Study 2 (AREDS2) color fundus photography (CFP) grading. Prospective cross-sectional study. We included 345 AREDS2 participants from 4 study centers and 122 control participants who lack CFP features of intermediate AMD. Both eyes were imaged with SD-OCT and CFP. The SD-OCT macular volume scans were graded for the presence of 5 retinal, 5 subretinal, and 4 drusen characteristics. In all, 314 AREDS2 participants with ≥1 category-3 AMD eye and all controls each had 1 eye entered into SD-OCT analysis, with 63 eyes regraded to test reproducibility. We assessed SD-OCT characteristics at baseline. In 98% of AMD eyes, SD-OCT grading of all characteristics was successful, detecting drusen in 99.7%, retinal pigment epithelium (RPE) atrophy/absence in 22.9%, subfoveal geographic atrophy in 2.5%, and fluid in or under the retina in 25.5%. Twenty-eight percent of AMD eyes had characteristics of possible advanced AMD on SD-OCT. Two percent of control eyes had drusen on SD-OCT. Vision loss was not correlated with foveal drusen alone, but with foveal drusen that were associated with other foveal pathology and with overlying focal hyperreflectivity. Focal hyperreflectivity over drusen, drusen cores, and hyper- or hyporeflectivity of drusen were also associated with RPE atrophy. Macular pathologies in AMD can be qualitatively and reproducibly evaluated with SD-OCT, identifying pathologic features that are associated with vision loss, RPE atrophy, and even possibly the presence of advanced AMD not apparent on CFP. Qualitative and detailed SD-OCT analysis can contribute to the anatomic characterization of AMD in clinical studies of vision loss and disease progression. Proprietary or commercial disclosure may be found after the references.

Comparison of observation, intravitreal bevacizumab, or pars plana vitrectomy for non-proliferative type 2 idiopathic macular telangiectasia

To compare visual and anatomic outcomes in eyes with type 2 idiopathic macular telangiectasia (Mactel) treated with either intravitreal bevacizumab (IVB), observation, or pars plana vitrectomy (PPV) with internal limiting membrane removal. Retrospective, consecutive, interventional case series of phakic patients with Mactel. Best-corrected Snellen visual acuity (BCVA) and complete ophthalmic exam was obtained prior to treatment and at subsequent 3-month intervals for a minimum of 6 months. Fluorescein angiographic and spectral-domain optical coherence tomography features were examined, and compared to BCVA at treatment initiation and follow-up. Fifty-six eyes of 28 patients were evaluated. Mean age was 65 ± 12 years, and mean follow-up was 24 ± 13 months. Patients were treated with either observation (n = 33), IVB (n = 15), or PPV (n = 8). Mean number of treatments for the IVB group was 2.5 ± 3.5 intravitreal injections. No significant differences in BCVA change were observed between treatment groups via one-way ANOVA (p = 0.49). Presence of inner retinal cysts was not correlated to BCVA (p > 0.05). Discontinuous outer nuclear layer was significantly related to worse initial and final vision, but not to BCVA change. IVB and PPV with ILM removal appear ineffective in improving visual outcome in eyes with non-proliferative Mactel. SD-OCT evidence of disrupted foveal outer nuclear layer is related to decreased BCVA, but not related to BCVA change following treatment.

Characteristics of spectral-domain optical coherence tomography and fundus autofluorescence in acute and chronic central serous chorioretinopathy

[Objective] To observe the characteristics of spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) in acute and chronic central serous chorioretinopathy (CSC).[Methods] Seven-three eyes of 67 patients with CSC diagnosed by slit-lamp microscopy,fundus photochromy,fundus fluorescein angiography (FFA) and indocyanine green angiography were enrolled in this study.All the patients were examined for FAF and SD-OCT.The patients were divided into acute CSC group (37 patients,37 eyes) and chronic CSC group (30 patients,36 eyes) according to the clinical features and FFA images.According to the OCT feature in retinal detachment area,they were divided into three categories,which including intact,non-intact and atrophy outer segment,respectively.According to the FAF characteristics,they were divided into hyper-FAF,hypo-FAF and mixed type,respectively.The characteristics of SD-OCT and FAF of both acute and chronic CSC patients were evaluated and analyzed.[Results] In acute CSC group,19 eyes (51.35％) were hypo-FAF,18 eyes (48.65％) were hyper-FAF.In chronic CSC group,two eyes (5.56％) were hypo-FAF,16 eyes (44.44％) were hyper-FAF,and 18 eyes (50.00％) were mixed type.There was significant difference between both groups (x2=31.872,P=0.000).The SD-OCT results showed that in acute group,15 eyes (40.54％) were intact outer segment,18eyes (48.65％) were non-intact outer segment,and four eyes (10.81％) were atrophy outer segment.In chronic group,five eyes (13.89％) were intact outer segment,17 eyes (47.22％) were non-intact outer segment,and 14 eyes (38.89 ％) were atrophy outer segment.There was significant difference between both groups (x2 =10.572,P=0.005).[Conclusion]s The FAF characteristics of acute and chronic CSC mainly manifests hypo-FAF and mixed type,respectively.The OCT characteristics of acute CSC mainly manifests intact outer segment and non-intact outer segment,but non-intact outer segment and atrophy outer segment in chronic CSC. Key words: Retinal diseases/diagnosis; Choroid diseases/diagnosis; Pigment epithelium of eye; Tomography, optical coherence; Diagnostic imaging

HYPERAUTOFLUORESCENT RING IN AUTOIMMUNE RETINOPATHY

To report the presence of a hyperautofluorescent ring and corresponding spectral-domain optical coherence tomography (SD-OCT) features seen in patients with autoimmune retinopathy. All eyes were evaluated by funduscopic examination, full-field electroretinography, fundus autofluorescence, and SD-OCT. Further confirmation of the diagnosis was obtained with immunoblot and immunohistochemistry testing of the patient's serum. Humphrey visual fields and microperimetry were also performed. Funduscopic examination showed atrophic retinal pigment epithelium (RPE) associated with retinal artery narrowing but without pigment deposits. The scotopic and photopic full-field electroretinograms were nondetectable in three patients and showed a cone-rod pattern of dysfunction in one patient. Fundus autofluorescence revealed a hyperautofluorescent ring in the parafoveal region, and the corresponding SD-OCT demonstrated loss of the photoreceptor inner segment-outer segment junction with thinning of the outer nuclear layer from the region of the hyperautofluorescent ring toward the retinal periphery. The retinal layers were generally intact within the hyperautofluorescent ring, although the inner segment-outer segment junction was disrupted, and the outer nuclear layer and photoreceptor outer segment layer were thinned. This case series revealed the structure of the hyperautofluorescent ring in autoimmune retinopathy using SD-OCT. Fundus autofluorescence and SD-OCT may aid in the diagnosis of autoimmune retinopathy and may serve as a tool to monitor its progression.