Ultra-widefield Optical Coherence Tomography Research Articles

Characterization of Vortex Vein Drainage System in Healthy Individuals Imaged by Ultra-Widefield Optical Coherence Tomography Angiography.

The purpose of this study was to investigate the choroidal characteristics of vortex vein (VV) drainage systems in healthy individuals using ultra-widefield optical coherence tomography angiography. The mean choroidal thickness (ChT) and choroidal vascularity index (CVI) of each VV quadrant (24 × 20 mm2 scan mode; superotemporal [ST], superonasal [SN], inferonasal [IN], and inferotemporal [IT] quadrants) were calculated. Furthermore, intervortex venous anastomosis (IVA) was classified into temporal, superior, inferior, and nasal types. A total of 207 healthy eyes were analyzed to find that the ST quadrant had the thickest choroidal layer and highest CVI (all P < 0.05). Among the four VV drainage quadrants, the mean ChT and CVI decreased in the sequence of ST, SN, IT, and IN (all P < 0.05). Moreover, men had a higher CVI than women in all VV quadrants (all P < 0.05). IVA was observed in all VV quadrants of 91 eyes (43.96%), and in the macular region of 33 eyes (15.94%). The ST drainage system was identified as the preferred VV drainage route in healthy eyes. Among the four VV drainage quadrants, the drainage system adhered to the ST-SN-IT-IN order of descending perfusion. Furthermore, age- and sex-related differences were noted in the choroidal VV drainage systems of healthy eyes. Additionally, almost half of the healthy eyes had IVA in their choroidal vessel networks. The VV drainage system may be considered a novel imaging biomarker for ocular diseases.

Wide-Field Optical Coherence Tomography in Patients with Diabetic Macular Edema.

Background: The goal of the study was to analyze variations in central, perifoveal, and peripheral retinal thickness (RT) and choroidal thickness (CT) in patients with diabetic macular edema (DME) measured with ultra-wide-field optical coherence tomography (UWF-OCT). Additionally, correlations between RT and CT in the central, perifoveal, and peripheral sectors and the presence of selected systemic factors were evaluated. Methods: A total of 74 consecutive adult diabetic patients with DME and 75 healthy controls were included. Study participants were divided into three groups: DME patients without panretinal photocoagulation (PRP; 84 eyes), DME patients after PRP (56 eyes), and healthy controls (125 eyes). RT and CT were analyzed in three zones: a central circle of 3 mm diameter (central), a ring contained between a centered 9 mm circle and the central 3 mm circle (perifoveal), and a second, more peripheral ring between centered 18 mm and 9 mm circles (peripheral). Additionally, DME subgroups were analyzed according to the correlation of RT and CT with age, axial length, best corrected visual acuity (BCVA), diabetes duration, insulin therapy duration, body mass index (BMI), glycosylated hemoglobin (HbA1c) values, intravitreal injection (IVI) count, and the advancement of retinopathy assessed by the simplified diabetic retinopathy severity scale (DRSS). Results: The increase in RT in the far peripheral sectors in DME patients was not significant. The increases in central and perifoveal RT and lower values of CT in PRP-naive DME patients were strongly associated with poorer BCVA. Patients with DME after PRP presented with BCVA improvements significantly related to the number of IVIs. The amount of DME and RT in peripheral sectors were both independent of systemic factors such as BMI, duration of diabetes, duration of insulin intake, retinopathy severity, and HbA1c levels. Conclusions: Peripheral retinal sectors in DME patients are less affected in terms of increase in their thickness compared to central ones. Functional and morphological associations of DME with UWF-OCT testing refer to central and perifoveal sectors.

Non-mydriatic ultra-widefield diffraction-limited retinal imaging.

We demonstrate a new non-mydriatic ultra-widefield optical coherence tomography retinal imaging system, designed with custom optics to improve the imaging field of view, lateral resolution, and patient comfort. The key motivation is to address the challenge with conventional systems that require pupillary dilation, adding time, expense, discomfort, and medical risk to the examination of the retina. Our system provides an ultrawide 100° field of view (beam scanning angle at the scanning pivot point) and maintains a lateral resolution of 20 µm on the center. It also allows a generous working distance of 16 mm, 2-3 times longer than existing ultra-widefield OCT imaging systems. This advanced system was able to avoid iris vignetting artifacts without pharmacological dilation and ensure diffraction-limited ultra-widefield imaging under a generalized eye model. This enables a comprehensive evaluation of retina diseases, especially those affecting the peripheral regions.

Choroidal and Retinal Thicknesses in Healthy Eyes Measured with Ultra-Wide-Field Optical Coherence Tomography.

Ultra-wide-field optical coherence tomography (UWF-OCT) has been recently introduced into clinical ophthalmological practice. To date, there are few data on the reference values of the retinal thickness (RT) and choroidal thickness (CT) measured with this technique. This study aimed to analyze the variance in RT and CT in the healthy eyes of white Caucasian patients with UWF-OCT tests performed with the largest available scan size of 23 × 20 mm. The data were analyzed with reference to the patients' age and gender and the axial length of the eyeball. The results of UWF-OCT scanning enabled us to visualize the shape of the retina and choroid in a large portion of the eyeball. Both anatomical entities became significantly thinner at the periphery. The peripheral CT was greater in the upper and temporal sectors; the RT was higher in the nasal compared to the temporal sectors. Both the choroid and retina showed a reduced thickness with age; however, the CT and RT did not show a statistically significant correlation with the axial length after adjusting for age and gender. Age-related variations in thickness were especially prominent in the choroid. The CT in UWF-OCT testing was significantly greater in females, while the RT was greater in males. UWF-OCT testing provides additional information on the anatomical structure of the retina and choroid compared to standard-field OCT.

Deep learning-driven automated quality assessment of ultra-widefield optical coherence tomography angiography images for diabetic retinopathy

AbstractImage quality assessment (IQA) of fundus images constitutes a foundational step in automated disease analysis. This process is pivotal in supporting the automation of screening, diagnosis, follow-up, and related academic research for diabetic retinopathy (DR). This study introduced a deep learning-based approach for IQA of ultra-widefield optical coherence tomography angiography (UW-OCTA) images of patients with DR. Given the novelty of ultra-widefield technology, its limited prevalence, the high costs associated with equipment and operational training, and concerns regarding ethics and patient privacy, UW-OCTA datasets are notably scarce. To address this, we initially pre-train a vision transformer (ViT) model on a dataset comprising 6 mm × 6 mm OCTA images, enabling the model to acquire a fundamental understanding of OCTA image characteristics and quality indicators. Subsequent fine-tuning on 12 mm × 12 mm UW-OCTA images aims to enhance accuracy in quality assessment. This transfer learning strategy leverages the generic features learned during pre-training and adjusts the model to evaluate UW-OCTA image quality effectively. Experimental results demonstrate that our proposed method achieves superior performance compared to ResNet18, ResNet34, and ResNet50, with an AUC of 0.9026 and a Kappa value of 0.7310. Additionally, ablation studies, including the omission of pre-training on 6 mm × 6 mm OCTA images and the substitution of the backbone network with the ViT base version, resulted in varying degrees of decline in AUC and Kappa values, confirming the efficacy of each module within our methodology.

Isolated Retinal Neovascularization in Retinopathy of Prematurity: Clinical Associations and Prognostic Implications

Isolated retinal neovascularization (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity (ROP). This study aimed to further classify the clinical course and significance of these lesions (previously described as "popcorn" based on clinical appearance) in patients with ROP as visualized with ultrawidefield OCT (UWF-OCT). Single center, retrospective case series. Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit. A prototype UWF-OCT device captured en face scans (>140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression. Differences in clinical demographics and disease progression between patients with and without IRNV. Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BWs) (660.1 vs. 916.8 g, P= 0.001), gestational age (GA) (24.9 vs. 26.1 weeks, P= 0.01), and were more likely to present with ROP in zone I (63.4% vs. 15.8%, P < 0.001). They were also more likely to progress to stage 3 (68.2% vs. 13.2%, P < 0.001) and receive treatment (54.5% vs. 15.8%, P= 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs. 3.73, P < 0.001) and averaged a higher VSS throughout their disease course. On multivariable logistic regression, IRNV was independently associated with progression to stage 3 (P= 0.02) and requiring treatment (P= 0.03), controlling for GA, BW, and initial zone 1 disease. In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Panretinal handheld OCT angiography for pediatric retinal imaging

Comprehensive visualization of retina morphology is essential in the diagnosis and management of retinal diseases in pediatric populations. Conventional imaging techniques often face challenges in effectively capturing the peripheral retina, primarily due to the limitations in current optical designs, which lack the necessary field of view to characterize the far periphery. To address this gap, our study introduces a novel ultra-widefield optical coherence tomography angiography (OCTA) system. This system, specifically tailored for pediatric applications, incorporates an ultrahigh-speed 800 kHz swept-source laser. The system’s innovative design achieves a 140° field of view while maintaining excellent optical performance. Over the last 15 months, we have conducted 379 eye examinations on 96 babies using this system. It demonstrates marked efficacy in the diagnosis of retinopathy of prematurity, providing detailed and comprehensive peripheral retinal angiography. The capabilities of the ultra-widefield handheld OCTA system in enhancing the clarity and thoroughness of retina vascularization assessments have significantly improved the precision of diagnoses and the customization of treatment strategies. Our findings underscore the system’s potential to advance pediatric ophthalmology and broaden the scope of retinal imaging.

Comparisons of choroidal thickness and volume in eyes with central serous chorioretinopathy to that of control eyes determined by ultra-widefield optical coherence tomography.

To compare choroidal thickness and volume in eyes with central serous chorioretinopathy (CSC) and healthy control eyes over a wide area of the fundus using ultra-widefield optical coherence tomography (UWF-OCT). Thirty-three eyes of 29 patients with CSC and 36 eyes of 21 healthy controls were examined retrospectively. Choroidal images were obtained with a prototype UWF-OCT device with a field of view of 105° or approximately 31.5-mm wide by 10.9-mm deep. Choroidal thickness and volume were measured in the images of 12 radial scans (every 15°) from the horizontal scan. The "new index" of the extent of focal choroidal protrusion was defined as the maximum steepness of choroidal thickness (MSCT). Choroidal volume in CSC eyes was significantly larger than in control eyes within the central 50° (P < 0.001). However, there was no significant difference in choroidal volume in the peripheral 50 to 105° (P = 0.071). The MSCTs were significantly steeper in CSC eyes than in control eyes at scan lines 1, 6, 7, 8, and 10 (P < 0.01, P < 0.001, P < 0.05, P < 0.01, P < 0.05). The choroid in CSC eyes was thickened only at the posterior pole, and its protrusion was significant mainly in the vertical direction. Focal choroidal thickening at the posterior pole, which we speculate includes congenital scleral changes, may affect the pathophysiology of CSC.

Quantitative evaluation of ocular vascularity and correlation analysis in patients with diabetic retinopathy by SMI and OCTA

AimsTo find potential relation between retrobulbar vessels and fundus microvessels and to detect sensitive and effective clinical indicators in predicting the progress of diabetic retinopathy (DR), ocular hemodynamics were measured using superb microvascular imaging (SMI) and ultrawide-field optical coherence tomography angiography (UWF-OCTA).MethodsObservational, cross-sectional study evaluating ocular hemodynamics in patients with DR by SMI (Aplio i900, Canon Medical) and UWF-OCTA (BM-400 K BMizar, Tupai Medical Technology). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the central retinal artery (CRA), posterior ciliary artery (PCA), and ophthalmic artery (OA) were measured by SMI. UWF-OCTA evaluated the fundus vascular parameters. A correlation analysis was used to determine the correlation between SMI and UWF-OCTA parameters.ResultsOne hundred thirty-nine eyes of 139 diabetic patients were included: 29 without DR (NDR), 36 with mild to moderate nonproliferative DR (M-NPDR), 37 with severe NPDR (S-NPDR), and 37 with proliferative DR (PDR). PSV and EDV of retrobulbar vessels decreased from NDR to S-NPDR while increasing PDR. RI of OA showed a decreasing trend in the progression of DR, but other vessels didn’t show the same trend. ROC curve analysis showed that CRAPSV, CRAEDV, PCAEDV, OAPSV, and OAEDV had diagnostic value distinguishing M-NPDR and S-NPDR. The correlation analysis observed a significant association between the SMI parameters of CRA and PCA and UWF-OCTA parameters. CRA hemodynamics were more associated with fundus vascular parameters, especially the retina, in the NDR group than in the M-NPDR group. In contrast, PCA consistently correlated with fundus vascular parameters, especially in the choroid, from the NDR to the M-NPDR group. However, OA showed a poor correlation with OCTA parameters.ConclusionThe velocity of retrobulbar vessels, mainly the CRA, may serve as a valuable predictor for assessing the progress of DR. The use of SMI in diabetic patients may help identify patients at risk of developing retinopathy.

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.

Optical coherence tomography imaging of the peripheral retina.

This review critically assesses the applicability of retinal periphery imaging technology, scrutinizing its practical limitations and potential advancements within ophthalmology. It underscores the significant costs and the need to evaluate the clinical utility of optical coherence tomography (OCT) and OCT angiography devices. It emphasizes how clinicians should consider their practice-specific use-cases while investing in devices with capabilities like ultra-widefield OCT, autofluorescence imaging, and angiography. The paper also highlights the challenges associated with image acquisition, such as artifact management and patient cooperation for extended fixation periods. This review outlines the utility of these modalities in various retinal pathologies, as well as their contribution to telemedicine and personalized care, facilitated by artificial intelligence for improved image processing, quantification, and interpretation. These techniques potentially offer a more comprehensive understanding of peripheral retinal conditions and associated pathologies, thus influencing clinical decision-making, particularly in remote regions with limited specialist access.

Optical coherence tomography findings of the peripheral retina in patients with congenital X-linked retinoschisis.

Congenital X-linked retinoschisis (XLRS) presents as macular retinoschisis/degeneration in almost all patients and as peripheral retinoschisis in half the patients. Although the optical coherence tomography (OCT) findings of macular retinoschisis have been well investigated, those of peripheral retinoschisis have rarely been reported. This study aimed to report the ultra-widefield OCT findings of the peripheral retina in patients with XLRS. Medical records of 10 Japanese patients (19 eyes) with clinically and/or genetically diagnosed XLRS were retrospectively reviewed. Funduscopic, electroretinographic, and OCT findings were reviewed and evaluated. Some were also genetically evaluated for the RS1 gene. OCT of the macula revealed schises and/or cystoid changes in the inner nuclear layer (INL) and outer nuclear layer. In contrast, OCT of the peripheral retina revealed schises and/or cystoid changes in the INL in eight eyes (44%), and/or splitting in the ganglion cell layer (GCL) in 10 (56%) of the 18 eyes with clear OCT images. No schisis or cystoid changes were found in the peripheral OCT images of eight eyes (44%). A 16-year-old boy presented with retinal splitting of the GCL and INL of the inferior retina, although he had no ophthalmoscopic peripheral retinoschisis. Genetic examinations were performed on three patients, all of whom had reported missense mutations in the RS1 gene. In XLRS, peripheral bullous retinoschisis results from GCL splitting in the retina. One of the 10 patients with XLRS showed intraretinal retinoschisis in the GCL in the inferior periphery, which was unremarkable on ophthalmoscopy (occult retinoschisis). Although both peripheral bullous retinoschisis and occult retinoschisis showed splitting/cystic changes in the GCL, further studies are needed to determine whether occult retinoschisis progresses to bullous retinoschisis.

Purtscher-like retinopathy induced by diffuse cutaneous systemic scleroderma.

Abstract We report a rare case of Purtscher-like retinopathy related to systemic sclerosis, presented unprecedently an ultra-widefield optical coherence tomography angiography image for this combination, and showed not only retinal but also choroidal vascular nonperfusion.

Characterization of the external limbus on corneoscleral topography with ultrawide-field optical coherence tomography

PurposeTo present a new method for 3-dimensional external limbal demarcation on corneoscleral topography derived from optical coherence tomography (OCT). Limbal shape is investigated and compared to other landmarks. MethodsImages from the anterior segment were obtained with a ultrawide-field (20 mm) OCT. An automated algorithm was developed to demarcate the topographic limbus based on the transition from corneal to scleral curvature. The internal limbus was manually identified as the scleral spur on the OCT images. The external topographic limbus was fit with a circle on a plane. Ellipticity and ovality were defined by the lateral limbal deviation from the best-fit circle. Toricity was defined by the axial deviation from the best-fit plane. Repeatability was assessed by the within-subject standard deviation from two repeated measurements. For comparison, the white-to-white (WTW) diameter was obtained from Pentacam HR. Results18 eyes from 11 subjects were analyzed. The topographic limbal diameter was 12.16 ± 0.68 mm (mean ± standard deviation) horizontally and 11.18 ± 0.65 mm vertically. The repeatability for the topographic limbal diameter was 0.054 mm. The internal and WTW horizontal limbal diameters were significantly smaller (linear mixed-effects model (GLMM), p <.017). The vertical internal limbal diameter was significantly larger (GLMM p <.05). The topographic limbus had significant ellipticity (0.25 ± 0.13 mm, wider horizontally, repeatability of 0.07 mm) and toricity (0.15 ± 0.08 mm, flatter horizontally, repeatability of 0.10 mm). Low coefficients of determination were found for the topographical limbus with the internal limbus (R2=0.021 and R2=0.039, for horizontal and vertical diameters respectively) and with the WTW (R2=0.146 for the horizontal diameter). ConclusionThe proposed method to demarcate the 3D external topographical limbus is repeatable. The topographic limbal shape and size cannot be accurately derived from WTW nor internal limbus measures. This new technology may improve the process of scleral lens fitting.

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.

TEN-YEAR LONGITUDINAL MORPHOLOGIC CHANGES IN DOME-SHAPED MACULAS IN HIGHLY MYOPIC EYES.

To determine the longitudinal changes in the morphologic features of dome-shaped macula in highly myopic eyes. Patients with a dome-shaped macula and high myopia (spherical equivalent <-8 diopters [D] or axial length ≥26.5 mm) were retrospectively studied. The medical records, optical coherence tomographic images, and ultra-widefield optical coherence tomography images were analyzed. A total of 113 eyes of 82 patients were studied with a mean follow-up of 122.32 ± 6.36 months. During the follow-up, the mean dome height was significantly increased from 181.51 ± 105.55 to 209.85 ± 130.84 µ m ( P < 0.001). There was also a significant increase in the axial length (30.83 ± 1.82-31.16 ± 1.86 mm; P < 0.001). Subgroup analyses showed that the dome height increased more than 50 µ m in 78 (69%) eyes, decreased in 23 (20%) eyes, and was stable in 12 (11%) eyes. The change in the axial lengths was significantly greater in the increased dome height group than in the decreased and stable dome height groups ( P = 0.042). Multivariable analysis showed that the greater axial length change (OR, 8.73; P = 0.017) and horizontal type dome-shaped macula (OR, 4.14; P = 0.026) were significantly associated with an increase in dome height. The direction of change in the dome-shaped macula height varies and 69% of the eyes had an increase in height, whereas 20% of the eyes had a decrease in height. The variations in the dome height may result from the difference between the deepening of the peridome scleral excavation and the changes of the axial length.

ULTRA-WIDEFIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN MILD FAMILIAL EXUDATIVE VITREORETINOPATHY.

To investigate ultra-widefield optical coherence tomography angiography (UWF-OCTA) to detect and evaluate mild familial exudative vitreoretinopathy and compare the detective ratio of UWF-OCTA with ultra-widefield scanning laser ophthalmoscopy and ultra-widefield fluorescein angiography. The patients with familial exudative vitreoretinopathy were included in this study. UWF-OCTA, using a 24- × 20-mm montage, was performed for all patients. All images were independently tested for the presence of familial exudative vitreoretinopathy-associated lesions. Statistical analysis was performed with SPSS V.24.0. Forty-six eyes of 26 participants were included in the study. Ultra-widefield optical coherence tomography angiography was found to be greatly superior to ultra-widefield scanning laser ophthalmoscopy in detecting peripheral retinal vascular abnormality ( P < 0.001) and peripheral retinal avascular zone ( P < 0.001). The detection rates of peripheral retinal vascular abnormality, peripheral retinal avascular zone, retinal neovascularization, macular ectopia, and temporal midperipheral vitreoretinal interface abnormality were comparable with ultra-widefield fluorescein angiography images ( P > 0.05). Furthermore, vitreoretinal traction (17/46, 37%) and small foveal avascular zone (17/46, 37%) were detected effectively on UWF-OCTA. Ultra-widefield optical coherence tomography angiography is a reliable noninvasive tool to detect familial exudative vitreoretinopathy lesions, especially in mild patients or asymptomatic family members. The unique manifestation of UWF-OCTA offers an alternative to ultra-widefield fluorescein angiography for the screening and diagnosis of FEVR.

Novel MFRP Mutation with Nanophthalmos, Optic Disc Drusen, and Peripheral Retinoschisis Imaged with Ultra-Widefield OCT.

To describe with multimodal imaging including the use of ultra-widefield optical coherence tomography (OCT) imaging a distinct phenotype of autosomal recessive nanophthalmos associated with a novel mutation of the MFRP gene (membrane-type frizzled-related protein). Case report and review of the relevant literature. Single patient followed by the Weill Cornell Medicine Department of Ophthalmology Retina and Glaucoma Services. A patient with a novel homozygous mutation in the MFRP gene (c.472C>T) presented with nanophthalmos, optic disc drusen, foveal hypoplasia, and extensive peripheral retinoschisis, which was revealed to be multilevel retinoschisis on ultra-wide field OCT. Unlike other reported cases, the findings associated with this novel mutation did not include foveoschisis nor clinically obvious retinitis pigmentosa. The patient underwent prophylactic peripheral laser iridotomy in both eyes. Here we present a patient with nanophthalmos, optic disc drusen, and foveal hypoplasia associated with extensive peripheral retinoschisis imaged by ultra-widefield OCT, but not foveal retinoschisis or prominent retinitis pigmentosa. The findings may expand the clinical spectrum of MFRP-associated nanophthalmos.

Effect of photodynamic therapy on choroid of the medial area from optic disc in patients with central serous chorioretinopathy.

To explore the effect of photodynamic therapy (PDT) on the choroid of medial area from optic disc and factors correlated with treatment outcomes, we evaluated choroidal changes using ultra-widefield optical coherence tomography (UWF-OCT) after PDT for central serous chorioretinopathy (CSC). In this retrospective case-series, we included CSC patients who received a standard-dose of full-fluence PDT. UWF-OCT were examined at baseline and 3 months after treatment. We measured choroidal thickness (CT), classified into central, middle, and peripheral sectors. We examined CT changes after PDT by sectors and treatment outcome. Twenty-two eyes of 21 patients (20 males; mean age 58.7 ± 12.3 years) were included. CT reduction after PDT was significant in all sectors, including peripheral areas: supratemporal, 330.5 ± 90.6 μm vs. 237.0 ± 53.2 μm; infratemporal, 240.0 ± 89.4 μm vs. 209.9 ± 55.1 μm; supranasal, 237.7 ± 59.8 vs 209.3 ± 69.3 μm; infranasal, 172.6 ± 47.2 μm vs. 155.1 ± 38.2 μm (P < 0.001, for all). In patients with retinal fluid resolution, despite no apparent difference in baseline CT, there was more significant reduction after PDT in supratemporal and supranasal peripheral sectors, compared with patients without resolution: supratemporal, 41.9 ± 30.3 μm vs. -1.6 ± 22.7 μm; supranasal, 24.7 ± 15.3 μm vs. 8.5 ± 3.6 μm (P < 0.019, for both). Whole CT decreased after PDT, including in medial areas from optic disc. This may be associated with the treatment response of PDT for CSC.

Relationship between ultra-widefield optical coherence tomography and ophthalmoscopy for detecting posterior inflammation in posterior uveitis and panuveitis.

To confirm the utility of ultra-widefield optical coherence tomography (W-OCT) for diagnosing uveitis. We retrospectively studied patients who had been diagnosed with uveitis and had undergone W-OCT. All patients had visited at Osaka Metropolitan University between January 2019 and January 2022. On W-OCT, vitreous opacity ("W-OCT VO") and the presence of vitreous cells ("W-OCT Cells") were identified by three specialists. We compared findings from ophthalmoscopy ("Ophthalmoscopic findings") and fluorescein angiography ("FAG findings") with those from W-OCT. This study investigated 132 eyes from 68 patients (34 males, 34 females; mean age, 53.97±22.71 years). Vitreous cells in posterior uveitis and panuveitis differed significantly between "W-OCT Cells" and "Ophthalmoscopic findings" for all cases (P = 0.00014). Vitreous opacities in posterior uveitis and panuveitis did not differ significantly between "W-OCT VO" and "Ophthalmoscopic findings" (P = 0.144) for all cases. Compared to "Ophthalmoscopic findings", "W-OCT Cells" offered 51.1% sensitivity and 66.7% specificity for all cases (p<0.01). Compared to "Ophthalmoscopic findings", "W-OCT VO" offered 78.6% sensitivity and 30% specificity for all cases (p = 0.19). In addition, "W-OCT Cells" did not differ significantly from "FAG findings" for all cases (P = 0.424). W-OCT was shown to offer significantly greater sensitivity than ophthalmoscopy for detecting vitreous cells. The results of this study may add an option for the evaluation of uveitis.