Choroidal thickness measurement in healthy Japanese subjects by three-dimensional high-penetration optical coherence tomography

Background  

We performed retinal and choroidal thickness mapping by three-dimensional high-penetration optical coherence tomography (OCT) and evaluated the choroidal thickness distribution throughout the macula in healthy eyes.     

Angiographic findings following tack fixation of a wireless epiretinal retina implant device in blind RP patients

Background  

The fixation of polyimide stimulator foils as the basic substrate of epiretinal prostheses by using retinal tacks may cause retinal or choroidal alterations such as retinal proliferations or choroidal neovascularizations. During the prospective trial for the semichronical testing of a wireless intraocular retinal implant (EPIRET3) we investigated alterations in angiographic findings during implantation and after explantation of the device, to detect potential vascular pathologies at the fixation site or elsewhere.     

Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization

Purpose  

To determine the incidence and features of macular retinal detachment (RD) after successful intravitreal injection of bevacizumab (IVB) for the treatment of myopic choroidal neovascularizations (CNVs).     

Nerve fiber layer thickness in exudative age-related macular degeneration in Japanese patients

Purpose  

To examine the peripapillary retinal nerve fiber (RNFL) thickness in Japanese patients with two major forms of exudative age-related macular degeneration (AMD), i.e., typical AMD and polypoidal choroidal vasculopathy (PCV).     

Thickness of photoreceptor layers in polypoidal choroidal vasculopathy and central serous chorioretinopathy

Background  

To evaluate retinal thickness using spectral-domain optical coherence tomography (SD-OCT) with reduced speckle noise in eyes with polypoidal choroidal vasculopathy (PCV) compared to those with normal eyes and those with central serous chorioretinopathy (CSC).     

Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with large retinal pigment epithelial detachment in age-related macular degeneration

Purpose  

To discuss the effect and outcome of a combined intravitreal triamcinolone acetonide (IVTA) injection with intravitreal bevacizumab (IVB) in treating choroidal neovascularization (CNV) associated with large retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD).     

Near-infrared reflectance imaging of neovascular age-related macular degeneration

Purpose  

To evaluate various types of neovascular age-related macular degeneration (AMD) by near-infrared fundus reflectance (NIR) as compared to fundus fluorescein angiography (FFA) and to test NIR for assessment of leakage due to choroidal neovascularization (CNV).     

Morphometric features on enhanced depth imaging optical coherence tomography scans in idiopathic posterior uveitis or panuveitis

Purpose

Enhanced depth imaging (EDI) optical coherence tomography (OCT) has emerged as a novel tool for qualitative and quantitative choroidal assessment in posterior uveitis. The objective of this study was to investigate the role of EDI-OCT to assess the choroidal and retinal changes in posterior uveitis.

Methods

In this retrospective study, EDI-OCT scans of patients with idiopathic posterior uveitis or panuveitis were reviewed. Morphological features from retina and choroid from the OCT scans were assessed and compared to the fellow normal eyes. Follow-up assessment was performed at 6-month follow-up.

Results

Nineteen patients with idiopathic posterior or panuveitis were included in the study. Choroidal examination using EDI-OCT scans showed areas of focal hypo-reflective and discrete hyper-reflective foci in one-third patients. Macular edema, disruption of the ellipsoid zone (generalized and discrete), outer retinal hyper-reflective foci, and intraretinal and subretinal fluid were observed.

Conclusions

The index study reports qualitative OCT-derived parameters as possible tools in monitoring disease progression in uveitis.

     

Choroidal Folds in Acute-Stage Vogt-Koyanagi-Harada Disease Patients with Relatively Short Axial Length

Purpose

To report 2 cases of Vogt-Koyanagi-Harada disease accompanied by remarkable choroidal folds in the acute stage. The early indicator of recurrence in these 2 cases was the identification of choroidal folds by spectral-domain optical coherence tomography (SD-OCT).

Case Reports

A 68-year-old woman (Case 1) presented with visual loss in both eyes. Funduscopic examination revealed optic disc swelling and serous retinal detachment in both eyes. SD-OCT revealed remarkable choroidal folds and serous retinal detachment. After the initiation of systemic steroid treatment, choroidal folds disappeared rapidly and the amount of serous retinal detachment reduced remarkably. Choroidal folds observed on SD-OCT were the early indicators of recurrence prior to the emergence of serous retinal detachment. A 62-year-old woman (Case 2) presented with bilateral blurred vision and metamorphopsia. SD-OCT showed remarkable choroidal folds and serous retinal detachment in both eyes. After the initiation of systemic steroid treatment, choroidal folds and serous retinal detachment disappeared. At the time of recurrence, choroidal folds were observed by OCT.

Discussion

During monitoring of Vogt-Koyanagi-Harada disease treatment, choroidal folds could be an early sign of recurrence. When choroidal folds are observed and recognized as an early indicator of recurrence, a prompt increase in steroids can improve the patients'' prognosis. Finally, both cases presented here had relatively short axial lengths, and we speculate that a shortened axial length may be a cause of choroidal folds in the acute stage of the disease.Key words: Vogt-Koyanagi-Harada disease, Choroidal folds, Shortened axial lengths, Acute stage     

Evaluation of peripapillary choroidal thickness in unilateral normal-tension glaucoma

Purpose

To evaluate the association of normal-tension glaucoma and peripapillary choroidal thickness.

Participants

Sixty-one patients with normal-tension glaucoma in one eye.

Methods

Spectral domain optical coherence tomography (SD-OCT) scans were obtained to estimate peripapillary choroidal thickness in a group of unilateral normal-tension glaucoma patients. The average peripapillary choroidal thicknesses of the glaucomatous eye and the nonglaucomatous eye of each patient were compared, and the choroidal thickness underlying the retinal nerve fiber layer defect in the glaucomatous eye was compared with the choroidal thickness of a compatible position in the contralateral normal eye. The associations of peripapillary choroidal thickness with independent parameters including the presence of glaucoma, age, sex, refractive error, axial length, central corneal thickness, intraocular pressure, visual field mean deviation, visual field pattern standard deviation, and systemic disease were assessed with mixed model univariate and multivariate analyses.

Results

The average peripapillary choroidal thickness was not statistically significantly different in the glaucomatous and nonglaucomatous eyes of the patients (P = 0.52). There was no definite difference between the choroidal thickness underlying the retinal nerve fiber layer defect in the glaucomatous eye and the choroidal thickness of a compatible position in the contralateral normal eye, indicating that there was no correlation of the retinal nerve fiber layer with choroidal thickness. Age (P = 0.004) and axial length (P ≤ 0.0001) were negatively associated with peripapillary choroidal thickness.

Conclusions

In unilateral normal tension glaucoma, there was no significant intereye difference in choroidal thickness measured with SD-OCT. The structural features of the choroid may not be associated with normal-tension glaucoma.     

Combined cases of polypoidal choroidal vasculopathy and typical age-related macular degeneration

Background  

When we classified neovascular exudative age-related macular degeneration (AMD) into three types of polypoidal choroidal vasculopathy (PCV), typical AMD, and retinal angiomatous proliferation (RAP) in our previous study, we reported 5.5% had the combined cases, such as one eye had PCV and the other eye had typical AMD. We examined the clinical characteristics of these combined cases in the current study.     

B-scan ultrasonography following open globe repair

Purpose

To examine the accuracy and predictive ability of B-scan ultrasonography in the post-repair assessment of an open globe injury.

Methods

In all, 965 open globe injuries treated at the Massachusetts Eye and Ear Infirmary between 1 January 2000 and 1 June 2010 were retrospectively reviewed. A total of 427 ultrasound reports on 210 patients were analyzed. Ultrasound reports were examined for the following characteristics: vitreous hemorrhage, vitreous tag, retinal tear, RD (including subcategories total RD, partial RD, closed funnel RD, open funnel RD, and chronic RD), vitreous traction, vitreous debris, serous choroidal detachment, hemorrhagic choroidal detachment, kissing choroidal detachment, dislocated crystalline lens, dislocated intraocular lens (IOL), disrupted crystalline lens, intraocular foreign body (IOFB), intraocular air, irregular posterior globe contour, disorganized posterior intraocular contents, posterior vitreous detachment, choroidal vs retinal detachment, vitreal membranes, and choroidal thickening. The main outcome measure was visual outcome at final follow-up.

Results

Among 427 B-scan reports, there were a total of 57 retinal detachments, 19 retinal tears, 18 vitreous traction, 59 serous choroidal detachments, 47 hemorrhagic choroidal detachments, and 10 kissing choroidal detachments. Of patients with multiple studies, 26% developed retinal detachments or retinal tears on subsequent scans. Ultrasound had 100% positive predictive value for diagnosing retinal detachment and IOFB. The diagnoses of retinal detachment, disorganized posterior contents, hemorrhagic choroidal detachment, kissing choroidal detachment, and irregular posterior contour were associated with worse visual acuity at final follow-up. Disorganized posterior contents correlated with particularly poor outcomes.

Conclusions

B-scan ultrasonography is a proven, cost-effective imaging modality in the management of an open globe injury. This tool can offer both diagnostic and prognostic information, useful for both surgical planning and further medical management.     

Reduction in choroidal thickness of macular area in polypoidal choroidal vasculopathy patients after intravitreal ranibizumab therapy

Background

To evaluate changes in retinal and choroidal thickness changes after three intravitreal ranibizumab (IVR) injections for polypoidal choroidal vasculopathy (PCV) using enhanced depth-imaging-optical coherence tomography (EDI-OCT).

Methods

In this retrospective, observational case series, EDI-OCT was used to measure changes in choroidal thickness at nine points in a lattice shape in the macula before and after introductory-stage IVR.

Results

Choroidal thickness was decreased at all nine points in the lattice shape, but was significantly decreased only at the fovea.

Conclusion

The subfoveal choroidal thickness may be reduced by introductory-stage IVR in patients with PCV. In particular, choroidal thickness at the fovea was reduced during the early stage of treatment.     

Multimodal fundus imaging in Best vitelliform macular dystrophy

Background  

Best vitelliform macular dystrophy (BVMD) is a rare autosomal dominant retinal disease of highly variable phenotypic expression. Interpretations of disease mechanisms based on histopathology, electrophysiology, genetic analysis, and retinal imaging are somewhat discordant in fundamental issues such as the location and extension of primary retinal changes. Herein we describe the morphological macular features in patients with BVMD undergoing simultaneous multimodal fundus imaging and compare to those of normal age-matched subjects.     

Choroidal thickness profile in healthy Indian children

Purpose:

The purpose was to study choroidal thickness and its profile based on location in healthy Indian children using enhanced depth spectral-domain-optical coherence tomography (SD-OCT).

Methods:

In this cross-sectional observational study 255 eyes of 136 children with no retinal or choroidal disease were consecutively scanned using enhanced depth SD-OCT. Eyes with any ocular disease or axial length (AXL) >25 mm or < 20 mm were excluded. A single observer measured choroidal thickness from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-microns intervals up to 2500 microns temporal and nasal to the fovea. Generalized estimating equations were used to evaluate the correlation between choroidal thickness at various locations and age, AXL, gender and spherical equivalent (SEq).

Results:

Mean age of the subjects was 11.9 ± 3.4 years (range: 5–18 years). There were 62 Females and 74 males. The mean AXL was 23.55 ± 0.74 mm. Mean subfoveal choroidal thickness was 312.1 ± 45.40 μm. Choroid was found to be thickest subfoveally, then temporally. Age, AXL and SEq showed a significant correlation with choroidal thickness, whereas gender did not affect choroidal thickness.

Conclusion:

Our study provides a valid normative database of choroidal thickness in healthy Indian children. This database could be useful for further studies evaluating choroidal changes in various chorioretinal disorders. Age and AXL are critical factors, which negatively correlated with choroidal thickness.     

Two Cases of Focal Choroidal Excavation Detected by Spectral-Domain Optical Coherence Tomography

Purpose

To report the clinical findings of 2 patients with focal choroidal excavation in the macula detected by spectral-domain optical coherence tomography (SD-OCT).

Methods

Three eyes of 2 patients with a focal macular choroidal excavation detected by SD-OCT were studied. The eyes were examined by fundus autofluorescence (FAF), fluorescein angiography, fundus-related microperimetry, and multifocal electroretinography (mfERG).

Results

In spite of a complaint of metamorphopsia, the visual acuity was normal in 2 eyes. SD-OCT demonstrated a choroidal excavation in the macula but the foveal contour was normal in 3 eyes. The excavation involved the outer retinal layers up to the external limiting membrane in all eyes, and a type 2 secondary choroidal neovascularization (CNV) developed in 1 of the 3 eyes. There were areas of hypoautofluorescence in the FAF images, and areas of decreased retinal sensitivity determined by microperimetry. These areas corresponded to the choroidal excavation in all eyes. The P1 amplitudes of the mfERGs were decreased in the fovea of 1 eye without a CNV.

Conclusions

The choroidal excavation remained stable for 3 years in 2 eyes, a secondary CNV developed in 1 eye during the course of the disease. More cases and longer follow-up periods will be necessary to determine the etiology, clinical course, and visual prognosis of eyes with a choroidal excavation.Key Words: Choroidal excavation, Choroidal neovascularization, Optical coherence tomography     

Suprachoroidal hemorrhage: Outcome of surgical management according to hemorrhage severity

Objective

To report the visual and anatomic outcome after surgical drainage of suprachoroidal hemorrhage according to hemorrhage severity.

Design

A retrospective chart review.

Participants

Forty-eight consecutive eyes undergoing surgical drainage of a suprachoroidal hemorrhage at The Medical College of Wisconsin were examined.

Intervention

Demographic and clinical data were abstracted from patients’ medical records. Eyes were classified into four categories of increasing hemorrhage complexity: (1) nonappositional choroidal hemorrhage without vitreous or retinal incarceration in the wound (12 eyes); (2) centrally appositional choroidal hemorrhage without vitreous or retinal incarceration in the wound (17 eyes); (3) choroidal hemorrhage with associated vitreous incarceration in the wound (11 eyes); and (4) choroidal hemorrhage with associated retinal incarceration in the wound (8 eyes).

Main outcome measures

Visual acuity, rate of persistent hypotony, and incidence of irreparable retinal detachment after surgical drainage for four classes of suprachoroidal hemorrhage were defined.

Results

Overall, 11 (23%) of 48 eyes had no light perception (NLP) vision develop, 9 (19%) of 48 eyes had persistent postsurgical hypotony (intraocular pressure < 6), and 21 (64%) of 33 eyes with retinal detachment enjoyed successful retinal reattachment surgery. A definite trend toward an increased rate of NLP vision (P < 0.02), persistent hypotony (P < 0.05), and irreparable retinal detachment (P = 0.11) was observed with increasing suprachoroidal hemorrhage complexity. Eyes with retinal incarceration, compared to eyes without retinal incar- ceration, had an increased rate of NLP vision (63% vs. 15%; P < 0.01), persistent postsurgical hypotony (50% vs. 13%; P < 0.05), and irreparable retinal detachment (50% vs. 20%; P = 0.07).

Conclusions

Eyes requiring surgical drainage of a suprachoroidal hemorrhage have a guarded prognosis, with a poorer outcome associated with increasing hemorrhage complexity. A classification system incorporating choroidal apposition, and vitreous and retinal incarceration in the wound, provides a format for reporting and assessing the efficacy of management strategies in this condition.     

Influence of scanning density on macular choroidal volume measurement using spectral-domain optical coherence tomography

Background

To evaluate the impact of scanning density on macular choroidal volume measurement using spectral-domain optical coherence tomography (SD-OCT).

Methods

Thirty eyes of normal subjects underwent consecutive raster choroidal scanning protocols using SD-OCT in enhanced-depth imaging mode. Manual choroidal segmentation was performed using the built-in automated retinal segmentation software to obtain five analyses with different inter-scan distances, including inter-scan distances of 30 μm, 60 μm, 120 μm, 240 μm, and 480 μm. The built-in software of the device automatically generated the choroidal thickness and volume map in the similar manner as for the retinal volume map, using the standardized Early Treatment Diabetic Retinopathy Study (ETDRS) grid. For each raster scan, mean absolute difference and relative difference of mean foveal choroidal thickness (FCT), foveal choroidal volume (FCV) and total macular choroidal volume (TCV) in comparison to “true value” (i.e., 30-μm inter-scan distance) were calculated.

Results

The maximum relative differences were 10 % and 16 % for TCV and FCV respectively. For mean FCT, the maximum absolute difference was 31 μm, and maximum relative difference was 12.7 %. No statistically significant differences were found in measurements of mean foveal choroidal thickness (p?=?0.912) and volume (p?=?0.944), as well as macular choroidal volume (p?=?0.912), with varying inter-scan distance.

Conclusions

Our study shows that approximately 16 scans over the macula with a inter-scan distance of 480 μm is sufficient to provide a clinically relevant and reliable choroidal thickness/volume map. This information could be useful in the design of choroidal scanning protocols for future clinical trials.     

Retinal blood flow velocity measured by retinal function imaging in retinitis pigmentosa

Background  

To measure the retinal blood flow velocity in patients with retinitis pigmentosa using the retinal function imaging technique.     

Wavy and elevated retinal pigment epithelial line in optical coherence tomographic images of eyes with atypical Vogt–Koyanagi–Harada disease

Purpose

We report the changes of the retinal pigment epithelium (RPE) determined by optical coherence tomography in a patient with atypical Vogt–Koyanagi–Harada (VKH) disease during the recovery phase.

Method

Case presentation.

Results

A 74-year-old woman presented with a central scotoma associated with disc hyperemia, serous retinal detachment, and scleral thickening in her left eye, and was diagnosed with VKH. OCT showed a serous retinal detachment and a wavy RPE contour that corresponded to the choroidal folds. The OCT images clearly showed the dynamic changes of the retina, RPE, and choroid during the recovery phase.

Conclusions

The OCT was found to be more sensitive in detecting the choroidal folds than angiography. OCT images are valuable not only in the diagnosis, but also for monitoring the morphology of the retina and choroid during the course of VKH.