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The current study aimed to examine the short-term choroidal response to optical defocus in schoolchildren. Myopic schoolchildren aged 8-16 were randomly allocated to control group (CG), myopic defocus group (MDG) and hyperopic defocus group (HDG) (n = 17 per group). Children in MDG and HDG received additional +3D and -3D lenses, respectively, to their full corrections on the right eyes. Full correction was given to their left eyes, and on both eyes in the CG. Axial length (AXL) and subfoveal choroidal thickness (SFChT) were then measured by spectral domain optical coherence tomography. Children wore their group-specific correction for 2 hours after which any existing optical defocus was removed, and subjects wore full corrections for another 2 hours. Both the AXL and SFChT were recorded hourly for 4 hours. The mean refraction of all subjects was -3.41 ± 0.37D (± SEM). SFChT thinned when exposed to hyperopic defocus for 2 hours but less thinning was observed in response to myopic defocus compared to the control group (p < 0.05, two-way ANOVA). Removal of optical defocus significantly decreased SFChT in the MDG and significantly increased SFChT in the HDG after 1 and 2 hours (mean percentage change at 2-hour; control vs. hyperopic defocus vs. myopic defocus; -0.33 ± 0.59% vs. 3.04 ± 0.60% vs. -1.34 ± 0.74%, p < 0.01). Our results showed short-term exposure to myopic defocus induced relative choroidal thickening while hyperopic defocus led to choroidal thinning in children. This rapid and reversible choroidal response may be an important clinical parameter in gauging retinal response to optical defocus in human myopia.

PurposeTo investigate the long-term effect of orthokeratology (ortho-k) on the choroidal thickness and choroidal contour in myopic children.MethodsSubjects were from a conducted 2-year randomised clinical trial. Children (n=80) aged 8–12 years with spherical equivalent refraction of −1.00 to −6.00D were randomly assigned to the control group (n=40) and ortho-k group (n=40). Optical coherence tomography images were collected at the baseline, 1-month, 6-month, 12-month, 18-month and 24-month visits, then the choroidal thickness and choroid contour were calculated. Axial length (AL) and other ocular biometrics were also measured.ResultsDuring 2 years, in the control group, the choroidal thickness became thinning and the choroidal contour became prolate with time at all visits (all p<0.001). Ortho-k can improve the choroidal thickness (all p<0.001) and maintain the choroidal contour at all visits (all p<0.05). In the ortho-k group, the choroidal contour was less changed in the temporal than nasal (p=0.008), and the choroidal thickness was more thickening in the temporal 3 mm (p<0.001). Two-year change in choroidal thickness was significantly associated with the 2-year AL change in the control group (r=−0.52, p<0.001), however, this trend was broken by ortho-k (r=−0.05, p=0.342). After being adjusted by other variables in the multivariable regression model, the effect of ortho-k on choroidal thickness was stable.ConclusionsIn the current 2-year prospective study, ortho-k can improve the choroidal thickness and maintain the choroidal contour, but this effect diminished in a long term. Further study with larger sample size and longer follow-up is warranted to refine this issue.

Purpose To assess choroid vascular characteristics in four subtypes of central serous chorioretinopathy (CSC) eyes under the new classification system. Methods There were 83 subjects in total for analysis including 16 individuals with acute CSC, 13 with non-resolving CSC, 12 with recurrent CSC, 16 with chronic CSC, and 26 healthy control eyes. We utilized the integrated software of SS-OCTA to acquire measurements of the central choroidal thickness (CT), the choriocapillaris perfusion area (CCPA), three-dimensional choroidal vascularity index (CVI) and three-dimensional choroidal vessel volume (CVV). The SNK-q test was conducted for pairwise comparisons among four subgroups of CSC and healthy control eyes. A multiple linear regression model was employed to investigate the relationship between CVI, CCPA and other factors. Results CT, CVI, and CCPA of the chronic CSC subgroup were significantly lower than the other three CSC subgroups. Lower CVI was significantly correlated with the subgroup of chronic CSC (β = -0.140, P = 0.016), lower CT (β = 0.0014, P < 0.01), and higher CCPA (β = -0.141, P < 0.01). Lower CCPA was significantly correlated with the subgroup of chronic CSC (β = -0.937, P < 0.01), diabetes (β = -0.118, P = 0.015), higher CVV (β = -0.414, P = 0.014), and higher CVI (β = -0.764, P < 0.01). Conclusions This is the first study to evaluate the choroidal characteristics of four subtypes of CSC under the new classification system in detail. It seems that chronic CSC displays distinct pathophysiological alterations in choroidal characteristics. Registration number : NCT05687422. Key messages What is known Central serous chorioretinopathy (CSC) has been recognized as a type of pachychoroid spectrum disease. Traditional classification methods for CSC include acute and chronic forms, and a recent definition encompasses acute, non-resolving, recurrent, and chronic CSC. What is new The choroidal thickness, the choriocapillaris perfusion area, and the three-dimensional choroidal vascularity index of the chronic CSC subgroup were significantly lower than acute subgroup, non-resolving subgroup and recurrent subgroup. Three-dimensional choroidal biomarkers are reliable imaging biomarkers to quantify structural alterations of choroidal vasculature, with considerable potential to contribute to the development of a more precise classification system. It seems that chronic CSC displays distinct pathophysiological alterations in choroidal characteristics.

Pachychoroid spectrum diseases have attracted increasing attention, though their pathophysiology has yet to be fully elucidated. In this study, we assessed the vascular diameters of vortex veins in pachychoroid spectrum diseases such as central serous chorioretinopathy (CSC), pachychoroid neovasculopathy without polypoidal lesions (PNV), and pachychoroid neovasculopathy with polypoidal lesions (polypoidal choroidal vasculopathy: PCV). In a retrospective case series of 94 eyes with CSC, 60 eyes with PNV and 57 with PCV, we binarized en face optical coherence tomography (OCT) images of choroidal vortex veins and analyzed the mean diameter of vortex veins. The presence of anastomosis between the superior and inferior vortex veins and central choroidal thickness (CCT) were also evaluated using OCT images. CSC showed significantly larger mean diameter of vortex veins than PCV (P < 0.05). Anastomosis between superior and inferior vortex veins was observed in over 90% of eyes with each pachychoroid spectrum disease. The patients with CSC were the youngest, followed by PNV patients, and then patients with PCV. The largest CCT values were observed in CSC eyes, followed by PNV eyes, and then PCV eyes. CCT correlated with the mean diameter of vortex veins (rs = 0.51, P < 0.01). These findings suggest that congestion of vortex veins might show gradual amelioration corresponding to the development of anastomosis between the superior and inferior vortex veins during the course of progression of pachychoroid spectrum diseases. Moreover, the mean diameter of vortex veins can be used as a parameter indicating choroidal congestion.

To determine the early signs of posterior staphylomas in highly myopic eyes of younger subjects by swept-source ultra-widefield optical coherence tomography (WF-OCT). This was an observational case series study. Highly myopic subjects younger than 20 years old who were examined consecutively by prototype WF-OCT were studied. High myopia was defined according to the Ministry of Health and Welfare, Japan classification. A posterior displacement of the sclera and two OCT features indicating the staphyloma edges were used as markers of a staphyloma. Fifty-five eyes of 30 patients with the mean age of 12.3 years, and the mean axial length of 27.9 mm were studied. Seven of the 55 eyes (12.7%) had a posterior displacement of the sclera and were diagnosed as having a staphyloma. Among the two OCT features of the staphyloma edges, a gradual thinning of the choroid toward the staphyloma edge and gradual re-thickening of choroid from the staphyloma edge toward the posterior pole were found in these 7 eyes. However, the other feature of an inward protrusion of the sclera at the staphyloma edge, was obvious in only 2 eyes. The subfoveal choroid and choroid nasal to the optic disc were significantly thinner in eyes with a staphyloma than those without it. The changes of the choroidal thickness toward the staphyloma edge with the posterior displacement of the sclera were considered an early sign which precedes an inward protrusion of sclera at the staphyloma edge.

To analyze features of the choriocapillaris in eyes with earlier stages of pachychoroid spectrum, this study included 46 eyes with PPE, 32 age-matched eyes with pachychoroid without epitheliopathy, and 30 normal controls. Macular 3 × 3 mm 2 angiographic images were obtained with swept-source optical coherence tomography. Vascular density and signal void area in the choriocapillaris were analyzed. Topographical correlation of signal voids with the dilated choroidal large vessel (pachyvessel) was assessed. Choriocapillaris vascular density was significantly lower in eyes with PPE compared with controls ( p  = 0.003). The number, the total area and the average size of signal voids was the highest in the PPE group followed by the pachychoroid without epitheliopathy and then controls (all p  ≤ 0.001). 89.0% signal void area colocalized with pachyvessels. The average size of the signal void was higher if it was colocalized with pachyvessel ( p  < 0.001). In conclusion, the area of flow impairment in the choriocapillaris was increased in eyes with pachychoroid and even greater when epitheliopathy was present. Pachyvessel was associated with choriocapillaris flow impairment by location and size.

We prospectively investigated the changes in choroidal blood flow and morphology after panretinal photocoagulation (PRP) in 39 eyes with severe nonproliferative diabetic retinopathy (S-NPDR). Seventeen eyes underwent PRP by conventional laser and 22 eyes underwent pattern scan laser (PASCAL). The choroidal blood flow was assessed by laser speckle flowgraphy, and the subfoveal choroidal thickness (SFCT) was measured with optical coherence tomography before and 1, 4, 8, and 12 weeks after the two types of PRP treatments. The choroidal mean blur rate (MBR) at the macular region was significantly reduced to 86.4% of the baseline level in the conventional laser group and 85.7% in the PASCAL group at Week 12 ( P  = 0.001, P  < 0.001, respectively). The SFCT was significantly increased at 1 week following PRP but it was significantly reduced at Week 8 (P  = 0.001, P  < 0.001, respectively) in both groups. The differences in the ratio of the MBR and the SFCT was not significant between the conventional laser and PASCAL groups at any time after PRP. The results suggest that appropriate PRP treatments even by the PASCAL method will reduce the choroidal blood flow and the choroidal morphological components.

The purpose of this study is to identify the characteristics of vortex vein ampullae in pachychoroid-spectrum disorders. This case-control study evaluated vortex vein ampullae using Optos Silverstone, an imaging device combining ultra-widefield scanning laser fundus imaging with swept-source optical coherence tomography. Consecutive patients with pachychoroid-spectrum disorders and controls who visited Kagoshima university hospital between January 2022 and December 2023 and underwent vortex vein ampullae evaluations. We compared morphological parameters of supratemporal and infratemporal vortex vein ampullae between eyes with pachychoroid-spectrum disorders and control subjects. We included 40 patients (46 eyes) with pachychoroid-spectrum disorders, and 14 healthy controls (15 eyes). We observed no significant differences in any supratemporal vortex vein ampullae morphological parameters ( P  ≥ 0.487 for all comparisons). In infratemporal vortex vein ampullae, eyes with pachychoroid-spectrum disorders showed significantly larger mean luminal volume (6.9 × 10 6  ± 1.8 × 10 6 pixels vs. 4.7 × 10 6  ± 1.5 × 10 6 pixels, P  < 0.001) and greater mean vessel diameter ( P  = 0.040) compared to controls, with no significant differences in luminal proportions ( P  = 0.353). After adjusting for potential confounders, the pachychoroid-spectrum disorders group still demonstrated significantly larger infratemporal vortex vein ampullae luminal volume and mean vessel diameter compared to controls ( P  ≤ 0.011 for both analyses). Enlargement of lumen and stroma was observed exclusively in the infratemporal vortex vein ampullae in eyes with pachychoroid-spectrum disorders. Impaired choroidal drainage alone may not fully account for the observed vortex vein ampullae alterations.

The aim of the study was to assess longitudinal changes in the spatial relationship of the choroidal vasculature to retinal vasculature in myopic eyes. In the population-based longitudinal Beijing Eye Study in 2001/2011, we examined all highly myopic eyes with assessable fundus photographs and a randomized group of non-highly myopic. Using fundus photographs, we qualitatively assessed changes in the location of major choroidal vessels in relationship to retinal vessels. The study consisted of 85 highly myopic eyes (58 participants;age:64.8 ± 9.4 years) and 85 randomly selected non-highly myopic eyes. A choroidal shift in relationship to the retinal vessels was detected more often in the highly myopic group than the non-highly myopic group (47/85 (55%) vs 6/85 (7%); P  < 0.001). In the highly myopic group, the choroidal vessel shift occurring on the disc-fovea line in 39 (44%) eyes, was similar to, or smaller than, the enlargement in gamma zone width in 26 (67%) eyes and in 11 (28%) eyes respectively. The choroidal vessel shift was larger ( P  = 0.002) in eyes without choroidal vessels in gamma zone than in eyes with large choroidal vessels in gamma zone. In 14 (17%) eyes, a localized centrifugal choroidal shift was observed in association with an increase in the stage of myopic maculopathy. The results suggest that highly myopic eyes show a change in the position of large choroidal vessels in relationship to retinal vessels, in association with development or enlargement of gamma zone and an increase in the stage of myopic maculopathy.

To analyze the epidemiology, clinical features, and Swept-Source Optical Coherence Tomography findings in patients with Focal Choroidal Excavation. 97 patients with FCE were identified from 50,000 scans of 25,000 individuals who underwent SS-OCT examinations. These patients’ clinical and imaging features were recorded, while data from 37 individuals with follow-up records were analyzed. FCE lesions were classified into three subtypes: (1) type 1: leptochoroid type (SFCT: <100 μm), (2) type 2: normochoroid type (SFCT: 100–200 μm), and (3) type 3: pachychoroid type (SFCT: >200 μm). A total of 108 FCEs were identified in 100 eyes, with 66 (61.1%) classified as Conforming type and 42 (38.9%) as non-conforming type. The maximum depth of FCEs in the study cohort was 96.6 ± 78.4 μm, the maximum width was 875.1 ± 960.1 μm, and choroidal thickness under FCE was 200.5 ± 191.5 μm. We observed 10 chorioretinopathy coexisting with FCE and categorized FCE based on choroidal thickness, highlighting three distinct types associated with different chorioretinopathy. Follow-up assessments revealed the relative stability of FCE and the efficacy of Anti-VEGF treatment for FCE-related CNV. Choroidal thickness playing a role in determining the specific type of FCE when combined with chorioretinopathy. Factors such as choroidal inflammation, scarring, and abnormal dilation of choroidal blood vessels may contribute to the damage or loss of outer retinal and inner choroidal tissues in FCE cases. FCE typically demonstrates stability over time, and Anti-VEGF treatment has shown efficacy in managing FCE-related CNV.