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To describe perifoveal microvascular changes occurring in X-linked juvenile retinoschisis (XLRS) using swept source optical coherence tomography angiography (SS OCTA). This is a serial case report of three patients. Retrospective data of patients affected by XLRS were collected. Structural optical coherence tomography (OCT) and color fundus photography (CFPh) were carried out with Topcon OCT 2000 3D OCT as part of the standard care. Two patients were imaged on Topcon Atlantis SS OCTA and one on Topcon Triton SS OCTA. SS OCTA images were acquired using the 3 × 3 mm fovea-centered cubes scanning protocol. Analysis of both perifoveal superficial vascular plexus (pSVP) and perifoveal deep vascular plexus (pDVP) was performed by two observers after automated segmentation. Four eyes of three males (mean age 14 ± 3.8 years) were analyzed. All eyes showed foveoschisis on CFPh images. OCT B-scans of three eyes showed schistic cysts in the ganglion cell layer, inner nuclear layer (INL) and outer nuclear layer (ONL); in one eye, cysts were depicted in INL and ONL only. In two eyes, SS OCTA showed abnormal foveal avascular zone (FAZ) shape in the pSVP, and in the other two, FAZ shape was abnormal in both plexuses. In all eyes, retinal vascular abnormalities (ie, microvascular protrusions) were present in pDVP. SS OCTA can depict perifoveal microvascular changes in young patients affected by XLRS. In this study, the structural and vascular changes seem to be more evident in the pDVP and may represent a useful biomarker of prognosis.

PurposeRetinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retinochoroidal parameters and renal impairment in hypertensive, non-diabetic patients.MethodsThis is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) scans of macular region. Patients were divided in groups: LowGFR and HighGFR and CKD− and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment.ResultsOne hundred and twenty eyes of 120 hypertensive patients were evaluated. The mean retinal thickness was thinner in CKD+ versus CKD− group (p < 0.009). LowGFR and CKD+ groups showed thinner choroidal values than HighGFR (p < 0.02) and CKD− (p < 0.001) groups. OCTA showed lower density in LowGFR than in HighGFR group (p < 0.001) and in CKD+ versus CKD− group (p < 0.001). Albuminuria was inversely related to choroidal and retinal thickness measures (p < 0.001) and to the indices of superficial parafoveal (p < 0.05) and foveal (p < 0.05) vascular densities.ConclusionsCKD is associated with retinal thinning, eGFR and decreasing renal function with progressive reduction of choroidal and retinal vascular density. SS-OCT and OCTA documented close association between CKD and reduction of both choroidal thickness and paracentral retinal vascular density in hypertensive patients.

PurposeData from healthy eyes is needed to interpret optical coherence tomography angiography (OCTA) findings. However, very little normative data is available for wide-field swept-source OCTA (WF SS-OCTA), particularly 12 × 12-mm and disc-centered angiograms. Therefore, we aim to report quantitative metrics in a large sample of control eyes.MethodsIn this cross-sectional observational study, 482 eyes of 375 healthy adults were imaged on the 100 kHz Zeiss PLEX® Elite 9000 using protocols centered on the fovea (3 × 3, 6 × 6, and 12 × 12-mm) and optic disc (6 × 6 and 12 × 12-mm) between December 2018 and January 2022. The ARI Network (Zeiss Portal v5.4) was used to calculate vessel density (VD) and vessel skeletonized density (VSD) in the superficial capillary plexus, deep capillary plexus, and whole retina, as well as foveal avascular zone (FAZ) parameters. Mixed-effect multiple linear regression models were used for statistical analysis.ResultsThe subjects’ median age was 55 (38–63) years, and 201 (53.6%) were female. Greater age and worse best-corrected visual acuity (BCVA) were associated with significantly lower VD and VSD (p < 0.05). VD and VSD differed based on race and cataract status, but not sex, on some scan protocols (p < 0.05). FAZ circularity decreased with age, and FAZ dimensions differed based on race and ethnicity in certain scan protocols.ConclusionsWe report a large database of parafoveal and peripapillary vascular metrics in several angiogram sizes. In referencing these values, researchers must consider characteristics such as age, race, and BCVA, but will have a valuable point of comparison for OCTA measurements in pathologic settings.

BackgroundTo evaluate the diagnostic ability of volumetric parameters to differentiate narrow angle from open angle and distinguish different configurations of narrow angle.MethodsThe current study was composed of two parts. In the first part, with gonioscopy as reference standard, we tested power of each parameter to differentiate narrow angle from open angle. In the second part, we evaluated the efficacy of different parameters to distinguish angle configurations which were subclassified into type 1 (pupillary block) and type 2 (non-pupillary block and multiple mechanisms) based on ultrasound biomicroscopy (UBM) images.ResultsIn part 1, the training set was composed of 117 narrow-angle eyes and 60 open-angle eyes, and the validation set included 38 narrow-angle eyes and 37 open-angle eyes. Anterior chamber volume (ACV) outperformed all the other parameters with an area under the curve (AUC) of 0.988. The sensitivity and specificity of the cut-off value 98.1 mm3 in the validation set were 90.0% and 97.1%, respectively. In part 2, training set was composed of 96 eyes of 88 patients with primary angle-closure disease, with 49 diagnosed as type 1 and 47 as type 2 configuration. 32 eyes were used for validation. A model comprised of iris volume (IV), iris thickness (IT) 2000 µm from the scleral spur and angle open distance (AOD) 750 µm from the scleral spur was found to have an AUC of 0.793 (95% CI, 0.695 to 0.870). Sensitivity and specificity of the model were 82.6% and 77.8% respectively in the validation set.ConclusionsWith ACV, we can detect patients with narrow angle from open angle faster and more easily than AOD and anterior chamber depth. Then, for patients with narrow angle, the combination of IV, IT and AOD750 measured by swept-source optical coherence tomography could further classify configurations of angle closure compared with UBM.

Abstract PurposeTo compare biometric measures from 2 modern swept-source OCT biometers (IOLMaster700 (Z, Carl-Zeiss-Meditec) and Anterion (H, Heidelberg Engineering)) and evaluate the effect of measurement differences on the resulting lens power (IOLP).MethodsBiometric measurements were made on a large study population with both instruments. We compared axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and corneal front and back surface curvature measurements. Corneal curvature was converted to power vectors and total power derived using the Gullstrand formula. A paraxial lens power calculation formula and a prediction for the IOL axial position according to the Castrop formula were used to estimate differences in IOLP targeting for emmetropia.ResultsThere were no systematic differences between measurements of AL (− 0.0146 ± 0.0286 mm) and LT (0.0383 ± 0.0595 mm), whereas CCT yielded lower (7.8 ± 6.6 µm) and ACD higher (0.1200 ± 0.0531 mm) values with H. With H, CCT was lower for thicker corneas. The mean corneal front surface radius did not differ (− 0.4 ± 41.6 µm), but the corneal back surface yielded a steeper radius (− 397.0 ± 74.6 µm) with H, giving lower mean total power (− 0.3469 ± 0.2689 dpt). The astigmatic vector components in 0°/90° and 45°/135° were the same between both instruments for the front/back surface or total power.ConclusionThe biometric measures used in standard formulae (AL, corneal front surface curvature/power) are consistent between instruments. However, modern formulae involving ACD, CCT or corneal back surface curvature may yield differences in IOLP, and therefore, formula constant optimisation customised to the biometer type is required.

This study compared the retinal structure between the eyes of children with a history of treated retinopathy of prematurity (ROP), spontaneously regressed ROP and full-term children using widefield optical coherence tomography angiography (OCTA) and swept-source OCT (SSOCT). We identified patients who were diagnosed with ROP and followed up. Age-matched full-term controls were also recruited. We reviewed the medical records of 34 ROP eyes (34 patients) treated with laser photocoagulation, 5 spontaneously regressed ROP eyes (5 patients), and 15 age-matched full-term controls (15 control eyes). The thickness of the foveal retina and choroid, the foveal avascular zone (FAZ), and ocular shape were assessed using OCTA and SSOCT (Xephilio OCT-S1) images. The mean foveal thickness of the treated ROP eyes was significantly thicker than that of the control eyes. The FAZ of the treated ROP eyes was significantly smaller than that of the control eyes. SSOCT images revealed that 5 of 34 eyes in the treated ROP group had a dome-shaped macula, while 18 had an elongated barrel shape. Understanding these structural changes is crucial for developing targeted treatments and optimizing visual function in this population.

Choroidal neovascularization (CNV) secondary to choroidal osteoma (CO) can cause profound visual loss, but detecting CNV and the tumor’s feeder vessels using traditional fluorescent angiography imaging is challenging. Newly developed TowardPi swept-source optical coherence tomography (SS-OCT) and OCT angiography (SS-OCTA) enable ultra-high resolution, enhanced penetration with longer wavelength (1060 nm), a rapid scan rate (400 KHz), reduced loss of signal strength with increasing depth, and 120° angular widefield of fundus view, enabling a nearly histological description of the retina and choroid. We therefore used this SS-OCT and SS-OCTA platform to observe the intrinsic features of osteoma in 23 eyes of 21 patients. It was found that the borders of CO were clearly demarcated from the adjacent choroidal Sattler’s and Haller’s layers, while on a corresponding B-scan the blood flow of the CO was detected mainly within the choriocapillaries and partly within Sattler’s layer. The CNV was identified as numerous branching or radiating vessels connecting with intrinsic feeder vessels displaying various patterns including ginseng, instant noodle, growth ring, tangle, spider web, medusa, seafan, and irregular shape. Moreover, tumor-like tissues were found to grow above the disrupted Bruch’s membrane. SS-OCTA can be used to detect the tumor vasculature in CO.

PurposeTo evaluate structural and functional ocular changes in patients with type 2 diabetes mellitus (DM2) and moderate diabetic retinopathy (DR) without apparent diabetic macular edema (DME) assessed by optical coherence tomography (OCT) and microperimetry.MethodsThis was a single-center cross-sectional descriptive study for which 75 healthy controls and 48 DM2 patients with moderate DR were included after applying exclusion criteria (one eye per patient was included). All eyes underwent a complete ophthalmic examination (axial length, macular imaging with swept-source OCT, and MAIA microperimetry). Macular thicknesses, ganglion cell complex (GCC) thicknesses, and central retinal sensitivity were compared between groups, and the relationships between the OCT and microperimetry parameters were evaluated.ResultsMacular thickness was similar in both groups (242.17 ± 35.0 in the DM2 group vs 260.64 ± 73.9 in the control group). There was a diminution in the parafoveal area thickness in the DM2 group in the GCC complex. Retinal sensitivity was reduced in all sectors in the DM2 group. The central global value was 24.01 ± 5.7 in the DM2 group and 27.31 ± 2.7 in the control group (p < 0.001). Macular integrity was 80.89 ± 26.4 vs 64.70 ± 28.3 (p < 0.001) and total mean threshold was 23.90 ± 4.9 vs 26.48 ± 2.6 (p < 0.001) in the DM2 and control group, respectively. Moderate correlations were detected between the central sector of MAIA microperimetry and retina total central thickness (− 0.347; p = 0.0035). Age, visual acuity, and hemoglobin A1c levels also correlated with retinal sensitivity.ConclusionMacular GCC thickness and central retinal sensitivity were reduced in patients with moderate DR without DME, suggesting the presence of macular neurodegeneration.

Purpose To describe the feasibility of peripheral OCT imaging in retinal diseases using a novel full-field device. Methods A total of 134 consecutive eyes were referred and imaged on the Optos Silverstone swept-source OCT (SS-OCT) (Optos PLC; Dunfermline, UK). Scanning laser ophthalmoscope (SLO) images and the associated SS-OCT images were obtained in the posterior pole, mid-periphery or far periphery based on the nature of the referral and on new areas of interest observed in the optomap images at the time of imaging. Results A total of 134 eyes (96 patients) were enrolled in the study. One hundred and twenty-five eyes (91 patients) with 38 retinal pathologies were prospectively assessed and 9 eyes (5 patients) were excluded due to incomplete image acquisition. The average age of the subjects was 54 years (range 21–92 years). Thirty-nine out of 125 eyes (31%) had macular pathologies. Eighty-six out of 125 eyes (69%) had peripheral only pathologies, an area which cannot be visualized by standard OCT devices with a 50 degree field-of-view. Conclusions The ability to capture peripheral pathologies using an integrated SLO-UWF imaging with full-field swept-source provided high-grade anatomical insight that confirmed the medical and surgical management in a majority of cases. Its use in the mid- and far periphery provides a holistic clinical picture, which can potentially aid in the understanding of various retinal pathologies.

PurposeThe course of Vogt-Koyanagi-Harada (VKH) disease is typically assessed qualitatively using indocyanine green angiography (ICGA) and enhanced-depth imaging optical coherence tomography (EDI-OCT). However, a quantitative approach could improve accuracy and objectivity. The aim of this study was to assess the clinical value of the automated measurement capabilities of swept-source optical coherence tomography (SS-OCT) to measure choroidal thickness (quantitative approach) in chronic VKH.MethodsProspective, longitudinal case–control study at a tertiary university hospital involving 23 chronic VKH patients (9 convalescent and 14 quiescent) and 17 age-matched controls. Choroidal thickness was automatically measured with SS-OCT.ResultsChoroidal thinning and improved vision were associated with treatment while increasing thickness and worsening vision were associated with posterior relapse. Overall, 41.6% of asymptomatic (no change in visual acuity) recurrences in the convalescent group and 25% of recurrences in the quiescent group were detected by SS-OCT. All recurrences diagnosed by SS-OCT showed signs of inflammation on ICGA.ConclusionsAutomatic measurement of choroidal thickness with SS-OCT is a rapid, non-invasive method of detecting posterior segment recurrences and treatment response in VKH patients, and could reduce the need for angiography to monitor this disease.