scholarly journals Measurement of the Active Toxoplasma Retinochoroiditis Lesion Size During the Disease Course With Swept Source Optical Coherence Tomography Angiography: A Retrospective Image Analysis

2021 ◽  
Author(s):  
Ferdane Atas ◽  
Mahmut Kaya ◽  
Tuğçe Toprak ◽  
Betul Akbulut Yagcı ◽  
Alper Selver ◽  
...  
Keyword(s):  
Image Analysis ◽  
Optical Coherence Tomography Angiography ◽  
Lesion Size ◽  
Swept Source ◽  
Macular Lesion ◽  
Black Pixel ◽  
Oral Corticosteroids ◽  
Reduction Percentage ◽  
Chorioretinal Scar

Abstract Purpose To measure the lesion size reduction in eyes with active toxoplasma retinochoroiditis during the disease course with swept- source optical coherence tomography angiography (SS-OCTA). Methods We retrospectively analyzed the chorioretinal lesion size in a group of 14 eyes with a single active toxoplasma retinochoroiditis lesion.SS-OCTA was performed at the baseline and follow -up in all eyes. The 6x6 mm choriocapillaris slab images were evaluated with an image analysis (Matlab). The number of black and white pixels in a 1500µm-diameter circle centered on each active lesion was counted at the time of baseline examination and at the first follow-up visit when the chorioretinal scar formation was noticed. Results Fourteen eyes with a single active toxoplasmosis retinochoroiditis lesion were included. Ten patients were female and three,male. Mean age was 29.1 ± 14.9 years. Active lesions were at the macula in five eyes, at the periphery in six eyes and juxtapapillary in three eyes. At the initial examination lesion area was observed as an area with a decreased flow signal on SS-OCTA.There was perilesional capillary disruption in superficial and deep capillary plexi together with a diffuse capillary network attenuation and non-detectable flow signal zones in the choriocapillaris slabs. In addition to sulfamethoxazole-trimethoprim and azithromycine combination oral corticosteroids were only co-administered in five (35%) eyes with macular involvement. The chorioretinal scar formation was observed in four to 16 weeks. At the time of inactivity, original lesion was diminished in size when compared to its baseline in all study eyes (p = 0.001) with a mean black pixel reduction percentage of 21.8%. The reduction was 15.4% in eyes with macular lesion, 31.6% with peripheral lesions and 18.1% with juxtapapillary lesions (p = 0.001, p = 0.032, p = 0.028, p = 0.043, respectively). Visual acuity was correlated with black pixel reduction percentage in eyes with macular lesion (r = 0.56, p < 0.001). Conclusion Active toxoplasma retinochoroiditis lesion size diminished with the healing process as expected and this could be monitorized with an OCTA based image analysis technique. Macular lesions showed less reduction in lesion size despite the addition of oral corticosteroids in contrast to peripheral and juxtapapillary lesions.

scholarly journals Swept Source-Optical Coherence Tomography Angiography for Management of Secondary Choroidal Neovascularization in Punctate Inner Choroidopathy

2021 ◽  
pp. 232-238
Author(s):  
Martin Stattin ◽  
Julia Forster ◽  
Daniel Ahmed ◽  
Katharina Krepler ◽  
Siamak Ansari-Shahrezaei
Keyword(s):  
Optical Coherence Tomography ◽  
Choroidal Neovascularization ◽  
Optical Coherence Tomography Angiography ◽  
Optical Coherence ◽  
Intravitreal Ranibizumab ◽  
Swept Source ◽  
Punctate Inner Choroidopathy ◽  
White Dot Syndrome ◽  
Oral Corticosteroids ◽  
Sd Oct

The purpose was to demonstrate the diagnostic and therapeutic feasibility of swept source-optical coherence tomography angiography (SS-OCTA) by picturing neovascular changes secondary to a rare white dot syndrome following long-term intravitreal ranibizumab (IVR). A 28-year-old Caucasian myopic female presented with visual loss in her right eye only. The clinical examination and multimodal imaging including spectral domain (SD)-OCT, blue-peak autofluorescence, fluorescein, and indocyanine green angiography (HRA Spectralis, Heidelberg Engineering; Heidelberg, Germany) as well as SS-OCTA (DRI Triton, Topcon; Tokyo, Japan) led to the diagnosis of idiopathic punctate inner choroidopathy with secondary subfoveal choroidal neovascularization (CNV). In addition to oral corticosteroids, a pro re nata regimen with IVR was initiated and guided by repeated SD-OCT and SS-OCTA. Six IVR were administered based on functional SS-OCTA en face scans illustrating vessel transformation and downsizing of the CNV area while SD-OCT B-scans were inconclusive as indirect signs of activity were absent throughout the follow-up period. SS-OCTA provided new possibilities for monitoring vessel development. IVR was managed based on vessel density as displayed by SS-OCTA.

Multimodal Imaging in a Patient with Traumatic Choroidal Ruptures

2017 ◽  
Vol 27 (6) ◽  
pp. e175-e178 ◽  
Author(s):  
Luisa Pierro ◽  
Chiara Giuffrè ◽  
Alessandro Rabiolo ◽  
Marco Gagliardi ◽  
Alessandro Arrigo ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Multimodal Imaging ◽  
Optical Coherence Tomography Angiography ◽  
Ocular Trauma ◽  
Global Evaluation ◽  
Fundus Examination ◽  
Optical Coherence ◽  
Swept Source ◽  
Blunt Ocular Trauma

Purpose To describe the case and the follow-up of a traumatic choroidal rupture characterized by means of multimodal imaging including color fundus photographs, infrared reflectance, blue autofluorescence, swept-source optical coherence tomography, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCT-A). Methods Case report. Results A 17-year-old boy was referred to our clinic complaining of reduction in visual acuity in the right eye (RE) after a blunt ocular trauma during a soccer match. Dilated fundus examination of RE showed 2 peripapillary choroidal ruptures located temporally and inferiorly to the optic disc. Among different imaging tools useful in the diagnosis and study of choroidal ruptures, particular attention must be paid to OCT-A, which showed the lesions as breaks in the choriocapillaris plexus with a hypointense appearance due to the lack of substance. Moreover, along the break it was possible to see the projection of the underlying choroidal vasculature, which appeared hyperintense. The retinal vascular plexa were spared. Conclusions All patients presenting with blunt ocular trauma should undergo fundus examination to exclude damage to the optic nerve, retina, and choroid, and need close follow-up to avoid the development of secondary complications such as choroidal neovascularization. Optical coherence tomography angiography might add relevant information in the global evaluation and follow-up of choroidal ruptures in a noninvasive fashion, and could replace other invasive modalities such as FA or ICGA.

scholarly journals Comparison of swept-source versus spectral-domain optical coherence tomography angiography for detection of macular neovascularization

2021 ◽  
Author(s):  
Anna Lentzsch ◽  
Laura Schöllhorn ◽  
Christel Schnorr ◽  
Robert Siggel ◽  
Sandra Liakopoulos
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence Tomography Angiography ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Swept Source ◽  
En Face ◽  
Increased Sensitivity ◽  
Sensitivity Specificity ◽  
Subretinal Hyperreflective Material

Abstract Purpose To compare swept-source (SS) versus spectral-domain (SD) optical coherence tomography angiography (OCTA) for the detection of macular neovascularization (MNV). Methods In this prospective cohort study, 72 eyes of 54 patients with subretinal hyperreflective material (SHRM) and/or pigment epithelial detachment (PED) on OCT possibly corresponding to MNV in at least one eye were included. OCTA scans were acquired using two devices, the PLEX Elite 9000 SS-OCTA and the Spectralis SD-OCTA. Fluorescein angiography (FA) was used as reference. Two graders independently evaluated en face OCTA images using a preset slab as well as a manually modified slab, followed by a combination of en face and cross-sectional OCTA. Results Sensitivity (specificity) for the automated slabs was 51.7% (93.0%) for SS-OCTA versus 58.6% (95.3%) for SD-OCTA. Manual modification of segmentation increased sensitivity to 79.3% for SS-OCTA but not for SD-OCTA (58.6%). The combination of en face OCTA with cross-sectional OCTA reached highest sensitivity values (SS-OCTA: 82.8%, SD-OCTA: 86.2%), and lowest number of cases with discrepancies between SS-OCTA and SD-OCTA (4.2%). Fleiss kappa as measure of concordance between FA, SS-OCTA, and SD-OCTA was 0.56 for the automated slabs, 0.60 for the manual slabs, and 0.73 (good agreement) for the combination of en face OCTA with cross-sectional OCTA. Concordance to FA was moderate for the automated slabs and good for manual slabs and combination with cross-sectional OCTA of both devices. Conclusion Both devices reached comparable results regarding the detection of MNV on OCTA. Sensitivity for MNV detection and agreement between devices was best when evaluating a combination of en face and cross-sectional OCTA.

scholarly journals The Diagnostic Conundrum of Retinitis and a Pigmented Scar

2021 ◽  
pp. 164-168
Author(s):  
Nikhila S. Khandwala ◽  
Jason M.L. Miller ◽  
Robert A. Hyde ◽  
Christopher D. Conrady ◽  
Rajesh C. Rao ◽  
...  
Keyword(s):  
Silicone Oil ◽  
Antiviral Agents ◽  
Retinal Vasculitis ◽  
Dual Therapy ◽  
Diagnostic Dilemma ◽  
Therapy Regimen ◽  
Oral Corticosteroids ◽  
Simplex Virus ◽  
Herpes Simplex Virus 2 ◽  
Chorioretinal Scar

We report a finding of a pigmented chorioretinal scar with acute retinal necrosis (ARN) caused by herpes simplex virus 2 (HSV-2) infection rather than toxoplasma, creating an initial diagnostic dilemma. A 53-year-old functionally monocular male presented with painless floaters and blurry vision in his seeing eye over a period of 4 days. An exam demonstrated anterior chamber (AC) reaction, vitritis, multifocal patches of whitening, and an occlusive retinal vasculitis. A superior pigmented chorioretinal scar with overlying contracted vitreous was noted in the periphery with no adjacent retinal whitening. The patient was treated for both ARN and toxoplasma chorioretinitis until PCR study of the vitreous and AC returned positive for HSV-2 and negative for toxoplasmosis. Management consisted of a dual therapy regimen of both oral and intravitreal antiviral agents as well as oral corticosteroids. The patient’s clinical course was complicated by rhegmatogenous retinal detachment within 2 weeks after symptom onset, requiring pars plana vitrectomy with silicone oil and intraoperative intraocular incubation with foscarnet. We review emerging evidence for pigmented chorioretinal scars in ARN specifically caused by HSV-2, as well as diagnostic and treatment dilemmas in the management of ARN and ARN detachments.

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