Macular and peripapillary microvasculature after dexamethasone injection in diabetic macular edema

Purpose To evaluate the microvascular changes in the macular and peripapillary area after intravitreal dexamethasone implant in diabetic macular edema (DME) Material and Methods We included 31 eyes of 31 patients treated with a single dose dexamethasone implant for DME. All subjects underwent swept-source optical coherence tomography (OCT) and OCT angiography imaging before (T0), and one month (T1), two months (T2), and four months (T4) after dexamethasone injection. The foveal avascular zone (FAZ) area of superficial and deep capillary plexus (SCP and DCP) was calculated by delineating the FAZ border using the measurement tool of the device. The vessel density (VD) of SCP and DCP and choriocapillaris (CC) in the macular and peripapillary area were automatically calculated. Results There was an insignificant reduction in FAZ area measurements of SCP after dexamethasone injection in DME patients (p = 0.846). The FAZ area of DCP were significantly smaller compared to T0 measurements at T1, T2, and T4 (p = 0.013, p = 0.031, and p = 0.029, respectively). The mean average parafoveal VD measurements were significantly decreased after dexamethasone injection in SCP and DCP (p = 0.004, p = 0.005). The peripapillary VD in retinal capillary plexuses and choriocapillaris showed no significant difference after dexamethasone injection. Conclusion Intravitreal dexamethasone leads to a significant FAZ area decrease in DCP with a reduction in parafoveal VD measurements. In addition, no significant VD changes were observed in the peripapillary area after dexamethasone. These findings indicate that dexamethasone may improve macular ischemia with no significant effects on peripapillary microvasculature in DME patients.

Analysis of Retinal Capillary Using Optical Coherence Tomographic Angiography of Unilateral Normal Tension Glaucoma

Purpose: The purpose of this study was to analyze retinal capillary parameters using optical coherence tomography angiography (OCTA) of the affected eye and the fellow eye of unilateral normal tension glaucoma (NTG) patients and compare the findings with eyes from a normal control group.Methods: A retrospective cross-sectional study was carried out on patients diagnosed with unilateral NTG (24 affected eyes and 24 fellow eyes each) and normal individuals (29 eyes, the control group). OCTA was used to measure the vascular density (VD) and perfusion density (PD) of the macular area and the peripapillary area.Results: In the superficial capillary plexus, the fellow eye group of unilateral NTG patients showed a decrease in VD of the inner-inferior and PD of the inner-inferior and outer-average peripapillary area, compared with the normal control group (p = 0.008, p < 0.001, and p = 0.001). In the affected NTG eye group, the VD (p = 0.014, p = 0.011, p < 0.001, p < 0.001, and p < 0.001) and PD (p = 0.017, p = 0.023, p < 0.001, p = 0.001, and p < 0.001) of the total, inner-average, inner-inferior, and outer-inferior peripapillary area, and the outer-inferior macular area decreased compared to the fellow eye and normal control group, as well as the VD of the outer-average peripapillary area (p = 0.010). The PD of the outer-average peripapillary area (p = 0.003); the VD (p = 0.041, p = 0.008, p = 0.006) and the PD (p = 0.013, p < 0.001, p = 0.001) of the total, inner-inferior, and outer-average macular area; and the PD of the outer-temporal macular area (p = 0.003) were lower than the normal control group. There was no difference in the VD or PD obtained from the deep capillary plexus of the macular area among the groups.Conclusions: It is useful to observe retinal capillary parameters using OCTA for patients with unilateral NTG.

Optical Coherence Tomography Angiography Acute of Non-Arteritic Anterior Ischemic Optic Neuropathy

Background Anterior ischemic optic neuropathy (AION) is divided into arteritic anterior ischemic optic neuropathy (AAION) which accounts for 15% and Nonarteritic anterior ischemic optic neuropathy (NAION) which accounts for 85% of cases. Non-arteritic anterior ischemic optic neuropathy (NAION) is an ischemic change involves the 1 mm thickness of the optic nerve head (optic disc). It affects around 10 cases per 100,000 per year in the age group over 50. Objective To assess the optical coherence tomography angiography peripapillary area pattern in diagnosed non-arteritic acute ischemic optic neuropathy patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision. Patients and Methods We enrolled 20 patients in cases group and 10 patients in control group were enrolled to assess the OCTA peripapillary area pattern in diagnosed NAAION patients within a period from one week to 3 weeks during (acute stage while the disc is still edematous) of acute painless diminution of vision compared to the pattern seen in the normal control group OCTA, FFA and VF (centralized 30-2 SITA strategy) were done to the cases group. But FFA and VF were excluded in the control group. Results The results of our study show statistically significant difference found between the two studied groups regarding central circle perfusion density, middle circle perfusion density (superior, inferior and nasal) and outer circle perfusion density (superior and temporal) while no statistically significant difference found between them regarding middle circle (temporal) and outer circle (inferior and nasal). Conclusion So according to this study in cases of NAION (acute stage), we can depend on perfusion density within the middle and outer circle of Early Treatment Diabetic Retinopathy Study (ETDRS) grid put on the disc and peripapillary area. As, these are the areas affected by decreased perfusion density. While, there is increased perfusion density within the central and middle circles, which could be due to, diffuse disc edema.

Analysis of the Peripapillary and Macular Regions Using OCT Angiography in Patients with Schizophrenia and Bipolar Disorder

Purpose: To measure RNFL and vasculature around the optic disc and in the macula in patients with schizophrenia (SZ) and bipolar disorder (BD) using optical coherence tomography angiography (OCTA). Methods: 24 eyes of patients with SZ and 16 eyes of patients with BD as well as 30 eyes of healthy subjects were examined with OCTA. The radiant peripapillary capillary (RPC) density and RNFL thickness were measured in the peripapillary area. Moreover, macular thickness and vessel density were measured in both superficial and deep layers. Results: Significantly decreased values of vessel density in the macular deep vascular complex were found in the eyes of patients with SZ, compared to BD and the control group. The macular thickness in the whole vascular complex and in the fovea was significantly lower in SZ and BD group than in the control group. The radiant peripapillary vascular density and RNFL thickness were similar across groups. Conclusions: The retinal microvascular dysfunction occurs in the macula in patients with SZ and BD, but not around optic disc. OCTA can become an essential additional diagnostic tool in detection of psychiatric disorders.

Macular Optical Coherence Tomography Imaging in Glaucoma

The advent of spectral-domain optical coherence tomography has played a transformative role in posterior segment imaging of the eye. Traditionally, images of the optic nerve head and the peripapillary area have been used to evaluate the structural changes associated with glaucoma. Recently, there is growing evidence in the literature supporting the use of macular spectral-domain optical coherence tomography as a complementary tool for clinical evaluation and research purposes in glaucoma.

Peripapillary and Macular Choroidal Vascularity Index in Eyes with Fuchs’ Uveitis

Background To investigate the choroidal vascularity alterations of macula and peripapillary area in eyes with unilateral Fuchs uveitis (FU). Methods This study included 18 eyes with unilateral FU and 18 healthy fellow eyes. The choroidal vascularity index (CVI) was analyzed and the results were compared between eyes with FU and healthy fellow eyes (control group). Results The mean subfoveal (s)CVI (%) value was significantly lower in the FU group as compared with the control group:60.92 ± 2.63 vs. 64.01 ± 2.54,respectively (p = 0.001). The mean pCVI (%) values of superior and inferior quadrant were significantly lower in the Fuchs group as compared with the control group:58.87 ± 4.48 vs. 61.98 ± 3.32, respectively, in superior quadrant (p = 0.035); and 57.29 ± 6.65 vs. 61.44 ± 4.76, respectively, in inferior quadrant (p = 0.014). Conclusion The chronic continuous inflammation in FU causes inflammation-mediated thinning in the vascular area of the subfoveal and peripapillary choroid. The changes in the peripapillary region are remarkable in terms of the further glaucoma risk of these eyes.

Non-invasive Diagnosis and Prognosis Values of 3D Pseudocontinuous Arterial Spin Labeling and Optical Coherence Tomography Angiography in Proliferative Diabetic Retinopathy

Background: 3D Pseudocontinuous Arterial Spin Labeling (3D-PCASL) MRI and optical coherence tomography angiography (OCTA) have been applied to detect ocular blood flow (BF). We aim to characterize the ocular BF in diabetic retinopathy (DR) using 3D-PCASL and OCTA, to discuss the relationship between ocular and cerebral BF, and to evaluate their potential utility to assess the severity of DR.Methods: A total of 66 participants (132 eyes) were included. Seventy-two eyes were classified in the proliferative diabetic retinopathy (PDR) group, and 60 were in the non-proliferative diabetic retinopathy NPDR group. Ocular and cerebral BF values were detected by 3D-PCASL using a 3.0T MRI scanner with two post-labeling delays (PLDs). Vessel density (VD)/perfusion density (PD) of the macular or peripapillary area were detected by OCTA. Parameters and clinical characteristics were compared between the PDR and NPDR eyes utilizing two-sample t-tests and chi-square tests. Spearman's rank correlation analysis, logistic regression analysis, and receiver operating characteristic curves (ROC) analyses were performed to evaluate the factors' role in DR severity.Results: The perfusions of the retinal/choroidal plexus (RCP), optic nerve head (ONH)/optic nerve (ON), and VD/PD of macular/peripapillary area in the PDR group were significantly lower compared to the NPDR group (p &lt; 0.05). They were protective factors for PDR [ORs = 0.842 for RCP (1.5 s PLD), 0.910 for ONH (1.5 s PLD), 0.905 for ON (both 1.5 and 2.5 s PLD), 0.707 for macular VD, 0.652 for peripapillary VD, p &lt; 0.05, respectively]. Ocular BF had a positive correlation with BF of the occipital lobe (OL) and temporal lobe (TL) in the cerebrum. The BF of RCP (lower than 7.825 mL/min/100 g at 1.5 s PLD) indicated PDR [areas under the curve (AUCs) = 0.682, 95% CI: 0.588–0.777, sensitivity: 70.7% specificity: 63.9%]. The AUC of RCP (PLD = 1.5 s) BF combined with peripapillary VD was 0.841 (95% CI: 0.588–0.777, sensitivity: 75.9% specificity: 82.9%).Conclusions: 3D-pcASL and OCTA may be effective non-invasive methods to measure ocular blood flow in DR patients and assess the severity of DR.

Vessel Density Loss of the Deep Peripapillary Area in Glaucoma Suspects and Its Association with Features of the Lamina Cribrosa

Purpose: To investigate the association of decreased vessel density (VD) in the deep peripapillary region and structural features of the lamina cribrosa (LC). Materials and Methods: 70 eyes of glaucoma suspects with enlarged cup-to-disc ratio were scanned and 51 eyes with adequate image quality were included in this study. All subjects had localized VD defects in the deep layer but intact VD in the superficial layer around the peripapillary region using optical coherence tomography angiography (OCTA). Only single-hemizone OCTA results from one eye of each subject had to fulfill the distinctive feature mentioned above to perform inter-eye and inter-hemizone comparisons. The thickness and depth of the LC, and prelaminar thickness were measured using enhanced depth imaging OCT (EDI-OCT). Paired t-tests were performed to evaluate differences in measurements of the LC and prelaminar thickness within each individual. p-values lower than 0.05 was considered to be statistically significant. Results: Eyes with deep VD defects in the peripapillary region in OCTA had thinner LC than the fellow eyes. The hemizone with the deep VD defects in the peripapillary region had a thinner LC and a deeper depth of LC than the other hemizone in the same eye. According to logistic regression analysis, a thin LC was a significant factor associated with deep VD defect in the peripapillary region. Conclusions: Glaucoma suspect eyes with deep VD defects in the peripapillary area exhibited structural differences in the LC. The structural changes of the LC was associated with the vessel density in the deep peripapillary layer at the stage of suspected glaucoma.

Unilateral macular serpiginous-like choroiditis as the initial manifestation of presumed ocular tuberculosis

Background Classic serpiginous choroiditis (SC) usually begins in the peripapillary area and spreads centrifugally, however, in some patients, the lesion can arise in the macular region. An association between lesions resembling classic SC and tuberculosis was recognized as a possibly distinct clinical entity and named as tuberculous serpiginous–like choroiditis. The differentiation of this tuberculous entity from SC is critical because the treatment of the former with immunosuppressive drugs leads to several potential adverse effects, and such treatment can have devastating consequences because of the worsening of a concomitant tuberculous infection. Case presentantion A 31-year-old woman presented with unilateral decreased vision and a fundus examination consistent with macular serpiginous choroiditis. A non-reactor tuberculin skin test and normal thoracic CT scan ruled out tuberculosis. However, after 2 months of treatment with steroids and immunosuppressive drugs, the contralateral eye developed similar lesions, further raising the suspicions of ocular tuberculosis. We conducted QuantiFERON® TB Gold, which was positive; hence, antituberculous therapy was started on the patient. The lesions started healing within a few weeks. After 1 year of finishing the therapy, the lesions remained healed without any recurrence. Conclusions Macular serpiginous-like choroiditis may be the initial presentation of presumed ocular tuberculosis. Nevertheless, the correct diagnosis of this entity can be challenging and delayed by the imprecise results from the currently available methods.

Serpiginous Choroiditis; Clinical Features, Diagnosis, and Treatment

Serpiginous choroiditis is a progressive disease that causes atrophy in layers of the choriocapillaris, retinal pigment epithelium, and photoreceptor, due to choroidal inflammation. It typically involves both eyes asymmetrically and spreads from the peripapillary area to the periphery. Although the etiology is unclear, an autoimmune and infectious mechanism seems likely to be the underlying process. The clinical condition is called “multifocal serpiginous choroiditis” if an underlying infectious cause such as Mycobacterium tuberculosis, Treponema pallidum, or herpesviruses is detected. The natural course of the disease usually consists of multiple recurrences of choroidal inflammation over a period of months to years. The vision loss occurs if the fovea is involved during these relapses. Multimodal imaging methods are important in the diagnosis, treatment, follow-up of the disease, and the detection of complications such as choroidal neovascularization. In treatment, it is aimed to suppress inflammation and prevent recurrences via systemic/local corticosteroids and immunomodulatory drugs. If an underlying infectious agent is detected, specific antimicrobial treatment should also be added.