Topcon's SS-OCTA was not able to detect all CNV lesions. Large pigment epithelial detachments were associated with signal loss. Fluorescence angiography still remains the gold standard, but the tested SS-OCTA device can be considered as a feasible additional diagnostic tool in AMD.

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Introduction To evaluate the effect of a 9-week treatment deferral due to healthcare restrictions caused by Austria’s first governmental lockdown associated with the coronavirus disease 2019 (COVID-19) pandemic on visual acuity (VA) in eyes compromised by exudative neovascular age-related macular degeneration (nAMD) after 1 year. Methods Retrospective data collection of 98 eyes (98 patients) with a treatment discontinuation at a tertiary eye care center (Clinic Landstraße, Vienna Healthcare Group, Austria) between March 16 and May 4, 2020. Prior to the lockdown, patients received multiple intravitreal injections (IVI) of anti-vascular endothelial growth factor with a personalized treatment interval for 3 years on average and at least three IVI after the lockdown. Results When the treatment interval doubled to 117.6 ± 31.4 days in spring 2020, patients lost 2.2 ± 4.6 ETDRS letters ( p = 0.002) on average before reinitiating therapy. In total, 4.1 ± 8.1 letters ( p < 0.0001) were lost despite continuous individual re-treatment over the course of the next year. In a univariate analysis, the extended interval time remained statistically significant ( p < 0.0001), indicating a larger VA reduction within intervals with increasing interval time in days. Conclusion The short-term treatment interruption had a persistent negative impact on the VA course of eyes under therapy after 1 year. Continuous therapy independent of the underlying treatment regimen remains of utmost importance in exudative nAMD. Our data should create awareness to regulators regarding future decisions despite the global pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00381-y.

Although peripheral schisis of the outer plexiform layer is often concomitant with central splitting in X-linked juvenile retinoschisis, this is the first known report of nonhereditary cleavage of the outer plexiform layer of the peripheral retina without central affection in a patient with documented stellate nonhereditary idiopathic foveomacular retinoschisis on the other eye. These findings suggest an accurate bilateral examination of the peripheral retina while confirming the diagnose of stellate nonhereditary idiopathic foveomacular retinoschisis.

Purpose A model was calculated during the first Austrian coronavirus disease-2019 (COVID-19) pandemic lockdown to estimate the effect of a short-term treatment interruption due to healthcare restrictions on visual acuity (VA) in neovascular age-related macular degeneration (nAMD). The model was compared to the real-life outcomes before treatment re-started. Methods Retrospective data-collection of 142 eyes in 142 patients receiving repeated intravitreal injections with anti-VEGF at a retina unit in Vienna in a personalized pro-re-nata regimen prior to the COVID-19 associated lockdown, when treatment was deferred between March 16 and May 4, 2020. During the lockdown, the preliminary data was integrated into pre-existing formulae based on the natural course of the disease in untreated eyes in the long term. Patients were re-scheduled and treated after gradually opening operating rooms. The calculation model was compared to the effective VA change. Results The model calculated an overall VA loss of 3.5 ± 0.8 letters early treatment diabetes retinopathy study (ETDRS) ( p < 0.001 [95% CI:3.3;3.6]) on average compared to 2.5 ± 6 letters ETDRS ( p < 0.001 [95% CI:1.5;3.5]) as measured with a mean treatment delay of 61 ± 14 days after previously scheduled appointments. The total difference between the model exercise and the real-life outcomes accounted for 1 ± 5.9 letters ETDRS ( p = 0.051 [95% CI: 0.1;1.9]). Conclusion The herein presented calculation model might not be suitable to estimate the effective VA loss correctly over time, although untreated eyes and eyes under therapy show similarities after short-term treatment interruption. However, this study demonstrated the potentially negative impact of the COVID-19 pandemic lockdown on patients compromised by nAMD.

Diabetic maculopathy (DM) is a microvascular dysfunction clinically characterized by microaneurysms (MA) leading to edema and central visual deprivation. This prospective explorative study investigated 27 eyes of 17 patients with DM by fluorescein/indocyanine green angiography (FA/ICGA; SPECTRALIS HRA-OCT, Heidelberg Engineering) and by swept source-optical coherence tomography angiography (SS-OCTA; DRI-OCT Triton Plus, Topcon) to identify clinically relevant MAs. The SS-OCTA cubes were split into the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) according to the automated segmentation. The images of all modalities were superimposed for alignment by an Early Treatment Diabetic Retinopathy Study grid overlay and compared to each other. In total, the mean number of MAs in FA was 33.4 ± 22 (standard deviation) (median 27.5 [q1:21.75;q3:38.25]), in ICGA 24.9 ± 16.9 (17.5 [14;35]), in the SCP 6.5 ± 3.7 (5.5 [3.75;9.25]) and in the DCP 18.1 ± 10.5 (18.5 [10.75;23.5]). Mixed effects models between ICGA and the DCP were borderline significant (p = 0.048; 95% confidence interval 0.21 to 13.49), whereas all other imaging methods differed significantly. Quantitative analysis of MAs in DM showed a plausible agreement between ICGA and the DCP in SS-OCTA. These findings contribute to the imaging methodology in DM.

Purpose To compare the lesion sizes of macular neovascularization (MNV) imaged with spectral‐domain (SD) and swept‐source (SS) optical coherence tomography angiography (OCTA) as well as indocyanine green angiography (ICGA). Methods In this prospective, observational case series, patients showing a secured diagnosis of MNV on ICGA or Fluorescein Angiography, were imaged by SD‐OCTA and SS‐OCTA on the same day. Lesion size was measured on 3 × 3‐mm2 and 6 × 6‐mm2 scans using the Maestro 2 SD‐OCTA (Topcon Corporation, Tokyo Japan) and the Triton SS‐OCTA device (Topcon Corporation, Tokyo Japan) and compared to ICGA (Spectralis HRA, Heidelberg, Germany). Results Twenty eyes from 20 patients (11 females, 55%) were enrolled. The neovascularization area measured on 6 × 6‐mm2 SD‐OCTA was lower compared to that outlined on SS‐OCTA, however, not reaching statistical significance (p = 0.094). Regarding 3 × 3‐mm2 measurements, the median lesion sizes between the two OCTA devices were comparable (p = 0.492). Indocyanine green angiography depicted a larger lesion area than both OCTA devices, however, not reaching statistical significance. Conclusion SD‐OCTA tends to show smaller areas of MNV extension than SS‐OCTA regarding 6 × 6 mm2 scans. The lesion size of MNV can be very well compared between the different devices, emphasizing the use of OCTA for monitoring neovascular area. Lesion measurements on SS‐OCTA correlate better with ICGA than SD‐OCTA.