PURPOSE-To examine choroidal thickness and area in healthy eyes using spectral domain optical coherence tomography (SD-OCT). DESIGN-Retrospective, observational case seriesMETHODS-Thirty-four eyes (34 subjects), with no retinal or choroidal disease, underwent high definition raster scanning using SD-OCT with frame enhancement software. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500 μm intervals up to 2500 μm temporal and nasal to the fovea. The central 1 mm area of the choroid was also measured, along with foveal thickness of the retina. All measurements were performed by two independent observers. Statistical analysis was used to correlate interobserver findings, choroidal thickness and area measurements with age, and choroidal thickness with retinal foveal thickness. RESULTS-The 34 subjects had a mean age of 51.1 years. Reliable measurements of choroidal thickness were obtainable in 74% of eyes examined. Choroidal thickness and area measurements had strong inter-observer correlation (r =0.92, P < 0.0001) and (r =0.93, P < 0.0001) respectively. Area had a moderate negative correlation with age (r =-0.62, P < 0.0001) that was comparable to the correlation between mean subfoveal choroidal thickness and age (r =-0.61, P < 0.0001). Retinal and choroidal thickness were found to be poorly correlated (r =-0.23, P = 0.18). Mean choroidal thickness showed a pattern of thinnest choroid nasally, thickening in the subfoveal region, and then thinning again temporally. Mean subfoveal choroidal thickness was found to be 272 μm (SD, +/-81 μm).CONCLUSIONS-Choroidal thickness can be measured using SD-OCT high definition raster scans in the majority of eyes. Choroidal thickness across the macula demonstrates a thin choroid nasally, thickest choroid sub-foveally, and again thinner temporally, and a trend toward decreasing choroidal thickness with age.

Purpose To understand the relationship between choroidal thickness and various disease factors in patients with age-related macular degeneration (AMD) using spectral-domain optical coherence tomography. Design Cross-sectional, retrospective analysis. Methods Fifty-seven eyes of 47 patients with wet and dry AMD seen between November 2009 and January 2010 at the New England Eye Center, Boston, Massachusetts, were analyzed. Choroidal thickness was measured by 2 independent observers at 11 sites with high-definition horizontal 1-line raster scans through the foveal center. A retrospective chart review was performed to obtain data concerning duration of disease, number of intravitreal anti–vascular endothelial growth factor injections, visual acuity, lens status, and concomitant retinal pathologic features. The Pearson correlation and Student t test were used for statistical analysis for assessment of choroidal thickness changes in wet and dry AMD. Results The choroid in eyes with wet and dry AMD demonstrated a wide range of thicknesses above and below the normal mean (range, 77.5 to 399.5 μm; standard deviation [SD], 90.2). Nearly one third (33.3%) of the eyes with AMD measured less than 1 SD below the mean. Eyes with wet AMD demonstrated a mean subfoveal choroidal thickness of 194.6 μm (SD, 88.4; n = 40) compared with 213.4 μm (SD, 92.2; n = 17) in the dry AMD group. The choroidal thickness in eyes with dry AMD was correlated inversely with age (r = −0.703; P = .002); however, analysis of the number of intravitreal anti–vascular endothelial growth factor injections, number of years of disease, and visual acuity failed to demonstrate any significant correlations with choroidal thickness. Conclusions This study demonstrated that choroidal thickness can be measured by spectral-domain optical coherence tomography and that variable choroidal thickness exists among patients with the clinical diagnosis of wet and dry AMD. However, it is unclear at this time why in some eyes, choroidal thickness either increases or decreases with the disease. Further studies need to be carried out to understand the significance of choroidal thickness with respect to visual function and disease progression over time.

red fluorescent protein; PB1, Phox and Bem 1; PBS, phosphate-buffered saline; PDK, phosphoinositide-dependent kinase; PI3K, phosphoinositide-3 kinase; PKC, protein kinase C; PKM, protein kinase M. AbstractIn vertebrates, a brain-specific transcript from the atypical protein kinase C (PKC) f gene encodes protein kinase M (PKM) f, a constitutively active kinase implicated in the maintenance of synaptic plasticity and memory. We have cloned the atypical PKC from Aplysia, PKC Apl III. We did not find a transcript in Aplysia encoding PKMf, and evolutionary analysis of atypical PKCs suggests formation of this transcript is restricted to vertebrates. Instead, over-expression of PKC Apl III in Aplysia sensory neurons leads to production of a PKM fragment of PKC Apl III. This cleavage was induced by calcium and blocked by calpain inhibitors. Moreover, nervous system enriched spliced forms of PKC Apl III show enhanced cleavage. PKC Apl III could also be activated through phosphorylation downstream of phosphoinositide 3-kinase. We suggest that PKM forms of atypical PKCs play a conserved role in memory formation, but the mechanism of formation of these kinases has changed over evolution.

Purpose To determine the effect of anti-vascular endothelial growth factor (VEGF) therapy on choroidal thickness in eyes with diabetic macular edema (DME) Design A retrospective, cohort analysis of 59 eyes from 59 patients with DME without prior anti-VEGF therapy Methods Choroidal thickness was measured using semi-automated segmentation of enhanced-depth imaging optical coherence tomography (EDI-OCT) images at 0.5mm intervals from 2.5mm nasal to 2.5mm temporal to the fovea. Changes in choroidal thickness with and without anti-VEGF treatment over 6 months were compared. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analyzed to evaluate the association of choroidal thickness with functional and anatomical outcomes. Results Of the 59 eyes with DME, 26 eyes were observed without treatment, while 33 underwent intravitreal anti-VEGF therapy (mean number of injections = 2.73) over 6 months. In untreated eyes, there was no significant change in BCVA (p=0.098), CFT (p=0.472), or choroidal thickness at all measurements along the macula (p=0.057 at the fovea). In eyes treated with anti-VEGF injections, choroidal thickness significantly decreased at the fovea (246.6μm to 224.8μm; p<0.001) and at 0.5 mm nasal (240.9μm to 221.9μm; p = 0.002) and 0.5 mm temporal (249.3μm to 224.8μm; p=0.011) to the fovea. The decrease in subfoveal choroidal thickness after anti-VEGF treatment was not associated with the cumulative number of anti-VEGF injections (R2=0.031, p=0.327), or to changes in BCVA (R2=0.017; p=0.470) or CFT (R2=0.040; p=0.263). Conclusions Central choroidal thickness decreases after anti-VEGF therapy for DME after 6 months, but may not be associated with functional or anatomical outcomes in eyes with DME.

Objective To study retinal morphological changes around the optic disc in patients with peripapillary atrophy (PPA) with high-resolution spectral domain optical coherence tomography (SD OCT). Design Cross-sectional, retrospective analysis Participants One hundred and three eyes of 73 patients with PPA and 21 eyes of 12 normal patients seen at the New England Eye Center, Tufts Medical Center between January 2007 and August 2009. Methods SD OCT images taken through the region of PPA were quantitatively and qualitatively analyzed. Inclusion criteria included eyes with at least 300 μm of temporal PPA as detected on color fundus photographs. The study population was divided into subgroups according to the following clinical diagnoses: glaucoma (n=13), age-related macular degeneration (n=11), high myopia (n=11), glaucoma and high myopia (n=3), and optic neuropathy (n=11). Fifty-four patients were classified with other diagnoses. Using OCT software, retinal thickness and retinal nerve fiber layer thickness (RNFL) were both manually measured perpendicular to the internal limiting membrane and retinal pigment epithelium (RPE) 300 μm temporal to the optic disc, within the region of peripapillary atrophy. Qualitative analysis for morphological changes in the atrophic area was also performed. Main outcome measures Qualitative assessment and quantitative measures of retinal and retinal nerve fiber layer thickness in PPA. Results The study group was categorized by 6 characteristics demonstrated in the area of PPA by SD OCT: RPE loss with accompanying photoreceptor loss, RPE disruption, RNFL thickening with plaque-like formation, intraretinal cystic changes, inner and outer retinal thinning, and abnormal retinal sloping. Statistical analysis of measurements revealed a statistically significant difference in the total retinal thickness between normal eyes and eyes with PPA (p = 0.0005), with normals 15% thicker than the PPA group; however, the RNFL thickness was not significantly different between the normal and PPA group (p = 0.05). Conclusion Eyes with peripapillary atrophy manifest characteristic retinal changes that can be described via SD OCT.

A critical method of monitoring patients with neovascular age-related macular degeneration (AMD) being treated with anti-vascular endothelial growth factor (anti-VEGF) is optical coherence tomography (OCT), which uses low-coherence interferometry of light to examine the retina in vivo on a micrometer scale. 1 Recent advances in spectral-domain OCT make visualization of the choroid feasible. Using image averaging and enhanced depth imaging, successful examination and measurement of choroidal thickness in normal and pathologic states have been reported. [2][3][4] It has been hypothesized that anti-VEGF may affect choroidal vasculature. 5 The goal of this study is to evaluate the effect of anti-VEGF on choroidal thickness using spectral-domain OCT in treatment-naive subjects. MethodsTwenty-two patients (22 eyes) with neovascular AMD were identified prior to first-time treatment with anti-VEGF at New England Eye Center. All patients with concomitant ocular pathologies were excluded. Twenty age-matched healthy eyes were identified as a control group. This study was approved by the institutional review board of the Tufts Medical Center.Patients were imaged with spectral-domain OCT prior to first-time treatment with anti-VEGF therapy and again at 3, 6, and 12 months (Figure 1). Control eyes were imaged at the time of identification and 6 months later. The scan pattern used was Cirrus high-definition 1line raster (Carl Zeiss Meditec), which is a 6-mm line consisting of 4096 A-scans and 20 Bscans averaged together without tracking.

Purpose To use spectral domain optical coherence tomography–guided duration of facedown positioning to study anatomical macular hole closure rates. Methods Retrospective review of patients with macular holes undergoing 23-gauge pars plana vitrectomy and intraocular gas tamponade. Spectral domain optical coherence tomography imaging was done on postoperative Day 1. Patients remained facedown for 2 more days if the macular hole was closed or 6 more days facedown if the macular hole was open or indeterminate. Results There were 8 Stage 2, 12 Stage 3, and 12 Stage 4 macular holes. On postoperative Day 1, 24 holes were closed by spectral domain optical coherence tomography and instructed to remain facedown for two more days. Twenty-three of 24 holes remained closed during the postoperative period. Eight holes were open or indeterminate on postoperative Day 1 and remained facedown for 6 more days. Six of 8 holes (75%) were closed at their last follow-up. The overall closure rate was 29/32 (90.6%). Average follow-up was 334 days. Conclusion Confirming early closure of macular holes with spectral domain optical coherence tomography imaging can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.

Caucasian race and use of a nonscleral patch graft during revision surgery was associated with a higher risk of experiencing a sooner reexposure of the GDD following revision of an initial exposure. Future studies should examine whether particular graft materials increase the risk of GDD reexposure.