Purpose: To describe characteristic elementary lesions of retinal pigment epithelium and choroidal vascular parameters determined by swept source optical coherence tomography (SS‐OCT) and OCT‐angiography (OCT‐A) in eyes with pachychoroid pigment epitheliopathy. Methods: Twenty‐seven patients with retinal pigment epithelium (RPE) abnormalities associated to pachychoroid features, with no history or findings indicative of subretinal fluid or soft drusen were evaluated. All eyes underwent comprehensive ophthalmic examination, fundus photography, SS‐OCT and OCT‐A. After binarization of B‐scan images with ImageJ Software, the choroidal vascularity index (CVI), the choroidal vascularity proportion (CVP) and flow voids area were calculated. Results: A total of 27 eyes of 23 patients, 19 of whom were male (70.37%), with a mean age of 59.11 ± 12.76 years were enrolled in this study. We detected six different types of RPE lesions: focal disruption in ellipsoid and interdigitation zones in 18 eyes (66.66%), RPE elevation with microbreak appearance in 12 eyes (44.44%), RPE thickening in 10 eyes (37.03%), small pigment epithelium detachment in seven eyes (25.92%), RPE spike in five eyes (18.51%) and outer nuclear layer thinning in five eyes (18.51%). The subfoveal choroidal thickness (SFCT) was 399, 78 ± 88, 13 μm. The mean inner choroidal thickness was 87.18 ± 36.67 μm. The CVI was 65.28 ± 3.35%. The CVP was 59.10 ± 0.58% in the choriocapillaris and 59.69 ± 1.42% in the Haller layer. The total choriocapillaris flow void area was 39.87 ± 1.21%. Conclusions: SS‐OCT and OCT‐A are valuable diagnostic tools to characterize pigment epithelium and choroidal changes in PPE eyes.
Purpose: To identify correlations of subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) with age and best corrected visual acuity in eyes with pachychoroid spectrum diseases (PSD) and their association to systemic hypertension using a retrospective study design. Methods: Our study included 82 eyes of 45 patients with PSD: 15 eyes had uncomplicated pachychoroid (UCP), 27 had pachychoroid pigment epitheliopathy (PPE), 32 had central serous chorioretinopathy (CSC) and 8 had pachychoroid neovasculopathy (PNV). All patients underwent DRI TRITON Swept‐Source Optical Coherence Tomography (SS‐OCT). A 1500 mm width subfoveal choroidal area was defined in SS‐OCT B‐scans and divided into luminal area (LA) and stromal area (SA) by the imageJ binarization technique. CVI was defined as the ratio of LA to the total subfoveal choroidal area (TCA). Results: The mean SFCT was 393, 23 ± 95, 65 μm and it was correlated negatively with age (p = 0.003, R = −0.326). We found a negative correlation of TCA and LA with age (p = 0.043, r = −0.227, p = 0.04, r = −0.230). Mean choroidal vascularity index was 64.45 ± 2, 74% with no correlation with age (p = 0.169, R = −0.155). No parameter among SFCT, CVI, TCA, LA and SA had a significant correlation with BCVA or spherical equivalent. Patients with essential hypertension were found to have significantly thinner SFCT when compared with healthy controls (374, 49 ± 83 141 μm vs. 423, 98 ± 130 466 μm, p = 0.046). CVI was not affected by a history of systemic hypertension (64.05 ± 1.97 vs. 64.83 ± 3.3, p = 0.207). The total choroidal area, luminal area, and stromal area, as well as the CVI correlated with SFCT (p < 0.001, r = 0.817, p < 0.001, r = 0.821, p < 0.001, r = 0.750 and p < 0.001, r = 0.371 respectively). Conclusions: SFCT and CVI are dynamic parameters that are affected in patients with pachychoroid diseases. Unlike CVI, SFCT is also affected by age, ocular and systemic factors like hypertension. CVI may be a more specific biomarker for PSD.
Purpose: To compare choroidal vascularity index (CVI) between eyes with different entities of pachychoroid spectrum diseases (PSD) and a control group. Methods: Eighty‐two eyes of 45 patients with PSD were included in our study. Fifteen eyes had uncomplicated pachychoroid (UCP), 27 eyes had pachychoroid pigment epitheliopathy (PPE), 32 eyes had central serous chorioretinopathy (CSC) and 8 had pachychoroid neovasculopathy (PNV). These eyes were compared to 67 eyes of 34 age‐matched healthy controls. All eyes underwent DRI‐OCT Triton Swept‐Source Optical Coherence Tomography (OCT). B‐scan images were binarized into blood vessels lumen and stroma using ImageJ software. The choroidal vascularity index (CVI) was defined as the ratio of luminal area (LA) to total choroidal area in a subfoveal region of 1500 μm width. Results: Mean CVI in patients with PSD was 64.45 ± 2.74%. A statistically significant difference was found between the PSD patients group and the control group (p < 0.001) with a higher CVI in PSD eyes. Pairwise comparisons revealed statistically significant differences between PPE/PNV groups (p < 0.05), PPE/control groups (p < 0.001), CRSC/control groups (p < 0.05) and CRSC/PPE groups (p = 0.05). The comparison between UCP/control groups, UCP/PPE groups, UCP/CRSC groups, UCP/PNV groups, PNV/control groups and PNV/CRSC groups showed no significant difference. Conclusions: Increased CVI may reflect choroidal vascular structure changes in eyes with PSD. These findings suggest that the CVI could be useful for evaluating choroidal vascular changes in eyes with PSD and predicting a potential progression form PPE to CRSC or PNV.
Purpose: To discuss the causes and risk factors of uveal effusion after trabeculectomy and to describe the management of this complication. Methods: This observational retrospective case series included 5 consecutive cases of uveal effusion that developed after trabeculectomy with intraoperative 5‐FU. All patients underwent ophthalmological examination including best corrected visual acuity (BCVA) measurement, anterior segment and fundus examinations. Fundus photography, B‐scan ultrasonography and Swept Source optical coherence tomography (SS‐OCT) were used to detect and monitor choroidal detachment and hypotony maculopathy. Anterior segment optical coherence tomography (AS‐OCT) was performed to assess iridocorneal angle opening and anterior chamber depth. Results: Four men and one woman were included. Mean age was 48.8 ± 15.1 y. One patient had nanophtalmia confirmed by B‐scan ultrasonography while four patients had postoperative hypotonia caused by overfiltration (3 cases) and bleb leak (1 case). All patients received corticosteroids and cycloplegics associated with a reformation of the anterior chamber and in one case we performed bleb revision. We showed resolution of the choroidal effusion, normalization of the ocular hypertension and restoration of visual acuity in all cases. Conclusions: Uveal effusion after trabeculectomy occurs in 3%–34% of cases. Its management can be challenging and requires close monitoring. Conservative management can overcome choroidal detachment, restore visual acuity and avoid aggressive surgery. References. 1. Schrieber C, Liu Y. Choroidal effusions after glaucoma surgery. Current Opinion in Ophthalmology. 2015; 26(2): 134–42. 2. Senthikumar VA, Michra C. Ultra‐widefield image of choroidal detachment after combined glaucoma filtration surgery. Indian J Ophthalmol. 2020; 68(8): 1669.
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