Luisa Pierro

The aim of this study was to perform quantitative optical coherence tomography angiography (OCTA) assessment of arteritic and non-arteritic anterior ischemic optic neuropathies (AION; NAION). The study was designed as an observational, cross-sectional case series. All patients underwent complete ophthalmologic evaluation including LogMAR best-corrected visual acuity (BCVA), structural optical coherence tomography (OCT) and OCTA images, and dye-based angiography. Retinal nerve fiber layer (RNFL) thickness was obtained from structural OCT, and vessel density (VD) and vessel tortuosity (VT) were measured for each optic nerve head vascular plexus. After selecting the quadrants showing visual field defects, measured by Humphrey 30.2 perimetry (Zeiss Meditec, Dublin, CA, USA), we assessed the correlation between the localization of visual field defects and the quadrants showing impairments of RNFL, VD, and VT. Thirty naïve AION patients (15 arteritic AION (AAION) and 15 non-arteritic AION (NAION)) were included. LogMAR BCVA was 0.6 ± 0.2 for AAION and 0.3 ± 0.3 for NAION (p < 0.01). AAION and NAION eyes showed significant differences in terms of visual field involvement as well as VD and VT values, with remarkably worse alterations affecting AAION eyes. VD values perfectly matched with the quadrants showing RNFL and visual field defects. On the contrary, VT resulted remarkably decreased in all the quadrants, with even worse values in the quadrants showing RNFL and visual field alterations. The present study showed that AAION eyes are more injured than NAION ones. VD represents a good parameter for the detection of the main site on vascular impairment. Remarkably, VT resulted in a more sensitive parameter for the quantitative detection of blood flow impairment in AION disease.

Choroidal osteoma is a rare, classically unilateral tumor. Less than half of the cases are complicated by the onset of choroidal neovascularization (CNV). The authors describe a case of bilateral choroidal osteoma in a 10-year-old female patient complicated by the onset of bilateral CNV. The diagnosis was made by multimodal imaging and ultrasonography. Best-corrected visual acuity (BCVA) was 20/63 for the right eye (OD) and 20/25 for the left eye (OS). Interestingly, CNV OD resulted exudative, whereas no signs of fluid were detected OS. OCT angiography (OCTA) clearly detected the presence of CNV in both eyes. The patient underwent a single 1.0 mg/0.025 mL aflibercept injection OD. At follow-up, BCVA improved to 20/32 OD after 1 month and to 20/25 after 3 months, with no exudation recurrence. Both BCVA and imaging findings were unremarkable OS, thus suggesting the possible “quiescent” nature of this CNV. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:398–400.]

To investigate the retinal capillary perfusion density by means of optical coherence tomography angiography (OCT-A) in idiopathic epiretinal membrane (ERM) and macular pseudoholes (MPH).

BACKGROUND AND OBJECTIVE: Optical coherence tomography angiography (OCTA) comparison between vessel density in patients with degenerative-subtype lamellar macular hole (LMH) and healthy individuals. Unaffected fellow eyes were also included in the study. PATIENTS AND METHODS: This observational, cross-sectional study examined 32 eyes affected by unilateral degenerative-subtype LMH, as well as the 32 fellow eyes of the enrolled population. Thirty healthy eyes were used as controls. ImageJ software was used to calculate macular vessel density in the three vascular plexuses (superficial capillary plexus [SCP], deep capillary plexus [DCP], choriocapillaris [CC]) in two regions: (1) a fovea-centered 1.5-mm diameter circular area after subtracting the foveal avascular zone (FAZ) area, obtaining a “ring” in the immediate FAZ proximity (peri-FAZ); (2) the area external to (1) included in the scan. RESULTS: In the peri-FAZ, the SCP of both LMH and fellow eyes showed higher vascular density than in controls ( P = .004 for LMH; P = .015 for fellow eye), whereas no difference was evident between LMH and fellow eyes ( P = .190). No changes were found in the DCP or the CC. No differences in vessel density of the three plexuses in the area outside the peri-FAZ were evident in any of the three groups. The FAZ in the SCP was larger in the LMH (0.39 ± 0.16 mm ² ) and in the fellow eye (0.39 ± 0.21 mm ² ) groups compared with controls (0.27 ± 0.07 mm ² ; P = .021 for LMH; P = .0043 for fellow eye), whereas it was similar between LMH and fellow eyes ( P = .967). CONCLUSIONS: Degenerative-subtype LMH in the immediate proximity of the FAZ has a larger FAZ and higher vascular density in the SCP compared with healthy eyes. Unaffected fellow eyes also have increased vascular density compared with controls. Microvascular changes are evident in both LMH and unaffected fellow eyes and might play a role in disease pathogenesis. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50:e112–e117.]

Retinal capillary hemangioma (RCH) is a benign retinal tumor defined by a vascular proliferation localized in the peripheral retina, juxtapapillary retina, or the intraneural portion of the optic nerve. In most cases, diagnosis of RCH is performed by fundus evaluation and confirmed by fluorescein fundus angiography. Nevertheless, a small RCH localized on or adjacent to the optic nerve head could be difficult to detect by fundus examination. Here, the authors report an atypical case of RCH, not ophthalmoscopically visible, but successfully detected first by optical coherence tomography (OCT) and then by OCT angiography, which confirmed its vascular nature. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:e81–e83.]

Torpedo maculopathy is characterized by a congenital, unilateral, and torpedo-shaped chorioretinal lesion with unclear pathogenesis and evolution. Although the optical coherence tomography angiography (OCTA) characteristics have already been defined in literature, the authors describe for the first time the presence of choroidal neovascularization (CNV) on the temporal edge of this lesion in a 36-year-old woman with a history of altered visual field in her left eye. The authors' investigation supports the hypothesis of an aberrant choroidal circulation underlying the pathogenesis of this condition, and proves the advantage conferred by OCTA in CNV detection over the other angiographic techniques. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:e210–e213.]

Aims To investigate the clinical spectrum of choroidal neovascularisation (CNV) in patients with dome-shaped macula with the aid of multimodal imaging. Methods In this cross-sectional, retrospective, observational study, we reviewed charts and imaging studies of 144 eyes of 79 consecutive patients with dome-shaped macula evaluated at a tertiary referral centre, including optical coherence tomography angiography (OCTA), fluorescein angiography (FA) and indocyanine green angiography (ICGA). Three masked graders evaluated the prevalence and type of CNV. Primary outcome measures were the diagnostic agreement between OCTA and FA±ICGA, the multimodal imaging characteristics and prevalence of CNV associated with dome-shaped macula. Results We identified 30 eyes with dome-shaped macula complicated by CNV with an estimated prevalence of 20.8% (95% CI 14.2 to 27.4). Twenty-two eyes (73%) showed a type 2 CNV while eight eyes (27%) showed a type 1 CNV. Serous macular detachment was present in 39 eyes (27%) and harboured a CNV in five cases (13%). The overall diagnostic agreement between OCTA and FA±ICGA was excellent (k=0.894, pConclusion Eyes with dome-shaped macula may either develop typical myopic CNV (ie, type 2 CNV) or pachychoroid-associated CNV (ie, type 1 CNV), similar to those observed in central serous chorioretinopathy. Accordingly, in case of serous macular detachment complicating dome-shaped macula, the presence of an associated CNV should be considered. When suspecting a CNV associated with dome-shaped macula, the application of both OCTA and FA±ICGA is superior to the use of one technique alone.

The authors report a case of a female patient affected by primary vitreoretinal lymphoma (PVRL) showing retinal involvement. In particular, multiple subretinal hyperreflective infiltrates were found on optical coherence tomography (OCT). These alterations appeared hyperautofluorescent on fundus autofluorescence images. Interestingly, they also appeared hyperreflective on OCT angiography images. This case report underlined the high utility of OCT-based methodologies in accurately detecting and describing PVRL features. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:e173–e174.]