Ichiro Maruko

Subfoveal Choroidal Thickness after Treatment of Central Serous Chorioretinopathy

PURPOSE To evaluate the subfoveal choroidal thickness after treatment of central serous chorioretinopathy (CSC) visualized by enhanced depth imaging spectral-domain optical coherence tomography (EDI OCT) and indocyanine green angiography (ICGA). DESIGN Retrospective, comparative series. PARTICIPANTS Twenty patients (20 eyes). METHODS The subfoveal choroidal thickness and height of the serous retinal detachment before and after treatment was measured using EDI OCT. Areas of choroidal vascular hyperpermeability were visualized with ICGA. Eyes with classic CSC were treated with laser photocoagulation (LP), whereas eyes with chronic CSC, which are not amenable to LP, were treated with half-dose verteporfin photodynamic therapy (PDT). MAIN OUTCOME MEASURES Change in choroidal thickness and height of the serous retinal detachment after treatment. RESULTS There were 12 eyes in the LP group and 8 eyes in the PDT group. The serous subretinal fluid resolved in both groups after treatment. In the LP group, the mean choroidal thickness was 345+/-127 microm at baseline and 340+/-124 microm at 4 weeks, a difference that was not significant (P = 0.2). The mean choroidal thickness in the PDT group increased significantly from 389+/-106 microm at baseline to 462+/-124 microm (P = 0.008) by 2 days after treatment, and then reduced rapidly to 360+/-100 microm (P = 0.001) at 1 week and 330+/-103 microm (P<0.001) after 4 weeks as compared with baseline. Indocyanine green angiography showed decreased hyperpermeability in the PDT group after treatment. CONCLUSIONS The subretinal fluid resolved in both disease groups; however, the choroidal thickness and hyperpermeability seen during ICGA was reduced after PDT. These findings suggest that PDT reduces the choroidal vascular hyperpermeability seen in CSC and may work by a different mechanism than LP.

Subfoveal choroidal thickness after treatment of Vogt-Koyanagi-Harada disease.

Purpose: To evaluate the subfoveal choroidal thickness in Vogt-Koyanagi-Harada (VKH) disease using enhanced depth imaging optical coherence tomography. Methods: Retrospective observational study. Subfoveal choroidal thickness was measured using enhanced depth imaging optical coherence tomography, in which the optical coherence tomography instrument was placed close enough to the eye to obtain an inverted image, which was averaged for 100 scans. All patients were diagnosed as having the ocular findings of VKH disease with or without extraocular disorders. The patients were followed during their initial treatment with corticosteroids. Results: All 8 patients (16 eyes) with acute phase VKH disease presented with thickening of the choroid. The serous retinal detachment disappeared in 1 month after corticosteroid treatment. The mean choroidal thickness in 16 eyes decreased from 805 ± 173 μm at the first visit to 524 ± 151 μm at 3 days (P < 0.001) and 341 ± 70 μm by 2 weeks (P < 0.001). Conclusion: Patients with active VKH disease have markedly thickened choroids, possibly related not only to inflammatory infiltration but also to increased exudation. Both the choroidal thickness and the exudative retinal detachment decreased quickly with corticosteroid treatment. Enhanced depth imaging optical coherence tomography can be used to evaluate the choroidal involvement in VKH disease in the acute stages and may prove useful in the diagnosis and management of this disease noninvasively.

Circadian Changes in Subfoveal Choroidal Thickness and the Relationship with Circulatory Factors in Healthy Subjects

PURPOSE To investigate circadian changes in subfoveal choroidal thickness (SFCT) and the relation to systemic factors in healthy subjects. METHODS Thirty-eight eyes of 19 healthy volunteers were enrolled. SFCT was measured by using prototype high-penetration optical coherence tomography. Intraocular pressure (IOP), systolic blood pressure (SBP), diastolic blood pressures (DBP), and heart rate (HR) were measured every 3 hours over a 24-hour period. Circadian changes in the mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP) were calculated. The difference between the maximal and minimal SFCTs was analyzed, and correlations between the SFCT and other systemic factors were evaluated. RESULTS There was a significant circadian variation in SFCT (P < 0.0001). The total mean SFCT was 280.3 ± 106.1 μm. At 6 PM, the mean SFCT (271.9 ± 103.5 μm) was the thinnest and at 3 AM it was the thickest (290.8 ± 110.8 μm). The SFCTs in 32 of 38 eyes were thickest between 3 and 9 AM and in 27 of 38 eyes, thinnest between 3 and 9 PM. The mean SFCT was significantly negatively correlated with the mean SBP (R(2) = 0.59, P = 0.02) in all eyes. There were no significant correlations between the mean SFCT and the mean DBP, MAP, HR, IOP, and MOPP in all eyes. CONCLUSIONS We investigated the circadian change of choroidal thickness using high-penetration optical coherence tomography in healthy volunteers. The significant diurnal change was found and the choroid was thicker at night and thinner in daytime. Fluctuations in the choroidal thickness may be related to SBP.

Reproducibility of Retinal and Choroidal Thickness Measurements in Enhanced Depth Imaging and High-Penetration Optical Coherence Tomography

PURPOSE Two optical coherence tomography (OCT) modalities can visualize the choroid: high-penetration OCT (HP-OCT) using a long wavelength, and enhanced depth imaging technique using Heidelberg OCT (EDI-OCT). The purpose of this study was to compare and investigate the agreement among the retinal/choroidal thickness parameters. METHODS Twenty-four eyes of 12 healthy volunteers were examined simultaneously using the prototype swept-source HP-OCT and EDI-OCT. Six independent examiners measured the central retinal/choroidal thicknesses on horizontal B-scan images. The reliability was evaluated by intraclass correlation coefficient (ICC). Intervisit reproducibility was assessed by examining 10 of the volunteers 4 months later. RESULTS Using HP-OCT, the average of all measurements was 209.1 ± 12.9 μm in the retina and 292.7 ± 77.3 μm in the choroid, and using EDI-OCT, 212.5 ± 13.3 μm in the retina and 283.7 ± 84.1 μm in the choroid. An intersystem comparison showed that the ICCs were 0.661 (95% confidence interval [CI], 0.535-0.754) for the retina and 0.921 (95% CI, 0.875-0.948) for the choroid. Using HP-OCT, the interexaminer ICC reproducibility values were 0.630 (95% CI, 0.447-0.791) for the retinal thickness and 0.912 (95% CI, 0.835-0.958) for the choroidal thickness; using EDI-OCT, the values for the retinal and choroidal thicknesses were 0.788 (95% CI, 0.607-0.898) and 0.970 (95% CI, 0.948-0.985), respectively. The intervisit ICC values for the retinal and choroidal thicknesses were 0.504 (95% CI, 0.376-0.609) and 0.893 (95% CI, 0.864-0.916). CONCLUSIONS The retinal and choroidal thicknesses were well-correlated between the instruments. Higher reliability and reproducibility are expected for the choroidal thickness measurements despite with higher morphologic interindividual variations.

Subfoveal Choroidal Thickness In Fellow Eyes Of Patients With Central Serous Chorioretinopathy

Purpose: To evaluate the subfoveal choroidal thickness in the fellow eyes of patients with CSC, a disease often associated with choroidal vascular hyperpermeability even in eyes without subretinal fluid. Methods: In this observational cross-sectional study, we measured the bilateral subfoveal choroidal thickness in patients with unilateral CSC using enhanced depth imaging spectral-domain optical coherence tomography. Areas of choroidal vascular hyperpermeability were visualized with indocyanine green angiography. Results: Sixty-six consecutive Japanese patients (50 men, 16 women; mean age, 52.8 years) with unilateral CSC were examined. The subfoveal choroid in symptomatic eyes was significantly thicker than that in fellow eye (414 ± 109 μm vs. 350 ± 116 μm, P < 0.001, respectively). The subfoveal choroid of eyes with choroidal vascular hyperpermeability was 410 ± 92 μm, which differed significantly (P < 0.001) from the choroid (239 ± 59 μm) of fellow eyes without choroidal vascular hyperpermeability. Conclusion: The subfoveal choroid in the fellow eyes of patients with CSC was thicker in the eyes with choroidal vascular hyperpermeability. Enhanced depth imaging spectral-domain optical coherence tomography can assess the effects of choroidal vascular hyperpermeability by measuring the choroidal thickness noninvasively.

Enhanced Depth Imaging Optical Coherence Tomography of the Sclera in Dome-Shaped Macula

PURPOSE To examine the posterior anatomic structure of eyes with dome-shaped macula using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). DESIGN Retrospective observational case series. METHODS Patients with dome-shaped macula, a condition defined as convex elevation of the macula as compared with the surrounding staphylomatous region in a highly myopic eye, were identified through routine examinations using optical coherence tomography (OCT). EDI-OCT was used to examine their posterior anatomic changes. The scleral thickness was measured from the outer border of the choroid to the outer scleral border under the fovea and 3000 μm temporal to the fovea. RESULTS The mean age of the 15 patients (23 eyes) was 59.3 (± 12.2) years, and the mean refractive error was -13.6 (± 5.0) diopters. The best-corrected visual acuity ranged from 20/15 to 20/800 (median: 20/30). Eight patients (53%) had dome-shaped macula bilaterally. The mean subfoveal scleral thickness in 23 eyes with dome-shaped macula was 570 (± 221) μm, and that in 25 eyes of 15 myopic patients with staphyloma but without dome-shaped macula was 281 (± 85) μm (P < .001) even though both groups had similar myopic refractive error. The scleral thickness 3000 μm temporal to the fovea was not different in the 2 groups. CONCLUSIONS Dome-shaped macula is the result of a relative localized thickness variation of the sclera under the macula in highly myopic patients, and it cannot be categorized into any of the known types of staphyloma. This finding suggests the ocular expansion in myopia may be more complex than previously thought.

Subfoveal Retinal and Choroidal Thickness After Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

PURPOSE To evaluate the morphologic retinal and choroidal changes after verteporfin photodynamic therapy (PDT) with and without ranibizumab for polypoidal choroidal vasculopathy using spectral-domain optical coherence tomography. DESIGN Retrospective, comparative series. METHODS The enhanced depth imaging optical coherence tomography technique was used in this retrospective, comparative series to measure the subfoveal retinal and choroidal thicknesses before and after treatment. RESULTS Twenty-seven eyes with polypoidal choroidal vasculopathy were examined retrospectively. Sixteen eyes were treated with PDT monotherapy (PDT group). Eleven eyes were treated with PDT after intravitreal ranibizumab injection (ranibizumab plus PDT group). The polypoidal lesions regressed in all cases at 3 months. The mean retinal thickness, including the retinal detachment, increased from 401 ± 157 μm before treatment to 506 ± 182 μm 2 days after PDT (P<.001) and decreased to 365 ± 116 μm by 1 week after treatment (P=.03) and 265 ± 127 μm by 6 months after treatment (P<.001). The mean choroidal thickness increased from 269 ± 107 μm before treatment to 336 ± 96 μm 2 days after PDT treatment (P < .001 compared with baseline) and decreased to 262 ± 96 μm by 1 week after treatment (P=.24) and 229 ± 104 μm by 6 months (P<.001). Although the choroidal thickness showed a similar trend with both therapies, the retinal thickness in the ranibizumab plus PDT group remained thinner than that in the PDT group until 6 months after treatment. CONCLUSIONS PDT was associated with decreased retinal and choroidal thicknesses. Combination therapy reduced the transient exudation after PDT in some cases, and monthly intravitreal ranibizumab injections maintained retinal thinning and seemed to improve vision better than PDT monotherapy.

One-year choroidal thickness results after photodynamic therapy for central serous chorioretinopathy.

Purpose: To retrospectively evaluate choroidal thickness 1 year after photodynamic therapy in eyes with central serous chorioretinopathy using optical coherence tomography. Methods: Central serous chorioretinopathy was diagnosed using fluorescein angiography, and indocyanine green angiography was used to evaluate choroidal vascular hyperpermeability. We measured the subfoveal choroidal thickness using enhanced depth imaging optical coherence tomography. Results: Thirteen eyes (13 patients; average age, 56.8 years) with central serous chorioretinopathy were observed 1 year after half-dose photodynamic therapy with verteporfin. The mean subfoveal choroidal thickness decreased significantly from 397 ± 108 μm at baseline to 323 ± 120 μm at 1 month, 312 ± 117 μm at 3 months, 317 ± 117 μm at 6 months, and 321 ± 122 μm at 1 year (P < 0.01, for each comparison with baseline). However, the subfoveal choroid thickness significantly increased 2 days after photodynamic therapy to 441 ± 120 (P < 0.01) compared with baseline. Central serous chorioretinopathy did not recur in any patient. Indocyanine green angiography images at 3 months showed less choroidal vascular hyperpermeability compared with baseline. Conclusion: Half-dose photodynamic therapy for central serous chorioretinopathy resulted in thinner subfoveal choroidal thickness 1 month after treatment, decreased the choroidal vascular hyperpermeability, and maintained the remission for 1 year. Enhanced depth imaging optical coherence tomography was helpful for monitoring the pathophysiologic choroidal changes in central serous chorioretinopathy.

One-Year Results of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

PURPOSE To investigate 1-year outcomes of intravitreal aflibercept for polypoidal choroidal vasculopathy (PCV). DESIGN Retrospective, multicenter, consecutive case series. PARTICIPANTS A total of 90 eyes of 87 patients with treatment-naïve PCV followed at 3 tertiary centers. METHODS Clinical records were reviewed and imaging studies were analyzed of eyes with PCV that underwent 3 consecutive monthly aflibercept injections followed by injections every 2 months. Additional (rescue) injections were performed for worsening. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and angiographic findings at 1 year. RESULTS The mean BCVA (logarithm of the minimum angle of resolution units) of the 90 eyes improved from 0.31 at baseline to 0.17 at 12 months (P < 0.001). The mean central retinal thickness decreased from 315 μm at baseline to 204 μm at 12 months (P < 0.001). At 12 months, 64 eyes (71.1%) achieved a dry macula, defined as absence of intraretinal or subretinal fluid on OCT. Of 83 eyes that underwent indocyanine green angiography at both baseline and 12 months, 46 (55.4%) showed complete and 27 (32.5%) showed partial resolution of polypoidal lesions. Eleven of 82 eyes (13.4%) showed decreased size of branching choroidal vascular networks. CONCLUSIONS Intravitreal aflibercept administered over 1 year improved both visual acuity and macular morphology in a large number of treatment-naïve eyes with PCV.

The optical coherence tomography-ophthalmoscope for examination of central serous chorioretinopathy with precipitates.

Purpose: To report the exact location of multiple yellowish dot-like precipitates in central serous chorioretinopathy (CSC) with the Optical Coherence Tomography (OCT)–Ophthalmoscope (Nidek-OTI, Gamagori, Japan). Design: Retrospective, observational study. Methods: Twenty eyes of 18 patients (average age, 53 years) with CSC were examined by the OCT-Ophthalmoscope. Multiple yellowish dot-like precipitates were seen in all eyes by biomicroscopic examination. Results: Multiple highly reflective dots (bright dots) were seen by the OCT-Ophthalmoscope in all 20 eyes. The bright dots were observed on the posterior surface of the detached neurosensory retina by cross-sectional B-scan OCT in all eyes and in the detached neurosensory retina in 14 eyes. The bright dots were preferentially located in the outer retinal layer. Transverse C-scan OCT confirmed that the location of the bright dots coincided with that of the precipitates. Conclusions: Both cross-sectional B-scan and transverse C-scan images obtained with the OCT-Ophthalmoscope showed subretinal and intraretinal bright dots in eyes with CSC, which may indicate that the yellowish dot-like precipitates are not only on the posterior surface of the detached retina but also in the detached neurosensory retina. Intraretinal precipitates in eyes with CSC may result from the accumulation of proteins or macrophages with the phagocytized photoreceptor outer segments.