Takamitsu Fujiwara

Enhanced Depth Imaging Optical Coherence Tomography Of The Choroid In Central Serous Chorioretinopathy

Purpose: The purpose of the study was to evaluate the choroidal thickness in patients with central serous chorioretinopathy, a disease attributed to increased choroidal vascular hyperpermeability. Methods: Patients with central serous chorioretinopathy underwent enhanced depth imaging spectral-domain optical coherence tomography, which was obtained by positioning a spectral-domain optical coherence tomography device close enough to the eye to acquire an inverted image. Seven sections, each comprising 100 averaged scans, were obtained within a 5° × 30° rectangle to encompass the macula. The subfoveal choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. Results: The mean age of subjects undergoing enhanced depth imaging spectral-domain optical coherence tomography was 59.3 years (standard deviation, 15.8 years). Seventeen of 19 patients (89.5%) were men, and 12 (63.2%) patients had bilateral clinical disease. The choroidal thickness measured in 28 eligible eyes of the 19 patients was 505 &mgr;m (standard deviation, 124 &mgr;m), which was significantly greater than the choroidal thickness in normal eyes (P ≤ 0.001). Conclusion: Enhanced depth imaging spectral-domain optical coherence tomography demonstrated a very thick choroid in patients with central serous chorioretinopathy. This finding provides additional evidence that central serous chorioretinopathy may be caused by increased hydrostatic pressure in the choroid.

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.

Prevalence and Significance of Subretinal Drusenoid Deposits (Reticular Pseudodrusen) in Age-Related Macular Degeneration

PURPOSE To determine the prevalence and significance of subretinal drusenoid deposits (reticular pseudodrusen) among patients with age-related macular degeneration (AMD). DESIGN A prospective study with a nested case-control study of consecutive patients with AMD seen in a referral retinal practice. PARTICIPANTS There were 153 patients with AMD, 131 of whom had > or =1 eye with late AMD, which was defined as either central geographic atrophy or choroidal neovascularization. The control group consisted of 101 patients who did not have AMD as their primary diagnosis, central serous chorioretinopathy, high myopia, retinal detachment, or laser treatment in the macular area. METHODS The presence of subretinal drusenoid deposits was determined by 2 methods, using the blue channel of color fundus photograph and the spectral domain optical coherence tomography (SD-OCT) sections. Soft drusen were determined from color fundus photographs and confirmed by SD-OCT. MAIN OUTCOME MEASURES Prevalence of ocular risk factors and subretinal drusenoid deposits in eyes with AMD and their association with late AMD. RESULTS There were 153 patients who had any form of AMD, with a mean age of 80.3 years. Subretinal drusenoid deposits were diagnosed in the case group in 13 (8.7%) of right and 18 (12.0%) of left eyes using the blue channel of the color photograph and in 58 (38.4%) of right and 54 (35.8%) of left eyes using SD-OCT. Soft drusen and subretinal drusenoid deposits detected by SD-OCT were found to be independently correlated with late AMD (soft drusen odds ratio = 16.66 [P<0.001]; subretinal drusenoid deposits as detected by OCT odds ratio = 2.64 [P = 0.034]). In the control group, subretinal drusenoid deposits were diagnosed in 6 (6.5%) of right and 6 (6.3%) of left eyes using SD-OCT. CONCLUSIONS Both soft drusen and subretinal drusenoid deposits occur in patients with AMD and both are significantly associated with late AMD. These findings suggest that detection and classification of drusen and consequently assignment of risk should be based on a methodology that includes SD-OCT.

Choroidal thickness and visual acuity in highly myopic eyes.

Purpose: To examine predictive factors for visual acuity in highly myopic eyes. Methods: Consecutive patients with high myopia (≥6 diopters [D]) with no other pathology such as lacquer cracks in the fovea, choroidal neovascularization, or myopic macular schisis, were evaluated. The study was performed in 2 retina centers, one in the United States and the other in Japan. Enhanced depth imaging optical coherence tomography was obtained, and the central foveal, outer retinal hyporeflective layer and inner segment to retinal pigment epithelium aggregate, and the subfoveal choroidal thicknesses were measured. Correlations were calculated among the measured variables and visual acuity. Generalized estimating equation models were used to identify predictors of visual acuity. Results: The New York cohort was composed of 35 eyes of 25 patients who had a mean age of 57 years (standard deviation, ±18.1 years) and a mean refractive error of −10.9 D (±3.6 D). The Japanese cohort was composed of 110 eyes of 61 patients who had a mean age of 46.8 years (±14.7 years) and a mean refractive error of −9.2 D (±3.1 D) and a mean axial length of 27 mm (±1.4 mm). The mean subfoveal choroidal thickness was 113.3 &mgr;m (±53.9 &mgr;m) in the New York group and 172.9 &mgr;m (±72.8 &mgr;m) in the Japanese group. In each group, the subfoveal choroidal thickness showed a significant inverse correlation with age and myopic refractive spherical equivalent. The subfoveal choroidal thickness was inversely correlated with logarithm of the minimum angle of resolution visual acuity (P = 0.041, New York group; P = 0.001, Japan group). The only significant predictor in the pooled data for logarithm of the minimum angle of resolution visual acuity was subfoveal choroidal thickness (P ⩽ 0.001). Clinic location was not a significant predictor. Conclusion: Choroidal thickness in high myopia is inversely correlated with increasing age and myopic refractive error and is an important predictor of visual acuity. Given that myopia is increasing worldwide, these findings may have epidemiologic significance.

Fundus autofluorescence and optical coherence tomographic findings in acute zonal occult outer retinopathy.

Purpose: The purpose of this study was to investigate the fundus autofluorescence and optical coherence tomography findings in eyes with acute zonal occult outer retinopathy (AZOOR). Methods: A retrospective observational case series of the fundus autofluorescence and spectral domain optical coherence tomography in a series of patients with AZOOR. Results: There were 19 eyes of 11 patients (10 women), who had a mean age of 49.1 ± 13.9 years. Fundus autofluorescence abnormalities were seen in 17 of the 19 eyes, were more common in the peripapillary area, and were smaller in extent than the optical coherence tomography abnormalities. Nine eyes showed progression of hypoautofluorescence area during the mean follow-up of 69.7 months. The mean thickness of the photoreceptor layer at fovea was 177 μm in eyes with AZOOR, which was significantly thinner than controls (193 μm, P = 0.049). Abnormal retinal laminations were found in 12 eyes and were located over areas of loss of the photoreceptors. The subfoveal choroidal thickness was 243 μm, which is normal. Conclusion: Fundus autofluorescence abnormalities in AZOOR showed distinct patterns of retinal pigment epithelial involvement, which may be progressive. Thinning of photoreceptor cell layer with loss of the outer segments and abnormal inner retinal lamination in the context of a normal choroid are commonly found in AZOOR.

High-resolution optical coherence tomography findings in optic pit maculopathy.

Purpose: The purpose of this study was to characterize retinal manifestations of optic pit maculopathy using high-resolution optical coherence tomography. Methods: Consecutive patients with optic pit maculopathy, diagnosed by their typical appearance by ophthalmoscopy, were imaged by color fundus photography and optical coherence tomography. The location and characteristics of any fluid within and under the retina were determined. Results: The mean age of the 16 patients (7 women) was 35.9 years (standard deviation: 18.5 years). The visual acuity ranged from 20/20 to 20/1000 (median, 20/200). Retinal detachment was found in 11 eyes (69%), intraretinal fluid in the outer nuclear layer in 15 eyes (94%), in the inner nuclear layer in 13 eyes (81%), in the ganglion cell layer in 7 eyes (44%), and in the subinternal limiting membrane space in 2 eyes (13%). An outer layer hole was identified in only 3 of 11 eyes (27%) with retinal detachment. Conclusion: Fluid from the optic pit can go directly to the subinternal limiting membrane space, ganglion cell layer, inner nuclear layer, outer nuclear layer, or the subretinal space, although the outer nuclear layer is most commonly affected. An outer layer hole appears not to be common in optic pit maculopathy.

Fundus Autofluorescence and Visual Acuity in Central Serous Chorioretinopathy

PURPOSE To investigate the fundus autofluorescence (FAF) abnormalities in central serous chorioretinopathy (CSC) and evaluate potential correlations with visual acuity. DESIGN Retrospective, observational case series. PARTICIPANTS Four hundred seventy-five eyes of 238 patients with CSC. METHODS Consecutive patients with CSC underwent FAF imaging, as well as routine ophthalmologic examinations. Confluent hypoautofluorescence was defined as a region of absent autofluorescence greater than one fourth of a disk diameter. Granular hypoautofluorescence was defined if there was a grainy or coarse region of decreased fluorescence as compared with normal surrounding areas greater than one fourth of a disc diameter in size. A descending tract was a downward leading swathe of decreased autofluorescence originating from the posterior pole to extend below the inferior arcade. MAIN OUTCOME MEASURES The pattern and frequency of FAF abnormalities and their correlations with corrected visual acuity. RESULTS The mean age of the subjects was 57.1 years (standard deviation, 13.3), and 181 (76.1%) were male. Confluent and granular hypoautofluorescence was detected in the macula of 54 (11.4%) and 300 (63.2%) of 475 eyes, respectively. Descending tracts from the macula were observed in 43 (9.1%) eyes and from the optic disc in 43 (9.1%) eyes. Multiple regression analysis revealed that confluent hypoautofluorescence of the macula, granular hypoautofluorescence of the macula, and increasing age all were independent predictors of decreased visual acuity. CONCLUSIONS The FAF abnormalities in CSC show multiple distinct patterns and seem to provide functional information.

Idiopathic choroidal neovascularization as an early manifestation of inflammatory chorioretinal diseases.

Purpose: We describe four patients with idiopathic choroidal neovascularization (ICNV) who developed inflammatory chorioretinal diseases in the ipsilateral or contralateral eye. Methods: The medical records of 58 eyes of 58 patients with an initial diagnosis of ICNV (age range, 19–49 years; mean, 34.9 years) were reviewed. Results: Of the 58 patients, 4 women (7.0%) with moderate to high myopia (age range, 17–39 years) developed inflammatory chorioretinal diseases. In Cases 1 and 2, white dots were transiently seen in the deep retina of the contralateral eye, consistent with the clinical features of multiple evanescent white dot syndrome (MEWDS). In Case 3, vitritis and multifocal white spots emerged in the ipsilateral eye. These white spots spread throughout the ocular fundus and progressed to punched-out chorioretinal scars, which led to a diagnosis of multifocal choroiditis (MFC). In Case 4, an enlarged blind spot and a few chorioretinal scars around the optic nerve head developed without vitritis in the ipsilateral eye, suggesting a diagnosis of punctate inner choroidopathy (PIC). Conclusions: These findings suggest that ICNV can be an early manifestation of inflammatory chorioretinal diseases, including MEWDS, MFC, and PIC.

Observation of the ocular fundus by an infrared-sensitive video camera after vitreoretinal surgery assisted by indocyanine green.

Purpose To investigate how long indocyanine green (ICG) dye remains in the ocular fundus and how the remaining dye interferes with ICG angiographic findings after vitreoretinal surgery assisted by ICG. Methods Eight eyes with macular hole, three with epiretinal membrane, and one with an intraocular foreign body were included. Those patients underwent vitrectomy facilitated by an intraocular administration of ICG. An infrared sensitive video camera was used to take fundus pictures pre- and postoperatively. In 2 of 12 cases, the authors performed ICG angiography at 2 weeks and at 3 months after the surgery. Results At 1 month after surgery, diffuse hyperfluorescence was observed throughout the posterior pole of the ocular fundus in all cases. The area where macular hole existed before the surgeries revealed hyperfluorescence in 6 of 8 eyes with macular hole (75%). These hyperfluorescent findings became less prominent with time postoperatively, while optic disk hyperfluorescence persisted for 12 months in all cases. In the early phase of ICG angiography at 2 weeks postoperatively, the retinal and choroidal circulation could be depicted. However, in the middle phase the choroidal veins were hardly visible. The angiographic pictures of the late phase mimicked those seen without intravascular administration of ICG. Even at 3 months after surgery, the optic nerve head revealed hyperfluorescence in the middle and late phases. Conclusions The residual ICG in the ocular fundus produced prolonged hyperfluorescence after surgery. This abnormal condition affected ICG angiographic findings in the middle and late phases.

Choroidal findings in idiopathic uveal effusion syndrome

Purpose We report choroidal findings by means of enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) in a patient with idiopathic uveal effusion syndrome (IUES). Case report A 41-year-old man was referred to us with ciliochoroidal and non-rhegmatogenous retinal detachments. Sclerectomies and sclerostomies were performed at the equator in the lower quadrants, resulting in resolution of the ciliochoroidal and retinal detachments. EDI-OCT demonstrated low-reflective areas in the outer choroid. The subfoveal choroidal thickness measured vertically from the outer border of the RPE to the inner border of the sclera was 787 μm which was significantly thicker than the normal value (272 ± 90 μm, n = 131) obtained from age-matched normal controls. Conclusions The findings made by EDI-OCT have provided additional evidence that choroidal alterations play a role in the pathological process in IUES.