Yukinori Sugano

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.

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.

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.

Morphologic Choroidal and Scleral Changes at the Macula in Tilted Disc Syndrome with Staphyloma Using Optical Coherence Tomography

PURPOSE To evaluate the macular choroidal and scleral changes in tilted disc syndrome (TDS) with staphyloma using optical coherence tomography (OCT) to determine the mechanism of serous retinal detachment (SRD) formation. METHODS All eyes underwent fluorescein (FA) and indocyanine green angiography (ICGA) in this retrospective, observational study. Enhanced-depth imaging (EDI) OCT and prototype high-penetration (HP) OCT were used to examine the choroid and sclera, respectively, at the upper and lower optical areas and the subfovea on vertical OCT sections. RESULTS Twenty-four eyes with TDS with inferior staphyloma were included. FA showed the macular area with the superior edge of staphyloma had a granular hyperfluorescent pattern and ICGA showed belt-like hypofluorescence. OCT showed SRDs in seven eyes. The mean EDI-OCT choroidal thicknesses in 19 eyes were: upper area, 211 ± 79 μm; subfovea, 153 ± 70 μm; and lower area, 158 ± 42 μm. The mean subfoveal and lower choroid were significantly (P < 0.01 for both) thinner than the upper area. The mean HP-OCT scleral thicknesses in 14 eyes were: upper area, 414 ± 36 μm; subfovea, 493 ± 40 μm; and lower area, 398 ± 83 μm. The subfoveal sclera was significantly (P < 0.01) thicker than the others. CONCLUSIONS The subfoveal choroid was relatively thin and the subfoveal sclera thickened in TDS with a staphyloma edge at the macula. The area with retinal pigment epithelial (RPE) atrophy was hyperfluorescent on FA; choriocapillaris occlusion was hypofluorescent on ICGA. Characteristic anatomic subfoveal scleral alterations might lead to a thinner choroid and inhibit chorioscleral outflow; a secondary RPE disorder subsequently could cause SRDs.

Choroidal Thickness Changes After Intravitreal Ranibizumab and Photodynamic Therapy in Recurrent Polypoidal Choroidal Vasculopathy

PURPOSE To evaluate subfoveal choroidal thickness changes in cases with recurrent polypoidal choroidal vasculopathy (PCV) after combination therapy with intravitreal ranibizumab and photodynamic therapy (PDT). DESIGN Retrospective observational case series study. METHODS We measured subfoveal choroidal thickness in PCV using optical coherence tomography (OCT) before and after PDT. In recurrent cases, the choroidal thickness was measured at the time of the recurrence. In nonrecurrent cases, choroidal thickness was measured 1 year after PDT. RESULTS Combination therapy was performed in 27 eyes (27 patients). Polypoidal lesions regressed within 3 months after initial treatment in all eyes. Retreatment was needed in 10 of 27 eyes (37.0%) after more than 3 months of follow-up. In recurrent cases, subfoveal choroid decreased from 188 μm at baseline to 157 μm 3 months after PDT (P < .01); however, choroidal thickness increased to 179 μm with recurrence (P = .54 compared to baseline; average, 8.0 months). In nonrecurrent cases, subfoveal choroid decreased from 257 μm at baseline to 210 μm 3 months after PDT and 212 μm 1 year after PDT (P < .01, respectively). CONCLUSION Subfoveal choroidal thickness in PCV at the time of recurrence returned to the baseline level after choroidal thinning as a result of PDT treatment. Choroidal thickness changes after PDT examined using OCT may reflect disease activity in PCV.

Morphologic analysis in pathologic myopia using high-penetration optical coherence tomography.

PURPOSE We evaluated retrospectively the morphologic choroidal and scleral characteristics in eyes with pathologic myopia using high-penetration optical coherence tomography (HP-OCT) or swept-source OCT (SS-OCT). METHODS The subfoveal choroidal and scleral thicknesses were measured using the prototype HP-OCT with a 1060 nm light source. We also measured the scleral thickness 3 mm superior, inferior, nasal, and temporal to the fovea on the horizontal and vertical OCT sections. The axial length (AL) in all eyes was measured using optical biometry. RESULTS We examined 58 eyes of 35 patients (7 men and 28 women, mean age 65.5 years) with an AL exceeding 26.5 mm. The mean AL was 29.0 ± 1.4 mm. The full-thickness choroid and sclera were visualized in all eyes. The mean subfoveal choroidal and scleral thicknesses were 52 ± 38 and 335 ± 130 μm, respectively. The mean scleral thicknesses 3 mm superior, inferior, nasal, and temporal to the fovea were 266 ± 78 (n = 57), 259 ± 72 (n = 56), 324 ± 109 (n = 39), and 253 ± 79 (n = 58) μm, respectively. The subfoveal sclera was thicker than 3 mm outside the fovea (P < 0.05, for each comparison). CONCLUSIONS The full-thickness choroid and sclera in all eyes with pathologic myopia were visualized using a prototype HP-OCT. The subfoveal sclera was thicker than 3 mm outside the fovea. HP-OCT is a useful tool for morphologic analyses of pathologic myopia.

Subfoveal Choroidal Thickness and Axial Length in Preschool Children with Hyperopic Anisometropic Amblyopia

Abstract Purpose: To investigate the relationship between subfoveal choroidal thickness and axial length in Japanese preschool children with hyperopic anisometropic amblyopia. Methods: Twenty-four children between the age of 3 and 6 years exhibiting hyperopic anisometropic amblyopia were examined. Differences in spherical equivalent between the two eyes were over 1.5 D in all children. Twenty-four eyes in 12 children without anisometropia and amblyopia were examined as age-matched normal controls. Subfoveal choroidal thickness was measured by using enhanced depth imaging optical coherence tomography. Axial length was measured with noncontact optical biometer. Results: The spherical equivalent ranged from +3.50 to +7.25 D in amblyopic eyes and from +0.75 to +3.50 D in fellow eyes. The subfoveal choroidal thickness was significantly greater in the amblyopic eyes than that in the fellow eyes (407.3 ± 54.2 μm versus 357.7 ± 54.3 μm, Paired t-test, p < 0.05). The axial length in the amblyopic eyes was significantly shorter than that in the fellow eyes (21.16 ± 0.64 mm versus 22.08 ± 0.72 mm, Paired t-test, p < 0.05). The mean choroidal thickness of the fellow eyes in hyperopic anisometropic amblyopia was greater than that in age matched normal children, although this difference did not reach statistical significance (326.0 ± 62.1 μm, p = 0.07). The subfoveal choroidal thickness in amblyopic children was negatively correlated with their axial length (r = −0.50, p < 0.01). Conclusion: The subfoveal choroidal thickness of amblyopic children abnormally increased and the thicker subfoveal choroid is mildly correlated with their shorter axial length. The anomalous subfoveal choroidal thicknesses in our amblyopic children may reflect a delay in emmetropization.

Photopigments in central serous chorioretinopathy.

PURPOSE To investigate functional abnormalities in eyes with central serous chorioretinopathy (CSC). DESIGN Observational case series. METHODS Sixteen eyes with CSC were enrolled. Autofluorescence densitometry was performed to measure the optical density of the photopigments. Serial fundus autofluorescence (FAF) images were obtained by Heidelberg Retina Angiogram 2. We calculated the autofluorescence optical density difference from the FAF images. To compare the distribution pattern of autofluorescence optical density difference to the findings of outer retina, spectral-domain optical coherence tomography (SD-OCT) was performed in the acute phase and after resolution of CSC. RESULTS The autofluorescence optical density difference decreased at the serous retinal detachment (SRD) in all 16 eyes. After resolution, the photoreceptor inner and outer segment junction (IS/OS) was irregular in 13 eyes and defective in 3 eyes on SD-OCT. The autofluorescence optical density difference did not improve in any eyes. Five eyes were reexamined 3 month after resolution. In 4 of the 5 eyes, SD-OCT showed that the IS/OS was well delineated and 1 eye defective. The autofluorescence optical density difference improved in 2 of the 4 eyes, but not in the other 2 eyes. In the 1 eye without well-delineated IS/OS, the autofluorescence optical density difference did not improve. CONCLUSION In eyes with CSC, the photopigment density decreased at the SRD. The density remained decreased immediately after resolution and showed delayed recovery. The photopigments decreased even in eyes with morphologic recovery of the outer retina.