A unique pattern of outer retina splitting as seen on en-face OCT and OCT-angiography

A splitting of the outer plexiform retinal layer in a saw-like hyporeflective pattern in addition to partially formed concentric circles centred at the foveola were observed using en-face OCT and OCT-angiography in a 27-year-old female patient with rhegmatogenous retinal detachment and a 50-year-old female patient with Vogt-Koyanagi-Harada chorioretinopathy.

Multimodal Imaging for the Assessment of Geographic Atrophy in Patients with "Foveal" and "No-Foveal" Sparing

INTRODUCTION

The aim of the study was to evaluate the applicability of optical coherence tomography (OCT) angiography (OCTA) for measuring geographic atrophy (GA) areas in age-related macular degeneration (AMD) patients with "foveal" and "no-foveal" sparing disease and compare it to other imaging modalities.

METHODS

A multimodal imaging protocol was applied, using infrared (IR) imaging, fundus autofluorescence (FAF), OCTA, and en-face OCT in 35 eyes of 23 AMD patients with GA. Patients were classified into 2 groups, with and without foveal sparing disease. GA area measurements for all imaging modalities were compared for each group separately.

RESULTS

The measured GA area was estimated to be 6.68 ± 3.18 mm2 using IR; 6.99 ± 3.09 mm2 using FAF; 6.56 ± 3.11 mm2 using OCTA, and 6.65 ± 3.14 mm2 using en-face OCT. There was no statistically significant difference in the GA area between different modalities (p = 0.977). When separate analysis was conducted for patients with "foveal" and "no-foveal" sparing disease, although GA measurements in FAF imaging displayed higher numerical values than the other modalities, especially in patients with foveal sparing, no statistically significant difference in the GA area was found between the different imaging modalities in either group (p = 0.816 for foveal sparing; p = 0.992 for no-foveal sparing group).

CONCLUSIONS

OCTA can be reliably used in the assessment of GA in AMD patients with and without foveal sparing disease. For both groups, measurements are comparable to IR, en-face OCT, and FAF, despite the fact that the latter recorded larger area of GA, mainly in the foveal sparing cases.

Case report: the first case of unilateral retinal pigment epithelium dysgenesis in China

Background

Unilateral retinal pigment epithelium dysgenesis (URPED) is a rare condition and is characterized by a unilateral and solitary lesion in the peripapillary region. The lesion presents with central atrophy, peripheral fibrosis, and hyperplastic changes in the retinal pigment epithelium (RPE). Herein, we report the first case of URPED in a Chinese individual using multimodal imaging techniques such as en-face optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).

Case presentation

A 10-year-old girl presented with 20/40 vision in her left eye. Presented as a solitary, unilateral, large and yellowish-white lesion, with fringe-like margins was observed in the posterior pole and lower middle periphery of the left eye continuous with the optic nerve, indicated URPED. Infrared fundal (IR) images showed that the fringe-like contour of the lesion was visible, with diffuse hyperreflective signals specifically in the fovea, while with peripheral dark spots, having a typical leopard-spot like appearance. Fundus autofluorescence (FAF) revealed a markedly scalloped lesion containing a hypoautofluorescence area mixed with an isoautofluorescence area. Spectral-domain optical coherence tomography (SD-OCT) revealed the outer segments of photoreceptors presented with an inhomogeneous signal in the fovea, with a weak local signal. The ellipsoid and interdigitation zones were thinner than normal, while the RPE/Bruch’s complex was not flat, with locally visible protrusions. En-face OCT image at the level of the RPE zone showed a mottled hyperreflective signal with peripheral hyporeflective spots, fringe-like margin lesions. OCTA of the avascular area of the fovea in the superficial, deep, and outer retinal layers appeared to be oval in shape, the choroid capillary layer revealed an increase in the density of the choroidal vasculature in the fovea.

Conclusions

This is the first report on URPED in China. Both en-face OCT and OCTA were essential in observing and studying the disease. Further investigation is required to better define the en-face OCT and OCTA features of URPED and clarify the disease characteristics and prognosis.

Functional and structural outcomes of ILM peeling in uncomplicated macula-off RRD using microperimetry & en-face OCT

PURPOSE

To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD).

METHODS

In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional-MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)-and anatomical-en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour].

RESULTS

All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05).

CONCLUSION

Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.

[Abnormal retinal artery perfusion and optical coherence tomography angiography]

INTRODUCTION

To analyze optical coherence tomography angiography (OCT-A) findings in patients with impaired retinal artery perfusion secondary to occlusion of the central retinal artery or its branches, cilioretinal artery occlusion or retinal vein occlusion (RVO).

METHODS

In this retrospective observational study of patients with impaired retinal artery perfusion, we recorded the results of clinical examination and multimodal imaging, including fluorescein angiography, spectral-domain (SD)-OCT, and OCT-A (Optovue) of the central 10 degrees with measurement of vascular density.

RESULTS

The files of 10 patients were analyzed (5 men, mean age: 63 years), including 3 retinal artery occlusions, 4 cilioretinal artery occlusions, isolated or combined with central retinal vein occlusion (CRVO), and 3 RVO with an arterial component. SD-OCT showed hyper-reflectivity of the inner nuclear layer consistent with paracentral acute middle maculopathy (PAMM) in the acute stage (8 eyes) resulting in retinal atrophy as early as the following month. OCT-A revealed capillary dropout in all patients with various degrees, the deep capillary plexus seemed to be more involved than the superficial plexus. A fern-like pattern was observed on en-face OCT in 4 eyes, outlining venular contours. Vascular density was significantly diminished (whole en-face density in the deep capillary plexus: 50.39 vs. 56.21 in the control group, P=0.001). On fluorescein angiography, reperfusion was observed in half of the eyes.

CONCLUSION

OCT-A can be very useful in patients with a transitory arterial occlusion by revealing involvement of the superficial and deep capillary plexus. It may enable a retrospective diagnosis in the case of reperfusion.

Docetaxel Retinopathy: A Case Report

Background

To report the use of En-face optical coherence tomography (OCT) in a patient treated with docetaxel and tamoxifen for breast cancer for the detection of macular edema (ME) without evidence of leakage on fluorescein angiography (FA).

Case Presentation

A 52-year-old woman treated for breast cancer presented with bilateral visual loss for 2 months. FA showed no significant leakage while spectral-domain OCT scans of both eyes showed foveolar and parafoveolar cystic spaces in a moderately thickened macula. En-face OCT segmented at the inner retina showed the petaloid arrangement of cystic cavities, comparable to a cystoid ME.

Conclusions

The combined use of tamoxifen could have potentiated the toxic effect of docetaxel on the macula. En-face OCT images may reveal a petaloid aspect of the macula due to cysts in the inner retina segmentation, when FA shows no leakage.