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En Face Optical Coherence Tomography in Diagnosis of Persistent Subretinal Fluid & Outer Retinal Folds after Rhegmatogenous Retinal Detachment Repair

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Purpose To evaluate the role of en face optical coherence tomography (OCT) as a diagnostic tool for the detection of persistent subretinal fluid (PSRF) and outer retinal folds (ORF) following successful rhegmatogenous retinal detachment (RRD) repair. Design Observational post hoc analysis of two prospective surgical trials. Participants All patients with gradable (signal strength ≥ 5 and no segmentation error) 6x6 mm macular cube scans using spectral-domain OCT (SD-OCT) (Carl Zeiss Meditec, Jena, Germany) obtained between 1 and 2 months postoperatively were included in this study. Methods Scans were assessed for the presence or absence of PSRF or ORFs using en face OCT and cross-sectional B scans by two masked graders with any disagreements adjudicated by the third senior masked grader. Main Outcome Measure Sensitivity, specificity and predictive accuracy {using area under curve (AUC)} of en face OCT in comparison to cross-sectional OCT as the gold standard Results Two hu...

The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease

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The Henle fiber layer (HFL) is comprised of bundles of unmyelinated photoreceptor axons intermingled with outer Müller cell processes. The photoreceptor axons extend from the cell bodies located in the outer nuclear layer and radially project toward the outer plexiform layer, the inner third of which includes the synaptic junctional complexes and the outer two-thirds of which includes the HFL. The oblique path of the HFL provides unique structural and reflectance properties and this radial anatomy is highlighted in many macular disorders including those with macular star exudation and HFL hemorrhage. Recent investigations using multimodal imaging techniques, especially cross sectional and en face optical coherence tomography (OCT), have provided new perspectives regarding HFL disruption in retinal diseases. The aim of this review is to highlight the pathoanatomy and multimodal imaging, especially OCT, associated with HFL disruption that is present in various macular diseases. A...

Persistent subfoveal fluid in pneumatic retinopexy versus pars plana vitrectomy for rhegmatogenous retinal detachment: posthoc analysis of the PIVOT randomised trial

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Purpose To assess the incidence of persistent subfoveal fluid (PSFF) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) following rhegmatogenous retinal detachment (RRD) repair and to determine its association with functional outcomes. Methods Posthoc analysis of the PIVOT randomised trial. Eyes with gradable en face and cross-sectional spectral-domain optical coherence tomography (SD-OCT) scans at 1–2 months postoperatively were included. Primary outcome was the proportion of patients with PSFF following PnR versus PPV at 1–2 months postoperatively. Secondary outcomes included association of PSFF with Early Treatment Diabetic Retinopathy Study (ETDRS) letter score at 3, 6 and 12 months and metamorphopsia score (MCHARTs) at 12 months. Results Of 176 participants enrolled in PIVOT, 158 (89.8%) had gradable SD-OCT scans. Intergrader agreement was 0.870 (Cohen’s kappa). The incidence of PSFF was 16% (13/81) following PnR and 10.4% (8/77) following PPV (p...

Navigating the White Dot Syndromes with Optical Coherence Tomography (OCT) and OCT Angiography (OCT-A)

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Introduction: White dot syndromes are a heterogeneous group of diseases that affect different layers in the retina and choroid. Multimodal imaging is fundamental in the diagnosis, but also can be crucial in unveiling the pathogenesis of these entities. Material and methods: Literature review. Results: Optical coherence tomography (OCT) provides depth-resolved, histological grade images of the vitreous, retina, and choroid. This technology is very useful to localize the primary nature and level of pathology of the various white dot syndromes. En face OCT can provide additional information regarding the interrelationship of lesion types. Vascular involvement at the level of the retina, choriocapillaris or choroid can be assessed by en face OCT angiography (OCT-A) and is not limited by masking, leakage or staining as can occur with conventional angiography (fluorescein or indocyanine green angiography) which requires dye injection. Conclusion: OCT and OCTA are fundamental in the diagno...

Recommendations for OCTA reporting in retinal vascular disease: A Delphi approach by International Experts

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Purpose: To develop a consensus nomenclature for reporting optical coherence tomography angiography (OCTA) findings in retinal vascular disease (e.g., diabetic retinopathy, retinal vein occlusion) by international experts. Design: Delphi-based survey SUBJECTS, PARTICIPANTS AND/OR CONTROLS: Twenty-five retinal vascular disease and OCTA imaging experts METHODS, INTERVENTION, OR TESTING: A Delphi method of consensus development was used, comprising two rounds of online questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-five experts in retinal vascular disease and retinal OCTA imaging were selected to constitute the OCTA Nomenclature in Delphi Study Group for retinal vascular disease. The four main areas of consensus were: definition of parameters of "widefield (WF)" OCTA, measurement of decreased vascular flow on conventional and WF-OCTA, nomenclature of OCTA findings, and OCTA in retinal vascular disease management and staging. The study endpoint was define...

Advanced retinal imaging and applications for clinical practice: A consensus review

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Imaging is an integral part of the evaluation and management of retinal disorders. Each imaging modality has its own unique capabilities and can show a different aspect or perspective of disease. Multimodal retinal imaging provides a wealth of substantive and insightful information; however, the integration of all this complex data can be overwhelming. We discuss the applications and the strengths and limitations of the many different retinal imaging tools that are approved for clinical use. These modalities include color fundus photography, widefield imaging, fundus autofluorescence, near infrared reflectance, optical coherence tomography angiography, and en face optical coherence tomography. We also cover the advantages and disadvantages of a multimodal approach. ( Read Full Article )

ADVANCED OCT ANALYSIS OF BIOPSY PROVEN VITREORETINAL LYMPHOMA: OCT findings in vitreo-retinal lymphoma

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Importance: Although the diagnosis of vitreoretinal lymphoma (VRL) can be challenging, early detection is critical for visual prognosis. Objective: To analyze the spectrum of optical coherence tomography (OCT) findings in patients with biopsy-proven VRL and correlate these features with clinical parameters. Design: Retrospective cross-sectional study SETTING: Multicenter chart review from 13 retina, uveitis and ocular oncology clinics worldwide over an 11-year period (2008-2019). Participants: Patients with a diagnosis of biopsy-proven VRL imaged with OCT at presentation EXPOSURE: The ocular information, systemic information and multimodal retinal imaging findings were collected and studied. Main outcome measure: Characteristics of VRL on OCT RESULTS: A total of 182 eyes of 115 patients (63 women, mean age 65 years) were included in this study. The disease was bilateral in 81 (70%) patients, and mean baseline visual acuity (VA) was 0.2±0.89 logMAR (Snellen equivalent of 20/32...

Long-term assessment of internal limiting membrane peeling for full-thickness macular hole using en face adaptive optics and conventional optical coherence tomography

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Objective: To evaluate the long-term structural and microvascular retinal effects of internal limiting membrane peeling for full-thickness macular hole (FTMH) using en face adaptive optics optical coherence tomography (AO-OCT), conventional OCT, and OCT angiography (OCTA). Design: Interventional case series. Participants: Patients with FTMH treated with vitrectomy, internal limiting membrane peeling, and gas tamponade. Methods: Eleven eyes with FTMH that had at least 12 months of postoperative follow-up were enrolled in the study. En face AO-OCT was used to image the superficial retina in the peeled and nonpeeled areas. En face structural OCT was performed to image the inner retinal dimples (IRDs), macular thickness, and retinal nerve fibre layer (RNFL). En face OCTA was used to examine the integrity of the peripapillary nerve fibre layer (NFL) plexus. Results: AO-OCT showed RFNL wrapping around the IRDs, and no obvious peripapillary NFL plexus dropout was seen with OCTA. Scattered ...

Longitudinal Assessment of Ellipsoid Zone Recovery using En Face Optical Coherence Tomography after Retinal Detachment Repair

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Purpose Suboptimal functional outcomes following rhegmatogenous retinal detachment (RRD) repair may be related to photoreceptor abnormalities including alterations of the ellipsoid zone (EZ) which may not be apparent on cross-sectional optical coherence tomography (OCT). This study assessed EZ recovery using en face OCT following RRD repair and its association with visual acuity. Design Post hoc analysis of a randomized controlled trial. Methods Patients with macula-off RRD were followed at 3, 6, 12 and 24 months post-operatively and annually thereafter. En face OCT of the EZ slab were analyzed. Hyporeflective areas were co-localized with EZ abnormalities on cross-sectional OCT B-Scans and measured by two masked graders. Primary outcome was change in area of EZ hyporeflectivity from 3 to 24 months and its association with ETDRS visual acuity recovery was also assessed. Results 271 images of 61 patients were assessed. Mean area of hyporeflectivity significantly decreased from 3 to 24...

En Face Optical Coherence Tomography Imaging of Foveal Dots in Eyes With Posterior Vitreous Detachment or Internal Limiting Membrane Peeling

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Purpose: To analyze the morphology of foveal hyperreflective dots (HRD) identified with en face optical coherence tomography (OCT) and evaluate the effects of internal limiting membrane (ILM) peeling and posterior vitreous detachment (PVD) on the number of these lesions. Methods: Retrospective cross-sectional study of patients with OCT angiography and en face OCT. Using en face OCT, superficial HRD lying on the foveal floor were measured and quantitated in eyes with ILM peel and in the fellow nonsurgical eyes. Eyes with foveal PVD were also compared to fellow eyes without foveal PVD. High-magnification en face OCT was also performed to better understand the morphology of HRD in the fovea. Results: Eyes that underwent ILM peel (n = 10) displayed fewer HRD (P = 0.012) compared to control fellow nonoperated eyes. In eyes with foveal PVD, the mean number of HRD was numerically greater, but without statistical significance, compared to the contralateral eye without foveal PVD. High-magni...

Longitudinal assessment of type 3 macular neovascularization using three-dimensional volume-rendering optical coherence tomography angiography

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Objective: To investigate the evolution of treatment-naive type 3 macular neovascularization (MNV) undergoing anti-vascular endothelial growth factor (VEGF) treatment through volume rendered three-dimensional (3D) optical coherence tomography angiography (OCTA). Design: Retrospective observational study. Participants: Patients with type 3 MNV and age-related macular degeneration (AMD). Methods: Included subjects had three loading injections of an anti-VEGF agent. The OCTA volume data at baseline and follow-up were processed with a previously published algorithm in order to obtain a volume-rendered representation of type 3 MNV. Progressive changes in type 3 lesions were analyzed via 3D OCTA volume rendering. Results: A total of 14 treatment-naive eyes with type 3 MNV from 11 AMD patients (7 females) were included. At both baseline and follow-up visits, a type 3 MNV complex was identifiable. Each complex was composed of a mean number of 2.5 ± 0.7 vascular branches at baseline a...

Optically Empty Choroidal Spaces In High Hyperopia

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Purpose: To describe the progressive optical coherence tomography findings of atypical choroidal cavitation in the inner choroid. Methods: Case report. Results: A 29-year-old asymptomatic woman was noted to display two flat translucent whitish subretinal lesions along the superotemporal arcade of the right eye, during routine retinal examination. Cross-sectional spectral domain optical coherence tomography of the choroid illustrated two hyporeflective lesions consistent with atypical choroidal cavitation of the Sattler layer, associated with corresponding thickening and bulging of the underlying choroid. En face optical coherence tomography through the lesions illustrated hyporeflectivity at the level of the inner choroid, compatible with choroidal cavitation. Progressive enlargement of these two choroidal lesions was noted with cross-sectional and en face optical coherence tomography. Conclusion: Intrachoroidal cavitation has been described in association with inferior peripapillar...

Identification and Characterization of Epivascular Glia using En Face OCT

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Purpose : To describe the clinical features of epivascular glia (EVG) using en face optical coherence tomography (OCT). Design : Retrospective cross-sectional study. Methods : Single institution en face OCT images were reviewed. Eyes displaying EVG were captured with manual internal limiting membrane segmentation and analysis with customized segmentation was performed. A random age- and gender-matched control group was selected to determine relative epiretinal membrane (ERM) prevalence. Results : Characteristic hyper-reflective internal limiting membrane (ILM) plaques with dendritic-like radiations were identified with en face OCT and displayed vascular predilection. 161 eyes with EVG (EVG group) and 2315 eyes without EVG (control group) were identified from a total cohort of 1298 patients (or 2476 eyes). The prevalence of EVG was 6.5% (161/2476) of eyes and 9.2% (119/1298) of patients in our cohort. Mean age was 79.3±10.7 years in the EVG group and 55.9±24.6 years in ...

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

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The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is ...

Deliberations of an International Panel of Experts on OCTA Nomenclature of nAMD

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A panel of imaging experts was assembled to review neovascular age-related macular degeneration optical coherence tomography angiography descriptors published to date, and test agreement on use of these terms, which was found to be low. Optical coherence tomography angiography (OCTA) has been used to identify and characterize macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). 1-4 Many studies have explored OCTA morphological features of MNV that might serve as biomarkers to assess disease activity and response to treatment. 1-6 The proliferation of studies however has resulted in an OCTA terminology that has been variable and inconsistent. To address inconsistency of nomenclature and allow harmonization, a multidisciplinary panel of retinal imaging experts with a history of relevant research contributions to the field was assembled with the purpose of reviewing published terminology and to recommend a reduced list of key terms pertinent to OCTA. Th...

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