Diagnostic Availability of Optical Coherence Angiography in Type 1 and 2 Choroidal Neovascularization

Purpose@#To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. @*Methods@#We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. @*Results@#Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). @*Conclusions@#Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

Diagnostic Availability of Optical Coherence Angiography in Type 1 and 2 Choroidal Neovascularization

Purpose@#To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. @*Methods@#We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. @*Results@#Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). @*Conclusions@#Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

Characteristics of the Gray Optic Disc Crescent and Associated Factors

PURPOSE: To investigate the characteristics of the gray optic disc crescent and associated factors. METHODS: We retrospectively reviewed stereo fundus photographs of 590 glaucoma patients and 273 non-glaucoma patients. An experienced investigator evaluated the presence or absence of the gray crescent (a crescent-shaped, slate-gray pigmentation on the periphery of the neuroretinal rim) which is entirely inside the scleral crescent. Correlations with age, gender, refractive error, disc diameters, and the presence of glaucoma or peripapillary atrophy were also analyzed. RESULTS: Out of 863 patients, the gray crescent was observed in 166 patients and was found in 19.0% of glaucoma patients and 19.8% of non-glaucoma patients. The gray crescent was most often located temporally (30.1%) and most frequently occurred within only 1 quadrant (63.9%). The prevalence of the gray crescent was not correlated with refractive error (p = 0.61) or the occurrence of glaucomatous optic neuropathy (p = 0.25), but was significantly related to peripapillary atrophy (p < 0.001) and the horizontal diameter of the optic disc (p = 0.001). CONCLUSIONS: The gray optic disc crescent is a common finding within a glaucomatous or non-glaucomatous eye and factors significantly related to occurrence of the gray crescent include peripapillary atrophy and the horizontal diameter of the optic disc. Patients with gray crescent require special attention when the optic disc is examined.

Effects of Argon Laser Iridotomy on the Corneal Endothelium of Pigmented Rabbit Eyes

PURPOSE: In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium. METHODS: Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy. RESULTS: Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy. CONCLUSIONS: Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.

Effects of Argon Laser Iridotomy on the Corneal Endothelium of Pigmented Rabbit Eyes

PURPOSE: In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium. METHODS: Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy. RESULTS: Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy. CONCLUSIONS: Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.

Monocanalicular and Bicanalicular Intubation with Sequential Probing for Congenital Nasolacrimal Duct Obstruction in Patients Over the Age of 24 Months

PURPOSE: The clinical effectiveness of monocanalicular or bicanalicular intubation with sequential probing was evaluated in patients over the age of 24 months with congenital nasolacrimal duct obstruction. METHODS: Patients over 24 months of age with congenital nasolacrimal duct obstruction who underwent monocanalicular intubation with sequential probing (19 patients, 20 eyes) or bicanalicular intubation with sequential probing (22 patients, 22 eyes) were studied. Success rates and complications were evaluated. Silicone tube was removed 6 months after surgery. Success was defined as no epiphora and no retention on fluorescein dye disappearance test. RESULTS: The success rate was 95.0% (19 eyes / 20 eyes) in the monocanalicular intubation group and complications included 7 cases of early tube dislodgement, which achieved successful outcome. The success rate was 82.6% (19 eyes / 22 eyes) in the bicanalicular intubation group and complications included 4 cases of punctal slitting, and 3 cases of tube extrusion. The success and complication rates were not significantly different between the 2 groups (p = 0.608, p = 1.000, respectively). CONCLUSIONS: In congenital nasolacrimal duct obstruction, the monocanalicular tube intubation group had similar success and complication rates to the bicanalicular tube intubation group. Silicone tube maintenance for 2 months in the monocanalicular group and for 3 months in the bicanalicular group was sufficient.