Diagnostic ability of superficial vascular density measured by optical coherence tomography angiography to differentiate high myopic eyes from eyes with primary open angle glaucoma

Purpose: To determine if high myopia and glaucoma can be differentiated based on the measurement of superficial vascular density in the peripapillary and macular areas by using Optical Coherence Tomography Angiography (OCTA). Methods: This prospective, observational, cross?sectional, comparative study was conducted on patients between 40 and 60 years of age diagnosed as primary open?angle glaucoma (POAG) or high myopia and compared with age?matched controls. The main outcome measures were the difference in SVD% in peripapillary and macular areas in POAG and high myopic eyes. Detailed ophthalmic examination and OCTA of the disc and peripapillary area and macula were performed. The SVD in each zone was calculated using ImageJ software and their difference were analyzed. Results: In total, 128 eyes of 70 patients were enrolled. Peripapillary SVD% in controls was 45.07 ± 3.44, 40.36 ± 8.27 in high myopia, and 31.80 ± 9.008 in POAG. The mean difference in peripapillary SVD% of POAG to control was ? 13.479, of POAG to high myopia was ?8.777 (both P < 0.001), and of high myopia to controls was ?4.701 (P = 0.012). Macular SVD% in controls was 27.30 ± 3.438, 22.33 ± 6.011 in high myopia, and 21.21 ± 5.598 in POAG. The mean difference in macular SVD% of POAG to controls was ?6.088, of high myopia to controls was ?4.965 (both P < 0.001), and of POAG to high myopia was ?1.122 (P = 0.984; not statistically significant). Conclusion: OCTA is a useful diagnostic tool in distinguishing glaucomatous and myopic eyes. The measurement of peripapillary SVD has a greater discriminatory ability than that of the macular area.

Updated guidelines for the management of polypoidal choroidal vasculopathy: Recommendations from the Indian Polypoidal Choroidal Vasculopathy Panel and the Vitreoretinal Society of India

In Asians, polypoidal choroidal vasculopathy (PCV) is becoming more widely recognized as a significant cause of exudative maculopathy. The previous set of Indian guidelines on the management of PCV were published in 2018, with a literature search updated up to November 2015. As the treatment of PCV evolves, retinal physicians must constantly modify their current practice. The current guidelines are based on the most up-to-date information on PCV and are an update to the previous set of guidelines. These guidelines were developed by a panel of Indian retinal experts under the aegis of the Vitreoretinal Society of India (VRSI), based on a comprehensive search and assessment of literature up to September 2021. The final guidelines i) provide the updated nomenclature in PCV; ii) discusses the newer diagnostic imaging features of PCV, especially in the absence of indocyanine green angiography (ICGA); and iii) recommends the best possible therapeutic approach in the management of PCV, including the choice of anti-vascular endothelial growth factor (anti-VEGF) agents, treatment regimen, and the role of switching between the anti-VEGF agents. In the face of non-availability of photodynamic therapy (PDT) in India, we constructed practical recommendations on anti-VEGF monotherapy in PCV. The current updated recommendations would provide a broader framework to the treating retinal physician for the diagnosis and management of PCV for optimal therapeutic outcomes.

Acute acquired comitant esotropia precipitated by excessive near work during the COVID-19-induced home confinement

Purpose: To evaluate the causes of acute acquired comitant esotropia (AACE) in young adults and children in the setting of COVID?19?induced home confinement. Methods: A retrospective, clinical study of all patients, who presented to the Pediatric Ophthalmology and Strabismus services of a tertiary eye care center in South India from August 2020 to January 2021 during the COVID?19 pandemic, with acute?onset, comitant esotropia. Results: 11 (73.3%) of the total 15 patients were students, above 10 years and with a mean age of 16.8 years. 12 patients (80%) had more than 8 hours of near activity a day with a mean duration of 8.6 hours per day. The most common near activity was online classes, followed by job?related work and mobile games, and 86.7% used smartphones for near work. The average esotropia was 22.73 prism diopter (PD) for distance and 18.73 PD for near. Majority (66.6%) had hyperopia with basic or divergence insufficiency esotropia, and the remaining 33.3% had myopia and fitted in to the Bielschowsky type AACE. There was no precipitating event other than sustained near work in all, except in one patient who also had fever prior to the onset of esotropia. Conclusion: The habit of long?time and sustained near work, especially on smartphones, may increase the risk of inducement of AACE

Real-time in vivo micromorphology and histopathology of choroidal osteoma using enhanced depth imaging.

Choroidal osteoma is a usually unilateral benign tumor of the choroid composed of mature bone. Optical coherence tomography (OCT) has been used to image osteoma for several years. With the advent of enhanced depth imaging (EDI) feature of spectral‑domain OCT (SD‑OCT), better visualization of the morphology of choroidal lesions has been possible. Herein we present a case of choroidal osteoma in a 45‑year‑old woman, wherein in vivo morphology of the choroidal osteoma had been visualized using EDI technique of SD‑OCT before and after performing photodynamic therapy. EDI OCT has proven to be a valuable noninvasive imaging modality, almost comparable to histopathological examination, for diagnosing choroidal osteomas and for providing an insight into the in vivo micromorphological changes occurring during the course of the disease.

Clinical features, management and visual outcome of polypoidal choroidal vasculopathy in Indian patients.

Aims: To present the clinical, indocyanine green angiography (ICGA) features and results of treatment for polypoidal choroidal vasculopathy (PCV) in Indian patients by a retrospective chart review. Materials and Methods: Forty five patients with PCV underwent complete ocular examination, fluorescein angiography (FFA) and ICGA. Treatment was advised for patients with macular involvement and progressive loss of visual acuity. Demographic data, clinical features and results of treatment were analyzed. Results: Mean age at presentation was 61.06 years. Mean follow up was 18 months. The disease was more prevalent in males. Forty three patients had unilateral disease. The most common location of polyps in ICGA was subfoveal (42.5%). Exudative form was seen in 34 of the 47 eyes and the remaining 13 eyes had a hemorrhagic presentation. Thirty four eyes underwent treatment which included thermal laser (n = 11), photodynamic therapy (PDT) (n = 11) and transpupillary thermo therapy (TTT) (n = 12). Statistical analysis was done using the Chi-square test. Subgroup analysis of visual outcome following various modalities of treatment showed that the results of PDT (P < 0.001) and thermal laser (P < 0.001) were statistically significant. Conclusions: PCV is an important differential diagnosis in patients presenting with serosanginous maculopathy and submacular hemorrhage. The disease was more prevalent in males and was unilateral in the Indian population. Timely intervention in cases with symptomatic polyps could achieve stabilization of visual acuity. Thermal laser and PDT were safe and effective.