One-year outcome of cystoid macular degeneration in central serous chorioretinopathy.

PURPOSE: To study structural and functional outcomes of cystoid macular degeneration (CMD) in chronic central serous chorioretinopathy (CSCR). METHODS: This retrospective study included 26 eyes having chronic CSCR with CMD who underwent either observation, photodynamic therapy (PDT), micropulse laser, or eplerenone therapy. Various optical coherence tomography parameters were analyzed at baseline and 1 year. RESULTS: Number of eyes that maintained or gained vision after treatment was 63.1%, compared to a loss of 2.1 ± 1.1 lines in observation group. Sub-foveal large choroidal vessel responded to PDT (p = 0.03); while CMT (p = 0.035) and intra-retinal cystoid spaces (0.037) responded to eplerenone. Longer duration of the symptoms and round cystoid spaces were associated with a decrease in CMT (p = 0.03) and decrease in cystoid spaces size (p = 0.02) respectively on follow up. CONCLUSION: Treatment of eyes with CMD prevents further deterioration of vision. Round configuration of intra-retinal cystoid space has a better anatomical outcome.

Characteristics of Central Serous Chorioretinopathy without Leakage.

PURPOSE: To describe optical coherence tomography (OCT) characteristics of central serous chorioretinopathy (CSCR) without any hyperfluorescent leakage on fundus fluorescein angiography (FFA). METHODS: This was a multicentric, retrospective, observational study of ten eyes of ten patients with CSCR without any hyperfluorescence leakage on FFA. Baseline patient characteristics, best corrected visual acuity, and OCT parameters like relative retinal pigment epithelium (RPE) reflectivity at the presumed leak site and control site were measured. RESULTS: Increased macular thickness, neurosensory detachment, and choroidal thickness were seen at the site of maximum subretinal fluid (SRF). Out of ten eyes, nine had photoreceptor outer segment (PROS) disruption (46% ± 26.33%) at the site of SRF pocket, and five had presumed former leak site characterized by PROS thinning. The presumed leak site demonstrated higher RPE reflectivity compared to the control site (0.92 ± 0.04 vs. 0.87 ± 0.04; P = 0.0058). CONCLUSION: CSCR without hyperfluorescent leakage on FFA may have PROS damage and changes in RPE hyperreflectivity.

Water-Drinking Test in Central Serous Chorioretinopathy.

PURPOSE: To evaluate choroidal changes in central serous chorioretinopathy (CSCR) patients after water-drinking test (WDT). METHODS: This prospective study included treatment-naïve acute and chronic CSCR eyes and healthy controls. Intraocular pressure and optical coherence tomography measurements with choroidal vascular index (CVI) measurements were done at baseline. Patients were asked to drink 1 L of water, and tests were repeated at 15, 30, and 45 min. RESULTS: Fifty-six eyes from 42 patients were enrolled. Choroidal area, luminal area, and stromal area were higher at baseline in eyes with acute CSCR compared to healthy controls. Chronic CSCR eyes showed an increase in choroidal area and stromal area and a decrease in the luminal area at 15 min. There was a significant decrease in CVI at 30 and 45 min in chronic CSCR and CVI at 45 min in fellow eyes of acute CSCR. Repeated-measures analysis of variance (ANOVA) showed a significant change in central macular thickness in acute CSCR, choroidal thickness in fellow eyes of acute CSCR, stromal area, and total choroidal area in chronic CSCR. Mixed model ANOVA showed that the change in various choroidal parameters seen had no interaction with the eye type. CONCLUSION: Although change in various parameters was seen in acute CSCR, chronic CSCR, and fellow eyes of acute CSCR following WDT, the change was not significantly different among the groups.

Wide-field individual retinal layer thickness in healthy eyes.

PURPOSE: To report the individual retinal layer thickness in healthy subjects using wide-field optical coherence tomography. METHODS: This was a prospective, cross-sectional study involving healthy subjects. A custom-designed semiautomated segmentation algorithm was used to split the retinal layers in seven bands, and individual retinal layer thicknesses were measured in horizontal (nasal, macular, and temporal segments) and vertical meridians (superior, macular, and inferior segments). The variation in retinal thickness was analyzed in different segments at an interval of 1 mm from reference points. Regression analysis was performed to identify the factors affecting retinal thickness. RESULTS: Twenty eyes of 20 healthy subjects with mean age of 28.9 ± 6.3 years were analyzed. Overall, nasal and superior segments (mean ± standard deviation: 279.6 ± 17.0 and 234.4 ± 19.2 µm) had maximum and minimum retinal thicknesses, respectively. A total of seven bands were delineated in each optical coherence tomography b scan in each segment. Retinal nerve fiber layer was thickest immediately nasal to optic disk margin in horizontal scan (72.4 ± 32.4 µm) and near the vascular arcades in vertical meridian. Outer plexiform layer, external limiting membrane-ellipsoid zone and interdigitation zone-retinal pigment epithelium-Bruch's complex showed significant variation in both horizontal and vertical meridians (all p values <0.05). Macular segment in both meridians showed the highest coefficient of variation. Age was the only significant factor affecting retinal thickness in multiple regression analysis (p = 0.001). CONCLUSIONS: Wide-field optical coherence tomography shows significant regional variation in overall and individual retinal layer thicknesses in macular and peripheral areas in healthy eyes with the highest variation in macular segment.

Wide-field choroidal vascular analysis in central serous chorioretinopathy.

PURPOSE: To report the wide-field choroidal vessel analysis in central serous chrorioretinopathy (CSCR) and their fellow eyes. METHODS: Wide-field optical coherence tomography (WF-OCT) images (55°) were obtained using Spectralis HRA + OCT (Heidelberg Engineering, Germany) in extremes of gazes in all quadrants and manual montages were created to obtain wide field images up to equator. Choroidal thickness (CT), large choroidal vessel layer thickness (LCVT), and choroidal vascularity index (CVI) were calculated in macular segment (twice the disc to fovea distance) and all four quadrants. Regression analysis was performed to identify the factors influencing CVI. RESULTS: Thirty-one patients of CSCR including 39 eyes of CSCR (32 chronic, 7 acute) and 23 fellow eyes were analyzed. CT and LCVT were significantly higher in submacular choroid than all extramacular segments in both CSCR and fellow eyes (all p values <0.01). CVI varied significantly in different segments in horizontal (p < 0.01 in both) and vertical meridian (p < 0.01 and p = 0.01 respectively) in CSCR and fellow eyes. Both CSCR and fellow eyes had highest CVI in nasal segment with minimum CVI in macular segment. Age (p = 0.85), gender (p = 0.39), chronicity of the disease (acute vs chronic, p = 0.57), axial length (p = 0.67), SBP (p = 0.81), and DBP (p = 0.94) were not significantly correlated to CVI. CONCLUSION: CVI shows significant regional variation with macular segment showing the lowest CVI whereas nasal segments have highest CVI in both CSCR and their fellow eyes. On the contrary, submacular segment has highest CT and LCVT with taper towards periphery in both CSCR and fellow eyes.

En-face choroidal vascularity map of the macula in healthy eyes.

PURPOSE: To report the en-face choroidal vascularity index in healthy eyes. METHODS: Thirty eyes of 30 healthy individuals were studied. Multiple high-density cross-sectional swept source optical coherence tomography scans were obtained to create a volume scan. The choroid was segmented for the whole volume scan and choroidal inner boundaries were flattened. Subsequently, multiple en-face scans separated by 25 µm were obtained and binarized. Choroidal vascularity index was calculated at level of choriocapillaris, medium, and large choroidal vessels. RESULTS: The mean age of the study cohort was 35.6 ± 8.8 years. The overall mean en-face choroidal vascularity index was 54.25 ± 0.55%. There was a statistically significant difference of choroidal vascularity index in choriocapillaris (53.16 ± 0.43%), medium choroidal vessel (51.38 ± 0.27%), and large choroidal vessel (55.69 ± 0.87%) (p < 0.01). Choroidal vascularity index analysis in three subgroups based on subfoveal choroidal thickness (low: <300 µm, medium: 300-400 µm, high: >400 µm) showed a statistically significant difference (p = 0.001). Choroidal vascularity index showed a significant correlation with subfoveal choroidal thickness (r = 0.441; p = 0.015), whereas there was no significant correlation of age (p = 0.21), refraction (p = 0.20), and gender (p = 0.67) with en-face choroidal vascularity index. CONCLUSION: En-face choroidal vascularity index shows a significant variation at the level of choriocapillaris, medium choroidal vessel, and large choroidal vessel in normal eyes. Choroidal vascularity index reaches a nadir at the level of medium choroidal vessel and reaches the maximum value at large choroidal vessel near choroidoscleral interface. En-face choroidal vascularity index shows a significant physiological variation and appears to increase with increase in subfoveal choroidal thickness.

En-face choroidal vascularity in central serous chorioretinopathy.

PURPOSE: To evaluate the choroidal vascularity index of eyes for acute and chronic central serous chorioretinopathy patients using swept-source optical coherence tomography generated en-face scans. METHODS: This was a retrospective study, in which slabs of en-face optical coherence tomography scans, at 5 µm intervals, spanning from the retina to choroid, were binarized using a validated algorithm to calculate choroidal vascularity index. The choroidal vascularity index was defined as the ratio between the choroidal vascular luminal area and the total choroidal area. Choroidal vascularity index was calculated for all the slabs of every subject in both the groups. RESULTS: A total of 30 eyes for each acute and chronic central serous chorioretinopathy groups were recruited. The mean choroidal vascularity index of the acute group was 45.21% ± 2.25% at the choriocapillaris, which increased to the maximal value of 48.35% ± 2.06% at 75% depth of the choroidal thickness and 45.31% ± 3.27% at the choroidoscleral interface; whereas for the chronic group, the mean choroidal vascularity index was 44.76% ± 2.60% at the choriocapillaris, which maximized at 50% choroidal depth (48.70% ± 1.32%) and then returned to 45.41% ± 6.02% at the choroidoscleral interface. CONCLUSION: For both groups, the choroidal vascularity index increased from choriocapillaris to maximum values at mid-choroid and returned to almost the choriocapillaris value at the choroidoscleral interface.

One year outcomes of eyes with polypoidal choroidal vasculopathy with ≥20/40 visual acuity treated with anti-vascular endothelial growth factor agents.

PURPOSE: To report the 12 months outcomes of treatment naïve polypoidal choroidal vasculopathy (PCV) in patients with ≥20/40 Snellen's best-corrected visual acuity (BCVA). METHODS: This was a retrospective study including eyes treated with monotherapy of anti-vascular endothelial growth factors (VEGF) agents (bevacizumab, ranibizumab, aflibercept, and ziv-aflibercept) on a pro-re-nata (PRN) protocol. Photodynamic therapy using verteporfin (vPDT) was used as rescue therapy. The primary study objective was change in BCVA at 12 months. Secondary objectives included change in optical coherence tomography parameters: central macular thickness (CMT) and pigment epithelial detachment (PED) height, the mean number of injections, and treatment-free interval at 12 months. RESULTS: A total of 18 eyes of 18 patients (7 males, 11 females) were included. The mean age was 58.0 ± 12.0 years. BCVA at baseline and 12 months were 0.16 ± 0.08 (Snellen equivalent 20/30) and 0.15 ± 0.15 logarithm of the minimum angle of resolution (20/30), respectively. Twelve (66.6%) eyes either improved or maintained BCVA. Mean (±standard deviation [SD]) CMT at baseline and 12 months were 188.2 ± 61.1 µ and 161.7 ± 47.4 µ (P = 0.15), respectively. PED height improved to 236.4 ± 208.7 µ at 12 months (P = 0.05). The mean (±SD) number of injections was 3.28 ± 1.96 with a treatment-free period of 6.83 ± 3.63 months. Three eyes required vPDT (4 treatment sessions; mean: 1.33) as a rescue therapy through 12 months. CONCLUSION: PRN anti-VEGF monotherapy in real-life situations for the treatment of naïve PCV eyes with good visual acuity (≥20/40) achieves maintenance or improvement of visual acuity through 12 months follow-up.

Regression in polypoidal choroidal vasculopathy treated with ziv-aflibercept monotherapy - short term study.

PURPOSE: The aim of this study was to evaluate the effectiveness of intravitreal ziv-aflibercept (IVZ) in the treatment of polypoidal choroidal vasculopathy (PCV) and its efficacy in regard to polyp regression using optical coherence tomography (OCT) and indocyanine green angiography (ICGA). METHODS: This was a retrospective study of eight eyes of eight patients with treatment-naïve PCV. Patients received IVZ on pro re nata protocol. OCT and ICGA parameters were assessed at baseline and subsequent visits with a minimum follow-up of 6 months. ICGA was repeated at 3-6 months to determine the disease activity and quantify the changes in branching vascular network (BVN) polyps. Quantifiable OCT parameters included central macular thickness, pigment epithelial detachment (PED) height, and subfoveal choroidal thickness. RESULTS: The mean age of the study cohort was 62.3 ± 7.7 years, with a mean follow-up of 7.1 ± 1.2 months. The baseline best-corrected visual acuity improved from 0.70 ± 0.36 logarithm of the minimum angle of resolution (Snellen's equivalent 20/100) to 0.63 ± 0.34 (20/80) at last follow-up which was statistically insignificant (P = 0.5). Post IVZ injections (mean ± standard deviation: 2.6 ± 0.7), the total number of polyps reduced significantly from 3 ± 3.5 to 1 ± 1.7 (P = 0.03) along with a reduction in BVN size (3.9 ± 4.8 to 2.7 ± 3.8mm2; P = 0.07). OCT analysis revealed a significant reduction in PED height from 462.5 ± 353.8 µ to 169.9 ± 127.2 µ (P = 0.02). CONCLUSION: IVZ leads to significant morphological changes on ICGA and OCT in terms of polyp regression and reduction of PED height, respectively, with a limited change in visual acuity. IVZ may serve as a cost-effective alternative to treat eyes with PCV.

Peripapillary choroidal vascularity quantification and characterization in healthy individuals.

INTRODUCTION: To characterize the peripapillary choroidal vasculature in healthy individuals using the choroidal vascular index (CVI), a previously established more robust tool of measurement of choroidal vascularity than choroidal thickness. METHODS: The peripapillary choroid in healthy individuals was analyzed using optical coherence tomography. OCT B-scan were analyzed using automated binarization, a previously established technique. This separates the choroidal layer into the stromal and vascular areas. Choroidal vascular index (CVI), the vascular area/total area, was computed for each image over the macula and the peripapillary area of the optic disc. Regression analysis and generalized estimating equation (GEE) were used to analyze various demographics, and CVI in the macula and each quadrant of the optic disc. RESULTS: Fifty eight eyes of 29 healthy individuals were included. Mean age was 42±17 years. Average CVI at the macula was 0.583. Average peripapillary CVI was 0.643 (nasal), 0.598 (temporal), 0.621 (superior) and 0.623 (inferior). Regression analysis of variables demonstrated there was no significant relationship between the demographic variables and macular CVI. However, the analysis demonstrated age and CVI of the peripapillary area were significantly correlated. Further stratification revealed significantly higher CVI in the optic disc in subjects over 45. CONCLUSION: Peripapillary CVI in all quadrants is higher than macular CVI in all age groups. CVI significantly increases after the age of 45 in the peripapillary area but not macular area. This suggests that stromal area decline is greater than the decline of the luminal area in the choroid at the peripapillary area as age increases.

Stress and vision-related quality of life in acute and chronic central serous chorioretinopathy.

BACKGROUND: To compare vision-related quality of life (VRQOL) between acute and chronic Central serous chorioretinopathy (CSC) and correlate this with Cohen's Perceived Stress Scale (PSS) questionnaire. METHODS: Patients who were diagnosed with both acute and chronic CSC were recruited in this study. Vision-related quality of life (VRQOL) was assessed with Rasch revised National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ25) and perceived stress with Cohen's PSS questionnaire in 118 subjects with either acute or chronic CSC. The quality of life score was compared between patients with acute and chronic CSC. Correlations between the functional score and visual acuity (VA), stage of CSC, and stress were studied. RESULTS: There was no significant difference in VRQOL between Acute and Chronic CSC. In Acute CSC, affected eye VA correlated significantly with near vision question of the visual function subscale. Better eye VA correlated significantly with distance vision, social function, role limitation and dependency of the socioeconomic subscale. In chronic CSC, affected eye VA correlated with social function question of the socioemotional subscale and the better eye VA correlated with driving and distance vision of the visual function subscale. No other significant correlations with VA were noted. No correlations were observed between outcome of Cohen's PSS questionnaire and NEI-VFQ25 scores of acute and chronic CSC. CONCLUSION: The VRQOL is similar between acute and chronic CSC. Perceived stress was not found to influence the VRQOL in CSC.

Ziv-aflibercept and bevacizumab for exudative age-related macular degeneration: A retrospective comparison of clinical outcomes and cost at 1 year.

PURPOSE: The purpose of this study was to compare intravitreal ziv-aflibercept (IVZ) monotherapy to intravitreal bevacizumab (IVB) monotherapy in patients with exudative age-related macular degeneration (eAMD). MATERIALS AND METHODS: Patients with treatment-naïve eAMD treated with pro re nata (PRN) monotherapy of IVZ (1.25 mg/0.05 ml) or IVB (1.25 mg/0.05 ml) with a minimum follow-up of 12 months were retrospectively analyzed. Study outcomes included change in best-corrected visual acuity (BCVA), central macular thickness, mean number of injections, and total medication cost in both the groups at 12 months. RESULTS: Forty-seven eyes (IVZ, 18/47 [38.3%] and IVB, 29/47 [61.7%]) from 47 treatment-naive patients were included. The change in BCVA for patients receiving IVZ was from 0.61 ± 0.33 logarithm of the minimum angle of resolution (Snellen 20/81; range: 20/38-20/174) to 0.45 ± 0.31 (Snellen 20/56; range: 20/27-20/115) at 1 year (P = 0.02). The total number of injections needed to achieve the resolution of intraretinal or subretinal fluid was 2.6 ± 1.4 and 3.5 ± 1.3 for IVZ and IVB, respectively (P = 0.029). Direct medication cost of IVZ and IVB in our cohort on PRN basis was an average of US$78 (2.6 × US$30) and US$175 (3.5 × US$50), respectively, through 1 year. CONCLUSION: IVZ-PRN monotherapy resulted in improved visual acuity, reduced treatment burden, and reduced direct medication cost in comparison to IVB-PRN monotherapy through 1 year.

Angiographic features of polypoidal choroidal vasculopathy using indocyanine green angiography and optical coherence tomography angiography: A comparative study.

BACKGROUND: To compare the vascular lesion size using optical coherence tomography angiography and indocyanine green angiography in eyes with polypoidal choroidal vasculopathy. METHODS: Treatment-naïve cases (46 eyes of 44 patients) with polypoidal choroidal vasculopathy were retrospectively analyzed. The comparison of mean area of branching vascular network and polyp detection rate was done between indocyanine green angiography and optical coherence tomography angiography and correlated with various optical coherence tomography features. RESULTS: The mean age of the study patients was 62.33 ± 10.74 years. The mean branching vascular network size was 7.47 ± 5.74 and 7.51 ± 5.69 mm² in indocyanine green angiography and optical coherence tomography angiography, respectively, with an excellent correlation (r = 0.997). Optical coherence tomography angiography overestimated (mean ± SD: 0.28 ± 0.19 mm²) and underestimated branching vascular network area (0.36 ± 0.33 mm²) in 23 eyes each as compared to indocyanine green angiography. However, the difference in branching vascular network size was not statistically significant (p = 0.53). Indocyanine green angiography and optical coherence tomography angiography could identify polyps in 43 of 46 (93.48%) and 32 of 46 (69.57%) patients, respectively. CONCLUSION: Branching vascular network size measurements with indocyanine green angiography and optical coherence tomography angiography were comparable and showed significant correlation, albeit the polyp identification rate was lower with optical coherence tomography angiography. Optical coherence tomography angiography may serve as a useful substitute to indocyanine green angiography in measurements of branching vascular network for photodynamic therapy and follow-up of polypoidal choroidal vasculopathy eyes.

Low incidence of pachydrusen in central serous chorioretinopathy in an Indian cohort.

Purpose: The aim of this study is to report the prevalence, clinical and swept-source optical coherence tomography (SS-OCT) characteristics of pachydrusen in eyes with central serous chorioretinopathy (CSCR) and their fellow eyes. Methods: A total of 264 eyes of 132 patients with a diagnosis of CSCR (acute/persistent/recurrent/chronic/inactive) in atleast one eye, were analyzed in this retrospective, cross-sectional study. SS-OCT parameters including choroidal thickness (CT), large choroidal vessel layer thickness (LCVT) at fovea and the site of pachydrusen were recorded. Paired t test and analysis of variance (ANOVA) was used to compare CT in eyes with CSCR (subfoveal and site of pachydrusen) and multiple groups respectively. Results: The mean age of the study patients was 42.9 ± 9.5 years with 119 males (90.15%). Bilateral CSCR was present in 31 patients. Nine eyes (chronic, 4; persistent, 2; and inactive/resolved CSCR, 3) showed presence of pachydrusen with an overall prevalence of 6.82% (9 eyes of 9 patients out of 132 patients). There was no significant difference of subfoveal CT (SFCT) in eyes with CSCR (422.4 ± 107.8 µ) vs fellow eyes (407.0 ± 96.5 µ) and eyes with CSCR associated with pachydrusen (413.7 ± 101.5 µ) vs fellow eyes of CSCR eyes with pachydrusen (431.6 ± 188.8 µ) (P = 0.71). LCVT as a percentage of CT was higher at the site of pachydrusen compared to SFCT (69.8% vs. 50.8%). Conclusion: CSCR can be associated with pachydrusen with a lower prevalence rate than previously reported. Whether the thickened large choroidal vessels at site of pachydrusen play any role in formation in pachydrusen needs further evaluation.

Subretinal hyperreflective material in central serous chorioretinopathy.

Purpose: To describe the the appearance and behavior of subretinal hyperreflective material (SHRM) in eyes with central serous chorioretinopathy (CSCR). Methods: This retrospective study included 20 eyes of 20 patients with CSCR presenting with SHRM, defined as sub-retinal deposits that appear hyper-reflective on OCT The eyes underwent either laser (15 eyes) or observation (5 eyes). Optical coherence tomography and fundus fluorescein angiography (FFA) characteristics were analyzed at baseline and resolution of neurosensory detachment, which were then co-related with the visual acuity at resolution. Results: Improvement in vision was seen in 16 eyes. Ellipsoid zone damage (P = 0.03) and external limiting membrane (ELM) damage (P = 0.000) at resolution; diffuse retinal pigment epithelium (RPE) abnormalities on FFA (P = 0.04), and the presence of scar (P = 0.000), were associated with poor visual outcome in univariate analysis. ELM damage at resolution was statistically significant (P = 0.001) in multivariate analysis. Conclusion: CSCR with SHRM have a good visual prognosis. ELM damage at resolution corelates with a poor visual acuity at resolution.

Choroidal hyper-reflective foci and vascularity in retinal dystrophy.

Purpose: To investigate choroidal hyper-reflective foci (HRF) in subjects with retinal dystrophy [Stargardt's disease (SGD) and retinitis pigmentosa (RP)] and their association with demographics, visual acuity, choroidal thickness (CT), and choroidal vascularity index (CVI). Methods: Single center retrospective study of subjects with previously diagnosed SGD or RP. Swept-source optical coherence tomography images were analyzed for the presence of choroidal HRFs and CVI using previously validated automated algorithm. A Spearman's rank correlation coefficient was used to evaluate the correlation between the number of HRF and various baseline parameters including age, visual acuity, intraocular pressure, and other optical coherence tomography (OCT) parameters (CT, choroidal area, and CVI) were evaluated in these subjects. Results: This study included 46 eyes (23 subjects) and 55 eyes (28 subjects) with previously diagnosed RP and SGD, respectively. In the RP group, the mean number of HRFs was 247.9 ± 57.1 and mean CVI was 0.56 ± 0.04. In SGD group, mean HRF was 192.5 ± 44.3 and mean CVI was 0.41 ± 0.04. Mean HRF was significantly greater in the RP group (0.02), however, the mean CVI was not statistically different. In RP, mean HRF were correlated only with CVI (r = 0.49; P = 0.001), however, in SGD, it correlated with only choroidal area (r = 0.27; P = 0.04). Conclusion: Choroidal HRF were present in both RP and SGD subjects with more HRFs in those with RP. These HRFs were associated with alteration in choroidal vascularity, which further adds into the pathogenesis of these diseases.

Identifying central serous chorioretinopathy biomarkers in coexisting diabetic retinopathy: a multimodal imaging study.

BACKGROUND: To describe clinical and imaging characteristics of patients presenting with diabetic retinopathy (DR) with coexisting acute or chronic central serous chorioretinopathy (CSCR). METHODS: This was a cross-sectional study which included 54 eyes of 27 patients with coexisting DR and CSCR. Demographic details, prior history of laser, best-corrected visual acuity (BCVA), central macular thickness (CMT), height of neurosensory detachment (NSD), subfoveal choroidal thickness (SFCT), subfoveal large choroidal vessel layer thickness (SF-LCVT), fluorescein angiography and indocyanine green angiography features were recorded. Subanalysis was done for patients with unilateral CSCR. Data was evaluated using Student t-test for quantitative data and χ2 test for qualitative data. CSCR between different grades of DR was analysed using analysis of variance. RESULTS: Prevalence of coexistent CSCR in eyes with DR was 0.4%. Mean age was 53.96±8.79 years, with 25 males. Mean CMT was 349.2±258 µm. Mean SFCT and SF- LCVT of 38 eyes were 376.40±86 µm and 178.80±62.8 µm, respectively. Fifteen eyes had centre involving diabetic macular oedema. Subanalysis of patients with unilateral CSCR showed that the loss of inner segment-outer segment (IS-OS) integrity (p=0.001), photoreceptor footplates at the NSD roof (p=0.001) on optical coherence tomography and dilated choroidal vessels (p=0.05) on indocyanine green angiography were found more often in the CSCR eyes compared with their fellow eyes. Features of CSCR among the different grades of DR were not significantly different between the groups. CONCLUSION: Our study describes features of a unique subset of patients presenting with coexistent DR and CSCR. Such coexistent nature needs special attention by the clinicians as this may change the treatment approach and alter outcomes.

Choroidal Vascularity in Non-arteritic Anterior Ischaemic Optic Neuropathy.

This study evaluates the peripapillary choroidal vascularity in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) and compares it with the vascularity of healthy fellow eyes and age-matched subjects. The peripapillary choroidal vascularity index (CVI), a new tool of measurement, was calculated using horizontal swept-source optical coherence tomography scans. CVI was calculated using a previously validated automated algorithm. CVI in NAION and fellow eyes of NAION patients were compared with age-matched eyes of healthy individuals using Kruskal-Wallis test. A total of 20 eyes of 20 patients with acute unilateral NAION with healthy fellow eyes (20 eyes) and 40 eyes of 40 healthy patients were included in the study. The average age of patients with NAION was 56 ± 8 and 55 ± 7 years in age-matched healthy controls. NAION eyes had a significantly lower CVI than age-matched controls in both nasal and temporal areas. NAION nasal CVI was 0.47 ± 0.47 compared to 0.62 ± 0.04 in controls (p < 0.001). NAION temporal CVI was 0.45 ± 0.48 compared to 0.58 ± 0.04 in controls (p < 0.001). Temporal CVI was 0.45 ± 0.48 in NAION eyes and was significantly lower than counterpart healthy fellow eyes 0.48 ± 0.02 (p = 0.007). In conclusion, NAION eyes have significantly reduced vascularity in the peripapillary area. CVI is lower in the nasal and temporal of the optic disc compared to healthy individuals. This may suggest those with smaller CVI are more prone to ischaemia from reduced vascularity resulting in NAION.

Evaluation of choroidal hyperreflective dots in acute and chronic central serous chorioretinopathy.

Purpose: To determine the association between hyperreflective dots (HRD) in the choroid and visual acuity and swept-source optical coherence tomography (SS-OCT)-derived structural parameters in central serous chorioretinopathy (CSC). Methods: SS-OCT images (single visit) of consecutive patients with CSC were evaluated for the presence of HRDs in the choroid using an automated algorithm and manual measurements of central macular and subfoveal choroidal thicknesses were obtained. Results: 61 eyes of 61 subjects were included in this retrospective study (32 subjects with acute and 29 with chronic CSC). Mean (± SD) choroidal HRD counts in acute and chronic CSC were 139.4 ± 29.9 and 124.9 ± 28.1, respectively (P = 0.04). In acute CSC, HRD was correlated with both age (P = 0.004) and subfoveal choroidal thickness (SFCT) (P = 0.016), but not with visual acuity or other OCT-derived measurements. In chronic CSC, HRD was correlated with central macular thickness (P = 0.011); neurosensory detachment height (P = 0.046); SFCT (P = 0.012). Considering all patients, the presence of HRDS was significantly negatively correlated with age (r = -0.401; P= 0.002) and SFCT (r = -0.332; P= 0.010). Conclusion: HRDs are correlated with both age and SFCT in acute CSC, and with CMT, height of neurosensory detachment and SFCT in chronic CSC. Development of HRDS is associated with the remodelling of chorioretinal structures as previously noted in CSC.

Diurnal variation in subfoveal and peripapillary choroidal vascularity index in healthy eyes.

Purpose: To report the diurnal variation in choroidal vascularity index (CVI) in subfoveal (SF-CVI) and peripapillary area in healthy eyes. Methods: The study was a cross-sectional study including 12 healthy subjects. Swept-source optical coherence tomography scans were taken at 9 am, 11 am, 1 pm, 3 pm, and 5 pm. Subfoveal choroidal thickness (SFCT) and CVI were calculated using automated segmentation techniques and previously validated algorithms. Systemic parameters including systolic blood pressure (SBP), diastolic blood pressure, mean arterial pressure, and mean ocular perfusion pressure were calculated and correlated with SFCT and CVI. Results: A total of 12 eyes (right eye) of 12 patients (mean age: 26 ± 3.77 years) were analyzed. The mean (±standard deviation) amplitude of SFCT and SF-CVI variation was 35.91 ± 14.8 µm (range, 15-69 µm) and 0.05 ± 0.02 (range, 0.02-0.08). The mean CVI showed a significant diurnal variation in the temporal quadrant of the peripapillary region (P = 0.02). Conclusion: SFCT and SF-CVI showed a significant diurnal variation in amplitude (peak-trough analysis) and SF-CVI correlated well with SBP suggestive of a direct influence of blood pressure on choroidal vascularity. The mean peripapillary CVI in the temporal quadrant also showed a significant diurnal variation with no significant change in other quadrants.