OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION.

PURPOSE: To investigate microvascular changes in the retina and choroid of chronic thromboembolic pulmonary hypertension (CTEPH) patients in comparison with healthy control subjects. METHODS: This observational clinical cohort study included 36 CTEPH patients (72 eyes) and 65 healthy control subjects (130 eyes). Optical coherence tomography (OCT) and optical coherence tomography angiography images were obtained from each participant using the AngioVue Imaging System (Optovue, Inc, Freemont, CA). RESULTS: A number of differences were found in the CTEPH cohort, including reductions in mean vessel density at the deep vascular complex of the macula and a reduction in mean subfoveal choroidal thickness. Furthermore, the CTEPH group displayed an increase in foveal avascular zone. The presence of at least one systemic disease, including arterial hypertension, diabetes, chronic coronary syndrome, and/or hyperlipidemia, in CTEPH patients increased the range of vascular complications. The presence of comorbidity was concomitant with a decrease in mean vessel density in the superficial vascular complex of the macula, excluding the fovea, and a decrease in mean vessel density in the radial peripapillary capillary plexus. CONCLUSION: Measurements of the foveal avascular zone and vessel density of the DVC and subfoveal choroidal thickness may be useful and sensitive predictors of retinal and choroidal circulation impairment in CTEPH patients without systemic disease.

Wide-Field Fluorescein Angiography in the Diagnosis and Management of Retinal Vein Occlusion: A Retrospective Single-Center Study.

BACKGROUND The aim of this retrospective study was to evaluate the role of wide-field fluorescein angiography (WF-FA) in the diagnosis and management of retinal vein occlusion (RVO) at a single center in Poland. MATERIAL AND METHODS This study included 106 patients (112 eyes) diagnosed with RVO (102 eyes) or impending RVO (10 eyes) (54% women and 46% men, aged 26 to 86 years). The medical records of the participants were reviewed in search of documentation on ocular and systemic diseases. Results of FA of central and peripheral retina and optical coherence tomography (OCT) scans, which had been used to establish treatment indications, were analyzed. WF-FA was performed with Spectralis HRA+OCT or Optos Tx200. RESULTS Actual RVO was found in 102 eyes. Of those cases, 46.1% were CRVO (central retinal vein occlusion), 40.2% branch retinal vein occlusion, 11.8% small tributary vein occlusion, and 1.9% hemispheric retinal vein occlusion. Neovascularization on an optic disc, neovascularization elsewhere, and veno-venous collateral vessels were observed in 32.3%, 17.4%, and 41.2% of the eyes, respectively. Peripheral ischemic zones were present in 59.8% of the eyes, in 20.6% of which, ischemia was not observed in the posterior pole. Dye leaks limited to peripheral vessels, peripheral vascular amputations, and central macular edema in OCT were observed in 17.6%, 43.1%, and 63.7% of the eyes, respectively. Retinal laser photocoagulation was conducted on 73.5% of the eyes. CONCLUSIONS Decision-making about management of patients with RVO should be done after physical examination and analysis of central and peripheral retina FA. In 20.6% of patients, assessment of the peripheral retina resulted in a change in treatment. The first changes suggestive of progression of thrombotic disease to the ischemic form appeared on the periphery in images from WF-FA.

WIDEFIELD FLUORESCEIN ANGIOGRAPHY IN THE DIAGNOSIS OF SUSAC SYNDROME.

PURPOSE: To present the clinical manifestations and results of key diagnostic investigations in patients with Susac syndrome, with special emphasis on the principal role of fluorescein angiography (FA) of the peripheral retina. METHODS: A retrospective analysis of medical records (collected 2000-2019) of 20 patients (15 women and five men), aged 20 to 51 years (mean age: 31.6 years) with complete or incomplete Susac syndrome diagnosed by an ophthalmic examination and widefield fluorescein angiography (WF-FA) by Spectralis and Optos Tx200. RESULTS: Fluorescein angiography abnormalities included vascular changes in the posterior pole in 64.7% and in the peripheral retina in 82.4%. Widefield FA abnormalities in the peripheral retina alone were seen in 35.3% and in the posterior pole, but without peripheral vascular involvement, in 17.6%. Secondary leakage from veins was noted in 58.8%. CONCLUSION: Widefield FA of the peripheral retina has a key role in cases of suspected Susac syndrome as it confirms the diagnosis and assesses disease activity. In addition to the characteristic findings, late-phase FA revealed leakage from veins which is not a typical sign. Patients experiencing migraine headaches may benefit from increasing awareness of neurologists and otologists who more promptly referred patients with suspected Susac syndrome for ophthalmologic evaluation and WF-FA of the peripheral retina.