Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN).

Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.

Intercalary membrane as the inner wall overlying optic and chorio-retinal colobomas. Deep penetration Swept Source-OCT study.

Five eyes of four patients were studied to analyze the structure of the inner wall of optic and chorioretinal colobomas using swept-source optical coherence tomography (SS-OCT). The colobomatous cavities and their relationship with adjacent structures were examined. SS-OCT permitted the study of the colobomatous cavities in all cases. In four of those cases, a Y-shaped intercalary membrane (ICM) was identified, with an origin in the retinal nerve fiber layer (RNFL), which covered the coloboma and in one case the coloboma was in contact with the vitreous cavity. Vitreous adhesion to the internal wall of the coloboma was found in three cases. No clinical or tomographic maculopathy was observed in any patient. High-resolution deep penetration SS-OCT allows in vivo study of optic and chorioretinal colobomas, identifying the RNFL as the main component of the ICM overlying the colobomatous cavities.

ANALYSIS OF AGE-RELATED CHOROIDAL LAYERS THINNING IN HEALTHY EYES USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To study the changes in the choroidal layers thickness with age in a healthy population using swept-source optical coherence tomography. METHODS: Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. One hundred and sixty-nine healthy eyes were evaluated using swept-source optical coherence tomography. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators determined the macular horizontal choroidal thickness (CT) and the Haller's layer thickness across a 9 mm line centered at the fovea. Subjects were divided into five age groups. RESULTS: Mean subfoveal choroidal thickness was 305.76 ± 80.59 µm (95% confidence interval: 294.85-319.33). Mean subfoveal thickness for Haller's layer was 215.47 ± 67.70 µm (95% confidence interval: 207.30-227.86) and mean subfoveal thickness for choriocapillaris plus Sattler's layer was 87.31 ± 40.40 µm (95% confidence interval: 83.38-95.65). No significant differences were found due to gender. Choroidal thickness profile was similar between groups with choroidal thickness and Haller's layer thickness decreasing with age (P = 0.002). CONCLUSION: Choroidal and Haller's layer thickness profiles are similar between different age groups. Age-related choroidal thinning is mostly at the expense of Haller's layer.

Component-resolved diagnostics in vernal conjunctivitis.

PURPOSE OF REVIEW: Conventional diagnostic tests in allergy are insufficient to clarify the cause of vernal conjunctivitis. Component-resolved diagnostic (CRD) by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process. RECENT FINDINGS: In a recent trial in patients suffered from eosinophilic esophagitis, after 2 years of the CRD-guided exclusion diet and specific immunotherapy, significant clinical improvement was observed, and 68% of patients were discharged (cure based on negative biopsy, no symptoms, and no medication intake). Our new objective was to evaluate IgE-mediated hypersensitivity by CRD in tears and serum from patients with vernal conjunctivitis and treat patients with identified triggering allergens by specific immunotherapy. Twenty-five patients with vernal conjunctivitis were evaluated. The identified triggering allergens were n Lol p 1 (11 cases), n Cyn d 1 (eight cases), group 4 and 6 grasses (six cases) and group 5 of grasses (five cases). Prick test and pollen IgE were positive in one case. Clinical improvement was observed in 13/25 vernal conjunctivitis patients after 1-year specific immunotherapy. SUMMARY: CRD seems to be a more sensitive diagnostic tool compared with prick test and IgE detection. Specific CRD-led immunotherapy may achieve clinical improvements in vernal conjunctivitis patients.

Component-resolved diagnostics in vernal conjunctivitis.

BACKGROUND: Conventional diagnostic tests in allergy are insufficient to clarify the origin of vernal conjunctivitis (VC). OBJECTIVES: To evaluate IgE-mediated hypersensitivity by component-resolved diagnosis (CRD) in tears and serum from patients with VC and to evaluate how to treat patients with identified triggering allergens by specific immunotherapy. METHODS: Patients were divided into 3 groups: (1) patients with VC (25 patients), (2) patients allergic to grass pollen with seasonal allergic conjunctivitis (AC) (50 patients), and (3) healthy blood donors (50 patients). If triggering allergens were detected, specific conventional immunotherapy was administered for 1 year. RESULTS: Twenty-five patients with VC were evaluated. The identified triggering allergens were n Lol p 1 (11 patients), n Cyn d 1 (8 patients), group 4 and 6 grasses (6 patients), and group 5 grasses (5 patients). Prick test and pollen IgE test results were positive in one patient. Clinical improvement was observed in 13 of the 25 patients with VC after 1 year of specific immunotherapy. CONCLUSION: CRD seems to be a more sensitive diagnostic tool compared with prick test and IgE detection. Specific CRD-led immunotherapy may achieve clinical improvements in patients with VC.

INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA: SIX YEARS OUTCOME.

PURPOSE: To report the visual outcome after 6-year follow-up in highly myopic eyes with choroidal neovascularization treated with anti-vascular endothelial growth factor drugs. METHODS: Retrospective, nonrandomized, multicenter, consecutive, and interventional case series. RESULTS: Seventy-eight patients were treated with intravitreal bevacizumab and 19 with ranibizumab. Mean age of the patients was 56.5 years (SD, 13.3). The average number of letters read was 56.7 (SD, 19.0) at baseline; 65.7 (SD, 18.4) at 12 months; 63.6 (SD, 20.6) at 24 months; 62.4 (SD, 21.4) at 36 months; 60.6 (SD, 22.0) at 48 months; 58.9 (SD, 22.9) at 60 months, and 58.4 (SD, 22.7) at 72 months (P < 0.01, between initial vs. 12, 24, and 36 months; P = 0.07, 0.3, and 0.5 between initial vs. 48, 60, and 72 months, respectively; Student's t-test paired data). The mean total number of intravitreal injections was 3.3 (SD, 2.3; range, 1-9). CONCLUSION: Bevacizumab and ranibizumab are effective therapies and show similar clinical effects in myopic eyes with choroidal neovascularization. Visual acuity gain is maintained at a 3-year follow-up. The improvement is no longer statistically significant at Years 4, 5, and 6.

Morphologic features of the choroidoscleral interface in a healthy population using swept-source optical coherence tomography.

OBJECTIVE: To analyze the morphologic features of the choroidoscleral interface in a healthy population using swept-source optical coherence tomography (SS OCT). DESIGN: Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. METHODS: A total of 276 healthy eyes from 154 subjects were evaluated using SS OCT. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators analyzed the morphologic features of the choroidoscleral interface in a masked fashion, classifying the contour and shape as concave (bowl-shaped) or inflective (S-shaped contour with ≥1 inflection point). RESULTS: The presence of a temporal choroidoscleral interface inflection was identified in 12.8% of the eyes. The mean choroidal thickness was 372.1 ± 76.8 µm and the average distance from the inflection point to the fovea was 4427.3 ± 627.9 µm. Nine patients showed an inflective profile in both eyes. No changes in the retinal profile were found in any of these cases. The mean age of the patients with an inflective profile was 16 ± 19 years (range 4-82) vs 36 ± 25 years (range 3-95) in the group with a concave contour (P = .001). The temporal choroidal thickness at 4000 and 5000 µm from the fovea was thicker in the group with a concave contour. CONCLUSIONS: Temporal choroidoscleral interface inflection or S-shaped profile of the choroidoscleral interface with focal thinning of the choroid can be considered a normal variation without clinical significance, especially in younger populations.

ASYMMETRY IN MACULAR CHOROIDAL THICKNESS PROFILE BETWEEN BOTH EYES IN A HEALTHY POPULATION MEASURED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To determine the difference in macular choroidal thickness (CT) profile between eyes in healthy individuals using swept-source optical coherence tomography. DESIGN: Cross-sectional noninterventional study. PARTICIPANTS: One hundred and forty eyes from 70 healthy patients with spherical equivalent between ± 3 D and with difference ≤ 0.25 D between eyes were scanned using a swept-source optical coherence tomography (Topcon Corporation). METHODS: Cross-sectional noninterventional study. One hundred and forty eyes from 70 healthy patients with spherical equivalent between ± 3 D and with difference #0.25 D between eyes were scanned using a swept-source optical coherence tomography (Topcon Corporation). A horizontal CT profile of the macula was created in both eyes by manually measuring the subfoveal CT from the posterior edge of retinal pigment epithelium (RPE) to the choroid/sclera junction. Three determinations were performed at successive points 1,000 mm nasal to the fovea and 5 more temporal to the fovea. The differences in CT between both eyes were analyzed. RESULTS: Mean age was 25.4 ± 19.9 years (from 4 to 75). The mean spherical equivalent was 0.18 ± 1.37 D (from -3 to +3). Mean macular nasal CT was thicker in the right eye (RE) than in the left eye (LE) (228.11 ± 69.23 µm vs. 212.27 ± 62.71 µm; P = 0.0002; Student's t-test paired data). Mean subfoveal CT and mean temporal CT was not statistically significantly different between the eyes. No statistically significant differences were observed comparing spherical equivalent in the RE compared with the LE. Both men and women showed a thicker mean nasal choroid in the RE versus the left (men, 226.97 ± 61.56 µm vs. 209.87 ± 60.31 µm; women, 229.63 ± 79.39 µm vs. 215.47 ± 66.68 µm, P = 0.003 and P = 0.03, respectively; Student's t-test paired data). At each nasal determination, CT in the RE was statistically significantly thicker than the LE (N1: 283.72 ± 81.10 µm vs. 269.76 ± 75.81 µm [P = 0.001]; in N2: 230.45 ± 73.47 µm vs. 211.33 ± 66.92 µm [P = 0.0002]; and in N3: 170.16 ± 61.00 µm vs. 155.72 ± 53.87 µm [P = 0.008], respectively). CONCLUSION: To the best of our knowledge, this is the first report suggesting thicker macular nasal choroid in the RE compared with the LE. In contrast, subfoveal CT and temporal CT were not found to be different between eyes.

Macular choroidal thickness profile in a healthy population measured by swept-source optical coherence tomography.

PURPOSE: To determine choroidal thickness (CT) profile in a healthy population using swept-source optical coherence tomography (SS-OCT). METHODS: This was a cross-sectional, noninterventional study. A total of 276 eyes (spherical equivalent ± 3 diopters [D]) were scanned with SS-OCT. Horizontal CT profile of the macula was created measuring subfoveal choroidal thickness (SFCT) from the posterior edge of retinal pigment epithelium (RPE) to the choroid-sclera junction. Three determinations were performed at successive points 1000 µm nasal and five more temporal to the fovea. Subjects were divided into five age groups. RESULTS: The mean SFCT was 301.89 ± 80.53 µm (95% confidence interval: 292.34-311.43). The mean horizontal macular choroidal thickness (MCT) was 258.69 ± 64.59 µm (95% confidence interval: 251.04-266.35). No difference in CT was found between men and women. Mean SFCT of the different study groups was 325.6 ± 51.1 (0-10 years), 316.7 ± 90.1 (11-20 years), 313.9 ± 80.3 (21-40 years), 264.6 ± 79.3 (41-60 years), and 276.3 ± 88.8 µm in subjects older than 60 years (P < 0.001; ANOVA test). Mean horizontal MCT was 286.0 ± 43.5, 277.7 ± 68.2, 264.0 ± 61.9, 223.4 ± 62.2, and 229.7 ± 66.1 µm, respectively (P < 0.001; ANOVA test). The CT profile was different for each age group. CONCLUSIONS: To our knowledge, this is the first population study of CT of healthy eyes across a broad range of age groups using SS-OCT. As has been determined using spectral-domain OCT, CT decreases with advancing age, especially after age 40. There were no differences due to sex. The greatest CT variation takes place in temporal sectors.

Direct comparison of spectral-domain and swept-source OCT in the measurement of choroidal thickness in normal eyes.

OBJECTIVE: To compare spectral-domain optic coherence tomography (SD-OCT) and swept-source OCT (SS-OCT) in the study of choroidal thickness (CT) in healthy eyes. METHODS: Prospective, cross-sectional, single-centre study. 82 healthy eyes of 46 patients were included. In a single session, Topcon 3D-2000 SD-OCT and 1050 nm SS-OCT prototype devices were used to perform OCT scans using a single line protocol. Two masked investigators independently, manually determined 13 CT measurements consisting of one subfoveal (SFCT), and six measurements on either side of the fovea (nasal and temporal) taken every 500 microns apart. The mean CT (MCT) was the mean average of these 13 measurements. RESULTS: SD-OCT was able to reproducibly measure the CT in 74.4% of eyes vs 100% with SS-OCT (p<0.05; Fisher's Exact test). In those eyes measured by both systems, mean SFCT was 279.4 ± 96.9 µm (range, 84-506) with SD-OCT vs 285.7 ± 88.9 µm (range 130-527) with SS-OCT (p=0.11; Student's t test paired data). Mean MCT was 243.8 ± 78.8 µm (range 103.6-433.2) with SD-OCT vs 242.2 ± 81.8 µm (range 97.6-459) with SS-OCT (p=0.64; Student's t test paired data). The difference in SFCT and MCT was not statistically significant between both devices. Intraclass correlation coefficient was higher than 0.9 interobserver and interdevice measurements. SFCT Bland-Altman plots showed 95% interobserver measurement agreement within ±34 for SD-OCT, ±22 for SS-OCT and ±60 µm intersystems. CONCLUSIONS: SS-OCT permitted accurate identification of the choroido-scleral border in 100% of normal eyes, suggesting that SS-OCT was the superior modality for the measurement of CT.

Intravitreal anti-VEGF therapy for choroidal neovascularisation secondary to pathological myopia: 4-year outcome.

OBJECTIVE: To report the visual outcome after 4-year follow-up in a series of highly myopic eyes with choroidal neovascularisation (CNV) treated with antivascular endothelial growth factor (anti-VEGF) drugs. METHODS: A retrospective, non-randomised, multicentre, consecutive, interventional case series study was performed. 92 highly myopic eyes with subfoveal CNV were treated with intravitreal injection (IVI) of anti-VEGF. The initial protocol (1 vs 3 injections) was dictated by surgeons' preferences and followed by an as-needed monthly regime. Best-corrected visual acuity (BCVA) was evaluated at baseline and then monthly. The primary aim was to analyse BCVA changes. The effect of age, spherical equivalent (SE) and treating drug were evaluated as secondary objectives. RESULTS: The mean age of the patients was 57 years (SD 14, range 30-93). The mean number of letters read was 46.1 (SD 16.8, range 5-70) at baseline, 55.5 (SD 18.6, range 10-85) at 12 months, 50.1 (SD 20.1, range 5-82) at 24 months, 54.2 (SD 21.9, range 2-85) at 36 months and 53.1 (SD 22.5, range 1-83) at 48 months (p=0.000, initial vs 12, 24 and 36 months; p=0.01 initial vs 48 months; Student t test for paired data). The mean total number of IVI was 4.9 (SD 5.4, range 1-29). SE and treating drug had no influence on the final visual outcome and number of injections required. CONCLUSIONS: Intravitreal bevacizumab and ranibizumab are effective therapies and show similar clinical effects in highly myopic CNV. Visual acuity gain is maintained at 4-year follow-up.

Spectral-domain optical coherence tomography study of macular structure as prognostic and determining factor for macular hole surgery outcome.

PURPOSE: To evaluate postoperative spectral-domain optical coherence tomography findings after macular hole surgery. METHODS: Retrospective, interventional, nonrandomized study. Overall, 164 eyes of 157 patients diagnosed with macular hole were operated on by vitrectomy and internal limiting membrane peeling. Preoperative and postoperative best-corrected visual acuity and spectral-domain optical coherence tomography images were obtained. Two groups were considered on the basis of the postoperative integrity of the back reflection line from the ellipsoid portion of the photoreceptor inner segment: group A (disruption of ellipsoid portion of the inner segment line, 60 eyes) and group B (restoration of ellipsoid portion of the inner segment line, 104 eyes). RESULTS: Logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly after the surgery of macular hole from a mean preoperative value of 0.79 ± 0.37 (range, 0.15-2.00) to a mean postoperative value of 0.35 ± 0.31 (range, 0.00-1.30) at the last follow-up visit (P < 0.01). Best-corrected visual acuity improved significantly in the 2 groups analyzed (all P < 0.01). A larger improvement was found in group B than in group A (P < 0.01). CONCLUSION: Ellipsoid portion of the inner segment line reconstruction seems to be a good prognostic factor for visual rehabilitation after macular hole surgery.

Ocular pain after intravitreal injection.

PURPOSE: To evaluate the efficacy of different anesthetics and topical anti-inflammatory treatment in patients undergoing intravitreal injections (IVI). METHODS: Prospective, randomized, double masked, comparative study. Patients undergoing 0.05 mL IVI were randomized to two different preoperative anesthetic regimes (regime A [0.5% tetracaine + naphazoline] versus regime B [5% lidocaine]) and two different post-injection topical protocols (protocol 1 [tobramycin qid] versus protocol 2 [tobramycin qid + diclofenac qid]). Patients were trained to score pain using a numerical rating pain scale from 0 (no pain) to 10 (excruciating pain) immediately after the injection, 30 min and 24 h later. Patients were instructed to take oral paracetamol (650-1000 mg, adjusted to the patient's weight) every six hours ad lib if necessary. RESULTS: A total of 156 patients were enrolled; 86 patients were randomized to regime A and 70 to regime B; 78 patients were assigned to each of the post-injection topical protocols. The average pain score immediately after the IVI was 2.77 (SD 2.12) for the whole group (2.85, SD 2.23 with tetracaine and 2.67, SD 2.00 with lidocaine; p = 0.73, Mann-Whitney U-test). Twenty-four hours later, the average pain score was 1.84, SD 2.45 (topical diclofenac + tobramycin) versus 1.75, SD 1.83 (topical tobramycin; p = 0.46, Mann-Whitney U-test). Forty-seven patients (30%) required oral paracetamol (average 3.3 and range 1-5 tablets). Conjunctival hemorrhage 30 min after the injection was less frequent and severe in eyes treated with topical naphazoline (p = 0.055, Mann-Whitney U-test). CONCLUSIONS: Topical tetracaine and lidocaine provide similar anesthesia before IVI. Topical diclofenac does not seem to reduce pain scores after IVI.

Systemic beta-blockers may reduce the need for repeated intravitreal injections in patients with wet age-related macular degeneration treated by bevacizumab.

PURPOSE: To evaluate the effect of concomitant systemic therapy in patients with choroidal neovascularization secondary to age-related macular degeneration (AMD) treated by intravitreal bevacizumab and to propose a mechanism for different interindividual response. METHODS: Retrospective, nonrandomized, single-center, consecutive interventional case series study. Forty-six eyes from 46 patients with choroidal neovascularization secondary to age-related macular degeneration were treated by monthly intravitreal 1.25 mg bevacizumab injections on a pro re nata regime. Patients' files were revised and changes in Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, central foveal thickness as determined by spectral domain optical coherence tomography, number of injections performed, occurrence of severe adverse effects, and systemic concomitant medication were recorded. The effect of systemic medication on final best-corrected visual acuity, central foveal thickness, and number of injections performed was evaluated. RESULTS: The most frequent systemic medications recorded were angiotensin-converting-enzyme inhibitors in 19 patients, beta-adrenergic blocking agents (n = 18), nonsteroidal antiinflammatory drugs (n = 17), diuretics (n = 16), calcium channel blockers (n = 14), benzodiazepines (n = 11), proton-pump inhibitors (n = 9), and statins (n = 8). Thirty-two patients had arterial hypertension. Average follow-up was 25.1 months (standard deviation [SD] = 8.9). Average gain in best-corrected visual acuity was 0.9 (SD = 13.6) and -2.1 letters (SD = 15.9) at 12 months and 24 months, respectively. The average reduction in central foveal thickness was 111 µm (SD = 54) and 105 µm (SD = 71) at 12 months and 24 months, respectively. The average number of intravitreal injections required was 6.7 (SD = 3.2). Patients on treatment with systemic beta-adrenergic blocking agents required less intravitreal injections (5.2, SD = 2.4 vs. 7.9, SD = 3.4) and this difference was statistically significant (P = 0.0068, multiple linear regression). CONCLUSION: Concomitant systemic beta-adrenergic blocking agents treatment may reduce the need for repeated intravitreal injections of bevacizumab in patients with choroidal neovascularization associated with age-related macular degeneration.

Photodynamic therapy for chronic central serous chorioretinopathy: a 4-year follow-up study.

PURPOSE: To evaluate the efficacy and safety of standard photodynamic therapy with verteporfin at 48 months in patients with chronic central serous chorioretinopathy. METHODS: A retrospective, multicenter, interventional case series analysis in patients with chronic central serous chorioretinopathy, treated with standard photodynamic therapy, and with ≥4 years of follow-up. Evaluations were performed every 3 months in the first year, every 6 months in the second year, and thereafter annually. Optical coherence tomography was performed in all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and thereafter as necessary. Retinal thickness on optical coherence tomography was measured manually, evaluating central macular thickness and neural retina thickness. Main outcomes included the evolution of best-corrected visual acuity, the resolution of subretinal fluid, documented with optical coherence tomography, the number of treatments, and the evaluation of neural retina thickness during the 48 months of follow-up. RESULTS: The study included 46 eyes of 42 patients, 38 men (90.4%) and 4 women (9.5%), with mean age of 49.19 ± 9.9 years (range, 32-70 years), and the minimal follow-up period was 48 months (mean, 56.8 ±10.3 months). Subretinal fluid was observed in all the included eyes at baseline, and 10 eyes (21.7%) had intraretinal diffuse or cystoid fluid. Concerning the mean best-corrected visual acuity, a statistically significant improvement (P < 0.01, Student t-test) was registered from 58.8 ± 18.3 letters at baseline to 66.9 ± 18.6 letters at 48th month. A complete resolution of subretinal fluid was achieved in 93.4%, and resolution of intraretinal fluid occurred in all 10 cases at 48 months. Neural retina thickness remained stable during the 48 months of follow-up (163.8 ± 47 µm at baseline and 163.8 ± 46 µm at 48 months). The mean number of treatments was 1.08 ± 0.3. No systemic or ocular side effects were registered. CONCLUSION: Standard photodynamic therapy with verteporfin was effective and safe in chronic central serous chorioretinopathy treatment with a significant improvement in the long term, both anatomic and visual, without inducing additional retinal atrophy or systemic adverse effects.

Macular choroidal thickness in normal pediatric population measured by swept-source optical coherence tomography.

PURPOSE: To evaluate choroidal thickness in healthy pediatric population by swept-source longer-wavelength optical coherence tomography (SS-OCT). METHODS: This was a cross-sectional comparative, noninterventional study. The macular area of 83 eyes from 43 pediatric patients (<18 years) was studied with an SS-OCT prototype system. Macular choroidal thickness was manually determined at 750-µm intervals by measuring the perpendicular distance from the posterior edge of the RPE to the choroid/sclera junction, along a horizontal 4500-µm line centered in the fovea. Three observers independently determined choroidal thickness. Pediatric choroidal thickness was compared with choroidal thickness from 75 eyes from 50 normal healthy adult volunteers (18 years or older). RESULTS: Mean age was 10 ± 3 years (3-17) in the pediatric population versus 53 ± 16 (25-85) in the adult population (P < 0.001). Mean spherical equivalent was not different (P = 0.06) between both groups. Mean subfoveal choroidal thickness was 312.9 ± 65.3 µm in the pediatric versus 305.6 ± 102.6 µm in the adult population (P = 0.19). Mean macular choroidal thickness was 285.2 ± 56.7 µm in the pediatric versus 275.2 ± 92.7 µm in the adult population (P = 0.08). The distribution of choroidal thickness along the horizontal line was different for both populations; the temporal choroid was thicker in the pediatric population (320, 322, and 324 µm; P = 0.002, 0.001, and 0.06, respectively), followed by the subfoveal (312 µm) and nasal choroid (281, 239, and 195 µm). CONCLUSIONS: Macular choroidal thickness in the pediatric population is not significantly thicker than that of healthy adults. Differences are more remarkable in the temporal side of the fovea.