Geographic Atrophy and OCT Angiography: Descriptive Study and Correlation With Autofluorescence.

BACKGROUND AND OBJECTIVE: Geographic atrophy (GA) involves the progressive loss of retinal pigment epithelium (RPE), photoreceptors, and choriocapillaris (CC). CC flow within a GA area is severely impaired in patients with atrophic age-related macular degeneration. The aim of this study was to compare GA area measured on optical coherence tomography angiography (OCTA) (CC nonperfusion area) and on fundus autofluorescence (FAF). PATIENTS AND METHODS: In this prospective, observational, cross-sectional study, OCTA and FAF were performed in patients with GA. On OCTA (CC segmentation), the CC nonperfusion area was measured manually using calipers. On FAF, GA was manually delimited, and the total surface was obtained using Region Finder software. The primary endpoint was to compare the CC nonperfusion area measured on OCTA and on the gold standard method (FAF). RESULTS: Forty eyes of 34 patients with a mean age of 82.63 years ± 9.21 years (range: 66 years to 100 years) were included. The mean GA area measured on FAF and OCTA was, respectively, 2.184 ± 3.045 mm2 and 2.349 ± 3.237 mm2 (P = .035). The mean difference was 0.165 ± 0.290 mm2. A strong correlation was found between both measurements (r = 0.97; P < .0001; confidence interval: 0.98-0.99), although the CC nonperfusion area was larger than the GA area on FAF (P = .035). CONCLUSIONS: In this study, the authors showed that in GA, the CC nonperfusion area correlates linearly with the GA area assessed by FAF. Also, the CC nonperfusion area is larger than the GA area measured by FAF, suggesting that CC degeneration could occur before RPE degeneration in GA. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e222-e228.].

In vivo visualization of perforating vessels and focal scleral ectasia in pathological myopia.

PURPOSE: To describe focal scleral ectasia in areas of macular/perimacular patchy chorioretinal atrophy secondary to pathologic myopia. METHODS: Thirty-nine consecutive patients with pathologic myopia and chorioretinal atrophy in at least one eye, with and without focal scleral ectasia, were analyzed by infrared reflectance (IR) and/or multicolor imaging, enhanced depth imaging optical coherence tomography (EDI-OCT) (39 patients, 78 eyes), and swept source (SS)-OCT (13 out of 39 patients, 26 eyes) cross-sectional scan. RESULTS: Focal scleral ectasia was found in 12 out of 68 eyes (11 out of 39 consecutive patients, 27 females/12 males; mean age 65.7 ± 11.9 years) with macular/perimacular patchy chorioretinal atrophy, and was always observed inferior or temporal to the macula (mean 1.25 ± 0.38/eye). Focal scleral ectasia, appearing on fundus examination as a deep dark round/oval lesion with well-defined borders, was characterized on EDI-OCT and SS-OCT by an abrupt posterior bow of the sclera with different degrees of scleral schisis on its borders. The retinal pigment epithelium and the choroid were absent in all lesions. IR reflectance and multicolor imaging showed large vessels that seem to emerge from the focal scleral ectasia, and crossing the area of patchy atrophy. EDI-OCT and SS-OCT revealed retrobulbar vessels perforating the sclera at the borders/bottom of the abrupt posterior bow of the sclera (i.e., focal scleral ectasia) and running through the superficial scleral thickness for the whole extension of the atrophic area. CONCLUSIONS: We showed that perforating vessels are localized at the border/bottom of focal scleral ectasia in pathologic myopia.

Stage 3 macular hole: role of optical coherence tomography and of B-scan ultrasonography.

PURPOSE: To analyze the various aspects of Stage 3 macular hole with optical coherence tomography (OCT) and B-scan ultrasonography. DESIGN: Observational case series. METHODS: Patients referred for full-thickness macular hole were prospectively screened with OCT and B-scan ultrasonography. OCT examination analyzed the diameter of the hole, the posterior hyaloid, the surrounding retina, and the inconstant presence of a pseudo-operculum. B-scan ultrasonography permitted the distinction between stage 3 and stage 4 holes, based on the detachment of the posterior hyaloid. RESULTS: The study included 62 eyes with stage 3 holes. On OCT, the typical aspect with a hyaloid detached from the macular area was observed in 37% of the eyes (group 3C). In 42% of the eyes (group 3B), a focal adherence was visible at the margin of the hole, as in stage 2 macular hole, but the hole was long-standing, large, and noneccentric. In 21% of the eyes, the hyaloid was not visible anterior to the retina but was still adherent to it (group 3A). In the absence of B-scan ultrasonography, these OCT features could be confused with a stage 4 macular hole. No difference in the size of the hole was observed between subgroups. CONCLUSION: OCT can show various aspects of stage 3 macular holes. B-scan ultrasonography was useful for assessing the location of the posterior hyaloid and to distinguish stage 3 from stage 4 macular holes. These features may provide additional information on the pathogenesis of macular hole and may have therapeutic implications.