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Purpose: Choroidal vascular hyperpermeability (CVH) on indocyanine green angiography (ICGA) is a hallmark feature of central serous chorioretinopathy (CSC). We identified three distinct CVH phenotypes in CSC: uni-focal indistinct signs of choroidal hyperpermeability (uni-FISH) with one focal area of CVH, multiple areas of focal CVH (multi-FISH), and diffuse hyperpermeability covering most of the posterior pole (DISH). This report investigates the distribution of these phenotypes and their association with signs of disease chronicity., Methods: The CERTAIN study is a monocentric, retrospective study on consecutive CSC patients referred to a large tertiary referral centre that underwent ultra-widefield (UWF) and 55° ICGA. Two independent graders assessed CVH patterns based on mid- to late-phase UWF and 55° ICGA with a third grader acting as referee., Results: Of the 167 eyes of 91 patients included in this study, 43 (26%) showed uni-FISH, 87 (52%) multi-FISH, and 34 (20%) showed DISH based on UWF ICGA. Median age (40 vs. 45 vs. 57; p < 0.001) and logMAR visual acuity (0 vs. 0 vs. 0.1, p < 0.001) differed significantly in-between groups, as did the occurrence of cystoid retinal degeneration (PCRD; 0% vs. 1% vs. 18%, p < 0.001) or diffuse atrophic RPE alterations (DARA; 0% vs. 17% vs. 29%, p < 0.001). The same was true when grading was based on 55° ICGA., Conclusions: The CVH patterns of uni-FISH, multi-FISH, and DISH are typical of CSC. These patterns correlate with established signs of CSC chronicity. Their predictive role in treatment response and prognosis remains to be evaluated., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: The role of the choroid in Leber hereditary optic neuropathy (LHON) remains unclear. The literature is scarce, with conflicting results and lacks axial length measurements. Therefore, we aimed to analyse the choriocapillaris (CC) vessel density (VD) and choroidal thickness (ChT) in all stages of LHON using swept source (SS) technology and considering the possible influence of axial length on choroidal parameters., Methods: This was a prospective cross-sectional observational study. A total of 119 eyes of 60 patients with molecularly confirmed LHON across all stages and 120 eyes of 60 control participants were included. We obtained the CC VD using optical coherence tomography angiography maps centred on the fovea. ChT was measured from the Bruch's membrane to the choroid-sclera interface in the macular and peripapillary regions., Results: The CC VD was not significantly affected in any sector or average, except for a slight change in the superior region of chronic eyes (52.08 ± 1.62% vs. 53.50 ± 2.29%, p = 0.002). ChT demonstrated a trend towards decreased values in asymptomatic eyes and increased values in the symptomatic stages that failed to reach statistical significance in sectors corresponding to the papillomacular bundle except for the macular nasal inner sector of chronic eyes (281.10 ± 67.12 μm vs. 252.08 ± 70.55 μm, p = 0.045). No significant correlations were observed between visual acuity and CC VD or ChT., Conclusion: The CC VD remained stable across the LHON stages. Choroidal vasculature does not appear to play a role in LHON pathophysiology. Further research is needed on ChT as a potential biomarker of LHON., (© 2023 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role., (© 2022 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To investigate whether the efficacy of anti-vascular endothelial growth factor (VEGF) monotherapy for polypoidal choroidal vasculopathy (PCV) differs between pachychoroid and non-pachychoroid phenotypes in the long term., Methods: This retrospective longitudinal study included 115 treatment-naïve eyes in 115 consecutive patients with symptomatic PCV who were treated with anti-VEGF monotherapy and were followed up for 5 years. Eligible eyes were assigned to either a pachy-PCV group, with a pachychoroid phenotype, or a non-pachy-PCV group, without a pachychoroid phenotype. Best-corrected visual acuity (BCVA) and other parameters over a 5-year period were compared between the groups., Results: Forty-eight eyes and 67 eyes were classified into the pachy-PCV and non-pachy-PCV groups respectively. Baseline and 5-year BCVA (logarithm of the minimum angle of resolution) were 0.19 ± 0.20 and 0.16 ± 0.28 in the pachy-PCV group, respectively, and 0.25 ± 0.26 and 0.26 ± 0.36 in the non-pachy-PCV group respectively. BCVA did not change significantly in either group (p = 0.18 and 0.08 respectively). BCVA did not differ between the groups at any observation time-point. Subfoveal choroidal thickness (SFCT) at baseline and at 5 years was significantly higher in the pachy-PCV group than in the non-pachy-PCV group (both p < 0.001); however, the mean rate of decrease in SFCT did not differ in either group over the 5-year period (22% vs. 23%, p = 0.81)., Conclusion: Our findings suggest that anti-VEGF monotherapy was similarly effective for pachychoroid- and non-pachychoroid-phenotype eyes with PCV, for at least 5 years, although further studies are required., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Axial myopia is characterized by a thinning of the choroid. We examined whether the myopic choroidal thinning also includes a thinning of the choriocapillaris., Methods: Using light microscopy, we measured thickness and density of the choriocapillaris at the posterior pole, posterior pole-equator midpoint (PPEMP), equator and close to the ora serrata on histological sections of 58 enucleated human globes (mean age: 62.4 ± 17.8 years; range: 24-88 years; mean axial length: 27.8 ± 4.0 mm; range: 22.0-37.0 mm)., Results: Choriocapillaris thickness decreased (p < 0.001) from the posterior pole (median: 3.9 µm; interquartile range (IQR): 3.3-6.0) to the equator (median: 2.7 µm; IQR: 1.5, 4.2). It was not significantly associated with axial length, neither at the posterior pole (p = 0.25), the PPEMP (p = 0.81), equator (p = 0.80) or ora serrata (p = 0.50). Mean choriocapillaris density decreased from the posterior pole to the equator (198 µm/300 µm; IQR: 152/300, 246/300 versus 156 µm/300 µm; IQR: 72/300, 216/300; p < 0.001). Choriocapillaris density was not significantly associated with axial length (posterior pole: p = 0.07; PPEMP: p = 0.33; equator: p = 0.22; ora serrata: p = 0.36)., Conclusions: The choriocapillaris thickness and density, decreasing from the posterior pole to the fundus periphery, were not significantly associated with axial length. These findings may be of interest for the understanding of high myopia and pathologic myopia., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: The ocular choroid is a sensitive biomarker of vascular perfusion in optic neuritis (ON) patients due to its vascular structures. The purpose of this study was to evaluate alterations in sub-macular choroidal thicknesses (sub-MCT) in aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) sero-positive neuromyelitis optica spectrum disease (AQP4-IgG+/NMOSD) and isolated ON (ION) patients using optical coherence tomography (OCT)., Methods: A total of 208 ON patients (275 eyes) and healthy controls (HCs) who underwent sub-MCT and retinal microstructure detection with OCT were enrolled in this study., Results: Among all the ON patients, 102 (49.0%) cases were identified as serum AQP4-IgG-positive, with 106 (51.0%) cases being negative, excluding multiple sclerosis as the ION cohort. The sub-MCT in the AQP4-IgG+/NMOSD patients decreased in 0-6 months after ON attacks. However, for the ION cohort, the sub-MCT decreased in 0-2 months and then stayed normal or slightly increased in 2-4 months after the first ON attack, finally sharply decreasing after 6 months. For unilateral AQP4-IgG+/NMOSD patients, eyes without ON also presented retinal layer thinning and sub-MCT slight reduction independent of ON attacks., Conclusions: The sub-MCT in AQP4-IgG+/NMOSD patients were reduced at all stages of ON, which distinguished the ION patients as decreasing only at chronic stage of ON. It implied that ocular vascular hypoperfusion plays a potential role in ON pathogenesis and the different patterns could be caused by the distinct pathogenesis of AQP4-IgG+/NMOSD and ION., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the long-term follow-up of patients with a circumscribed choroidal hemangioma (CCH) treated with limited single spot photodynamic therapy (PDT) at the Amsterdam University Medical Center, location AMC (AUMC)., Methods: This cross-sectional study included 17 patients, treated between 2001 and 2012. Evaluation included best corrected visual acuity, slitlamp examination, fundoscopy, ophthalmic ultrasonography (USG), fluorescein/indocyanine green angiography (FA/ICG), fundus autofluorescence (FAF) and optical coherence tomography (OCT)., Primary Outcome: recurrence rate, secondary outcomes: long-term functional and structural changes., Results: An unexpected high recurrence rate of 35% (n6) was found with a mean follow-up time between treatment and recurrence of almost 6 years, range 2.8-10.7 years. With a recurrence, the classical CCH pattern was no longer recognizable on FA or ICG. Signs of leakage were best observed with OCT, and the recurrence could be confirmed with USG. Retreatment with PDT of all recurrences was successful. After a successful initial PDT, the achieved visual acuity (VA) showed a small decrease over time, median VA from 0.10 LogMar to 0.15 LogMar (p 0.09) after a mean follow-up of 11.36 years (range 5.1-15.5 years). During follow-up study visit, the OCT revealed a slightly increased thickness of the choroid in 86% of cases at the site of the original tumour, without a clear correlation to the recurrences., Conclusion: Limited single spot PDT is a safe and effective treatment for CCH preserving a good VA. However, because of the relatively high recurrence rate found in this study, we recommend regular follow-up with OCT every 6 months., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To assess geographic atrophy (GA) using a multimodal imaging approach, focusing on alterations at the level of the retinal pigment epithelium (RPE) and the choriocapillaris (CC) layers, by lesion demarcation, and assessment of morphological alterations within the atrophic area and in the transition zone., Methods: Fifty-seven eyes of 34 patients with atrophic age-related macular degeneration (AMD) were included in this prospective, observational, cross-sectional study. Multimodal imaging using wide-field polarization-sensitive optical coherence tomography (PS-OCT), optical coherence tomography angiography (OCT-A) and fundus autofluorescence (FAF) was performed. The images were overlaid and used to analyse and compare alterations in the retina and the CC., Results: Mean atrophic lesion size was 8.15 mm 2 (range: 2.23-17.23 mm 2 ). In 52 of 57 eyes (91%), OCT-A displayed focal hypodense areas at the CC level in the transition zone of GA, as well as increased focal depolarizing material (e.g. melanin-containing structures) showed in PS-OCT en face depolarizing material maps. These regions of increased depolarizing material at the transition zone corresponded to the hypodense areas on OCT-A scans. All 57 eyes presented with abnormal FAF patterns at the transition zone. All 57 eyes showed distinct alterations of CC flow pattern architecture. Six eyes (11%) demonstrated reduced and three eyes (5%) a complete loss of CC flow pattern architecture across the entire area of GA, while 48 of 57 eyes (84%) presented with irregular mixed patterns of different focal alterations of CC flow architecture within the area of GA. Reduced CC patterns exceeding GA lesion margins into the transitional zone were found in all eyes., Conclusions: Optical coherence tomography angiography images revealed different degrees of flow impairment within the atrophic lesion area and its transition zone. Alterations in RPE morphology and tissue integrity resulting in accumulation of depolarizing material, such as melanin, could result in misinterpretation of OCT-A imaging in areas in the shadow of depolarizing material. These changes seem to be partially independent from autofluorescence altering processes., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To determine the relationships among retinal/choroidal thickness, retinal microvascular network and visual field in high myopia., Methods: This cross-sectional study included a total of 62 subjects, comprising 31 eyes with high myopia and 31 eyes with emmetropia or low myopia. Optical coherence tomography was used to quantify the thickness of ganglion cell complex (GCC), inner nuclear layer and outer plexiform layer (INOPL), outer retinal layer (ORL) and choroid layer (ChL). Optical coherence tomography angiography was used to quantify the superficial vessel density (SVD) and deep vessel density (DVD). Retinal light sensitivity (RLS) was measured by microperimetry-1 (MP1). The inner ring (1-1.75 mm), the outer ring (1.75-2.5 mm) and the whole ring (1-2.5 mm) around the macula were analysed and compared between the two groups. Pearson correlation analysis was performed to analyse the relationship among them., Results: In the highly myopic group, the thinning of retinal/choroidal thickness and the decrease in retinal vessel density and RLS were found when compared to the emmetropia or low myopia (p < 0.05). Decreased RLS was correlated with decreased ORL thickness (r = -0.469, p = 0.008) and choroid thickness (r = 0.398, p = 0.030). There was no correlation between retinal microvascular network parameters and RLS (p > 0.05), but DVD showed a negative correlation with ORL (r = -0.474, p = 0.007)., Conclusion: Early visual field defects in highly myopic eyes may be influenced by the ORL loss and defect of choroidal circulation. The deep retinal microvascular network may have a compensatory action in the hypoxic setting of high myopia., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To study the characteristics of choroid thickness (CT) of the optic disc and macula in children with type 1 diabetes mellitus (T1DM) without visual impairment and diabetic retinopathy (DR) and analyse associated factors., Methods: A square area of 6 × 6 mm around the centre of the optic disc and macula was scanned. The indices analysed mainly included CT at the macular centre (1 mm), and temporal, superior, nasal or inferior aspect of the inner ring (1-3 mm) and outer ring of (3-6 mm) optic disc and macula. Independent risk factors were analysed using multifactor linear regression., Results: A total of 44 children with T1DM and 48 healthy subjects were enrolled. The diabetic group showed significant increase in the inferior inner ring of parapapillary CT (100.99 ± 30.42 μm versus 89.41 ± 34.00 μm, p = 0.04) and nasal outer ring of parapapillary CT (157.02 ± 47.35 μm versus 131.15 ± 35.17 μm, p = 0.01) as compared to those values in the healthy controls. Spherical equivalent refraction and family history of hypertension are independent factors of both peripappillary choroid thickness (PPCT) and macular choroid thickness (PMCT). Spherical equivalent refraction (p = 0.01) and serum cholesterol (p = 0.03) were independent factors of the inferior inner ring of parapapillary CT, whereas family history of hypertension was an independent factor of the nasal outer ring of parapapillary CT (p = 0.001)., Conclusion: In children with diabetes without DR or visual impairment, the CT increase in nasal outer ring of parapapillary (PPNO) and the inferior inner ring of parapapillary (PPII) may be the characteristic pre-DR alteration at the early stage of DM. For children with higher serum cholesterol and family history of hypertension, the change of the nasal outer ring of parapapillary CT and the inferior inner ring of parapapillary CT may be more advanced., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To assess dimensions and associations of the peripapillary border tissue of the choroid (PBT-C) and peripapillary scleral flange (PBT-S)., Methods: The histomorphometric investigation included histological sections of enucleated eyes of Caucasian patients. Using light microscopy, the PBT dimensions were measured., Results: The study included 85 eyes (85 patients) with an age of 62.0 years (14.1 years) (mean (SD)) (range:37-87 years) and mean axial length of 26.7 mm (3.5 mm) (range:21.0-37.0 mm). Thicker PBT-C thickness (mean: 68.8 μm (35.7 μm)) was associated with shorter axial length (p < 0.001; standardized regression coefficient beta: -0.50), and longer PBT-C length (mean: 531 μm (802 μm)) was correlated with longer axial length (p < 0.001;beta:0.66). PBT-C cross-sectional area (mean 17 050 μm 2 (10 420 μm 2 )) was not significantly associated with axial length (p = 0.37). Decreasing with longer axial length (p < 0.001;beta:0.64), the angle between PBT-C and Bruch's membrane was approximately 90° in non-highly myopic eyes without overhanging Bruch's membrane (BM), it ranged between 100° and 180° in eyes with BM overhanging into the intrapapillary region, and it was close to 0° in eyes with parapapillary gamma zone. Thicker thickness of PBT-S (mean:83 μm (21 μm)) was correlated with presence of glaucoma (p = 0.02). Optic nerve pia mater thickness (mean:109 μm (44 μm)) increased with glaucoma presence (p = 0.046;beta:0.31) but not with axial length (p = 0.34)., Conclusions: Peripapillary border tissue of the choroid (PBT-C) and PBT-S as continuation of the optic nerve pia mater are distinct structures, with PBT-C remodelling during myopic axial elongation and PBT-S being mostly independent of axial elongation. PBT-C and PBT-S may be of importance for the optic nerve head biomechanics and PBT-C for separation of the choroidal space from the intrapapillary compartment., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background and Objectives: Gene-therapy, stem-cell transplantation and surgical robots hold the potential for treatment of currently untreatable retinal degenerative diseases. All of the techniques require entry into the subretinal space, which is a potential space located between the retina and the retinal pigment epithelium (RPE). Knowledge about obstacles and critical steps in relation to subretinal procedures is therefore needed. This thesis explores the functional and histological consequences of separation of the retina from the RPE, extensive RPE damage, a large cut in the retina (retinotomy) and RPE phagocytosis in a porcine model., Methods: Experiments were performed in 106 female domestic pigs of Danish landrace distributed over five studies. Under general anesthesia, different procedures for expansion of the subretinal space were conducted. Outcomes were visual function measured electrophysiologically with multifocal electroretinogram (mfERG) and retinal morphology examined histologically. Study I: The effect of anesthesia on mfERG was examined by repeated recordings for 3 hr in isoflurane or propofol anesthesia. Outcome was mfERG amplitude. Study II: Consequences of a large separation of the photoreceptors from the RPE were examined by injecting a perfluorocarbon-liquid (decalin) into the subretinal space. Two weeks after, in a second surgery, decalin was withdrawn. Outcomes were mfERG and histology 4 weeks after decalin injection. Study III: Extensive RPE damage was examined by expanding the subretinal space with saline and removing large sheets of RPE-cells through a retinotomy. Outcomes were mfERG and histology 2, 4 and 6 weeks after the procedure. Study IV: Consequences of a large retinotomy were examined by similar procedures as in Study III, but in study IV only a few RPE cells were removed. Outcomes were mfERG and histology 2 and 6 weeks after surgery. Study V: Clearance of the subretinal space was examined by injecting fluorescent latex beads of various sizes into the subretinal space. Outcome was histologic location of the beads at different time intervals after the procedure., Results: Study I: MfERG amplitudes decreased linearly as a function of time in propofol or isoflurane anesthesia. Duration of mfERG recording could be decreased without compromising quality, and thereby could time in anesthesia be reduced. Study II: MfERG and histology remained normal after reattachment of a large and 2-week long separation of the photoreceptors and RPE. Repeated entry into the subretinal space was well tolerated. Fluid injection into the subretinal space constitutes a risk of RPE-damage. Study III: Removal of large sheets of retinal pigment epithelial cells triggered a widespread rhegmatogenous-like retinal detachment resulting in visual loss. Study IV: A large retinotomy with limited damage of the RPE was well tolerated, and visual function was preserved. Study V: Subretinal latex beads up to 4 μm were phagocytosed by the RPE and passed into the sub-RPE space. Beads up to 2 μm travelled further through the Bruch's membrane and were found in the choroid, sclera and inside blood vessels., Conclusion: A large expansion of the subretinal space, repeated entry, a large retinotomy and limited RPE damage is well tolerated and retinal function is preserved. Subretinal injection of fluid can damage the RPE and extensive RPE damage can induce a rhegmatogenous-like retinal detachment with loss of visual function. Foreign substances exit the subretinal space and can reach the systemic circulation., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To determine the influence of baseline myopic macular degeneration (MMD) severity on outcomes with intravitreal aflibercept (IVT-AFL) in patients with myopic choroidal neovascularization (CNV)., Methods: MYRROR was a randomized, double-masked study in patients with myopic CNV treated with IVT-AFL/sham over 48 weeks. At baseline/week 48, images were retrospectively graded for MMD., Results: At baseline, 115 eyes had a valid MMD grading result; at week 48, grading results were available for 99 eyes [IVT-AFL (n = 78)/sham (n = 21)]. Severity of baseline MMD was distributed as follows: category 1: 19/115 (17%); category 2: 67/115 (58%); category 3: 22/115 (19%); category 4: 7/115 (6%). Higher MMD category was associated with older age (nominal p = 0.007) and longer axial length (nominal p = 0.025). At week 48, patients in the mild and severe groups had visual acuity gains of +13.5 and +12.4 letters, respectively. Baseline MMD severity did not significantly affect visual/anatomical outcomes or number of treatments. Visual Functioning Questionnaire-25 scores improved more in mild (+5.6) versus severe (+0.4) MMD (nominal p = 0.03). There were no new safety events., Conclusions: Visual acuity gains, morphological outcomes and dosing frequency were not affected by baseline MMD severity in patients treated with IVT-AFL. A benefit with IVT-AFL treatment was observed for all baseline MMD stages included in this study., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: 'Type A' behavioural characteristics and psychosocial stress have traditionally been associated with chronic central serous chorioretinopathy (cCSC). However, a characteristical personality profile could not be identified in these patients and the presumed association with stress is subject to controversy, due to a lack of convincing studies using validated measuring instruments. In this study, we aimed to assess maladaptive personality traits, psychological morbidity and coping strategies in patients with cCSC, in order to identify potentially modifiable psychosocial aspects which could be used in support to current standard treatment., Methods: A cross-sectional study in a cohort of 86 patients with cCSC using validated questionnaires. Findings were compared to both Dutch population reference data and reference data from patients treated for Cushing's disease., Results: Maladaptive personality traits were not more prevalent in patients with cCSC than in the general population, and psychological morbidity was not increased. Patients with cCSC were shown to make more use of passive coping, active coping and seeking social support. Interestingly, personality, psychological morbidity and coping characteristics of patients with cCSC were more comparable to features of patients treated for Cushing's disease than to population-based data., Conclusion: Maladaptive personality traits such as type A behavioural characteristics are not more prevalent in patients with cCSC. Patients with cCSC make more use of certain coping strategies, which could be addressed by psychosocial care to improve self-management. Further research is needed establish whether the course of disease can be improved by altering coping and reducing 'stress'., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate changes in subfoveal choroidal thickness (SFChT) during orthokeratology (Ortho-K) lens wear and after its cessation and the association of short-term change in SFChT with the long-term eye elongation in Ortho-K subjects., Design: A prospective clinical trial., Methods: Fifty myopic children aged between 9 and 14 years were enrolled. Twenty-nine subjects continuously wore Ortho-K lens for 12 months and discontinued for 1 month. Twenty-one subjects wearing single vision distance spectacles for 12 months were included as the control group. SFChT was assessed using optical coherence tomography. Ocular parameters, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and apical corneal power (ACP), were also measured., Results: After 12 months of follow-up, AL elongation was larger and SFChT change was smaller in the control group compared to the Ortho-K group (both p < 0.001). In the Ortho-K group, SFChT increased by 16 μm from baseline at the 1-month visit (p < 0.001), and the magnitude of choroidal thickening remained unchanged at the 6- and 12-month visit (p = 0.289). One month after discontinuation of Ortho-K lens, SFChT and ocular parameters of the anterior segment, including ACP, CCT and ACD recovered to baseline level (All p > 0.05), and AL increased by 0.23 ± 0.18 mm compared to baseline (p = 0.018). SFChT change at 1-month was negatively associated with AL change at 13-month (standard β, -0.581, p = 0.001) after adjusting for other influencing factors, including baseline age and the ocular parameters., Conclusion: Subfoveal ChT (SFChT) significantly increased after short-term Ortho-K lens treatment and the increase maintained throughout the period of treatment. One month after Ortho-K lens cessation, SFChT, ACP, CCT and ACD returned to baseline. Short-term response in SFChT is associated with long-term change in AL in children undergoing Ortho-K lens and may be a predictor for the effectiveness of the treatment., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To explore the subfoveal thickness of sclera (SST), choroid (SCT) and retina (SRT) as well as their relationship in healthy Chinese children with varying levels of refractive error., Methods: A total of 810 healthy Chinese schoolchildren and adolescents underwent a series of comprehensive ocular examinations, as well as swept-source optical coherence tomography (OCT) after induced cycloplegia. The thicknesses of the sclera, choroid and retina below the central fovea were measured manually, and each measurement was compared across different refractive statuses. Independent factors associated with the thickness of each layer were analysed., Results: The mean SST, SCT and SRT were 524 ± 57 μm, 195 ± 49 μm and 224 ± 19 μm, respectively. The SSTs and SCTs of myopes were significantly thinner than those of emmetropes and hyperopes (all p < 0.001). Although the choroid seemed to be thicker in hyperopes (225 ± 46 μm) than in emmetropes (211 ± 45 μm), no statistically significant difference was observed between emmetropes and hyperopes in the sclera and choroid. Thinner SSTs and SCTs were associated with greater levels of myopia, whereas the SRT was similar in children with different myopic levels. SST (p < 0.001) and SCT (p = 0.003) as well as age (p < 0.001), sex (p < 0.001) and axial length (p < 0.001) were independently associated with spherical equivalent refraction (SER). Older age (p = 0.013), myopic-shifted SER (p < 0.001), thicker SCT (p < 0.001) and thinner SRT (p = 0.012) were independently associated with a thinner SST., Conclusion: The subfoveal sclera and choroid were thinner in myopes than in emmetropes and hyperopes, while the retina remains constant. Age, refractive error and choroidal and retinal thicknesses are related to subfoveal scleral thickness., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica.)

Purpose: To describe the change in the retinal morphology after full macular translocation (FMT) for exudative age-related macular degeneration (AMD) and identify predictive factors for the visual outcome., Methods: All patients who underwent FMT from December 2008 through July 2013 were selected. Exclusion criteria were FMT for other disease than AMD, age <60 years, <12 months of follow-up or no available images. Spectral domain optical coherence tomography, fundus autofluorescence, fluorangiography and indocyanine green angiography were evaluated., Results: In total, 51 patients were included with a mean follow-up of 30 months. The presence of the external limiting membrane (ELM) was a significant predictor for a favourable visual outcome 1 year after FMT (OR = -0.30). Other significant predictive factors were the absence of intraretinal fluid (OR = 0.28) and the mixed choroidal neovascularization type (OR = -0.47), whereas nonresponders (OR = 0.41) and fibrotic lesions (OR = 0.35) were less likely to have a good visual function after surgery., Conclusion: Full macular translocation (FMT), that permits to relocate the diseased macula onto an area of unaffected retinal pigment epithelial and choroid, can restore the anatomy and visual function in some patients with AMD when the outer retina layers are not irreversibly damaged. The presence of the ELM seems to be the most reliable factor in predicting the functional outcome., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: Tissue inhibitor of metalloproteinase (TIMP) is known to play a role in age-related macular degeneration (AMD). We wished to investigate alterations in different late stages of AMD: neovascular AMD and geographic atrophy (GA)., Methods: This was a prospective case-control study. A total of 125 participants were included consecutively during a period of 18 months. We included 46 patients with neovascular AMD, 46 patients with GA without any sign of choroidal neovascularization in either eye, and 33 healthy aged controls. Patients with immune-affecting disorders were not included. Commercial immunoassay kits were used to quantify levels of TIMP-1, TIMP-3, MMP-2 and MMP-9 in blood plasma., Results: We found that patients with neovascular AMD had lower plasma concentration of TIMP-3 (p = 0.028) than healthy controls. Patients with GA had higher plasma levels of TIMP-1 (p < 0.001) and MMP-9 (p = 0.022) compared to healthy controls. Also, we found that TIMP-1 levels in patients with GA increased with age (Spearman's rho = 0.04, p = 0.006)., Conclusion: Matrix metalloproteinases (MMPs) and TIMPs, which are known to be involved in age-related changes in Bruch's membrane, are significantly altered systemically, suggesting the presence of an imbalance in the homeostasis of the extracellular matrix. These imbalances may explain differences in the clinical manifestation of late AMD., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To study peripapillary choroidal thickness (PPCT) around the optic disc and establish zones using a new swept source optical coherence tomography (SS-OCT) device. To evaluate PPCT differences between patients with multiple sclerosis (MS) and age- and sex-matched healthy controls., Methods: A total of 102 healthy subjects and 51 patients with MS were consecutively recruited. Healthy subjects were divided into teaching (n = 51, used to establish choroidal zones) and validating (n = 51, used to compare measurements with MS patients) populations. An optic disc 6.0 × 6.0-mm three-dimensional scan was obtained using SS-OCT Triton. A 26 × 26 cube-grid centred on the optic disc was generated automatically to measure PPCT. Four choroidal zones were established and used to compare PPCT between healthy controls and patients with MS., Results: Peripapillary choroidal thickness (PPCT) was significantly thinner in patients in all concentric zones (p ≤ 0.0001): 134.02 ± 16.59 μm in MS group versus 171.56 ± 12.43 μm in the control group in zone 2; 182.23 ± 20.52 versus 219.03 ± 17.99 μm, respectively, in zone 3; and 223.52 ± 10.70 versus 259.99 ± 10.29 μm, respectively, in zone 4. The choroidal thinning in the MS group tended to decrease as we distanced from the optic nerve head. Peripapillary choroidal thickness (PPCT) had a similar pattern in controls and MS; it was thicker in the superior region, followed by temporal, nasal and inferior regions., Conclusion: Patients with MS showed peripapillary choroidal thinning when compared with healthy subjects in all zones around the optic disc. Peripapillary choroidal tissue shows a concentric pattern, increasing in thickness when increasing the distance from the optic nerve. The new SS-OCT could be useful for evaluating choroidal thinning in clinical practice., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To assess choroidal structural changes in patients with retinal dystrophies using choroidal vascularity index (CVI), a novel optical coherence tomography (OCT) based tool., Methods: This retrospective study included 26 patients with retinal dystrophies (17 with retinitis pigmentosa, four with Stargardt disease, three with cone-rod dystrophy, one each with Best disease and Bietti crystalline dystrophy) and 32 healthy controls. Subfoveal OCT images were used for analysis. Mean CVI was compared between retinal dystrophy and control group, as well as among the retinal dystrophy subgroups., Results: Mean CVI in eyes with retinal dystrophies was 52 ± 9% and it was significantly lower compared to that in normal eyes (70 ± 3%, p < 0.001). The differences among subgroups of retinal dystrophy were not statistically significant (p = 0.084). All types of retinal dystrophy were associated with lower CVI (all p < 0.001), after adjusting for age, gender, visual acuity and duration of symptoms. Older age was also shown to be independently associated with lower CVI (p = 0.012). Gender, visual acuity (VA) and duration of symptoms did not significantly affect CVI., Conclusion: Decreased choroidal vascularity was seen in eyes with retinal dystrophies. (CVI) may be a helpful tool in monitoring choroidal involvement in retinal dystrophies., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate fundus abnormalities in Vogt-Koyanagi-Harada (VKH) disease by a noninvasive tool, multispectral imaging (MSI)., Methods: A total of 77 patients with VKH and 163 healthy controls were enrolled between January and April 2015. The MSI findings were evaluated in combination with fundus fluorescein angiography (FFA), optical coherent tomography (OCT) and fundus photography (FP). Additionally, we compared extent of exposure of choroidal blood vessels between patients with VKH and healthy controls to evaluate retinal transmission function., Results: A number of features could be recognized by MSI which included (i) general depigmentation, (ii) clumping of pigment and (iii) macular depigmentation and/or hyperpigmentation. The percentages of these three abnormalities discovered by MSI in 52 inactive VKH patients with a duration of more than 2 months in VKH were 67.3%, 75% and 84.6% respectively, which were all significantly higher than those detected by FFA, OCT or FP (p = 0.0398, p < 0.0001). Our study showed that MSI detected a higher percentages of these four abnormalities in patients with sunset glow fundus than in patients without this phenomenon (p = 0.0492, p < 0.0001). Additionally, at the same wavelength (590 nm), exposure of choroidal blood vessels in inactive patients was stronger than in healthy controls and active patients (p < 0.01, p < 0.001)., Conclusion: Our results show that MSI is a sensitive noninvasive method to investigate the retinal pigment epithelium (RPE) in VKH disease. It is more likely to detect RPE abnormalities with MSI than when using FFA, OCT or FP. Retinal transmission function in inactive patients is stronger than that observed in active patients or healthy controls., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate factors associated with choroidal microcirculation in the peripapillary chorioretinal atrophy (PPA) zone in eyes with normal-tension glaucoma (NTG) and myopic disc., Methods: In 100 eyes of 100 NTG patients with myopic disc and 20 eyes of 20 age-matched myopic controls, 4.5 × 4.5 mm scans were made of the optic nerve head with optical coherence tomography angiography (OCTA). Peripapillary chorioretinal atrophy (PPA) area and PPA superficial choroidal image intensity (PPA-CI) were calculated with image j software. Clinical characteristics, laser speckle flowgraphy-measured mean blur rate in the temporal tissue area (temporal MT), the central thresholds (the averaged standard automated perimetry-measured visual field thresholds in the four paracentral points) and 3D-OCT-measured ganglion cell complex thickness in the papillomacular bundle (PMB-GCCT) were recorded., Results: The NTG patients had significantly lower intraocular pressure, PMB-GCCT and central threshold values, and a larger PPA area, than the controls. The area under the receiver operating characteristics curve to differentiate NTG with parafoveal scotoma (PFS) from controls was 0.76 for temporal MT, 0.85 for PPA-CI and 0.87 for PMB-GCCT. Univariate and multivariate analyses revealed that PPA-CI was negatively correlated with age, pulse rate, best-corrected visual acuity, axial length and PPA area, and positively correlated with temporal MT, PMB-GCCT and the central thresholds., Conclusion: Peripapillary chorioretinal atrophy (PPA)-CI was associated with temporal MT, ageing, bradycardia, axial length elongation and changes in central retinal structure and visual function in patients with NTG and myopic disc. Thus, microcirculation deep within the PPA zone might be a clinically useful biomarker of PFS in NTG., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background and Purpose: A population-based Copenhagen birth year 1948 cohort with high myopia recorded since age 14 years (spherical equivalent less than or equivalent to -6 D) has been followed over 50 years. Despite complications, current follow-ups have outlined a better visual prognosis than usually drawn from selected clinical series in the literature. For the present status at age 66 years, focus was on visual ability and choroidal thickness., Methods: Twenty-eight of the original 39 participants were available in 2014. Medical history was updated. Best-corrected visual acuity (BCVA) data were compared with subfoveal choroidal thickness (SFCT), now measured by enhanced depth optical coherence tomography., Results: Due to at least better eye visual acuity (VA), all patients had maintained their everyday visual capacity. Only one participant was marginal regarding visual status for a driver's licence; low vision was not on record. Based on all eyes, choroidal thickness correlated negatively with axial length (AL), which also held for the fraction with high myopia (AL >26.5 mm). In high myopia, the mean choroidal subfoveal thickness was 114 ± 75 μm versus 182 ± 94 μm in lower myopia (p = 0.01)., Conclusion: Despite the generally maintained individual visual capacity in the series, significant correlation could be demonstrated between SFCT and (i) axial elongation and (ii) recorded VA, with a negative and a positive sign, respectively. Overall, the visual prognosis was relatively benign, in particular when compared with the selected high myopia hospital series that predominate in the ophthalmic literature., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the efficacy and safety of eplerenone for chronic nonresolving central serous chorioretinopathy (CSC)., Methods: Prospective, double-blind, randomized placebo-controlled study. Nineteen eyes of 17 patients with persistent subretinal fluid (SRF) due to CSC were enrolled and randomized to receive eplerenone 50 mg/day or placebo for 3 months, followed by a 3-month follow-up. The main outcome measure was change in SRF from baseline to 3 months of treatment. Secondary outcomes included change in SRF at any time-point, complete resolution of SRF, improvement in choroidal thickness and change in best-corrected visual acuity (BCVA)., Results: Thirteen eyes were treated with eplerenone and six with placebo. Both groups showed reduction in SRF throughout the treatment period, with a significant reduction at months 1, 3 and 5 only in the treatment group. Twenty-three per cent in the treatment group and 30.8% per cent in the placebo group experienced complete resolution of SRF. A significant improvement in BCVA was noted in the placebo group at 4 months, as well as a significant difference in BCVA between groups at 3 months in favour of the placebo group (p = 0.005). There was no significant difference in choroidal thickness in either group throughout the study period. No adverse events related to eplerenone were noted in the treatment group., Conclusion: In this study, eplerenone was not found to be superior to placebo in eyes with chronic CSC., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To assess thickness and associations of the peripapillary choroidal layers., Methods: The population-based Beijing Eye Study included 3468 participants with an age of 50+ years. Using spectral-domain optical coherence tomography, we measured the large vessel layer (LVL) and small-to-medium vessel layer (SMVL) of the peripapillary choroid in a circular scan with a diameter of 3.4 mm around the optic nerve head centre at eight locations equidistant (45°) to each other. The ratio of SMVL thickness to LVL thickness was calculated., Results: Measurements were available for 3000 (86.5%) study participants (mean age: 64.4 ± 9.6 years; range: 50-93 years). SMVL (mean thickness: 31 ± 7 μm; range: 17-70 μm) and LVL (103 ± 48 μm; range: 9-313 μm) were thickest superiorly, followed by the temporal region, nasal region, and inferior region. Thicker SMVL was associated (regression coefficient r: 0.33) with younger age (p < 0.001; standardized regression coefficient β: -0.26), higher cognitive function (p = 0.02; β: 0.05), shorter axial length (p < 0.001; β: -0.12), thicker lens (p < 0.001; β: 0.07), smaller disc area (p < 0.001; β: -0.08), smaller parapapillary β/γ zone (p < 0.001; β: -0.10) and lower prevalence of angle-closure glaucoma (p = 0.04; β: -0.04). Thicker LVL thickness was correlated (r: 0.45) with younger age (p < 0.001; β: -0.34) and higher cognitive function (p = 0.01; β: 0.05), shorter axial length (p < 0.001; β: -0.09)), thicker lens (p = 0.009; β: 0.06), smaller disc area (p < 0.001; β: -0.09), smaller parapapillary alpha zone (p = 0.04; β: -0.04), smaller β/γ zone (p < 0.001; β: -0.14) and lower prevalence of angle-closure glaucoma (p = 0.057; β: -0.04). A higher SMVL-to-LVL thickness ratio was related with older age (p < 0.001; β: 0.36), longer axial length (p < 0.001; β: 0.09), lower best-corrected visual acuity (BCVA) (p = 0.002; β: 0.07), larger optic disc area (p < 0.001; β: 0.10) and larger β/γ zone (p < 0.001; β: 0.19)., Conclusion: Small-to-medium vessel layer (SMVL) and LVL, thickest superiorly and thinnest inferiorly, increased with younger age and higher cognitive function after adjusting for axial length and prevalence of angle-closure glaucoma. With older age, longer axial length, larger optic disc area and larger β zone, LVL decreased more than SMVL in thickness. The association between thicker peripapillary choroidal thickness and better cognitive function may deserve further attention., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate systemic leucocyte activity in subtypes of age-related macular degeneration (AMD) and onset of neovascular AMD., Methods: Patients with early and late AMD and age-matched control individuals were recruited consecutively, and venous blood was sampled for differential leucocyte counts. Patients with neovascular AMD were grouped based on time of blood sampling in relation to diagnosis of neovascular AMD: diagnosis of new neovascular AMD more than 30 days before blood sampling, within 30 days of blood sampling and more than 30 days after blood sampling., Results: Of 347 recruited participants, 330 fulfilled the eligibility criteria (77 age-matched controls, 33 with early AMD, 56 with geographic atrophy and 164 with neovascular AMD). We did not find any differences in the differential counts between patients at different stages of AMD and age-matched control individuals. However, lymphocyte and monocytes-basophils-eosinophils mixed (MXD) counts were both significantly increased in patients with new neovascular AMD. Among these patients; higher MXD correlated with lower BCVA, larger central foveal thickness and larger total lesion size; higher lymphocytes correlated with smaller total lesion size; higher neutrophils correlated with CNV lesion size; and higher neutrophil-to-lymphocyte ratio correlated with larger lesion size., Conclusions: Systemic leucocyte activity is associated with onset of CNV in patients with AMD and correlate with lesion size and BCVA, which suggest that acute systemic immune activity may play a role in neovascular flaring of AMD., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare choroidal thickness after vitrectomy between epiretinal membrane (ERM) with and without vitreomacular traction (VMT)., Methods: In this retrospective study, 228 consecutive participants with ERM who underwent vitrectomy were categorized into two groups according to the presence of VMT on spectral domain-optical coherence tomography: VMT group (ERM with VMT, n = 21) and non-VMT group (ERM without VMT, n = 207). The primary outcome was the mean subfoveal choroidal thickness (SFCT) at baseline, and at 3 and 6 months postsurgery., Results: At baseline, the prevalence of VMT in eyes with ERM was 9.6% (21/228), and mean SFCT was greater in the VMT than in the non-VMT group (270.3 ± 93.4 vs. 223.7 ± 82.1 μm; p = 0.015). After surgery, mean SFCT decreased in the VMT group (241.7 ± 92.3 μm at 3 months and 228.8 ± 86.4 μm at 6 months; p < 0.001), but remained unchanged in the non-VMT group (223.6 ± 78.9 μm at 3 months and 223.3 ± 82.6 μm at 6 months; p = 0.696). There were no differences in mean SFCT between the groups at 3 and 6 months after surgery (p = 0.339 and p = 0.772, respectively)., Conclusion: Choroidal thickness was greater in ERM eyes with than without VMT possibly due to direct anteroposterior traction on the retina and choroid, increased vascular endothelial growth factor associated with stress on retinal pigment epithelial cells and inflammation. After vitrectomy, mean SFCT reduced in the eyes with VMT, but not in those without VMT., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To suggest a novel classification of neovascular age-related macular degeneration (AMD) based on optical coherence tomography angiography (OCTA) and to correlate morphological characteristics based on optical coherence tomography (OCT)/OCTA with clinical criteria of disease activity., Methods: A total of 88 eyes with neovascular AMD (14 treatment-naïve, 74 eyes following anti-vascular endothelial growth factor treatment (VEGF)) were examined using the AngioVue OCTA system (Optovue, Inc., Fremont, CA, USA) and evaluated based on vascular morphology. Choroidal neovascularization (CNV)-vessel morphology based on OCTA and associations with retinal layers were described and correlated with clinical markers of disease activity., Results: In treatment-naïve CNV, CNV-vessel morphology based on OCTA showed a dense-net configuration (DN) in 12 of 14 eyes, a loose-net configuration (LN) in one of 14 eyes and an unidentifiable CNV pattern in one of 14 eyes, whereas in treated CNV, DN was registered in 43.2% (32/74), LN in 27% (20/74), DN with additional LN (mixed type) in 14.9% (11/74) and an unidentifiable CNV pattern in 14.9% (11/74). Clinical correlations revealed a significantly longer disease duration for LN with a median value of 4.3 years compared to DN with 2.0 years (p = 0.009) and for CNV involving the outer retina with 3.1 years compared to CNV not involving the outer retina with 1.9 years (p = 0.051)., Conclusion: Optical coherence tomography angiography (OCTA) allows identification of distinct CNV-specific vascular patterns at the level of the outer retinal layer and choriocapillaris. Correlation with clinical and functional parameters may be useful to better understand pathophysiological mechanisms and guide efficient therapeutic strategies., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate the influence of choroidal thickness (CT) on visual acuity (VA) in young persons with extremely high myopia., Methods: We conducted a case-control study of young men with extremely high myopia and controls with emmetropia recruited from a mandatory medical eye review for employment purposes. Retinal and choroidal imaging was performed using enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT)., Results: We included 105 extremely high myopic subjects with spherical equivalent (SE) -10 dioptre (D) or worse and 50 emmetropic subjects with SE less than 0.5 D. The mean SE was -11.56 ± 2.04 D (range, -10 to -23 D) for myopic group and 0.14 ± 0.25 D for emmetropic group. The mean age of included myopic and emmetropic subjects was 21.51 ± 1.22 years and 21.96 ± 0.89 years, respectively. In the univariate analysis, subfoveal CT was significantly associated with best-corrected visual acuity (BCVA) (β = -0.039, p = 0.015). However, in the multiple linear regression analysis, after adjusting for SE and presence of any pathological myopia lesions such as posterior staphyloma, lacquer cracks or chorioretinal atrophy, subfoveal CT was not independently associated with BCVA (p = 0.937)., Conclusion: Extremely high myopic eyes had thinner choroid, but CT was not an independent predictor of VA. Other factors related to myopia are likely responsible for the diminished VA in young extremely high myopic eyes., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To measure the juxtapapillary choroidal thickness in eyes with normal-tension glaucoma (NTG) and to compare it with healthy eyes., Methods: Twelve radial B-scan images of the optic nerve head (ONH) were obtained from 96 patients with NTG and 48 healthy subjects matched by age using swept-source (SS) optical coherence tomography (OCT). The juxtapapillary choroidal thickness was defined as the average choroidal thickness within 500 μm from the border tissue of Elschnig. Choroidal thinning in patients with NTG was assessed by calculating the relative choroidal thickness, defined as the ratio of the measured juxtapapillary choroidal thickness in each meridian to the corresponding value in age-matched healthy controls. Retinal nerve fibre layer (RNFL) damage as reflected by circumpapillary RNFL thickness (measured using spectral-domain OCT) was also assessed., Results: The juxtapapillary choroid was significantly thinner in NTG eyes than in healthy control eyes in the inferotemporal and superotemporal sectors. The relative choroidal thinning was topographically associated with the hemispheric location of dominant RNFL damage. The average juxtapapillary choroidal thickness was not associated with either the global RNFL thickness or the visual field mean deviation. Age and untreated intraocular pressure were significantly associated with the juxtapapillary choroidal thickness in NTG eyes in both univariate and multivariate analyses (all p < 0.05)., Conclusions: Decreased microvascular circulation in the ONH as a result of juxtapapillary choroidal thinning could be an important part of the pathogenesis of optic nerve damage in NTG., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the changes of peripapillary and subfoveal choroidal thickness (CT) after trabeculectomy., Methods: Prospective longitudinal study included 37 eyes with open-angle glaucoma. The subfoveal and peripapillary CT was measured using enhanced depth imaging spectral domain optical coherence tomography before trabeculectomy and 1 week, 3 and 6 months postoperatively. The associations between changes in the CT, intraocular pressure (IOP) and axial length were analysed., Results: The medium subfoveal CT (IQR) increased from 182 (97) μm at baseline to 267 (107) μm 1 week, 213 (97) μm 3 months and 207 (91) μm 6 months postoperatively (p < 0.001). The peripapillary CT increased in all four quadrants at all follow-ups (p < 0.05). The subfoveal and peripapillary choroidal thickening correlated with the magnitude of IOP reduction (p < 0.05) and axial length shortening (p < 0.01) during whole follow-up period. There was a peripapillary CT increase of 2.9 μm per mmHg of IOP reduction (p < 0.001, CI 1.5-4.4) and 4.8 μm per mm of baseline axial length (p = 0.049, CI 0.03-9.6) 1 week postoperatively after adjustment for baseline IOP. Six months postoperatively, the decrease in axial length was the only factor associated with peripapillary choroidal thickening (p = 0.031; regression coefficient: 73.29 μm/mm, CI 7.1-139.5)., Conclusion: Intraocular pressure (IOP) reduction after trabeculectomy caused the increase in subfoveal and peripapillary CT for at least 6 months postoperatively correlating with greater IOP reduction and axial length shortening. In the long term, the decrease in axial eye length, but not IOP, was the only factor to be associated with peripapillary choroidal thickening., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To search for histomorphometric differences between eyes with primary high myopia (PHM) or secondary high axial myopia (SHM) caused by congenital glaucoma, and non-highly myopic eyes (NHM)., Methods: Histologic anterior-posterior sections were histomorphometrically examined., Results: The investigation included 58 human globes (mean age: 61.5 ± 18.5 years; axial length: 27.3 ± 4.0 mm; range: 21.0-39.0 mm). Bruch's membrane thickness was thinner in SHM than in PHM (posterior pole: p = 0.007; parapapillary region: p = 0.007); midpoint posterior pole/equator = 0.05) and thinner in SHM than in NHM (all p < 0.04), while PHM and NHM did not differ (all p > 0.50). Choroidal thickness did not differ (all p ≥ 0.40) at any measurement location between SHM and PHM, and was thinner (p < 0.05) in both myopic groups than in NHM. Posterior sclera was thinner (p < 0.001) in both myopic groups than in NHM, with no significant difference between both myopic groups. Pars plana scleral thickness was thinner (p = 0.02) in SHM than in PHM after adjusting for axial length. Scleral volume (p = 0.41) and choroidal volume (p = 0.74) did not differ between any of the groups., Conclusions: Thinning of Bruch's membrane overall is typical for SHM while eyes with PHM have a normal Bruch's membrane thickness. It may point to Bruch's membrane as an active part in the process of emmetropization/myopization. SHM in contrast to PHM showed scleral thinning in the pars plana region suggesting that the process of emmetropization/myopization takes place posterior to the pars plana. Both SHM and PHM unspecifically showed an axial length associated with thinning of choroid and posterior sclera, while both myopic groups did not differ with NHM in choroidal and scleral volume., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare lamina cribrosa (LC) and choroidal thicknesses using enhanced depth imaging optical coherence tomography (EDI-OCT) in patients with Parkinson's disease (PD) and healthy controls., Methods: A total number of 44 eyes of 22 patients with PD and 50 eyes of 25 healthy subjects were utilized in this institutional cross-sectional study. After a complete ophthalmic examination, all eyes were imaged with OCT (RTVue-100 version 5.1 Fourier-domain optical coherence tomography; Optovue Inc., Fremont, CA, USA); LC and choroidal thickness were assessed., Results: The mean LC thicknesses were 209.4 ± 40.2 μm in patients with PD and 292.5 ± 33.7 μm in control subjects. There was a significant difference in the mean LC thickness between the groups (p < 0.0001). The choroidal thickness measurements of the PD group at the subfoveal region and 1.5 mm temporal and 1.5 mm nasal to the fovea were 228.1 ± 44.3, 193.2 ± 41.4 and 188.4 ± 49.0 μm, respectively, whereas measurements for the controls were, respectively, 246.5 ± 38.2, 227.3 ± 34.7 and 216.7 ± 51.4 μm. The choroid was significantly thinner in eyes of the PD group compared to that of the controls (p = 0.001, p < 0.001, and p = 0.006). There was no significant correlation between the disease severity and OCT parameters. The duration of the disease showed a statistically significant negative correlation with LC (rs[94] = -0.700, p < 0.001), and average subfoveal and temporal and nasal choroid thicknesses (rs[94] = -0.282, p = 0.006; rs[94] = -0.324, p = 0.001, rs[94] = -0.240, and p = 0.020, respectively)., Conclusions: Regardless of the disease severity, PD may cause atrophy and volume loss in the lamina cribrosa, and choroid. An enhanced depth imaging technique may be used as an additional modality in the diagnosis and follow-up of patients with PD., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)