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Purpose: To analyze the characteristics of optical coherence tomography in acute macular neuroretinopathy (AMN) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and discuss the prognostic predictors. Methods: Patients with AMN following SARS-CoV-2 infection were divided into two groups according to the presence or absence of hyperreflective outer nuclear layer (ONL) lesion involving the fovea. Results: The first visit included 14 eyes in the fovea-involved group and 20 eyes in the no fovea-involved group. Ellipsoid zone (EZ) hyporeflection and interdigitation zone (IZ) interruption were detected in all eyes. Other common manifestations were myoid zone (MZ) hyperreflection (76.5%), ONL hyperreflection (73.5%), outer plexiform layer (OPL) thickening (64.7%), and EZ interruption (50%). The follow-up period was 48.4 ± 55.3 days. At the last visit, 12 eyes were in the fovea-involved group and 13 eyes in the no fovea-involved group. IZ interruption was detected in all eyes. Other common manifestations were EZ hyporeflection (92.0%), ONL atrophy (40.0%), OPL thickening (36.0%), OPL linear (32.0%), and MZ hyperreflection (32%). The improvement of visual acuity (VA) was -0.5 ± 0.5 and -0.2 ± 0.4 in the fovea-involved group and the no fovea-involved group, respectively, with a statistically significant difference between them (P = 0.045). Initial VA, initial cotton wool spot, initial ONL cyst, final ONL cyst, and final OPL linear were associated with final VA (P = 0.000, P = 0.029, P = 0.044, P = 0.049, P = 0.049, respectively). Conclusions: In the early stage of AMN following SARS-CoV-2 infection, IZ interruption and EZ hyporeflection were the most common manifestations, and pathology of IZ was more serious than that of EZ. Subsequently, OPL and ONL atrophied, and ONL atrophied faster. Regardless of whether hyperreflective ONL involved the fovea, VA improved, with a more noticeable improvement found in the fovea-involved group. The presence of initial ONL cyst and initial cotton wool spot, rapid atrophy of OPL, and poorer initial VA indicating poorer VA outcome.

Purpose: To study ultra-widefield indocyanine green angiography (ICGA) patterns in central serous chorioretinopathy (CSC). Methods: A cross-sectional observational study was undertaken on 30 patients aged 20 to 60 years with CSC at the retina clinic of a tertiary care center. Of them, 43 eyes were affected by CSC, whereas 17 eyes were unaffected as the bilateral disease was observed in 13 patients. All patients were evaluated for best-corrected visual acuity, intraocular pressure, detailed slit-lamp bio-microscopy, indirect ophthalmoscopy, ultra-widefield imaging for pseudo color photograph, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), and ICGA, and macular swept-source optical coherence tomography (SSOCT) characteristics. Results: The mean age of patients was 41.43 ± 8.81 years (range: 25-59 years). The median log MAR visual acuity in CSC eyes was 0.30 (range: 0.17-1.0), whereas it was 0 in non-CSC fellow eyes (P < 0.001). Pachy-vessels and late hyperpermeability on ultra-widefield ICGA were observed in all eyes. Vortex vein anastomosis was present in 93% of the affected eyes versus 88.2% in unaffected fellow eyes (P = 0.61). Disc and posterior poles were the sites of the maximum number of anastomoses in both affected and unaffected eyes (P = 0.77). Asymmetry in vortex vein drainage of the macula was present in 88.4% of affected eyes and 88.2% of unaffected eyes. Conclusion: Studying the ICGA findings in CSC patients emphasized the role of choroidal circulation in pathogenesis as Pachy vessels were observed in all eyes affected with CSC and even fellow eyes of patients. Vortex vein anastomosis around the disc or posterior pole and asymmetric drainage from the macula were noted and could be contributing to CSC pathology. [ABSTRACT FROM AUTHOR]

Purpose: Comparison of diagnostic capability of macular ganglion cell complex thickness vs. retinal nerve fiber layer (RNFL) thickness in patients of primary open-angle glaucoma (POAG). Settings and Design: This cross-sectional observational study was carried out between June 2021 and October 2022 at a tertiary care hospital in North India. Methods: A total of 118 eyes were included in the study with 30 control and the rest 88 eyes with POAG were divided into three groups based on visual field loss Group 1 (30 eyes): early field loss with mean deviation (MD) < -6 dB; Group 2 (30 eyes): moderate field loss with MD -6 to -12 dB; and Group 3 (28 eyes): severe field loss with MD > -12 dB. Optical coherence tomography (OCT) scans to measure RNFL loss and ganglion cell inferior plexiform layer (GCIPL) loss were taken for each patient. Statistical Analysis Used: Categorical variables were analyzed using either the Chi-square test or Fisher's exact test. A receiver operating characteristics analysis was calculated to determine optimal cut-off values of superior, inferior, and average GCIPL and RNFL for determining the severity of field loss as compared to controls (30 normal eyes). Results: In the mild field loss group the sensitivity of superior, inferior, and average GCIPL was 86.7, 96.7, and 96.7%, respectively. Similarly, the specificity was 96.7, 93.3, and 100%, respectively. In the same group, the sensitivity of superior, inferior, and average RNFL was 70, 93, and 66%, respectively. Similarly, the specificity was 46.7, 83.3, and 70%, respectively. In the moderate and severe groups, the results were comparable. Conclusion: The sensitivity and specificity of GCIPL loss are significantly better than that of RNFL parameters in the mild field loss group. [ABSTRACT FROM AUTHOR]

Purpose: Retinoschisis is a distinctive condition characterized by intraretinal layer clefts, primarily associated with X‑linked recessive inheritance due to RS1 gene mutations. This study aims to uncover the RS1 mutation spectrum in a cohort of 22 X‑linked retinoschisis cases from South India and emphasizes the genotypic and phenotypic associations within patients harboring only RS1 mutations. Methods: A total of 22 probands were suspected of having X‑linked retinoschisis. All study subjects underwent ophthalmic investigations, including assessments of visual acuity, fundus examination, optical coherence tomography (OCT), and electroretinogram (ERG). RS1 gene screening was conducted using Sanger sequencing, and the pathogenicity of the variants was assessed through Sorting Intolerant from Tolerant (SIFT) and PolyPhen‑2 in silico tools. Results: The study found that the probands had an average visual acuity of 0.79 ± 0.39 log of minimum angle of resolution (logMAR), ranging from 0.17 to 1.77. During fundus examination, the probands exhibited a characteristic spoke wheel‑like pattern in the macular region. Furthermore, OCT analysis revealed distinct alterations in the inner retinal microstructure, and ERG results consistently showed a reduction in b‑wave amplitude. Eventually, Sanger sequencing results showed hemizygous mutations in the RS1 gene in only 12 probands, including a novel missense mutation in the RS1 gene’s signal sequence. Conclusion: This study provides valuable insights into the spectrum of RS1 mutations in X‑linked retinoschisis probands from South India. It reveals distinct genotypic–phenotypic associations and highlights the clinical manifestations associated with the disease pathogenesis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the agreement in the macular vascular density (MVD) measured by two protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. Design: Cross‑sectional observational study. Methods: Healthy volunteers between the age group of 19 and 39 years were recruited. Topcon DRI OCT Triton plus (Topcon Corporation, Tokyo, Japan) was used to acquire the fovea‑centered optical coherence tomography angiography (OCTA) image using two protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. MVD was measured by the manufacturer software in the superficial capillary plexus slab in five regions: central, superior, nasal, inferior, and temporal subfields of early treatment diabetic retinopathy study grid in each protocol. Results: The study included 79 eyes of 40 healthy volunteers. The difference in the mean MVD between two protocols was 3.84% in right eye and 4.2% in left eye in central subfield, 0.93% in right eye and 1.13% in left eye in superior subfield, 0.06% in right eye and 1.45% in left eye in nasal subfield, 1.65% in right eye and 0.7% in left eye in inferior subfield, 0.4% in right eye and 0.54% in left eye in temporal subfield. The measurements were significantly higher in 6 mm × 6 mm in central subfield in both the eyes and in nasal field in the left eye. Whereas, the measurements were significantly higher in 4.5 mm × 4.5 mm in superior and inferior subfield in both the eyes and in temporal subfield in the left eye. Conclusion: The protocols should not be used interchangeably and it is necessary to include recommendation of the field of view to measure MVD while standardizing OCTA reporting. [ABSTRACT FROM AUTHOR]

To analyze FAZ superficial (s) and deep (d) area and dimensions by using spectral‑domain optical coherence tomography angiography (OCTA) in healthy eyes and to assess effect of age, gender, axial length (AL), central foveal thickness (CFT), and central choroidal thickness (CCT) on FAZ. We aimed to study FAZ dimensions with OCTA in healthy Indian eyes with the purpose of creating a normative database. Settings and Design: Observational cross‑sectional study. Methods: In total, 200 healthy eyes in the age group of 20–60 years having best corrected visual acuity better than 6/12 (Snellen’s) with no systemic illness/intraocular surgery were included. FAZ parameters were calculated using OCTA, and the same was evaluated for any correlation with different ocular parameters mentioned above. The data were reported as frequencies/percentages and mean ± SD. The association between quantitative variables was evaluated using Pearson’s correlation coefficient. Results: The dFAZ area (0.56 ± 0.12 mm2 ) was larger than the sFAZ area (0.42 ± 0.13 mm2 ). Females had larger FAZ than males. AL and CFT had a negative correlation, whereas CCT had a positive correlation with FAZ. Age did not influence FAZ. sFAZ and dFAZ varied significantly in healthy eyes. Conclusion: FAZ parameters calculated using OCTA in healthy Indian eyes suggested that the area and dimensions in both SCP and DCP are larger in individuals from the Indian subcontinent when compared to other parts of the world. FAZ area and dimensions, when compared to previous studies, were variable. Thus, there is a need to establish normative data for ethnicity for proper interpretation of FAZ using OCTA. [ABSTRACT FROM AUTHOR]

Purpose: Optical properties of commonly used multifocal and extended-depth-of-focus (EDOF) intraocular lenses (IOLs) can induce artifacts or changes in optical coherence tomography (OCT) measurements. Our purpose was to investigate the possible effects of different IOLs on peripapillary and macular OCT parameters. Methods: The preoperative and postoperative third-month peripapillary OCT and ganglion cell analysis (GCA) parameters of patients having monofocal (Alcon IQ), multifocal (PanOptix), or EDOF (Vivity) IOL implanted during cataract surgery were compared. Results: Sixty-four eyes of 64 patients were included (21 monofocal, 24 multifocal, and 19 EDOF). Although all OCT image qualities increased postoperatively, only GCA image quality changes in the monofocal and multifocal groups reached statistical significance. Most peripapillary retinal nerve fiber layer (RNFL) and GCA parameters were similar preoperatively and postoperatively. The superior RNFL thickness in the monofocal group and the temporal RNFL thickness in the EDOF group were higher postoperatively (P = 0.04 and P = 0.02, respectively). Most GCA and RNFL value changes between preoperative and postoperative measurements were similar between groups. In the parameters that changed, postoperative values were higher in the monofocal group (P = 0.02 for minimum ganglion cell layer and inner plexiform layer, P = 0.04 for average RNFL). Conclusion: Trifocal and EDOF IOLs do not seem to have a negative effect on OCT parameters. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the variations in choroidal thinning between emmetropic and myopic subjects after caffeine intake. Methods: Forty-five healthy participants (age mean ± standard deviation [SD]: 20.75 ± 1.6 years) recruited in a prospective cross-sectional study. They were divided into three groups, based on refractive error status, emmetropes (spherical equivalent [SE] -0.25 to +0.25D), myopes (SE ≥-0.50D to ≤-6.00D), and high myopes (SE ≥-6.00D). The participants underwent choroidal thickness [ChT] measurements using optical coherence tomography [OCT] (Topcon 3D OCT-1 Maestro System) at baseline, 20, 40, and 60 minutes after consuming 200 mg of caffeine. The measurements of ChT were taken from five different areas horizontally. Results: Compared to baseline measurement, the ChT significantly decreased after 200 mg caffeine intake in all conditions (P < 0.001). There was a statistically significant difference in ChT at baseline between the refractive groups (χ²(2)=6.548, P = 0.038) as the high myope group showed lesser horizontal ChT within Nasal at (1 mm) area compared to the myope group (P = 0.032), however, no other significant differences in mean scores of horizontal ChT at baseline were found. The thinning in ChT in the high myope group was lesser compared to both emmetrope and myope groups; however, it was not statistically significant (P > 0.05). Conclusion: The results of this study suggest that the reduction in ChT due to caffeine consumption is not significantly affected by the refractive status of the eye. Thus, it is safe to hypothesize that the vascular part of the choroid behaves identically to vasoconstrictive in both emmetropic and myopic eyes. The choroidal thinning found in myopic and high myopic eyes and/or the reduced choroidal vascularity index were not apparent in this study. Therefore, further longitudinal studies recruiting greater numbers of participants, including myopes and high myopes, and measuring both vascular and stromal layers to investigate such variations are warranted. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the usefulness of optical coherence tomography angiography (OCTA) in assessing retinal microvascular structural changes in preterm-born children and compare them with those in term-born children. The Web of Science Library, Cochrane Library, PubMed, Embase, CNKI, Wanfang, VIP, and Sino Med databases were searched systematically to extract studies published till April 25, 2023. Two independent reviewers searched all the literature and completed the data extraction and quality assessment. Mean differences (MDs) with 95% confidence intervals (CIs) were used to assess the continuous estimates. STATA software (v15.1; StataCorp, College Station, TX) was used to analyze the data. Twelve published studies were eligible for inclusion in this study. The meta-analysis revealed that the foveal avascular zone (FAZ) area of preterm-born children was remarkably smaller than that of term-born children, with the laser photocoagulation (LP)-ROP group showing the most pronounced reduction. The foveal superficial capillary plexus vessel density (SCP-VD) and deep capillary plexus vessel density (DCP-VD) were remarkably higher in the preterm-born group than in the control group, with variations in subgroups (LP-ROP, anti-VEGF-ROP, SR-ROP, and Pre-T-ROP). The parafoveal SCP-VD was remarkably lower in preterm-born children compared to that of the controls, while no significant difference was identified in the parafoveal DCP-VD. Preterm-born children had a smaller FAZ area, higher foveal SCP-VD and DCP-VD, and lower parafoveal SCP-VD compared to their term-born counterparts. The parafoveal DCP-VD did not differ substantially between preterm- and term-born children. OCTA is an effective modality for assessing alterations in the retinal microvasculature in preterm children. [ABSTRACT FROM AUTHOR]

Purpose: Mutations of G protein-coupled receptor 143 (GPR143) and FERM domain containing 7 (FRMD7) may result in congenital nystagmus (CN) in the first 6 months of life. We aimed to compare the differences in ocular oscillations between patients with these two gene mutations as well as the functional and structural changes in their retinas and visual pathways. Methods: Medical records were retrospectively reviewed to identify patients of congenital nystagmus with confirmed mutations in either GPR143 or FMRD7 genes from January 2018 to May 2023. The parameters of the ocular oscillations were recorded using Eyelink 1000 Plus. The retinal structure and function were evaluated using optical coherence tomography and multi-focal electroretinography (mERG). The visual pathway and optical nerve projection were evaluated using visual evoked potentials. The next-generation sequencing technique was used to identify the pathogenic variations in the disease-causing genes for CN. Results: Twenty nystagmus patients of GPR143 and 21 patients of FMRD7 who had been confirmed by molecular testing between January 2018 and May 2023 were included. Foveal hypoplasia was detected only in patients with the GPR143 pathogenic variant. mERG examination showed a flat response topography in the GPR143 group compared to the FRMD7 group. VEP showed that bilateral amplitude inconsistency was detected only in the patients with GPR143 gene mutation. The amplitude and frequency of the ocular oscillations were not found to differ between patients with two different genetic mutations. Conclusions: Although the etiology and molecular mechanisms are completely different between CN patients, they may have similar ocular oscillations. A careful clinical examination and electrophysiological test will be helpful in making a differential diagnosis. Our novel identified variants will further expand the spectrum of the GPR143 and FRMD7 variants. [ABSTRACT FROM AUTHOR]

Purpose: This study was planned to compare the clinical results and optical coherence tomography (OCT) data of patients who underwent adalimumab (ADA), infliximab (IFX) and switched protocols between these two methods in cases of Behçet's associated uveitis (BAU). Methods: The patients with BAU who were treated with anti-TNF-a agents for at least one year were qualified for the chart review. The outcome parameters were the steroid-free remission state, the best-corrected visual acuity (BCVA), the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT) of the patients at the last visit. Results: After a mean follow-up of 16.60 months, the rate of active inflammation decreased from 63.6% to 15.1%. Mean BCVA increased, mean CMT and mean SFCT decreased significantly at the last visit (P < 0.001, P < 0.001, respectively). Conclusion: Anti-TNF-a treatment and switching protocols between these two agents effectively and safely control intraocular inflammation in BAU patients. [ABSTRACT FROM AUTHOR]

Keratoconus eyes develop corneal decompensation more often compared to eyes with primary congenital glaucoma (PCG) following Descemet's membrane (DM) tear. This study was conducted to compare the posterior corneal morphology in areas with DM breaks with regards to DM and pre-Descemet's layer (PDL) between the two. In this cross-sectional comparative study, anterior segment optical coherence tomography (AS-OCT) scans of the posterior cornea of advanced keratoconus eyes with hydrops (n = 12), PCG eyes with Haab's striae (n = 15), and healthy control eyes (n = 14) were compared for DM-PDL morphology. These were further corroborated by the histopathology of corneal buttons from keratoconus (n = 14) and PCG (n = 13) cases obtained following penetrating keratoplasty and compared with controls (enucleated retinoblastoma globes, n = 6) on light microscopy and collagen IV immunostaining. AS-OCT showed a thicker median DM/PDL complex in PCG (80 µm) versus keratoconus eyes (36 µm, P = 0.01; Kruskal-Wallis test). The median height and length of detached DM-PDL were significantly more in keratoconus versus PCG (145 µm, 1766.1 ± 1320.6 µm vs. 26.5 µm, 453.3 ± 303.2 µm, respectively, P = 0.012; Kruskal-Wallis test). Type-1 DM/PDL detachment (seen as a characteristic taut chord) in keratoconus (90%) was the most common morphological pattern versus intracameral twin protuberance (92%) following DM breaks in PCG. Histopathology confirmed thicker DM in PCG (median: 63.4 µm) versus keratoconus eyes (median: 33.2 µm) or controls (27.1 µm) (P = 0.001; Kruskal-Wallis test). Greater height/length of DM/PDL detachment compounded by poor healing response (lower DM/PDL thickness) probably causes more frequent corneal decompensation in keratoconus eyes when compared to PCG eyes following DM tears. [ABSTRACT FROM AUTHOR]

To study the choroidal thickness (CT) and central macular thickness (CMT) in post-fever retinitis (PFR) and their correlation with visual acuity and treatment. Methods: A retrospective, observational study of patients presenting with PFR from 2013 to 2021 and with spectral domain optical coherence tomography (SD-OCT) (Heidelberg®, SpectralisTM, Heidelberg, Germany) images were included. The CT and CMT were measured at presentation and at the final visit. The CT was measured subfoveally and at points 2000 µm superior, inferior, medial, and lateral from the fovea using the caliper tool. Results: Seventy-nine eyes of 65 patients were included for this study. The mean age was 39.03 (±16.00) years with female preponderance of 53.84% (n = 35). Mean follow-up duration was 30 days. Mean CT at presentation and at follow-up was 254.12 µm and 241.51 µm, respectively. CT was decreased in majority of the eyes 67.1% (n = 53) from their baseline value. Mean CMTs at presentation and final visit were 454.8 µm and 223.7 µm, respectively. Best corrected visual acuity had a positive correlation with CMT (r = 0.340; P = 0.002) and negligible correlation with CT. A significant decrease in the mean CT was noted in patients who received doxycycline either alone or in combination with a steroid as compared to those who did not receive any treatment (P < 0.001). The significance of which is unknown presently. Conclusion: CMT has a greater role in determining the final visual outcome than CT. CT can be reduced post-treatment with no effect on vision. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to establish DROL (disruption of retinal outer layers), PROS (photoreceptor outer segment length), SND (subfoveal neuroretinal detachment), and hyperreflective walls of foveal cystoid spaces (HRW) as optical coherence tomography (OCT) biomarkers and predictors of central macular thickness (CMT) and visual acuity in diabetic macular edema (DME) treated with intravitreal ranibizumab (IVR). Methods: In this prospective, interventional study performed at a tertiary care center over a span of 1 year from December 2021 to December 2022, 50 eyes of 46 patients of DME were included. Visual acuity and spectral domain OCT imaging were performed at baseline. Using inbuilt calipers on SD-OCT, the horizontal extent of DROL and the vertical extent of PROS were measured manually. SND and HRW were assessed qualitatively. IVR was administered and patients were followed up at 4, 8, and 12 weeks. Results: The eyes without DROL had statistically significant (P < 0.05) lesser CMT and better BCVA (best-corrected visual acuity) (P < 0.05) after pro re nata injection of IVR. There was a positive correlation between the extent of baseline DROL with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05), whereas negative correlation with the extent of baseline PROS with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05). The presence of HRW and SND predicted non-resolution of CMT and worse visual acuity after treatment with IVR in DME. Conclusion: DROL, PROS, SND, and hyperreflective walls of foveal cystoid spaces may be utilized as qualitative as well as quantitative biomarkers to predict the post-treatment CMT and visual acuity in DME. [ABSTRACT FROM AUTHOR]

Purpose: To study the optic nerve head characteristics on optical coherence tomography (OCT) in patients with papilledema and correlate them with intracranial pressure (ICP). Methods: A retrospective hospital-based study of 46 eyes of 23 patients with bilateral optic disc edema secondary to increased ICP. The clinical profile and the OCT features in terms of retinal nerve fiber layer thickness (RNFL), ganglion cell inner plexiform layer (GCIPL) thickness, and enhanced depth imaging (EDI) B scan images of the optic nerve head were studied and correlated with the ICP. Results: Papilledema was secondary to idiopathic intracranial hypertension (IIH) (n = 20), obstructive hydrocephalus (n = 2), and communicating hydrocephalus (n = 1). The mean ICP in 20 IIH patients was 347 mmH2O. The ICP and RNFL thickness in all four quadrants were found to be weakly positively correlated: superior RNFL r (38) = 0.17, P = 0.30, and nasal RNFL r (38) = 0.30, P = 0.05, inferior RNFL r (38) = 0.29, P = 0.07, and temporal RNFL, r (38) = -0.001, P = 0.99. The GCIPL layer thickness and the ICP were weakly negatively correlated in all sectors: superior (38) = -0.23, P = 0.16, superonasal, r (38) = -0.07, P = 0.67, inferonasal r (38) = -0.08, P = 0.64, inferior r (38) = -0.21, P = 0.19, inferotemporal r (38) = -0.23, P = 0.17, superotemporal, r (38) -0.21, P = 0.20. Descriptive features on the B scan, such as peripapillary hyperreflective ovoid mass-like structures and microcystic spaces, were observed most commonly with an ICP of 251-350 mmH2O, and the hyperreflective dots in the RNFL layer and Bruch's membrane inward denting were observed more commonly with an ICP of 351-450 mmH2O. Conclusion: The RNFL thickness in all four quadrants had a weak positive correlation, and the GCIPL layer had a weak negative correlation with the ICP. The EDI descriptive features on OCT may vary with ICP. [ABSTRACT FROM AUTHOR]

Purpose: To describe the subretinal hyporeflective globule in cases of central serous chorioretinopathy (CSC). Methods: A retrospective analysis of consecutive cases of CSC presenting to a tertiary eye care center in eastern India was conducted. Subretinal hyporeflective globules were identified as small globular lesions below the external limiting membrane/ellipsoid zone, but above the RPE layer. They had a hyperreflective border with a hyporeflective core and a clear posterior tail of hyper-transmission. Results: The present study analyzed 137 eyes of 137 patients. Eighty (58.4%) eyes had acute disease at presentation, 48 (35%) eyes had chronic disease, and eight (5.8%) eyes had resolved CSC. Subretinal hyporeflective globules were seen in 27 (21.8%) eyes, of which choroidal caverns were seen in seven (5.1%) eyes. Twenty-five eyes with chronic CSC and only two eyes with acute CSC had subretinal hyporeflective globules. Three eyes with resolved CSC had subretinal hyporeflective globules. Conclusion: We describe subretinal hyporeflective globule as a novel optical coherence tomography (OCT) finding in cases of CSC and describe its clinical correlates. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to assess the effect of hypertension, and use of systemic beta blockers (BB) and other antihypertensives on ocular perfusion by optical coherence tomography angiography (OCTA) in normal, suspect, and glaucomatous eyes. Methods: Cross-sectional study in tertiary eye care center. Prospectively recruited consenting subjects between 18 and 90 years with or without glaucoma. Measured the optic nerve peripapillary perfusion and flux and macular vessel density (MVD: 6 × 6 and 3 × 3 mm) in the superficial retinal layer using OCTA. Results: Included 200 eyes (112 patients). Compared to nonhypertensives or those on non-BB antihypertensives (NBB), hypertensives on BB had lower peripapillary perfusion (43.45,43.40, 42.05%, P = 0.003), and MVD (6 × 6 mm: 16.65, 16.70,15.75 mm/mm2, P = 0.002; 3 × 3 mm: 18.70, 18.50, 18.00 mm/mm2, P = 0.025). Those on systemic BB with vasodilatory properties had similar perfusion parameters as nonhypertensives and NBB. Those on systemic BB without vasodilating properties had significantly lower peripapillary perfusion (42.05 vs 43.30%, P = 0.011) and MVD (6 × 6 mm: 15.15 vs 16.60 mm/mm2, P < 0.001; 3 × 3 mm: 17.40 vs 18.70 mm/mm2, P = 0.005) compared to nonhypertensives. On multivariate analysis, peripapillary perfusion increased with increase in diastolic blood pressure (β:0.051, p: 0.04) and increasing age was the only factor found to be significantly associated with decreased peripapillary and macular perfusion parameters. Conclusion: Systemic BB users have worse ocular perfusion parameters compared to those on other medications or nonhypertensives on univariate analysis but similar perfusion on multivariate analysis. Those on BB with vasodilation have better ocular perfusion parameters. All BB cannot be considered equally detrimental to ocular perfusion. Further well-controlled prospective studies are needed to reassess the effects of BB with or without vasodilation on ocular perfusion. [ABSTRACT FROM AUTHOR]

Purpose: To compare the safety and efficacy of subconjunctival injection (MMC: 0.02%) to those with subconjunctival application of sponges soaked in Mitomycin C (MMC: 0.02%) intra-operatively in patients who underwent phacotrabeculectomy. Methods: A total of 68 patients undergoing phacotrabeculectomy were randomized into two groups; the sponge group received 0.02% MMC-soaked sponges (n = 38), and the injection group received subconjunctival injection of 0.02% MMC (n = 30). The primary outcome was post-operative mean intra-ocular pressure reduction (IOP). The secondary outcomes were bleb morphology using Indiana Bleb Appearance Grading Score (IBAGS) and anterior segment optical coherence tomography (AS-OCT), post-operative use of 5-fluorouracil, and complications rates. These were compared at 1 week and 1, 3, and 6 months post-operatively. Complete success was defined as ≥30% reduction in IOP without anti-glaucoma medications. Results: In sponge and injection groups, the mean pre-operative IOP was 29.1 ± 8.1 and 29.8 ± 8.8 mmHg, respectively. At 6 months, IOP in sponge and injection groups reduced by 52% (14 ± 3.6 mmHg, P < 0.001) and 50% (15.2 ± 4.1 mmHg, P < 0.001), respectively. Complete success was observed in 90.9% in the sponge group and 95.83% in the injection group. Both groups had diffuse, shallow, relatively avascular blebs at 6 months using IBAGS and AS-OCT. A few complications were seen in the sponge group during this period, which were not vision-threatening. Conclusion: Subconjunctival MMC injection is an effective, safe, convenient, and time-saving alternative to sponge-soaked delivery of MMC in phacotrabeculectomy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and correlate the structural changes between peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer (GCL) + inner plexiform layer (IPL) in different stages of glaucoma using PanoMap® optical coherence tomography (OCT). Design: Retrospective observational study. Methods: Glaucoma diagnostic test data were collected from early to moderate open-angle glaucoma patients. The average and minimum GCL + IPL thickness, sectoral GCL + IPL thickness, and the average and sectoral RNFL thickness were correlated with the different glaucoma stages. Results: This study included 157 eyes from 157 glaucoma patients. Patients were grouped into pre-perimetric, early, and moderate glaucoma. The mean average RNFL thickness, RNFL thickness per sector, average GCL + IPL thickness, and minimum GCL + IPL thickness were different between the three groups (P < 0.001), except for the nasal sector (P = 0.643).The mean GCL + IPL thickness in all six sectors showed differences between the groups (P < 0.001), except the superonasal sector (P < 0.002).The inferior GCL + IPL sector is the thinnest, followed by the inferotemporal sector. There was a strong correlation between the mean average RNFL and the average GCL + IPL thickness in the pre-perimetric group (r = 0.4963, P < 0.001) and the moderate group (r = 0.6534, P < 0.001).The early glaucoma group did not show significant correlation (r = 0.2963, P = 0.0536). Conclusion: Peripapillary RNFL and macular GCL + IPL thinning was evident in different stages of glaucoma, with more thinning observed with increasing glaucoma severity. The peripapillary RNFL and macular GCL + IPL average thickness values were highly correlated in the pre-perimetric and moderate stages of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between visual function and macular ganglion cell complex (GCC) thickness measured by Fourier–domain optical coherence tomography (OCT) and evaluate the diagnostic value of GCC measurement compared to retinal nerve fiber layer (RNFL) thickness and macular thickness in detecting early, moderate, and severe glaucomas. Methods: Subjects underwent standard automated perimetry (SAP), OCT imaging with optic nerve head mode and GCC mode. The relationship between OCT parameters (mean GCC thickness, mean RNFL thickness, and macular thickness) and perimetry global indices (mean deviation [MD] and pattern standard deviation [PSD]) was evaluated by regression analysis. Diagnostic values of mean RNFL thickness, GCC parameters, and macular thickness were compared with the area under the receiver operating characteristic curves (AUC). Results: A total of 84 eyes, 42 of each normal and primary open-angle glaucoma patients were included in the study. Compared with linear models, second-order polynomial models better described relationships between GCC thickness and MD (P < 0.001), and between GCC thickness and PSD (P = 0.00). RNFL parameter, inferior RNFL thickness had the highest AUC for detecting early glaucoma. The AUC of mean GCC thickness for early glaucoma was higher than that of mean RNFL; however, the difference was not significant (P = 0.09), which was higher than that of macular thickness. Conclusion: The relationship between visual field (VF) sensitivity and GCC thickness is best expressed by the curvilinear function. Macular GCC thickness and RNFL thickness showed similar diagnostic values but were better than macular thickness for detecting early glaucoma but inferior to macular thickness and RNFL thickness for detecting moderate glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma (PPG) and comparison to retinal nerve fiber layers. Methods: This study was a prospective hospital-based study. A total of 30 PPG and control patients were studied for retinal nerve fiber layer thickness (RNFL) and ganglion cell-inner plexiform layer complex (GC-IPL) by spectral-domain optical coherence tomography. PPG was defined as eyes with a normal visual field and one or more localized RNFL defects that were associated with a typical glaucomatous disc appearance. Diagnostic abilities of GC-IPL, optic nerve head (ONH), and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity, and specificity. Results: GC-IPL parameters showed significant changes in PPG cases as compared to normal subjects in each region (P value < 0.001). RNFL parameters also differed significantly from normal subjects in all quadrants (P value 0.003 to < 0.001). Within GC-IPL parameters, the superotemporal region had the maximum area under the curve (AUC), followed by inferior, superior, and inferotemporal regions. Within RNFL parameters, the inferior quadrant had the maximum AUC, followed by superior and nasal quadrants. the GC-IPL parameters in PPG showed that the AUC of the GC-IPL parameters was much higher than those of the ONH and RNFL values. Conclusion: Although both the parameters RNFL and GC-IPL showed significant changes in PPG patients compared to healthy subjects, a higher AUC of GC-IPL points toward the higher sensitivity of GC-IPL than RNFL for detecting glaucoma in early stages. [ABSTRACT FROM AUTHOR]

Purpose: To analyze primary congenital glaucoma (PCG) anterior chamber and angle anomalies over 360° as possible biomarkers of severity and prognosis. Methods: A cross-sectional observational study was conducted analyzing anterior segment anomalies of PCG patients over 4 years of age who underwent trabeculectomy combined with trabeculotomy and age-matched controls using anterior segment optical coherence tomography (ASOCT), CASIA-2. Anterior iridotrabecular adhesions or anterior iris insertion was identified and quantified from the scleral spur using the iridotrabecular contact (ITC) index parameter as a surrogate. Results: There was a variable but significantly increased anterior iridotrabecular adhesion on ITC index, ITC area, corneal volume, anterior chamber volume, iris volume, anterior chamber depth, and small/absent trabecular meshwork in PCG eyes compared to control eyes. In PCG eyes, anterior iridotrabecular adhesion had a positive correlation with pre-operative central corneal thickness (CCT) (r = 0.53, P = 0.02), review iris thickness (r = 0.4, P = 0.04), and ITC area (r = 0.85, P < 0.001). Review iris thickness had a negative correlation with pre-operative vertical cup-disc ratio (r = -0.51, P = 0.008). Iris hypoplasia with fewer or absent folds, collarette, pupillary ruff, and pupillary ruff to collarette distance was significantly different from controls. Conclusion: ASOCT in PCG eyes has shown that they have variable anterior iridotrabecular tissue adhesions, anomalous tissue/membranes in the angle, and iris hypoplasia correlating with pre-operative cup-disc ratio. These features could be used as gonioscopic and clinical biomarkers to assess the severity and prognosis of the disease. The presence of abnormal iris morphology and iridotrabecular tissue anomalies in PCG suggests that it is more than just isolated trabeculodysgenesis and is probably best considered as part of the anterior segment dysgenesis spectrum. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and correlate the structural changes between peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer (GCL) + inner plexiform layer (IPL) in different stages of glaucoma using PanoMap® optical coherence tomography (OCT). Design: Retrospective observational study. Methods: Glaucoma diagnostic test data were collected from early to moderate open-angle glaucoma patients. The average and minimum GCL + IPL thickness, sectoral GCL + IPL thickness, and the average and sectoral RNFL thickness were correlated with the different glaucoma stages. Results: This study included 157 eyes from 157 glaucoma patients. Patients were grouped into pre-perimetric, early, and moderate glaucoma. The mean average RNFL thickness, RNFL thickness per sector, average GCL + IPL thickness, and minimum GCL + IPL thickness were different between the three groups (P < 0.001), except for the nasal sector (P = 0.643).The mean GCL + IPL thickness in all six sectors showed differences between the groups (P < 0.001), except the superonasal sector (P < 0.002).The inferior GCL + IPL sector is the thinnest, followed by the inferotemporal sector. There was a strong correlation between the mean average RNFL and the average GCL + IPL thickness in the pre-perimetric group (r = 0.4963, P < 0.001) and the moderate group (r = 0.6534, P < 0.001).The early glaucoma group did not show significant correlation (r = 0.2963, P = 0.0536). Conclusion: Peripapillary RNFL and macular GCL + IPL thinning was evident in different stages of glaucoma, with more thinning observed with increasing glaucoma severity. The peripapillary RNFL and macular GCL + IPL average thickness values were highly correlated in the pre-perimetric and moderate stages of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To study the optic nerve head characteristics on optical coherence tomography (OCT) in patients with papilledema and correlate them with intracranial pressure (ICP). Methods: A retrospective hospital-based study of 46 eyes of 23 patients with bilateral optic disc edema secondary to increased ICP. The clinical profile and the OCT features in terms of retinal nerve fiber layer thickness (RNFL), ganglion cell inner plexiform layer (GCIPL) thickness, and enhanced depth imaging (EDI) B scan images of the optic nerve head were studied and correlated with the ICP. Results: Papilledema was secondary to idiopathic intracranial hypertension (IIH) (n = 20), obstructive hydrocephalus (n = 2), and communicating hydrocephalus (n = 1). The mean ICP in 20 IIH patients was 347 mmH2O. The ICP and RNFL thickness in all four quadrants were found to be weakly positively correlated: superior RNFL r (38) = 0.17, P = 0.30, and nasal RNFL r (38) = 0.30, P = 0.05, inferior RNFL r (38) = 0.29, P = 0.07, and temporal RNFL, r (38) = −0.001, P = 0.99. The GCIPL layer thickness and the ICP were weakly negatively correlated in all sectors: superior (38) = −0.23, P = 0.16, superonasal, r (38) = −0.07, P = 0.67, inferonasal r (38) = −0.08, P = 0.64, inferior r (38) = −0.21, P = 0.19, inferotemporal r (38) = −0.23, P = 0.17, superotemporal, r (38) −0.21, P = 0.20. Descriptive features on the B scan, such as peripapillary hyperreflective ovoid mass-like structures and microcystic spaces, were observed most commonly with an ICP of 251–350 mmH2O, and the hyperreflective dots in the RNFL layer and Bruch’s membrane inward denting were observed more commonly with an ICP of 351–450 mmH2O. Conclusion: The RNFL thickness in all four quadrants had a weak positive correlation, and the GCIPL layer had a weak negative correlation with the ICP. The EDI descriptive features on OCT may vary with ICP.

Purpose: To discuss the features of an artifact on optical coherence tomography angiography (OCTA), termed “pupil vignetting artifact,” and describe how it may masquerade as true chorioretinal pathology. Design: This was a retrospective, observational case series. Methods: The authors studied 12 eyes at a vitreoretinal clinic in Eastern India, reviewing a dark shadow such as an artifact on OCTA images. Results: In all 12 eyes, there was an appearance of a dark shadow on OCTA imaging, located at the macula, superior, superotemporal, or superonasal to the fovea, which did not correspond to any ischemic area responsible for flow-void or any media opacity casting a posterior shadow. It was believed to be an artifact caused by the vignetting effect of the pupil as the incident OCT beam clips the iris during OCTA scanning, and therefore reduces the amount of total light incident on the retina. The variability in the size, shape, and location of the artifact is contributed by a few factors such as variable angle of incident light on the pupil, pupillary dynamics, and curvature of the retinal surface. Conclusion: Pupil vignetting artifact is a unique undescribed phenomenon appearing at the macula on OCTA imaging that can masquerade as numerous true chorioretinal pathologies. This article aims to describe this artifact to avoid misinterpretation and further confusion in real-life clinical practice.

Aims: To measure the foveal pit morphology parameters and evaluate their correlations with age and sex. Settings and Design: A retrospective cross-sectional matched comparison study in a tertiary center. Methods and Materials: Forty men and 40 age-matched women who had normal macular structures and foveal contours were enrolled. Foveal pit parameters including top width, base width, nasal width, temporal width, minimal thickness, nasal thickness, temporal thickness, nasal height, temporal height, nasal slope, and temporal slope were measured on horizontal B-scan macular optical coherence tomography and compared between men and women. Statistical Analysis Used: Paired t-tests and Pearson's correlation analysis. Results: The average patient age was 51.4 ± 17.5 (21–84) years. Women had a wider base width (313.1 ± 68.0 μm vs 266.8 ± 70.9 μm, P = 0.006), wider temporal width (1043.1 ± 245.6 μm vs 968.9 ± 261.0 μm, P = 0.006), thinner nasal thickness (345.6 ± 36.2 μm vs 359.7 ± 35.8 μm, P = 0.048), and flatter temporal slope (11.60 ± 2.52° vs 12.98 ± 2.68°, P = 0.016) than men. With age, the base width (r = 0.35, P = 0.025) and temporal width (r = 0.54, P = 0.0003) tended to be wider and the temporal slope was flatter (r = -0.45, P = 0.003) in women but not men. The minimal thickness tended to be thinner in the elderly group (r = 0.038, P = 0.015). Conclusions: Women had a significantly wider base width, wider temporal width, thinner nasal thickness, and flatter temporal slope of the foveal pit than age-matched men. The base width and temporal width were wider and the temporal slope was flatter with age in women but not men.

Purpose: This study aimed at evaluation of patients diagnosed with optic disc edema (ODE) in terms of demographics, etiology, clinical presentation, and optical coherence tomography parameters. Methods: An observational cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with ODE underwent comprehensive ophthalmic evaluation. Peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters were assessed using optical coherence tomography. Radiologic investigations were done as deemed necessary. Results: One hundred and forty-eight eyes with ODE (134 eyes from 67 patients with bilateral ODE and 14 eyes from 14 patients with unilateral ODE) and 148 eyes of age- and gender-matched control group were included in the study. The mean age of the study population was 31.51 ± 13.33 years, with 44 (54.3%) males and 37 (45.6%) females. Bilateral ODE was seen in 82.7% of patients. Idiopathic intracranial hypertension was the most common cause of bilateral ODE, and nonarteritic anterior ischemic optic neuropathy was the most common cause of unilateral presentation. Decreased vision and headache were the main symptoms reported by a majority of patients. Peripapillary RNFL thickness was significantly increased in the ODE group compared to controls. Conclusion: The current study provides the clinical profile and optic disc and RNFL measurements of ODE patients in an Eastern Indian population. Detailed history and careful evaluation are necessary, as the treatment strategy is highly dependent on the underlying etiologies.

This article from the Indian Journal of Ophthalmology discusses cone dysfunction in patients with ethambutol toxicity. Ethambutol is a medication used in the treatment of tuberculosis, but it can cause optic neuropathy as a side effect. The article presents three cases of cone dysfunction in patients taking ethambutol, with symptoms including intolerance to light and a decrease in vision. The patients were all females between the ages of 40 and 72. Various tests, such as fundus examination, visual field tests, and electroretinograms, were conducted to assess the extent of the cone dysfunction. The article concludes that ethambutol can cause not only optic nerve toxicity but also cone dysfunction, and physicians should be aware of these ocular toxicities when prescribing the medication. [Extracted from the article]

The aim of this paper is to present the surgical technique of selective Bowman's layer transplantation as well as the results of the surgery in patients with trophic corneal ulcers. The methodology of the study included three eyes from three patients with neurotrophic corneal ulcers grafting with corneal Bowman's layer. Pre- and postoperative analyses of the anterior segment of the eye were based on optical coherence tomography and slit-lamp assessment. Postoperatively a gradual corneal stroma restoration and fast corneal epithelialization were noticed. Based on our observations, the stiff and firm structure of Bowman's layer is supposed to strengthen the corneal surface and maintain its shape. It acts also as an antipathogen and antitoxin corneal barrier. Application of this acellular corneal layer transplantation to cover trophic corneal ulcers is an interesting, modern and crucial method of neurotrophic keratitis treatment. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore the influence of high altitude on myopia, macular choroidal thickness (mCT), and macular retinal thickness (mRT) in adolescents. Methods: Two schools, one in Shanghai (at sea level) and one in Shigatse, Tibet (more than 4000 m above sea level), were selected. Refractive error was measured by an autorefractor instrument and subjective refraction, and mCT and mRT were measured at three concentric circles by optical coherence tomography. Student's t-test, Chi-square test, and multiple linear regression analyses were used to analyze the data. Results: A total of 1114 participants (657 and 457 in Shanghai and Tibet, respectively) were enrolled in this cross-sectional study. The average age of the participants was 18.81 ± 1.10 years, and 44.34% were males. The spherical equivalent (SE) of adolescents in Shanghai was significantly lower than that of adolescents in Tibet (-4.14 ± 2.37 D and -2.12 ± 1.87 D, P < 0.01). The prevalence of myopia and high myopia among adolescents in Shanghai (94.52%, 19.48%) was significantly higher than those among adolescents in Tibet (44.74%, 2.41%) (P < 0.01). The mCT of Tibetan adolescents was significantly thicker than that of Shanghai adolescents (295.80 ± 62.46 μm and 218.71 ± 61.42 μm, P < 0.01), especially the central mCT. The mRT of Tibetan adolescents was also thicker than that of Shanghai adolescents (301.42 ± 23.26 μm and 281.04 ± 12.24 μm, P < 0.01). Conclusions: Compared with Shanghai adolescents, the choroid of Tibet adolescents is thicker, and the myopia prevalence is lower. It is speculated that increased altitude is associated with the thickening of mCT and a low myopia prevalence. [ABSTRACT FROM AUTHOR]

Purpose: To compare the quantification of intraretinal hard exudate (HE) using en face optical coherence tomography (OCT) and fundus photography. Methods: Consecutive en face images and corresponding fundus photographs from 13 eyes of 10 patients with macular edema associated with diabetic retinopathy or Coats' disease were analyzed using the machine-learning-based image analysis tool, "ilastik." Results: The overall measured HE area was greater with en face images than with fundus photos (en face: 0.49 ± 0.35 mm2 vs. fundus photo: 0.34 ± 0.34 mm2, P < 0.001). However, there was an excellent correlation between the two measurements (intraclass correlation coefficient [ICC] = 0.844). There was a negative correlation between HE area and central macular thickness (CMT) (r = -0.292, P = 0.001). However, HE area showed a positive correlation with CMT in the previous several months, especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy (CMT 3 months before: r = 0.349, P = 0.001; CMT 4 months before: r = 0.287, P = 0.012). Conclusion: Intraretinal HE can be reliably quantified from either en face OCT images or fundus photography with the aid of an interactive machine learning–based image analysis tool. HE area changes lagged several months behind CMT changes, especially in eyes treated with anti-VEGF injections. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes. Methods: A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI. Results: Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704. Conclusions: In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity. [ABSTRACT FROM AUTHOR]

Context: This study adds to the existing body of literature on the role of optical coherence tomography (OCT) parameters in active thyroid eye disease (TED) among the Indian population. Purpose: Comparison of choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in active and inactive TED. Settings and Design: An observational, cross-sectional analytical study conducted at a tertiary eye care hospital in North India that included patients with active and inactive TED. Methods: Demographic details and clinical evaluation were performed for all TED patients. SFCT was determined with OCT by using the Cirrus linear measurement tool. CVI was calculated using Image J software. The SFCT and CVI measurements were compared between both groups. Statistical Analysis Used: Comparison between active and inactive TED groups was done using Mann–Whitney U test for non-parametric data and Student t test for parametric data. Multivariate regression analysis was performed with SFCT and CVI as dependent variables. Results: Sixty-two eyes of 31 patients were included. Thirteen eyes had active TED, and 49 eyes had inactive TED. SFCT was significantly lower in eyes with higher clinical activity score (CAS) and older age. No significant difference was found in CVI between active and inactive TED eyes. Conclusion: SFCT was lower in eyes with higher CAS and older age. Our findings differ from previous studies, which showed a positive correlation between SFCT and CAS. There was no significant difference in CVI between active and inactive TED eyes. [ABSTRACT FROM AUTHOR]

Purpose: To assess macular sensitivity and fixation pattern obtained by microperimetry and ganglion cell complex (GCC) obtained by optical coherence tomography (OCT) in cases with unilateral amblyopia and to compare with control. Methods: The study was conducted with 30 patients with amblyopia, aged 5–18 years, and 30 control eyes of healthy children in the same age group. Participants underwent full ophthalmological examination. Macular sensitivity, stabilization, and location of fixation values were measured using microperimetry. The GCC values were obtained by OCT. Measurements were compared between amblyopic eyes, fellow eyes, and controls. Any correlation between GCC, macular sensitivity, and fixation was investigated. P < 0.05 was considered statistically significant. Results: The mean age was 10.13 ± 3.49 years in the amblyopia group and 11.53 ± 2.7 years in the control group. Three groups were formed: amblyopic eyes (Group 1, n = 30), fellow eyes (Group 2, n = 30), and control eyes (Group 3, n = 30). The macular sensitivity values were found highest in the control group (P = 0.007). Bivariate contour ellipse area 1, which is the numerical value of fixation stabilization, was measured to be the lowest in the control group (P < 0.0001). In the analysis among the three groups, no significant difference was observed in terms of the GCC (P = 0.229). In the correlation analyses, a significant correlation was detected between macular sensitivity and GCC values in amblyopic eyes. Conclusion: In amblyopic eyes, the macular sensitivity was significantly lower and the GCC thickness was found to be in a positive correlation with macular sensitivity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes with fibrin glue in comparison with vicryl sutures for limbal conjunctival wound closure in strabismus surgery. Methods: In this prospective interventional study, patients undergoing horizontal muscle strabismus surgery were randomized into two groups: the vicryl suture group and the fibrin glue group. The limbal conjunctival incisions were closed with 8–0 vicryl in the suture group and with fibrin glue in the other group. The outcomes measured were post-operative conjunctival inflammation and wound apposition, patient comfort with the help of a questionnaire, and conjunctival thickness using anterior segment optical coherence tomography (AS-OCT) for both groups at 6 weeks. Results: The study included 64 eyes of 64 patients (32 eyes in each group). The fibrin glue group performed better than the vicryl suture group for most of the symptoms like redness, irritation, watering, and foreign body sensation till 2 weeks post-operatively (P < 0.001), after which both the groups performed similarly. As for clinical signs, no significant difference was noted between the two groups, except for conjunctival hyperemia, which was significantly lesser in the fibrin glue group at 2 weeks post-operatively (P < 0.001). The conjunctival thickness measured at 6 weeks using AS-OCT revealed that the thickness increased significantly in the suture group compared to that in the glue group (P < 0.001 medial site, P = 0.004 lateral site). Conclusion: Because of greater patient comfort and reduced inflammation associated with fibrin glue, it may be considered as a procedure of choice for conjunctival wound closure in strabismus surgery in the absence of the cost constraints. [ABSTRACT FROM AUTHOR]

Purpose: To discuss the features of an artifact on optical coherence tomography angiography (OCTA), termed “pupil vignetting artifact,” and describe how it may masquerade as true chorioretinal pathology. Design: This was a retrospective, observational case series. Methods: The authors studied 12 eyes at a vitreoretinal clinic in Eastern India, reviewing a dark shadow such as an artifact on OCTA images. Results: In all 12 eyes, there was an appearance of a dark shadow on OCTA imaging, located at the macula, superior, superotemporal, or superonasal to the fovea, which did not correspond to any ischemic area responsible for flow‑void or any media opacity casting a posterior shadow. It was believed to be an artifact caused by the vignetting effect of the pupil as the incident OCT beam clips the iris during OCTA scanning, and therefore reduces the amount of total light incident on the retina. The variability in the size, shape, and location of the artifact is contributed by a few factors such as variable angle of incident light on the pupil, pupillary dynamics, and curvature of the retinal surface. Conclusion: Pupil vignetting artifact is a unique undescribed phenomenon appearing at the macula on OCTA imaging that can masquerade as numerous true chorioretinal pathologies. This article aims to describe this artifact to avoid misinterpretation and further confusion in real‑life clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the surgical outcomes of petalloid multilayered inverted internal limiting flap using perfluorocarbon liquid (PFCL) in extra‑large macular holes (MHs) (minimum linear diameter >550 µm and basal diameter [BD] >1000 µm). Methods: This was a prospective interventional series of 103 eyes of 99 patients with extra‑large MHs which were treated with 25‑gauge pars plana vitrectomy, petalloid multilayered inverted internal limiting membrane flaps under PFCL and 15% perfluoropropane (C3F8) gas tamponade. Intraoperative optical coherence tomography (i‑OCT) was used to confirm correct positioning of flaps. Follow‑up was at 1 week, 1 month, and 3 months postoperatively. Results: Mean age of patients was 58.282 ± 16.3 years. Mean preoperative best corrected visual acuity (BCVA) was logarithm of minimum angle of resolution (logMAR) 1.206 ± 0.384, and the value at the third month was logMAR 0.793 ± 0.337. Mean minimum linear diameter(MLD) was 711.96 ± 270.744 µm. MLD ranged from 557µm (minimum MLD) to 2657 µm (maximum MLD). Mean BD was 1301.165 ± 425.914 µm. Type 1 closure was seen in 92.2% eyes, 5.8% eyes had type 2 closure, and 1.9% eyes had type 3 closure. Eyes with both type 1 closure (P = 0.001) and type 2 closure (P = 0.009) showed a significant improvement in BCVA postoperatively at 3 months. Conclusion: Petalloid multilayered inverted internal limiting membrane flap under PFCL technique with adjunctive use of i‑OCT showed improved morphological and functional outcomes in the treatment of extra‑large MHs. We present here a large series of extra‑large MHs, in which a novel technique of petalloid multilayered inverted ILM flaps was used. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the retinal microvascular differences after successful macular hole surgery by using the superior and temporal inverted flap technique. Methods: In this retrospective study, patients with idiopathic macular holes with a horizontal diameter of 250–400 μm at the narrowest point, and who have a follow‑up of 6 months were included in the study. Group 1 included 14 patients’ 14 eyes that have been treated using the superior inverted flap technique. Group 2 included 15 patients’ 15 eyes that have been treated using the temporal inverted flap technique. The vessel density (VD) ratios in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) at the central area and the four parafoveal quadrants were compared between the groups at baseline and postoperative month 6. Results: The mean baseline BCVA improved significantly in both groups at postoperative month 6 (1.21 to 0.50 and 1.32 to 0.52 logMAR, respectively; P < 0.05). There was no significant difference in mean BCVA between the two groups at postoperative month 6 (P < 0.05). The mean VD in SCP in the center area increased significantly in both groups at month 6 postoperatively (P = 0.011 and 0.020, respectively); however, the mean VD in DCP in the center area did not significantly change in both groups (P = 0.079 and 0.078, respectively). The mean VD ratios in SCP and DCP at the four parafoveal quadrants did not change significantly in both groups at month 6 (P < 0.05 for both). Conclusions: Both techniques are safe for retinal microvasculature at postoperative month 6. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to describe imaging characteristics and detection rates of phenotypic features in macular telangiectasia type‑2 (MacTel) on multicolor (MC), blue reflectance (BR), green reflectance (GR), infrared reflectance (IR), and fundus autofluorescence (FAF) and to evaluate sensitivity, specificity, and predictive values across modalities. Methods: In this monocentric observational study, 282 eyes of 148 patients with MacTel underwent color fundus photograph, MC, BR, GR, IR, FAF, spectral‑domain optical coherence tomography (SD‑OCT), OCT‑angiography (OCT‑A), and fundus fluorescein angiography (FFA). Grading was done by two graders qualitatively and quantitatively for the presence of the following prespecified MacTel findings [crystals, right‑angle vessels (RAVs), plaques, subretinal neovascularization (SRNV), and MacTel area]. Across each imaging modality, the detection rate of RAVs and SRNV was compared with reference standard OCT‑A (RAVs and SRNV) and FFA (SRNV), whereas that of plaques was compared with reference standard SD‑OCT. Results: MC identified overall MacTel characteristics in 92.7% of eyes. Regarding the presence, number, and quadrants of RAVs and the presence and number of crystals, MC and GR had superior detection rates as well as the highest sensitivity and negative predictive value. Retinal plaques were better detected using FAF (97%), followed by MC (88%). In proliferative MacTel, SRNV was identified in 86% and 79% of eyes on MC and IR, respectively. While BR clearly delineated MacTel area in 100% eyes, FAF was able to ascertain a larger area of involvement in proliferative MacTel. Conclusion: The findings demonstrate the ability of MC, its component channels, and FAF to describe MacTel characteristics qualitatively and quantitatively. [ABSTRACT FROM AUTHOR]

Purpose: The present study was done to assess the use of optical coherence tomography angiography (OCTA) in detecting earlier stages of diabetic retinopathy and for the early management and effective blood glucose control in preclinical diabetic patients for preventing retinal nerve fiber layer (RNFL) thinning. Methods: A tertiary care center–based prospective observational study was conducted from the year 2021 to 2022 in the Department of Ophthalmology. The study included 50 cases and 50 controls. The parameters analyzed by using OCTA (Topcon 3D OCT‑1 Maestro2) were RNFL thickness and peripapillary vessel density. Results: We found that the RNFL thickness in the temporal and superior disc in patients with preclinical diabetic retinopathy was significantly (0.041 and 0.044, respectively) decreased. The duration of diabetes and glycated hemoglobin (HbA1c) were the risk factors for peripapillary vessel density reduction in patients with preclinical diabetic retinopathy (P < 0.001). Conclusion: RNFL thinning is an early sign of retinal neurodegeneration and is associated with peripapillary vessel density reduction. Early management and effective blood glucose control in diabetes patients may be beneficial for preventing RNFL thinning in superior and temporal disc. [ABSTRACT FROM AUTHOR]

Purpose: To assess the utility of pre‑defined imaging biomarkers on optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with diabetic macular edema (DME) following anti‑vascular endothelial growth factor (anti‑VEGF) therapy in determining visual and anatomical outcomes. Methods: In this prospective, non‑randomized, and interventional study, 17 patients with treatment‑naive DME were included. OCT biomarkers [size/reflectivity of cysts, disorganization of retinal inner layers, integrity of ellipsoid zone or external limiting membrane, subfoveal serous retinal detachment, hyper‑reflective foci (HRF)] and OCTA [vascular density (VD), foveal avascular zone (FAZ), and total micro‑aneurysms in superficial capillary plexus and deep capillary plexus (DCP)] were analyzed at baseline and after three monthly intravitreal anti‑VEGF injections. Response was defined as a decrease of 10% or more in central macular thickness from the baseline after three injections. Results: 13/17 (76.47%) patients were categorized as responders to anti‑VEGF therapy. Non‑responders had significantly greater hyper‑reflectivity of cysts (P = 0.015), larger cystic spaces (P = 0.023), and an increased number of HRF (P = 0.04) at baseline. On OCTA, non‑responders showed larger FAZ in DCP (1.35 ± 0.21 versus 1.14 ± 0.28 mm² ) (P = 0.042) and lower VD (61.17 ± 0.45 versus 62.73 ± 3.32) in DCP at baseline. At 3 months, the VD increased in responders (63.10 ± 3.42) compared to a decrease in non‑responders (60.82 ± 1.13) (P = 0.032). Conclusions: Non‑responders show a higher number of micro‑aneurysms, larger FAZ, and lower VD in the DCP on OCTA and higher cyst hyper‑reflectivity and HRF and larger cystic spaces on OCT imaging [ABSTRACT FROM AUTHOR]

Purpose: Idiopathic macular telangiectasia type 2 (IMT) is a neurodegenerative disease characterized by bilateral, idiopathic, and perifoveal retinal telangiectatic vessel formations. We aimed to compare proximal nailfold videocapillaroscopy (NV) findings between patients with IMT and healthy individuals and evaluate the optical coherence tomography angiography (OCTA) parameters of the patients with IMT according to their NV findings. Methods: The study included 43 patients with IMT and 92 healthy controls of similar age and gender without any additional diseases. The OCTA and NV findings of the patients and controls were examined. Results: The mean age was 59.76 ± 5.73 years in the IMT group and 58.23 ± 4.96 years in the control group. Of the 43 patients with IMT, 19 were found to have increased capillary tortuosity, six had microhemorrhage, and 18 had bizarre capillaries (P < 0.001). In the IMT group, the total vascular density value of the superficial capillary plexus was higher among the patients with capillary microhemorrhage (P = 0.001), and the subfoveal choroidal thickness was lower among those with increased capillary tortuosity and bizarre capillaries (P = 0.04 and P = 0.07, respectively). Conclusion: This is the first study in which the NV findings of patients with IMT were compared with those of a control group. We found higher rates of increased capillary tortuosity, microhemorrhage, and bizarre capillaries in the IMT group compared to the controls. We consider that this situation is caused by microvascular damage. We also think that IMT is a systemic disease that affects both proximal nailfold capillaries and eye vessels. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate hemodynamic changes in the retina, peripapillary area, and choroid in patients undergoing coronary artery bypass grafting (CABG). Methods: This prospective case series included 35 eyes of 35 patients. Vessel density (VD) of superficial capillary plexus, deep capillary plexus, radial peripapillary capillary, foveal avascular zone area, and subfoveal choroidal thickness changes were evaluated using optical coherence tomography angiography (OCTA) 1 day before and 2 weeks after surgery. The correlation of these parameters with aortic cross‑clamp (ACC) duration and cardiopulmonary bypass (CPB) duration was evaluated. Results: There were no differences in the OCTA measurements of the patients after CABG compared to before surgery (P > 0.05). Inside‑disc VD showed a negative correlation with both ACC (P = 0.036) and CPB duration (P = 0.048); peripapillary inferior hernia showed a negative correlation with both ACC (P = 0.042) and CPB duration (P = 0.027). Another negative correlation was observed between mean peripapillary VD and CPB duration (P = 0.039). Conclusion: The CPB procedure had no permanent effect on retinal choroid and optic disc blood flow postoperatively. Prolonged ACC and CPB times seem to be important in terms of optic nerve blood flow. Clinicians should be alert for postoperative ocular complications after long surgeries. [ABSTRACT FROM AUTHOR]

Background: Brolucizumab is a new anti‑vascular endothelial growth factor (anti‑VEGF) in the treatment of neovascular age‑related macular degeneration (nAMD) and idiopathic polypoidal choroidal vasculopathy (IPCV). Materials and Methods: A retrospective, consecutive, interventional study was conducted from a tertiary eye hospital, in which treatment‑naïve and treatment‑switch patients were included. They underwent an intravitreal injection of brolucizumab. The decision to reinject was made based on the presence of fluid on spectral domain optical coherence tomography (SD‑OCT) or worsening of vision at follow‑up. Outcome measures were changes in best‑corrected visual acuity (BCVA), central subfield thickness (CST), fluid (subretinal/intraretinal/sub‑retinal pigment epithelium fluid) levels, and OCT biomarkers and safety analysis. Results: A total of 59 eyes of 50 patients with a total of 132 intravitreal injections were included. There was a statistically significant improvement (P < 0.05) in BCVA from baseline in logMAR treatment‑naïve patients (mean BCVA at baseline 0.6 ± 0.41 and 0.37 ± 0.56). The mean baseline CST of all patients significantly reduced from 582.92 ± 233.11 µm at baseline to 474.06 ± 252.89 µm at the final treatment visit. Thirty‑eight percent of patients showed complete resolution of SHRM after a single injection. The interval between each subsequent injection increased from a mean of 67 to 96 days in treatment‑switch patients and from 47 to 151 days in treatment‑naïve patients. Conclusion: Brolucizumab promises reduced number of injections with longer treatment intervals. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors. Methods: We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends. Results: A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. “Diabetic macular edema,” “retinopathy,” “ranibizumab,” and “optical coherence tomography angiography” were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, “deep learning” (AAY:2020.83), “optical coherence tomography angiography” (AAY:2019.59), “intravitreal Aflibercept” (AAY:2019.29), and “dexamethasone implant” (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run. Conclusion: In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow‑up of DME patients, such as deep learning systems, are still research hotspots. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at evaluation of patients diagnosed with optic disc edema (ODE) in terms of demographics, etiology, clinical presentation, and optical coherence tomography parameters. Methods: An observational cross‑sectional study was conducted from August 2021 to July 2022. Patients diagnosed with ODE underwent comprehensive ophthalmic evaluation. Peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters were assessed using optical coherence tomography. Radiologic investigations were done as deemed necessary. Results: One hundred and forty‑eight eyes with ODE (134 eyes from 67 patients with bilateral ODE and 14 eyes from 14 patients with unilateral ODE) and 148 eyes of age‑ and gender‑matched control group were included in the study. The mean age of the study population was 31.51 ± 13.33 years, with 44 (54.3%) males and 37 (45.6%) females. Bilateral ODE was seen in 82.7% of patients. Idiopathic intracranial hypertension was the most common cause of bilateral ODE, and nonarteritic anterior ischemic optic neuropathy was the most common cause of unilateral presentation. Decreased vision and headache were the main symptoms reported by a majority of patients. Peripapillary RNFL thickness was significantly increased in the ODE group compared to controls. Conclusion: The current study provides the clinical profile and optic disc and RNFL measurements of ODE patients in an Eastern Indian population. Detailed history and careful evaluation are necessary, as the treatment strategy is highly dependent on the underlying etiologies. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the corneal epithelial thickness changes after photorefractive keratectomy (PRK) and the impact of long-term artificial tear usage on epithelial thickness changes in these patients. Methods: This study was performed on 71 patients (142 eyes) without dry eye disease who received PRK for myopic refractive correction. The corneal epithelial thickness profile was obtained before, one, three, and six months after surgery using anterior segment optical coherence tomography. Patients were randomly divided into two groups: group A, who received preservative-free artificial tears post-surgery, and group B, who did not receive artificial tears. Results: The epithelial thickness decreased universally in the first month and then increased in the 3- and 6-month follow-ups. Group A had a significantly thicker epithelium in central, paracentral, and midperipheral zones compared with group B in the 3-month follow-up. In the 6-month follow-up, no significant differences were detected between groups. At the last follow-up, the central, paracentral, and midperipheral zone epithelial thicknesses in all patients were significantly higher than preoperative values, but peripheral zone thickness only increased to preoperative values. Conclusions: Patients using artificial tears showed a faster thickening, especially in the central and paracentral zones, but there were no significant differences between the two groups in the final follow-up. Artificial tear usage may increase the rate of the epithelial remodeling process in post-PRK patients without significantly altering the final epithelial thickness profile. Further studies are warranted to evaluate the influence of different factors on epithelial remodeling. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors. Methods: We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends. Results: A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. "Diabetic macular edema," "retinopathy," "ranibizumab," and "optical coherence tomography angiography" were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, "deep learning" (AAY:2020.83), "optical coherence tomography angiography" (AAY:2019.59), "intravitreal Aflibercept" (AAY:2019.29), and "dexamethasone implant" (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run. Conclusion: In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow-up of DME patients, such as deep learning systems, are still research hotspots. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at evaluation of patients diagnosed with optic disc edema (ODE) in terms of demographics, etiology, clinical presentation, and optical coherence tomography parameters. Methods: An observational cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with ODE underwent comprehensive ophthalmic evaluation. Peripapillary retinal nerve fiber layer (RNFL) thickness and optic nerve head parameters were assessed using optical coherence tomography. Radiologic investigations were done as deemed necessary. Results: One hundred and forty-eight eyes with ODE (134 eyes from 67 patients with bilateral ODE and 14 eyes from 14 patients with unilateral ODE) and 148 eyes of age- and gender-matched control group were included in the study. The mean age of the study population was 31.51 ± 13.33 years, with 44 (54.3%) males and 37 (45.6%) females. Bilateral ODE was seen in 82.7% of patients. Idiopathic intracranial hypertension was the most common cause of bilateral ODE, and nonarteritic anterior ischemic optic neuropathy was the most common cause of unilateral presentation. Decreased vision and headache were the main symptoms reported by a majority of patients. Peripapillary RNFL thickness was significantly increased in the ODE group compared to controls. Conclusion: The current study provides the clinical profile and optic disc and RNFL measurements of ODE patients in an Eastern Indian population. Detailed history and careful evaluation are necessary, as the treatment strategy is highly dependent on the underlying etiologies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the retinal microvascular differences after successful macular hole surgery by using the superior and temporal inverted flap technique. Methods: In this retrospective study, patients with idiopathic macular holes with a horizontal diameter of 250–400 μm at the narrowest point, and who have a follow-up of 6 months were included in the study. Group 1 included 14 patients' 14 eyes that have been treated using the superior inverted flap technique. Group 2 included 15 patients' 15 eyes that have been treated using the temporal inverted flap technique. The vessel density (VD) ratios in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) at the central area and the four parafoveal quadrants were compared between the groups at baseline and postoperative month 6. Results: The mean baseline BCVA improved significantly in both groups at postoperative month 6 (1.21 to 0.50 and 1.32 to 0.52 logMAR, respectively; P < 0.05). There was no significant difference in mean BCVA between the two groups at postoperative month 6 (P < 0.05). The mean VD in SCP in the center area increased significantly in both groups at month 6 postoperatively (P = 0.011 and 0.020, respectively); however, the mean VD in DCP in the center area did not significantly change in both groups (P = 0.079 and 0.078, respectively). The mean VD ratios in SCP and DCP at the four parafoveal quadrants did not change significantly in both groups at month 6 (P < 0.05 for both). Conclusions: Both techniques are safe for retinal microvasculature at postoperative month 6. [ABSTRACT FROM AUTHOR]