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Pigmented paravenous chorioretinal atrophy (PPCRA) is an uncommon form of chorioretinal atrophy characterized by perivenous aggregations of pigment clumps associated with peripapillary and radial zones of retinal pigment epithelial atrophy that are distributed along the retinal veins. Most patients are asymptomatic, and evidence suggest that PPCRA is slowly progressing. Unless macular involvement is present, the majority of patients usually retain a normal visual function. Our ability to diagnose PPCRA has recently improved thanks to multimodal imaging, especially with the advent of ultra-widefield (UWF) imaging. Blood tests and functional and genetic testing can help with the correct differential diagnosis of pseudo-PPCRA or other disorders with similar characteristics. Although the cause of PPCRA is unknown, it is possible that it has a genetic basis. In this review we provide a summary of the multimodal imaging characteristics of PPCRA, and discuss its possible pathogenesis, based on the genes that have been associated with this disease.

Purpose: To characterize hemi-retinal vein occlusion (HRVO) in patients presenting to a multi-tier ophthalmology hospital network., Methods: This retrospective, hospital-based study analyzed 2,834,616 new patients between August 2010 and June 2021. Patients with a clinical diagnosis of HRVO in at least one eye were included as cases. Data were collected using an electronic medical record system. Data were compared to the findings noted in branch RVO (BRVO) and central RVO (CRVO) patients., Results: HRVO constituted 0.9% ( n = 191) of all the retinal vein occlusions (RVOs), with the mean age being 60.55 ± 10.14 years. Most patients were male (125, 65.45%) with unilateral (92.67%) affliction. Majority presented during the sixth (31.41%) or seventh (32.46%) decade of life. Most patients reported mild (37.07%) or moderate (27.32%) visual impairment, with vision < 20/200 being less common in HRVO (25.8%) and BRVO (17.2%) compared to CRVO (44.1%) ( P < 0.00001). Glaucoma was diagnosed and treated in 49 (23.90%) eyes, which was much higher than CRVO (11.45%) and BRVO (5.04%) ( P < 0.001), though neovascular glaucoma was much less than CRVO (2.9% vs. 9.2%) ( P = 0.0037). On follow-up, HRVO eyes (12.2%) had lesser vision loss compared to CRVO eyes (13.7%) (this difference does not look very significant to me), though BRVO had the least (9.1%) vision loss., Conclusion: HRVO is a rare RVO, presenting more in males. It causes less-severe visual impairment compared to CRVO. Large majority of patients with HRVO do not have identifiable systemic risk factors other than age. Preexisting glaucoma was more associated with HRVO compared to other RVOs., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To investigate the effect of image averaging on qualitative and quantitative assessments of optical coherence tomography angiography (OCTA) images from eyes of patients with branch retinal vein occlusion (BRVO)., Methods: Macular OCTA images of 33 eyes of 33 patients with BRVO were obtained using the HS100 HR-SD-OCT system (Canon, Inc.). For each eye, five OCTA cube scans were obtained with a 3 × 3 mm scan protocol, and the data were averaged and compounded into a single high image quality cube data using built-in software. Pre- and post-averaging images were compared qualitatively and quantitatively in superficial capillary plexus (SCP) and deep capillary plexus (DCP) OCTA image slabs., Results: After averaging, all OCTA images showed marked improvement in image quality with less background noise and better vessel continuity. The number of microaneurysms in both the SCP and DCP was larger in single images than in averaged images. A significant increase in the detection rate of capillary telangiectasia in the DCP was noted after image averaging. The number of eyes with disrupted foveal avascular zone (FAZ) decreased significantly after averaging (P = .0253). Five eyes (15.2%) with a disrupted FAZ on the single image showed an intact FAZ after averaging. Vessel length density (VLD) and fractal dimension (FD) significantly decreased and vessel diameter index (VDI) increased after averaging, while significant changes were not observed in vessel density (VD) in both the SCP and DCP. In the SCP, lower VD, VLD, and fractal dimension were significantly correlated with worse visual acuity., Conclusions: OCTA averaging has a significant effect on qualitative and quantitative assessments in eyes with BRVO.

Purpose: To quantify the susceptibility of the deep capillary plexus (DCP) in comparison with that of the superficial capillary plexus (SCP) in eyes with branch retinal vein occlusion (BRVO) using swept-source optical coherence tomography angiography (SS-OCTA)., Methods: SS-OCTA (TritonTM; Topcon, Tokyo, Japan) scans (3 × 3 mm) of 41 patients with BRVO were retrospectively analyzed. The mean vessel densities (VDs) of the SCP and the DCP were calculated in eyes with BRVO using the ImageJ program (National Institutes of Health, Bethesda, MD, USA) and compared with those in the normal fellow eye without any morbidity or unaffected sector in the BRVO eye., Results: The reduction rate of mean VD in SCP and DCP between the affected and unaffected sector of eyes with BRVO was 13.88 and 24.60%, respectively. Additionally, the reduction rate of mean VD in the SCP and DCP in the affected sector of BRVO eyes versus the corresponding sector of fellow eyes was 13.31 and 24.49%, respectively., Conclusion: The DCP was 1.77-1.84 times more affected than the SCP by ischemic damage in eyes with BRVO., (© 2019 S. Karger AG, Basel.)

Purpose: To analyze vascular changes in branch retinal vein occlusion (BRVO) using projection-resolved optical coherence tomography angiography (PR-OCTA)., Methods: We reviewed 30 consecutive eyes of 30 cases with BRVO retrospectively. PR-OCTA was performed during the acute, intermediate, and remission phases when anti-vascular endothelial growth factor drugs suppress cystic changes. The main outcome measures were vessel density (VD) and retinal thickness changes in the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP)., Results: The VDs did not change longitudinally in the SCP and DCP during the follow-up period. The VD was significantly (p = 0.0105) greater in the ICP during remission than the acute phase. The full retinal thickness (internal limiting membrane [ILM] to retinal pigment epithelium [RPE]) and inner retinal thickness (ILM to inner plexiform layer [IPL]) decreased significantly (p = 0.0002 and p = 0.0014, respectively) during the follow-up period. When the inner retina was thinner than 117 μm, the VD in the ICP increased significantly (p = 0.045) during the follow-up period. When the inner retinal layer did not become thinner, the VD in the ICP remained unchanged., Conclusion: PR-OCTA showed the three distinct vascular plexuses in BRVO. The VDs remained unchanged during the follow-up period in the SCP and DCP but increased significantly in the ICP during remission. Inner retinal thinning might cause increases in the VD in the ICP because of projection artifacts and segmentation errors despite using PR-OCTA.

Objective: To compare the macular vascular density in branch retinal vein occlusion (BRVO) versus normals on optical coherence tomography angiography (OCTA) using fractal analysis and to describe the factors bearing on final visual outcomes., Participants: This study is a retrospective observational comparative case series. Diagnosed cases of unilateral BRVO that underwent treatment and resolved were included. The other eye served as control., Methods: OCTA images of the cases and control eyes were analyzed using fractal dimension on the MATLAB platform. Vascular density fraction was calculated for each eye for both the retinal vascular layers. Images were cleaned of artifacts before processing. Total vascular density in normals was compared with those with branch retinal vein occlusion., Results: 116 eyes were normal and 98 had BRVO. The mean age of the normals was 56.63 ± 12.5 years and 58.41 ± 10.7 years of the BRVO group (p = 0.6). Superficial vascular density fraction was noted as 0.29 ± 0.08 (95% CI 0.27-0.31) and 0.25 ± 0.1 (95% CI 0.23-0.27) respectively (p = 0.003). Deep vascular density was noted as 0.39 ± 0.11 (95% CI 0.32-0.41) and 0.14 ± 0.09 (95% CI 0.12-0.19) (p < 0.0001). Pearson's correlation coefficient was -0.4 (p = 0.04) for the effect of age on vascularity, -0.53 (p = 0.001) for the effect of vascularity on final vision, and 0.35 (p = 0.09) for the effect of duration of symptoms on final vision., Conclusions: In BRVO vascular density decreases significantly in the deeper retinal layer. Vision deficit correlates to increased age, duration of symptoms, and greater vascularity loss., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To understand the relationship between baseline ischemic index (IsI) values on ultra-widefield fluorescein angiography and classification as ischemic central retinal vein occlusion (CRVO)., Methods: Single-center retrospective cohort study of CRVO patients imaged using ultra-widefield fluorescein angiography from which IsI values were calculated. An ischemic CRVO was defined as those eyes with an afferent pupillary defect and counting fingers acuity or worse or neovascularization during the first year of follow-up. Logistic regression was performed to characterize the relation between the IsI and clinical outcomes., Results: Sixty eyes of 60 treatment-naive CRVO patients with baseline ultra-widefield fluorescein angiography and ≥1 year of follow-up were identified. Those with an IsI ≥35% were significantly more likely to have an ischemic CRVO during the first year of follow-up than those with an IsI <35% (83.3 vs. 13.9%, odds ratio 111, P < 0.0001). Baseline and final logarithm of the minimum angle of resolution acuity were worse in eyes with an IsI ≥35% (1.18 vs. 0.46, P < 0.001 and 1.26 vs. 0.45, P < 0.001, respectively) despite similar baseline and final central subfield thickness (P = 0.1-0.23)., Conclusion: A baseline IsI of ≥35% on ultra-widefield fluorescein angiography in eyes with treatment-naive CRVO was sensitive (90%) and specific (92.5%) for classification as an ischemic CRVO during the first year of follow-up.

Background/purpose: To report a case of a branch retinal vein occlusion secondary to a retinal arteriolar macroaneurysm (RAM)., Methods: Retrospective case report describing examination findings, treatment outcome and unique multimodal imaging features demonstrated on fluorescein angiography, optical coherence tomography, optical coherence tomography angiography and adaptive optics photography of the retinal vessels and RAM., Results: A 61-year-old man presented with 20/200 vision in the right eye because of a branch retinal vein occlusion secondary to a RAM. After sector panretinal photocoagulation and a course of 24 intravitreal antivascular endothelial growth factor injections over 4 years, visual acuity improved to 20/25. Fluorescein angiography showed filling of the RAM even after 4 years. Optical coherence tomography angiography demonstrated venous collateral vessels in both the superficial and deep capillary plexuses, and adaptive optics imaging revealed a gap between the RAM wall and occluded vein., Conclusion: Multimodal imaging of this unusual presentation illustrated a novel mechanism of branch retinal vein occlusion in which a primary RAM adjacent to the junction of two retinal veins led to obstruction of venous flow without evidence of direct compression. This supports the theory that perianeurysmal microenvironment changes may be of importance in the pathogenesis of venous occlusion.

Purpose: To examine retinal blood flow at arteriovenous crossings using spectral-domain optical coherence tomography (SD-OCT)., Methods: Retrospective observational case series of 11 arteriovenous crossings in 10 eyes examined by SD-OCT and fluorescein angiography on suspicion of manifest or imminent branch retinal vein occlusion., Results: Fluorescein angiographic evidence of turbulence was seen at 5 of 11 arteriovenous crossings, whereas laminar angiographic flow was intact at the crossing and downstream thereof at the remaining 6 crossings. On SD-OCT, chaotic reflectivity patterns were seen at the point of crossing and downstream thereof in all 5 cases with angiographic turbulence, whereas an intravascular trilayer SD-OCT pattern consistent with laminar flow was seen throughout the examined course of the vein in the eyes with laminar angiographic flow., Conclusion: We examined retinal blood flow at and near arteriovenous crossings and found that SD-OCT may rival fluorescein angiography in the ability to demonstrate turbulent venous blood flow.

Purpose: This study aimed to develop a method for automated artery-vein classification in optical coherence tomography angiography (OCTA), and to verify that differential artery-vein analysis can improve the sensitivity of OCTA detection and staging of diabetic retinopathy (DR)., Methods: For each patient, the color fundus image was used to guide the artery-vein differentiation in the OCTA image. Traditional mean blood vessel caliber (m-BVC) and mean blood vessel tortuosity (m-BVT) in OCTA images were quantified for control and DR groups. Artery BVC (a-BVC), vein BVC (v-BVC), artery BVT (a-BVT), and vein BVT (a-BVT) were calculated, and then the artery-vein ratio (AVR) of BVC (AVR-BVC) and AVR of BVT (AVR-BVT) were quantified for comparative analysis. Sensitivity, specificity, and accuracy were used as performance metrics of artery-vein classification. One-way, multilabel ANOVA with Bonferroni's test and Student's t-test were employed for statistical analysis., Results: Forty eyes of 20 control subjects and 80 eyes of 48 NPDR patients (18 mild, 16 moderate, and 14 severe NPDR) were evaluated in this study. The color fundus image-guided artery-vein differentiation reliably identified individual arteries and veins in OCTA. AVR-BVC and AVR-BVT provided significant (P < 0.001) and moderate (P < 0.05) improvements, respectively, in detecting and classifying NPDR stages, compared with traditional m-BVC analysis., Conclusions: Color fundus image-guided artery-vein classification provides a feasible method to differentiate arteries and veins in OCTA. Differential artery-vein analysis can improve the sensitivity of OCTA detection and classification of DR. AVR-BVC is the most-sensitive feature, which can classify control and mild NPDR, providing a quantitative biomarker for objective detection of early DR.

Competing Interests: There are no conflicts of interest

Background: Pigmented paravenous retinochoroidal atrophy (PPRCA) is an unusual retinal degeneration, and its performance on optical coherence tomography angiography (OCTA) is unclear. We report a Chinese female case of PPRCA and her OCTA features., Case Presentation: A 66-year-old female patient was referred to the author's center for gradual progressive loss of vision in both eyes and photophobia of 2 years duration. She reported having no family history of inherited ocular diseases. The funduscopic examination revealed bone-spicule pigmentation and retinochoroidal atrophy along the retinal veins. This patient was diagnosed with PPRCA which is a rare disease, uncommon in females, more commonly affecting the paravascular fundus. Noninvasive imaging techniques features of this patient was described, including ultra-wide field fundus autofluorescence, spectral domain optical coherence tomography (SD-OCT), OCTA (SSADA), etc. The en face OCTA images demonstrated areas of flow void beneath the retinal pigment epithelium-Bruch membrane layer suggestive of choriocapillaris hypoperfusion that corresponded with indocyanine green angiography (ICGA). Further studies should be conducted to clarify the relationship between choriocapillaris hypoperfusion and the development of PPRCA., Conclusions: The OCTA features in patients with PPRCA has not been described previously in the literature. This case might provide preliminary information regarding the pathophysiology of PPRCA and improve our understanding of the nature of this disease.

The wide-field montage technique of optical coherence tomography angiography provides good delineation of the improvement in microvascular disturbance associated with branch retinal vein occlusion after treatment with anti-vascular endothelial-derived growth factor injection. It may be further evaluated for the assessment of treatment progress in patients with retinal vein occlusion.

To avoid fluorescein angiography in a pregnant woman diagnosed with a central retinal vein occlusion (CRVO), swept-source optical coherence tomography angiography (SS-OCTA) was performed and showed no evidence of decreased central retinal perfusion leading to the diagnosis of a nonischemic CRVO. Five months after an intravitreal injection of steroid, both her vision and the retinal appearance had returned to normal. This case demonstrates how a noninvasive, safe, 12 mm × 12 mm SS-OCTA image of a CRVO is useful in evaluating the retinal perfusion at presentation and follow-up during pregnancy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:206-208.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To evaluate changes of vascular flow of patients treated with intravitreal injections of anti-vascular endothelial growth factor for macular edema secondary to retinal vein occlusion (RVO) with optical coherence tomography angiography (OCTA)., Methods: Patients with RVO with macular edema and treated with intravitreal injections of anti-vascular endothelial growth factors were retrospectively evaluated. The following examinations were performed before and after treatment: best-corrected visual acuity, spectral domain optical coherence tomography, fluorescein angiography, and OCTA (Optovue, Inc). Automatic measurement of vascular density of the superficial and deep capillary plexus was also performed and compared with age- and sex-matched healthy subjects., Results: Twenty-eight eyes of 28 patients (mean age 66.2 years; males 19%) were evaluated, including 13 central RVO, 11 branch RVO, and 4 hemicentral RVO. After treatment, mean central macular thickness significantly decreased from 644 μm to 326 μm and best-corrected visual acuity increased from 20/125 to 20/63 (P < 0.01 for both results). On OCTA, perifoveal capillary disruption (P = 0.029) and the number of cysts in the superficial capillary plexus and deep capillary plexus (P < 0.002) significantly decreased after treatment. The mean vascular density in the superficial capillary plexus slightly decreased during follow-up from 46.44% to 45.01% (not significantly). These densities were significantly less than those observed in healthy controls (P < 0.001)., Conclusion: Optical coherence tomography angiography showed regression of macular edema, reduced capillary disruption and cysts, and slight decrease in mean macular vascular density with time and despite treatment. Thus, OCTA enables qualitative and quantitative evaluation during follow-up of patients treated for RVO.

Venous loops are relatively rare manifestations of diabetic retinopathy. The authors describe a case characterized by the development of a venous loop during a 3-year period. Optical coherence tomography angiography (OCTA) revealed a hyperintense signal from the lesion, attesting an ordinary flow into the venous loop. OCTA also showed an area of capillary loss in proximity of the lesion, which is in agreement with the proposed pathogenesis for venous loops, developed to bypass an area of retinal vessels occlusion. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:518-520.]., (Copyright 2017, SLACK Incorporated.)

Purpose: Widefield photography and angiography provide access up to 200-degrees of the retinal periphery. The range of normal peripheral findings has not been characterized, yet is relevant to studies addressing putative peripheral retinal vascular pathology., Methods: This study was an observational retrospective cohort study. Adult patients with epiretinal membrane or choroidal nevi who underwent imaging with Optos 200 MA/200Tx were included. Dye transit times, peripheral arteriovenous shunting, presence of vessels crossing the horizontal raphe, right angle vessels, terminal networks, absence of capillary detail, ground glass hyperfluorescence, peripheral drusen, and microaneurysms were evaluated., Results: Fifty-eight eyes of 31 patients met inclusion criteria. Mean peripheral arterial filling time was 8.65 ± 2.54 seconds (range 3-15 seconds). One or more peripheral anomalies were noted in all patients (P < 0.01). The prevalences of findings were: arteriovenous shunting (0.00%), vessels crossing the horizontal raphe (44.83%), right angle vessels (70.69%), terminal networks (77.59%), absence of capillary detail (98.28%), ground glass hyperfluorescence (87.93%), drusen (34.48%), and microaneurysms (41.38%)., Conclusion: There was a high prevalence of peripheral vascular anatomic variations in eyes expected to have normal peripheral retinal vasculature. These findings may provide a reference for future studies addressing putative pathologic peripheral angiographic findings.

Purpose: To evaluate the clinical utility of optical coherence tomography angiography (OCTA) in patients with retinal vein occlusion (RVO), and to systematically compare OCTA images with changes seen on color fundus photography and fluorescein angiography (FA)., Design: Reliability analysis., Methods: Eighty-one eyes of 76 patients with a history of RVO (branch, central, or hemicentral), both acute and chronic, underwent OCTA and color fundus photography. In 29 eyes, data were compared to FA imaging. Comparative and multimodal analysis of the 3 imaging procedures were performed., Results: We identified good agreement between FA and OCTA scans centered on the macula for capillary nonperfusion (intraclass correlation coefficient [ICC] 0.825 for the 3 × 3-mm scan and 0.891 for the 8 × 8-mm scan). Agreement for area of capillary changes (dilation, pruning, and telangiectasia) was also substantial (ICC 0.712 for the 3 × 3-mm scan and 0.787 for the 8 × 8-mm scan). For foveal avascular zone grading, agreement was good for the 3 × 3-mm scan (kappa = 1.000 for radius and kappa = 0.799 for outline) but poor for the 8 × 8-mm scan (kappa = 0.156 for radius and kappa = 0.600 for outline). The quality of the images obtained was an important issue for OCTA, as 15.1% of scans were nongradable, particularly in patients unable to maintain fixation., Conclusions: OCTA is a quick, reliable, and noninvasive method to evaluate the area of capillary nonperfusion and foveal avascular zone morphology in patients with RVO. However, good fixation is a requirement for acquisition of good-quality images., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To noninvasively evaluate the retinal microvasculature in human subjects with retinal venous occlusions using optical coherence tomography angiography and assess potential clinical applications., Methods: This was a prospective, observational study of adult human subjects with clinical and imaging findings demonstrating retinal venous occlusion. Subjects underwent complete ophthalmic examination and fluorescein angiography as appropriate for their standard of care. Optical coherence tomography angiography was performed on a prototype spectral domain-OCTA system in 3 mm × 3 mm and 6 mm × 6 mm regions centered on the fovea and parafoveal areas. Retinal vasculature was assessed within three horizontal slabs consisting of the superficial, middle, and deep retina. The vasculature within each slab was reconstructed using intensity contrast-based algorithms and visualized as en-face images. Optical coherence tomography angiograms were manually segmented to verify the accuracy of the automated segmentation algorithms., Results: Optical coherence tomography angiography was able to demonstrate almost all of the clinically relevant findings in 25 subjects with acute and chronic retinal venous occlusion. These findings were consistent with clinical, anatomic, and fluorescein angiographic findings including areas of impaired vascular perfusion, retinal atrophy, vascular dilation, shunt vessels, and some forms of intraretinal edema., Conclusion: Optical coherence tomography angiography is an investigational method that generates high-resolution, noninvasive angiograms that qualitatively illustrate most of clinically relevant findings in retinal venous occlusion. Optical coherence tomography angiography corresponds well with fluorescein angiograms and in many cases provides more detailed anatomic and blood flow information. Optical coherence tomography angiography, in conjunction with standard spectral domain-OCT, is at least equally as effective as fluorescein angiography for evaluation and management of the macular complications of retinal venous occlusions.

Purpose: To develop a novel, simplified method for correcting the ischemic index of nonperfused areas in diabetic retinopathy (DR)., Methods: We performed a retrospective review of 103 eyes with naive DR that underwent ultra-widefield angiography (UWFA) over a year. UWFAs were graded according to the quantity of retinal non-perfusion, and uncorrected ischemic index (UII) and corrected ischemic index (CII) were calculated using a simplified, novel method., Results: The average differences between UII and CII in the non-proliferative DR group and the proliferative DR group were 0.7 ± 0.9% in the <25% CII group, 3.0 ± 0.9% in the 25% to 49.9% CII group, and 3.6 ± 0.6% in the >50% CII group, respectively. A CII >25% was critical for determining DR progression (p < 0.001)., Conclusions: Distortion created by UWFA needs to be corrected because the difference between UII and CII in DR increases with the ischemic index.

In this study, we have introduced an accurate retinal images registration method using affine moment invariants (AMI's) which are the shape descriptors. First, some closed-boundary regions are extracted in both reference and sensed images. Then, AMI's are computed for each of those regions. The centers of gravity of three pairs of regions which have the minimum of distances are selected as the control points. The region matching is performed by the distance measurements of AMI's. The evaluation of region matching is performed by comparing the angles of three triangles which are built on these three-point pairs in reference and sensed images. The parameters of affine transform can be computed using these three pairs of control points. The proposed algorithm is applied on the valid DRIVE database. In general (for the case, each sensed image is produced by rotating, scaling, and translating the reference image with different angles, scale factors, and translation factors), the success rate and accuracy is 95 and 96 %, respectively.

The purpose of this study was to evaluate whether ultra wide field fluorescein angiography (UWFFA), a tool established for the detection of peripheral non-perfusion, can also detect macular pathology. A retrospective imaging review was performed on patients with central retinal vein occlusion. UWFFA was graded for angiographic leakage (petalloid and/or diffuse leakage) and presence of abnormalities in the foveal avascular zone and was then correlated to spectral-domain optical coherence tomography (SD-OCT). Sixty-six eyes met inclusion criteria. Intergrader agreement was highly reliable for grading macular leakage on UWFFA (kappa = 0.75) and moderately reliable for the evaluation of an abnormal foveal avascular zone (kappa = 0.43). Angiographic leakage on UWFFA correlated to macular edema on SD-OCT (P > .0001), and abnormalities in the foveal avascular zone on UWFFA correlated to ganglion cell layer atrophy on SD-OCT (P = .0002). Intergrader reliability in grading UWFFA was better when assessing macular leakage than when assessing macular ischemia. UWFFA findings correlated to macular edema and signs of macular ischemia on SD-OCT., (Copyright 2012, SLACK Incorporated.)

Purpose: To develop a method of imaging the retina using wide-field fluorescein angiography and use this method to investigate the areas of perfusion abnormalities in patients treated with ranibizumab for central retinal vein occlusion., Methods: Cross-sectional analysis of patients recruited to a prospective study. Patients in a prospective study of ranibizumab for central retinal vein occlusion were imaged with wide-field angiography. Fluorescein angiograms taken with the Optos P200 Scanning Laser Ophthalmoscope were obtained of the posterior portion of the eye and of the periphery through ocular steering. Resultant images of the periphery were registered to the posterior image using thin-plate spline warping. A transformation was used to measure the retinal surface area. Perfusion characteristics were compared with injection frequencies and protocol refraction visual acuity measurements., Results: Of 22 patients imaged, 7 would be classified as nonperfused by the Central Retinal Vein Occlusion Study (CVOS) angiographic criteria. However, all patients showed confluent areas of nonperfusion in the retinal periphery ranging in size from 16 disk areas to 242 disk areas. The areas of peripheral nonperfusion were not significantly different in the Central Retinal Vein Occlusion Study-perfused group versus nonperfused group. The area of peripheral nonperfusion was not correlated with the number of injections (r = -0.13, P = 0.58), but was inversely correlated with visual acuity (r = -0.52, P = 0.013). Blood vessels at the border of the peripheral nonperfusion did not show signs of neovascular growth or profuse leakage., Conclusion: Angiographic mapping of the retina is possible using image-processing techniques with wide-field images. Eyes with central retinal vein occlusion develop widespread peripheral vascular obliteration in regions that are difficult to image with conventional fundus cameras. These nonperfused areas may have important implications for visual function.

Purpose: To study the peripheral angiographic features of branch retinal vein occlusions (BRVO) and hemicentral retinal vein occlusions (HRVO) and explore associations with macular edema and neovascularization., Design: Retrospective observational case series., Participants: Seventy-eight outpatients., Methods: An imaging database of angiograms performed at a single academic institution was searched for patients with a diagnosis of BRVO or HRVO. Images were graded for the presence of untreated nonperfusion (areas without evidence of laser photocoagulation), late peripheral vascular leakage (LPVL), neovascularization, macular edema, and prior laser treatment. Optical coherence tomography images were reviewed for all patients to confirm the presence of macular thickening and to exclude eyes with vitreomacular traction., Main Outcome Measures: Angiographic evidence of nonperfusion, neovascularization, macular edema, LPVL, and prior laser treatment., Results: Angiograms from 80 eyes of 78 patients were analyzed with a diagnosis of BRVO (86%) or HRVO (14%). Angiographic macular edema (80%), untreated nonperfusion (82%), neovascularization (21%), and LPVL (58%) were observed. Untreated nonperfusion at any location was significantly associated with macular edema (P = 0.043). Untreated nonperfusion anterior to the globe equator was significantly associated with macular edema (P = 0.007). Untreated nonperfusion was significantly associated with the presence of neovascularization (P = 0.033). Late peripheral vascular leakage was not associated with other angiographic or clinical findings studied., Conclusions: Ultra wide-field angiography provides visualization of peripheral retinal pathology in BRVO and HRVO patients, which may be useful in their evaluation and treatment. Our findings support the hypothesis that areas of untreated retinal nonperfusion may be the source of production of biochemical mediators that promote neovascularization and macular edema., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Optical coherence tomography (OCT) is used to image branch retinal vein occlusion (BRVO) but lacks information about leakage dynamics and perfusion status. Topographical angiography (TAG) is capable of providing this information and has been described previously in age-related macular degeneration. This study evaluates TAG in BRVO., Methods: We included 56 eyes of 40 consecutive patients with BRVO and a reduction in central vision. Two groups were established based on whether argon laser coagulation was performed or not. A standardized follow-up was performed. The chorioretinal fluorescence pattern was reconstructed following TAG. Quantitative measurements were also performed., Results: TAG performed from indocyanine green angiography (ICGA) showed smaller lesion size (LS) compared to fluorescein angiography (FA) (mean difference: early phase = -1.6 mm(2), late phase = -1.8 mm(2)). The extent of mean LS from early to late phase increased by 0.8 mm(2) in FA and by 0.6 mm(2) in ICGA. TAG could visualize different degrees of leakage topographically., Conclusion: TAG gives new insights into the pathophysiology of BRVO: it enables the visualization of dynamics of leakage and the demonstration of the effects of intravasal stasis. Furthermore, TAG is less impaired by masking phenomena than FA. Functional retinal imaging shows distinct advantages over OCT: quantification of leakage activity is possible using TAG.

Background: To determine fundus fluorescein angiography (FA) findings in cases with intermediate uveitis in the inactive phase., Methods: This prospective study included all eligible cases with a diagnosis of intermediate uveitis that were treated at the uvea unit of Trakya University ophthalmology department between January 2002 and January 2004. Study criteria included patients in the inactive phase who had no complaints, no biomicroscopic or ophthalmoscopic inflammatory findings in the anterior and posterior segments, and no period of inflammation that had occurred within the previous 6 months. Cases receiving immunosuppressive treatment were not excluded. FA was performed in all cases, which were evaluated by 2 independent observers., Results: A total of 21 eyes from 21 cases with intermediate uveitis were included in the study. FAs of the cases were taken approximately 8.8 (SD 5.4) months (range 6-23 months) after the last activation. In these FAs, no pathological findings were identified in 5 eyes (23.8%); optic disc hyperfluorescence was observed in 14 eyes (66.7%); large vein staining was observed in 2 eyes (9.5%); peripheral venous leakage was observed in 6 eyes (28.6%); and cystoid macular edema was observed in 5 eyes (23.8%)., Interpretation: These findings indicate that retinal vascular inflammatory changes persist in cases with intermediate uveitis even if the clinical manifestations have been treated.

Purpose: To quantify photodynamic venous occlusion-induced preretinal neovascularization with fluorescein isothiocyanate-dextran (FITC-dextran) angiography in adult Sprague-Dawley rats., Methods: Argon green laser was used to ablate retinal veins in the experimental group (24 rats), and applied between the vessels in the control group (10 rats) after systemic injection of rose bengal. Animals were systemically infused with FITC-dextran and killed 14 days after laser treatment. Retinal flat-mounts were observed under a fluorescence microscope. The number and area of neovascular tufts were measured. Confocal microscopy and histological study were performed to rule out possible artifacts, and to confirm FITC-dextran angiography findings., Results: Out of the entire group of 34 albino rats, no preretinal neovascularization was found in the control group (total 20 eyes, 10 rats). In the experimental group (total 48 eyes, 24 rats) 43 eyes (90%) developed well demarcated neovascular tufts revealed by FITC-dextran angiography. This well demarcated boundary of neovascular tufts was reconfirmed by confocal microscopy and histological study. There were no significant differences in the number or area of neovascular tufts between the right and left eyes., Conclusion: FITC-dextran angiography provides a time- and labour-efficient basis for quantifying both the number and area of preretinal neovascularization induced by photodynamic venous occlusion in adult rats. This model is suitable for angiostatic study in the adult animals.

Purpose: To report long-term follow-up of patients with pigmented paravenous retinochoroidal atrophy (PPRCA) and to assess the involvement of the choroid and retinal pigment epithelium (RPE) in PPRCA., Methods: Clinical features of PPRCA were studied retrospectively in four patients followed for 6-26 years. Retinal pigment epithelium and choroidal changes were analysed with fluorescein and indocyanine green (ICG) angiography., Results: The two younger patients, aged 16 and 28 years and followed for 6 and 18 years, respectively, showed stationary RPE atrophy and pigmentation. Indocyanine green angiography visualized slight to modest atrophy of the choriocapillaris. The two older patients, aged 69 and 70 years and each followed for 26 years, showed slow progression of disease during follow-up. Indocyanine green angiography revealed choriocapillaris atrophy partly extending into the areas shown as hyperfluorescent in fluorescein angiography., Conclusion: Pigmented paravenous retinochoroidal atrophy is probably a slowly progressive disease, particularly in older patients. The choriocapillaris atrophy in this disease is more properly evaluated by ICG angiography and can be underestimated by fluorescein anigiography.

Background: In patients with branch retinal vein occlusion (BRVO), we investigated the presence of indocyanine green (ICG) and fluorescein hyperfluorescence at the site of occlusion. We also assessed the association of this feature with the clinical outcome of these patients., Methods: Both indocyanine green (ICG) videoangiography and fluorescein angiography (FAG) were performed in 21 eyes with BRVO of less than 1 month duration. Deterioration of the disease was defined clinically as an increase in retinal hemorrhages or retinal edema. Capillary nonperfusion was quantified with computer image analysis from the FAG pictures., Results: ICG videoangiography showed focal hyperfluorescence along the venous wall at the site of the affected A-V crossing in 9 of the 21 eyes, and FAG showed this feature in 10 eyes. The ICG hyperfluorescence was more prominently and focally detected than the hyperfluorescence on FAG, which was sometimes diffusely seen throughout the whole occluded area. Eight of the nine eyes showing ICG hyperfluorescence had clinical deterioration with an increase in retinal hemorrhage or edema. This deterioration occurred more frequently in eyes with hyperfluorescence and/or late leakage than in ones without these features. The mean nonperfused area was significantly larger in eyes with hyperfluorescence than in eyes without these features., Conclusion: The ICG hyperfluorescence at the site of A-V crossing is associated with disease deterioration in patients with fresh BRVO. The ICG hyperfluorescence was more easily detectable than the hyperfluorescence on FAG, although the difference in sensitivity between the two methods is not great.

Purpose: To determine the usefulness of fluorescein angiography in studying Takayasu disease., Methods: We examined 31 eyes in 16 patients with Takayasu disease using indirect ophthalmoscopy, color photography, and fluorescein angiography. Ophthalmoscopic and fluorescein angiographic findings were compared., Results: Fluorescein angiography revealed no additional retinal changes in 10 eyes that had no retinal vein dilatation as seen by indirect ophthalmoscopy. Seven (33%) of 21 eyes that had dilated retinal veins also had additional abnormal findings, such as microaneurysms, arteriovenous shunts, retinal neovascularization, and avascular areas. Some differences in grading the stages of retinopathy were noted with these newly found retinal changes, as compared with the classifications determined by ophthalmoscopy alone., Conclusions: In Takayasu disease, studying the fundus of patients with fluorescein angiography is particularly important in correctly classifying the stages of retinopathy when the retinal vein appears dilated in ophthalmoscopic observation.

Pathologic retinal choroidal anastomoses are relatively rare. Until now, they have been described in age-related macular degeneration only in occult pigment epithelial detachments or following fibrous scarring. We report the occurrence of a retinal choroidal anastomosis with blood flow from an actively proliferating classic choroidal neovascular membrane into a retinal vein in a 72-year-old male with age-related macular degeneration. Indocyanine green videoangiography performed by scanning laser ophthalmoscope demonstrated the anastomosis, whereas it could not be identified clinically or with fluorescein videoangiography.

In addition to documenting pathologic vessel changes fluorescein angiography also makes it possible to show hemodynamic changes in retinal thrombosis. An interruption of laminary flow can be seen in the fluorescein angiogram at arteriovenous intersections. The retinal circulation time can be an aid to prognosis. If the interval does not exceed four seconds the prognosis is generally favorable but when it is considerably longer the prognosis with regard to visual acuity is generally poor and, furthermore, sequelae such as rubeosis iridis and secondary glaucoma must be expected. The therapeutic efficacy of laser coagulation can be judged more accurately by photographic and fluorescein angiographic documentation of the course.

Fundus fluorescein angiograms of 21 gyrate atrophy patients were evaluated. In 16 of 21 patients between 2 to 13 angiograms were taken during the follow-up which extended from 1.6 to 13.4 years. In 5 of 21 patients the fluorescein angiography was done once. Optic disc drusen occurred in 3 patients. Optic disc atrophy was not observed. Some attenuation occurred in the retinal arteries in the far-advanced stages. Up to the midretinal venous phase 5 of 13 patients had a markedly increased visibility of the larger choroidal vessels in areas of ophthalmoscopically intact retina. Pigment epithelial window defects presented in 17 of 21 patients. In 4, they were seen to enlarge into patches of chorioretinal atrophy during this long-term follow-up. Contrary to the general notion, the macula was affected frequently, i.e. in 9 of 21 patients; In 6 the pigment epithelial window defects presented in the macula, one had bilateral cystoid macular oedema, and in 2 patients the patches of chorioretinal atrophy were central.