Search

PURPOSE Asymmetric dilated vortex vein (ADVV) observed in eyes with pachychoroid spectrum diseases is thought to be due to congestion of choroidal blood flow. The purpose of this study was to quantitatively investigate the blood flow velocity of ADVV using laser speckle flowgraphy (LSFG). STUDY DESIGN Retrospective case series. METHODS This was a retrospective case series with 23 eyes of 18 patients with ADVV on en-face OCT. A pair of choroidal veins from ADVV side (defined as ADVV vein) and non-ADVV side (defined as non-ADVV vein) was selected in each eye under the following criteria: (i) equivalent proximity to the deviated watershed, (ii) does not overlap with retinal blood vessels in the en-face OCT image, (iii) has approximately the same blood vessel diameter. Rubber bands were placed on the selected choroidal veins on the LSFG color map. Mean blur rate (MBR) values of ADVV and non-ADVV veins were statistically compared. RESULTS The average MBR was 10.11 ± 1.9 in the ADVV veins and 13.49 ± 6.2 in the non-ADVV veins, showing significantly lower values in the ADVV veins (P = 0.03). The blood vessel diameter of the ADVV was 10.26 ± 3.0 and in the non-ADVV veins, 10.63 ± 2.9 pixels; not significantly different (P = 0.66). The distance from the deviated watershed to the ADVV was 53.3 ± 24.8 and to the non-ADVV veins, 46.80 ± 20.3 pixels; not significantly different (P = 0.41). CONCLUSION In eyes with ADVV, the blood flow velocity in the ADVV veins was lower than in the non-ADVV veins, suggesting anatomical congestion of ADVV.

The introduction of optical coherence tomography angiography (OCTA) has granted a significant improvement in the assessment of patients with diabetes. In this review, we will provide a description of the prominent OCTA findings in diabetes. In detail, this imaging technology proved that both the retinal and choroidal circulation is affected in diabetic subjects. The recent employment of widefield technology and a three-dimensional (3D) visualization in OCTA imaging are also discussed.

To evaluate the clinical characteristics of pachydrusen in central serous chorioretinopathy (CSC) and investigate the relationship between choroidal circulation and pachydrusen. In a retrospective case series of 302 eyes of 151 patients with treatment-naive CSC, we assessed the incidence of pachydrusen and their features on indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Pachydrusen were observed in 82 of the 302 eyes (27.2%). The patients with pachydrusen were significantly older than those without pachydrusen. In 36 of the 82 eyes with pachydrusen, the choriocapillaris perfusion phase of ICGA was recorded. Pachydrusen were localized within the geographic filling delay of the choriocapillaris in 26 of the 36 eyes (72.2%). In the late phase of ICGA, pachydrusen corresponded to punctate hyperfluorescent spots in 69 of the 82 eyes (84.1%) and localized within sites of choroidal vascular hyperpermeability in 45 eyes (54.9%). En face OCT revealed pachydrusen to be localized over the dilated outer choroidal vessels in 70 of the 82 eyes (85.4%). B-mode OCT showed pachydrusen under the retinal pigment epithelium (RPE) in 72 of the 82 eyes (87.8%). There was no significant difference in central choroidal thickness between eyes with and without pachydrusen. Pachydrusen in patients with CSC were frequently localized within the choriocapillaris filling delay and over the dilated outer choroidal vessels. Moreover, they were frequently observed under the RPE and corresponded to punctate hyperfluorescent spots on ICGA. These findings suggest that inner choroidal circulation impairment due to dilatation of outer choroidal vessels might induce pachydrusen.

Purpose: This study aimed to evaluate choroidal thickness (CT) and choroidal vascularity index (CVI) in patients with Graves’ disease (GD) without ocular involvement. Methods: Fifty patients diagnosed with GD and 50 age and gender matched healthy control subjects were retrospectively evaluated. Measurements were taken from five different points on CT images. Choroid images were classified as lumen regions (LA) and stromal regions (SA) using the image binarization method. CVI was calculated by dividing LA by the total choroidal area (TCA). The effects of Thyrotropin Receptor Antibody (TRAb), age, GD duration, blood pressure, axial length measurements, and intraocular pressure were analyzed on CT and CVI measurements. Results: Mean age was 40.1 ± 13.5 years in the patient group and 39.3 ± 13.6 years in the control group ( p = 0.89). There was no significant difference between the GD group and control group in terms of CT measurements. There was a significant difference between the mean CVI measurements of the GD group and control group (68.03 ± 3.41 and 66.62 ± 3.11, respectively) ( p Conclusion: While there was no significant difference between the CT measurements of the GD group and the control group, the GD group had significantly higher CVI measurements.

We describe an unusual case of ultra wide fluorescein angiography (UWFA) documented peripheral retinal neovascularization (NVE) with delayed vitreous hemorrhage after placement of an encircling scleral buckle (a common procedure for repair of retinal detachment). Anterior segment ischemia is a rare complication after scleral buckle surgery for the treatment of retinal detachment and results from altered choroidal flow through the impingement of the anterior and long posterior ciliary arteries. UWFA performed for the evaluation of vitreous hemorrhage confirmed ischemia anterior to the scleral buckle and consequential NVE. This case represents the utility of UWFA in evaluating and managing this exceptionally rare complication associated with a common procedure in the field of vitreoretinal surgery.

AimTo analyse the peripheral extent of choroidal circulation using ultra-widefield (UWF) indocyanine green angiography (ICGA) in healthy eyes.MethodsUWF ICGA images of 55 eyes of 36 healthy subjects were captured using the Optos California (Optos, Dunfermline, United Kingdom) in this prospective observational study. Images were analysed to locate the peripheral extent of the visible choroidal circulation, and the boundary was marked in ImageJ (v1.52). Each pixel annotated as the border of the choroidal circulation was projected individually to its anatomically correct location on the three-dimensional model eye, and spherical trigonometry was applied (using the Optos software) to calculate its respective radial distance from the centre of the optic disc in metric units (corrected by stereographic projection) for each quadrant.ResultsThe mean area of the peripheral extent was estimated to be 893.2 mm2 (95% CI: 844.2 to 942.3 mm2). The mean distance (range) of this boundary from optic nerve centre was 18.22 mm (95% CI: 14.0 to 23.14 mm). Multiple regression analysis with age, gender, axial length or ethnicity showed no relationship. There was excellent inter-grader reproducibility, with intraclass correlation coefficients of 0.95 (95% CI: 0.80 to 0.99, ppConclusionsThe peripheral choroidal boundary may be defined using UWF ICGA. Knowledge of the normal extent and its variability is essential to understand the impact of disease on the choroidal vasculature.

The retina is supplied by two circulations: the choroidal circulation via the choroidal vessels and the retinal circulation via the central retinal artery (Jakobiec 1982). In up to 32% of the eyes (Justice and Lehmann 1976), an additional branch, the cilioretinal artery, may extend from the choroidal circulation to supply a portion of the inner retina, mainly in the macular region.

Background The involvement of choroidal lesions in acute macular neuroretinopathy (AMN) is not yet fully understood. We quantitatively examined sequential changes in the morphology and circulation hemodynamics of the choroid using enhanced depth imaging optical coherence tomography (EDI-OCT) and laser speckle flowgraphy (LSFG) in a patient with AMN. Case presentation A 15-year-old boy was referred to our hospital due to AMN in his right eye alone. The next day AMN developed in his left eye. Three months later, AMN lesions in both eyes spontaneously resolved and the morphology of macular photoreceptors improved. Using EDI-OCT, central choroidal thickness (CCT) was examined for a period of three months, starting from the initial visit. Using LSFG, macular mean blur rate (MBR) was examined for three months, starting 1 week after the initial visit. At the first visit, CCT of the right eye with AMN was 82 μm higher than that of the left eye, which had not yet developed AMN, and decreased by 86 μm after three months. In the left eye, similarly, CCT increased by 16 μm after the AMN onset at 1 week compared with a pre-onset value at the first visit and thereafter decreased by 57 μm at 3 months. Macular MBR increased by 20–55% OD and 51–71% OS during the follow-up until 3 months. Conclusions We found that the choroid at the macula thickened at the onset of AMN and became thin with the regression of disease. Therefore, in concert with MBR data, these results further strengthened our hypothesis that choroidal circulation impairment plays a role in the pathogenesis of AMN.

Purpose The purpose of this study was to evaluate the interocular differences in choroidal vasculature, choriocapillaris perfusion, and retinal microvascular network, and to explore their associations with interocular asymmetry in axial lengths (ALs) in children with anisomyopia. Methods Refractive error, AL, and other biometric parameters were measured in 70 children with anisomyopia. Using optical coherence tomography (OCT) and OCT-angiography, we measured the submacular choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow deficit (CcFD), retinal vessel density (VD), and foveal avascular zone (FAZ) area. Results The mean interocular differences in spherical equivalent refraction and AL were −2.26 ± 0.94 diopters and 0.95 ± 0.46 mm, respectively. Submacular ChT, TCA, LA, SA, and CVI were all significantly lower in the more myopic (longer AL) eyes than in the less myopic (shorter AL) fellow eyes. In eyes with longer ALs, both the CcFD and FAZ areas were significantly greater, whereas the superficial and deep retinal VDs were significantly less. After adjusting for corneal power and intraocular pressure, interocular differences in LA (β = −0.774), SA (β = −0.991), and CcFD (β = 0.040) were significantly associated with interocular asymmetry in AL (all P < 0.05). Conclusions In pediatric anisomyopes, eyes with longer ALs tended to have lower choroidal vascularity and choriocapillaris perfusion than the contralateral eyes with shorter ALs. Longitudinal investigations would be useful follow-ups to test for a causal role of choroidal circulation in human myopia.

PURPOSE. The effects of coffee intake on the ratio of stromal and luminal components in the choroid and the underlying mechanism remain unclear. This prospective cross-sectional study aimed to explore how coffee intake affects the choroidal component ratio and circulation. METHODS. Forty-nine right eyes of healthy adult volunteers were evaluated as the coffee intake group. Thirty-two right eyes of healthy volunteers served as the control group. The participants consumed 185 mL of coffee or water, respectively, and the systemic hemodynamics, enhanced-depth imaging optical coherence tomographic (EDI-OCT) images, and foveal mean blur rate (MBR), an indicator of blood flow velocity, were recorded at baseline and after coffee or water intake. The EDI-OCT images were binarized using ImageJ software, and subfoveal choroidal thickness (SCT) and whole, luminal, and stromal choroidal areas were calculated. RESULTS. In the coffee intake group, significant decreases in SCT and luminal area peaked at 60 minutes after intake (both P < 0.001), whereas a significant increase in MBR peaked at 30 minutes (P < 0.001). No significant stromal area fluctuations were observed. SCT and luminal area fluctuations exhibited a significant positive correlation (r = 0.978, P < 0.001). Significant negative correlations of luminal area fluctuations with MBR fluctuations were observed by stepwise regression analysis (r = –0.220, P < 0.001). The control group exhibited no significant fluctuations. CONCLUSIONS. Coffee-induced choroidal thinning may result mainly from a reduction in the choroidal vessel lumen, and this vessel lumen reduction correlated with an increased choroidal blood flow velocity after coffee intake. These coffee-induced changes in choroidal component ratio and circulation should be considered when evaluating choroids.

To investigate the topographic relationship between polypoidal choroidal vasculopathy (PCV) growth and choroidal watershed zones (CWZ) by using indocyanine green angiography (ICGA).We evaluated PCV lesions smaller than the CWZ at baseline and followed up more than 6 months. The CWZ was traced in the early phase ICGA at baseline. The vascular lesion of PCV was traced in baseline and follow-up ICGA. These traces were overlapped and topographic relationships between CWZs and PCV growth were evaluated.Among 31 eyes of 31 patients, enlargement of a PCV lesion was observed in 20 patients (64.5%) at mean follow-up of 30.4 months (6-68 months). A topographical relationship between the CWZ and PCV growth was demonstrated in 14 eyes (70.0%), as the shape of the PCV lesion conformed to the boundary of the CWZ, and/or the growth of the branching vascular network was aligned to the direction of the CWZ extension to the periphery. Growth beyond the boundary of the CWZ was noted in 9 eyes (45.0%), however growth area was greater inside the CWZ than outside in all eyes. Of 15 eyes of extrafoveal lesion at baseline, 8 eyes in which the vascular lesion progressed to the fovea had the CWZ involving the fovea, whereas PCV in three eyes with an extrafoveal CWZ remained as a non-subfoveal disease after mean follow-up of 17.0 months (p = 0.019).A subfoveal CWZ was related to PCV growth to the fovea. Topographical relationships between PCV growth and the CWZ suggest that choroidal circulation is a predisposition for PCV growth.

Central serous chorioretinopathy (CSCR) is a condition originating from alterations to the choroidal circulation. Indocyanine green angiography (ICGA) is recommended for a few selective chorioretinal diseases, including CSCR. This chapter summarizes current knowledge about the use of ICGA in CSCR, focusing on all angiographic findings of both acute and chronic forms. Because of its enhanced ability to image the choroidal circulation, ICGA adds some important information to the standard fluorescein angiography imaging. In CSCR with persistent and/or recurrent exudation, pigment epithelium changes occur, making the differential diagnosis challenging. In all such cases, ICGA assists to differentiate CSCR from other entities, such as polypoidal choroidal vasculopathy.

Torpedo maculopathy is characterized by a congenital, unilateral, and torpedo-shaped chorioretinal lesion with unclear pathogenesis and evolution. Although the optical coherence tomography angiography (OCTA) characteristics have already been defined in literature, the authors describe for the first time the presence of choroidal neovascularization (CNV) on the temporal edge of this lesion in a 36-year-old woman with a history of altered visual field in her left eye. The authors' investigation supports the hypothesis of an aberrant choroidal circulation underlying the pathogenesis of this condition, and proves the advantage conferred by OCTA in CNV detection over the other angiographic techniques. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:e210–e213.]

Background To evaluate changes of choroidal circulation quantitatively using laser speckle flowgraphy in patients with acute zonal occult outer retinopathy. Design Retrospective observational case series. Participants Sixteen eyes of 11 acute zonal occult outer retinopathy patients: seven non-treated eyes with good visual acuity and nine systemic corticosteroid-treated eyes with progressive visual acuity loss. Six eyes with thyroid-associated ophthalmopathy receiving systemic corticosteroid therapy served as controls. Methods The mean blur rate, an index of quantitative relative blood flow velocity, in the affected area was measured by laser speckle flowgraphy. The changes of mean blur rate, best-corrected visual acuity and the average threshold at the affected area on Humphrey perimetry during 24-week follow up were analysed. Main Outcome Measures Mean blur rate, best-corrected visual acuity, and the average threshold. Results In non-treated eyes, the average mean blur rate significantly increased at 24 weeks, with a significant increase of the average threshold. In corticosteroid-treated eyes, the mean blur rates at 1, 4, 12 and 24 weeks were significantly higher than the pretreatment value, with significant improvement of best-corrected visual acuity and the average threshold. The increase in mean blur rate at 4 weeks in corticosteroid-treated acute zonal occult outer retinopathy eyes was significantly higher than that in corticosteroid-treated control eyes. Conclusions In eyes with acute zonal occult outer retinopathy, the mean blur rate at the affected area significantly increases along with improvement of visual functions. These results suggest that impaired choroidal circulation is involved in the pathogenesis of acute zonal occult outer retinopathy.

AIM: To evaluate the axial length (AXL) in unilateral idiopathic central serous chorioretinopathy (CSC). METHODS: This retrospective case-control study was comprised of a consecutive case series of 35 patients with acute unilateral idiopathic CSC, and age- and sex-matched 50 control eyes. AXL of both eyes of unilateral CSC patients and the control eyes were investigated. AXL was measured by ultrasonic biometry, and the adjusted AXL was calculated for CSC eyes as measured AXL plus differences of foveal thickness between CSC and normal fellow eyes in millimeters. The main outcome measures were comparison of AXL between CSC, fellow and control eyes. RESULTS: The mean age of 35 CSC patients was 45.5y, and 31 males were included. The adjusted AXL of CSC eyes was 23.52 mm, and the AXL of fellow eyes was 23.46 mm, and of control eyes 23.94 mm. The AXL of both CSC and fellow eyes were significantly shorter than control eyes (CSC vs control, P=0.044; fellow vs control, P=0.026). There was no statistically significant difference in AXL between CSC and fellow eyes. CONCLUSION: In unilateral idiopathic CSC, the AXL of CSC and fellow eyes are shorter than that of control eyes. Short AXL may be related with choroidal circulation abnormality in CSC.

PubMedID: 26902374 Purpose: To evaluate choroidal thickness (CT) and investigate the involvement of choroidal circulation in patients with systemic sclerosis (SSc). Methods: A total of 120 eyes of 60 SSc patients and 60 eyes of 30 healthy controls were evaluated. CT measurements were performed at the subfoveal region, 1000 µm nasal and 1000 µm temporal to the fovea, using enhanced depth imaging optical coherence tomography. CT measurements were compared between the patients and controls. Results: The average subfoveal, parafoveal nasal and parafoveal temporal CT were significantly thinner in SSc patients when compared with healthy controls (297.77 ± 60.8 µm vs 339.8 ± 50.4 µm; 267.32 ± 51.1 µm vs 308.65 ± 49.9 µm; 270.63 ± 46.3 µm vs 309.22 ± 42.4 µm, respectively; p

Purpose: To examine the definition, evaluation methodology, association to ocular blood flow and potential clinical value of contrast sensitivity (CS) testing in clinical and research settings, focusing in patients with ischemic retinal disease. Methods: A review of the medical literature focusing on CS and ocular blood flow in ischemic retinal disease. Results: CS may be more sensitive than other methods at detecting subtle defects or improvements in primarily central retinal ganglion cell function early on in a disease process. CS testing attempts to provide spatial detection differences which are not directly assessed with standard visual acuity chart testing. Analyzing all studies that have assessed both CS change and ocular blood flow, it is apparent that both choroidal circulation and retinal circulation may have an important role in influencing CS. Conclusion: The concept that CS is directly influenced by ocular blood flow is supported by reviewing the studies involving both. Although the studies in the literature have not established a direct cause and effect relationship per se, the literature review makes it logical to assume that changes in retinal and choroidal blood flow influence CS. This raises the possibility that a subjective visual characteristic, specifically CS, may be able to be evaluated more objectively by studying blood flow. It appears appropriate to study the relationship between blood flow and CS more extensively to develop improved ways of measuring various aspects of blood flow to the eye and to best quantify early changes in visual function.

This paper discusses the interrelationship between retinal and choroidal blood flow, citing particularly the circulatory changes in light and dark adaptation, and the response vessels to hypoxia. The problems of diabetic retinopathy are also considered.

In a material comprising seven patients with familial cerebro-macular degeneration a grave visual disability had developed within a few years after the onset of the disease, this being at 3 1/2 to 7 years of age. The night vision was only moderately reduced. A severe red-green colour vision defect was demonstrated in three patients. This is in accord with the loss of red and green cone responses found in one patient by chromatic adaptation studies. On the other hand, a remarkably good response of the blue cone system was registered. Normal pulse amplitudes were found by dynamic tonometry in four patients indicating good choroidal circulation. This supports the theory that the degeneration of the neuroepithelium is of primary type. The selectivity in loss of response functions being demonstrated here, might, however, also be related to parallel degenerations taking place in ganglion cells.

Multiple linear regression-analysis of variance was used to define relationships between final visual acuity and several parameters in 31 patients with reattached primary rhegmatogenous retinal detachments. Older patient age, preoperative macular detachment, clinically visible macular lesions, greater detachment duration and extent, and higher subretinal fluid butyrylcholinesterase activity were all inversely related to final acuity. The relationship of each parameter to final acuity, in conjunction with and apart from all the other parameters, was defined. Collectively the parameters accounted for 85% of the variation about the mean of the clinically observed finally acuities. The parameters could be weighted to give a generally, reasonably accurate prediction of final acuity at the time of surgery. The findings are consistent with a pathophysiological sequence involving alterations in the choroidal circulation and the blood-ocular barrier of the posterior segment.

Aim. To analyze the subfoveal choroid thickness and choroidal volume in unilateral ocular ischemic syndrome (OIS).Methods. A retrospective review was conducted for all patients with unilateral OIS from October 2010 through June 2014. The subfoveal choroidal thickness (SFChT) and choroidal volume of both eyes were compared.Results. 19 unilateral OIS patients were included in this study. The mean SFChT of OIS eyes was significantly lower than that of fellow eyes (OIS eyes: 208.89 ± 82.62 μm and fellow eyes: 265.31 ± 82.77 μm,P<0.001). The choroidal volume of OIS eyes was significantly smaller than that of fellow eyes (OIS eyes: 0.16 ± 0.05 mm3and fellow eyes: 0.21 ± 0.05 mm3,P<0.001).Conclusion. The choroidal thickness and volume of OIS eyes were smaller than those of unaffected fellow eyes. Decreased choroidal circulation caused by carotid artery stenosis might affect the discordance of choroidal thickness and choroidal volume.

Hintergrund Bisher dachte man, dass die ICG-Fullung schneller ist als die Fluoreszeinfullung. Interessanterweise wurden die Fullungseigenschaften der zwei Farbstoffe nie mittels prazisen quantitativen Methoden verglichen. Da wahrend der 2-Kanal-Simultanangiographie ICG und Fluoreszein als Mischung injiziert werden, konnen die Fullungseigenschaften der Farbstoffe miteinander verglichen werden. Methoden Die simultane ICG- und Fluoreszeinangiographie wurde mit einem Rodenstock Scanning-Laser-Ophthalmoskop durchgefuhrt. Die Angiographiebilder wurden mit einem Grafikcomputer in Echtzeit digitalisiert. Die Fullungscharakteristika der zwei Farbstoffe wurden nach Bewegungskorrektur der Einzelbilder in unterschiedlichen Regionen der Netzhaut (ROIs) mit einem Computerprogramm off-line berechnet. Resultate Die Fluoreszeinfullung war bei 56,5 % der Probanden schneller als die ICG-Fullung. Bei 26 % der untersuchten Personen war eine gemischte Fullung nachweisbar. Je nach Position der ROIs war entweder die ICG- oder Fluoreszeinfullung schneller. Nur bei 17,5 % der Probanden war die ICG-Fullung schneller als die Fluoreszeinfullung. Schlussfolgerungen Unsere Ergebnisse zeigen, dass die Fluoreszeinfullung bei mehr als 50 % der Probanden schneller ist als die ICG-Fullung und nur eine Minderheit der untersuchten Personen eine schnellere ICG-Fullung haben. Unserer Erfahrung nach gibt es keine Faustregel fur die Fullung; das Fullungsmuster der zwei Farbstoffe ist individuell. Background The ICG filling is supposed to be faster than Fluorescein filling. Interestingly the filling characteristics of these dyes were never correlated directly using precise quantitative methods. Since ICG and Fluorescein are injected as a mixture, the simultaneous 2-channel angiography provides a suitable method to correlate the filling characteristics of the dyes. Material and Methods The simultaneous ICG and Fluorescein angiograms were recorded with a Rodenstock Scanning Laser Ophthalmoscope. The angiographic images were digitized real-time with a graphic workstation. Filling characteristics of the two dyes was calculated after off-line eye tracking in different regions of interests (ROIs) on the central retina. Results The Fluorescein filling was faster than the ICG filling in 56.5 % of our patients. In 26 % of our patients was a mixed filling detectable. Depending on the position of the ROIs the Fluorescein or ICG filling was faster. In only 17.5 % of our cases was the ICG filling faster than the Fluorescein filling. Conclusion Our results show that Fluorescein filling in more than 50 % of the cases is faster than ICG filling and only a minority of the patients has a faster ICG filling. According to our experience the filling pattern of the two dyes is individual, there is no rule of thumb for the filling.

The retina receives its nutrients from two separate circulations: retinal and choroidal circulation. This short overview describes the determinants in the regulation of these circulations. Retinal circulation is characterized by a low blood flow while flow in the choroid is high. The choroidal circulation is mainly controlled by sympathetic innervation and is not autoregulated. Retinal circulation lacks autonomic innervation, shows an efficient autoregulation and is mainly influenced by local factors. Local mediators released by endothelial cells and surrounding retinal tissue also have a substantial role in the regulation of retinal circulation.

Systemic lupus erythematosus (SLE) associated with antiphospholipid syndrome can have ocular complications. We report a 44-year-old Chinese lady with recurrent relapses of SLE and antiphospholipid syndrome with high disease activity, presenting with visual distortion in her right eye for 2 months. There was subretinal hemorrhage in her right eye, confirmed on investigations to be choroidal neovascularization secondary to a variant of age-related macular degeneration known as polypoidal choroidal vasculopathy (PCV). Anti-vascular endothelial growth factor therapy resolved her eye condition. SLE could be associated with PCV via common mechanisms, including complement pathway activation and vasculitis involving the choroidal circulation.

Purpose: To study the long-term visual outcome in patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Methods: Fifteen patients (28 eyes) with APMPPE were reassessed at Westmead Hospital Eye Clinic (Westmead, NSW, Australia) up to 18 years (mean 6.4 years) after their initial presentation to one of the authors (PM) or to their pnvate ophthalmologist. Stereo retinal photographs and visual acuities taken at the initial presentation were compared with those obtained at the most recent follow-up visit. Results: The last recorded visual acuity was 6/6 or better in 16 eyes (57%), 6/9–6/18 in four eyes (14%) 6/24–6/60 in five eyes (18%) and worse than 6/60 in three eyes (11%). Nine patients (60%) were treated with oral prednisone during the acute episode with little therapeutic effect observed. Six patients (40%) described a prodromal flu-like illness. Conclusion: This study suggests that the long-term visual outcome following an acute episode of APMPPE may not be as favourable as initially portrayed by Gass. It confirms other study findings suggesting that APMPPE may not be a benign self-limiting disease. Older age at onset and initial foveal involvement were associated with a worse visual outcome.

Continuous real time Laser Doppler Flowmetry (LDF), has been used in humans, for the evaluation of the subfoveal choroidal circulation and the investigation of the regulatory processes of the choroidal blood flow in response to various physiological stimuli, as increases and decreases of the ocular perfusion pressure. A progressive decrease of the choroidal blood flow was observed with the aging and the progession of the age related macular degeneration. Abnormal regulation of the choroidal blood flow in patients suffering with neovascular AMD or Diabetic microangiopathy were also reported. The correlation of the subfoveal choroidal blood flow with the anatomical changes of the choroidal circulation as observed by OCT are under investigation.

The choroidal circulation is crucial in supplying nutrients as well as oxygen to the outer retina. The capillaries of the choriocapillaris are fenestrated and have a high protein permeability that allows the establishment of a high oncotic pressure, presumably contributing to movement of fluid out of the retina through the stroma to the sclera. The pores of the choriocapillaris are facing the RPE. Bruchs membrane acts as a sieve depending on the amount and chemical properties of the deposited waste products. The accumulation of fluid under the RPE or within the retina implies a tight Bruchs membrane. Lipids as result of the the outer segment turn over accumulate and decrease the permeability of Bruchs membrane precluding the evacuation of the waste products and initiate a vicious circle. Active transport by the RPE is impaired. The tight junctions of the RPE are ruptured, the fluid irruption into the retina results in the disorganisation of the outer layers of the retina. A progressive breakdown of all defense mechanisms especially the reabsorbtion pump tips over the balance. The mechanismsm of the restauration are partially known. All choroidal diseases can induce these featuree and clinicians may analyze the resulting steps

Sir, The retinochoroidal anastomosis represents a communication between the retinal and choroidal circulation and is described in a subset of patients with neovascular age-related macular degeneration (AMD).1

Based on previous work, this paper describes the anatomical and functional characteristics of the choroidal vasculature, namely the choriocapillaris, the arterial and arteriovenous anastomosis, the segmental distribution of the short posterior ciliary arteries, and the choroidal veins. The characteristics of the choroidal innervation with reference to the sensory nerve endings are reviewed. Some features of Bruch's membrane may explain the fundoscopic and angiographic appearance of the angioid streaks and the role of its basement membranes in the formation and transport of drusen.

The aim of the study was to investigate the relationship between choroidal blood flow and systemic and ocular variables in patients with healthy eyes. In this prospective cross-sectional study, we examined 241 eyes of 241 healthy Japanese subjects (92 males and 149 females; mean age, 37.8 ± 17.0 years). The mean blur rate, a measure of the relative blood flow of the choroid, was determined using laser speckle flowgraphy. The total cross-sectional choroidal, luminal, and stromal areas of the choroid were determined by the binarization method. We investigated the correlation between choroidal MBR and systemic and ocular variables. Choroidal mean blur rate correlated with age (r = −0.385, P

The aim of this study was to explore the relationship between subjectively estimated and objectively measured finger temperature on the one, and choroidal blood flow on the other side.We measured submacular choroidal blood flow (CBF) in 73 healthy subjects. Based on the history of cold hands and feet, they were divided in three groups, reporting "never", "sometimes" and "always" having cold extremities. As an objective measure of finger temperature, it was recorded at the fingertips with an infrared thermometer (IRT). Analysis of variance for CBF based on the group selection and with blood and intraocular pressures as covariates was performed, as well as the correlation between CBF and IRT.There were 37 subjects in the group with "never" cold extremities, 20 in the group with "sometimes", and 16 subjects in the group with "always" cold extremities. Average age was 44.2 ± 12.9 years. CBF was 11.5 ± 7.3 AU (arbitrary units), 13.6 ± 6.1 AU and 14.3 ± 4.6 AU in the three groups, respectively. The ANOVA p-value was 0.04. Pearson's R for correlation between CBF and IRT was - 0.51, p0.001.Subjectively and objectively, colder extremities are associated with higher CBF, possibly due to the redistribution of blood flow.

Purpose: To evaluate the choroidal thickness changes in the eyes with myopic choroidal neovascularization (mCNV) after intravitreal injection of bevacizumab (IVB). Methods: Ten highly myopic eyes with mCNV treated with IVB were included. All patients underwent a single, horizontal B-scan image centered on the fovea, before, and 1 month and 3 month after IVB using Heidelberg optical coherence tomography (OCT). Choroidal thickness (CT) defined as the distance from the retinal pigment epithelium to the chorio-scleral interface in OCT image at the fovea, 2mm nasally and 2mm temporally was measured. Results: Foveal mean CT was 52.8 microns before IVB, and it significantly decreased to 37.5 microns 1 month after (P

Acta Ophthalmol. 2010: 88: 850–853 Abstract. Purpose: To evaluate the influence of menopausal status and age on peripheral and ocular circulation assessed by means of continuous laser Doppler flowmetry (LDF). Methods: Fifty-three healthy participants were recruited randomly. Twenty-six men and 27 women were divided into two age groups. Choroidal blood flow was measured by LDF and peripheral circulation was measured at the fingertips (digit IV) using the Perimed PeriFlux (Jarfalla, Sweden) laser Doppler System 5000. Independent t-test and two-way analysis of variance (anova) were performed. Results: Group distribution was: male/female = 14/16 for the younger group and 12/11 for the older group. Average age across groups was 31.3 ± 6.8/28.4 ± 7.0 years and 66.3 ± 8.3/61.5 ± 3.6 years, respectively. Finger and choroidal LDF flow values were significantly different between the two female age groups (p

Retinoblastoma can extend outward through different structures of the eye. It may disseminate through the optic nerve into the CNS and through the sclera to the orbit. Retinoblastoma can also give rise to systemic metastasis after gaining access to the choroidal circulation or after locoregional dissemination to the orbit and lymph nodes. Usual metastatic sites of retinoblastoma include the CNS, bone and the bone marrow (MacKay et al. 1984). Less frequently, retinoblastoma can metastasize to other organs, such as the liver or distant lymph nodes.

A preliminary investigation has been made of choroidal blood flow using a computer-aided image analysis approach to interpretation of indocyanine green (ICG) dye choroidal angiograms. The goal of the study was to characterise blood flow through the choroidal arteries vs. choroidal capillaries and veins. The methods of analysis used are briefly reviewed, and preliminary data obtained mainly from monkey eyes are presented. Preliminary conclusions are made regarding the relationship between compliance of choroidal arterial vessels and blood flow through them.

The functional anatomy of the normal choroidal circulation in man is described from scanning electron microscopic examination of methyl methacrylate microvascular casts. Distal and para-optic short posterior ciliary arteries supply wedge-shaped areas of choroid. Regional variations in choriocapillary morphology are well recognised; the lobules are densely packed at the posterior pole with a high capillary to inter-capillary ratio. Choroidal capillaries are flattened providing a large surface area for metabolic exchange with the retinal pigment epithelium. In acute choroidal ischaemia (from a variety of systemic disease), wedge shaped choroidal lesions may correspond to occlusion of short posterior ciliary arteries and geographic or focal lesions to occlusion of choroidal arterioles or choriocapillary lobules.

To evaluate the effect of posterior juxtascleral triamcinolone acetonide (TA) injection combined with photodynamic therapy with verteporfin (PDT) for treating exudative age-related macular degeneration (AMD), the best-corrected visual acuity (BCVA), the retreatment rates and the rate of choroidal hypoperfusion were investigated.A total of 67 eyes with subfoveal choroidal neovascularization (CNV) due to AMD were included. Forty-four eyes underwent PDT alone (PDT-alone group), and 23 eyes underwent PDT with the posterior juxtascleral injection of TA (PDT+TA group). Every 3 months after the PDT, the eyes were evaluated with regard to BCVA and requirement for retreatment by fluorescein angiography (FA) with the aid of optical coherence tomography (OCT). Choroiocapillaris hypoperfusion was assessed by indocyanine green angiography (ICGA) at 3 and 12 months. All patients completed a 1-year follow-up.At the baseline, there was no difference in lesion type, size or visual acuity between the two groups. At 1 year, the change in BCVA was -0.0811 logarithm of the minimum angle of resolution (LogMAR) in the PDT-alone group, compared with -0.0432 logMAR in the PDT+TA group. There was no significant difference in the change in BCVA between the two groups (P = 0.6910). The PDT+TA group required a lower mean number of treatments (1.64 compared with 2.34 [P = 0.0223]) and showed a higher rate of choriocapillaris occlusion at 3 months, but no significant difference at 1 year (P = 0.9243)Fewer retreatments were required in the TA+PDT group. There was no significant difference in the change in BCVA between the two groups. Adjacent TA may promote short-term choriocapillaris hypoperfusion.

Objective The purpose of this study was to report optical coherence tomography (OCT) and angiographic findings in a patient with pregnancy-induced hypertension (PIH). Case report A 39-year-old woman, who was diagnosed with PIH, reported blurred and distorted vision at 5 days after an emergency cesarean delivery. OCT revealed a large serous retinal detachment (SRD) that included areas in the macula, along with an increased choroidal thickness noted in both eyes. Indocyanine green angiograms indicated delayed filling of the choroidal circulation in the early phase but choroidal hyperpermeability in the mid-phase. The SRD was gradually resolving without any treatment except for antihypertensive drugs. At 40 days after the initial examination, OCT revealed both the disappearance of the SRD and marked improvement of the choroidal thickening. Conclusion Ophthalmologists need to be aware that PIH can cause choroidal ischemia, a breakdown of the outer blood–retinal barrier, and lead to the development of SRD.

PURPOSE To measure the oscillation phase delay between retinal arterioles and venules in order to analyze pulse wave propagation in the ocular circulation of vasospastic and nonvasospastic subjects and a change thereof during the cold pressor test in another group of healthy subjects. METHODS Twenty-four young, healthy women, 12 vasospastic and 12 nonvasospastic, were analyzed. A retinal vessel analyzer was used to obtain 1-minute recordings of the ocular fundus. A phase delay between the arteriole and venule pulsations was assessed at three sites, one (proximal) in the close retinal vicinity of the disc, one (middle) 1 to 2 disc diameters away from the disc, and a third (distal) 3 to 4 disc diameters away from the disc; and, assuming that venules are counterphased to the choroidal circulation, a choroid-to-retina pulse delay was calculated. In addition, the change in these parameters was analyzed during the modified cold-pressor test in 10 healthy subjects (five women, five men). RESULTS Pulse oscillations in arterioles led those in venules by 95.0 degrees +/- 39.0 degrees , 60.5 degrees +/- 57.5 degrees , and 47.5 degrees +/- 64.0 degrees in vasospastic subjects, and 76.0 degrees +/- 58.0 degrees , 31.5 degrees +/- 60.0 degrees , and 2.5 degrees +/- 80.5 degrees in nonvasospastic subjects in the proximal, middle, and distal measuring sites, respectively. Calculated choroid-to-retina pulse delays in vasospastic subjects were 0.20 +/- 0.10, 0.28 +/- 0.14, and 0.30 +/- 0.11 seconds and in nonvasospastic subjects 0.25 +/- 0.15, 0.35 +/- 0.11, and 0.43 +/- 0.2 seconds at the proximal, middle, and distal measuring sites, respectively. The difference was significant between vasospastic and nonvasospastic subjects (P = 0.033) and among the measuring sites (P = 0.0023). During exposure to cold, the choroid-to-retina pulse delays changed from 0.31 +/- 0.08, 0.40 +/- 0.16, and 0.51 +/- 0.26 seconds to 0.26 +/- 0.12, 0.30 +/- 0.10, and 0.33 +/- 0.14 seconds at the proximal, middle, and distal measuring sites, respectively (P = 0.024 for the change from baseline to cold exposure, and P = 0.022 for measuring sites). CONCLUSIONS Retinal vessels in vasospastic subjects demonstrate an altered pattern of oscillation phase delay between arterioles and venules. Vessels in vasospastic subjects seem to conduct pulse waves faster and are thus stiffer than those in nonvasospastic subjects. The pattern of oscillation demonstrates changes during the cold pressor test in healthy subjects, indicating faster pulse-wave propagation.

To evaluate quantitative choroidal dye filling velocity in patients with Vogt-Koyanagi-Harada disease (VKH) before and after corticosteroid treatment using indocyanine green (ICG) angiography.ICG angiography was performed in seven VKH patients before and after systemic corticosteroid treatment. Choroidal dye curves were obtained by image analysis software and analyzed using an exponential model. The model's time constant (tau) was used to evaluate choroidal dye filling velocity.Compared with controls, acute phase choroidal tau values in VKH patients were significantly longer, suggesting choroidal circulation disturbance. During the recovery phase, choroidal tau values were significantly shortened, suggesting choroidal circulatory disturbance improvement.Choroidal dye filling velocity may be useful for VKH diagnosis and verification of corticosteroid treatment effectiveness.

Purpose To evaluate the dynamics of choroidal circulation in experimental acute hypertension, using the indocyanine green leukocyte angiography (ILA) method, which the authors have developed for the evaluation of leukocyte dynamics in choroidal circulation. Methods Japan White rabbits were used in the present study. Leukocytes were collected by centrifugal separation of the autologous blood, and were stained with indocyanine green (ICG) dye. The ICG-stained leukocyte fluid was injected into an ear vein, and fundus images were obtained by infrared laser and a scanning laser ophthalmoscope. Experimental acute hypertension was induced by the intravenous drip injection of angiotensin II (AII). Results The fluorescent dots rapidly moved in choroidal arteries at a decreasing velocity, passed very slowly through choroidal capillaries and drained into choroidal veins. Under normal blood pressure, the mean leukocyte velocities in arteries, capillaries and veins were 8.63±1.68, 0.52±0.07, and 6.96±2.20 mm/s, respectively. On the other hand, the respective mean velocities in acute hypertension induced by AII were 13.50±1.82, 0.81±0.09, and 10.54±3.91 mm/s. Besides flow velocity, no change in leukocyte dynamics was observed. Conclusions Under the condition of acute hypertension induced by AII, leukocytes moved faster in the total choroidal circulation (from arteries to veins) compared to their velocity under the condition of normal blood pressure. Blood velocities might increase in the total choroidal circulation at an early stage in acute hypertension induced by AII, resulting in increased choroidal blood flow. ILA makes it possible to evaluate the changes in choroidal circulation under various pathologic conditions.

PURPOSE. To obtain high-quality angiograms of the rat choriocapillaris with continuous laser-targeted angiography (LTA), for the purpose of assessing the choroidal circulation system in vivo by studying the patterns of the images. METHODS. A slit lamp was modified to incorporate two kinds of lasers (argon and diode). Carboxyfluorescein was encapsulated in heat-sensitive liposomes and injected intravenously. Encapsulated carboxyfluorescein was released locally by applying a continuous heat beam provided by diode laser (810 nm) with various powers. Video angiograms were generated with excitation illumination provided by argon laser (488 and 514 nm) to observe highly selective images of the choriocapillaris. RESULTS. Three distinct phases (filling, plateau, and draining) were observed in fluorescent images of choriocapillaris by applying the diode laser continuously. In the plateau phase, a lobe-shaped area of choriocapillaris peripheral to the laser site was illuminated, and this finite area did not change in size with continuous laser application to the same spot. When laser power was increased, a larger area of choriocapillaris was illuminated in the plateau phase. The filling and draining phases demonstrated the flow patterns in choriocapillaris lobules, which filled from a central spot and drained along a peripheral ring. CONCLUSIONS. This study showed that the rat choriocapillaris is divided into independent functional units and that the choroidal circulation is segmental under normal conditions. The results implied that in LTA, the diode laser warms up a choroidal artery and the released fluorescein flows downstream to an area of choriocapillaris fed by the same artery. LTA appeared to be a powerful method to analyze choroidal circulation in vivo.