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The purpose of the study was to detect Hard Exudates (HE) and classify Disorganization of Retinal Inner Layers (DRIL) implementing a Deep Learning (DL) system on optical coherence tomography (OCT) images of eyes with diabetic macular edema (DME). We collected a dataset composed of 442 OCT images on which we annotated 6847 HE and the presence of DRIL. A complex operational pipeline was defined to implement data cleaning and image transformations, and train two DL models. The state-of-the-art neural network architectures (Yolov7, ConvNeXt, RegNetX) and advanced techniques were exploited to aggregate the results (Ensemble learning, Edge detection) and obtain a final model. The DL approach reached good performance in detecting HE and classifying DRIL. Regarding HE detection the model got an AP@0.5 score equal to 34.4% with Precision of 48.7% and Recall of 43.1%; while for DRIL classification an Accuracy of 91.1% with Sensitivity and Specificity both of 91.1% and AUC and AUPR values equal to 91% were obtained. The P-value was lower than 0.05 and the Kappa coefficient was 0.82. The DL models proved to be able to identify HE and DRIL in eyes with DME with a very good accuracy and all the metrics calculated confirmed the system performance. Our DL approach demonstrated to be a good candidate as a supporting tool for ophthalmologists in OCT images analysis., (© 2024. The Author(s).)

Background and Objective: To describe the presence of eyelashes artifact in ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) images., Patients and Methods: In this prospective, cross-sectional study, 52 healthy, young subjects were imaged with the SS-OCTA system. OCTA scans were taken in primary and extremes of gaze, and a montage was automatically created. The en face choriocapillaris images were then exported, and a semi-automated algorithm was used for subsequent quantitative analysis., Results: The authors noted the presence of some linear regions of reduced brightness, which were assumed to represent a shadow effect due to patient eyelashes. In order to quantify this effect, the authors performed a quantitative analysis of the superior and inferior regions in the retinal and choroidal vessels., Conclusions: The authors' qualitative and quantitative analysis showed the presence of regions of false-positive hypoperfusion secondary to eyelashes artifacts. To the authors' knowledge, this represents the first description of this new type of shadowing artifact affecting OCTA images. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:740-743.]., (Copyright 2019, SLACK Incorporated.)

Background and Objective: The aim of the study was to determine optical coherence tomography angiography (OCTA) findings and to identify mutations in the RS1 gene in a three-generation family with X-linked juvenile retinoschisis (XLRS)., Patients and Methods: Clinical and genetic assessments were performed in 12 family members. OCTA was performed at baseline (12 members including cases and carriers) and after acetazolamide administration (three cases). Twenty healthy subjects (20 eyes, controls) were chosen for comparison. Molecular genetic analysis of the RS1 gene was performed in all family members., Results: Deep capillary plexus density was reduced in cases compared with controls (P < .01) and was negatively related with retinal thickness (P < .05). After treatment, retinal thickness decreased (P < .05) and deep capillary plexus density increased (P < .05) in cases. In three cases and in four carriers, p.Arg197 His mutation was found., Conclusion: OCTA shows reduced macular deep vessel density in patients with XLRS probably related to vessel displacement and disruption due to schitic cysts. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e20-e31.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To investigate the relationship between perfusion of the choriocapillaris (CC) and macular function in eyes with intermediate age-related macular degeneration., Methods: In this prospective, observational, cross-sectional study, macular optical coherence tomography angiography images and multifocal electroretinograms were obtained in 20 eyes with intermediate age-related macular degeneration from 20 patients. The main outcome measures were (1) the percent nonperfused choriocapillaris area (PNPCA), which represents a measure of the total area of CC vascular dropout, and (2) the average size of the CC signal voids, which represent contiguous regions of CC dropout. Furthermore, amplitude and implicit time of multifocal electroretinograms N1 and P1 waves in the two central rings (R1 and R2) were included in the analysis., Results: Of the 20 patients enrolled, only 17 eyes from 17 patients (13 women) were included in this analysis. Three patients were excluded because of poor scan quality. Mean ± SD age was 75.1 ± 7.9 years (range, 62-89 years). The best corrected visual acuity was 0.17 ± 0.13 logarithm of the minimum angle of resolution. In univariate analysis, both the PNPCA and average signal void size were found to have a significant direct relationship with N1 implicit time in the R2 ring (P = 0.006 and P = 0.035, respectively). Neither PNPCA nor the average signal void size was associated with P1 or N1 implicit times in R1., Conclusions: In intermediate age-related macular degeneration eyes, PNPCA and average signal void size are related to N1 multifocal electroretinogram implicit times, which suggests an association between CC perfusion and photoreceptor function.

The authors present the case of a 59-year-old woman in treatment with interferon alfa-2b for stage IV melanoma and widespread metastases who presented with interferon-associated retinopathy. An ocular examination revealed multiple retinal cotton-wool spots and hard exudates. Interferon treatment was suspended. The patient was followed up for 5 months following the baseline visit by means of en face optical coherence tomography (OCT), spectral-domain OCT, and OCT angiography. Multimodal imaging was useful in the follow-up of this condition, permitting the characterization of all the lesions hallmarking the interferon-retinopathy and showing that this illness was related to a reduction of the retinal vascular perfusion. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:498-504.]., (Copyright 2017, SLACK Incorporated.)

Background and Objective: To evaluate the effect of navigated retinal laser photocoagulation on visual acuity (VA) and retinal sensitivity in eyes with acute central serous chorioretinopathy (CSC)., Patients and Methods: Prospective, noncomparative, interventional case series of 30 eyes of 29 patients with acute CSC were treated using navigated photocoagulation. Patients were monitored for 180 days., Results: Mean VA improved from 0.3 ± 0.1 to 0.1 ± 0.1 logMAR (P < .001). Mean retinal sensitivity within central 8° and 4° improved from 9.4 ± 4.7 dB to 14.9 ± 3.6 dB and from 9.0 ± 5.6 dB to 14.6 ± 4.2 dB respectively (P < .001). In all cases, a decrease in mean central retinal thickness of -50.6 ± 2.9 µm (P < .001) and in mean subretinal fluid thickness of -52.0 ± 3.3 µm (P < .001) was observed during follow-up., Conclusion: Navigated retinal laser photocoagulation demonstrated safety and accuracy for the treatment of acute CSC. VA and retinal sensitivity evaluations showed a significant improvement associated with resolution of the subretinal fluid during follow-up., (Copyright 2015, SLACK Incorporated.)

Purpose: Retinal structural changes in a case of spontaneous resolution of vitreomacular traction (VMT) syndrome were followed by means of multimodal retinal imaging approach., Methods: Confocal scanning laser ophthalmoscopy (cSLO) including digital infrared and blue reflectance (BR) imaging and spectral-domain optical coherence tomography (SD-OCT) were performed in a young man with VMT syndrome., Results: At the time of diagnosis, multimodal retinal imaging documented outer retina abnormalities linked to VMT. At 1 month follow-up visit, improvement of best-corrected visual acuity and resolution of metamorphopsia were accompanied by documentation of VMT resolution and outer retina restoration., Conclusions: Both cSLO and SD-OCT imaging, particularly BR and en face OCT adapted to the outer plexiform layer contour, allowed to depict outer retina changes in the course of VMT resolution. A strict correlation between topographic BR images and en face OCT scans was evident.

Purpose. To evaluate the effects of intravitreal ranibizumab (IVR) treatment on the blood flow of the optic nerve head (ONH) and of retinal vessels of the peripapillary region of eyes with diabetic macular edema (DME) assessed using laser speckle flowgraphy (LSFG). Methods. Forty eyes of 30 patients treated with IVR for DME were included in this prospective clinical study. Mean blur rate (MBR) and relative flow volume (RFV) of the ONH and of a superior retinal artery and an inferior retinal vein of the peripapillary region were measured using LSFG at baseline, 2 weeks (T1), and 1 month (T2) after IVR injection. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured in all cases. Results. The BCVA improved and CRT decreased significantly during the follow-up period (p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p = 0.046 ; MT, p = 0.023 ; MV, p = 0.025), with no significant change at T2 compared to T1. MBR of the retinal artery and vein changed significantly at 2 weeks after IVR and did not change significantly thereafter (p = 0.004 and p = 0.01 , respectively). The median of RFV of the 2 vessels was 269.5 (221.6–285.5) and 306.8 (285.6–372.4) at baseline and 199.7 (152.4–204.7) and 259.1 (140.9–336.8) at 4 weeks, respectively (p = 0.292 and p = 0.002 , respectively). Blowout time changed significantly in ONH from 47.6 (44.2–50.2) at baseline to 54.4 (46.8–65.3) at 1 month after IVR (p = 0.001). Conclusion. IVR injection leads to a reduction of ocular blood flow both in the ONH and in the retinal peripapillary vessels associated with peripapillary vessel constriction. The reduction of CRT and related improvement of vision may be related to the changes in ocular blood flow. [ABSTRACT FROM AUTHOR]

Aims: To evaluate superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) perfusion in macular and near/mid periphery regions in diabetic patients using widefield swept-source optical coherence tomography angiography (WSS-OCTA). Methods: Ninety-four diabetic patients (94 eyes) classified as diabetics without diabetic retinopathy (no DR) (25 eyes), mild DR (23 eyes), moderate/severe DR (26 eyes), proliferative DR (20 eyes) and a control group of 25 healthy subjects (25 eyes) were imaged with the WSS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). Quantitative analysis was performed in the macular and peripheral regions. The main outcome measures were perfusion density (PD) and vessel length density of SCP, DCP and CC. Results: Peripheral retina (all sectors) showed lower SCP and DCP PD compared to the macular region (p < 0.001). In diabetics without DR and DR in different stages, SCP and DCP PD significantly decreased at advancing stages of DR (p < 0.001). At DCP level, central PD was significantly directly related to peripheral PD (superior, R = 0.682 and 0.479; temporal, R = 0.918 and 0.554; inferior, R = 0.711). A good sensitivity and an excellent specificity were found in terms of prediction of disease worsening, especially for central and temporal sectors in all plexuses and for all sectors both central and peripheral of DCP. Conclusions: The widefield OCTA is useful for the study of central and peripheral retina in diabetic patients with or without diabetic retinopathy, assessing good correlation between central and peripheral retina. [ABSTRACT FROM AUTHOR]

Purpose: To assess the reproducibility and repeatability of macular ganglion cell-inner plexiform layer (GC-IPL) thickness measurements in healthy subjects. Procedures: In this observational study, 60 healthy eyes were subjected to macular GC-IPL thickness measurements by means of Cirrus™ high-definition optical coherence tomography (Cirrus version 6.0; Carl Zeiss Meditec, Dublin, Calif., USA) by two examiners in two sessions. Average, minimum and 6 sectoral GC-IPL thicknesses were measured. Inter- and intraobserver reproducibility was tested and analyzed by means of the concordance correlation coefficient (CCC). The repeatability of measurements was assessed by the coefficient of repeatability (CR). Results: Mean age (±SD) was 29.63 (±5.1) years. The CRs for average GC-IPL thickness were 2.1 and 2.2 µm for the first and the second operator, respectively. Inter- and intraobserver CCCs ranged from 0.91 (95% CI: 0.89-0.93) to 0.98 (95% CI: 0.96-0.99) and from 0.92 (95% CI: 0.88-0.94) to 0.98 (95% CI: 0.97-0.99), respectively. Conclusions: GC-IPL thickness measurements in young healthy subjects showed excellent reproducibility and repeatability, especially for average and sectoral GC-IPL thickness measurements. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this work was to characterize the choriocapillaris (CC) in patients with Stargardt disease (STGD) using the swept source widefield optical coherence tomography angiography (SS WF OCTA) and to compare CC perfusion density to retinal sensitivity, analyzed using microperimetry (MP). This cross-sectional study included 9 patients (18 eyes) with STGD and central CC atrophy (stage 3 STGD). The CC was analyzed using SS WF OCTA and areas of different CC impairment were quantified and correlated with retinal sensitivity analyzed using MP. The main outcome measures were the percent perfused choriocapillaris area (PPCA), retinal sensitivity, and correlation between PPCA and retinal sensitivity. Seventeen eyes of 9 patients suffering from stage 3 STGD were analyzed. SS WF OCTA revealed a vascular rarefaction in central atrophic zones and a near atrophy halo of choriocapillaris impairment. In all eyes were noticed a central atrophy (CA) area with absolute absence of CC that corresponded to 0 dB points at MP, a near atrophy (NA) zone of PPCA impairment that included points with decreased sensitivity at MP and a distant from atrophy (DA) zone with higher PPCA and retinal sensitivity values. The mean difference of PPCA and retinal sensitivity between NA and CA and DA and CA was statistical significantly different (p < 0.01), the latter showing higher values. A direct relationship between PPCA and retinal sensitivity was found (p < 0.001). Choriocapillaris damage evaluated using SS WF OCTA correlates with MP, these data suggest that CC impairment may be a predictor of retinal function in patients with STGD. [ABSTRACT FROM AUTHOR]

Background: To investigate anatomical/functional changes after oral eplerenone therapy for chronic central serous chorioretinopathy (CCSC) in successfully treated eyes and fellow eyes and assess timing of foveal subretinal fluid (SRF) resolution. Methods: Twenty-one eyes of 21 patients suffering from CCSC with monolateral foveal SRF successfully treated with oral eplerenone were enrolled in this retrospective study (group 1). The fellow eyes (21 eyes; group 2), healthy or affected by CCSC, without foveal SRF were considered in the analysis. A control healthy group was enrolled as well (healthy controls; n = 21). Main outcome measures during follow-up included changes of best corrected visual acuity (BCVA, logMAR), central macular thickness (CMT; µm), SRF (µm), subfoveal choroidal thickness (SFCT; µm), superficial capillary plexus density (SCPD, %), deep capillary plexus density (DCPD, %), and choriocapillaris density (CCD, %) and percentage of eyes showing foveal SRF resolution at different time points. Results: Functional and anatomical parameters significantly improved during the study in group 1. BCVA increased significantly (p < 0.001), while CMT, SFCT, and SRF decreased significantly (p < 0.001; p < 0.001, and p = 0.037, respectively). SCPD, DCPD, and CCD did not show any statistically significant difference during follow-up. In 71.4% of eyes, resolution of SRF was observed within 60 days and in the remaining 28.6%, at 120 days. In fellow eyes, SFCT decreased significantly (p < 0.001), whilst all other parameters did not modify. Conclusions: Eplerenone treatment in chronic CSCR potentially improves recovery of retinal and choroidal morphology as well as visual acuity gain. A complete resolution of foveal SRF was observed in all eyes during a 4-month follow-up, with most eyes healing at 2 months. [ABSTRACT FROM AUTHOR]