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To develop an automated retina layer thickness measurement tool for the ImageJ platform, to quantitate nuclear layers following the retina contour. We developed the ThicknessTool (TT), an automated thickness measurement plugin for the ImageJ platform. To calibrate TT, we created a calibration dataset of mock binary skeletonized mask images with increasing thickness masks and different rotations. Following, we created a training dataset and performed an agreement analysis of thickness measurements between TT and two masked manual observers. Finally, we tested the performance of TT measurements in a validation dataset of retinal detachment images. In the calibration dataset, there were no differences in layer thickness between measured and known thickness masks, with an overall coefficient of variation of 0.00%. Training dataset measurements of immunofluorescence retina nuclear layers disclosed no significant differences between TT and any observer's average outer nuclear layer (ONL) (p = 0.998), inner nuclear layer (INL) (p = 0.807), and ONL/INL ratio (p = 0.944) measurements. Agreement analysis showed that bias between TT vs. observers' mean was lower than between any observers' mean against each other in the ONL (0.77 ± 0.34 µm vs 3.25 ± 0.33 µm) and INL (1.59 ± 0.28 µm vs 2.82 ± 0.36 µm). Validation dataset showed that TT can detect significant and true ONL thinning (p = 0.006), more sensitive than manual measurement capabilities (p = 0.069). ThicknessTool can measure retina nuclear layers thickness in a fast, accurate, and precise manner with multi-platform capabilities. In addition, the TT can be customized to user preferences and is freely available to download.

Purpose: To describe a case of zonisamide-induced bilateral choroidal effusion., Case Report: A 72-year-old woman presented with a 4-day history of bilateral blurred vision 9 days after initiating oral zonisamide for essential tremor. Clinical examination revealed an asymmetric choroidal detachment with open anterior chamber angle and intraocular pressure within the normal range. Posterior segment ultrasonography and ultrasound biomicroscopy both confirmed the presence of bilateral ciliochoroidal effusion. Zonisamide treatment was discontinued. One month after treatment discontinuation, the ophthalmological examination was normal and no further treatment was needed., Conclusion: Zonisamide can cause an idiosyncratic reaction leading to choroidal effusion with or without acute angle closure. Early withdrawal of the causative agent is the key to reversing this condition. These findings indicate that zonisamide and other sulfa-derived drugs must be ruled out in the differential diagnosis of choroidal effusion of unknown cause.

In recent years, minimally invasive glaucoma surgery has emerged as a novel approach to lowering intraocular pressure. This technique, which is usually reserved for mild to moderate cases, is less invasive than classic filtration surgery and potentially offers a better safety profile. The XEN Gel Stent is implanted through a minimally invasive, ab interno procedure to create a subconjunctival pathway. Conjunctival tissue disruption is minimal, and flow is restricted to avoid hypotony. Data on the optimal approach to managing complications associated with this procedure are limited due to the relatively recent commercialization of this device. Here, we report a case of a persistent leaking bleb caused by XEN Stent exposure, which was managed by ab interno repositioning of the stent through the anterior chamber and direct suturing of the conjunctival defect.

Purpose: To assess the feasibility of swept-source optical coherence tomography (SS-OCT) for clinical follow-up of patients with birdshot chorioretinopathy (BC)., Methods: Prospective longitudinal, observational, 12-month case-control study in a tertiary care center. The study population included 12 patients (24 eyes) diagnosed with BC and 21 age- and sex-matched healthy controls (42 eyes). The macular areas in both affected and healthy eyes were prospectively analyzed with SS-OCT at 1050 nm, using 2D 12.0-mm radial and horizontal scans and the 3D raster scan protocol (12.0 × 9.0 mm). Anatomical and structural abnormalities, as well as retinal and choroidal thickness (measured automatically), were evaluated and compared with visual field (VF) testing and indocyanine green angiography (ICGA)., Results: The most common qualitative abnormalities in the retina were thinning/loss of architecture and outer retinal hyperreflective foci, and in the choroid they were focal depigmentation, thinning/absence of Sattler's layer, generalized thinning, and hyperreflective foci. The most significant changes in the retina from baseline to the 12-month follow-up were decreases in intraretinal cysts, subretinal fluid, and hyaloid thickening. In the choroid, focal depigmentation decreased significantly, while vascular pattern loss increased. Compared to the healthy volunteers, patients with BC had thinner choroids and retinas at both baseline and study end. Retinal thickness decreased significantly in BC patients over the 12-month study period, but choroidal thickness remained unchanged. Findings from ICGA, VF, and SS-OCT were perfectly correlated in most (≈ 60%) patients., Conclusions: SS-OCT is a non-invasive, rapid method of assessing choroidal and retinal changes in patients with birdshot disease. This technique provides a simple method of monitoring the course of the disease that can be used to complement conventional tests.

Objective: To study the effectiveness and limitations of photodynamic therapy (PDT) as treatment of choice in patients with symptomatic circumscribed choroidal haemangioma., Methods: A retrospective study was conducted on 16 patients (13 men and 3 women, with mean age of 54.88 years) with circumscribed choroidal haemangioma, who attended our centre and were treated with PDT in the last 7 years., Results: All patients had circumscribed choroidal haemangioma, which caused a decrease in visual acuity (VA) secondary to the presence of intraretinal microcystic oedema or neurosensory detachment. The mean initial VA was 0.23, and the final mean VA after performing PDT was 0.38 (all the VA were measured in decimal scale). It should be noted that patients needed a mean of 1.69 PDT sessions. Three of the patients needed rescue treatment with trans-pupillary thermotherapy, intravitreal injection of anti-vascular endothelial growth factor (ranibizumab, aflibercept) or a dexamethasone intravitreal implant (Ozurdex ® ). The indication for a change of treatment was the persistence of intraretinal microcystic oedema and/or neurosensory detachment (or incomplete resolution) after 3 PDT sessions. As overall results, 62.5% of patients evolved into anatomical and functional (increase in AV or stability) resolution., Conclusions: PDT is a straight forward and fast procedure, with a good anatomical and functional response, causing minimal damage to adjacent vessels., (Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Unlabelled: Ocular B-mode ultrasonography (US) is an important adjuvant for the clinical assessment of a variety of ocular diseases. When ophthalmoscopy is not possible, mainly due to opacification of the transparent media (e.g., mature cataract or vitreous haemorrhage), US can guide the ophthalmologist in diagnosing disease and choosing treatment. The superficial location and cystic structure of the eye make US ideal for imaging of the eye. Moreover, dynamic study helps distinguish between various conditions that would otherwise be difficult to differentiate in some clinical setting, such as vitreous, retinal, and choroidal detachment. US is also good technique for detecting other pathologic conditions such as lens dislocation, vitreous haemorrhage, asteroid hyalosis, optic disc drusen, and tumors (e.g., choroidal melanoma, metastases, hemangioma). An understanding of the basic anatomy of the eye, the US technique, and common entities that affect the ocular globe will allow radiologists to offer this valuable imaging modality to patients and referring clinicians. This article focuses on the US anatomy and pathologic conditions that affect the posterior ocular segment., Teaching Points: • US is specially indicated when ocular fundus cannot be assessed on ophthalmoscopy. • Multipurpose equipment with high-frequency transducers is optimal for imaging the eye. • Ultrasound can reliably depict ocular anatomy and pathology as detachments and tumours. • Dynamic examination is vital for distinguishing certain pathologic conditions as detachments.

We present the ultrasound and optic coherence tomography follow-up of a presumed choroidal metastasis from a contralateral melanoma. A 53-year-old male was diagnosed with uveal melanoma with extraescleral extension in his left eye. A year later, the fundus examination revealed a flat, gray-green, pigmented choroidal lesion in the right eye. The ultrasonography showed a mass, almost flat, and all these findings were compatible with a choroidal melanocytic lesion with risk factors for growth. One month later, melanocytic skin lesions appeared on the scalp, as well as small tumors. Three months later, an ultrasonography on B scan showed a growth of the tumor size. The patient developed a progressive deterioration and died. Three possibilities can explain the occurrence of a choroidal pigmented tumor in the contralateral eye: first, bilateral primary choroidal melanomas; second, both choroidal tumors are metastatic in origin from an unknown primary melanoma; and third, the contralateral tumor is a metastatic tumor from the primary choroidal melanoma.

A 45-year-old man presented with a mobile shadow in the central visual field of his left eye for the preceding 4 months. His visual acuity was not affected. Funduscopy showed a brownish, oval-shaped structure floating in the vitreous cavity of the left eye. B-scan ultrasound demonstrated an oval-spherical hypoechogenic structure floating at the posterior pole. The absence of pertinent medical history and normal results from systemic exploration suggested a congenital etiology. The condition was observed regularly without any evidence of change. Differential diagnosis of vitreous cysts is important in order to establish an adequate therapeutic approach., (Copyright 2014, SLACK Incorporated.)

Objective: The purpose of this article is to report the correlation between spectral domain-optical coherence tomography and autofluorescence findings in 3 consecutive cases with sclerochoroidal calcification., Design: Observational case series., Participants: The study involved 3 patients with bilateral sclerochoroidal calcification., Methods: B-scan ultrasonography, spectral domain-optical coherence tomography, and autofluorescence were performed in each eye. The choroidal vascular thickness and autofluorescence patterns of the calcified plaques were evaluated with spectral domain-optical coherence tomography and autofluorescence, respectively., Results: An important variation of choroidal vascular thickness overlying sclerochoroidal calcification was observed in spectral domain-optical coherence tomography. Autofluorescence showed 2 patterns of autofluorescence closely correlated with changes in choroidal vascular thickness. In those zones where the thicknesses of choriocapillaris complex were reduced, a hyperautofluorescence pattern was observed in autofluorescence. The hypoautofluorescence pattern was observed in outpouching zone of retinal pigment epithelium-choriocapillaris complex seen in spectral domain-optical coherence tomography. The hypoautofluorescence pattern was closely correlated with remarkable reduction of the choriocapillaris complex. There were no significant differences between the patterns of autofluorescence except the extension., Conclusions: Spectral domain-optical coherence tomography and autofluorescence are noninvasive complementary imaging studies that may help to improve our knowledge about sclerochoroidal calcification. Characteristic patterns of autofluorescence were closely correlated with spectral domain-optical coherence tomography findings. More patients need to be evaluated with both complementary studies to establish conclusions related with these findings., (Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate our experience in the treatment of uveal melanoma by means of Iodine-125 brachytherapy. A reprospective case series study., Material and Method: Patients diagnosed of uveal melanoma and treated with Iodine-125 brachytherapy in the Ciudad Sanitaria y Universitaria de Bellvitge (CDUV), from September 1996 to December 2000 and follow up of more than one year., Results: During the period of study, 145 patients were diagnosed of uveal melanoma, of which, 77 were treated with Iodine-125 COMS type plaques; among these, 58 were elegible for this study. After a mean of 2.4 year follow up period (878 days) a mean reduction in height of 53.84% and a mean reduction in volume of 75.88% was observed. As for visual acuity, 32.7% of patients presented a vision of 0.1 or better in last follow up check; 13.5% presented low vision at the moment of diagnosis and continued the same up to last follow up check. The rest of patients experienced loss which conditioned vision to less than 0.1. As for complications, we have observed transient diplopia (8.6%), cataract (3.4%), vitreous bleeding (10.3%), neovascular glaucoma (6.8%), radiation retinopathy (17.24%), radiation neuropathy (6.8%), posterior scleritis (2%), pigmental scattering (2%), tumor progression (2%), endophtalmitis (2). Secondary enucleations were carried out in 6.8% of patients. Metastatic disease was observed in 15.5% of the patients., Conclusions: Brachytherapy with Iodine-125 may induce significant regression in most of patients affected of uveal melanoma, with good preservation of visual acuity and a low rate of complications.

Systemic cancer may present intraocular features in three forms: as a sign of the presence of lymphoreticular tumors, of solid tumors or as a paraneoplastic syndrome.