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Purpose: To evaluate the surgical outcomes of a perfluoro-n-octane (PFO)-assisted superior inverted internal limiting membrane (ILM) flap without the peeling-off technique for the treatment of a large macular hole (MH).Methods: This retrospective interventional case series examined 13 eyes with a MH ≥ 400 μm. All eyes underwent 25-gauge pars plana vitrectomy. An ILM flap stained with 0.025% brilliant blue G was made in the superior area of the hole. The ILM in the temporal, nasal, and inferior areas around the hole was not peeled off. The hole was gently covered using the inverted ILM flap, which was stabilized using a small amount of PFO. Fluidair exchange was performed slowly. The small amount of residual PFO was removed by evaporation. The patients were instructed to maintain a facedown position for 1 day postoperatively. Anatomical closure of the hole and visual acuity were assessed postoperatively.Results: The average hole size was 605.08 ± 102.41 μm. Nine eyes had an idiopathic MH, two exhibited age-related macular degeneration, and one each had high myopia and a traumatic MH. All eyes achieved type I closure. The foveal contour improved gradually during follow-up: 92.3% of eyes had a U-shaped fovea, and 61.5% exhibited complete recovery of the ellipsoid zone. The visual acuity improved from 0.91 to 0.55 logarithm of the minimum angle of resolution (p = 0.003).Conclusions: The PFO-assisted superior inverted ILM flap without peeling-off was effective for stabilizing the flap over the hole and consequently achieving good anatomical and visual outcomes in large MHs.

Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS).Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed.Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0).Conclusions: Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.

Purpose: To report a case of extensive syphilitic punctate inner retinitis (SPIR) triggering bilateral macular ischemia after intravitreal triamcinolone injections, and the multimodal retinal imaging findings.Case summary: A 69-year-old male patient with nonproliferative diabetic retinopathy was transferred to our hospital because of bilateral visual deterioration (to counting fingers) after the first intravitreal triamcinolone injection. Fundus examination revealed numerous yellow punctate precipitates in the superficial retinae, retinal arteriolitis, and vitritis. The punctate lesions and surrounding retinal regions showed decreased vascular density on optical coherence tomography angiography, and focal hypofluorescence on fluorescein angiography. The patient was positive for all of the Venereal Disease Research Laboratory test, the fluorescent treponemal antibody-absorption test, and Treponema pallidum hemagglutination; we diagnosed bilateral SPIR. After treatment with aqueous crystalline penicillin solutions (24 million units per day for 14 days), the punctate lesions reduced but arteriolitis progressed to obliterative vasculitis. After 6 months, the bilateral SPIR and vitritis resolved, and the bilateral visual acuity improved to 20/100. However, inner retinal and macular ischemia persisted because of capillary nonperfusion attributable to obliterative vasculitis.Conclusions: Extensive SPIR can develop after an initial intravitreal steroid injection; the inner retinal ischemia and visual loss may persist after treatment because obliterative vasculitis develops. Therefore, patients scheduled for intravitreal steroid injections should be screened for syphilis infection.

Purpose: To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV).Methods: This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed.Results: This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure.Conclusions: Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

We report a case of bilateral panuveitis and its resolution based on multimodal retinal images after she was administered the first dose of a viral vector-based vaccine against SARS-CoV-2.A 72-year-old woman complained of bilateral blurred vision with headache, neck stiffness, and tinnitus 3 days after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. Initial examination revealed anterior chamber reactions, left optic disc hyperemia, and bilateral chorioretinal folds with choroidal thickening. Fluorescein and indocyanine green angiography revealed bilateral choroiditis and papillitis. Systemic steroid therapy dramatically alleviated panuveitis and meningeal signs. No recurrence was noted until 3 months after discontinuation of steroids.Bilateral panuveitis mimicking Vogt-Koyanagi-Harada disease can develop shortly after the first dose of the ChAdOx1 nCoV-19 vaccine. Ophthalmologists should consider bilateral panuveitis as a presumed post-vaccination adverse event. Systemic steroid therapy may be effective for the nCoV-19 vaccine-associated panuveitis.

PURPOSE To investigate the angiographic findings assessed using fluorescein angiography and their prognostic values of idiopathic epiretinal membrane. METHODS Seventy-three eyes of idiopathic epiretinal membrane that had been followed up for 6 months after surgical treatment were included. Midphase fluorescein angiography images were obtained at baseline. Structural changes, including central subfield macular thickness, intraretinal cystic lesion, and ectopic inner retinal layer on the fovea, were assessed using optical coherence tomography. The main outcome measures were microvascular leakage (ML) and its association with optical coherence tomography findings and best-corrected visual acuity (BCVA). RESULTS Of a total of 73 eyes, 37 showed ML and had worse BCVA (P = 0.040), greater central subfield macular thickness (P = 0.028), and more ectopic inner retinal layer (P < 0.001) than those without ML at baseline. Also, ML was associated with worse postoperative BCVA (P < 0.001) and ectopic inner retinal layers (P < 0.001; P = 0.034) at baseline and 6 months. The baseline factors associated with postoperative BCVA of ≥20/25 were better BCVA (P = 0.027) and the absence of ML (P < 0.001). CONCLUSION Half of the idiopathic epiretinal membrane eyes showed that ML was associated with inner retinal deformity and poor visual recovery. Fluorescein angiography helped to predict visual prognosis after idiopathic epiretinal membrane surgery.

Purpose: To report the first case of Curtobacterium endophthalmitis within 6 hours after open globe injury, with extensive phlebitis and secondary subretinal neovascularization. Case summary: A 53-year-old man with hypersensitivity to beta-lactam antibiotics was admitted due to visual disturbance in the left eye experienced while working in a rural area. Fundus examination was impossible due to a full-layer corneal laceration and traumatic cataract in the left eye. B-scan ultrasonography and orbital computed tomography showed no shadowing of retained intraocular foreign bodies. After a corneal scraping smear, primary closure, lensectomy, and vitrectomy were performed. Organic material was observed in a focal area of pale macula, accompanied by extensive retinal phlebitis in the mid-periphery. After diagnosing acute bacterial endophthalmitis, intravitreal vancomycin and dexamethasone were injected. Curtobacterium pusillum was cultured on an automated microbial identification system. Intravenous vancomycin and oral clarithromycin were administered for 2 weeks. After 3 months, endophthalmitis had not recurred, and the visual acuity reached 20/100. However, subretinal neovascularization was newly detected under the damaged macula. No complications of neovascularization were observed until 6 months after primary closure. Conclusions: Curtobacterium pusillum can induce acute endophthalmitis through direct penetration in cases of ocular trauma, and may be accompanied by extensive phlebitis and secondary subretinal neovascularization. In cases of open globe injury sustained in rural areas, acute endophthalmitis caused by a rare Gram-positive bacillus, such as Curtobacterium species, should be considered.

Purpose To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. Methods The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. Results Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. Conclusions Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.

To present two cases of concomitant retinal neovascularization (RNV) in acquired peripheral retinoschisis and analyze its characteristics on optical coherence tomography angiography (OCTA) and based on a literature review.This was an observational, retrospective case study.Case 1 presented with bullous retinoschisis and RNV near the schisis cavity. OCTA revealed no angioflow into the retinal arterioles of the cavity. An arterial filling delay to the retinoschisis with extensive leakage from the RNV was noted on fluorescein angiography. Case 2 involved the superficial retinoschisis and telangiectatic vessels inside the schisis cavity. OCTA revealed damage to the superficial capillary plexus of the cavity, absence of angioflow to the inner schisis layer, and increased angioflow to the RNV. Fluorescein angiography showed focal leakage from the RNV and diffuse leakage from telangiectasia. No vision-threatening complications were identified in either patient up to the last follow-up, subsequent to laser photocoagulation.Acquired peripheral retinoschisis is associated with RNV. Inner retinal ischemia caused by hemodynamic resistance or a damaged superficial capillary plexus can interrupt angioflow to the inner schisis retinal layer on OCTA findings and develop RNV inside or outside the retinoschisis.

In this study, the parafoveal tissue was displaced concurrently causing more prominent perifoveal deformation after macular hole surgery. Postoperative metamorphopsia was correlated with perifoveal deformation suggesting that photoreceptor disarrangement is the key mechanism of metamorphopsia., Purpose: To investigate the correlation between postoperative metamorphopsia and macular deformation after macular hole surgery. Methods: This study included 28 eyes of 28 patients who underwent vitrectomy and internal limiting membrane removal for an idiopathic macular hole. The retinal vasculatures were compared between preoperative and postoperative photographs, and postoperative deformation of the macula was assessed as deformation of the square grid. The displacement of each node was measured, and deformation of the grid was calculated as differences in the coordinates of the adjacent nodes. These parameters were analyzed to find correlation with metamorphopsia measured using the M-charts after 6 postoperative months. Results: The average deformations in the vertical and horizontal lines of the grid were 94.29 μm and 49.72 μm, respectively. Perifoveal deformation was significantly greater than parafoveal deformation (P = 0.001∼0.019). The multiple regression analysis demonstrated that the vertical M-score correlated with superior perifoveal deformation of the vertical line on the fovea (P = 0.036), and the horizontal M-score correlated with temporal perifoveal deformation of the horizontal line on the fovea (P = 0.032). Conclusion: The parafoveal tissue was displaced with the fovea concurrently after internal limiting membrane removal in macular hole surgery causing perifoveal deformation, which correlated with postoperative metamorphopsia.

To evaluate the duration of room air tamponade and its associated factors.Retrospective cohort study METHODS: The present study reviewed the medical records of patients who received room air tamponade after vitrectomy between Jun 2015 and Dec 2016. The room air duration was assessed by patient interviews 2 weeks after surgery. Relationships between the variables and tamponade duration were determined using logistic regression analysis. The remaining air level was determined from medical records.The room air tamponade had dissipated by 11.1 ± 1.3 days after surgery. The duration was 11.2 ± 1.3 days for eyes with a spared posterior capsule, longer than the duration in other eyes (10.1 ± 0.9 days). Increased axial length was correlated with increased duration. Axial length and a spared posterior capsule were significantly correlated with tamponade duration. Its half-life was presumed about 3.3 days. The room air seems to be absorbed at a constant rate.The data suggest that room air tamponade remains in the vitreous cavity for an average of 11.1 days. Axial length and posterior capsule status were associated with duration.

Background Postoperative intraretinal fluid (IRF) is reportedly associated with visual outcomes after epiretinal membrane (ERM) surgery. However, preoperative IRF is common, and persistent IRF would have different impact on visual function from postoperative newly developed IRF. Therefore, we aimed to investigate the incidence rate and clinical implications of perioperative IRF in ERM. Methods Medical records of patients who underwent vitrectomy for idiopathic ERM between January 2014 and January 2017 were reviewed retrospectively. The incidence of IRF was analyzed using optical coherence tomography preoperatively and 1, 3, and 6 months postoperatively. On the basis of the presence or absence and the time of detection of IRF, patients were divided into three groups, namely preoperative IRF group, New IRF group, and IRF(−) group. Correlations of various parameters including age, sex, baseline visual acuity (VA), central subfield macular thickness, lens status, and surgical factors with IRF, along with the effect of IRF on VA, were evaluated. Results This study included 155 eyes from 155 patients. Thirty-six (23.2%) and 49 (31.6%) eyes demonstrated preoperative and newly developed IRF, respectively. Seventy eyes (45.2%), which did not exhibit IRF during the study period, were assigned to the IRF(−) group. At baseline, the IRF(−) group showed a better VA than the other two groups. Postoperatively, VA improved significantly in all three groups. There was no difference in VA between the IRF(−) and new IRF groups at 6 months; however, the preoperative IRF group had significantly lower VA than the other two groups. Conclusion IRF associated with ERM was frequently observed preoperatively and postoperatively, but it did not prevent postoperative vision improvement. Preoperative IRF was related to lower postoperative vision improvement.

This study aims to quantitatively investigate the optical coherence tomographic angiography (OCTA) findings of capillary congestion and its association with macular edema (ME) recurrence in chronic branch retinal vein occlusion (BRVO). We retrospectively reviewed the medical records of 115 consecutive patients with major ischemic BRVO who reached stable macula (without ME for two consecutive visits) at baseline (the first visit within the stable period). All patients were classified into a recurrence or non-recurrence groups depending on ME recurrence. Capillary congestion of deep capillary plexuses (DCP-C) and other abnormal capillary lesions were segmented, and their areas, vascular densities, and mean retinal thicknesses (MRT) were calculated. The main outcomes were differences between the two groups and risk factors for recurrence among baseline and OCTA parameters. A total of 76 eyes were included, of which 22 (28.9%) recurred. DCP-C existed in all eyes at baseline. MRT of DCP-C (p = 0.006) was greater in the recurrence group. Greater MRT of DCP-C (OR: 1.044; p = 0.002) and more frequent intravitreal injections (OR: 1.803; p

Introduction We present a case of ischemic retinal vasculitis in adult-onset Henoch-Schonlein purpura (HSP) and the first report of capillary reperfusion through regenerative angiogenesis using optical coherence tomography angiography (OCTA). Case report A 34-year-old male complained of bilateral blurred vision after successive episodes of abdominal pain, purpura, and hematuria. Fundus examination showed perivascular infiltration and phlebitis. Fluorescein angiography and OCTA revealed extensive capillary nonperfusion. Laser photocoagulation was performed on the peripheral nonperfused area. Intravenous methylprednisolone with azathioprine was administered and continuously tapered. With consecutive OCTA follow-up, the capillary nonperfusion of the maculae progressively reperfused. Capillary buds and loops emerged within the nonperfused area, continued to elongate and branch, and finally connected with adjacent preexisting capillaries. Conclusions Regenerative angiogenesis was the mainstay process for capillary reperfusion in this patient. Systemic steroid therapy might support capillary reperfusion and recover the damaged ischemic maculae from ischemic retinal vasculitis of HSP.

This study aimed to investigate growth of polypoidal choroidal vasculopathy (PCV) without exudative findings assessed in en face optical coherence tomography (OCT) images and its clinical implications. Fifty patients who were diagnosed with PCV and had no disease activity after treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) were included. Patients were followed up for at least 12 months. Measurement of best-corrected visual acuity and volume scan using swept-source OCT was performed at each visit. The neovascular area of PCV was assessed using en face OCT. Growth group comprised patients who showed increase in neovascular area in the en face images without exudative findings. The main outcome measure was relationship between growth of PCV and recurrence. Among 50 eyes of 50 patients with average age of 68.5 ± 8.6 years, 25 (50%) eyes were included in the growth group. Exudative recurrence was noted more frequently in the growth group (18 eyes, 72%) than in the non-growth group (6 eyes, 24%, P = .002, odds ratio = 8.143). More injections were performed in the growth group (4.7 ± 2.1 vs. 1.9 ± 2.4, P = .002), but there was no difference in visual acuity at 1 year. After an exudative recurrence following the lesion growth, more frequent injections were required than before the recurrence to achieve no disease activity (P = .002). PCV lesion growth without fluid preceded exudative recurrence and worsening of response to anti-VEGF treatment.

Purpose: To assess the value of positive immunoglobulin (Ig) M serum antibody (Ab) findings in uveitis patients. Methods: We reviewed medical records of patients who had a positive serological test for Toxoplasma gondii-specific IgM Ab. Their clinical data, including history, demographic characteristics, laboratory findings, clinical findings, treatment outcomes, and recurrences, were reviewed retrospectively. Results: Of 2919 uveitis patients who underwent a serological test for suspected ocular toxoplasmosis (OT), 18 presented with positive Ig M results. All 18 patients (100.0% specificity) were clinically diagnosed with OT. None had any retinochoroidal scar at the initial visit, indicating the OT was a recent and primary infection. However, 15 patients (83.3%) had no history suspected to account for the Toxoplasma transmission. Conclusions: The T. gondii IgM serum Ab is a specific biomarker for diagnosis of primary OT. Epidemiological studies are warranted to investigate the non-classic transmission routes of T. gondii in OT.

To investigate the clinical features associated with early visual loss in patients with idiopathic epiretinal membrane.Patients with idiopathic epiretinal membrane with visual acuity of ≥20/40, intact ellipsoid zone, and follow-up duration of at least 24 months were included in this retrospective age-matched control study. The disk-fovea-vascular (DFV) distance, central macular thickness, membrane configuration, and ellipsoid zone were assessed using fundus photography and spectral domain optical coherence tomography.We analyzed the progression group (n = 15; vision loss ≥2 lines because of membrane progression) and the control group (n = 30; age matched). Compared with the controls, the mean DFV distance decreased (P0.001), central macular thickness increased (P = 0.017), and the ratio of the follow-up and baseline DFV distances (traction index of membrane) was significantly lower (P = 0.001) in the progression group. No differences were observed in the follow-up membrane configuration and ellipsoid zone. Factors associated with early vision loss were the DFV distance change (ρ = 0.657; P = 0.008) and traction index of membrane (ρ = -0.636; P = 0.011). Their area under receiver-operating characteristic curves were significant (DFV distant change: 0.915, traction index of membrane: 0.910, respectively; P0.001, both).Assessing the DFV distance is useful in quantifying the tangential contraction of macula and the prediction of vision loss in idiopathic epiretinal membrane.

To investigate the association between sex hormone deficiency and soft drusen in women and men.We retrospectively reviewed the medical records and fundus photographs of subjects who underwent a health screening for additional examination of climacterium and age-related changes including sex hormone status. In women, sex hormone deficiency was defined as cessation of menstruation that had lasted for at least 12 months and follicular stimulating hormone (FSH) levels ≥ 25 mIU/mL; in men, it was defined as testosterone levels ≤ 3.5 ng/mL. The subjects were divided into two groups-the soft drusen and control groups-based on the presence of soft drusen in the fundus photographs. The total drusen area was measured using ImageJ™ software.Of total 2036 subjects, 638 (271 women; 367 men) were included. Two hundred thirteen subjects (33.4%) had soft drusen (97/271 women, 116/367 men). In women, sex hormone deficiency was more common in the soft drusen group than in the control group (P0.001); this was not the case in men. Multivariate logistic regression analysis revealed that sex hormone deficiency was an independent risk factor for soft drusen in women (P0.001; odds ratio [OR] = 3.494), as was age (P0.001; OR = 1.092). A long post-menopausal period was a risk factor for large soft drusen (≥ 125 μm). (P0.001; OR = 1.220). Age was significantly associated with total drusen area in both women (P = 0.022; β = 0.406) and men (P = 0.015; β = 0.246).Sex hormone deficiency and its duration were significantly associated with the development and progression of soft drusen in women but not in men. It may be necessary to assess and manage the sex hormone deficiency in women with age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To investigate the displacement of foveal retinal layers in surgically closed macular holes (MHs) after removal of the internal limiting membrane (ILM). PATIENTS AND METHODS: Medical records of 26 consecutive patients who underwent vitrectomy and removal of the ILM for idiopathic MH were retrospectively reviewed. En face optical coherence tomography images were exported at the level of the choroid, ellipsoid zone (EZ), and inner plexiform layer (IPL) at baseline and at 1, 3, and 6 months. The foveal center of the EZ and IPL was marked in the choroid en face image. The choroidal images were overlapped to match the vasculature in each patient, and the postoperative displacement of the foveal center was compared to baseline. RESULTS: The center of the EZ and IPL was displaced significantly toward the disc during the first 3 months. The mean horizontal displacement at 1, 3, and 6 months was 52.7 μm, 112.5 μm, and 115.4 μm, respectively, for the EZ and 75.2 μm, 117.1 μm, and 136.5 μm, respectively, for the IPL. The location of the foveal center was significantly correlated between the EZ and the IPL ( P ≤ .016). CONCLUSIONS: The fovea was displaced nasally and slightly inferiorly after removal of the ILM. The displacement of the photoreceptor and inner retinal layers was concurrent. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:414–422.]

PURPOSE To investigate the difference in choroidal hyperpermeability (CH) assessed using digital fundus camera (DFC) and scanning laser ophthalmoscope (SLO) and its effect on photodynamic therapy (PDT) outcomes in chronic central serous chorioretinopathy. METHODS Midphase indocyanine green angiography (ICGA) images were acquired using both DFC and SLO in 38 consecutive eyes with chronic central serous chorioretinopathy in this retrospective study. Scanning laser ophthalmoscope-ICGA was taken immediately after DFC-ICGA. Photodynamic therapy was applied to the area of CH associated with subretinal fluid (CH-SRF). The main outcome measures included the areas of CH in the macula and CH-SRF, resolution of SRF, and change in the best-corrected visual acuity. RESULTS Areas of CH (5.187 ± 2.625 mm vs. 3.170 ± 1.661 mm, P < 0.001) and CH-SRF (2.315 ± 1.111 mm vs. 1.465 ± 0.709 mm, P < 0.001) were greater in DFC than in SLO. Sixteen eyes underwent DFC ICGA-guided PDT (DFC-PDT group) and 22 underwent SLO ICGA-guided PDT (SLO-PDT group). Subretinal fluid resolution at 12 months was 100.0% and 90.9% in the DFC-PDT and SLO-PDT groups, respectively, without statistical differences. The improvement of best-corrected visual acuity was earlier in the SLO-PDT group than in the DFC-PDT group (3 months, P = 0.002 vs. 6 months, P = 0.003), but the final best-corrected visual acuity showed no difference. CONCLUSION In chronic central serous chorioretinopathy, larger areas of CH and CH-SRF were observed with DFC than with SLO, which caused the ophthalmologists performing ICGA-guided PDT to determine a larger laser spot. This seemed to affect the time of visual recovery, but not the final outcome.