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Mawaddah Sabr,1,&ast; Valmore A Semidey,2 Marcos J Rubio-Caso,2 Renad Aljuhani Jnr,3 Gorka Sesma1,&ast; 1Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Gorka Sesma, Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Al Urubah Branche Road, West Building 2nd Floor, Riyadh, 11462, Saudi Arabia, Tel +966114849700, Fax +966114821908, Email gsesma@kkesh.med.saBackground: Retinal detachment is a major postsurgical threat in pediatric cataract surgery; however, the effect of axial length remains unclear. This study aimed to assess the relationship between axial length and detachment risk in vulnerable patients.Methods: This retrospective cohort study analyzed 132 eyes of 84 pediatric cataract surgery patients aged < 20 years old. Axial length was measured preoperatively, and the incidence of retinal detachment was recorded over a median follow-up of 4 years. Logistic regression analysis was used to examine the axial length-detachment relationship.Results: Twenty eyes had postoperative retinal detachments. The median axial length was longer in the detachment group (23.6 mm) than in the non-detachment group (21.6 mm). Eyes with axial length ≤ 23.4 mm had 0.55-fold decreased odds of detachment compared to longer eyes. Preexisting myopia and glaucoma confer heightened risk. Approximately half of the patients retained some detachment risk eight years postoperatively.Conclusion: Shorter eyes (axial length ≤ 23.4 mm) appear to be protected against pediatric retinal detachment after cataract surgery, whereas myopia, glaucoma, and axial elongation > 23.4 mm elevate the postoperative risk. Understanding these anatomical risk profiles requires surgical planning and follow-up care of children undergoing lensectomy.Plain language Summary: This study investigated the protective role of a shorter axial length in preventing retinal detachment after pediatric cataract surgery. This highlights the correlation between smaller eye sizes and reduced detachment risk, emphasizing the need for careful consideration of anatomical factors in surgical planning and patient monitoring, particularly for patients with preexisting myopia or postoperative glaucoma. Keywords: pediatric cataract surgery, axial length, retinal detachment, myopia, congenital glaucoma, congenital cataract

Purpose To study choroidal thickness (CT) and its determinants based on optical coherence tomography (OCT) in the healthy adult Saudi population. Materials and methods This cross-sectional study was conducted in 2021 at a tertiary eye hospital in Saudi Arabia. The autorefractor-based refractive status (spherical equivalent) of each eye was documented. CT was measured from the enhanced depth OCT images at the fovea to the 1500 µm nasal and temporal to the fovea. CT was defined as the distance from a hyper-reflective line representing retinal pigment epithelium (RPE)-Bruch's membrane to the choroid-scleral junction. The CT was correlated with demographic and other variables. Results The study sample included 288 eyes of 144 participants (mean age 31.5±8.3 years; males 94, 65.3%). Emmetropia, myopia, and hypermetropic spherical equivalent were noted in 53 (18.4%), 152 (52.5%), and 83 (28.8%) eyes, respectively. The mean sub-foveal (SFCT), nasal, and temporal CT were 329.4±56.7μm, 302.3±63.5 μm, and 312.8± 56.7μm, respectively. CT varied significantly by location (p   <0.001). CT was negatively correlated with age (r = -0.177, P   <0.001). CT in emmetropic and myopic eyes was 319.7±53 μm and 313.1±53 μm, respectively. The difference in CT based on refractive status (p   = 0.49) or sex was non-significant (p   = 0.6). Regression analysis suggested that age (p   <0.001), refractive error (p   = 0.02), scanning time (p   <0.001), and scanning location (p   = 0.006) were significant predictors of CT. Conclusion CT measurements of the eyes of healthy Saudis can be used as reference values for studies evaluating CT changes due to various chorioretinal diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al Marshood et al.)

Background: Intraocular lymphoma (IOL) is an uncommon ophthalmic malignancy and poses a diagnostic challenge. Uveitis associated with systemic lymphoma (USL) has been predominantly attributed to non-Hodgkin lymphoma (NHL) and rarely reported with Hodgkin lymphoma (HL) in the literature., Methods: Case report with review of the literature., Results: A 25-year-old healthy male presented with bilateral granulomatous panuveitis including vasculitis and discrete chorioretinal yellowish-white lesions. Macular optical coherence tomography (OCT) of both eyes revealed a disruption of ellipsoid and interdigitation zones over the areas of subretinal lesions as well as a small sub-retinal pigment epithelium (RPE) deposit in one eye. Thorough uveitis workup revealed clavicular, axillary and cervical lymphadenopathy, and biopsy of lymph nodes confirmed the diagnosis of nodular lymphocyte-predominant (NLP) HL. Six months later and after receiving chemotherapy, all symptoms and most of clinical signs resolved., Conclusions: Clinical features of USL do not differ between HL and NHL. However, the age of presentation may be much younger in HL. Ocular manifestations can precede systemic HL diagnosis, as shown in our patient. Therefore, USL should be part of the differential diagnosis of panuveitis. Paraneoplastic inflammation is thought be the cause of uveitis associated with HL. The sub-RPE deposit and disruption of ellipsoid and interdigitation zones on OCT have not been documented before as a manifestation of uveitis secondary to HL. In addition, the NLP subtype of HL was reported in only 1 case with uveitis in the literature.

Background: To correlate retina-choroidal anatomy as assessed via swept-source OCT (SS-OCT) with retinal function as determined by best-corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG)., Methods: Thirty-three eyes from 33 patients including 16 with neovascular AMD (nvAMD) and 17 controls were included. Patients were included in the present study after a complete ophthalmologic examination, including BCVA, slit-lamp study, intraocular pressure measurement, dilated fundus examination after tropicamide instillation, SD-OCT, SS-OCT, fundus photographs and mfERG. Age, sex, BCVA, number of anti-VEGF intravitreal injections in the nvAMD group, were recollected. Outer retinal and choroidal thickness were determined at the fovea and 500 μm temporal, superior, nasal and inferior. First-order response from mfERG was collected. P1 amplitude was recorded in R1, R2 and the average of R1 + R2. The measurements recollected from the SS-OCT, mfERG and BCVA were compared., Results: Better BCVA was found with thicker outer retina foveal thickness (r = 0.349; P  = 0.047), with thicker subfoveal choroidal thickness (r = 0.443; P  = 0.010), and with higher amplitude in P1 at R1 (r = 0.346; P  = 0.037). Outer retina foveal thickness did not correlate with P1 amplitude at R1 (r = 0.072; P  = 0.692), R2 (r = 0.265; P  = 0.137) either with the average P1 amplitude at R1 + R2 (r = 0.253; P  = 0.156). A thicker subfoveal choroidal thickness was related with higher amplitude in P1 at R1 (r = 0.383; P  = 0.028), R2 (r = 0.409; P  = 0.018) and the average of R1 + R2 (r = 0.419; P  = 0.015)., Conclusions: Choroidal thickness demonstrated a positive correlation with retinal function in the sample studied, so a thicker choroid is related to a better retinal function measured with mfERG and BCVA.

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.)

Purpose: To describe the findings in circumscribed choroidal haemangioma (CCH) using en face swept-source optical coherence tomography (SS-OCT)., Methods: En face images were obtained employing DRI-1 Atlantis OCT (Topcon, Tokyo, Japan), using a three-dimensional volumetric scan of 12×9 mm. Images were obtained from the retinal pigment epithelium to 1000 μm in depth of the tumour., Results: Twenty-two eyes from 22 patients with the clinical diagnosis of CCH were included. In 20 eyes (90.9%), a characteristic pattern was visualised in the en face image across the vascular tumour. A multilobular pattern, similar to a honeycomb, with hyporeflective, confluent, oval or round areas corresponding with the lumen of the tumour vascular spaces, and hyper-reflective zones, which may represent the vessels walls and connective tissue of the tumour. Ten eyes (45.4%) showed a hyper-reflective halo surrounding the tumour. Seventeen tumours (77.2%) showed small diameter vessels at the inner zone and larger vessels in the outer area. Twelve patients (54.5%) had previously received treatment (photodynamic therapy, transpupillary thermotherapy, dexamethasone intravitreal implant or brachytherapy with ruthenium-106). No differences were found between treated and untreated patients in any of the measured parameters., Conclusions: En face SS-OCT is a rapid, non-invasive, high-resolution, technology, which allows a complementary study to cross-sectional scans in CCH. A characteristic multilobular pattern, with a hyper-reflective halo surrounding the tumour, was found in en face SS-OCT images. No morphological differences were found between naïve patients and patients who received previous treatment., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: To determine the prevalence of vitreomacular interface (VMI) pathology, using spectral-domain optical coherence tomography (SD-OCT)., Methods: VMI status was classified into macular posterior vitreous detachment (PVD), focal vitreomacular adhesion (VMA; ≤1,500 μm), broad VMA (>1,500 μm), focal vitreomacular traction (VMT; ≤1,500 μm), broad VMT (>1,500 μm), full-thickness macular hole (FTMH) with the presence of VMT, and FTMH without the presence of VMT., Results: A total of 1,976 eyes were included. A nonpathologic VMI was observed in 1,875 eyes (94.8%), including 1,050 (53.1%) with PVD, 120 (6.1%) with focal VMA and 705 (35.6%) with broad VMA. A pathologic state of the VMI was diagnosed in 101 eyes (5.1%). Thirty-three eyes (1.7%) were classified as focal VMT, 29 (1.4%) as broad VMT, 39 (1.9%) as FTMH, resulting in 6 small, 12 medium and 21 large FTMHs, six eyes had VMT associated to FTMH., Conclusions: Even in a tertiary care, retinal referral practice, VMI pathology is a relatively rare condition. There was a higher prevalence in a tertiary hospital study compared to population-based studies., (© 2016 S. Karger AG, Basel.)

Purpose: To describe en face swept-source optical coherence tomography (SS-OCT) findings in the retinal pigment epithelium (RPE) and choroid and to correlate them with fluorescein angiography (FA) and/or indocyanine green angiography (ICGA) in neovascular age-related macular degeneration (AMD)., Methods: Thirty-eight eyes with the recent diagnosis of neovascular AMD were imaged using an SS-OCT system. En face images were obtained at RPE, choriocapillaris, Sattler's layer and Haller's layer level. Analysis of the images and correlation with colour fundus photographs, FA, ICGA in selected cases, were made., Results: En face images at RPE level revealed changes in all eyes. The neovascular complex appeared hyper-reflective in 9 of 38 eyes (23.7%), and in 29 of 38 eyes (76.3%), it was hyporeflective. The choriocapillaris en face image showed pathological changes in all eyes as well, and in 20 out of 38 eyes (52.6%), the alterations were hyper-reflective, while 18 of 38 eyes (47.4%) showed hyporeflective changes. Twenty (52.6%) eyes and 19 (50.0%) had a hyper-reflective lesion in Sattler's layer and Haller's layer, respectively, and 15 (39.4%) cases showed a hyporeflective lesion in both layers. No differences were found between the neovascular complex area, horizontal and vertical diameters, measured in the en face image and FA (p=0.171, p=0.061, p=0.133, respectively). Hyporeflective changes were predominant at RPE level and hyper-reflective at choriocapillaris, Sattler's and Haller's layers., Conclusions: En face SS-OCT is a rapid, non-invasive, high-resolution, promising technology, which allows a complementary study to angiography of neovascular AMD. There is a correlation between angiography and en face SS-OCT images in neovascular AMD., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

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.)