Suprachoroidal haemhorrage and vortex vein varix: A potential association Paolo Milani, Marco Mazzola, Fulvio Bergamini European Journal of Ophthalmology, 2022 Purpose: To report on the association between a vortex vein varix and suprachoroidal hemorrhage. Case description: A healthy 60 years-old man with high myopia (–10 diopters) was seen because of sudden paracentral metamorphopsias after emesis. Multimodal imaging included Spectral-Domain Optical Coherence Tomography (SD-OCT), ultrasonography and retinal angiography with fluorescein and indocyanine green. His vision was 20/20 but clinical assessment and imaging procedures evaluations showed a suprachoroidal hemorrhage in the temporal part of the para-macular area. The lesion corresponded to a mild hypo-fluorescence area on fluorescein angiography and to a massive detachment of the inner part of the choroid from the suprachoroidal space on SD-OCT. Indocyanine green angiography disclosed engorgement of a big choroidal vessel in the area of the lesion. An adjacent vortex vein varix was found on SD-OCT. A few weeks later the suprachoroidal hemorrhage resolved spontaneously, whereas the vortex vein varix persisted. Conclusion: We speculate that vortex vein varixes might represent a risk factor for the occurrence of suprachoroidal hemorrhage in high myopia and that this association may be worth investigating. Summary statement: In a high myopia suprachoroidal hemorrhage might be secondary to vortex vein varixes.
A Global and Sector-Based Comparison of OCT Angiography and Visual Field Defects in Glaucoma Alan W. Kong, Marcus L. Turner, Murtaza Saifee, Mohit Jethi, Marta Mora, et al. Journal of Ophthalmology, 2022 Purpose. To evaluate the correlation of optical coherence tomography angiography (OCTA) and spectral-domain optical coherence tomography (SD-OCT) with visual field for global and sector-based indices among glaucoma and glaucoma-suspected eyes. Patients and Methods. This is a retrospective study, and in total, 48 glaucoma eyes and 31 glaucoma suspect eyes were included. The correlation between visual field parameters and radial peripapillary capillary (RPC) vessel density via OCTA was compared to the correlation with retinal nerve fiber layer (RNFL) thickness via SD-OCT. The RPC vessel density and RNFL thickness were divided into eight sectors, which included the temporal upper, temporal lower, superotemporal, inferotemporal, superonasal, inferonasal, nasal upper, and nasal lower sectors. Pearson correlations with 95% confidence intervals were calculated with resampling, and correlations were compared with a Fisher Z transformation. Results. Both RPC vessel density (R = 0.63, 95% CI [0.24, 0.86]) and RNFL thickness (R = 0.49, 95% CI [0.23, 0.69]) were correlated with the mean deviation when comparing global indices of glaucoma patients. In glaucoma suspects, the correlations between the mean deviation and RPC vessel density (R = 0.21, 95% CI [−0.05, 0.49]) and RNFL thickness (R = 0.01, 95% CI [−0.35, 0.39]) were not significant. Glaucoma eyes had the highest correlation between the mean sensitivity and RPC vessel density and RNFL thickness for the superotemporal, superonasal, temporal upper, and inferotemporal sectors. Conclusion. Across a diverse population and heterogeneous glaucoma types, RPC vessel density measurements correlate with global and sector-wise visual field indices similar to RNFL thickness.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF CONGENITAL RETINAL MACROVESSEL WITH ANOMALOUS RETINAL ANASTOMOSIS ASSOCIATED WITH CONTRALATERAL MYELINATED NERVE FIBERS AND RETINAL VASCULAR ABNORMALITIES Chiara Preziosa, Paolo Milani, Paola Ciasca, Fulvio Bergamini, Giovanni Staurenghi, et al. Retinal Cases and Brief Reports, 2021 PURPOSE To describe a case of congenital retinal macrovessel complicated by cystoid macular edema associated with contralateral myelinated retinal nerve fibers and retinal vascular abnormalities studied with optical coherence tomography angiography (OCTA). METHODS Case report. RESULTS A healthy 25-year-old woman with decreased vision in her right eye was found to have a congenital retinal venous macrovessel in the macula associated with cystoid edema. In the contralateral amblyopic eye, the examination revealed a tuft of myelinated retinal nerve fibers along the superotemporal vascular arcade associated with superficial vascular abnormalities. A complete multi-imaging examination was obtained, including fundus color photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), and optical coherence tomography angiography. At 1-week follow-up, the optical coherence tomography displayed spontaneous resolution of the edema that remained stable at consecutive 1-month follow-up. CONCLUSION Congenital retinal macrovessels can be associated with other ocular developmental anomalies. Vascular complications can occur, leading to macular edema and retinal ischemia. Optical coherence tomography angiography can be useful for the diagnosis and follow-up of this condition.
Comment on: Diagnostic algorithm utilising multimodal imaging including optical coherence tomography angiography for the detection of myopic choroidal neovascularization Paolo Milani, Fabrizio Scotti, Fulvio Bergamini Eye Basingstoke, 2021 Bagchi et al. [1] interestingly purposed a decision-making flow chart for cases clinically suspected of myopic choroidal neovascularization (mCNV) that may occasionally be misdiagnosed. In addition to an accurate clinical examination, diagnosis with complete multimodal imaging remains the best strategy because the sensitivity and specificity of spectral-domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), and fluorescein angiography (FA) alone is good but not infallible with a sensitivity ranging from 94 to 74% [1]. However, we believe that the flow chart warrants reconsideration for two main reasons. First, difficulty in determining the lesion activity clinically or on tomographic imaging. Some patients have reduced baseline visual acuity due to high myopia or concomitant diseases, such as amblyopia, cataract, and glaucoma. Therefore, these patients, especially those who are old, may be oblivious to further visual deterioration for months and may seek ophthalmologists’ care months after symptom onset when the mCNV is in the scar stage. Thus, non-invasive and fast SD-OCT to assess lesion characteristics becomes crucial, but in some eyes tomographic signs of activities, including the presence of hyperreflective material with intraretinal or subretinal fluid, intraretinal fuzzy area, and retinal pigment epithelium elevation, may be difficult to detect or dependent on the examiners’ interpretation and experience. Similarly, presence of ellipsoid zone and external limiting membrane interruption as signs of activity, as reported by some authors [2, 3], require additional validation and consensus since visual improvement and mCNV inactivity may occur after intravitreal treatment despite ellipsoid zone and external limiting membrane reconstitution within the lesion [4]. Occasionally, it is challenging to distinguish fibrosis from active mCNV on SDOCT. In such cases, OCTA may be potentially helpful, although there is a risk of false-negative diagnosis because of macular haemorrhage and chorioretinal atrophy. In fact, mCNV was identified on OCTA in 74.07% of cases by Bagchi et al. [1], concluding that the lesion shape (tight rather than a loose net) and presence of a black surrounding halo are the characteristic features of activity. In contrast, a low specificity of choroidal dark halo with no association with lesion activity was reported recently [5]. We therefore strongly believe that interpretation of mCNV features on OCTA is inter-observer dependent and that artifacts and acquisition modality can greatly affect diagnosis, eventually leading to poor quality imaging in almost 24.1% of cases [5]. Nevertheless, we reported that in 80% of fibrosis secondary to mCNV (inactive mCNV), the original neovascular network remains well discernable several months after treatment even if enclosed within the scar area [6]. This observation, in particular, seems inconsistent with the proposed algorithm. According to it, mCNV should be treated if considered negative on SD-OCT but positive on OCTA (as commonly seen with fibrosis or inactive mCNV) independently from its features on FA. Evidently, although SD-OCT is mostly sufficient for accurately diagnosing mCNV, we are convinced that FA should be strongly considered in mCNV cases with negative or doubtful SD-OCT outcomes, regardless of its invasiveness. In these cases, combined SD-OCT with OCTA, when available, may provide inaccurate diagnosis and lead to * Paolo Milani dottpaolomilani@hotmail.com
The macular choriocapillaris flow in glaucoma and within-day fluctuations: An optical coherence tomography angiography study Paolo Milani, Lara Enrica Urbini, Ennio Bulone, Ugo Nava, Deborah Visintin, et al. Investigative Ophthalmology and Visual Science, 2021 Purpose To assess quantitatively the choriocapillaris (CC) perfusion area in the macular area of healthy eyes, eyes with primary open-angle glaucoma, and eyes with ocular hypertension using optical coherence tomography angiography (OCTA). Methods A consecutive series of healthy individuals and patients with glaucoma and ocular hypertension were recruited prospectively in this single-center, cross-sectional study based in Milan, Italy. OCTA was performed in the morning and evening, along with a complete ophthalmologic examination. Macular superficial capillary plexus vessel density (SCP-VD) and the thicknesses of the retina and ganglion cell complex (GCC), as well as their fluctuations, were investigated. Results Thirty-nine eyes from 24 individuals with glaucoma (mean age = 58.79 ± 6 years), 43 eyes from 27 individuals with ocular hypertension (59.19 ± 6 years), and 54 eyes from 35 controls (58.27 ± 6 years) were enrolled. The mean CC perfusion area values were not significantly different among the three groups in the morning or evening (P ≥ 0.47). In contrast, SCP-VD, retinal thickness, and GCC thickness were statistically different among the groups (P ≤ 0.016), except for the foveal SCP-VD (P ≥ 0.19) and the evening foveal thickness (P = 0.57). Diurnal changes in the CC perfusion area, SCP-VD, retinal thickness, and GCC thickness were not statistically significant (P ≥ 0.16). Systemic hypertension, sex, age, axial length, and diurnal changes in intraocular pressure were not significantly associated with morning or evening measurements, or with diurnal fluctuations (P ≥ 0.07). Conclusions The macular CC flow perfusion area appears unaffected in eyes with primary open-angle glaucoma. No significant diurnal changes were observed in any of the parameters investigated.
Diurnal measurements of macular thickness and vessel density on OCT angiography in healthy eyes and those with ocular hypertension and glaucoma Paolo Milani, Sara Bochicchio, Lara Enrica Urbini, Ennio Bulone, Stefania Callegarin, et al. Journal of Glaucoma, 2020 Supplemental Digital Content is available in the text. Precis: Macular superficial capillary plexus (SCP) and thickness are reduced in eyes with glaucoma and ocular hypertension, but do not change significantly during the day. No relationships with age, intraocular pressure, systemic hypertension, or axial length were found. Purpose: The purpose of this study was to evaluate diurnal differences in retinal thickness and vessel density (VD) of the macular SCP and deep capillary plexus (DCP) using optical coherence tomography angiography among 3 groups: eyes with glaucoma, eyes with ocular hypertension, and healthy eyes. Methods: A consecutive series of individuals was recruited prospectively. Optical coherence tomography angiography was performed in the morning and in the evening. Results: Forty eyes from 23 individuals with glaucoma (58.35±6 y), 52 eyes from 32 individuals with ocular hypertension (58.84±7 y), and 73 eyes from 44 controls (57.84±6 y) were enrolled. Morning and evening measurements of all SCP-VD and retinal thickness parameters were statistically significantly different (P<0.04) among the 3 groups of eyes. None of the DCP-VD parameters were significantly different. Daily changes in SCP-VD, DCP-VD, and retinal thickness among the groups of eyes were not statistically significant. Systemic hypertension, age, axial length, and diurnal changes in intraocular pressure were not significantly associated with diurnal fluctuations of SCP-VD, DCP-VD, or retinal thickness (P>0.19). A positive linear correlation in diurnal changes was found between SCP-VD and DCP-VD in the fovea and in the parafovea (r=0.5567 and 0.5892, respectively) and between SCP-VD and retinal thickness in the fovea and in the parafovea (r=−0.2288 and 0.2418, respectively). Conclusions: Macular SCP-VD and thickness are reduced in eyes with glaucoma and ocular hypertension. Although diurnal changes in SCP-VD, DCP-VD and macular thickness were not significant among the groups, some linear correlations in increasing or decreasing values of the investigated parameters were found.
