Publications by authors named "Kaori Sayanagi"

52 Publications

Impact of photoreceptor density in a 3D simulation of panretinal laser photocoagulation.

BMC Ophthalmol 2021 May 7;21(1):200. Epub 2021 May 7.

Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7, Suita, Osaka, 565-0871, Japan.

Background: During panretinal photocoagulation (PRP), the outer retina, especially the photoreceptors, are destroyed. During such procedures, the impact of the retinal photocoagulation, which is performed in the same photocoagulated area, may change if it is applied to different locations with different photoreceptor densities. Thus, we aimed to evaluate the influence of photoreceptor density on PRP.

Methods: We constructed a three-dimensional (3D) average distribution of photoreceptors with 3D computer-aided design (CAD) software using previously derived photoreceptor density data and calculated the number of photoreceptors destroyed by scatter PRP and full-scatter PRP (size 400-μm on the retina, spacing 1.0 spot) using a geometry-based simulation. To investigate the impact of photoreceptor density on PRP, we calculated the ratio of the number of photoreceptors destroyed to the total number of photoreceptors, termed the photoreceptor destruction index.

Results: In this 3D simulation, the total number of photoreceptors was 96,571,900. The total number of photoreceptors destroyed by scatter PRP and full-scatter PRP were 15,608,200 and 19,120,600, respectively, and the respective photoreceptor destruction indexes were 16.2 and 19.8%, respectively.

Conclusions: Scatter PRP is expected to have 4/5 of the number of photoreceptors destroyed by full-scatter PRP.
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http://dx.doi.org/10.1186/s12886-021-01945-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103585PMC
May 2021

Flow pattern and perforating vessels in three different phases of myopic choroidal neovascularization seen by swept-source optical coherence tomography angiography.

Graefes Arch Clin Exp Ophthalmol 2021 Mar 9. Epub 2021 Mar 9.

Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, 565-0871, Suita, Osaka, Japan.

Purpose: To compare the choroidal neovascularization (CNV) flow patterns and the relationship between perforating vessels (PVs) and CNV in the three different stages of networks in myopic CNV (mCNV) using swept-source optical coherence tomography angiography (SS-OCTA).

Methods: This retrospective study included 28 eyes with mCNV that was divided into three phases (active, scar, and atrophic) and observed by SS-OCTA. SS-OCTA findings, with special focus on the relationship between the PVs and CNV, were compared among the three phases.

Results: Overall, the CNV signal was detected in 31 of the 34 areas of CNV (91%); in the active, scar, and atrophic phases, respectively, CNV signals were detected in eight of eight areas of CNV (100%), 10 of 11 areas of CNV (91%), and 13 of 15 areas of CNV (86%). Two signal patterns were observed in each phase, i.e., dense and loop; in the atrophic phase, seven eyes were unclassifiable. The ratio between the dense and loop patterns did not differ significantly among the phases. In 30 of 34 areas of CNV for which clear images were obtained, the PVs and CNV were connected directly or indirectly in 19 area of CNV, and in five areas of CNV, trunk-like vessels were connected to the PVs within the CNV. The numbers of foveal or parafoveal CNVs accompanied by PVs were significantly (p=0.0048) greater than those of the extrafoveal CNV.

Conclusions: OCTA provides detailed observation of mCNV and the relationship between CNV and PVs. Although the CNV signal pattern does not differ depending on the degree of atrophy, there are cases in which only the trunk-like vessels connect to the PVs within the CNV in the atrophic phase without CNV flow signal.
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http://dx.doi.org/10.1007/s00417-021-05134-yDOI Listing
March 2021

Identification of as a susceptibility gene for neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

Br J Ophthalmol 2020 Mar 9. Epub 2020 Mar 9.

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China

Purpose: The endothelial and cell-specific angiopoietin-Tie pathway plays an important regulatory role in angiogenesis. In this study, we investigated the associations of the () gene with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV), using haplotype-tagging single-nucleotide polymorphisms (SNPs) analysis.

Methods: This study involved totally 2343 subjects, including a Hong Kong Chinese cohort (214 nAMD patients, 236 PCV patients and 433 control subjects), a Shantou Chinese cohort (189 nAMD patients, 187 PCV patients and 531 control subjects) and an Osaka Japanese cohort (192 nAMD patients, 204 PCV patients and 157 control subjects). Thirty haplotype-tagging SNPs in were genotyped in the Hong Kong cohort using TaqMan technology. Two SNPs (rs625767 and rs2273717) showing association in the Hong Kong cohort were genotyped in the Shantou and Osaka cohorts. The SNP-disease association of individual and pooled cohorts were analysed.

Results: Two SNPs (rs625767 and rs2273717) showed suggestive association with both nAMD and PCV in the Hong Kong cohort. In the meta-analysis involving all the three cohorts, rs625767 showed significant associations with nAMD (p=0.01; OR=0.82, 95% CI 0.70 to 0.96; I=0%), PCV (p=0.02; OR=0.83, 95% CI 0.71 to 0.97; I=27%) and pooled nAMD and PCV (p=0.002; OR=0.82, 95% CI 0.72 to 0.93; I=0%), with low inter-cohort heterogeneities.

Conclusion: This study revealed as a novel susceptibility gene for nAMD and PCV in Japanese and Chinese. Further studies in other populations are warranted to confirm its role.
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http://dx.doi.org/10.1136/bjophthalmol-2019-315746DOI Listing
March 2020

Tachyphylaxis during treatment of exudative age-related macular degeneration with aflibercept.

Graefes Arch Clin Exp Ophthalmol 2019 Nov 3;257(11):2559-2569. Epub 2019 Sep 3.

Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.

Purpose: At present, the standard treatment of neovascular age-related macular degeneration (AMD) is the repeated administration of antivascular endothelial growth factor (VEGF) agents. However, we often encounter patients who develop tachyphylaxis for anti-VEGF agents. In this study, we investigated the characteristics of patients who developed tachyphylaxis on repeated intravitreal aflibercept (IVA) injections for neovascular AMD and the frequency of tachyphylaxis.

Methods: Three hundred thirteen eyes (313 patients) with treatment-naïve AMD who achieved resolution soon after starting IVA and were followed up for ≥ 12 months were enrolled in this retrospective, interventional, consecutive case series. The eyes were investigated for tachyphylaxis to aflibercept. Tachyphylaxis was defined as absence of any improvement (more than 100 μm) in or worsening of CRT within 1 month after more than two repeated monthly IVA injections when the exudative change remained.

Results: Twenty-eight (8.9%) of the 313 eyes developed tachyphylaxis (occult with no classic, n = 14; polypoidal choroidal vasculopathy, n = 14) at an annual rate of about 3%. The mean number of IVA injections was 10.5 ± 7.8, and the mean interval until tachyphylaxis was 20.9 ± 14.0 months. There was a significant difference in the AMD subtypes between the group with tachyphylaxis and the group without it (p = 0.0029). Occult with no classic type and polypoidal choroidal vasculopathy were the only AMD subtypes in the eyes with tachyphylaxis. In the analysis of the eyes that had occult with no classic or polypoidal choroidal vasculopathy, only intraretinal edema was significantly less common (p = 0.042). A combination of photodynamic therapy and aflibercept was effective in 13 (87%) of 15 eyes with tachyphylaxis, and switching to intravitreal ranibizumab was effective in 5 (56%) of 9 eyes.

Conclusions: Tachyphylaxis occurs after repeated IVA injections in a minority of patients with AMD for a long term and is more likely to occur in eyes with lesions beneath the retinal pigment epithelium and no intraretinal edema. Treatment of AMD should be performed keeping this fact in mind, while considering the consecutive treatment.
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http://dx.doi.org/10.1007/s00417-019-04456-2DOI Listing
November 2019

Time course of swept-source optical coherence tomography angiography findings after photodynamic therapy and aflibercept in eyes with age-related macular degeneration.

Am J Ophthalmol Case Rep 2019 Sep 1;15:100485. Epub 2019 Jun 1.

Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

Purpose: To report swept-source optical coherence tomography angiography (SS-OCTA) findings after full-fluence photodynamic therapy (PDT) and aflibercept intravitreal injection (IVA) for age-related macular degeneration (AMD).

Methods: Five eyes of five patients with AMD treated with PDT and IVA were include into the study. We retrospectively reviewed the data obtained from the five patients using SS-OCTA before and after treatment. Three eyes had type 1 choroidal neovascularization (CNV) and two eyes had polypoidal choroidal vasculopathy.

Results: Before treatment, the CNV signals detected in all cases, decreased in three eyes and were not detected completely in two eyes at 1 months after treatment. The areas indicating CNV increased over time, but they did not increase to the baseline level. No CNV signal was detected in one eye during follow-up. In all cases, the exudation unchanged or resolved without additional IVA; the exudation recurred in two cases. In one eye, the CNV signal and the exudation occurred simultaneously; however, there was no association in another eye. A feeder vessel, from which the CNV signal seemed to originate, was seen in one of the five eyes.

Conclusion And Importance: SS-OCTA is useful to monitor the morphology of CNV after PDT and IVA, indicating that the remodeling of the choroidal vasculature occurs gradually after treatment. The presence or absence of the CNV signal might indicate CNV activity.
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http://dx.doi.org/10.1016/j.ajoc.2019.100485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556523PMC
September 2019

Evaluation of retinal nonperfusion in branch retinal vein occlusion using wide-field optical coherence tomography angiography.

Acta Ophthalmol 2019 Sep 22;97(6):e913-e918. Epub 2019 Mar 22.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Japan.

Purpose: To characterize wide-field optical coherence tomography angiography (OCTA) features of retinal nonperfusion in eyes with branch retinal vein occlusion (BRVO).

Methods: Automated scanning of five 12 × 12-mm areas of swept-source OCTA and wide-field fluorescein angiography (FA) images was performed in a consecutive case series of 27 eyes in 27 patients with BRVO in this institutional cross-sectional study. The correlation between the areas of retinal nonperfusion detected by both examinations was assessed. Panoramic images obtained in five 12 × 12-mm OCTA scans in eyes with retinal nonperfusion were binarized or skeletonized, and the associations between vascular parameters such as vascular density (VD) and vascular length (VL) with the wide-field FA characteristics were evaluated.

Results: The mean area of retinal nonperfusion in the OCTA images was 81.0 ± 66.8 mm (range, 0.0-188.8). The mean areas of retinal nonperfusion in FA and the total FA images were, respectively, 84.7 ± 72.5 mm (range, 0.0-221.9) and 184.1 ± 167.7 mm (range, 0.0-515.0). The mean VD was 27.6 ± 3.5% (range, 19.6-33.7), and the mean VL was 12.4 ± 8.5% (range, 5.4-31.3). Separate regression analyses of the areas of retinal nonperfusion in FA (p = 0.0004, R  = 0.4627) and the total FA (p = 0.0008, R  = 0.4214) images showed a significant association with the VL.

Conclusions: OCTA images based on wide-field technologies can quantitatively evaluate retinal nonperfusion in eyes with BRVO.
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http://dx.doi.org/10.1111/aos.14087DOI Listing
September 2019

Effect of intravitreal injection of aflibercept or ranibizumab on chorioretinal atrophy in myopic choroidal neovascularization.

Graefes Arch Clin Exp Ophthalmol 2019 Apr 14;257(4):749-757. Epub 2019 Jan 14.

Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

Purpose: To compare chorioretinal atrophy (CRA) progression in myopic choroidal neovascularization (mCNV) between intravitreal injections of ranibizumab (IVR) and aflibercept (IVA) in the eyes with mCNV.

Methods: Thirty eyes (28 patients) with treatment-naïve mCNV were included in this study. IVR or IVA was administered for up to 1 year. The best-corrected visual acuity (BCVA) was measured, and fundus photographs and fundus autofluorescence were obtained before and 1, 3, 6, and 12 months after the initial treatment. The clinical characteristics including the macular choroidal thickness in various areas and CRA progression were compared between the drugs. The clinical characteristics and macular choroidal thicknesses were compared between eyes with and without CRA progression.

Results: The BCVA improved significantly (p < 0.05 for all comparisons) from 0.44 to 0.26, 0.19, 0.20, and 0.17 after 1, 3, 6, and 12 months, respectively. CRA progressed in 12 (40%) eyes over 1 year. The CRA progression did not differ significantly between aflibercept and ranibizumab. The foveal choroid was significantly (p = 0.0043) thinner in aflibercept-treated eyes compared with ranibizumab-treated eyes at 1 year. Subfoveal CNV tended to cause CRA progression more frequently at 1 year, although this did not reach significance.

Conclusions: IVA to treat mCNV caused more severe thinning of the foveal choroid than ranibizumab; however, no significant difference was seen in CRA progression between the drugs and the choroidal thickness should not be associated with CRA progression. The CNV location may predict CRA progression after anti-vascular endothelial growth factor therapy for mCNV.
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http://dx.doi.org/10.1007/s00417-018-04214-wDOI Listing
April 2019

The impact of spot size, spacing, pattern, duration and intensity of burns on the photocoagulation index in a geometric simulation of pan-retinal laser photocoagulation.

Acta Ophthalmol 2019 Jun 3;97(4):e551-e558. Epub 2018 Dec 3.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.

Purpose: To evaluate the impact of spot size, spacing, pattern, duration and intensity of burns on the photocoagulation index, using a geometric simulation of pan-retinal laser photocoagulation.

Methods: Simulations of full-scattered pan-retinal laser photocoagulation were performed on a retinal map, using a geometry-based method. Simulations consisted of 300-, 400- or 500-μm diameter equidistant spots on the retina with 1.0-spot width spacing, as well as 400-μm diameter spots on the retina in an equidistant pattern or grid pattern, with 1.0-, 0.75-, 0.50-, 0.25- or 0-spot width spacing. For each simulation, we calculated the ratio of the total photocoagulated retinal area to the whole retina, termed the photocoagulation index. We recalculated the photocoagulation indexes using the expansion ratios of photocoagulated lesions by different duration and intensity of burns from a previous study.

Results: The photocoagulation indexes of the simulated pan-retinal laser photocoagulation with 300-, 400- and 500-μm diameter spots were 20.8%, 20.6% and 21.0%, respectively. The photocoagulation indexes of the 1.0-, 0.75-, 0.50-, 0.25- and 0-spot width spacing configurations of pan-retinal laser photocoagulation burns for the equidistant pattern were 20.6%, 27.1%, 36.7%, 53.2% and 83.1%, respectively, and those for the grid pattern were 17.9%, 23.5%, 31.8%, 46.1% and 72.0%, respectively. The photocoagulation indexes obtained with the equidistant and grid patterns changed (range, 1.7-84.7% and 1.5-73.4%, respectively) when the duration or burn intensity of the pan-retinal photocoagulation was changed.

Conclusion: This geometric simulation method could evaluate the impact of a range of conditions on the photocoagulation index.
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http://dx.doi.org/10.1111/aos.13939DOI Listing
June 2019

Characteristics of patients with neovascular age-related macular degeneration who are non-responders to intravitreal aflibercept.

Br J Ophthalmol 2018 Jun 15. Epub 2018 Jun 15.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.

Purpose: To investigate the frequency and patient characteristics that influence anatomic response of intravitreal aflibercept in treatment-naïve neovascular age-related macular degeneration (AMD).

Design: Retrospective, interventional, consecutive case series.

Methods: Three hundred and sixty-five eyes of 365 patients with AMD who underwent 3 monthly intravitreal aflibercept treatments with follow-up for at least 12 months were investigated. Treatment response was evaluated as follows. Responders were defined as those with complete resolution of exudation, including intraretinal oedema, subretinal fluid and pigment epithelial detachment, or more than a 100 µm decrease of central retinal thickness at 3 months compared with baseline. Non-responders were defined as patients exhibiting an increase in exudation or a decreased central retinal thickness of less than 100 µm.

Results: Nineteen (5.2%) of 365 eyes were identified as non-responders. The remaining were responders to intravitreal aflibercept. The non-responders group was significantly associated with choroidal vascular hyperpermeability on indocyanine green angiography and lower frequency of subretinal hyper-reflective materials on optical coherence tomography. The central choroidal thickness at baseline and after 3 monthly injections tended to be thicker in the non-responder group than the responder group, although the differences did not meet statistical significance (p=0.066 and p=0.051, respectively). Additional treatments with either intravitreal ranibizumab or PDT in combination with aflibercept were effective in 15 (79%) of 19 non-responders.

Conclusion: Intravitreal aflibercept is effective for treating eye pathology in most naïve AMD cases. However, non-responsiveness may occur in small subgroup of patients with choroidal vascular hyperpermeability.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312275DOI Listing
June 2018

Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion.

Invest Ophthalmol Vis Sci 2018 06;59(7):2708-2716

Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.

Purpose: To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes.

Methods: The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed.

Results: The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R2 = 0.524, P < 0.001 and R2 = 0.457, P < 0.001, respectively) and at 12 months (R2 = 0.521, P < 0.001 and R2 = 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P = 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P = 0.02) after treatment.

Conclusions: Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.
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http://dx.doi.org/10.1167/iovs.17-23437DOI Listing
June 2018

RETINAL MICROVASCULATURE AND VISUAL ACUITY AFTER INTRAVITREAL AFLIBERCEPT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study.

Retina 2018 Oct;38(10):2067-2072

Department of Ophthalmology, Graduate School of Medicine, Osaka University, Suita, Japan.

Purpose: To investigate vascular perfusion and foveal avascular zone area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after intravitreal aflibercept therapy in central retinal vein occlusion eyes and their association with best-corrected visual acuity.

Methods: Thirty-five subjects with central retinal vein occlusion and macular edema were evaluated. After macular edema resolution following intravitreal aflibercept, subjects underwent optical coherence tomography angiography to measure SCP and DCP perfusion and the foveal avascular zone within a 3 × 3-mm area. Correlations between best-corrected visual acuity and optical coherence tomography angiography measurements were examined.

Results: After intravitreal aflibercept therapy, mean retinal vascular area was 3.41 ± 0.74 mm in the SCP and 3.25 ± 0.91 mm in the DCP. Foveal avascular zone area was 1.03 ± 1.04 mm in the SCP and 1.78 ± 1.73 mm in the DCP. Improved best-corrected visual acuity was significantly associated with better SCP and DCP perfusion (both P < 0.001) and with smaller SCP and DCP foveal avascular zone areas (both P < 0.001). Additionally, SCP and DCP perfusion were negatively correlated with macular edema before treatment (P < 0.05) and ischemia (determined via pretreatment fluorescein angiography, P < 0.05), and positively correlated with photoreceptor integrity (P < 0.001).

Conclusion: Patients with better retinal perfusion and less retinal ischemia are associated with better visual outcomes after aflibercept in eyes with central retinal vein occlusion.
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http://dx.doi.org/10.1097/IAE.0000000000001828DOI Listing
October 2018

A prospective multicenter study on genome wide associations to ranibizumab treatment outcome for age-related macular degeneration.

Sci Rep 2017 08 23;7(1):9196. Epub 2017 Aug 23.

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan.

We conducted a genome-wide association study (GWAS) on the outcome of anti-VEGF treatment for exudative age-related macular degeneration (AMD) in a prospective cohort. Four hundred and sixty-one treatment-naïve AMD patients were recruited at 13 clinical centers and all patients were treated with 3 monthly injections of ranibizumab followed by pro re nata regimen treatment for one year. Genomic DNA was collected from all patients for a 2-stage GWAS on achieving dry macula after the initial treatment, the requirement for an additional treatment, and visual acuity changes during the 12-month observation period. In addition, we evaluated 9 single-nucleotide polymorphisms (SNPs) in 8 previously reported AMD-related genes for their associations with treatment outcome. The discovery stage with 256 patients evaluated 8,480,849 SNPs, but no SNPs showed genome-wide level significance in association with treatment outcomes. Although SNPs with P-values of <5 × 10 were evaluated in replication samples of 205 patients, no SNP was significantly associated with treatment outcomes. Among AMD-susceptibility genes, rs10490924 in ARMS2/HTRA1 was significantly associated with additional treatment requirement in the discovery stage (P = 0.0023), and pooled analysis with the replication stage further confirmed this association (P = 0.0013). ARMS2/HTRA1 polymorphism might be able to predict the frequency of injection after initial ranibizumab treatment.
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http://dx.doi.org/10.1038/s41598-017-09632-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569099PMC
August 2017

Retinal Microvasculature and Visual Acuity in Eyes With Branch Retinal Vein Occlusion: Imaging Analysis by Optical Coherence Tomography Angiography.

Invest Ophthalmol Vis Sci 2017 04;58(4):2087-2094

Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.

Purpose: To investigate microvascular changes in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes with resolved branch retinal vein occlusion (BRVO) and their association with best-corrected visual acuity (BCVA).

Methods: Eighty-five eyes (82 consecutive patients) with BRVO after resolution of the macular edema were retrospectively evaluated. All patients underwent optical coherence tomography angiography (OCTA) for assessment of microvascular changes, including capillary telangiectasia, microaneurysm, and disruption of the foveal avascular zone (FAZ). The areas of vascular perfusion and FAZ in the SCP and DCP were quantitatively evaluated. Best-corrected visual acuity was measured on the same day as OCTA examination. The correlation between BCVA and OCTA findings was assessed.

Results: In eyes with resolved BRVO, the mean vascular perfusion areas in the SCP and DCP within a 3 × 3-mm area were 3.75 ± 0.49 and 3.80 ± 0.55 mm2, respectively. The mean FAZ areas of the SCP and DCP were 0.57 ± 0.36 and 0.76 ± 0.38 mm2, respectively. Better BCVA was significantly associated with a larger vascular perfusion area in the SCP (P < 0.001) and DCP (P < 0.001), and a smaller FAZ area in the SCP (P = 0.025) and DCP (P = 0.017). Stepwise multiple regression analysis revealed that the vascular perfusion area in the DCP was the most important parameter significantly correlated with BCVA (R2 = 0.33, P < 0.001).

Conclusions: Preservation of the deep retinal vasculature is crucial for better visual function in BRVO.
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http://dx.doi.org/10.1167/iovs.16-21208DOI Listing
April 2017

Features of the choriocapillaris in myopic maculopathy identified by optical coherence tomography angiography.

Br J Ophthalmol 2017 11 17;101(11):1524-1529. Epub 2017 Mar 17.

Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

Aim: To describe the choriocapillaris features imaged by optical coherence tomography angiography (OCTA) in eyes with myopic maculopathy.

Methods: In this retrospective, non-invasive, observational case series, 26 eyes with myopic maculopathy and 12 age-matched healthy eyes underwent fluorescein angiography, indocyanine green angiography (ICGA) (highly myopic eyes only), OCT and OCTA, and the choriocapillaris features seen on OCTA and ICGA were compared.

Results: In all five (19%) eyes with patchy atrophy of the 26 highly myopic eyes, OCTA showed complete loss of the choriocapillaris and large choroidal vessels in the atrophic area. In nine (35%) eyes with diffuse atrophy in the atrophic area, OCTA showed low-density choriocapillaris in all eyes and medium and large choroidal vessels in seven (78%) eyes. In 23 eyes (88%) with lacquer cracks, OCTA showed partial loss of the choriocapillaris in 22 (96%) eyes in the area of the lacquer cracks. OCTA could not visualise the full length of the lacquer cracks in any eyes compared with ICGA.

Conclusions: OCTA visualised the choriocapillaris clearly. The choriocapillaris features differed depending to the category of myopic maculopathy. In eyes with lacquer cracks, choriocapillaris rupture might be less advanced than the breaks in Bruch's membrane and retinal pigment epithelium.
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http://dx.doi.org/10.1136/bjophthalmol-2016-309628DOI Listing
November 2017

Identification of ANGPT2 as a New Gene for Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy in the Chinese and Japanese Populations.

Invest Ophthalmol Vis Sci 2017 02;58(2):1076-1083

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China 3Shantou University/The Chinese University of Hong Kong Joint Shantou International Eye Center, Shantou, China 4Prince of Wales Hospital Eye Centre, Hong Kong, China.

Purpose: We determine the angiopoietin 2 (ANGPT2) gene as a new susceptibility gene for neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV).

Methods: A total of 34 haplotype-tagging single-nucleotide polymorphisms (SNPs) were first genotyped in an exploratory Hong Kong Chinese cohort. Suggestive SNPs were replicated in a Shantou Chinese cohort and an Osaka Japanese cohort, with a total of 2343 subjects. The SNP rs800292 in the complement factor H (CFH) gene was genotyped in all the subjects. Genetic association and gene-gene interaction were analyzed.

Results: In the Hong Kong cohort, four SNPs in ANGPT2 (rs13255574, rs4455855, rs13269021, and rs11775442) were nominally associated with nAMD and PCV. The four ANGPT2 SNPs showed the same trends of association in the Shantou and Osaka cohorts. Combining the data from the 3 study cohorts revealed that SNPs rs4455855 and rs13269021 achieved study-wise significance (P < 0.0016), conferring an approximately 1.3-fold of increased risk for nAMD and PCV. Interaction analysis revealed the CFH SNP rs800292 has a highly significant interaction with the ANGPT2 SNP rs13269021 in nAMD and PCV in the combined analysis. Subsequent stratification analysis confirmed the interaction.

Conclusions: This study reveals ANGPT2 as a new susceptibility gene for nAMD and PCV, and it may affect disease susceptibility in association with CFH. Thus, this report provides new insights into the genetic architecture of nAMD and PCV.
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http://dx.doi.org/10.1167/iovs.16-20575DOI Listing
February 2017

Simulation of panretinal laser photocoagulation using geometric methods for calculating the photocoagulation index.

Eur J Ophthalmol 2017 Mar 13;27(2):205-209. Epub 2016 Sep 13.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita - Japan.

Purpose: To establish geometrically based methods for simulating panretinal laser photocoagulation (PRP) for the photocoagulation index.

Methods: A formula for calculating the curved surface area of a spherical dome was used for the simulation. If the radius of the dome is c and the height of the dome is h, then the curved surface area (S) of the dome is S = π (c2 + h2). We calculated the area of the whole retina using this formula and the anatomical dimensions of the standard eyeball. To simulate PRP with a 400-μm spot on the retina with 1-spot spacing, we drew 400-μm-diameter circles, separated by 400 μm, on a retinal map. We calculated the ratio of the total retinal photocoagulated area to the whole retina, termed the photocoagulation index, in order to investigate the impact of the extent of the photocoagulated area and the pulse duration on PRP.

Results: The whole retinal area was 1,092 mm2. The numbers of spots in the scattered and full-scattered PRP were 1,222 and 1,814, respectively. The photocoagulation index was 14.1% and 20.9% for scattered and full-scattered PRP, respectively. These values changed to 14.3% (5.6%) and 21.3% (8.3%), respectively, for PRP with a 100-ms pulse or a 20-ms pulse.

Conclusions: This method will be useful for investigating the impact of various PRP parameters (duration, spacing, intensity of burns, extent of photocoagulated area, etc.) on the photocoagulation index.
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http://dx.doi.org/10.5301/ejo.5000865DOI Listing
March 2017

Association of ABCG1 With Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy in Chinese and Japanese.

Invest Ophthalmol Vis Sci 2016 Oct;57(13):5758-5763

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China 4Joint Shantou International Eye Center, Shantou, China 5Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.

Purpose: We investigated the association of the ATP-binding cassette, subfamily G, member 1 (ABCG1) gene with polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD) in independent Chinese and Japanese cohorts.

Methods: A total of 12 haplotype-tagging single-nucleotide polymorphisms (SNPs) and the SNP rs57137919 in the ABCG1 gene were first analyzed in a Hong Kong Chinese cohort of 235 nAMD, 236 PCV, and 365 controls, using TaqMan genotyping assays. Two SNPs (rs57137919 and rs225396) that showed a disease-association were genotyped in a Shantou Chinese cohort of 189 nAMD, 187 PCV, and 670 controls, and an Osaka Japanese cohort of 192 nAMD, 204 PCV, and 157 controls, totaling 2435 subjects. Association analysis was performed in individual cohorts, followed by a pooled analysis of the data from all three cohorts.

Results: In the Hong Kong cohort, SNP rs57137919 was associated with PCV (odds ratio [OR] = 1.35). A tagging SNP rs225396 was associated with nAMD (OR = 1.28) and PCV (OR = 1.32). In the Osaka cohort, SNP rs225396 was associated with nAMD (OR = 1.42) and PCV (OR = 1.74). In the pooled analysis involving the 3 study cohorts, rs225396 showed an enhanced association with nAMD (P = 0.01, OR = 1.21, I2 = 14%) and PCV (P = 0.0001, OR = 1.35, I2 = 46%).

Conclusions: In this study, we have newly identified a haplotype-tagging SNP, rs225396, in ABCG1 to be associated with PCV and nAMD in Chinese and Japanese cohorts. This provides new evidence to support ABCG1 as a susceptibility gene for PCV and nAMD. Further replication in other populations should be warranted.
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http://dx.doi.org/10.1167/iovs.16-20175DOI Listing
October 2016

ONE-YEAR RESULTS OF INTRAVITREAL AFLIBERCEPT FOR POLYPOIDAL CHOROIDAL VASCULOPATHY.

Retina 2016 Jan;36(1):37-45

Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.

Purpose: To evaluate the 1-year results of intravitreal aflibercept injections for polypoidal choroidal vasculopathy based on indocyanine green angiography findings.

Methods: Twenty-nine eyes with treatment-naive polypoidal choroidal vasculopathy treated with intravitreal aflibercept injections and followed longer than 1 year were retrospectively reviewed. The best-corrected visual acuity, optical coherence tomography findings, and polypoidal lesions in indocyanine green angiography were evaluated.

Results: The mean number of injections through 1 year was 3.9 ± 1.9 (range: 1-8). Fourteen eyes (48%) were received no additional injections because of no recurrence of exudative change after the first loading dose. The mean best-corrected visual acuity levels at 6 months and 1 year significantly improved, and the mean central retinal thickness significantly decreased at all observation points from the baseline. At 3 months, the polypoidal lesions completely resolved in 19 (66%) eyes. At 1 year, the complete resolution of polypoidal lesions was seen in 4 of 10 eyes with persistent polypoidal lesions at 3 months. However, polypoidal lesions recurred at 1 year in 5 of 19 eyes (26%) with complete resolution of polypoidal lesions at 3 months.

Conclusion: Aflibercept is effective for the eyes with treatment-naive polypoidal choroidal vasculopathy to achieve the resolution of polypoidal lesions. The authors need to carefully observe the eyes after confirming complete resolution of polypoidal lesion because of recurrent polyps seen in one-quarter of the study eyes.
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http://dx.doi.org/10.1097/IAE.0000000000000767DOI Listing
January 2016

Comparison of visual prognoses between natural course of simple hemorrhage and choroidal neovascularization treated with intravitreal bevacizumab in highly myopic eyes: a 1-year follow-up.

Retina 2015 Mar;35(3):429-34

Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.

Purpose: To compare the long-term outcomes of simple hemorrhage (SH) without any treatments and myopic choroidal neovascularization (mCNV) treated with intravitreal bevacizumab in highly myopic eyes.

Methods: Twenty eyes (17 patients) with SH and 28 eyes (27 patients) with mCNV were included. We retrospectively evaluated the refractive error, axial length, age, best-corrected visual acuity, and the integrity of photoreceptor inner segment/outer segment junction and compared the two groups.

Results: The mean patient age was 41.6 ± 11.2 years, the mean refractive error -12.7 ± 3.57 diopters, and the mean axial length was 29.64 ± 1.42 mm. Patients in the SH group were significantly (P < 0.001) younger than those in the mCNV group (34.8 vs. 46.5 years, respectively). There were no significant differences in other parameters between the groups. Compared with baseline, the best-corrected visual acuity improved significantly (P < 0.01) at 12 months in both groups. The change in vision at 12 months in the SH group was significantly (P < 0.05) better than that in the mCNV group, although there were no significant differences at 3 months or 6 months. The final integrity of photoreceptor inner segment/outer segment junction was significantly associated with the final best-corrected visual acuity (P < 0.05).

Conclusion: Eyes with SH had a more favorable visual prognosis compared with eyes with mCNV treated with intravitreal bevacizumab. The differential diagnosis of these pathologies is important.
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http://dx.doi.org/10.1097/IAE.0000000000000332DOI Listing
March 2015

En-face high-penetration optical coherence tomography imaging in polypoidal choroidal vasculopathy.

Br J Ophthalmol 2015 Jan 8;99(1):29-35. Epub 2014 Aug 8.

Department of Ophthalmology, Osaka University Medical School Room E7, Suita, Osaka, Japan.

Aim: To observe the choroidal microstructure in polypoidal choroidal vasculopathy (PCV) using high-penetration optical coherence tomography (HP-OCT) with a long-wavelength light source that visualises tissue beneath the retinal pigment epithelium (RPE) and deep choroid, and to compare the findings with those of indocyanine green angiography (ICGA).

Methods: In this retrospective, non-invasive, observational case series, 19 eyes (18 patients) with PCV were observed using HP-OCT (swept source, 100 000 A-scans/s, 1060 nm wavelength) and ICGA. The HP-OCT scan protocol was a 3×3-mm or 6×6-mm square containing 256×256 or 512×128 A-scans. The choroidal thickness (CT) was measured using HP-OCT.

Results: ICGA showed 43 polypoidal lesions in 14 eyes and a vascular network in 17 eyes. HP-OCT showed 41 of the 43 polypoidal lesions visualised by ICGA as RPE rings with inner reflectivity and 15 eyes with a vascular network. Six eyes with RPE rings with inner reflectivity on HP-OCT were not visualised on ICGA images. The choroidal vascular network was dilated in 14 (33%) of 43 polypoidal lesions and 22 (47%) of 47 polypoidal lesions on ICGA and HP-OCT images, respectively. The mean CT at the fovea was 250 μm. The CT at the dilated choroidal vessels beneath the polypoidal lesions was significantly (p = 0.0095) thicker than that of the undilated choroidal vessels beneath the polypoidal lesions.

Conclusions: HP-OCT can visualise choroidal vascular abnormalities in eyes with PCV and should be useful for understanding the pathogenesis of these abnormalities.
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http://dx.doi.org/10.1136/bjophthalmol-2013-304658DOI Listing
January 2015

Pathology detection rate of spectral domain optical coherence tomography devices.

Br J Ophthalmol 2014 Jun 25;98 Suppl 1:i3-6. Epub 2014 Feb 25.

Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Background: Spectral domain optical coherence tomography (SDOCT) allows for higher resolution scans and higher scanning speeds compared to time domain OCT (TDOCT). The purpose of this study is to compare the pathology detection rates of various SDOCT devices to the Stratus TDOCT.

Methods: Patients with neovascular age-related macular degeneration were imaged on the Stratus and one of four SDOCT devices. The images were then analysed in a masked manner evaluating for the presence of epiretinal membrane (ERM), pigment epithelial detachment (PED) and subretinal fluid (SRF). After determining that low scan density with one of the devices was likely the cause of missed PED and SRF compared to the other SDOCT devices the study was repeated with a higher scan density.

Results: 60 eyes from 60 patients with neovascular macular degeneration were imaged on each SDOCT device, for a total of 240 eyes from 240 patients imaged on Stratus. There were no instances where pathology was visible on Stratus but was missed on SDOCT. The highest incidence of missed pathology was with SRF, followed by ERM and PED.

Conclusions: The increased resolution and image quality of SDOCT devices over TDOCT allows for finer discrimination of retinal structures. The increased speed of SDOCT allows for dense coverage of the macula resulting in the ability to see smaller areas of PED and SRF. There was a critical threshold for the distance between B-scans in the three-dimensional cube scan for detection of pathology.
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http://dx.doi.org/10.1136/bjophthalmol-2013-303846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033177PMC
June 2014

Comparison of spectral-domain and high-penetration OCT for observing morphologic changes in age-related macular degeneration and polypoidal choroidal vasculopathy.

Graefes Arch Clin Exp Ophthalmol 2014 Jan 18;252(1):3-9. Epub 2013 Oct 18.

Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

Background: We compared the visibility of retinal and choroidal pathologies using high-penetration optical coherence tomography (HP-OCT) with a long-wavelength light source (1,050 nm) and conventional spectral-domain OCT (SD-OCT) in age-related macular degeneration (AMD).

Methods: One hundred and forty-six eyes were included: 63 eyes with AMD, 79 eyes with polypoidal choroidal vasculopathy (PCV), and four eyes with retinal angiomatous proliferation. The SD-OCT and HP-OCT images were compared using the grading criteria to grade the visibility of the retinal changes, the line corresponding to the retinal pigment epithelium (RPE), and the chorioscleral interface (CSI). In 132 eyes with a pigment epithelial detachment (PED), we graded the structures inside the PED, Bruch's line, and the CSI. We compared the visibility of those changes in eyes with subretinal hyperreflective changes due to a subretinal hemorrhage (SRH) (n = 17) or a hemorrhage inside the PED (HPED) (n = 12).

Results: HP-OCT provided superior visibility of the following structures compared to SD-OCT (P < 0.01): the CSI, structures inside the PED, Bruch's line inside the PED, the CSI inside the PED, SRH, type 1 CNV, polyps, and HPED. There were no significant differences between the two OCT devices in the scores for the RPE line, retinal morphology, or type 2 CNV and/or fibrin.

Conclusion: HP-OCT visualizes morphologies beneath the RPE better than SD-OCT, and is equivalent to SD-OCT for visualizing morphologies above the RPE.
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http://dx.doi.org/10.1007/s00417-013-2474-5DOI Listing
January 2014

3D Spectral domain optical coherence tomography findings in choroidal tumors.

Eur J Ophthalmol 2011 May-Jun;21(3):271-5

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Purpose: To report the optical coherence tomographic features differentiating choroidal nevus from choroidal melanoma by 3D spectral-domain optical coherence tomography (SD-OCT) and OCT characteristics of other choroidal tumors.

Methods: A total of 67 consecutive eyes with choroidal tumors including choroidal nevus (25 eyes), indeterminate choroidal melanocytic lesion (11 eyes), malignant melanoma (23 eyes), metastasis (4 eyes), hemangioma (2 eyes), and osteoma (2 eyes) were imaged with 3D SD-OCT (OCT-1000; Topcon Inc., Paramus, NJ). The images were analyzed for the presence or absence of SD-OCT findings such as retinal pigment epithelium (RPE)/choriocapillaris reflectivity, RPE irregularity, drusen, sub-RPE fluid, RPE thickness, subretinal deposit, subretinal fluid, intraretinal edema, retinal thickness, and photoreceptor inner and outer segment junction (IS/OS). Visualization of the choroidal tumor and its intrinsic reflectivity OCT features were also assessed.

Results: When compared with nevus, subretinal deposit, subretinal fluid, and intraretinal edema were detected significantly more frequently in the eyes with malignant melanoma (p<0.001). SD-OCT visualization of the tumor was limited only to the anterior aspect. Choroidal nevus, indeterminate lesions, melanoma, and metastatic lesions had variable intrinsic reflectivity pattern. Intrinsic features of hemangioma included choroidal hollowness whereas osteoma demonstrated high intrinsic reflectivity.

Conclusions: SD-OCT provides useful information to observe and document the retinal and RPE changes secondary to choroidal tumors that help differentiate choroidal nevus from malignant melanoma. Improvements in the current OCT systems are needed to better characterize intrinsic features of choroidal tumors.
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http://dx.doi.org/10.5301/EJO.2010.5848DOI Listing
July 2011

Simultaneous intravitreal injection of triamcinolone acetonide and tissue plasminogen activator for central retinal vein occlusion: a pilot study.

Br J Ophthalmol 2011 Jan 21;95(1):69-73. Epub 2010 May 21.

Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.

Purpose: To evaluate the efficacy and safety of simultaneous intravitreal injection of triamcinolone acetonide (TA) and tissue plasminogen activator (tPA) for macular oedema associated with central retinal vein occlusion (CRVO).

Methods: Twenty eyes of 20 patients with CRVO were enrolled. A mixture of TA (4 mg) and tPA (25 μg) was injected into the vitreous of 20 eyes with CRVO. Best corrected visual acuity (BCVA) and macular thickness before and 1, 3, 6 and 12 months after the procedure were measured.

Results: The BCVA improved three lines or more in 65%, 55%, 55% and 53% of eyes and the mean macular thickness decreased from 1072 μm to 455, 450, 480 and 409 μm (p<0.001) at 1, 3, 6 and 12 months, respectively. Fifteen (75%) of the 20 eyes required at least one additional injection to prevent a recurrence of macular oedema. The intraocular pressure increased in four eyes.

Conclusion: Overall, intravitreal injection of the TA/tPA mixture improved the BCVA by three lines or more in at least 50% of eyes and decreased the mean macular thickness at four time points without serious side effects. A randomised clinical trial is necessary to evaluate the efficacy of this treatment.
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http://dx.doi.org/10.1136/bjo.2010.180000DOI Listing
January 2011

Spectral-domain optical coherence tomographic findings in myopic foveoschisis.

Retina 2010 Apr;30(4):623-8

Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

Purpose: The purpose of this study was to investigate the sensitivity of various scan modes of spectral-domain optical coherence tomography (SD-OCT) for detecting pathologies that may accompany myopic foveoschisis, which is important for making surgical decisions and planning surgical strategies for myopic foveoschisis.

Methods: Twenty-one eyes of 18 patients were diagnosed with myopic foveoschisis by SD-OCT. Patients were examined with SD-OCT using both a five-line raster scan and a three-dimensional scan at the same visit. The detection rates of pathologies such as macular hole, epiretinal membrane, retinal vascular microfolds, internal limiting membrane detachment, paravascular microhole, and photoreceptor inner and outer segments defect were compared between modes.

Results: The three-dimensional scanning mode of the SD-OCT tended to be superior to both the one-line and five-line raster scanning modes for detecting inner and outer segments, epiretinal membrane, macular hole, paravascular microhole, and internal limiting membrane. The three-dimensional mode had a significantly higher detection rate (71%) of retinal vascular microfolds than both the 1-line (19%, P < 0.01) and 5-line raster scanning modes (33%, P < 0.05).

Conclusion: The three-dimensional scan mode of SD-OCT was more sensitive for detecting the pathologies that accompany myopic foveoschisis, providing important information for vitreous surgery.
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http://dx.doi.org/10.1097/iae.0b013e3181ca4e7cDOI Listing
April 2010

Fourier domain optical coherence tomographic and auto-fluorescence findings in indeterminate choroidal melanocytic lesions.

Br J Ophthalmol 2010 Apr 12;94(4):474-8. Epub 2009 Oct 12.

Department of Ophthalmic Oncology, Cole Eye Institute (i3-129), Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

Aim: To compare detection rates of drusen and subretinal fluid by Fourier domain optical coherence tomography (FD OCT) and orange pigment by fundus autofluorescence (FAF) with ophthalmoscopy in indeterminate choroidal melanocytic lesions.

Methods: In a consecutive case series of 38 patients with indeterminate choroidal melanocytic lesion that would have been categorised as a small tumour according to the size-based nomenclature used in the Collaborative Ocular Melanoma Study, each eye was submitted to ophthalmoscopic examination, FD OCT and FAF. The presence of drusen, subretinal fluid and orange pigment was recorded for each lesion by a single observer at the time of initial ophthalmoscopic evaluation and on fundus photographs. FD OCT and autofluorescence images were reviewed in all cases in a masked fashion.

Results: The ophthalmoscopic examination revealed drusen in 42%, subretinal fluid in 53% and orange pigment in 50% of patients. FD-OCT detected drusen in 45% and subretinal fluid in 58% of cases, and FAF detected orange pigment in 58% of cases. Based on the McNemar test, none of the differences were statistically significant at the 0.05 level.

Conclusions: FD OCT and FAF complement clinical examination by verifying and documenting retinal and RPE changes associated with indeterminate choroidal melanocytic lesions. The detection rates by FD OCT and FAF of important qualitative prognostic factors appear to be equivalent to ophthalmoscopy by a trained observer. Once validated in a larger number of patients, FD OCT and FAF findings can be incorporated into diagnostic algorithms.
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http://dx.doi.org/10.1136/bjo.2009.162636DOI Listing
April 2010

Outer retinal folds in highly myopic macular hole and retinal detachment.

Retin Cases Brief Rep 2009 ;3(4):419-21

From the Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.

Purpose: To report the intraretinal microstructure in macular hole and retinal detachment in a highly myopic eye using spectral-domain optical coherence tomography.

Methods: Two eyes of two patients with macular holes and retinal detachment were examined with spectral-domain optical coherence tomography. Fundus photographs and time-domain optical coherence tomography images also were obtained.

Results: Spectral-domain optical coherence tomography disclosed outer retinal fold formation toward the subretinal space at the level of the photoreceptor inner and outer segment layer, the cystoid spaces expanding outside of the macular hole and epiretinal membrane in all eyes.

Conclusion: The outer retinal fold may indicate the tension of the inner retina and the redundancy of the outer retina, which may be responsible for the occurrence of macular holes and retinal detachment in these eyes.
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http://dx.doi.org/10.1097/ICB.0b013e31818ad3bcDOI Listing
November 2014

Comparison of retinal thickness measurements between three-dimensional and radial scans on spectral-domain optical coherence tomography.

Am J Ophthalmol 2009 Sep 3;148(3):431-8. Epub 2009 Jun 3.

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Purpose: To compare retinal thickness (RT) measurements between traditional 6 radial line scans and three-dimensional (3D) scans using spectral-domain optical coherence tomography (SD-OCT).

Design: Prospective, consecutive case series.

Methods: Twenty eyes of 17 patients with macular diseases and 8 healthy subjects were scanned using 2 different methods (3D scan and 6 radial line scan) using 2 different SD-OCT devices (Topcon OCT-1000 [Topcon Inc, Paramus, New Jersey, USA] and Canon SPOCT [(Canon/Optopol Inc, Depew, New York, USA]) by an experienced OCT operator. In 16 eyes, the data of TD-OCT were also obtained for comparison. The RT in 9 regions based on Early Treatment Diabetic Retinopathy Study areas were analyzed and compared. Bland-Altman plots were used to evaluate agreement.

Results: In the eyes with macular diseases, there was no significant difference in the RT between 3D and 6 radial line scans except the center subfield (P = .011) on the Topcon OCT-1000, and inner inferior (P = .031) and outer nasal (P = .014) areas on the Canon SPOCT. In the healthy subjects, there was no significant difference between the different scans on both SD-OCT devices. The 95% limit of subjects was 3.2 to 30.6 microm and 16.7 to 28.3 microm in the eye with macular diseases on OCT-1000 and SPOCT, respectively, and 6.7 to 13.6 microm and 10.8 to 32.3 microm in healthy subjects on OCT-1000 and SPOCT, respectively.

Conclusions: Preliminary results suggest the RT obtained by the 2 different scan patterns, 3D scan and 6 radial line scan, did not differ significantly on SD-OCT.
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http://dx.doi.org/10.1016/j.ajo.2009.04.008DOI Listing
September 2009

Spectral-domain optical coherence tomography findings after indocyanine green-assisted vitrectomy for idiopathic macular hole.

Retin Cases Brief Rep 2009 ;3(2):109-11

From the Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Purpose: To report the intraretinal changes seen on the spectral-domain optical coherence tomography after indocyanine green (ICG) assisted internal limiting membrane peeling for macular hole.

Methods: A 76-year-old woman with closed macular hole after ICG-assisted internal limiting membrane peeling presented poor visual acuity. Infrared-red, fundus autofluorescence, ICG fluorescence, time-domain OCT and spectral-domain optical coherence tomography images were obtained.

Results: Spectral-domain optical coherence tomography showed the irregular bumps of the retinal pigment epithelium, thinning of the overlying photoreceptor inner and outer segment layer, and enhanced reflectivity of external limiting membrane layer that corresponded to residual ICG fluorescence dots. The area of retinal pigment epithelium changes and inner and outer segment layer disruption seemed to correspond to residual ICG fluorescence in the previous macular hole bed.

Conclusion: The intraretinal changes were observed in areas of retained ICG after ICG-assisted internal limiting membrane peeling. Spectral-domain optical coherence tomography detected these changes clearly.
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http://dx.doi.org/10.1097/ICB.0b013e31818a4721DOI Listing
November 2014

Spectral domain optical coherence tomography and fundus autofluorescence findings in pseudoxanthoma elasticum.

Ophthalmic Surg Lasers Imaging 2009 Mar-Apr;40(2):195-7

Cole Eye Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

A 39-year-old man with pseudoxanthoma elasticum who had a loss of vision was examined using digital imaging. Spectral domain optical coherence tomography (SD-OCT) detected subfoveal deposits that coincided with hyperautofluorescent areas on fundus autofluorescence imaging. These deposits seemed to cause the patient's rapid visual loss because no angioid streaks or choroidal neovascularization were present in the fovea. These deposits were not observed on fundus and infrared photography. SD-OCT combined with fundus autofluorescence imaging may be a useful tool for diagnosis of the atypical deposits in patients with pseudoxanthoma elasticum, which could lead to visual loss.
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http://dx.doi.org/10.3928/15428877-20090301-19DOI Listing
April 2009