The learning and practice of vitreoretinal disorders have undergone a radical transformation in the past decade. The pace of innovation in this subspecialty is astounding. Treatments, techniques, and technologies that are the standard of care today did not even exist a decade ago. Advances in diagnostic technologies such as optical coherence tomography (OCT). OCT angiography and multimodal imaging and their widespread application in routine clinical practice have catalyzed paradigm changes in the medical treatment of several common retinal conditions. New-found delight in treating previously untreated or undertreated disorders and the quest to further excel have created a constant need for ...

Optical coherence tomography (OCT) angiography is a promising technique that provides depth resolved images of blood flow in the retina and choroid with levels of detail far exceeding that obtained with older forms of imaging and offers several advantages over conventional angiography to visualize the chorioretinal vasculature in a rapid and noninvasive manner. However, as with any evolving imaging technique, there are ongoing challenges in terms of need for new equipment, limitations of imaging capability and software processing techniques, as well as in understanding the implications of the imaging and its correlation with pathophysiology of the retina and choroid. This ...

Purpose: To evaluate and correlate the functional treatment response using microperimetry (MP3) with the morphological findings on optical coherence tomography angiography (OCTA) in wet AMD pre- and post-treatment with anti-vascular endothelial growth factor (VEGF). This was a single-centre prospective, interventional study. Methods: Patients with wet AMD were treated with 3 injections of intravitreal anti-VEGF at monthly intervals for 3 months and followed at 1, 2, 3, and 6 months postinjection. Using “overlay” features, morphologic characteristics of OCTA at the site of choroidal neovascular membrane (CNVM) lesion were analyzed and correlated functionally with MP3. Data were collected including visual acuity at ...

Purpose: The “double-layer sign (DLS)” describes the shallow and irregular elevation of the retinal pigment epithelium from the underlying intact Bruch's membrane visualized on the spectral domain optical coherence tomography. In this study, we evaluated the frequency, characteristics of the space within the double layer and other features in the pachychoroid spectrum to aid the clinical diagnosis of these variants. Methods: This retrospective study evaluated the features of the DLS on multimodal imaging in consecutive patients with a clinical diagnosis of one of the four variants of pachychoroid: pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PCN), chronic central serous chorioretinopathy ...

Purpose: To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS). Methods: A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed. Results: Of the 46 eyes, 23 ...

The panorama of vitreoretinal surgery has considerably transformed with the advent of microincision vitrectomy surgery (MIVS). [1] Although the central idea of MIVS was to create a microincision sclerotomy, it never accomplished the goal of being sutureless. In our clinical experience, we advocate the concept of suturing the port site, if needed, to avoid postoperative wound leak and hypotony. [2] The art of wound construction is the talk of the town in the current scenario of vitreoretinal surgery to avoid untoward complication and even in terms of cosmesis. The IJO article “Influence of orientation of the external linear incision created ...

A 57-year-old man with diabetes mellitus was referred to us for management of proliferative diabetic retinopathy. Enface optical coherence tomography angiography (OCTA) montage images were acquired using Zeiss Plex Elite 9000 (CA, USA). Montage view (at level of superficial plexus) showed extensive capillary nonperfusion areas. A well-defined irregular vascular proliferation of fine convoluted exuberant vessels with terminal anastomosis was seen above the superior arcade [Figure 1] a, which corresponded and correlated well to the active neovascularization (NVE) seen on the fundus fluorescein angiography (FFA) (Heidelberg Engineering, Germany) [Figure 1] b. The OCTA section through the vitreo-retinal interface showed proliferation of ...

AZOOR (acute zonal occult outer retinopathy) is a rare retinal disorder presenting with sudden onset scotoma and photopsia. [1] The pathognomic feature for diagnosing AZOOR is the presence of “trizonal pattern” on fundus autofluorescence (FAF). [2] We present a 36-year-old male complained of scotoma and photopsia since 1 month in both eyes, more predominantly in left eye. On examination, best-corrected visual acuity was 20/20 OU (both eyes). Dilated fundus examination OU showed orange-yellow-colored demarcation line in the peripapillary area [Figure 1] a. FAF imaging OU revealed corresponding abnormal area of speckled hyperautofluorescence around an area of hypoautofluorescence in the ...

During our routine practice, we become busy in a set clinical atmosphere and sometimes ‘see’ what we already have on the back of our minds. The patient may not be responding to a treatment as our diagnosis probably requires a revision. In such scenarios, the case reports of such rare cases are helpful for reference and planning management. In the paper ‘Posterior Polar Annular and Hemispheric Choroidal and Retinal Dystrophy: Optical Coherence tomography angiography description of a rare case’, [1] author/s have described a recently reported retinal disease, posterior polar hemispheric choroidal dystrophy, [2] and commented on its classification ...

Purpose: To evaluate the relationship between tear meniscus height (TMH) values measured by optical coherence tomography (OCT) and the severity of epiphora (Munk scoring). Methods: In this prospective cross-sectional study, consecutive patients with epiphora were studied. All patients underwent Munk epiphora scoring, lacrimal syringing, and detailed ophthalmological examination. Using OCT, the TMH (i.e., the line intersecting level of tear meniscus and lower eyelid) values were calculated. The relationship between TMH and epiphora was analyzed by comparing TMH values across various grades of epiphora using Kruskal–Wallis test. Results: A total of 38 patients (56 eyes) were included. The mean ...

A 44-year-old female presented with central vision loss and photopsia in both eyes since 2 months. Multimodal imaging, field defects, electroretinogram abnormalities, and spectral domain optical coherence tomography changes were all suggestive of acute zonal occult outer retinopathy. En-face optical coherence tomography angiography (OCTA) images demonstrated hyper-reflective dots at the level of ellipsoid zone in both eyes in the presence of normal retinochoroidal vasculature. The patient was started on oral azathioprine and prednisolone. On two consecutive monthly follow-ups, en-face OCTA images demonstrated serial changes in the hyper-reflective dot morphology at ellipsoid zone level that have not been previously reported in ...

A 2-year-old male child presented to the ocular emergency following penetrating injury with a metallic foreign body. Clinical examination revealed a nasal corneal perforation with iris tissue prolapse [ [Figure 1] , yellow arrow ]. To further delineate the extent of the corneal perforation and associated anterior segment changes, integrated optical coherence tomography (iOCT) was used. It showed corneal wound gaping for entire corneal thickness from the paracentral region to the periphery of the cornea. Within the gaping, prolapsing hyperreflective tissue was made out in continuity with the iris tissue onto the surface of the epithelium, suggestive of iris tissue [Figure 2] a ...

A 36-year-old male presented with history of injury in the left eye 3 years back with a copper wire. Examination revealed the presence of typical sunflower cataract with golden yellow deposits over the anterior lens capsule with dull glow and old vitreous hemorrhage. Non-contrast computerized tomography revealed retained intraocular foreign body in the pars plana region. The patient underwent phacoemulsification with intraocular lens implantation followed by pars plana vitrectomy and foreign body removal. Intraoperatively, fleck-like deposits were noted on the retinal surface in a circinate manner around the fovea and also over mid-peripheral retina. Postoperative swept source optical coherence tomography ...

Sir, Microscope-integrated intraoperative optical coherence tomography (iOCT, 2 mm depth penetration) helps in achieving the optimal results by providing the real-time images of tissue manipulation during the surgery. The iOCT is of great value while performing lamellar corneal surgeries, cataract surgeries, and intraocular lens implantation surgery. [1] , [2] It has also been noted to provide an advantage during placement of the glaucoma drainage devices in cadaveric eyes and needling of the blebs. [3] , [4] Pasricha et al . described the four-dimensional visualizations of the muscle and the scleral wound while passing the scleral sutures. [5] A 45-year-old male patient with alternate ...

A 51-year-old male presented with the sudden appearance of a black spot in front of the left eye since 2 days. He had undergone an uneventful mitral valve replacement surgery 1 year back. BCVA was 6/6, N6 and 6/18, N9 in right and left eye, respectively. Anterior segment examination was unremarkable. Fundus evaluation of the left eye showed a grayish well-defined parafoveal intraretinal lesion, congruent to the clinical scotoma [Figure 1] . Multicolor composite image showed greenish hue in the ischemic area which was appreciated best on infrared (IR) reflectance channel [Figure 2] . Fundus autofluorescence showed hypoautofluorescence, and fundus ...

A 48-year-old male, diagnosed case of Eales' vasculitis, presented with best-corrected visual acuity (BCVA) of hand movements with a near-total combined retinal detachment in the right eye (OD) and BCVA 6/9 in the left eye (OS). OD fundus showed fibrovascular proliferation (FVP) nasally at the equator and a retinal break located inferior to the FVP [Figure 1] a and [Figure 1] b. Swept-source optical coherence tomography (OCT) (Topcon Corp, Tokyo, Japan) showed a grade 1 epiretinal membrane (ERM) in both eyes (OU). Preoperative fluorescein angiography OCT was performed. The patient underwent 23-gauge pars plana vitrectomy (PPV) with ERM peeling ...

We present a rare case of retinal racemose angioma complicated with fleeting macroaneurysm (MA). A 50-year-old female presented with diminution of vision in her right eye for 6 years. Fundus examination showed a racemose angioma with hemorrhagic MA temporal to the fovea in the right eye. On subsequent follow-ups, spontaneous thrombosis of MA was noted with the development of new MA inferior to the fovea, with intraretinal hemorrhage extending into the fovea. Focal laser to MA resulted in resolution of MA with improvement in vision. We report optical coherence tomography angiographic features of the fleeting MA in a case of ...

Purpose: The aim is to study the changes in ocular coherence tomography (OCT) parameters of large (≥400 μ) full-thickness macular holes (FTMHs) after a failed surgery and evaluate the outcome of fluid-gas exchange (FGE) in the treatment of persistent macular hole and role of OCT in predicting outcome after the secondary intervention. Methods: Changes occurring in the OCT parameters of FTMH after a failed vitrectomy were evaluated. FGE was done in an operating room with three pars plana sclerostomy ports. The anatomical and functional outcomes of FGE for these persistent macular holes were also assessed. Anatomical closure was defined as the ...

Purpose: The purpose of this study is to detect the optic nerve head (ONH) and peripapillary perfusion in eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION) compared to the fellow normal eyes using optical coherence tomography angiography (OCTA) and to compare with nonischemic disc edema (papilledema). Methods: Retrospective analysis of patients with unilateral NAION who underwent OCTA was performed. All patients underwent comprehensive ocular examination including visual field testing. ONH was imaged using 6 mm × 6 mm scan by Topcon DRI Triton ® OCT system. Vascularity loss was analyzed using ImageJ software in diseased eyes in comparison to normal fellow ...

Silicone oil (polydimethylsiloxane) is one of the most commonly used intraocular tamponade agents in ophthalmic practice. [1] , [2] Optical coherence tomography (OCT) has been used to study the vitreoretinal interface or retinal changes in these oil-filled eyes. One of the common artifacts seen in these eyes is the presence of a crescentic hyperreflective focus above the fovea which represents the interface between posterior margin of silicone oil and retinal surface. [3] However, in our case, due to approximation in the peripheral retina, silicone oil led to an artifactual displacement of the retina on the scan, although the interface focus is ...

A 6-year-old boy presented with sudden vision loss after close globe injury with iron rod. Best-corrected visual acuity (BCVA) was Perception of light (PL). Fundus examination showed an area of the optic nerve head (ONH) excavation and filled with hemorrhage with blood emanating into the vitreous [Figure 1] a. The patient underwent MRI orbit which confirms the diagnosis of ONH avulsion. The patient received intravenous steroids, but partial avulsion converted into full [Figure 1] b with BCVA no PL. Optical coherence tomography showed avulsion at ONH section [Figure 1] c. An area of hypolucency on ultrasound was seen at ONH ...

Five eyes of four patients were studied to analyze the structure of the inner wall of optic and chorioretinal colobomas using swept-source optical coherence tomography (SS-OCT). The colobomatous cavities and their relationship with adjacent structures were examined. SS-OCT permitted the study of the colobomatous cavities in all cases. In four of those cases, a Y-shaped intercalary membrane (ICM) was identified, with an origin in the retinal nerve fiber layer (RNFL), which covered the coloboma and in one case the coloboma was in contact with the vitreous cavity. Vitreous adhesion to the internal wall of the coloboma was found in three ...

etti's crystalline dystrophy (BCD) is a rare autosomal recessive retinal dystrophy characterized by deposition of crystals in the retina. The purpose of this article is to describe retinal abnormalities in BCD using multimodal imaging. An 18-year-old girl presented with decrease of vision and nyctalopia. She was assessed with color fundus picture, red-free photographs, short-wave autofluorescence, spectral-domain optical coherence tomography (OCT) and en face OCT and was diagnosed to have BCD based on typical presentation. Retinal crystals were better visualized on en face OCT as compared to conventional B scan OCT.

Purpose: The aim of this study is to describe a modified surgical technique of continuous intraoperative optical coherence tomography (iOCT)-guided shield ulcer debridement with tuck-in multilayered Amniotic membrane transplantation (ML AMT) in vernal keratoconjunctivitis (VKC) with shield ulcer with plaque. Methods: Seven eyes of seven patients presenting with VKC with shield ulcer with plaque were enrolled in this prospective case series and planned for shield ulcer debridement with ML AMT. Debridement of the ulcer base with double-layered AMT was done under the continuous guidance of iOCT. The main outcome measure was the time for complete reepithelialization. Statistical analysis was ...