Paracentral acute middle maculopathy (PAMM) refers to retinal lesions with changes in the inner nuclear layer on spectral domain optical coherence tomography (OCT). PAMM is associated with retinal vascular pathology involving the deep capillary plexus. We report two cases of PAMM in Indian subjects using multimodal imaging highlighting the OCT angiography (OCTA) findings. The first case is of a middle-aged female with a paracentral scotoma with SS-OCT (swept-source optical coherence tomography) and OCTA findings suggestive of “chronic” PAMM. The second case presented with sudden decreased vision, and multiple creamy white lesions suggestive of “acute” PAMM, imaging features depicting a possible ...

Purpose: To analyze the morphological changes in the iris-knot complex configuration using spectral-domain optical coherence tomography (SD-OCT) following the single pass four throw (SFT) pupilloplasty. Methods: In this retrospective case series, eyes with SFT pupilloplasty were examined by SD-OCT (Optovue). Iris morphology compared to the normal iris, presence of specific patterns (single hump, double humps, peaks and valleys, tethering), prolene suture, knot complex (length and orientation), and intraocular lens (IOL) vault were evaluated. Results: Overall, 41 knots of 26 patients with a mean time duration of 3.1 ± 2 months from surgery were analyzed. Iris configurations seen were single hump ...

Purpose: The purpose of this study is to provide normative database for subfoveal choroidal thickness in Indian eyes using swept-source optical coherence tomography. Methods: This is a cross-sectional study based at a tertiary eye care center in Northern India. Two hundred and thirty eight eyes of 119 healthy subjects were examined in terms of axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included age 19–60 years, no retinal or choroidal disorder, and patients with clear media and good fixation. Patients with high hypermetropia (>4 D) or myopia (>6 D) or any systemic disease likely to affect choroidal thickness ...

In this issue of Indian Journal of Ophthalmology , the authors have performed a large study with 119 healthy patients (238 eyes) with an aim to establish a normative database of subfoveal choroidal thickness in Asian Indian eyes using the technology of swept-source (SS) optical coherence tomography (OCT). [1] The authors included subjects with a mean age of 28.7 years (range: 19–45 years). The authors concluded that the mean subfoveal choroidal thickness (in the central 1 mm) was 299.10 ± 131.2 μm compared with 294.8 ± 46.5 μm obtained using spectral-domain (SD) technology. [1] In the era ...

The intraocular manifestations of rickettisial retinitis include retinal vasculitis, maculopathy, optic neuritis, and neurosensory detachment. Extensive leakage of dye on the fundus fluorescein angiography may obscure visualization in eyes with retinitis. We report the vascular changes in eyes with rickettsial retinitis and its response to treatment using optical coherence tomography angiography. The microvascular abnormalities we noted were, capillary drop out areas corresponding to retinitis patches, vascular loops, and pruning of vessels. The choriocapillary slabs showed signal void areas. Post-treatment there was vascular remodeling with decrease in non-perfused area, appearance of new vascular lateral branching, and appearance of collaterals.

Purpose: The aim of this study was to present an experimental optical coherence tomography (OCT)–guided anterior segment (AS) imaging chick embryo model. Through this model, we aimed to reveal similarities and differences between human cornea, AS tissues, and chick embryo tissues by quantitative image analysis. Methods: Ex vivo , the chick embryos' globes were determined by detailed AS camera of spectral-domain (SD)-OCT in 10 fertilized specific pathogen-free eggs on the 20 th day. Quantitative image analysis of anterior chamber tissues was performed with SD-OCT in detail. After imaging, cross sections of the chick embryo globes containing cornea with anterior ...

Purpose: To identify optical coherence tomography-angiography (OCT-A) findings to predict treatment response during anti-vascular endothelial growth factor (VEGF) therapy in eyes with para foveal telangiectasia (PFT) group II. Methods: In this retrospective series, Twelve eyes of seven patients diagnosed with PFT group II without evidence of sub-retinal neovascular membrane (SRNVM) clinically or on spectral domain-OCT (SD-OCT) were included. All patients underwent OCT-A on the Topcon DRI OCT Triton ® with 4.5 mm macula scans. The patients with abnormal vascular nets were further classified into type A and B nets and administered intravitreal anti-VEGF therapy. Visual acuity and size of type ...

A 40-year-old female with iridocorneal endothelial syndrome was referred after Ahmed glaucoma valve (AGV) implantation 3 months ago. The patient was on oral acetazolamide 250 mg tds, topical timolol 0.5% bd, and brimonidine 0.2% bd with intraocular pressure 40 mmHg in the right eye (RE) and 16 mmHg in the left eye (LE). The patient's visual acuity was 1/60 RE and 6/6 in LE with a relative afferent pupillary defect in RE. Anterior segment biomicroscopy revealed supracorneal AGV tube lying within pseudocorneal groove in RE and iridocorneal adhesions just beneath corneal perforation [Figure 1] a ...

Four years after phacoemulsification and implantation of intraocular lens (IOL) in the capsular bag, this patient developed anterior-capsular phimosis and small focal shiny areas within IOL [IOL glistening, [Figure 1] ]. The anterior segment optical coherence tomography [ASOCT, [Figure 2] ] showed a distended posterior capsule (PC) and focal areas of hyperreflectivity within the IOL

A 36-year-old female presented initially with photophobia and visual deterioration. After examination and laboratory tests, patient was diagnosed with cystinosis. Cysteamine drops 4 × 1 drops/day was given as treatment for 1 year. During follow-up, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) was performed. Photophobia was relieved and IVCM obtained the decrease in size and density of corneal crystals 1 year after. Depth of corneal crystals did not change but crystal density score reduced with cysteamine treatment.

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 ...