Blood flow velocity and thickness of the choroid in a patient with chorioretinopathy associated with ocular blunt trauma

Incidence of Epiretinal Membrane Formation After Pars Plana Vitrectomy for Giant Retinal Tear-Associated Retinal Detachment

Objective

To report the incidence of postoperative epiretinal membrane (ERM) formation after primary pars plana vitrectomy (PPV) for giant retinal tear associated retinal detachment (GRT-RD) repair as well as its clinical characteristics and visual outcomes at a level one trauma and tertiary referral academic center.

Patients and Methods

Patients with primary RD repair for GRT-RD at West Virginia University from September 2010 to July 2021 were identified using the ICD-10 codes (H33.031, H33.032, H33.033 and H33.039). Imaging studies including optical coherence tomography (OCT) were manually reviewed pre- and post-operatively for ERM formation after PPV for GRT-RD repair in patients who underwent PPV or combined PPV and scleral buckle (SB). Univariate analysis was performed to analyze clinical factors for ERM formation.

Results

The study included 17 eyes of 16 patients who underwent PPV for GRT-RD. Postoperative ERM was observed in 70.6% (13 of 17 eyes) of the patients. Anatomic success was achieved in all patients. The mean (range) preoperative and final best corrected visual acuity (BCVA) in logMAR units by macula status was 0.19 (0-0.5) and 0.28 (0-0.5) for macula-on and 1.7 (0.5-2.3) and 0.7 (0.2-1.9) for macular-off GRT-RDs. Clinical variables including use of medium-term tamponade with perfluorocarbon liquid (PFCL), cryopexy, endodiathermy, number of tears or total clock hours of tears did not correlate with an increased risk of ERM formation.

Conclusion

Post-vitrectomized eyes for GRT-RD repair have a significantly higher incidence of ERM formation, nearing 70% in our study. Surgeons may consider prophylactic ILM peel at the time of removal of tamponade agents or weigh in ILM peel at the time of primary repair, a more challenging surgical technique in our opinion.

Analyses of Foveal Avascular Zone in Patients with General Blunt Ocular Trauma Using Optical Coherence Tomography Angiography

PURPOSE

To investigate the effect of blunt ocular trauma (BOT) on foveal circulation, and in particular the foveal avascular zone (FAZ), using optical coherence tomography angiography (OCTA).

METHODS

This retrospective study consisted of 96 eyes (48 traumatized eyes and 48 nontraumatized eyes) from 48 subjects with BOT. We analyzed the FAZ area of deep capillary plexus (DCP) and superficial capillary plexus (SCP) immediately after BOT and at 2 weeks after BOT. We also evaluated the FAZ area of DCP and SCP in patients with and without blowout fracture (BOF).

RESULTS

There were no significant differences in FAZ area between traumatized and nontraumatized eyes at DCP and SCP in the initial test. In traumatized eyes, the FAZ area at SCP was significantly reduced on follow-up when compared to initial test (p = 0.01). In case of eyes with BOF, there was no significant differences in FAZ area between traumatized and nontraumatized eyes at DCP and SCP on initial test. No significant difference of FAZ area was found on follow-up relative to the initial test, whether in the DCP or SCP. In case of eyes without BOF, there was no significant differences of FAZ area between traumatized and nontraumatized eyes at DCP and SCP in initial test. Also, no significant difference of FAZ area at DCP was found on follow-up test compared to initial test. However, the FAZ area at SCP was significantly reduced in follow-up test compared with that in the initial test (p = 0.04).

CONCLUSIONS

Temporary microvascular ischemia occurs in the SCP of patients after BOT. Patients should be warned of transient ischemic changes that may occur after trauma. OCTA can provide useful information regarding the subacute changes in the FAZ at SCP after BOT, even without evident findings of structural damage on fundus examination.

Association of OCT-A characteristics with postoperative visual acuity after rhegmatogenous retinal detachment surgery: a review of the literature

PURPOSE

Emerging evidence has suggested that macular microcirculation and microstructural changes after rhegmatogenous retinal detachment (RRD) successful reattachment surgery are currently evaluated in detail by OCT-Angiography (OCT-A). New imaging technology has revealed the existence of microscopic macular changes, even in cases that retinal morphology appears to be normal in fundus biomicroscopy. The use of OCT-A for the examination of foveal characteristics has attracted significant attention in recent years as the technique offers a potential explanation of the suboptimal recovery of visual acuity and incomplete restoration of the macula despite anatomical repair. However, the available evidence that is needed to establish the OCT-A parameters as predicting factors in clinical practice is both limited and contradictory.

METHODS

A detailed review of the literature was conducted. The association of OCT-A characteristics with postoperative visual acuity after RRD surgery, including vitrectomy with gas tamponade and in some cases scleral buckle, was extensively analyzed.

RESULTS

A comprehensive update on microcirculation and microstructural changes of the macula using OCT-A after RRD repair may indicate potential factors of functional outcomes in clinical practice.

CONCLUSION

A review of the existing literature sheds light on the microvascular changes of the macular capillary plexus that may significantly affect functional outcomes after RRD surgery. The current article discusses important aspects of key publications on the topic, highlights the importance of long-term effectiveness of these possible prognostic factors and proposes the need for further future research.

Effect of blunt ocular trauma on retinal microvasculature: An optical coherence tomography angiography study

BACKGROUND

To evaluate the retinal vascular changes and foveal avascular zone area in patients with unilateral blunt ocular trauma using optical coherence tomography angiography.

METHODS

This retrospective study consisted of 50 traumatized and 50 contralateral sound eyes of the patients with blunt ocular trauma. The foveal avascular zone area, choriocapillaris flow area, foveal, parafoveal, and perifoveal vessel densities in both superficial capillary plexus and deep capillary plexus and central macular thickness were evaluated.

RESULTS

There were no significant differences between traumatized and sound eyes in the foveal avascular zone area (p:0.36), choriocapillaris flow area (p:0.43), central macular thickness (p:0.67), and in vessel densities of superficial capillary plexus over all regions (p > 0.05 for all). However, the vessel densities of deep capillary plexus were significantly lower in traumatized eyes (p < 0.05 for all).

CONCLUSION

Optical coherence tomography angiography demonstrated a significant decrease in retinal deep capillary plexus vessel density of the eyes effected by blunt ocular trauma, even with no evident findings on fundus examination or structural spectral domain-optical coherence tomography changes.

Changes in choroidal blood flow velocity in patients diagnosed with central serous chorioretinopathy during follow-up for pachychoroid pigment epitheliopathy

Purpose

To evaluate chronological changes in choroidal blood flow velocity in two patients with pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) in the same eye.

Observations

Two males aged 36 and 43 years old with PPE were diagnosed with CSC in the same eyes during follow-up. Using laser speckle flowgraphy, the macular mean blur rate (MBR), an index of relative blood flow velocity, was sequentially evaluated in the affected and unaffected eyes. In the affected eye, the macular MBR values at the onset of PPE and CSC were higher, at 25% and 33% in Case 1 and 21% and 51% in Case 2, respectively, than those on PPE regression; but the same trends were not observed in their fellow eyes. The increases in MBR changing rates were 1.3 and 2.5 times higher in Cases 1 and 2, respectively, at the onset of CSC than those at the onset of PPE.

Conclusion and importance

In the affected eyes, the rates of MBR change increased at the alternate onsets of PPE and CSC. The increased MBR changing rates were 1.3-2.5 times higher at the onset of CSC than those at the onset of PPE. Our data suggest that choroidal hyperperfusion is involved in the pathogenesis of both diseases and that its severity may differ between CSC and PPE. These results may support the hypothesis that PPE and CSC clinically overlap and have a common pathogenic background.

Increased thickness and decreased blood flow velocity of the choroid in a patient with acute macular neuroretinopathy

Background

The involvement of choroidal lesions in acute macular neuroretinopathy (AMN) is not yet fully understood. We quantitatively examined sequential changes in the morphology and circulation hemodynamics of the choroid using enhanced depth imaging optical coherence tomography (EDI-OCT) and laser speckle flowgraphy (LSFG) in a patient with AMN.

Case presentation

A 15-year-old boy was referred to our hospital due to AMN in his right eye alone. The next day AMN developed in his left eye. Three months later, AMN lesions in both eyes spontaneously resolved and the morphology of macular photoreceptors improved. Using EDI-OCT, central choroidal thickness (CCT) was examined for a period of three months, starting from the initial visit. Using LSFG, macular mean blur rate (MBR) was examined for three months, starting 1 week after the initial visit. At the first visit, CCT of the right eye with AMN was 82 μm higher than that of the left eye, which had not yet developed AMN, and decreased by 86 μm after three months. In the left eye, similarly, CCT increased by 16 μm after the AMN onset at 1 week compared with a pre-onset value at the first visit and thereafter decreased by 57 μm at 3 months. Macular MBR increased by 20–55% OD and 51–71% OS during the follow-up until 3 months.

Conclusions

We found that the choroid at the macula thickened at the onset of AMN and became thin with the regression of disease. Therefore, in concert with MBR data, these results further strengthened our hypothesis that choroidal circulation impairment plays a role in the pathogenesis of AMN.

Macular perfusion changes assessed with optical coherence tomography angiography after vitrectomy for rhegmatogenous retinal detachment

PURPOSE

To explore macular perfusion changes in patients with rhegmatogenous retinal detachment (RRD) involved the macula following successful surgery and to evaluate the correlation between macular blood flow density and visual outcomes using optical coherence tomography angiography (OCTA).

METHODS

This retrospective study included 14 eyes (14 patients) with macular-off RRD that underwent a standard three-port 23-gauge pars plana vitrectomy (PPV) and intraocular gas tamponade combined with phacoemulsification, aspiration, and intraocular lens implantation. OCTA was used to evaluate the macular perfusion changes throughout postoperative 12 weeks in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillary plexus (CCP). The fellow unaffected eyes were used as controls for comparison.

RESULTS

A significant increase in the superficial capillary plexus flow density (SCPFD) (P = 0.000) was observed over time in RRD eyes with successful PPV, as well as the deep capillary plexus flow density (DCPFD) (P = 0.000) and the choriocapillary plexus flow density (CCPFD) (P = 0.000). Final best-corrected visual acuity (BCVA) was positively associated with CCPFD (r = - 0.577, P = 0.031) and non-correlated with SCPFD and DCPFD (P > 0.05).

CONCLUSIONS

Macular perfusion gradually recovered following successful RRD repair by PPV. OCTA provided a non-invasive method to explore the underlying reason for different postoperative visual outcomes in macular-off RRD patients.

Choroidal volume changes following blow-out fracture repair

PURPOSE

To investigate the serial choroidal volume change following orbital blow-out fracture (BOF) repair.

METHODS

The choroidal volume was measured by optical coherence tomography in patients who underwent BOF repair, preoperatively and postoperatively at 1, 4, 12 and 24 weeks. The orbital volume ratio (OVR) was obtained by dividing the orbital volume of the traumatized orbit by that of the contralateral side using three-dimensional computed tomography imaging. The choroidal volume change was compared between both eyes using a linear mixed model.

RESULTS

We analyzed the choroidal volume of 11 patients. Choroidal volume showed a trend of slight increase during the immediate postoperative period, and then, choroidal volume decreased abruptly between postoperative 1 to 4 weeks (β-coefficient - 0.22, P < 0.001). Choroidal volume also showed gradual decrease between postoperative 4 to 24 weeks (β-coefficient - 0.02, P < 0.001). During the study period, there were no significant differences in choroidal volume change between BOF and contralateral unaffected eyes (β-coefficient - 0.20, P = 0.711). The hyperopic refractive errors (β-coefficient 0.27, P = 0.028) and the larger preoperative OVR (β-coefficient 10.37, P = 0.013) were associated with larger choroidal volume.

CONCLUSIONS

Choroidal volume showed a similar decreasing change following BOF repair between the BOF and the contralateral unaffected eyes. Moreover, choroidal volume of both eyes was associated with the degree of orbital volume expansion due to BOF, suggesting that choroidal volume change after BOF repair was affected not only by trauma-associated local hemodynamic changes but also by systemic influences such as inflammatory response.