Qualitative comparison of choroidal vascularity measurement algorithms

Purpose: To compare the accuracy of manual and automated binarization technique for the analysis of choroidal vasculature. Methods: This retrospective study was performed on a total of 98 eyes of 60 healthy subjects. Fovea-centered swept source optical coherence tomography (SS-OCT) scans were obtained and choroidal area was binarized using manual and automated image binarization technique separately. Choroidal vessel visualization in the binarized scans were subjectively graded (grades 0–100) by comparing them with the original OCT scan images by two masked graders. The subjective variability and repeatability was compared between two binarization method groups. Intergrader and intragrader variability was estimated using paired t-test. The degree of agreement between the grades for each observer and between the observers was evaluated using Bland–Altman plot. Results: The mean accuracy grades of the automatically binarized images were significantly (P < 0.001) higher (93.38% ± 1.70%) than that of manually binarized images (78.06% ± 2.92%). There was a statistically significant variability and poor agreement between the mean interobserver grades in the manual binarization arm. Conclusion: Automated image binarization technique is faster and appears to be more accurate in comparison to the manual method

Interobserver Agreement of Novel Classification of Central Serous Chorioretinopathy

Objective To validate the newly proposed multimodal-imaging-based classification for central serous chorioretinopathy (CSCR). Methods This was a retrospective study performed in a total of 87 eyes of 44 patients with a diagnosis of CSCR. Multimodal images in the form of auto-fluorescence, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) images, of all the patients, were presented to two masked retina specialists. The masked observers graded each eye into simple or complex; primary, recurrent, resolved; and specific features such as foveal involvement, outer retinal atrophy, and choroidal neovascularization (CNV). Interobserver agreement was assessed using Cohen's kappa. In areas of non-consensus, a detailed discussion was carried out with a third independent grader.  Results The mean age of the 44 patients (32 males and 12 females) was 49.2±9.3 years. We found a moderate-strong agreement between the two observers in all subclassifications, that included “simple or complex” (kappa value=0.91, 95% CI 0.82-0.99, p<0.001); “primary/recurrent/resolved” (kappa value=0.88, 95% CI 0.80-0.96, p<0.001) and “foveal involvement” (kappa value=0.89,95%CI 0.8-0.98, p<0.001). However, there was less agreement between the two graders with respect to classification of “outer retinal atrophy” (kappa value=0.72, 95%CI 0.57-0.87, p<0.001) and “presence/absence of CNV” (kappa value=0.75, 95% CI 0.58-0.92, p<0.001). Non-consensus in categorizing "outer retinal atrophy" was seen in eyes with sub-retinal hyper-reflective material (SHRM) and outer nuclear layer (ONL) thinning overlying subretinal fluid, and non-consensus in categorizing "CNV" was seen in eyes with inner choroidal atrophy. Conclusion Our study reports the validity and strong interobserver agreement in several aspects of the multimodal-imaging-based classification. This could support its implementation in clinical practice and pave way for appropriate treatment guidelines

Peripapillary versus macular combined hamartoma of the retina and retinal pigment epithelium: imaging characteristics

Supplemental Material available at https://www.ajo.com/.International audiencePURPOSE: To compare clinical, optical coherence tomography (OCT), and fundus autofluorescence (FAF) characteristics of peripapillary vs macular variants of combined hamartoma of the retina and retinal pigment epithelium (combined hamartoma). DESIGN: Retrospective observational, comparative case series. METHODS: SETTING: Multicenter collaborative study. STUDY POPULATION: Fifty eyes with a clinical diagnosis of combined hamartoma. OBSERVATIONAL ANALYSIS: A comparative analysis of color fundus photographs (CFPs), OCT, and FAF was performed for peripapillary and macular variants of combined hamartoma. MAIN OUTCOME MEASURES: Pigmentation and OCT features of macular and peripapillary combined hamartoma. RESULTS: The review of imaging from 50 eyes of 49 patients diagnosed with combined hamartoma identified 18 (36%) peripapillary lesions, 27 (54%) macular lesions, and 5 (10%) peripheral lesions. A comparative analysis of peripapillary vs macular combined hamartoma identified differences in the following features: lesion pigmentation on CFPs corresponding to hypoautofluorescent FAF (88% vs 0%, P < .001) and OCT features of full-thickness involvement (88% vs 3%, P < .001), preretinal fibrosis (27% vs 81%, P < .001), maxi peaks (5% vs 88%, P < .001), intraretinal cystoid spaces (72% vs 40%, P < .038), outer plexiform layer involvement (5% vs 96%, P < .001), ellipsoid zone disruption (83% vs 3%, P < .001), RPE disruption (77% vs 3%, P < .001), and choroidal neovascularization (16% vs 0%, P = .028). CONCLUSIONS: This comparative analysis identified a higher frequency of pigmentation with hypoautofluores-cence, full-thickness retinal involvement, intraretinal cystoid spaces, ellipsoid zone disruption, RPE disruption, and choroidal neovascularization in peripapillary combined hamartoma. These findings suggest that lesions occurring near or at the optic nerve are associated with a more severe degree of pigmentary changes and retinal disruption than those located in the macula

Safety of 6000 intravitreal dexamethasone implants

Purpose To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. Methods Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 mu g) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. Results A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7 +/- 12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. Conclusion This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable