Retinal structure and microcirculation alterations in dysthyroid optic neuropathy: A comprehensive OCTA study.

PurposeThe retina could serve as a window of neuroinflammation, but the in vivo changes in macrophage-like cell (MLC), such as microglia, in acute ischemic retinal stroke remain unclear. Thus, the current study aimed to investigate the in vivo changes in MLC characterized by en face optical coherence tomography (OCT) after acute ischemic retinal stroke.MethodsTwenty patients with unilateral acute nonarteritic reperfused central retinal artery occlusion (CRAO) were participated in this study, and their contralateral eyes served as control group. A 3 μm en face OCT slab on the inner limiting membrane of the optic nerve head (ONH) region or macular region was used to visualize and binarize the MLCs. The MLCs were binarized and quantified using a semiautomated method. OCT angiography was used to evaluate the reperfusion status and obtain the structural data of the inner retina in the ONH and macula. The thickness of the ganglion cell complex in the macular region was measured. The optical intensity and optical intensity ratio of the inner retina were calculated to evaluate the ischemia severity.ResultsIn the ONH region, decreased vessel densities of radial peripapillary capillaries accompanied by increased thickness of the retinal nerve fiber layer were found in the CRAO eyes in comparison to the unaffected eyes (p=0.001, p=0.009, respectively). In the macular region, significantly lower vessel densities in both the superficial and deep capillary plexus and increased thickness of the ganglion cell complex were also found in the CRAO eyes (all p ≤ 0.001). The ONH and macular MLC quantities and densities in CRAO eyes were significantly higher than those in the unaffected eyes (both p<0.001). Larger and plumper MLCs were observed in the CRAO eyes compared with their unaffected eyes. ONH and macular MLC densities were positively associated with the disease duration in the acute phase and the optical intensity ratio of inner retina.ConclusionsThe increased density and morphological changes of MLCs may indicate the aggregation and activation of MLCs following acute reperfused CRAO. The aggregation of MLCs may be more pronounced in CRAO eyes with longer disease duration and more severe ischemia. MLCs characterized by en face OCT may serve as an in vivo visual tool to investigate neuroinflammation in the ischemic-reperfusion process of stroke.

To evaluate progressive changes in retinal nerve fibre layer (RNFL), ganglion cell layer/inner plexiform layer (GCL/IPL) and visual function in thyroid eye disease (TED) patients with and without orbital decompression. Sixty TED patients (105 eyes) were included. All patients were divided into mild, moderate-to-severe and dysthyroid optic neuropathy (DON) groups. Orbital decompression was performed in the moderate-to-severe and DON groups. Optic coherence tomography (OCT), visual field (VF) and best-corrected visual acuity (BCVA) were performed pre- and postoperatively. Preoperative follow-up was performed in the mild group and in part of the moderate-to-severe and DON groups. After decompression, the thickness of GCL/IPL and RNFL significantly decreased in DON group (p < 0.05), with varying degrees of decrease in eyes with optic disc swelling, atrophy and normal appearance. The mean GCL/IPL thickness significantly decreased in moderate-to-severe group (p < 0.05), the mean RNFL thickness slightly decreased with no statistical significance (p = 0.07). During the preoperative follow-ups, the mean GCL/IPL thickness significantly decreased (p = 0.04), whereas the mean RNFL thickness tended to increase (p = 0.13) in DON group. The thickness of GCL/IPL and RNFL did not change significantly in the mild and moderate-to-severe groups (p > 0.05). BCVA and VF did not change significantly in any group (p > 0.05) preoperatively. Swelling and degeneration of retinal ganglion cells (RGCs) may coexist in DON eyes, leading to continuous changes in the RNFL and GCL/IPL thickness either before or after decompression. Slight swelling and degeneration of RGCs may exist in moderate-to-severe TED eyes, although OCT measurements and visual functions remain stable before surgery.

BackgroundTo explore the changes in blood supply and structure around the optic nerve head (ONH) in thyroid-associated ophthalmopathy (TAO) patients with suspected dysthyroid optic neuropathy (DON).MethodsTAO patients [19 with DON; 24 non-DON (NDON); 20 with equivocal DON (EDON)], and 34 control subjects were examined. Optical coherence tomography angiography (OCTA) was used to obtain peripapillary retinal nerve fiber layer (p-RNFL) and vessel density parameters, including the ONH whole image vessel density (ONH-wiVD) and the radial peripapillary capillary vessel density (RPC-VD) in early DON.ResultsAlthough there were no differences in p-RNFL thickness among the groups, there were differences in the ONH-wiVD of each grid section and the RPC-VD in all areas (P < 0.01). Compared with healthy controls, the EDON eyes had significantly lower RPC-VDs in all aeras (P < 0.05).The peripapillary region was further divided into eight sectors, and the RPC-VD in the temporal upper, superior temporal, and temporal lower sectors in the EDON group were significantly lower than in the controls. The visual impairment was closely related to the loss of peripapillary capillary vessel density. Univariate correlation analysis showed that the ONH-wiVD and RPC-VD of the TAO groups were negatively correlated with the intraocular pressure (r = − 0.296, P = 0.006; r = − 0.258, P = 0.016 respectively).ConclusionsEDON patients had significantly lower ONH-wiVD and RPC-VD than control subjects, and the temporal and upper VDs were more likely to be affected in the early stage of TAO. The combined use of spectral domain optical coherence tomography and OCTA technologies offer a new method for early diagnosis of suspected DON patients.

To evaluate optic nerve head (ONH) vessel density (VD) changes after cataract surgery using optical coherence tomography angiography (OCTA). This was a prospective observational study. Thirty-four eyes with mild/moderate cataracts were included. ONH scans were obtained before and 3mo after cataract surgery using OCTA. Radial peripapillary capillary (RPC) density, all VD, large VD and retinal nerve fiber layer thickness (RNFLT) in total disc, inside disc, and different peripapillary sectors were assessed and analyzed. Image quality score (QS), fundus photography grading and best-corrected visual acuity (BCVA) were also collected, and correlation analyses were performed between VD change and these parameters. Compared with baseline, both RPC and all VD increased in inside disc area 3mo postoperatively (from 47.5%±5.3% to 50.2%±3.7%, and from 57.87%±4.30% to 60.47%±3.10%, all P<0.001), but no differences were observed in peripapillary area. However, large VD increased from 5.63%±0.77% to 6.47%±0.72% in peripapillary ONH region (P<0.001). RPC decreased in inferior and superior peripapillary ONH parts (P=0.019, <0.001 respectively). There were obvious negative correlations between RPC change and large VD change in inside disc, superior-hemi, and inferior-hemi (r=-0.419, -0.370, and -0.439, P=0.017, 0.044, and 0.015, respectively). No correlations were found between VD change and other parameters including QS change, fundus photography grading, postoperative BCVA, and postoperative peripapillary RNFLT. RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract. No obvious VD changes are found in peripapillary area postoperatively.

PurposeThere is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials.MethodsA retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥2.ResultsOut of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1–140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78±1.99 to 0.50±0.58 at 24 weeks, 0.50±0.82 at 52 weeks and 1.00±1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55±1.54 to 0.83±1.27, 1.00±1.17 and 0.63±0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period.ConclusionMMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.

Optical coherence tomography angiography is a non-invasive imaging technique that is able to visualize the different retinal vascular layers using motion contrast to detect blood flow without intravenous dye injection. This method might help to assess microangiopathy in diabetic retinopathy during screening and follow-up. To quantify retinal microvasculature alterations in both eyes of diabetic patients in relation to systemic risk factors using optical coherence tomography angiography. Both eyes of 36 diabetic patients and 45 individuals without diabetes were examined. Duration of diabetes, insulin therapy, blood pressure, HbA1c, dyslipidemia, axial length and the presence of diabetic retinopathy were recorded. Retinal vessel density was measured by optical coherence tomography angiography. The effect of risk factors on vessel density and between-eye asymmetry was assessed using multivariable regression analysis. Vessel density was significantly lower and between-eye difference was significantly higher in diabetic patients compared to controls (p<0.05). Both vessel density and between-eye asymmetry significantly correlated with diabetes duration (p<0.05) after controlling for the effect of risk factors. The between-eye asymmetry in vessel density was significantly higher in patients without clinically detectable diabetic retinopathy compared to control subjects (p<0.001). There is a decrease in retinal vessel density and an increase in between-eye asymmetry in patients with diabetes compared to healthy subjects. By using optical coherence tomography angiography, the detection of these microvascular alterations is possible before clinically detectable diabetic retinopathy and might serve as a useful tool in both screening and timing of treatment. Orv Hetil. 2018; 159(8): 320-326.

(1) Introduction: The aim of this study is to assess retinal vessel density (VD) in the superficial capillary plexus layer (SP) and deep capillary plexus layer (DP) in children with chronic heart failure (CHF) in the course of dilated cardiomyopathy (DCM) using optical coherence tomography angiography (OCTA). (2) Methods: Thirty children with CHF due to DCM lasting more than six months, with an enlarged left ventricle and impaired left ventricular systolic function (left ventricular ejection fraction (LVEF) ≤ 55%), were enrolled to have both their eyes assessed for this study. Mean age of the children was 9.9 ± 3.57 years. The control group consisted of an additional 30 children without CHF (mean age 11.27 ± 3.33 years) matched for age and gender against the study group. All participants underwent transthoracic echocardiography to measure LVEF using Simpson method. Blood serum was tested for N-terminal-pro-brain natriuretic peptide (NT-proBNP) marker value. All children underwent OCTA with evaluation of the foveal avascular zone (FAZ), whole superficial vessel density (wsVD), foveal superficial vessel density (fsVD), parafoveal superficial vessel density (psVD), whole deep vessel density (wdVD), foveal deep vessel density (fdVD), parafoveal deep vessel density (pdVD), whole thickness (WT), foveal thickness (FT), and parafoveal thickness (PFT). (3) Results: Retinal VD in SP was significantly lower in children with CHF as compared to the controls. The following SP parameters in the study group were statistically significantly lower than these same measurements for the control group. Details, with study group findings quantified first, include wsVD (46.2% vs. 49.83%, p < 0.05), fsVD (18.07% vs. 24.15%, p < 0.05), and psVD (49.24% vs. 52.51%, p < 0.05). The WT (311.03 micrometers (μm) vs. 323.55 μm, p < 0.05), FT (244.57 μm vs. 256.98 μm, p < 0.05), and PFT (320.63 μm vs. 332.02 μm, p < 0.05). No significant differences in DP retinal VD were found between the two groups. No statistically significant differences in the FAZ were found. The fsVD and FT were correlated with biometry and the age of the study participants. There was a correlation between FAZ and FT (p < 0.001). There were no correlations between retinal VD in both plexuses and refractive error, sex, NT-proBNP, and LVEF. (4) Conclusions: In children with CHF in the course of DCM as compared to the control group, significantly decreased retinal VD in SP was observed. The results of our study indicate that measurements of the OCTA may be a useful diagnostic method in children with chronic heart failure, but it is necessary to conduct further studies in larger groups of participants and long-term observation of these patients.

Glaucoma patients had a reduction in the inner annulus peripapillary choroidal microvascular density (PCMD) that became worse as the glaucoma severity progressed, which might provide new evidence supporting the vascular theory. To compare PCMD among normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and healthy controls using optical coherence tomography (OCT) angiography (OCTA). The study included 40 POAG, 25 NTG, and 33 healthy controls. All subjects underwent OCT and OCTA testing. The inner annulus and outer annulus PCMD, as well as peripapillary vessel density (VD), were calculated. One-way analysis of variance was used to compare the vascular parameters of the 3 groups. Pearson correlation analysis or Spearman correlation test was used to evaluate the correlation between PCMD and glaucomatous severity factors. The spatial positional relationship between PCMD and corresponding peripapillary retinal nerve fiber layer (RNFL) thickness and visual field (VF) mean deviation (MD) was also assessed. The average and 4 quadrants of the inner annulus PCMD and peripapillary VD in the 2 glaucomatous groups were significantly lower than in normal eyes ( P <0.05). Strong correlations were found between inner annulus PCMD and VF MD, peripapillary VD, and RNFL in POAG patients. Similarly, the inner annulus PCMD in NTG patients was strongly correlated with peripapillary VD and RNFL (all r >0.5). Strong positional correlations were found between inner superior quadrantal PCMD and RNFL thickness in both POAG and NTG patients ( r =0.566 and 0.731, respectively). Likewise, inner inferior quadrantal PCMD exhibited a strong correlation with RNFL thickness in POAG patients ( r =0.608). Strong positional correlations were also found between inner superior PCMD and VF MD in both POAG and NTG patients ( r =0.589 and 0.622, respectively). Inner inferior PCMD exhibited a moderate correlation with VF MD in both POAG and NTG patients ( r =0.487 and 0.440, respectively). The study found that the inner annulus PCMD decreased to varying degrees in NTG and POAG patients. The inner annulus PCMD was closely related to the structural and visual function parameters of glaucoma in both NTG and POAG. Furthermore, inner PCMD demonstrated a spatial correlation with corresponding RNFL thickness and VF MD.

Systemic sclerosis (SSc) is a connective tissue disorder characterized by microvascular injury, autoimmunity, and excessive collagen deposition leading to fibrosis. Despite advances in understanding peripheral microvascular changes, the relationship between retinal, peripheral, and systemic vascular involvement remains inadequately explored. To evaluate and correlate optical coherence tomography angiography (OCTA), nailfold capillaroscopy (NC), and transient elastography findings in SSc patients. This prospective single-center study enrolled 40 SSc patients (2013 ACR/EULAR criteria) and 45 healthy controls between December 2024 and August 2025. All participants underwent comprehensive ophthalmologic examination with OCTA imaging, NC evaluation, and liver stiffness measurement (LSM) using transient elastography. Retinal vessel density was assessed in superficial and deep capillary plexuses across macular and peripapillary regions. Clinical parameters including modified Rodnan skin score, disease duration, and organ involvement were recorded. SSc patients showed significantly reduced deep parafoveal (p = 0.048), deep temporal (p = 0.025), and deep inferior (p = 0.019) vessel densities, with decreased superior retinal nerve fiber layer thickness (p = 0.024) versus controls. Active capillaroscopic patterns appeared in 60% of patients. Strong correlations existed between OCTA parameters and age, disease duration, and LSM (r=-0.409 p = 0.011 for DWI-age, r=-0.392 p = 0.015 for DWI-LSM). Diffuse cutaneous SSc demonstrated lower superficial vessel densities than limited disease (p = 0.010-0.023). OCTA-detected retinal microvascular changes correlate significantly with peripheral microvascular damage and systemic fibrotic burden in SSc, representing a valuable non-invasive monitoring tool with preferential deep capillary plexus involvement reflecting systemic vasculopathy.

PurposeThe purpose of this study was to investigate changes in visual function following surgery and identify predictors of postoperative visual function in patients with idiopathic epiretinal membrane (iERM).MethodsThis retrospective study included 37 eyes with iERM. Macular structure was assessed using optical coherence tomography (OCT) and OCT angiography (OCTA), whereas visual function was evaluated using best-corrected visual acuity (BCVA) and microperimetry. All parameters were measured preoperatively (baseline) and at 3 and 6 months postoperatively. Associations between macular structural parameters and visual function outcomes were analyzed.ResultsCentral retinal thickness (CRT) decreased significantly at both 3 and 6 months postoperatively. Parafoveal vessel density (PFVD) of the deep capillary plexus (DCP) and BCVA improved significantly at 3 months, with no significant changes observed between 3 and 6 months. Retinal sensitivity (RS) and fixation stability (FS) demonstrated significant improvement at 6 months, whereas macular integrity (MI) showed no significant postoperative changes. Multiple linear regression analysis revealed that baseline PFVD of the DCP was a significant predictor of postoperative BCVA. Logistic regression analysis identified baseline PFVD of the DCP as an independent predictor of postoperative FS improvement.ConclusionsBCVA, RS, and FS improve significantly following iERM surgery, with BCVA improving earlier than microperimetry parameters. A higher baseline PFVD of the DCP is a significant prognostic factor for better BCVA and FS improvement.Translational RelevanceMicroperimetry offers an objective and quantitative evaluation of macular functional changes after iERM surgery. PFVD of the DCP, as measured by OCTA, can serve as a valuable predictor of BCVA and FS outcomes postoperatively.

To analyze the correlation between orbital compliance and retinal vessel density (VD) based on dynamic Scheimpflug analyzer (Corvis ST) and optical coherence tomographic angiography (OCT-A). In this prospective observational study, 65 eyes of 44 patients with thyroid-associated ophthalmopathy (TAO) in quiescent stage were included (15 males and 29 females). The whole eye movement (WEM) was detected by Corvis ST. The superficial capillary plexus VD (SCP-VD) and deep capillary plexus VD (DCP-VD) were obtained by scanning the 3 × 3mm area around the fovea using OCT-A, while the peripapillary vessel density (ppVD) was obtained by scanning the 4.5 × 4.5mm area around the optic disk. Covariances including biomechanically corrected intraocular pressure (bIOP), axial length, age and gender were adjusted during data analysis. The mean WEM of the participants was 0.235 ± 0.066mm. The mean SCP-VD and DCP-VD in whole image were 46.20% ± 3.77% and 50.51% ± 3.96%; the mean whole pp-VD was 49.75% ± 2.01%. WEM was positively correlated with SCP-VD (r = 0.327, p = 0.01) and the whole pp-VD (r = 0.394, p < 0.01) after adjusting by gender, axial length (AL), age and bIOP, but it was not significantly correlated with DCP-VD (r = 0.072 p = 0.581). Increase in orbital pressure might reduce retinal microvascular perfusion. Our data suggest orbital mechanical compression may be an important cause of retinal VD changes in quiescent patients with TAO.

ABSTRACTPurpose: To investigate changes in peripapillary retinal vessel density after acute intraocular pressure (IOP) elevation caused by laser peripheral iridotomy (LPI) in primary angle-closure suspects (PACS) by optical coherence tomography angiography (OCTA).Materials and Methods: Ninety-seven participants with PACS were included in this cross-sectional observational study. OCTA and IOP measurement were performed at baseline and 1 h after LPI. PACS eyes were further divided into three groups according to IOP increase 1 h after LPI (group 1 = IOP elevation <5 mmHg, 42eyes; group 2 = IOP elevation ≥5 mmHg and <10 mmHg, 34 eyes; group 3 = IOP elevation ≥10 mmHg, 21eyes). The changes of vessel density in radial peripapillary capillary (RPC) and entire retina were compared among groups.Results: When all eyes were included, the vessel density of RPC and entire retina 1 h after LPI were significantly decreased compared to the baseline (RPC: 64.5 ± 7.9 vs.67.8 ± 6.8, P < .001; retina: 86.3 ± 4.6 vs.88.3 ± 3.8, P < .001). There were significant differences among the three groups in the RPC and retinal vessel density at 1 h after LPI (RPC: 67.4 ± 7.3 vs. 63.2 ± 7.6 vs. 60.9 ± 7.5, P = .003; retinal: 87.7 ± 4.0 vs. 85.8 ± 4.5 vs. 84.3 ± 5.2, P = .015). In group 2 with an increased IOP from 5 mmHg to 10 mmHg, the reduction of vessel density in the RPC was more significant than that of the entire retina (RPC vs. retina: 7.1 ± 10.0% vs. 3.0 ± 4.4%, P = .006).Conclusions: LPI-induced IOP spikes resulted in a decrease in retina vessel density with PACS eyes by OCTA. The reduction of RPC vessel density was more significant than that of the entire retina in the subgroup of IOP increase from 5 to 10 mmHg. This suggests that vessel density in RPC was more sensitive to IOP increase than that of the entire retina in the peripapillary area.

IntroductionThe aim of this study was to evaluate retinal and choriocapillaris (CC) vessel density, using optical coherence tomography angiography (OCTA), in the macular region at baseline and after three once-monthly intravitreal injections of bevacizumab (loading phase) in patients affected by exudative age-related macular degeneration (AMD).MethodsA total 38 eyes of 38 patients with exudative AMD (16 women, 22 men; mean age 72.47 ± 7.46 years) were included in this study. We evaluated vessel density in different macular areas (whole image, fovea and parafovea) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and CC. In addition, central macular thickness (CMT) and choroidal thickness in the foveal region and 500 µm in the nasal and temporal directions were analyzed by enhanced depth image-OCT.ResultsThere were no significant differences in vessel density in the SCP, DCP and CC after the loading phase compared to baseline (p > 0.05). In contrast, CMT (p = 0.039; 320.63 ± 175.05 vs. 372.47 ± 167.05 µm) and subfoveal choroidal thickness (SFCT) (p < 0.001; 189.21 ± 37.66 µm vs 170.37 ± 37.96 µm) significantly decreased after the loading phase compared to baseline. No significant correlations were found between SFCT and CC vessel density in the fovea, and between CMT and SCP and DCP (p > 0.05) at baseline and after the loading phase. Also, best corrected visual acuity did not correlate with CMT, SCP and DCP at baseline and after treatment (p > 0.05).ConclusionMacular and choroidal thickness did not correlate with vessel density, but probably correlated to vascular exudation. The anti-VEGF treatment, acting on vascular hyperpermeability, determines the reduction of the retinal and choroidal exudation, resulting in a decrease of their thicknesses. Consequently, these parameters could reflect the effectiveness of the anti-VEGF injections for treating exudative AMD respect to OCTA parameters.Trial RegistrationClinicalTrials.gov indentifier, NTC04138420.

Choroidal osteoma (CO), also known as osseous choristoma, is a rare benign osseous tumour of the choroid. It is diagnosed based on the presence of a yellowish-white to orange lesion deep in the retinal pigment epithelium (RPE) with well-defined margins and bone density in ultrasonography (Pellegrini et al. 2014). Patients are usually asymptomatic and the lesion is found incidentally. Choroidal neovascularization (CNV) is the most frequent complication of CO and leads to severe visual impairment. Anti-vascular endothelial growth factor (Anti-VEGF) therapy has been recommended for CNV-related CO (Song & Roh 2009). Here, we report a case of extrafoveal CO associated with CNV. A 75-year-old woman, incidentally diagnosed with CO at the age of 68 years, presented with a two-month history of metamorphopsia in the left eye. Best-corrected visual acuity (BCVA) was 0 logMar in the right eye and 0.7 logMar in the left eye. Anterior segment findings were unremarkable in both eyes. A fundus examination of the right eye was unremarkable, whereas, in the left eye, it revealed a yellowish-white area with small haemorrhages in the superior temporal retina that suggested an extrafoveal CO associated with CNV (Fig. 1A,B). Baseline evaluation of the right eye. (A, B) Colour fundus photography and multicolour image showing the choroidal osteoma with subretinal haemorrhage. The black circle underlines macular haemorrhage spots. (C−E) Optical coherence tomography (OCT) angiography, fluorescein angiography and indocyanine green angiography revealed late-stage choroidal neovascularization within the tumour. The red circle underlines macular haemorrhage spots (F, G) A and B scan echography showed a slightly elevated choroidal mass with high reflectivity and acoustic shadowing. (H) Enhanced depth imaging optical coherence tomography (EDI-OCT) showed a hyper-reflective mass in the subretinal space associated with a neurosensory detachment and detected a sponge-like structure of the choroid. (I, J) Fluorescein and indocyanine angiography of the superotemporal region of the contralateral normal eye. (K) Optical coherence tomography (OCT) scan of the macular region without any pathological feature. (L−P) Colour fundus photography, multicolour image, fluorescein angiography and indocyanine green angiography and OCT angiography showing regression of the choroidal neovascularization after four months of treatment. (Q) Enhanced depth imaging optical coherence tomography (EDI-OCT) revealed resolution of the subretinal fluid. [Correction added on 17 June 2016 after first online publication: Figure 1 has been replaced to correct the labelling of Fig. 1E and 1O]. Optical coherence tomography (OCT) angiography (angiovue software RTVue; Optovue Inc., Fremont, CA, USA) showed a hyporeflective area surrounded by a hyper-reflective-edged ring in direct relation to the osteoma. It also showed a dense irregular vascular network within the tumour in the outer retinal layer and choroid capillary layers. Moreover, the CNV detected in the choroidal layer had fine glomerular-like hyper-reflection (Fig. 1C). Visualization of vessels is better with non-invasive OCT angiography than with fluorescein angiography (FA) and Indocyanine green angiography (ICGA); in fact, with the latter two techniques, the leaking vessels of the CNV usually are overshadowed by the dye in the late phases (Wang et al. 2015). Fluorescein angiography (FA) showed early hyperfluorescence due to leakage surrounded by an area of blocked fluorescence, and late staining of the lesion showed well-defined borders (Fig. 1D). Indocyanine green angiography (ICGA) confirmed the presence of an active CNV secondary to CO (Fig. 1E). Standardized A and B scan echography revealed a slightly elevated choroidal mass with high reflectivity and acoustic shadowing (Fig. 1F,G). Enhanced depth imaging optical coherence tomography (EDI-OCT) performed with the Heidelberg Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany) showed a hyper-reflective mass in the subretinal space associated with neurosensory detachment and elongation of the outer segments. Enhanced depth imaging optical coherence tomography (EDI-OCT) also revealed a sponge-like structure of the choroid with horizontal tubules (Fig. 1H). The findings obtained in our patient strongly support the diagnosis of OC as opposed to sclerochroidal calcification (SCC). In fact, unlike OC, SCC does not feature growth, decalcification or intralesional vessels of CNV, as recently reported by Shields et al. (2015). After obtaining informed consent, we administered three monthly intravitreal injections of ranibizumab in the left eye. Four months later, the patient's BCVA was 0.1 logMar, and a fundus examination revealed resolution of the subretinal haemorrhage (Fig. 1L,M). Fluorescein angiography (FA) and ICGA showed regression of the CNV (Fig. 1N,O) and spectral domain OCT revealed no subretinal fluid (Fig. 1Q). Optical coherence tomography (OCT) angiography demonstrated a smaller and more rarified vascular network inside a capsular formation (Fig. 1P). These findings remained unchanged during the 12-month follow-up. In summary, OCT angiography reveals unique features in the vascular changes of CNV in CO not visualized with other imaging methods. However, additional studies are needed to verify whether this technique can partially replace FA and ICGA in the diagnosis and follow-up of CNV secondary to CO.

This cross-sectional optical coherence tomography angiography (OCTA) study aimed to assess the macular and optic nerve head (ONH) vascular density, foveal avascular zone, and outer retina and choriocapillaris flow in oligoarticular juvenile idiopathic arthritis (oJIA). Prospective. Twenty-two eyes of 22 oJIA patients with uveitis (oJIA-U), 20 eyes of 20 oJIA patients without uveitis (isolated oJIA), and 26 healthy volunteers of similar ages and sexes were investigated. The superficial capillary plexus (SCP) and deep capillary plexus (DCP), ONH, foveal avascular zone (FAZ) parameters, the flow area of the outer retina, and choriocapillaris were evaluated. Compared with the control group, both the oJIA-U group and isolated oJIA group showed significantly decreased vessel density of parafovea (p = 0.031 and p = 0.047, respectively) in DCP. Choriocapillaris flow area at 1mm radius was significantly lower in the oJIA-U group compared to the control group (p = 0.001). Choriocapillaris flow area at 2- and 3-mm radius were significantly lower in the oJIA-U group compared to the control group (p < 0.001, for both) and isolated oJIA-U group compared to the control group (p = 0.008 and p = 0.001, respectively). The VD and thickness parameters of SCP and ONH, FAZ, and outer retina flow area were similar between the groups. oJIA patients with and without uveitis revealed a decreased vessel density in the deep parafoveal region and choriocapillaris flow. Our findings suggest that retinal choroidal microvascular changes could be evident in oJIA-U patients without posterior segment involvement as well as oJIA patients without uveitis.