Faculty Bibliography

PURPOSE/OBJECTIVE:To characterize the topographic relationships among vitreous structures, including the premacular bursa, prevascular vitreous fissures, cisterns, and lacunae, in healthy participants using en face and cross-sectional swept-source (SS) OCT. DESIGN/METHODS:Prospective, comparative study. PARTICIPANTS/METHODS:Sixty eyes of 60 healthy participants (age range, 4-35 years). Eyes of individuals younger than 20 years (n = 29) were compared with eyes of individuals 20 years of age or older (n = 31). METHODS:From each study eye, 12 × 12-mm SS OCT volume scans comprising 1024 × 1024 A-scans centered at the fovea were acquired. MAIN OUTCOME MEASURES/METHODS:En face and cross-sectional data were analyzed to characterize topographic relationships between hyperreflective spaces anterior to the vitreoretinal interface. RESULTS:Prevascular vitreous fissures are an almost universal feature of human eyes. Cisterns became more prevalent over the course of the first 20 years (r = 0.49; P = 0.002). In 97% of eyes in individuals older than 20 years, en face and cross-sectional SS OCT showed the premacular bursa and prepapillary gap merge at a distance superior to the optic nerve and then follow a superonasal course anteriorly. However, only 69% of individuals younger than 20 years demonstrated such a connection (P = 0.01). A close topographic relationship of vitreous fissures and cisterns to the underlying vasculature of the posterior pole was visible on en face projections. En face imaging readily distinguished these spaces. Degenerative, eyewall-parallel fissure planes and their course were described for the first time in a 3-dimensional manner. The fissure planes were rare in younger eyes (12%) and significantly more common in older eyes (42%; P < 0.001). CONCLUSIONS:En face SS OCT demonstrated that (1) premacular bursa and Cloquet's canal are not connected in younger patients, but are connected in older patients; (2) prevascular vitreous fissures overly the retinal vessels; and (3) cisterns are continuous with prevascular fissures.

Purpose/UNASSIGNED:To describe features of neovascularization in proliferative diabetic retinopathy (PDR) using optical coherence tomography angiography (OCTA). Methods/UNASSIGNED:A retrospective case series was performed in 23 eyes from 21 patients who underwent OCTA of neovascular complexes (NVCs) due to PDR. Eyes were imaged with the DRI Triton swept-source OCTA, Avanti RTVue XR or Cirrus HD-OCT 5000 as part of routine clinical examination. Segmentation was adjusted to include vasculature between the vitreous cavity and the internal limiting membrane (ILM). The presence of NVCs was confirmed by clinical examination and multimodal imaging such as color or red-free fundus photography, fluorescein angiography, multicolor imaging or near-infrared reflectance. Results/UNASSIGNED:Thirty-five NVCs were imaged, of which, 34% were neovascularization of the disc (NVD) and 66% were neovascularization elsewhere (NVE). On structural OCT B-scans, NVE appeared as medium to highly reflective tissue that breached the ILM, while NVD showed highly reflective tissue protruding from the disc in a sea fan configuration. Flow signal was seen on OCTA in all cases of NVE and in 67% of NVD lesions. Areas with minimal or absent retinal flow signal identified retinal nonperfusion areas and were found adjacent to 87% of NVE. Intraretinal microvascular abnormalities (IRMAs) were noted next to 70% of NVE. Absent flow signal was seen in 4 NVD cases showing posterior shadowing and were considered inactive. Conclusion/UNASSIGNED:OCTA appears useful for imaging NVCs, IRMAs, and retinal nonperfusion areas in eyes with diabetic retinopathy. This imaging modality enables noninvasive screening and monitoring of PDR and can obviate the need for additional testing in certain clinical settings.

BACKGROUND AND OBJECTIVE/OBJECTIVE:To describe a two-forceps bimanual approach for complex diabetic detachments. PATIENTS AND METHODS/METHODS:Curved scissors were used to create a zone of decreased resistance within a thick fibrovascular membrane in a previously vitrectomized patient. Using two forceps, the linear defect was propagated into the periphery in a direction tangential to the retina. The tissue was repeatedly regrasped at the leading edge of the propagating tear, allowing for progressive separation of the hyaloid from the retinal surface. RESULTS:Separation of the diabetic membrane and hyaloid from the retinal surface in a previously vitrectomized patient. CONCLUSION/CONCLUSIONS:The authors describe a two-forceps approach for dense fibrovascular proliferation in the setting of persistently attached cortical vitreous that may be employed in cases of severe diabetic retinopathy with traction and fibrovascular membranes, even after previous vitrectomy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e176-e178.].

PURPOSE/OBJECTIVE:To describe the fibrillar architecture of the posterior cortical vitreous and identify variations across eyes of different axial lengths in vivo. METHODS:Sixty-four eyes of 32 subjects were examined with swept-source optical coherence tomography (SS-OCT). Grading of vitreous degeneration, presence of vitreous cisterns/lacunae, posterior hyaloid status, directionality of vitreous fibers and their relations to vitreous spaces, and lamellar reflectivity of the posterior vitreous were assessed. RESULTS:A consistent pattern of fibrillar organization was discovered. Eyewall parallel fibers formed a dense meshwork over the retinal surface and fibers oriented in a perpendicular fashion to this meshwork were found to envelop the various vitreous spaces, intersecting at variable angles of insertion to the eyewall parallel fibers. Lamellar reflectivity suggestive of splitting of the cortical fibrillar meshwork was detected in 27 eyes (42%) with 56% of these eyes demonstrating perpendicularly oriented intersecting fibers. Fifty-six percent of eyes with lamellar reflectivity had an axial length > 25 mm. CONCLUSION/CONCLUSIONS:SS-OCT imaging revealed fibrillar organization of the posterior vitreous. Eye wall parallel hyperreflectivity of cortical vitreous was a universal finding. This pattern is suggestive of a splitting of cortical vitreous tissue and may represent a precursor to vitreoschisis. Perpendicular fibers appear to be important constituents of the walls of the various liquid vitreous spaces.

Purpose: Blood is one of the main absorbers in the near-infrared spectrum and therefore retinal vessels appear dark in near-infrared reflectance (NIR) images. Proliferative diabetic retinopathy (PDR) is characterized by the growth of abnormal vessels which also absorb light and appear dark against a lighter fundus background. We aim to study the usefulness of NIR imaging in the detection and follow-up of neovascular complexes (NVCs) in PDR.
Method(s): Retrospective study of 20 eyes of 17 patients with PDR who underwent NIR imaging with optical coherence tomography (OCT) using the Spectralis System as part of routine clinical examination. NVCs presence and activity was determined using clinical, tomographic and angiographic criteria.
Result(s): Twenty-seven NVCs were imaged, of which, 48% were neovascularization of the disc (NVD) and 52% were elsewhere (NVE). Mean patient follow-up was 3.7 years. Consecutive images were obtained from 3 to 5 time-points. All patients underwent laser treatment and 7 had additional intravitreal therapy. At baseline, NVCs were absent, present and active and present and inactive, respectively in 11%, 85% and 4% of cases. NIR identified active NVCs as hyporreflective irregular dark vessels originating from the retinal venules in NVE or from the disc in NVD. Associated hyperreflective fibrotic tissue was seen at baseline in 26%. NIR regression shown by reduced dark perfusion was observed in the 1 follow-up visit in 33% of cases and in 70% of cases in the 4 visit, consistent with various laser sessions. Progression with new vascular dark fronds was documented in about 40% scans in all time points. Four eyes developed a wolf's jaw configuration with vascular hyporreflective new vessels and hyperreflective tissue from extensive fibrosis. Fibrosis was more apparent in later images, reaching 77%. In a minority of cases (7%) the NVC was no longer seen in NIR, although was still identifiable on OCT over the NVC area.
Conclusion(s): NIR is a non-invasive imaging modality commonly performed alongside OCT and frequently overlooked which can be useful to evaluate NVCs in PDR. Blood is one of the main absorbers in the NIR spectrum and therefore changes in NVC contrast and reflectivity due to blood perfusion can help in the detection and monitoring of diabetic proliferative disease and aid clinicians in daily practice

PURPOSE/OBJECTIVE:To report a giant retinal pigment epithelium rip in a patient with a bullous retinal and choroidal detachment. METHODS:Case report with widefield imaging, fundus autofluorescence, and optical coherence tomography of the retina. RESULTS:This 62-year-old patient had a history of advanced glaucoma, trabeculectomy, blebitis, and endophthalmitis. He had cataract surgery 6 weeks before presentation. He was found to have a large bullous retinal and choroidal detachment with a large retinal pigment epithelium tear at the limit of the choroidal detachment. After vitrectomy for retinal detachment repair, the tear was observed to extend inferiorly at the margins of the choroidal detachment. CONCLUSION/CONCLUSIONS:This case report demonstrates that large retinal pigment epithelium rips can be found associated with large bullous choroidal and retinal detachments. These tears seem similar to tears that have been observed after trabeculectomy.