Background: Focal choroidal excavation (FCE) is one of the pachychoroid spectrum diseases. It may be an isolated lesion or associated with other ophthalmological disorders. The aim of the study was to present the epidemiology, clinical features and multimodal imaging findings in FCE. Methods: This is a case series of 14 consecutive patients with a diagnosis of FCE, confirmed by multimodal imaging, from a review of the 5076 optical coherence tomography (OCT) scans in 2538 patients. Choroidal thickness (CT) was measured under the fovea and in the area of maximum choroidal thickening in the affected eye and under the fovea in the fellow eye. Results: The mean age of the subjects was 40 ± 13.58 years. FCE occurred unilaterally and was an isolated lesion in all cases. The fellow eye did not show any macular pathology in all patients. Twelve eyes presented conforming FCEs and two non–conforming FCEs. In 79% of cases, FCE was subfoveal. The mean maximum CT was 390 μm in the affected eye with the presence of pachyvessels. A total of 13 patients were asymptomatic, while one patient reported a visual disturbance due to neovascularization secondary to FCE. Of all the multimodal imaging techniques, optical coherence tomography (OCT) provided the most important data in the diagnosis of FCE. Conclusions: Our study confirmed that FCE is a rare ocular condition, but it may be more common in Caucasian population than previously known. Multimodal imaging methods, mainly OCT, are crucial in FCE diagnostics. Further studies are needed to expand the available knowledge about its etiology and clinical course.

In patients with eye surface disorders such as dry eye syndrome or Meibomian gland dysfunction (MGD) it is necessary to improve the tear film condition in order to obtain visual system measurements before cataract surgery. The aim of the project was to analyze the Thermal Pulsation System (TPS) impact on the visual system parameters used in cataract surgery qualification. The study included six patients (11 eyes) with MGD diagnosis. All patients were treated with TPS. The obtained results were compared and used to calculate the power and type of the intraocular lens (IOL). As a treatment result, the power of astigmatism has changed in 64% of the eyes. Planned surgical treatment type has changed in 27% of cases. TPS also affected the cylinder axis in three eyes, which was 27% of cases. Based on the calculations, power of the recommended IOL has changed in five eyes (46%). Stabilization of visual system parameters after TPS allowed to improve the accuracy of the results. It also ensured the proper astigmatism treating method during cataract surgery and allowed selection of the proper IOL power and type.

Tamoxifen is a drug used in breast cancer therapy, which inhibits the division of neoplastic cells targeting estrogen receptors. The drug is generally well-tolerated and its use does not cause serious side-effects. The standard dose of the drug is 20 mg once a day for 3 to 5 years. Available epidemiological data have shown that the incidence of ocular toxicity of tamoxifen ranges between 0.9% and 12.0% and increases with higher tamoxifen dose. A rare known complication of tamoxifen use is the development of retinopathy. We present a case of 57-year-old woman presented to an ophthalmologist with decreased visual acuity in her right eye. She has been treated with tamoxifen 20 mg daily for 7 years for breast cancer. Clinical examination and multimodal imaging methods help confirm the diagnosis of unilateral tamoxifen associated retinopathy (TAR). Optical coherence tomography angiography (OCTA) was crucial in the diagnostic process and differential diagnosis, especially in differentiating it from type 2 macular telangiectasias. The correct diagnosis of TAR is very important in deciding the treatment option of tamoxifen. Based on our diagnosis, the oncologist recommended another course of treatment. Tamoxifen therapy was discontinued and switched to letrozole 2.5 mg once a day. The patient attends ophthalmological examination regularly. Visual acuity, OCT and OCTA results remain stable.

Ocular decompression retinopathy (ODR) is characterized by multiple retinal hemorrhages. It is a rare complication associated with rapid decrease of intraocular pressure (IOP). The course of ODR is usually asymptomatic and self-limiting, which was confirmed by the observation of our patient. In this study, we present a 5-month follow up of a 77-year-old woman with acute right eye (RE) filtration angle closure who developed symptoms of ODR. Clinical examination and multimodal imaging modalities, including color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA) and fluorescein angiography (FA), were used to confirm the diagnosis and performed regularly in monitoring the course of the disease. Fundus lesions in the RE included diffuse intraretinal hemorrhages in the posterior pole, which gradually resolved during follow-up time. The fundus of the left eye (LE) was normal. The patient underwent conservative therapy, laser therapy and surgery, achieving stabilization of the IOP and improvement of the local condition in the RE. Of the various multimodal imaging techniques, color fundus photography and OCT seemed to be the most specific and helpful in monitoring the patient with ODR.

Floppy eyelid syndrome is a common ophthalmic condition characterized by a sagging eyelid, which causes its spontaneous wrinkling during sleep. It can be a result of local and systemic diseases. A characteristic group of patients who suffer from floppy eyelid syndrome are middle-aged men with an increased body mass index. Obesity in this group of patients is recognized as the strongest risk factor for the occurrence of obstructive sleep apnea syndrome. The aim of the article is to review the diagnostic methods that are used in the case of floppy eyelid syndrome. The paper also discusses therapeutic methods including surgical techniques.

Optic nerve head drusen (ONHD) are benign calcified deposits that can compress local capillaries, disrupt blood flow and potentially lead to visual loss. The aim of the study was to present the correlations between optical coherence tomography (OCT), OCT angiography (OCTA) results and fundus autofluorescence (FAF) findings in patients with ONHD, and to highlight the importance of multimodal imaging in the diagnosis and management of this pathology. This retrospective study included 21 patients (36 eyes) with ONHD, with a mean age of 45.75 years (range: 19-71 years), who had no other ocular pathologies. All participants underwent a full ophthalmic examination and multimodal imaging using the DRI Triton OCT (Topcon). Drusen presence was divided into quadrants based on FAF and correlated with OCT and OCTA results. Optic nerve head drusen were unilateral in 6 patients (28.57%) and bilateral in 15 (71.43%). Drusen were most common in the nasal and superior quadrants (NQ and SQ) but were significantly more frequent in the inferior (IQ) and temporal (TQ) quadrants in patients with bilateral ONHD. Eyes with drusen located in the IQ and TQ showed a significantly decreased radial peripapillary capillary (RPCP) vessel density (VD). Retinal nerve fibre layer (RNFL) measurements showed the strongest positive correlations with RPCP, especially in the IQ (r = 0.78, p < 0.001). Ganglion cell layer and nerve fiber layer (GCL++) thickness showed significant correlations with RPCP VD, particularly in the IQ and TQ (p < 0.001 for both). Fundus autofluorescence is a valuable tool for identifying superficial drusen. Optical coherence tomography and OCTA are effective in assessing optic nerve fiber integrity and microvascular changes. Microcirculation assessment using OCTA should focus not only on the radial peripapillary capillaries (RPCP), but also on the macular region. Multimodal imaging plays a crucial role in the accurate diagnosis and comprehensive evaluation of patients with ONHD. Further longitudinal studies are needed to investigate how these correlations evolve over time, particularly in the context of ONHD progression.