Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a heterogeneous clinical phenotype, depending on the influence of different factors in its pathogenesis, including the presence of subretinal fluid (SRF), trophism of the retinal pigmented epithelium (RPE) and choroidal hyper-permeability. Our study has the purpose of assessing the ability of scanning laser ophthalmoscopy (SLO) retromode imaging, compared to fundus autofluorescence (FAF), to identify outer retinal features in a cohort of patients with a diagnosis of CSCR. A total of 27 eyes of 21 patients were enrolled in our study. All patients underwent full ophthalmological examination, including fundus retinography, fundus fluorescein angiography, optical coherence tomography (OCT), FAF and SLO retromode imaging. For each patient, the following features were evaluated: SRF, the presence of pigmented epithelium detachment (PED), RPE dystrophy, and RPE atrophy. RPE dystrophy was further characterized according to the appearance in FAF of iso-, hyper- and hypo-autofluorescent dystrophy. The ability to identify each feature was evaluated for FAF and SLO retromode alone, compared to a multimodal imaging approach. FAF identified SRF in 11/14 eyes (78%), PED in 14/19 (74%), RPE dystrophy with iso-autofluorescence in 0/13 (0%), hyper-autofluorescence in 18/19 (95%), hypo-autofluorescence in 20/20 (100%), and RPE atrophy in 7/7 (100%). SLO retromode imaging identified SRF in 13/14 eyes (93%), PED in 15/19 (79%), RPE dystrophy with iso-autofluorescence in 13/13 (100%), hyper-autofluorescence in 13/19 (68%), hypo-autofluorescent in 18/20 (90%), and RPE atrophy in 4/7 (57%). SLO retromode imaging is able to detect retinal and RPE changes in CSCR patients with a higher sensitivity than FAF, while it is not able to identify the depth of lesions or supply qualitative information about RPE cells’ health status, meaning that it is less specific. SLO retromode imaging may have a promising role in the assessment of patients with CSCR, but always combined with other imaging modalities such as OCT and FAF.

Background: This study investigates the relationship between retinal vascularization and macular function in patients with cone dystrophies (CDs). Methods: Twenty CD patients (40 eyes) and 20 healthy controls (20 eyes) were enrolled in this prospective case-control study. Patients underwent full ophthalmological examination, microperimetry, full-field, pattern and multifocal electroretinogram (ERG, PERG, mfERG) and optical coherence tomography angiography (OCTA). Main outcome measures were as follows: foveal and parafoveal inner and outer retinal thickness; microperimetry sensitivity in the central 4° and 8°, ERG b wave amplitudes and peak times, PERG P50 and N95 amplitudes and latencies, and mfERG N1 to P1 amplitudes; and superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillary (CC) plexus vessel densities, divided into foveal and parafoveal region. Results: Retinal thickness, SCP and DCP densities were significantly related to PERG. A significant relationship was found between foveal and parafoveal retinal thicknesses and foveal SCP density (p < 0.001 and p = 0.018, respectively) and between parafoveal retinal thickness and parafoveal SCP density (p = 0.002). Foveal and parafoveal retinal thicknesses were significantly related to parafoveal DCP density (p = 0.007 and p < 0.001). Foveal and parafoveal retinal thicknesses, foveal SCP and parafoveal DPC densities were significantly reduced in CD patients compared to controls (p < 0.001; p = 0.010 and p = 0.008, respectively). PERG and mfERG amplitudes were significantly reduced in CD patients compared to controls (p < 0.01). Conclusions: CD eyes showed reduced retinal thickness significantly related to reduced vessel density, possibly caused by a decreased metabolic demand. In addition, vessel density significantly correlated with loss of function.

Acute posterior syphilitic placoid chorioretinopathy (ASPPC) is a rare ocular manifestation of syphilis characterized by outer retinal layers involvement and drop in visual acuity. The current work documents outer retinal layer involvement in this pathology and their reconstitution with treatment by means of adaptive optics (AO). Three eyes of two patients together with four controls eyes were included in the study. Patients underwent optical coherence tomography (OCT) and OCT angiography (OCTA) scan centered on fovea, where vessel density (VD) and vessel perfusion (VP) were calculated. AO images centered on fovea were acquired and cone density (CD) and cone spacing (CS) were measured and compared to control group. Multimodal imaging was performed at presentation, at 10 days, and at 2-month follow-up. All eyes improved in visual acuity, with reconstitution in outer retinal layers at 2-month follow-up. Overall choriocapillary layer VD and VP improved. AO imaging was able to identify outer retinal alterations at presentation and at follow-ups, with improvement in tissue architecture. CD and CS was respectively lower and greater than controls at all follow-ups and improved within patients at the 2-month follow-up. In conclusion, AO was able to document outer retinal alterations in ASPPC at presentation and improvement over the follow-up, representing a tool to study photoreceptor layer involvement in this pathology.

Background. To determine the effectiveness of intravitreal ranibizumab (IVR) approach over 1‐year follow‐up in patients younger than 50 years old with central and branch retinal vein occlusion (RVO) complicated by macular edema (ME). Methods. Prospective, open‐label case series. Patients initiating IVR injections from January 2015 to May 2017 were consecutively recruited. Each patient underwent monthly ophthalmic examination and structural OCT over 12 months. A single IVR injection was administered at baseline, followed by a PRN regimen. Outcome measures are best‐corrected visual acuity (BCVA); central foveal thickness (CFT); number of IVR injections; subretinal fluid (SRF); epiretinal membrane; and outer retinal layer (ORL) status. Results. Thirty‐eight patients (27 males) were included in the study. At follow‐up, mean BCVA improved from 0.40 ± 0.17 to 0.10 ± 0.10 LogMAR in patients with central RVO and from 0.39 ± 0.19 to 0.19 ± 0.07 LogMAR in those with branch RVO, with 20 eyes gaining ≥3 ETDRS lines. In addition, mean CFT significantly decreased in both subgroups at the end of follow‐up. All patients with SRF at baseline (9) disclosed complete resolution after 1 year. Likewise, ORL appeared reconstituted in most cases. At 12 months, 3.6 ± 2.4 and 4.4 ± 2.4 IVR injections were required for central and branch RVO, respectively, with only 5 eyes showing ME persistence. Conclusions. Our study indicates that IVR injections can be a valid therapeutic option in patients under 50 years of age with ME secondary to RVO.

To evaluate the impact of retinal fluid volumes on the development of atrophy and fibrosis in neovascular age-related macular degeneration (nAMD) during routine care. Retrospective longitudinal study. Treatment-naïve eyes with nAMD from the Vienna Imaging Biomarker Eye Study (2007–2018), initiating anti-VEGF therapy. Volumes of intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED) were automatically quantified on OCT using an approved artificial intelligence algorithm within the 1-, 3-, and 6-mm ETDRS regions. Macular neovascularization (MNV) type and baseline presence of subretinal hyperreflective material (SHRM) were assessed. Fluid volumes were modeled as time-dependent biomarkers using repeated-measure Cox models to evaluate cumulative effects over time on the development of atrophy and fibrosis, with hazard ratios calculated for quartiles (Qs) at each visit. Associations with change in visual acuity (VA) were performed in a subset of eyes with ≥12 months of follow-up. Retinal fluid volumes, development of atrophy and fibrosis, and change in VA. A total of 1060 eyes of 998 patients were included. Higher IRF volumes increased the risk of both atrophy and fibrosis (all P < 0.001). Subretinal fluid reduced the risk of atrophy (Q4, P ≤ 0.001) and fibrosis (1-mm, P = 0.028) in the 1- and 3-mm regions, but increased the risk of fibrosis in the 6-mm region (P ≤ 0.031). Higher PED volumes increased the risk of atrophy in the 6-mm region (P < 0.001), and fibrosis at all locations (P ≤ 0.002). Age and baseline presence of SHRM were associated with atrophy (P < 0.001), whereas type 2 and mixed/undefined MNVs were associated with both atrophy (P < 0.001) and fibrosis (P ≤0.004). In 552 eyes, time-related presence of fibrosis was associated with VA decline at all locations (P < 0.001). In all areas, Q4 of IRF was associated with linear VA decline (P <0.001). Larger SRF volumes (Q4) in the 1-mm region were associated with better vision (P <0.05). Higher PED volumes (Q3, Q4) were linked to VA decline at all locations (P < 0.001). Assessment of the cumulative effects of retinal fluid volumes during anti-VEGF therapy using time-dependent biomarker modeling revealed notable associations with risk of atrophy, fibrosis, and VA decline. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.