PURPOSE\nTo measure macular choroidal thickness in normal eyes at different points using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate the association of choroidal thickness and age.\n\n\nDESIGN\nRetrospective, observational case series.\n\n\nMETHODS\nEDI OCT images were obtained in patients without significant retinal or choroidal pathologic features. The images were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. Seven sections were obtained within a 5 x 30-degree area centered at the fovea, with 100 scans averaged for each section. The choroid was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-microm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate variations of choroidal thickness at each location and to correlate choroidal thickness and patient age.\n\n\nRESULTS\nThe mean age of the 30 patients (54 eyes) was 50.4 years (range, 19 to 85 years), and 14 patients (46.7%) were female. The choroid was thickest underneath the fovea (mean, 287 microm; standard deviation, +/- 76 microm). Choroidal thickness decreased rapidly in the nasal direction and averaged 145 microm (+/- 57 microm) at 3 mm nasal to the fovea. Increasing age was correlated significantly with decreasing choroidal thickness at all points measured. Regression analysis suggested that the subfoveal choroidal thickness decreased by 15.6 microm for each decade of life.\n\n\nCONCLUSIONS\nChoroidal thickness seems to vary topographically within the posterior pole. The thickness of the choroid showed a negative correlation with age. The decrease in the thickness of the choroid may play a role in the pathophysiologic features of various age-related ocular conditions.

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Normal Eyes

Optical coherence tomography angiography.

Descemet's stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology.

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China

Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications.

We describe the use of a simple tool to evaluate the postoperative alignment of toric intraocular lenses (IOLs). The entire anterior segment is scanned using anterior segment optical coherence tomography and analyzed with an internal dedicated tool. A topographic map is displayed along with an anterior segment image, including a linear axis marker centered on the corneal apex. The marker can be rotated until it is aligned with the line connecting the IOL marking dots, precisely reproducing the IOL astigmatic axis, which is measured in angle degrees. The value of the IOL astigmatic axis is compared with the value of the astigmatic axis shown in real time on the same screen in the topographic map. Evaluating the alignment of a toric IOL axis simultaneously with the topographic astigmatic axis eliminates the potential errors that result from head tilting and strictly correlates with the astigmatic correction achieved.

Evaluation of postoperative toric intraocular lens alignment with anterior segment optical coherence tomography

We present the case of a 57-year-old woman who had combined Descemet-stripping automated endothelial keratoplasty (DSAEK) and phacoemulsification with implantation of a toric intraocular lens (IOL) Surgery was intended to treat a cataract developing in a post-penetrating keratoplasty (PKP) eye with high astigmatism and endothelial decompensation Six months after uneventful surgery, the cornea was clear and the corrected distance visual acuity was 20/20 with a refraction of +025 -100 × 10 (from -300 -850 × 12 preoperatively) The internal topography map (OPD-Scan) showed an IOL rotation of 4 degrees The endothelial cell loss was 15% of the eye-bank value Descemet-stripping automated endothelial keratoplasty combined with phacoemulsification and toric IOL implantation is a relatively simple and very effective procedure for eyes with endothelial failure and high post-PKP astigmatism The speed of visual rehabilitation and final visual acuity achieved with this approach was superior to that obtained with other surgical procedures

Combined Descemet-stripping automated endothelial keratoplasty and phacoemulsification with toric intraocular lens implantation for treatment of failed penetrating keratoplasty with high regular astigmatism.

Stromal disease (ectasia, opacities, scars, or melting) that occurs after penetrating keratoplasty (PK) can variously affect visual outcome.1,2 To date, even in the presence of healthy endothelium, this type of complication has been treated with subsequent PK.3 Instead, the selective replacement of the diseased stroma by means of deep anterior lamellar keratoplasty (DALK) using pneumatic dissec tion (big bubble) has not been attempted, mainly because of the extreme likelihood of breaking the descemetic scar at the junction between the donor and host cornea. We describe a new surgical technique (smallbubble DALK) that uses pneumatic dissection to bare Descemet membrane (DM) only in a central optical zone and predescemetic manual dissection to remove the surrounding peripheral stroma.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/1893537/est140002.pdf

Small-bubble deep anterior lamellar keratoplasty technique.

Descemet stripping automated endothelial keratoplasty for endothelial decompensation in buphthalmos.

Purpose To report the results of a modified big-bubble deep anterior lamellar keratoplasty technique using the intraoperative red reflex to visualize the amount of residual stroma beneath the inserted cannula. Methods A total of 132 consecutive keratoconic eyes were included in this retrospective, noncomparative, interventional case series. Before starting surgery, pharmacologic mydriasis was induced in all eyes undergoing a big-bubble deep anterior lamellar keratoplasty procedure. After partial trephination of the recipient cornea, a spatula was inserted at the base of the incision and advanced into depth using as a reference the thin dark line seen in the red reflex ahead of the advancing tip; the stromal depth reached was measured using anterior segment optical coherence tomography. Finally, the spatula was exchanged for a 27-gauge cannula, and air was injected to create a big bubble. The stromal depth reached with the spatula, success rate of big-bubble formation, and complications were recorded. Results The big bubble was obtained in 118 of 132 eyes (89.4%). Of the remaining 14 eyes, 11 underwent completion of the procedure by manual dissection and 3 were converted to penetrating keratoplasty because the bubble burst while trying to enlarge it. Perforation did not occur in any case during cannula insertion. The average thickness reached with the stromal dissection was 64.3 ± 19.5 μm. Conclusions The thin dark line, seen in the red reflex obtained with pharmacologic dilation, provides a useful and effective reference that can be used to visualize and judge the depth of dissection, thus allowing a safer and reproducible approach to the pre-Descemetic stroma.

Vincenzo Scorcia

Papers

Evaluation of postoperative toric intraocular lens alignment with anterior segment optical coherence tomography

Combined Descemet-stripping automated endothelial keratoplasty and phacoemulsification with toric intraocular lens implantation for treatment of failed penetrating keratoplasty with high regular astigmatism.

Small-bubble deep anterior lamellar keratoplasty technique.

Descemet stripping automated endothelial keratoplasty for endothelial decompensation in buphthalmos.

Red Reflex-Guided Big-Bubble Deep Anterior Lamellar Keratoplasty: A Simple Technique to Judge Dissection Depth.