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

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity".

Choriocapillaris: Fundamentals and advancements

Intra-arterial chemotherapy (IAC), also known as superselective ophthalmic artery chemotherapy or chemosurgery, is currently widely accepted as one of the primary treatment modalities for intraocular retinoblastoma worldwide. Following the introduction of the technique in 1998, IAC has evolved over the past decades to be safer and more effective. Accumulated evidence shows that IAC is more effective in providing eye salvage in group D and E retinoblastoma as compared to conventional systemic intravenous chemotherapy (IVC). In contrast to IVC, IAC has the added benefits of reduced overall treatment duration and minimal systemic toxicity. This review provides a comprehensive update on the history, technique, indications, contraindications, and outcome of IAC. We have also identified the strengths, weaknesses, opportunities and threats (SWOT analysis) of the technique in this review.

/pdf/intra-arterial-chemotherapy-in-retinoblastoma-a-paradigm-48diuus8z0.pdf

Intra-arterial chemotherapy in retinoblastoma - A paradigm change.

Summary Purpose To determine the efficacy of rescue intra-arterial chemotherapy (IAC) for retinoblastoma recurrence following failed initial IAC Methods Retrospective, non-comparative, interventional case series of 12 eyes in 12 patients Intervention Rescue IAC employed chemotherapy agents of melphalan (5 mg, 75 mg) alone or with additional topotecan (1 mg) Main outcome measure Tumor control and globe salvage Results The median patient age at initial presentation was 16 months At initial examination, the International Classification of Retinoblastoma grouping was group B ( n  = 1), group D ( n  = 7), or group E ( n  = 4) The initial IAC was primary in 5 cases (42%) and secondary following failure of intravenous chemotherapy in 7 (58%) In all cases, initial IAC was delivered using melphalan 3 mg ( n  = 3), melphalan 5 mg ( n  = 7), or combination melphalan 5 mg/topotecan 1 mg ( n  = 2) for a median of 3 cycles The mean interval from initial IAC to recurrence necessitating rescue IAC was 5 months (median 4, range 2–10 months) Of the 12 patients, 3 (25%) had undergone previous enucleation of the opposite eye and the rescue IAC was planned for the only remaining eye Rescue IAC was delivered for recurrent solid tumor ( n  = 1), recurrent subretinal seeds ( n  = 7), recurrent vitreous seeds ( n  = 1), or combination recurrent subretinal/vitreous seeds ( n  = 3) IAC was technically successful through the ophthalmic artery in 9 cases (75%) or the middle meningeal artery in 3 (25%) Rescue IAC involved median 3 cycles (mean 3, range 2–4 cycles) of higher dose melphalan in 4 cases (33%) or combination melphalan/topotecan in 8 (67%) At mean follow-up of 20 months (median 14 months, range 7–36 months), complete tumor control was achieved in 9 eyes (75%) and globe salvage in 8 eyes (67%) Of the 3 failure eyes, all were initially groups D or E, previously treated with initial IAC, and 2 had previous intravenous chemotherapy There were 4 eyes that came to enucleation for persistent subretinal/vitreous seeds ( n  = 3) or neovascular glaucoma without viable tumor ( n  = 1) There was no case of cerebrovascular stroke, systemic metastasis, or death Conclusion Rescue IAC following retinoblastoma recurrence after initial IAC provided tumor control in 75% of cases and globe salvage in 67% Rescue IAC can be considered in children who fail initial IAC, especially if the opposite eye has been enucleated

Rescue intra-arterial chemotherapy following retinoblastoma recurrence after initial intra-arterial chemotherapy.

Purpose To measure the choroidal thickness (CT) and analyze the morphologic features of chorioretinal structures using a portable handheld spectral domain-optical coherence tomography in patients with retinoblastoma after intraarterial chemotherapy. Methods This was a case-control study. Eighteen eyes of 9 patients with unilateral retinoblastoma treated with intraarterial chemotherapy were assessed by spectral-domain optical coherence tomography. Submacular CT was measured at the foveola and at points located 500 μm and 2 mm from the foveola. The treated eye was compared with the untreated (control) eye. Results Mean submacular CT was 174 ± 111.1 μm in the treated eyes and 259 ± 42.2 μm in the control eyes (P = 0.054). Several point locations showed statistically significant differences comparing CT (treated eye vs. control eye), including subfoveolar (P = 0.030), nasal 0.5 mm (P = 0.037), nasal 2 mm (P = 0.049), and temporal 2 mm (P = 0.031). In 4 patients with ophthalmoscopically visible choroidal atrophy, submacular CT was reduced by 73.3 ± 14.1% compared with the control eye. In 5 patients with no ophthalmoscopically visible choroidal atrophy, submacular CT was reduced by 0.5 ± 11.9% compared with the control eye. Conclusion Intraarterial chemotherapy for retinoblastoma can cause reduction in subfoveolar CT. Spectral-domain optical coherence tomography confirmed choroid to be thinned in eyes with or without clinical evidence of choroidal atrophy.

Choroidal thickness after intraarterial chemotherapy for retinoblastoma.

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Choroidal thickness after intraarterial chemotherapy for retinoblastoma.