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

Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).

ポリープ状脈絡膜血管症におけるpachychoroid neovasculopathyの遺伝的・臨床的特徴

PurposeTo determine the safety and effectiveness of orbital decompression for thyroid eye disease (TED) in our unit. To put this in the context of previously published literature.Patients and methodsA retrospective case review of all patients undergoing orbital decompression for TED under the care of one orbital surgeon (SMS) between January 2009 and December 2015. A systematic literature review of orbital decompression for TED.ResultsWithin the reviewed period, 93 orbits of 55 patients underwent decompression surgery for TED. There were 61 lateral (single) wall decompressions, 17 medial one-and-a-half wall, 11 two-and-a-half wall, 2 balanced two wall, and 2 orbital fat only decompressions. For the lateral (single) wall decompressions, mean reduction in exophthalmometry (95% confidence interval (CI) was 4.2 mm (3.7-4.8), for the medial one-and-a-half walls it was 2.9 mm (2.1-3.7), and for the two-and-a-half walls it was 7.6 mm (5.8-9.4). The most common complications were temporary postoperative numbness (29% of lateral decompressions, 17% of other bony decompressions, OR 0.50, 95% CI 0.12-2.11) and new postoperative diplopia (9% of lateral decompressions, 39% of other bony decompressions, OR 6.8, 95% CI 1. 5-30.9). Systematic literature searching showed reduction in exophthalmometry for lateral wall surgery of 3.6-4.8 mm, with new diplopia 0-38% and postoperative numbness 12-50%. For other bony decompressions, reduction in exophthalmometry was 2.5-8.0 mm with new diplopia 0-45% and postoperative numbness up to 52%.ConclusionDiffering approaches to orbital decompression exist. If the correct type of surgery is chosen, then safe, adequate surgical outcomes can be achieved.

/pdf/orbital-decompression-for-thyroid-eye-disease-methods-59xlaggntq.pdf

Orbital decompression for thyroid eye disease: methods, outcomes, and complications.

Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults.

Purpose
To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings.

/pdf/graded-decompression-of-orbital-fat-and-wall-in-patients-rkxbwjpi3d.pdf

Graded decompression of orbital fat and wall in patients with Graves' orbitopathy.

Purpose

To compare choroidal thickness after vitrectomy between epiretinal membrane (ERM) with and without vitreomacular traction (VMT).



Methods

In this retrospective study, 228 consecutive participants with ERM who underwent vitrectomy were categorized into two groups according to the presence of VMT on spectral domain–optical coherence tomography: VMT group (ERM with VMT, n = 21) and non-VMT group (ERM without VMT, n = 207). The primary outcome was the mean subfoveal choroidal thickness (SFCT) at baseline, and at 3 and 6 months postsurgery.



Results

At baseline, the prevalence of VMT in eyes with ERM was 9.6% (21/228), and mean SFCT was greater in the VMT than in the non-VMT group (270.3 ± 93.4 vs. 223.7 ± 82.1 μm; p = 0.015). After surgery, mean SFCT decreased in the VMT group (241.7 ± 92.3 μm at 3 months and 228.8 ± 86.4 μm at 6 months; p < 0.001), but remained unchanged in the non-VMT group (223.6 ± 78.9 μm at 3 months and 223.3 ± 82.6 μm at 6 months; p = 0.696). There were no differences in mean SFCT between the groups at 3 and 6 months after surgery (p = 0.339 and p = 0.772, respectively).



Conclusion

Choroidal thickness was greater in ERM eyes with than without VMT possibly due to direct anteroposterior traction on the retina and choroid, increased vascular endothelial growth factor associated with stress on retinal pigment epithelial cells and inflammation. After vitrectomy, mean SFCT reduced in the eyes with VMT, but not in those without VMT.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aos.13097

Changes in choroidal thickness after vitrectomy for epiretinal membrane combined with vitreomacular traction

Nasal packing after dacryocystorhinostomy (DCR) is an optional procedure to prevent nasal bleeding [1,2]. Although improvements in surgical technique have reduced the need for this practice, nasal packing is still needed more for Asians than for Caucasians due to anatomical differences. Compared to Caucasians, Asians have a thicker lacrimal bone, a thicker frontal process of the maxilla, and a narrower nasal passage [3-5]. In addition, the proportion of the maxilla to the lacrimal bone in the lacrimal sac fossa is greater than in Caucasians [4]. Such anatomical differences make osteotomy more difficult and prone to nasal bleeding in Asians when performing DCR. Postoperative nasal bleeding is unpleasant for patients and can be severe in certain cases [2,6]. It can potentially affect the mucosal healing process and can cause fibrosis and induce scarring at the newly formed rhinostomy site, all of which could result in an impairment of ostial patency [7]. Therefore, the minimization of intra- and postoperative bleeding is important to consider in an attempt to achieve successful surgical results.

The effects of nasal packing are not limited to hemostasis, as it also directly affects wound healing [8-14]. In the field of endoscopic sinus surgery, a number of papers have investigated whether or not nasal packing, both in general and in regard to the type used, affected nasal mucosal re-epitheliazation, fibrous tissue proliferation, granulation, and synechiae formation [8,11-13]. More recently, the effects of nasal packing materials after DCR have started to draw attention [10], but there are no well-established conclusions due to the scarcity of reports. Furthermore, the lack of standardization in the measurement of DCR surgical outcomes makes it difficult to compare and interpret the results of previous studies [15].

Packing materials are broadly divided into non-absorbable and absorbable materials. Non-absorbable materials include Vaseline gauze strips and Merocel, which inhibit bleeding through a compression mechanism [8]. Absorbable materials such as Gelfoam [1,9] and MeroGel [10] have been reported to be successful as packing materials after DCR. Nasopore, a bioresorbable dressing for the nasal cavity, is composed of fully synthetic biodegradable, fragmentable foam that absorbs fluids while supporting and providing pressure against the surrounding tissue. As such, it could potentially prevent undesired postoperative adhesions [13].

To investigate the effects of postoperative packing with Nasopore, we placed Nasopore at the anastomosis site of newly formed anterior mucosal flaps. Patients who had their nasal cavities packed with Merocel packing were recruited as a control group. Merocel, due to its non-absorbable character, is supposed to be removed within 2 to 3 days after its application.

We investigated the degree of postoperative re-bleeding and the level of patient discomfort and compared the anatomical and functional success rate 3 months post-surgery between Nasopore and Merocel. To our knowledge, this is the first report to investigate the effect of Nasopore on the surgical outcome of DCR.

/pdf/effects-of-nasopore-packing-on-dacryocystorhinostomy-optxfp4igs.pdf

Effects of Nasopore Packing on Dacryocystorhinostomy

PURPOSE To investigate the peripapillary choroidal thickness (PCT) of polypoidal choroidal vasculopathy (PCV) and exudative age-related macular degeneration (AMD) and to evaluate their responses to anti-vascular endothelial growth factor (VEGF). METHODS Thirty eyes with PCV and 25 eyes with exudative AMD who were treatment naive were included in this study. PCT and subfoveal choroidal thickness were evaluated both before and after intravitreal anti-VEGF. RESULTS The initial mean PCT of PCV (153.78 ± 56.23 μm) was thicker than that of exudative AMD (88.77 ± 23.11 μm, p < 0.001). Temporal, superior, nasal, and inferior PCTs of PCV were all thicker than those observedin exudative AMD (all p < 0.05). After anti-VEGF, the mean PCT of PCV was significantly reduced (134.17 ± 41.66 μm, p < 0.001), but the same was not true not in exudative AMD (86.87 ± 22.54 μm, p = 0.392). PCTshowed a similar tendency in all quadrants. CONCLUSIONS PCV exhibits a thick choroid in the peripapillary region. PCT decreases after anti-VEGF in PCV but not in exudative AMD. In exudative AMD, subfoveal choroidal thickness decreased, but that in the peripapillary region did not.

/pdf/peripapillary-choroidal-thickness-change-of-polypoidal-1xzk5adm9d.pdf

Peripapillary Choroidal Thickness Change of Polypoidal Choroidal Vasculopathy after Anti-vascular Endothelial Growth Factor.

PURPOSE To compare the postoperative refractive error (RE) using A-scan ultrasound (US) and partial coherence interferometry (PCI) after phacovitrectomy for idiopathic epiretinal membrane (iERM) and cataract. METHODS Eighty-eight participants (88 eyes) with iERM and cataracts underwent phacovitrectomies with internal limiting membrane removal. Postoperative RE was the main outcome measured, calculated by subtracting intended spherical equivalent (SE) from 6-month postoperative SE. Secondary outcomes included axial length (AL) measured by 2 methods, change in best-corrected visual acuity (BCVA), and change in central subfield thickness (CSFT). RESULTS Mean postoperative RE using US showed greater myopic shift compared with that using PCI (-0.569 ± 0.571 D vs -0.169 ± 0.415 D, respectively, p<0.001). The 6-month postoperative RE was within ±0.50 D in 43.2% (38/88) using US vs 84.1% (74/88) using PCI and within ±1.00 D in 84.1% (74/88) using US vs 96.6% (85/88) using PCI. Mean AL measured by US was shorter than that measured by PCI (23.50 ± 1.27 mm vs 23.58 ± 1.30 mm, respectively, p<0.001). Postsurgery, BCVA improved from 0.374 ± 0.264 logMAR to 0.144 ± 0.124 logMAR (p<0.001), and CSFT decreased from 449.2 ± 78.5 µm to 378.2 ± 47.0 µm (p<0.001). The BCVA improvement significantly correlated with decreased CSFT (R = 0.268, p = 0.011). CONCLUSIONS Estimation of intraocular lens power for phacovitrectomies for iERM and cataracts is more accurate when assessed by PCI than by US.

Comparison of refractive error in phacovitrectomy for epiretinal membrane using ultrasound and partial coherence interferometry.

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