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Rothenbuehler, Simon, P., MD*; Maloca, Peter, MD*,†; Scholl, Hendrik P., N., MD, MA*,‡; Gyger, Cyrill, MSc*; Schoetzau, Andreas, MSc§; Kuske, Lorenz, MD*; Mosimann, Nathanael, MD*; Zweifel, Sandrine, A., MD; Barthelmes, Daniel, MD, PHD; Tufail, Adnan, MD, FRCOphth; Hasler, Pascal, W., MD*

doi: 10.1097/IAE.0000000000001686
Original Study

Purpose: To analyze submacular perforating scleral vessels (PSVs) using enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT).

Methods: Twenty-two eyes of 11 healthy women were included in this retrospective study. Central EDI-SDOCT scans (3 × 4.5 × 1.9 mm, 13.5 mm2 scan area) were acquired and postprocessed by denoising, manual sclera segmentation, and PSV investigated by five graders.

Results: Mean age was 22.4 ± 6.2 years. Mean refractive error was −0.44 ± 0.8 diopters. Mean axial length was 23.08 ± 0.63 mm. The coefficient of agreement for grading was good. Mean number of submacular PSVs was 0.33 ± 0.2 per mm2 (range from 0 to 9 per eye). Subfield analysis showed 0.2 ± 0.5 (range 0–2) and 2.1 ± 1.8 (range 0–7) vessels, respectively, for central 1-mm diameter and 3-mm diameter. Quadrant analysis showed 0.7 ± 0.9, 0.5 ± 0.9, 0.3 ± 0.6, and 0.4 ± 0.6 vessels, respectively for superior, inferior, nasal, and temporal quadrants. Total number of PSV showed no significant side difference (median difference 0.5, confidence interval −3.0 to 3.0, P = 0.94) or an influence of axial length (P = 0.16).

Conclusion: This is the first description of three-dimensional EDI-SDOCT visualization of submacular PSV in healthy eyes. This method allows for in vivo imaging of a critical component of outer retinal perfusion at the posterior pole.

Perforating scleral vessels can be investigated by EDI-OCT. Image postprocessing with speckle noise reduction and three-dimensional visualization allows for quantification and analysis of vessel structures possibly important for choroidal perfusion of the foveal outer retina. The authors found a mean number of 0.33 ± 0.2 perforating scleral vessels per mm2 in the submacular area.

*OCTlab, Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland;

Medical Retina Department, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom;

Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland;

§Department of Biomedical Statistics, University of Basel, Basel, Switzerland; and

Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Reprint requests: Simon P. Rothenbuehler, MD, OCT Research Laboratory OCTlab, Department of Ophthalmology, University Hospital Basel, Mittlere Strasse 91, CH-4056 Basel, Switzerland; e-mail:

Supported in part by prize money of the Swiss VitreoRetinal Group, Retina Award 2015.

A. Tufail has been on advisory boards for Novartis, Pfizer, GSK, Thrombogenics, Bayer, and Allergan. The remaining authors have no conflicting interests to disclose.

P. Maloca and S. P. Rothenbuehler contributed equally to this work.

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P. Maloca is owner of intellectual property on speckle noise analysis technology discussed in this work.

© 2018 by Ophthalmic Communications Society, Inc.