Zimmermanbang5424
To compare refractive outcomes and accuracy of modern optical biometry (OB), swept-source optical coherence tomography (OCT), ultrasound biometry (UB) and effect of macula status in rhegmatogenous retinal detachment (RRD) managed with either combined phacovitrectomy or sequential vitrectomy and cataract surgery compared to a control, phacoemulsification alone.
Retrospective, comparative, consecutive study of 154 eyes; Group 1 underwent phacovitrectomy (n70), group 2 underwent vitrectomy with subsequent cataract surgery (n41) and group 3 underwent cataract surgery alone (n43).
No difference in mean absolute error (MAE) was found between Group 2 (0.41±0.56) and Group 3 (0.41±0.29); both were superior to Group 1 (0.74±0.57). Between Group 1 and Group 2, no statistically significant difference in MAE was found between macula-on subgroups (p=0.057) but this was statistically significant between macula-off subgroups (p=0.009). Subgroup analysis by biometry showed that the difference in MAE between macula-off OB Group 1 and Group 2 against our control, Group 3, were not significant (p=0.078 and p=0.119 respectively); MAE was significantly different when considering macula-off UB cases (p<0.001 and p=0.038 respectively).
All three groups had comparable refractive outcomes when using OB. However, phacovitrectomy macula-off cases had inferior refractive outcomes when the UB had to be used. In macula-off RRD, when OB is not reliable, it is preferable to perform sequential surgery rather than phacovitrectomy.
All three groups had comparable refractive outcomes when using OB. However, phacovitrectomy macula-off cases had inferior refractive outcomes when the UB had to be used. In macula-off RRD, when OB is not reliable, it is preferable to perform sequential surgery rather than phacovitrectomy.
The aim of this study was to determine the natural course of vitreomacular traction (VMT) in patients with diabetic retinopathy (DR), and to evaluate the factors associated with VMT relief.
Seventy-four eyes of 65 patients with VMT accompanying DR were evaluated retrospectively. The presence of intravitreal injection (IVI), and the presence of panretinal photocoagulation (PRP) were obtained from the medical records of the patients. Spontaneous release of VMT (R-VMT), the horizontal length of vitreomacular traction (HLVMT), the presence of hyperreflective retinal spots (HRS), the presence of epiretinal membrane (ERM), and grade of VMT were evaluated from the spectral-domain optical coherence tomography (SD-OCT) images. Factors associated with the spontaneous release of VMT were evaluated by logistic regression analysis.
Spontaneous release was observed in 28 eyes (37.8%). Vandetanib The HLVMT was lower in the R-VMT group compared with the persistent VMT (P-VMT) group (p=0.03). P-VMT group had a higher rate of HRS and ERM compared with the R-VMT group (respectively; p=0.003 and p=0.031). No statistically significant difference was observed between the R-VMT and P-VMT groups in terms of IVI and PRP treatment (respectively; p=0.938 and p=0.36). The absence of HRS was the most important prognostic factor for the spontaneous release of VMT (p=0.029).
Spontaneous release of VMT was observed higher rates of patients without HRS, ERM, and patients with lower HLVMT.
Spontaneous release of VMT was observed higher rates of patients without HRS, ERM, and patients with lower HLVMT.
To document a peculiar case of optic disc pit-associated maculopathy (ODP-M) with extensive nasal retinoschisis with lamellar outer retinal hole.
Case report.
A 41 year-old woman presented to the eye clinic complaining of new photopsias and enlargement of the blind spot in the left eye. Uncorrected visual acuity was 20/20 in both eyes. Fundus examination of the left eye revealed an anomalous appearing optic nerve with a gray oval depression at the temporal margin of the disk consistent with an ODP.
Optical coherence tomography confirmed the presence of the pit and demonstrated outer plexiform layer schisis superonasal to the fovea as well as extensive inner and outer retinal schisis nasal to the nerve extending to the equator. A large lamellar outer retinal hole was noted nasal to the disk without associated retinal detachment. The vitreous appeared to be attached over the nasal retina.
Multimodal imaging revealed an unusual ODP associated retinopathy with dramatically more extensive retinoschisis and a lamellar outer retinal hole nasal to the nerve despite the temporal location of the pit. Although the precise pathophysiologic mechanisms are not fully understood, forces associated with the vitreo-retinal adhesion may have contributed to the distribution of the schisis in this case.
Multimodal imaging revealed an unusual ODP associated retinopathy with dramatically more extensive retinoschisis and a lamellar outer retinal hole nasal to the nerve despite the temporal location of the pit. Although the precise pathophysiologic mechanisms are not fully understood, forces associated with the vitreo-retinal adhesion may have contributed to the distribution of the schisis in this case.
To describe clinical features including multimodal imaging in a case of diffuse subretinal fibrosis and uveitis syndrome.
A young patient presented with counting fingers in both eyes (OU) due to posterior uveitis and unresponsive to systemic corticosteroids. Ultra-wide field (UWF) pseudo-color and autofluorescence (FAF) imaging, optical coherence tomography angiography En-face, optical coherence tomography angiography (OCT-A) and spectral-domain optical coherence (SD-OCT) were performed.
Clinical examination revealed a bilateral fibrosis plaque in both fovea and macular multifocal choroidal lesions associated, with no vitritis. UWF-FAF allowed us to determine activity showing a hyperfluorescent pattern. En-face OCT-A at the level of the ellipsoid layer showed multiple hyperreflective lesions surrounding an hyperreflective fibrosis plaque in OU, which improved and stabilized during the follow-up. OCT-A at the level of RPE-choriocapillaris revealed neocapillary network changes along the chronification of the disease. The patient required the addition of intravitreal dexamethasone implants (ozurdex®) to control the acute rebounds and anti-TNF? to control the underlying inflammatory process.
This is the first Diffuse Subretinal Fibrosis with Uveitis syndrome reported with a complete En-face OCT-A and OCT-A examination. link2 This multi-modal imaging will improve the monitoring of the disease's activity and the chronicity changes.
This is the first Diffuse Subretinal Fibrosis with Uveitis syndrome reported with a complete En-face OCT-A and OCT-A examination. This multi-modal imaging will improve the monitoring of the disease's activity and the chronicity changes.
To describe a case of AA amyloidosis which produced an orbital inflammatory response with a novel presentation.
Case report.
A 24 year-old Caucasian female with a history of intravenous (IV) heroin use was hospitalized for tricuspid valve endocarditis and methicillin resistant Staphylococcus aureus bacteremia, as well as acute renal failure. She received hemodialysis and IV daptomycin and had negative blood cultures for 3 weeks, when she developed sudden bilateral orbital swelling and blurred vision. Visual acuity was 20/200 in the right eye (OD) and 20/400 in the left eye (OS). Examination revealed proptosis, conjunctival chemosis and desiccation, optic disc swelling, creamy choroidal infiltrates and inferiorly located exudative retinal detachments in both eyes (OU). Multimodal imaging demonstrated thickening of the sclera, choroid and choriocapillaris as well as outer retinal disruption, subretinal fluid and deposits of hyperfluorescent debris within the choriocapillaris, outer retina and vitreous. Oral prednisone at 60 mg per day resolved the choroidal infiltrates and exudative detachments. Persistent nephrotic syndrome called for a renal biopsy, which demonstrated AA amyloidosis.
- Orbital and choroidal AA amyloidosis can induce a local inflammatory response manifesting as orbital swelling, papillitis, posterior scleritis, choroiditis and exudative retinal detachment, which responds to steroid therapy. The underlying pathology is likely a reactive inflammation and vaso-occlusive process involving the choriocapillaris and orbital vasculature to the presence of amyloid fibrils.
- Orbital and choroidal AA amyloidosis can induce a local inflammatory response manifesting as orbital swelling, papillitis, posterior scleritis, choroiditis and exudative retinal detachment, which responds to steroid therapy. The underlying pathology is likely a reactive inflammation and vaso-occlusive process involving the choriocapillaris and orbital vasculature to the presence of amyloid fibrils.
We sought to determine the earliest diagnostic signs of hydroxychloroquine retinopathy up to the point of clinical recognition.
Retrospective series of 6 patients (5 parafoveal disease; 1 pericentral disease) with at least 3 examinations over 3.5 years or more preceding diagnosis of HCQ retinopathy. Spectral domain optical coherence tomography (sdOCT) cross-sections, fundus autofluorescence (FAF) and visual fields were generated clinically. Stored sdOCT data were re-examined later to generate topographic ellipsoid zone (EZ) maps, minimum intensity (MI) analysis and sequential plots of regional retinal thickness. Retrospective series of six patients (5 parafoveal disease; one pericentral disease) with at least three examinations over 3.5 years or more preceding diagnosis of hydroxychloroquine retinopathy.
Spectral domain optical coherence tomography cross-sections and fields showed similar sensitivity; fundus autofluorescence was not helpful. In parafoveal cases, EZ topography and minimum intensity analyase.
To describe the peripheral optical coherence tomography (OCT) findings in a female choroideremia carrier.
Case report.
A 56 year-old woman was referred for visual disturbance complaining of some occasional photopsias and increasing difficulty with her vision at night in both eyes. Best-corrected visual acuity was 20/20 in the right eye and 20/150 in the left eye. Fundus examination revealed mildly tilted disks and peripapillary atrophy with subtle retinal pigment epithelial changes in the periphery.
Macular OCT in the right eye appeared unremarkable but the in the left eye there was diffuse ellipsoid zone (EZ) band disruption. Green-light fundus autofluorescence (FAF) revealed mottled areas of decreased AF in the mid and far periphery creating an irregular mosaic pattern. Peripheral OCT scans revealed more diffuse EZ alterations than were apparent on the FAF imaging. Genetic testing revealed a heterozygous pathogenic variant in the CHM gene (c.715C>T, p.Arg239). An additional heterozygous mutation was noted in the CNGB1 gene (c.290+2T>C, splice donor).
Choroideremia carriers may manifest widespread photoreceptor alterations which may be more extensive than apparent on FAF imaging.
Choroideremia carriers may manifest widespread photoreceptor alterations which may be more extensive than apparent on FAF imaging.
To report a case of a pituitary macroadenoma that presented with bilateral intraretinal hyporeflective spaces located primarily in the inner nuclear layer in the macular SD-OCT.
Case report.
Based on the findings of a macular SD-OCT, a 53-year-old man was considered as having cystoid macular edema secondary to a retinovascular condition. He was treated with intravitreal VEGF inhibitors and corticosteroids with no improvement. Confrontation visual fields suggested a bitemporal defect. MRI confirmed the presence of a non-secreting pituitary macroadenoma compressing the optic chiasm.
Not all intraretinal hyporeflective spaces in the OCT are secondary to a retinal vascular condition. link3 Hyporeflective spaces in the INL on OCT imaging that do not leak on fluorescein angiography may be secondary to optic atrophy from chiasmal compression.
Not all intraretinal hyporeflective spaces in the OCT are secondary to a retinal vascular condition. Hyporeflective spaces in the INL on OCT imaging that do not leak on fluorescein angiography may be secondary to optic atrophy from chiasmal compression.
