Progression of macular retinoschisis following intravitreal aflibercept injection for myopic macular neovascularization-a case report and review of literature.

BACKGROUND: Macular retinoschisis (MRS) and myopic macular neovascularization (mMNV) are both potentially blinding complications of high myopia. In this case report, we highlight the progression of MRS after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for mMNV, as well as an extensive review of the literature on this topic. CASE DESCRIPTION: A 49-year-old woman presented with two weeks of recent onset blurring and metamorphopsia in her right eye. She had high myopia in both eyes (right eye - 20/60 with - 16D, left eye - 20/20 with - 13D). Slit-lamp ophthalmoscopy found a normal anterior segment in both eyes. On fundus examination, features of pathological myopia with posterior staphyloma and peripapillary atrophy were observed in both eyes. An active mMNV, as well as intraretinal fluid, minimal perifoveal inner and outer MRS, and focal posterior vitreous traction along the inferotemporal retinal arcade, were detected on optical coherence tomography (OCT) of the right eye. The patient received an intravitreal injection of Aflibercept (2 mg/0.05 ml). RESULTS: OCT scans at two- and four-month follow-up visits revealed regressed mMNV with a taut epiretinal membrane, progressive worsening of outer MRS, and the development of multiple perifoveal retinal detachment inferior to the fovea. Pars plana vitrectomy surgery was performed for the progressive MRS with good anatomical (resolved MRS) and functional outcome (maintained visual acuity at 20/60) at the last one-month post-surgery visit. CONCLUSION: Intravitreal anti-VEGF injections for mMNV can cause vitreoretinal interface changes, exacerbating MRS and causing visual deterioration. Vitrectomy for MRS could be one of several treatment options.

UTILITY OF EN FACE OPTICAL COHERENCE TOMOGRAPHY IN INTRAOCULAR LYMPHOMA.

PURPOSE: To report the en face optical coherence tomography (OCT) features of intraocular lymphoma. METHODS: Retrospective, observational case report. RESULTS: A 59-year-old man, a known case of primary testicular carcinoma, complained of right eye blurred vision since 1 week. He had previously undergone systemic intravenous chemotherapy (R-CHOP regimen), orchiectomy, and external beam radiotherapy for the primary malignancy. His right eye vision was 20/30, 6/6 reduced Snellen. The right eye anterior segment examination was normal. Fundus examination showed vitreous cells 1+ and a large, bumpy, subretinal dull-yellow lesion sparing the fovea with multiple discrete yellow retinal lesions at the posterior pole. Magnetic resonance imaging of the brain was normal. Multimodal imaging was used to document the clinical features. On the en face OCT, multiple hyperreflective lesions were identified on the superficial, deep, and outer retinal slabs of the scan corresponding to the vertical hyperreflective lesions extending from the retinal nerve fiber layer to the retinal pigment epithelium. The subretinal pigment epithelium lesion can be well delineated in the choriocapillaris segment. He was treated with multiple injections of intravitreal methotrexate 400 µg/0.1 mL along with systemic chemotherapy in conjunction with the oncologist. At the 6-month follow-up, fundus lesions had regressed. In addition, resolution of the lesions was noted on the OCT and en face OCT scans. CONCLUSION: En face OCT imaging can be considered for monitoring the therapeutic efficacy after intravitreal chemotherapy in intraocular lymphoma.

Structural and Functional Outcomes of Surgery for Lamellar Macular Holes with or without Epimacular Proliferations.

PURPOSE: To compare the clinical, optical coherence tomography (OCT) features, and surgical outcomes of lamellar macular hole (LMH) depending on the presence of epimacular membrane proliferation (EMPF). METHODS: This retrospective chart review included 112 eyes with LMH. The patients were divided into two groups depending on the presence of EMPF. Group 1 had LMH without EMPF and Group 2 had LMH with EMPF. The best-corrected visual acuity was recorded and OCT scans were obtained. RESULTS: Lamellar macular hole without and with EMPF was noted in 62 (55%) and 50 (45%) eyes, respectively. The presence of EMPF was associated with lower presenting visual acuity (P = 0.049), wider LMH size at the largest diameter on the horizontal scan (P = 0.001), thinner residual retinal tissue (P = < 0.0001), and larger IS-OS defects (P = < 0.0001) as compared to the non-EMPF group. Of the 112 eyes, 18 eyes underwent surgery for LMH. Seven eyes had EMPF and the remaining eleven did not have EMPF. The average follow-up time for patients post-surgery and under observation was 16.8 and 24.1 weeks, respectively. A significant improvement in visual acuity was noted in the operated eyes with no EMPF as compared to the eyes with EMPF (P = 0.008). Worsening visual acuity (P = 0.021) was noted in eyes with LMH associated with EMPF which did not undergo surgery. Eyes with LMH and no EMPF, which were not operated on showed a minimal negative change in visual acuity. CONCLUSION: LMH with EMPF showed a higher association with accompanying ellipsoid zone disruption. Better anatomical and functional outcomes were achieved in those eyes that underwent surgery for LMH with no presence of EMPF and ellipsoid zone defect.

Bilateral Sequential Acute Macular Neuroretinopathy in an Asian Indian Female with ß Thalassemia Trait following (Corona Virus Disease) COVID-19 Vaccination and Probable Recent COVID Infection - Multimodal Imaging Study.

INTRODUCTION: Corona virus disease (COVID-19) has been associated with a variety of ophthalmic manifestations including acute macular neuroretinopathy and paracentral middle maculopathy. Posterior segment manifestations after post COVID-19 vaccinations have been reported. CASE REPORT: A 25- year-old Asian Indian female developed sequential bilateral AMN following a single dose of COVISHIELD™ vaccine. On investigations she was found to have a ß thalassemia trait. Presentation started unilaterally and progressed to the other eye after a month. On clinical examination, the fundus was apparently normal in both eyes. Significant changes suggestive of AMN were seen on multimodal imaging of the posterior segment of the respective eye at the time of involvement which resolved spontaneously in due course. CONCLUSION: We report a temporal association of COVID-19 vaccination and AMN.