Retinal and choroidal changes observed with 'En face' enhanced-depth imaging OCT in central serous chorioretinopathy.

AIMS: To describe retinal and choroidal changes in acute and quiescent central serous chorioretinopathy (CSC) observed with 'En face' spectral domain optical coherence tomography (SD OCT) combined with enhanced-depth imaging (EDI). METHODS: A prospective and descriptive study at the Rothschild Ophthalmologic Foundation (Paris, France) between September 2011 and February 2012. Eyes with a clinical diagnosis of CSC were examined using SD OCT with EDI, fluorescein and indocyanine green angiography. 3D reconstruction of 197 transverse sections with SD OCT, spaced of 30 µ, provided a virtual macular brick through which 496 sections in the coronal plane resulted in a C-scan or En face OCT image. RESULTS: 23 of 29 eyes (79%) had serous retinal detachment (all active CSC) and 22 had pigment epithelial detachment (75%). Pigment epithelial hyperplasia was visualised in nine eyes (31%). Posterior cystoid retinal degenerations were present in five eyes (17%). The mean choroidal thickness was 491.5 µ. In 11 eyes (38%), En face OCT showed multiple hyper reflective points located at the level of the choriocapillary layer and choroidal cavitations were found in two patients. CONCLUSIONS: En face OCT imaging using SD OCT is an easy, reproducible, non-invasive and effective tool to understand choroidal changes in acute and quiescent CSCR. It provides complementary morphological information, describes new semiological entities and might substitute other exams in the future.

Macular edema in central retinal vein occlusion: correlation between optical coherence tomography, angiography and visual acuity.

To analyze the characteristics and the course of macular edema secondary to central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) and to determine correlations between clinical, tomographic and angiographic data, in particular including retinal ischemia. In this retrospective study, 53 consecutive patients with CRVO were included. At each follow-up visit, patients underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) and OCT. Fluorescein angiography was performed at baseline and on demand during follow-up. 243 OCTs were analyzed. Mean age was 61 years and mean follow-up 13 months. The first structural change, observed very early after the onset of the occlusion, was a diffuse increase at the level of the outer nuclear layer without change at the level of the inner retina. This early change seemed characteristic of retinal vein occlusion. Cystoid spaces were subsequently observed in all retinal layers and were combined with serous retinal detachment in 51 %. During the first 6 months, central retinal thickness was higher in ischemic CRVO (mean, 691 µm) than in non-ischemic CRVO (mean, 440 µm, p < 0.01). In eyes with foveal thickness (central retinal thickness without subretinal fluid) of 700 µm or greater, peripheral ischemia was present in 69 % of eyes, final BCVA was 20/200 or less in 75 % and never reached 20/40 during follow-up. The integrity of the junction of the photoreceptors' inner and outer segments was correlated with a better prognosis (p < 0.05). Foveal thickness was inversely correlated to BCVA at each visit and could have a prognostic value. OCT examination in CRVO revealed useful data for the diagnosis of CRVO and its prognosis. The largest macular edemas seemed to be the hallmark of ischemic CRVO.

Angiography features of early onset drusen.

AIMS: Drusen are rarely observed in patients < 50 years of age. Two types of early onset drusen (EOD) are commonly described: basal laminar drusen (BLD) and drusen associated with Malattia Leventinese (ML). Our purpose was to classify the phenotype of EOD on the basis of fundus examination, and fluorescein angiography (FA) and indocyanine green angiography (ICGA) features. METHODS: We performed a prospective study including 48 consecutive EOD patients. All of them had a complete ophthalmologic examination including FA and ICGA. RESULTS: BLD (67%) were extremely hyperfluorescent on FA and ICGA. ML (10%) was characterised by a combination of small radial and large round drusen with differences in staining in both FA and ICGA. We evidenced a third type of EOD (23%) harbouring an aspect of large colloid drusen (LCD), mildly hyperfluorescent in the early phases of FA, with a progressive staining in late phases. In intermediate and late phases of ICGA, LCD presented as hypofluorescent dot surrounded by a hyperfluorescent halo bordered by a thin hypofluorescent ring. CONCLUSION: Three types of EOD are distinguished by their FA and ICGA features. We report a new kind of juvenile drusen, distinct from BLD and ML, named LCD, associated with a good vision and absence of complications.

Vitreoretinal dysplasia masquerading as Peters' anomaly.

PURPOSE: Vitreoretinal dysplasia is characterized by a congenital bilateral nonattachment of the retina. In some cases, anteroposition of the iris and lens can lead to corneolenticular contact and corneal opacity, masquerading as Peters' anomaly. We report 3 cases of vitreoretinal dysplasia initially diagnosed as Peters' anomaly. METHODS: Case report. RESULTS: Case 1: In a 3-year-old boy with bilateral corneal opacities, high frequency ultrasound showed iridolenticular adherences as in Peters' anomaly, but color Doppler imaging of the posterior pole revealed a bilateral total retinal detachment. Case 2: In an 18-month-old boy with bilateral corneal opacity and dense cataract, ultrasound revealed a shallow anterior chamber and bilateral vitreous hemorrhage with retinal detachment. Case 3: In a 6-month-old girl with bilateral central corneal opacity, shallow anterior chamber, iridocorneal synechiae, and a cataract, ultrasound revealed a total retinal detachment in the right eye, and was uncertain in the left eye. Corneal transplantation was attempted in the left eye, but a retinal detachment was discovered peroperatively. There were associated central nervous system anomalies. CONCLUSIONS: Vitreoretinal dysplasia is a potentially evolving disease and can lead to anterior chamber thinning, corneal opacity, and secondary glaucoma. Anterior and posterior segment ultrasound is essential to fix the correct diagnosis and prognosis.