Fundus Autofluorescence in Posterior and Panuveitis-An Under-Estimated Imaging Technique: A Review and Case Series.

Fundus autofluorescence (FAF) is a prompt and non-invasive imaging modality helpful in detecting pathological abnormalities within the retina and the choroid. This narrative review and case series provides an overview on the current application of FAF in posterior and panuveitis. The literature was reviewed for articles on lesion characteristics on FAF of specific posterior and panuveitis entities as well as benefits and limitations of FAF for diagnosing and monitoring disease. FAF characteristics are described for non-infectious and infectious uveitis forms as well as masquerade syndromes. Dependent on the uveitis entity, FAF is of diagnostic value in detecting disease and following the clinical course. Currently available FAF modalities which differ in excitation wavelengths can provide different pathological insights depending on disease entity and activity. Further studies on the comparison of FAF modalities and their individual value for uveitis diagnosis and monitoring are warranted.

Evaluation of agreement in macular vascular density measured by different protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm.

PURPOSE: To evaluate the agreement in the macular vascular density (MVD) measured by two protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. DESIGN: Cross-sectional observational study. METHODS: Healthy volunteers between the age group of 19 and 39 years were recruited. Topcon DRI OCT Triton plus (Topcon Corporation, Tokyo, Japan) was used to acquire the fovea-centered optical coherence tomography angiography (OCTA) image using two protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. MVD was measured by the manufacturer software in the superficial capillary plexus slab in five regions: central, superior, nasal, inferior, and temporal subfields of early treatment diabetic retinopathy study grid in each protocol. RESULTS: The study included 79 eyes of 40 healthy volunteers. The difference in the mean MVD between two protocols was 3.84% in right eye and 4.2% in left eye in central subfield, 0.93% in right eye and 1.13% in left eye in superior subfield, 0.06% in right eye and 1.45% in left eye in nasal subfield, 1.65% in right eye and 0.7% in left eye in inferior subfield, 0.4% in right eye and 0.54% in left eye in temporal subfield. The measurements were significantly higher in 6 mm × 6 mm in central subfield in both the eyes and in nasal field in the left eye. Whereas, the measurements were significantly higher in 4.5 mm × 4.5 mm in superior and inferior subfield in both the eyes and in temporal subfield in the left eye. CONCLUSION: The protocols should not be used interchangeably and it is necessary to include recommendation of the field of view to measure MVD while standardizing OCTA reporting.

Role of multimodal imaging in coexistent pachychoroid spectrum disease.

PURPOSE: To describe the role of multimodal imaging in a case of coexisting pachychoroid diseases. CASE DESCRIPTION: We report a case of a 43 year old lady with coexistent central serous chorioretinopathy (CSC) and pachychoroid neovasculopathy (PNV) in the same eye which posed a diagnostic challenge. Fundus examination showed neurosensory detachment (NSD) at the macula along with retinal pigment epithelial alterations. Optical coherence tomography (OCT) showed a shallow pigment epithelial detachment and OCT angiography showed the presence of vascular network in outer retina choriocapillaris slab suggesting a diagnosis of PNV. However, fundus fluorescein angiography (FFA) showed a smoke stack leak adjacent to the site of vascular network. Focal laser photocoagulation of the leaky point resulted in resolution of NSD pointing towards a diagnosis of CSC. CONCLUSION: This case emphasises the role of multimodal imaging in identifying the source of leak in coexistent pachychoroid spectrum diseases.

Targeted laser photocoagulation of larger capillary aneurysms with rim in diabetic macular edema.

This is a retrospective series of five eyes of four cases with diabetic macular edema (DME) secondary to large capillary aneurysms. Larger capillary aneurysms were identified noninvasively based on the presence of white rim in color photograph. On optical coherence tomography (OCT), the larger capillary aneurysms were seen as vertically oval structures with heterogeneous lumen and hyperreflective margin. Two of the four eyes were treated with intravitreal therapy with poor response before considering laser photocoagulation. In one eye, laser photocoagulation was considered as primary therapy in view of the poor response to intravitreal therapy in the fellow eye. In one eye, intravitreal steroid with prompt laser was considered. In one eye, laser was considered as primary therapy. Complete obliteration of the capillary lumen was noted on OCT in all the five eyes after laser photocoagulation. Complete resolution of macular edema was noted in all the five eyes with no recurrence over a follow-up period of 4-18 months. DME secondary to larger capillary aneurysms responds well to targeted laser photocoagulation. These larger capillary aneurysms can be identified on clinical examination and color photograph by the presence of white rim and can be confirmed on OCT.

Laser photocoagulation of a hypofluorescent perifoveal exudative vascular anomalous complex/capillary macroaneurysm.

PURPOSE: To report successful treatment of a hypofluorescent perifoveal exudative vascular anomalous complex (PEVAC)/capillary macroaneurysm. CASE DESCRIPTION: A 63 year old healthy gentleman had a perifoveal isolated aneurysmal lesion with white rim. Optical coherence tomography (OCT) showed cystoid macular edema (CME) with neurosensory detachment. The aneurysmal lesion was seen in the inner retina as a hyperreflective intraretinal structure with a heterogenous lumen suggestive of PEVAC/capillary macroaneurysm. OCT angiography showed a capillary loop and a slightly hyperreflective lesion at the tip of the loop in the superficial capillary plexus slab. Minimal reduction in edema was noted following one dose of intravitreal triamcinolone (2 mg). Fundus fluorescein angiography performed at 6 weeks demonstrated the capillary loop, but the aneurysmal lesion remained hypofluorescent with no definite leak in the late phase. Few perifoveal microaneurysms were seen in both the eyes. Six weeks later, focal laser photocoagulation of the aneurysmal lesion was performed, which resulted in complete resolution of macular edema at 1 month. There was no recurrence of macular edema till his recent follow up, which is 4 month post laser. DISCUSSION: PEVAC is typically described as unifocal lesion and is not associated with other retinal vascular abnormalities. But in this case, in addition to the lesion, perifoveal microaneurysms were seen in both the eyes. Despite the absence of leak on fundus fluorescein angiography, targeted focal laser photocoagulation resulted in complete resolution of macular edema at 1 month. CONCLUSION: Laser photocoagulation would be helpful even in hypofluorescent PEVAC/capillary macroaneurysms.

Subhyaloid hypopyon as a diagnostic cue in syphilitic necrotizing retinitis.

PURPOSE: To describes one case of syphilitic necrotizing retinitis and one case of presumed syphilitic necrotizing retinitis with presence of subhyaloid hypopyon. CASE DESCRIPTION: We report two cases of necrotizing retinitis, which were noted to have yellow boat-shaped lesions at the inferior edge of retinitis resembling subhyaloid hypopyon. The subhyaloid location was confirmed on optical coherence tomography in one case. Both the cases were positive for venereal disease research laboratory test (VDRL) and Treponema pallidum hemagglutination (TPHA). But in one case, polymerase chain reaction (PCR) of the aqueous humor was positive for Pseudomonas aeruginosa and responded well to piperacillin. As piperacillin is effective against Pseudomonas and the efficacy of piperacillin in the management of syphilis is not studied, we may have to consider it as a case of presumed syphilitic retinitis. DISCUSSION: Subhyaloid hypopyon is an uncommon presentation and is reported in two cases of syphilitic necrotizing retinitis in literature. Severe infection and necrosis confined to the inner retina leads to collection of white blood cells and necrotic material in the subhyaloid space and would settle down resulting in subhyaloid hypopyon. Two cases of subhyaloid hypopyon reported in literature and 2 cases reported in our article are syphilitic retinitis and is not reported in other entities. CONCLUSION: It is possible that subhyaloid hypopyon may serve as a diagnostic cue in syphilitic necrotizing retinitis.

Predictors of visual outcome in post-fever retinitis: a retrospective analysis.

PURPOSE: To identify the predictors of final visual outcome in cases with post-fever retinitis (PFR). METHODS: This is a retrospective study of cases with diagnosis of post-fever retinitis. Colour fundus photograph and optical coherence tomography (OCT) parameters at presentation and final visit were analysed. Various factors at presentation [age, systemic illness, best-corrected visual acuity (BCVA), area of retinitis and hard exudates, OCT parameters], at final visit (OCT parameters) and the treatment modalities used were correlated with BCVA at final visit. RESULTS: Twenty-four eyes of 16 patients with PFR were included in the study. Median BCVA at presentation was 6/60 and at final visit was 6/9. By multiple linear regression after adjusting for other variables, for every 1 unit increase in height of subretinal fluid (SRF) at fovea at presentation, the value of final BCVA decreased by 0.001 unit. For every 1 unit increase in extent of ellipsoid zone (EZ) loss and subfoveal deposit height, the value of final BCVA decreased by 0.0001 unit and 0.004 unit, respectively. The baseline OCT parameters that had negative correlation with final BCVA included central macular thickness (r: - 0.5182, p: 0.02), maximum SRF height (r: - 0.5539, p < 0.01) and SRF height at fovea (r: - 0.582, p < 0.01). The OCT parameters at final visit which had a negative correlation with final BCVA included disorganisation of retinal inner layers (DRIL) within 1000 microns from centre of fovea (r: - 0.6494, p < 0.01), height of subfoveal deposit (r: - 0.7627, p < 0.01), horizontal extent of subfoveal deposit (r: - 0.6695, p < 0.01) and extent of EZ loss (r: - 0.8216, p < 0.01). CONCLUSION: Height of SRF at presentation, extent of EZ loss and subfoveal deposit height at final visit were associated with poor final BCVA in PFR.

Ocular Injury due to Arecanut: A Unique Occupational Hazard in Central Karnataka.

PURPOSE: To evaluate the ocular manifestations and visual outcomes of ocular injury by arecanut. METHODS: We analysed cases with ocular injury by arecanut from August 2018 to December 2019, retrospectively. Mode of injury, visual acuity and ocular manifestations of trauma were recorded. RESULTS: Out of the 40 cases, closed globe injuries were seen in 97.5% of cases. All the injuries were due to the direct impact of arecanut during harvesting. The mean age was 45.15 ± 12.84 years. The mean best-corrected visual acuity (BCVA) at presentation was 20/40. A significant number of cases (35%) required surgical intervention. Mean BCVA at final follow-up was 20/30 but 16.66% of cases had BCVA of <20/60 even after definitive therapy. CONCLUSION: Ocular trauma due to arecanut is an important and preventable cause of visual impairment in central Karnataka. Modifications in harvesting technique would prevent ocular injuries.