ACUTE EXUDATIVE MACULOPATHY AND BACILLARY LAYER DETACHMENT IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY AFTER PHOTODYNAMIC THERAPY.

PURPOSE: To describe the incidence and characteristics of photodynamic therapy-induced acute exudative maculopathy (PAEM) and bacillary layer detachment in patients with chronic central serous chorioretinopathy. METHODS: This was a prospective observational case series including 92 eyes of 75 patients who underwent photodynamic therapy. Best-corrected visual acuity, optical coherence tomography, and optical coherence tomography angiography were performed before, 3 days, 1 month, and 3 months after half-fluence photodynamic therapy. Two groups were established depending on the presence or absence (N = 28 and N = 64, respectively) of PAEM. Choriocapillaris flow voids increase, subfoveal choroidal thickness, and the presence of choroidal neovascularization were collected. RESULTS: The incidence of PAEM was 28/92 (30.4%). There was no difference in the age, sex, baseline subretinal fluid, subfoveal choroidal thickness, or the presence of choroidal neovascularization between groups (P ≥ 0.094). No differences emerged in the subretinal fluid at 1 and 3 months after photodynamic therapy between groups (P ≥ 0.524), nor in the mean best-corrected visual acuity gain at 3 months (4.1 ± 7.6 vs. 3.6 ± 6.4 letters; P = 0.773). A bacillary layer detachment was observed in 13 patients with PAEM (46.4%). CONCLUSION: Photodynamic therapy-induced acute exudative maculopathy is frequent in patients with chronic central serous chorioretinopathy but has a favorable prognosis. There was no association between PAEM and age, sex, subfoveal choroidal thickness, or choroidal neovascularization; however, it was related to choriocapillaris flow voids increase.

Reduced macular vessel density in COVID-19 patients with and without associated thrombotic events using optical coherence tomography angiography.

PURPOSE: Thrombotic events (TE) represent one of the major complications of SARS-CoV-2 infection. The objective is to evaluate vessel density (VD) and perfusion density (PD) by optical coherence tomography angiography (OCTA) in COVID-19 patients, and compare the findings with healthy controls. The secondary objective is to evaluate if there are differences in OCTA parameters between COVID-19 patients with and without associated TE. METHODS: Cross-sectional case-control study that included patients with laboratory-confirmed diagnosis of COVID-19 with and without TE related to the infection and age-matched healthy controls. Ophthalmological examination and OCTA were performed 12 weeks after diagnosis. Demographic data and medical history were collected. Macular OCTA parameters in the superficial retinal plexus were analyzed according to ETDRS sectors. RESULTS: Ninety patients were included, 19 (20%) COVID-19 patients with associated TE, 47 (49.5%) COVID-19 patients without TE, and 29 (30.5%) healthy controls. Fifty-three (55.7%) were male, mean age 54.4 (SD 10.2) years. COVID-19 patients presented significantly lower VD than healthy controls: central (p = 0.003), inner ring (p = 0.026), outer ring (p = 0.001). PD was also significantly decreased: outer ring (p = 0.003), full area (p = 0.001). No differences in OCTA parameters were found between COVID-19 patients with and without TE. CONCLUSIONS: OCTA represents a promising tool for the in vivo assessment of microvascular changes in COVID-19. Patients with SARS-CoV-2 infection show lower VD and PD compared to healthy controls. However, no differences were found between COVID-19 when considering TE. Prospective studies are required to further evaluate the retinal microvascular involvement of SARS-CoV-2 and its impact on the vasculature of other organs.

Evaluation of mechanical closure resistance of sutureless vitrectomy sclerotomies after conjunctival cauterization with bipolar diathermy forceps.

BACKGROUND: Suturing is the most widely used technique to close leaking sclerotomies after transconjunctival sutureless vitrectomy (TSV). However, with the aim of avoiding the disadvantages caused by conjunctival stitches, there have been described other closure techniques, such as the cauterization of the conjunctiva placed over the incisions. To continue advancing knowledge of the incisional occlusion effect achieved by conjunctival diathermy, it would be also interesting to study the wound closure resistance obtained under intraocular pressure (IOP) changes, given that in the early postoperative period eyes are subjected to pressure stress. In our study, we compare the mechanical resistance observed in sclerotomies treated with bipolar diathermy after TSV compared to that found in incisions in which cauterization was not performed. METHODS: This was an experimental, randomized, and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, cauterization was performed with bipolar diathermy forceps on the conjunctiva placed over one of the superior sclerotomy sites; no maneuver was performed over the other superior incision. IOP was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape. RESULTS: In 35 % of cases (28 of 80 eyes), sclerotomies subjected to diathermy allowed intraocular fluid escape first (p = 0.01). When comparing opening pressure values, cauterized incisions leaked at significantly higher pressure levels than those in which diathermy was not applied (p < 0.001). CONCLUSIONS: Bipolar diathermy on sutureless sclerotomies has demonstrated to be, in our experimental model, an effective method for increasing the sclerotomy closure resistance. Although its use in vitrectomized eyes has previously been described, our study is the first to analyze the response of cauterized sclerotomies to IOP increases.

Association between macular perfusion and photoreceptor layer status in diabetic macular edema.

PURPOSE: To evaluate the relationship between the photoreceptor layer status (inner segment ellipsoid band and external limiting membrane) and the foveal avascular zone size, as a result of macular perfusion, in patients with diabetic macular edema. METHODS: This observational case series study included 151 eyes of 118 patients with naive diabetic macular edema. The length of the disrupted photoreceptor layer was assessed by optical coherence tomography. The foveal avascular zone diameter was measured on fluorescein angiogram. RESULTS: No significant association was found between the foveal avascular zone size and the mean lengths of the disrupted inner segment ellipsoid band nor the external limiting membrane in patients with naive diabetic macular edema. CONCLUSION: Macular ischemia, which lengthens the distance from the perifoveal vessels to the center of the fovea and may disrupt the normal flow of nutrients by simple diffusion to the photoreceptor line, does not seem to influence on inner segment ellipsoid band nor external limiting membrane integrity. Future studies may evaluate the effect of choroidal vascularization on the photoreceptor layer status to enhance the knowledge about the photoreceptor layer nutrients source.

Multilayered Exudative Bacillary Layer Detachment in Active Choroidal Neovascularization: A New Optical Coherence Tomography Sign.

In this article, we present three cases diagnosed with active choroidal neovascularization (CNV): two cases diagnosed with neovascular age-related macular degeneration (nAMD), and one case with myopic CNV in an elderly eye that presented a characteristic and unique optical coherence tomography (OCT) sign consisting of well-defined, circular-shaped multiple concentric layers of alternating iso-hyperreflective material located between the external limiting membrane and outer photoreceptor layers, which seems to be a multilayered bacillary layer detachment (BALAD). Multilayered exudative BALAD in active CNV may be a new and characteristic OCT sign. [Ophthalmic Surg Lasers Imaging Retina 2024;55:92-94.].

Surgical Approaches to Serous Retinal Detachment With Retina-Lens Touch in Eyes With Nanophthalmos.

Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina-lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.

Subfoveal choroidal thickness as a potential predictor of treatment response after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy.

OBJECTIVE: To evaluate the impact of subfoveal choroidal thickness (SFCT) and other clinical biomarkers in intravitreal anti-vascular endothelial growth factor response in treatment-naive Caucasian patients diagnosed with polypoidal choroidal vasculopathy (PCV/AT1). DESIGN: Cross-sectional study. PARTICIPANTS: Treatment-naive patients diagnosed with PCV/AT1 recruited in a single centre from January 2013 to December 2020. METHODS: Eligibility was determined in treatment-naive PCV patients who received a loading dose of 3 injections of 0.5 mg ranibizumab. A diagnosis of PCV/AT1 was made based on the diagnostic criteria in the efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with sumptomatic macular polypoidal choroidal vasculopathy study. Choroidal thickness was manually measured by enhanced depth imaging technology in Spectralis spectral domain optical coherence tomography. RESULTS: Eighty-three eyes of 83 patients were included in this study, 47 patients diagnosed with PCV/AT1 with a good response to 3 intravitreal injections of ranibizumab and 36 with a poor response. The receiver operating characteristic curve of treatment effect against the SFCT revealed that the area under the curve was 0.85 (range, 0.74-0.96). Based on the Youden index, the optimal SFCT cut-off point for predicting a poor response to anti-vascular endothelial growth factor is 257 µm. In the multivariate analysis, the SFCT remained statistically significant (odds ratio 1.02 [range, 1.01-1.04]; P = 0.008). The combined effect of treatment effect against clinical biomarkers produced an area under the curve of 0.90 (range, 0.82-0.98). CONCLUSION: SFCT is a risk factor for a poor response to the 3 loading injections of ranibizumab in treatment-naive PCV/AT1 Caucasian patients. A cut-off point of 257 µm could be a valuable parameter for defining the population at risk for an inadequate response to ranibizumab.

Intervortex Venous Anastomosis in the Macula in Central Serous Chorioretinopathy Imaged by En Face Optical Coherence Tomography.

PURPOSE: To assess the presence of macular intervortex venous anastomosis in central serous chorioretinopathy (CSCR) patients using en face optical coherence tomography (EF-OCT). METHODS: A cross-sectional study where EF-OCT 6 × 6 and 12 × 12 mm macular scans of patients with unilateral chronic CSCR were evaluated for anastomosis between vortex vein systems in the central macula. The presence of prominent anastomoses was defined as a connection with a diameter ≥150 µm between the inferotemporal and superotemporal vortex vein systems which crossed the temporal raphe. Three groups were studied: CSCR eyes (with an active disease with the presence of neurosensorial detachment; n = 135), fellow unaffected eyes (n = 135), and healthy eyes as controls (n = 110). Asymmetries, abrupt termination, sausaging, bulbosities and corkscrew appearance were also assessed. RESULTS: In 79.2% of the CSCR eyes there were prominent anastomoses in the central macula between the inferotemporal and superotemporal vortex vein systems, being more frequent than in fellow eyes and controls (51.8% and 58.2% respectively). The number of anastomotic connections was higher in the affected eye group (2.9 ± 1.8) than in the unaffected fellow eye group (2.1 ± 1.7) and the controls (1.5 ± 1.6) (p < 0.001). Asymmetry, abrupt terminations and the corkscrew appearance of the choroidal vessels were more frequent in the affected eyes, although no differences in sausaging or bulbosities were observed. CONCLUSIONS: Intervortex venous anastomoses in the macula were common in CSCR, being more frequently observed in affected eyes than in fellow unaffected eyes and healthy controls. This anatomical variation could have important implications concerning the pathogenesis and classification of the disease.

Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment.

PURPOSE: To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). METHODS: This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. RESULTS: One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks (p < 0.001) and with increased myopia (p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44-7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21-1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29-1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08-0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. CONCLUSIONS: Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year.

Utility of an additional photodynamic therapy session after multiple failed PDT treatments in chronic central serous chorioretinopathy.

PURPOSE: To assess the efficacy of an additional photodynamic therapy (PDT) in chronic central serous chorioretinopathy (cCSCR) patients who have two or more previous failed PDTs. METHODS: Ten eyes of 10 patients with cCSCR who had received two or more PDTs without complete resolution of the subretinal fluid (SRF) or with early recurrence (before 3 months) were included. An additional half-fluence PDT was performed. Swept-source optical coherence tomography (OCT) and OCT angiography were performed before, 3 days, 1 month, 3 months, 6 months and 12 months after treatment. Age, gender, best-corrected visual acuity (BCVA), subfoveal choroidal thickness, SRF and vessel occlusion in the choriocapillaris (CC) were collected. RESULTS: The median number of previous PDTs was 3 (range 2 to 4). BCVA before and 12 months after treatment was 72 letters (50 to 95) and 78 letters (55 to 100) (p=0.094). Median initial SRF was 94 µm (50 to 306), being 0 µm (range 0 to 81) at the end of the follow-up (p=0.007). After the additional PDT, 8 out of 10 patients had a complete SRF resorption. All the patients except one who had a complete response (7/8) had an occlusion in the CC 3 days after PDT. CONCLUSION: Despite previous failed PDTs in cCSCR, good anatomical results can be achieved, this being more likely if an early vessel occlusion in the CC is observed. Even when the BCVA did not improve, the high rate of fluid resolution could justify the additional PDT treatment in order to maintain visual function.

Early changes in choriocapillaris flow voids as an efficacy biomarker of photodynamic therapy in central serous chorioretinopathy.

PURPOSE: To assess the early changes produced in the choriocapillaris (CC) and choroidal vasculature using swept-source optical coherence tomography angiography (SS-OCTA) in patients with persistent central serous chorioretinopathy (CSCR) as predictors of the efficacy after photodynamic therapy (PDT). METHODS: Prospective observational study in 52 eyes of 52 patients with persistent subretinal fluid (SRF). SS-OCTA scans of the 6 × 6 mm macular region were assessed before; 2-3 days, one month and three months after half-fluence PDT. Vessel occlusion in the CC and choroid was measured as flow signal voids (FSV). RESULTS: A 3.67 ± 4.12 and 2.76 ± 3.63 fold increase in CC and CH FSV, due to vessel occlusion, was observed at 2-3 days after PDT versus baseline. There was less SRF at 3 months in patients with an increase in FSV (≥1-fold) compared to those without this increase (<1-fold) after PDT (p ≤ 0.003). An association between the increase in CC and choroidal FSV at the early control (2-3 days) and the height of SRF at 1 month was found (R=-0.405; p = 0.002 and R=-0.356; p = 0.008 respectively). In a multivariate model, the SRF at one month was not associated with age, gender, visual acuity, or FSV (p ≥ 0.288). At 3 months, flow restoration was achieved in the choroid versus the baseline (p = 0.619), but there was a persistent increase in the CC FSV (p = 0.008). CONCLUSIONS: Early vessel occlusion by OCTA after PDT in CSCR was associated with good treatment response. Therefore, an increase in FSV immediately after PDT could be a biomarker to predict SRF resorption.

Repeatability of choriocapillaris flow voids by optical coherence tomography angiography in central serous chorioretinopathy.

PURPOSE: To assess the repeatability of flow signal voids (FSV) measurements of the choriocapillaris (CC) and choroid (CH) in central serous chorioretinopathy (CSCR) by Swept-Source optical coherence tomography angiography (SS-OCTA). METHODS: Cross-sectional study including 104 eyes of 52 patients with unilateral CSCR. Two consecutive macular 6x6 mm SS-OCTA scans (Plex Elite 9000; Zeiss, Dublin, CA) were obtained from the affected eyes with persistent subretinal fluid (SRF) (CSCR group) and the fellow unaffected eyes (control group). FSV area and the number of contours measurements were analyzed using three slabs: inner CC, outer CC and CH. The repeatability of the measurements was assessed with intraclass correlation coefficients (ICC) and coefficients of variation (CV). RESULTS: In the CSCR group, ICCs for the FSV area in the three slabs were all ≥0.859, observing higher values for the outer CC and the CH (0.959 and 0.964) than for the inner CC (0.859). Similar ICC values were obtained for the FSV area in control eyes, observing the highest values for the outer CC (0.949), followed by the CH (0.932) and inner CC (0.844). Regarding the FSV number of contours measurements, ICCs were higher for the outer CC and CH (0.949 and 0.932) than for inner CC (0.844). CV for the FSV area was 4.7%, 3.8% and 8.6% in the CSCR eyes and 4.8%, 3.9% and 9.3% in the control group for the inner CC, outer CC and CH respectively. CONCLUSION: SS-OCTA offers good repeatability to quantify macular FSV in CSCR eyes and fellow eyes.

Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning.

PURPOSE: To assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL). METHODS: Retrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n = 100); Group 2, partial SRF resorption (n = 66); and Group 3, absence of any SRF resorption (n = 50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1 vs. 2 and 3 together; 3rd compares groups 2 vs. 3. RESULTS: The mean age was 55.6 ± 10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529 ± 0.035. In the second model, the mean accuracy was higher (0.670 ± 0.046). In the third approach, the algorithm showed a precision of 0.74 ± 0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69 ± 0.15 in group 3 (absence of SRF resolution). CONCLUSION: Despite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.

Clinical characteristics of full thickness macular holes that closed without surgery.

PURPOSE: To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH). METHODS: Retrospective collaborative study of FTMH that closed without surgical intervention. RESULTS: A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final VA correlated to the basal diameter (p<0.001). Time for closure of FTMH (median 2.8 months) correlated to the narrowest diameter (p<0.001) and the presence of SRF (p=0.001). Mean time for closure (in months) was 1.6 for eyes with trauma, 4.3 for eyes without trauma but with therapy for CME, 4.4 for eyes without trauma and without therapy in less than 200 µm in size and 24.7 for more than 200 µm. CONCLUSION: Our data suggest an observation period in new onset FTMH for non-surgical closure, in the setting of trauma, treatment of CME and size <200 µm.

Goldmann-Favre/Enhanced S Cone Syndrome, 30 years mysdiagnosed as gyrate atrophy.

PURPOSE: Case report of a Goldmann-Favre/Enhanced S Cone syndrome (GFS/ESCS) misdiagnosed for 30 years. OBSERVATIONS: Clinical case, the patient had been experiencing with poor nocturnal visual acuity since childhood. The fundus examination showed extensive areas of peripheral chorioretinal atrophy with posterior demarcation borders, and a clinical diagnosis of gyrate atrophy was established, although normal levels of ornithine should have made this diagnosis doubtful. 30 years later it was reassessed with electrophysiologic and genetic studies and diagnosed as Goldman-Favre/Enhanced S Cone Syndrome (GFS/ESCS). CONCLUSIONS AND IMPORTANCE: High phenotypic variability of GFS/ESCS makes it difficult to distinguish clinically from diseases such as retinitis pigmentosa, congenital retinoschisis, and gyrate atrophy. Electrophysiology and genetic studies aid in diagnosis. GFS/ESCS is a clinical diagnosis and should be suspected before molecular test. We present a novel mutation for this disease.

Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection.

PURPOSE: To describe macular vessel density and perfusion in COVID-19 patients using coherence tomography angiography (OCTA) and to investigate whether there is a correlation between retinal vascular abnormalities and clinical and laboratory parameters. METHODS: Cross-sectional analysis conducted at the Hospital Clinico San Carlos in Madrid, Spain. Patients with laboratory-confirmed COVID-19 that were attended in the Emergency Department (ED) from March 23 to March 29, 2020 were included. Fundus examination and OCTA were performed 4 weeks after being attended in ED. Macular OCTA parameters were analyzed and correlated with clinical (severity and hypoxemia- oxygen saturation < 92%) and laboratory parameters during hospital stay (D-Dimer-DD, lactate dehydrogenase-LDH and C-reactive protein-CRP). RESULTS: 80 patients were included, mean age 55(SD9) years old; 46.3% male. We reported macular vessel density and perfusion measurements in COVID-19 patients. Those patients with D-Dimer ≥ 500 ng/ml during SARS-CoV-2 infection had a decrease of central vessel density (mean difference 2.2; 95%CI 0.4-3.9) and perfusion density (mean difference 4.9; 95%CI 0.9-8.9) after the acute phase of COVID-19. These variations of vessel density and perfusion density were not documented in patients with LDH ≥ 500 U/L, CRP ≥ 10 mg/L and hypoxemia. CONCLUSIONS: COVID-19 patients showed short-term retinal vasculature abnormalities which may be related to a prothrombotic state associated with SARS-CoV-2 infection. Since the retinal microvasculature shares many morphological and physiological properties with the vasculature of other vital organs, further research is needed to establish whether patients with increased D-Dimer levels require more careful assessment and follow-up after COVID-19.

OBJETIVO: Evaluar la densidad vascular (DV) y la perfusión vascular (PV) retiniana en pacientes con COVID-19 mediante una angiografía por tomografía de coherencia óptica (OCTA), e investigar si existe una correlación entre las anomalías vasculares de la retina y los parámetros clínicos y de laboratorio. MÉTODOS: Análisis transversal realizado en el Hospital Clínico San Carlos, Madrid. Se incluyeron pacientes con diagnóstico confirmado de COVID-19 atendidos en el Servicio de Urgencias (SU) del 23 al 29 de marzo del 2020. Se realizó una exploración oftalmológica y OCTA cuatro semanas después de acudir al SU. Se analizaron los parámetros maculares de OCTA y se correlacionaron con parámetros clínicos (gravedad e hipoxemia-saturación de oxígeno < 92%) y de laboratorio durante la estancia hospitalaria (dímero D [DD], lactato deshidrogenasa [LDH] y proteína C reactiva [CRP]. RESULTADOS: Se incluyeron 80 pacientes, edad media 55 (DE nueve) años; 46,3% hombres. Las personas con DD > 500 ng/mL durante la infección por SARS-CoV-2 tuvieron una disminución de la DV central (diferencia de medias 2,2; IC 95% 0,4 a 3,9) y PV central (diferencia de medias 4,9; IC 95% 0,9 a 8,9) después de la fase aguda de COVID-19. Estas variaciones no se documentaron en los pacientes con LDH > = 500 U/L, CRP > = 10 mg/L y con hipoxemia. CONCLUSIONES: Los pacientes con COVID-19 mostraron anomalías de la vasculatura retiniana a corto plazo que pueden estar relacionadas con un estado protrombótico asociado con la infección por SARS-CoV-2. Dado que la microvasculatura de la retina comparte muchas propiedades morfológicas y fisiológicas con la vasculatura de otros órganos vitales, es necesario seguir investigando para determinar si los pacientes con niveles elevados de DD requieren una evaluación y un seguimiento más cuidadoso.

Reduced retinal vessel density in COVID-19 patients and elevated D-dimer levels during the acute phase of the infection.

PURPOSE: To describe macular vessel density and perfusion in COVID-19 patients using coherence tomography angiography (OCTA) and to investigate whether there is a correlation between retinal vascular abnormalities and clinical and laboratory parameters. METHODS: Cross-sectional analysis conducted at the Hospital Clinico San Carlos in Madrid, Spain. Patients with laboratory-confirmed COVID-19 that were attended in the Emergency Department (ED) from March 23 to March 29, 2020 were included. Fundus examination and OCTA were performed 4 weeks after being attended in ED. Macular OCTA parameters were analyzed and correlated with clinical (severity and hypoxemia- oxygen saturation<92%) and laboratory parameters during hospital stay (D-Dimer-DD, lactate dehydrogenase-LDH and C-reactive protein-CRP). RESULTS: 80 patients were included, mean age 55(SD9) years old; 46.3% male. We reported macular vessel density and perfusion measurements in COVID-19 patients. Those patients with D-Dimer≥500ng/ml during SARS-CoV-2 infection had a decrease of central vessel density (mean difference 2.2; 95%CI 0.4-3.9) and perfusion density (mean difference 4.9; 95%CI 0.9-8.9) after the acute phase of COVID-19. These variations of vessel density and perfusion density were not documented in patients with LDH≥500U/L, CRP≥10mg/L and hypoxemia. CONCLUSIONS: COVID-19 patients showed short-term retinal vasculature abnormalities which may be related to a prothrombotic state associated with SARS-CoV-2 infection. Since the retinal microvasculature shares many morphological and physiological properties with the vasculature of other vital organs, further research is needed to establish whether patients with increased D-Dimer levels require more careful assessment and follow-up after COVID-19.

Simple maneuver for unfolding giant retinal tear inverted flap trapped under perfluorocarbon bubble.

Inverted retinal detachments secondary to giant retinal tears are sometimes difficult to unfold with the perfluorocarbon (PFC) bubble even after complete epiretinal dissection due to the tendency of the flap to maintain its inverted configuration. The following maneuver has been performed in two cases. After reducing the PFC bubble volume to the level of the border of the flap, the tip of the same perfluorocarbon injection cannula is used to capture the inverted retinal flap with gentle suction. The flap is lifted and brought centripetally to "cover" the PFC bubble and then released by stopping suction. Then bubble volume can be increased to reapply the entire retina, allowing for continuation of surgery. This simple maneuver allows, in one quick surgical step and without the introduction of new instruments, unfolding of persistently inverted giant retinal tears.

Dexamethasone intravitreal implant in cystoid macular edema secondary to paclitaxel therapy.

PURPOSE: To report the first case of cystoid macular edema (CME) induced by nabpaclitaxel treated with intravitreal dexamethasone implant. OBSERVATIONS: A 67 year-old man diagnosed with unresectable pancreatic cancer presented with decreased vision in both eyes while receiving nab-paclitaxel. He was diagnosed with CME and intravitreal dexamethasone implants were administered in both eyes. Central retinal thickness (CRT) of both eye decreased 1 month after the implant but CME persisted. 2 months after Ozurdex implant nabpaclitaxel was discontinued, improving central macular thickness and the CME significantly in both eyes. CONCLUSION AND IMPORTANCE: Cessation of nab-paclitaxel could lead to resolution of CME more than intravitreal dexamethasone implant, although intravitreal dexamethasone implant achieved some reduction in central macular thickness.