Persistence of foveal capillary plexi in a case of fovea plana evident on OCT angiography.

We report the case of a 12-year-old boy with fovea plana discovered on a systematic work-up. His best-corrected visual acuity was limited to 20/25 in both eyes. Anterior segment examination showed no evidence of iris transillumination or aniridia. Macular OCT revealed persistence of the inner nuclear layers in the foveolar area and an absence of foveal pits, suggesting a diagnosis of fovea plana. Fluorescein angiography revealed that the foveal avascular zone (FAZ) was absent. OCT angiography revealed persistence of the superficial and deep capillary plexi. Our case confirms that OCT angiography affords additional insights into macular exploration and the diagnosis of fovea plana by revealing absence of the foveal pit associated with persistence of both superficial and deep capillary plexi in the foveal area.

Posterior segment involvement in cat-scratch disease: A case series.

INTRODUCTION: Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. MATERIALS AND METHODS: A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrénées. RESULTS: Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. CONCLUSION: Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.

[Management of complicated retinal detachment using a heavy silicon oil as temporary tamponade]. / Tamponnement interne par huile de silicone lourde (Oxane Hd) dans les décollements de rétine complexes.

PURPOSE: To assess the efficacy and safety of a heavy silicon oil (a silicon oil-RMN3 mixture, a mixed fluorinated and hydrocarbonated olefin) as temporary internal tamponade in selected cases of retinal detachment with inferior breaks. PATIENTS AND METHODS: Forty-six patients were operated on (inferior and/or posterior breaks: 38; proliferative vitreoretinopathy > or =C2: 18; anterior proliferative vitreoretinopathy: 14), with a mean follow-up of 39 months. Seventeen patients were operated on with a heavy silicon oil of a 1.03 g/cm3 density and 29 patients with a silicon oil of a 1.02 g/cm3 density. Heavy silicon oil was removed in 41 patients after a mean of 9.3 weeks. RESULTS: Anatomic success was achieved in 35 cases after a mean follow-up of 39 months. Recurrent retinal detachment with proliferative vitreoretinopathy occurred in eight cases during heavy silicon oil tamponade. The removal was difficult in three cases with the 1.02 g/cm3 density silicon oil. Complications included glaucoma (eight eyes), major emulsification (two eyes), and an intraocular inflammation reaction to topical steroids (five eyes). CONCLUSION: Heavy silicon oil (Oxane Hd) is as safe and effective as standard silicon oil in the treatment of selected retinal detachment, but intraocular manipulations are quite difficult. A prospective study is necessary to compare the efficacy of Oxane Hd and standard silicon oil in selected cases of retinal detachment with inferior breaks and in cases of large inferior retinectomy.

[Specifications of retinal detachment surgery in highly myopic eyes of 10 or more dioptres and hemorrhagic complications: 79 cases]. / Particularités du traitement chirurgical du décollement de rétine du myope fort de plus de 10 dioptries et son risque hémorragique. A propos de 79 cas.

INTRODUCTION: We report a series of 79 eyes undergoing primary surgery for rhegmatogenous retinal detachment associated with severe myopia greater than 10 diopters. Specific surgical procedures are recommended for these patients in order to minimize the high incidence of postoperative hemorrhagic complications. MATERIALS AND METHODS: Seventy-nine eyes of 76 patients treated for retinal detachment with severe myopia greater than 10 diopters were reviewed. Scleral buckling was performed in 21 eyes and pars plana vitrectomy in 58 eyes. RESULTS: After a mean follow-up period of 23.8 months, the final anatomical success rate was 93.7% (74 cases). Postoperative hemorrhagic complications (suprachoroidal hemorrhage and vitreous hemorrhage) occurred in four cases after scleral buckling and in ten cases after vitrectomy. DISCUSSION: In this study, primary scleral buckling for retinal detachment was less frequently performed than vitrectomy. Broad scleral buckling may not be associated with higher postoperative hemorrhagic complications, when the buckle does not extend over six clock hours. Postoperative hemorrhagic complications also occurred after vitrectomy; however, scleral buckling associated with vitrectomy does not seem to increase the complication rate. CONCLUSION: This retrospective study of 79 cases of rhegmatogenous retinal detachment with severe myopia higher than 10 diopters suggests that vitrectomy is often considered a primary procedure. Broad scleral buckling associated with vitrectomy is a safe and effective procedure, with an acceptable incidence of complications when not extending over six clock hours.