Aneurysmal type 2 neovascularization: A new entity.

PURPOSE: To report three cases of aneurysmal type 2 neovascularization (AT2), a novel entity within the pachychoroid disease (PD) spectrum. METHODS: We conducted an observational retrospective study of three patients with subretinal polyps treated with intravitreal aflibercept. We reviewed clinical and imaging data of the three patients. Best corrected visual acuity (BCVA), central macular thickness (CMT), choroidal subfoveal thickness, choroidal thickness under the polyps and the presence of a dry macula were assessed at baseline and throughout the follow-up. RESULTS: All of the patients showed granular hypoautofluorescence on fundus autofluorescence. Indocyanine green angiography revealed prominent hyperfluorescent branching vascular networks ending in multiple aneurysmal dilatations. Optical coherence tomography (OCT) demonstrated that the aneurysmal lesions were localized in the subretinal space. Additionally, OCT showed retinal pigment epithelial microtears, the double-layer sign and pachyvessels. En face OCT-A perfectly defined prominent telangiectatic branching vascular networks in all the patients, but only revealed polyps in two out of the three patients. Cross-sectional OCT-A demonstrated polyps as patchy circular hypoflow signals in each case. After the intravitreal treatment, BCVA remained unimproved in all of the patients, despite decreased CMT and achievement of a dry macula, as a result of the development of subretinal fibrosis. CONCLUSION: In summary, we describe a new entity within the spectrum of PD, which we have termed AT2. This novel disease is characterized by the presence of aneurysmal dilatations in the subretinal space, along with the typical features of PD, such as choroidal vascular hyperpermeability, thickening of the choroid and pachyvessels.

Optical coherence tomography angiography analysis of choroidal microvasculature in various forms of diabetic macular edema.

INTRODUCTION: Optical coherence tomography angiography (OCTA) research in diabetic macular edema (DME) has focused on the retinal microvasculature with little attention to the choroid. The goal of this study was to analyze the association between quantitative choroidal OCTA parameters and various forms of DME observed on optical coherence tomography. METHODS: We conducted a retrospective study of 61 eyes of 53 patients with DME. DME was classified as early or advanced, and as sponge-like diffuse retinal thickening (DRT), cystoid macular edema (CME) or serous retinal detachment (SRD). Quantitative OCTA parameters (vessel density [VD] in the superficial capillary plexus [SCP], middle capillary plexus [MCP], deep capillary plexus [DCP] and choriocapillaris [CC]) were recorded. RESULTS: The VD in the CC and SCP was significantly higher in patients with early DME compared to patients with advanced DME (P value<0.01). CC VD was lower in subjects with SRD compared to DRT and CME (P value<0.001). Moreover, it was lower in CME compared to DRT (P value<0.05). No statistical differences were found between VD in the MCP and DCP (P value>0.05). Furthermore, CC VD was lower in patients with increased retinal thickness, disruption of the ellipsoid zone (EZ) or external limiting membrane (ELM), and disorganization of the inner retinal layers (DRIL) (P value<0.05). CONCLUSION: CC ischemia plays an important role in the pathogenesis of DME. We demonstrated a decrease in CC VD in patients with severe DME, SRD, retinal thickening, EZ and/or ELM disruption and DRIL.

Multimodal imaging in phototoxic maculopathy: description of findings in a series of 12 patients. / Imagen multimodal en la maculopatía fototóxica: descripción de hallazgos en una serie de 12 pacientes.

OBJECTIVE: To study the differences between solar retinopathy (SR) and the maculopathy produced by laser pointer (LPM) using multimodal imaging. METHOD: A retrospective series is presented of 20 eyes of 12 patients with injuries associated with light, 7 with SR-compatible injuries, and 5 with LPM. At diagnosis, a complete ophthalmological examination was performed, including visual acuity (VA), retinography, and spectral domain optical coherence tomography (OCT). The patients were followed-up for a mean period of 20 months. RESULTS: LPM is common in paediatrics (mean age 15.60±1.5years), and SR affects patients of all ages (mean age 47.56±1.51years). VA at diagnosis in LPM is greater, and recovery is more complete than in solar retinopathy. In conventional retinography, SR is shown as a single lesion in the macular area (100% of cases), while LPM usually presents as multifocal lesions (86% of cases). Infrared reflectance makes this difference clearer. The main sign in OCT is the disruption of the ellipsoid layer and interdigitation zone. This sign is maintained over time, and its size is greater in the SR than in the LPM. Hyper-reflective columns and hyper-reflective reaction of the retinal pigment epithelium are associated with the acute phase. CONCLUSIONS: LPM and SR show significant differences in the type of patient affected, as well as in the signs in multimodal imaging, as well as in functional impairment and their evolution.

Treat-and-extend approach with aflibercept: Effects on different subtypes of age-related choroidal neovascularisation. / Estrategia «Tratar y Extender¼ con aflibercept: efecto en diferentes tipos de neovascularización coroidea asociada a la edad.

OBJECTIVE: To describe functional/morphological outcomes of treat-and-extend (TAE) with aflibercept in different subtypes of neovascularizations (CNV) secondary to exudative age-related macular degeneration (AMD). METHODS: Retrospective study was conducted on 30 eyes of 30 patients treated with 2 mg-aflibercept according to a TAE protocol. Examinations included best corrected visual acuity (BCVA), number of injections, and visits needed. A quantitative/qualitative analysis was also performed with fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) at baseline, and at 3, 6, and 12 months. RESULTS: BCVA significantly improved from 0.61±0.26 logMAR to 0.38±0.34 logMAR. Among the total AMD patients, type 1 CNV was diagnosed in 11 eyes (36%), type 2 CNV in 7 eyes (23%), mixed CNV in 5 eyes (16%), and type 3 CNV or retinal angiomatous proliferation (RAP) in 7 eyes (23%). The final mean number of injections was 7.5±1.65, 8.71±0.76, 7.4±0.89, 7.2±0.7, and number of visits 6.6±2.17, 7.89±1.46, 5.8±1.7, and 7.14±1.57, respectively in type 1, type 2, mixed, and type 3 or RAP. There was no difference between the different subtypes of CNV (P>.05). CONCLUSIONS: Aflibercept in TAE is effective for all exudative-AMD subtypes. No significant differences in patient's visual gain, mean number of injections, or number of visits needed were found among the subtypes of CNV.

Focal choroidal excavation: Clinical findings and complications.

OBJECTIVE: To describe the clinical findings and its complications in 2 patients with focal choroidal excavation (FCE). METHODS: A retrospective case-series including 4 eyes of 2 patients with FCE that underwent a comprehensive ophthalmological examination including slit-lamp examination, colour fundus photography, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography. RESULTS: In the 2 patients, both the anterior and posterior segment evaluations were mostly normal despite the of presence yellowish spots in the macular area of the right eye of patient 1, and of a small yellowish elevated lesion with serous macular detachment in the macular area of the left eye in patient 2. At diagnosis, SD-OCT revealed a conforming FCE in patient 1, and in patient 2, an FCE with perilesional subretinal fluid and a neuroepithelium detachment, suspicious of FCE complicated with central serous retinopathy (CSCR). At one year of follow-up, patient 1 developed choroidal neovascularisation (CNV) over the focal choroidal excavation. FA and indocyanine green angiography examinations revealed areas with hypofluorescence in earlier frames, and a diffuse leakage in late frames. After ranibizumab injections, the SD-OCT of patient 1 revealed no active exudation, while patient 2 showed partial resolution of subretinal fluid. CONCLUSIONS: FCE is a newly described entity of unclear aetiology. It is characterised by a choroidal excavation in eyes, with absence of posterior staphyloma, scleral ectasia, trauma, or retinal disease. Although most lesions remain stable, there could be an association with CRSC or CNV.

[Safety and efficacy of outpatient glaucoma surgery]. / Seguridad y eficacia de la cirugía ambulatoria del glaucoma.

PURPOSE: To assess the outcome of filtration surgery and to evaluate the incidence of postoperative complications in outpatient glaucoma surgery cases. METHODS: This retrospective study comprised 134 patients with glaucoma who underwent trabeculectomy either as out-patient (n= 54) or as in-patient (n= 80). The authors compared demographic data, preoperative glaucoma medications, surgical procedures, amount of filtration achieved, and postoperative complications between both groups. RESULTS: The two groups were comparable in terms of age, gender distribution, or degree and duration of glaucoma and number of ocular hypotensive medications. The overall intraocular pressure (IOP) reduction was similar in both groups. There was no statistically significant difference in mean IOP three months following surgery (p=0.16), the incidence of hyphaema (p=0.36), shallow anterior chamber (p=0.38), or leaking bleb (p=0.22) between the two groups. The average postoperative follow-up and the number of control visits were similar in both groups. CONCLUSIONS: The low rate of complications and the final results confirm the safety and security of ambulatory surgery for glaucoma.

[Clinical and angiographic findings in three patients with serpiginous choroiditis]. / Manifestaciones clínicas y angiográficas en tres pacientes con coroidopatía serpiginosa.

PURPOSE/METHODS: Serpiginous choroiditis is a rare, chronic, progressive, and recurrent bilateral disorder primarily involving the choriocapillaris and the retinal pigment epithelium. Progression typically occurs as pseudopodia extensions away from the optic discs and usually infringes upon the macula and foveal region. RESULTS/CONCLUSIONS: We studied three cases of geographic choroidopathy, showing the ophthalmoscopic picture and the fluorescein angiographic of the fundus oculi, characterised by typical disease lesions. Finally, some considerations in differential diagnosis between pigment epithelium inflammatory diseases will be reported.

[Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery]. / Factores clínicos de riesgo de la vitreorretinopatía proliferativa después de la cirugía del desprendimiento de retina.

PURPOSE: To identify the clinical risk factors for the development of severe proliferative vitreoretinopathy (PVR) after scleral buckling procedures for retinal detachment (RD). METHODS: A retrospective study of 124 patients with rhegmatogeneus RD treated initially with buckling procedures, with either no PVR or with no PVR of grade C-l or less at initial examination was conducted. After surgery, severe PVR was defined as grade C-2 or worse. Univariate analysis and stepwise logistic regression evaluated the data relating to 34 statistical series (96 variables). RESULTS: Severe PVR develop after surgery in 13 patients (10.48%). Seven significant predictive variables were identified: grade A preoperative PVR (p=0.005), detachment involving more than 2 quadrants (p=0.019), preoperative vitreous traction (p=0.002), intravitreal injection (p=0.046), scleral perforation (p=0.001), unsealed break (p=0.001), and postoperative vitreous traction (p=0.012). CONCLUSIONS: The results indicate that in addition to the extent of detachment, and presence of preoperative inflammation or low grade PVR, iatrogenic problems also are important factors in the pathogenesis of severe PVR after surgery for RD.