Retinal neovascularization secondary to proliferative diabetic retinopathy characterized by spectral domain optical coherence tomography.

PURPOSE: The purpose of this study was to characterize diabetic retinal neovascularization (NV) and accompanying retinal and vitreal morphologic changes using high-resolution spectral domain optical coherence tomography. METHODS: A cross-sectional retrospective analysis was performed on 16 eyes of 14 nonconsecutive subjects with proliferative diabetic retinopathy that were seen between August 2011 and December 2011 at the New England Eye Center, Boston, MA. Patients who had NV of the disk, NV elsewhere, and intraretinal microvascular abnormalities were scanned using optical coherence tomography directly over the region of the abnormal vessels. RESULTS: Characteristic changes of the retinal vasculature, retina, and vitreous were seen in the 16 eyes with NV. This study describes optical coherence tomography characteristics of 1) NV of the disk, 2) NV elsewhere, 3) intraretinal microvascular abnormality, 4) NV causing traction without retinal detachment; and 5) NV causing traction with retinal detachment. The morphologic appearance of vitreous traction was found to be consistent with the previous histologic reports. CONCLUSION: It is possible to image diabetic NV using spectral domain optical coherence tomography and to visualize the spectrum of retinal, retinal vascular, and vitreal changes seen through these areas of abnormal retinal vasculature.

Exercise-induced acute changes in systolic blood pressure do not alter choroidal thickness as measured by a portable spectral-domain optical coherence tomography device.

PURPOSE: To measure choroidal thickness in patients manifesting an acute change in systemic arterial blood pressure using a portable spectral-domain optical coherence tomography device (iVue). METHODS: Fifteen patients (15 eyes) undergoing cardiac exercise stress testing were scanned using a portable spectral-domain optical coherence tomography system (iVue). Two scan protocols were used: cross line scan for measuring choroidal thickness and the retina map scan to measure retinal thickness. Each patient was scanned before and within 3 minutes after the stress test. Blood pressure was measured at the same time as the acquisition of the scans. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid-sclera junction at 500-µm intervals up to 1,000 µm temporal and nasal to the fovea. Retinal thickness was measured by an automated software. All choroidal thickness measurements were performed by two independent observers. RESULTS: Fifteen patients (15 eyes) with a mean age of 60.6 (±10.4 years) were scanned. There was a significant increase in systolic but not diastolic pressure after stress testing (P < 0.05). The mean choroidal thickness measurements showed no significant difference before and after exercise stress testing (P > 0.05). In addition, there was no significant difference in retinal thickness before and after stress testing measurements (P > 0.05). CONCLUSION: There was no change in choroidal thickness or retinal thickness, despite an acute change in the systemic systolic blood pressure induced by exercise.

Bilateral simultaneous central serous chorioretinopathy in a teenage girl with systemic arterial hypertension.

We present a case of bilateral simultaneous central serous chorioretinopathy (CSCR) in a teenage girl with a history of systemic arterial hypertension. A 19-year-old Caucasian female, with a history of systemic arterial hypertension, presented with gradual decrease in her central vision for 1 month. She was diagnosed with bilateral simultaneous CSCR, based on the findings of spectral domain optical coherence tomography (SD-OCT), indocyanine green angiography (ICG), fundus auto-fluorescence, fluorescein angiography and color fundus photographs, which are described. Blood pressure was 134/95 mmHg at presentation. Systemic evaluation failed to reveal a cause for the high blood pressure, and included a panel of blood tests, which were all normal. Her best-corrected visual acuity was 20/30 OD and 20/25 OS. Dilated fundus examination showed normal optic discs and retinal vasculature, with no evidence of hypertensive retinopathy. However, shallow retinal fluid associated with pigmentary changes was noted in the center of both maculae. OCT and ICG findings were consistent with the diagnosis of bilateral CSCR. CSCR can manifest in patients with demographics outside the range of those previously reported. This is the first report of CSCR occurring in a teenage girl, with a history of systemic arterial hypertension. It is important to consider this disease in any patient who has a clinically compatible presentation.

Pulmonary Kaposi sarcoma presenting as complete lung consolidation.

The patient in our case presented with progressive dyspnoea and cough. Chest radiograph reveals complete opacification of the hemithorax. Complete lung consolidation was not seen on chest CT. The patient in this case had extensive pulmonary and endobronchial Kaposi sarcoma (KS) that led to complete consolidation of the right lung that was diagnosed via bronchoscopy. After diagnosis, he was restarted on antiretroviral therapy and single-agent chemotherapy for treatment of pulmonary KS.

Case report on renal failure reversal in lambda chain multiple myeloma with bortezomib and dexamethasone.

Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count-18,900/µL with no bandemia, hemoglobin 10.8 gm/dL, potassium-6.7 mEq/L, bicarbonate-15 mEq/L, blood urea nitrogen-62 mg/dL, SCr-5.6 mg/dL (baseline: 1.10), and corrected calcium-11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen.

Analysis of choroidal thickness in eyes treated with focal laser photocoagulation using SD-OCT.

OBJECTIVE: To analyze the effect of focal laser photocoagulation on choroidal thickness in patients with diabetic macular edema (DME), using spectral-domain optical coherence tomography (SD-OCT). DESIGN: Retrospective review. PARTICIPANTS: Twenty-two eyes of 22 patients diagnosed with DME and treated with focal laser photocoagulation (treatment group) and 19 fellow treatment-naive eyes (control group) who underwent high-definition 1-line raster scanning using the Cirrus SD-OCT at the New England Eye Center, Tufts Medical Center (Boston, Mass.) between November 2009 and April 2012. METHODS: The SD-OCT images were analyzed for the measurement of choroidal thickness by 2 independent observers experienced in analyzing OCT images, before treatment and at 3 months after focal laser photocoagulation in the treatment group, and at baseline (when the fellow eye in the treatment group was treated) and at 3-month follow-up in the control group. RESULTS: There was no significant difference in the mean choroidal thickness in the treatment and control groups (n = 22, p = 0.93 and n = 19, p = 0.1, respectively) at 3-month follow-up. There was no significant association of the number of focal laser treatments with the mean choroidal thickness (n = 41, r = -0.31, p = 0.68). CONCLUSIONS: Focal laser photocoagulation does not appear to alter choroidal thickness in eyes with DME in the short term, as assessed using SD-OCT. Long-term follow-up of eyes with DME and other retinal diseases treated with laser photocoagulation may provide further insight into the effects of this treatment modality on the choroid.

De novo appearance of a choroidal osteoma in an eye with previous branch retinal vein occlusion.

This report describes the de novo appearance of a choroidal osteoma occurring 8 years after laser photocoagulation for previous branch retinal vein occlusion (BRVO). A 62-year-old man presented with an asymptomatic yellowish orange lesion in the macula on fundus examination of his left eye during a regular follow-up visit for bilateral BRVO associated with macular edema that had previously been treated with laser photocoagulation. The lesion was observed for 1.5 years until a decrease in vision occurred. Fundus photography revealed a yellow-to-orange, well-defined lesion in the macular region. Fluorescein angiography was consistent with choroidal neovascularization (CNV). Optical coherence tomography and B-scan ultrasonography showed features consistent with choroidal osteoma. This is the first report of the de novo appearance of a choroidal osteoma occurring years after laser photocoagulation for BRVO. CNV developed secondary to the lesion, which was treated with intravitreal bevacizumab, leading to subjective and anatomic improvement.

Sequential optical coherence tomography images of retinal necrosis in acute ocular toxoplasmosis.

PURPOSE: To describe the features of sequential spectral-domain optical coherence tomography (OCT) images in an eye with acute primary toxoplasmosis. METHODS: Case report of an individual diagnosed with acute primary toxoplasmic retinochoroiditis. Initial and follow-up spectral-domain OCT findings are described. RESULTS: This patient developed retinitis as a result of an acute infection consistent with Toxoplasma gondii suggested by toxoplasma-specific IgM serology and the response to therapy. The retinitis appeared initially as a hyperreflective region on spectral-domain OCT. An intraretinal cyst consistent with T. gondii parasitic infection was identified. Subsequent OCT images demonstrated progression to full-thickness retinal necrosis with the development of cystic spaces in the retina. CONCLUSION: Optical coherence tomography may be useful in characterizing the features, extent, and location of retinitis caused by T. gondii. Specific OCT features may indicate whether the infection is acute phase or becoming quiescent.

Analysis of the morphology and vascular layers of the choroid in retinitis pigmentosa using spectral-domain OCT.

BACKGROUND AND OBJECTIVE: To analyze choroidal morphology and vascular layers in eyes with retinitis pigmentosa (RP) using spectral-domain optical coherence tomography. PATIENTS AND METHODS: Cross-sectional, retrospective analysis of 14 patients (14 eyes) with RP and 33 healthy subjects (33 eyes) who underwent high-definition one-line raster scanning at a single center. Two independent raters evaluated the morphology, thickness, and vascular layers of the choroid in both groups. RESULTS: The choroid had an irregular shape in 11 of 14 eyes (79%) with RP. The thickest point of choroid was not subfoveal as in healthy eyes, and exaggerated nasal thinning of the choroid was observed in nine of 14 eyes (65%) with RP. Mean subfoveal total choroidal thickness and large choroidal vessel layer thickness were significantly lower in eyes with RP (P = .04 and P = .02, respectively) than in healthy eyes. CONCLUSION: Choroidal morphology is altered and an exaggerated thinning of the large choroidal vessel layer is observed in eyes with RP. Further studies involving correlation of disease stage and severity with choroidal changes may provide further insight into the involvement of choroid in RP and other inherited retinal dystrophies.

Bilateral simultaneous stage 1 macular hole.

The authors describe two cases of bilateral simultaneous stage 1 macular hole diagnosed via optical coherence tomography (OCT). Vitreomacular traction, foveal pseudo cysts, and outer retinal changes were present initially. Resolution of the foveal pseudo cysts and outer retinal changes occurred in cases where a complete posterior vitreous detachment was noted. The initial step in the pathogenesis of macular holes is "traction" from the detaching posterior hyaloid. However, there are missing links in the exact inciting events and in the progression of the disease. The development of bilateral stage 1 macular holes simultaneously is unique and interesting because an unknown common inciting factor might be at play in these cases.