POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH CENTRAL SEROUS CHORIORETINOPATHY: Pachychoroid Spectrum of Diseases.

PURPOSE: To study multimodal imaging features of polypoidal choroidal vasculopathy (PCV) associated with central serous chorioretinopathy (CSC) in the same eye. METHODS: A retrospective observational study of cases of suspected PCV which underwent indocyanine green angiography, fundus fluorescein angiography and optical coherence tomography was done, to look for simultaneous typical CSC-like active leak in the same eye. The relevant history, best-corrected visual acuity, optical coherence tomography, fundus fluorescein angiography, and indocyanine green angiography findings were analyzed. RESULTS: From 226 patients reviewed, 195 patients had PCV from which 6 eyes (3.07%) with features of PCV associated with typical CSC-like active leak in the same eye were identified; 3 men and 3 women with a mean age of 62.6 years. Optical coherence tomography showed notched pigment epithelial detachment in two and irregular peaked pigment epithelial detachment in four cases with subretinal fluid and/or subretinal haemorrhage over a thick choroid with dilated outer choroidal vessels. Fundus fluorescein angiography showed stippled hyperfluorescence at polyp area and a separate typical CSC-like active leak-Inkblot in three and Smokestack in three cases. On indocyanine green angiography, multiple polyps were noted with choroidal hyperpermeability in late phase at the site of CSC leak. CONCLUSION: The coexistence of PCV with typical CSC-like active leaks and a thick choroid in the same eye simultaneously provides strong evidence that these diseases have an association and support the hypothesis that these conditions may originate from predisposed thick choroid.

INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANE: Long-Term Visual and Anatomical Outcomes After Intravitreal Anti-vascular Endothelial Growth Factor Therapy.

PURPOSE: To assess the long-term visual and anatomical outcomes after intravitreal anti-vascular endothelial growth factor therapy for inflammatory choroidal neovascular membrane (CNVM). METHODS: Retrospective case series of 15 consecutive cases of newly diagnosed inflammatory CNVM who were treated with intravitreal bevacizumab or ranibizumab injections. RESULTS: The study included 8 women and 7 men with mean age at presentation with CNVM of 40.53 ± 17.46 years (range, 11-70 years), and mean follow-up duration after anti-vascular endothelial growth factor therapy was 20.53 ± 14.53 months (range, 6-48 months). All eyes had classic CNVM confirmed by fluorescein angiography, most commonly located in the peripapillary area (8 eyes, 53.3%), followed by juxtafoveal (4 eyes, 26.7%), and subfoveal location (3 eyes, 20%). All CNVMs showed complete resolution with mean 2.6 ± 1.2 injections per eye. Preinjection mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.79 ± 0.76 (approximate Snellen equivalent 20/123) and mean central macular thickness of 435.9 ± 190.2 µm improved significantly to mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.46 ± 0.43 (approximate Snellen equivalent 20/58) and mean central macular thickness of 262.13 ± 108.70 µm (P value 0.02 and <0.0001, respectively) at the final visit. Recurrence was seen in 26.7% eyes (4/15), all of which regressed with single injection. Only complication noted was subretinal fibrosis in one eye (6.7%). CONCLUSION: For inflammatory CNVM, in addition to immunosuppression in cases with active inflammation, anti-vascular endothelial growth factor therapy seems as a very effective treatment modality resulting in significant visual improvement and foveal flattening. Incidence of major complications is rare, and the recurrence rate seems low.

Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch's membrane opening minimum rim width optical coherence tomography measurements.

Purpose: To compare glaucomatous from non-glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch's membrane opening minimum rim width (BMO-MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods: This study was conducted in 40 eyes, comprising 20 eyes with non-glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO-MRW. Results: The 5-fold cross-validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86-1.00) using BMO-MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion: Hence, OCT-based BMO-MRW values could be used as an additional test to compare glaucomatous with non-glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.

Posterior choroidal fluid loculation in central serous chorioretinopathy presenting as a choroidal elevation: A rare Pachychoroid phenotype.

PURPOSE: To describe an unusual variant of central serous chorioretinopathy (CSC) presenting as a choroidal elevation with subretinal fluid and its response to accepted treatment modalities of CSC. DESIGN: A retrospective case series. SUBJECTS: Six eyes of three patients, two males and one female, with a mean age of 55.3 years, were included in the study. All of them had Pachychoroid features, solitary choroidal elevation and subretinal fluid on optical coherence tomography (OCT); none of the patients had a previous episode of CSC. METHODS: Patients were studied with biomicroscopy, ultrasonography, fluorescein angiography and indocyanine green angiography. Systemic evaluation to rule out inflammatory and infective pathologies, and an oncologist referral also was done. Patients were managed in the line of central serous chorioretinopathy, using conservative treatment, focal laser and oral eplerenone. MAIN OUTCOME MEASURES: Resolution of subretinal fluid and choroidal elevation. RESULTS: Complete resolution of choroidal elevation and subretinal fluid was noted in all the three patients. There was no recurrence till the end of follow-up. CONCLUSION: Pachychoroid disease may present as solitary choroidal elevation with subretinal fluid due to exaggerated posterior choroidal fluid loculation and has a favourable outcome. However, it should be considered after exclusion of other differential diagnoses.

Pediatric choroidal neovascularization: Etiology and treatment outcomes with anti-vascular endothelial growth factors.

PURPOSE: To describe the etiology and treatment outcomes of choroidal neovascularization (CNV) in a pediatric population with intravitreal anti-vascular endothelial growth factors (VEGF). METHODS: Retrospective single center interventional case series. A total of 26 eyes of 23 consecutive pediatric patients with CNV of various etiologies were treated with intravitreal injection of anti-VEGF agents. RESULTS: There were 15 males (65.2%) and eight females (34.8%), diagnosed with CNV during the study period. The mean age at presentation with CNV was 11.7 ± 3.3 years, (range 4-16 years) and the mean follow was 28.1 ± 18 months, (range 8-72 months). Inflammatory CNV was the most common etiology. The mean best corrected visual acuity (BCVA) and mean central macular thickness (CMT) at presentation, were logMAR 0.8 ± 0.3 and 367.6 ± 134.8 µm respectively. At the final visit, CNV in all eyes remained regressed with significant improvement in mean BCVA to logMAR 0.4 ± 0.4 (p < 0.0001) and mean CMT to 242.5 ± 82.4 µm (p < 0.0001). A mean of two intravitreal injections per eye was required for CNV regression. CONCLUSION: Intravitreal anti-VEGF therapy for pediatric CNV is an effective treatment in majority of affected eyes.

Assessment of retinal manifestations of Parkinson's disease using spectral domain optical coherence tomography: A study in Indian eyes.

PURPOSE: To assess the retinal manifestations of Parkinson's disease using optical coherence tomography. METHODS: A prospective case-control study comparing 30 eyes from 15 patients with Parkinson's disease and 22 eyes from 11 healthy age-matched controls. Total macular subfield thickness and the thickness of the ganglion cell layer, nerve fiber layer, and peripapillary retinal nerve fiber layer were measured with spectral-domain optical coherence tomography (SD-OCT). RESULTS: The mean age of PD patients was 68.4 years ± 10.64 (range: 46-82) and in the control group was 66.36 ± 5.22 (range: 64-68). The average disease duration in patients with PD was 6.7 ± 2.8 years (range: 2-10 years). The mean best-corrected visual acuity in PD was 20/26 and 20/20 in controls, with P = 0.0059, which was significant. Significant difference was also found in the contrast sensitivity between both groups. Structural differences in the central macular thickness (P = 0.0001), subfield thicknesses in the superior (P = 0.003), inferior (P = 0.001), nasal (P = 0.004), and temporal subfields (P = 0.017) was seen. Severe thinning of the ganglion cell layer was seen in PD patients (P = 0.000) as well as of the nerve fiber layer (P = 0.004). Peripapillary retinal nerve fiber thickness measured showed significant thinning in superotemporal (P = 0.000), superonasal (P = 0.04), inferonasal (P = 0.000), inferotemporal (P = 0.000), nasal (P = 0.000), and temporal quadrants (P = 0.000). CONCLUSION: Visual dysfunction was observed in patients with PD along with structural alterations on OCT, which included macular volumes, ganglion cell layer, and peripapillary retinal nerve fiber layer.

OCT angiography for the diagnosis and management of choroidal neovascularization secondary to choroideremia.

PURPOSE: To describe the multimodal imaging findings and treatment outcomes in choroidal neovascularization secondary to Choroideremia. OBSERVATIONS: A 13-year-old male presented with reduced visual acuity in the left eye. He gave a history of nyctalopia. His best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/40 in the left eye. Based on multimodal imaging, the diagnosis of choroideremia in both eyes with a subfoveal choroidal neovascularization in the left eye was made. He underwent five intravitreal anti-vascular endothelial growth factor (VEGF) injections of Ranibizumab over a period of 3 years, with the final injection given due to recurrence of neovascularization. Post-treatment, his BCVA improved to 20/20 in the left eye with regression of the neovascular network. CONCLUSIONS AND IMPORTANCE: This case highlights the role of OCTA in diagnosis of choroidal neovascularization in choroideremia as well as its successful management with anti-VEGF injections with long term follow up.

Optic Disc Pit Maculopathy: One-Year Outcomes of Pars Plana Vitrectomy with Foveal Sparing Inverted Internal Limiting Membrane Flap.

Purpose To evaluate the anatomical and visual outcomes in optic disc pit maculopathy following pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap Methods Retrospective interventional case series of 10 patients diagnosed with serous macular detachment secondary to optic disc pit who underwent PPV with inverted ILM flap and were followed up for a year. Results A p-value of less than 0.05 was defined as statistically significant. The mean age of patients was 27.2 ± 10.6 years, preoperatively the mean best-corrected visual acuity of the logarithm of the minimum angle of resolution was 0.91 ± 0.42 (approximate Snellen equivalent 20/162), which improved to the logarithm of the minimum angle of resolution of 0.58 ± 0.29 (approximate Snellen equivalent 20/76) at end of one year, (p=0.008). The mean central macular thickness was 804.9 ± 294.1 m which improved to 273.4 ± 102.54 m, (p=0.002). After surgery, at end of one year, 60% of patients (6/10) had 15- or more-than-15-letter improvement of vision on Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing, 20% (2/10) gained a 10-letter improvement and 20% (2/10) retained the same vision. Conclusion PPV with inverted ILM flap can be considered as a good approach for the management of serous macular detachment secondary to optic disc pit and produce good anatomical and visual results at one year with stabilization of the disease.

Central serous chorioretinopathy: Current update on management.

Central serous chorioretinopathy (CSC), the fourth most common nonsurgical retinopathy with a usual self-limiting course, is known to present with persistent or recurrent form with distressing visual loss. Evolution of newer mutimodal imaging techniques have revolutionized the understanding about the pathophysiology of CSC, and hence the diagnosis and management. Multifactorial etiopathology of CSC promotes the use of multiple treatment modalities. With advances in investigative options, treatment options including conventional focal laser, micropulse laser, photodynamic therapy, and transpupillary thermotherapy are also advancing and refining. Medical management for CSC is also under evaluation with a wide spectrum of new drugs in vogue. However, standard of treatment is yet to be established through randomized clinical trials. This review article discusses the current approach to multimodal treatment options for CSC including conventional as well as newer therapeutic modalities.

Central serous chorioretinopathy: Current update on pathophysiology and multimodal imaging.

Central serous chorioretinopathy (CSC), the fourth most common nonsurgical retinopathy, is characterized by serous retinal detachment most commonly involving the macular region. Although natural history of CSC shows a self-limiting course, patients are known to present with persistent, recurrent, or even bilateral CSC with distressing visual loss. Multimodal imaging techniques for CSC include optical coherence tomography (OCT) with enhanced depth imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography. Evolution of new imaging techniques in addition to conventional imaging modalities has revolutionized the understanding about the pathophysiology of CSC and hence the diagnosis and management. This review article elaborates on current understanding about pathophysiology and risk factors, as well as multimodal imaging-based features of CSC.

Graded subthreshold transpupillary thermotherapy for chronic central serous chorioretinopathy.

BACKGROUND AND OBJECTIVE: To study the safety and efficacy of "graded" subthreshold transpupillary thermotherapy (TTT), a novel treatment protocol for chronic central serous chorioretinopathy (CSC) and an alternative to photodynamic therapy (PDT). PATIENTS AND METHODS: This retrospective pilot study included 10 eyes with chronic CSC that underwent TTT with 810-nm continuous diode laser treatment using a subthreshold power (60% reduced from threshold) for 60 seconds. Treatment was repeated at 20% increase in power from the baseline if submacular fluid persisted on optical coherence tomography (OCT) after 1 month (graded fashion). RESULTS: The mean chronic CSC duration was 20.3 ± 8.3 months. Eight eyes (80%) showed resolution of CSC on OCT. Mean number of TTT sittings required was 1.5. Although 5 eyes (50%) had 3 or more lines of improvement in Snellen visual acuity, 3 eyes (30%) had up to 2 lines of improvement. None of the patients developed macular burn or scar. CONCLUSION: The safety enhanced graded subthreshold TTT was beneficial in patients with chronic CSC.