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PURPOSE: To describe the clinical and multimodal imaging features of stellate multiform amelanotic choroidopathy (SMACH; also known as serous maculopathy due to aspecific choroidopathy). METHODS: Retrospective observational case series of eyes presenting with SMACH. Multimodal imaging including fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and indocyanine green angiography (ICGA) was analyzed. RESULTS: Eighteen eyes from 18 patients (mean age: 28 ± 19 years) were included. The mean follow-up duration was 9 years. Ophthalmoscopy showed a yellowish orange, dendriform choroidal lesion. At presentation, subretinal fluid (SRF) was seen in 10 of 18 cases (56%). Eight patients (44%) showed no evidence of SRF during a mean follow-up of 6 years. Cross-sectional OCT showed hyperreflective fibrous-like changes within the inner choroid with choriocapillaris flow preservation on OCTA. En face OCT showed a hyperreflective choroidal lesion with finger-like projections oriented in a stellate configuration. On ICGA, SMACH showed early and late hypofluorescence. None of the cases showed lesion growth. CONCLUSION: SMACH seems to be a unilateral choroidopathy characterized by distinctive multimodal imaging features. As SRF was absent in some cases, while a dendriform pattern was a consistent finding in all eyes, the authors propose renaming this entity "stellate multiform amelanotic choroidopathy," a name that retains its previous abbreviation "SMACH."
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Enfermedades de la Retina , Adolescente , Adulto , Niño , Humanos , Persona de Mediana Edad , Adulto Joven , Coroides/patología , Estudios Transversales , Angiografía con Fluoresceína/métodos , Verde de Indocianina , Imagen Multimodal/métodos , Enfermedades de la Retina/patología , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodosRESUMEN
PURPOSE: To evaluate the efficacy and safety of double-fluence photodynamic therapy for the treatment of circumscribed choroidal hemangioma. METHODS: Retrospective observational study including patients affected by circumscribed choroidal hemangioma and treated with double-fluence photodynamic therapy. The photodynamic therapy was performed with verteporfin infusion intravenously (dose of 6 mg/m2 body surface area over 10 minutes), followed by the application of two consecutive spots of 50 J/cm2 light at 689 nm for 83 seconds. RESULTS: Twenty-three eyes of 23 patients were included. The mean best-corrected visual acuity increased from 20/45 to 20/28, the mean tumor thickness decreased from 2,758 ± 530 µm to 722 ± 314 µm (P < 0.05), and the mean central retinal thickness decreased from 404 ± 209 µm to 188 ± 56 µm (P < 0.05) in 12 months, respectively. A total reabsorption of macular subretinal fluid, cystoid macular edema, and SRF associated with the tumor was obtained within 6 months in all cases, with persistence of tumor-associated intraretinal fluid up to 12 months only in two patients. No cases of side effects or need for retreatment were reported during the follow-up (average time of 25 months). CONCLUSION: Double-fluence photodynamic therapy is a safe and effective treatment for circumscribed choroidal hemangiomas and should be considered as the first line of treatment for these lesions.
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Neoplasias de la Coroides , Hemangioma , Fotoquimioterapia , Porfirinas , Neoplasias de la Coroides/diagnóstico , Neoplasias de la Coroides/tratamiento farmacológico , Angiografía con Fluoresceína , Hemangioma/diagnóstico , Hemangioma/tratamiento farmacológico , Humanos , Fármacos Fotosensibilizantes/uso terapéutico , Porfirinas/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: Radiation retinopathy is a common side effect of ocular radiotherapy with no long-term effective therapy. Optical coherence tomography angiography (OCTA) and wide-field fluorescein angiography (FA) are widely used for the study of radiation maculopathy and peripheral nonperfusion, respectively. We investigated the role of extended field imaging (EFI-OCTA) for the study of retinal and choroidal alterations after radiotherapy for choroidal melanoma. METHODS: Cross-sectional observational study of 20 eyes of 20 patients diagnosed with radiation retinopathy. All patients underwent a complete imaging evaluation including FA and indocyanine green angiography (ICGA) with 55° and 102° lens (Spectralis Heidelberg Engineering, Heidelberg, Germany). Optical coherence tomography angiography imaging was performed with the Zeiss PlexElite 9000 Swept Source OCTA (Carl Zeiss Meditec, Dublin, CA) using a 12 × 12-mm volume scan pattern centered on the fovea and a +20.00-diopter lens specifically designed to obtain EFI examination. The imaging methods were then compared in terms of visible field of view, extension of nonperfused areas, and vessel density. RESULTS: The mean extension ratio of EFI-OCTA compared to OCTA without EFI, FA/ICGA 55° and FA/ICGA 102° was, respectively, 1.98 ± 0.02, 1.21 ± 0.01 and 0.36 ± 0.003. The mean extension of retinal and choroidal nonperfused areas evaluated by EFI-OCTA (63.03 ± 48.21 and 38.63 ± 30.83 mm2) were significantly higher than with OCTA without EFI (40.40 ± 34.87 and 24.26 ± 21.82 mm2, P < 0.001) but lower than with FA/ICGA 102° (140.7 ± 69.23 and 108.3 ± 69.51 mm2, P < 0.001). No significant differences were found between mean extension of retinal and choroidal ischemic areas measured with EFI-OCTA and FA/ICGA 55° (69.64 ± 51.92 and 47.23 ± 33.59 mm2). The mean vessel density of EFI-OCTA (retina and choroid segmentation) was significantly different compared to OCTA without EFI (P < 0.05). Retinal vessel density was negatively correlated to retinal extension of nonperfused areas (r = -0.5, P = 0.02), and choroidal vessel density was negatively correlated to choroidal nonperfused areas (r = -0.6, P = 0.003) measured with EFI-OCTA. CONCLUSION: In our series, EFI-OCTA captured larger areas than OCTA without EFI and FA/ICGA with 55° lens. EFI-OCTA images showed a good definition of retinal and choroidal vascular changes after radiotherapy, suggesting a possible role of this safe and noninvasive imaging technique in the follow-up of patients with radiation retinopathy.
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Neoplasias de la Coroides/radioterapia , Coroides/patología , Angiografía con Fluoresceína/métodos , Melanoma/radioterapia , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Adulto , Anciano , Neoplasias de la Coroides/diagnóstico , Femenino , Fondo de Ojo , Humanos , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate multimodal imaging findings of solitary idiopathic choroiditis (SIC; also known as unifocal helioid choroiditis) to clarify its origin, anatomic location, and natural course. DESIGN: Multicenter retrospective observational case series. PARTICIPANTS: Sixty-three patients with SIC in 1 eye. METHODS: Demographic and clinical data were collected. Multimodal imaging included color fundus photography, OCT (including swept-source OCT), OCT angiography (OCTA), fundus autofluorescence, fluorescein and indocyanine green angiography, and B-scan ultrasonography. MAIN OUTCOME MEASURES: Standardized grading of imaging features. RESULTS: Mean age at presentation was 56 ± 15 years (range, 12-83 years). Mean follow-up duration in 39 patients was 39 ± 55 months (range, 1 month-25 years). The lesions measured a mean of 2.4 × 2.1 mm in basal diameter, were located inferior (64%) or nasal to the optic disc, and appeared yellow (53%). No systemic associations were found. The lesions all appeared as an elevated subretinal mass, with OCT demonstrating all lesions to be confined to the sclera, not the choroid. On OCT, the deep lesion margin was visible in 12 eyes with a mean lesion thickness of 0.6 mm. Overlying choroidal thinning or absence was seen in 95% (mean choroidal thickness, 28 ± 35 µm). Mild subretinal fluid was observed overlying the lesions in 9 patients (14%). Retinal pigment epithelial disruption and overlying retinal thinning was observed in 56% and 57%, respectively. OCT angiography was performed in 13 eyes and demonstrated associated choroidal and lesional flow voids. Four lesions (6%) were identified at the macula, leading to visual loss in 1 patient. One lesion demonstrated growth and another lesion showed spontaneous resolution. CONCLUSIONS: In this largest series to date, multimodal imaging of SIC demonstrated a scleral location in all patients. The yellow and white clinical appearance may be related to scleral unmasking resulting from atrophy of overlying tissues. Additional associated features included documentation of deep margin on swept-source OCT, trace subretinal fluid in a few patients, and OCTA evidence of lesional flow voids. Because of the scleral location of this lesion in every patient, a new name, focal scleral nodule, is proposed.
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Coroides/patología , Coroiditis/diagnóstico , Angiografía con Fluoresceína/métodos , Esclerótica/patología , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Hemangioma Capilar , Enfermedades de la Retina , Neoplasias de la Retina , Humanos , Epitelio Pigmentado de la Retina , Neoplasias de la Retina/complicaciones , Neoplasias de la Retina/diagnóstico , Enfermedades de la Retina/diagnóstico , Imagen Multimodal , Hemangioma Capilar/complicaciones , Hemangioma Capilar/diagnóstico , Angiografía con Fluoresceína/métodos , Tomografía de Coherencia Óptica/métodosRESUMEN
PURPOSE: To evaluate baseline features and morphologic changes of vitreoretinal adhesion and outer retinal layers outside the macula after intravitreal ocriplasmin injection. To study the relation between vitreous detachment and attenuation of retinal outer segments signal. METHODS: Retrospective cases series of 15 eyes. Each eye was scanned with the 55° wide-field optical coherence tomography lens in 6 different locations, three horizontal B-scan (central, temporal, and nasal) and three vertical B-scan (central, superior, and inferior) at baseline, 1 week, 1 month, 3 months, and 6 months after injection. RESULTS: After ocriplasmin injection, vitreomacular traction (VMT) resolved in 12 patients (80%), 3 of them presenting a complete posterior vitreous detachment. Eight patients (53%) showed a panretinal attenuation of photoreceptors outer segment signal, 7 with VMT resolution and 1 with non-posterior vitreous detachment and no VMT resolution. In three patients after VMT resolution the attenuation involved also areas with no posterior vitreous detachment. The attenuation resolved during follow-up in 7/8 eyes (87.5%). CONCLUSION: Intravitreal ocriplasmin injection induced resolution of VMT in most cases and more rarely a release of vitreopapillary adhesion and a complete posterior vitreous detachment. An acute panretinopathy was visible in more than half of the patients and was not related to vitreous detachment.
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Fibrinolisina/uso terapéutico , Fibrinolíticos/uso terapéutico , Fragmentos de Péptidos/uso terapéutico , Retina/patología , Desprendimiento del Vítreo/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Retina/diagnóstico por imagen , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Desprendimiento del Vítreo/diagnóstico por imagen , Desprendimiento del Vítreo/patologíaRESUMEN
BACKGROUND: To evaluate macular changes in fellow eyes of patients diagnosed with lamellar macular hole (LMH) using spectral-domain optical coherence tomography (SD-OCT) and blue fundus autofluorescence (B-FAF). METHODS: Fellow eyes of patients diagnosed with a LMH were retrospectively evaluated on OCT. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were recorded. Corresponding B-FAF images, vitreo-macular relations, and type of epiretinal membranes (ERMs) were also examined. RESULTS: Thirty-five patients were included. At baseline, six fellow eyes (17%) showed a normal foveal profile, 26 (74%) had a tractional ERM, and three cases (9%) revealed a bilateral LMH, one of them with a lamellar hole-associated epiretinal proliferation (LHEP). A posterior vitreous detachment (PVD) was present in 29 patients (83%), four (11%) had only a vitreo-papillary adhesion (VPA), and two (6%) had both vitreo-macular adhesion (VMA) and VPA. After a mean follow-up of 4.6 ± 1.9 years, one eye (3%) developed a vitreous detachment from the macula with persistent VPA, and one developed a PVD from a VPA with subsequent ERM formation. BCVA and mean CFT remained stable in 35 eyes (100%). Likewise, no B-FAF signal variations were detected. One patient developed a LMH during the 3rd year of follow-up. CONCLUSIONS: Our data suggest that the presence of a LMH in one eye does not increase significantly the risk of developing the same condition in the fellow eye after 4 years. Bilateral condition is uncommon, and an ERM is often detected in the fellow eye. LHEPs were not observed in fellow eyes with foveal integrity, and all LHEPs observed (in main and fellow eyes) were always associated with LMHs; this supports the hypothesis that LHEP is a consequence and not a causative factor for LMHs. The occurrence of a LMH in one fellow eye after 3 years follow-up may suggest that a higher incidence of bilateral disease could develop in a longer time span.
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Fóvea Central/patología , Perforaciones de la Retina/diagnóstico , Tomografía de Coherencia Óptica/métodos , Agudeza Visual , Anciano , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Perforaciones de la Retina/fisiopatología , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE: To investigate changes in macular function after intravitreal dexamethasone implant (Ozurdex) for macular edema (ME) secondary to retinal vein occlusion (RVO). METHODS: Nineteen treatment-naive patients with RVO-related ME were treated with intravitreal Ozurdex and followed up to 6 months to evaluate functional outcomes, by means of best-corrected visual acuity, microperimetry, and multifocal electroretinography, and their correlations with morphological parameters by enhanced depth imaging optical coherence tomography. RESULTS: Nineteen eyes of 19 patients were included for analysis. At 1 month, mean best-corrected visual acuity, retinal sensitivity, and central macular thickness (CMT) improved from 0.50 ± 0.34 LogMAR, 10.51 ± 4.31 dB, and 762 ± 259 µm (baseline) to 0.38 ± 0.34 LogMAR (p = 0.043), 12.28 ± 5.06 dB (p = 0.025), and 385 ± 191 µm (p = 0.001), respectively. At 3 months, improvement of mean retinal sensitivity and CMT was still significant (11.62 ± 5.05 dB [p = 0.047] and 518 ± 251 µm [p = 0.006]). Multifocal electroretinography measurements also showed (nonsignificant) improvement. No significant changes in choroidal thickness were recorded. Improvements recorded during the first 3 months were no longer significant from month 4. At each time point, we found a negative significant correlation between CMT and retinal sensitivity. Interestingly, 7 eyes did not undergo retreatment of less than 6 months; these eyes showed a significantly better baseline retinal sensitivity than eyes requiring retreatment of less than 6 months (12.27 ± 3.52 dB vs. 9.48 ± 4.53 dB [p = 0.038]). CONCLUSIONS: In eyes with ME secondary to RVO, intravitreal dexamethasone implant provides functional benefits as soon as 1 month after treatment. In most cases, the optimum retreatment interval is less than 6 months from first intravitreal Ozurdex. Microperimetry is a very useful tool to characterize macular function. Baseline macular sensitivity may predict the need for early (<6 months) retreatment.
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Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Retina/fisiología , Oclusión de la Vena Retiniana/tratamiento farmacológico , Implantes de Medicamentos , Electrorretinografía , Femenino , Estudios de Seguimiento , Humanos , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Edema Macular/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Retratamiento , Tomografía de Coherencia Óptica , Agudeza Visual , Pruebas del Campo Visual , Campos Visuales/fisiología , Cuerpo VítreoRESUMEN
Diabetic macular edema is considered the most important factor related to visual impairment in patients with diabetic retinopathy. Together with the use of grid and focal laser photocoagulation, today the intravitreal administration of pharmacotherapies represents the standard of care for the treatment of this complication: anti-vascular endothelium growth factor agents and steroids are the drugs currently used for this aim. Differently from laser therapy, which prevents visual deterioration, the intravitreal approach allows the promotion of visual recovery. However, the intravitreal injections require to be repeated with high frequency, and this carries the risk of drug- and procedure-related adverse effects.
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Retinopatía Diabética/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Edema Macular/tratamiento farmacológico , Fluocinolona Acetonida/efectos adversos , Fluocinolona Acetonida/uso terapéutico , Glucocorticoides/efectos adversos , Humanos , Inyecciones Intravítreas , Triamcinolona Acetonida/efectos adversos , Triamcinolona Acetonida/uso terapéuticoRESUMEN
Purpose: To describe the clinical and multimodal imaging features in a case of resolution of pre-macular fibrosis after photodynamic therapy (PDT) of retinal hemangioblastoma (RH) not related to von-Hippel-Lindau (VHL). Observations: A 25-year-old man presenting with blurred vision and central metamorphopsia in his left eye (LE) due to macular epiretinal membrane secondary to a peripheral RH. The patient had a comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), wide-field fundus photography and autofluorescence (FAF), wide-field optical coherence tomography (OCT) and OCT angiography (OCTA), fluorescein angiography (FA) and indocyanine green angiography (ICGA) and ocular ultrasound. Baseline BCVA was 20/200 in his LE, and it improved to 20/40 nineteen months after anti-VEGF and photodynamic therapy were performed. The treatment led to a progressive shrinkage of the tumor and associated intraretinal exudation, and to a progressive resolution of the epiretinal membrane. Conclusions and importance: Treatments performed on the peripheral retina may result in changes at the level of the vitreo-retinal interface in the macular region. In our patient, after an intravitreal anti-VEGF associated with PDT, a posterior vitreous detachment (PVD) was induced resulting in auto-peeling of the macular epiretinal membrane secondary to a peripheral RH. An accurate assessment of the macular area by OCT is highly recommended in the first days following treatments.
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The choroid is the main part of the uvea, the vascular layer of the eye that lies between the retina and the sclera. The high vascular component of the choroid makes this structure susceptible to inflammation in multisystemic diseases, as well as the most common site of metastasis in the eye. Therefore, the choroid is involved in many pathological conditions, from uveitis to intraocular tumors. Differentiating between inflammatory and neoplastic lesions deforming the choroidal profile can sometimes be challenging. In addition, scleral disorders can also deform the choroidal profile. Choroidal imaging includes ophthalmic ultrasonography, indocyanine green angiography, and optical coherence tomography (OCT). Recent advances in choroidal imaging techniques, such as enhanced depth imaging optical coherence tomography (EDI-OCT) and swept-source optical coherence tomography (SS-OCT), have facilitated an in-depth analysis of the choroid. The purpose of this review article is to report on and highlight the most common OCT findings to help in the differential diagnosis between inflammatory and neoplastic lesions deforming the choroidal profile.
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OBJECTIVE: To compare multimodal imaging findings in patients with choroidal lymphoma (CL). METHODS: Multicenter retrospective observational case series. Multimodal imaging features of patients with CL were reviewed with particular attention to the patterns of choroidal infiltration on indocyanine green angiography (ICGA) and optical coherence tomography (OCT). RESULTS: Eighteen eyes of 15 patients were included in this study. Average tumor thickness on ultrasonography was 2.6 mm (range, 1.2-5.7 mm). Choroidal infiltration on ICGA was characterized by multifocal, round areas (300-500 microns diameter) of hypocyanescence in all cases, whereas OCT at the same region disclosed diffuse choroidal infiltration. By OCT, the tumor surface contour was primarily placid (22%), dome-shaped (11%), or undulating (67%). CONCLUSIONS: In this analysis of eyes with CL, ICGA demonstrated multifocal sub-millimeter regions of choroidal hypocyanescence whereas OCT documented diffuse choroidal infiltration. This incongruence could be a distinctive diagnostic feature of choroidal lymphoma, assisting with differentiation from other pathological entities.
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Verde de Indocianina , Linfoma , Humanos , Tomografía de Coherencia Óptica/métodos , Estudios Retrospectivos , Angiografía con Fluoresceína/métodos , Coroides/patología , ColorantesRESUMEN
Background: Optical coherence tomography angiography (OCTA) is a valuable imaging tool for the diagnosis of several retinal and choroidal diseases. Its role in ocular oncology is clinically promising but still controversial. In this review, we report the main applications and limits of the use of OCTA for the study of intraocular tumors. Summary: OCTA allows a rapid, safe, low-cost, and high-resolution visualization of the retinal and choroidal vasculature. Attempts have been made to use this technology in ocular oncology to differentiate benign and malignant lesions and to assist physicians in the evaluation and monitoring of post-treatment complications. Main limitations include failure in correct segmentation due to the tumor inner profile or thickness, poor penetration of the laser into the lesion, masking effect from overlying fluid, media opacities and poor fixation. Key Messages: The main applications of OCTA in ocular oncology consist of the documentation of tumor-associated choroidal neovascularizations and the study of vascular changes following tumor treatments. In particular, the diffusion of wide-field protocols makes OCTA suitable for the diagnosis and follow-up of radiation chorio-retinopathy, allowing a detailed visualization of both macular and peripheral ischemic changes. Optimistically, future innovations in OCTA technology may offer new perspectives in the diagnosis and follow-up of intraocular tumors.
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PURPOSE: To describe a case of choroidal nevus with intralesional cavitations detected with enhanced depth imaging optical coherence tomography and to show its changes during an 8-year follow-up. METHODS: A case report. RESULTS: A 55-year-old male patient was found to have a pigmented lesion at the posterior pole of his right eye, just temporal to the fovea. A complete multiimaging examination was obtained and showed a lesion of about 4 mm of diameter with a small amount of subretinal fluid and chronic changes in the retina overlying the lesion. Based on clinical examination, a diagnosis of choroidal nevus was made, but interestingly the enhanced depth imaging optical coherence tomography revealed the presence of intralesional cavitations. Close follow-up with no intervention was planned, and over 8 years of observation, the lesion remained stable in size, with a gradual increase of the central necrosis. CONCLUSION: Benign pigmented choroidal lesions can show internal cavitations likely secondary to internal necrosis. This feature does not represent a sign of malignancy of the lesion. Enhanced depth imaging optical coherence tomography is a feasible imaging tool for the visualization of the internal cavitations and to follow their evolution over time.
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Neoplasias de la Coroides , Nevo Pigmentado , Neoplasias Cutáneas , Masculino , Humanos , Persona de Mediana Edad , Neoplasias de la Coroides/diagnóstico , Neoplasias de la Coroides/patología , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patología , Tomografía de Coherencia Óptica/métodos , Coroides/patología , NecrosisRESUMEN
PURPOSE: To describe a case of combined branch retinal vein and artery occlusion (CBRVAO) complicated by foveal neovascularization (FNV). OBSERVATIONS: A 52-year-old healthy woman presented at the Eye Clinic of Sacco Hospital (Milan, Italy) with a 3-year history of CBRVAO in her right eye. At baseline, her visual acuity was 20/20 Snellen with unremarkable anterior segment and normal intra-ocular pressure. On fundoscopy, a reddish foveal lesion with an underlying crescent-shaped pre-retinal subhyaloid hemorrhage could be appreciated. FNV was confirmed by means of fluorescein angiography and optical coherence tomography angiography; no signs of macular edema were present.The patient was treated with two intravitreal injections of anti-VEGF agents and with completion of scatter retinal photocoagulation. At her last follow-up (6 months later), shrinkage of FNV and resorption of the pre-retinal subhyaloid hemorrhage were documented by means of multimodal imaging. CONCLUSIONS AND IMPORTANCE: FNV is a rare clinical finding that can complicate retinal vascular disorders and can be effectively managed with good visual outcomes. Our case highlights the importance of multimodal imaging to diagnose FNV in retinal vaso-occlusive disorders and then to assess the response to treatment during the follow-up.
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PURPOSE: To document by optical coherence tomography angiography the presence of a choroidal neovascularization (CNV) secondary to unilateral retinal pigment epithelium dysgenesis and describe its changes after treatment with intravitreal bevacizumab. METHODS: Case report. RESULTS: A 51-year-old woman referred to our ocular oncology service for a possible choroidal osteoma in her left eye was found to have a unilateral retinal pigment epithelium dysgenesis complicated by CNV. Best-corrected visual acuity at baseline was 20/200. A complete ophthalmological evaluation including color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography was performed. The CNV appeared as a tangled vascular network on optical coherence tomography angiography. After 2 intravitreal injections of bevacizumab, the best-corrected visual acuity improved to 20/50, and optical coherence tomography angiography showed a progressive contraction of the CNV. Unilateral retinal pigment epithelium dysgenesis margins remained stable at consecutive follow-up. CONCLUSION: Optical coherence tomography angiography is a useful imaging technique for the diagnosis and follow-up of CNVs secondary to unilateral retinal pigment epithelium dysgenesis. Anti-vascular endothelial growth factor agents represent an effective therapy for the treatment of CNV in patients with this disease.
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Neovascularización Coroidal , Enfermedades de la Retina , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Neovascularización Coroidal/diagnóstico por imagen , Neovascularización Coroidal/etiología , Femenino , Angiografía con Fluoresceína , Humanos , Inyecciones Intravítreas , Persona de Mediana Edad , Enfermedades de la Retina/complicaciones , Enfermedades de la Retina/tratamiento farmacológico , Epitelio Pigmentado de la Retina , Tomografía de Coherencia ÓpticaRESUMEN
AIMS: To study widefield imaging features, analyse risk factors for progression and compare treatment modalities of peripheral exudative haemorrhagic chorioretinopathy (PEHCR). METHODS: Clinical and imaging data from each visit were collected, including near-infrared reflectance, fluorescein angiography, indocyanine green angiography, optical coherence tomography using the Spectralis platform (Heidelberg Engineering). Clinical features and treatment performed were recorded. Lesions were classified according to treatments used and according to the prognostic index of macular involvement (MI) and intravitreal bleeding (IVB). RESULTS: 50 eyes of 35 patients were retrospectively enrolled. Using widefield imaging, peripheral subretinal fluid (SRF) was detected in 31 (62%) eyes and peripheral neovascular networks were detected in 42 (84%) eyes and graded as focal, diffuse and subtotal in 22 (44%), 17 (34%) and 11 (22%) eyes, respectively. MI secondary to PEHCR during the follow-up was documented in 17 (34%) eyes, while IVB occurred in 7 (14%) eyes. Both MI and IVB correlated with peripheral SRF and lesion grade. Active treatment included anti-vascular endothelial growth factor (anti-VEGF) injections, photodynamic therapy (PDT) and combined anti-VEGF and PDT for 13 (26%), 1 (2%) and 18 (36%) eyes, respectively. In eyes with risk factors, anti-VEGF and combined treatment inversely correlated with MI incidence. CONCLUSIONS: In our series, peripheral subretinal exudation and the extension of peripheral involvement represented risk factors for MI in eyes with PEHCR. In those high-risk eyes, active treatment is warranted.
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Enfermedades de la Coroides , Enfermedades de la Retina , Inhibidores de la Angiogénesis/uso terapéutico , Enfermedades de la Coroides/tratamiento farmacológico , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Inyecciones Intravítreas , Enfermedades de la Retina/tratamiento farmacológico , Estudios Retrospectivos , Líquido Subretiniano/diagnóstico por imagen , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: To describe a case of congenital retinal macrovessel complicated by cystoid macular edema associated with contralateral myelinated retinal nerve fibers and retinal vascular abnormalities studied with optical coherence tomography angiography (OCTA). METHODS: Case report. RESULTS: A healthy 25-year-old woman with decreased vision in her right eye was found to have a congenital retinal venous macrovessel in the macula associated with cystoid edema. In the contralateral amblyopic eye, the examination revealed a tuft of myelinated retinal nerve fibers along the superotemporal vascular arcade associated with superficial vascular abnormalities. A complete multi-imaging examination was obtained, including fundus color photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), and optical coherence tomography angiography. At 1-week follow-up, the optical coherence tomography displayed spontaneous resolution of the edema that remained stable at consecutive 1-month follow-up. CONCLUSION: Congenital retinal macrovessels can be associated with other ocular developmental anomalies. Vascular complications can occur, leading to macular edema and retinal ischemia. Optical coherence tomography angiography can be useful for the diagnosis and follow-up of this condition.
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Edema Macular , Enfermedades de la Retina , Vasos Retinianos , Adulto , Femenino , Angiografía con Fluoresceína , Humanos , Edema Macular/complicaciones , Fibras Nerviosas Mielínicas , Enfermedades de la Retina/diagnóstico por imagen , Vasos Retinianos/anomalías , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia ÓpticaRESUMEN
PURPOSE: To investigate the pathogenesis of Multiple Evanescent White Dot Syndrome (MEWDS) using multimodal imaging (MMI). METHODS: Retrospective case series of 7 patients with acute MEWDS. Each patient underwent: near-infrared reflectance (IR), blue and near-infrared autofluorescence (FAF and NIRAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), enhanced depth imaging optical coherence tomography (EDI-OCT) on Spectralis, and optical coherence tomography angiography on OCTA Spectralis, XR Avanti or Plex Elite 9000. RESULTS: OCTA and FA findings of early hyperfluorescence depict an unaffected choriocapillaris. On ICGA early to late hypofluorescent lesions corresponded to the hyporeflectivity on IR, consistent with altered reflectivity of the RPE. The SDI-OCT showed ellipsoid zone disruption as confirmed by FAF hyperautofluorescence. Some lesions showed a hypertransmission sign underneath the RPE, possibly due to changes in RPE intracellular melanin as suggested by NIRAF hypoautofluorescence. CONCLUSIONS: The MMI findings of MEWDS are secondary to RPE reflectivity changes, suggesting its pivotal role.
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Imagen Multimodal , Epitelio Pigmentado de la Retina/diagnóstico por imagen , Síndromes de Puntos Blancos/diagnóstico por imagen , Adulto , Colorantes/administración & dosificación , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Humanos , Verde de Indocianina/administración & dosificación , Masculino , Imagen Óptica , Epitelio Pigmentado de la Retina/patología , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Síndromes de Puntos Blancos/patología , Adulto JovenRESUMEN
BACKGROUND/PURPOSE: To document by optical coherence tomography angiography, the onset of a choroidal neovascularization (CNV) secondary to traumatic choroidal rupture and describe its changes after an intravitreal injection of bevacizumab. METHODS: Case report. RESULTS: A 20-year-old woman presented referring vision loss after a blunt ocular trauma in her left eye. The patient underwent a complete ophthalmic examination. Best-corrected visual acuity was 20/200. Fundus examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography displayed a choroidal rupture with no evidence of CNV. Optical coherence tomography angiography showed the choroidal rupture as a line of choriocapillaris rarefaction because of the mechanical damage. Six months later, best-corrected visual acuity decreased to 20/300; optical coherence tomography angiography displayed the growth of a CNV, characterized by a tangled vascular network. After one intravitreal injection of bevacizumab, optical coherence tomography angiography documented a contraction of the CNV. CONCLUSION: Optical coherence tomography angiography is a useful imaging technique for the diagnosis and follow-up of patients with choroidal ruptures. Anti-vascular endothelial growth factor agents represent an effective therapy for the treatment of CNVs secondary to this affection.