Multimodal and retro-mode imaging in sclerochoroidal calcification: A case report.

We present a case report on sclerochoroidal calcification (SCC), a rare condition involving calcium pyrophosphate deposits in the posterior pole of the eye in a 70-year-old patient. We provide an account of the clinical presentation and its appearance in multimodal images, using color fundus photography, swept-source optical coherence tomography (SS-OCT), ocular ultrasound, and the novel retro-mode imaging (RMI) technique. Visual acuity was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). Color fundus photography revealed yellowish deposits located in the upper temporal arcade of both eyes. SS-OCT demonstrated masses of scleral origin. Ocular ultrasounds confirmed the calcification of these masses. RMI detected hyper-reflective images with marked superficial elevation. Systemic laboratory results did not detect any abnormalities, leading to the diagnosis of bilateral idiopathic SCC.

Imaging characteristics of idiopathic scleroma: a retrospective case series and review of the literature.

BACKGROUND: Idiopathic scleroma (previously coined solitary idiopathic choroiditis or focal scleral nodule) is an innocuous lesion affecting the sclera with intraocular manifestations. It is often the basis of many misdiagnoses such as amelanotic choroidal melanoma, osteoma or metastatic lesions. Patients are often asymptomatic and the course is benign. With increasing use of community based imaging, more of such cases are being identified. This paper is a retrospective case series investigating the multi-modal imaging findings of idiopathic scleroma. METHODS: A retrospective analysis of prospectively collected data were analysed. Over the course of January 2008-January 2022, 44 patients diagnosed with idiopathic scleroma and imaged with wide-field colour fundus photography, fundus autofluorescence, ocular coherence tomography (OCT) and B-scan ultrasonography. Due to a poor image, only 43 images were included for OCT review. We also reviewed our patient's demographics, symptoms and baseline ophthalmic characteristics upon presentation. RESULTS: The mean age was 52 years (range 32-79) and there was no predilection towards gender. All lesions were post equatorial with the most common location being inferotemporal (n = 16, 36%); 32 lesions (73%) were yellow on fundus photography. 82% (n = 36/44) of lesions exhibited hyperautoflourescence and 43 lesions (98%) showed hyperechogenicity on B-scan ultrasonography. 100% of lesions originated from the sclera with no lesions showing active inflammation. 20 (47%) lesions had associated blood vessels overlying them on OCT. DISCUSSION: Idiopathic scleroma is a yellow, hyperautofluorescent, hyperechogeneic scleral lesion that has no signs of active inflammation. These characteristics help define them from other more sinister cause of amelanotic fundal lesions.

[Capabilities of optical coherence tomography in examination of senile scleral plaques]. / Vozmozhnosti opticheskoi kogerentnoi tomografii v otsenke senil'noi skleral'noi blyashki.

Senile scleral plaque (SSP) is a degenerative disease of the sclera manifested by the appearance of gray spots with clearly defined borders anteriorly from the insertion site of horizontal rectus muscles. Even with minimal changes over time changes over time are minor, SSP weakens the structural function of the sclera and creates a risk of a complicated course associated with scleromalacia. Interest in the study of SSP is increasing due to the growing number of transscleral intravitreal injections. PURPOSE: To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT). MATERIAL AND METHODS: The study examined 13 patients (21 eyes) with average age of 77.1±6.3 years. OCT scanning was performed to determine OCT signs of SSP, the length (parallel to the limb), the width and height of the SSP, as well as the depth and thickness of the overlying sclera. RESULTS: A combination of nasal and temporal SSP was observed in 14 eyes, and nasal only SSP was detected in 6 eyes. In all cases, OCT presented a characteristic picture of SSP observed as an intrascleral cavity with hyperreflective content with lower reflectivity than the surrounding tissues, and clear borders represented by unchanged scleral fibers. The length of the SSP parallel to the limb was 3296±820 µm, the width - 2312±436 µm, the height of the SSP cavity - 482±89 µm. The depth of SSP site was 213±36 µm, the thickness of the overlying sclera - 125±29 µm. CONCLUSION: Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.

Idiopathic sclerochoroidal calcifications: Case report, metabolic causes and differential diagnosis / Calcificações esclerocoroidais idiopáticas: relato de caso, causas metabólicas e diagnóstico diferencial

Abstract Sclerochoroidal calcifications (SC) are a rare and benign ocular condition characterized by yellow-white irregular subretinal lesions usually found in the supero-temporal arcade of the midperipheral fundus in middle-aged elderly men. We present a clinical case of a 79- year-old patient who during a fundus examination presented raised whitish nodules in the supero-temporal arcade in the right eye. After performing optical coherence tomography, ultrasound, ocular computed tomography and laboratory analysis, she was diagnosed with idiopathic sclerochoroidal calcifications The pathogenesis of sclerochoroidal calcifications remains unclear but systemic conditions should be discarded. It is important to distinguish sclerochoroidal calcifications from other conditions such as tumors.

Resumo Calcificações esclerocoroidais (SC) são uma condição ocular rara e benigna caracterizada por lesões sub-retinianas irregulares amarelo-brancas, geralmente encontradas na arcada superotemporal do fundo médio-periférico em homens idosos de meia-idade. Apresentamos um caso clínico de uma paciente de 79 anos que durante exame de fundo apresentou nódulos esbranquiçados elevados na arcada superotemporal do olho direito. Após realizar tomografia de coerência óptica, ultra-sonografia, tomografia computadorizada ocular e análise laboratorial, ela foi diagnosticada com calcificações esclerocoroidais idiopáticas A patogênese das calcificações esclerocoroidais permanece incerta, mas as condições sistêmicas devem ser descartadas. É importante distinguir calcificações esclerocoroidais de outras condições, como tumores.

CORRELATION BETWEEN POSTERIOR STAPHYLOMA AND DOME-SHAPED MACULA IN HIGH MYOPIC EYES.

PURPOSE: To investigate the relationship between posterior staphyloma and dome-shaped macula (DSM) in highly myopic eyes. METHODS: The clinical data were collected from patients with high myopia: diopter, best-corrected visual acuity, axial length, fundus images, optical coherence tomography, and 3D magnetic resonance imaging. A DSM was defined as a convex curvature of the macula in one or both of the vertical and horizontal optical coherence tomography scans. The relationship between DSM and posterior staphyloma was evaluated. RESULTS: A total of 123 eyes were included. Dome-shaped macula was found in 18 eyes (14.63%). Twelve eyes with DSM had positive 3D magnetic resonance imaging findings. Nine eyes had horizontal oval-shaped dome, and a band-shaped inward convexity that extended horizontally from the optic disc through the fovea could be seen. Three eyes had round dome, and 3D magnetic resonance imaging showed a round inward convexity of the macular area. Five inward convexities were the border of multiple staphylomas, five were the boundary of one staphyloma, and two were within a single staphyloma. CONCLUSION: The formation of highly myopic DSM is related to the morphological change of the entire posterior segment.

Reaction on "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma".

BACKGROUND: In the recently published article entitled "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma" Jacobsen et al. describe a case in which a hyper-intense extra-ocular lesion on MRI was erroneously diagnosed as an extrascleral extension of the tumor. Based upon this the authors conclude "the superiority of ocular ultrasound in the diagnostic management of extra scleral extension in choroidal melanoma". In our view, there are numerous flaws in the investigation that cast doubt on this message. MAIN: First of all, this is quite a bold statement when only one patient has been evaluated. Secondly, the manuscript only presents a post-contrast T1-weighted image, whereas multiple MRI-sequences need to be included to determine if a hyperintense region is an extrascleral invasion. Moreover, no modern MRI-techniques such Dynamic Contrast Enhanced (DCE) or Diffusion Weighted Imaging (DWI) have been included in the evaluation of this patient, making it hard to use this single case to compare the efficacy of MRI and Ultrasound. The presented data do, however, give clear clues that the hyperintense lesion is likely to be inflammatory. CONCLUSION: Although the study falls short in providing a comprehensive comparison between current MRI techniques and ultrasound, it does show that the evaluation of ocular MR-images should be made in a multi-disciplinary setting involving both ophthalmologist and radiologists, since the field of ocular MRI is continuously progressing.

Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography.

PURPOSE: To determine the early signs of posterior staphylomas in highly myopic eyes of younger subjects by swept-source ultra-widefield optical coherence tomography (WF-OCT). METHODS: This was an observational case series study. Highly myopic subjects younger than 20 years old who were examined consecutively by prototype WF-OCT were studied. High myopia was defined according to the Ministry of Health and Welfare, Japan classification. A posterior displacement of the sclera and two OCT features indicating the staphyloma edges were used as markers of a staphyloma. RESULTS: Fifty-five eyes of 30 patients with the mean age of 12.3 years, and the mean axial length of 27.9 mm were studied. Seven of the 55 eyes (12.7%) had a posterior displacement of the sclera and were diagnosed as having a staphyloma. Among the two OCT features of the staphyloma edges, a gradual thinning of the choroid toward the staphyloma edge and gradual re-thickening of choroid from the staphyloma edge toward the posterior pole were found in these 7 eyes. However, the other feature of an inward protrusion of the sclera at the staphyloma edge, was obvious in only 2 eyes. The subfoveal choroid and choroid nasal to the optic disc were significantly thinner in eyes with a staphyloma than those without it. CONCLUSIONS: The changes of the choroidal thickness toward the staphyloma edge with the posterior displacement of the sclera were considered an early sign which precedes an inward protrusion of sclera at the staphyloma edge.

Rectus Extraocular Muscle Paths and Staphylomata in High Myopia.

PURPOSE: To investigate the relationship between displacement of extraocular muscles (EOMs) and staphyloma in high myopia using magnetic resonance imaging (MRI). DESIGN: Retrospective case-control study. METHODS: Setting: Institutional study. POPULATION: Twenty-nine highly myopic patients (46 eyes), 11 age-matched healthy control subjects (21 eyes), and 34 patients (66 eyes) with sagging eye syndrome. PROCEDURES: MRI was analyzed for aspect ratio (AR) of the ocular cross section, locations of staphylomata and EOMs, and status of superior rectus to lateral rectus (SR-LR) band ligament. MAIN OUTCOME MEASURES: Association between staphylomata with EOM paths and the LR-SR band. RESULTS: Several associations of staphylomata were statistically significant (P < .05). Most staphylomata were superotemporal. Myopic patients with staphyloma had larger ARs in quasi-coronal images than in myopic subjects without staphyloma or normal controls. Compared to patients with high myopia without staphyloma and normal controls, when staphyloma was present, there was more inferior LR displacement, larger LR-globe angle, and larger SR-LR displacement angle than in myopic subjects without staphyloma. Staphyloma in the superotemporal quadrant was associated with greater SR-LR angle than in other quadrants. There were significantly more ruptures of SR-LR band ligament in highly myopic patients with staphyloma than in those without staphyloma. CONCLUSIONS: Local staphylomata in high myopia reflect ocular asphericity and correlate with EOM paths. Myopic staphylomata are associated with inferior displacement of LR path and defect of the LR-SR band ligament.

Calcificaciones esclerocoroideas como hallazgo casual / Sclerochoroidal calcification as casual finding

La calcificación esclerocoroidea (CEC) es infrecuente y benigna. Se suele detectar en una exploración rutinaria hallándose múltiples lesiones blanco-amarillentas en el ecuador temporal superior de la retina en varones de mediana edad y ancianos. Se expone el caso de un paciente varón de 79 años de edad que presentó en una revisión rutinaria glaucoma pseudoexfoliativo en el ojo derecho, así como lesiones subretinianas blanco-amarillentas sobreelevadas en la región ecuatorial temporal superior en ambos ojos. Tras instaurar tratamiento hipotensor y realizarse autofluorescencia, tomografía de coherencia óptica (OCT), ecografía, tomografía computarizada (TC) ocular y analítica completa, se diagnosticó de CEC idiopáticas. La CEC requiere un estudio oftalmológico y sistémico completo porque puede asociar enfermedad endocrina. También se recomienda el seguimiento evolutivo periódico y descartar posibles complicaciones como la atrofia del epitelio pigmentario suprayacente, desprendimiento seroso, o la aparición de neovascularización. Debe realizarse el diagnóstico diferencial con lesiones benignas y malignas para evitar tratamientos innecesarios

Sclerochoroidal calcification (SCC) is uncommon and benign. It is usually detected in a routine examination, finding multiple yellow-white lesions in the upper temporal region of the retina in middle-aged and elderly men. A case report is presented of a 79 year-old male patient, who during a routine examination with a pseudoexfoliative glaucoma in the right eye, as well as raised white-yellow subretinal lesions in the upper temporal region in both eyes. After establishing hypotensive treatment and performing autofluorescence, optical coherence tomography (OCT), ultrasound, ocular computed tomography (CT) and complete laboratory analysis, idiopathic SCC was diagnosed. SCC requires a complete ophthalmological and systemic study as it can be associated with endocrine disease. Periodic follow-up is also recommended, as well as to rule out possible complications, such as atrophy of the overlying pigment epithelium, serous detachment, or the appearance of neovascularization. The differential diagnosis should be made of benign and malignant lesions, in order to avoid unnecessary treatment

Episcleral racemose hemangioma.

Racemose hemangioma is a rare, benign vascular malformation. In the episclera, it appears as dilated, tortuous blood vessels that pass from the fornix over the globe surface to the limbal area, without capillary architecture, and then loop backward into the fornix. Fluorescein angiogram reveals the vascular malformation with rapid flow and confirms the episcleral vessels to be large in caliber and with a curvilinear, twisted configuration. We report the case of a 22-year-old man with nonhemorrhagic, coincidental racemose hemangioma of the episclera.

Sclerochoroidal calcification as casual finding. / Calcificaciones esclerocoroideas como hallazgo casual.

Sclerochoroidal calcification (SCC) is uncommon and benign. It is usually detected in a routine examination, finding multiple yellow-white lesions in the upper temporal region of the retina in middle-aged and elderly men. A case report is presented of a 79 year-old male patient, who during a routine examination with a pseudoexfoliative glaucoma in the right eye, as well as raised white-yellow subretinal lesions in the upper temporal region in both eyes. After establishing hypotensive treatment and performing autofluorescence, optical coherence tomography (OCT), ultrasound, ocular computed tomography (CT) and complete laboratory analysis, idiopathic SCC was diagnosed. SCC requires a complete ophthalmological and systemic study as it can be associated with endocrine disease. Periodic follow-up is also recommended, as well as to rule out possible complications, such as atrophy of the overlying pigment epithelium, serous detachment, or the appearance of neovascularization. The differential diagnosis should be made of benign and malignant lesions, in order to avoid unnecessary treatment.

ENLARGEMENT OF SCLEROCHOROIDAL CALCIFICATIONS: MULTIMODAL IMAGING UPDATE.

PURPOSE: To report the multimodal imaging and enlargement of sclerochoroidal calcifications over a 10-year period. METHODS: Case report of a 74-year-old white man who presented for routine follow-up and was found to have yellow chorioretinal lesions in the right eye. RESULTS: Multimodal imaging was performed and confirmed sclerochoroidal calcifications. Comparison of fundus photography over a 10-year period demonstrated growth of preexisting lesions and the development of new lesions in the right eye. CONCLUSION: Over time, this patient developed new sclerochoroidal calcifications and enlargement of preexisting calcifications. We, therefore, recommend regular follow-up with periodic multimodal imaging for these patients.

Knobby Eye Syndrome.

INTRODUCTION: A spherical globe is traditionally assumed, but this study employed magnetic resonance imaging (MRI) to demonstrate frequent occurrence of non-spherical staphylomata in strabismic patients. METHODS: High-resolution, surface coil MRI was obtained in multiple image planes in 21 highly myopic subjects (36 eyes) and compared with 17 normal controls (33 eyes). Images were analyzed for axial length, aspect ratio of eye shape, and deflection of muscle paths. RESULTS: All but two high myopes had strabismus. While myopic globes were generally spherical in 10 myopic eyes including both orthotropic subjects, 15 globes exhibited diffuse posterior staphylomata, 16 equatorial staphylomata, and 4 both posterior and equatorial staphylomata. Equatorial scleral ectasias were positioned to contact and elongate paths of horizontal rectus muscles in some gaze positions. Axial length in myopes averaged 28.8 ± 3.8 (SD) mm and did not differ significantly between regular vs. irregular staphylomata. Globe aspect ratios in the coronal, axial, and sagittal planes were significantly greater than normal in myopes (P < 0.005), but correlated significantly with axial length only in the axial and sagittal planes (P < 0.03). While myopes with irregular staphylomata were older at 57 ± 11 years than subjects with spherical globes at 24 ± 8 years (P < 0.0005), other clinical features were similar. CONCLUSION: Irregular equatorial or posterior staphylomata are common in strabismic axial high myopes, acting, like "cams" affixed to the normally spherical globe so that they may have no mechanical effect until rotating eccentrically against muscles. After rotational contact, staphylomata would nonlinearly increase muscle tension with further duction. Imaging may be clinically informative about this "knobby eye syndrome."

The relationship between scleral staphyloma and choroidal thinning in highly myopic eyes: The Beijing Eye Study.

Based on the Beijing Eye Study 2011, a detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of subfoveal choroidal thickness (SFCT) and relative height of posterior scleral staphyloma. OCT images were obtained in 103 highly myopic eyes (≤-6.00 diopters) and 227 normal eyes. The mean SFCT in highly myopic eyes was 110.6 ± 85.2 µm (range, 3 to 395 µm). The SFCT of high myopia without posterior scleral staphyloma(55 eyes) was 157.79 ± 85.18 µm, which was significantly greater than that (54.94 ± 49.96 µm) of high myopia with posterior scleral staphyloma (48 eyes) (P < 0.001). In multivariate analysis, posterior scleral staphyloma was the most important factor of choroidal thinning in high myopia (F = 22.63; P < 0.001), then age (F = 19.14; P < 0.001), axial length (F = 17.37; P < 0.001) and gender (F = 17.31; P < 0.001). The SFCT in highly myopic eyes is very thin and undergoes further thinning with increasing age and axial length (refractive error). Posterior staphyloma formation was a key factor in choroidal thinning in highly myopic eyes and to be a good indicator for risk management of choroidal thinning. Abnormalities of the choroid may play a role in the pathogenesis of myopic degeneration.