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ABSTRACT We report a case of acute methanol toxicity with unique optical coherence tomography findings. A 56-year-old man was referred to our ophthalmology clinic with a history of handmade vodka consumption and vision loss. On ophthalmologic examination, his vision was 20/100 in his right eye and 20/200 in his left eye. Bilateral mild optic disk hyperemia was detected on fundus examination. Because of the severity of systemic symptoms in such cases, it is very difficult to include optical coherence tomography in the ophthalmologic examination. However, we managed to perform optical coherence tomography and recorded shallow subretinal fluid and a prominent middle limiting membrane sign as acute retinal structural changes in the patient. The patient was treated with hemodialysis, intravenous ethanol, and sodium bicarbonate. On the fourth day of treatment, visual acuity improved to 20/20 in both eyes. In addition, the prominent middle limiting membrane sign and subretinal fluid disappeared. In this unusual case, retinal pigment epithelium damage and retinal ischemia may have contributed to the prominent middle limiting membrane and subretinal fluid, which are novel optical coherence tomography findings of methanol toxicity.
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BACKGROUND: Beta-blockers may counteract the effect of catecholamines on central serous chorioretinopathy (CSC) pathology and accelerate the improvement of neurosensory retinal detachment. Oral propranolol has been associated with decreased duration of CSC in some studies. We describe two patients with visually symptomatic chronic CSC (cCSC) treated successfully with intravitreal metoprolol. CASE PRESENTATIONS: After obtaining the patients' informed consent, two eyes of two 43-year-old men diagnosed with cCSC treated unsuccessfully with oral spirolactone, micropulse laser and intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents were treated with one off-label intravitreal injection of metoprolol (50 µg/0.05 ml). Baseline (pre-injection) and follow-up examinations (at 1 month post-injection) included best-corrected visual acuity (BCVA), anterior and posterior segment biomicroscopy, fundus autofluorescence, spectral domain optical coherence tomography (Spectralis, Heidelberg), and electroretinogaphy (ERG) according to International Society for Clinical Electrophysiology of Vision (ISCEV) full-field scotopic and photopic standard protocols. ERG results at baseline (pre-injection) and at 1 month post-injection were compared using paired t-tests. RESULTS: There was no significant difference in any of the ISCEV recommended ERG parameters with respect to a- and b-wave amplitude and implicit time, and oscillatory potentials maximal amplitude. BCVA improved in both patients. Neither patient developed clinical evidence of intraocular inflammation. Subretinal and/or intraretinal fluid had improved in both patients at 1 month after the metoprolol injection. CONCLUSION: These preliminary findings suggest that intravitreal metoprolol may be a safe alternative therapy for patients with cCSC.
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PURPOSE: To study the regression patterns of subretinal fluid (SRF) in central serous chorioretinopathy (CSCR) on sequential en face optical coherence tomography (OCT) and its relationship to leak locations. METHODS: Retrospective study on patients with acute CSCR. Inclusion criteria were (i) availability of data, sequential OCT and OCT angiography (B scan and en face OCT) every 2 weeks until resolution of SRF or 6 months, whichever is earlier; (ii) single active leak. Exclusion criteria were (i) presence of macular neovascularization or atypical CSCR, (ii) diffuse pigment epitheliopathy, (iii) multiple leaks. Serial en face OCT scans were evaluated and the area of SRF was measured using ImageJ software. Correlation coefficient was calculated for the regression rate of SRF area and central retinal thickness (CRT) over the first month of follow-up and the time of complete SRF resolution. RESULTS: Out of the 25 eyes, 20 eyes demonstrated a centripetal regression, and 5 eyes demonstrated a centrifugal regression. In eyes with a leakage point <1000µ from the fovea, 86% resolved in a centripetal fashion, and in eyes with leak site ≥1000µ away from fovea, 70% eyes resolved centripetally. There was a correlation (r=-0.47, p=0.018) of the rate regression of SRF area during the first month and timing of resolution. In contrast, this correlation was absent (r=-0.16, p=0.44) for CRT regression. CONCLUSION: Our en face-based analysis of sequential OCTs of regressing CSCR demonstrated a tendency for the subfoveal SRF to resolve towards the end or a centripetal pattern of regression. Prediction of resolution of SRF at 1 month is better with en face area of SRF in comparison to CRT.
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Central Serous Chorioretinopathy , Central Serous Chorioretinopathy/diagnosis , Fluorescein Angiography/methods , Humans , Retrospective Studies , Tomography, Optical Coherence/methods , Visual AcuityABSTRACT
PURPOSE: To study the implementation of the new multimodal imaging-based classification system of central serous chorioretinopathy (CSCR). METHODS: Ninety-three eyes with CSCR with available fundus autofluorescence (FAF), optical coherence tomography (OCT), and OCT angiography at presentation were included in this study. An anonymous data set was classified by two masked graders. Each case was classified as per presence of (i) simple versus complex (< or >2 disc diameters of retinal pigment epithelium abnormality) CSCR; (ii) primary versus recurrent versus resolved CSCR; (iii) persistent (presence of subretinal fluid >6 months) or not; (iv) outer retinal atrophy (ORA); (v) foveal involvement; and (vi) macular neovascularization (MNV). Agreement between the graders was calculated. RESULTS: Kappa value was 0.91 (95% CI 0.8-1.0) for the entire classification; 0.84 (95% CI 0.73-0.95) for simple versus complex; 1.0 (95% CI 1.0-1.0) for primary versus recurrent versus resolved CSCR; 1.0 (95% CI 1.0-1.0) for persistent or not; 0.9 (95% CI 0.81-0.99) for ORA or not; 0.95 (95% CI 0.84-1.0) for presence or absence of MNV; 1.0 (95% CI 1.0-1.0) for presence or absence of foveal involvement. CONCLUSION: The new multimodal imaging based CSCR classification showed "near perfect" agreement between two retinal experts.
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BACKGROUND: To analyze the relationship between the central foveal thickness (CFT) and the integrity of the ellipsoid portion of inner segments (EPIS) and interdigitating zone (IZ) retinal layers in the visual outcome of uveitic macular edema (UME). METHODS: Prospective, observational, and cross-sectional study of eyes with UME. Spectral-domain optical coherence tomography (SD-OCT) macular morphological pattern, CFT, and integrity of the outer retinal layers were analyzed. We arranged the data by EPIS or IZ integrity and contrasted it with student t-test (quantitative variables) and Fisher exact test or χ² distribution (categorical variables) to evaluate visual impairment and retinal measures. Receiver operator curve (ROC) estimation and logistic regression (probit) assessed if the sample´s variance could be associated with IZ or EPIS integrity. RESULTS: We included 145 SD-OCT macular scans from 45 patients at different stages of UME. Cystoid macular edema (CME) increased the risk of severe (P ≤ 0.0162) and moderate visual loss (P ≤ 0.0032). The highest CFT values occurred in patients with moderate (478.11 ± 167.62 µm) and severe (449.4 ± 224.86 µm) visual loss. Of all morphological patterns of macular edema, only CME showed a statistically significant relationship with severe visual impairment (44.92%, p = 0.0035, OR 4.29 [1.62-11.4]). Likewise, an increased probability of severe visual loss correlated negatively with both, IZ (37.93%, P ≤ 0.001, OR 10.02) and EPIS (38.98%, P ≤ 0.001, OR 13.1) disruption. A CFT > 337 µm showed a higher probability of IZ (AUROC = 0.7341, SEN 77.59%, ESP 65.52) and EPIS (AUROC = 0.7489, SEN 76.37%, ESP 65.12%) loss of integrity. Moreover, when BCVA reached 0.44 LogMAR (≤ 20/50 Snellen eq.), it was more likely to have IZ (AUROC = 0.8706, ESP 88.51%, SEN 77.59%) and EPIS (AUROC = 0.8898, ESP 88.3%, SEN 76.27) disruption. CONCLUSIONS: Significantly increased CFT has a higher probability for EPIS and IZ disruption, which significantly increases the risk for irreversible visual loss in eyes with UME. Evaluating these layers' integrity by optical coherence tomography helps predict the visual outcome and make the right therapeutic decisions. Trial registration The study was registered on April 13, 2020, at the Instituto Tecnologico y de Estudios Superiores de Monterrey Research Committee (License No. COFEPRIS 20 CI 19 039 002), project registration No. P000338-CAVICaREMU-CI-CR002, and the Ethics Committee (License No. CONBIOETICA 19 CEI 011-2016-10-17), project registration No. P000338-CAVICaREMU-CEIC-CR002.
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Objetivo: Determinar la incidencia de líquido subretiniano luego de cirugía exitosa de agujero macular y su impacto sobre la agudeza visual final. Diseño del estudio: Estudio retrospectivo y descriptivo. Métodos: Se analizaron 32 ojos de 32 pacientes con diagnóstico de agujero macular tratado con vitrectomía más pelaje de la membrana limitante interna; se calculó la incidencia de líquido subretiniano según los hallazgos de la tomografía de coherencia óptica del postoperatorio y se realizó comparación de variables entre los subgrupos con y sin presencia de líquido. Resultados: Se obtuvo una incidencia de líquido subretiniano de 15.6%, sin evidenciarse una diferencia estadísticamente significativa entre los subgrupos con y sin líquido para las variables de edad, género, estado del cristalino, diámetro del agujero, posición postquirúrgica, agudeza visual mejor corregida prequirúrgica y postquirúrgica a los a los 3 y a los 6 meses. Se identificó menor cronicidad en los agujeros con presencia de líquido subretiniano que en aquellos que no lo presentaban. Conclusiones: Los resultados obtenidos en este estudio, apoyan la teoría que sugiere que la presencia de líquido subretiniano no influye sobre la agudeza visual final alcanzada luego de vitrectomía más pelaje de la membrana limitante interna para el tratamiento de agujero macular. Además, se documentó una incidencia de líquido subretiniano inferior a la reportada previamente en la literatura, lo cual podría estar relacionado con la técnica quirúrgica utilizada.
Objective: To determine subretinal fluid incidence after successful macular hole surgery and its impact on visual recovery. Study design: Retrospective and descriptive study. Methods: 32 eyes of 32 patients with macular hole that were managed with vitrectomy and internal limiting membrane peeling were analyzed. Subretinal fluid incidence was calculated according to postoperative optical coherence tomography findings and subgroups with and without subretinal fluid were compared. Results: We found a subretinal fluid incidence of 15.6%, with no statistically significant differences between subgroups for age, sex, lens status, hole diameter, postsurgical position, presurgical and postsurgical best corrected visual acuity at 3 and 6 months. The holes with subretinal fl uid were less chronic compared with the holes without fluid. Conclusions: This study supports the theory that proposes no influence of subretinal fluid in the visual recovery after vitrectomy with internal limiting membrane peeling for macular hole treatment. Additionally, the subretinal fluid incidence reported here is the lowest in literature; this could be explained by the surgical technique used.