In Vivo Study of the Long Term Structural Changes Induced by Macular Argon Laser.

PURPOSE: To assess the long-term structural changes induced by macular argon laser using en face optical coherence tomography (OCT). MATERIALS AND METHODS: We reviewed the charts and OCT pictures of patients who had undergone macular laser for diabetic macular edema at least four years ago. Clinical parameters were recorded for each eye, including laser settings. We obtained En face pictures, that were flattened at the RPE (retinal pigment epithelium) plane. We then measured the retinal surface covered by laser marks and the maximal diameter of the largest identified lesion at this plane. The most superficial level of neurosensory retinal damage as well as the total retinal thickness at this location were measured from the RPE. We also measured the distance between the RPE and the deeper plane at which laser marks were detected. RESULTS: 21 eyes of 16-patients were analyzed. The mean age (±SD) was 61.7 ± 15.5 years. Patients had undergone macular laser 6.5 ± 2.8 years prior to entering our study. In 16 eyes the most superficial laser marks were detected at the inner plexiform/inner nuclear layers. The level of neurosensory retinal damage was 159 ± 48 microns over the RPE (62.6 ± 18.3% of the retinal thickness). The deepest level at which laser marks were retrieved was 125 ± 110 microns below the RPE. The growth of laser marks was correlated to time (Pearson's correlation coefficient = 0.23; p = 0.1). CONCLUSIONS: Argon laser marks gradually expand in the horizontal and vertical axes. The damage induced by argon laser in the neurosensory retina often reaches inner layers.

Choroidal Nevus-Associated Neovascular Membrane Demonstrated by OCT Angiography.

We present a case of choroidal nevus, complicated by a choroidal neovascular membrane (CNV) that was detected by OCT angiography. Choroidal nevi are relatively common intraocular tumors. The presence of subretinal and intraretinal fluids can indicate that a CNV has occurred as a complication, warranting prompt management. However, subretinal and intraretinal fluids are also documented in nevi without CNV. OCT angiography may be of great help in determining whether those fluids are associated or not with a CNV, therefore guiding therapy.

En face Integrated Central Avascular Zone (EFICAZ): a noninvasive tool for correlating morphological and functional damage in central diabetic macular edema.

BACKGROUND: As numerous factors account for diabetic maculopathy, retinal thickness alone is poorly correlated to visual function in diabetic macular edema. En face optical coherence tomography (OCT) enables assessing retinal changes at specific layers. By averaging several planes, overall changes can be better appreciated. METHODS: Retrospective analysis of a consecutive group of 16 patients (30 eyes) with diabetic macular edema in at least one eye, was compared to a control group of 17 healthy subjects (34 eyes). Healthy volunteers and diabetic patients being seen as part of their regular care underwent swept source OCT fundus imaging. En face Integrated Central Avascular Zone (EFICAZ) was manually determined and measured on images obtained by swept-source optical coherence tomography (OCT). EFICAZ was then compared between both populations and, for diabetic patients, correlated with best corrected visual acuity, as measured by the Snellen chart. RESULTS: In healthy subjects, a moderate correlation was found between age and EFICAZ (Pearson's coefficient = 0.45, P = 0.01). In age-matched populations (mean age of 63 ± 3.8 years for eight healthy subjects and 62.7 ± 8.9 years for diabetic patients; P = 0.9), EFICAZ was significantly higher in diabetic than non-diabetic eyes (2.92 ± 1.10 mm2 versus 1.86 ± 0.53 mm2; P < 0.01). In diabetic patients, correlation between the size of EFICAZ and visual acuity (Pearson's correlation coefficient = -0 .72, P < 0.001) was stronger than between OCT measured central subfield retinal thickness and visual acuity (Pearson's correlation coefficient = -0.02, N.S). CONCLUSIONS: EFICAZ increases with age in normal subjects. It is significantly larger in diabetic than in non-diabetic subjects. It offers a better way to determine visual acuity than OCT measurement of central retinal thickness. This new approach, which takes into account several factors involved in diabetic maculopathy, could be useful in monitoring response to therapy. It can easily be combined with other modalities.

LOCATING AND CHARACTERIZING ANGIOID STREAKS WITH EN FACE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To characterize angioid streaks (AS) with en face optical coherence tomography (OCT). METHODS: Case report of a patient with myopia presenting with choroidal neovascularization secondary to AS. Swept-source en face OCT ability to image the streaks was compared with spectral-domain and swept-source B-scans as well as color and red-free pictures. A 48-year-old man with myopia presented with sudden central visual loss. Choroidal neovascularization secondary to AS was diagnosed and intraocular anti-vascular endothelial growth factor given with clinical and OCT features improvement. RESULTS: Angioid streaks were visualized as less dark than the overlying retinal and the underlying choroidal vasculature. En face OCT located the changes at the level of Bruch membrane. An AS was found to be interrupted by the choroidal neovascularization, what was not captured by other modalities. CONCLUSION: En face OCT allows to assess the extent of changes in Bruch membrane and their spatial relationship to choroidal neovascularization.

EN FACE IMAGING OF RETINAL ARTERY MACROANEURYSMS USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To describe the advantages of en face view with swept-source optical coherence tomography in assessing the morphologic features of retinal arterial macroaneurysms, their consequences on adjacent retina, planning laser treatment, and evaluating its effects. METHODS: Three eyes were treated for retinal arterial macroaneurysms and followed by swept-source optical coherence tomography in 2014-2015. En face images of the retina and choroid were obtained by EnView, a swept-source optical coherence tomography program. RESULTS: Retinal arterial macroaneurysms have a typical optical coherence tomography appearance. En face view allows delineation of the macroaneurysm wall, thrombotic components within the dilation, and lumen measurement. Hemorrhage, lipids, and fluids can be precisely described in terms of amount and extent over the macula and depth. This technique is also practical for planning focal laser treatment and determining its effects. CONCLUSION: En face swept-source optical coherence tomography is a rapid, noninvasive, high-resolution, promising technology, which allows excellent visualization of retinal arterial macroaneurysms and their consequences on surrounding tissues. It could make angiography with intravenous injection redundant in planning and assessing therapy.

[Renal vein thrombosis--renal colic with unusual course].

Although renal vein thrombosis (RVT) is a complication of various renal and medical conditions, nephrotic syndrome is known as the most frequent one. RVT in patients suffering from nephrotic syndrome is rarely present with flank pain. Most patients are asymptomatic and recover spontaneously. The treatment of RVT consists of handling the primary condition and treating the thrombosis itself by anticoagulation. In severe cases with grave prognosis thrombolytic therapy is needed. This is a case study of a 38 year old male who presented with severe renal colic which subsequently diagnosed as RVT complication of the nephrotic syndrome. The article also reviews the literature regarding the frequency, etiological factors, pathophysiology, radiological diagnosis and disease treatment.