Optic disc and choroidal metastases secondary to breast cancer: A case report.

AIM: To report an uncommon case of optic disc and multiple choroidal metastases secondary to breast cancer, assessed with swept source optical coherence tomography (SS-OCT), fluorescein (FA), and infracyanine (ICGA) angiographies. METHODS: Observational case report. CASE PRESENTATION: A 40-year-old woman with history of left breast carcinoma presented with blurred vision in her right eye (RE). Her visual acuity was 1/20 in the RE and 10/10 in the left eye. Fundus examination of the RE showed a large yellowish elevation of the posterior pole and a particular whitish nodular papillary cluster protruding from the optic disc into the vitreous. Infrared imaging enhanced the papillary nodular infiltrates. Characteristic findings of choroidal metastasis were noted within the macular lesion on SS-OCT and ICGA. SS-OCT showed specific "lumpy bumpy" irregularity of the anterior surface of the choroid and elevated hyperreflective nodular lesions of the optic disc associated to peripapillary subretinal fluid. The papillary lesions appeared as a bunch of hypofluorescent dots on both FA and ICGA, and ultra-wide field FA was helpful clearly delimiting the large macular lesion. Besides, comprehensive imaging and especially ICGA could detect two asymptomatic choroidal metastases in a systematic assessment of the fellow eye. CONCLUSION: Optic disc metastases are extremely rare. Their diagnosis can be easily done on fundus examination when presenting with characteristic whitish cluster nodular infiltrates of the optic disc. However multimodal imaging remains very useful for the assessment of the local extension of the lesion and for diagnosing associated asymptomatic choroidal lesions gone unnoticed at the fundus examination.

Optical Coherence Tomography Angiography in idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome: A case report.

PURPOSE: Since its first description by Chang et al. in 1995, the diagnosis of Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome has been based on the findings of Fundus Fluorescein Angiography (FFA). Our purpose was to describe the utility of optical coherence tomography angiography (OCT-A) in its diagnosis and management. CASE DESCRIPTION: A 40-year-old female presented with bilateral blurred vision. Her best corrected visual acuity was at 8/10. Fundus examination revealed blurred disc margins, perivascular exudates, arterial sheaths and retinal hemorrhages bilaterally. FFA showed staining of the optic disc with dye leakage in the right eye, a punctuate hyperfluorescence of the temporosuperior artery in the left eye, bilateral vascular sheathing and capillary dropout. OCT-A showed simultaneous presence of papillary aneurysm and neovascularization of the optic nerve head in the right eye, a papillary aneurysm in the left eye and bilateral capillary non-perfusion. Our patient was diagnosed with IRVAN syndrome. Oral steroids associated with panretinal laser photocoagulation and intravitreal injection of bevacizumab in the right eye resulted in vanishing of the papillary neovascularization with no recurrence on OCT-A at 10-month follow-up. CONCLUSIONS: OCT-A is an additional tool to FFA for visualization of arterial macroaneurysms and retinal neovascularization without the interference of dye leakage. It well demarcates nonperfused areas and ensures follow-up of retinal neovascularization. Its limitations are the limited field of view and the low sensitivity in detecting arteriolar dilations. Thus, OCT-A is unable to outplace FFA but should be considered alternately with it for non-invasive follow-up of IRVAN syndrome.

Optical coherence tomography angiography microvascular changes in diabetics without diabetic retinopathy.

PURPOSE: The purpose of this study was to analyze the retinal vasculature of diabetic eyes without clinical retinopathy in order to detect microvascular abnormalities, comparing them to that of healthy nondiabetic control eyes. METHODS: This is a prospective, cross-sectional study including 40 patients (76 eyes). Twenty patients (40 eyes) were diabetics with no diabetic retinopathy group (NDRG). The twenty other patients (36 eyes) were nondiabetic and constituted the control group (CG). Images were obtained using the AngioVue optical coherence tomography angiography (OCTA) software of RTVue XR spectral-domain OCT device. We performed 3 mm × 3 mm and 6 mm × 6 mm scans to evaluate the foveolar avascular zone (foveal) size, a remodeling of the FAZ, microaneurysms, vessel tortuosity, and superficial vascular density. All statistics were performed using IBM SPSS statistics (version 21). RESULTS: The average FAZ size was 314.6 ± 15.3 µm in the NDRG versus 291.5 ± 14.1 in the CG. The difference was not significant (P = 0.56). FAZ remodeling was noted in 40% of eyes in the NDRG and in 2.8% of eyes in the CG (P = 0.0001). Flow alteration zones (nonperfusion zones) were seen in 77.5% in the NDRG (P = 0.0001). Microaneurysms were present only in the NDRG (70% of eyes). Parafoveolar vascular density was 52.8% ± 0.7% in the NDRG and 54.1% ± 0.25% in the CG but without significant difference (P = 0.206), and vascular tortuosity was significantly present in the NDRG with 32.5% of eyes versus 11.1% of eyes in the CG (P = 0.003). CONCLUSION: OCTA is a promising tool to identify microvascular changes in the diabetic retina before clinically visible retinopathy occurrence. It may identify in the future individuals at risk of developing retinopathy and therefore those needing a better balance of diabetes.

Unilateral proptosis revealing a fronto-ethmoidal mucocele.

Backgroud: The fronto-ethmoidal mucocele is a benign condition leading commonly to limited eye movement or ocular pain but it could also induce visual acuity impairment by compressing the optic nerve Aim: To discuss, through a case report, different ophthalmologic manifestations of the fronto-ethmoidalmucocele. Reported case: A 46-years-old man with no general history consulted for a bilateral ocular redness and itching. He reported, however, a mild protrusion of his left globe evolving for oneyear. The clinical examination revealed a unilateral proptosis in the left eye with a discrete limitation of theadduction. A brain and orbital computer tomography (CT)and a magnetic resonance imaging(MRI)revealed a grade I exophthalmos caused by an oval formation of fluid density in the left anterior and posterior ethmoidal cells in addition to the frontal sinus,driving theeyeball and internal oculomotor muscles back and out.The patient was referred to otorhinolaryngology department for a precocious surgical management. CONCLUSION: The ophtalmologic manifestations of the disease depend on the location, the size of the formation and involvement of adjacent structures. The loss of vision and the apex syndrome due to the compressionof the ocular globe are the most serious complications.