Subfoveal and Parafoveal Choroidal Thickening in Patients with Keratoconus Using the ETDRS Grid on Swept-Source OCT.

INTRODUCTION: There is growing evidence that confirms morphological changes in the posterior structures in patients with keratoconus (KC); however, isolated alterations could have been missed. This study assesses choroidal thickness (CT) in the fovea and beyond in KC eyes. METHODS: This prospective case-control and non-randomized study enrolled 107 eyes, 62 eyes of 62 patients with KC, and 45 age-matched eyes of 45 control subjects with axial length in the range of 22-26 mm. Swept-source optical coherence tomography (SS-OCT) was performed to manually measure the subfoveal choroidal thickness (SCT) using a single-line scan. CT was obtained automatically from the Early Treatment Diabetic Retinopathy Study (ETDRS) grid using the 12-lines radial scan pattern. A two-way repeated-measures analysis of variance (ANOVA) was conducted to evaluate CT variations among macular eccentricity, parafoveal area, and the interaction between both factors. CT was compared in all parafoveal areas between groups and subgroups of KC. RESULTS: SCT was significantly thicker in KC eyes (357 ± 57 µm) than in healthy eyes (325 ± 63 µm) (p < 0.001). Significant choroidal thickening was observed in the central ring and outer and inner rings of the temporal, superior, and inferior parafoveal macular areas (p < 0.001), except in the outer ring of the nasal macular zone (p > 0.05) of KC compared to healthy eyes. The CT significantly decreased from the center to the outer ring regardless of the presence of KC (p < 0.001). The choroid in the nasal macular zone was significantly thinner than that in the temporal, superior, and inferior parafoveal areas (p < 0.001). CONCLUSIONS: The choroidal structure increased its thickness not only in the subfoveal area, but also in eight parafoveal areas of the ETDRS grid encompassing a wider area of macular examination. These findings demonstrate and corroborate that keratoconus is not a purely corneal disease. Furthermore, it confirms the role that the choroidal structure has in the pathophysiology of keratoconus.

Outcome Measures for Disease Monitoring in Intraocular Inflammatory and Infectious Diseases (OCTOMERIA): Understanding the Choroid in Uveitis with Optical Coherence Tomography (OCT).

PURPOSE: To compare imaging modalities for the choroid of the eye, and evaluate various choroidal changes in uveitides entities. METHODS: A comprehensive systematic literature review was conducted looking at current imaging modalities available to assess choroid architecture and commonly used parameters available to qualify and quantify choroidal changes, before looking at specific uveitides entities with choroidal involvement which have been broadly separated into non-infectious and infectious in etiology. RESULTS: We describe the various modalities currently available to evaluate the choroid of the eye such as Ultrasound B Scan, ICGA, and OCT. Choroidal changes in various ocular and systemic diseases such as Behcet's Disease, Sarcoidosis, Syphillis, Tuberculosis, and many more have been reported and published. CONCLUSION: Multiple choroidal tomographic and angiotomographic findings have been demonstrated for evaluation in uveitis. These findings can manifest in multiple ocular and systemic diseases, and can be illustrated using the various imaging modalities at present. Future advancements in choroidal imaging would help to adapt these findings into parameters for clinical practice to properly evaluate these ocular and systemic diseases.

Primary Sjögren's syndrome-related Choroiditis in a Newly Diagnosed Older Adult.

PURPOSE: To report a case of secondary bilateral choroiditis in a patient with primary Sjögren's syndrome(pSS). STUDY DESIGN: Case report. RESULTS: A 69-year-old woman visited our hospital for consultation due to decreased visual acuity in both eyes for 1 month. At the first visit, best corrected visual acuity (BCVA) was 0.2 and 0.3 in her right and left eyes, respectively. Intraocular pressure values were 15 mmHg and 16 mmHg in her right and left eyes, respectively. Examination revealed edema of the eyelids and conjunctiva,and corneal fluorescence staining was positive. No inflammation in the anterior chamber or vitreous opacities were observed. Bilateral multiple retinal detachments were observed on the posterior fundus, and optical coherence tomography revealed bilateral multiple areas of retinal neuroepithelial detachment, choroidal thickening, and choroidal folds. No abnormal fluorescence leakage was observed on fundus fluorescein angiography or indocyanine green angiography. In addition, systematic manifestations included recurrent bilateral parotid gland enlargement. Labial gland biopsy revealed dilated glandular ducts, scattered interstitial glands, and lymphocytic foci. Salivary gland scintigraphy revealed severe impairment of glandular excretory function. Moreover, blood tests for anti-Ro/SSA and anti-La/SSBantibodies were positive. The patient was diagnosed with primary Sjögren's syndrome. After 2 months treatment with oral prednisolone acetate combined with hydroxychloroquine, her BCVAimproved to 0.8 and 1.0 in the right and left eyes, respectively. The fundus also recovered to normal, and no recurrence was observed during the 1-year follow-up period. CONCLUSIONS: The current case highlights that pSS, which usually manifests with dry eye and keratoconjunctivitis, may manifest with chronic choroiditis in both eyes as well. Based on our experience with this case, patients with clinically suspected bilateral choroiditis should be evaluated for pSS.

Subretinal fluid accumulation in a patient with polycythemia vera after receiving a prostaglandin I2 analogue treatment.

Purpose: To report a case of polycythemia vera (PV) with subretinal fluid accumulation after the administration of prostaglandin I2 (PGI2) analogue. Observations: A 57-year-old woman diagnosed as having PV was referred to our department for the evaluation of severe metamorphopsia in the left eye, which gradually progressed after the initiation of oral administration of PGI2 mimetics. At the first visit, the patient's best-corrected visual acuities (BCVAs) were 20/20 OD and 20/30 OS. Fundus examination and optical coherence tomography revealed the presence of subretinal fluid (SRF) in the left eye and multiple serous pigment epithelial detachments (PEDs) in both eyes. Fluorescein angiography revealed central serous chorioretinopathy (CSC)-like lesions, consisting of dye pooling corresponding to the PEDs in both eyes and dye leakage in the left eye. Indocyanine green angiography and laser speckle flowgraphy revealed dilated choroidal veins and reduced choroidal blood flow, respectively. The central choroidal thickness (CCT) measured at the first visit showed a relatively thickened choroid in the left eye. Laboratory data showed mild pancytosis. The patient was diagnosed as having CSC associated with a background of PV, presumably triggered by the PGI2 analogue. One month after cessation of drug administration, the patient's BCVA improved, the CCT slightly decreased, and serous retinal detachment and PED disappeared in the left eye. Conclusions and importance: Our case of PV presenting with CSC-like lesions after PGI2 analogue administration indicates the possible risk of SRF accumulation by PGI2 analogues in patients with PV.

Panuveitis following Vaccination for COVID-19.

Background: COVID-19 vaccination has been accompanied by reports of inflammatory events. This report details a case of panuveitis following vaccination for COVID-19 Case.Description: A 43 year old female developed panuveitis with decreased vision three days after her second dose of Pfizer-Biontech mRNA vaccine. The choroid was significantly thickened and there was anterior chamber and vitreous inflammation. Shortly after onset of ocular symptoms she was also found have an asymptomatic COVID-19 infection. Treatment with oral and topical corticosteroids resulted in improvement in the panuveitis, with a mild recurrence after the initial attempt to taper these drugs.Conclusion: This report demonstrates a likely occurrence of vaccine-related panuveitis secondary to the Pfizer-Biotech mRNA vaccine for COVID-19.

Acute lymphocytic leukemia with initial manifestation of serous retinal detachment and choroidal thickening: case report and literature review.

This report describes a patient who had acute lymphocytic leukemia with exudative retinal detachment (RD), which mimicked Vogt-Koyanagi-Harada disease (VKH). A 61-year-old woman presented with painless loss of vision in the left eye. Fundus examination revealed RD in her left eye. B-scan ultrasonography confirmed localized RD and choroidal thickening. Fundus fluorescein angiography revealed stippled pinpoint hyperfluorescence in the upper macula. One week later, reduced visual acuity was noted in the right eye. B-scan ultrasonography and optical coherence tomography revealed serous RD in both eyes. A provisional diagnosis of VKH was made. However, subsequent hematologic analysis detected an extremely high leukocyte count. Elevated numbers of leukocytes and tumor cells were found in cerebrospinal fluid. Bone marrow biopsy revealed 77% primary atypical blood cells, 89% of which were immature lymphocytes. The patient was subsequently diagnosed with acute lymphocytic leukemia and transferred to the Department of Hematology. However, the patient and her family refused chemotherapy; she eventually died. Our findings suggest that exudative RD, similar to VKH, could be a sign of leukemia. Pinpoint hyperfluorescence leakage is important for differential diagnosis, particularly with respect to VKH.

Unilateral serous retinal detachment with choroidal thickening as a first presenting sign of acute myeloid leukemia.

PURPOSE: Serous retinal detachment is rare in leukemia, but bilateral or unilateral cases have been reported as the presenting sign of acute leukemia or the first sign of relapsing leukemia. We here report a case of unilateral serous retinal detachment with choroidal thickening before the detection of atypical lymphocytes or myeloblasts as the initial manifestation of subsequently diagnosed acute myeloid leukemia. OBSERVATIONS: A 43-year-old woman presented with serous retinal detachment in her left eye. Choroidal thickening was also revealed by B-scan ultrasonography and optical coherence tomography. Atypical lymphocytes or myeloblasts were not apparent on hematologic analysis at initial presentation, but an increased leukocyte count and the presence of 40% blasts in a peripheral smear were detected 1 month later. A bone marrow biopsy led to a diagnosis of acute promyelocytic leukemia. The retinal detachment and choroidal thickening showed amelioration 4 days after the onset of chemotherapy and had resolved 2 months later. CONCLUSIONS AND IMPORTANCE: The present findings suggest that, although retinal detachment is not a common manifestation in patients with leukemia, unilateral serous retinal detachment with choroidal thickening may be a presenting sign of acute myeloid leukemia.

[Central serous chorioretinopathy following the use of phosphodiesterase 5 inhibitors]. / Le cas clinique du mois. Choriorétinite séreuse centrale après prise d'inhibiteurs de la phosphodiestérase de type 5.

Central serous chorioretinopathy occurs primarily in young caucasian men. It is characterized by the development of a serous detachment of the sensory retina with the apparition of a relative central scotomata. An association with phosphodiesterase 5 inhibitors is reported in some articles. We described two cases of central serous chorioretinopathy following the use of tadalafil and sildenafil.

La choriorétinite séreuse centrale est une pathologie touchant principalement les jeunes hommes caucasiens. Elle se caractérise par un décollement séreux rétinien se traduisant le plus souvent par l'apparition d'un scotome central relatif. Une association avec une prise d'inhibiteurs de la phosphodiestérase de type 5 est relatée dans plusieurs articles. Nous rapportons deux cas de choriorétinite séreuse centrale ayant suivi la prise de tadalafil et sildénafil.

Detection of Asymptomatic Choroiditis by Fundus Examination in Vogt-Koyanagi-Harada Disease.

PURPOSE: To describe the ophthalmoscopic changes of the choroidal vessels in the posterior pole of Vogt-Koyanagi-Harada disease patients whose choroid is thickened due to asymptomatic choroiditis. METHODS: Three patients whose choroidal vessels are indistinct or not visible in the posterior pole by ophthalmoscopy were examined by fundus photography and enhanced-depth imaging optical coherence tomography (EDI-OCT). RESULTS: They did not complain of vision problems, and visual acuity was good. Serous retinal detachment was not observed by ophthalmoscopy or by OCT. However, choroidal thickening was observed in the EDI-OCT, while choroidal vessels became blurred or invisible on ophthalmoscopy. After steroid therapy, choroidal thickness decreased to normal levels and the small and large choroidal vessels previously indiscernible became visible by ophthalmoscopy and fundus photography. CONCLUSIONS: Asymptomatic choroiditis not accompanied by serous retinal detachment can be detected and assessed by observing the changes in the choroidal vessels by ophthalmoscopy and fundus photography.

Evaluation of Macular Ganglion Cell-inner Plexiform Layer and Choroid in Psoriasis Patients Using Enhanced Depth Imaging Spectral Domain Optical Coherence Tomography.

PURPOSE: To evaluate changes in the thickness of the central macula, macular ganglion cell-inner plexiform layer (mGCIPL), and subfoveal choroid in patients with psoriasis using spectral domain optical coherence tomography (SD-OCT). METHODS: The measurements of macular, mGCIPL thicknesses and subfoveal choroidal thickness (SFCT) obtained by SD-OCT of psoriasis patients (n = 46). These measurements were compared with those of 50 healthy controls. RESULTS: The macular, mGCIPL, and choroidal thicknesses did not differ between the controls and psoriatic subjects (p>0.05). When the patients were divided into two distinct groups, only the SFCT was significantly thicker in the severe psoriasis group compared with the mild psoriasis group (p = 0.003). CONCLUSIONS: These findings suggest that choroidal alterations are seen without macular changes in patients with psoriasis. Severe psoriasis appears to be related to increases in SFCT as a consequence of possible inflammatory cascades that are part of the disease's pathogenesis.

Choroidal thickening and macular serous retinal detachment in pregnancy-induced hypertension.

OBJECTIVE: The purpose of this study was to report optical coherence tomography (OCT) and angiographic findings in a patient with pregnancy-induced hypertension (PIH). CASE REPORT: A 39-year-old woman, who was diagnosed with PIH, reported blurred and distorted vision at 5 days after an emergency cesarean delivery. OCT revealed a large serous retinal detachment (SRD) that included areas in the macula, along with an increased choroidal thickness noted in both eyes. Indocyanine green angiograms indicated delayed filling of the choroidal circulation in the early phase but choroidal hyperpermeability in the mid-phase. The SRD was gradually resolving without any treatment except for antihypertensive drugs. At 40 days after the initial examination, OCT revealed both the disappearance of the SRD and marked improvement of the choroidal thickening. CONCLUSION: Ophthalmologists need to be aware that PIH can cause choroidal ischemia, a breakdown of the outer blood-retinal barrier, and lead to the development of SRD.