Morphological integrity of the outer retinal layers and visual prognosis in chronic central serous chorioretinopathy after half-dose photodynamic therapy: a qualitative SD-OCT analysis.

The study aims to investigate the morphological integrity of the outer retinal layers (ORLs) (an ellipsoid layer (EL) + external limiting membrane) and visual prognosis in chronic central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) completely resorbed after half-dose photodynamic therapy (HD PDT) using enhanced-depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). This retrospective study included 40 eyes of 38 chronic CSCR patients treated with HD PDT between December 2012 and June 2016. However, only 34 eyes (85%) with complete SRF resorption 3 months after HD PDT had their 6th and 12th month data analyzed. Morphological integrity of the ORLs was further analyzed in relation to best-corrected visual acuity (BCVA) and disease duration. Thirty-four eyes of 34 patients (male/female: 82.35/17.65%) with mean age of 49.90 ± 7.80 (32-61) years were studied. The mean logMAR BCVA improved significantly from 0.52 ± 0.31 at baseline to 0.34 ± 0.36 and 0.26 ± 0.26 at the 6th and 12th months after HD PDT, respectively (p < 0.001). The proportion of eyes with completely normal morphological ultrastructural integrity of the ORLs was 44.12% at the 6th month, which increased to 64.71% at the 12th month after HD PDT. However, the EL morphological disruption was associated with significantly lower mean logMAR BCVA 12 months after HD PDT (p = 0.029). The disease duration had no effect on mean logMAR BCVA gain. Even after complete resorption of serous neurosensory retinal detachment after HD PDT in chronic CSCR, the ORLs, especially the EL, may not be anatomically restored. The EL morphological ultrastructural integrity seems to be the most important factor influencing visual prognosis.

Do mydriatics effect serous pigment epithelial detachment elevation? A case report on central serous chorioretinopathy.

This report aimed to determine if pupil-dilating eye drops (mydriatics) affected serous pigment epithelial detachment elevation in an eye with central serous chorioretinopathy using spectral domain-optical coherence tomography. A 47-year-old man presented to our clinic with metamorphopsia in his right eye, which had best corrected visual acuity of 20/20. Spectral domain-optical coherence tomography revealed minimal subretinal fluid and serous pigment epithelial detachment. During the follow-up examination after the final diagnosis of central serous chorioretinopathy and serous pigment epithelial detachment, different pigment epithelial detachment elevations on optical coherence tomography images before and after pupil dilation were found incidentally. These elevations were re-measured separately on different days before and after pupil dilation with 2.5% phenylephrine and 1% tropicamide to determine if this was a mydriatic-induced increase in pigment epithelial detachment elevation, which was eventually found to be the case. Mydriatics appeared to affect pigment epithelial detachment elevation in central serous chorioretinopathy. A thorough consideration of pre-dilation ocular examination and imaging data in central serous chorioretinopathy may be valuable.

Retinal Angiomatous Proliferation: Multimodal Imaging Characteristics and Follow-up with Eye-Tracked Spectral Domain Optical Coherence Tomography of Precursor Lesions.

OBJECTIVES: To present the multimodal imaging characteristics of precursor retinal angiomatous proliferation (RAP) lesions and follow-up results with eye-tracked spectral-domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: Six eyes of 6 patients aged 77.5±5.9 years diagnosed with precursor RAP lesion were included in this prospective observational case series. Best corrected visual acuity (BCVA) measurement and complete ophthalmologic examination were performed for all subjects, as well as fundus photography (FP), fundus autofluorescence (FAF), SD-OCT, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography angiography (OCTA), and their long-term follow-up results are presented. RESULTS: The mean BCVA was 0.8±0.16 (0.6-1) Snellen and the mean follow-up was 26.3±14.8 months. Images of the precursor RAP lesions demonstrated no specific findings on FP and FAF, showed focal hypofluorescent foci with no leakage on FA and IGA, and appeared as extrafoveal small, round, well-defined, hyperreflective foci typically located in the outer retinal layers on SD-OCT B-scans with high sampling density. OCTA demonstrated the precursor lesions as the deep capillary plexus abnormalities in 3 eyes. Two eyes progressed to stage 1 RAP during the follow-up period. CONCLUSION: This study defined the diagnostic characteristics and clinical course of precursor RAP lesions. Our findings highlight the importance of B-scans with high sampling density for the diagnosis of precursor lesions and using eye-tracking mode SD-OCT during follow-up.

Direct Treatment Costs of Neovascular Age-related Macular Degeneration and Comparison of Gained and/or Preserved Vision with Expenditure.

OBJECTIVES: The aim was to quantify the direct medical cost of neovascular age-related macular degeneration (AMD) versus gained or preserved vision. MATERIALS AND METHODS: Data of patients treated for neovascular AMD between January 2009 to January 2014 were reviewed. Patients with complete follow-up for two years, treated with only intravitreal ranibizumab injections and with no intraocular surgery were included. Demographics, diagnostic investigations, the number of visits and injections, changes in visual acuity (VA) at one year and two years from baseline were noted. Total cost was calculated for the first and second years, and the cost of improving or preserving initial vision level was determined with subgroup analysis. RESULTS: Two-hundred eyes of 175 patients (86 male and 89 female) with a mean age of 72.3±7.8 years were included. Mean VA was 0.67 logMAR at baseline, 0.60 logMAR at the end of the first year, and 0.67 logMAR at the end of the second year. At the end of the 2 years, VA increased in 82 eyes (41%), remained the same in 42 eyes (21%), and decreased in 76 eyes (38%). The mean number of visits in the first and second years were 6.56 (3-12) and 5.74 (3-10), respectively. An average of 4.42 (1-8) injections were performed in the first year and 2.25 (0-7) in the second. The total direct medical cost for AMD was 9,628 TL (Turkish Lira) per patient for 2 years, which consisted of 529 TL in visit costs, 115 TL in fluorescein and indocyanine angiography costs, 611 TL in injection procedure costs, and 8,371 TL in drug costs. The cost of one line of VA gain was 11,911 TL in the first year. CONCLUSION: This study showed that treatment increased or stabilized vision in a reasonable proportion of patients, that cost of management decreases in the second year, and that drug expenses are the leading item in reimbursement.

Evaluation of the learning curve of non-penetrating glaucoma surgery.

PURPOSE: To evaluate the learning curve of non-penetrating glaucoma surgery (NPGS). METHODS: The study included 32 eyes of 27 patients' (20 male and 7 female) with medically uncontrolled glaucoma. Non-penetrating glaucoma surgeries performed by trainees under control of an experienced surgeon between 2005 and 2007 at our tertiary referral hospital were evaluated. Residents were separated into two groups. Humanistic training model applied to the one in the first group, he studied with experimental models before performing NPGS. Two residents in the second group performed NPGS after a conventional training model. Surgeries of the residents were recorded on video and intraoperative parameters were scored by the experienced surgeon at the end of the study. Postoperative intraocular pressure, absolute and total success rates were analyzed. RESULTS: In the first group 19 eyes of 16 patients and in the second group 13 eyes of 11 patients had been operated by residents. Intraoperative parameters and complication rates were not statistically significant between groups (p > 0.05, Chi-square). The duration of surgery was 32.7 ± 5.6 min in the first group and 45 ± 3.8 min in the second group. The difference was statistically significant (p < 0.001, Student's t test). Absolute and total success was 68.8 and 93.8% in the first group and 62.5 and 87.5% in the second group, respectively. The difference was not statistically significant. CONCLUSIONS: Humanistic and conventional training models under control of an experienced surgeon are safe and effective for senior residents who manage phacoemulsification surgery in routine cataract cases. Senior residents can practice these surgical techniques with reasonable complication rates.

THE IMPORTANCE OF THE PERIPHERAL RETINA IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: This research investigated the peripheral retinas of patients with central serous chorioretinopathy (CSCR). METHODS: Sixty patients with CSCR and 60 age- and gender-matched controls were included in this prospective cross-sectional study. All 120 participants underwent ocular examinations and peripheral retinal evaluations using a Goldmann three-mirror lens. RESULTS: The examinations demonstrated peripheral retinal degeneration, atrophic or hyperplastic retinal pigment epithelial changes, and retinal breaks. The peripheral retinal degeneration rate was 39% in the CSCR group and 15% in the control group, and the CSCR group reported significantly more lattice degeneration than the control group (22 vs. 3%) (P = 0.004, odds ratio = 1.97, confidence interval = 0.68-5.65 and P = 0.002, odds ratio = 4.55, confidence interval = 0.77-26.83, respectively). Symptomatic U-shaped retinal breaks were found in three eyes (5%) in the CSCR group, and the rate of peripheral retinal degeneration was higher in the patients with chronic CSCR (vs. acute CSCR). However, this difference was not significant (P = 0.244). CONCLUSION: This study showed that peripheral retinal abnormalities, particularly lattice degeneration, are more common in patients with CSCR. Therefore, the authors recommend regular retinal examinations, with the inclusion of peripheral retinal assessments, for patients with CSCR.

Von Hippel-Lindau Disease: The Importance of Retinal Hemangioblastomas in Diagnosis.

Von Hippel-Lindau (VHL) disease is a familial cancer syndrome characterized by benign or malignant tumors which may involve more than one system. Retinal hemangioblastomas are usually the initial manifestation of VHL disease and can cause vision loss. A 32-year-old man presented to our clinic with vision loss in the left eye for 2 months. He had a history of cerebral hemangioblastoma operation. Family history showed that his mother had unilateral vision loss and died because of renal cell carcinoma. Ophthalmologic examination revealed multiple retinal hemangioblastomas in both eyes. VHL gene sequencing was performed and heterozygous p.R161X mutation was detected. His sister and daughter were also found to have the same variant. A treatment and follow-up plan was initiated for the patient and affected family members. Considering VHL disease in the differential diagnosis of retinal hemangioblastomas has a very important role in the early detection of life-threatening tumors in these patients.

Three-dimensional Optical Coherence Tomography Imaging and Treatment of Glaucomatous Optic Nerve Head Defects Associated with Schisis-like Maculopathy.

We present the three-dimensional (3D) spectral-domain optical coherence tomography (SD-OCT) findings of schisis-like maculopathy associated with structural changes of the optic nerve (ON) head as well as the treatment outcomes of a case of advanced glaucoma. In addition to ophthalmological examination, B-scan and 3D-SD-OCT images of the ON head, peripapillary retina, and the macula were obtained. The B-scan images only detected typical retinoschisis findings. However, the 3D-SD-OCT images of the ON head revealed defects of various sizes, shapes, and depths at the outer wall of the prelaminar and laminar regions of the ON canal. The 3D images were able to establish that these defects were both adjacent to and interconnected with the retinal layers. The patient successfully received 3D-SD-OCT-guided thermal laser treatment that is used in congenital optic disc pits complicated with macular schisis. In brief, 3D-SD-OCT is very useful for demonstrating the ON head defects that can lead to schisis-like maculopathy in cases of advanced glaucoma.

The Role of Posterior Vitreous Detachment and Vitreomacular Adhesion in Patients With Age-Related Macular Degeneration.

BACKGROUND AND OBJECTIVE: The aim of this study was to assess the prevalence of posterior vitreous detachment (PVD) and vitreoretinal interface in patients with age-related macular degeneration (AMD). PATIENTS AND METHODS: This clinical trial included 206 eyes of 138 patients who presented to the authors' clinic between January 2012 and November 2014. Patients were divided into three groups: 98 eyes of 67 patients with exudative AMD, 55 eyes of 36 patients with nonexudative AMD, and 53 eyes of 35 patients having no vitreoretinal disease. All patients underwent complete ocular examination, including best-corrected visual acuity, Goldmann applanation tonometry, fundus photography, spectral-domain optical coherence tomography, and B-mode ultrasonography at 6 months and 12 months after the initial examination. RESULTS: Total and partial PVD rates were significantly higher at baseline, 6 months, and 12 months in both exudative and nonexudative AMD groups when compared to the control group (Chi-square test, P = .006, P = .001, and P = .009, respectively). The prevalence of total PVD was significantly higher in nonexudative AMD, whereas partial PVD was higher in exudative AMD. The exudative AMD group reported significantly more VMA than the other two groups at baseline, 6 months, and 12 months (Chi-square test, P =.005, P = .003, and P = .019, respectively). CONCLUSION: This study indicates that the incidence of vitreoretinal interface abnormalities such as partial PVD and vitreomacular adhesion were higher in the exudative AMD group. It can be concluded that abnormal adhesive and tractional forces due to PVD may play a role in the progression of AMD. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:223-229.].

Are Multiple Retinal Arterial Macroaneurysms Considered a Sign of Cerebral Aneurysms?

The aim of this study is to report the coexistence of retinal arterial macroaneurysms (RAMs) and cerebral aneurysms (CAs) in a 58-year-old woman with hypertension. She was noted as having a 1-week history of vision loss in her left eye, along with a 2-month history of a nonspecific headache. Visual acuity was 20/32 in her left eye and 20/20 in her right eye. A fundus examination revealed multiple areas of retinal hemorrhages that were surrounded by circinate exudation in her left eye, as well as the generalized attenuation of the retinal arteries in both of her eyes. Angiographically, hyperfluorescent round leakage points confirmed the presence of five saccular RAMs. Surprisingly, computed tomography angiography completed based on the recommendation of neurology department identified three saccular CAs. Aging, hypertension, and female preponderance are the common risk factors for both RAMs and CAs. Accordingly, RAMs and CAs may exist simultaneously in hypertensive patients. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:79-82.].

Evaluation of posterior vitreous detachment after uneventful phacoemulsification surgery by optical coherence tomography and ultrasonography.

BACKGROUND: The aim was to investigate the effect of uneventful phacoemulsification on vitreoretinal interface evaluated by optical coherence tomography (OCT) and ultrasound. METHODS: One hundred and fifty eyes were evaluated for the presence or absence of posterior vitreous detachment by ultrasound and OCT prior to cataract surgery. Only those eyes with intact vitreoretinal adhesion were included in the study. All patients underwent cataract surgery. At one month, three months and six months, all patients were assessed with OCT and ultrasound. The data were analysed for statistical significance. RESULTS: The study was carried out on 30 of 31 patients with no posterior vitreous detachment. The mean age of patients was 62.63 ± 7.15 years (range 49 to 75 years) and 15 were female. Posterior vitreous detachment developed in 17 patients (56.66 per cent) at one month, 21 patients (70 per cent) at three months and 22 patients (73.33 per cent) at six months following the surgery. No complications or acute symptoms were detected associated with posterior vitreous detachment. CONCLUSION: Vitreoretinal interface changes and vitreoretinal separations and progression of separation can be easily evaluated by OCT. The current study confirms that posterior vitreous detachment occurs commonly soon after cataract surgery.

The Prevalence and Characteristics of Charles Bonnet Syndrome in Turkish Patients with Retinal Disease.

PURPOSE: The aim of this study is to investigate the prevalence and clinical characteristics of Charles Bonnet syndrome (CBS) in a group of Turkish patients with various retinal diseases. METHODS: Two hundred and sixty-four patients with a best-corrected visual acuity of ≤20/40 in the better-seeing eye were asked with a standardized question whether they had symptoms of CBS. If they responded positively, a questionnaire was verbally administered to learn more about the details of the symptoms. RESULTS: There were 125 (47.3%) females and 139 (52.7%) males with a mean age of 72.1 years (range 31-90). Seventeen (6.4%) patients were diagnosed with CBS. Three (17.7%) patients had noncomplex hallucinations and 14 (82.3%) had complex hallucinations. CONCLUSION: CBS is not uncommon in visually impaired patients with retinal disease. Clinicians who care for visually impaired patients should be aware of CBS.

Characteristics of Fundus Autofluorescence in Active Polypoidal Choroidal Vasculopathy.

OBJECTIVES: To define characteristic fundus autofluorescence (FAF) findings in eyes with active polypoidal choroidal vasculopathy (PCV). MATERIALS AND METHODS: Thirty-five eyes of 29 patients with active PCV who were diagnosed at Ege University Faculty of Medicine, Department of Ophthalmology, Retina Division between January 2012 and November 2014 were included in the study. All the patients underwent a complete ophthalmological examination including fundus photography, spectral-domain optical coherence tomography, fluorescein angiography, FAF photography, and indocyanine green angiography (ICGA). ICGA was used to diagnose active PCV and identify lesion components. FAF findings were described at the retinal site of the corresponding lesions identified and diagnosed using ICGA. RESULTS: The mean age of the 29 study patients (15 men, 14 women) was 64.6±7.5 years (range, 54-82 years). ICGA revealed active PCV in 35 eyes, consisting of polypoid lesions in 11 eyes (31.4%), branching vascular networks (BVN) in 10 eyes (28.6%), and a combination of polypoid lesions and BVNs in 14 eyes (40%). On FAF images, 4 different patterns were detected at the corresponding retinal sites of 25 polypoid lesions detected by ICGA: confluent hypoautofluorescence with a hyperautofluorescent ring in 18 eyes (72%), hyperautofluorescence with hypoautofluorescent ring in 2 eyes (8%), confluent hypoautofluorescence in 1 eye (4%), and granular hypoautofluorescence in 1 eye (4%). The remaining 3 eyes (12%) demonstrated blocked hypoautofluorescence because of the excessive hemorrhaging in the macula. The FAF images showed the granular hypoautofluorescent FAF pattern in all 24 BVNs (100%) consistent with the location of the lesions on ICGA. CONCLUSION: The typical PCV lesions, polypoid lesions and BVNs had characteristic autofluorescent findings on FAF imaging. Non-invasive, quick, and repeatable FAF imaging can be considered a reliable and helpful diagnostic technique for the diagnosis of active PCV.

Correlation of Handheld Infrared Skin Thermometer and Infrared Videothermography Device for Measurement of Corneal Temperature.

PURPOSE: In our study, we aimed to investigate the correlation of handheld infrared skin thermometer and videothermography device for the measurement of corneal temperature. METHODS: Forty healthy individuals (80 eyes) were enrolled to the study. Participants underwent a detailed ophthalmologic examination and medical history review for excluding any ocular and systemic diseases. The measurements of the central corneal temperature were performed in a room having constant temperature, humidity, and brightness levels. To avoid any variability, all the temperature measurements were performed in the same examination room by a single examiner. The temperature was measured with a handheld infrared skin thermometer (MEDISANA, FTN) from the corneal surface. The same instrument was also used to measure the subjects' body temperature. Moreover, the subjects underwent the corneal temperature measurement by a noncontact videothermography device (Optris PI 450; Optris GmbH). RESULTS: The male to female ratio was 19:21 among the subjects. The mean age was 25.1±4.7 years. The mean body temperature was 36.93±0.33°C. The mean corneal temperatures measured by the handheld infrared skin thermometer and the ocular videothermography device were 36.94±0.28°C and 35.61±0.61°C, respectively (P<0.01). The mean temperature difference was 1.34±0.57°C, with a 95% confidence interval. There was a moderate correlation between the corneal temperatures measured by the 2 devices in the right, the left eyes, and both eyes, respectively (P=0.450, 0.539, 0.490). CONCLUSIONS: Handheld infrared skin thermometers can be used for the evaluation of the corneal temperature. These devices may provide a simple, practical, and cheaper way to detect the corneal temperature, and the widely performed corneal temperature measurements may afford us to understand the temperature variability in numerous ocular conditions in a better way.

Long-term Choroidal Thickness Changes After Acute Solar Retinopathy.

BACKGROUND AND OBJECTIVE: To identify long-term changes in choroidal thickness after solar retinopathy. PATIENTS AND METHODS: The study included 25 eyes of 25 men with acute solar retinopathy. Ocular examination, best corrected visual acuity (BCVA), and retinal and choroidal thickness measurements obtained using spectral-domain optical coherence tomography were evaluated. RESULTS: The mean follow-up was 6.1 ± 0.4 months. The initial BCVA decreased in the affected eyes (P < .001). The mean BCVA (logMAR) improved significantly from 0.16 ± 0.06 to 0.03 ± 0.05 at 6 months (P < .001). There were no significant differences in the initial retinal and choroidal thicknesses between the affected and other eyes, while there was a significant decrease in the mean macular thickness and mean macular volume at 1 month and the mean choroidal thickness increased (P < .001). CONCLUSION: Significant retinal and choroidal thickness changes occurred after solar retinopathy. The changes in choroidal thickness suggest that the effects of solar retinopathy might not be limited to the retina.