Multimodal imaging in Susac syndrome with classic clinical triad presentation.

A 22-year-old male was referred for headaches, hearing impairment, and right eye scotoma. Branch retinal artery occlusion was revealed during the ophthalmological examination. Susac syndrome was suspected due to the symptoms described and the absence of cardiovascular risk factors. An extensive ophthalmological examination, including multimodal imaging was carried out, which is of special interest as it is considered to be a rare syndrome.

ATYPICAL HEALING IN A CASE WITH RETINAL PIGMENT EPITHELIUM APERTURES.

PURPOSE: To analyze the multimodal imaging features in a case showing resolution of retinal pigment epithelium (RPE) apertures in association with an avascular pigment epithelium detachment secondary to nonneovascular age-related macular degeneration. METHODS: Report of a case diagnosed with aperture of the RPE with multimodal imaging long-term follow-up. Color fundus photography, fundus autofluorescence, eye-tracked spectral domain optical coherence tomography (OCT), and OCT angiography findings are discussed. RESULTS: A 71-year-old man diagnosed with nonneovascular age-related macular degeneration presented with three different areas of RPE aperture in his right eye. At baseline, best-corrected visual acuity was 20/100 in his right eye. Dilated fundus examination showed three round areas of RPE atrophy, and fundus autofluorescence demonstrated marked hypoautofluorescence in the corresponding areas. The OCT scans showed discontinuities of the RPE band with no evidence of RPE tear. The OCT angiography showed no evidence of abnormal blood flow within the sub-RPE space. Over time, fundus autofluorescence and eye-tracked spectral domain OCT scans demonstrated spontaneous resolution of two of the RPE defects and reduction of the size of the third one, with complete flattening of the pigment epithelium detachment. CONCLUSION: Distinction between RPE tears and apertures is important due to their different etiopathogenic mechanism and prognosis. To the best of our knowledge, this is the first report of a case of complete closure of an RPE aperture. The mechanism of the observed RPE closure remains unknown, and further studies are warranted to better understand the mechanisms of RPE restoration and remodeling.

Prognostic Tomographic Classification of Myopic Choroidal Neovascularization.

BACKGROUND AND OBJECTIVES: To investigate the prognostic value of the development of a hyperreflective envelopment of the neovascular tissue in myopic choroidal neovascularization (mCNV) after the first intravitreal ranibizumab injection and to establish a tomographic classification of mCNV depending on this healing process. PATIENTS AND METHODS: Twenty-five eyes of 25 patients with mCNV were retrospectively studied. Patients were classified into type A (presence of a hyperreflective coating of the neovascular tissue 1 month after first intravitreal ranibizumab) and type B (absence of or partial coating). Visual acuity (VA) and number of injections were recorded. Differences between both types were assessed at 6 and 12 months of follow-up. RESULTS: Fifteen patients (60%) were classified as type A and 10 as type B (40%). Type A showed better VA than type B. VA improvement was only significant for type A. No differences in the number of injections were observed; however, a trend to a larger amount in type B was observed. CONCLUSIONS: The proposed classification may have prognostic value, with type A mCNV showing better visual outcomes. Further studies are needed to confirm these findings. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:775-779.].

Safety of bilateral same-day intravitreal injections of anti-vascular endothelial growth factor agents.

PURPOSE: The aim was to evaluate the safety of bilateral same-day injections with intravitreal antiangiogenic drugs for macular diseases. METHODS: Cross-sectional retrospective review of unilateral and bilateral same-day antiangiogenic injections was conducted between January 2011 and March 2016 in the Unit of Macula, University and Polytechnic Hospital La Fe (Valencia, Spain). A total of 8,172 injections were administered, among which 6,560 were unilateral and 1,612 were bilateral injections. Patients were included in the study regardless of the diagnosis. Ranibizumab and aflibercept were the antiangiogenic drugs used. The presence of endophthalmitis or retinal detachment was evaluated. RESULTS: A total of 1 (0.012%) culture-proven endophthalmitis and 19 (0.233%) acute intraocular inflammations were registered. In the unilateral injections group, there were 18 (0.274%) acute intraocular inflammations and 1 (0.015%) culture-proven endophthalmitis. One (0.062%) of the 1,612 bilateral same-day injections had a unilateral acute intraocular inflammation, and there were no culture-proven endophthalmitis in this group. CONCLUSION: Bilateral same-day injections are more convenient for patients and their caregivers than the unilateral injections administered on different days. In our study, the prevalence of culture-proven endophthalmitis and acute intraocular inflammation was lower in the bilateral injections than in the unilateral group. These data support the idea that bilateral same-day injections are a safe and valid treatment to use in our clinical practice.

Choroidal thickness and visual prognosis in type 1 lesion due to neovascular age-related macular degeneration.

PURPOSE: To evaluate the association between subfoveal choroidal thickness and the visual outcome in eyes with type 1 choroidal neovascularization (CNV) due to neovascular age-related macular degeneration (nAMD). METHODS: This was a retrospective, longitudinal, cross-sectional study including patients diagnosed with nAMD type 1 lesions managed with intravitreal injections of ranibizumab in a PRN strategy during 24 months. Retrospective chart review of patients with type 1 CNV recording the visual acuity, number of intravitreal injections, multimodal imaging data, and follow-up period was performed. Subfoveal choroidal thickness was measured using enhanced depth imaging scans obtained with spectral-domain optical coherence tomography. RESULTS: Twenty-five eyes of 21 patients were included. The mean baseline logMAR best-corrected visual acuity was 0.52 (+0.35) (median 0.5; range 0.1-1; interquartile range (IQR) 0.3-0.8) and improved to 0.39 (+0.39) (median 0.4; range 0.1-1; IQR 0.2-0.5) by the end of the follow-up (p = 0.038). Subfoveal choroidal thickness was 202.8 (+60.3) µm (median 218; range 81-285; IQR 146-258). Statistical mixed effects model demonstrated an association between rate of improvement of visual acuity with subfoveal choroidal thickness after 24 months (p<0.001) (95% confidence interval 0.0002-0.0001 logMAR month µm); higher thickness values were correlated with better visual acuity. CONCLUSIONS: Thicker subfoveal choroid was associated with better visual outcomes in patients with type 1 CNV due to nAMD following a strict PRN regimen with intravitreal ranibizumab at 24 months of follow-up.

Automated macular choroidal thickness measurement by swept-source optical coherence tomography in pseudoxanthoma elasticum.

INTRODUCTION: Pseudoxanthoma elasticum (PXE) typically involves elastic fibers in blood vessels and Bruch membrane. Our purpose was to analyze retinal and choroidal macular thickness in patients with angioid streaks due PXE compared with a control group. METHODS: Best-corrected visual acuity (BCVA), axial length (AL), and macular swept-source optical coherence tomography were obtained. Automated segmentations of the retina and the choroid were used to obtain the corresponding thickness values. An age, gender and AL matched control group was used to compare the thickness values. RESULTS: Twelve eyes of 6 patients were included. The mean BCVA was 0.68 ± 0.29 versus 1.0 in controls (p < 0.001). The mean macular retinal thickness was thinner in eyes with PXE (p = 0.038). Only patients with choroidal neovascularization (NV) showed statistically significant differences in the mean macular choroidal thickness (p = 0.008). CONCLUSIONS: The present study shows that choroidal thickness may be thinner in eyes with NV due to angioid streaks in PXE compared with healthy eyes analyzed by an automated segmentation of the choroid. Further studies are warranted in order to assess the importance of this choroidal changes in the pathogenesis of retinal disturbances related to PXE and its influence in long-term follow-up.

ArcSterile®: un lujo rentable / Arcsterile®: a cost-effective luxury

Objetivo. El objetivo de este estudio es evaluar la seguridad y rentabilidad económica de la cabina quirúrgica de ambiente controlado (ArcSterile®) para la realización de dichos procesos. Material y métodos. Estudio retrospectivo y observacional en el que comparamos las variables de gestión hospitalaria entre los pacientes intervenidos en ArcSterile® y los pacientes intervenidos en el quirófano convencional durante un periodo de 12 meses. Las variables estudiadas fueron: el número total de pacientes tratados, la demora asistencial y el coste por proceso. Resultados. Se realizaron 2011 procedimientos quirúrgicos en la cabina de ambiente controlado ArcSterile® y 1736 en el quirófano convencional durante un periodo de 12 meses. Se incluyeron cirugías menores como chalación, pterigión, inyecciones intravítreas y otras. No se incluyeron cirugías de cataratas ni vitrectomías. La utilización del ArcSterile® supuso un aumento del 14 % en el número de pacientes intervenidos durante 12 meses. El coste por hora de la utilización de la cabina quirúrgica ArcSterile® fue de 30.75 euros frente a los 142.78 euros del quirófano convencional. Conclusiones. La incorporación del ArcSterile® ha permitido tratar a un número mayor de pacientes que antes se trataban en el quirófano convencional, lo que optimiza el uso del mismo para pacientes que requieren una cirugía más compleja y genera un ahorro económico de 134 121.39 euros durante los 12 meses evaluados. La aplicación de esta cabina quirúrgica a la cirugía ambulatoria oftalmológica y también a otras especialidades médicas podría suponer una alternativa eficaz y eficiente al quirófano convencional, con grandes beneficios tanto clínicos como económicos (AU)

Objective. The aim of this study is to evaluate the safety, economic profiltability, and cost-effectiveness of the controlled ambient surgical cabin ArcSterile®. Materials and methods. Retrospective observational study comparing the profitability of surgical procedures using the ArcSterile® with those using the operating room throughout a 12-month period by analysing the following variables: total number of treated patients, delay in surgical assistance delay and the cost per procedure. Results. Throughout a 12-month period, a total number of 2011 surgical procedures were performed with the ArcSterile®, and 1736 surgical procedures were performed in the conventional operating room. Minor ocular surgeries including chalazia, pterigium, intravitreal injections and others were considered, whereas cataract and vitrectomy surgeries were disregarded. The use of the ArcSterile® was associated with an increase of 14 % in the number of surgeries. The cost per hour of the use of the ArcSterile® was 30.75 euro, whereas it was 142.78 euro for the conventional operating room. Conclusions. The ArcSterile® may allow to treat more patients and to treat them earlier compared with the conventional operating room, optimizing the use of the latest for patients who need a more complex surgery. We estimated an economic impact of 134 121.39 euro savings during the 12-month period of analysis. The use of the ArcSterile® surgical cabin for outpatient ocular surgery may represent an effective and efficient alternative to the operating room with many clinical and economic benefits (AU)

Macular retinal and choroidal thickness in unilateral relentless placoid chorioretinitis analyzed by swept-source optical coherence tomography.

BACKGROUND: The purpose of this study is to evaluate the retinal and choroidal thickness of the macular region in patients with unilateral relentless placoid chorioretinitis (RPC) and macular involvement. Patients diagnosed with RPC affecting only one eye underwent a comprehensive ophthalmologic examination including best-corrected visual acuity (BCVA), axial length (AL) measurement, slit-lamp examination, and color fundus and autofluorescence photography. The macular region was scanned by swept-source optical coherence tomography in the 1,050-nm wavelength. Automated segmentations of the retina and the choroid were used to obtain the corresponding thickness values. RESULTS: A total number of three patients (two men and one woman; age range 17 to 62 years) were included. Eyes with clinically evident RPC had a mean AL of 24.62 ± 0.11 mm, whereas in the clinically healthy fellow eyes, the mean AL was 24.65 ± 0.03 (p = 0.70). The mean BCVA was 0.93 ± 0.16 in eyes with RPC, and 1.0 in all the fellow eyes (p = 0.70). Slit-lamp examination did not reveal any sign of vitreous inflammation in any cases. The mean macular retinal thickness was 288.10 ± 10.22 µm in eyes with RPC, and 300.30 ± 7.17 µm in the healthy fellow eyes (p = 0.20). The mean central choroidal thickness was 260.70 ± 140.60 µm in eyes with RPC, and 262.30 ± 123.10 µm in the fellow eyes (p = 0.99). The mean macular choroidal thickness was 248.60 ± 128.40 and 255.10 ± 123.60 µm, respectively (p = 0.99). CONCLUSIONS: The pathogenesis of RPC remains unknown. No changes in the retinal and choroidal thickness were observed in the macular area of eyes diagnosed with RPC with macular involvement compared with the asymptomatic healthy fellow eyes. Further prospective studies are warranted in order to investigate the role of the choroid in cases of RPC.