SEROUS MACULAR DETACHMENT IN BEST DISEASE: A Masquerade Syndrome.

PURPOSE: To describe the clinical and multimodal imaging findings of a series of cases of serous macular detachment (SMD) caused by Best disease (BD) masquerading as neovascular age-related macular degeneration or central serous chorioretinopathy that were inappropriately treated with intravitreal anti-vascular endothelial growth factor or laser therapy. This study will also present data to support age-related progressive choroidal thickening in BD patients, which may play a role in the development of SMD in this population. METHODS: Clinical examination and multimodal imaging findings, including color fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and optical coherence tomography-angiography, were reviewed and analyzed. Subfoveal choroidal thickness was also formally measured, and an age-related choroidal thickness analysis was performed and compared with a normal population. RESULTS: Twenty-six eyes of 13 patients (5 women) were included. Median age was 44 years. Nine patients presented with a history of SMD and subretinal fluid recalcitrant to various therapies, including intravitreal anti-vascular endothelial growth factor injections and photodynamic therapy. Best disease was subsequently diagnosed genetically in six patients and by detailed family history in seven. Mean logarithm of the minimum angle of resolution best-corrected visual acuity for all 26 eyes at last follow-up was +0.36 (Snellen equivalent of 20/46). Subfoveal choroidal thickness positively correlated with age for our cohort, increasing linearly at a rate of 25.6 µm per decade (R = 0.64; P < 0.001). Choroidal neovascularization was identified in four eyes on optical coherence tomography angiography, but these eyes did not respond to anti-vascular endothelial growth factor treatment. CONCLUSION: The diagnosis of BD should be considered in patients presenting with SMD and recalcitrant subretinal fluid masquerading as neovascular age-related macular degeneration or chronic central serous chorioretinopathy to avoid unnecessary treatment procedures. The positive correlation of subfoveal choroidal thickness with age in BD patients may be a factor in the pathogenesis and development of SMD in this population. Recognizing the multimodal imaging features of SMD associated with BD, described in detail in this study, will guide practitioners to the accurate diagnosis of BD and reduce the risk of unnecessary intraocular procedures with potential complications.

Surgical outcomes and incidence of retinal redetachment in cases with complicated retinal detachment after silicone oil removal: univariate and multiple risk factors analysis.

PURPOSE: To analyze the surgical outcomes and retinal redetachment frequency after silicone oil (SO) removal for complex retinal detachment. METHODS: This institutional-based study included 894 consecutive patients who underwent pars plana vitrectomy with SO endotamponade for complicated retinal detachment. The effects of preoperative best-corrected visual acuity, vitreous base shaving, intraoperative scleral buckling, retinectomy, SO viscosity, duration of SO, and vitreous hemorrhage at the first postoperative week on the risk of redetachment were investigated. RESULTS: During a mean follow-up of 39.9 months, anatomical success was not achieved in 118 patients (13.2%) after SO removal. On multivariate analysis, risk factors for recurrent retinal detachment included giant retinal tear (adjusted odds ratio [aOR], 12.39; P < 0.001), high myopia (aOR, 2.70; P = 0.011), surgeries without scleral buckling (aOR, 1.97; P = 0.039), inadequate vitreous base shaving (aOR, 117.62; P < 0.001), and vitreous hemorrhage at the first postoperative week (aOR, 12.13; P < 0.001). CONCLUSION: Retinal detachment etiology, inadequate vitreous base shaving, lack of intraoperative scleral buckling, and vitreous hemorrhage at the first postoperative week after SO removal were significant risk factors for retinal redetachment after SO removal, but preoperative visual acuity, SO viscosity, and duration of SO had no significant effect on redetachment.

Intravitreal silicone oil induced changes in corneal biomechanics.

Our aim was to detect the early effects of pars plana vitrectomy (PPV) combined with intravitreal silicone oil (SO) on corneal biomechanics. 19 eyes underwent PPV with SO tamponade (group 1) and 16 eyes underwent. PPV without tamponade (group 2). Corneal biomechanical parameters were measured preoperatively and at the first postoperative month by ocular response analyzer. The mean preoperative intraocular pressure (IOP) by Goldmann applanation tonometry (GAT) and the mean corneal-compensated intraocular pressure (IOPcc) were significantly lower in group 1 than group 2 (p = 0.005, p = 0.002, respectively). The mean preoperative corneal hysteresis (CH) and corneal resistance factor (CRF) were significantly higher in group 1 than group 2 (p = 0.017, p = 0.002, respectively). However, the difference in Goldmann-correlated intraocular pressure (IOPg) between the groups was not significant (p = 0.360). In group 1, IOPcc, IOPg and IOP-GAT significantly increased postoperatively (p = 0.002, p = 0.004, p = 0.002, respectively) but CH and CRF decreased (p = 0.007, p = 0.153, respectively). In group 2, IOPcc, IOPg and IOP (GAT) increased postoperatively but the differences were not significant (p = 0.851, p = 0.693, p = 0.336, respectively). The mean CRF increased significantly (p = 0.026) postoperatively but the decrease in CH was not significant (p = 0.196). Statistically significant differences were found in the changes of preoperative and postoperative means of IOPcc, IOPg, IOP-GAT and CRF between the groups (p = 0.024, p = 0.037, p = 0.014, p = 0.006, respectively). However, the difference in the decreases in CH between the two groups was not statistically significant (p = 0.206). SO tamponade may affect corneal biomechanical parameters in the early postoperative period, which may be related to the surgery itself, SO tamponade or IOP changes.

Early effects of pars plana vitrectomy combined with intravitreal gas tamponade on corneal biomechanics.

PURPOSE: To detect the early effects of pars plana vitrectomy (PPV) combined with intravitreal gas tamponade on corneal biomechanics and compare these effects of sulfur hexafluoride (SF6) and perfluropropane (C3F8). METHODS: 19 eyes underwent PPV with C3F8, 14 eyes underwent PPV with SF6 tamponade and 16 eyes underwent PPV without tamponade. Corneal biomechanical parameters were measured preoperatively and at the first postoperative week by an ocular response analyzer. RESULTS: There were no significant differences of corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg) between the groups preoperatively. The mean CRF, IOPcc and IOPg significantly increased at the first postoperative week in the C3F8 group. In the SF6 group, CRF increased significantly but the increases in IOPcc and IOPg were not significant. In the PPV group, the increases in CRF, IOPcc and IOPg were not significant. The mean CH decreased in the C3F8, SF6 and PPV groups postoperatively but these results were not significant. No statistically significant differences were found between the changes of preoperative and postoperative CH, CRF and IOPg between the groups, but the increase in IOPcc was statistically significantly higher in the C3F8 group than the others. CONCLUSION: SF6 and C3F8 gas tamponade may affect corneal biomechanical parameters at the early postoperative period which should be related with surgery, gas tamponade or intraocular pressure changes.

Microtrauma-induced recurrent hyphema and secondary glaucoma associated with chronic acetylsalicylic acid use.

To report a case of microtrauma-induced recurrent hyphema and secondary glaucoma associated with voluntary chronic acetylsalicylic acid (ASA) use. A 43-year-old male developed advanced glaucoma in his right eye after a two-month followup period of recurrent microhyphema, which had been induced by strong eye-rubbing. In spite of topical and systemic antiglaucoma medication, as well as topical corticosteroid and cycloplegic drugs and bed rest under hospitalization, the hyphema and glaucoma were not controlled. His medical history revealed that he had been using ASA for 2 years in order to prevent heart attacks. We asked the patient to stop ASA intake and the hyphema cleared considerably on the third day after discontinuation of the drug. One week after stopping ASA, trabeculectomy with mitomycin C was performed without any complications. Glaucoma and recurrent hyphema were controlled after surgery without any medical treatment. Chronic ASA intake may cause recurrent hyphema and secondary glaucoma even after a microtrauma. Medical histories of patients must always be taken, especially in cases of prolonged recurrent hyphema.

Autofluorescence and optical coherence tomography findings in optic disc pit-associated maculopathy: case series.

The aim of this case series was to report and discuss the clinical, fundus autofluorescence (FAF), and optical coherence tomography (OCT) findings of four eyes of three cases with optic disc pit (ODP)-related serous macular detachment. Three cases were referred to the retina department of our hospital for decreased visual acuities in four of their eyes. In addition to ophthalmological examinations, OCT and FAF were also performed. ODP-related serous macular detachment was detected clinically in all the eyes. OCT also showed two typical components named as 'bilaminar structure' in all eyes and OCT and FAF photography showed precipitates in the retinal outer layers of the detachment area in three eyes. OCT and autofluorescence photography findings can support clinical observations in the diagnosis of ODP-related maculopathy.

Focal Choroidal Excavation Following Blunt Trauma.

The authors report a case of nonconforming focal choroidal excavation (FCE) identified in an eye following blunt, nonperforating trauma to the globe. Multimodal imaging was undertaken including color fundus photographs, enhanced depth imaging optical coherence tomography, fluorescein angiography, and fundus autofluorescence. This shows that FCE may result from blunt ocular trauma. The authors hypothesize that loss of structural support provided by an intact Bruch's membrane may be a key factor in precipitating the specific morphological changes associated with FCE occurring in a range of clinical settings. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:187-190.].

Increased levels of circulating CD34+ cells in neovascular age-related macular degeneration: relation with clinical and OCT features.

PURPOSE: To investigate the levels of circulating CD34+ stem cells in patients with neovascular type age-related macular degeneration (AMD) and its relation with clinical and optical coherence tomography (OCT) findings. METHODS: The study consisted of 55 patients: 28 patients (18 male and 10 female) with neovascular type AMD as a study group and 27 patients (12 male and 15 female) scheduled for cataract surgery as a control group. The level of CD34+ stem cells was measured by flow cytometry. Demographic and clinical data were recorded. RESULTS: The mean ages of patients in the study and control groups were 71 ± 8 and 68 ± 6 years, respectively. There was no statistically significant difference in terms of age, sex, or systemic disease association between study and control groups. However, smoking status was significantly higher in the study group (67.9% vs 37.0%; p = 0.02). Stem cell levels were significantly higher in the study group (1.5 ± 0.9 vs 0.5 ± 0.3; p<0.001), but there was no relation between stem cell levels and clinical and OCT findings. CONCLUSIONS: Increased circulating CD34+ stem cell levels were observed in patients with choroidal neovascular membrane associated with AMD, but no significant relation was found between cell levels and clinical and OCT findings.

Vogt-Koyanagi-Harada disease: clinical and demographic characteristics of patients in a specialized eye hospital in Turkey.

PURPOSE: To evaluate clinical and demographic features of Vogt-Kayanagi-Harada disease (VKH) disease in Turkish patients and compare them with previously published data. METHODS: Demographic and clinical features of 32 patients diagnosed as VKH in a tertiary referral center were retrospectively reviewed. RESULTS: The mean age at presentation was 33.6 ± 10.4 years. Seventy-five percent of the patients were female and 62.5% of the patients presented during the last 2 years. The disease was complete in 31.2%, incomplete in 50%, and probable in 18.8% of the patients. The clinical course was acute in 50%, chronic recurrent in 34.4%, and chronic in 15.6%. The most common findings were bilateral serous retinal detachment ± papillitis in acute cases and retinal pigment epithelial changes of the macula in chronic cases. CONCLUSIONS: Although rare in Turkey, VKH disease seems to have increased during the last few years. The disease is incomplete and acute in half of the patients and has a quite good visual prognosis.