Linking the Presence of Macular Oedema to Structural and Functional Alterations in Retinitis Pigmentosa.

OBJECTIVE: To investigate the association between the central retinal thickness (CRT), the retinal nerve fibre layer thickness (RNFL), and the functional alterations in retinitis pigmentosa (RP) patients. METHODS: Forty-three patients with typical RP and nineteen age-matched controls, who underwent SD-OCT (macular and optic disc OCT protocols) and electrophysiology, were included. The RP group was divided into two subgroups: with clinical appearance of macular oedema (ME-RP; 30 eyes) and without macular oedema (no-ME; 44 eyes). Central retinal thickness OCT data were averaged in three zones (zone 1 [0°-3°], zone 2 [3°-8°], and zone 3 [8°-15°]) and were evaluated in relation to the RNFL thickness and electrophysiological data. RESULTS: The ME-RP group showed increased CRT (zone 1) and RNFL thickness compared to the controls and no-ME-RP (p ≤ 0.002). The no-ME-RP group had reduced CRT thickness (all zones; p ≤ 0.018) compared to the controls and ME-RP, whereas the RNFL thickness in the no-ME-RP group was reduced only compared to the ME-RP group (p < 0.001). The ME-RP group showed significantly more attenuated functional responses than the no-ME-RP patients. A significant positive interaction was found between the CRT (zones 1 and 2) and the RNFL thickness within ME-RP (p ≤ 0.010). Significant negative interactions were found between CRT, RNFL thickness, and functional findings within ME-RP (p ≤ 0.049). CONCLUSION: The presence of macular oedema correlated well with increased RNFL thickness and residual function in RP patients. Such association provides evidence of an underlying transneuronal mechanism of retinal degeneration. Simultaneous monitoring of CRT and RNFL thickness may help in the future to evaluate the progression of the disease and the efficacy of treatments in RP patients.

Choroidal Manifestation of Systemic Non-Tuberculous Mycobacterial Infection: A Case Series.

PURPOSE: To describe choroidal findings associated with disseminated systemic non-mycobacterial infection. METHODS: A retrospective observational case series included two patients (four eyes) with non-tuberculous mycobacterial disease. The activity of choroidal lesions was assessed by clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, indocyanine green angiography, fluorescence angiography, and optical coherence tomography (OCT) angiography. The relationships between clinical symptomatology, choroidal findings, and systemic disease activity were evaluated. RESULTS: One subject diagnosed with aortic graft infection showed positive cultures for Mycobacterium chimaera. One HIV-positive subject showed a positive saliva culture for Mycobacterium avium. At presentation, all subjects showed chorioretinal manifestation. In one patient, the lesions were active and in the other patient, the lesions appeared inactive. With activity of disseminated chorioretinitis, the lesions had indistinct, blurred borders on fluorescence angiography and indocyanine green angiography and were hyporeflective with well-defined borders on OCT imaging. CONCLUSION: Multimodal imaging enables distinction between active and inactive lesions, thus supporting therapeutic management. Choroidal presentation of active disseminated mycobacterium infection indicates activity of systemic disease. Thus, even if the patient is not immunocompromised, an underlying systemic involvement should be ruled out.

[Acute Macular Neuroretinopathy]. / Akute makuläre Neuroretinopathie.

BACKGROUND: Acute macular neuroretinopathy (AMNR) is a rare unilateral or bilateral macular disorder. It typically occurs in young women presenting with sudden onset of central scotomas. They correspond to sharp reddish-brown areas in the macular region. The lesions often can only be observed with infrared reflectance imaging. These flat oval or wedge-shaped lesions are often grouped as a flower around the fovea. PATIENTS AND METHODS: Retrospective case series of 4 patients with AMNR. Clinical morphological features using different imaging techniques are presented. RESULTS: Four young women (26, 27, 28, 29 years of age) complained of seeing dark spots in the central visual field. In 3 patients, the scotomas occurred bilaterally. Three patients reported a history of preceding flu-like illness. In all 4 cases, visual acuity in both eyes was 1.0 with normal anterior and posterior segments. The corresponding retinal lesions were only noted in the infrared image of the optical coherence tomography (OCT). OCT images showed focal abnormalities in the photoreceptor outer segments. Follow-up periods varied between 9 and 36 months. In all patients, symptoms improved with at least partial recovery of the retinal architecture. CONCLUSIONS: Patients with AMNR suffer from acute onset of unilateral or bilateral central scotomas. Visual acuity is often only mildly affected. AMNR has a variable prognosis. In some cases, a self-limiting course with retinal recovery is observed while some patients have persistent reduction in visual acuity. Because there is no causative treatment for AMNR, an observational treatment approach is generally recommended.

Pembrolizumab-triggered Uveitis: An Additional Surrogate Marker for Responders in Melanoma Immunotherapy?

Immunotherapy leads to significantly prolonged survival of patients with metastatic melanoma. Autoimmune side effects including colitis, dermatitis, and endocrine abnormalities are common in patients treated with ipilimumab [anti-CTLA4 (cytotoxic T-lymphocyte-associated protein 4)]. Antibodies such as pembrolizumab that interfere with the PD-1 (programmed cell death 1)/PD-L1 pathway show greater efficacy and less toxicity than ipilimumab. Here we report 2 cases of pembrolizumab-induced uveitis associated with complete or partial tumor response. We suggest that uveitis may serve as a surrogate marker for a tumor response to therapy with pembrolizumab.