RECURRENT OPTIC DISC PIT MACULOPATHY DUE TO VALSALVA'S MANEUVER

PURPOSE

We report a patient with recurrent optic disc pit (ODP) maculopathy after Valsalva's maneuver and discuss its pathophysiology. We also hypothesize the role of Valsalva's maneuver in its genesis.

METHOD

Case report of one patient, male, 12 years old.

RESULTS

Serous retinal detachment may occur in association with the ODP, a developmental anomaly of the optic nerve head. Histopathologically, it consists of a dysplastic retina herniation into a pocket extending posteriorly through a defect in the lamina cribrosa into the subarachnoid space. These three different compartments-intraocular space, optic nerve head, and subarachnoid space-and the dynamic interactions among them should be understood as the key factors for the occurrence of ODP-related serous retinal detachment.

CONCLUSION

Based on the possibility that serous retinal detachment secondary to the ODP could be related to the Valsalva's maneuver, we strongly recommend that patients with ODP be advised to avoid intense physical or work activities that may increase abdominal, thoracic, and cerebral pressure and to refrain from playing wind instruments to avoid pretreatment, per treatment, and post-treatment intercurrences.

A Case Report of Bilateral Exudative Retinal Detachment in Severe Pre-eclampsia

We report a case of a 31-year-old gravida 2 para 1 female presenting to the optician with a two-week history of blurred vision and persistent headaches at 29 weeks gestation. Visual acuity on presentation was 6/100 in the right eye and 6/24 in the left eye. Fundoscopy of both eyes revealed serous retinal detachment in the absence of background retinal changes. On urgent admission to the maternity assessment unit, blood pressure was 189/126 mmHg and urine dipstick revealed 4+ proteinuria. Due to recurrent poor foetal heart rate variability on cardiotocography monitoring, an emergency caesarean was conducted. Sixteen hours following delivery, visual symptoms had improved, and clinical examination revealed normal blood pressure. An optical coherence tomography scan performed three months later was dry bilaterally with minor retinal pigment epithelium clumping. Serous retinal detachment involves the separation of the neurosensory retinal layer from the underlying retinal pigment epithelium. It is rare in pre-eclampsia but can be seen in patients with severe disease. The presentation of serous retinal detachment includes acute visual loss, reduced visual acuity, floaters, and flashing lights appearing in the vision. Although alarming on initial presentation, resolution is commonly seen within a couple of days postpartum. The pathogenic mechanism for serous retinal detachment development is widely discussed and thought to include changes to the choroidal circulation. Overall, although often self-resolving, a move to thorough antenatal care and vigilant monitoring in pre-eclamptic women is vital to prevent complications like this from occurring.

The efficacy of different anti-vascular endothelial growth factor agents, and dexamethasone implant therapy in patients with serous retinal detachment caused by Irvine-Gass syndrome

PURPOSE

The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS).

DESIGN

Retrospective cohort, comparative study.

METHODS AND MATERIALS

The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit.

RESULTS

Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032).

CONCLUSION

All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.

Surgical Approaches to Serous Retinal Detachment With Retina-Lens Touch in Eyes With Nanophthalmos

Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina-lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.

Serous macular detachment in ocular toxoplasmosis: A review

Ocular toxoplasmosis, a disease of the eye caused by the protozoan parasite Toxoplasma gondii, represents a common cause of posterior uveitis. The Authors review the current Literature regarding the uncommon presentation of ocular toxoplasmosis as macular serous retinal detachment (SRD). It is imperative to keep in mind that inflammatory SRD is a possible presentation of toxoplasmic retinochoroiditis. Underestimation of this clinical scenario and treatment with steroids alone without appropriate antiparasitic drugs, could lead to devastating consequences.

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.

The place of dexamethasone implant in patients with Vogt-Koyanagi-Harada disease who experienced systemic treatment-related hepatic dysfunction: A case series

We presented our observation with dexamethasone (DEX) implant in six eyes of three patients with Vogt-Koyanagi-Harada (VKH) disease who experienced hepatic dysfunction due to the systemic immunosuppressive therapy during their follow-up. Three cases who could not continue with the azathioprine (AZA) or adalimumab (ADA) treatment due to elevated liver enzymes were given consecutive bilateral DEX implant injections during the follow-up. In the first case, oral AZA was discontinued due to an elevation of the liver enzymes at the 2nd month of AZA treatment, and then she received five bilateral DEX implant administrations during the follow-up of 61 months without any intraocular pressure rise or disease recurrence. The remaining two patients had an elevation of the liver enzymes when ADA treatment was added to the prophylactic isoniazid therapy and they each received three bilateral DEX implant administrations within a year again without any complications and disease recurrence. DEX implant can be a safe and effective alternative for individuals with VKH disease whose systemic treatment is ceased due to adverse effects of the systemic treatment and intravitreal therapy with DEX implant can be beneficial to achieve a recurrence-free follow-up.

Exudative Retinal Detachment in Nigerians: Demographics and Causes

Background

Exudative retinal detachment (ERD) is a rare type of retinal detachment (RD), and information on its causes and presentation in Nigerians and Black Africans is scarce.

Aim

To report the prevalence, vision at presentation, and causes of ERD in a cohort of RD patients.

Materials and Methods

A prospective, multicentre, hospital-based study. We examined consecutive eyes diagnosed with ERD in ophthalmic patients seen within 1 year in four ophthalmic hospitals in Nigeria. The patients had a complete eye examination, including visual acuity, intraocular pressure measurement, slit lamp examination of the anterior segment, dilated fundus examination, and other ancillary investigations. Statistical analysis was done using SPSS version 22.0.

Results

Nine out of 237 patients were diagnosed with ERD, giving a hospital-based prevalence of 3.8% of RDs. The mean age of patients was 45.8 ± 21.6 years (6 months-80 years), male:female = 2:1. ERD was bilateral in one patient and unilateral in eight patients. There was no gender association (P = 0.84), but systemic disease was associated with a risk of ERD (P = 0.001). Five out of 9 (55.6%) patients had an associated systemic disease. The systemic diseases include two patients (40%) who had chronic renal failure, two patients (40%) who had systemic hypertension, and one patient (10%) who had lung cancer. Other ocular causes of ERD include post endophthalmitis, coats disease, and age-related macular degeneration in one eye each. 80 % of eyes were blind at presentation.

Conclusion

ERD is a rare form of RD in Nigerians and is associated with systemic diseases. There are inflammatory, neoplastic, vascular, and degenerative causes of ERD. At presentation, most eyes are blind. Early presentation will be beneficial in salvaging vision. Also, awareness of the occurrence and causes of ERD should be created amongst eye care practitioners.

Diffuse choroidal hemangioma in pregnancy: Symptomatic diffuse choroidal hemangioma spontaneously resolving postpartum

We present the case of a pregnant young woman with symptomatic diffuse choroidal hemangioma (CH), diagnosed with Sturge-Weber syndrome (SWS). Three months postpartum, there was full spontaneous resolution of the subretinal fluid and improvement in the visual acuity (VA). A 29-year-old, 31-week pregnant female with a coagulation disorder and enoxaparin (clexane) treatment, complained of a left visual disturbance of 2 weeks duration. On examination, the right eye was normal; left eye VA was 6/12 (20/40) with a left eyelid port-wine stain and on funduscopic examination there was a serous retinal detachment. On ultrasound, there was diffuse thickening of the choroid with a focus superior and nasal to the disc with active vascularization - a diagnosis of diffuse CH was made. Magnetic resonance imaging (MRI) and MR venography studies of the brain and orbit revealed engorged orbital vasculature, and the diagnosis of SWS was made. Three months after Cesarean section with birth of a healthy baby boy, VA returned to 6/9 with full resorption of subretinal fluid. On fundoscopic exam, there were no retinal or vein occlutions but there were tortuous blood vessels with A-V crossing. This is a rare case of newly diagnosed SWS with symptomatic diffuse CH in pregnancy. Postpartum, there was full resolution of the subretinal fluid. A watchful waiting approach can be considered in such cases.

Posterior sclerectomy for persistent serous retinal detachment with secondary glaucoma in Sturge-Weber syndrome: A case report

INTRODUCTION

A serous retinal detachment is one of the most likely ocular manifestation of Sturge-Weber syndrome (SWS). This finding can frequently occur as a complication after filtering surgery to maintain the intraocular pressure (IOP). Proper treatment has been approached with choroidal hemangioma as an organ target. To the best of our knowledge, various treatments for SRD are associated with diffuse choroidal hemangioma has been approached. However, a second retinal detachment following radiation therapy has worsened the situation. Here, we report an unexpected serous retina and choroidal detachment after non penetrating trabeculectomy. Although radiation therapy has been proposed for previous detachment to the ipsilateral eye in this case, repetition radiation therapy was not suggested concerning the health and quality of life especially in for young subjects. However, the kissing choroidal detachment in this case necessitated immediate intervention. Thus, posterior sclerectomy was performed for the recurrent retinal detachment. We believe that an intervention for a SWS case related complication will remain a significant and important to share as a public health contribution.

CASE PRESENTATION

A 20 year-old male confirmed with SWS with no known family history was diagnosed with SWS. He was gain from another hospital for glaucoma therapy. On the left brain MRI showed severe hemiatrophy in the frontal and parietal lobes and leptomeningeal angioma. Although his right (RE) eye had 3 gonio surgeries, 2 Baerveldt tube shunts and Micropulse trans-scleral cyclophotocoagulation, his IOP remained uncontrollable when he was 20 years old. RE IOP was in controlled after non-penetrating filtering surgery hence, his RE developed a recurrent serous retinal detachment. A posterior sclerectomy was performed in 1 quadrant of the globe to drain subretinal fluid.

CONCLUSION

Sclerectomies to the inferotemporal quadrant of the globe for serous retinal detachment associated with SWS are considered efficient for optimal drain subretinal fluid, resulting in complete regression of detachment.

The relation between serum inflammatory marker levels and serous retinal detachment in macular edema secondary to retinal vein occlusion Serum inflammatory marker levels in serous retinal detachment secondary to retinal vein occlusion

PURPOSE

To assess blood-derived inflammatory markers in macular edema (ME) secondary to retinal vein occlusion (RVO) with and without serous retinal detachment (SRD).

MATERIALS-METHODS

Treatment-naive patients with ME secondary to RVO were divided into two groups according to the existence of SRD in optical coherence tomography (OCT) images; group 1 consisted of 60 patients with SRD, and group 2 consisted of 60 patients without SRD. Age and gender-matched 60 patients formed group 3 as healthy controls. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation index (SII) were calculated from blood samples to assess the differences in the levels of blood-derived inflammatory markers and the presence of SRD.

RESULTS

The PLR, NLR, and SII values were higher in groups 1 and 2 than in group 3 (p<0.05, each comparison). The NLR and SII values were also significantly elevated in group 1 compared to group 2 (p = 0.000 and p = 0.000, respectively). The optimal cutoff value to estimate SRD in patients with ME secondary to RVO for NLR was 2.08 with 66.7% sensitivity and 65% specificity; for SII was 530.93 with 68.3% sensitivity and specificity.

CONCLUSION

SII is a reliable and cost-effective tool for predicting SRD, an inflammatory OCT biomarker in ME secondary to RVO.

Severe retinal hemorrhages at various levels with a serous retinal detachment in a pediatric patient with aplastic anemia-A case report

Background

Aplastic anemia can cause ophthalmic abnormalities in patients. Vision loss in a child with aplastic anemia due to massive retinal hemorrhages at various levels is rare.

Case presentation

A pediatric patient with aplastic anemia presented with retinal hemorrhages at multiple levels along with a serous retinal detachment in both eyes and subsequent retinal changes after pars plana vitrectomy.

Conclusion

Anemia and thrombocytopenia in aplastic anemia could cause severe retinal hemorrhages and result in retinal atrophy and retinal edema. Vitrectomy can be performed to remove vitreous hemorrhage, but risk factors for retinal atrophy and edema need further investigation.

Changes in Choroidal Thickness and Structure in Preeclampsia with Serous Retinal Detachment

Preeclampsia is a pregnancy-specific syndrome characterized by hypertension and proteinuria. We retrospectively investigated the clinical features, including choroidal layer thickness and luminal area to stromal area ratio, in a case series of preeclampsia with serous retinal detachment (SRD). The subjects were pregnant women with SRD during hospitalization for preeclampsia from October 2014 to June 2021. Based on medical records, affected eyes, time of onset, fundus examination findings, and subfoveal choroidal thickness (SCT), the choroidal layer thickness and choroidal vascular index (CVI) in each patient was examined. Thirteen eyes from seven patients (mean age 30.7 ± 4.7 years) were included in the study. In all cases, SRD improved without topical ocular treatment. The mean SCT at the initial visit was 424.4 ± 70.5 μm, and all patients had choroidal thickening, which significantly decreased to 286.0 ± 57.9 μm (p < 0.01) at the last visit. The mean choroidal inner layer was 162.7 ± 69.4 μm at the initial visit and 122.3 ± 35.5 μm at the final follow-up visit (p = 0.06), showing no significant difference; however, the mean choroidal outer layer was 261.7 ± 47.6 μm at the initial visit and 163.7 ± 37.1 μm at the final follow-up visit (p < 0.01), thus showing a significant decrease. The mean CVI was 67.2 ± 1.3% at the initial visit, yet it had significantly decreased to 65.4 ± 1.1% (p < 0.01) at the final follow-up visit. The findings of this study show that SRD with preeclampsia is associated with increased thickening of the choroidal outer layer, especially in the choroidal luminal area.

Bacillary Layer Detachment in Acute Vogt-Koyanagi-Harada Disease

Objectives

To evaluate the frequency and treatment response of eyes with bacillary layer detachment (BLD) in acute Vogt-Koyanagi-Harada (VKH) disease using spectral-domain optical coherence tomography (SD-OCT).

Materials and Methods

We retrospectively reviewed the medical records of 58 eyes of acute VKH patients with at least 6 months of follow-up between January 2009 and March 2021. SD-OCT, color fundus photographs, and fluorescein angiography images were analyzed in all patients.

Results

The study included 58 eyes of 29 patients. BLD was detected in 33 of the 58 eyes (56.9%) at baseline. Mean serous retinal detachment (SRD) height was 918.50±336.64 μm in the BLD group and 215.33±167.83 μm in the group without BLD (p<0.05). A positive correlation was found between SRD height and the presence of BLD (r=0.783, p<0.05). BLD was significantly more common in patients with a baseline SRD height greater than 500 μm (p<0.05). As subfoveal central choroidal thickness (CCT) could not be measured by enhanced depth imaging-OCT at baseline due to extreme choroidal thickness in all eyes, the earliest post-treatment CCT measurements were analyzed. At the completion of pulse steroid therapy, mean CCT was 425±82.87 μm in the BLD group and 385.58±82.87 μm in the group without BLD (p=0.04). The mean time to BLD resolution was 12.88±6.5 days (range: 2-26).

Conclusion

BLD is a common tomographic finding in eyes with acute VKH disease and can be differentiated from the associated SRD through careful SD-OCT analysis. Though it is mostly observed in patients with more serious disease, the presence of BLD has no negative effect on long-term visual function.

Aflibercept as a Treatment for Secondary Central Serous Chorioretinopathy in a Patient With Myasthenia Gravis

We report on a case of central serous chorioretinopathy (CSCR) secondary to chronic steroid use that showed sustained improvement when treated with an aflibercept intravitreal injection. A 44-year-old woman presented with decreased visual acuity of the left eye (OS). The patient had a recent history of myasthenia gravis and was being treated with systemic corticosteroids and immunosuppressants. At presentation, her visual acuity was 20/80 OS; an examination (using fluorescein angiography) of the left fundus revealed a serous retinal detachment of the posterior pole that extended to the mid-periphery and multiple areas of leakage, which findings were consistent with CSCR. The patient also had a history of unresolved strabismic amblyopia in her right eye. The patient's CSCR was managed with one injection of intravitreal aflibercept (2 mg/0.05 mL). One month following treatment, her visual acuity improved to 20/20 OS, and the serous retinal detachment had resolved. Ten months following treatment, an examination revealed a sustained improvement, with a visual acuity of 20/20 OS. Concomitantly, the patient's amblyopic eye revealed an improved visual acuity of 20/20. Our case suggests that some cases of secondary CSCR may respond to treatment with intravitreal aflibercept. This case also suggests that the CSCR imposed a unique form of occlusion therapy that helped improve the amblyopia of the contralateral eye in this adult patient.

Clinical relevance of fibrin membranous structures in the intra-photoreceptor outer segment separation on spectral domain optical coherence tomography (SD-OCT) in initial-onset acute Vogt-Koyanagi-Harada disease

PURPOSE

The purpose of the study was to investigate clinical relevance of fibrin membranous structure (FMS) in the photoreceptor outer segments on spectral-domain optical coherence tomography (SD-OCT) in untreated initial-onset acute Vogt-Koyanagi-Harada (VKH) disease.

METHODS

Clinical charts of 39 patients (78 eyes) diagnosed with initial-onset VKH disease were retrospectively reviewed. Age, gender, period from the onset of symptoms to first visit, visual acuity (VA), intraocular pressure (IOP), anterior chamber cells, serous retinal detachment (SRD), SD-OCT findings, as well as fluorescein (FA), and indocyanine green angiography (ICGA) were collected.

RESULTS

FMS was observed in 24 out of 39 VKH patients in either eye (61.5%). VKH patients with FMS (FMS group) were significantly younger and had the shorter period from the onset of symptoms to the first visit compared with those without FMS (non-FMS group). Mean logMAR VA and proportion of pooling of dye, mean central retinal thickness (CRT) were significantly higher in FMS group than in non-FMS group. In contrast, hyperfluorescence of the optic disc on FA was more in non-FMS group than in FMS group. Significant positive correlations between CRT and logMAR VA or IOP were only observed in the FMS group. Total amount of corticosteroids was significantly greater in FMS group than in non-FMS group. However, there were no significant differences in LogMAR VA and IOP between two groups at 6 months after treatment initiation.

CONCLUSION

FMS on SD-OCT is a critical feature observed in the early stage of initial-onset acute VKH disease, which is more common in younger patients and is related to the disease activity.

Correlation between serum immunoglobulin levels and retinal structure in patients with newly diagnosed Vogt‑Koyanagi‑Harada disease

Immunoglobulins serve immunomodulatory roles in numerous autoimmune diseases. The aim of the present study was to investigate the correlations between serum Ig levels and retinal structural parameters in patients with newly diagnosed acute Vogt‑Koyanagi‑Harada (VKH) disease. A total of 138 participants were enrolled and the foveal thickness (FT), serous retinal detachment (SRD), sensory retinal thickness, central FT (CFT), cube volume (V) and cube average thickness (AT) were assessed by optical coherence tomography. The patients were divided, according to the extent of SRD, into a high‑detachment group (>500 µm) and a low‑detachment group (≤500 µm). Rate‑scattering turbidimetry was performed to measure the Ig levels. The high‑detachment group comprised 51 (36.96%) patients. The proportion of males was significantly greater in the high‑detachment group compared with the low‑detachment group (58.82 vs. 40.23%; P<0.05) and best‑corrected visual acuity was significantly worse in the high‑detachment group compared with the low‑detachment group (P<0.001). The IgE levels in the high‑detachment group were significantly greater compared with the low‑detachment group (P<0.05). FT, SRD, CFT, V and AT were significantly greater in the high‑detachment group compared with the low‑detachment group (P<0.001). The IgE levels were positively associated with SRD, CFT and AT (P<0.05). Multivariate binary logistic regression analysis demonstrated that male sex (B=2.447; P<0.05) and serum IgE levels (B=0.997, P<0.05) may be independent risk factors for severe SRD. The results of the present study demonstrated that males are more likely to develop severe SRD and that serum IgE levels were associated with the extent of detachment. These data suggested that IgE may be involved in the progression of VKH disease.

Suprachoroidal triamcinolone acetonide injection: a novel therapy for serous retinal detachment due to Vogt-Koyanagi Harada disease

PURPOSE

To assess the efficacy and safety of Suprachoroidal triamcinolone acetonide injection [SCTA] as an adjunctive therapy in management of Vogt-Koyanagi Harada [VKH] serous retinal detachment.

DESIGN

Prospective parallel group study.

PARTICIPANTS

12 eyes of 6 patients with bilateral multiple serous retinal detachment of VKH in acute phase on systemic steroids.

METHODS

Each patient was received single SCTA injection (SCTA group, n = 6 eyes) and the other non-injected eye (Standard treatment group, n = 6 eyes), patients were followed for 1, 3, and 6 months to assess changes in best corrected visual acuity [BCVA], central foveal thickness [CFT] and intraocular pressure [IOP] between both groups.

MAIN OUTCOME MEASURES

The primary end point was changes in BCVA from baseline till 6^th months follow-up. Secondary end points were changes in CFT and IOP from baseline to 6 months of follow-up.

RESULTS

BCVA at one and three months was significantly better in eyes received SCTA than in non-injected eyes (p-value = 0.026 for each). CFT at one and three months was significantly higher in non-injected eyes than in eyes received SCTA (p-value = 0.028 for each). IOP showed no significant differences between both groups.

CONCLUSIONS

SCTA is an effective adjuvant treatment for VKH serous retinal detachment, without any serious ocular adverse effects or increase in IOP and causing significant reduction in CFT and rapid improvement in BCVA when combined with oral steroids.

Quantitative assessment of macular function after surgery for optic disc pit maculopathy: A case report

RATIONALE

We describe a case of optic disc pit maculopathy (ODP-M) in which vitrectomy with juxtapapillary laser (JPL) treatment led to the reattachment of retinoschisis (RS) as well as serous retinal detachment (SRD).

PATIENT CONCERNS

An 80-year-old man complained of distorted vision and decreased visual acuity (VA) in his left eye for 12 months.

DIAGNOSIS

We conducted quantitative functional evaluation on the area of RS and SRD using the Humphrey visual field analyzer. Fundus examination and optical coherence tomography showed SRD and RS in connection with the optic disc. The best-corrected logarithm of the minimum angle of resolution (logMAR) VA was 0.7.

INTERVENTIONS

The patient underwent JPL treatment combined with pars plana vitrectomy. During surgery, posterior vitreous detachment and tamponade were created with sulfur hexafluoride.

OUTCOMES

After surgery, SRD (and subsequently RS) gradually reduced and had completely disappeared at 31 months. VA gradually improved and was 0.0 (logMAR) at 28 months. The analysis of the mean macular thickness of the central 3-mm diameter showed that the macula thickness recovered to 300 μm at 17 months postoperatively. Retinal sensitivity began to improve at 24 months postoperatively and had increased at 48 months postoperatively.

LESSONS

In conclusion, vitrectomy with JPL treatment for ODP-M had a favorable anatomical outcome as well as a long-term functional outcome. These findings provide useful information for clinicians who are planning a therapeutic strategy, including the choice of surgical procedure for ODP-M.

Peripapillary and macular retinoschisis - A vision-threatening sequelae of advanced glaucomatous cupping

Purpose:

To present a selected case series of advanced glaucoma-associated peripapillary and macular retinoschisis and response to various treatment strategies with a comprehensive literature review.

Methods:

Retrospective observational case series. Retrospective review of five selected cases of advanced glaucoma with peripapillary and macular retinoschisis.

Results:

All five patients had advanced glaucomatous damage with macular and peripapillary retinoschisis, three (patients 2, 3, and 5) had a neurosensory detachment of the macula. Increased intraocular pressure was managed with maximal antiglaucoma medications and G6 micropulse diode laser treatment in the first patient, transscleral diode laser in the second patient, mitomycin-C augmented trabeculectomy in the third patient, maximal antiglaucoma medications alone in the fourth patient, pars plana vitrectomy followed by trabeculectomy in the fifth patient.

Conclusion:

We speculate that peripapillary and macular retinoschisis may indicate a vision-threatening sequelae of advanced glaucoma. The probable inciting factor for this vision-threatening pathology being elevated intraocular pressure, fluctuations in intraocular pressure, and chronic glaucoma with advanced cupping. We emphasize that meticulous examination of the macula in patients with advanced glaucoma is mandatory. It is imperative to do OCT macula in patients with advanced glaucoma to diagnose this distinct entity at an earlier stage and preserve the existing visual potential.

Deep Learning for Detecting Subretinal Fluid and Discerning Macular Status by Fundus Images in Central Serous Chorioretinopathy

Subretinal fluid (SRF) can lead to irreversible visual loss in patients with central serous chorioretinopathy (CSC) if not absorbed in time. Early detection and intervention of SRF can help improve visual prognosis and reduce irreversible damage to the retina. As fundus image is the most commonly used and easily obtained examination for patients with CSC, the purpose of our research is to investigate whether and to what extent SRF depicted on fundus images can be assessed using deep learning technology. In this study, we developed a cascaded deep learning system based on fundus image for automated SRF detection and macula-on/off serous retinal detachment discerning. The performance of our system is reliable, and its accuracy of SRF detection is higher than that of experienced retinal specialists. In addition, the system can automatically indicate whether the SRF progression involves the macula to provide guidance of urgency for patients. The implementation of our deep learning system could effectively reduce the extent of vision impairment resulting from SRF in patients with CSC by providing timely identification and referral.

Rare Case of Bilateral Diffuse Uveal Melanocytic Proliferation with Dermal and Mucosal Hyperpigmentations

Purpose: The demonstration of a rare case of bilateral diffuse uveal melanocytic proliferation (BDUMP) due to a lung carcinoma with unusual dermal lesions. Case description: A 76-year-old man with painless bilateral vision loss revealed leopard or giraffe spot chorioretinopathy and bilateral serous retinal detachment. Ultrasound biomicroscopy revealed uveal swelling expanding into the anterior chamber angle. Dermal and mucosal lesions were present on the lip, breast, groin, scrotum, and penis. Screening analyses revealed a non-small cell lung carcinoma. Conclusions: The diagnosis of BDUMP, a rare paraneoplastic syndrome, was made. The ophthalmological diagnosis led to screening investigations and revealed the underlying malignant disease. Uncommonly, multiple dermal and mucosal lesions could be detected and were analyzed histopathologically.

Spontaneous resolution of serous retinal detachment in preeclampsia

A 24-year-old pregnant woman applied with 2 days of sudden vision loss. Funduscopy showed serous retinal detachment along in the right eye and tear was not found. In the left eye, there were two small subretinal fluid accumulationsThe patient was diagnosed with serous retinal detachment due to preeclampsia. Serous retinal detachment of the patient regressed spontaneously within 1 month. All pregnant women with gestational hypertension should undergo retinal examination.

Macular Hole Surgery in Dome-Shaped Maculopathy

Purpose

To present a successful case of macular hole surgery in a patient with dome-shaped maculopathy (DSM).

Observations

Patient with DSM had successful closure of a full-thickness macular hole with surgery. There was persistent subretinal fluid after the surgery, which showed some response to a combination of a diuretic and a nonsteroidal anti-inflammatory drug (NSAID).

Conclusions and Importance

Full-thickness macular hole in DSM may be effectively managed with modern surgical techniques.

Comparison of the effects of aflibercept and dexamethasone in central retinal vein occlusion with serous retinal detachment

Clinical relevance: Previous studies have shown the efficacy of aflibercept and dexamethasone in central retinal vein occlusion. However, the efficacy of these two drugs in central retinal vein occlusion accompanied by serous macular detachment has not been investigated and compared. This results in a search for more precise data to evaluate the effects of two drugs in real-world studies.Background: The aim of this study is to compare the efficacy of intravitreal aflibercept and dexamethasone implantation injections in central retinal vein occlusion accompanied by serous retinal detachment.Methods: Sixty-eight eyes of 68 patients with treatment-naive macular oedema post-central retinal vein occlusion were enrolled in the retrospectively designed study. All of the patients had serous retinal detachment at baseline. The patients received three intravitreal aflibercept injections with an interval of four weeks and followed by pro re nata treatment protocol (intravitreal aflibercept group, n = 37) or a single dose dexamethasone implantation injection (dexamethasone implantation group, n = 31). Best-corrected visual acuity, central retinal thickness and the height of serous retinal detachment parameters were compared at baseline, and in the first, second, third and sixth months.Results: The groups were similar in terms of baseline characteristics (p > 0.05 for all). The visual gain was greater in the intravitreal aflibercept group (p = 0.013). While the intravitreal aflibercept group had a significant central retinal thickness decrease in the first and sixth months (p = 0.011 and p = 0.001, respectively), this superiority was not observed during the entire follow-up period (p = 0.212). There was no difference in serous retinal detachment resolution between the groups (p = 0.403). Two patients in the intravitreal aflibercept group (5.4%) and five patients in the dexamethasone implantation group (16.1%) had serous retinal detachment at the final visit (p = 0.158).Conclusion: Both intravitreal aflibercept and dexamethasone implantation injections seemed to be effective in the treatment of central retinal vein occlusion with serous retinal detachment. Intravitreal aflibercept treatment yielded better results in terms of visual gain and showed a faster anatomical response.

Hyperreflective foci as biomarkers for inflammation in diabetic macular edema: Retrospective analysis of treatment naïve eyes from south India

Purpose:

The aim of this study was to analyze the factors associated with hyperreflective foci (HRF) in diabetic macular edema (DME) in treatment naïve eyes.

Methods:

This retrospective observational study included 131 eyes of 91 treatment naïve patients with DME. Details of ophthalmological examination with duration of vision loss and systemic parameters were noted. The spectral-domain optical coherence tomography (SD-OCT) images were analyzed for number and location of HRF and the associated imaging biomarkers.

Results:

Inner retinal (IR) HRF were seen in 88 eyes (67%), outer retinal (OR) in 28 (21%), and subretinal (SR) in 12 (9%). The IR had (7.1 ± 7) HRF, the OR (6.5 ± 4.8), and SR (3.9 ± 2.9). A greater proportion of eyes with HRF also had subretinal fluid (SRF), significantly higher blood pressure and lower serum triglycerides. Univariate linear regression analysis showed women (3 HRF greater vs. men, P = 0.04), eyes with cystoid spaces (2.95 more HRF vs. no cystoid spaces, P = 0.02), and SRF (2.96 more HRF vs. no SRF, P = 0.007) had more HRF, whereas higher triglycerides (1 HRF lesser per 50 mg lower TGL, P = 0.03) had lesser.

Conclusion:

Our study highlights the importance of HRF as an imaging biomarker in DME suggesting an inflammatory origin. Long-term observations of large cohorts with automated analysis can give more insights.

Recurrent Episodes with Serous Retinal Detachment and Anterior Uveitis in a Patient Using Nivolumab (Anti -PD-1 Antibody) Therapy: A case report and literature review

Aim: Nivolumab is an immune checkpoint inhibitor that has recently been widely used for metastatic malignant melanoma. We report a case who developed multiple different ocular immune-related side effects (iRAEs) related to nivolumab.Case Presentation: A 60-year-old man on nivolumab treatment for metastatic malignant melanoma developed a decrease in vision in both eyes several days after the third infusion. The initial best-corrected visual acuity (BCVA) was counting fingers in both eyes. Slit-lamp examination revealed no abnormal findings in the anterior segment of both eyes. Posterior segment evaluation showed serous retinal detachment, including the whole macula and inferior retina in both eyes, and optical coherence tomography (OCT) confirmed the diagnosis. On en face OCT analysis, hyperautoflorescent dots were noticed on the whole macular region but more intense at the inferior quadrant corresponding to serous retinal detachment. On Fluorescein Angiography (FA), no abnormality was observed. Oral corticosteroid treatment was administered. Subretinal fluid resolved one week after treatment in the right eye and two weeks after treatment in the left eye. BCVA was 20/20 in both eyes at first month of treatment. After that, oral corticosteroid treatment was tapered and stopped at the end of the second month. The patient was followed monthly. Two months after the treatment patient presented with an anterior uveitis episode with mild vision loss. Slit-lamp examination revealed 3+ cells in the anterior chamber and posterior synechia in both eyes. Posterior segment examination was normal. The patient was treated with topical corticosteroid and cycloplegic for two months. Hyperautoflorescent dots formed with serous detachment disappeared six months after the onset of serous detachment, and they did not occur during anterior uveitis episodes.Conclusions: This is the first clinical report of nivolumab-associated ocular iRAEs presenting with recurrent episodes presenting with serous retinal detachment and anterior uveitis. En face OCT imaging may help diagnose and show the activity of the posterior segment manifestation. When managed properly and observed closely following general and ocular conditions, it is possible to held iRAEs and overcome them by oral and/or topical corticosteroid therapy without interrupting the nivolumab.

Bilateral Serous Retinal Detachment and Posterior Reversible Encephalopathy Syndrome Precipitated by Eclamptic Attack

Eclampsia is a severe hypertensive disease accompanied by tonic-clonic convulsions in the second half of pregnancy or during delivery in the absence of other aetiology. The association between eclampsia and serous retinal detachment is not common. We report a case of a 20-year-old primipara with eclampsia who developed bilateral exudative retinal detachment after delivery. Brain computed tomography (CT) reported findings in the occipital lobes consistent with posterior reversible encephalopathy syndrome. A few weeks after delivery, there was spontaneous resorption of subretinal fluid and complete resolution of bilateral serous retinal detachment with residual signs of choroidal ischemia, including Elschnig’s spot, Siegrist streak and some pigmentary changes in the retinal pigment epithelium. Visual acuity returned to normal in both eyes and there was complete resolution of the disease.

Comparing the Results of Vitrectomy and Sclerectomy in a Patient with Nanophthalmic Uveal Effusion Syndrome

Nanophthalmic uveal effusion syndrome (UES) is an extremely rare idiopathic disease characterized by a short axial length of the eye, extremely thick sclera and choroid. These structural changes can lead to spontaneous serous detachment of the retina and peripheral choroid. There are many other causes of UES such as trauma, inflammation, cataract surgery, glaucoma, or retinal detachment. UES is classified into three types. All are characterized by a relapsing-remitting clinical course. The loss of visual acuity ranges from mild to very severe, depending on macular involvement. Changes of the retinal pigment epithelium develop secondary after long-standing choroidal effusion and retinal detachment. Subretinal exudates could be seen and mistakenly diagnosed as chorioretinitis. UES can be very difficult to treat. The most commonly used treatment is surgery involving the creation of surgical sclerostomies (scleral window surgery) or partial thickness sclerectomies to support transscleral drainage. In our case, we present a bilateral nanophthalmic UES, which was misdiagnosed as bilateral ocular Vogt-Koyanagi-Harada disease. We documented the course of the disease and the results of the different surgical approaches in both eyes. A pars plana vitrectomy was performed in the right eye and a sclerectomy with sclerostomies in the left eye. In the left eye, even long lasting loss of visual acuity due to a serous retinal detachment was partially reversed.

Effects of dexamethasone treatment on serous retinal detachment in ranibizumab-resistant diabetic macular edema

Purpose

To evaluate outcome of intravitreal dexamethasone implant (IDI) treatment on serous retinal detachment (SRD) in patients with ranibizumab-resistant diabetic macular edema (DME).

Materials and methods

Forty-eight eyes of 48 patients with DME resistant to ranibizumab were enrolled in this retrospective and comparative study. Patients were divided into two groups according to presence of serous retinal detachment: (1) SRD or (2) non-SRD groups. All patients had at least three monthly ranibizumab injections, after which they were treated with IDI. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), use of antiglaucomatous drugs, and presence of cataract progression were noted at 1, 3, and 6 months post-IDI treatment.

Results

There was not any statistically significant difference in terms of baseline characteristics of the patients. The mean CRT was declined in both groups at 1, 3, and 6 months (p < 0.001). After IDI treatment, the mean BCVA was improved in both groups at 1, 3, and 6 months (p < 0.001). When groups were compared, the change in CRT was higher in the SRD group (p = 0.018), while there was no statistically significant difference between groups in terms of BCVA changes (p = 0.448).

Conclusion

The presence of SRD resulted in higher anatomical gain. SRD had no effects on visual changes after dexamethasone treatment in patients with ranibizumab-resistant DME.

Acute bilateral serous retinal detachments with spontaneous resolution in a 6-year-old boy

A healthy 6-year-old boy presented with acute bilateral vision loss, multiple serous retinal detachments between the vascular arcades and a thickened choroid. Spontaneous resolution occurred over several weeks. We hypothesize that the clinical constellation in our patient is suggestive of acute exudative polymorphous vitelliform maculopathy (AEPVM) or might be an atypical presentation of Vogt-Koyanagi-Harada (VKH) disease. We propose that it was caused by an autoimmune-mediated activation of inflammatory cells at the level of the choroid, induced by an unknown trigger.

Uveal Effusion Associated with Presumed Viral Encephalitis

Background Uveal effusion is a rare disease that is characterized by exudative detachment of the ciliary body and choroid. Herein, we report a rare case of uveal effusion associated with viral encephalitis, which resolved following the treatment of the viral encephalitis and administration of corticosteroids.Case presentation A 67-year-old man who was hospitalized for viral encephalitis was referred to our clinic. He had been treated for herpes zoster ophthalmicus in his left eye 3 weeks previously. Choroidal detachment and uveal effusion between the ciliary body and sclera were observed. He was prescribed oral and topical steroids and cycloplegics to treat uveal effusion, and an antiviral agent (Acyclovir) to treat viral encephalitis. After 4 weeks, the choroidal detachment resolved completely.Conclusions Uveal effusion syndrome can develop in association with viral encephalitis and be treated successfully with oral and topical steroids; we suggest that medical treatment should be attempted prior to surgery.Abbreviations ADEM: Acute disseminated encephalomyelitis; BCVA: Best corrected visual acuity; CSF: Cerebrospinal fluid; CT: Computed tomography; MRI: Magnetic resonance imaging; WBC: White blood cell.

Hypertensive choroidopathy in atypical hemolytic-uremic syndrome

PURPOSE

We present the case of a 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome with a hypertensive crisis, who presented a bilateral serous retinal detachment.

CASE DESCRIPTION

A 22-year-old woman, diagnosed as having atypical hemolytic uremic syndrome, was referred for blurred vision in both eyes, evolving over 7 days. Treatment including hemodialysis, plasma exchange, systemic steroids, antihypertensive medications and eculizumab was started 1 month prior to referral. At presentation, best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye. Retinal examination revealed bilateral serous retinal detachment in the posterior pole and some small, flat, variably pigmented lesions. Optical coherence tomography confirmed marked serous retinal detachment in both eyes. Fluorescein and indocyanine green angiography was performed. Treatment for systemic hypertension was changed. Seven days later, dilated fundus examination and optical coherence tomography demonstrated a significant regression of the serous retinal detachment. Her visual acuity improves in both eyes at the last control, showing at fundus examination a complete resolution of the exudative detachment but a persistence of variable flat pigmented lesion.

CONCLUSION

Although multiple organ systems are commonly affected in hemolytic uremic syndrome, ocular involvement has only been described in very few cases. Ocular manifestations in atypical hemolytic uremic syndrome include retinal, choroidal and vitreal hemorrhages, retina and/or ischemic signs. Bilateral serous retinal detachment may also be a sign of atypical hemolytic uremic syndrome or even the first manifestation of a hypertensive event.

Characteristics of diabetic macular edema patients with serous retinal detachment

To determine characteristics of diabetic macular edema patients with serous retinal detachment (SRD).We classified naïve diabetic macular edema (DME) patients with or without SRD, and compared their baseline characteristics; intravitreal bevacizumab (IVB) responsiveness; aqueous concentrations of IL (interleukin)-1β, -2, -8, -10, -17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF). In addition, factors associated with the existence of SRD were identified.Of the 64 DME patients, 14 had SRD. The average levels of aqueous VEGF and PlGF were significantly higher in the SRD group than in the control group (P = .022 and P = .041, respectively). The best-corrected visual acuity (BCVA) and central subfield thickness (CST) did not differ significantly between the 2 groups at baseline or after 3 consecutive monthly IVBs. In multivariate logistic regression analysis, the level of aqueous VEGF was the only factor associated with the existence of SRD (odds ratio: 1.03; P = .038).Rather than aqueous inflammatory cytokines, levels of aqueous VEGFs were associated with the occurrence of SRD in DME patients. In terms of prognosis, the existence of SRD was not related with BCVA or CST changes.

A Case Of Ipilimumab-Induced Unusual Serous Retinal Detachment In Bilateral Eyes

Purpose

Ipilimumab is an immune checkpoint inhibitor that is now widely used for patients with metastatic malignant melanoma. However, this immune checkpoint inhibitor can induce related adverse events in various organs. Here, we report a case of bilateral drug (ipilimumab)-induced serous retinal detachment (SRD), and the characteristic features found during swept-source optical coherence tomography (SS-OCT).

Case

A 78-year-old man with metastatic melanoma received 4 cycles of dacarbazine, nimustine, vincristine, and interferon-beta starting in January 2014, followed by 47 cycles of nivolumab starting in September 2014. Treatment with ipilimumab was started in June 2017. After 2 cycles of ipilimumab, the patient noticed impairment of the visual field in both of his eyes (at day 22) and visited our department in August 2017. Best corrected visual acuity at this initial visit was 16/20 in both eyes, while a fundus examination revealed SRD and retinal pigment epithelial detachments in both eyes. When using the horizontal and vertical 12 mm B-scanned images of SS-OCT, we detected SRD accompanied by a widely distributed high reflection of the photoreceptor outer segment, including the area where the SRD appeared. In addition, the image also showed the interdigitation zone was indistinguishable. Fluorescein angiography showed little leakage in the maculae. During his course of follow-up examinations, there was an increase in the SRD at the beginning, after which it then gradually decreased. However, the obscurity of the interdigitation zone remained.

Conclusion

Ipilimumab may cause impairment of the outer retinal layer. We suggest that this is a presumed ipilimumab-induced SRD.

Comparison of Ranibizumab versus Aflibercept in Treating Macular Edema among Patients with Serous Retinal Detachment Secondary to Branch Retinal Vein Occlusion

Purpose: To compare the effectiveness of ranibizumab and aflibercept in macular edema (ME) with serous retinal detachment (SRD) following branch retinal vein occlusion (BRVO).Methods: Once every month for 3 months, 33 patients were treated with ranibizumab (Group 1), whereas 30 others were treated with aflibercept (Group 2). In 9 months after that, patients were evaluated every 4 weeks and received additional injections if they met prespecified criteria for retreatment. Corrected visual acuity (BCVA), central foveal thickness (CFT), and height of SRD was measured.Results: During the first 3 months, the improvement of CFT, BCVA, and height of SRD were greater in Group 2 than Group 1. Those differences disappeared in the subsequent 9 months, and changes in CFT, BCVA, and height of SRD were similar between groups at all other visits.Conclusion: Aflibercept was more effective than ranibizumab from baseline to Month 3 in ME with SRD following BRVO.

Bilateral Serous Retinal Detachment from Neonatal-Onset Multisystemic Inflammatory Disorder

PURPOSE

Neonatal-onset Multisystem Inflammatory Disorder (NOMID) is a systemic syndrome characterized by rash, large joint osteoarthropathies and chronic meningitis. Ocular manifestations include optic disc edema, corneal opacities and uveitis. We report the novel finding of serous retinal detachments (RD) in NOMID.

METHODS

Case report.

RESULTS

An eight-month-old girl was referred to the ED for work-up of optic disc edema. Physical exam revealed flat fontanelles; macrocephaly and frontal bossing; diffuse urticarial rash; and swollen joints; WBC count and inflammatory markers were elevated. Ophthalmology exam revealed decreased visual acuity, optic disc edema and bilateral serous RD. MRI revealed bilateral enhancement of the ocular choroid and enlargement of the third and fourth ventricles secondary to aqueductal webbing. After infectious testing returned negative, the patient was treated with anakinra, an interleukin-1 receptor antagonist. Three months later, the serous RDs resolved.

CONCLUSION

Physicians should consider NOMID in infants presenting with diffuse rash, bilateral disc edema and serous retinal detachments.

The clinical features of posterior scleritis with serous retinal detachment: a retrospective clinical analysis

AIM

To summarize the clinical features, systemic associations, risk factors and choroidal thickness (CT) changing in posterior scleritis (PS) with serous retinal detachment.

METHODS

This retrospective study included 23 patients diagnosed PS with retinal detachment from August 2012 to July 2017. All patients' medical history and clinical features were recorded. The examinations included best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination, and routine eye examinations. Posterior coats thickness (PCT) was determined by B-scan ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and clinical data were compiled and analyzed.

RESULTS

After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5±9.24 years old. Ocular pain and blurred vision were the two most common complained symptoms by patients. Anterior scleritis occurred in 12 patients, which was confirmed by ultrasound biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular area. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with fluid in Tenon's capsule demonstrated as a typical T-sign. The average PCT was 2.51±0.81 mm in the PS-affected eyes and only 1.09±0.29 mm in the unaffected eye (P<0.0001). The subfoveal CT was 442.61±55.61 µm, which correlated with axis length (r=-0.65, P=0.001) and PCT (r=0.783, P<0.001). The BCVA and IOP did not correlate with either CT or PCT.

CONCLUSION

PS with serous retinal detachment presented a variety of symptoms, such as pain, visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound is a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

Central serous chorioretinopathy following ingestion of sildenafil citrate

INTRODUCTION

We report a case of a 35-year-old man who presented with headache followed by decreased vision, metamorphopsia, and altered color perception in his left eye, after repeated intake of sildenafil citrate (four times; 100 mg) in a limited period (3 days).

METHODS

On the first ocular examination, best-corrected distance visual acuity (CDVA) was 20/80 in his left eye and 20/20 in his right eye. On fundus examination, loss of foveal reflex and serous retinal detachment in the foveal region were detected. Fluorescein angiography of the left eye was compatible with a leakage area with determined borders. The patient was advised to stop sildenafil intake.

RESULTS

After 4 weeks, CDVA increased to 20/25, and the fundus examination revealed significant improvement of the macular edema. Optical coherence tomography showed increased foveal thickness to 350 μm.

CONCLUSION

Advising patients with central serous chorioretinopathy to stop sildenafil intake should be considered.

Longitudinal follow-up of two patients with isolated paracentral acute middle maculopathy

Objective: To describe longitudinal retinal changes in two cases of isolated paracentral acute middle maculopathy (PAMM).

Case series: We reported two cases (64 and 67-year-old men) with isolated PAMM, who were followed-up for over 5 and 2.5 years, respectively. Both cases exhibited similar clinical natural histories. The first examinations took place several days after onset, with funduscopy showing that both cases exhibited paracentral scotoma with good visual acuity and small gray lesions, while optical coherence tomography (OCT) showed the presence of a hyperreflective band that ranged from the inner plexiform layer to the outer plexiform layer (OPL). The lesions became unremarkable within 1 month. The hyperreflective band also became unremarkable and was limited to the inner nuclear layer (INL) within 1 month, with the band disappearing within several months. Subsequently, OCT showed there was a thin and irregular INL and OPL, an excavated change of the inner retinal surface, along with outer nuclear layer (ONL) thickening. After several years, OCT angiography demonstrated normal flow of macular capillaries in the superficial capillary plexus, and decreased flow in the lesion with dilation of the capillaries around the area in the deep capillary plexus (DCP). Focal serous retinal detachment (SRD) occurred in one case after 4–5 years.

Conclusion: Our findings indicated that long-term retinal changes in PAMM resulted in excavation of the inner retinal surface, INL thinning, ONL thickening and abnormal vasculature, especially in the DCP. Focal SRD may be a rare complication that can present at 4 years after onset.

A Comparison Study of Ranibizumab and Aflibercept in Patients with Naive Diabetic Macular Edema in Presence of Serous Retinal Detachment

Aim of the study: The aim of this study is to compare the efficacy of intravitreal injection of Aflibercept and Ranibizumab in the treatment of naive diabetic macular edema (DME) with serous retinal detachment (SRD). Materials and methods: In this prospective, non-randomized-cohort study, 60 eyes with DME with SRD were divided into 2 groups: group 1 consisted of 30 eyes treated with intravitreal injection of 0.5 mg/0.1 mL Ranibizumab (IVR) and group 2 consisted of 30 eyes treated with intravitreal injection of 2 mg/0.05 mL Aflibercept (IVA). After three sequential injections with 30-40-day interval as a loading dose, all patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central macular thickness (CMT), SRD's height (SRDH) and the number of reinjections of the drugs were compared. Results: The groups were similar in terms of age and sex (p > 0.05). There was no difference between groups in terms of the baseline BCVA, CMT and SRDH (p > 0.05). There was no significant difference between groups with regard to BCVA and CMT values for 12 months (p > 0.05). SRDH decreased significantly in both groups; however, the reduction of SRDH was considerably higher in group 2 for 12 months (p < 0.05). The mean number of reinjection was 4.40 ± 0.85 in group 1 and 3.16 ± 0.75 in group 2 and it was noticeably lower in group 2 (p < 0.001). The number of cases with persistent SRD at the end of the study was 14 (46.6%) in group 1 and 5 (16.6%) in group 2 (p < 0.001). Conclusions: Aflibercept may treat SRD more efficiently in patients with DME compared to Ranibizumab with fewer injections.

Bilateral serous retinal detachment accompanied by a rare intraretinal fluid configuration in preeclampsia and PRES Syndrome

Purpose: To present the association between posterior reversible encephalopathy (PRES) syndrome due to preeclampsia and bilateral serous retinal detachment (SRD) accompanied by intraretinal fluid configuration. Methods: A 24-year-old woman, at 28 weeks of gestation presented with blurred vision bilaterally related to bilateral SRD involving the center of the macula accompanied by intraretinal fluid. The patient was diagnosed as pre-eclampsia accompanied by PRES syndrome. The patient approved and underwent delivery the same day. On day 9, ophthalmologic examination revealed complete resolution of SRD and normal visual acuity bilaterally and cranial MRI showed complete resolution of the vasogenic edema with medical treatment. Conclusion: SRD and accompanying retinal edema must be considered among etiological factors leading to sudden vision loss in patients with preeclampsia and PRES syndrome. Abbreviations: PRES = Posterior reversible encephalopathy, SRD = Serous retinal detachment, SD-OCT = Spectral-domain optical coherence tomography, RPE = Retinal pigment epithelium, CSC = Central serous chorioretinopathy, ONL = Outer nuclear layer, INL = Inner nuclear layer, IPL = Inner plexiform layer, RNFL = retinal nerve fiber layer.

Myelin Oligodendrocyte Glycoprotein-IgG-positive Recurrent Bilateral Optic Papillitis with Serous Retinal Detachment

Autoantibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been detected in inflammatory demyelinating central nervous system diseases. A 30-year-old woman had blurred vision, marked optic nerve disc swelling, serous retinal detachment at the macular on optic coherence tomography, and MOG-IgG seropositivity. The patient was thought to have optic papillitis associated with MOG-IgG. Her symptoms rapidly improved after high-dose methylprednisolone therapy. We hypothesize that serous retinal detachment was secondary, arising from optic papillitis. This is the first report of the concurrence of optic papillitis with MOG-IgG and serous retinal detachment. MOG-IgG should be tested in patients with marked optic disc swelling.

Optical coherence tomography findings predictive of response to treatment in diabetic macular edema

Objective

To evaluate the short-term efficacy of intravitreal bevacizumab (IVB) and posterior sub-tenon triamcinolone injections (PSTI) on the basis of spectral-domain optical coherence tomography (SD-OCT) patterns in diabetic macular edema (DME).

Methods

We retrospectively reviewed 73 eyes of 73 patients with DME. Based on the presence of serous retinal detachment (SRD), eyes were categorized into two groups, and either IVB or PSTI treatment was performed. Central macular thickness (CMT) and the degree of SRD were assessed preoperatively and 1 month postoperatively. The severity of intraretinal edema was approximated based on the distance from the external limiting membrane to the internal limiting membrane.

Results

In eyes with SRD, reduction of SRD was greater with IVB than with PSTI. Moreover, reduction of intraretinal edema was greater with PSTI than with IVB. In eyes without SRD, PSTI achieved greater CMT reduction, compared with IVB.

Conclusions

In DME patients with SRD, IVB achieved greater reduction of SRD, compared with PSTI; however, intraretinal edema responded more favorably to PSTI, regardless of the presence of SRD. Our results suggest that the classification of DME based on OCT findings may be useful to predict responses to IVB or PSTI treatments.

Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema

AIM

To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema (DME) determined with optical coherence tomography (OCT).

METHODS

In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) and the relationship between the systemic risk factors and DME patterns was evaluated.

RESULTS

Of the 57 patients with DME, 21 (36.8%) had DRT, 24 (42.1%) had CME and 12 (21.0%) had SRD. Micro- or macro-albuminuria was significantly higher in the DRT pattern (61.9%) compared with the SRD (50.0%) and CME patterns (25.0%; P=0.040). Hemoglobin A1c (HbA1c) level was significantly higher and patients were younger in the DRT pattern group (P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group.

CONCLUSION

Micro- or macro-albuminuria may be more frequent and HbA1c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.

Pregnancy-induced hypertension-related chorioretinitis resembling uveal effusion syndrome: A case report

RATIONALE

Pregnancy-induced hypertension (PIH) is a major cause of maternal and fetal mortality. Hypertensive choroidopathy is a preliminary sign of vasogenic edema in the choroid, and is associated with PIH. Here, we report a post-natal case of PIH-related chorioretinitis with bilateral severe serous retinal detachment (SRD) resembling uveal effusion syndrome.

PATIENT CONCERNS

A 35-year-old woman was diagnosed with severe PIH at 37 weeks of pregnancy. She underwent an emergency cesarean delivery. Four days after delivery, she perceived a sudden decrease of vision. At presentation, fundus examination demonstrated bullous SRD and multiple white mottles in the posterior poles of both eyes. Optical coherence tomography (OCT) showed macula edema and retinal pigment epithelium (RPE) folds. Indocyanine green angiography (ICGA) demonstrated delayed filling of choroidal circulation in the early phase and multiple hyperfluorescent spots in the mid phase.

DIAGNOSES

PIH.

INTERVENTIONS

Antihypertension treatment alone resulted in gradual resolution of the SRD.

OUTCOMES

At 463 days after delivery, fundus photographs of both eyes showed leopard spots corresponding to hyperautofluorescent spots with dark rim observed on fundus autofluorescence images.

LESSONS

Ophthalmologists should be aware of PIH-related chorioretinitis with similar clinical manifestations as uveal effusion syndrome, and should treat with antihypertensive agents in cooperation with obstetricians.

Ocular Complications in Influenza Virus Infection

Purpose: To describe a case series of ocular complications associated with upper respiratory tract infections. Methods: Four patients aged 21-61 years (three females, one male) had confirmed ocular complications connected with a general upper respiratory tract infection with myalgia and fever. Ophthalmological examination, including a visual acuity test, a slit-lamp exam, intraocular pressure measurements, fluorescein and indocyanine green angiography, optical coherence tomography (OCT), and diagnostic tests for influenza were performed in the patients (RT-PCR, HAI). Results: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) was diagnosed in three patients and serous macular detachment (SME) in one. Influenza virus infection was confirmed by molecular biological methods (RT-PCR) or the hemagglutination inhibition test (HAI) in two patients. All patients were treated with systemic prednisone. Conclusion: A coincidence between APMPPE and SME epitheliopathy and influenza virus infection was observed in different months of a given epidemic season.

[Dome-shaped macula: features of differential diagnostics with clinical examples]

The phenomenon of dome-shaped macula (DSM) constitutes protrusion of membranes of the posterior pole of the eye toward the vitreous body due to local thickening of sclera layers. The phenomenon was detected using enhanced depth imaging optical coherence tomography (EDI-OCT). In uncomplicated forms of DSM, all layers of the retina are contiguous, but the setting of DSM can involve a number of pathological conditions causing decrease in vision. One of the most often described concurrent conditions in DSM is serous retinal detachment (SRD). Such complicated forms of DSM are often masked as a non-pigmented neoplasm of the choroid, in particular hemangioma (HC).

PURPOSE

To demonstrate the possibilities of differential diagnostics of DSM with HC using modern instrumental diagnostic methods.

MATERIAL AND METHODS

The study involved two clinical cases of patients with DSM and HC, who underwent comprehensive ophthalmological examination including EDI-OCT and OCT angiography, fluorescent angiography (FA), indocyanine-green angiography (ICG) and magnetic resonance imaging of brain and orbits (MRI).

RESULTS

The most simple and highly informative method for differential diagnostic of DSM with HC is currently EDI-OCT. In difficult differential diagnostic cases, it is recommended to use FA and MRI. Additionally, for identification of the cause of SRD in DSM, OCT-angiography and ICG-angiography can be used. Thus, diagnostics of DSM is difficult today primarily because of the low awareness of ophthalmologists about the presence of such macula pathology. Detection of this anatomical feature by means of ophthalmoscopy alone can be difficult and requires special skills and experience. The use of EDI-OCT, as well as FA and MRI in difficult differential diagnostic cases, and correct interpretation of the obtained data can help avoid diagnostic errors.