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Bai G, Wei H, Li S. THE DIAGNOSTIC VALUE OF MULTISPECTRAL FUNDUS IMAGING IN HYPERTENSIVE RETINOPATHY. Retina 2024; 44:1092-1099. [PMID: 38320305 DOI: 10.1097/iae.0000000000004060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To observe the diagnostic value of multispectral fundus imaging (MSI) in hypertensive retinopathy (HR). METHODS A total of 100 patients with HR were enrolled in this cross-sectional study, and all participants received fundus photography and MSI. Participants with severe HR received fundus fluorescein angiography (FFA). The diagnostic consistency between fundus photography and MSI in the diagnosis of HR was calculated. The sensitivity of MSI in the diagnosis of severe HR was calculated by comparison with FFA. Choroidal vascular index was calculated in patients with HR using MSI at 780 nm. RESULTS MSI and fundus photography were highly concordant in the diagnosis of HR with a Kappa value = 0.883. MSI had a sensitivity of 96% in diagnosing retinal hemorrhage, a sensitivity of 89.47% in diagnosing retinal exudation, a sensitivity of 100% in diagnosing vascular compression indentation, and a sensitivity of 96.15% in diagnosing retinal arteriosclerosis. The choroidal vascular index of the patients in the HR group was significantly lower than that of the control group, whereas there was no significant difference between the affected and fellow eyes. CONCLUSION As a noninvasive modality of observation, MSI may be a new tool for the diagnosis and assessment of HR.
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Affiliation(s)
- Guitao Bai
- Department of Ophthalmology, Zigong First People's Hospital, Zigong, China; and
| | - Hao Wei
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shuangle Li
- Department of Ophthalmology, Zigong First People's Hospital, Zigong, China; and
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Limoli C, Raja LD, Wagner SK, Ferraz D, Bolz M, Vujosevic S, Nucci P, Nicholson L, Keane PA, Khalid H, Huemer J. Exploring Patient Demographics and Presence of Retinal Vascular Disease in Paracentral Acute Middle Maculopathy. Am J Ophthalmol 2024; 260:182-189. [PMID: 38104758 DOI: 10.1016/j.ajo.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To investigate the sociodemographic profile, the association with retinal vascular diseases (RVD) and systemic comorbidities, and visual outcomes of patients with paracentral acute middle maculopathy (PAMM) in a large, ethnically diverse single-center cohort. DESIGN Retrospective cohort study. METHODS Electronic health record query for all patients presenting with PAMM at Moorfields Eye Hospital, London, was completed. Detailed demographic, clinical, and systemic information were collected and analyzed. RESULTS A total of 78 eyes of 78 patients with confirmed PAMM were included in the study. Forty patients (51.3%) presented with no RVD, 20 patients (25.6%) with retinal vein occlusion (RVO), 16 patients (20.5%) with retinal artery occlusion (RAO), and 2 patients (2.6%) with concomitant RAO and RVO. Patients with PAMM+RAO were older than those with RVO (P = .02) and more likely to have a history of major adverse cardiovascular events (MACE) (P = .01), with a significantly worse presenting best corrected visual acuity (BCVA) (20/50) compared to patients with RVO (P = .02) and no RVD (P < .001). Individuals with isolated PAMM had a significantly higher prevalence of previous MACE (P = .04) and sickle cell disease (SCD) (P = .04) compared to those with RVO. At the last follow-up, 64 patients (85.3%) had a good BCVA (>20/32). CONCLUSIONS The significant association of PAMM with RVD supports the hypothesis of an ischemic etiology. Individuals with isolated PAMM had a higher prevalence of MACE and SCD. Thus, it is important to prompt immediate referral for a comprehensive systemic evaluation. Across the whole cohort, PAMM was associated with good BCVA improvement during follow-up, indicating a good visual prognosis.
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Affiliation(s)
- Celeste Limoli
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom; Ophthalmology, Università degli Studi di Milano (C.L.), Milano, Lombardia, Italy
| | - Laxmi Deepa Raja
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom
| | - Siegfried Karl Wagner
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom; Institute of Ophthalmology, University College London (S.K.W., P.A.K., H.K.), London, United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (S.K.W., P.A.K.), London, United Kingdom
| | - Daniel Ferraz
- IDOR-d'Or Institute for Research and Education (D.F.), Rede d'Or, Sao Paolo, Brazil
| | - Matthias Bolz
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University (M.B., J.H.), Linz, Austria
| | - Stela Vujosevic
- Eye Clinic, IRCCS MultiMedica (S.V.), Lombardia, Italy;; Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano (S.V., P.N.), Milano, Lombardia, Italy
| | - Paolo Nucci
- Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano (S.V., P.N.), Milano, Lombardia, Italy
| | - Luke Nicholson
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom
| | - Pearse Andrew Keane
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom; Institute of Ophthalmology, University College London (S.K.W., P.A.K., H.K.), London, United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (S.K.W., P.A.K.), London, United Kingdom
| | - Hagar Khalid
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom; Institute of Ophthalmology, University College London (S.K.W., P.A.K., H.K.), London, United Kingdom; Ophthalmology Department, Faculty of Medicine, Tanta University (H.K.), Tanta, Al Gharbiya, Egypt
| | - Josef Huemer
- From the Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, United Kingdom; Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University (M.B., J.H.), Linz, Austria.
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Cicinelli MV, La Franca L, Berni A, Bottazzi L, Rabiolo A, Lattanzio R, Udaondo P, Bandello F. Rate and associations of inner retinal thinning in eyes with retinal vein occlusion and regressed macular oedema. Eye (Lond) 2024; 38:138-144. [PMID: 37391514 PMCID: PMC10764826 DOI: 10.1038/s41433-023-02647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To investigate the associations between visual acuity (VA) and structural optical coherence tomography (OCT) features in retinal vein occlusion (RVO) eyes after cystoid macular oedema (CMO) regression and to assess whether inner retinal thinning is progressive. METHODS Retrospective observational study of RVO eyes with regressed CMO for at least 6 months. OCT scans at CMO regression were analysed, and features were correlated with VA at that visit. The inner retinal thickness was longitudinally compared between RVO and unaffected fellow eyes (controls) with linear mixed models. The rate of inner retinal thinning was obtained as the interaction term between disease status and time. Associations between inner retinal thinning and clinical characteristics were explored. RESULTS Thirty-six RVO eyes were followed for 34.2 ± 21.1 months after CMO regression. The presence of ellipsoid zone disruption (regression estimate[standard error(SE)] = 0.16[0.04] LogMAR vs. intact, p < 0.001) and lower inner retinal thickness (regression estimate[SE] = -0.25[0.12] LogMAR for 100-μm increase, p = 0.01) were associated with worse VA. The inner retinal thickness decreased faster in RVO than controls (rate of retinal thinning -0.27 ± 0.09 μm/month vs. -0.08 ± 0.11 μm/month, p = 0.01). Macular ischaemia was associated with a faster rate of retinal thinning (interaction term macular ischaemia*follow-up time, p = 0.04). CONCLUSION Inner retinal and photoreceptors' layers integrity are associated with better visual acuity once CMO resolves. RVO eyes undergo progressive inner retinal thinning after CMO regression, faster in eyes with macular ischaemia.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Lamberto La Franca
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Berni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Bottazzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patricia Udaondo
- Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, No. 106, Valencia, Spain
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Takao M, Oishi A, Shimizu T, Kuwatsuka Y, Kitaoka T. Paracentral acute middle maculopathy in systemic sclerosis and subsequent branch retinal artery occlusion. Am J Ophthalmol Case Rep 2023; 32:101955. [PMID: 38020208 PMCID: PMC10663736 DOI: 10.1016/j.ajoc.2023.101955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose We report a case of systemic sclerosis-associated paracentral acute middle maculopathy (PAMM) in a young woman who subsequently developed branch retinal artery occlusion. Observations A 22-year-old woman presented with a paracentral scotoma. Optical coherence tomography (OCT) revealed bilateral paracentral acute middle maculopathy. Upon systemic examination, she was diagnosed with systemic sclerosis (SSc). She subsequently developed branch retinal artery occlusion despite vasodilator medications. After the prescription of aspirin, she did not experience a new event for one year. Conclusion and importance This case illustrates that SSc may affect the retinal vascular system and vision and cause PAMM. The optimal prophylaxis for patients with recurrent retinal events should be investigated in future studies.
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Affiliation(s)
- Miki Takao
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Ophthalmology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yutaka Kuwatsuka
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Xiao H, Guo N, Li J, Jin L, Liu Y, Lin S, Fang L, Liu X, Zuo C. Paracentral Acute Middle Maculopathy Following Acute Primary Angle Closure and Acute Primary Angle Closure Glaucoma. Clin Ophthalmol 2023; 17:3513-3523. [PMID: 38026591 PMCID: PMC10674771 DOI: 10.2147/opth.s437075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To report the prevalence, clinical characteristics and risk factors for paracentral acute middle maculopathy (PAMM) following acute primary angle closure (APAC) and acute primary angle closure glaucoma (APACG). Methods This retrospective study consecutively recruited patients diagnosed with APAC or APACG. Based on the spectral domain optical coherence tomography characteristics, PAMM eyes were divided into three stages. Characteristics of different stages such as the time from symptoms to treatment (TST), retinal thickness and BCVA improvement were analyzed. The risk factors of PAMM were evaluated by binary logistic regression models. Results A total of 781 eyes of 781 APAC or APACG patients were included, and PAMM was found in 22 (2.9%) of them. Stage III eyes had a significantly longer TST than stage I eyes (P = 0.008) while exhibiting significantly thinner retinal thicknesses (P < 0.0001). The BCVA improvement was significantly worse in the eyes treated in stage III than in those treated in stage I (P = 0.008). Older age, longer axial length and without type 2 diabetes were associated with a lower risk of incident PAMM (OR = 0.95, P = 0.028; OR = 0.52, P = 0.019; OR = 3.92, P = 0.022). Conclusion PAMM can be secondary to APAC or APACG at a rate of 2.9%. Different visual outcomes were observed in patients who received the intervention at different stages of PAMM. Younger patients with a shorter axial length and type 2 diabetes were found to be more susceptible to PAMM.
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Affiliation(s)
- Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Ni Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Junyi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Yuan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Shufen Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Lei Fang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Xing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, People’s Republic of China
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6
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Bousquet E, Santina A, Abraham N, Daily MJ, Sarraf D. Detection of Paracentral Acute Middle Maculopathy Can Prevent Blindness and Death. Retina 2023; 43:1827-1832. [PMID: 37748460 DOI: 10.1097/iae.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Elodie Bousquet
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Ahmad Santina
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Neda Abraham
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | | | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
- Greater Los Angeles Virginia Healthcare Center, Los Angeles, California
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7
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Miller CG, Brucker AJ, Perry LM, Kim BJ, Martin ME, Frey NV, Aleman TS. OUTER RETINOPATHY AND MICROANGIOPATHY IN ACUTE MYELOGENOUS LEUKEMIA. Retin Cases Brief Rep 2023; 17:683-689. [PMID: 37903306 DOI: 10.1097/icb.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
PURPOSE To describe a patient with acute myelogenous leukemia who presented with a recurrent, bilateral, outer retinopathy, before and after consolidative peripheral blood stem cell transplantation complicated by chronic graft-versus-host disease. METHODS This is a retrospective review of records from a 23-year-old woman with acute myelogenous leukemia who underwent comprehensive ophthalmic evaluations for over a year including chromatic perimetry and multifocal electroretinograms, imaging with spectral domain optical coherence tomography, near-infrared and short-wavelength fundus reflectance and autofluorescence, fluorescein and optical coherence tomography angiography. RESULTS The patient presented with recurrent, unilateral paracentral scotomas. There was localized loss of inner segment ellipsoid (EZ) and photoreceptor outer segment signals (IZ) in the pericentral retina of both eyes co-localizing with hyperreflective lesions on near-infrared reflectance. She subsequently lost vision (visual acuity = 20/200) in the right eye a year after consolidative peripheral blood stem cell transplantation complicated by steroid-resistant-chronic graft-versus-host disease. There was loss of the EZ and IZ signals corresponding to a dense central cone scotoma and multifocal electroretinograms depression. Near-infrared autofluorescence, fluorescein and optical coherence tomography angiography were within normal limits. Visual acuity (20/20) and retinal sensitivities improved with restoration of the EZ/IZ signals after oral prednisone and intravenous rituximab, but left a residual photoreceptor loss and paracentral scotoma. CONCLUSION We propose that an immune-mediated microangiopathy may explain the protracted, recurrent course of primary photoreceptor abnormalities in our patient, which was further complicated by manifestations of chronic graft-versus-host disease following consolidative peripheral blood stem cell transplantation. Outer retinal findings previously documented in leukemia may be explained by a similar mechanism.
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Affiliation(s)
- Charles G Miller
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Alexander J Brucker
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Linda M Perry
- Cell Therapy and Transplant Program, Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Kim
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Mary Ellen Martin
- Cell Therapy and Transplant Program, Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noelle V Frey
- Cell Therapy and Transplant Program, Abramson Cancer Center, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tomas S Aleman
- Department of Ophthalmology, Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Vitiello L, Salerno G, Coppola A, Abbinante G, Gagliardi V, Pellegrino A. Simultaneous Branch Retinal Artery and Central Retinal Vein Occlusion Improved with No Ocular Therapy: A Case Report. Tomography 2023; 9:1745-1754. [PMID: 37736992 PMCID: PMC10514818 DOI: 10.3390/tomography9050139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023] Open
Abstract
A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, Polla, 84035 Salerno, Italy
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Pinna A, Zinellu A, Serra R, Boscia G, Ronchi L, Dore S. Combined Branch Retinal Artery and Central Retinal Vein Occlusion: A Systematic Review. Vision (Basel) 2023; 7:51. [PMID: 37606497 PMCID: PMC10443287 DOI: 10.3390/vision7030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023] Open
Abstract
We performed a systematic review and analyzed the current available data on branch retinal artery occlusion (BRAO) with simultaneous central retinal vein obstruction (CRVO), a rarely described occurrence. MEDLINE/PubMed and ISI Web of Sciences searches were performed according to MOOSE guidelines. Studies were considered eligible if they (1) described patients with simultaneous BRAO + CRVO and (2) had been published in peer-reviewed journals. We initially identified 239 records from databases. Ultimately, only 19 reports met the selection criteria. Twenty-nine patients (15 men, 14 women; mean age 43 ± 15 years) were analyzed. Seventeen (59%) patients presented vascular risk factors. Mean visual acuity at onset and final visual outcome were 20/83 and 20/45, respectively, an insignificant improvement. Vision improved in 48% of cases. A marked heterogeneity in treatment approach was found. Eight (28%) patients received no therapy, whereas for 21 (72%) a large variety of topical and/or systemic drugs was given. In the treated group, mean visual acuity at onset and final visual outcome were 20/90 and 20/44, respectively, a not statistically significant improvement. Results suggest that combined BRAO + CRVO occurs at a younger age than isolated BRAO or CRVO. At present, there is insufficient evidence to support any specific management to improve vision in simultaneous BRAO + CRVO.
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Affiliation(s)
- Antonio Pinna
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (R.S.)
| | - Rita Serra
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (R.S.)
| | - Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Lorenza Ronchi
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
| | - Stefano Dore
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
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Sadiq SA, Mishra S, Mirza RG. Hyperreflective Vasculature: A Negative Prognostic Sign for Retinal Vein Occlusion on Near-Infrared Reflectance Imaging. Ophthalmic Surg Lasers Imaging Retina 2023; 54:266-270. [PMID: 37184991 DOI: 10.3928/23258160-20230404-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVE To investigate the clinical significance of hyperreflective vasculature visualized on near-infrared reflectance (NIR) in patients with retinal vein occlusion (RVO). METHODS In this retrospective study, RVO patients with NIR imaging and at least 1-year follow-up, and without confounding disease, were included. Two blinded independent graders identified vascular hyperreflectivity (HR) by detection of whiter signals in vessels. Visual acuity (VA), macular thickness (MT), and number of administered anti-vascular endothelial growth factor (anti-VEGF) injections were assessed. RESULTS RVO patients with HR (n = 20) and without HR (n = 31) demonstrated similarity in age, sex, and class of RVO. At presentation, the HR group had higher MT (P = 0.002) but no difference in VA (P = 0.1018). At 1 year, patients with HR had worse VA (P = 0.001), decreased MT (P = 0.011), and received more anti-VEGF injections (P < 0.001). CONCLUSION RVO patients with HR on NIR had significantly worse visual outcomes. Vascular HR on NIR imaging may be a biomarker, portending worse visual prognoses in RVO. [Ophthalmic Surg Lasers Imaging Retina 2023;54:266-270.].
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11
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Mishra P, Mohanty S, P S, Moharana B, Das D. Paracentral Acute Middle Maculopathy As the Presenting Sign of Ischemic Cardiomyopathy. Cureus 2023; 15:e35418. [PMID: 36994255 PMCID: PMC10042500 DOI: 10.7759/cureus.35418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
Paracentral acute middle maculopathy (PAMM) is a type of ischemic maculopathy affecting intermediate and deep retinal capillary plexuses. A typical presentation is acute onset scotoma with or without vision loss. It is characterized by greyish-white parafoveal lesions. Sometimes very subtle lesions can be missed on clinical examination. The main diagnostic modality is spectral domain optical coherence tomography (SD-OCT) wherein focal or multifocal lesions are seen as bands of hyperreflectivity in the inner nuclear and outer plexiform layers. This entity can be associated with systemic microvascular diseases. Here, we report an interesting case of PAMM as the only presenting sign in a patient with ischemic cardiomyopathy, highlighting the necessity for a thorough systemic examination in such patients.
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Affiliation(s)
| | - Satyapriya Mohanty
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Shanmugasundaram P
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Bruttendu Moharana
- Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Debasish Das
- Cardiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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12
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The role of near-infrared reflectance imaging in retinal disease: A systematic review. Surv Ophthalmol 2022; 68:313-331. [PMID: 36535488 DOI: 10.1016/j.survophthal.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Near-infrared reflectance (NIR) retinal imaging aids in a better visualization of structures at the level of outer retina, retinal pigment epithelium, and choroid. It has multiple advantages, including easy acquisition in association with structural spectral domain optical coherence tomography, more comfort for patients, and enhanced contrast and spatial resolution. It helps in the diagnosis of chorioretinal diseases that present with minimal funduscopic findings and can be used to follow up many chorioretinal conditions. We describe the chorioretinal NIR imaging appearance and the clinical role of NIR imaging in ocular inflammatory disease, vascular and acquired disease, degenerative disease, tumors, associated systemic condition, toxic and traumatic disease, optic nerve head conditions, and physiological findings.
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13
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Retinal ischemic cascade: New insights into the pathophysiology and imaging findings. Surv Ophthalmol 2022; 68:380-387. [PMID: 36464134 DOI: 10.1016/j.survophthal.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Retinal ischemia gives rise to a complex spectrum in which the cumulative profile of ischemia of the middle and inner retina can be highly variable. We reviewed the current knowledge on paracentral acute middle maculopathy (PAMM) pathophysiology and accompanying risk factors, the middle and inner retinal vasculature and blood flow, and the vulnerability of the middle retina in vaso-occlusive disorders. The inner nuclear layer (INL) is easily affected by slight degrees of retinal hypoperfusion and ischemia. INL infarction starts at perivenular sites, manifesting as skip PAMM lesions and a fern-like appearance in cross-sectional and en face views, respectively. With horizontal progression, INL infarction may develop into diffuse globular PAMM. If vertical progression occurs, the entire middle and inner portions of the retina can be affected. Transmural infarction of the middle and inner retina would be at the end of this spectrum. This gradient of ischemic progression resembles an ischemic cascade. We review the evidence supporting the term "retinal ischemic cascade," which encompasses a broad continuum of manifestations with roots in middle retinal infarction. With this terminology, variations in spatial and temporal progression and resolution of ischemia can also be delivered; it further enables addressing the possible associations between the middle and inner retinal ischemic patterns.
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14
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Ramtohul P, Iovino C, Au A, Bacci T, Pichi F, Corradetti G, Corvi F, Manoharan N, Marin AI, Tadayoni R, Sadda S, Freund KB, Sarraf D. Clinical and Morphologic Characteristics of Perivenular Fernlike Leakage on Ultrawide-field Fluorescein Angiography. Ophthalmol Retina 2022; 6:1070-1079. [PMID: 35545196 DOI: 10.1016/j.oret.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To analyze the spectrum of the perivenular fernlike leakage on ultrawide-field fluorescein angiography (UWFA) and discuss its potential implications in the current understanding of the retinal venous outflow. DESIGN Retrospective, observational case series. PARTICIPANTS Eyes presenting with fernlike patterns of dye leakage on UWFA were included in this study. METHODS Analysis of the clinical characteristics and multimodal imaging findings using UWFA and wide-angle swept-source OCT-angiography (SS-OCTA). MAIN OUTCOME MEASURES The disease spectrum, anatomic origin, and clinical implications of this fernlike leakage. RESULTS Multimodal retinal images from 40 eyes of 29 patients with fernlike leakage on UWFA were studied. The underlying etiologies included a wide range of inflammatory disorders, including pars planitis (18 eyes) and central retinal vein occlusion (2 eyes). On UWFA, the fernlike leakage originated from the retinal capillaries and venules directly adjacent to the veins and spared the periarterial zone. This perivenular fernlike leakage involved the far periphery in all cases and progressed more diffusely and centripetally in cases with more severe intraocular inflammation. On wide-angle SS-OCTA, the impairment of deep capillary plexus (DCP) flow signals precisely colocalized with the perivenular fernlike leakages identified on UWFA. CONCLUSIONS The fernlike leakage on UWFA refers to the distinctive perivenular dye leakage that originates from the retinal capillaries and venules. Multimodal imaging correlation suggests that the predominant impairment is at the level of the DCP. The axial symmetry of the fernlike leakage with the veins and sparing of the periarterial zone may support the dominant venous role of the DCP.
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Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, chemin des Bourrely, Marseille, France; Vitreous Retina Macula Consultants of New York, New York, New York
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Adrian Au
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York, New York; Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Giulia Corradetti
- Department of Ophthalmology, Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California
| | - Federico Corvi
- Department of Ophthalmology, Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Alejandro Itzam Marin
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ramin Tadayoni
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France; Hôpital Fondation Adolphe de Rothschild, 75019, Paris, France
| | - SriniVas Sadda
- Department of Ophthalmology, Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of New York, New York, New York
| | - David Sarraf
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
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15
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Koçak N, Erduran B, Subaşı M, Yeter V. PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH BRANCH RETINAL ARTERY OCCLUSION DUE TO POLYCYTHEMIA IN A PATIENT WITH TETRALOGY OF FALLOT. Retin Cases Brief Rep 2022; 16:558-560. [PMID: 32969982 PMCID: PMC9394495 DOI: 10.1097/icb.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the occurrence of paracentral acute middle maculopathy (PAMM) associated with branch retinal artery occlusion secondary to polycythemia in a patient with tetralogy of Fallot. METHODS Case report. RESULTS A 30-year-old man presented with acute vision loss and superior visual deficit in his left eye for two days. His medical record had a tetralogy of Fallot. Complete blood count showed an erythrocyte count of 9.88 million/µL (4.4-5.6), hemoglobin of 17.7 g/dL (13.5-16.9), and hematocrit of 65.4% (40-49). The best-corrected visual acuity was 20/25 in the left eye, and a diagnosis of left inferotemporal branch retinal artery occlusion was made. Spectral-domain optical coherence tomography revealed a characteristic hyperreflective band-like lesion on the inner nuclear layer consistent with PAMM. CONLUSION Polycythemia may be a trigger for branch retinal artery occlusion-associated PAMM. We suggest a new precursor cause of PAMM that is previously undescribed.
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Affiliation(s)
- Nurullah Koçak
- Department of Ophthalmology, Ondokuzmayıs University Hospital, Atakum, Turkey
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16
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Clinical Features of Central Retinal Vein Occlusion in Young Patients. Ophthalmol Ther 2022; 11:1409-1422. [PMID: 35697973 PMCID: PMC9191544 DOI: 10.1007/s40123-022-00534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022] Open
Abstract
Retinal vein occlusion (RVO) is the second most common retinal vascular disease. Central RVO (CRVO), in which obstruction occurs posterior to the lamina cribrosa due to various causes, manifests with extensive venous tortuosity, dilatation of blood vessels in the four quadrants, and retinal hemorrhage. The presence of macular edema decreases visual acuity in patients with CRVO, especially in elderly patients with hypertension, hyperlipidemia, and diabetes. In the last decade, treatment modalities for CRVO have improved, with anti-vascular endothelial growth factor agents being widely used as treatment. However, there are cases of refractory or recurrent macular edema. Moreover, CRVO also occurs in young patients. This article reviews previous studies and case reports and summarizes the differences in etiological factors, clinical manifestations, treatment, and prognosis between young and elderly patients. Due to the low incidence of CRVO in young patients, clinical data from these age groups are limited. Hence, further studies are warranted to explore the differences between age groups to improve individualization of treatment of young patients.
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17
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Paracentral Acute Middle Maculopathy and Nonischemic Central Retinal Vein Obstruction in a Young Patient with Protein C Deficiency. Case Rep Ophthalmol Med 2022; 2022:1237148. [PMID: 35706776 PMCID: PMC9192315 DOI: 10.1155/2022/1237148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/28/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To report a case of protein C deficiency with paracentral acute middle maculopathy (PAMM) and nonischemic central retinal vein obstruction (NI-CRVO). Case Report. A previously healthy twenty-one-year-old male was referred with sudden-onset, painless, unilateral paracentral scotomata in the right eye for a week. His uncorrected visual acuity was 20/20 in both eyes. In fundus examination of the right eye, mild venous tortuosity, retinal hemorrhages, and a gray-white opacity in the papillomacular bundle were observed. In the macular spectral-domain optical coherence tomography images, a hyperreflective band was noticed at the level of the inner nuclear layer, indicating PAMM. Fundus appearance and fluorescein angiography findings indicated NI-CRVO diagnosis made. The systemic and laboratory evaluations disclosed a protein C deficiency. Conclusion In this report, in a healthy young male, combined PAMM and NI-CRVO showed to be the cause of blurred vision in the setting of protein C deficiency.
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18
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Association of Paracentral Acute Middle Maculopathy with Visual Prognosis in Retinal Artery Occlusion: A Retrospective Cohort Study. J Ophthalmol 2022; 2022:9404973. [PMID: 35637681 PMCID: PMC9148221 DOI: 10.1155/2022/9404973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background The association between paracentral acute middle maculopathy (PAMM) and visual acuity in patients with retinal artery occlusion (RAO) is unknown. This study explored the clinical features and prognostic factors for visual acuity of RAO accompanied by PAMM. Methods This retrospective study included patients with RAO who underwent FFA and OCT examinations at Shenzhen Eye Hospital from July 2015 to June 2019. The changes in vision and macular structure were observed. Results Eighty-eight patients were included. There were 58 patients (65.9%) with central RAO (CRAO) and 30 (34.1%) with branch RAO (BRAO). Fifty-two eyes were diagnosed with PAMM, of which 33 eyes (63.5%) were from CRAO patients and 19 (36.5%) were from BRAO patients. At diagnosis, the PAMM group had significantly better logMAR BCVA values than the no-PAMM group (median (IQR), 1.35 (0.725–2) vs. 2.15 (1.47–2.3), P=0.002). In addition, the PAMM group had significantly better logMAR BCVA values during follow-up than the no-PAMM group (median (IQR), 1 (0.05–2) vs. 2 (1.15–2.3), P=0.001). After adjustment for age, gender, CRAO/BRAO, comorbidities, and symptom duration, PAMM was associated with good visual acuity improvement (RR = 3.29, 95% CI: 1.29–8.37, P=0.013). Conclusion PAMM was associated with good visual acuity improvement during follow-up in patients with RAO.
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19
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Paracentral Acute Middle Maculopathy and the Ischemic Cascade: Toward Interventional Management. Am J Ophthalmol 2022; 234:15-19. [PMID: 34343488 DOI: 10.1016/j.ajo.2021.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To present select cases of paracentral acute middle maculopathy (PAMM) demonstrating progressive vascular occlusion and the ischemic cascade and illustrate scenarios in which therapeutic intervention may be considered. DESIGN Perspective. METHODS Review and interpretation of selected literature, with perspective on the evaluation and management of patients with PAMM lesions. Multimodal imaging of 3 illustrative cases of PAMM are presented, including cross-sectional and en face optical coherence tomography (OCT), with progressive vascular occlusion and evidence of the ischemic cascade noted in 2 of the cases. RESULTS All 3 cases showed evidence of PAMM at baseline, including perivenular PAMM in 2 cases. Progression from a mild central retinal vein occlusion (CRVO) to a more severe CRVO was noted in the first case, while the second case progressed from an incomplete to complete central retinal artery occlusion (CRAO). In the third case, there was resolution of PAMM lesions associated with partial CRAO after the patient began taking aspirin. CONCLUSIONS Perivenular PAMM can be the only presenting sign of retinal vascular occlusion. In such cases, it is important to differentiate between partial CRVO and incomplete CRAO as the underlying cause. We provide guidance on making this important distinction, which plays a critical role in directing the nature and urgency of the systemic work-up. In patients with PAMM caused by partial retinal arterial occlusion, a benign empirical approach, such as low-dose aspirin (81 mg), may be reasonable to reduce the likelihood of subsequent vision loss from progression to complete arterial occlusion. A clinical trial, however, is necessary to support such a strategy.
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20
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Sheludchenko VM, Kozlovskaya NL, Smirnova TV, Krasnolutskaya EI, Budzinskaya MV, Durzhinskaya MH. [Biomarkers of retinal ischemia in thrombotic microangiopathy associated with malignant arterial hypertension on optical coherence tomography]. Vestn Oftalmol 2022; 138:169-176. [PMID: 36287152 DOI: 10.17116/oftalma2022138052169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
UNLABELLED Malignant arterial hypertension is a clinical syndrome characterized by severe diastolic arterial hypertension with signs of ischemic damage to various organs. In some malignant arterial hypertension cases, thrombotic microangiopathy occurs - a rare life-threatening condition characterized by multiple systemic thrombosis of the microvasculature, including in the eyes, which can be clarified by optical scanning of the retina. PURPOSE To determine markers of retinal ischemia in the eyes with thrombotic microangiopathy associated with malignant arterial hypertension. MATERIAL AND METHODS The study included 6 patients (12 eyes) with thrombotic microangiopathy associated with malignant arterial hypertension who were examined by optical coherence tomography (OCT) and OCT angiography (OCT-A). All patients suffered from renal dysfunction, which etiology was determined by renal biopsy verifying the presence of renal thrombotic microangiopathy in all cases. RESULTS According to OCT findings, there were bilateral local foci of thinning of the inner nuclear layer with elevation of the outer plexiform and outer nuclear layers of the retina in 5 out of 6 patients (83%). OCT-A revealed that in most cases (67%), these changes had perivascular localization and corresponded to the areas of attenuation of the deep capillary plexus. A statistically significant thinning of the inner nuclear layer of the retina was found in thrombotic microangiopathy associated with malignant arterial hypertension in comparison with the control group. CONCLUSION Presence of renal thrombotic microangiopathy confirmed by renal biopsy and the anatomical similarity of the microvasculature of the kidneys and the eyes, give basis to consider the foci of «chronic» paracentral acute middle maculopathy detected with OCT in patients with malignant arterial hypertension as biomarkers of thrombotic microangiopathy of the eye.
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Affiliation(s)
| | - N L Kozlovskaya
- City Clinical Hospital No. 20 named after A.K. Yeramishantsev, Moscow, Russia
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
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21
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Alkabes M, Vujosevic S, Muraca A, De Cillà S. Paracentral acute middle maculopathy (PAMM) associated with ulcerative colitis and coexisting hyperhomocysteinemia: A case report. Eur J Ophthalmol 2022; 32:NP139-NP143. [DOI: 10.1177/1120672120962042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Paracentral acute middle maculopathy (PAMM) is a tomographic finding of a retinal occlusive vascular disorders with different aetiologies. Despite the well documented triple association among hyper-homocysteine, retinal vein occlusion and PAMM, up to date no reports exist on the development of PAMM in young patients affected by ulcerative colitis (UC). Case description: A multimodal imaging study, including fundus photographs, optical coherence tomography (OCT) B-scans, OCT angiography (OCT-A) and fluorescein and indocyanine green angiography, was performed in a 32-years-old male complaining of acute-onset paracentral scotoma in the right eye. Fundus images demonstrated the typical dark gray area of retinal capillary ischemia, corresponding on OCT B-scans to the hyper-reflective plaques in the INL, and consistent with PAMM lesions.The deep capillary plexus (DCP) was normal on OCT-A. Fluorescein angiography revealed a concurrent branch retinal vein preocclusion and showed capillary drop out parafoveally. Patient’s anamnesis was negative except for a 15-years history of UC and use of acetylsalicylic acid (ASS). At the time of presentation, UC was quiescent, but new blood tests revealed concomitant high values of homocysteinemia requiring oral vitamin B12 and folate supplementation. Two months later PAMM lesions had disappeared on OCT B-scans and a retinal thinning at the level of the inner nuclear layer (INL) was visible. The DCP on OCT-A remained unchanged without any sign of capillary ischemia. Conclusions: Although no definitive evidence directly links UC with PAMM, the latter should be suspected in young patients affected by IBD with coexisting hyper-homocysteinemia and unexplained visual symptoms.
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Affiliation(s)
- Micol Alkabes
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Stela Vujosevic
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Milano, Italy
| | - Andrea Muraca
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Stefano De Cillà
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
- Department of Health Sciences, University East Piedmont “A.Avogadro”, Novara, Italy
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22
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Bradly K, Relvas LJM, Draganova D, Postelmans L. Cerebral malaria associated with mixed forms of acute macular neuroretinopathy and paracentral acute middle maculopathy. J Fr Ophtalmol 2021; 45:e157-e159. [PMID: 34802751 DOI: 10.1016/j.jfo.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- K Bradly
- CHU Brugmann, ULB, place A. Van Gehuchten 4, 1020 Bruxelles, Belgium; CHU Saint-Pierre, ULB, rue des Alexiens 13, 1000 Bruxelles, Belgium.
| | - L J M Relvas
- CHU Brugmann, ULB, place A. Van Gehuchten 4, 1020 Bruxelles, Belgium; CHU Saint-Pierre, ULB, rue des Alexiens 13, 1000 Bruxelles, Belgium
| | - D Draganova
- CHU Brugmann, ULB, place A. Van Gehuchten 4, 1020 Bruxelles, Belgium; CHU Saint-Pierre, ULB, rue des Alexiens 13, 1000 Bruxelles, Belgium
| | - L Postelmans
- CHU Brugmann, ULB, place A. Van Gehuchten 4, 1020 Bruxelles, Belgium
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23
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Antaki F, Milad D, Sahyoun JY, Coussa RG. Paracentral acute middle maculopathy in non-ischaemic central retinal vein occlusion: the role of en face optical coherence tomography. BMJ Case Rep 2021; 14:e246842. [PMID: 34764101 PMCID: PMC8587704 DOI: 10.1136/bcr-2021-246842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Fares Antaki
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Daniel Milad
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Jean-Yves Sahyoun
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Razek Georges Coussa
- Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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24
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Ang MJ, Chen JJ, McDonald HR. PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER EPIRETINAL MEMBRANE REMOVAL. Retin Cases Brief Rep 2021; 15:647-650. [PMID: 31299669 DOI: 10.1097/icb.0000000000000883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To describe a patient with newly developed paracentral acute middle maculopathy after uncomplicated epiretinal membrane removal. METHODS Retrospective chart review. RESULTS A 74-year-old white man underwent uncomplicated vitrectomy and epiretinal membrane removal in his left eye. One week later, the patient complained of a small paracentral visual field deficit and decreased visual acuity. Spectral domain optical coherence tomography revealed a characteristic hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with paracentral acute middle maculopathy. The patient was closely followed and endorsed subjective improvement of his paracentral visual deficit at 3 months postoperatively. CONCLUSION Paracentral acute middle maculopathy, although rare, may be encountered after epiretinal membrane removal.
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Affiliation(s)
- Michael J Ang
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; and
| | - Judy J Chen
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; and
- West Coast Retina Medical Group, San Francisco, California
| | - H Richard McDonald
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; and
- West Coast Retina Medical Group, San Francisco, California
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25
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Li XX, Qian TW, Lyu YN, Xu X, Yu SQ. Quantitative analysis of retinal intermediate and deep capillary plexus in patients with retinal deep vascular complex ischemia. Int J Ophthalmol 2021; 14:1025-1033. [PMID: 34282387 DOI: 10.18240/ijo.2021.07.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To quantitatively analyze the retinal intermediate and deep capillary plexus (ICP and DCP) in patients with retinal deep vascular complex ischemia (RDVCI), using 3D projection artifacts removal (3D PAR) optical coherence tomography angiography (OCTA). METHODS RDVCI patients and gender- and age-matched healthy controls were assessed and underwent OCTA examinations. The parafoveal vessel density (PFVD) of retinal deep vascular complex (DVC), ICP, and DCP were analyzed, and the percentage of reduction (PR) of PFVD was calculated. RESULTS Twenty-four eyes in 22 RDVCI patients (20 in acute phase and 4 in chronic phase) and 24 eyes of 22 healthy subjects were enrolled as the control group. Significant reduction of PFVD in DVC, ICP, and DCP was observed in comparison with the controls (DVC: acute: 43.59%±6.58% vs 49.92%±5.49%, PR=12.69%; chronic: 43.50%±3.33% vs 51.20%±3.80%, PR=15.04%. ICP: acute: 40.28%±7.91% vs 46.97%±7.14%, PR=14.23%; chronic: 41.48%±2.87% vs 46.43%±3.29%, PR=10.66%. DCP: acute: 45.44%±8.27% vs 51.51%±9.97%, PR=11.79%; chronic: 37.78%±3.48% vs 51.73%±5.17%, PR=26.97%; all P<0.05). No significant PR difference was found among DVC, ICP, and DCP of RDVCI in acute phase (P=0.812), but significant difference in chronic phase (P=0.006, DVC vs DCP, ICP vs DCP). No significant difference in PR between acute and chronic phases in the DVC (P=0.735) or ICP (P=0.681) was found, but significant difference in the DCP (P=0.041). CONCLUSION The PFVD of DVC, ICP, and DCP in RDVCI is significantly decreased in both acute and chronic phases. ICP impairment is stabilized from acute to chronic phase in RDVCI, whereas subsequent DCP impairment is uncovered and can be explained by ischemia-reperfusion damage.
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Affiliation(s)
- Xin-Xin Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Tian-Wei Qian
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Ya-Nan Lyu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai 200080, China
| | - Su-Qin Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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Clinical Characteristics of Paracentral Acute Middle Maculopathy in Eyes with Retinal Vascular Occlusion Diseases in Chinese Patients. J Ophthalmol 2021; 2021:8867570. [PMID: 34239722 PMCID: PMC8235965 DOI: 10.1155/2021/8867570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/06/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022] Open
Abstract
Aim To investigate the incidence and clinical characteristics of paracentral acute middle maculopathy (PAMM) and its relationship with prominent middle limiting membrane (p-MLM) sign in eyes with retinal artery occlusion (RAO) or retinal vein occlusion (RVO) in a Chinese clinical setting. Methods In this retrospective observational study from January 2015 to May 2020, multimodal imaging data of 807 eyes including 555 consecutive patients with RVO or 252 consecutive patients with RAO were reviewed. All patients were scanned using the spectrum-domain optical coherence tomography (OCT), and some of them underwent color fundus photography, fundus fluorescence angiography, en face OCT, and OCT angiography. Results PAMM was detected in 49 eyes of 49 RAO patients and 29 eyes of 29 RVO patients. The mean ages at presentation were 64.49 ± 13.90 years and 54.00 ± 18.48 years in RAO and RVO patients (P=0.006), respectively. Eyes with RAO were more prone to develop PAMM (19.44% [49/252] vs. 5.23% [29/555]; P < 0.001). Of the 78 eyes with PAMM, 24 eyes (7 eyes with RVO and 17 eyes with RAO) were found with p-MLM sign. An interesting phenomenon that had been overlooked before was that the hyperreflective line of the p-MLM sign was usually continuous, regardless of the type of PAMM lesion. Conclusions This series is the largest to date to describe the clinical characteristics of PAMM and p-MLM sign in Chinese patients. The incidence of PAMM and p-MLM sign in patients with RAO was relatively higher than that in patients with RVO. These signs alone probably represent milder ischemia and prompt us to carry out a comprehensive and meticulous examination to prevent the further development of the disease. In addition, the hyperreflective line of the p-MLM sign was usually continuous, which could support the totally venous nature of the retinal deep capillary plexus to some extent.
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Michl M, Liu X, Kaider A, Sadeghipour A, Gerendas BS, Schmidt‐Erfurth U. The impact of structural optical coherence tomography changes on visual function in retinal vein occlusion. Acta Ophthalmol 2021; 99:418-426. [PMID: 32996711 PMCID: PMC8359321 DOI: 10.1111/aos.14621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
Purpose We aimed to determine the correlation between optical coherence tomography (OCT)‐ and demographic features and baseline best corrected visual acuity (BCVA) in treatment‐naïve patients with retinal vein occlusion (RVO). Methods This was a cross‐sectional posthoc analysis of OCT images that included RVO patients from two prospective, open‐label, multicentre studies. The morphological grading was done manually, in the standardized setting of a reading centre. Main outcome measure was the estimated difference in Early Treatment Diabetic Retinopathy Study letters associated with each individual biomarker. Results Included were 381/301 treatment‐naïve patients with BRVO/CRVO. For BRVO, statistically significant correlations with BCVA were seen for a 100 µm increase in central subfield thickness (CST; −3.1 letters), intraretinal cysts at centre point (CP; +4.1), subretinal fluid (SRF) at CP (+3.0) and hyperreflective foci (HRF) at the central B‐scan (−2.2). In CRVO, a 100 µm increase in CST was associated with a loss of −3.4 letters. In the total cohort, 100 µm increase in CST, SRF at CP and HRF at the central B‐scan correlated with a difference of −3.2,+3.2 and −2.0 letters. A 10‐year increase in age and female gender yielded a −2.0 and −2.5 letter decrease in the total cohort. Adjusted multiple R2 for the respective group was 18.3%/26.3%/23.5%. Conclusions Of all parameters studied, only CST and age were consistently associated with worse BCVA in treatment‐naïve RVO patients. Morphology on OCT explained only a modest part of functional loss in this patient cohort.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Xuhui Liu
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
- Department of Ophthalmology The First Affiliated Hospital of Zhengzhou University Zhengzhou City China
| | - Alexandra Kaider
- Center for Medical Statistics Informatics and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Amir Sadeghipour
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Bianca S. Gerendas
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Ursula Schmidt‐Erfurth
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
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Iyer PG, Swaminathan SS, Trivizki O, Shi Y, Shen M, Kansora M, Gregori G, Rosenfeld PJ. Widefield en face optical coherence tomography monitoring of the peri-venular fern-like pattern of paracentral acute middle maculopathy. Am J Ophthalmol Case Rep 2021; 22:101047. [PMID: 33763621 PMCID: PMC7973291 DOI: 10.1016/j.ajoc.2021.101047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/14/2020] [Accepted: 02/21/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To demonstrate the ability of widefield en face swept source optical coherence tomography (OCT) imaging to monitor peri-venular fern-like patterns of paracentral acute middle maculopathy (PAMM) associated with retinal arterial occlusions. Observations The peri-venular fern-like pattern of PAMM was diagnosed on the 12 × 12 mm en face structural OCT images from three patients. Fluorescein angiography images were unremarkable. Over time, all three patients demonstrated significant improvement in visual acuity with resolution of their peri-venular PAMM. Conclusions The peri-venular fern-like pattern of PAMM is usually associated with retinal vein occlusions, but we identified three cases with this pattern in eyes with presumed incomplete retinal arterial occlusions. Our cases support the ischemic cascade theory that begins within the deep capillary plexus and ascends in the retina depending on the severity of the ischemic event. Using the 12 × 12 mm en face structural OCT images, we are able to demonstrate a wider area of ischemia in PAMM compared with the traditional 6 × 6 mm scans.
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Affiliation(s)
- Prashanth G Iyer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Swarup S Swaminathan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary Kansora
- Veterans Affairs North Texas Health Care System - Dallas, UT Southwestern Medical Center, Dallas, TX, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Eah KS, Kim YN, Park YJ, Lee JY, Kim JG, Yoon YH, Kim YJ. CENTRAL RETINAL VEIN OCCLUSION IN YOUNG PATIENTS: Clinical Characteristics and Prognostic Factors. Retina 2021; 41:630-637. [PMID: 32604341 DOI: 10.1097/iae.0000000000002872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the clinical characteristics and prognostic factors of young patients with central retinal vein occlusion (CRVO). METHODS This retrospective cohort study involved treatment-naïve patients with CRVO. Medical records regarding basic demographics, predisposing factors, ocular characteristics, and treatments were reviewed and compared according to age at CRVO onset. RESULTS We enrolled 263 patients, of whom 69 were younger patients. Younger patients had higher prevalence of nontraditional risk factors including physical or psychological stress (P = 0.032), hematologic abnormalities (P = 0.003), and better visual acuity at baseline and last visit (all P < 0.001) and were unlikely to undergo intravitreal injections (47.8 vs. 68.6%, P < 0.001) during follow-up. Younger patients had higher prevalence of paracentral acute middle maculopathy (28.1 vs. 4.7%, P < 0.001). Older age (odds ratio = 1.165, P = 0.028), male sex (odds ratio = 7.074, P = 0.034), coexisting renal disease (odds ratio = 7.845, P = 0.050), and poor baseline visual acuity (odds ratio = 16.069, P = 0.002) were significant risk factors for poor visual outcomes in young CRVO patients. CONCLUSION Younger CRVO patients had a milder clinical course with fewer treatments and were more likely to have nontraditional risk factors than older patients.
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Affiliation(s)
- Kyu Sang Eah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Goel N. Concurrent branch retinal artery occlusion in central retinal vein occlusion: 3 cases reports and literature review. Saudi J Ophthalmol 2021; 34:212-215. [PMID: 34085018 PMCID: PMC8081080 DOI: 10.4103/1319-4534.310406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 09/17/2019] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
Concurrent branch retinal artery occlusion (BRAO) and central retinal vein occlusion (CRVO) are the infrequently encountered clinical entities, with only a handful of cases elaborated in the literature. This case series describes three patients who presented with a dramatic fundus appearance that led to the diagnosis of unilateral BRAO and CRVO. Hypertension could be identified as a predisposing factor in only one patient. All three patients had relatively good visual acuity at presentation. The role of spectral-domain optical coherence tomography in confirming the simultaneous presence of BRAO is also illustrated.
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Affiliation(s)
- Neha Goel
- Department of Vitreoretina, ICARE Eye Hospital and Postgraduate Institute, NOIDA, Uttar Pradesh, India
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Martins DGDS, Rodriguez EEC, Choquechambi YC, Martins TGDS. Paracentral acute middle maculopathy in patient with atherosclerosis and angioplasty with stents in the coronary artery. EINSTEIN-SAO PAULO 2021; 19:eRC5521. [PMID: 33656059 PMCID: PMC7901525 DOI: 10.31744/einstein_journal/2021rc5521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 11/11/2020] [Indexed: 11/05/2022] Open
Abstract
Sophisticated imaging systems have helped to redefine the clinical presentation of acute macular neuroretinopathy and have markedly enhanced diagnostic sensitivity. The proposed mechanism of paracentral acute middle maculopathy is related to ischemia at the level of the superficial and deep retinal capillary plexi. This is a case report of a patient who developed an acute macular neuroretinopathy after an uneventful angioplasty with stents in the coronary artery.
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Riazi-Esfahani H, Khalili Pour E, Fadakar K, Ebrahimiadib N, Ghassemi F, Nourinia R, Khojasteh H, Attarian B, Faghihi H, Ahmadieh H. Multimodal imaging for paracentral acute maculopathy; the diagnostic role of en face OCT. Int J Retina Vitreous 2021; 7:13. [PMID: 33593444 PMCID: PMC7885468 DOI: 10.1186/s40942-021-00283-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background To describe the features of multimodal imaging and the diagnostic role of en face OCT in the paracentral acute middle maculopathy (PAMM) spectrum. Methods In this observational case series, 5 eyes of 5 patients with acute PAMM were identified. Demographic characteristics as well as data regarding the underlying disease, presenting visual acuity (VA) and ophthalmic examination results were recorded. All patients underwent multimodal imaging within 3 days after symptom onset. Results The mean age of patients was 52.2 (range, 33–67) years. Systemic comorbidities including diabetes mellitus and hypertension were identified in two patients. Except for one patient diagnosed with isolated PAMM, other patients had signs of retinal vascular disease such as a cilioretinal artery or branch retinal artery obstruction, non-ischemic central retinal vein occlusion, or a combination of these vascular disorders. The central vision was preserved in two cases; however, the remaining cases presented with profound VA reduction. Different patterns of PAMM including arterial, globular, and fern-like were observed in en face OCT at deep capillary plexus (DCP) level. En face OCT images could precisely delineate the margin of the PAMM area. Optical coherence tomography angiography (OCTA) showed decreased vascular density in DCP. Unresolved projection artifact by conventional OCTA software was observed in DCP and choriocapillaris slabs in all cases. Conclusion En face structural OCT in PAMM can delineate the area of ischemia and the degree of foveal involvement. Unresolved projection artifact by conventional OCTA software in the PAMM area can be seen in DCP and choriocapillaris layers.
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Affiliation(s)
- Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Fadakar
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Khojasteh
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnoosh Attarian
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hooshang Faghihi
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hirano Y, Suzuki N, Tomiyasu T, Kurobe R, Yasuda Y, Esaki Y, Yasukawa T, Yoshida M, Ogura Y. Multimodal Imaging of Microvascular Abnormalities in Retinal Vein Occlusion. J Clin Med 2021; 10:jcm10030405. [PMID: 33494354 PMCID: PMC7866190 DOI: 10.3390/jcm10030405] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/24/2022] Open
Abstract
The technologies of ocular imaging modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have progressed remarkably. Of these in vivo imaging modalities, recently advanced OCT technology provides high-resolution images, e.g., histologic imaging, enabling anatomical analysis of each retinal layer, including the photoreceptor layers. Recently developed OCTA also visualizes the vascular networks three-dimensionally, which provides better understanding of the retinal deep capillary layer. In addition, ex vivo analysis using autologous aqueous or vitreous humor shows that inflammatory cytokine levels including vascular endothelial growth factor (VEGF) are elevated and correlated with the severity of macular edema (ME) in eyes with retinal vein occlusion (RVO). Furthermore, a combination of multiple modalities enables deeper understanding of the pathology. Regarding therapy, intravitreal injection of anti-VEGF drugs provides rapid resolution of ME and much better visual improvements than conventional treatments in eyes with RVO. Thus, the technologies of examination and treatment for managing eyes with RVO have progressed rapidly. In this paper, we review the multimodal imaging and therapeutic strategies for eyes with RVO with the hope that it provides better understanding of the pathology and leads to the development of new therapies.
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Hormel TT, Jia Y, Jian Y, Hwang TS, Bailey ST, Pennesi ME, Wilson DJ, Morrison JC, Huang D. Plexus-specific retinal vascular anatomy and pathologies as seen by projection-resolved optical coherence tomographic angiography. Prog Retin Eye Res 2021; 80:100878. [PMID: 32712135 PMCID: PMC7855241 DOI: 10.1016/j.preteyeres.2020.100878] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is a novel technology capable of imaging retinal vasculature three-dimensionally at capillary scale without the need to inject any extrinsic dye contrast. However, projection artifacts cause superficial retinal vascular patterns to be duplicated in deeper layers, thus interfering with the clean visualization of some retinal plexuses and vascular pathologies. Projection-resolved OCTA (PR-OCTA) uses post-processing algorithms to reduce projection artifacts. With PR-OCTA, it is now possible to resolve up to 4 distinct retinal vascular plexuses in the living human eye. The technology also allows us to detect and distinguish between various retinal and optic nerve diseases. For example, optic nerve diseases such as glaucoma primarily reduces the capillary density in the superficial vascular complex, which comprises the nerve fiber layer plexus and the ganglion cell layer plexus. Outer retinal diseases such as retinitis pigmentosa primarily reduce the capillary density in the deep vascular complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Retinal vascular diseases such as diabetic retinopathy and vein occlusion affect all plexuses, but with different patterns of capillary loss and vascular malformations. PR-OCTA is also useful in distinguishing various types of choroidal neovascularization and monitoring their response to anti-angiogenic medications. In retinal angiomatous proliferation and macular telangiectasia type 2, PR-OCTA can trace the pathologic vascular extension into deeper layers as the disease progress through stages. Plexus-specific visualization and measurement of retinal vascular changes are improving our ability to diagnose, stage, monitor, and assess treatment response in a wide variety of optic nerve and retinal diseases. These applications will be further enhanced with the continuing improvement of the speed and resolution of the OCT platforms, as well as the development of software algorithms to reduce artifacts, improve image quality, and make quantitative measurements.
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Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - John C Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
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An D, Yu P, Freund KB, Yu DY, Balaratnasingam C. Three-Dimensional Characterization of the Normal Human Parafoveal Microvasculature Using Structural Criteria and High-Resolution Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 61:3. [PMID: 32749461 PMCID: PMC7443114 DOI: 10.1167/iovs.61.10.3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To use structural criteria to reconcile the three-dimensional organization and connectivity of the parafoveal microvasculature. Methods The parafoveal microvasculature was perfused and labeled in 16 normal human donor eyes for lectin, alpha smooth muscle actin, and filamentous actin. Established structural criteria gathered using confocal microscopy, including vessel diameter, endothelial cell morphology, and presence/density of smooth muscle cells, were used to differentiate arteries, arterioles, capillaries, venules, and veins. Three-dimensional visualization strategies were used to define the connections between retinal arteries and veins within the superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Results The parafoveal microvasculature has two different inflow patterns and seven different outflow patterns. The SVP and ICP were connected to retinal arteries by arterioles. Inflow into the DCP occurred only via small arterioles (a1; mean diameter, 8.3 µm) that originated from the ICP. Direct connections between the DCP and retinal arteries were not identified. Each capillary plexus formed its own venule that drained independently or in conjunction with venules from other plexuses into a retinal vein at the level of the ganglion cell layer. For the DCP, a1 was significantly smaller than its draining venule (mean diameter, 18.8 µm; P < 0.001). Conclusions The SVP and ICP of the parafoveal microvasculature have both in series and in parallel arterial and venous connections. Arterial supply to the DCP originates from the ICP, but with direct drainage to the retinal vein. These findings may help to develop an understanding of the pattern of retinal lesions characterizing a myriad of retinal vascular diseases.
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Paracentral acute middle maculopathy: from diagnosis toward clinical perspectives. OPHTHALMOLOGY JOURNAL 2020. [DOI: 10.17816/ov48528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In this review of literature, we reviewed the current state of knowledge on paracentral acute middle maculopathy (PAMM). The diversity of clinical manifestations, a variety of related cardiovascular and ocular conditions, as well as reported idiopathic cases, allow considering PAMM as a distinct clinical phenomenon or a syndrome. Taking into account already described and potential associations with systemic and ocular morbidity, PAMM may apply for a place of an important clinical biomarker not only for ocular but for systemic disorders in a broad cohort of patients. However, the understanding of the pathophysiology of PAMM and of its actual clinical significance is far from complete, and further studies are warranted.
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Paracentral acute middle maculopathy after meningococcal vaccination in a young female. Can J Ophthalmol 2020; 55:e192-e195. [DOI: 10.1016/j.jcjo.2020.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
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38
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Ryu SY, Chung EJ. Paracentral Acute Middle Maculopathy after Severe Headache. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.1095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tabuenca Del Barrio L, Mozo Cuadrado M, Compains Silva E, Plaza Ramos P. Paracentral acute middle maculopathy. J Fr Ophtalmol 2020; 43:665-667. [DOI: 10.1016/j.jfo.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/28/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
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Scharf J, Freund KB, Sadda S, Sarraf D. Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses. Prog Retin Eye Res 2020; 81:100884. [PMID: 32783959 DOI: 10.1016/j.preteyeres.2020.100884] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
The retinal capillary vasculature serves the formidable role of supplying the metabolically active inner and middle retina. In the parafoveal region, the retinal capillary plexuses (RCP) are organized in a system of three capillary layers of varying retinal depths: the superficial capillary plexus (SCP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). While the dynamic flow through these plexuses is complex and not completely understood, current research points to a hybrid model that includes both parallel and in series components in which blood flows in a predominantly serial direction between the superficial vascular complex (SVC) and deep vascular complex (DVC). Each capillary plexus autoregulates independently, so that under most conditions the retinal vasculature supplies adequate blood flow and oxygen saturation at varying depths despite diverse environmental stressors. When the flow in the deep vascular complex (i.e. ICP and DCP) fails, an ischemic lesion referred to as Paracentral Acute Middle Maculopathy (PAMM) can be identified. PAMM is an optical coherence tomography (OCT) finding defined by the presence of a hyperreflective band at the level of the inner nuclear layer (INL) that indicates INL infarction caused by globally impaired perfusion through the retinal capillary system leading to hypoperfusion of the DVC or specifically the DCP. Patients present with an acute onset paracentral scotoma and typically experience a permanent visual defect. Lesions can be caused by a diverse set of local retinal vascular diseases and systemic disorders. PAMM is a manifestation of the retinal ischemic cascade in which the mildest forms of ischemia develop at the venular end of the DCP, i.e. perivenular PAMM, while more severe forms progress horizontally to diffusely involve the INL, and the most severe forms progress vertically to infarct the inner retina. Management is targeted toward the identification and treatment of related vasculopathic and systemic risk factors.
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Affiliation(s)
- Jackson Scharf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - K Bailey Freund
- Retina Department, Vitreous Retina Macula Consultants of New York, New York, NY, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States.
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Paracentral acute middle maculopathy-review of the literature. Graefes Arch Clin Exp Ophthalmol 2020; 258:2583-2596. [PMID: 32661700 DOI: 10.1007/s00417-020-04826-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023] Open
Abstract
Paracentral acute middle maculopathy (PAMM) is a recently identified spectral-domain optical coherence tomography (SD-OCT) finding characterized by a hyper-reflective band spanning the inner nuclear layer (INL), which typically evolves to INL atrophy in later stages. Typical clinical features include the sudden onset of one or multiple paracentral scotomas, normal or mild reduction in visual acuity, and a normal fundus appearance or a fundus with a deep grayish lesion. Although its pathophysiology is not yet fully understood, ischemia at the level of the intermediate and deep capillary plexa has been demonstrated to play a major role. Since its first description, an increasing number of publications on PAMM have been published in ophthalmology scientific journals. The purpose of this study is to provide a review of the current literature on PAMM.
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Au A, Hilely A, Scharf J, Gunnemann F, Wang D, Chehaibou I, Iovino C, Grondin C, Farecki ML, Falavarjani KG, Phasukkijwatana N, Battista M, Borrelli E, Sacconi R, Powell B, Hom G, Greenlee TE, Conti TF, Ledesma-Gil G, Teke MY, Choudhry N, Fung AT, Krivosic V, Baek J, Lee MY, Sugiura Y, Querques G, Peiretti E, Rosen R, Lee WK, Yannuzzi LA, Zur D, Loewenstein A, Pauleikhoff D, Singh R, Modi Y, Hubschman JP, Ip M, Sadda S, Freund KB, Sarraf D. Relationship Between Nerve Fiber Layer Hemorrhages and Outcomes in Central Retinal Vein Occlusion. Invest Ophthalmol Vis Sci 2020; 61:54. [PMID: 32460316 PMCID: PMC7405700 DOI: 10.1167/iovs.61.5.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the depth and pattern of retinal hemorrhage in acute central retinal vein occlusion (CRVO) and to correlate these with visual and anatomic outcomes. Methods Retinal hemorrhages were evaluated with color fundus photography and fluorescein angiography at baseline and follow-up. Snellen visual acuity (VA), central foveal thickness (CFT), extent of retinal ischemia, and development of neovascularization were analyzed. Results 108 eyes from 108 patients were evaluated. Mean age was 63.6 ± 16.1 years with a predilection for the right eye (73.1%). Average follow-up was 17.2 ± 19.2 months. Mean VA at baseline was 20/126 and 20/80 at final follow-up. Baseline (P = 0.005) and final VA (P = 0.02) in eyes with perivascular nerve fiber layer (NFL) hemorrhages were significantly worse than in eyes with deep hemorrhages alone. Baseline CFT was greater in the group with perivascular hemorrhages (826 ± 394 µm) compared to the group with deep hemorrhages alone (455 ± 273 µm, P < 0.001). The 10 disc areas of retinal ischemia was more common in patients with perivascular (80.0%) and peripapillary (31.3%) versus deep hemorrhages alone (16.1%, P < 0.001). Neovascularization of the iris was more common, although this differrence was not significant, in the groups with peripapillary (14.3%) and perivascular (2.0%) NFL versus deep hemorrhages alone (0.0%). Conclusions NFL retinal hemorrhages at baseline correlate with more severe forms of CRVO, with greater macular edema, poorer visual outcomes, and greater risk of ischemia and neovascularization. This may be related to the organization of the retinal capillary plexus. The depth and pattern of distribution of retinal hemorrhages in CRVO may provide an easily identifiable early biomarker of CRVO prognosis.
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Affiliation(s)
- Adrian Au
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Assaf Hilely
- Stein Eye Institute, University of California, Los Angeles, California, United States
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jackson Scharf
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Frederic Gunnemann
- Stein Eye Institute, University of California, Los Angeles, California, United States
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Derrick Wang
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Ismael Chehaibou
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Claudio Iovino
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Christelle Grondin
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | | | - Khalil Ghasemi Falavarjani
- Eye Research Center and Eye Department, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nopasak Phasukkijwatana
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marco Battista
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Brittany Powell
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Grant Hom
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Tyler E. Greenlee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Thais F. Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | | | - Mehmet Yasin Teke
- Ophthalmology Department, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada
| | - Adrian T. Fung
- Discipline of Ophthalmology, Westmead and Central Clinical Schools, University of Sydney; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Valerie Krivosic
- Hôpital Lariboisière, AP-HP, Université Paris-Diderot, Sorbonne Paris Cité. France
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Mee Yon Lee
- Department of Ophthalmology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
| | - Yoshimi Sugiura
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - Giuseppe Querques
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Peiretti
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Richard Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Won Ki Lee
- Retina Center, Nune Eye Hospital, Gangnam-gu, Seoul, Republic of Korea
| | | | - Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Rishi Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Yasha Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| | - Jean Pierre Hubschman
- Stein Eye Institute, University of California, Los Angeles, California, United States
| | - Michael Ip
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, United States
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, California, United States
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PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A CASE OF HIGH-FLOW DIRECT CAROTID CAVERNOUS FISTULA. Retin Cases Brief Rep 2020; 16:419-421. [PMID: 32205713 DOI: 10.1097/icb.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To report a case of paracentral acute middle maculopathy in a patient with high-flow carotid cavernous fistula. METHODS A case report of a 53-year-old male patient who sustained an iatrogenic high-flow carotid cavernous fistula and secondary paracentral acute middle maculopathy. RESULTS At review 1-week postembolization of the carotid cavernous fistula, there was no significant improvement in visual acuity, tests of optic nerve function, external ophthalmoplegia, and ptosis. Spectral domain optical coherence tomography was performed, which revealed hyperreflectivity of the parafoveal plexiform layers of the right eye with ill-defined margins straddling the inner nuclear layer. CONCLUSION We suggest that spectral domain optical coherence tomography be performed in cases of high-flow direct carotid cavernous fistula where the best-corrected visual acuity is reduced out of keeping with other ophthalmic manifestations.
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Smirnova TV, Kozlovskaya NL, Sheludchenko VM, Budzinskaya MV. [Optical coherence tomography angiography in the diagnosis of retinal microangiopathy in atypical hemolytic-uremic syndrome (a case report)]. Vestn Oftalmol 2020; 136:226-234. [PMID: 32880144 DOI: 10.17116/oftalma2020136042226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The article describes a clinical case of acute macular neuroretinopathy and «chronic» paracentral acute middle maculopathy in a patient with atypical hemolytic-uremic syndrome - an orphan disease characterized by systemic thrombosis in the vessels of the microcirculatory bed due to chronic uncontrolled activation of the alternative complement pathway. Optical coherence tomography angiography data confirm the ischemic nature of the disease with localization in the deep vascular plexus of the retina in acute macular neuroretinopathy and in the superficial vascular plexus of the retina in «chronic» paracentral acute middle maculopathy. The use of modern diagnostic methods, including optical coherence tomography angiography, can help improve detection of the pathology and expand its understanding in severe microangiopathic syndromes, which include atypical hemolytic-uremic syndrome.
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Affiliation(s)
- T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
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Smirnova TV. [Spectrum of diseases associated with paracentral acute middle maculopathy]. Vestn Oftalmol 2020; 136:279-283. [PMID: 32880151 DOI: 10.17116/oftalma2020136042279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Paracentral acute middle maculopathy (PAMM) is a rare disease affecting middle layers of the central retina that is seen as a focal hyperreflective band-like lesion on optical coherence tomography. Paracentral acute middle maculopathy is associated mainly with vascular diseases. Optical coherence tomography angiography (OCTA) findings confirm the ischemic nature of paracentral acute middle maculopathy.
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Affiliation(s)
- T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
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Ciloglu E, Unal F, Sukgen EA, Koçluk Y. Evaluation of Foveal Avascular Zone and Capillary Plexuses in Diabetic Patients by Optical Coherence Tomography Angiography. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:359-365. [PMID: 31389212 PMCID: PMC6685831 DOI: 10.3341/kjo.2018.0025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/30/2018] [Accepted: 05/17/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. Methods Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm2), deep VD (%) and deep AVZ area (mm2) were evaluated via optic coherence tomography angiography. Results Superficial AVZ was 0.438 ± 0.05 mm2 in the DM group, 0.246 ± 0.022 mm2 in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm2 in the DM group, and 0.342 ± 0.022 mm2 in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm2 in the DM group, and 34.86 ± 0.75 mm2 in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm2 in the DM group, and 33.47 ± 0.56 mm2 in the control group (p < 0.001). Conclusions In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.
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Affiliation(s)
- Emine Ciloglu
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey.
| | - Fikret Unal
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey
| | - Emine Alyamaç Sukgen
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey
| | - Yusuf Koçluk
- Department of Ophthalmology, Adana Training and Research City Hospital, Adana, Turkey
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McLeod D. Misery Perfusion, Diffusive Oxygen Shunting and Interarterial Watershed Infarction Underlie Oxygenation-Based Hypoperfusion Maculopathy. Am J Ophthalmol 2019; 205:153-164. [PMID: 30905727 DOI: 10.1016/j.ajo.2019.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe and explain the entire range of acute ischemic macular damage that follows panretinal hypoperfusion from central retinal artery or vein occlusion. DESIGN Perspective article. METHODS To correlate the fundoscopic, fluorescein angiographic, oximetric, and optical coherence tomographic (OCT) features developing within the posterior inner retina following incremental reductions in arteriovenous perfusion pressure across the retinal circulation. RESULTS The spectrum of acute oxygenation-based hypoperfusion maculopathy (OHM) is consistent with that predictable from a modified Krogh cylinder model of tissue oxygenation. Diffusive oxygen shunting plays a significant role in the "artery-dominated" generation of ischemic signs during misery perfusion. Three major grades of OHM severity can be discerned according to the predominant oxygenation status of ganglion cells within the superficial inner retina, whether this is normoxic (OHM1), hypoxic (OHM2), or anoxic (OHM3). Densely opaque axoplasmic sentinels are arranged along normoxic/hypoxic interfaces in OHM2. In OHM1 and OHM2, relative hypermetabolism and interarterial watershed infarction of fundal interneurons (WIFI) underpin subtle middle-retinal opacification with periarterial sparing. The fundal signs are optimally displayed en face using autofluorescence imaging whereas cross-sectional OCT reveals Paques' plaque formation. CONCLUSIONS An exquisite and supremely accessible exhibition of classical oxygen physiopathology unfolds in eyes with panretinal hypoperfusion courtesy of the transparent ocular media and the pattern of macular neuroretinal opacification that evolves as upstream tissues extract oxygen to the detriment of tissues downstream. Recent attempts to overrule the simple conceptual framework embodied in WIFI have no plausible anatomical nor physiological basis. Overreliance on OCT can result in misdiagnosis.
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Affiliation(s)
- David McLeod
- Academic Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester University National Health Service Foundation Trust, and Centre for Ophthalmology and Vision Research, Institute of Human Development, University of Manchester, Manchester, United Kingdom.
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48
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Diagnostic and Therapeutic Challenges. Retina 2019; 39:1819-1823. [DOI: 10.1097/iae.0000000000002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, Midena E, Sivaprasad S, Tadayoni R, Wolf S, Loewenstein A. Guidelines for the Management of Retinal Vein Occlusion by the European Society of Retina Specialists (EURETINA). Ophthalmologica 2019; 242:123-162. [PMID: 31412332 DOI: 10.1159/000502041] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
The high prevalence of cardiovascular disease particularly in the elderly population is associated with retinal vascular disease. Retinal vein occlusions represent severe disturbances of the hypoxia-sensitive neurosensory retina. Acute and excessive leakage leads to the diagnostic hallmarks of retinal hemorrhage and edema with substantial retinal thickening. Advanced diagnostic tools such as OCT angiography allow to evaluate retinal ischemia and identify the risk for late complications and will soon reach clinical routine besides fluorescein angiography. Accordingly, the duration of non-perfusion is a crucial prognostic factor requiring timely therapeutic intervention. With immediate inhibition of vascular leakage, anti-VEGF substances excel as treatment of choice. Multiple clinical trials with optimal potential for functional benefit or a lesser regenerative spectrum have evaluated aflibercept, ranibizumab, and bevacizumab. As retinal vein occlusion is a chronic disease, long-term monitoring should be individualized to combine maintenance with practicability. While steroids may be considered in patients with systemic cardiovascular risk, surgery remains advisable only for very few patients. Destructive laser treatment is an option if reliable monitoring is not feasible. Ophthalmologists are also advised to perform a basic systemic workup to recognize systemic concomitants. The current edition of the EURETINA guidelines highlights the state-of-the-art recommendations based on the literature and expert opinions in retinal vein occlusion.
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Affiliation(s)
| | | | - Bianca S Gerendas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Edoardo Midena
- Department of Ophthalmology, University of Padua, Padua, Italy
| | - Sobha Sivaprasad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ramin Tadayoni
- Department of Ophthalmology, Lariboisière Hospital Paris, Paris, France
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
| | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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50
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Casalino G, Coppola M, Earley O, Contieri F, Bandello F, Chakravarthy U. Paracentral acute middle maculopathy as a cause of unexplained visual loss in central retinal vein occlusion. Saudi J Ophthalmol 2019; 33:168-171. [PMID: 31384162 PMCID: PMC6664399 DOI: 10.1016/j.sjopt.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/02/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022] Open
Abstract
A 79-year-old man presented with unilateral unexplained sudden onset visual loss in the setting of central retinal vein occlusion (CRVO). Non ischemic CRVO in the right eye (RE) was confirmed on fluorescein angiography. Spectral domain optical coherence tomography (SD-OCT) showed absence of macular edema and hyperreflective band-like lesions in the middle retinal layers of the RE suggesting a diagnosis of paracentral acute middle maculopathy (PAMM). Patient was observed and after 3 months, best-corrected visual acuity in the RE spontaneously improved from 38 to 56 ETDRS letters. SD-OCT scans showed thinning of the inner nuclear layer of the RE. OCT angiography in the RE revealed a mild attenuation of the vascular flow signal in the superficial capillary plexus and patchy areas of vascular flow void in the deep capillary plexus, as compared to the fellow eye. The present case outlines the importance of recognising PAMM as a cause of unexplained visual loss. In the setting of a CRVO with sudden vision loss and absence of macular edema, clinicians should pay attention to any hyperreflectivity and/or to thinning of the middle retinal layers on SD-OCT.
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Affiliation(s)
- Giuseppe Casalino
- Ophthalmology Macular Service, Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.,Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy.,Ophthalmology Unit, Ospedale di Desio, ASST Monza, Italy
| | | | - Oliva Earley
- Ophthalmology Macular Service, Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Fabio Contieri
- Department of Ophthalmology, Hospital Universitario Reina Sofia Cordoba, Andalucía, Spain
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Usha Chakravarthy
- Ophthalmology Macular Service, Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
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