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Cohen SY, Chowers I, Nghiem-Buffet S, Mrejen S, Souied E, Gaudric A. Subretinal autofluorescent deposits: A review and proposal for clinical classification. Surv Ophthalmol 2023; 68:1050-1070. [PMID: 37392968 DOI: 10.1016/j.survophthal.2023.06.009] [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: 03/09/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence. We describe SADs according to their putative pathophysiological origin and also according to their clinical pattern, i.e., number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium phagocytic capacity, with direct or indirect retinal pigment epithelium injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the retinal pigment epithelium and the photoreceptor outer segments. Clinically, however, they could be classified into eight subclasses of SADs, as observed on fundus autofluorescence as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or nonpatterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely available short-wavelength fundus autofluorescence could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
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Affiliation(s)
- Salomon Yves Cohen
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France.
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Hospital, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Sarah Mrejen
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Eric Souied
- Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France
| | - Alain Gaudric
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, AP-HP, Hôpital Lariboisière, Université Paris Cité, Paris, France
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2
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Cicinelli MV, Ramtohul P, Marchese A, Bandello F, Bailey Freund K, Miserocchi E, Jampol LM. Latest advances in white spot syndromes: New findings and interpretations. Prog Retin Eye Res 2023; 97:101207. [PMID: 37574123 DOI: 10.1016/j.preteyeres.2023.101207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
White spot syndromes (WSS) pose challenges in the field of ophthalmology, particularly in terms of accurate diagnosis and effective management. However, recent advancements in multimodal imaging (MMI) have significantly contributed to our understanding of WSS, allowing for improved characterization of these inflammatory chorioretinopathies. By employing various imaging modalities, including fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, optical coherence tomography (OCT), ultra-widefield imaging, and OCT angiography, researchers and clinicians have gained valuable insights into the underlying pathophysiological changes and clinical progression of WSS. Furthermore, MMI has unveiled novel and atypical variants within the spectrum of WSS, expanding our knowledge in this field. Notably, the identification of secondary forms of WSS occurring concurrently with unrelated chorioretinal disorders has suggested a potential autoimmune mechanism underlying these conditions. The introduction of MMI has also facilitated a more comprehensive evaluation of previously ill-defined entities, such as acute zonal occult outer retinopathy, leading to improved diagnostic criteria and enhanced recognition of distinct features. This review paper provides a comprehensive overview of the latest advances and interpretations in WSS. By integrating MMI into the diagnosis and management of these conditions, this review aims to enhance patient outcomes and provide valuable insights into the complexities surrounding WSS.
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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.
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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3
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Gurtler N, Bughin A, Vaclavik V, Kaisari E, Guex-Crosier Y. Acute bilateral blindness due to diffuse outer retinopathy following clear lens exchange: a case report. BMC Ophthalmol 2023; 23:428. [PMID: 37872478 PMCID: PMC10594781 DOI: 10.1186/s12886-023-03171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND As the trend of refractive lens exchange for presbyopia continues to grow, our case report shows the first occurrence of an acute bilateral outer retinopathy following uncomplicated sequential clear lens extraction in an otherwise healthy individual. CASE PRESENTATION A 54-year-old male without significant medical history benefited from a sequential bilateral lens exchange for presbyopia. He then experienced a rapid vision loss in both eyes, accompanied by photopsias and myodesopsias, with symptoms appearing respectively 4 and 3 weeks after the surgeries. Multimodal imaging revealed a fulminant outer retinopathy, leading to a total loss of light perception within a few days. Immediate intravenous corticosteroid therapy was administered, permitting to recover a small area of central visual function in both eyes, enabling shape and color distinction. The primary diagnostic hypothesis is a presumed autoimmune retinopathy, triggered by the cataract extraction, while an alternative diagnosis could be a toxic reaction secondary to the use of intracameral cefuroxime and lidocaine during the surgery. CONCLUSION In this report, the authors describe the first recorded instance of outer retinopathy following cataract surgery. This occurrence raises the possibility of auto-immunization leading to retinal atrophy and vision loss as a potential outcome after undergoing cataract surgery.
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Affiliation(s)
- Nicolas Gurtler
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Alice Bughin
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Veronika Vaclavik
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Eirini Kaisari
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland
| | - Yan Guex-Crosier
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Avenue de France 15, 1002, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1005, Lausanne, Switzerland.
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4
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Thenappan A, Nanda A, Lee CS, Lee SY. Retinitis Pigmentosa Masquerades: Case Series and Review of the Literature. J Clin Med 2023; 12:5620. [PMID: 37685687 PMCID: PMC10489117 DOI: 10.3390/jcm12175620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Retinitis pigmentosa (RP) displays a broad range of phenotypic variations, often overlapping with acquired retinal diseases. Timely recognition and differentiation of RP masquerades is paramount due to the treatable nature of many such conditions. This review seeks to present examples of pseudo-RP cases and provide a comprehensive overview of RP masquerades. We first present two pseudo-RP cases, including comprehensive clinical histories and multimodal retinal imaging, to highlight the important role of accurate diagnoses that subsequently steered effective intervention. Subsequently, we conduct an in-depth review of RP masquerades to provide valuable insights into their key distinguishing features and management considerations. The recent approval of ocular gene therapy and the development of investigational gene-based treatments have brought genetic testing to the forefront for RP patients. However, it is important to note that genetic testing currently lacks utility as a screening tool for inherited retinal diseases (IRDs), including RP. The integrity of a precise clinical assessment remains indispensable for the diagnosis of both RP and RP masquerade conditions, thereby facilitating prompt intervention and appropriate management strategies.
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Affiliation(s)
- Abinaya Thenappan
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arjun Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Chang Sup Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics and Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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5
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Lin BR, Russell JF, Al-Khersan H, Goldhardt R. A systematic review of acute zonal occult outer retinopathy with a focus on attempted treatment modalities. CURRENT OPHTHALMOLOGY REPORTS 2022; 10:168-178. [PMID: 36742288 PMCID: PMC9894323 DOI: 10.1007/s40135-022-00305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Benjamin R. Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Jonathan F. Russell
- Department of Ophthalmology and Visual Sciences, University of Iowa; Iowa City, Iowa
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Raquel Goldhardt
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
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6
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The Role of the Inner Nuclear Layer for Perception of Persisting Tiling Inside a Monocular Scotoma. Brain Sci 2022; 12:brainsci12111542. [DOI: 10.3390/brainsci12111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
We report two patients, one with and one without long-term persistent tiling inside an arcuate macular scotoma. In both cases, the scotoma was caused by a cilioretinal artery occlusion. Both patients were almost identical regarding the location and extent of the scotoma. In both cases, there was a comparable degree of atrophy on optical coherence tomography for the retinal nerve fibre, ganglion cell, and inner plexiform layers. The main difference was the preservation of the inner nuclear layer in the patient with persistent tiling. In this patient, optical coherence angiography demonstrates preserved perfusion of the superior vascular plexus, which was not the case in the patient with the negative scotoma who also had atrophy of the inner nuclear layer. Recreational use of cannabinoid enhanced the intensity of perceived tiling in the relative scotoma of the first patient. A review of the literature suggests that the persistent tiling described in our case is different to teichopsias of retinal or cerebral origin. These data suggest that persistent monocular tiling in a scotoma arises from retinal circuit activity that requires the preservation of the inner nuclear layer. Future research should investigate this functional–structural relationship in other diseases, including glaucoma.
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7
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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8
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Acute zonal occult outer retinopathy-like presentation secondary to scleral buckle. Am J Ophthalmol Case Rep 2022; 28:101716. [PMID: 36275187 PMCID: PMC9579325 DOI: 10.1016/j.ajoc.2022.101716] [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: 10/21/2021] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To describe a case of acute zonal occult outer retinopathy-like (AZOOR-like) presentation following scleral buckle surgery for rhegmatogenous retinal detachment. Observations A 48-year-old man underwent successful scleral buckle with cryotherapy for repair of a left eye inferior macula-on rhegmatogenous retinal detachment. Five years later he presented with a six-month history of left peripheral field restriction. Fundus autofluorescence and optical coherence tomography demonstrated degeneration of the photoreceptors in a ring pattern around the left macula. Humphrey visual fields showed functional loss corelating with the imaging, with a paracentral ring scotoma. Electrophysiology demonstrated a delayed 30 Hz flicker latency in the left eye confirming cone system dysfunction. Conclusion and Importance Scleral buckling surgery for repair of a rhegmatogenous retinal detachment may be associated with a late AZOOR-like presentation.
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9
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Özyol E, Özyol P. Acute zonal occult outer retinopathy: optical coherence tomography angiography findings and treatment response. GMS OPHTHALMOLOGY CASES 2022; 12:Doc16. [PMID: 35912130 PMCID: PMC9285114 DOI: 10.3205/oc000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a rare condition primarily affecting the outer retina based on electrophysiologic studies. In addition to characteristic fundus appearance, spectral domain optical coherence tomography and fundus autofluorescence are unique in diagnosing AZOOR. There are a few reports on optical coherence tomography anjiography (OCTA) in AZOOR disease. In this report, we present a case using multimodal imaging including OCTA and treatment response to combined systemic antiviral, antiinflammatory, and immunosuppressive drugs. En-face OCTA outer retinal slab may provide useful tips for diagnosis and treatment response.
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Affiliation(s)
- Erhan Özyol
- SANKO University, Faculty of Medicine, Department of Ophthalmology, Gaziantep, Turkey,*To whom correspondence should be addressed: Erhan Özyol, SANKO Üniversitesi, Tip Fakültesi, Göz Hastalıkları, AD 27000, Gaziantep, Turkey, Phone: +90 3422115000, E-mail:
| | - Pelin Özyol
- SANKO University, Faculty of Medicine, Department of Ophthalmology, Gaziantep, Turkey
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10
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Ronzina IA, Sheremet NL, Zhorzholadze NV. [Asymmetric form of pigmentary retinopathy (case study)]. Vestn Oftalmol 2021; 137:114-121. [PMID: 34726865 DOI: 10.17116/oftalma2021137051114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Unilateral pigmentary retinopathy (PR) is a rare, atypical form of hereditary retinal pathology. Different types of secondary retinopathy associated with various non-hereditary diseases, trauma or intoxication can imitate unilateral PR. Therefore, it is important to determine the cause of visual disorders and differentiate between unilateral and asymmetric PR. The article presents an example of using modern structural and functional diagnostic methods that helped diagnose the asymmetric form of the disease in a patient with suspected unilateral PR.
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Affiliation(s)
- I A Ronzina
- Research Institute of Eye Diseases, Moscow, Russia
| | - N L Sheremet
- Research Institute of Eye Diseases, Moscow, Russia
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11
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Rueda-Rueda T, Sánchez-Vicente JL, Espiñeira-Periñán MA, Muñoz-Morales A, Rodríguez-Fernández C, López-Herrero F. Two case reports of acute zonal occult outer retinopathy (AZOOR): Importance of multimodal diagnosis. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:500-504. [PMID: 34479708 DOI: 10.1016/j.oftale.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
A presentation is made of two cases of acute zonal occult outer retinopathy (AZOOR); one a young man of 19 years, and the other a 42-year-old woman. The young man complained of unilateral scotoma and photopsia. The woman presented with bilateral visual loss and photopsia. Multimodal imaging, including fundus photography, fluorescein angiography, fundus autofluorescence, spectral-domain optical coherence tomography, and visual field testing, supported the diagnosis of AZOOR. The differential diagnosis is complicated, since it has clinical features in common with other retinopathies. This means that it is essential to use modern imaging tests, especially those where the characteristic trizonal pattern is shown, such as in autofluorescence and OCT.
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Affiliation(s)
- T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M A Espiñeira-Periñán
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - A Muñoz-Morales
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Rodríguez-Fernández
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F López-Herrero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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12
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Paraneoplastic ocular syndrome: a pandora's box of underlying malignancies. Eye (Lond) 2021; 36:1355-1367. [PMID: 34345027 DOI: 10.1038/s41433-021-01676-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes affecting the visual system are a group of conditions that arise in the systemic malignancy framework. In this review, we have provided a detailed and comprehensive overview of the published literature on the various ophthalmic paraneoplastic manifestations. A systematic review of many databases has been performed to identify ample literature on the paraneoplastic syndromes related to ophthalmology. We have discussed here the clinical features, pathogenesis, and treatment strategies of various ophthalmic paraneoplastic syndromes. It can be challenging to distinguish these disorders from their non-paraneoplastic counterparts and to determine the appropriate systemic assessment for the tumour responsible, to have a proper approach towards the management of the syndrome. METHOD: We searched PubMed, Science Direct and Journal of Ophthalmology for studies published in English between 1995 and April 2020, incorporating the general search term "paraneoplastic ocular syndrome" with connecting terms relevant to subheadings-e.g. Key search terms were cancer-associated retinopathy, (CAR), melanoma-associated retinopathy, (MAR), paraneoplastic retinopathy, autoimmune retinopathy, autoimmune-related retinopathy, and optic neuropathy, (ARRON), acute zonal occult outer retinopathy, (AZOOR), paraneoplastic vitelliform maculopathy, paraneoplastic vitelliform retinopathy, bilateral diffuse uveal melanocytic proliferation, (BDUMP), paraneoplastic optic neuropathy, (PON), polyneuropathy, organomegaly, endocrinopathy, monoclona gammopathy, and skin changes syndrome (POEMS) and various other terms. References from identified studies have been reviewed and included if deemed appropriate, valid, and scientifically important. If referenced in a selected English paper, we contemplated papers in other languages too. We preferentially selected papers that have been published in the last 10 years, but we have included relevant older references.
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Herbort CP, Arapi I, Papasavvas I, Mantovani A, Jeannin B. Acute Zonal Occult Outer Retinopathy (AZOOR) Results from a Clinicopathological Mechanism Different from Choriocapillaritis Diseases: A Multimodal Imaging Analysis. Diagnostics (Basel) 2021; 11:diagnostics11071184. [PMID: 34209956 PMCID: PMC8303680 DOI: 10.3390/diagnostics11071184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and aim: AZOOR is a rare disease characterized by loss of zones of outer retinal function, first described by J Donald Gass in 1993. Symptoms include acute onset photopsias and subjective visual field losses. The syndrome is characterized by a normal fundus appearance, scotomas and electroretinographic changes pointing towards outer retinal dysfunction. Evolution, response to immunosuppressive treatment and outcome are difficult to predict. The aim of this small case series was to identify the morphological changes and sequence of events in AZOOR thanks to multimodal imaging. Methods: Charts of AZOOR patients seen in the Centre for Ophthalmic Specialized care (COS, Lausanne, Switzerland) were analyzed by multimodal imaging including fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), blue light fundus autofluorescence (BL-FAF) and spectral domain optical coherence tomography (SD-OCT) in addition to a complete ophthalmological examination including visual field testing and microperimetry, as well as OCT angiography (OCT-A) and ganglion-cell complex analysis when available. Cases and Results: Three AZOOR patients with a mean follow-up of 47 ± 25.5 months were included following the clinical definitions laid down by J Donald Gass. The primary damage was identified at the level of the photoreceptor outer segments with an intact choriocapillaris and retinal pigment epithelium (RPE) layer, these structures being only secondarily involved with progression of the disease. Conclusion: Although AZOOR has often been included within white dot syndromes, some of which are now known to be choriocapillaris diseases (choriocapillaritis entities), our findings clearly commend to differentiate AZOOR from entities such as MEWDS (Multiple evanescent white dot syndrome), APMPPE (Acute Posterior Multifocal Placoid Pigment Epitheliopathy), MFC (Multifocal Choroiditis) and others, as the damage to photoreceptors is primary in AZOOR (a retinopathy) and secondary in choriocapillaritis (a choriocapillaropathy).
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Affiliation(s)
- Carl P. Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Clinic Montchoisi Teaching Centre, 1006 Lausanne, Switzerland; (I.P.); (B.J.)
- Correspondence:
| | - Ilir Arapi
- Department of Ophthalmology, University Hospital Centre “Mother Teresa”, 1000 Tirana, Albania;
| | - Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Clinic Montchoisi Teaching Centre, 1006 Lausanne, Switzerland; (I.P.); (B.J.)
| | | | - Bruno Jeannin
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care (COS), Clinic Montchoisi Teaching Centre, 1006 Lausanne, Switzerland; (I.P.); (B.J.)
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Comparison of clinical characteristics in patients with acute zonal occult outer retinopathy according to anti-retinal antibody status. Graefes Arch Clin Exp Ophthalmol 2021; 259:2967-2976. [PMID: 33876277 DOI: 10.1007/s00417-021-05198-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/19/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the clinical characteristics of patients with acute zonal occult outer retinopathy (AZOOR), according to the presence or absence of anti-retinal antibodies (ARAs) that are frequently detected in autoimmune retinopathy. METHODS Retrospective observational case series. This study included 33 patients with acute-stage AZOOR who had been followed up for more than 6 months after the initial visit. The median follow-up period was 26 months. Immunoblot analyses were used to detect autoantibodies for recoverin, carbonic anhydrase II, and α-enolase in serum from these patients. Main outcome measures comprised clinical factors at the initial and final visits, including best-corrected visual acuity, mean deviation on Humphrey perimetry, and retinal morphology, which were statistically compared between patients with AZOOR who exhibited ARAs and those who did not. RESULTS At least one serum ARA was detected in 42% of patients with AZOOR. There were no significant differences in clinical factors between the two groups, including follow-up period, best-corrected visual acuity and mean deviation at the initial and final visits, a-wave amplitude on single-flash electroretinography at the initial visit, and frequencies of improvement of the macular ellipsoid zone and AZOOR recurrence. CONCLUSIONS Our findings suggest that the presence of ARAs did not influence visual outcomes or outer retinal morphology in patients with AZOOR.
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15
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Costello F, Chen JJ. The role of optical coherence tomography in the diagnosis of afferent visual pathway problems: A neuroophthalmic perspective. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:97-113. [PMID: 33832689 DOI: 10.1016/b978-0-12-821377-3.00007-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive ocular imaging technique that has become a standard tool in neuroophthalmic practice. Specifically, OCT captures retinal manifestations of neuroaxonal injury caused by lesions along anterior and posterior regions of the afferent visual pathway, in patients presenting with vision loss. More recently, the advent of OCT angiography (OCTA) has enabled evaluation of the choroidal and retinal microvasculature, thus informing our understanding regarding vascular mechanisms associated with optic nerve and retinal injuries. Much of our longitudinal experience with OCT in the field of neuroophthalmology has been acquired from the study of optic neuritis (ON) caused by inflammatory disorders of the central nervous system (CNS). Over the past two decades, OCT has emerged as a surrogate endpoint for CNS neuroaxonal injury in multiple sclerosis (MS) research trials. On a more pragmatic level, OCT is used in the clinical arena to diagnose ON associated with: MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD). Subsequent advancements in swept-source (SS) and enhanced depth imaging (EDI) have established OCT as the new "gold standard" in the diagnosis of optic disc drusen. Recent studies have highlighted pathognomonic OCT features that distinguish cases of true papilledema from pseudopapilledema, in patients presenting with undifferentiated optic disc elevation. Preoperative OCT measures of neuroaxonal integrity have shown prognostic value in predicting postoperative visual outcomes for patients with compressive anterior visual pathway lesions. Finally, OCT is indispensable in differentiating optic neuropathies from retinal diseases in patients with visual loss and a nondiagnostic fundus examination. An in-depth discussion regarding the technical aspects of OCT is beyond the scope of this chapter. Instead, we wish to highlight the value OCT brings to the diagnosis and management of common neuroophthalmic conditions, with emphasis on optic neuropathies and retinal disorders.
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Affiliation(s)
- Fiona Costello
- Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
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Abstract
Illusions and hallucinations are commonly encountered in both daily life and clinical practice. In this chapter, we review definitions and possible underlying mechanisms of these phenomena and then review what is known about specific conditions that are associated with them, including ophthalmic causes, migraine, epilepsy, Parkinson's disease, and schizophrenia. We then discuss specific syndromes including the Charles Bonnet syndrome, visual snow syndrome, Alice in Wonderland syndrome, and peduncular hallucinosis. The scientific study of illusions and hallucinations has contributed significantly to our understanding of how eye and brain process vision and contribute to perception. Important concepts are the distinction between topologic and hodologic mechanisms underlying hallucinations and the involvement of attentional networks. This chapter examines the various ways in which pathological illusions and hallucinations might arise in relation to the phenomenology and known pathology of the various conditions associated with them.
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Affiliation(s)
- Clare L Fraser
- Department of Ophthalmology, Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, and Australian National University Medical School, Canberra, Australia
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Guijarro A, Muñoz N, Alejandre N, Recuero S, Sanchez-Pernaute O, Carreño E. Long term follow-up and effect of immunosuppression in acute zonal occult outer retinopathy. Eur J Ophthalmol 2020; 32:1120672120981874. [PMID: 33349048 DOI: 10.1177/1120672120981874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a rare syndrome characterized by sudden onset of photopsia, scotomas, and abnormal electrophysiological tests, predominantly affecting young women. Although its pathogenesis remains unknown, auto-reactivity to retinal components is thought to mediate tissue damage. A 42-year-old woman presented with symptoms and examination consistent with the diagnosis of AZOOR. She was treated with azathioprine for 5 years. In spite of the immunosuppressive treatment, clear progression in the visual field, autofluorescence, electrophysiological tests and optical coherence tomography was observed. Treatment with intravenous immunoglobulins (IVIg) and subcutaneous Abatacept was subsequently started with little efficacy. Hereby, we present a case of progressive AZOOR despite aggressive immunosuppression with 10-year follow up. Currently, there is no consensus regarding management of AZOOR, and the convenience of administering aggressive immunosuppression remains uncertain.
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Affiliation(s)
- Andrea Guijarro
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Nelida Muñoz
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Sheila Recuero
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Ester Carreño
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
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18
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Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss. Curr Neurol Neurosci Rep 2020; 20:51. [PMID: 32930896 DOI: 10.1007/s11910-020-01071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses. RECENT FINDINGS Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions. With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can be challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhances the provider's ability to make early diagnosis and monitor progression of these conditions.
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Acute Idiopathic Blind Spot Enlargement and Acute Zonal Occult Outer Retinopathy: Potential Mimics of Neuro-Ophthalmic Disease. J Neuroophthalmol 2020; 40 Suppl 1:S43-S50. [PMID: 32796345 DOI: 10.1097/wno.0000000000001021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 1988, William Hoyt, MD, et al described "acute idiopathic blind spot enlargement" (AIBSE) in 7 symptomatic patients who had no apparent abnormalities of the optic disc or surrounding retina. With the use of multifocal electroretinography, they showed that the scotoma was caused by occult retinal dysfunction. In 1992, J. Donald Gass, MD, described "acute zonal occult outer retinopathy" (AZOOR) in 13 patients who had sudden loss of often large zones of visual field without fundus abnormalities. Most patients developed zonal atrophy of retinal pigment epithelium and had no improvement in vision. Gass believed that AZOOR, multiple evanescent white dot syndrome, multifocal choroiditis, and AIBSE were all variants of the same disorder. Despite over 3 decades of numerous reports, the classification of these entities, their pathogenesis, and treatment remain controversial. AIBSE and AZOOR may be mistaken for an acute optic neuropathy, so it behooves the neuro-ophthalmologist to be familiar with these disorders. This review describes the initial recognition of AIBSE and its relationship to AZOOR.
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Abstract
'Photopsia' describes the symptom of visual disturbances that are typically flash-like, sudden in onset and brief, and occurring without light entering the eye. Patients reporting photopsia often pose a diagnostic challenge, given the wide range of possible neurological and ophthalmological causes. We review the common causes of photopsia, discuss the assessment and workup of this symptom, and stress the importance of close interdisciplinary liaison to help with its diagnosis and management. We discuss a patient with acute zonal occult outer retinopathy to illustrate these points.
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Affiliation(s)
- Jasvir Virdee
- Ophthalmology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Trust, Birmingham, UK.,Metabolic Neurology, University of Birmingham, Birmingham, UK
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Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of regression following intravitreal dexamethasone (Ozurdex) implant. Retin Cases Brief Rep 2020; 16:466-469. [PMID: 32541439 DOI: 10.1097/icb.0000000000001009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the use of dexamethasone (Ozurdex, Allergan Inc.) intravitreal implant in the management of acute zonal occult outer retinopathy (AZOOR). METHODS Observational case report RESULTS:: A 63-year-old woman presented with a 10-year history of progressing bilateral, though asymmetric, visual impairment and scotomata with clinical and imaging findings compatible with AZOOR. The right eye had recently progressed rapidly until macular involvement occurred with loss of visual acuity. Under our observation progression toward the fovea in the left eye occurred, Ozurdex intravitreal implant treatment was offered and administered. Autofluorescence imaging documented resolution of the hyperautofluorescent borders and slight regression of the involved retina. An injection was repeated every 6 months for 3 injections, and after a follow-up period of 20 months after the first and 8 months after the last injection, no further signs of progression were observed in her left eye. CONCLUSION Dexamethasone implant effectively achieved regression of active disease in a patient with longstanding, progressive AZOOR.
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Almeida C, Silva A, Marques S, Ribeiro M. Ocular Syphilis mimicking Acute Zonal Occult Outer Retinopathy (AZOOR). ACTA ACUST UNITED AC 2020; 95:284-288. [PMID: 32376127 DOI: 10.1016/j.oftal.2020.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 11/28/2022]
Abstract
Ocular syphilis can simulate various ophthalmic pathologies with multiple possible ophthalmic findings. Timely treatment of these patients can minimize visual damage, but its diagnosis is often a challenge for the ophthalmologist. We review a case report of a 45-year-old man with a rare and atypical clinical presentation of ocular syphilis, its clinical and imaging characteristics, its diagnosis, treatment and evolution. The patient presented with bilateral painless loss of vision, photopsia and peripheral scotomas with about 1 week evolution. There were no signs of ocular inflammation. The complementary ophthalmic study revealed an acute zonal occult outer retinopathy-like ("AZOOR-like") presentation. Ocular syphilis does not always present with ocular inflammation and its presentation as "AZOOR-like" is very rare. So, we should always maintain a high index of suspicion for this condition, as early diagnosis and treatment are essential for a better prognosis.
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Affiliation(s)
- C Almeida
- Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
| | - A Silva
- Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - S Marques
- Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - M Ribeiro
- Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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23
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Two cases of unilateral cone-rod dysfunction with negative electroretinograms. Doc Ophthalmol 2019; 139:247-256. [DOI: 10.1007/s10633-019-09711-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
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24
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Kaye R, De Salvo G. A case report of acute zonal occult outer retinopathy. Eur J Ophthalmol 2019; 29:27-31. [PMID: 31282209 DOI: 10.1177/1120672119853143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the diagnostic complexities of a patient with acute zonal occult outer retinopathy. CASE REPORT A healthy female presented with acute bilateral visual field loss and photopsia. On initial examination, her visual acuity, colour vision, fundus examination and fluorescein angiography were normal. Fundus autofluorescence, however, revealed scattered hyperautofluorescence in both eyes and electrodiagnostic tests were abnormal. A differential diagnosis including acute zonal occult outer retinopathy was postulated and serology requested. The patient's past medical history included both breast and endometrial cancer and raised the possibility of cancer-associated retinopathy. A normal full-body positron emission tomography scan, negative antibodies for cancer-associated retinopathy and abnormal electroretinogram led to a diagnosis of acute zonal occult outer retinopathy. CONCLUSION It has been more than 20 years since Gass first described the syndrome of acute zonal occult outer retinopathy. Typically affecting young, healthy females, acute zonal occult outer retinopathy is characterised by photopsia, minimal fundoscopic changes and electroretinographic abnormalities. Visual field loss is permanent and often associated with slow-progressing degeneration of the retinal pigment epithelial cells. Retinal photoreceptor dysfunction is an uncommon and unrecognised cause of acute visual loss. Acute zonal occult outer retinopathy should be considered as a differential diagnosis in those patients with deceptively normal fundal examinations, abnormal electroretinograms and visual field loss.
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Affiliation(s)
- Rebecca Kaye
- Ophthalmology Department, Southampton General Hospital, Southampton, UK
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25
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Errera M, Robson AG, Wong T, Hykin PG, Pal B, Sagoo MS, Pavesio CE, Moore AT, Webster AR, MacLaren RE, Holder GE. Unilateral pigmentary retinopathy: a retrospective case series. Acta Ophthalmol 2019; 97:e601-e617. [PMID: 30597758 DOI: 10.1111/aos.13981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the clinical characteristics and address the aetiology in a group of patients presenting with unilateral retinal pigmentary changes, best described as unilateral pigmentary retinopathy (UPR). METHODS The cohort of 42 patients was identified retrospectively from the Moorfields Eye Hospital electrophysiology database. All had undergone full-field [electroretinography (ERG)] and pattern electroretinography (PERG), with 13 additionally having multifocal ERG (mfERG). The clinical findings, fundus photographs and fundus autofluorescence (AF) images were reviewed. RESULTS All index eyes showed ERG evidence of generalized photoreceptor dysfunction with most showing a similar degree of rod and cone involvement. However, although the fellow eyes all had a normal fundus examination, there were bilateral but asymmetrical ERG abnormalities in eight patients and a further four patients had PERG evidence of macular dysfunction in the fellow eye. A relevant medical history or the diagnosis of an ophthalmologic entity that might be related to the unilateral fundus changes was ascertained in 15 cases (~36%) including acute zonal occult outer retinopathy, trauma, systemic malignancy or autoimmune disease, retinal vasculitis, presumed pregnancy-related choroidal ischaemia and meningitis. Two patients had a family history of retinitis pigmentosa (RP; 4.8%). CONCLUSION The underlying aetiology in most cases of UPR cannot accurately be identified, but an heritable cause is unlikely. Aspects of the history clearly suggest an acquired disorder in some patients. Twenty-five patients (60%) with nongenetic UPR did not adhere to the pattern of rod greater than cone dysfunction that occurs in RP (rod-cone dystrophy), and the pattern of rod > cone dysfunction seen in true RP is thus not a feature of most patients with UPR.
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Affiliation(s)
- Marie‐Hélène Errera
- Moorfields Eye Hospital London UK
- Quinze‐Vingts National Ophthalmology Hospital DHU Sight Restore. CIC 1423 Sorbonne‐Universités UPMC Université ParisFrance
| | - Anthony G. Robson
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | | | - Philip G. Hykin
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Bishwanath Pal
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Mandeep S. Sagoo
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Carlos E. Pavesio
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Anthony T. Moore
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Andrew R. Webster
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Robert E. MacLaren
- Oxford University Hospitals NHS Foundation Trust UK. Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford UK
| | - Graham E. Holder
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
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Barnes AC, Lowder CY, Bessette AP, Baynes K, Srivastava SK. Treatment of Acute Zonal Occult Outer Retinopathy With Intravitreal Steroids. Ophthalmic Surg Lasers Imaging Retina 2019; 49:504-509. [PMID: 30021037 DOI: 10.3928/23258160-20180628-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report on the use of intravitreal steroids in the management of acute zonal occult outer retinopathy (AZOOR), a rare disorder affecting the outer retina. PATIENTS AND METHODS Retrospective case series of nine eyes of five patients with AZOOR who received intravitreal triamcinolone acetonide (IVTA), dexamethasone intravitreal implant, and/or fluocinolone acetonide implant. Treatment response was determined by reported symptoms and multimodal imaging findings. Patients were observed for at least 1 year following intravitreal steroid treatment (range: 14 months to 63 months). RESULTS Seven eyes received IVTA, six eyes received the dexamethasone intravitreal implant, and one eye received the fluocinolone acetonide implant. All patients experienced disease stability or improvement based on symptomatic response and multimodal imaging findings after intravitreal steroids. One eye developed central serous retinopathy, and another eye a choroidal neovascular membrane. Five of nine eyes experienced ocular hypertension. All phakic eyes developed cataracts. CONCLUSION Intravitreal steroids effectively achieved disease stability in patients with AZOOR. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:504-509.].
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Khanna S, Martins A, Oakey Z, Mititelu M. Non-paraneoplastic autoimmune retinopathy: multimodal testing characteristics of 13 cases. J Ophthalmic Inflamm Infect 2019; 9:6. [PMID: 30806850 PMCID: PMC6391508 DOI: 10.1186/s12348-019-0171-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 02/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Non-paraneoplastic autoimmune retinopathy (npAIR) is a rare autoimmune disease that primarily affects retinal photoreceptor function and results in profound and often times permanent vision loss. Delay in diagnosis and treatment initiation may contribute to the poor visual prognosis. METHODS A retrospective chart review of all patients diagnosed with autoimmune retinopathy at the University of Wisconsin-Madison Eye Clinics between January 2012 and January 2017 was performed. Twenty eyes of 15 patients had evidence of any form of autoimmune retinopathy through a combination of symptoms, ocular findings, visual fields, optical coherence tomography, fundus autofluorescence, full-field and multifocal electroretinography, and serum anti-retinal antibodies. Clinical records were also analyzed for demographic data, systemic comorbidities, visual acuity, treatment employed, and disease progression. RESULTS We identified 18 eyes from 13 patients who fit the criteria for non-paraneoplastic autoimmune retinopathy. Sixty-nine percent of patients were female with a mean age of symptom onset of 56.9 ± 20.3 years. Sixty-seven percent of eyes had an associated autoimmune condition, most commonly hypothyroidism. Serum testing revealed a preponderance of antibodies against carbonic anhydrase II, while imaging revealed characteristic changes. Fundus autofluorescence most commonly showed hyperautofluorescence around the macula. The delayed diagnosis led to a larger reduction in the horizontal extent of ellipsoid zone in 1-mm perifoveal area on optical coherence tomography with resulting visual decline. There was no difference in the change of visual acuity when stratifying for patients with autoimmune conditions (p = 0.52) or treatment status (p = 0.50). None of the patients who received treatment developed contralateral eye involvement or experienced disease progression based on visual acuity or symptoms. CONCLUSION Non-paraneoplastic autoimmune retinopathy has a wide and often challenging to diagnose spectrum of clinical symptoms and imaging findings. Immunosuppressive therapy can be considered empiric in the face of a suggestive presentation and can be initiated after an evaluation of clinical findings and multimodal testing, though treatment does not appear to affect regeneration of the ellipsoid zone on OCT or impact visual acuity. Treatment should be primarily used to prevent disease progression and contralateral eye involvement. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Saira Khanna
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2880 University Avenue, Madison, WI 53705 USA
| | - Aline Martins
- Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
| | - Zackery Oakey
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2880 University Avenue, Madison, WI 53705 USA
| | - Mihai Mititelu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2880 University Avenue, Madison, WI 53705 USA
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28
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Marvasti AH, Chen KC, Ferreyra HA, Falardeau J. Acquired unilateral scotoma. Surv Ophthalmol 2019; 64:117-122. [DOI: 10.1016/j.survophthal.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Dogra M, Kumar N, Tigari B, Singh R. Multimodal imaging of acute zonal occult outer retinopathy in a Indian male. Indian J Ophthalmol 2018; 66:1858-1859. [PMID: 30451200 PMCID: PMC6256902 DOI: 10.4103/ijo.ijo_570_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Kumar
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Basavraj Tigari
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Naik AU, Ezhilvathani N, Biswas J. Acute zonal occult outer retinopathy: Is optical coherence tomography angiography useful? Indian J Ophthalmol 2018; 66:1637-1639. [PMID: 30355889 PMCID: PMC6213690 DOI: 10.4103/ijo.ijo_966_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 44-year-old female presented with central vision loss and photopsia in both eyes since 2 months. Multimodal imaging, field defects, electroretinogram abnormalities, and spectral domain optical coherence tomography changes were all suggestive of acute zonal occult outer retinopathy. En-face optical coherence tomography angiography (OCTA) images demonstrated hyper-reflective dots at the level of ellipsoid zone in both eyes in the presence of normal retinochoroidal vasculature. The patient was started on oral azathioprine and prednisolone. On two consecutive monthly follow-ups, en-face OCTA images demonstrated serial changes in the hyper-reflective dot morphology at ellipsoid zone level that have not been previously reported in the literature.
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Affiliation(s)
- Anmol U Naik
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
| | - N Ezhilvathani
- Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Deparment of Uvea and Ocular Pathology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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Introini U, Casalino G, Dhrami-Gavazi E, Mukkamala SK, Mrejen S, Schubert H, Cohen SY, Azzolini C, Bandello F, Chang S, Yannuzzi LA. Clinical course of acute zonal occult outer retinopathy complicated by choroidal neovascularization. Int J Retina Vitreous 2018; 4:32. [PMID: 30181904 PMCID: PMC6114516 DOI: 10.1186/s40942-018-0134-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/23/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose To report the clinical course and multimodal imaging features of acute zonal occult outer retinopathy (AZOOR) complicated by choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) treatment or photodynamic therapy (PDT). Methods Observational case series. Retrospective analysis of patients presenting to different institutions with evidence of AZOOR and neovascular lesions. Diagnosis of AZOOR was made on the basis of clinical presentation and multimodal imaging. All patients underwent a comprehensive ophthalmic evaluation and multimodal retinal imaging, including color fundus photos, fundus autofluorescence, fundus fluorescein angiography and spectral-domain optical coherence tomography. Results Four patients (three males, mean age 53.5 years) were included in the study. Mean follow-up was 5.1 years. Presentation of AZOOR was unilateral in two patients and bilateral in the remainder two patients. One of the patients presenting with unilateral AZOOR developed zonal lesions in the fellow eye during follow-up. All patients presented with unilateral type 2 (subretinal) CNV. Three patients underwent intravitreal anti-VEGF injections and one patient underwent a single PDT. Multimodal retinal imaging showed zonal or multizonal progression during treatment. After treatment, visual acuity and CNV stabilization was observed in all patients. Conclusions The presence of CNV expands the clinical spectrum of AZOOR. CNV complicating AZOOR may be effectively treated with intravitreal injections of anti-VEGF, despite progression of the zonal lesions. Further studies are required to define the role of treatment in the progression of the zonal lesions.
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Affiliation(s)
- Ugo Introini
- 1Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe Casalino
- 1Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,2Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Elona Dhrami-Gavazi
- Vitreous Retina Macula Consultants of New York, New York, USA.,4Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, USA
| | - Sri Krishna Mukkamala
- Vitreous Retina Macula Consultants of New York, New York, USA.,4Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, USA
| | - Sarah Mrejen
- Ophthalmic Center for Imaging and Laser, Paris, France
| | - Hermann Schubert
- 4Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, USA
| | | | - Claudio Azzolini
- 6Department of Surgical Sciences, Ophthalmology Section, University of Insubria Ospedale di Circolo, Varèse, Italy
| | - Francesco Bandello
- 1Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Stanley Chang
- 4Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, USA
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Wang M, Sadaka A, Prager T, Lee AG, Pellegrini F, Cirone D, De Simone L, Cimino L. From A… to… Z(OOR): The Clinical Spectrum of Acute Zonal Occult Outer Retinopathy. Neuroophthalmology 2018; 42:215-221. [PMID: 30042791 PMCID: PMC6056215 DOI: 10.1080/01658107.2017.1400076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/10/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022] Open
Abstract
Acute idiopathic blind spot enlargement (AIBSE) is often caused by Acute Zonal Occult Outer Retinopathy (AZOOR), an outer retinal disease. We report two illustrative cases of AZOOR. The first one was a 21-year-old white female who presented with a scotoma and "shimmering lights" in her left eye. In the second case, a 73-year-old white female was referred for evaluation of a "bitemporal hemianopsia" that started years prior, with no clinical significant photopsias. To our knowledge, case two is the longest documented duration of bilateral, progressive, and chronic, idiopathic, enlargement of the blind spot (CIBSE) documented in the English language ophthalmic literature.
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Affiliation(s)
- Margaret Wang
- Blanton Eye Institute, Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
| | - Ama Sadaka
- Department of Ophthalmology, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas Prager
- Blanton Eye Institute, Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
| | - Andrew G Lee
- Blanton Eye Institute, Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
- Department of Ophthalmology, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, Texas, USA
- Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Francesco Pellegrini
- Neuro-Ophthalmology Service, Department of Ophthalmology, De Gironcoli Hospital, Conegliano, TV, Italy
| | - Daniele Cirone
- Uveitis Service, Department of Ophthalmology, Murri Hospital, Fermo, FM, Italy
| | - Luca De Simone
- Department of Ophthalmology, University Campus Bio-Medico of Rome, Rome, RM, Italy
- Immunology Eye Unit, Azienda USL IRCCS, Reggio Emilia, RE, Italy
| | - Luca Cimino
- Immunology Eye Unit, Azienda USL IRCCS, Reggio Emilia, RE, Italy
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ULTRA-WIDE-FIELD FUNDUS AUTOFLUORESCENCE FINDINGS IN PATIENTS WITH ACUTE ZONAL OCCULT OUTER RETINOPATHY. Retina 2018; 37:1104-1119. [PMID: 27755372 DOI: 10.1097/iae.0000000000001311] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine whether ultra-wide-field fundus autofluorescence (UWFFAF) findings in acute zonal occult outer retinopathy correlated well with perimetry, optical coherence tomography, and electroretinography findings. METHODS Retrospective observational study on 16 eyes of 10 subjects with AZOOR seen at a single referral center from October 2012 to March 2015 who had UWFFAF performed. Chi-square analysis was performed to compare categorical variables, and Mann-Whitney U test used for comparisons of nonparametric continuous variables. RESULTS All eyes examined within 3 months of symptom onset (five of the five eyes) had diffusely hyperautofluorescent areas on UWFFAF. The remaining eyes contained hypoautofluorescent lesions with hyperautofluorescent borders. In 11/16 (68.8%) eyes, UWFFAF showed the full extent of lesions that would not have been possible with standard fundus autofluorescence centered on the fovea. There were 3 patterns of spread: centrifugal spread (7/16, 43.8%), centripetal spread (5/16, 31.3%), and centrifugal + centripetal spread (4/16, 25.0%). The UWFFAF lesions corresponded well with perimetric, optical coherence tomography, and electroretinography abnormalities. CONCLUSION The UWFFAF along with optical coherence tomography can be useful in the evaluation and monitoring of acute zonal occult outer retinopathy patients.
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Acute Zonal Occult Outer Retinopathy (AZOOR) and Related Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1085:233-237. [PMID: 30578522 DOI: 10.1007/978-3-319-95046-4_49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a presumed inflammatory disorder with outer retinal dysfunction. Typically, the onset is acute and it is unilateral, with symptoms of photopsias and nasal field loss; scotoma is usually contiguous with the optic nerve. Later, the other eye is involved in nearly three fourths of patients. The central vision remains good in most cases. Patients are usually young women with myopia. Fundus: May be normal in the beginning, but may show a grayish-white line at the border of normal and involved retina, usually in peripapillary area. This line disappears within weeks and is replaced with an orange zone. With time, retinal vessels attenuate and a large zone of retinal pigment epithelium (RPE) depigmentation appears, sort of a sector retinitis pigmentosa (RP) or unilateral or asymmetric RP. Rarely, mild vitritis may occur, and relative afferent pupillary defect (RAPD) is present in about 75% of cases.
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Kuo YC, Chen N, Tsai RK. Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex. BMC Ophthalmol 2017; 17:236. [PMID: 29207977 PMCID: PMC5718015 DOI: 10.1186/s12886-017-0638-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AZOOR was first described by Gass in 1993 as a syndrome with rapid loss of one or more extensive zones of the outer retinal segments. It is characterized by photopsia, minimal funduscopic changes, and electroretinographic abnormalities. The efficacy of systemic steroids in treating AZOOR has been previously described and advocated by the concept of autoimmune retinopathy. However, the use of intravitreal of sustained-released steroid had not been mentioned to date. CASE PRESENTATION A 34-year-old man had sudden onset of central scotoma and photopsia in the left eye. His visual acuity continued deteriorating. The visual field defect demonstrated bilateral enlarged blind spots and altitudinal defects. Fluorescein angiography (FA) showed nonspecific retinal inflammation, and an electroretinogram (ERG) illustrated decreased amplitude of the b wave in both eyes. Optical coherence tomography (OCT) examinations revealed parafoveal loss of the photoreceptor inner/outer segment (IS/OS) junction. Therefore, acute zonal occult outer retinopathy (AZOOR) was diagnosed. Although his vision did not improve under the initial treatment of systemic corticosteroid and calcium channel blocker, remarkable improvement was noticed after the intravitreal injection(IVI) of Ozurdex, consistent with the recovered IS/OS junction disruption. CONCLUSIONS We herein report a typical case of AZOOR, suggesting that the intravitreal injection of steroid may benefit in certain patients.
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Affiliation(s)
- Yi Chun Kuo
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Nancy Chen
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Rong Kung Tsai
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Sec. 3, Chung-Yang Rd., Hualien, 970, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Saleh MGA, Campbell JP, Yang P, Lin P. Ultra-Wide-Field Fundus Autofluorescence and Spectral-Domain Optical Coherence Tomography Findings in Syphilitic Outer Retinitis. Ophthalmic Surg Lasers Imaging Retina 2017; 48:208-215. [PMID: 28297032 DOI: 10.3928/23258160-20170301-03] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the ultra-wide-field fundus autofluorescence (UWFFAF) and optical coherence tomography (OCT) features of syphilitic outer retinopathy (SOR). PATIENTS AND METHODS Retrospective chart review. RESULTS Three patients with SOR were investigated. Treatment with parenteral penicillin led to improvement of outer retinopathy, visual acuity, and symptoms. UWFFAF showed speckled hyperautofluorescence, hypoautofluorescence, and normal autofluorescence, similar to what has been described as a trizonal pattern in acute zonal occult outer retinopathy (AZOOR) in the chronic case of SOR, but with hyperautofluorescent areas in the two acute cases. OCT showed disruption of the photoreceptor outer segment ellipsoid zone and external limiting membrane, which improved after penicillin treatment, and corresponded to normalization of the hyperautofluorescent areas on UWFFAF. There was irregularity and nodular thickening of retinal pigment epithelium on OCT in areas of mottled hyperautofluorescence. CONCLUSION SOR can present similarly to AZOOR on UWFFAF and should be highly suspected in cases presenting like AZOOR. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:208-215. ].
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Relationship between Choroidal Thickness and Visual Field Impairment in Acute Zonal Occult Outer Retinopathy. J Ophthalmol 2017; 2017:2371032. [PMID: 28758030 PMCID: PMC5516752 DOI: 10.1155/2017/2371032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate sequential changes in choroidal thickness at the affected area in patients with acute zonal occult outer retinopathy (AZOOR). Methods This retrospective observational case series included 14 affected eyes and 6 unaffected fellow eyes from 10 AZOOR patients with impaired macular area. Using enhanced depth imaging optical coherence tomography, choroidal thicknesses at the subfovea and at nasal and temporal sites 1000 μm away from the fovea were manually measured at baseline and 3 and 6 months thereafter. Changes in the choroidal thicknesses and the average threshold at the affected area on Humphrey perimetry were compared during the 6-month follow-up. Results In AZOOR eyes, the average threshold at the affected area significantly increased over time, while outer retinal structure ameliorated. The mean choroidal thicknesses at all the sites measured significantly decreased at 3 and 6 months compared with baseline values in AZOOR eyes, but not in fellow eyes. There was an inverse correlation between the changing rates of the average threshold and the subfoveal choroidal thickness at 6 months from baseline. Conclusion The current data suggest that choroidal thickness at AZOOR-affected area significantly decreased with regression of AZOOR and this anatomical change correlated with the functional recovery.
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ACUTE ZONAL OCCULT OUTER RETINOPATHY: Structural and Functional Analysis Across the Transition Zone Between Healthy and Diseased Retina. Retina 2017; 38:118-127. [PMID: 28590963 DOI: 10.1097/iae.0000000000001513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess structure and function across the transition zone (TZ) between relatively healthy and diseased retina in acute zonal occult outer retinopathy. METHODS Six patients (6 eyes; age 22-71 years) with acute zonal occult outer retinopathy were studied. Spectral-domain optical coherence tomography, fundus autofluorescence, near-infrared reflectance, color fundus photography, and fundus perimetry were performed and images were registered to each other. The retinal layers of the spectral-domain optical coherence tomography scans were segmented and the thicknesses of two outer retinal layers, that is, the total receptor and outer segment plus layers, and the retinal nerve fiber layer were measured. RESULTS All eyes showed a TZ on multimodal imaging. On spectral-domain optical coherence tomography, the TZ was in the nasal retina at varying distances from the fovea. For all eyes, it was associated with loss of the ellipsoid zone band, significant thinning of the two outer retinal layers, and in three eyes with thickening of the retinal nerve fiber layer. On fundus autofluorescence, all eyes had a clearly demarcated peripapillary area of abnormal fundus autofluorescence delimited by a border of high autofluorescence; the latter was associated with loss of the ellipsoid zone band and with a change from relatively normal to markedly decreased or nonrecordable visual sensitivity on fundus perimetry. CONCLUSION The results of multimodal imaging clarified the TZ in acute zonal occult outer retinopathy. The TZ was outlined by a distinct high autofluorescence border that correlated with loss of the ellipsoid zone band on spectral-domain optical coherence tomography. However, in fundus areas that seemed healthy on fundus autofluorescence, thinning of the outer retinal layers and thickening of the retinal nerve fiber layer were observed near the TZ. The TZ was also characterized by a decrease in visual sensitivity.
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Si S, Song W, Song Y, Hu Y. The clinical characteristics and prognosis of acute zonal occult outer retinopathy. Int Ophthalmol 2017; 38:1177-1185. [PMID: 28573534 DOI: 10.1007/s10792-017-0580-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE This prospective observational case series study aimed to observe the clinical characteristics of acute zonal occult outer retinopathy (AZOOR) and its prognosis in Chinese Han patients. METHODS Six eyes of 5 female patients diagnosed with AZOOR were followed up for 4 months to observe the natural disease course. All enrolled subjects underwent a series of ocular examinations at the onset and each return visit, including best corrected visual acuity (BCVA), split lamp microscopy, fundus photography, optical coherence tomography (OCT), perimetry, multifocal electroretinogram and fundus fluorescein angiography. RESULTS Over the follow-up, all enrolled patients recovered on BCVA, perimetry and OCT in different degrees. Among them, one patient recovered completely since the ocular examination results returned to normal. CONCLUSION AZOOR is a rare ocular disorder in Chinese population. Our results demonstrated that visual functions of enrolled patients significantly improved spontaneously, indicating that Chinese female Han patients with AZOOR have good visual outcomes during the follow-up period without any specific managements.
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Affiliation(s)
- Shancheng Si
- Department of Ophthalmology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Wei Song
- Department of Ophthalmology, Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Zhongshan East Road 1501, Nanhu District, Jiaxing City, 314000, Zhejiang Province, China
| | - Yifan Song
- Department of Ophthalmology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Yuntao Hu
- Department of Ophthalmology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China. .,Department of Ophthalmology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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Prevalence of Antiretinal Antibodies in Acute Zonal Occult Outer Retinopathy: A Comprehensive Review of 25 Cases. Am J Ophthalmol 2017; 176:210-218. [PMID: 27993590 DOI: 10.1016/j.ajo.2016.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To perform a comprehensive review and to investigate the presence and role of autoimmune antibodies in 25 cases of acute zonal occult outer retinopathy (AZOOR) identified using the classification originally proposed by J. Donald Gass. DESIGN Observational case series. METHODS Setting: Institutional. STUDY POPULATION Twenty-five patients were identified by characteristic symptoms (abrupt onset of photopsias, followed by large scotomata at or connected to the blind spot), ocular findings (paucity of pigmentary changes with no sign of vitreous inflammation and abnormal electroretinogram in at least 1 eye), and a negative family history for retinitis pigmentosa. OBSERVATION PROCEDURES Patients underwent a full comprehensive ophthalmologic examination, fundus retinography, Goldmann kinetic visual field (GVF), and full-field electroretinogram (ffERG). Blood samples were also obtained to verify for the presence of antiretinal antibodies by Western blot analysis. MainOutcome Measures: Clinical presentation, best-corrected visual acuity (BCVA), fundus abnormalities, visual field defects, ffERG changes, and presence of antiretinal antibodies. RESULTS Sixteen patients (64%) presented with photopsias, 56% (14/25) with night blindness, and 56% (14/25) with loss of peripheral vision. Sixty-four percent (16/25) of cases were bilateral. All patients demonstrated retinal vascular attenuation, optic nerve head pallor, and mottling of retinal pigment epithelium. The most common visual field changes included enlargement and expansion of the blind spot extending into large pericentral or other types of scotomata (64%). Both scotopic and photopic ffERG values were abnormal and affected to a similar degree in our patients. Nine patients (36%) had a greater than 20% asymmetry in ERG values between the 2 eyes. All patients had antiretinal antibodies on Western blot with an average of 6.6 bands. CONCLUSION Evidence suggests that AZOOR is a unique form of autoimmune retinopathy and retinal manifestation suggests possible antiretinal antibody leakage from the disc margin with spread of immune products under the retina, resulting in large scotomata that connect to the optic nerve head.
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Ching D, Brown M, Forrest C, Hayne D. Pure small cell carcinoma of the prostate preceded by acute zonal occult outer retinopathy: A case report. Int J Surg Case Rep 2016; 28:97-100. [PMID: 27693838 PMCID: PMC5045564 DOI: 10.1016/j.ijscr.2016.09.001] [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: 05/19/2016] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Pure small cell prostate cancer (SCPC) cases are very rare. Acute zonal occult outer retinopathy (AZOOR) has been described as a non-neoplastic retinopathy. We report the first case of pure SCPC preceded by AZOOR in the literature. CASE REPORT A 59year old gentleman presented with an obstructed infected urinary system. He had a diagnosis of AZOOR 6 months ago that was investigated with full body imaging without any suspicious findings. However, the most recent CT findings demonstrated extensive disease dissemination. The patient underwent rigid cystoscopy and resection that confirmed a diagnosis of pure SCPC. DISCUSSION AZOOR is a clinical syndrome of photopsia and rapid zonal field loss. The exact aetiology remains unknown and its association with malignancy remains contentious. Paraneoplastic manifestations of unexplained visual loss in SCPC are rare with only 2 cases reported in the literature. There are no cases demonstrating an association between AZOOR and SCPC. CONCLUSION Pure SCPC is an aggressive malignancy with most cases presenting with extensive disease dissemination on diagnosis. Early detection has a role in improving prognosis but is challenging. Further research is required to establish a standard treatment protocol.
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Affiliation(s)
- Daniel Ching
- Department of Urology, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Matthew Brown
- Department of Urology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Cindy Forrest
- Department of Pathology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Perth, WA, Australia
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Giocanti-Aurégan A, Cohen S, Fajnkuchen F. Syndrome d’AZOOR. J Fr Ophtalmol 2016; 39:e199-e200. [DOI: 10.1016/j.jfo.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 10/20/2022]
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Trese MG, Cohen SR, Besirli CG. Recovery of outer retina in acute idiopathic blind spot enlargement (AIBSE). Am J Ophthalmol Case Rep 2016; 1:13-15. [PMID: 29503882 PMCID: PMC5757343 DOI: 10.1016/j.ajoc.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/16/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the anatomic and functional recovery of the ellipsoid zone in a case of acute idiopathic blind spot enlargement (AIBSE), which was documented by serial high-resolution optical coherence tomography imaging. Observations The patient's clinical presentation and follow up visits were documented via Humphrey's Visual Fields, fundus autofluorescence, and high resolution spectral domain optical coherence tomography (SD-OCT). At presentation, Humphrey's Visual Field testing showed an enlarged blind spot in the right eye. Fundus autofluorescence and optical coherence tomography showed an increased peripapillary autofluorescence and loss of the outer retinal layers, respectively. At 3 months a modest improvement in the visual field was observed. This improvement was stable at both the 7 and the 15 month follow up visits. SD-OCT corresponding to the areas of visual field improvement demonstrated recovery of the outer retina. Conclusion and importance Serial OCT imaging demonstrated anatomic evidence of ellipsoid zone recovery in isolated AIBSE. Anatomic recovery was consistent with the functional gain detected by visual field improvement.
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Affiliation(s)
| | | | - Cagri G. Besirli
- Corresponding author. University of Michigan, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105, United States.University of MichiganKellogg Eye Center1000 Wall St.Ann ArborMI48105United States
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Abstract
PURPOSE To describe male acute zonal occult outer retinopathy (AZOOR) patients with improvement of photoreceptor structure and visual function. CASE SERIES Medical records for eight eyes in seven patients (mean age, 36.9 years; range, 22 to 57 years) with AZOOR were reviewed retrospectively. Of the seven patients, four were treated with high-dose methylprednisolone therapy and three were not treated. All patients presented with photopsias and severe vision loss in the affected eyes. Visual acuity ranged from 0.2 to 1.5 on a Snellen decimal scale and Humphrey visual field testing showed blind spot enlargement or ring scotomas. Fundus and angiographic examinations found no specific abnormalities, leading to a diagnosis of AZOOR. Spectral domain optical coherence tomography showed attenuation of the photoreceptor inner segment ellipsoid zone. Multifocal electroretinography demonstrated that there were decreased responses at the site of the spectral domain optical coherence tomography abnormalities and corresponding visual field loss. Three patients had a spontaneous resolution with restoration of photoreceptor structure and visual function, and four patients had a visual improvement with restoration of photoreceptor structure and visual function after steroid pulse therapy. CONCLUSIONS These results suggest that male AZOOR patients may have a tendency of visual improvement both with and without treatment.
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Affiliation(s)
- Ali Tavallali
- Vitreous-Retina-Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University, New York, NY, USA
| | - Lawrence A Yannuzzi
- Vitreous-Retina-Macula Consultants of New York, New York, NY, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University, New York, NY, USA
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Levison AL, Baynes K, Lowder CY, Srivastava SK. OCT Angiography Identification of Choroidal Neovascularization Secondary to Acute Zonal Occult Outer Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2016; 47:73-5. [DOI: 10.3928/23258160-20151214-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022]
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The Fundus Autofluorescence Spectrum of Punctate Inner Choroidopathy. J Ophthalmol 2015; 2015:202097. [PMID: 26266044 PMCID: PMC4526209 DOI: 10.1155/2015/202097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the fundus autofluorescence (FAF) spectrum of punctate inner choroidopathy (PIC). Methods. This is a retrospective observational case series of 27 consecutive patients with PIC admitted from October 2013 to March 2015, who underwent short-wavelength- (SW-) and near-infrared- (NIR-) FAF imaging, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA). Results. There were three primary findings on the FAF imaging of patients with PIC. First, active PIC lesions revealed hypoautofluorescent spots with hyperautofluorescent margin. After the lesions regressed, the hyperautoflurescent margin faded. Second, subclinical and most of the atrophic PIC lesions appeared to be hypoautofluorescent spots. But subclinical PIC lesions were more distinctive on NIR-FAF imaging than on SW-FAF imaging. Third, hypoautofluorescent spots of PIC lesions coexisted with hyperautofluorescent patches on SW-FAF imaging. These hyperautofluorescent patches were demonstrated to be multiple evanescent white dot syndrome (MEWDS) or acute zonal occult outer retinopathy (AZOOR) lesions by subsequent multimodal imaging and faded during follow-up examinations. Conclusion. FAF imaging helps in noninvasively tracking the evolution of PIC lesions and identifying the combined MEWDS or AZOOR lesions, complementary to SD-OCT and angiographic studies.
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