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Sadhar B, Yarkoni AG, Patel KK, Mantopoulos D, Milman T, Shields CL, Fine HF. Vitreoretinal Lymphoma Masquerading as Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2024; 55:467-470. [PMID: 38752916 DOI: 10.3928/23258160-20240410-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
The following is a case of vitreoretinal lymphoma masquerading as central serous chorioretinopathy (CSCR). A 74-year-old man presented with blurred vision in the left eye with unilateral subretinal fluid in the setting of exogenous corticosteroid use, which was diagnosed as CSCR and resolved with corticosteroid cessation. He later experienced a similar self-limited episode in the right eye. Subsequently, he developed bilateral vitritis with yellow-white subretinal pigment epithelial infiltrates. Vitreous biopsy confirmed a diagnosis of large B-cell lymphoma. Vitreoretinal lymphoma can masquerade as a number of ocular pathologies, including CSCR. [Ophthalmic Surg Lasers Imaging Retina 2024;55:467-470.].
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Ratra D, Pradhana D, Dutta Majumder P. Surgical management for treatment-resistant cases of inflammatory exudative retinal detachment: Mission impossible? Indian J Ophthalmol 2023; 71:2543-2547. [PMID: 37322677 PMCID: PMC10418000 DOI: 10.4103/ijo.ijo_2575_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD). Methods A retrospective analysis of eyes with ERD that underwent vitrectomy. Results Twelve eyes (10 patients) with ERD, non-responsive to medical therapy, underwent vitrectomy. The mean age was 35.7 ± 17.7 years. Five eyes (42%) had Vogt-Koyanagi-Harada disease, three (25%) had presumed tuberculosis (TB), two (17%) pars planitis, and one (8%) had sympathetic ophthalmia. The mean time of vitrectomy was 6.76 ± 4.1 months after onset. Six (50%) eyes had a recurrence, two settled with medical treatment, and four underwent re-surgery. The mean follow-up was 2.7 years. At the last visit, 10 (83.3%) eyes had attached retina; the best-corrected visual acuity (BCVA) had reduced to 1.6 ± 0.7 logarithms of the minimum angle of resolution (logMAR) from 1.3 ± 0.7 at baseline. Conclusion Vitrectomy in ERD can act as an adjuvant to conventional medical therapy and help maintain structural integrity. Early vitrectomy may help preserve visual function.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Divya Pradhana
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Department of Uvea and Intraocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Enders C, Lang GE, Mayer B, Werner JU. Morphometric analyses in patients treated with subthreshold laser photocoagulation for central serous chorioretinopathy. BMC Ophthalmol 2022; 22:504. [PMID: 36550415 PMCID: PMC9773550 DOI: 10.1186/s12886-022-02732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To analyze changes in selected parameters in optical coherence tomography (OCT) after subthreshold laser coagulation (ST-LP) in patients with central serous chorioretinopathy (CSCR). MATERIALS AND METHODS Fifty-four eyes of 49 patients with CSCR were included in the study. Each patient underwent therapy with ST-LP with a frequency-doubled Neodym-YAG Laser and OCT imaging. In OCT the thickness of the central subfield, cube volume, average cube thickness, volume under the ETDRS grid, and average thickness under the ETDRS grid were collected. RESULTS Decreases in total OCT volume and central retinal subfield thickness were statistically significant (p < 0.05). Possible correlations were observed between visual acuity at V3 (3 months after ST-LP) and Baseline and between central retinal subfield thickness at V1 (4 weeks after ST-LP) and visual acuity at BL. CONCLUSION A decrease in retinal thickness and retinal volume could be shown after ST-LP. Central retinal subfield thickness measured by OCT could be a more sensitive measure than mean retinal thickness or macular volume for early detection of disease recurrence occurring in some patients 3 months after ST-LP.
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Affiliation(s)
- C. Enders
- grid.6582.90000 0004 1936 9748Ulm University, Ulm, Germany
| | - G. E. Lang
- grid.6582.90000 0004 1936 9748Ulm University, Ulm, Germany
| | - B. Mayer
- grid.6582.90000 0004 1936 9748Ulm University, Ulm, Germany
| | - J. U. Werner
- grid.6582.90000 0004 1936 9748Ulm University, Ulm, Germany
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Sirakaya E, Kilic D, Aslan Sirakaya H. Comparison of intravitreal ranibizumab, aflibercept and bevacizumab therapies in diabetic macular edema with serous retinal detachment. Eur J Ophthalmol 2022; 33:1459-1466. [PMID: 36482707 DOI: 10.1177/11206721221144797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To compare the effects of ranibizumab, aflibercept and bevacizumab treatments in treatment-naive diabetic macular edema(DME) patients with serous retinal detachment(SRD). Material and methods This is a retrospective, comparative study. In a sample of 86 eyes of 86 untreated DME patients with accompanying SRD, 23 patients were treated with ranibizumab (IVR), 28 patients with aflibercept (IVA), and 35 patients with bevacizumab (IVB). All were injected intravitreally once a month for a 3-month loading dose. Subsequently, all participants were evaluated every months and if neccessary they received additional intravitreal treatments.Mean changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), and SRD height over the 6-months study period were compared. Results At baseline, the groups did not differ in mean BCVA,CRT and SRD height. During the first 3 months, in IVA group the mean decrease in CRT and SRD height were significantly more than in the other two groups ( p < 0.05 for all). However, these differences disappeared at 6 months.The number of injections was similar between the groups during the study period. Conclusion In patients with DME accompanied by SRD, IVA is a more advantageous option in terms of reduction in CRT and SRD height from baseline to 3 months. In the 6-month period of treatment, IVR, IVA and IVB therapies areanatomically and functionally similar and significant effective modalities.
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Affiliation(s)
- Ender Sirakaya
- Department of Ophthalmology, Health Science University, The Kayseri City Hospital, Kayseri, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Health Science University, The Kayseri City Hospital, Kayseri, Turkey
| | - Hatice Aslan Sirakaya
- Department of Internal Medicine, Health Science University, The Kayseri City Hospital, Kayseri, Turkey
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Phang DSK, Ariffin N, Abd Aziz H, Vendargon FM, Sonny Teo KS. Bilateral Serous Retinal Detachment in Pregnancy. Cureus 2022; 14:e30019. [DOI: 10.7759/cureus.30019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
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Xiang XL, Cao YH, Jiang TW, Huang ZR. Intravitreous injection of conbercept for bullous retinal detachment: A case report. World J Clin Cases 2022; 10:9510-9517. [PMID: 36159403 PMCID: PMC9477655 DOI: 10.12998/wjcc.v10.i26.9510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/25/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diffuse retinal pigment epitheliopathy (DRPE) associated with bullous retinal detachment is a severe variant of DRPE that is frequently misdiagnosed and often improperly treated.
CASE SUMMARY A 36-year-old female patient complained of "painless vision decline in the left eye with obscuration for 10 d". Slit-lamp microscopic fundus examination revealed white-yellow subretinal exudates in the posterior pole in both eyes, retinal detachment with shifting subretinal fluid in the left eye, and no retinal hiatus. Fundus fluorescein angiography revealed multiple subretinal leakage foci and localized hypofluorescent lesions with patched hyperfluorescence. There was fluorescence leakage in the retinal vessels in the retinal detachment area and occluded blood vessels in the lower and peripheral areas. Indocyanine green angiography revealed multifocal lamellar hyperfluorescence in the middle stage and low fluorescence in the retinal detachment area in the late stage. Retinal anatomical reduction significantly improved with intravitreal conbercept injections.
CONCLUSION Intravitreal injection of conbercept can anatomically reattach the retina in patients with bullous retinal detachment.
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Affiliation(s)
- Xiao-Li Xiang
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
| | - Yi-Hong Cao
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
| | - Ting-Wang Jiang
- Department of Key Laboratory, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
| | - Zheng-Ru Huang
- Department of Ophthalmology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu 215500, Jiangsu Province, China
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El Khatib BA, Noble CW, Chang L, Im L, Patronas M. ANGIOGRAPHIC SMOKESTACK LEAKAGE NOT ASSOCIATED WITH CENTRAL SEROUS CHORIORETINOPATHY. Retin Cases Brief Rep 2022; 16:643-648. [PMID: 32925817 PMCID: PMC9394505 DOI: 10.1097/icb.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To report a series of cases with smokestack leakage on fundus fluorescein angiography outside the clinical setting of central serous chorioretinopathy. METHODS A multicenter, observational retrospective case series evaluating fundus fluorescein angiography on Topcon and Optos systems. RESULTS Seven patients with neovascularization due to ischemic retinopathy demonstrated a unique smokestack pattern of angiographic leakage. The patients' ages ranged between 44 and 71 years and were seen at 3 academic teaching hospitals in the Washington-Baltimore metropolitan area. Five patients had been diagnosed with proliferative diabetic retinopathy, one with sickle cell ischemic retinopathy, and one with branch retinal artery occlusion; none of the patients had a known history or clinical signs of current or past central serous chorioretinopathy. CONCLUSION This is the first published case series to the author's knowledge of ischemic retinopathy displaying a smokestack leakage pattern on fundus fluorescein angiography that is classically described with idiopathic central serous chorioretinopathy.
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Affiliation(s)
- Bahaeddin A. El Khatib
- Department of Ophthalmology, the George Washington University, Washington, District of Columbia; and
| | - Carl W. Noble
- Department of Ophthalmology, the George Washington University, Washington, District of Columbia; and
| | - Luke Chang
- Department of Ophthalmology, the University of Maryland, Baltimore, Maryland
| | - Lily Im
- Department of Ophthalmology, the University of Maryland, Baltimore, Maryland
| | - Marena Patronas
- Department of Ophthalmology, the George Washington University, Washington, District of Columbia; and
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Calisir K, Barut A, Kadiye MS. Spontaneous Resolution of Bilateral Bullous Serous Retinal Detachment in Preeclampsia: A Case Report from Somalia. Int Med Case Rep J 2022; 15:511-515. [PMID: 36164318 PMCID: PMC9509007 DOI: 10.2147/imcrj.s379710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
A 29-year-old preeclamptic postpartum patient with no symptoms of hypertension in her medical history before pregnancy was referred to the ophthalmology outpatient clinic with the complaint of sudden bilateral vision loss. Slit-lamp fundus examination and B-scan ultrasonography showed serous retinal detachment (SRD) in both eyes. She was diagnosed with bullous SRD due to preeclampsia (PE). The patient’s fundoscopy findings regressed spontaneously, and visual acuities improved within one month. SRD should be considered in case of vision loss before or after birth in patients with PE, and such patients should undergo retinal examination.
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Affiliation(s)
- Kenan Calisir
- Mogadishu Somalia Turkey Training and Research Hospital, Department of Ophthalmology, Mogadishu, Somalia
- Correspondence: Kenan Calisir, Mogadishu Somalia Turkey Training and Research Hospital, Department of Ophthalmology, Banadir, Mogadishu, Somalia, Tel +90 544 582 8442, Email
| | - Adil Barut
- Mogadishu Somalia Turkey Training and Research Hospital, Department of Obstetrics and Gynecology, Mogadishu, Somalia
| | - Mohamed Salad Kadiye
- Mogadishu Somalia Turkey Training and Research Hospital, Department of Ophthalmology, Mogadishu, Somalia
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Gujar R, Muzi A, Cagini C, Mariotti C, Piccolino FC, Chhablani J, Lupidi M. In-vivo visualization of the photoreceptors using Spectralis High Magnification Module imaging in central serous chorioretinopathy. Am J Ophthalmol Case Rep 2022; 25:101249. [PMID: 35024496 PMCID: PMC8728573 DOI: 10.1016/j.ajoc.2021.101249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/19/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To visualize photoreceptors using the Spectralis High Magnification Module (HMM) in a case of central serous chorioretinopathy (CSCR) and to correlate the findings with those of optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). Observations A 35-year-old Caucasian male presenting with chronic CSCR in the left eye was examined using HMM, OCT and OCT-A. The photoreceptors mosaic was assessed both in diseased and apparently uninvolved areas. A partial topographic correlation between the loss of photoreceptors on HMM images and an altered reflectivity of the photoreceptor layer on en-face OCT was noted. Interestingly, a correlation between the photoreceptor damage on HMM and choriocapillaris flow-void areas on OCT-A was seen. Conclusions and Importance HMM is a non-invasive imaging modality, allowing the in-vivo visualization of photoreceptor damage in a diseased retina. A focal abnormal perfusion of the choriocapillaris might influence the integrity of the overlying photoreceptors in CSCR.
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Affiliation(s)
- Ramkailash Gujar
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, 06156, Perugia, Italy
| | - Alessio Muzi
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, 06156, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, 06156, Perugia, Italy
| | | | - Felice Cardillo Piccolino
- Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Viale Benedetto XV 5, 16132, Genova, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Marco Lupidi
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, 06156, Perugia, Italy.,Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Viale Benedetto XV 5, 16132, Genova, Italy.,Centre de l'Odéon, 113 Boulevard St Germain, 75006, Paris, France
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A clinical case of bilateral exudative retinal detachment against the background of severe preeclampsia. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov61171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This article describes a clinical case of a bilateral exudative retinal detachment development in a young woman with severe preeclampsia. The data of the ophthalmological examination, as well as those of the dynamic observation of the patient, are presented. The possible mechanisms of the formation of exudative retinal detachment on the background of preeclampsia are considered in detail. The described clinical case is of great interest, since this condition is a rare complication in preeclampsia. Exudative retinal detachment against the background of preeclampsia requires adherence to bed rest, normalization of blood pressure, control of proteinuria and, as a rule, does not require surgical intervention.
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Choroidal thickness after phacoemulsification: nonrandomized comparison of postoperative topical ketorolac vs dexamethasone vs combination of ketorolac-dexamethasone eyedrops. J Cataract Refract Surg 2021; 47:46-52. [PMID: 33196570 DOI: 10.1097/j.jcrs.0000000000000477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effect of topical dexamethasone vs ketorolac vs combined dexamethasone-ketorolac after phacoemulsification on choroidal thickness (CT). SETTING Tertiary university-based hospital. DESIGN Prospective nonrandomized comparative case series. METHODS Ninety-two eyes of 92 patients were assigned to the 3 groups after uneventful phacoemulsification: Group 1, dexamethasone; Group 2, ketorolac; Group 3, combined dexamethasone-ketorolac applied topically. CT at subfoveal (SFCT), nasal, and temporal as primary and central retinal thickness (CRT) as secondary outcomes were measured preoperatively and at 1 month, 3 months, and 6 months postoperatively using enhanced depth-imaging optical coherence tomography. RESULTS Preoperative CT was similar between the groups (all P > .05). The groups differed in pattern of changes in nasal and temporal CT (both P < .001) although their changes of CRT (P = .13) and SFCT (P = .55) over time were similar. The mean of SFCT at 1 month, 3 months, and 6 months was significantly higher than baseline in dexamethasone (P < .001 for all follow-ups) and combined (P < .001 for both 1 month and 3 months and P = .03 for 6 months) groups, whereas it was not statistically significant in the ketorolac group (P = .07). There was an increase in the nasal and temporal CT in 3 groups, persisted at 6 months in dexamethasone (both P < .001) and ketorolac (both P < .001) groups, whereas the change was not statistically significant at 6 months in the combined group. Choroidal thickness measurements were performed in 31 eyes of 31 patients in group 1, 29 eyes of 29 patients in group 2, and 32 eyes of 32 patients in group 3. CONCLUSIONS Dexamethasone and combined groups had statistically significant changes of SFCT after phacoemulsification; however, the ketorolac group did not. The pattern of SFCT changes was similar between 3 groups.
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Kim YH, Lee B, Kang E, Oh J. Peripapillary Choroidal Vascularity Outside the Macula in Patients With Central Serous Chorioretinopathy. Transl Vis Sci Technol 2021; 10:9. [PMID: 34251422 PMCID: PMC8288056 DOI: 10.1167/tvst.10.8.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose To investigate choroidal vascularity outside the macula in central serous chorioretinopathy (CSC). Methods Fifty normal controls and 103 patients with a history of CSC (31 with acute CSC, 32 with chronic CSC, and 40 with resolved CSC) were included. Using swept-source optical coherence tomography, we measured choroidal thickness (CT) and choroidal vascularity index (CVI) at the subfoveal and nasal peripapillary areas. Results Subfoveal CT in the acute CSC group was greater than that in all other groups (all P < 0.05). Peripapillary CT in the acute and chronic CSC groups was significantly greater than that in controls (all P ≤ 0.005). However, subfoveal and peripapillary CT in the resolved CSC group was not different from controls. Subfoveal CVI in the acute group (64.71% ± 2.68%) was higher than that in controls (61.68% ± 5.68%) (P = 0.015). Peripapillary CVIs in the acute (67.35% ± 6.04%) and chronic groups (64.90% ± 5.31%) were higher than controls (54.57% ± 7.02%) (all P < 0.001). Subfoveal CVI in the resolved CSC group was not different from controls (P = 0.252), whereas peripapillary CVI (62.61% ± 6.03%) was higher (P < 0.001). Conclusions Unlike CT, CVI outside the macula was increased in all eyes with both current and past history of CSC. These findings suggest that the choroidal vascularity outside the macula may represent choroidal characteristics in addition to the subfoveal area. Translational Relevance Peripapillary CVI outside the macula may provide additional information beyond what is known through subfoveal choroid studies.
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Affiliation(s)
- Young Ho Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Boram Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Edward Kang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Veerappan Pasricha M, Callaway NF, Nguyen QD, Do DV. Serous retinal detachment as a presenting sign of acute lymphoblastic leukemia: A case report and literature review. Am J Ophthalmol Case Rep 2021; 23:101142. [PMID: 34222714 PMCID: PMC8242964 DOI: 10.1016/j.ajoc.2021.101142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe a unique case of unilateral serous retinal detachment as the presenting sign of B-cell acute lymphoblastic leukemia (ALL). Observations A 74 year old woman presented with right eye blurry vision and was found to have an underlying serous retinal detachment, along with cotton wool spots, inner retinal hemorrhages, and retinal pigment epithelial changes throughout her bilateral fundi. Fluorescein angiography demonstrated bilateral vasculitis and ultrasonography revealed asymmetric thickening and enhancement of the affected eyes’ choroid. This prompted a systemic lab workup and results were suspicious for an underlying hematologic malignancy. The patient was admitted to the hospital for bone marrow biopsy confirming B-cell ALL, underwent intensive intravenous and intrathecal chemotherapy, and was discharged one month later. Follow up appointment in the ophthalmology clinic demonstrated functional and anatomic improvement in the serous retinal detachment and choroidal thickening suggestive of infiltration in her right eye. Conclusions SRDs are an uncommon ocular manifestation of leukemia, and even less common as a presenting sign of the disease. A comprehensive literature review demonstrated 11 other cases reported worldwide. We present the first such case with additional findings of leukemic retinopathy, optic nerve and choroidal infiltration, and vasculitis, as well as a complete library of ophthalmic imaging from the patient's initial presentation. Importance A new diagnosis of serous retinal detachment(s) without any obvious cause should raise suspicion for leukemia and prompt further workup. Early recognition of this hematologic malignancy is crucial for prompt initiation of life-saving therapy.
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Key Words
- /Acronyms: Acute lymphoblastic leukemia, (ALL)
- Acute lymphoblastic leukemia
- Acute lymphocytic leukemia
- Acute lymphoid leukemia
- Central serous chorioretinopathy
- Exudative retinal detachment
- Serous retinal detachment
- autofluorescence, (AF)
- central serous chorioretinopathy, (CSR)
- cotton wool spots, (CWS)
- fluorescein angiogram, (FA)
- intravenous, (IV)
- magnetic resonance imaging, (MRI)
- optical coherence tomography, (OCT)
- retinal pigment epithelium, (RPE)
- serous retinal detachment, (SRD)
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Affiliation(s)
- Malini Veerappan Pasricha
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Natalia F Callaway
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA
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Jain M, Gopal L, Padhi TR. Dome-shaped maculopathy: a review. Eye (Lond) 2021; 35:2458-2467. [PMID: 33875828 DOI: 10.1038/s41433-021-01518-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/25/2021] [Accepted: 03/25/2021] [Indexed: 01/11/2023] Open
Abstract
First described by Gaucher and associates in 2008 in eyes with high myopia, dome-shaped maculopathy (DSM) is an anterior convex protrusion of the macula towards the vitreous cavity observable on OCT. This seems to be related to a localized scleral thickness, which might be the result of regional variation in the scleral bio-mechanical properties and the process of emmetropization causing asymmetric scleral growth. The presence of DSM can be associated with an increased risk of complications. The clinical spectrum ranges from being asymptomatic to metamorphopsia and mild-to-moderate gradual visual loss over years. Visual impairment in DSM results from retinal pigment epithelial changes, sub-foveal serous detachment, retinoschisis and myopic choroidal neovascularization. In this review, we compile and review the available information on the pathophysiology, nomenclature, classification, clinical features including imaging, differential diagnosis, complications associated with DSM and the gaps in our understanding of this entity thus far.
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Affiliation(s)
- Mukesh Jain
- Department of Vitreo-Retinal Services, L.V. Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India.
| | - Lingam Gopal
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Tapas Ranjan Padhi
- Department of Vitreo-Retinal Services, L.V. Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
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Karimi S, Arabi A, Shahraki T, Safi S. Central Serous Chorioretinopathy in a Case of Regressed Familial Retinoblastoma. J Ophthalmic Vis Res 2020; 15:559-564. [PMID: 33133447 PMCID: PMC7591842 DOI: 10.18502/jovr.v15i4.7802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To present a case of central serous chorioretinopathy (CSC) in association with regressed familial retinoblastoma. Case Report A 23-year-old man with regressed unilateral familial retinoblastoma in his left eye presented with decreased vision of the left eye since two months ago. The patient had undergone chemotherapy and cryotherapy for the treatment of retinoblastoma 20 years ago. In the left eye, funduscopy disclosed regressed mass of retinoblastoma, inferonasal to the optic disc, and focal subfoveal neurosensory detachment. Optical coherence tomography (OCT) and fluorescein angiography revealed CSC. As there was no sign of recurrence of retinoblastoma and retinal findings did not show late-onset chemotherapy-related retinopathy, the patient was diagnosed with CSC and followed up. After two months, visual acuity of the left eye improved, and repeated macular OCT revealed absorption of the subretinal fluid. Conclusion Subretinal fluid accumulation in a patient with regressed retinoblastoma is not always a sign of tumor recurrence or a treatment-related retinopathy.
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Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Garcia-Ben A, González Gómez A, García Basterra I, García-Campos JM. Factors associated with serous retinal detachment in highly myopic eyes with inferior posterior staphyloma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:478-484. [PMID: 32561184 DOI: 10.1016/j.oftal.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the factors associated with persistent serous retinal detachment in highly myopic eyes with inferior posterior staphyloma. METHODS A total of 27 highly myopic patients (44 eyes) with an inferior posterior staphyloma were recruited. Serous retinal detachment was investigated; 13 eyes had persistent sub-macular fluid (study group), and 31 eyes lacked sub-macular fluid (control group). All patients underwent complete ophthalmologic examinations, including axial length measurement and fluorescein angiography (FA). Triton Deep Range Imaging (DRI) optical coherence tomography (OCT) (Topcon Corp., Tokyo, Japan) scans through the fovea measured choroidal thicknesses, macular bend height, and vitreoretinal interface factors. RESULTS Of the 44 eyes, 13 had neurosensory retinal detachment and 31 did not. No significant differences were found in any of the studied variables (age, gender, spherical equivalence, axial length, vitreomacular traction, epiretinal membrane, internal limiting membrane detachment), except a higher macular bend height (p = 0.01), and a reduced macular choroidal thickness (p = 0.02), which were associated with the risk of serous retinal detachment. No statistically significant differences in best-corrected visual acuity (BCVA) were observed between the study and control groups. Serous retinal detachment always occurred at the bisected retinal pigment epithelium of the macula corresponding to the upper edge of the staphyloma, and was characterised by multiple hyperfluorescent granular patches on fluorescein angiography. CONCLUSIONS A higher macular bend height and a reduced macular choroidal thickness may be important factors in the development of serous retinal detachment in patients with inferior posterior staphyloma.
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Affiliation(s)
- A Garcia-Ben
- Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - A González Gómez
- Servicio de Oftalmología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - I García Basterra
- Servicio de Oftalmología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - J M García-Campos
- Servicio de Oftalmología, Centro de Investigaciones Médico-Sanitarias, Málaga, España
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Işık MU, Değirmenci MFK, Sağlık A. Efficacy of the subthreshold micropulse yellow wavelength laser photostimulation in the treatment of chronic central serous chorioretinopathy. Int J Ophthalmol 2020; 13:1404-1410. [PMID: 32953579 DOI: 10.18240/ijo.2020.09.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
AIM To evaluate the efficacy and safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC). METHODS The medical records of 58 eyes of 58 patients with CCSC were reviewed. A 577-nm SMYL system was used for the treatment. Fundus fluorescein angiography was used as the primary method of identifying CCSC, and resolution of subretinal fluid (SRF) evaluated by optical coherence tomography (OCT) and fundus autofluorescence. Central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), subfoveal choroidal thickness (SFCT), subretinal fluid height (SRFH), and subfoveal fluid basement diameter values were measured by spectral domain-OCT (SD-OCT) for all eyes. RESULTS The mean age of the patients was 42.4±9.9 (range: 20-72)y. The mean follow-up was 11.4±8.5 (range: 6-37)mo. Median BCVA at at the final follow up after treatment was statistically significant from the baseline. Complete SRF resolution was 12.1% of the eyes in the 1st month, 67.2% of the eyes in the 3rd month and 67.2% of the eyes in the last follow up. The initial median CMT, CMV, TMV, and SFCT values before treatment was significantly higher than 3rd month visit values (P<0.001). In the multivariate analysis performed, age and disease duration were found to be a risk factor for persistent SRF (P=0.017, P=0.016, respectively). CONCLUSION SMYL treatment provides a significant anatomical and functional improvement and is effective in eliminating SRF in eyes with CCSC.
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Affiliation(s)
- Mehmed Uğur Işık
- Department of Ophthalmology, Kastamonu University Faculty of Medicine, Kastamonu 37100, Turkey
| | | | - Ayhan Sağlık
- Department of Ophthalmology, Harran University Faculty of Medicine, Şanlıurfa 63000, Turkey
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18
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Central Serous Chorioretinopathy: Multimodal Imaging and Management Options. Case Rep Ophthalmol Med 2020; 2020:8890404. [PMID: 32855831 PMCID: PMC7443246 DOI: 10.1155/2020/8890404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 01/27/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic maculopathy characterized by thickened choroid, retinal pigment epithelial detachment, and variable subretinal fluid. CSCR predominantly affects young men, with risk factors including corticosteroid use, the type A behavior pattern, and psychological stress. While usually self-limited with a good visual prognosis, recurrent and persistent CSCR can lead to outer retinal and/or retinal pigment epithelial atrophy, choroidal neovascularization, and visual loss. This article reviews current multimodal imaging and treatment options, which include observation, mineralocorticoid receptor antagonists, thermal laser photocoagulation, and off-label photodynamic therapy with verteporfin.
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Yanagi Y. Pachychoroid disease: a new perspective on exudative maculopathy. Jpn J Ophthalmol 2020; 64:323-337. [PMID: 32318919 DOI: 10.1007/s10384-020-00740-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pachychoroid, or the structural and functional abnormalities of the choroid, is one of the most important causes of exudative maculopathies. The purpose of this article is to review the current definitions of pachychoroid and their potential consequences. Most publications are from Asian countries. Although no consensus diagnosis has been reached, pachychoroid is defined by thickened choroid and choroidal vascular hyperpermeability, pachyvessels with inner choroidal attenuation; it is closely linked to pachydrusen. Although some studies suggest choroidal congestion may play a role in its pathogenesis, the exact causes of this condition are still unknown. Pachychoroid is associated with exudative maculopathies including central serous chorioretinopathy, pachychoroid neovasculopathy and polypoidal choroidal vasculopathy (PCV). It is widely accepted that macular neovascular membranes may develop secondary to pachychoroid. Recent clinical observations illustrate the importance of pachychoroid in the etiology of macular neovascularization including neovascular age-related macular degeneration (nAMD). CONCLUSION Pachychoroid is an important cause of exudative maculopathies. Both drusen and pachychoroid are increasingly recognized as important causes of macular neovascularization, and eyes formally categorized as typical nAMD or PCV can be further sub-categorized based on the presence or absence of pachychoroid and drusen. There is a need to develop a consensus definition, which will greatly enhance our understanding of pachychoroid and facilitate the development of individual interventions in pachychoroid diseases.
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Affiliation(s)
- Yasuo Yanagi
- Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan. .,Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.
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20
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OCULAR PERFUSION PRESSURE AND CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY AND PIGMENT EPITHELIOPATHY. Retina 2020; 39:143-149. [PMID: 29095356 DOI: 10.1097/iae.0000000000001916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate ocular perfusion pressure (OPP) in patients with central serous chorioretinopathy (CSC) and pigment epitheliopathy (PE). METHODS In this retrospective study, we included patients with acute idiopathic unilateral CSC and age- and sex-matched normal controls. The patients with CSC were classified into two groups according to the PE presence on their fellow eyes. We compared OPP among CSC patients with or without PE and normal controls. RESULTS Among a total of 47 patients with CSC, 21 were classified into the PE group and 26 into the non-PE group. The mean OPP (±SD) of CSC and fellow eyes in the PE group (50.02 ± 4.98 and 50.83 ± 4.12 mmHg, respectively) was greater than that in the non-PE group (43.69 ± 6.88 and 44.0 ± 6.57 mmHg, respectively) and normal controls (45.64 ± 8.73 mmHg) (all, P < 0.05). The mean macular choroidal thickness of CSC and fellow eyes in the PE group (344.4 ± 31.8 and 310.1 ± 37.0 μm, respectively) was thicker than that in the non-PE group (318.5 ± 43.8 and 282.8 ± 36.1 μm, respectively) (all, P < 0.05). Greater macular choroidal thickness and higher OPP were associated with PE (P = 0.002 and P = 0.003). CONCLUSION Forty-five percent of the patients with acute unilateral CSC had PE in their fellow eyes. Increased OPP may influence the development of bilateral CSC characteristics.
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Kwak JH, Hong SW, Ra H, Kim EC, Kang NY, Baek J. Effect of Acetazolamide on Choroidal Morphology in Central Serous Chorioretinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:493-499. [PMID: 31833245 PMCID: PMC6911784 DOI: 10.3341/kjo.2019.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to elucidate the influence of acetazolamide on choroidal structure changes during the treatment of central serous chorioretinopathy (CSC). METHODS This was a retrospective study of 45 eyes from 45 patients with acute CSC who were divided into an acetazolamide group (group 1, n = 20) and an observation group (group 2, n = 25). The main outcome measures were the changes in best-corrected visual acuity, subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) at one week, one month, two months, and three months, respectively. RESULTS Although statistical significance was not reached, best-corrected visual acuity improved in both groups at month 3 (from 0.06 ± 0.07 to 0.01 ± 0.03 in group 1 and 0.17 ± 0.24 to 0.09 ± 0.18 in group 2; p = 0.083 and 0.183, respectively). Separately, SRF height and CVI showed a significant decrease at three months in both groups (all p < 0.05), while a significant SRF height decrease was also noted in group 1 at one month (p = 0.038). In group 1, a significant decrease in the SFCT and CVI started at one week and one month (p = 0.021 and 0.008), respectively. However, in group 2, a significant decrease in the SFCT and CVI started at one month and two months (p = 0.005 and 0.015), respectively. CONCLUSIONS Acetazolamide has no effect on final functional or anatomical status at three months in eyes with CSC but does shorten the time for SRF absorption and accompanying choroidal structural changes.
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Affiliation(s)
- Jae Hyuck Kwak
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Seung Woo Hong
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Ho Ra
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Eun Chul Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Nam Yeo Kang
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Jiwon Baek
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.
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Kopsidas K, Javidi H, Kelly SP, Aslam T, Black G, Mahmood S. Unique Case of Bilateral Exudative Retinal Detachment following Creatine Supplementation in a Patient with Autosomal Dominant Bestrophinopathy. Case Rep Ophthalmol 2019; 10:374-378. [PMID: 31762771 PMCID: PMC6873073 DOI: 10.1159/000503853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/02/2019] [Indexed: 11/19/2022] Open
Abstract
We report a case of bilateral serous retinal detachment in a patient with rod-cone dystrophy caused by mutation of BEST1. This followed creatine monohydrate use as a dietary supplement. A 39-year-old male with rod-cone dystrophy and low hyperopia developed extensive bilateral exudative retinal detachment following creatine monohydrate diet supplementation. Five days after stopping creatine use, the bilateral retinal detachments resolved completely. This may indicate a causative relation of creatine supplementation to development of serous retinal detachment in a susceptible patient with pre-existing retinal dystrophy.
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Affiliation(s)
- Konstantinos Kopsidas
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hedayat Javidi
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Simon P. Kelly
- Department of Ophthalmology, Bolton NHS Foundation Trust, Bolton, United Kingdom
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Graeme Black
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester, United Kingdom
| | - Sajjad Mahmood
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
- *Sajjad Mahmood, Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL (UK), E-Mail
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Bilateral serous retinal detachment in association with preeclampsia. Can J Ophthalmol 2019; 54:e98-e100. [PMID: 31109507 DOI: 10.1016/j.jcjo.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 11/23/2022]
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The Efficacy of Intravitreal Conbercept for Chronic Central Serous Chorioretinopathy. J Ophthalmol 2019; 2019:7409426. [PMID: 31205784 PMCID: PMC6530212 DOI: 10.1155/2019/7409426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 02/02/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of conbercept for patients with chronic central serous chorioretinopathy (CSC). Methods A retrospective clinical study. Thirty-one patients (35 eyes) with chronic CSC were given intravitreal injections of conbercept and followed up for at least 6 months. Observed indicators included best-corrected visual acuity (BCVA), central macular thickness (CMT), and resolution of subretinal fluid (SRF). Serial changes in BCVA and CMT were analyzed by using repeated measures analysis of variance. Results During the 6-month follow-up, the mean number of injections required and performed was 1.77 ± 0.60. The logMAR BCVA was 0.48 ± 0.26 at the baseline, 0.34 ± 0.26, 0.30 ± 0.26, 0.27 ± 0.26, 0.24 ± 0.26, and 0.23 ± 0.26 at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 27.173, P < 0.05). CMT was 313.74 ± 144.51 μm at the baseline and decreased to 263.49 ± 120.44 μm, 225.91 ± 91.98 μm, 195.77 ± 66.69 μm, 189.74 ± 65.41 μm, and 199.49 ± 81.50 μm at 2-week and 1-, 2-, 3-, and 6-month follow-ups, respectively (F = 18.093, P < 0.05). Full resolution of SRF was achieved in 8 (22.9%) eyes at 1 month, 16 (45.7%) eyes at 2 months, 22 (62.9%) eyes at 3 months, and 27 (77.1%) eyes at 6 months after the initial treatment of anti-VEGF injection. No severe adverse event was noted relevant to the therapy. Conclusions Intravitreal injection of conbercept may effectively reduce the CMT and improve the BCVA in chronic CSC in a short term of 6 months.
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Kaldırım H, Yazgan S, Kırgız A, Atalay K, Savur F. A Comparison Study of Ranibizumab and Aflibercept in Patients with Naive Diabetic Macular Edema in Presence of Serous Retinal Detachment. Curr Eye Res 2019; 44:987-993. [PMID: 30983426 DOI: 10.1080/02713683.2019.1608260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aim of the study: The aim of this study is to compare the efficacy of intravitreal injection of Aflibercept and Ranibizumab in the treatment of naive diabetic macular edema (DME) with serous retinal detachment (SRD). Materials and methods: In this prospective, non-randomized-cohort study, 60 eyes with DME with SRD were divided into 2 groups: group 1 consisted of 30 eyes treated with intravitreal injection of 0.5 mg/0.1 mL Ranibizumab (IVR) and group 2 consisted of 30 eyes treated with intravitreal injection of 2 mg/0.05 mL Aflibercept (IVA). After three sequential injections with 30-40-day interval as a loading dose, all patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central macular thickness (CMT), SRD's height (SRDH) and the number of reinjections of the drugs were compared. Results: The groups were similar in terms of age and sex (p > 0.05). There was no difference between groups in terms of the baseline BCVA, CMT and SRDH (p > 0.05). There was no significant difference between groups with regard to BCVA and CMT values for 12 months (p > 0.05). SRDH decreased significantly in both groups; however, the reduction of SRDH was considerably higher in group 2 for 12 months (p < 0.05). The mean number of reinjection was 4.40 ± 0.85 in group 1 and 3.16 ± 0.75 in group 2 and it was noticeably lower in group 2 (p < 0.001). The number of cases with persistent SRD at the end of the study was 14 (46.6%) in group 1 and 5 (16.6%) in group 2 (p < 0.001). Conclusions: Aflibercept may treat SRD more efficiently in patients with DME compared to Ranibizumab with fewer injections.
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Affiliation(s)
- Havva Kaldırım
- Bagcilar Training and Research Hospital, Ophthalmology Department, Istanbul Health Sciences University , Istanbul , Turkey
| | - Serpil Yazgan
- Medical Faculty, Department of Ophthalmology, Bulent Ecevit University , Zonguldak , Turkey
| | - Ahmet Kırgız
- Beyoglu Eye Training and Research Hospital, Ophthalmology Department, Istanbul Health Sciences University , Istanbul , Turkey
| | - Kursat Atalay
- Bagcilar Training and Research Hospital, Ophthalmology Department, Istanbul Health Sciences University , Istanbul , Turkey
| | - Fatma Savur
- Bagcilar Training and Research Hospital, Ophthalmology Department, Istanbul Health Sciences University , Istanbul , Turkey
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FACTORS ASSOCIATED WITH SEROUS RETINAL DETACHMENT IN HIGHLY MYOPIC EYES WITH VERTICAL OVAL-SHAPED DOME. Retina 2019; 39:587-593. [DOI: 10.1097/iae.0000000000001970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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27
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Zhang F, Qiu Y, Stewart JM. A CASE OF RELAPSING RETINAL PIGMENT EPITHELIAL DETACHMENT IN PERIPAPILLARY PACHYCHOROID PIGMENT EPITHELIOPATHY. Retin Cases Brief Rep 2018; 12 Suppl 1:S110-S113. [PMID: 29135703 DOI: 10.1097/icb.0000000000000658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To report the findings in a patient with peripapillary pachychoroid pigment epitheliopathy who demonstrated a retinal pigment epithelial detachment (PED) that was present at some times but not other times. METHODS A review of 24 months of the clinical course and findings on multimodal imaging, including color fundus photography, fundus autofluorescence, spectral domain optical coherence tomography, and enhanced depth imaging optical coherence tomography. Choroidal thickness was measured by exporting the optical coherence tomography images to ImageJ (National Institutes of Health) for analysis. RESULTS A 75-year-old Asian woman complaining of metamorphopsia had a relapsing PED but no intraretinal or subretinal fluid. Multimodal imaging demonstrated an orange-reddish appearance and hyperautofluorescence/hypoautofluorescence in the nasal macula, chronically thickened choroid located beneath the PED and peripapillary region, and variability in the presence of Sattler layer of the choroid, with its disappearance in the foveal region during exacerbation of the condition, and its emergence when the PED resolved. CONCLUSION In pachychoroid pigment epitheliopathy, PED can develop and spontaneously resolve, and variations in choroidal thickness and the presence of Sattler layer may be an indicator of changes in disease activity.
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Affiliation(s)
- Fuyan Zhang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Department of Ophthalmology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Institute of Medical Science of Guizhou University, Guiyang, China
| | - Yuxing Qiu
- Department of Preventive Medicine, School of Public Health, Binzhou Medical University, Yantai, China
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Yumusak E, Gokcinar NB, Ornek K. Choroidal thickness changes in non-treated acute and ranibizumab-treated chronic central serous chorioretinopathy. Medicine (Baltimore) 2018; 97:e12885. [PMID: 30412084 PMCID: PMC6221658 DOI: 10.1097/md.0000000000012885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the changes in subfoveal retinal, and choroidal thicknesses (CT) in the non-treated acute and the ranibizumab-treated chronic central serous chorioretinopathy (CSCR) patients.This retrospective study included 32 eyes of 32 consecutive patients with CSCR. There were 12 patients who presented with a spontaneous resolution of CSCR (Group 1) and 20 patients who were treated with ranibizumab for persistent subretinal fluid (SRF) (Group 2). Optical coherence tomography (OCT) imaging of subfoveal retinal thickness and enhanced depth imaging OCT of CT at subfoveal; at nasal and temporal 500 μm (T500); at nasal and temporal 1500 μm (T1500) were analyzed. The Student t test and multivariate analysis were used to compare variables within and between groups, respectively and correlations were analyzed using Pearson correlation coefficient. A P value of P < .05 was accepted as significant.The mean patient age was 38.94 ± 8.41 years (range, 20-53 years). Female/male ratio was 4/28. The mean duration of follow-up was 21.6 ± 8.2 months in the chronic CSCR group. Visual acuity improved and central foveal thickness (FT) decreased significantly in both groups. CT decreased significantly only at nasal 1500 μm (N1500) in the acute group and at all measured points in the chronic group compared with baseline, except at T500 (P = .07). No significant difference in central FT was detected between the 2 groups. Compared with the acute group, baseline subfoveal CT was significantly higher in chronic patients. There was a significant difference between the groups in baseline and final CT at T500. No significant difference was found at T1500. At nasal 500 μm and N1500, the difference between the groups was significant only for final CT values.Chronic CSCR was associated with higher baseline CT values in the subfoveal region and at T500. CT significantly decreased at most of the measured points in ranibizumab-treated chronic CSCR patients, whereas it significantly decreased only at 1 point in spontaneously resolved acute CSCR patients.
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Affiliation(s)
- Erhan Yumusak
- Kirikkale University, School of Medicine, Department of Ophthalmology, Kirikkale
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García-Ben A, Garcia-Basterra I, González-Gómez A, Baquero-Aranda I, Morillo-Sanchez MJ, Soler-García A, García-Campos JM. Comparison of long-term clinical evolution in highly myopic eyes with vertical oval-shaped dome with or without untreated serous retinal detachment. Br J Ophthalmol 2018; 103:385-389. [DOI: 10.1136/bjophthalmol-2018-311895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/23/2018] [Indexed: 01/10/2023]
Abstract
BackgroundTo compare the long-term clinical evolution of highly myopic eyes with vertical oval-shaped dome associated with or without untreated serous retinal detachment.MethodsTwenty-eight patients with high myopia (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmological examinations, including optical coherence tomography at baseline every 6 months for 2 years. Fluorescein angiographies were performed in cases with serous retinal detachment to rule out choroidal neovascularisation.ResultsThere were no statistical differences in baseline age, sex, spherical equivalence or axial length between the two groups. Serous retinal detachment always occurred at the top of the inward macular incurvation. Moreover, no statistically significant differences in mean best-corrected visual acuity were observed during the 24-month follow-up period in the study and control groups and between the two groups at all time points. The mean central foveal thickness was significantly higher in the study group at each visit (p=0.001, in all cases). At the final follow-up visit, complete resolution of the serous retinal detachment was achieved in 1 of the 11 study group’s eyes.ConclusionsSerous retinal detachment is a complication associated with vertical oval-shaped domes that seems to remain stable in terms of visual function over time without treatment.
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Arsan A, Kanar HS, Sonmez A. Visual outcomes and anatomic changes after sub-threshold micropulse yellow laser (577-nm) treatment for chronic central serous chorioretinopathy: long-term follow-up. Eye (Lond) 2018; 32:726-733. [PMID: 29303148 PMCID: PMC5898868 DOI: 10.1038/eye.2017.293] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022] Open
Abstract
PurposeTo analyze the long-term efficacy of 577 nm sub-threshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC) and to evaluate the anatomic outcome, visual results and safety profile of the treatment.Patients and methodsThis prospective study assessed 39 eyes of 39 patients with non-resolving CCSC lasting more than three months. All eyes were treated by using 577 nm SMYL system with 5% duty cycle (DC) and each patients was monitored monthly. The main outcome measures were best-corrected visual acuity (BCVA), contrast sensitivity (CS) and subretinal fluid (SRF) height, central macular thickness (CMT), central macular volume (CMV), total macular volume (TMV), and subfoveal choroidal thickness (SFCT) measured by spectral domain optical coherence tomography (SD-OCT).ResultsThe median follow-up time period was 17.82±0.42 (13-23 months) months. The BCVA was improved significantly at final follow-up in comparison of baseline visit (P<0.01) in 35 eyes (89.7%) and in 4 eyes (10.3%) was stable. The median CMT, CMV, TMV before treatment was 369 μm, 0.30 mm3, and 9.86 mm3, in comparison to 250 μm, 0.19 mm3, and 8.76 mm3 at final follow-up, respectively (P<0.01 for all these parameters). Initial median SFCT was recorded as 364 μm and 342 μm at the final follow-up (P<0.001).DiscussionResults suggest that SMYL treatment is an effective method as response was rapid and procedure is safe to manage the non-resolving CCSC eyes.
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Affiliation(s)
- A Arsan
- Turkey Ophthalmology Society, Istanbul, Turkey
| | - H S Kanar
- Turkey Ophthalmology Society, Istanbul, Turkey
| | - A Sonmez
- Turkey Ophthalmology Society, Istanbul, Turkey
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Mistry S, Sudharshan S, Ganesan S, Akbar AB, Biswas J. Vogt-Koyanagi-Harada disease like presentation in patients with chronic myeloid leukemia. Am J Ophthalmol Case Rep 2018; 10:221-225. [PMID: 29780937 PMCID: PMC5956718 DOI: 10.1016/j.ajoc.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 03/08/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To report two rare cases of chronic myeloid leukemia (CML) on tyrosine kinase inhibitors presenting as bilateral serous retinal detachment and ocular inflammation, simulating Vogt-Koyanagi-Harada (VKH) disease. Methods Case series and review of literature. Result Two young patients (one male and one female) with CML on treatment with tyrosine kinase inhibitors (imatinib and dasatanib) under remission presented with bilateral sudden vision loss. One patient had bilateral multiple pockets of serous retinal fluid while the other had panuveitis with exudative retinal detachment. There was neither prodromal symptoms nor systemic signs and symptoms suggestive of VKH in both cases. They responded well to systemic steroid therapy without recurrences with complete visual recovery. Conclusion and importance CML patients can have features similar to VKH even during stable hematological phase and may be possibly associated with the use of tyrosine kinase inhibitors. Hence it is important not to misdiagnose and treat such patients with long term immunomodulators.
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Affiliation(s)
- Saurabh Mistry
- Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - S Sudharshan
- Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Yoon YS, Lee S, Woo JM, Min JK. A Case of Central Serous Chorioretinopathy after Tadalafil Treatment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.1.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yo Sep Yoon
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seunghwan Lee
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Je Moon Woo
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Kee Min
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Kim JM, Kim JY. Selective Retina Therapy in Patients with Central Serous Chorioretinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Min Kim
- Myung-Gok Eye Resarch Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Kim
- Myung-Gok Eye Resarch Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Ibrahim AM, Elgouhary SM, Nassar MK, El Batanony AH. Changes in Choroidal Thickness after Cataract Surgery. Semin Ophthalmol 2017; 33:664-670. [DOI: 10.1080/08820538.2017.1416410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Asmaa Mohamed Ibrahim
- Ophthalmology department, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | | | - Moustafa Kamal Nassar
- Ophthalmology department, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
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Qu Y, Gong D, Yu W, Dong F. Characteristics of the Choriocapillaris Layer in Optical Coherence Tomography Angiography of Acute Central Serous Chorioretinopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 48:1000-1005. [DOI: 10.3928/23258160-20171130-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
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Arora S, Pyare R, Sridharan P, Arora T, Thakar M, Ghosh B. Choroidal thickness evaluation of healthy eyes, central serous chorioretinopathy, and fellow eyes using spectral domain optical coherence tomography in Indian population. Indian J Ophthalmol 2017; 64:747-751. [PMID: 27905337 PMCID: PMC5168916 DOI: 10.4103/0301-4738.194999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The purpose of this study is to establish a normative database of subfoveal choroidal thickness (CT) in healthy young Indians using spectral domain optical coherence tomography (SD OCT). Evaluation and comparison of CT of central serous chorioretinopathy (CSC) and fellow eyes were also performed. Materials and Methods: This was a prospective, cross-sectional, and observational study. It included 112 normal eyes of 112 healthy volunteers who had no evidence of ocular or systemic disease, 84 CSC eyes with acute, treatment-naïve CSC, and 69 fellow eyes with no evidence of neurosensory detachment or pigment epithelium detachment on SD OCT. Complete history, examination, and SD OCT were performed in all eyes. Results: The mean age of 81 patients (84 eyes) with CSC was 35.04 ± 8.86 years, 69 fellow eyes was 34.61 ± 8.71 years, and 112 healthy volunteers (112 eyes) was 33.16 ± 9.4 years (P < 0.05). The mean subfoveal CT of CSC eyes was 429 ± 74.18 μ, fellow eyes was 360 ± 57.99 μ, and normal eyes was 301.80 ± 46.59 μ (P < 0.001). Conclusion: CT varies not only with age, axial length, and refractive error but also with races. Therefore, it is important to establish a normative database in a particular population before carrying out further research in diseased states. CT in CSC eyes is significantly thicker than fellow eyes, and CT of fellow eyes is significantly thicker than normal eyes. This reinforces the fact that choroidal permeability is increased in both eyes of patients with CSC.
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Affiliation(s)
- Supriya Arora
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Richa Pyare
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Preethi Sridharan
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Tarun Arora
- Dr. R P Centre for Ophthalmic Sciences, All Institute of Medical Sciences, New Delhi, India
| | - Meenakshi Thakar
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Basudeb Ghosh
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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Elbay A, Ozdemir H, Koytak A, Melikov A. Intravitreal Dexamethasone Implant for Treatment of Serous Macular Detachment in Central Retinal Vein Occlusion. J Ocul Pharmacol Ther 2017; 33:473-479. [DOI: 10.1089/jop.2016.0187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmet Elbay
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hakan Ozdemir
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arif Koytak
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arif Melikov
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Selective retina therapy with automatic real-time feedback-controlled dosimetry for chronic central serous chorioretinopathy in Korean patients. Graefes Arch Clin Exp Ophthalmol 2017; 255:1375-1383. [DOI: 10.1007/s00417-017-3672-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 01/19/2023] Open
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SUBFOVEAL CHOROIDAL THICKNESS IN PAPILLITIS TYPE OF VOGT-KOYANAGI-HARADA DISEASE AND IDIOPATHIC OPTIC NEURITIS. Retina 2016; 36:992-9. [PMID: 26509220 DOI: 10.1097/iae.0000000000000816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the subfoveal choroidal thickness before and after treatment in papillitis type of Vogt-Koyanagi-Harada (VKH) disease and idiopathic optic neuritis (ON) using enhanced depth imaging spectral domain optical coherence tomography. METHODS A total of 11 eyes of 7 patients (average age 47.3 years old) with papillitis type of VKH disease and 11 eyes of 8 patients (average 36.4 years old) with idiopathic ON case were included. The subfoveal choroidal thickness before and 1 month after treatment was measured using enhanced depth imaging spectral domain optical coherence tomography technique. Diagnosis was defined using fluorescein and indocyanine green angiography for VKH disease and magnetic resonance imaging for ON. Either case was treated with systemic steroid therapy. RESULTS The mean subfoveal choroidal thickness before treatment in papillitis type of VKH disease was significantly thicker than in idiopathic ON case (527 ± 119 μm vs. 321 ± 86 μm, P < 0.01). Choroidal thickness in papillitis type of VKH disease decreased significantly to 313 ± 91 μm 1 month after treatment (P < 0.01, as compared with baseline), whereas choroidal thickness in idiopathic ON case remained about the same (319 ± 89 μm, P = 0.62, as compared with baseline). CONCLUSION Although papillitis type of VKH disease is often misdiagnosed as idiopathic ON case, the initial choroidal thickness and its change after treatment may be useful in the differential diagnosis and management.
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Kameda Y, Hirose A, Iida T, Uchigata Y, Kitano S. Giant retinal pigment epithelial tear associated with fluid overload due to end-stage diabetic kidney disease. Am J Ophthalmol Case Rep 2016; 5:44-47. [PMID: 29503946 PMCID: PMC5758016 DOI: 10.1016/j.ajoc.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/05/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of a giant retinal pigment epithelial (RPE) tear associated with fluid overload in a patient with diabetic macular edema (DME) and kidney disease. Observations A 60-year-old man with type 2 diabetes mellitus and end-stage diabetic kidney disease who had gained weight because of fluid overload complained of a visual disturbance in the left eye that had started a few days earlier. The left fundus showed a RPE defect in two temporal quadrants under an extensive serous retinal detachment (SRD) with exacerbation of the original DME. Seven days later, he was admitted for severe edema and pleural effusion. No overt signs of congestive heart failure were noted. On admission, the RPE defect had markedly widened to involve the macula. Spectral-domain optical coherence tomography images showed substantial intraretinal fluid and an extensive SRD with rolled edges of the retinal pigment epithelium, which led to the diagnosis of a RPE tear. The fluid under the SRD was absorbed on the fourth hospital day and the substantial intraretinal fluid resolved on the eleventh day after systemic management of fluid overload only without ophthalmic treatment. The change in the appearance of the RPE area was minimal and the visual field defect remained even after 6 months. Conclusions and importance A RPE tear may develop in association with fluid overload in patients with diabetes.
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Affiliation(s)
- Yusuke Kameda
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
- Corresponding author. Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.Diabetes CenterTokyo Women's Medical University School of Medicine8-1 Kawada-choShinjuku-kuTokyo162-8666Japan
| | - Akira Hirose
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Shigehiko Kitano
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
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Li M, Liu Q, Luo Y, Li Y, Lin S, Lian P, Yang Q, Li X, Liu X, Sadda S, Lu L. Enhanced Depth SD-OCT Images Reveal Characteristic Choroidal Changes in Patients With Vogt-Koyanagi-Harada Disease. Ophthalmic Surg Lasers Imaging Retina 2016; 47:1004-1012. [DOI: 10.3928/23258160-20161031-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/30/2016] [Indexed: 11/20/2022]
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Sharma H, Majumder PD, Rao C, Biswas J. A case of Acute Myeloid Leukemia masquerading as unilateral exudative detachment. Am J Ophthalmol Case Rep 2016; 4:47-49. [PMID: 29503924 PMCID: PMC5757459 DOI: 10.1016/j.ajoc.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 08/09/2016] [Indexed: 12/01/2022] Open
Abstract
Purpose Leukemias can involve almost every part of the human eye. Ophthalmic manifestations of leukemias can be divided into direct infiltration, secondary vascular changes and neuro-ophthalmological changes. Our case presented with exudative retinal detachment mimicking Vogt Koyanagi Harada's disease (VKH). Observations A 30-years old Asian (Indian) female presented with insidious onset of painless diminution of vision from her right eye for one month. She gave history of fever and severe headache at the time of onset of ocular symptoms. Fundus examination revealed exudative retinal detachment at the posterior pole of her right eye. Fundus fluorescein angiography showed early stippled pin point hyperfluorescence, placoid pooling of the dye and late disc staining in both the eyes. A provisional diagnosis of Vogt Koyanagi Harada disease was made and routine blood investigations and a physician check-up for fitness for systemic steroids was done. Peripheral blood smear showed the presence of blast cells. The patient was diagnosed to have Acute Myeloid Leukemia (AML) and was started on chemotherapy. Conclusions and Importance Acute myeloid leukemia can present as an exudative retinal detachment and can mimic similarly presenting conditions like VKH. Hence, this very important differential diagnosis should be kept in mind and it stresses the importance of simple laboratory investigations like whole and differential blood counts.
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Affiliation(s)
- Hitesh Sharma
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
| | - Chetan Rao
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
| | - Jyotirmay Biswas
- Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai 600 006, Tamil Nadu, India
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Abstract
PURPOSE To evaluate choroidal thickness (CT) in patients with Cushing syndrome (CS) with enhanced depth imaging optical coherence tomography. METHODS Twenty-eight patients with CS and 38 healthy volunteers were enrolled in this observational cross-sectional study. Patients with newly diagnosed CS who have been admitted to Erciyes University Department of Endocrinology in 3 years time interval were compared with age- and sex-matched healthy volunteers. Choroidal thickness was measured at the fovea and 2 points nasal and 2 points temporal to the fovea with 500-μm intervals each. RESULTS Choroidal thickness measurements were higher in patients with CS than in the control group at all examination points; however, the difference was found to be significant at the center of the fovea (367.8 ± 94.4 μm vs. 329 ± 90.5 μm) and 1,000 μm temporal to the fovea. Choroidal thickness measurements were significantly higher in adrenocorticotrophic hormone (ACTH)-dependent CS group than in the control group at all measurement points (CT at fovea 388.2 ± 92.4 μm vs. 329.1 ± 90.5 μm). All CT measurements were found to be correlated with ACTH levels. CONCLUSION Cushing syndrome is associated with increased CT. The ACTH-dependent CS may increase CT more than ACTH-independent CS. This effect may be directly related to ACTH itself or increased plasma cortisol levels or both.
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Demirok G, Kocamaz F, Topalak Y, Altay Y, Sengun A. Macular ganglion cell complex thickness in acute and chronic central serous chorioretinopathy. Int Ophthalmol 2016; 37:409-416. [DOI: 10.1007/s10792-016-0278-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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Lincoff N, Nadeem M, Younus Z, Thirkill CE. Exudative Polymorphous Vitelliform Retinopathy: Importance of Early Recognition of the Condition in Patients with Metastatic Melanoma. Ophthalmol Ther 2016; 5:121-7. [PMID: 26892474 PMCID: PMC4909671 DOI: 10.1007/s40123-016-0044-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Because of the advent of monoclonal antibodies in the treatment of metastatic melanoma, patients with this disease are surviving longer.
Early recognition of the disease has therefore become even more important. Case report We present a patient with vitelliform maculopathy, a paraneoplastic retinal maculopathy that is under-recognized. Clinically the retinal findings of serous detachments and pigmentary macular changes are remarkable, while at the same time these patients have surprisingly very few symptoms. This is in contrast to patients who develop melanoma associated retinopathy (MAR) who are very symptomatic early in the disease, but with more subtle retinal findings. Conclusion Monoclonal antibody treatment is changing the survival rates in metastatic disease making early diagnosis even more important. Exudative polymorphous vitelliform maculopathy (EPVM) needs to be recognized early to avoid delay in diagnosis of metastatic disease.
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Affiliation(s)
- Norah Lincoff
- Buffalo General Medical Center, State University of New York, Buffalo, 100 High Street, Buffalo, NY, 14203, USA.
| | - Muhammad Nadeem
- Buffalo General Medical Center, State University of New York, Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Zilfah Younus
- Buffalo General Medical Center, State University of New York, Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Charles E Thirkill
- Ocular Immunology Lab 1220, University of California, Davis, U. C. Davis, Davis, CA, USA
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Lee H, Bae K, Kang SW, Woo SJ, Ryoo NK, Kim SJ, Han G. Morphologic Characteristics of Choroid in the Major Choroidal Thickening Diseases, Studied by Optical Coherence Tomography. PLoS One 2016; 11:e0147139. [PMID: 26766530 PMCID: PMC4713229 DOI: 10.1371/journal.pone.0147139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/21/2015] [Indexed: 11/18/2022] Open
Abstract
We investigated morphologic features of choroid in the choroidal thickening diseases, including central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV), and Vogt-Koyanagi-Harada disease (VKH), by a novel tomographic classification system of the choroid. This cross-sectional study involved 30 patients with active CSC, 30 patients with active PCV, and 27 patients with active VKH, and 30 normal controls. Utilizing enhanced depth imaging optical coherence tomography, we classified the morphology of the choroid into five categories: 1) Standard (S), 2) Dilated outer layer and Attenuated inner layer (DA), 3) Darkened (D), 4) Marbled (M), and 5) Pauci-Vascular (PV) types. Additional tomographic characteristics of the choroid such as choroidal vascular dilation, convolution, scleral invisibility, and choroidal hyper- or hypo-thickening were identified as well. The distribution of five choroidal tomographic morphology and additional tomographic characteristics in each group were analyzed. The DA type was observed in the CSC group more frequently than in the normal control group (53.3% vs 3.3%, P < 0.001). Additional tomographic characteristics, such as choroidal vascular dilation (76.7%), and choroidal hyper-thickening (36.7%), were more prevalent in the CSC group than in the control group. The PCV group showed higher prevalence of DA type (33.3% vs. 3.3%, P = 0.006) than the control group. The VKH group showed a significantly higher frequency of the D type (63.0%), convolution (40.7%), and scleral invisibility (70.4%) than controls (0% for all three findings). In conclusion, CSC and PCV shared common morphologic characteristics of choroid, including dilated outer vascular layer and focally attenuated innermost layer. Dense hypo-reflectivity and convolution of choroid were the specific tomographic markers for acute VKH. A new tomographic classification system of choroid may provide discrimination ability and insight into major pachychoroidopathies.
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Affiliation(s)
- Hoyoung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kunho Bae
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Na-Kyung Ryoo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyule Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Al-Sharkawy H, Farag R. Sub-foveal choroidal thickness in acute central serous chorioretinopathy and its correlation with central macular thickness. DELTA JOURNAL OF OPHTHALMOLOGY 2016. [DOI: 10.4103/1110-9173.195259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kang S, Park YG, Kim JR, Seifert E, Theisen-Kunde D, Brinkmann R, Roh YJ. Selective Retina Therapy in Patients With Chronic Central Serous Chorioretinopathy: A Pilot Study. Medicine (Baltimore) 2016; 95:e2524. [PMID: 26817895 PMCID: PMC4998269 DOI: 10.1097/md.0000000000002524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated visual outcomes, changes of maximum macular thickness (MMT) and subretinal fluid (SRF), and safety in patients with chronic central serous chorioretinopathy (CSC) after treatment with selective retina therapy (SRT). Retrospective cohort study of patients with chronic CSC presenting to a university-based hospital from January 2014 through January 2015 was conducted. A total of 12 eyes of 12 patients with chronic CSC lasting for at least 3 months was recruited. The follow-up period ranged from 3 to 12 months. Following evaluation of test spots at temporal arcades, SRT (Q-switched neodymium-doped yttrium lithium fluoride [Nd:YLF] laser; wavelength, 527 nm, pulse duration, 1.7 microsececond) was applied to the surrounding areas of leakage observed on fluorescein angiogram and/or pigment epithelial detachment (PED). Changes in best-correct visual acuity (BCVA), MMT, and SRF and macular sensitivity (MS) by microperimetry (MP) were evaluated. Eyes received treatment in a mean of 3.83 spots at the pulse energy of 65 to 90 μJ. Mean BCVA (logMAR) improved from 0.23 ± 0.12 at baseline to 0.14 ± 0.13 at 3 months. MMT decreased from 341.4 ± 85.5 μm at baseline to 236.0 ± 57.9 μm at 3 months. SRF completely resolved in 75% (9 eyes) at 3 months. Large PEDs (2 eyes) were flattened at 3 months. Retreatment was performed in 4 eyes. MP showed no evidence of scotoma around SRT-treated lesions. SRT treatment targeting the surrounding area of leakage point showed favorable visual and structural outcomes in chronic CSC patients without the risk of scotoma.
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Affiliation(s)
- Seungbum Kang
- From the Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (SK, YGP, JRK, YJR); Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea (SK); and Medical Laser Center Lübeck GmbH, Lübeck, Germany (ES, DT-K, RB)
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Abd Elhamid AH. Subthreshold micropulse yellow laser treatment for nonresolving central serous chorioretinopathy. Clin Ophthalmol 2015; 9:2277-83. [PMID: 26664043 PMCID: PMC4671811 DOI: 10.2147/opth.s87499] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To report the efficacy and safety of micropulse 577 nm yellow laser in the treatment of nonresolving central serous chorioretinopathy (CSC) cases. Patients and methods The study included 15 eyes with nonresolving CSC lasting more than 3 months. All the patients were subjected to complete ophthalmic examination, in addition to contrast sensitivity measurement, fundus fluorescein angiography, and optical coherence tomography. All eyes were subjected to 577 nm subthreshold micropulse laser treatment, using the IQ 577 device, and followed up after 4 weeks, 2 months, 3 months, and 6 months. The outcome measures were change in best-corrected visual acuity, contrast sensitivity, subretinal fluid height, and change in macular thickness measured by optical coherence tomography. Results The average age of the patients was 36.4 years; eleven were males and four were females. Average duration of the leakage was 4.6 months. The mean best-corrected visual acuity measured 6 months after laser treatment was 0.85±0.097, in comparison to 0.67±0.097 before laser treatment (statistically significant [SS], P<0.05). The mean central macular thickness before laser was 389.6±46.4 µm, in comparison to 263.6±24 µm after 6 months (SS, P<0.05). The mean post-laser log contrast sensitivity measured using the Pelli–Robson contrast sensitivity chart was 1.73±0.14, while the initial log contrast sensitivity was 1.48±0.28 (SS, P<0.05). Conclusion Subthreshold micropulse laser treatment is an effective and safe treatment option for patients with nonresolving CSC.
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Abstract
PURPOSE We report here, the morphological characteristics of the retina and choroid in a patient with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, who was not aware of her pregnancy before visiting our hospital. METHODS Case report. RESULTS The patient complained of visual disturbances in both eyes for a few days. Extensive serous retinal detachment and hyperreflective foci were observed in both eyes on spectral domain optical coherence tomography (SDOCT). Enhanced depth imaging technique using SDOCT revealed choroidal thickening and unclear choroidal vessel contour. Her blood pressure was 230/168 mmHg. Laboratory data showed hemolysis and liver dysfunction. Obstetrical examination disclosed her pregnancy. She was diagnosed as having HELLP syndrome. Because her general condition improved after prompt Cesarean delivery, the fundus lesions were rapidly resolved with choroidal thinning. CONCLUSION The eyes in a patient with HELLP syndrome showed characteristic choroidal morphology. The choroidal morphology shown with SDOCT might be one of the pathognomonic signs for a diagnosis of HELLP syndrome.
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