1
|
Durmaz Engin C, Saatci AO. Macular oedema exacerbation and bacillary layer detachment following the scatter laser photocoagulation in a patient with proliferative diabetic retinopathy. Clin Exp Optom 2024; 107:465-468. [PMID: 36919523 DOI: 10.1080/08164622.2023.2188175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Ceren Durmaz Engin
- Department of Ophthalmology, Karadeniz Eregli State Hospital, Zonguldak, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| |
Collapse
|
2
|
Doobin D, Sharma T, Horowitz J. RUPTURED RETINAL ARTERIAL MACROANEURYSMS ASSOCIATED WITH HEMORRHAGIC BACILLARY LAYER DETACHMENTS. Retin Cases Brief Rep 2024; 18:269-273. [PMID: 36730461 PMCID: PMC10898541 DOI: 10.1097/icb.0000000000001371] [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: 02/04/2023]
Abstract
BACKGROUND/PURPOSE Bacillary layer detachments (BALAD) are a recently recognized form of retinal detachment involving a splitting of photoreceptors at the inner segment myoid zone, with separation of the external limiting membrane and ellipsoid zone on optical coherence tomography (OCT). A growing number of disease processes are recognized to cause BALAD, and here we present three of the first cases of hemorrhagic retinal artery macroaneurysms that resulted in BALAD. METHODS A retrospective review of three patients who presented for acute, painless, monocular vision loss was performed. Multimodal imaging including fundus photography and OCT are included in this analysis. RESULTS Three elderly female patients, all with a history of hypertension, presented with ruptured macroaneurysms involving the macula. All three patients had evidence of BALAD on OCT. Various management strategies were used. CONCLUSION Hemorrhagic retinal arterial macroaneurysms can be associated with BALAD, observed best on OCT. This is most likely secondary to the rapid accumulation of intraretinal fluid during the hemorrhage, which leads to an avulsion at the inner segment myoid zone-a site of inherent structural weakness in the photoreceptors. Visual recovery may be improved in instances of hemorrhagic macroaneurysms associated with BALAD, similar to other disease entities where BALAD occurs, although further research is needed.
Collapse
Affiliation(s)
- David Doobin
- Department of Ophthalmology, Columbia University, New York, New York; and
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University, New York, New York; and
| | - Jason Horowitz
- Department of Ophthalmology, Columbia University, New York, New York; and
| |
Collapse
|
3
|
Yordi S, Cakir Y, Cetin H, Talcott KE, Srivastava SK, Hu J, Ehlers JP. Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration from a Phase III Clinical Trial. Ophthalmol Retina 2024:S2468-6530(24)00066-6. [PMID: 38360182 DOI: 10.1016/j.oret.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/20/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate the incidence of bacillary layer detachment in patients with neovascular age-related macular degeneration (nAMD) and their response to anti-VEGF therapy. DESIGN Post hoc analysis of the brolucizumab 6-mg and aflibercept 2-mg arms from the HAWK clinical trial, a 48-week, prospective, double-masked, phase III trial. PARTICIPANTS Participants (n = 652 and 652 eyes) randomized to brolucizumab 6-mg and aflibercept 2-mg arms from HAWK (NCT02307682). METHODS Spectral-domain OCT scans were obtained at 4-week intervals throughout the HAWK trial and segmented automatically using a proprietary, machine learning-enabled, higher-order feature extraction platform. MAIN OUTCOME MEASURES The incidence of bacillary layer detachment and effect of anti-VEGF therapy in these eyes on best-corrected visual acuity (BCVA), central subfield thickness (CST), retinal fluid volumes, subretinal hyper-reflective material (SHRM) volume, and ellipsoid zone (EZ) integrity from baseline to week 48. RESULTS Classic bacillary layer detachment was identified in 7.2% (47/652) of eyes, demonstrating worse BCVA and higher CST, EZ total attenuation, subretinal fluid (SRF), and SHRM volume at baseline than eyes without bacillary layer detachment. Anti-VEGF treatment resulted in resolution of bacillary layer detachment in 97.9% of eyes by week 48. In eyes with bacillary layer detachment, anti-VEGF treatment improved BCVA and decreased SRF and SHRM volume; however, eyes with bacillary layer detachment never reached the level of BCVA improvement as eyes without bacillary layer detachment. A greater proportion of eyes with bacillary layer detachment had high-exudative volatility (increased mean standard deviation after loading dose) of CST, SRF, and total fluid than eyes without bacillary layer detachment (P < 0.05 for each comparison). CONCLUSIONS Bacillary layer detachment, an OCT signature representing photoreceptor schisis, is identifiable in a notable proportion of eyes with nAMD. Anti-VEGF therapy resulted in a very high proportion of bacillary layer detachment resolution with significantly decreased SRF and SHRM volumes. The majority of eyes with bacillary layer detachment have high-exudative volatility, which may be associated with lower BCVA outcomes. The presence of bacillary layer detachment may provide an important imaging biomarker to be considered for clinical trial inclusion/exclusion based on trial design and therapeutic goals because of its unique behavior. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yavuz Cakir
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine E Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joanne Hu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
4
|
Serels CM, Bhatter P, Srivastava SK, Lowder CY, Mammo DA. Bacillary Layer Detachment as a Presenting Feature of Ocular Sarcoidosis. Ophthalmic Surg Lasers Imaging Retina 2023; 54:686-690. [PMID: 38113357 DOI: 10.3928/23258160-20231023-02] [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: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Bacillary layer detachment (BALAD) is a recently described finding on optical coherence tomography (OCT) that has been reported in a variety of uveitic and retinal diseases. To add to the growing literature on conditions associated with this finding, we report on the first cases of BALADs in ocular sarcoidosis. PATIENTS AND METHODS Observational, retrospective chart review of patients with BALADs as a feature of sarcoid-associated uveitis. RESULTS Three patients presented with blurry vision and bacillary layer detachments on OCT who were either known to have or found to have sarcoid-associated uveitis. All three patients had resolution of the BALAD and improvement in visual acuity with a combination of high-dose oral steroids and/or systemic immunosuppression. CONCLUSIONS Patients presenting with BALAD should be assessed for sarcoidosis, if appropriate, given the systemic implications of this diagnosis. [Ophthalmic Surg Lasers Imaging Retina 2023;54:686-690.].
Collapse
|
5
|
Dhoot AS, Gupta RR, Balaratnasingam C, Freund KB. Diagnostic and Therapeutic Challenges. Retina 2023; 43:2051-2056. [PMID: 37229719 DOI: 10.1097/iae.0000000000003843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
6
|
Chen YG, Chang YH, Shen HC, Pao SI, Hou YC, Liang IC. Prevalence of bacillary layer detachment in diabetic macular edema and response to 3 anti-vascular endothelial growth factor treatment. Medicine (Baltimore) 2023; 102:e35576. [PMID: 37861489 PMCID: PMC10589533 DOI: 10.1097/md.0000000000035576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Spectral-domain optical coherence tomography is widely used in maculopathy, including diabetic macular edema (DME). Bacillary layer detachment (BALAD) is a novel optical coherence tomography finding, defined as the separation of the intraretinal layer between the inner segment myoids and ellipsoids. A total of 161 treatment-naïve eyes with centrally involved DME that underwent 3 monthly loading doses of anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections were enrolled and analyzed retrospectively. BALAD was found in 6.2% of eyes with concurrent subretinal fluid (SRF). All eyes were divided into 3 groups: no either group had neither SRF or BALAD; the SRF only group had SRF but no BALAD; and the BALAD group had both SRF and BALAD. A significant increase in baseline central foveal thickness (CFT) in the BALAD group was observed (no either vs SRF only vs BALAD, baseline CFT: 387.6 ± 74.29 vs 440.6 ± 106.79 vs 642.0 ± 188.86; P < .01). Total resolution of BALAD was noted after anti-VEGF therapy, along with a significant decrease in CFT in all groups (CFT decrease: 82.4 ± 87.07 vs 187.6 ± 138.88 vs 252.1 ± 127.63; P < .01). Eyes with BALAD tended to have the worst baseline visual acuity (baseline logarithm of the minimum angle of resolution VA: 0.76 ± 0.353 vs 0.63 ± 0.303 vs 1.15 ± 0.300; P = .046) but showed the most improvement after treatment (logarithm of the minimum angle of resolution VA change: -0.14 ± 0.235 vs -0.22 ± 0.275 vs -0.27 ± 0.250; P = .079). After resolution of BALAD, all eyes in the BALAD group exhibited ellipsoid zone and/or interdigitation zone disruption corresponding to the BALAD area. BALAD is a novel optical coherence tomography finding associated with a spectrum of diseases including DME. With anti-VEGF therapy, total resolution of BALAD and a significant decrease in CFT can be obtained. However, ellipsoid zone/interdigitation zone disruption tended to develop.
Collapse
Affiliation(s)
- Yann-Guang Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yun-Hsiang Chang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Hsin-Ching Shen
- Department of Ophthalmology, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin, Taiwan, R.O.C
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, R.O.C
| | - Shu-I. Pao
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yu-Chih Hou
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan, R.O.C
| | - I-Chia Liang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan, R.O.C
| |
Collapse
|
7
|
Chem N, Stephenson KA, Joe AW, Mammo ZN. Haemorrhagic bacillary layer detachment secondary to retinal artery macroaneurysm. BMJ Case Rep 2023; 16:e255807. [PMID: 37640415 PMCID: PMC10462938 DOI: 10.1136/bcr-2023-255807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Nolan Chem
- Department of Ophthalmology & Visual Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirk Aj Stephenson
- Department of Ophthalmology & Visual Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron W Joe
- Department of Ophthalmology & Visual Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zaid N Mammo
- Department of Ophthalmology & Visual Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Fouad YA, Salman AG, Ashour DM, Elkady MS, Abdel-Khalek N, Nowara M, Ebeid WM. Bacillary layer detachment with malignant choroidal tumors: a case series. BMC Ophthalmol 2023; 23:142. [PMID: 37024887 PMCID: PMC10077734 DOI: 10.1186/s12886-023-02892-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
PURPOSE To study the incidence and characteristics of bacillary layer detachment (BALAD) occurring with the two most common choroidal malignancies, choroidal metastasis and choroidal melanoma. METHODS A retrospective multicentric record analysis. Eyes with a diagnosis of choroidal melanoma or choroidal metastasis that had good-quality fundus photography and spectral domain optical coherence tomography (OCT) scans of the macular and tumor regions allowing for delineation of the retinal layers were included for analysis. Qualitative image evaluation was done by two independent graders for the presence, location, and OCT features of BALAD, as well as any associated intraretinal or subretinal fluid. Demographic and clinical data were also retrieved. RESULTS Of the 11 eyes with choroidal metastasis and 7 eyes with choroidal melanoma that were included in the final analysis, 6 (54.5%) and 1 (14.3%) had BALAD, respectively. The BALAD co-localized with the subretinal fluid in all cases and with the intraretinal fluid in 1/3 cases (33.3%), was foveal in location in 3 eyes (42.9%), was overlying the tumor in 6 eyes (85.7%), and varied in number and size. Reflectivity within the BALAD was consistently higher than the vitreous and adjacent subretinal fluid, and discernable suspended hyperreflective particles were noted in 5 eyes (71.4%). CONCLUSION BALAD is relatively common with choroidal metastasis. The OCT features described supplement our recognition of this new entity.
Collapse
Affiliation(s)
- Yousef Ahmed Fouad
- Ophthalmology Department, Ain Shams University, Ramses st, Cairo, 11517, Cairo, Egypt.
| | | | - Doaa Maamoun Ashour
- Ophthalmology Department, Ain Shams University, Ramses st, Cairo, 11517, Cairo, Egypt
| | | | - Noha Abdel-Khalek
- Ophthalmology Department, Ain Shams University, Ramses st, Cairo, 11517, Cairo, Egypt
| | - Mohamed Nowara
- Vitreoretinal Service, Al Mashreq Eye Center, Cairo, Egypt
| | - Weam Mohamed Ebeid
- Ophthalmology Department, Ain Shams University, Ramses st, Cairo, 11517, Cairo, Egypt
| |
Collapse
|
9
|
Palmieri F, Younis S, Raslan W, Fabozzi L. Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration: Case Series. Biomedicines 2023; 11:biomedicines11030988. [PMID: 36979967 PMCID: PMC10046666 DOI: 10.3390/biomedicines11030988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE This study seeks to report the clinical and multimodal imaging findings of eight eyes of seven patients with neovascular age-related macular degeneration (nAMD) who developed bacillary layer detachment (BALAD). Setting/Venue: The patients were analysed at the Western Eye Hospital in London, UK. METHODS The approaches of this research include clinical examinations and multimodal imaging-based description of cases of nAMD with BALAD. RESULTS We report multimodal imaging findings of bacillary layer detachment (BALAD) in patients with nAMD. CONCLUSIONS A bacillary layer detachment was detected in patients with neovascular age-related macular degeneration. This multimodal imaging finding is not commonly described in the literature for this disease.
Collapse
Affiliation(s)
- Filomena Palmieri
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Saad Younis
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Walid Raslan
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Lorenzo Fabozzi
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| |
Collapse
|
10
|
Amini A, Riazi-Esfahani H, Cheraqpour K, Johari M, Bolkheir A, Mahdizad Z, Ghassemi F. Bacillary Layer Detachment in Diabetic Retinopathy: A Case Report. Case Rep Ophthalmol 2023; 14:62-67. [PMID: 36820306 PMCID: PMC9938396 DOI: 10.1159/000529314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/16/2023] [Indexed: 02/24/2023] Open
Abstract
To our knowledge, this is the first report to describe bacillary layer detachment (BLD) in a patient with diabetic retinopathy treated with anti-vascular endothelial growth factor. We present the case of a 55-year-old diabetic female who was referred to our hospital complaining of decreased vision in her left eye for 2 weeks. Fundus examination of both eyes was compatible with diabetic retinopathy. Spectral-domain optical coherence tomography of the left eye showed a large dome-shaped cystic space with marginal septa, splitting the myoid zone, consistent with the BLD phenotype. A single dose of intravitreal bevacizumab injection was administered. After 4 weeks, BCVA was improved significantly with complete resolution of BLD. Underlying choroidal ischemia in patients with different vascular disorders like diabetes mellitus may lead to photoreceptor stress and BLD. This study adds to the growing literature, which describes BLD as a marker of fluid accumulation in relation to several macular diseases.
Collapse
Affiliation(s)
- Abdulrahim Amini
- Department of Ophthalmology, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina and Vitreous Service, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Johari
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Bolkheir
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Mahdizad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina and Vitreous Service, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina and Vitreous Service, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Yordi S, Sarici K, Cetin H, Lunasco LM, Le TK, Sevgi DD, Zahid R, Meng X, Reese JL, Srivastava SK, Ehlers JP. Bacillary Detachment in Neovascular Age-Related Macular Degeneration: Incidence, Clinical Features, and Response to Anti-VEGF Therapy. Ophthalmol Retina 2022; 6:1061-1069. [PMID: 35654365 PMCID: PMC10576655 DOI: 10.1016/j.oret.2022.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the incidence of bacillary layer detachment among patients with neovascular age-related macular degeneration (nAMD) and their response to anti-VEGF therapy. DESIGN Post hoc analysis of the OSPREY clinical trial, a prospective, double-masked, phase II study comparing 6-mg brolucizumab with 2-mg aflibercept over 56 weeks. PARTICIPANTS Participants with treatment-naive nAMD at the initiation of the trial were included in the analysis (n = 81). METHODS Spectral-domain OCT (SD-OCT) scans were obtained at 4-week intervals throughout the OSPREY study and were segmented automatically using a proprietary, machine learning-enabled higher-order feature-extraction platform. MAIN OUTCOME MEASURES The presence of bacillary detachment, and in these eyes the effect of anti-VEGF therapy on change from baseline in visual acuity (VA), central subfield thickness (CST), retinal fluid volumes, subretinal hyper-reflective material (SHRM) volume, subretinal pigment epithelium (sub-RPE) fluid volume, and ellipsoid zone (EZ) integrity at week 56. RESULTS Bacillary detachment was identified in 7.4% (6 of 81) eyes, which had higher fluid volumes, increased CST, EZ attenuation, and increased sub-RPE volume at baseline compared with eyes without bacillary detachment. Anti-VEGF treatment resulted in the resolution of bacillary detachment in 100% of the eyes. In eyes with bacillary detachment at baseline, the anti-VEGF treatment decreased CST, fluid burden, and SHRM volumes throughout the treatment course; however, there was no significant change from baseline in VA, sub-RPE volume, or EZ integrity throughout the 56-week course of anti-VEGF treatment. CONCLUSIONS Bacillary detachment is an OCT signature that is identifiable in a notable proportion of nAMD eyes. Anti-VEGF therapy resulted in 100% resolution of bacillary detachment and significant decreases in CST and SHRM volume; however, improvements in VA may have been limited by persistent EZ attenuation.
Collapse
Affiliation(s)
- Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kubra Sarici
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leina M Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Duriye Damla Sevgi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Zahid
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Xiangyi Meng
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jamie L Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
12
|
Cox JT, Wu F, Rossin EJ, Tang WM, Eliott D. Bacillary Layer Detachment Associated With Endogenous Fungal Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2022; 6:316-319. [PMID: 37007928 PMCID: PMC9976034 DOI: 10.1177/24741264221101224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To recognize the novel finding of a bacillary layer detachment (BALAD) secondary to endogenous fungal endophthalmitis. Methods: Chart review, literature review. Results: BALAD is a recently described condition in which the photoreceptor layer splits at the level of the inner segment myoid. We describe a case of BALAD associated with endogenous fungal endophthalmitis and subsequent development of choroidal neovascularization, although it is unclear if BALAD contributed to neovessel formation. Conclusions: BALAD is generally seen in the setting of inflammatory or infectious retinal diseases. This is the first report of BALAD secondary to endogenous fungal endophthalmitis.
Collapse
Affiliation(s)
- Jacob T. Cox
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Frances Wu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Elizabeth J. Rossin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Bacillary Layer Detachment in a Korean Cohort with Neovascular Age-Related Macular Degeneration. Retina 2022; 42:1028-1037. [PMID: 35152248 DOI: 10.1097/iae.0000000000003437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the incidence and characteristics of bacillary layer detachment (BALAD) in neovascular age-related macular degeneration (AMD). METHODS This retrospective study was performed at Kim's Eye Hospital in South Korea. Patients who were diagnosed with neovascular AMD between January 2017 and December 2017 were included. The incidence of BALAD was compared among different types of macular neovascularization. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at diagnosis were compared between patients showing BALAD at diagnosis and those who did not. RESULTS Among the 442 patients included, BALAD was observed in 20 patients(4.5%). There was a significant difference in the incidence of BALAD between type 1 MNV(2.7%), type 2 MNV(12.5%), and type 3 MNV (0%)(P<0.001). The BCVA was significantly worse (mean 1.26±0.79 vs 0.62±0.50, P=0.001), and the CRT was significantly greater (mean 648.2±211.1 µm vs 464.0±175.5 µm, P<0.001) in patients with BALAD than in those without it. After anti-vascular endothelial growth factor therapy, all BALADs resolved. CONCLUSIONS This study first reported the incidence of the BALAD in neovascular AMD in Korean population. The incidence of BALAD was the highest in type 2 MNVs. BALAD generally develops in eyes with great macular thickness and poor visual acuity.
Collapse
|
14
|
Bridge arch-shaped subretinal fluid in neovascular age-related macular degeneration - evolution and outcomes. Retina 2022; 42:1012-1019. [PMID: 35152246 DOI: 10.1097/iae.0000000000003436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study factors leading to bridge arch-shaped subretinal fluid (SRF) on optical coherence tomography (OCT) in wet age-related macular degeneration and evaluate its anatomical and functional outcomes. METHODS In this single-center, retrospective study, patients with bridge arch-shaped SRF and choroidal neovascular membrane (CNVM) were included. RESULTS We identified 623 eyes in 431 patients with chronic CNVM and 24 (4%) eyes in 21 patients showed bridge arch-shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type 1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean ETDRS letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch-shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti-VEGF injections given before developing bridge arch-shaped SRF was 6.5 ± 7.09. During development of bridge arch-shaped SRF, visual acuity reduced by -20.57 ± 31.13 letters (p=0.033) and fibrotic type 2 CNVM (n=18, 75%) was noted. RPE tear was noted in 8 (33%) eyes. At final visit, further reduction in visual acuity of -7.136 ± 13.73 ETDRS letters (p=0.011) after developing bridge arch-shaped SRF was seen. Mean number of injections given after developing bridge arch shaped SRF was 4.76 ± 3.76. CONCLUSION Bridge arch-shaped SRF is an uncommon finding seen in eyes with type 2 chronic CNVMs. Presence of RPE breach and tear and non-aggressive treatment regimen with intravitreal anti-VEGF injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favourable therapeutic response.
Collapse
|
15
|
Mambretti M, Casalino G. Correspondence. Retina 2022; 42:e1. [PMID: 34173363 DOI: 10.1097/iae.0000000000003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Venkatesh R, Reddy NG, Agrawal S, Pereira A, Yadav NK, Chhablani J. Bacillary layer detachment on optical coherence tomography in exudative age-related macular degeneration. Eur J Ophthalmol 2021; 33:11206721211064017. [PMID: 34816742 DOI: 10.1177/11206721211064017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the bacillary layer detachment on optical coherence tomography in exudative age-related macular degeneration. METHODS Retrospective, observational cases. CASE DESCRIPTIONS Two cases of exudative age-related macular degeneration, one diagnosed as polypoidal choroidal vasculopathy following exudative age-related macular degeneration and other as wet age-related macular degeneration with choroidal neovascular membrane showed separation of myoid and ellipsoid zones of photoreceptor layer on optical coherence tomography. This is termed as BALAD. Other associated features noted were the presence of subretinal hyperreflective material, submacular hemorrhage and subretinal fluid. Both cases were treated with monthly intravitreal injections of Inj. Ranibizumab (0.5 mg/0.05 ml). Following 3 intravitreal injections at monthly intervals, reattachment of the bacillary layer detachment were noted in case 1 while the bacillary layer detachment persisted in case 2. CONCLUSION Multimodal imaging using optical coherence tomography in these cases revealed the separation of the bacillary layer following exudative age-related macular degeneration; a finding which is not routinely described in literature.
Collapse
Affiliation(s)
- Ramesh Venkatesh
- Department of Retina-Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | - Nikitha G Reddy
- Department of Retina-Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | - Sameeksha Agrawal
- Department of Retina-Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | | | - Naresh Kumar Yadav
- Department of Retina-Vitreous, 80219Narayana Nethralaya, Bengaluru, India
| | - Jay Chhablani
- 6595University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, Pittsburg, USA
| |
Collapse
|
17
|
Ramtohul P, Malclès A, Gigon E, Freund KB, Introini U, Bandello F, Cicinelli MV. Long-Term Outcomes of Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration. Ophthalmol Retina 2021; 6:185-195. [PMID: 34587559 DOI: 10.1016/j.oret.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/03/2021] [Accepted: 09/21/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the clinical characteristics, multimodal imaging features, and long-term treatment outcomes of eyes with neovascular age-related macular degeneration (nAMD) and bacillary layer detachment (BALAD) treated with intravitreal anti-VEGF therapy. DESIGN Retrospective, longitudinal, case series. PARTICIPANTS Treatment-naive patients with nAMD (n = 30) showing BALAD on OCT and undergoing anti-VEGF therapy. METHODS Clinical records and multimodal imaging results of up to 4 years after diagnosis were reviewed. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) values were compared over time. The cumulative risk of and risk factors for subretinal fibrosis were assessed using Cox regression analyses, and adjusted hazard ratio (aHR) was computed. RESULTS Thirty eyes of 30 patients were included. Macular neovascularization (MNV) subtypes were distributed as follows: type 1, 63%; type 2, 27%; mixed type 1 and 2, 3%; type 3, 3%; aneurysmal type 1, 3%. The BCVA significantly improved after anti-VEGF loading phase (Snellen equivalent, from 20 of 118 to 20 of 71, P = 0.03), but it returned to the baseline levels at 4 years (Snellen equivalent, 20 of 103, P = 0.6). The cumulative risk of subretinal fibrosis was 77% at 4 years. The risk factors associated with subretinal fibrosis included hemorrhagic BALAD (aHR, 2.02; 95% confidence interval [CI] 1.54-3.22; P < 0.01) and the presence of subretinal hyperreflective material (aHR, 1.83; 95% CI 1.35-3.14; P < 0.01). CONCLUSIONS BALAD was found in association with all types of MNV in patients with nAMD. Long-term observation revealed poor functional outcomes related to the high risk of subretinal fibrosis.
Collapse
Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Chemin des Bourrely, Marseille, France.
| | - Ariane Malclès
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Edward Gigon
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Ugo Introini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
18
|
Ramtohul P, Freund KB. Reply. Retina 2021; 41:e72-e74. [PMID: 34334705 DOI: 10.1097/iae.0000000000003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Chemin des Bourrely, Marseille, France
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| |
Collapse
|
19
|
Soh YQ, Hoang QV, Jung JJ. Correspondence. Retina 2021; 41:e71-e72. [PMID: 34310546 DOI: 10.1097/iae.0000000000003269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yu Qiang Soh
- Department of Ophthalmology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York
| | - Jesse J Jung
- East Bay Retina Consultants, Inc, Oakland, California
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| |
Collapse
|