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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; 8:754-764. [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] [MESH Headings] [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.
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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.
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Sarici K, Vajzovic L, Jaffe GJ, Hadziahmetovic M. Bacillary layer detachment associated with photodynamic therapy-related acute exudative maculopathy in a case of central serous chorioretinopathy. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00164-9. [PMID: 39038615 DOI: 10.1016/j.jcjo.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/20/2024] [Indexed: 07/24/2024]
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3
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Steptoe PJ, Pearce I, Beare NAV, Sreekantham S, Mohammed BR, Barry RJ, Denniston AK, Murray PI. Clinical Outcomes of Observed and Treated Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis. Ocul Immunol Inflamm 2024; 32:683-689. [PMID: 37134304 DOI: 10.1080/09273948.2023.2195934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To assess the efficacy of treatment on acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinopathy (RPC). METHODS Cases were identified from three UK uveitis centers. Retrospective analysis of visual acuity recovery; OCT structural outcomes; and retinal lesion quantification in observed and treated cases of APMPPE/RPC. RESULTS There were nine APMPPE and three RPC cases. Out of 12 patients, six were female. Median age: 26.5 years (range, 20-57 years). Four cases (six eyes) were observed, and eight cases (15 eyes) received corticosteroids ± immunosuppression. 4/4 observed and 6/10 treated foveal involving eyes regained 0.00 LogMAR vision. Observed lesions achieved more favorable anatomical outcomes. New lesions post-presentation developed in 1/6 (16%) observed eye versus 10/15 (66%) treated eyes. In three cases, a delayed, rebound lesion occurrence was observed post-high-dose corticosteroids. CONCLUSIONS While subject to potential treatment bias, in this small case series, natural history alone appears non-inferior to corticosteroid treatment.
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Affiliation(s)
- Paul J Steptoe
- Deanery of Clinical Sciences, College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Ian Pearce
- St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nicholas A V Beare
- St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Robert J Barry
- Birmingham and Midland Eye Centre, Birmingham, UK
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Rare Diseases, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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4
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Prenner V, Reiter GS, Fuchs P, Birner K, Frank S, Coulibaly L, Gumpinger M, Bogunovic H, Schmidt-Erfurth U. Advancing the visibility of outer retinal integrity in neovascular age-related macular degeneration with high-resolution OCT. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00157-1. [PMID: 38901467 DOI: 10.1016/j.jcjo.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/22/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To compare the visibility and accessibility of the outer retina in neovascular age-related macular degeneration (nAMD) between 2 OCT devices. METHODS In this prospective, cross-sectional exploratory study, differences in thickness and loss of individual outer retinal layers in eyes with nAMD and in age-matched healthy eyes between a next-level High-Res OCT device and the conventional SPECTRALIS OCT (both Heidelberg Engineering GmbH, Heidelberg, Germany) were analyzed. Eyes with nAMD and at least 250 nL of retinal fluid, quantified by an approved deep-learning algorithm (Fluid Monitor, RetInSight, Vienna, Austria), fulfilled the inclusion criteria. The outer retinal layers were segmented using automated layer segmentation and were corrected manually. Layer loss and thickness were compared between both devices using a linear mixed-effects model and a paired t test. RESULTS Nineteen eyes of 17 patients with active nAMD and 17 healthy eyes were included. For nAMD eyes, the thickness of the retinal pigment epithelium (RPE) differed significantly between the devices (25.42 μm [95% CI, 14.24-36.61] and 27.31 μm [95% CI, 16.12-38.50] for high-resolution OCT and conventional OCT, respectively; p = 0.033). Furthermore, a significant difference was found in the mean relative external limiting membrane loss (p = 0.021). However, the thickness of photoreceptors, RPE integrity loss, and photoreceptor integrity loss did not differ significantly between devices in the central 3 mm. In healthy eyes, a significant difference in both RPE and photoreceptor thickness between devices was shown (p < 0.001). CONCLUSION Central RPE thickness was significantly thinner on high-resolution OCT compared with conventional OCT images explained by superior optical separation of the RPE and Bruch's membrane.
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Affiliation(s)
- Veronika Prenner
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gregor Sebastian Reiter
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Fuchs
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Klaudia Birner
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sophie Frank
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Leonard Coulibaly
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Markus Gumpinger
- Christian Doppler Laboratory for Artificial Intelligence in Retina, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Artificial Intelligence in Retina, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Casalino G, Malerba A, Fabris S, Bolli N, Croci GA, Pellegrini M, Rossi FG, Mapelli C, Viola F. Transient Bacillary Layer Detachment During the Disease Course of Primary Vitreoretinal Lymphoma. Ocul Immunol Inflamm 2024:1-6. [PMID: 38838286 DOI: 10.1080/09273948.2024.2359627] [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: 07/07/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE To report the clinical course and the retinal imaging features of a case of cytology-proven primary vitreoretinal lymphoma (PVRL) presenting with a transient bacillary layer detachment (BALAD) during the disease course. METHODS Observational case report. RESULTS A 50 year-old woman was referred to us with a 2-month history of vitritis in both eyes, poorly responding to oral prednisolone. After discontinuation of oral prednisolone, worsening of vitritis and the appearance of multiple creamy-like subretinal infiltrates in the mid-peripheral retina of both eyes, along with the exclusion of common causes of intermediate/posterior uveitis, made us consider PVRL. Aqueous humor sampling detected MYD88 L265P mutation, and subsequent diagnostic pars plana vitrectomy in the left eye yielded a positive cytology for large B cell lymphoma consistent with PVRL. During the disease course, optical coherence tomography of the macula showed a BALAD in the right eye, which resolved during follow-up. CONCLUSION Our case indicates that BALAD is a possible rare manifestation of PVRL, and this should be considered in the differential diagnosis process in order to avoid diagnostic delays.
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Affiliation(s)
- Giuseppe Casalino
- Ophthalmology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Malerba
- Ophthalmology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Fabris
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Niccolò Bolli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giorgio Alberto Croci
- Pathology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Pellegrini
- Department of Biomedical and Clinical Science "Luigi Sacco", Eye Clinic, Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Gaia Rossi
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Mapelli
- Ophthalmology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Ophthalmology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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6
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Song YY, Kim JT, Chang YS, Lee MW, Lee SC. Increased incidence and diverse manifestations of multiple evanescent white dot syndrome during the COVID-19 pandemic. Sci Rep 2024; 14:12425. [PMID: 38816508 PMCID: PMC11139874 DOI: 10.1038/s41598-024-63255-w] [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: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
The advent of coronavirus disease 2019 (COVID-19) pandemic has affected the incidence and course of various diseases and numerous studies have investigated ocular involvement associated with COVID-19 and corresponding vaccines. In this study, we compared the incidence of multiple evanescent white dot syndrome (MEWDS) before and during the COVID-19 pandemic at a single center in Korea and analyzed the demographic and clinical features of patients with MEWDS presenting during the COVID-19 pandemic. We categorized patients with MEWDS into two groups according to date of diagnosis. Pre-COVID19 group included patients diagnosed during the pre-pandemic period (between March 11, 2017, and March 10, 2020), whereas post-COVID19 group included patients diagnosed during the pandemic period (between March 11, 2020, and March 10, 2023). 6 and 12 patients were included in pre-COVID19 group and post-COVID19 group, respectively. Among all hospital visits during the pre-pandemic and pandemic periods, 0.011% and 0.030% were due to MEWDS, indicating a significant increase during the pandemic (p = 0.029, B = 2.756). The annual incidence of patients with MEWDS in 2017-2022 were 0.73, 0.75, 0.78, 1.32, 2.49, and 2.07 per 10,000 population, respectively, corresponding to a significant increase (p = 0.039, B = 1.316). Our results imply that the incidence and manifestation of MEWDS are likely to become more diverse in the COVID-19 pandemic era.
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Affiliation(s)
- Yong Yeon Song
- Onnuri Eye Hospital, #325 Baekje-daero, Jeonju, Republic of Korea.
| | - Jung Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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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
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8
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Bezci Aygun F, Kadayifcilar S. Unusual ocular manifestation: Bacillary layer detachment in acute malignant hypertension. J Fr Ophtalmol 2024:104164. [PMID: 38575421 DOI: 10.1016/j.jfo.2024.104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 04/06/2024]
Affiliation(s)
- F Bezci Aygun
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - S Kadayifcilar
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
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Ramtohul P, Au A, Kunkler AL, Bacci T, Dolz-Marco R, Gallego-Pinazo R, Yannuzzi N, Sarraf D, Freund KB. CENTRAL BOUQUET HEMORRHAGE: Clinical and Multimodal Imaging Features. Retina 2024; 44:551-557. [PMID: 38109663 DOI: 10.1097/iae.0000000000004025] [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: 12/20/2023]
Abstract
PURPOSE To describe the clinical characteristics, multimodal imaging features, and anatomic basis of a distinctive pattern of deep retinal hemorrhages located in the central fovea, a presentation referred to as "central bouquet hemorrhage." METHODS Retrospective, observational, multicenter case series of eyes with central bouquet hemorrhage. Multimodal imaging features were reviewed and analyzed. RESULTS Ten eyes from 10 patients (4 women and 6 men), with a mean age of 55.6 ± 21.7 years (range 25-84 years) were included. Underlying etiologies were neovascular age-related macular degeneration (40%), lacquer cracks in pathological myopia (30%), macular telangiectasia Type 2 (10%), proliferative diabetic retinopathy (10%), and ocular trauma associated with angioid streaks (10%). On ophthalmoscopy, all eyes with central bouquet hemorrhage displayed a deep retinal hemorrhage with round margins in the central fovea and associated with petaloid hemorrhages radiating in the surrounding Henle fiber layer. Cross-sectional optical coherence tomography showed a well-delineated round hyperreflective lesion involving the central foveal Henle fiber layer/outer nuclear layer in all cases. Accompanying hyperreflective hemorrhages tracking along the obliquely oriented Henle fiber layer were present in all eyes. Resolution occurred in all patients, either spontaneously (30%) or after treatment with intravitreal anti-vascular endothelial growth factor injections (70%), and was associated with partial visual acuity improvement (from 20/113 to 20/36). CONCLUSION "Central bouquet hemorrhage" is a novel descriptive term describing a characteristic round pattern of intraretinal blood in the fovea associated with Henle fiber layer hemorrhage and encountered in a spectrum of macular disease.
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Affiliation(s)
- Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Adrian Au
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Anne L Kunkler
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Tommaso Bacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | | | | | - Nicolas Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - 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
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10
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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.
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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
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Mahar PS, Monis MD, Memon AS, Azam M. Bilateral Acute Posterior Multifocal Placoid Pigment Epitheliopathy With Bacillary Layer Detachment Following Sinopharm COVID-19 Vaccination: A Case Report. Cureus 2024; 16:e55369. [PMID: 38562362 PMCID: PMC10982682 DOI: 10.7759/cureus.55369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Various ocular manifestations associated with COVID-19 and vaccines, affecting both the anterior and posterior segments of the eye have been documented in the literature. In this report, we present the case of a 25-year-old male who complained of sudden-onset blurred vision and metamorphopsia in both eyes one day after receiving the second dose of the Sinopharm COVID-19 vaccine. The visual loss was painless, with no reported flashes or floaters. The patient had no significant medical or surgical history, no history of trauma, and no drug intake. Upon ocular examination, the best-corrected visual acuity was 6/60 (Snellen chart) in both eyes. The anterior segments appeared unremarkable, while fundoscopy revealed multiple yellowish-white subretinal lesions at the posterior pole of both eyes. Spectral domain optical coherence tomography (SD-OCT) confirmed the presence of subretinal fluid (SRF) with neurosensory detachment in each eye, along with bacillary layer detachment (BALAD). There were no signs of inflammation in the vitreous cavity. A diagnosis of acute posterior multifocal plaque pigment epitheliopathy (APMPPE) was established. The patient was prescribed nepafenac 0.1% drops to be instilled three times a day in both eyes and was advised to return for a follow-up examination in two weeks. At the follow-up visit, the patient's vision had improved to 6/9 in the right eye and 6/6 in the left eye, with most of the SRF absorbed. Unilateral APMPPE with BALAD has been mentioned in the literature following various COVID-19 vaccinations, but, to the best of our knowledge, this is the first case report where bilateral APMPPE with BALAD is reported. This case emphasizes the importance of a thorough eye examination for individuals experiencing ocular symptoms after receiving the COVID-19 vaccine.
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Affiliation(s)
- P Salim Mahar
- Ophthalmology, Aga Khan University Hospital, Karachi, PAK
- Ophthalmology, Isra Postgraduate Institute of Ophthalmology, Karachi, PAK
| | | | | | - Muhammad Azam
- Ophthalmology, Isra Postgraduate Institute of Ophthalmology, Karachi, PAK
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12
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Roditi E, Panicker S, Fung AT. Intravascular large B-cell lymphoma of the eye: Literature review and new findings. Asia Pac J Ophthalmol (Phila) 2024; 13:100053. [PMID: 38556129 DOI: 10.1016/j.apjo.2024.100053] [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: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/21/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Intravascular large B-cell lymphoma (IVLBCL) is an extremely rare, aggressive, multi-system disease that can affect the eye. We describe the ophthalmic presentation, multimodal imaging and treatment response of uveal IVLBCL. METHODS Review and case report. RESULTS Twenty-five published cases of IVLBCL involving the eye including our own were identified. Of these, 15 patients (60%) had clinically-detectable intraocular involvement, 6 (24%) had extraocular ophthalmic involvement only and 4 (16%) had subclinical, undiagnosed intraocular involvement that was retrospectively detected on post-mortem ocular histopathology. The male to female ratio was 1.08:1 with a mean presenting age of 65.1 ± 11.7 years (range 38-82 years). The majority of cases had bilateral involvement (21/25 patients, 84%). Extraocular manifestations included diplopia, ptosis and ophthalmoplegia. Intraocular manifestations included serous retinal detachment (13/28, 46%), retinal hemorrhages (9/28, 32%), vascular changes (9/28, 32%), retinal pigment epithelial changes (7/28, 25%), thickened choroid (6/28, 21%), vitritis (5/28, 17%), cotton-wool spots (3/28, 10%), and a subretinal lesion (1/28, 3%). Histopathological diagnosis was most commonly confirmed on post-mortem enucleation (8/25 patients, 32%), skin (6/25 patients, 24%) or brain biopsy (6/25 patients, 24%). CONCLUSION The presence of intra-retinal hemorrhages, cotton wool spots and/or Roth spots help differentiate IVLBCL from other similarly presenting diseases such as central serous chorioretinopathy and Vogt-Koyanagi-Harada disease. New signs not previously described in IVLBCL include macular bacillary layer detachment and hypo-cyanescent spots on ultra-wide field indocyanine green angiography. The diagnosis is elusive and requires tissue biopsy, but systemic chemotherapy and rituximab can lead to rapid improvement of the eye.
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Affiliation(s)
- Eduardo Roditi
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shyam Panicker
- Department of Haematology, Blood Transplant and Cellular Therapies, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead and Central Clinical Schools, Specialty of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, New South Wales, Australia.
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Pandya BU, Grinton M, Mandelcorn ED, Felfeli T. RETINAL OPTICAL COHERENCE TOMOGRAPHY IMAGING BIOMARKERS: A Review of the Literature. Retina 2024; 44:369-380. [PMID: 37903455 PMCID: PMC10885864 DOI: 10.1097/iae.0000000000003974] [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: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE The aim of this literature review was to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically. METHODS The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features. RESULTS Thirty-seven OCT terminologies were identified. The vitreomacular interface disorder group included the four stages of epiretinal membrane, macular pseudohole, tractional lamellar hole (LH), degenerative LH, cotton ball sign, and foveal crack sign. The age-related macular degeneration group included outer retinal tubulation, multilayered pigment epithelial detachment, prechoroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete retinal pigment epithelium and outer retinal atrophy, and reticular pseudodrusen. The uveitic disorder group consisted of bacillary layer detachment, syphilis placoid, rain-cloud sign, and pitchfork sign. The disorders relating to the toxicity group included flying saucer sign and mitogen-activated protein kinase (MEK) inhibitor-associated retinopathy. The disorders associated with the systemic condition group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorder group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, inner nuclear layer microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω). CONCLUSIONS Thirty-seven OCT terminologies were summarized, and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential because of their predictive and prognostic value.
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Affiliation(s)
- Bhadra U. Pandya
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Grinton
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
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14
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Fernández-Vigo JI, López-Guajardo L, Dolz-Marco R, Donate-López J. Multilayered Exudative Bacillary Layer Detachment in Active Choroidal Neovascularization: A New Optical Coherence Tomography Sign. Ophthalmic Surg Lasers Imaging Retina 2024; 55:92-94. [PMID: 38198613 DOI: 10.3928/23258160-20231207-01] [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: 01/12/2024]
Abstract
In this article, we present three cases diagnosed with active choroidal neovascularization (CNV): two cases diagnosed with neovascular age-related macular degeneration (nAMD), and one case with myopic CNV in an elderly eye that presented a characteristic and unique optical coherence tomography (OCT) sign consisting of well-defined, circular-shaped multiple concentric layers of alternating iso-hyperreflective material located between the external limiting membrane and outer photoreceptor layers, which seems to be a multilayered bacillary layer detachment (BALAD). Multilayered exudative BALAD in active CNV may be a new and characteristic OCT sign. [Ophthalmic Surg Lasers Imaging Retina 2024;55:92-94.].
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15
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Desai A, Tyagi M. Bacillary layer detachment as an inflammatory biomarker in toxoplasmosis retinochoroiditis: serial evolution on optical coherence tomography. BMJ Case Rep 2023; 16:e256629. [PMID: 38129084 DOI: 10.1136/bcr-2023-256629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
We describe the clinical course and serial evolution of bacillary layer detachment (BALAD) on optical coherence tomography (OCT) in toxoplasmosis retinochoroiditis and its importance as an inflammatory biomarker. Colour fundus photography and swept-source OCT of the BALAD were done at the time of presentation and subsequently at 1 week, 2 weeks, 4 weeks and at 11 weeks. Treatment involved oral trimethoprim (160 mg) + sulphamethoxazole (800 mg) two times per day, started at presentation for 2 months. Oral prednisolone was started after 1 week at a dose of 50 mg a day and tapered weekly over the next 5 weeks. The BALAD initially increased after starting treatment with trimethoprim-sulphamethoxazole and regressed within 1 week after initiation of oral prednisolone. Best corrected visual acuity improved to 20/40 from 20/160 at presentation (Snellen equivalent). This suggests that BALAD is an indicator of an acute inflammatory event and the accumulated fluid is secondary to retinal and choroidal inflammation.
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Affiliation(s)
- Arjun Desai
- Anant Bajaj Retina Institute, LVPEI, Hyderabad, Telangana, India
| | - Mudit Tyagi
- Anant Bajaj Retina Institute, LVPEI, Hyderabad, Telangana, India
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16
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Govetto A, Radice P, Lucchini S, Bacherini D, Rizzo S, Savastano A. Recovery of bacillary layer detachment associated with macula-off rhegmatogenous retinal detachment: Evidence of foveation mechanisms? Am J Ophthalmol Case Rep 2023; 32:101923. [PMID: 37693691 PMCID: PMC10482997 DOI: 10.1016/j.ajoc.2023.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To describe the mechanisms of postoperative foveal restoration in three patients with bacillary layer detachment (BALAD) associated with macula-off rhegmatogenous retinal detachment. Observations BALAD associated with macula-off rhegmatogenous retinal detachment presented with two different morphologies: with an intact foveal roof (case 1) and lamellar, with an open foveal roof (cases 2 and 3). In case 1 visual acuity significantly improved and foveal morphology completely restored at postoperative month 6, with a marked increase in foveal thickness. Case 2 presented with a lamellar BALAD in a long-standing retinal detachment, and it was treated with scleral buckling with an unfavourable evolution into a full-thickness hole in the early postoperative period. It was then addressed with internal limiting membrane peeling and inverted flap, which resulted in the resolution of the lesion, but with limited postoperative visual and anatomical recovery. Case 3 lamellar BALAD was directly addressed with pars plana vitrectomy, ILM peeling and inverted flap, with a remarkable foveal anatomical restoration and visual acuity improvement over the follow-up period. Conclusions and importance The process of foveation may play a key role in the healing process of BALAD associated with rhegmatogenous retinal detachment. Lamellar BALAD should be considered and treated as a FTMH associated with retinal detachment. The two BALAD subtypes may represent different clinical stages of the BALAD spectrum.
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Affiliation(s)
- Andrea Govetto
- Ophthalmology Department, Vitreoretinal Division, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Paolo Radice
- Ophthalmology Department, Vitreoretinal Division, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Sara Lucchini
- Ophthalmology Department, Vitreoretinal Division, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Daniela Bacherini
- Ophthalmology Department, Careggi Hospital, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, Pisa, Italy
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17
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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.].
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18
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Fernández-Vigo JI, Moreno-Morillo FJ, Burgos-Blasco B, Ly-Yang F, Oribio-Quinto C, García-Caride S, Donate-López J. TWO-YEAR CLINICAL OUTCOMES AFTER PHOTODYNAMIC ACUTE EXUDATIVE MACULOPATHY IN PATIENTS WITH CHRONIC CENTRAL SEROUS CHORIORETINOPATHY. Retina 2023; 43:1988-1995. [PMID: 37343292 DOI: 10.1097/iae.0000000000003876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
PURPOSE To analyze the 2-year clinical outcomes after photodynamic therapy-induced acute exudative maculopathy (PAEM) in patients with chronic central serous chorioretinopathy. METHODS Prospective observational study that included 64 eyes of 64 patients with chronic central serous chorioretinopathy who received half-fluence photodynamic therapy and had a 2-year follow-up. Patients were classified into two groups based on whether they had had PAEM at 3 days after treatment (PAEM+, n = 22; ≥50 µ m) increase in subretinal fluid or not (PAEM-, n = 42). Best-corrected visual acuity and subretinal fluid changes evaluated with optical coherence tomography were registered at 3 days, 1 month, 3 months, 1 year, and 2 years after photodynamic therapy. The number of recurrences, the appearance of outer retinal atrophy, and choroidal neovascularization were analyzed. RESULTS Best-corrected visual acuity was 75.9 ± 13.6 (20/32) and 82.0 ± 11.0 letters (20/25) at 2 years in the PAEM+ and PAEM- groups, respectively ( P = 0.055). There were no differences in the best-corrected visual acuity change (4.2 ± 7.7 vs. 3.3 ± 7.1 letters; P = 0.654) and the subretinal fluid decrease (-117.3 ± 74.2 vs. -138.5 ± 83.6 µ m; P = 0.323) at 2 years between patients with and without PAEM. No differences in the number of recurrences ( P = 0.267), the appearance of choroidal neovascularization ( P = 0.155), or outer retinal atrophy ( P = 0.273) between both groups were noted. CONCLUSION Patients with chronic central serous chorioretinopathy with and without PAEM presented similar results at 2 years in best-corrected visual acuity gain, subretinal fluid reduction, and complication rate.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; and
- Department of Ophthalmology, Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | | | - Barbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; and
| | - Fernando Ly-Yang
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; and
| | - Carlos Oribio-Quinto
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; and
| | - Sara García-Caride
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; and
| | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; and
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19
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Ramtohul P, Freund KB, Parodi MB, Introini U, Bandello F, Miserocchi E, Cicinelli MV. PUNCTATE INNER PACHYCHOROIDOPATHY: Demographic and Clinical Features of Inner Choroidal Inflammation in Eyes with Pachychoroid Disease. Retina 2023; 43:1960-1970. [PMID: 37657077 DOI: 10.1097/iae.0000000000003926] [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: 09/03/2023]
Abstract
PURPOSE To perform an unsupervised machine learning clustering of patients with punctate inner choroidopathy (PIC) and provide new insights into the significance of pachychoroid disease features in PIC eyes. METHODS Retrospective multicenter study, including 102 eyes from 82 patients diagnosed with PIC. Demographics, clinical data, and multimodal imaging, including fundus photography, optical coherence tomography, and indocyanine green angiography, were collected. Clusters of eyes were identified, and multilevel logistic regression analysis was performed to compare between-group differences. RESULTS Using 17 clinical features, two distinct clusters of patients with PIC were identified. Cluster 1 patients were characterized by older age, high myopia, myopic maculopathy features, thin choroids, multiple lesions, and a higher likelihood of developing patchy chorioretinal atrophy. Cluster 2 consisted of younger age, emmetropia or low myopia, thick choroids, choroidal vascular hyperpermeability on late-phase indocyanine green angiography, and high prevalence of focal choroidal excavation. These features exhibited significant differences ( P < 0.05) between the two clusters. CONCLUSION While PIC typically affects young myopic female patients with thin choroids, a subset of patients with PIC exhibits features associated with pachychoroid disease. Considering the potential influence of choroidal venous insufficiency on PIC manifestations and secondary complications, we propose the term "punctate inner pachychoroidopathy" to characterize this distinct subtype of PIC.
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Affiliation(s)
- Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - 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
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Ugo Introini
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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20
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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]
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21
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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.
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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
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22
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Martins Melo I, Jhaveri A, Bansal A, Lee WW, Oquendo PL, Curcio CA, Muni RH. Pathophysiology of Secondary Macular Hole in Rhegmatogenous Retinal Detachment. Invest Ophthalmol Vis Sci 2023; 64:12. [PMID: 37815508 PMCID: PMC10573647 DOI: 10.1167/iovs.64.13.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023] Open
Abstract
Purpose To describe the pathophysiology of secondary macular hole (MH) in rhegmatogenous retinal detachment (RRD). Methods A retrospective cohort of 360 consecutive primary fovea-off RRDs presenting to St. Michael's Hospital, Toronto, from January 2012 to September 2022 were included. Preoperative OCT was assessed for bacillary layer detachment (BALAD) abnormalities. Histological sections of normal eyes were assessed to inform OCT interpretations. Primary outcome measure was the progression of BALAD to full-thickness MH (FTMH). Results Of the 360 patients, 22.5% (n = 81) had BALAD abnormalities at presentation. Eight percent (29/360) had associated MH, of which 79.3% (23/29) were a BALAD-lamellar hole and 20.7% (6/29) were FTMH. After reattachment, 62% of MHs persisted (18/29), of which 83% (15/18) had BALAD-lamellar holes that subsequently progressed to FTMH in a mean of 8.1 ± 3.2 days. BALAD-lamellar holes had significantly worse postoperative visual acuity (P < 0.001) when compared with other BALAD abnormalities (58/81) or with the rest of the cohort (279/360). OCT spectrum from BALAD to FTMH includes (1) cleavage planes extending from Henle fiber layer into the BALAD; (2) central outer nuclear layer thinning; (3) Müller cell cone loss with tissue remnants at the foveal walls; (4) retinal tissue operculum close to BALAD-MH; and (5) progressive thinning or degradation of the posterior band of BALAD-lamellar hole leading to FTMH. Histological specimens identified foveal regions of low mechanical stability. Conclusions BALAD plays a crucial role in the pathophysiology of MH in RRDs, which forms owing to sequential changes in four critical areas: RPE-photoreceptor interface, myoid zone, Henle fiber layer, and Müller cell cone with surrounding tissue. Timely management of fovea-off RRD with BALAD may be prudent to avoid the progression to BALAD-lamellar hole, subsequent FTMH, and worse functional outcomes.
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Affiliation(s)
- Isabela Martins Melo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aaditeya Jhaveri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Bansal
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wei Lee
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Paola L. Oquendo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Alabama, United States
| | - Rajeev H. Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Institute, Toronto, Ontario, Canada
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23
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Kwak JJ, Lee J, Byeon SH. CLINICAL FEATURES AND PROGNOSTIC VALUE OF BACILLARY LAYER DETACHMENT IN ACUTE VOGT-KOYANAGI-HARADA DISEASE. Retina 2023; 43:1700-1707. [PMID: 37315551 DOI: 10.1097/iae.0000000000003858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To evaluate the characteristics of bacillary layer detachment (BALAD) in acute Vogt-Koyanagi-Harada (VKH) disease and determine its prognostic value. METHODS Seventy patients with acute VKH disease with a minimum follow-up of 6 months were studied. The primary outcomes were clinical characteristics associated with BALAD, including features on multimodal imaging at baseline and follow-up. The secondary outcomes included best-corrected visual acuity and VKH with recurrence features. RESULTS Of 70 eyes (36 patients), 41 (58.6%) showed BALAD. The mean baseline best-corrected visual acuity and mean best-corrected visual acuity after resolution of serous retinal detachment were significantly lower in the BALAD group than in the no-BALAD group (0.90 ± 0.49 vs. 0.35 ± 0.35 log minimum angle of resolution, P < 0.001 and 0.39 ± 0.27 vs. 0.20 ± 0.20 log minimum angle of resolution, P = 0.020). The loss of ellipsoid zone integrity at baseline, proportion of serous retinal detachment, duration of serous retinal detachment, loss of ellipsoid zone integrity at 1 month, and subfoveal choroidal thickness at baseline were significantly higher in the BALAD group ( P = 0.017, P = 0.006, P = 0.023, P = 0.002, and P = 0.046, respectively). The mean best-corrected visual acuity and subfoveal choroidal thickness did not differ between the two groups at 6 months ( P = 0.380 and P = 0.180, respectively). Bacillary layer detachment at baseline was found to be a significant prognostic factor for VKH with recurrence features ( P = 0.007). CONCLUSION Vogt-Koyanagi-Harada with BALAD featured more severe clinical characteristics than VKH without BALAD during the acute phase. Patients with baseline BALAD require more vigilant monitoring as they are more likely to show recurrence features within the first 6 months.
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Affiliation(s)
- Jay Jiyong Kwak
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and
| | - Junwon Lee
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and
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24
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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
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25
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Ramtohul P, Cicinelli MV, Dolz-Marco R, Gal-Or O, Mrejen S, García-Martínez JR, Goldberg A, de Souza EC, Miserocchi E, Cunningham ET, Yannuzzi LA, Freund KB, Tsui E. THE CHRYSANTHEMUM PHENOTYPE OF IDIOPATHIC MULTIFOCAL CHOROIDITIS. Retina 2023; 43:1377-1385. [PMID: 37071923 PMCID: PMC10527426 DOI: 10.1097/iae.0000000000003815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To describe the clinical characteristics and multimodal imaging features of a distinctive subtype of active idiopathic multifocal choroiditis (iMFC) lesions with grey-yellow chorioretinal lesions surrounded by smaller satellite dots, a presentation referred to as "chrysanthemum lesions." METHODS Retrospective, observational, multicenter case series of eyes with active iMFC and chrysanthemum lesions. Multimodal imaging features were reviewed and presented. RESULTS Twenty-five eyes from 20 patients (12 women and 8 men), with a mean age of 35.8 ± 17.0 years (range, 7-78 years) were included. Chrysanthemum lesions were equally located in the macula (48.0%) or the mid/far periphery (52.0%). The number of lesions per eye varied from 1 (16.0%) to more than 20 (56.0%). On optical coherence tomography, chrysanthemum lesions showed typical features of iMFC, including subretinal hyperreflective material splitting the retinal pigment epithelium/Bruch membrane. Chrysanthemum lesions were hypoautofluorescent on fundus autofluorescence imaging, hyperfluorescent on fluorescein angiography, hypofluorescent on indocyanine green angiography, and associated with choriocapillaris flow signal deficit on optical coherence tomography angiography. CONCLUSION Active iMFC may present with findings resembling chrysanthemum lesions. The distinctive lesion morphology on ophthalmoscopic examination, the large number of lesions, and the high prevalence of exclusive midperipheral and far peripheral involvement may represent a distinctive phenotype of iMFC.
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Affiliation(s)
- Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Orly Gal-Or
- Department of Ophthalmology, 36632 Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel
| | - Sarah Mrejen
- Ophthalmic Center for Imaging and Laser, Paris, France
| | | | - Alla Goldberg
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | | | - Elisabetta Miserocchi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Emmett T. Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
| | | | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Edmund Tsui
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
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Betsch DM, Sarraf D, Francisconi CLM. EXUDATIVE RETINAL DETACHMENT AFTER INTRAVITREAL BROLUCIZUMAB INJECTION. Retin Cases Brief Rep 2023; 17:463-465. [PMID: 36893333 DOI: 10.1097/icb.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report an unusual case of a patient who presented with intraocular inflammation (IOI) and an exudative retinal detachment after first brolucizumab injection and to compare this case to the existing literature. METHODS An 80-year-old woman being treated for neovascular age-related macular degeneration presented 11 days after her first intravitreal injection of brolucizumab with IOI and an exudative retinal detachment. She was treated with systemic and topical steroids. The patient's chart was thoroughly reviewed, and notes were made on visual acuities and ocular examination findings at each relevant visit. Optical coherence tomography and ultra-widefield fluorescein angiography (UWFA) images were taken across multiple timepoints. RESULTS The patient's IOI and exudative retinal detachment resolved three weeks after brolucizumab injection. In the literature, the incidence of IOI has been reported to be higher with brolucizumab versus aflibercept, but most of these cases were considered to be mild to moderate in severity. More recently, reports of severe IOI and retinal vasculitis associated with brolucizumab have been published in postmarketing surveillance articles. CONCLUSION To the authors' knowledge, this is the first report of exudative retinal detachment after intravitreal brolucizumab injection. As the experience with this new drug continues to grow, reports of these events are critical to increase the understanding, so that future management strategies can be developed to improve patient outcomes.
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Affiliation(s)
- Devin M Betsch
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Canada; and
| | - David Sarraf
- Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, California
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Sanchez-Quiros J, Burgos-Blasco B, Montolío-Marzo E, Medina-García E, Ramos-Amador JT, Diaz-Valle D. Toxoplasmic maculopathy with bacillary layer detachment in a pediatric patient. J AAPOS 2023; 27:176-179. [PMID: 37054965 DOI: 10.1016/j.jaapos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/15/2023]
Abstract
We report the case of a 14-year-old girl with ocular toxoplasmosis presenting with severe panuveitis with anterior segment involvement, moderate vitreous haze, focal retinochoroiditis, extensive retinal periphlebitis, and macular bacillary layer detachment. Toxoplasmosis treatment was complicated by Stevens-Johnson syndrome, which developed 8 days after starting trimethoprim-sulfamethoxazole.
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Affiliation(s)
- Julia Sanchez-Quiros
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Barbara Burgos-Blasco
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Montolío-Marzo
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Medina-García
- Pediatrics, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jose Tomas Ramos-Amador
- Pediatrics, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Diaz-Valle
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Departments of Immunology, Ophthalmology, and ENT, Faculty of Medicine, Complutense University of Madrid, IdISSC, Madrid, Spain
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Ledesma-Gil G, Desmettre T, Mainster MA. BACILLARY LAYER DETACHMENT AFTER PHOTODYNAMIC THERAPY FOR CENTRAL SEROUS CHORIORETINOPATHY. Retin Cases Brief Rep 2023; 17:239-241. [PMID: 34580248 DOI: 10.1097/icb.0000000000001190] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical and optical coherence tomography findings of a patient with chronic central serous chorioretinopathy who developed a short-term bacillary layer detachment after photodynamic therapy (PDT). METHODS A 56-year-old man presented with metamorphopsia and 20/100 visual acuity in his right eye. He was diagnosed with active, chronic central serous chorioretinopathy based on clinical findings and multimodal imaging. His visual problems and retinal findings persisted for 3 months before he was treated with half-fluence, half-dose verteporfin PDT. RESULTS The patient had a prominent decrease in his vision postoperatively. Two days after treatment, multimodal imaging showed a marked increase in exudation that merged preoperative neurosensory retinal detachments. A prominent subfoveal bacillary layer detachment was also present. The subretinal fluid and bacillary layer detachment resolved over the next 8 weeks, with a return of visual acuity to its baseline level and normalization of retinal structures except for a small zone of subfoveal ellipsoid zone and interdigitation zone disruption. CONCLUSION Half-fluence, half-dose verteporfin PDT caused a fulminant increase in subretinal fluid and an associated subfoveal bacillary layer detachment. We hypothesize that chronic central serous chorioretinopathy-related chorioretinal dysfunction contributed to the severe PDT-induced local inflammatory reaction that caused the patient's bacillary layer detachment. Hyperacute choroidal exudation too fulminant for containment in subretinal space extended into and exceeded photoreceptor inner segment tensile strength, cleaving the myoid layer and/or dissecting it from the ellipsoid layer. This finding broadens the causality spectrum of bacillary layer detachments and vision losses that can follow PDT.
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Affiliation(s)
- Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | | | - Martin A Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas
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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.
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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
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Desmettre T, Mainster MA, Ledesma-Gil G. Half-Fluence, Half-Dose Photodynamic Therapy: Less Direct Damage but More Inflammation? Pharmaceuticals (Basel) 2023; 16:ph16040494. [PMID: 37111251 PMCID: PMC10142015 DOI: 10.3390/ph16040494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Objective: To present clinical findings and multimodal imaging of three patients who developed bacillary layer detachments (BALADs) shortly after half-fluence, half-dose (HFHD) verteporfin photodynamic therapy (PDT). Methods: Retrospective observational case series. Three patients were treated with HFHD-PDT for (1) macular neovascularisation five years after resolved central serous chorioretinopathy (CSC), (2) persistent serous retinal detachment (SRD) from chronic CSC, and (3) neovascular age-related macular degeneration with persistent SRD despite intravitreal anti-VEGF therapy. Results: Each patient developed a BALAD after HFHD-PDT. Acute fulminant exudation caused subretinal fluid expansion into the inner photoreceptor layer, cleaving myoid from ellipsoid zones in the central macula. Subretinal fluid and the BALADs subsequently resolved over 6–8 weeks. Conclusions: The subretinal fluid and BALAD following HFHD-PDT were transient and did not cause photoreceptor damage over a 6-month follow-up period. We speculate that the reduced-impact HFHD protocol decreases direct tissue damage but increases proinflammatory cytokines. The long-term pathophysiological consequences of the resolved BALADs are unknown.
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Affiliation(s)
- Thomas Desmettre
- Centre de Rétine Médicale, 187 rue de Menin, 59520 Marquette-Lez-Lille, France
- Correspondence: ; Tel.: +33-(0)-320-02-11-77
| | - Martin A. Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS 66208, USA
| | - Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City 06800, Mexico
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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.
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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
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Cunningham ET, Yamamoto JH, Arevalo JF, Smit DP. Retinal Detachment in Uveitis. Ocul Immunol Inflamm 2023; 31:1-2. [PMID: 36693192 DOI: 10.1080/09273948.2022.2162804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Joyce Hisae Yamamoto
- The Department of Ophthalmology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Fuganti RM, Casella AM, Roisman L, Zett C, Maia M, Farah ME, Lima LH. Case series bacillary layer detachment associated with acute central serous chorioretinopathy in patients with COVID-19. Am J Ophthalmol Case Rep 2022; 28:101690. [PMID: 36090956 PMCID: PMC9448706 DOI: 10.1016/j.ajoc.2022.101690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/06/2022] [Accepted: 08/21/2022] [Indexed: 11/12/2022] Open
Abstract
Bacillary layer detachment (BALAD) may be associated with the systemic inflammatory reaction related to COVID-19 disease, and steroid use. The causality spectrum of BALAD and vision losses can be followed by acute central serous chorioretinopathy presentation.
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34
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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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: 5] [Impact Index Per Article: 2.5] [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.
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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.
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Ramtohul P, Cabral D, Oh D, Galhoz D, Freund KB. En face ultra-widefield optical coherence tomography of the vortex vein system in central serous chorioretinopathy. Ophthalmol Retina 2022; 7:346-353. [PMID: 36228952 DOI: 10.1016/j.oret.2022.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To investigate whether noninvasive en face ultrawidefield (UWF) OCT can demonstrate salient features of the choroidal vasculature in eyes with central serous chorioretinopathy (CSC). DESIGN Retrospective observational case series. PARTICIPANTS Patients diagnosed with CSC who underwent UWF indocyanine green angiography (ICGA) and widefield OCT imaging were included. METHODS Widefield OCT imaging was performed with a horizontal 23-mm × vertical 20-mm field of view of 5 visual fixations (1 central and 4 peripheral fixations) to compose structural en face UWF OCT montage images and UWF choroidal thickness maps. Automated image alignment was performed before grading. MAIN OUTCOME MEASURES A comparison of choroidal vascular findings seen with UWF ICGA and en face UWF OCT images, including size and distribution of choroidal venous drainage areas and identification of dilated choroidal veins (pachyvessels) crossing the physiologic choroidal watershed zones. The spatial correlation between choroidal vascular hyperpermeability on UWF ICGA images and areas of choroidal thickening on UWF choroidal thickness maps was determined. RESULTS Forty-two eyes from 27 patients with CSC with a mean age of 56 ± 12 years (range, 31-77 years) were included. Quantitative measures of vortex vein drainage areas on en face UWF OCT images were significantly and positively correlated with those obtained with UWF ICGA (mean Pearson r = 0.825, P < 0.01). Identification of pachyvessels crossing the choroidal watershed zones showed an excellent correlation between UWF ICGA and en face UWF OCT images (mean Spearman ρ = 0.873, P < 0.01). In all cases, choroidal vascular hyperpermeability was observed on UWF ICGA spatially colocalized with areas of choroidal thickening on the UWF choroidal thickness map. Congestion within the entire drainage area of the dominant vortex systems was observed on UWF choroidal thickness maps. CONCLUSIONS In eyes with CSC, noninvasive en face UWF OCT imaging can show distinctive features of choroidal venous insufficiency previously identified with UWF ICGA. Ultrawidefield OCT choroidal thickness maps enable quantitative assessment of choroidal congestion. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, New York; NMS Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Daniel Oh
- Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear and Throat Hospital, New York, New York; Columbia University Irving Medical Center, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York; Department of Ophthalmology, New York University Grossman School of New York, New York
| | - Daniel Galhoz
- NMS Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University Grossman School of New York, New York.
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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.
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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
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Agarwal A, Invernizzi A. The Role of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Differential Diagnosis of Posterior Uveitis. Ocul Immunol Inflamm 2022; 30:682-689. [PMID: 35593586 DOI: 10.1080/09273948.2022.2071743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities. METHODS Narrative review. RESULTS In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis. CONCLUSIONS Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan, Milan, Italy.,The Discipline of Clinical Ophthalmology and Eye Health, Save Sight Institute, Sydney Eye Hospital, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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Giannini JP, Lu R, Bower AJ, Fariss R, Tam J. Visualizing retinal cells with adaptive optics imaging modalities using a translational imaging framework. BIOMEDICAL OPTICS EXPRESS 2022; 13:3042-3055. [PMID: 35774328 PMCID: PMC9203084 DOI: 10.1364/boe.454560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 05/18/2023]
Abstract
Adaptive optics reflectance-based retinal imaging has proved a valuable tool for the noninvasive visualization of cells in the living human retina. Many subcellular features that remain at or below the resolution limit of current in vivo techniques may be more easily visualized with the same modalities in an ex vivo setting. While most microscopy techniques provide significantly higher resolution, enabling the visualization of fine cellular detail in ex vivo retinal samples, they do not replicate the reflectance-based imaging modalities of in vivo retinal imaging. Here, we introduce a strategy for imaging ex vivo samples using the same imaging modalities as those used for in vivo retinal imaging, but with increased resolution. We also demonstrate the ability of this approach to perform protein-specific fluorescence imaging and reflectance imaging simultaneously, enabling the visualization of nearly transparent layers of the retina and the classification of cone photoreceptor types.
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Gaillard MC, Vaclavik V, DeGottrau P, Odermatt R, Schiappacasse L, Schalenbourg A. Bacillary Layer Detachment (BALAD) in Macular Choroidal Metastasis of a Low-grade Rectal Adenocarcinoma. Klin Monbl Augenheilkd 2022; 239:582-585. [PMID: 35472810 DOI: 10.1055/a-1778-4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Marie-Claire Gaillard
- Department of Ophthalmology, HFR Fribourg, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Veronika Vaclavik
- Department of Ophthalmology, HFR Fribourg, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.,Department of Ophthalmology, Jules-Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland
| | - Philippe DeGottrau
- Department of Ophthalmology, HFR Fribourg, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Rahel Odermatt
- Department of Hematology and Oncology, HFR Fribourg, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Luis Schiappacasse
- Department of Oncology, Radiation Oncology Service, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Ann Schalenbourg
- Department of Ophthalmology, Jules-Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland
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Bacillary Layer Retinal Detachment in Neovascular Age-Related Macular Degeneration. Ophthalmol Retina 2022; 6:183-184. [PMID: 35248250 DOI: 10.1016/j.oret.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 01/26/2023]
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Ball JM, Chen S, Li W. Mitochondria in cone photoreceptors act as microlenses to enhance photon delivery and confer directional sensitivity to light. SCIENCE ADVANCES 2022; 8:eabn2070. [PMID: 35235359 PMCID: PMC8890704 DOI: 10.1126/sciadv.abn2070] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 05/10/2023]
Abstract
Mammalian photoreceptors aggregate numerous mitochondria, organelles chiefly for energy production, in the ellipsoid region immediately adjacent to the light-sensitive outer segment to support the high metabolic demands of phototransduction. However, these complex, lipid-rich organelles are also poised to affect light passage into the outer segment. Here, we show, via live imaging and simulations, that despite this risk of light scattering or absorption, these tightly packed mitochondria "focus" light for entry into the outer segment and that mitochondrial remodeling affects such light concentration. This "microlens"-like feature of cone mitochondria delivers light with an angular dependence akin to the Stiles-Crawford effect (SCE), providing a simple explanation for this essential visual phenomenon that improves resolution. This new insight into the optical role of mitochondria is relevant for the interpretation of clinical ophthalmological imaging, lending support for the use of SCE as an early diagnostic tool in retinal disease.
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Affiliation(s)
- John M. Ball
- Retinal Neurophysiology Section, National Eye Institute, NIH, Bethesda, MD 20892, USA
| | - Shan Chen
- Retinal Neurophysiology Section, National Eye Institute, NIH, Bethesda, MD 20892, USA
| | - Wei Li
- Corresponding author. (J.M.B.); (W.L.)
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ACUTE EXUDATIVE MACULOPATHY AND BACILLARY LAYER DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY PATIENTS AFTER PHOTODYNAMIC THERAPY. Retina 2022; 42:859-866. [PMID: 35019888 DOI: 10.1097/iae.0000000000003404] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the incidence and characteristics of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) and bacillary layer detachment (BALAD) in patients with chronic central serous chorioretinopathy (CSCR). METHODS Prospective observational case series including 92 eyes of 75 patients that underwent PDT. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and OCT angiography were performed before, 3 days, 1 month and 3 months after half-fluence PDT. Two groups were established depending on the presence or absence (N=28 and N=64 respectively) of PAEM. Choriocapillaris flow voids increase, subfoveal choroidal thickness (SFCT) and the presence of choroidal neovascularization (CNV) were collected. RESULTS The incidence of PAEM was 28/92 (30.4%). There was no difference in the age, gender, baseline subretinal fluid (SRF), SFCT or the presence of CNV between groups (p≥0.094). No differences emerged in the SRF at one and three months after PDT between groups (p≥0.524), nor in the mean BCVA gain at three months (4.1±7.6 versus 3.6±6.4 letters; p=0.773). A BALAD was observed in 13 patients with PAEM (46.4%). CONCLUSION PAEM is frequent in patients with chronic CSCR but has a favorable prognosis. There was no association between PAEM and age, gender, SFCT or CNV, however, it was related to choriocapillaris flow voids increase.
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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
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