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Tayal A, Daigavane S, Gupta N. Vogt-Koyanagi-Harada Disease: A Narrative Review. Cureus 2024; 16:e58867. [PMID: 38800227 PMCID: PMC11116741 DOI: 10.7759/cureus.58867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Vogt-Koyanagi-Harada (VKH) disease is an idiopathic immune-related sickness that affects multiple systems and melanocytes in organs such as the uvea, ear, and meninges. The primary cause of activity is cellular immunological responses. Vogt-Koyanagi disease is identified primarily by skin abnormalities and anterior uveitis. Harada's illness is distinguished by neurological symptoms and exudative retinal detachments, which are associated with the HLA-DR4 and HLA-DRw53 genes. Pigmented races, such as Hispanics and Native Americans, are more likely to have VKH disease. Clinical features are blurred vision, floaters, alopecia, vitiligo, diffuse choroidal inflammation with disc edema, and exudative retinal detachment. Differential diagnoses include posterior scleritis, uveal effusion syndrome, central serous chorioretinopathy, and sympathetic ophthalmitis. The investigations used are optical coherence tomography (OCT), fundus fluorescein angiography (FA), and B-scan ultrasonography (USG). Treatment is done by using systemic steroids, cycloplegics, and immunosuppressants.
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Affiliation(s)
- Ayushi Tayal
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nivesh Gupta
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Chen C, Cheng Y, Zhang Z, Zhang Y, Hou S, Wang G, Peng X. The multimodal imaging features and outcomes of multifocal choroiditis/punctate inner choroidopathy lesion with multiple evanescent white dot syndrome-like features: a retrospective study. BMC Ophthalmol 2024; 24:3. [PMID: 38166867 PMCID: PMC10763055 DOI: 10.1186/s12886-023-03277-6] [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: 06/11/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Multiple evanescent white dot syndrome (MEWDS)-like features is a rare condition triggered by a macular disease or iatrogenic injury, exhibiting MEWDS changes in the fundus. This study aims to describe the multimodal imaging features and outcomes of multifocal choroiditis/punctate inner choroidopathy (MFC/PIC) lesions with MEWDS-like features. METHODS Six cases were studied retrospectively. All cases were given regional and oral corticosteroids. RESULTS All cases showed an isolated juxtafoveal yellowish-white MFC/PIC lesion with disruption of RPE-Bruch's membrane-choriocapillaris complex (RPE-BM-CC), subretinal hyperreflective materials and choroidal thickening on optical coherence tomography. Two weeks after presentation, the grayish-white dots disappeared spontaneously and the corticosteroids were given. After four weeks, the ellipsoid zone (EZ) around the lesion and hyper-autofluorescence resolved. After 13 weeks, five cases showed shrinkage of the juxtafoveal lesion and restoration of foveal EZ. After six months, the juxtafoveal lesion became pigmented. Only one case developed type 2 choroidal neovascularization. CONCLUSIONS The clinical course of MEWDS-like manifestations is still evanescent in our cases. The yellowish-white juxtafoveal MFC/PIC lesions with disruption of RPE-BM-CC and choroidal thickening showed a well-controlled prognosis after corticosteroid treatment.
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Affiliation(s)
- Chunli Chen
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yizhe Cheng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhihan Zhang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yang Zhang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Simeng Hou
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Ge Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Xiaoyan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China.
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3
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Meng Y, Xu Y, Xiao D, Chen C, Hua D, Xu Y. Assessment of retinal and choroidal microcirculation after unilateral recession-resection surgery for horizontal strabismus by swept-source optical coherence tomography angiography. Sci Rep 2023; 13:19247. [PMID: 37935770 PMCID: PMC10630482 DOI: 10.1038/s41598-023-46670-3] [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: 02/15/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023] Open
Abstract
This study explored the possible hemodynamic changes of the retina and choroid after horizontal strabismus surgery using swept-source optical coherence tomography angiography (SS-OCTA). 32 eyes of 32 patients who underwent unilateral horizontal rectus muscle recession-resection surgery were included. SS-OCTA examinations were performed preoperatively and one week postoperatively. Several OCTA measurements were used, including vessel density (VD) of the superficial vascular complex (SVC), VD of the deep vascular complex (DVC), VD of the choriocapillaris (CC), choroidal vascular index (CVI) and choroidal thickness (CT). No significant change in VD of SVC, DVC, and CC was observed whereas CT increased significantly with CVI unchanged. Recession-resection surgery for horizontal strabismus seemed not to significantly influence the microcirculation of the retina and CC in the early postoperative period. However, choroidal thickening happened with a constant CVI probably due to the postoperative inflammation. Further studies are needed to investigate the long-term effects of unilateral recession-resection surgery for horizontal strabismus on the microcirculation of the retina and choroid.
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Affiliation(s)
- Yang Meng
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yishuang Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Di Xiao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Dihao Hua
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Yonghong Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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4
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COMPARISON OF PRIMARY AND SECONDARY FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retina 2022; 42:2368-2378. [DOI: 10.1097/iae.0000000000003609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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Singh RB, Perepelkina T, Testi I, Young BK, Mirza T, Invernizzi A, Biswas J, Agarwal A. Imaging-based Assessment of Choriocapillaris: A Comprehensive Review. Semin Ophthalmol 2022:1-22. [PMID: 35982638 DOI: 10.1080/08820538.2022.2109939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. METHODS A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. RESULTS The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. CONCLUSION The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Tatiana Perepelkina
- Department of Ophthalmology, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Benjamin K Young
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Tuba Mirza
- Department of Ophthalmology, Ascension Macomb Oakland Eye Institute, Warren, MI, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
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6
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Chen W, Chen H, Mi L, Li J, Lin H, Chen W. Subfoveal Choroidal Thickness After Femtosecond Laser-Assisted Cataract Surgery for Age-Related Cataracts. Front Med (Lausanne) 2022; 9:826042. [PMID: 35860729 PMCID: PMC9289166 DOI: 10.3389/fmed.2022.826042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare the effects of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) on subfoveal choroidal thickness (SFCT) in patients with age-related cataracts. Methods In this prospective consecutive study, 26 patients (26 eyes) with age-related cataracts without previous ocular surgery or other ocular diseases who had FLACS were included as the study group. Twenty-six age-matched patients (26 eyes) who underwent CPS in the same period were also included as the control group. The SFCT and the foveal retinal thickness (FRT) were measured at baseline and at 1 day (D1), 7 days (D7), 1 month (M1), and 3 months (M3) postoperatively by spectral-domain optical coherence tomography. Aqueous flare was also measured with a laser flare meter. Results The mean SFCTs of the FLACS group at baseline and at D1, D7, M1, and M3 were 185.2, 174.3, 184.2, 180.8, and 184.1 μm, respectively. A Bonferroni posttest showed that the choroid became thinner on postoperative D1 (P = 0.006). The measurements at 1 week, 1 month, and 3 months postoperatively showed no significant differences in the SFCTs compared with that at baseline (P = 0.66, P = 0.22, and P = 0.53, respectively). A different trend was observed in the CPS group. The choroid became thicker by the 3-month postoperative measurement, as follows: 1 day (P = 0.28), 1 week (P = 0.016), 1 month (P = 0.020), and 3 months (P < 0.001). Conclusion The mean SFCT significantly and temporarily decreased following FLACS. In contrast, an increased SFCT was observed following CPS.
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Affiliation(s)
- Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Haotian Lin,
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
- Weirong Chen,
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7
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Steptoe PJ, Pearce I, Beare NAV, Sreekantam S, Mohammed BR, Barry RJ, Steeples LR, Denniston AK, Murray PI. Proposing a Neurotropic Etiology for Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis. FRONTIERS IN OPHTHALMOLOGY 2022; 1:802962. [PMID: 38983970 PMCID: PMC11182168 DOI: 10.3389/fopht.2021.802962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 07/11/2024]
Abstract
Purpose To reassess the underlying pathophysiology of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinitis (RPC) through comparison with the non-inoculated eye of the von Szily animal model of neurotropic viral retinal infection. Methods Narrative review. Results Literature reports of isolated neurotropic viral entities and rising serological viral titers in APMPPE after presentation support a potential direct infective etiology. In general, viral transport along axons results in mitochondrial stasis and disruption of axoplasmic flow. Clinical manifestations of axoplasmic flow disruption in APMPPE/RPC may signify the passage of virus along the neuronal pathway. From a case series of 11 patients, we demonstrate a timely, spatial, and proportional association of optic disc swelling with APMPPE lesion occurrence. Signs within the inner retina appear to precede outer retinal lesions; and acute areas of outer nuclear layer (ONL) hyperreflectivity appear to be the result of coalescence of multiple hyperreflective foci resembling axonal spheroids (which occur as a consequence of axoplasmic disruption) and follow the Henle fiber layer neurons. Underlying areas of retinal pigment epithelium (RPE) hyper-autofluorescence follow ONL hyperreflectivity and may signify localized infection. Areas of apparent choriocapillaris hypoperfusion mirror areas of RPE/Bruch's membrane separation and appear secondary to tractional forces above. Increases in choroidal thickness with lesion occurrence and focal areas of choriocapillaris hypoperfusion are observed in both APMPPE/RPC and the von Szily model. Conclusions The neurotrophic infection model provides significant advantages over the existing primary choriocapillaris ischemia hypothesis to account for the range of imaging signs observed in APMPPE and RPC.
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Affiliation(s)
- Paul J Steptoe
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - Ian Pearce
- St. Paul's Eye Unit, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Nicholas A V Beare
- St. Paul's Eye Unit, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Robert J Barry
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Centre for Rare Diseases, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Baharani A, Errera MH, Jhingan M, Samanta A, Agarwal A, Singh SR, Reddy P RR, Grewal DS, Chhablani J. Choroidal Imaging in uveitis: an update. Surv Ophthalmol 2022; 67:965-990. [PMID: 35007618 DOI: 10.1016/j.survophthal.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
An important goal of advancements in ocular imaging algorithms and devices has been to improve the image acquisition and resolution of deeper ocular tissues, namely the choroid and its vasculature that are otherwise inaccessible to direct clinical examination. These advancements have contributed to the understanding of the pathophysiology of a number of ocular inflammatory conditions. We focuse on the imaging characteristics of clinical conditions where imaging the choroid has improved or radically changed the understanding of the disease, has helped in differentiation of phenotypically similar but distinct lesions, and where imaging features have proven vital formonitoring disease activity. The last two decades have seen some major developments in ocular imaging relevant to uveitis. The current review addresses both the imaging characteristics and their interpretation on conventional modalities such as fundus photography, fluorescein angiography, indocyanine green angiography and fundus autofluorescence and the recent additions in the armamentarium including optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography.
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Affiliation(s)
- Abhilasha Baharani
- Uveitis Services, Neoretina Eyecare Institute, Ramchander House, Chapel Road, Nampally, Hyderabad, India. 500001
| | - Marie-Helen Errera
- Department of Ophthalmology, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213
| | - Mahima Jhingan
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Raja Rami Reddy P
- Retina Services, Neoretina Eyecare Institute, Ramchander House, Chapel Road, Nampally, Hyderabad, India. 500001
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University School of Medicine, 2351 Erwin Rd Durham, NC 27705-4699
| | - Jay Chhablani
- Department of Ophthalmology, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop Street, Pittsburgh, PA, 15213.
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9
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Finkelstein MT, Najjar RP, Chougule P, Mathur R, Milea D. Chromatic pupillometry in multiple evanescent white dot syndrome masquerading as atypical optic neuritis. Acta Ophthalmol 2021; 100:713-715. [PMID: 34411454 DOI: 10.1111/aos.14998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Raymond P. Najjar
- Singapore Eye Research Institute Singapore Singapore
- The Ophthalmology & Visual Sciences ACP (EYE‐ACP) SingHealth and Duke‐NUS Singapore Singapore
| | | | - Ranjana Mathur
- Singapore Eye Research Institute Singapore Singapore
- The Ophthalmology & Visual Sciences ACP (EYE‐ACP) SingHealth and Duke‐NUS Singapore Singapore
- Singapore National Eye Centre Singapore Singapore
| | - Dan Milea
- Singapore Eye Research Institute Singapore Singapore
- The Ophthalmology & Visual Sciences ACP (EYE‐ACP) SingHealth and Duke‐NUS Singapore Singapore
- Singapore National Eye Centre Singapore Singapore
- Copenhagen University Copenhagen Denmark
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10
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Kammoun S, Khochtali S, Sehli M, Ben Amor S, Feki J, Khairallah M. Atypical multimodal imaging findings in a patient with multiple evanescent white dot syndrome. J Fr Ophtalmol 2020; 44:e115-e121. [PMID: 33162178 DOI: 10.1016/j.jfo.2020.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- S Kammoun
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia
| | - S Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - M Sehli
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia.
| | - S Ben Amor
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia
| | - J Feki
- Department of Ophthalmology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, El-Ferdaous avenue, 3029 Sfax, Tunisia
| | - M Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Kang HG, Kim TY, Kim M, Byeon SH, Kim SS, Koh HJ, Lee SC, Lee CS. Expanding the Clinical Spectrum of Multiple Evanescent White Dot Syndrome with Overlapping Multifocal Choroiditis. Ocul Immunol Inflamm 2020; 30:81-89. [PMID: 32870040 DOI: 10.1080/09273948.2020.1795206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate multifocal evanescent white dot syndrome (MEWDS) patients with and without overlapping multifocal choroiditis (MFC). METHODS Thirty-four patients diagnosed between November 2008 and August 2018 at 2 hospitals were retrospectively reviewed. Multimodal imaging including optical coherence tomography angiography (OCTA) was assessed. RESULTS Twenty-seven (79%) patients were women (overall mean age, 30 years). Five developed MFC lesions in the affected eyes, and one developed MFC in the unaffected fellow eye. Another developed combined MEWDS and MFC in the fellow eye during follow-up. Eyes with MFC had thicker choroids (316.5 and 197.3 µm, respectively; P = .001) at presentation, which became thinner after resolution (P = .043). Those with subfoveal MFC had poor visual prognosis (P = .019). Areas of suspected choriocapillaris flow deficit were identified on OCTA. CONCLUSION Some MEWDS patients may develop overlapping MFC in the same or fellow eyes, presenting with increased choroidal thickness which decreased after resolution.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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12
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Multiple evanescent white dot syndrome following influenza immunization - A multimodal imaging study. Am J Ophthalmol Case Rep 2020; 19:100845. [PMID: 32885094 PMCID: PMC7453109 DOI: 10.1016/j.ajoc.2020.100845] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/19/2020] [Accepted: 07/26/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the multimodal imaging (MMI) findings and clinical course of a case of Multiple Evanescent White Dot Syndrome (MEWDS) following immunization with inactivated intra-dermal influenza virus, and to explore whether similarities exist with other, previously reported cases. Observations A 34-year-old Caucasian man presented with unilateral onset of para-central scotomata, photopsias, and dyschromatopsia two weeks after administration of an influenza vaccine. Clinical examination and MMI were indicative of MEWDS. The patient's MMI abnormalities and symptoms resolved spontaneously after four weeks. Conclusion and importance This is the first reported case of MMI of post-influenza vaccination-associated MEWDS. Comparison with eight previously reported cases of MEWDS following various immunizations revealed that subjects tended to be healthy, young to middle age women with a median time to onset of two weeks. Vision tended to recover spontaneously over one to three months.
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Quantitative analysis of retinal and choriocapillary vascular density of multiple evanescent white dot syndrome by optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2020; 258:1697-1707. [PMID: 32350652 DOI: 10.1007/s00417-020-04687-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To describe optical coherence tomography angiography (OCTA) and other multimodal imaging features of multiple evanescent white dot syndrome (MEWDS). METHODS The retinal and choriocapillary vascular density of MEWDS patients were measured by OCTA (OptoVue Inc.) in the acute and recovery phases. And other multimodal imaging data were also retrospectively reviewed. RESULTS Sixteen patients with a mean age of 26.5 ± 6.99 years were included. Three patients were complicated with choroidal neovascularization (CNV). The mean baseline logMAR BCVA of the affected eyes was 0.52 ± 0.36 (Snellen equivalent 20/50). OCTA revealed significant reductions in vascular densities of deep capillary plexus (45.72 ± 3.70%, P = 0.0007), and choriocapillaris (46.08 ± 3.22%, P < 0.0001) of the affected eyes compared with the contralateral eyes (50.23 ± 4.06% and 52.28 ± 4.19%, respectively) in the acute phase. During the recovery phases, vascular densities of deep capillary plexus (49.50 ± 3.15%, P < 0.0001) and choriocapillaris (53.67 ± 2.58%, P < 0.0001) increased significantly in the affected eyes while those of the superficial capillary plexus remained stable. SD-OCT revealed an increase of the subfoveal choroidal thickness and disruption of the outer retinal layer, including ellipsoid zone discontinuities and the accumulation of hyperreflective material, corresponding to the hypofluorescent spots and dots on ICGA, respectively. BCVA increased to normal values after recovery, together with restoration of the structural morphology and choroidal thickness on SD-OCT, except in eyes with CNV. CONCLUSION The inner retinal layer and choroid can be secondarily transiently compromised in MEWDS. MEWDS complicated with CNV is associated with worse visual outcomes.
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Ito Y, Ito M, Ueno S, Kataoka K, Takeuchi J, Kominami T, Takayama K, Terasaki H. Changes in intraocular pressure and aqueous flare in eyes with multiple evanescent white dot syndrome. Jpn J Ophthalmol 2020; 64:378-384. [PMID: 32215769 DOI: 10.1007/s10384-020-00738-z] [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: 10/30/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the changes in intraocular pressure (IOP) and aqueous flare in eyes with multiple evanescent white dot syndrome (MEWDS) during the disease course. STUDY DESIGN Retrospective observational study. METHODS Twenty-one patients with unilateral MEWDS were retrospectively evaluated. IOP values were compared between the affected and fellow eyes 2 weeks, 1 month, and 3 months following disease onset in 17 patients, and within 7 days from disease onset in 11 patients. Aqueous flare values measured using a laser flare-cell meter in ten eyes between 1 weeks and 1 month from disease onset were compared between the affected and fellow eyes. RESULTS IOP values were significantly lower in the affected eyes than in the fellow eyes at both 2 weeks (P=0.002) and 1 month from disease onset (P=0.02). However, IOP values of affected eyes did not show significant differences from the fellow eyes within 7 days ((P=0.11) and 3 months of onset (P=0.30). Aqueous flare values were significantly increased in the affected eyes compared to those in the fellow eyes (P=0.010) and significantly correlated with IOP values (r=-0.67, P=0.035). CONCLUSION IOP values mildly decreased in association with aqueous flare values in the acute phase in eyes with MEWDS.
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Affiliation(s)
- Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Mari Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinji Ueno
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keiko Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun Takeuchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Taro Kominami
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kei Takayama
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
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Heirani M, Shandiz JH, Shojaei A, Narooie-Noori F. Choroidal Thickness Profile in Normal Iranian Eyes with Different Refractive Status by Spectral-Domain Optical Coherence Tomography. J Curr Ophthalmol 2020; 32:58-68. [PMID: 32510015 PMCID: PMC7265263 DOI: 10.1016/j.joco.2019.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/10/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate the choroidal thickness and its association with age, gender, spherical equivalent (SE), and axial length (AL) in a sample of Iranian population with different refractive status using spectral-domain optical coherence tomography (SD-OCT). Methods In a cross-sectional study, a total of 469 right eyes of 469 healthy subjects comprising 194 (41.4%) males and 275 (58.6%) females were examined. The mean age was 32.76 ± 15.77 years (range, 4-60 years). All subjects were divided into different groups according to their refractive status, age, and AL. The choroidal thickness was evaluated through enhanced-depth imaging (EDI) modality at subfoveal (Sf), 1, and 3 mm nasal (N1 and N3, respectively), temporal (T1 and T3, respectively), superior (S1 and S3, respectively), and inferior (I1 and I3, respectively) to the foveal center. Results In the whole population, the mean subfoveal choroidal thickness (SfChT) was 329.83 ± 70.33 μm, and the choroid was thickest at S1 (342.04 ± 71.28 μm) and thinnest at N3 (209.00 ± 66.0 μm). Our data indicated a significant difference in the mean choroidal thickness across all points in different age groups (P < 0.0001). For emmetropic, myopic, and hyperopic subjects, mean SfChT values were 346.64 ± 59.63, 319.66 ± 73.17, and 364.00 ± 74.54 μm, respectively. Linear regression estimated that SfChT decreased about 12.8 and 8.71 μm for every 10 years of aging and each diopter increasing in myopia, respectively. Additionally, the SfChT decreased as 13.48 μm per mm increase in AL. Conclusions The mean SfChT of a sample of Iranian emmetropic subjects was 346.64 ± 59.63 μm. The choroidal thickness has a decreasing trend with increasing age, and the choroid is thinner in myopes and thicker in hyperopes compared with emmetropic subjects. In the whole participants, the thickest and thinnest points were S1 and N3, respectively.
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Affiliation(s)
- Mohsen Heirani
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian Shandiz
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Foroozan Narooie-Noori
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Schuerch K, Ma JH, Wolf S, Ebneter A, Zinkernagel MS, Munk MR. Longitudinal Retinal Layer Changes and Clinical Outcome in Patients with Multiple Evanescent White Dot Syndrome. Ocul Immunol Inflamm 2020; 29:1114-1120. [PMID: 32125930 DOI: 10.1080/09273948.2020.1717545] [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: 10/24/2022]
Abstract
Purpose: To evaluate longitudinal changes in retinal layer thickness and clinical outcome in patients with MEWDS.Methods: In 20 patients with MEWDS, SD-OCT images and BCVA were assessed at baseline, and at months 1, 3, and 12. SD-OCTs were segmented and measurements were performed within the fovea and a MEWDS lesion. Baseline and follow-up values in the affected eye were compared to measurements performed at the corresponding location in the fellow eye.Results: ONL thickness was 4.7% thicker in MEWDS-eyes compared with the baseline, with a significant decrease of 9% at 3 months. Within the lesion, INL thickness was 7.9% increased at baseline and decreased significantly over the follow-up of 12 months. BCVA was decreased at baseline (0.2 ± 0.18logMAR) and at the 3 months but after 12 months had increased to 0.01 ± 0.04 logMAR.Conclusion: MEWDS shows the involvement of different retinal layers and characteristic changes over the disease course.
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Affiliation(s)
- Kaspar Schuerch
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jeffrey H Ma
- Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marion R Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
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Pellegrini M, Veronese C, Bernabei F, Lupidi M, Cerquaglia A, Invernizzi A, Zicarelli F, Cimino L, Bolletta E, Vagge A, Ciardella AP. Choroidal Vascular Changes in Multiple Evanescent White Dot Syndrome. Ocul Immunol Inflamm 2019; 29:340-345. [PMID: 31697565 DOI: 10.1080/09273948.2019.1678650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To evaluate choroidal structural changes in patients with multiple evanescent white dot syndrome (MEWDS) during the acute and recovery stages.Methods: Enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of 16 patients with unilateral MEWDS were acquired during the acute and recovery stages in both eyes. Images were binarized with the ImageJ software to measure subfoveal choroidal thickness (CT), total choroid area, luminal area and choroidal vascularity index (CVI).Results: In the acute stage, subfoveal CT, total choroidal area and CVI were significantly higher in eyes with MEWDS compared to fellow eyes (371.2 ± 101.8 vs 317.1 ± 90.3 µm, p = .001; 2.826 ± 0.686 vs 2.524 ± 0.674 mm2, p = .014; 69.49 ± 3.51 vs 68.27 ± 3.41%, p = .044, respectively). In the recovery stage, subfoveal CT, total choroidal area and CVI in eyes with MEWDS significantly decreased to respectively 333.4 ± 90.5 µm, p = .007, 2.592 ± 0.570 p = .002, and 67.31 ± 2.74%, p = .014.Conclusions: Choroidal thickness and vascularity are significantly increased during the acute stage of MEWDS.
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Affiliation(s)
- Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Chiara Veronese
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Bernabei
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Cerquaglia
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Aldo Vagge
- Eye Clinic of Genoa, Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Antonio P Ciardella
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Doğan G, Şen S, Çavdar E, Mayalı H, Cengiz Özyurt B, Kurt E, Kasırga E. Should we worry about the eyes of celiac patients? Eur J Ophthalmol 2019; 30:886-890. [DOI: 10.1177/1120672119850071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose: In this article, we evaluate subfoveal choroidal thickness in celiac patients with respect to adherence to the gluten-free diet and nonadherence to the gluten-free diet, comparing with age and sex matched healthy controls using spectral-domain optical coherence tomography. Materials and Methods: A case-control study among 42 celiac patients and 42 healthy participants was conducted in the Department of Pediatric Gastroenterology. Celiac patients of our policlinics compliant with spectral-domain optical coherence tomography examination enrolled in the study. Celiac patients had been asked verbally about their adherence to gluten-free diet, were evaluated according to negative or positive EmA and anti-TG2 for defining adherence, and were divided into two groups (adherence to gluten-free diet and nonadherence to gluten-free diet). Results: Subfoveal choroidal thickness was thinner in EmA (+) or anti-TG2 (+) eyes than EmA(−) or anti-TG2 (−) eyes in celiac patients, but it was not statistically significant. The mean subfoveal choroidal thickness values in eyes with celiac disease, whose diagnosis time was longer than 60 months, were thinner than shorter group. Longer duration of gluten-free diet was associated with adherence difficulty and thinner choroidal thickness (r = −0.15, p = 0.34). Adherence to gluten-free diet was 88.2% for children below the age of 60 months and 57.1% for children older than 60 months. Conclusion: In conclusion, in addition to other extraintestinal manifestations of celiac disease, diagnosis time longer than 60 months in pediatric celiac patients, nonadherence to the gluten-free diet, and antibody positivity should be focused on during ophthalmologic examination and choroid measurement.
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Affiliation(s)
- Güzide Doğan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Semra Şen
- Department of Pediatric Infection Disease, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Ercüment Çavdar
- Department of Ophthalmology, Akhisar State Hospital, Manisa, Turkey
| | - Hüseyin Mayalı
- Department of Ophthalmology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Beyhan Cengiz Özyurt
- Department of Public Health, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Emin Kurt
- Department of Ophthalmology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Erhun Kasırga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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20
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Singh SR, Vupparaboina KK, Goud A, Dansingani KK, Chhablani J. Choroidal imaging biomarkers. Surv Ophthalmol 2018; 64:312-333. [PMID: 30496750 DOI: 10.1016/j.survophthal.2018.11.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
The choroid is the vascular coat of the eye, and its role has been studied in multiple chorioretinal disorders. Recent advancements in choroidal imaging techniques, including enhanced depth imaging optical coherence tomography, swept source optical coherence tomography, en face optical coherence tomography, and optical coherence tomography angiography have facilitated an in-depth analysis of the choroid. The gradual shift from manual to automated segmentation and binarization methods have led to precise and reproducible measurements of choroidal parameters. These qualitative and quantitative parameters, called choroidal imaging biomarkers, have evolved over the past decade from a simple linear subfoveal choroidal thickness to more complex 3D choroidal reconstruction, thus widening the spectrum encompassing multiple parameters. These biomarkers have provided a better understanding of the pathogenesis, are helpful in diagnostic dilemmas, and, in the future may also help to devise treatment options. The lack of normative data, absence of standardized parameters, and limitations of the imaging techniques, however, have led to ambiguity and difficulty in the interpretation of these variables. We attempt to address these lacunae in the literature and provide a basic understanding of the choroid in both health and disease using these choroidal biomarkers.
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Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
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Changes of Subfoveal Choroidal Thickness after Cataract Surgery: A Meta-Analysis. J Ophthalmol 2018; 2018:2501325. [PMID: 30607294 PMCID: PMC6260537 DOI: 10.1155/2018/2501325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/08/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023] Open
Abstract
Purpose To investigate the effect of cataract surgery on subfoveal choroid thickness (SFCT) using enhanced-depth imaging optical coherence tomography (EDI-OCT). Materials and Methods Relevant publications were searched systematically through various databases from inception to March 2018. The unit of choroidal thickness measurements is micrometers. Studies comparing SFCT before and after cataract surgery were retrieved. All qualified articles were analyzed using RevMan 5.3. Results A total of 13 studies with 802 eyes from 646 patients were identified for inclusion. There was a significant increase of SFCT at 1 week (MD = 6.62, 95% CI: 1.20-12.05, P=0.02, I2 = 0%), 1 month (MD = 8.30, 95% CI: 3.20-13.39, P=0.001, I2 = 0%), and 3 months (MD = 8.28, 95% CI: 1.84-14.73, P=0.01, I2 = 0%) after cataract surgery. In subgroup analysis, SFCT in Asians and patients without nonsteroidal anti-inflammatory drugs (NSAIDs) in postoperative medication was significantly thicker (P < 0.05). No statistically significant increase of SFCT was found in diabetic mellitus (DM) patients for 1 day (P=0.89), 1 week (P=0.59), 1 month (P=0.52), and 3 months (P=0.42) after cataract surgery. Conclusions This meta-analysis suggested that SFCT increased since 1 week after the cataract surgery and the increase lasted for at least 3 months. Asians and patients without NSAIDs in postoperative medication were more likely to have a thicker SFCT after cataract surgery, whereas DM patients were less likely to increase in SFCT.
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Pereira F, Lima LH, de Azevedo AGB, Zett C, Farah ME, Belfort R. Swept-source OCT in patients with multiple evanescent white dot syndrome. J Ophthalmic Inflamm Infect 2018; 8:16. [PMID: 30317398 PMCID: PMC6186261 DOI: 10.1186/s12348-018-0159-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022] Open
Abstract
Background Swept-source optical coherence tomography (SS-OCT) has a higher scanning rate and longer wavelength in comparison with spectral-domain OCT (SD-OCT), allowing an improved imaging of retinal vascular plexuses and choriocapillaris. The present two patients diagnosed with multiple evanescent white dot syndrome (MEWDS) underwent fundus autofluorescence (FAF), en-face SS-OCT, and SS-OCT angiography (OCTA) imaging, and its features were described and correlated. Results The clinical and imaging findings of both cases were consistent with the diagnosis of MEWDS. Color fundus photograph revealed subtle deep retinal white spots in the posterior pole and around the optic disk. FAF showed several hyperautofluorescent lesions corresponding topographically to the subtle deep retinal white lesions observed on color fundus photographs. Cross-sectional SS-OCT showed disruption of the ellipsoid zone (EZ) within the macular area in all study patients. En-face SS-OCT at the level of the outer retina showed lower reflectivity correspondent to the diffuse attenuation due to the EZ disruption on cross-sectional OCT. SS-OCTA demonstrated flow preservation within the retinal vasculature and choriocapillaris. Conclusions SS-OCT imaging allows a better visualization of the choriocapillaris, and its normal appearance in MEWDS may suggest that the outer retina and photoreceptors represent the primary site of inflammation.
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Affiliation(s)
- Felipe Pereira
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Luiz H Lima
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP, 04023-062, Brazil.
| | - Alexandre Gomes B de Azevedo
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Claudio Zett
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP, 04023-062, Brazil.,Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Michel E Farah
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP, 04023-062, Brazil.,Vision Institute, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP, 04023-062, Brazil.,Vision Institute, São Paulo, Brazil
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Matsubara H, Uchiyama E, Suzuki K, Matsuda Y, Kondo M. A Case of Focal Choroidal Excavation Development Associated with Multiple Evanescent White Dot Syndrome. Case Rep Ophthalmol 2018; 9:388-394. [PMID: 30283324 PMCID: PMC6167642 DOI: 10.1159/000492747] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022] Open
Abstract
Focal choroidal excavation (FCE) is described as an excavated lesion of the choroid that can be detected by optical coherence tomography (OCT). While the exact pathogenesis of FCE remains unclear, it has been proposed in some cases that there is an association with the inflammation in the outer retina. We present a case of FCE development that was detected by spectral domain OCT (SD-OCT) and found to be associated with multiple evanescent white dot syndrome (MEWDS). A 40-year-old Japanese woman was diagnosed with MEWDS based on multiple white dots observed from the posterior pole to the midperiphery, along with yellow granularity in the fovea. SD-OCT revealed separation between the retinal pigment epithelium (RPE) and Bruch's membrane (BM) and discontinuations of the ellipsoid zone, RPE, and BM. At 4 weeks after onset, several of the white dots disappeared, the yellow granularity in the fovea became small, and we detected nonconforming choroidal excavation under the central fovea. The choroidal excavation gradually deepened and changed to a conforming pattern. These findings suggest that the degree of the impairment caused by inflammation and the plasticity of the BM and RPE complex may be associated with different types of acquired FCE.
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Affiliation(s)
- Hisashi Matsubara
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eriko Uchiyama
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Katsuya Suzuki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshito Matsuda
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Ophthalmology, Komonokousei Hospital, Mie, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
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Sisk RA, Hufnagel RB, Laham A, Wohler ES, Sobreira N, Ahmed ZM. Peripheral Cone Dystrophy: Expanded Clinical Spectrum, Multimodal and Ultrawide-Field Imaging, and Genomic Analysis. J Ophthalmol 2018; 2018:2984934. [PMID: 30116628 PMCID: PMC6079493 DOI: 10.1155/2018/2984934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present new clinical features, multimodal and ultrawide-field imaging characteristics of peripheral cone dystrophy (PCD), and results of laboratory and genetic investigation to decipher the etiology. METHODS Retrospective observational case-series. RESULTS Three patients with PCD presented with bilateral paracentral scotomas and a mean visual acuity of 20/25. All exhibited confluent macular hyperautofluorescence with a central bull's eye lesion. Spectral-domain optical coherence tomography revealed loss of outer retinal elements, particularly the inner segment ellipsoid band and external limiting membrane, within the area of macular hyperautofluorescence. This area corresponded with a lightened fundus appearance and variable retinal pigment epithelium (RPE) abnormalities. Full field and multifocal electroretinography distinguished PCD from other photoreceptor dystrophies. Ultrawide-field imaging revealed irregular peripheral retinal lesions in a distribution greater nasally than temporally and not contiguous with the macular lesion. Functional and anatomic testing remained stable over a mean follow-up of 3 years. Laboratory investigation for causes of uveitis was negative. Whole exome sequencing identified rare variants in genes associated with macular or cone dystrophy or degeneration. CONCLUSIONS In contrast to the original description, the funduscopic and fluorescein angiographic appearance of PCD is abnormal, although the defects are subtle. Peripheral lesions may be observed in some patients. Bilateral, symmetric, macular hyperautofluorescence associated with outer retinal atrophy that spares the fovea is a characteristic of PCD. Pathogenic variants in the same gene were not shared across the cohort, suggesting genetic heterogeneity. Further evaluation is warranted.
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Affiliation(s)
- Robert A. Sisk
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Eye Institute, Cincinnati, OH, USA
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert B. Hufnagel
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ailee Laham
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elizabeth S. Wohler
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nara Sobreira
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zubair M. Ahmed
- Department of Otorhinolaryngology, School of Medicine, University of Maryland, Baltimore, MD, USA
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AGE-RELATED CHANGES IN CHOROIDAL VASCULAR DENSITY OF HEALTHY SUBJECTS BASED ON IMAGE BINARIZATION OF SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2018; 38:508-515. [PMID: 28234809 DOI: 10.1097/iae.0000000000001571] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the vascular density of the choroid in a healthy population using swept-source optical coherence tomography. METHODS A cross-sectional, noninterventional study. INCLUSION CRITERIA best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, no systemic or ocular diseases, and ages ranging between 3 and 85 years. One hundred and thirty-six eyes from 136 subjects were analyzed, 86 eyes (63.2%) were from male and 50 eyes (36.8%) from female subjects. The eyes were divided into different age groups to analyze the possible age-related changes. Twelve-millimeter horizontal, fovea-centered B-scans were used. Choroidal stroma and vessel area analysis involved automated segmentation and binarization using validated algorithms. RESULTS Mean age was 33.1 ± 24.5 years. Mean choroidal area was 0.5554 ± 0.1377 mm. Mean stromal area was 0.2524 ± 0.0762 mm, and mean vascular region area was 0.3029 ± 0.0893 mm. The percentage of choroidal vascularity (vascular area/total area) was 54.40 ± 8.35%. Choroid area, vascular region, and percentage of choroidal vascular density were statistically higher in the <18-year-old group versus the >18-year-old group (P < 0.001). The stromal region was not different (P = 0.46). In the same way, choroid area, vascular region, and percentage of choroidal vascular density between the 5 age groups were statistically different (P < 0.001), showing larger figures in the 0 to 10-year-old group, but not stromal region (P = 0.71). There were no gender-related differences. CONCLUSION The luminal area and the percentage of vascular/total area decrease with increasing age, while the stromal area remains stable.
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Inter- and intraobserver repeatability and reproducibility of choroidal thickness measurements using two different methods. Int Ophthalmol 2018; 39:1061-1069. [DOI: 10.1007/s10792-018-0909-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
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FOVEAL EXUDATE AND CHOROIDAL NEOVASCULARIZATION IN ATYPICAL CASES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retina 2018; 37:2025-2034. [PMID: 28098736 DOI: 10.1097/iae.0000000000001486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe atypical cases of multiple evanescent white dot syndrome (MEWDS) associated with foveal exudation, increased choroidal thickness, and secondary Type 2 (subretinal) neovascularization. METHODS Four cases of atypical MEWDS were studied at a retina referral center. Patients underwent evaluation with multimodal retinal imaging, including fluorescein angiography, indocyanine green angiography, spectral-domain and enhanced depth imaging optical coherence tomography (OCT). Two patients were imaged with OCT angiography. RESULTS Four patients (3 female, 1 male) with a median age of 23.5 years presented with acute onset, painless, decreased central vision. All cases demonstrated fundus findings consistent with MEWDS on color photography, indocyanine green angiography, fluorescein angiography, fundus autofluorescence, and structural OCT imaging. On structural OCT, all 4 patients were noted to have hyperreflective subretinal material and increased subfoveal choroidal thickness ranging from 307 μm to 515 μm. Type 2 neovascularization was diagnosed in all four patients using fluorescein angiography, indocyanine green angiography, and/or OCT angiography. Two patients had poor visual acuity at the last follow-up despite resolution of characteristic clinical findings of MEWDS. CONCLUSION A subset of patients with atypical MEWDS may develop persistent poor vision due to subfoveal exudation and secondary Type 2 neovascularization. Patients showing increased choroidal thickness at presentation may be more susceptible to this unusual presentation.
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Swaminathan SS, Zheng F, Miller AR, Gregori G, Davis JL, Rosenfeld PJ. Swept-Source OCT Angiography of Multiple Evanescent White Dot Syndrome With Inflammatory Retinal Pigment Epithelial Detachment. Ophthalmic Surg Lasers Imaging Retina 2018; 49:145-151. [PMID: 29443367 DOI: 10.3928/23258160-20180129-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022]
Abstract
A 30-year-old woman with photopsias and decreased vision was diagnosed with multiple evanescent white dot syndrome (MEWDS) with an atypical inflammatory subfoveal retinal pigment epithelial detachment (PED) and imaged using swept-source optical coherence tomography (SS-OCT) during several visits. SS-OCT imaging revealed a focal area of attenuated choriocapillaris underneath the PED. An attempt to treat the presumed macular inflammatory lesion with corticosteroids resulted in bilateral exudation consistent with central serous chorioretinopathy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:145-151.].
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ANALYSIS OF AGE-RELATED CHOROIDAL LAYERS THINNING IN HEALTHY EYES USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2017; 37:1305-1313. [DOI: 10.1097/iae.0000000000001347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zheng F, Gregori G, Schaal KB, Legarreta AD, Miller AR, Roisman L, Feuer WJ, Rosenfeld PJ. Choroidal Thickness and Choroidal Vessel Density in Nonexudative Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Imaging. Invest Ophthalmol Vis Sci 2017; 57:6256-6264. [PMID: 27849311 PMCID: PMC5114036 DOI: 10.1167/iovs.16-20161] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To analyze the relationship between choroidal thickness and the distribution of choroidal blood vessels in eyes with nonexudative AMD. Methods Eyes with a diagnosis of nonexudative AMD were imaged using a prototype 100-kHz swept-source (SS) optical coherence tomography (OCT) instrument (Carl Zeiss Meditec, Dublin, CA, USA) with a central wavelength of 1050 nm. We used an OCT cube scan pattern consisting of 512 × 512 A-scans over a 12 × 12 mm retinal area. The eyes were partitioned into two groups based on the presence or absence of reticular pseudodrusen (RPD). All scans were segmented using an automated algorithm. In addition, five eyes from each of the two groups were randomly chosen for manual segmentation. Binary choroidal vessels maps were generated from suitable OCT choroidal slabs, and the relationship between the density of large choroidal vessels and choroidal thickness was analyzed using an Early Treatment Diabetic Retinopathy Study–like target centered on the fovea. Results Twenty-five eyes were enrolled in each group. The automated algorithm produced accurate choroidal thickness maps with an average difference between the manual and automated segmentations of 13.7 μm. There was a significant and stable correlation between choroidal thickness and choroidal vessel density across the two groups. Both average choroidal thickness and vessel density were significantly lower in eyes with RPD. Conclusions Our fully automated choroidal segmentation algorithm was able to capture the different patterns of choroidal thickness over a wide area. Choroidal thickness has a clear relationship with the density of large choroid vessels in our sample, irrespective of the presence or absence of RPD.
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Affiliation(s)
- Fang Zheng
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States 2Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Giovanni Gregori
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Karen B Schaal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Andrew D Legarreta
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Andrew R Miller
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Luiz Roisman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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Multimodal Imaging in an Unusual Cluster of Multiple Evanescent White Dot Syndrome. J Ophthalmol 2017; 2017:7535320. [PMID: 28584665 PMCID: PMC5444036 DOI: 10.1155/2017/7535320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/14/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To describe an unusual cluster of multiple evanescent white dot syndrome (MEWDS) encountered within a 3-month period. Methods This retrospective observation study is comprised of seven patients who presented with MEWDS in a 3-month period in central Israel. Data were collected from patients' medical records on clinical, multimodal imaging, and viral serology findings. Results Six women and one man of mean age 31.5 ± 7.2 years. Three reported a precedent viral infection. All had unilateral decreased vision. Funduscopy revealed foveal granularity. Main Imaging Findings Hyperfluorescent spots on blue autofluorescence (BAF), hypofluorescent spots on indocyanine green angiography, dark lesions on infrared photos, and ellipsoid zone irregularities on spectral domain optical coherence tomography (SD-OCT). Resolution of the spots on BAF correlated with anatomic (SD-OCT) and visual recovery. OCT angiography performed following the convalescence stage demonstrated intact retinal and choroidal flow. Serologic findings were inconclusive. Conclusion We report a unique cluster of MEWDS patients presented in a short period of time. SD-OCT findings of ellipsoid zone disruption in combination with other multimodal imaging modalities are outlined meticulously. Recognizing these imaging features along with high index of clinical suspicion is important for the diagnosis of MEWDS. Serologic testing might be considered in future patients.
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Ruiz-Medrano J, Flores-Moreno I, Gutierrez-Bonet R, Chhablani J, Ruiz-Moreno JM. Update of choroidal imaging techniques: Past, present and future. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:128-136. [PMID: 27908566 DOI: 10.1016/j.oftal.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
The choroid is the middle layer of the eye, a very vascular and pigmented tissue, with its role in several ophthalmological pathologies already having been clearly established. But it was not until the last few years that we have been able to reliably and precisely measure and quantify its shape and thickness. Ultrasound technology and indocyanine green angiography were the first techniques used for the study of the choroid, and they still maintain their use and clinical indications for the diagnosis and management of several pathologies. But it was the advent of optical coherence tomography that was the greatest breakthrough in choroidal imaging. In this chapter, the past, current and future image modalities for the study of the choroid will be discussed, with special focus on optical coherence tomography and its latest developments.
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Affiliation(s)
- J Ruiz-Medrano
- Servicio de Oftalmología, Hospital Clínico Universitario San Carlos, Madrid, España.
| | - I Flores-Moreno
- Servicio de Oftalmología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - R Gutierrez-Bonet
- Servicio de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - J Chhablani
- Retina Department, L V Prasad Eye Institute, Hyderabad, India
| | - J M Ruiz-Moreno
- Departamento de Oftalmología, Universidad de Castilla-La Mancha, Albacete, España; VISSUM Corporación, Madrid, España
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Yannuzzi NA, Swaminathan SS, Zheng F, Miller A, Gregori G, Davis JL, Rosenfeld PJ. Swept-Source OCT Angiography Shows Sparing of the Choriocapillaris in Multiple Evanescent White Dot Syndrome. Ophthalmic Surg Lasers Imaging Retina 2017; 48:69-74. [DOI: 10.3928/23258160-20161219-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/29/2016] [Indexed: 11/20/2022]
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EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retina 2016; 36 Suppl 1:S178-S188. [DOI: 10.1097/iae.0000000000001255] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hashimoto Y, Saito W, Saito M, Hasegawa Y, Mori S, Noda K, Ishida S. Relationship between choroidal thickness and visual impairment in multiple evanescent white dot syndrome. Acta Ophthalmol 2016; 94:e804-e806. [PMID: 26891597 DOI: 10.1111/aos.12992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yuki Hashimoto
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Wataru Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Michiyuki Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yuka Hasegawa
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Shohei Mori
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kousuke Noda
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Susumu Ishida
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
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Parodi MB, Iacono P, Zucchiatti I, Bandello F. Choroidal Neovascularization Associated with Multiple Evanescent White Dot Syndrome Treated with Intravitreal Ranibizumab. Ocul Immunol Inflamm 2016; 26:608-611. [DOI: 10.1080/09273948.2016.1247175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Pierluigi Iacono
- Fondazione G. B. Bietti per l’Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Ilaria Zucchiatti
- Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
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Fiore T, Iaccheri B, Cerquaglia A, Lupidi M, Torroni G, Fruttini D, Cagini C. Outer Retinal and Choroidal Evaluation in Multiple Evanescent White Dot Syndrome (MEWDS): An Enhanced Depth Imaging Optical Coherence Tomography Study. Ocul Immunol Inflamm 2016; 26:428-434. [DOI: 10.1080/09273948.2016.1231329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tito Fiore
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Barbara Iaccheri
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Cerquaglia
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giovanni Torroni
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Daniela Fruttini
- Department of Internal Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
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Choroidal changes observed with enhanced depth imaging optical coherence tomography in patients with mild Graves orbitopathy. Eye (Lond) 2016; 30:917-24. [PMID: 27315349 DOI: 10.1038/eye.2016.93] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/11/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeTo evaluate the choroidal thickness in patients with Graves orbitopathy (GO) using enhanced depth imaging-optical coherence tomography (EDI-OCT).MethodsThirty-one patients with GO were evaluated prospectively. All subjects underwent ophthalmologic examination including best-corrected visual acuity, intraocular pressure measurement, biomicroscopic, and fundus examination. Choroidal thickness was measured at the central fovea. In addition, visual evoked potential measurement and visual field evaluation were performed.ResultsThe mean choroidal thickness was 377.8±7.4 μ in the GO group, and 334±13.7 μ in the control group. (P=0.004). There was a strong correlation between the choridal thickness and the clinical activity scores (CAS) of the patients (r=0.281, P=0.027). Additionally, there was a correlation between the choroidal thickness and the visual-evoked potential (VEP) P100 latency measurements of the patients (r=0.439, P=0.001).ConclusionsThe results of this study demonstrate that choroid is thicker in patients with GO. The choroidal thickness is also correlated with the CAS and VEP P100 latency measurements in these patients.
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ASYMMETRY IN MACULAR CHOROIDAL THICKNESS PROFILE BETWEEN BOTH EYES IN A HEALTHY POPULATION MEASURED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2016; 35:2067-73. [PMID: 25946688 DOI: 10.1097/iae.0000000000000590] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the difference in macular choroidal thickness (CT) profile between eyes in healthy individuals using swept-source optical coherence tomography. DESIGN Cross-sectional noninterventional study. PARTICIPANTS One hundred and forty eyes from 70 healthy patients with spherical equivalent between ± 3 D and with difference ≤ 0.25 D between eyes were scanned using a swept-source optical coherence tomography (Topcon Corporation). METHODS Cross-sectional noninterventional study. One hundred and forty eyes from 70 healthy patients with spherical equivalent between ± 3 D and with difference #0.25 D between eyes were scanned using a swept-source optical coherence tomography (Topcon Corporation). A horizontal CT profile of the macula was created in both eyes by manually measuring the subfoveal CT from the posterior edge of retinal pigment epithelium (RPE) to the choroid/sclera junction. Three determinations were performed at successive points 1,000 mm nasal to the fovea and 5 more temporal to the fovea. The differences in CT between both eyes were analyzed. RESULTS Mean age was 25.4 ± 19.9 years (from 4 to 75). The mean spherical equivalent was 0.18 ± 1.37 D (from -3 to +3). Mean macular nasal CT was thicker in the right eye (RE) than in the left eye (LE) (228.11 ± 69.23 μm vs. 212.27 ± 62.71 μm; P = 0.0002; Student's t-test paired data). Mean subfoveal CT and mean temporal CT was not statistically significantly different between the eyes. No statistically significant differences were observed comparing spherical equivalent in the RE compared with the LE. Both men and women showed a thicker mean nasal choroid in the RE versus the left (men, 226.97 ± 61.56 μm vs. 209.87 ± 60.31 μm; women, 229.63 ± 79.39 μm vs. 215.47 ± 66.68 μm, P = 0.003 and P = 0.03, respectively; Student's t-test paired data). At each nasal determination, CT in the RE was statistically significantly thicker than the LE (N1: 283.72 ± 81.10 μm vs. 269.76 ± 75.81 μm [P = 0.001]; in N2: 230.45 ± 73.47 μm vs. 211.33 ± 66.92 μm [P = 0.0002]; and in N3: 170.16 ± 61.00 μm vs. 155.72 ± 53.87 μm [P = 0.008], respectively). CONCLUSION To the best of our knowledge, this is the first report suggesting thicker macular nasal choroid in the RE compared with the LE. In contrast, subfoveal CT and temporal CT were not found to be different between eyes.
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Lavezzo MM, Sakata VM, Morita C, Rodriguez EEC, Abdallah SF, da Silva FTG, Hirata CE, Yamamoto JH. Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes. Orphanet J Rare Dis 2016; 11:29. [PMID: 27008848 PMCID: PMC4806431 DOI: 10.1186/s13023-016-0412-4] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/16/2016] [Indexed: 12/18/2022] Open
Abstract
Vogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.
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Affiliation(s)
- Marcelo Mendes Lavezzo
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Viviane Mayumi Sakata
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Celso Morita
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Ever Ernesto Caso Rodriguez
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Smairah Frutuoso Abdallah
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Felipe T G da Silva
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Carlos Eduardo Hirata
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil
| | - Joyce Hisae Yamamoto
- Uveitis Service, Department of Ophthalmology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Diana, 863 apto 91J, 05019-000, São Paulo, Brazil.
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EXPANDED CLINICAL SPECTRUM OF MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH MULTIMODAL IMAGING. Retina 2016; 36:64-74. [DOI: 10.1097/iae.0000000000000685] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ruiz-Medrano J, Flores-Moreno I, Montero JA, Duker JS, Ruiz-Moreno JM. Morphologic features of the choroidoscleral interface in a healthy population using swept-source optical coherence tomography. Am J Ophthalmol 2015; 160:596-601.e1. [PMID: 26045044 DOI: 10.1016/j.ajo.2015.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the morphologic features of the choroidoscleral interface in a healthy population using swept-source optical coherence tomography (SS OCT). DESIGN Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. METHODS A total of 276 healthy eyes from 154 subjects were evaluated using SS OCT. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators analyzed the morphologic features of the choroidoscleral interface in a masked fashion, classifying the contour and shape as concave (bowl-shaped) or inflective (S-shaped contour with ≥1 inflection point). RESULTS The presence of a temporal choroidoscleral interface inflection was identified in 12.8% of the eyes. The mean choroidal thickness was 372.1 ± 76.8 μm and the average distance from the inflection point to the fovea was 4427.3 ± 627.9 μm. Nine patients showed an inflective profile in both eyes. No changes in the retinal profile were found in any of these cases. The mean age of the patients with an inflective profile was 16 ± 19 years (range 4-82) vs 36 ± 25 years (range 3-95) in the group with a concave contour (P = .001). The temporal choroidal thickness at 4000 and 5000 μm from the fovea was thicker in the group with a concave contour. CONCLUSIONS Temporal choroidoscleral interface inflection or S-shaped profile of the choroidoscleral interface with focal thinning of the choroid can be considered a normal variation without clinical significance, especially in younger populations.
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Abbey AM, Kuriyan AE, Modi YS, Thorell MR, Nunes RP, Goldhardt R, Yehoshua Z, Gregori G, Feuer W, Rosenfeld PJ. Optical coherence tomography measurements of choroidal thickness in healthy eyes: correlation with age and axial length. Ophthalmic Surg Lasers Imaging Retina 2015; 46:18-24. [PMID: 25559504 DOI: 10.3928/23258160-20150101-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/01/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate subfoveal choroidal thickness (CT) in healthy eyes using spectral-domain optical coherence tomography (SD-OCT) and provide correlations between age and axial length. PATIENTS AND METHODS Enhanced depth SD-OCT imaging was performed with Cirrus (Carl Zeiss Meditec, Dublin, CA) and Spectralis (Heidelberg Engineering, Heidelberg, Germany) instruments. CT was measured from the outer limit of the retinal pigment epithelium to the inner surface of the sclera. RESULTS The study enrolled 155 patients, with at least 20 in each decade between 22 and 89 years old. Mean axial length was 23.6 mm. Mean Heidelberg subfoveal CT was 286 µm. The correlation between Heidelberg and Zeiss subfoveal CT measurements was strong (r = .978) and significant (P < .001). Mean subfoveal CT was 7.7 µm thinner by Heidelberg versus Cirrus (P < .001). Multiple linear regression analysis revealed that age (P < .001), axial length (P = .001), and sex (P = .025) were significantly related to Heidelberg subfoveal CT. CONCLUSION There is a strong negative correlation between CT and age (P <.001), with a 25 µm decrease in CT for each decade of life. Increasing axial length demonstrated a negative correlation with CT, decreasing 24.9 µm for each mm of axial length. Future studies of CT measurements can be performed on either instrument and must account for axial length, age, and sex to make appropriate conclusions.
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Nunes RP, Goldhardt R, de Amorim Garcia Filho CA, Thorell MR, Abbey AM, Kuriyan AE, Modi YS, Shah M, Yehoshua Z, Gregori G, Feuer W, Rosenfeld PJ. Spectral-Domain Optical Coherence Tomography Measurements of Choroidal Thickness and Outer Retinal Disruption in Macular Telangiectasia Type 2. Ophthalmic Surg Lasers Imaging Retina 2015; 46:162-70. [PMID: 25707040 DOI: 10.3928/23258160-20150213-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/23/2014] [Indexed: 11/20/2022]
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Evaluation of the retinal, choroidal, and nerve fiber layer thickness changes in patients with toxic anterior segment syndrome. Graefes Arch Clin Exp Ophthalmol 2014; 253:467-75. [PMID: 25467759 PMCID: PMC4345267 DOI: 10.1007/s00417-014-2880-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/04/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate changes in choroidal, retinal, and nerve fiber layer (NFL) thickness following toxic anterior segment syndrome (TASS). Methods Macular and peripapillary choroidal thickness was measured using enhanced depth imaging (EDI) optical coherence tomography (OCT) on the day of the diagnosis and on three follow-up exams (months 1 to 4). A similar OCT analysis of central retinal and NFL thickness was performed. Results Thirteen TASS patients were included. Average age was 72.8 ± 8.7 years. Macular choroidal thickness in the superior, subfoveal, and nasal macula in the study eye was larger than the control eye and decreased at months 2–4. This was statistically significant only for the superior macula (p = 0.004). Peripapillary choroidal thickness was larger in the study eye at baseline compared with the control eye—significantly so in the nasal (p = 0.026) and inferior (p = 0.033) locations. Peripapillary choroidal thickness peaked at the baseline or 1st month exam and decreased thereafter. Retinal thickness increased significantly with time, peaking at the 2nd month and decreasing thereafter. No changes were found in the NFL. Conclusions TASS may have a transient effect on the choroid. Changes in retinal thickness are probably a normal transient postoperative response and not a result of TASS.
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Hashimoto Y, Saito W, Noda K, Ishida S. Acquired focal choroidal excavation associated with multiple evanescent white dot syndrome: observations at onset and a pathogenic hypothesis. BMC Ophthalmol 2014; 14:135. [PMID: 25410093 PMCID: PMC4246602 DOI: 10.1186/1471-2415-14-135] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022] Open
Abstract
Background The mechanism underlying focal choroidal excavation (FCE) remains largely unknown. We evaluated the sequential progression of FCE generation using enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with multiple evanescent white dot syndrome (MEWDS). Case presentation A 37-year-old woman suffered MEWDS in the right eye. EDI-OCT showed the loss of photoreceptor inner segment/outer segment junction line, detachment between the retinal pigment epithelium (RPE) and Bruch’s membrane, and dome-shaped, moderately reflective, focal photoreceptor-layer lesions corresponding to perifoveal white dots. The region with pigment epithelium detachment involved RPE/Bruch’s membrane ruptures. After 1 month, almost all white dots spontaneously resolved together with improvements of the perifoveal OCT findings. Interestingly, perifoveal region developed a conforming-type FCE. An abnormal hyper-reflective lesion on OCT, regarded as fibrosis formation, simultaneously appeared within the choroid below the FCE and subsequently increased in size. Conclusions These results suggest that the RPE/Bruch’s membrane disruption due to chorioretinal abnormalities and subsequent intrachoroidal scar formation play a role in the pathogenesis on an acquired FCE.
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Affiliation(s)
| | - Wataru Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Noda Y, Ogawa A, Toyama T, Ueta T. Long-term increase in subfoveal choroidal thickness after surgery for senile cataracts. Am J Ophthalmol 2014; 158:455-9.e1. [PMID: 24875000 DOI: 10.1016/j.ajo.2014.05.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the impact of cataract surgery on subfoveal choroidal thickness and central retinal thickness in the elderly. DESIGN Prospective observational case series. METHODS This cohort study included 29 eyes of 29 patients with senile cataract, but no previous ocular surgery or other ocular abnormality. All 29 eyes received standard surgery by phacoemulsification and intraocular lens implantation. Subfoveal choroidal thickness and central retinal thickness were measured at baseline and 1, 3, and 6 months postoperatively by spectral-domain optical coherence tomography. Multiple regression analysis was conducted to identify predictors of larger changes in subfoveal choroidal thickness, including sex, age, baseline choroidal thickness, axial length, refractive status before surgery, and duration of surgery. RESULTS The 29 patients with senile cataract received cataract surgery without complication. Mean subfoveal choroidal thickness was 193.8, 208.9, 210.2, and 209.3 μm at baseline and at postoperative 1, 3, and 6 months, respectively, with a statistically significant increase after surgery (repeated-measures ANOVA; P < .0001). In 20 eyes (69.0%), subfoveal choroidal thickness remained high even 6 months after surgery. Multiple regression analysis revealed that male sex (P = .014) and thicker baseline choroid (P = .0048) predicted larger increases in subfoveal choroidal thickness. In contrast, the tendency of transient increase in central retinal thickness was not statistically significant. CONCLUSION Most elderly patients with senile cataracts are expected to maintain increased subfoveal choroidal thickness for at least 6 months after cataract surgery.
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Géhl Z, Kulcsár K, Kiss HJM, Németh J, Maneschg OA, Resch MD. Retinal and choroidal thickness measurements using spectral domain optical coherence tomography in anterior and intermediate uveitis. BMC Ophthalmol 2014; 14:103. [PMID: 25176513 PMCID: PMC4236668 DOI: 10.1186/1471-2415-14-103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/12/2014] [Indexed: 08/20/2024] Open
Abstract
Background Macular edema is a common cause of visual loss at uveitic patients. The aim of our study was to investigate retinal and choroidal thickness at the macula in anterior (AU) and intermediate (IMU) uveitis and in healthy individuals using spectral domain optical coherence tomography (SD-OCT). Methods Case-control study of 21 patients with AU and 23 patients with IMU and 34 age-matched healthy controls was performed with Spectralis SD-OCT (Heidelberg Engineering, Germany). High resolution SD-OCT scans and macular mapping were applied for automated measurement of retinal thickness. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields on enhanced depth imaging (EDI) scans. Evaluation of central retinal subfield thickness, 3 mm and 6 mm perifoveal rings was performed in the corresponding ETDRS zones in patient groups. Results The mean central retinal subfield thickness was significantly higher in IMU (368.65 ± 115.88 μm, p = 0.0003), but not significantly different in AU (290.42 ± 26.37 μm p = 0.6617) compared to that of in controls (278.55 ± 18.31 μm). In both uveitis groups retina was significantly thicker in the 3 and 6 mm perifoveal rings than that of in controls (359 ± 15.24 μm in AU and 390.55 ± 70.90 μm in IMU vs 345,41 ± 15.28 μm in the control group, p = 0.0388 and p < 0.0001) in the 3 mm and (313.83 ± 16.63 μm in AU and 343.33 ± 57.29 μm in IMU vs 299 ± 13.82 μm in the control group, p = 0.0171 and p < 0.0001) in the 6 mm ring. Central choroidal thickness was 311.94 ± 60.48 μm in the control eyes, showed no significant difference in AU (312.61 ± 90.35 μm) and IMU (303.17 ± 93.66 μm) eyes, and was also similar at the perifoveal rings. Conclusion Significant topographical changes could be detected in the macula of AU and IMU patients. Retinal thickness in the perifoveal rings was increased both in AU and IMU, but in the center only in IMU. Choroidal thickness seems to be unaffected by uveitis, even in the presence of macular edema, at least in the early stage of the inflammatory disease process.
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Affiliation(s)
- Zsuzsanna Géhl
- Department of Ophthalmology, Semmelweis University Budapest, Mária u, 39, Budapest H-1085, Hungary.
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Bittencourt MG, Kherani S, Ferraz DA, Ansari M, Nasir H, Sepah YJ, Hanout M, Do DV, Nguyen QD. Variation of choroidal thickness and vessel diameter in patients with posterior non-infectious uveitis. J Ophthalmic Inflamm Infect 2014; 4:14. [PMID: 26530342 PMCID: PMC4884007 DOI: 10.1186/s12348-014-0014-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Choroidal thickness (CTh) and choroidal vessel diameter (VD) in the Haler’s layer were evaluated as markers of inflammatory insult in non-infectious uveitis (NIU). Spectral-domain optical coherence tomography (Spectralis®, Heidelberg Engineering Inc.) scans were acquired from 23 normal subjects (39 eyes – group 1), 7 subjects with high myopia (14 eyes – group 2), and 19 patients with NIU (23 eyes – group 3). In groups 1 and 2, CTh and VD were measured at 3 different points of the same horizontal OCT scan passing through the fovea and a mean calculated. Mean CTh and VD were calculated in 2 other locations, 2 mm superior and inferior from the chosen foveal horizontal scan. In group 3, three measurements of CTh and VD were obtained within 1 mm of a horizontal scan passing through a retinal lesion; mean CTh and VD were then computed. A ratio (R) between the VD and the corresponding CTh was calculated. Results Group 1, 2 and 3 mean age was 29.6, 29.1 and 45.9 years, respectively. Sixteen normal subjects, three myopic subjects and six NIU patients were male.. Group 1 mean CTh did not differ from group 2 (261.6±45.6 vs. 260.2±50.6 µm µm; p>0.05); mean VD was marginally higher in Group 2 (159.8±32.2 vs. 163.2±33.2 µm; p>0.05). Group 3 demonstrated thinner CTh (193.6±54.6 µm) than Groups 1 and 2 (p = 0.02 and <0.001). Group 3 mean VD (123.6±37.4 µm) was also less than that in Groups 1 and 2; the difference was statistically significant only when compared to group 2, p = 0.01. R did not differ across groups (p-values >0.05), indicating that variations in CTh and VD followed the same trend. Conclusions The study reports potential quantitative OCT-derived parameters that may be explored in future trials of non-infectious uveitis. Thinning of choroid and decrease of vessel diameter are observed in patients with chronic NIU compared to controls. Electronic supplementary material The online version of this article (doi:10.1186/s12348-014-0014-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Millena G Bittencourt
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Saleema Kherani
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Daniel A Ferraz
- Hospital das Clínicas, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 Instituto Central, Cerqueira César, São Paulo, SP, CEP 05403-900, Brazil.
| | - Mehreen Ansari
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Humzah Nasir
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Yasir J Sepah
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
| | - Mostafa Hanout
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
| | - Diana V Do
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
| | - Quan Dong Nguyen
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
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Chhablani J, Wu L. Update on choroidal vascular imaging using optical coherence tomography. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.936386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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