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Roy R, Chattree S, Kala U, Majumdar B, Desai J, Bhattacharya S, Sen A, Goel S, Thomas NR, Chowdhury M, Das K, Nigam E, Das D, Saurabh K. Multicolor imaging: Current clinical applications. Surv Ophthalmol 2024; 69:378-402. [PMID: 38122907 DOI: 10.1016/j.survophthal.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Multicolor (MC) imaging is an innovative pseudocolor fundus imaging modality based on confocal scanning laser ophthalmoscopy. It effectively scans the retina at different depths to create a composite image. The green reflectance image depicts the middle retinal while blue reflectance image provides images of the retinal surface. The infrared reflectance image depicts retinal structures at the level of outer retina and choroid. We systematically analyze published case reports, case series, and original articles on MC imaging where it has helped in discovering additional clinical features of retinal diseases not readily apparent on conventional color fundus photography and played a role in monitoring the response to treatment.
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Affiliation(s)
- Rupak Roy
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India.
| | - Surabhi Chattree
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Urvashi Kala
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Bristi Majumdar
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Janhavi Desai
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Sampurna Bhattacharya
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Ahana Sen
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | | | | | - Maitreyi Chowdhury
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Kalpita Das
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Eesh Nigam
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Debmalya Das
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
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Verbeek S, Dalvin LA. Advances in multimodal imaging for diagnosis of pigmented ocular fundus lesions. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00209-0. [PMID: 37480939 PMCID: PMC10796850 DOI: 10.1016/j.jcjo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/25/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
Pigmented ocular fundus lesions can range from benign to malignant. While observation is reasonable for asymptomatic benign lesions, early recognition of tumours that are vision or life threatening is critical for long-term prognosis. With recent advances and increased accessibility of multimodal imaging, it is important that providers understand how to best use these tools to detect tumours that require early referral to subspecialty centres. This review aims to provide an overview of pigmented ocular fundus lesions and their defining characteristics using multimodal imaging. We cover the spectrum of pigmented ocular fundus lesions, including freckle and focal aggregates of normal or near-normal uveal melanocytes, retinal pigment epithelium (RPE) hyperplasia, congenital hypertrophy of the RPE, RPE hamartoma associated with familial adenomatous polyposis, congenital simple hamartoma of the RPE, combined hamartoma of the retina and RPE (congenital hypertrophy of the RPE), choroidal nevus, melanocytosis, melanocytoma, melanoma, adenoma, and RPE adenocarcinoma. We describe key diagnostic features using multimodal imaging modalities of ultra-widefield fundus photography, fundus autofluorescence, optical coherence tomography (OCT), enhanced-depth imaging OCT, ultrasonography, fluorescein angiography, indocyanine green angiography, and OCT angiography (OCTA), with particular attention to diagnostic features that could be missed on fundus examination alone. Finally, we review what is on the horizon, including applications of artificial intelligence. Through skilled application of current and emerging imaging technologies, earlier detection of sight- and life-threatening melanocytic ocular fundus tumours can lead to improved patient prognosis.
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Affiliation(s)
- Sara Verbeek
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Zhang X, Yang Y, Wen Y, Xiao H, Peng J, Zhao P. Description and surgical management of epiretinal membrane due to combined hamartoma of the retina and retinal pigment epithelium. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:9-14. [PMID: 37846430 PMCID: PMC10577870 DOI: 10.1016/j.aopr.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 10/18/2023]
Abstract
Purpose To outline the characteristics of Combined Hamartoma of the Retina and Retinal Pigmentation Epithelium (CHRRPE) and provide a comprehensive overview of surgical management of epiretinal membrane (ERM) caused by CHRRPE. Main text CHRRPE is a rare ocular tumor. It clinically mimics other diseases such as retinoblastoma and choroidal melanoma. The present study reviewed the multimodal imaging of CHRRPE, highlighted the multimodal imaging modalities which are useful for revealing the unique features of CHRRPE and hence allowing physicians to confirm the diagnosis.Although most of CHRRPEs are benign harmatoma, progressive visual loss may occur because of the traction of the tumor and other complications. It is treated through surgical removal of the ERM caused by CHRRPE to free retina from the traction. Currently, there is no consensus on the surgical management of CHRRPE. Therefore, the current review was designed to explore the surgical management of ERM caused by CHRRPE and hence provide updated data on this subject. Conclusions Multimodal imaging technologies, especially optical coherence tomography (OCT), significantly contributes to the diagnosis of CHRRPE and visual prognosis. Surgical management of CHRRPE through removal of ERM is beneficial in patients with worsening VA which is secondary to ERM which is associated with CHRRPE. However, the strategy is limited to patients with long-standing poor vision. However, earlier surgical therapy and subsequent postoperative amblyopia therapy can be explored for children of amblyogenic age.
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Affiliation(s)
- Xuerui Zhang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Yang
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanjun Wen
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haodong Xiao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Iovino C, Ramtohul P, Au A, Romero-Morales V, Sadda S, Freund KB, Sarraf D. Vitelliform maculopathy: Diverse etiologies originating from one common pathway. Surv Ophthalmol 2023; 68:361-379. [PMID: 36720370 DOI: 10.1016/j.survophthal.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
Vitelliform lesions (VLs) are associated with a wide array of macular disorders but are the result of one common pathway: retinal pigment epithelium (RPE) impairment and phagocytic dysfunction. VLs are defined by the accumulation of yellowish subretinal material. In the era of multimodal advanced retinal imaging, VLs can be further characterized by subretinal hyperreflectivity with optical coherence tomography and hyperautofluorescence with fundus autofluorescence. VLs can be the result of genetic or acquired retinal diseases. In younger patients, VLs usually occur in the setting of Best disease. Additional genetic causes of VL include pattern dystrophy or adult-onset vitelliform macular dystrophy. In older patients, acquired VLs can be associated with a broad spectrum of etiologies, including tractional, paraneoplastic, toxic, and degenerative disorders. The main cause of visual morbidity in eyes with VLs is the onset of macular atrophy and macular neovascularization. Histopathological studies have provided new insights into the location, nature, and lifecycle of the vitelliform material comprised of melanosomes, lipofuscin, melanolipofuscin, and outer segment debris located between the RPE and photoreceptor layer. Impaired phagocytosis by the RPE cells is the unifying pathway leading to VL development. We discuss and summarize the nature, pathogenesis, multimodal imaging characteristics, etiologies, and natural course of vitelliform maculopathies.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Adrian Au
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Veronica Romero-Morales
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, USA; Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, NYU Grossman School of New York, New York, NY, USA
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, CA, USA.
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Naseripour M, Sedaghat A, Gordiz A, Mirshahi R. Double Retina Sign: A New Optical Coherence Tomography Finding in Combined Hamartoma of the Retina and Retinal Pigment Epithelium. J Curr Ophthalmol 2023; 35:90-92. [PMID: 37680298 PMCID: PMC10481987 DOI: 10.4103/joco.joco_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 09/09/2023] Open
Abstract
Purpose To describe a case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) with peculiar optical coherence tomography (OCT) findings. Methods Case report. Results A 7-year-old girl with a history of decreased visual acuity in the left eye since early childhood presented with pigmented epiretinal membrane in favor of CHRRPE based on clinical and paraclinical findings. In OCT images, an area of retinal defect was noted, and the retina doubled up on itself near the defect (double retina sign). Conclusion Careful examination of OCT images in patients with CHRRPE can reveal new findings.
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Affiliation(s)
- Masood Naseripour
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arzhang Gordiz
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Ledesma-Gil G, Essilfie J, Gupta R, Fung AT, Lupidi M, Pappuru RR, Nayak S, Sahoo NK, Kaliki S, Yannuzzi LA, Reid K, Lim L, Sacconi R, Dave V, Singh SR, Ayachit A, Gabrielle PH, Cai S, Lima LH, Querques G, Arevalo JF, Freund KB, Shields CL, Chhablani J. Presumed Natural History of Combined Hamartoma of the Retina and Retinal Pigment Epithelium. Ophthalmol Retina 2021; 5:1156-1163. [PMID: 33516918 DOI: 10.1016/j.oret.2021.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To correlate structural changes of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) with patient age. DESIGN Retrospective study. PARTICIPANTS Fifty eyes of 49 patients (age range, 1-74 years) with CHRRPE studied at 9 tertiary vitreoretinal institutions. METHODS We analyzed the clinical findings with respect to lesion topography and pigmentation as well as investigated the OCT findings regarding the thickness, vitreoretinal interface, outer plexiform layer distortion, ellipsoid zone disruption, and retinal pigment epithelium-Bruch's membrane complex involvement of CHRRPE. MAIN OUTCOME MEASURES Clinical and imaging findings of CHRRPE at different ages. RESULTS Analysis of 50 CHRRPE patients revealed that younger patients were more likely to demonstrate partial thickness involvement of the retina (P = 0.009) with predominantly inner retinal layer involvement (P = 0.04). The inverse was true for older patients with CHRRPE. In addition, older patients more commonly showed pigmentary changes. Eyes with CHRRPE were more likely to show an increase in central macular thickness independently of tumor location. CONCLUSIONS Based on these findings, we believe that CHRRPE typically begins in the inner retina and continues toward the outer retina over time, with increase in central macular thickness, despite the location of the tumor.
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Affiliation(s)
- Gerardo Ledesma-Gil
- Vitreous Retina Macula Consultants of New York, New York, New York; Retina Department, Institute of Ophthalmology, Fundación Conde de Valenciana, Mexico City, Mexico
| | - Juliet Essilfie
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York
| | - Rajan Gupta
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Adrian T Fung
- Westmead Hospital, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Save Sight Institute, University of Sydney, Sydney, Australia
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Sameera Nayak
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Niroj Kumar Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L. V. Prasad Eye Institute, Hyderabad, India
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
| | - Kate Reid
- Department of Ophthalmology, Canberra Hospital, Canberra, Australia; School of Clinical Medicine, Australian National University, Canberra, Australia
| | - Lianne Lim
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vivek Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Sumit R Singh
- Jacobs Retina Center at Shiley Eye Institute, University of California at San Diego, La Jolla, California
| | - Apoorva Ayachit
- Department of Vitreoretina, M. M. Joshi Eye Institute, Hubballi, Karnataka, India
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, Dijon University Hospital, Dijon, France; Center for Taste and Feeding Behaviour, INRA, Dijon, France
| | - Sophie Cai
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luiz H Lima
- Federal University of São Paulo, São Paulo, Brazil
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Zola M, Ambresin A, Zografos L. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGING OF A CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM. Retin Cases Brief Rep 2021; 15:289-293. [PMID: 30074568 DOI: 10.1097/icb.0000000000000788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the case of a small pigmented tumor in the macular region investigated using optical coherence tomography angiography (OCT-A) in the context of a multimodal approach. METHODS Case report. RESULTS A 24-year-old man was referred for evaluation of an asymptomatic unilateral round comma-shaped pigmented tumor located in the macular region of his right eye. Spectral-domain OCT revealed an irregular hyperreflective mass within the retina, with a thickened hyaloid membrane and abrupt margins, and a complete posterior shadowing effect. On fluorescein angiography, early hyperfluorescence without leakage in the middle and late phases and a subtle halo of hyperfluorescence in the late phase were observed. OCT-A revealed the presence of intrinsic vascularization at the level of the inner capillary plexus, with signal intensity present at the level of the outer capillary plexus. In the superficial scans, the retinal vessels were oriented radially to the lesion and were in continuity with the vascular network within the tumor mass. No choroidal vessels could be identified. CONCLUSION We report the case of a congenital simple hamartoma of the retinal pigment epithelium investigated using OCT-A as part of multimodal imaging. OCT-A provided a new insight in the assessment of the lesion, differential diagnosis, and follow-up of the patient. This imaging modality could be an important non-invasive tool in the management of congenital hamartomas of the retinal pigment epithelium.
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Affiliation(s)
- Marta Zola
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
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Alba-Linero C, Liscombe-Sepúlveda JP, Llorenç V, GiraltJosa J, Adán A. Use of ultra-wide field retinal imaging and optical coherence tomography angiography in the diagnosis of incomplete Susac syndrome. Eur J Ophthalmol 2020; 31:3238-3247. [PMID: 33106042 DOI: 10.1177/1120672120965482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe clinical findings through ultra-wide field (UWF) images and optical coherence tomography angiography (OCT-A), in Susac's syndrome (SS). METHODS SS patients were retrospectively analyzed in a single center. Clinical features, ultra-wide-field retinographies (UWF-PR), UWF fluorescein angiographies (UWF-FA), and optical coherence tomography angiography & en face (OCT-A/EF) were reviewed. RESULTS Twelve eyes from six patients with a mean follow-up of 35.66 months ± SD 36.88 were included. UWF-PR showed areas of retinal whitening and cotton-wool spots in all the eyes after acute attack. Segmentary mid peripheral arteriolitis could be observed in five eyes by UWF-FA in acute and convalescent stages. OCT-A revealed capillary density changes in all of the affected eyes. During the acute phase there was a well-preserved superficial capillary network, while deep retinal plexus showed a lower density in the affected areas. OCT-A/EF revealed deep retinal plexus drop-out and surrounding edematous retina in acute attacks, becoming atrophic over time. Conversely, superficial plexus was much less affected. Perifoveal reperfusion was seen in seven eyes after the acute attack. CONCLUSIONS UWF-PR/FA and OCT-A/EF might be helpful to stablish an early diagnosis and to monitor SS progression.
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Affiliation(s)
| | | | - Victor Llorenç
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Joan GiraltJosa
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
| | - Alfredo Adán
- Clinic Institute of Ophthalmology (ICOF), Clinic Hospital of Barcelona, Barcelona, Spain
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OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY EVALUATION OF COMBINED HAMARTOMA OF THE RETINA AND RETINAL PIGMENT EPITHELIUM. Retina 2020; 39:1009-1015. [PMID: 29370036 DOI: 10.1097/iae.0000000000002053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study multimodal imaging features of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). METHODS Six patients (3 males, mean age 11 years) and a healthy age-matched control group made up of 15 healthy subjects (8 males, mean age 12.6 years) were included in the analysis. Complete ophthalmologic examination was performed, including best-corrected visual acuity, anterior and posterior segment slit-lamp evaluation, and tonometry. The multimodal imaging protocol included fundus images, structural optical coherence tomography (OCT), and swept-source OCT angiography (OCTA). The main outcome measures included the qualitative evaluation of both OCT and OCTA features of CHRRPE, retinal and choroidal thickness measurements, and the quantitative analysis of superficial capillary plexus, deep capillary plexus, and choriocapillaris vessel densities. RESULTS Optical coherence tomography features of CHRRPE were examined extensively. Multiple little hyperreflective triangular outer retinal alterations were found at the CHRRPE edges in all patients; these were dubbed the "shark-teeth" sign. Optical coherence tomography angiography showed rarefaction and morphologic alterations of all retinal plexa. Moreover, quantitative analysis revealed a statistically significant decrease in superficial capillary plexus, deep capillary plexus, and choriocapillaris vessel densities in patients affected by CHRRPE compared with the control group. CONCLUSION Optical coherence tomography and OCTA analyses allowed the accurate qualitative and quantitative analyses of CHRRPE features. Further studies are needed to better define OCTA changes of CHRRPE better and to improve our understanding of the possible causes of the shark-teeth sign.
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Fukumoto M, Oosuka S, Sato T, Kida T, Ikeda T. Spontaneous Closure of the Macular Hole in a Patient with Acquired Vitelliform Lesion. Case Rep Ophthalmol 2020; 11:16-21. [PMID: 32009934 PMCID: PMC6984144 DOI: 10.1159/000505315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/08/2019] [Indexed: 11/19/2022] Open
Abstract
In this paper, we report an extremely rare case of spontaneous closure of a macular hole (MH) that developed in a patient in whom acquired vitelliform lesion (AVL) occurred after vitrectomy for atopic retinal detachment (ARD). A 32-year-old male developed ARD in both eyes, and retinal reattachment was achieved after vitrectomy. Five years after surgery, optical coherence tomography showed localized serous retinal detachment (SRD) and a granular lesion with a higher brightness in the subretinal fluid, thus leading to the diagnosis of AVL. One month later, an MH developed, and a follow-up examination performed 6 weeks later revealed that the MH had spontaneously closed and the SRD decreased. In the fovea, fluorescein angiography revealed a window defect due to atrophy of the retinal pigment epithelium (RPE). These findings in this present case suggest the possibility that RPE dysfunction was involved in the development of AVL and MH.
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Affiliation(s)
- Masanori Fukumoto
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
| | - Shou Oosuka
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
| | - Takaki Sato
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
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11
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Gupta R, Fung AT, Lupidi M, Pappuru RR, Nayak S, Sahoo NK, Kaliki S, Yannuzzi L, Reid K, Lim L, Sacconi R, Dave V, Singh SR, Ayachit A, Gabrielle PH, Cai S, Lima LH, Querques G, Arevalo JF, Freund KB, Shields CL, Chhablani J. Peripapillary Versus Macular Combined Hamartoma of the Retina and Retinal Pigment Epithelium: Imaging Characteristics. Am J Ophthalmol 2019; 200:263-269. [PMID: 30689986 DOI: 10.1016/j.ajo.2019.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare clinical, optical coherence tomography (OCT), and fundus autofluorescence (FAF) characteristics of peripapillary vs macular variants of combined hamartoma of the retina and retinal pigment epithelium (combined hamartoma). DESIGN Retrospective observational, comparative case series. METHODS Setting: Multicenter collaborative study. STUDY POPULATION Fifty eyes with a clinical diagnosis of combined hamartoma. Observational Analysis: A comparative analysis of color fundus photographs (CFPs), OCT, and FAF was performed for peripapillary and macular variants of combined hamartoma. MAIN OUTCOME MEASURES Pigmentation and OCT features of macular and peripapillary combined hamartoma. RESULTS The review of imaging from 50 eyes of 49 patients diagnosed with combined hamartoma identified 18 (36%) peripapillary lesions, 27 (54%) macular lesions, and 5 (10%) peripheral lesions. A comparative analysis of peripapillary vs macular combined hamartoma identified differences in the following features: lesion pigmentation on CFPs corresponding to hypoautofluorescent FAF (88% vs 0%, P < .001) and OCT features of full-thickness involvement (88% vs 3%, P < .001), preretinal fibrosis (27% vs 81%, P < .001), maxi peaks (5% vs 88%, P < .001), intraretinal cystoid spaces (72% vs 40%, P < .038), outer plexiform layer involvement (5% vs 96%, P < .001), ellipsoid zone disruption (83% vs 3%, P < .001), RPE disruption (77% vs 3%, P < .001), and choroidal neovascularization (16% vs 0%, P = .028). CONCLUSIONS This comparative analysis identified a higher frequency of pigmentation with hypoautofluorescence, full-thickness retinal involvement, intraretinal cystoid spaces, ellipsoid zone disruption, RPE disruption, and choroidal neovascularization in peripapillary combined hamartoma. These findings suggest that lesions occurring near or at the optic nerve are associated with a more severe degree of pigmentary changes and retinal disruption than those located in the macula.
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Affiliation(s)
- Rajan Gupta
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases
| | - Adrian T Fung
- Westmead Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia; Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Sameera Nayak
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases
| | | | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Lawrence Yannuzzi
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA; Department of Ophthalmology, New York University, New York, New York, USA; Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Kate Reid
- Department of Ophthalmology, Canberra Hospital, Canberra, Australian Capital Territory, Australia; School of Clinical Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lianne Lim
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vivek Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases
| | | | - Apoorva Ayachit
- Department of Vitreoretina, M M Joshi Eye Institute, Hubballi, Karnataka, India
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, Dijon University Hospital, Dijon, France; Center for Taste and Feeding Behaviour, INRA, UMR1324, Dijon, France
| | - Sophie Cai
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luiz H Lima
- Federal University of São Paulo, São Paulo, Brazil
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA; Department of Ophthalmology, New York University, New York, New York, USA; Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases.
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