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Agarwal S, Nayak MA, Sawal RT. Bilateral symmetric acute zonal occult outer retinopathy. BMJ Case Rep 2024; 17:e258150. [PMID: 38760027 DOI: 10.1136/bcr-2023-258150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
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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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Karska-Basta I, Romanowska-Dixon B, Pojda-Wilczek D, Bakunowicz-Łazarczyk A, Kubicka-Trząska A, Gerba-Górecka K. Acute Zonal Occult Outer Retinopathy in a Patient Suffering from Epilepsy: Five-Year Follow-Up. Medicina (B Aires) 2021; 57:medicina57111276. [PMID: 34833494 PMCID: PMC8624097 DOI: 10.3390/medicina57111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
We report an unprecedented case of a young patient with epilepsy coexisting with acute zonal occult outer retinopathy (AZOOR), a rare white dot syndrome of unknown etiology, associated with damage to the large zones of the outer retina. Recently, it has been established that epileptic episodes contribute to an inflammatory response both in the brain and the retina. A 13-year-old male patient with epilepsy was referred by a neurologist for an ophthalmologic consultation due to a sudden deterioration of visual acuity in the left eye. The examination, with a key role of multimodal imaging including color fundus photography, fluorescein angiography, indocyanine green angiography (ICGA), fundus autofluorescence (FAF), swept-source optical coherence tomography (SS-OCT) with visual field assessment, and electroretinography indicated AZOOR as the underlying entity. Findings at the first admission included enlargement of the blind spot in visual field examination along a typical trizonal pattern, which was revealed by FAF, ICGA, and SS-OCT in the left eye. The right eye exhibited no abnormalities. Seminal follow-up revealed no changes in best corrected visual acuity, and multimodal imaging findings remain unaltered. Thus, no medical intervention is required. Our case and recent laboratory findings suggest a causative link between epilepsy and retinal disorders, although this issue requires further research.
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Affiliation(s)
- Izabella Karska-Basta
- Division of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (B.R.-D.); (A.K.-T.)
- Department of Opthalmology and Ocular Oncology, University Hospital, 31-501 Kraków, Poland;
- Correspondence:
| | - Bożena Romanowska-Dixon
- Division of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (B.R.-D.); (A.K.-T.)
- Department of Opthalmology and Ocular Oncology, University Hospital, 31-501 Kraków, Poland;
| | - Dorota Pojda-Wilczek
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Alina Bakunowicz-Łazarczyk
- Department of Pediatric Ophthalmology and Strabismus, Medical University of Białystok, Białystok University Children’s Hospital, 15-274 Białystok, Poland;
| | - Agnieszka Kubicka-Trząska
- Division of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (B.R.-D.); (A.K.-T.)
- Department of Opthalmology and Ocular Oncology, University Hospital, 31-501 Kraków, Poland;
| | - Karolina Gerba-Górecka
- Department of Opthalmology and Ocular Oncology, University Hospital, 31-501 Kraków, Poland;
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Rueda-Rueda T, Sánchez-Vicente JL, Espiñeira-Periñán MA, Muñoz-Morales A, Rodríguez-Fernández C, López-Herrero F. Two case reports of acute zonal occult outer retinopathy (AZOOR): Importance of multimodal diagnosis. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:500-504. [PMID: 34479708 DOI: 10.1016/j.oftale.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
A presentation is made of two cases of acute zonal occult outer retinopathy (AZOOR); one a young man of 19 years, and the other a 42-year-old woman. The young man complained of unilateral scotoma and photopsia. The woman presented with bilateral visual loss and photopsia. Multimodal imaging, including fundus photography, fluorescein angiography, fundus autofluorescence, spectral-domain optical coherence tomography, and visual field testing, supported the diagnosis of AZOOR. The differential diagnosis is complicated, since it has clinical features in common with other retinopathies. This means that it is essential to use modern imaging tests, especially those where the characteristic trizonal pattern is shown, such as in autofluorescence and OCT.
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Affiliation(s)
- T Rueda-Rueda
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M A Espiñeira-Periñán
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - A Muñoz-Morales
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Rodríguez-Fernández
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F López-Herrero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Costello F, Chen JJ. The role of optical coherence tomography in the diagnosis of afferent visual pathway problems: A neuroophthalmic perspective. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:97-113. [PMID: 33832689 DOI: 10.1016/b978-0-12-821377-3.00007-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive ocular imaging technique that has become a standard tool in neuroophthalmic practice. Specifically, OCT captures retinal manifestations of neuroaxonal injury caused by lesions along anterior and posterior regions of the afferent visual pathway, in patients presenting with vision loss. More recently, the advent of OCT angiography (OCTA) has enabled evaluation of the choroidal and retinal microvasculature, thus informing our understanding regarding vascular mechanisms associated with optic nerve and retinal injuries. Much of our longitudinal experience with OCT in the field of neuroophthalmology has been acquired from the study of optic neuritis (ON) caused by inflammatory disorders of the central nervous system (CNS). Over the past two decades, OCT has emerged as a surrogate endpoint for CNS neuroaxonal injury in multiple sclerosis (MS) research trials. On a more pragmatic level, OCT is used in the clinical arena to diagnose ON associated with: MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD). Subsequent advancements in swept-source (SS) and enhanced depth imaging (EDI) have established OCT as the new "gold standard" in the diagnosis of optic disc drusen. Recent studies have highlighted pathognomonic OCT features that distinguish cases of true papilledema from pseudopapilledema, in patients presenting with undifferentiated optic disc elevation. Preoperative OCT measures of neuroaxonal integrity have shown prognostic value in predicting postoperative visual outcomes for patients with compressive anterior visual pathway lesions. Finally, OCT is indispensable in differentiating optic neuropathies from retinal diseases in patients with visual loss and a nondiagnostic fundus examination. An in-depth discussion regarding the technical aspects of OCT is beyond the scope of this chapter. Instead, we wish to highlight the value OCT brings to the diagnosis and management of common neuroophthalmic conditions, with emphasis on optic neuropathies and retinal disorders.
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Affiliation(s)
- Fiona Costello
- Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
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Guijarro A, Muñoz N, Alejandre N, Recuero S, Sanchez-Pernaute O, Carreño E. Long term follow-up and effect of immunosuppression in acute zonal occult outer retinopathy. Eur J Ophthalmol 2020; 32:1120672120981874. [PMID: 33349048 DOI: 10.1177/1120672120981874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a rare syndrome characterized by sudden onset of photopsia, scotomas, and abnormal electrophysiological tests, predominantly affecting young women. Although its pathogenesis remains unknown, auto-reactivity to retinal components is thought to mediate tissue damage. A 42-year-old woman presented with symptoms and examination consistent with the diagnosis of AZOOR. She was treated with azathioprine for 5 years. In spite of the immunosuppressive treatment, clear progression in the visual field, autofluorescence, electrophysiological tests and optical coherence tomography was observed. Treatment with intravenous immunoglobulins (IVIg) and subcutaneous Abatacept was subsequently started with little efficacy. Hereby, we present a case of progressive AZOOR despite aggressive immunosuppression with 10-year follow up. Currently, there is no consensus regarding management of AZOOR, and the convenience of administering aggressive immunosuppression remains uncertain.
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Affiliation(s)
- Andrea Guijarro
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Nelida Muñoz
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Sheila Recuero
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Ester Carreño
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
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Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020; 75:100797. [DOI: 10.1016/j.preteyeres.2019.100797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
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Al-Fakhri AS, Alsulaiman SM. Recovery of the Ellipsoid and Interdigitation Zones in Acute Behcet’s Uveitis after Therapy. Ocul Immunol Inflamm 2019; 28:1129-1132. [DOI: 10.1080/09273948.2019.1644351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Sulaiman M. Alsulaiman
- Vitreoretinal Division and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Mehrotra N, Nagpal M, Khandelwal J, Juneja R. Panoramic optical coherence tomography angiography features in acute zonal occult outer retinopathy. Indian J Ophthalmol 2018; 66:1856-1858. [PMID: 30451199 PMCID: PMC6256877 DOI: 10.4103/ijo.ijo_826_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Navneet Mehrotra
- Department of Vitreo-Retina, Retina Foundation, Near Shahibag Underbridge, Shahibag, Ahmedabad, Gujarat, India
| | - Manish Nagpal
- Department of Vitreo-Retina, Retina Foundation, Near Shahibag Underbridge, Shahibag, Ahmedabad, Gujarat, India
| | - Jayesh Khandelwal
- Department of Vitreo-Retina, Retina Foundation, Near Shahibag Underbridge, Shahibag, Ahmedabad, Gujarat, India
| | - Rakesh Juneja
- Department of Vitreo-Retina, Retina Foundation, Near Shahibag Underbridge, Shahibag, Ahmedabad, Gujarat, India
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