IMAGING AND CLINICAL FEATURES OF PULSATILE POLYPOIDAL CHOROIDAL VASCULOPATHY

PURPOSE

To investigate the imaging and clinical features of polypoidal choroidal vasculopathy (PCV) with pulsation.

METHODS

The PCV eyes were classified into pulsatile and nonpulsatile PCV groups according to the pulsation on indocyanine green angiography. Imaging features including the dye filling time of the polyp and clinical features were compared.

RESULTS

A total of 75 eyes were classified into the pulsatile PCV (30 eyes) and the nonpulsatile PCV (45 eyes) groups. The initial filling time and complete filling time of the polyp of the pulsatile PCV group (2.59 ± 0.93 and 8.33 ± 3.42 seconds) were shorter than those of the nonpulsatile PCV group (4.11 ± 1.87 and 10.63 ± 3.81 seconds, P < 0.001 and P = 0.010, respectively). The pigment epithelial detachment height of the pulsatile PCV group (414.90 ± 377.15 µ m) was greater than that of the nonpulsatile PCV group (247.81 ± 164.07 µ m, P = 0.030). The pulsatile PCV group showed a higher prevalence of subretinal hemorrhage (43.33%) after intravitreal injection than the nonpulsatile PCV group (13.95%, P = 0.005) during 12 months. The mean number of injections during 12 months of the pulsatile PCV group (5.48 ± 1.46) was greater than that of the nonpulsatile PCV group (4.09 ± 1.21, P < 0.001).

CONCLUSION

Eyes with pulsatile PCV showed shorter filling time of the polyp, greater pigment epithelial detachment height, higher prevalence of subretinal hemorrhage, and more intravitreal injection numbers during 12 months. These might suggest that PCV has distinct imaging and clinical features according to the polyp pulsation.

Association between the arm-to-choroidal circulation time and clinical profile in patients with polypoidal choroidal vasculopathy

PURPOSE

To investigate the association between the arm-to-choroidal circulation time (ACT) on indocyanine green angiography (IA) and clinical profile in patients with polypoidal choroidal vasculopathy (PCV).

STUDY DESIGN

Single-center retrospective study.

METHODS

We included 38 eyes of 38 patients with PCV diagnosed using multimodal imaging and did not undergo previous treatment. All patients were treated with monthly aflibercept injections for 3 months and treat-and-extend regimens for the subsequent 12 months. Posterior vortex vein ACT was assessed on the first visit using Heidelberg IA. The patients were divided into two groups: ACT ≥20 s (L group; eight eyes) and ACT <20 s (S group; 30 eyes). The clinical profiles before and after treatment were analyzed to assess associations with ACT.

RESULTS

The mean ACT was 16.39±3.3 s (L group: 21.25±1.49 s, women:men=2:6, mean age: 77.3±6.5 years; S group: 15.10±2.17 s, women:men=7:23, mean age: 75.5±6.9 years). No significant difference was observed in the mean subfoveal choroidal thickness between the L and the S groups (176±75 μm vs. 230±79 μm, P=0.10). However, there were significant differences between the L and S groups in retinal fluid accumulation and hemorrhage recurrence (eight/eight eyes, 100% vs. 13/30 eyes, 43%, P<0.001), mean aflibercept injections (8.8±1.6 vs. 7.0±1.6, P<0.01) during the 12-month period, and the number of polypoidal lesions (1.8±0.7 vs. 1.3±0.5, P<0.05).

CONCLUSION

Patients with PCV and ACT >20 s are more likely to experience exudative change recurrence in the retina during treatment because they have more polypoidal lesions.

BILATERAL CHOROIDAL DETACHMENTS SECONDARY TO IPILIMUMAB AND PEMBROLIZUMAB USE

PURPOSE

To report the occurrence of bilateral choroidal detachments due to the use of ipilimumab and pembrolizumab immunochemotherapeutics to treat widely metastatic cutaneous melanoma and to raise awareness about this potentially vision-threatening adverse drug event.

METHODS

A 77 year-old man presented with acute onset, painless, and bilateral blurry vision. He had started ipilimumab and pembrolizumab 2 weeks prior for Stage IV metastatic cutaneous melanoma.

RESULTS

Clinical examination revealed bilateral choroidal detachments. After discussion with the patient's medical oncologist, the patient discontinued both medications and began oral prednisone to expedite visual recovery. The choroidal detachments subsequently resolved, and visual acuity improved 2 weeks later.

CONCLUSION

Ipilimumab and pembrolizumab have been reported both in monotherapy and in combination to cause a wide variety of ophthalmic adverse events. This is the first report of choroidal detachments as a complication.

Choroidal structure as a biomarker for visual acuity in intravitreal aflibercept therapy for polypoidal choroidal vasculopathy

PURPOSE

To investigate the relationship between choroidal structure and visual acuity after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy (PCV).

METHODS

We conducted a retrospective, single-centre and observational study including 18 eyes of 18 patients with PCV (73.8 ± 10.2 years of age) who were treated with three monthly intravitreal aflibercept injections followed by additional treatments in a treat-and-extend protocol. The cross-sectional images of the macula were obtained with enhanced depth imaging optical coherence tomography at baseline, at 3 months, and at 12 months. The choroidal layer was divided into luminal or stromal segments by applying binarization processing to calculate these areas. The relationships between age, spherical equivalent, best-corrected visual acuity (BCVA), baseline value, or changes in the luminal or the stromal areas, and the BCVA change at 12 months were analysed using multiple regression analyses and model selection procedures.

RESULTS

Both stromal and luminal areas were decreased at 3 and 12 months compared to baseline areas (5% and 9% at 3 months, 6% and 12% at 12 months, p < 0.0001, p < 0.0001, p < 0.0001 and p < 0.0001, respectively). Greater improvement of visual acuity (VA) at 12 months was significantly associated with younger age, greater spherical equivalent, worse baseline BCVA, greater baseline luminal area, and smaller baseline stromal area.

CONCLUSIONS

Choroidal structure might be useful as a new biomarker for potential Visual outcomes after intravitreal aflibercept therapy for PCV.

Central Serous Chorioretinopathy Complicating Systemic Corticosteroid Therapy

Purpose.

To present evidence that systemic corticosteroid therapy may cause central serous chorioretinopathy.

Methods.

A 20-year-old male with idiopathic thrombocytopenic purpura was examined during systemic treatment with corticosteroids (100 mg daily).

Results.

The patient had central serous chorioretinopathy. Spontaneous recovery accompanied discontinuation of the steroid treatment.

Conclusions.

This case provides further evidence that Cortisol may play a role in the development of central serous chorioretinopathy.

Optical Coherence Tomography Angiography Offers New Insights into Choriocapillaris Perfusion

The choriocapillaris (CC) represents a fundamentally important vascular layer that is subject to physiologic changes with increasing age and that is also associated with a wide range of chorioretinal diseases. So far, information on blood flow in this specific layer has remained limited. With the advent of optical coherence tomography angiography (OCTA), new perspectives and possibilities of CC imaging have begun to evolve. This article shall review the opportunities and challenges of applying OCTA technology to the CC layer and summarize the current clinical efforts in OCTA CC imaging exemplarily in dry age-related macular degeneration and central serous chorioretinopathy.

Diabetic choroidopathy

Early histopathological studies of diabetic choroids demonstrated loss of choriocapillaris (CC), tortuous blood vessels, microaneurysms, drusenoid deposits on Bruchs membrane, and choroidal neovascularization. The preponderance of histopathological changes were at and beyond equator. Studies from my lab suggest that diabetic choroidopathy is an inflammatory disease in that leukocyte adhesion molecules are elevated in the choroidal vasculature and polymorphonuclear neutrophils are often associated with sites of vascular loss. Modern imaging techniques demonstrate that blood flow is reduced in subfoveal choroidal vasculature. Angiography has shown areas of hypofluorescence and late filling that probably represent areas of vascular loss and/or compromise. Perhaps, as a result of vascular insufficiency, the choroid appears to thin in DC unless macular edema is present. Enhanced depth imaging (EDI-SD) OCT and swept source (SS) OCT have documented the tortuosity and loss in intermediate and large blood vessels in Sattler's and Haller's layer seen previously with histological techniques. The risk factors for DC include diabetic retinopathy, degree of diabetic control, and the treatment regimen. In the future, OCT angiography could be used to document loss of CC. Because most of the measurement and imaging are in the posterior pole, the severity of DC may be underappreciated in the published accounts of DC assessed with imaging techniques. However, it is now possible to document DC and quantify these changes clinically. This suggests that DC should be evaluated in future clinical trials of drugs targeting DR because vascular changes similar to those in DR are occurring in DC.

Comparison of Clinical Features After 20-Gauge Vitrectomy Versus 23-Gauge Vitrectomy

PURPOSE

To compare the clinical features after 20-gauge (20G) versus 23-gauge (23G) pars plana vitrectomy (PPV).

DESIGN

This was a prospective observational study.

METHODS

Patients who underwent 20G or 23G PPV participated in the study. Sutures were used in all patients who had 20G and as necessary in patients who had 23G. All patients were examined with ultrasound biomicroscopy and tonometry for intraocular pressure (IOP) preoperatively and postoperatively at 1 day, 1 week, 1 month, and 6 months.

RESULTS

Forty-nine eyes underwent 20G PPV and 97 eyes underwent 23G PPV. Hypotony appeared more frequently in the 23G group (9 patients of 97, 9%) than in the 20G group (1 patient of 49, 2%) 1 day after surgery. Mean IOP was statistically significantly lower in the 23G group 1 day after surgery (P = 0.000). Postoperatively, choroidal detachment (CD) was found in both the 23G group (22/97, 23%) and the 20G group (1/49, 2%). In the 23G group, the mean IOP of eyes with CD was significantly lower than those without CD. There was no statistically significant difference in vitreous incarceration between the 2 groups (P = 0.317).

CONCLUSIONS

Choroidal detachment and hypotony were common complications in the early stages after 23G PPV. The incidence of postoperative vitreous incarceration was similar in both groups.

Combined intravitreal anti-VEGF and photodynamic therapy versus photodynamic monotherapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis of comparative studies

Purpose

The aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal vascular endothelial growth factor (VEGF) inhibitors compared to those of PDT alone in the treatment of polypoidal choroidal vasculopathy (PCV).

Methods

A systematic search of Pubmed, Embase, and the Cochrane Library was performed to identify all comparative studies that compared the outcomes of the two approaches. Outcomes of interest included visual outcomes, anatomic variables, and adverse events.

Results

Two randomised controlled trials and nine retrospective studies including a total of 543 cases were identified. At three and six months post-injection, no significant difference in visual acuity was found in the combined therapy group compared with the PDT monotherapy group, with pooled weighted mean differences (WMDs) of 0.074 (−0.021, 0.17) at three months and 0.082 (−0.013, 0.18) at six months. However, the mean changes in visual acuity at month 12 in the combined therapy group were significantly better than those in the PDT monotherapy group, with pooled WMDs of 0.11 (0.012, 0.21). Similar efficacy was found at 24 months (WMD: 0.21; 95%CI: 0.054, 0.36; P = 0.008). Patients in the combined therapy group also might benefit from reduced retinal haemorrhage (OR: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Polyp regression, recurrence of PCV, central retinal thickness reduction, and pigment epithelial detachment resolution did not differ significantly between the two treatments.

Conclusions

Combined treatment appeared to result in better visual acuity and lower retinal haemorrhage. However, combined treatment did not affect the resolution and recurrence of lesions. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.

Spontaneous bilateral retinal pigment epithelium rips with good visual acuity

Retinalpigment epithelium (RPE) rips commonly occur in retinochoroidal disorders including age-related macular degeneration, idiopathic polypoid alchoroidal vasculopathy, central serous chorioretinopathy, high myopia andchoroidal neovascularization. Most patients have unilateral involvement and poor visual prognosis. A 55-year-old female presented with decreased vision in her right eye for one week. Her best-corrected visual acuity was 6/12 in the right eye and 6/6-2 in the left. Fundus examination revealed a large juxtafoveal RPE rip in the right eye and multiple small pigment epithelium detachments in the left. No abnormal hyperfluorescent lesions were detected byfundus angiography. High-doseoral antioxidant was prescribed. A pigment epithelium detachment (PED) in the left eye grew larger over the follow-up period. Ultimately, a RPE rip also occurred in the left eye in the 17th week offollow-up. Her best-corrected visual acuity was 6/9. Although reinvestigation was done, no other choroidal abnormalities were demonstrated by optical coherence tomography (OCT) and fundus angiography. During the observation, RPE tears were reattached spontaneously in both eyes. A considerable amount of RPE proliferation, migration, and repopulation was also demonstrated by OCT and fundus autofluorescence. After 2.5 years of follow-ups, her best-corrected visual acuity was 6/9 in the right eye and 6/6 in the left. We hypothesize that the increased surface tension of RPE is the etiology of RPE rips in this case. Furthermore, the underlying chorioretinal abnormality directly affects the visual prognosis and further studies are needed in prevention, pathogenesis and treatment.

Imaging evidence of diabetic choroidopathy in vivo: angiographic pathoanatomy and choroidal-enhanced depth imaging

Purpose

To describe the pathoanatomy of diabetic choroidopathy (DC) in pre-diagnosed diabetic retinopathy (DR) cases and to provide angiographic and optical evidence for DC using indocyanine green angiography (ICGA) and enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT).

Methods

A retrospective analysis of 80 eyes from 40 DR patients was conducted. In Group One, choroidal vascular abnormalities were evaluated by comparing angiographic findings from simultaneous ICGA with those from fundus fluorescein angiography (FFA). In Group Two, EDI SD-OCT was used to evaluate the subfoveal choroidal thickness (SFCT) and define the choroid boundary in order to acquire the bilateral and symmetric choroidal area (CA). Data were then analyzed by Image Pro Plus 6.0.

Results

In Group One, choroidal abnormalities that were evident using ICGA but not FFA included early hypofluorescent spots in 47 eyes (75.81%), late hyperfluorescent spots in 37 eyes (59.68%), and late choroidal non-perfusion regions in 32 eyes (51.61%). In particular, a significant difference between proliferative DR (PDR) in 17 of 23 eyes (73.91%) and non-PDR in 16 of 39 eyes (41.03%) was observed in late choroidal non-perfusion regions. Eighteen of 31 eyes (58.06%) also exhibited “inverted inflow phenomena.” In Group Two, both the SFCT and CA of eyes with diabetic macular edema and serous macular detachment were significantly greater than those in the other eyes. The CA in panretinal photocoagulation (PRP) treated cases was also greater than that in non-PRP treated cases.

Conclusions

Early hypofluorescent spots, late choroidal non-perfusion regions, inverted inflow phenomena, higher SFCT, and larger CA are qualitative and quantitative indexes for DC. Moreover, the late choroidal non-perfusion region is a risk factor for DC with DR. Our study suggests that the supplemental use of ICGA and EDI SD-OCT with FFA is a better choice for DR patients.

[Association of the ARMS2 gene with clinical features in polypoidal choroidal vasculopathy]

Polypoidal choroidal vasculopathy (PCV) exhibits subretinal and sub-pigment epithelial lesions, as wells as classic choroidal neovascularization. From a genetic point of view, variants of age-related maculopathy susceptibility 2 (ARMS2) A69S and CFH I62V are reported to be strongly associated with PCV. We investigated whether these two major genetic variants are associated with funduscopic manifestations of PCV. Although there was no association between CFH I62V variants and clinical expression in PCV, the risk variants of ARMS2 A69S were associated with subretinal hemorrhage, hemorrhagic pigment epithelial detachment (PED), and serous PED. Neither variant was associated with classic CNV. The mean onset age in bilateral patients was significantly lower than in unilateral patients. There was also a significantly higher frequency of risk variants in ARMS2 A69S in bilateral patients than in unilateral patients. The risk variants of ARMS2 A69S were associated with hemorrhagic and sub-pigment epithelial lesions and with bilaterality. Genotyping of ARMS2 A69S is useful in understanding clinical features in PCV.

Comparisons of outcomes with different intervals between adjunctive ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE

To determine the optimal time for administration of intravitreal ranibizumab injections before photodynamic therapy (PDT) as combined therapy to treat polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective, comparative, interventional case series.

METHODS

The study included 99 eyes (98 patients) with treatment-naïve subfoveal PCV treated with an intravitreal ranibizumab injection followed by PDT. The combination therapy included 1 ranibizumab injection administered 7 days before PDT (7-day group) or 2 days before PDT (2-day group). All eyes were followed for over 12 months.

RESULTS

Intravitreal ranibizumab was administered 7 days before PDT in 59 eyes and 2 days before PDT in 40 eyes. In the 7-day group, the best-corrected visual acuity (BCVA) did not improve significantly at 3 months (P = .086) or 12 months (P = .259) compared with baseline. In the 2-day group, BCVA improved significantly at 3 months (P < .001) and 12 months (P < .001). The polypoidal lesions regressed completely in 46 eyes (78.0%) in the 7-day group and in 34 eyes (85.0%) in the 2-day group; 38 eyes (64.4%) and 35 eyes (87.5%), respectively, did not require additional treatment, which differed significantly (P = .008) between the 2 groups. Subretinal hemorrhages did not develop in either group within 1 month after the combined therapy.

CONCLUSIONS

Administration of an intravitreal ranibizumab injection 2 days before PDT achieves significantly better visual outcomes and requires fewer additional treatments compared with administration of the injection 7 days before PDT.

Five-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE

To evaluate the 5-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective study.

METHODS

Forty-two eyes of 36 patients with PCV followed up for at least 60 months after PDT were reviewed. All eyes were primarily treated with PDT. Main outcome measure was best-corrected visual acuity (BCVA; logMAR [logarithm of minimal angle of resolution]) at baseline and at each follow-up visit. We also classified the eyes into 3 groups: improved (improvement ≥0.3 logMAR), decreased (deterioration ≥0.3 logMAR), and stable.

RESULTS

During the mean follow-up duration, 73.64 ± 13.47 months, the mean number of PDT was 2.21 ± 1.62 treatments. Recurrence was noted in 33 eyes (78.6%) during follow-up. The mean baseline BCVA was 0.78 ± 0.48 logMAR (20/120 Snellen equivalent), and the final BCVA at 60 months was 0.67 ± 0.52 logMAR (20/93 Snellen equivalent) (P = .050, paired t test). On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%), stable in 23 eyes (54.8%), and decreased in 5 eyes (11.9%).

CONCLUSION

At 60 months after initial PDT, 88.1% of PCV patients showed stable or improved BCVA after PDT. Despite a high recurrence rate, PDT remained effective for 5 years, and represents a good therapeutic approach to PCV.

Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up

PURPOSE

To compare the long-term results of the efficacy of photodynamic therapy (PDT) with or without intravitreal bevacizumab (IVB) injections for polypoidal choroidal vasculopathy.

DESIGN

Retrospective, comparative, interventional case series.

METHODS

We included 69 eyes of 69 patients with macula-involved polypoidal choroidal vasculopathy. All patients were followed up for more than 2 years. We compared the treatment outcomes between groups and investigated the factors influencing visual improvement at 24 months of follow-up.

RESULTS

Thirty-six patients received PDT combined with IVB and 33 patients received PDT monotherapy. At 3 months, the mean logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 0.73 to 0.53 in the combined therapy group (P < .001) and from 0.79 to 0.72 in the PDT monotherapy group (P = .02), with a significant difference in treatment efficacy between the 2 groups (P < .001). However, the improvements in BCVA were not statistically significant after 21 months in the combined therapy group and 15 months in the monotherapy group. The difference in treatment efficacy between the 2 groups was not significant after 6 months. Initial BCVA (P = .005), lesion size (P = .011), patient age (P = .018), and location of polyps (P = .006) significantly predicted the final visual outcome rather than treatment modality (P = .243).

CONCLUSIONS

PDT combined with IVB for symptomatic PCV was temporarily superior to PDT monotherapy, and the treatment efficacy decreased with time. Initial BCVA, lesion size, and location were more significant than treatment modality as the factors influencing final visual improvement.

Treatment of polypoidal choroidal vasculopathy with photodynamic therapy combined with intravitreal injections of ranibizumab

PURPOSE

To evaluate the 1-year efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injections of ranibizumab for polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective chart review.

METHODS

We retrospectively reviewed the medical records of 63 consecutive patients (66 eyes) with subfoveal PCV who were treated with PDT combined with intravitreal injections of ranibizumab. Of the 66 eyes, 29 had no history of treatment for PCV, 10 had been treated previously with only intravitreal injections of anti-vascular endothelial growth factor agents, and 27 had been treated previously with PDT. All eyes had a minimal follow-up of 12 months.

RESULTS

The combined therapy reduced substantially the exudative change immediately after initiation of treatment. In treatment-naïve eyes, mean VA before treatment (0.47 ± 0.37 logarithm of the minimal angle of resolution [logMAR]) improved to 0.32 ± 0.30 (P < .01) at 3 months and to 0.29 ± 0.29 (P < .01) at 12 months. Polypoidal lesions were reduced in all eyes and disappeared completely in 79.1% of cases. In eyes treated previously with only anti-vascular endothelial growth factor therapy, some visual improvement was achieved, but in eyes treated previously with PDT, mean visual acuity (0.61 ± 0.45) deteriorated to 0.68 ± 0.52 at 12 months. Of all 66 eyes, 5 showed extensive postoperative subretinal hemorrhage, in 2 of which a vitreous hemorrhage developed, necessitating pars plana vitrectomy.

CONCLUSIONS

PDT combined with ranibizumab led to significant visual recovery in treatment-naïve eyes with PCV, but not in eyes with PCV that had demonstrated recurrence after previous PDT. PDT in combination with ranibizumab still has a risk of the postoperative hemorrhagic complications.

Clinical features and follow-up results of pulsating polypoidal choroidal vasculopathy treated with photodynamic therapy

PURPOSE

 To report on the clinical course of pulsating polypoidal choroidal vasculopathy (PCV) treated with photodynamic therapy (PDT).

METHODS

  A total of 63 eyes of 58 consecutive patients diagnosed with PCV, treated with PDT and followed up for at least 6months were enrolled. Best-corrected visual acuity (BCVA), fluorescein angiography and high-speed indocyanine green angiography (ICGA) using confocal scanning laser ophthalmoscopy (HRA) were performed.

RESULTS

  Of the 63 PCV eyes, 14 eyes (22.2%) of 14 patients were classified as having pulsating PCV. The mean age of pulsating PCV patients was 60.6±7.0years (48-69years), which was younger than non-pulsating PCV patients (65.7years, p=0.035). The mean follow-up period was 23.9±10.7months, and PDT was administered 1.6±0.9 times to pulsating PCV patients. The mean logMAR BCVAs were 0.85±0.47 at presentation and 0.71±0.52 at final examination. Extensive haemorrhagic events were more common in pulsating than in non-pulsating PCV patients (57.1% versus 26.5%, p=0.032). However, the risk of haemorrhage within 3months of PDT was similar for both pulsating PCV and the remaining patients (14.3% versus 20%, p=0.723).

CONCLUSION

  Pulsating PCV showed distinctive features including a relatively younger patient age at presentation, and a haemorrhagic tendency (especially extensive). However, the use of PDT did not directly increase the risk of haemorrhage in pulsating PCV patients.

Correlation of the recurrent FBN1 mutation (c.364C>T) with a unique phenotype in a Chinese patient with Marfan syndrome

PURPOSE

To describe a Chinese patient with Marfan syndrome who had a unique phenotype and a recurrent mutation in the fibrillin-1 (FBN1) gene.

CASE AND METHODS

A 31-year-old man who had a spontaneous bilateral lens dislocation into the vitreous cavity in childhood was found to have retinal and choroidal detachments in both eyes. A congenital atrial septal defect was detected. Pars plana vitrectomy, lensectomy, and silicone oil tamponade were performed on his right eye. Genomic DNA was extracted from leukocytes of peripheral blood, and the 65 exons and flanking intronic sequences of the FBN1 gene were amplified by polymerase chain reaction for mutational screening.

RESULTS

A recurrent mutation, c.364C>T was detected in exon 4 that resulted in p.Arg122Cys. The visual acuity of the right eye improved to 6/60 one year after the surgeries.

CONCLUSION

DNA screening helps in the diagnosis of Marfan syndrome with unique phenotypes. The mutation c.364C>T can be considered to be a hotspot for Marfan patients with predominant ectopia lentis.

Clinical characteristics of posterior staphyloma in eyes with pathologic myopia

PURPOSE

To determine the morphologic features (grade and type) of posterior staphylomas and to analyze the relationship between the morphologic features and the incidence of myopic macular lesions.

DESIGN

Observational case series.

METHODS

Two hundred and nine eyes of 108 consecutive patients with high myopia were studied. The grade of staphylomas was determined from B-scan ultrasonographic images across the optic disk. The type of staphyloma was determined by binocular funduscopy and was classified according to the criteria of Curtin. The participants were divided into two groups: younger than 50 years and 50 years and older. The long-term morphologic progression of staphylomas was analyzed in nine patients who were followed up for more than 20 years.

RESULTS

Ninety percent of 209 eyes had a staphyloma. The prevalence of staphylomas and more advanced grades of staphylomas (> grade 2) were significantly higher in the older than in the younger patients. The higher grades of staphylomas were associated with more severe myopic retinal degeneration. Type II staphyloma was the most prominent overall; however, in older subjects, the incidence of type II was decreased significantly, and that of type IX was increased significantly. The eyes with type IX staphyloma tended to have more severe myopic retinal degeneration than eyes with type II staphylomas. The long-term follow-up study demonstrated a progression from type II to type IX with increasing age.

CONCLUSIONS

These results suggest that the morphologic features of staphylomas worsens as the patient ages. The progression from type II to type IX probably increases the mechanical tension on the macular area of highly myopic eyes, which then leads to myopic fundus lesions.

Technical note: method for estimating volume of subretinal fluid in cases of localized retinal detachment by OCT ophthalmoscopy

The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments.

[A new method for functional diagnosis and correction of vision. Color-pulse campimetry in patients with central chorioretinal dystrophy]

A new technique has been proposed for color-pulse campimetry and quantum-wave correction of vision on an ACO-05 spectral ophthalmological apparatus in central chorioretinal dystrophy. A correlation of scotomas in the central field of vision with visual acuity and retinal optical coherent tomographic findings was studied. After a 7-day course of photostimulation on the ACO-05 apparatus, visual acuity increased by 0.05 and 0.08 without and with correction, respectively. There were simultaneous increases in electrophysiological characteristics: the critical flicker frequency by 1.1 Hz, systemic electroretinography (ERG) to white light by on an average of 2 microV, central ERG to red light by an average of 1.4 microV, and foveal photosensitivity by an average of 0.8 dV, (p < 0.05). After alternative photostimulation, there was a 2-fold reduction in the area of central scotomas. Color-pulse campimetry is easy-to-use and accessible and may be recommended for introduction into ophthalmological care. The ACO-05 apparatus is convenient and reliable in operation; the parameters of stimulation are reproducible; and side effects have not been found.

Facial and physical features of Aicardi syndrome: infants to teenagers

Aicardi syndrome is a sporadic disorder that affects primarily females and is hypothesized to be caused by heterozygous mutations in an X-linked gene. Its main features include of a triad of infantile spasms, agenesis of the corpus callosum, and distinctive chorioretinal lacunae. Additional common findings include moderate to profound mental retardation, gray matter heterotopia, gyral anomalies, and vertebral and rib defects. To date, no consistent facial dysmorphisms have been described. We examined 40 girls with Aicardi syndrome and determined that consistent facial features appeared in over half the study participants and included a prominent premaxilla, upturned nasal tip, decreased angle of the nasal bridge, and sparse lateral eyebrows. Externally apparent microphthalmia was seen in 10/40 (25%). Various skin lesions (including multiple nevi, skin tags, hemangiomas, one giant melanotic nevus, and a history of a previously removed angiosarcoma) were present in 8/40 (20%). Hand abnormalities were seen in 3/40 (7.5%) and included camptodactyly, proximal placement of the thumb and hypoplasia of the fifth finger. This study clearly delineates the existence of a distinctive facial phenotype of Aicardi syndrome not previously described. We recommend that features of a prominent premaxilla with upturned nasal tip and vascular malformations/vascular tumors be added to the modified diagnostic criteria in order to improve the ability of geneticists to diagnose Aicardi syndrome.

Longitudinal cohort study of patients with birdshot chorioretinopathy. IV. Visual field results at baseline

PURPOSE

To describe visual field parameters at baseline examination of 80 participants in a longitudinal cohort study of birdshot chorioretinopathy and to identify relationships between these parameters and visual acuity, symptoms, clinical findings, and results of laboratory tests.

DESIGN

Single-center cross-sectional study.

METHODS

Standardized Fastpac, full-threshold Humphrey 30-2 (Carl Zeiss Meditec, Dublin, California, USA) visual field studies were performed for both eyes of all patients. A standardized protocol identified foveal threshold and mean deviation, specified categories of total deviation, and assigned visual field pattern descriptors. These parameters were compared with best-corrected visual acuity (BCVA), symptoms, color confusion score (CCS), cataract, vitreous inflammatory reactions, retinal vasculitis, birdshot lesion characteristics, and ocular coherence tomography (OCT) and fluorescein angiography parameters.

RESULTS

Each visual field parameter was closely related to the others, although mean deviation could be abnormal in the presence of a near normal foveal threshold. Mean deviation was related to BCVA, but the correlation was moderate (the Spearman correlation, -0.55; P < .001). It was also related to CCS and the symptoms of blurry vision, poor contrast sensitivity, and nyctalopia. The most common visual field patterns were multiple foci and arcuate defects. Among clinical and laboratory findings, visual field parameters were most closely related to absence of the third highly reflective band on OCT (P < .001).

CONCLUSIONS

Patients with birdshot chorioretinopathy may have a variety of visual field abnormalities, even with normal BCVA. Abnormalities seem to be associated with retinal damage. Automated visual field testing may provide objective measures for monitoring disease activity.

Assessment of central serous chorioretinopathy by optical coherence tomography and multifocal electroretinography

PURPOSE

To evaluate central serous chorioretinopathy (CSCR) by means of optical coherence tomography (OCT) and multifocal electroretinogram (mf-ERG) at presentation and after resolution of the acute phase.

DESIGN

Prospective comparative observational case series with a normal sample.

PATIENTS AND METHOD

Twenty-one eyes of 21 patients with unilateral CSCR were examined. Both eyes underwent complete ophthalmological examination, which included measurement of best-corrected visual acuity, fluorescein angiography, OCT and mf-ERG recording. Our results were compared with the corresponding findings of 33 normal volunteers of the same age.

RESULTS

At presentation, the averaged mean retinal thickness of the fovea, measured by OCT, was 303 mum in the affected eyes, 69.3% higher compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 11.29 nV/degree(2), 50.8% lower compared to the normal controls (p < 0.001). After regression of CSCR, the averaged mean retinal thickness of the fovea was 213 microm in the affected eyes, 19.3% greater compared to the normal controls (p < 0.001). The averaged mean retinal response density of the mf-ERG of the affected eyes in area 1 was 16.05 nV/degree(2), 30.1% lower compared to normal controls (p < 0.001). It is interesting that 6 of 21 fellow nonaffected eyes showed abnormal values, with an averaged mean retinal thickness of OCT (246 mum) and an averaged mean retinal response density of mf-ERG in area 1 (12 microV/degree(2)). In the remaining 15 eyes, the OCT and the mf-ERG values were within normal limits.

Choroidal and Optic Nerve Infarction in Hepatitis C-Associated Polyarteritis Nodosa

A 39-year-old man presented with headache, weight loss, bilateral subdural hematomas, pansinusitis, and visual loss. The neuro-ophthalmologic examination disclosed deep choroidal lesions and bilateral optic disc edema. Orchiectomy for testicular torsion showed acute vasculitis consistent with polyarteritis nodosa (PAN). Polymerase chain reaction (PCR) testing revealed hepatitis C. This is the first reported case of PAN due to hepatitis C with early findings of choroidal and optic nerve infarction.

The value of contrast sensitivity in diagnosing central serous chorioretinopathy

A 39-year-old hyperopic male was referred for laser refractive treatment. In the course of the pre-operative evaluation he complained of a recent deterioration of vision. The suspicion of unilateral central serous chorioretinopathy (CSCR) was confirmed by contrast sensitivity testing and by ocular fundus examination. Contrast sensitivity (CS) for six spatial frequencies (1, 2, 4, 8, 12 and 16 c/deg) was evaluated using Gabor patches of gratings projected on a high-resolution display by means of a stimulus generator card. Although VA remained unaltered, the pattern of contrast sensitivity function varied at different stages of CSCR: during the acute stage, performance at all spatial frequencies was depressed, while at two-month follow up, intermediate and high spatial frequencies were mainly affected. It is concluded that the level of visual deficit in CSCR cannot be evaluated by measuring visual acuity. History and contrast sensitivity can play a central role in setting the correct diagnosis and characterising its stage.

[Automated static perimetry in 5 eyes with multiple evanescent white dot syndrome]

PURPOSE

Multiple evanescent white dot syndrome (MEWDS) is a self-limiting disease in which reduced visual acuity and retinal changes recover without treatment. It also shows visual field defects including an enlarged blind spot of Mariotte. However the final outcome of the field change has rarely been documented. We therefore retrospectively studied the visual field change in eyes with MEWDS by reviewing the multiple results of automated static perimetry recorded in the clinical course of the disease.

SUBJECTS

We reviewed the clinical course of five eyes with MEWDS using the multiple recordings of the Humphrey central 30-2 program taken during their clinical course.

RESULTS

The initial findings of perimetry included an enlarged blind spot of Mariotte, depression of the central field, and paracentral scotoma. These field defects recovered within 2 weeks to 4 months.

CONCLUSION

Visual field defects as well as vision and retinal changes recover without treatment in eyes with MEWDS.

Hypotony maculopathy

Hypotony maculopathy, first described in 1954 by Dellaporta, usually occurs after antiglaucomatous surgery or after perforating eye injuries; it is characterized by hypotony associated with fundus abnormalities, including papilloedema, vascular tortuosity and chorioretinal folds. In hypotony maculopathy, the scleral wall collapses inward, resulting in redundancy of the choroid and retina, leading to chorioretinal wrinkling. As the antero-posterior diameter of the vitreous cavity decreases, the very thick perivofeal retina surrounding the very thin foveal retina is thrown into radial folds around the fovea. It has been reported that hypotony maculopathy occurs in up to 20% of cases of glaucoma filtering surgery and has become more common after the introduction of antimetabolites. Young age, myopia, primary filtering surgery, systemic illnesses and elevated preoperative intraocular pressure (IOP) have been found to be associated with hypotony maculopathy. Hypotony maculopathy is treated with procedures designed to elevate IOP, which may reverse the inward scleral bowing and improve visual acuity. The successful treatment of hypotony maculopathy depends on the correct identification of its cause. Once the cause is detected, treatment should be employed as soon as possible because delayed normalization of the IOP may result in permanent macular chorioretinal changes and poor vision. This review will explore the definition, mechanisms, clinical findings and treatment of hypotony maculopathy.

Central retinal sensitivity measured with the micro perimeter 1 after photodynamic therapy for polypoidal choroidal vasculopathy

PURPOSE

To evaluate central retinal sensitivity and its relation to the symptomatic change noted in central visual disturbance shortly after photodynamic therapy (PDT) in eyes with polypoidal choroidal vasculopathy (PCV).

DESIGN

Retrospective interventional case series.

METHODS

We reviewed retrospectively 20 eyes of 20 patients who underwent PDT for the treatment of subfoveal PCV. Microperimetry in the macular area was performed with Micro Perimeter 1 (MP1) [Nidek, Vigonza, Italy] before and at one, three, and six months after PDT. Forty measurement points were located within the central 10 degree of the macula.

RESULTS

After PDT, although most eyes showed a reduction in exudation, the mean posttreatment visual acuity did not change significantly. At one month after PDT, however, retinal sensitivities within the central 2 degree, 6 degree, and 10 degree fields, which were 3.6 +/- 3.1, 5.1 +/- 3.4, and 6.2 +/- 3.6 dB [decibels] at baseline, improved to 5.9 +/- 3.8 (P = .003), 7.1 +/- 3.6 (P = .003), and 8.1 +/- 3.5 dB (P = .004). At one month after treatment, 14 patients (70%) noted subjective improvement of the central visual disturbance and mean retinal sensitivity within the central 2 degree, 6 degree, and 10 degree fields had improved more than 2 dB in 11, 10, and eight eyes, respectively. At three and six months after PDT, however, postoperative improvement of the retinal sensitivities was diminished.

CONCLUSIONS

Retinal sensitivity in the macular area of eyes with subfoveal PCV improved shortly after PDT, and may account, at least in part, for the immediate subjective improvement in central vision after PDT.

The use of propranolol to treat central serous chorioretinopathy: an evaluation by serial OCT

PURPOSE

Although usually self-limiting, central serous chorioretinopathy (CSCR) may recur or adopt a chronic course, with permanent impairment of visual acuity. Previously suggested treatments for nonresolving or recurrent CSCR have included invasive techniques, such as laser photocoagulation and intravitreal triamcinolone. We evaluated the evidence for epinephrine in the pathophysiology of CSCR and the role beta-blockade may play in treating this condition.

METHODS

This study was comprised of a literature review and interventional case report. Two (2) patients with nonresolving or recurrent CSCR were commenced on a trial of oral propranolol 40 mg twice a day and followed up at monthly intervals. Visual acuity, metamorphopsia, and central retinal thickness quantified by ocular coherence tomography (OCT) were recorded at baseline and follow-up visits.

RESULTS

Two successive trials of propranolol in 1 patient and a trial in a 2nd patient with recurrent CSCR were associated with an improvement in visual acuity, symptoms, and retinal thickness. One (1) patient demonstrated recovery, remission, and subsequent rerecovery, which coincided with the commencement, cessation, and retreatment with propranolol.

CONCLUSIONS

Although there may have been a spontaneous improvement without treatment, beta-blockade has a plausible mechanism or action in CSCR.

Sympathetic-parasympathetic activity and reactivity in central serous chorioretinopathy: a case-control study

PURPOSE

This case-control study was conducted to evaluate autonomic function activity and reactivity in patients with central serous chorioretinopathy (CSCR), because stress and type A personality, known risk factors, are also related to autonomic nervous system activity.

METHODS

Patients with CSCR were selected from the outpatient department and medical retina services in one center. Control subjects were chosen from the healthy subjects of similar age group. The autonomic activity (both sympathetic and parasympathetic) in 45 patients with CSCR was evaluated and compared with that in 28 healthy control subjects, by using HRV (heart rate variability) analysis according to the guidelines laid down by the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Autonomic reactivity (both sympathetic and parasympathetic) was also evaluated in 32 patients with CSCR and compared with that in 28 healthy control subjects, by using standard autonomic function tests: HRV, as a measure of the resting sympathetic and parasympathetic activity (tone), and changes in blood pressure response and heart rate changes during various stressor stimuli in the tests as a measure of sympathetic and parasympathetic reactivity.

RESULTS

Patients with CSCR showed significantly decreased parasympathetic activity (P = 0.002), significantly increased sympathetic activity (P = 0.005), and significantly increased sympathetic-parasympathetic balance (P = 0.004) as measured from different measures of beat-to-beat heart rate variability. The patients also showed significantly decreased parasympathetic reactivity (P = 0.03). Sympathetic reactivity showed a trend toward lessening.

CONCLUSIONS

Autonomic function, both activity and reactivity components of sympathetic and parasympathetic system, is impaired in patients with CSCR. Because autonomic supply modulates the choroidal blood flow, there may be a correlation between measures of autonomic function and the presence of CSCR.

Assessment of macular function by microperimetry in unilateral resolved central serous chorioretinopathy

PURPOSE

To determine macular sensitivity and fixation characteristics in patients with unilateral resolved central serous chorioretinopathy (CSC) using fundus-related microperimetry.

METHODS

We reviewed 15 eyes with resolved CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The best-corrected visual acuity (VA) (BCVA), mean retinal sensitivity in the central 10 degrees (central microperimetry, cMP-1) and in the paracentral 10-20 degrees (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with measurements in control eyes.

RESULTS

BCVA at the time of this study was 20/20 in all the affected eyes, and fundus examination and optical coherence tomography findings revealed no serous detachment. Eyes with CSC showed statistically significantly lower cMP-1 sensitivity and lower, but not significantly, pMP-1 sensitivity than control eyes (P<0.001, P=0.11, respectively). Eyes with CSC were not significantly different from control eyes in fixation location (P=1.00) or fixation stability (P=0.91). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 12 (80%) and relatively unstable in 3 (20%).

CONCLUSION

Our study shows that eyes with resolved CSC can have lower retinal sensitivity in the central macula than control eyes, even after good VA has been obtained.

Alcohol- and light-induced electro-oculographic responses in age-related macular degeneration & central serous chorioretinopathy. alcohol- and light-induced EOG responses in ARMD & CSC

The non-photic electro-oculographic (EOG) response induced by alcohol has been proposed as an indicator of retinal pigment epithelial (RPE) integrity, and reported to be abnormal in age-related macular degeneration (ARMD). To evaluate this proposal, we have measured the alcohol-EOG as well as the ISCEV-standard EOG in patients with ARMD (n=11 patients, 4 eyes with drusen, 8 eyes with 'dry' and 7 eyes with 'wet' lesions) and central serous chorioretinopathy (CSC, n=11 patients, 7 eyes with active and 6 eyes with inactive lesions), compared with 29 normal controls. We recorded the alcohol-induced EOG response after a single oral administration of ethanol at 160 mg/kg, followed by an ISCEV-standard EOG. Blood alcohol levels were monitored with a breath analyzer. We found that neither the alcohol-EOG nor the light-induced EOG response showed any difference between either ARMD or CSC patients and normal controls. Nor was there difference among eyes of different ARMD or CSC subgroups. In addition, blood alcohol concentrations near the time of the alcohol-EOG peak showed no obvious relationship with peak/baseline ratios. These data suggest that neither the alcohol- nor the light-induced EOG is a sensitive indicator of these diseases.

Different transitions of multifocal electroretinogram recordings between patients with age-related macular degeneration and polypoidal choroidal vasculopathy after photodynamic therapy

AIM

To compare and evaluate the transitions in retinal function after photodynamic therapy (PDT) between age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) using multifocal electroretinograms (mfERGs).

METHODS

10 eyes with choroidal neovascularisation (CNV) secondary to AMD and 11 eyes with CNV secondary to PCV were included in the study. mfERGs were recorded before PDT, and 1 week and 3 months after PDT. mfERG recordings were acquired by a Veris system (V.3.1.3) using a 103 hexagon stimulus. The first-order kernel was used to calculate amplitudes and latencies. Mean amplitudes and latencies from two central rings rated 0-4 degrees of visual angle were analysed and compared with each disease.

RESULTS

In AMD, the mean first negative peak (N1) amplitudes tended to decrease, and the mean first positive peak (N1P1) amplitudes reduced to significant levels (p = 0.047) 1 week after PDT. 3 months after PDT, there were no significant differences in the mean N1 and N1P1 amplitudes compared with pre-PDT values. In PCV, there were no significant changes in the mean N1 and N1P1 amplitudes 1 week after treatment. However, 3 months after PDT, mean amplitudes showed significant increases in N1 (p = 0.008) and N1P1 (p = 0.006) amplitudes compared with pre-PDT values.

CONCLUSIONS

mfERG recording transitions are different between patients with AMD and those with PCV. In patients with AMD, these results may show transient impairments in retinal function 1 week after PDT, but in those with PCV, the efficacy of PDT is superior to the impairment after PDT.

Safety enhanced photodynamic therapy with half dose verteporfin for chronic central serous chorioretinopathy: a short term pilot study

AIM

To evaluate short term safety of an enhanced photodynamic therapy (PDT) protocol with half dose verteporfin for treating chronic central serous chorioretinopathy (CSC).

METHODS

20 eyes of 18 patients with symptomatic chronic CSC underwent PDT using 3 mg/m2 verteporfin. Verteporfin was infused over 8 minutes followed by indocyanine green angiography guided laser application 2 minutes later. Serial optical coherence tomography (OCT) and multifocal electroretinography (mfERG) recordings were performed before PDT, at 4 days, 2 weeks, and 1 month after PDT. The best corrected visual acuity (BCVA), OCT central retinal thickness, and mean mfERG response amplitudes and peak latencies were compared longitudinally. Subgroup analysis was further performed for eyes with or without pigment epithelial detachment (PED).

RESULTS

At 1 month after PDT, the median BCVA improved from 20/40 to 20/30 (p = 0.001). The mean central retinal thickness also reduced from 276 microm to 158 microm (p < 0.001) and 17 (85%) eyes had complete resolution of serous retinal detachment and/or PED. MfERG showed no significant changes in the mean N1 and P1 response amplitude and latency for all eyes. Subgroup analysis demonstrated that eyes without PED had a significant increase in the mean central mfERG P1 response amplitude with reduction in P1 peak latency at 1 month post-PDT. For eyes with PED, transient reduction in the mean central P1 response amplitude was observed at 4 days post-PDT.

CONCLUSIONS

The modified safety enhanced PDT protocol with half dose verteporfin appeared to be a beneficial treatment option for patients with chronic CSC, especially in eyes without serous PED. Further controlled study is warranted to demonstrate the long term safety and efficacy of this treatment option.

Prospective evaluation of fundus changes in patients with orbital mass lesions

PURPOSE

To study fundus changes associated with orbital mass lesions.

METHODS

In a prospective, interventional case series, 28 patients undergoing surgery for discrete orbital masses had detailed fundus examination under dilation using direct and indirect ophthalmoscopy. Preoperative visual acuity and the amount and duration of proptosis were noted. Fundus photographs were taken, and postoperative changes were documented. The main outcome measures were the frequency of various fundus changes and their correlation with other clinical features.

RESULTS

Nineteen (68%) of 28 patients had fundus changes; the commonest change was optic disk edema, seen in 14 patients (50%). The mean amount of proptosis +/- SD was 7.7 +/- 7.1 mm for patients with fundus changes and 4.22 +/- 2.1 mm for patients with normal fundus. Of 19 patients with fundus changes, 12 (63%) had an intraconal mass, and 11 (58%) had globe indentation. Twenty patients (71%) had diminished visual acuity preoperatively; of these patients, 8 (40%) had improvement in vision after surgery, 10 (50%) did not have any change in vision, and 2 (10%) had a postoperative decrease in visual acuity. Five (62%) of 8 patients with postoperative improvement in visual acuity had proptosis for < 2 years before surgery was undertaken, while only 1 (10%) of 10 patients retaining their preoperative vision had a duration of proptosis of < 2 years.

CONCLUSION

Fundus changes are frequently seen with orbital masses. An increased amount of proptosis, intraconal location, and globe indentation are associated with fundus changes. Postoperative improvement in visual acuity is less likely in patients with a longer duration of symptoms.

Prehypertension may be common in patients with central serous chorioretinopathy

PURPOSE

To test an observational hypothesis that patients with central serous chorioretinopathy (CSCR) may have a tendency towards hypertension compared with normal individuals.

METHODS

In this case-control study we evaluated resting blood pressure in 32 patients with CSCR and compared it with that in 32 healthy controls in a standard laboratory environment. Differences in resting systolic and diastolic blood pressure were measured.

RESULTS

Mean systolic blood pressure was 123.56+/-4.8 in the CSCR group and 113.63+/-12.62 in the control group. Mean diastolic blood pressure was 84.75+/-10.2 in the CSCR group and 76.75+/-0.4 in the control group. The difference in mean blood pressure values between the two groups was statistically significant.

CONCLUSION

Patients with CSCR may be predisposed to prehypertension. Hence they should be advised on lifestyle modification and followed up periodically for early detection of progression to stage 1 or 2 hypertension.