Areas Of Retinal Edema Research Articles

Paracentral Acute Middle Maculopathy in a Patient with Cilioretinal Artery Occlusion

Introduction: A 49-year-old woman presented at Inoda Eye Clinic with inferior visual field defect in the left eye. Ophthalmoscopic examination revealed well-demarcated retinal edema of the superior region at the posterior pole in the left eye. The area of retinal edema was consistent with the area of the cilioretinal artery, and therefore, cilioretinal artery occlusion was suspected. Optical coherence tomography showed hyperreflective bandlike lesions involving the middle layers of the retina at the level of the inner nuclear layer. Optical coherence tomography angiography showed decreased flow sign in outer retina layer and choriocapillaris layer rather than in superficial layer. Based on these findings, the patient was diagnosed with paracentral acute middle maculopathy due to cilioretinal artery occlusion. Optical coherence tomography angiography is a useful diagnostic examination instead of fluorescein angiography for evaluation of cilioretinal artery occlusion.

Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence.

To describe retinal findings of various imaging modalities in acute retinal ischemia. Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A) and fundus autofluorescence (FAF) images of 13 patients (mean age 64y, range 28-86y) with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome. All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions. Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.

Teleophthalmology image-based navigated retinal laser therapy for diabetic macular edema: a concept of retinal telephotocoagulation.

To determine the feasibility and efficacy of a retinal telephotocoagulation treatment plan for diabetic macular edema. Prospective, interventional cohort study at two clinical sites. Sixteen eyes of ten subjects with diabetic macular edema underwent navigated focal laser photocoagulation using a novel teleretinal treatment plan. Clinic 1 (King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia) collected retinal images and fundus fluorescein angiogram. Clinic 2 (Palmetto Retina Center, West Columbia, SC, USA) created image-based treatment plans based on which macular laser photocoagulation was performed back at clinic 1. The primary outcome of the study was feasibility of image transfer and performing navigated laser photocoagulation for subjects with diabetic macular edema between two distant clinics. Secondary measures were change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by spectral-domain optical coherence tomography at 3months after treatment. The teleretinal treatment plan was able to be successfully completed in all 16 eyes. The mean logMAR BCVA at baseline was 0.49±0.1, which remained stable (0.45±0.1) 3months after treatment (p=0.060). The CRT improved from 290.1±37.6μm at baseline to 270.8±27.7μm 3months after treatment (p=0.005). All eyes demonstrated improvement in the area of retinal edema after laser photocoagulation, and no eyes demonstrated visual acuity loss 3months after treatment. This study introduces the concept of retinal telephotocoagulation for diabetic macular edema, and demonstrates the feasibility and safety of using telemedicine to perform navigated retinal laser treatments regardless of geographical distance.

Retro-Mode Scanning Laser Ophthalmoscopy Planning for Navigated Macular Laser Photocoagulation in Macular Edema.

Purpose. To compare treatment areas and navigated macular laser photocoagulation (MLP) plans suggested by retro-mode scanning laser ophthalmoscopy (RM-SLO) image versus optical coherence tomography (OCT) central retinal thickness map and treatment planning among retina specialists. Methods. Thirty-nine eyes with diabetic or branch retinal vein occlusion-related ME undergoing navigated MLP with navigated photocoagulator had OCT and RM-SLO taken. OCT map and RM-SLO image were imported to the photocoagulator and aligned onto the retina. Two retina specialists placed laser spot marks separately based on OCT and RM-SLO images in a random fashion. The spots placed by each physician were compared between OCT and RM-SLO and among physicians. The areas of retinal edema on OCT and RM-SLO of the same eye were also compared. Results. The average number of laser spots using RM-SLO and OCT template was 189.6 ± 77.4 and 136.6 ± 46.8, respectively, P = 0.003. The average area of edema on RM-SLO image was larger than that on OCT map (14.5 ± 3.9 mm2 versus 10.3 ± 2.8 mm2, P = 0.005) because of a larger scanning area. There was narrow variability in treatment planning among retina specialists for both RM-SLO (P = 0.13) and OCT (P = 0.19). Conclusion. The RM-SLO image superimposed onto the fundus of the same eye can be used to guide MLP with narrow variability in treatment planning among retina specialists. The treatment areas suggested by RM-SLO-guided MLP plans for ME were shown to be larger than those suggested by OCT-guided plans.

Diagnostic Evaluation of Type 2 (Classic) Choroidal Neovascularization: Optical Coherence Tomography, Indocyanine Green Angiography, and Fluorescein Angiography

To evaluate the diagnostic characteristics of type 2 (classic) choroidal neovascularizations secondary to age-related macular degeneration using spectral domain-optical coherence tomography (SD OCT), indocyanine green angiography (ICGA), and fluorescein angiography (FA). Observational case series. Institutional. Thirteen treatment-naïve eyes with type 2 choroidal neovascularization without an occult component. Greatest horizontal dimension, based on the anatomic features of the neovascular complex by SD OCT (Spectralis; Heidelberg Engineering), ICGA, and FA; retinal leakage area in late-phase FA and ICGA; and the area of retinal edema in SD OCT. For direct comparison, ICGA and FA images were overlaid manually on infrared plus SD OCT images using VirtualDub and Paint.NET software. Greatest horizontal dimension was measured using Image J software (National Institutes of Health). The mean greatest horizontal dimension of the neovascular complex and the retinal leakage area consistently were smaller on ICGA compared with the area of retinal edema on SD OCT. According to FA, the greatest horizontal dimension of early, well-demarcated hyperfluorescence was significantly smaller than the neovascular complex on SD OCT. In addition, the greatest horizontal dimension of the retinal leakage area in late-phase FA consistently was smaller than the area of retinal edema on SD OCT. In classic choroidal neovascularization, ICGA and FA seem to underestimate the extension of the neovascular complex and the associated retinal pathologic features compared with SD OCT imaging.

Retinal Edema Secondary to Oral Contraceptives

This report presents 2 cases of retinal lesions which disappeared with cessation of oral contraceptives reappeared when the medication was resumed and again regressed when therapy was stopped. The first case a 21-year-old patient complained of blurriness of vision in her right eye of 3-weeks duration. She had been taking C-Quens for 1 month for dysmenorrhea. Examination found a 1 disc-diameter retinal edema in the right eye and a scotoma. C-Quens were discontinued and no other therapy given. After 3 weeks symptoms had diappeared and the retina was normal. After resuming C-Quens for 2 weeks the blurriness recurred. Retinal edema was again present in the same area as before and a similar scotoma was present. The drug was discontinued after 2 weeks symptoms disappeared and all retinal findings were normal. Permanent avoidance of C-Squens was recommended. A 26-year-old patient who had received 50 mg daily of Enovid for 13 months for dymenorrhea complained of blurred vision in her right eye of 2 weeks duration. An area of retinal edema was found and a small scotoma was present. The Enovid was discontinued and within 10 days findings were normal. Enovid was restarted within another 10 days symptoms reappeared; it was stopped within a week findings were normal. Later the patient took another oral contraceptive (Ortho-Novum). After 3 months ophthalmoscopy showed normal fundi. Results are considered presumptive evidence that the retinal findings were due to the oral contraceptive involved.