Neuroepithelial Detachment Research Articles

Анализ ОКТ-предикторов анатомических и функциональных результатов aнтиангиогенной терапии отслойки пигментного эпителия при неоваскулярной возрастной макулярной дегенерации

Abstract Analysis of OCT predictors of anatomical and functional results of anti-VEGF therapy of pigment epithelium detachment in neovascular age-related macular degeneration E.V. Kozina, S.N. Sakhnov, V.V. Myasnikova, E.V. Bykova S. Fyodorov Eye Microsurgery Federal State Institution, Krasnodar branch, Krasnodar, Russian Federation Kuban State Medical University Ministry of Health of Russia, Krasnodar, Russian Federation Purpose. Analysis of optical coherence tomography (OCT) biomarkers for anatomical results prediction of anti-angiogenic therapy (antiVEGF) of pigment epithelial detachments (PED) in neovascular macular degeneration (n-AMD). Material and methods. Primary tomograms of 260 patients with PED higher than 200 µm were analyzed. The shape, height, length of the detachment and subpigmentary space reflectivity were assessed. After anti-VEGF injections, reattachment of PED according to OCT was observed in 114cases (44%) – 1st group; in 111 cases (43%) OCT showed PED resistance – 2nd group; in 35 cases (13%), the pigment epithelium tear (RPET) of 3–4 degrees was happened – 3rd group. In each OCT were studied of the following biomarkers: the ellipsoidal zone and RPE integrity, intra – and subretinal fluid, the drusen under RPE around PED, hyperreflective foci in retina. Results. A statistically significant difference was revealed between 1st and 2nd groups in the height and length of pigment epithelium detachment: PED height (506.2±204.3 µm) and length (3206.2±722.1 µm) have a tendency to reattachment during anti-VEGF therapy (р<0.05). High PED with neuroepithelial detachment has a higher risk of RPET (р<0.05). Presence of RPE defects and large hyperreflective foci in the retina can be considered as a predictor of the PED reattachment (р<0.05). Low PED with reflectivity subpigmentary space is a predictor of PED resistance (р<0.05). Conclusion. Patients with high PED, with neuroepithelial detachment, should be given antiVEGF therapy with great caution. Lower PED with hyperreflectity under PED tend to be anatomically resistant to therapy. Biomarkers of the adherence of the PE can be RPE defects and large hyperreflective inclusions in the internal layers. Key words: retinal pigment epithelium detachment, pigment epithelium tear, OCT biomarkers, hyperreflective foci, antiangiogenic therapy

Дифференциальная диагностика центральной отслойки нейроэпителия, ассоциированной с ямкой диска зрительного нерва: два клинических случая

Optic disc pit is a congenital, rare anomaly that represents a limited depression in the optic disc. A rather frequent complication of this pathology is detachment of neuroepithelium in the central zone, which occurs due to fluid infiltration into the subretinal space and causes a decrease in visual acuity. Modern methods such as optical coherence tomography and fluorescence angiography are used for diagnosis. Treatment of this pathology is only surgical and all known methods are aimed at stopping the seepage of fluid from the optic disc pit. It is also necessary to perform differential diagnostics of central detachment of neuroepithelium associated with optic disc pit. Purpose. To demonstrate an approach to the differential diagnosis of central detachment of neuroepithelium associated with optic disc pit on the basis of two clinical cases. Material and methods. This article presents two clinical cases: neuroepithelial detachment associated with optic disc pit and chronic central serous chorioretinopathy. Results and discussion. Comparison of the two clinical cases revealed similarities in ophthalmoscopic pattern and differences on OCT and FAG images. Conclusion. Fluid accumulation under neuroepithelium is not a pathognomonic sign, therefore it is important to perform differential diagnosis in central serous retinal detachment associated with optic disc pit. Keywords: optic disc pit, neuroepithelial detachment, differential diagnosis

Влияние исходных структурных нарушений и послеоперационного изменения перфузии на функциональное восстановление сетчатки после хирургического лечения сквозных макулярных разрывов

Purpose. To evaluate effect of preoperative local structural retinal changes and capillary perfusion in idiopathic full-thickness macular holes (FTMH) on the recovery of functional activity of the retina after surgical treatment. Materials and methods. We used optical coherence tomography (OCT) and OCT-angiography (OCT-A), microperimetry, multifocal electroretinography. In 25 eyes with FTMH the density of capillaries in the superficial and deep capillary plexus (SCP and DCP), retinal sensitivity (RS), amplitude and implicit time of P1 were studied at 13 points located at different distances from the fixation point were evaluated. Data were analyzed in the projection of the hole, intraretinal cystic changes (ICC), neuroepithelial detachment (NED) and intact retina before surgical treatment, 7 days, and 3 months after. Results. In the area of hole, ICC, and NED, in comparison with intact areas of the retina, a significant decrease in RS, an increase in implicit time and a decrease in amplitude of P1, and a decrease in capillary density in the SCP and DCP were revealed. Functional restoration of the retina with an increase in its perfusion was noted 3 months after the surgery. The correlation was found between postoperative changes in RS and changes in capillary density in the SCP in the projection of NED (R=0.32, p=0.001) and ICC (R=0.19, p=0.001), as well as in the DCP in the projection of NED and ICC (R=0.31, p=0.001). The change in the amplitude P1 in the postoperative period significantly correlated with the change in perfusion in the SCP in the projection of the NED (R=0.38, p=0.001) and the hole area (R=0.31, p=0.001), as well as in the DCP in the projection of the ICC (R=0.31, p=0.01) and in the area of NED (R=0.28, p=0.001). Conclusion. Thus, when using a multimodal topographically oriented approach, a relationship was found in the postoperative period of changes in functional parameters at various points in the macular area with changes in local perfusion at the level of both SCP and DCP, while the relationship is most significant in the projection of NED along the tear edge and in the areas of ICC. Key words: full-thickness macular hole (FTMH), microperimetry, multifocal electroretinography, multimodal imaging, optical coherence tomography, optical coherence tomography-angiography

Анализ эффективности анти-VEGF терапии диабетического макулярного отека в авитреальных глазах

Aim. To analyze the clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in avitreal eyes. Methods. 34 patients (38 eyes) with vitreous loss and DME on the background of preproliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) were examined in the main study group. The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injections of Lucentis 0.5 mg (IVIL) were carried out according to «three monthly injections» scheme, then – to «on demand» scheme. Results. Complete regression of DME in avitreal eyes occurred in 74 % of cases; in eyes with native vitreous body – in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed that number of IVIL was significantly less in patients with DME on the background of PPDR than PDR. Conclusion. Presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in DME treatment is comparable in eyes with native vitreous body and avitreal eyes. Key words: diabetes mellitus; diabetic macular edema; preproliferative diabetic retinopathy; proliferative diabetic retinopathy; avitria; Lucentis intravitreal injections.

Случай центральной серозной хориоретинопатии после взрывной травмы

Relevance. Over the past decade, clinical cases of central serous chorioretinopathy after an eye injury have increasingly appeared in the press. Purpose. Currently, there are no cases of description of central serous chorioretinopathy after an explosive injury in the literature available for review. Presenting our clinical case, we will try to fill this gap. Methods. A 41-year-old man with concomitant injuries was admitted to inpatient treatment at a multidisciplinary clinic after a close detonation of a high-powered explosive device. At the end of the second week from the moment of injury, against the background of an improvement in the general well-being of the patient, the «flickering spot» in front of the gaze of the left eye began to actively disturb. On the 21st day after injury, both eyes were examined using an optical coherence tomograph with a rocking source (OCT) DRI OCT Triton by Topcon (Japan). In the lower quadrants on the edge of the macula of the left eye, a serous detachment of the neuroepithelium was detected with dimensions of 5310×5253 μm and a maximum height of 706 μm with two detachments of the retinal pigment epithelium. On the 28th day from the moment of injury, during the control OCT study, flattening was noted, but with an increase in the area of serous detachment of the neuroepithelium and the preservation of detachments of the retinal pigment epithelium. In connection with the professional requirements for the patient's state of health, delimiting laser coagulation of the retina was performed against the background of the treatment of concomitant pathology. Results and discussion. On the 33rd day after the injury, complete adherence of the serous detachment of the neuroepithelium and detachments of the retinal pigment epithelium was noted with the disappearance of the patient's complaints. Conclusion. The presented clinical case is of great interest, since eye trauma and, in particular, explosive trauma are quite rare causes of the development of central serous chorioretinopathy. Key words: clinical case, serous chorioretinopathy, neuroepithelial detachment, pigment epithelium detachment, blast injury, post-traumatic retinopathy, eye injury

Stellate nonheritable idiopathic foveomacular retinoschisis in juveniles: case report

BackgroundStellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is a rare type of retinoschisis with a spoke-like splitting that occurs in the outer plexus layer. We present a case of stellate nonhereditary idiopathic foveomacular retinoschisis in a juvenile, in which two eyes show different development trends and macular retinoschisis could be associated with mechanical force in the Henle fibre layer. The removal of mechanical force can partially restore vision.Case presentationA 14-year-old girl with bilateral SNIFR was diagnosed and followed up with spectral-domain optical coherence tomography (SD-OCT). During the two follow-up visits, vitreous adhesion was released in the left eye, and visual acuity improved. Neuroepithelial detachment was aggravated in the right eye, and visual acuity decreased. Therefore, vitrectomy was performed on the right eye. After surgery, the patient’s retina was reattached, and her vision was partially restored.ConclusionsWe reported a juvenile with bilateral SNIFR. Each of her eyes showed different development trends, so we adopted different treatment methods for each eye. Vitrectomy was performed on the patient to address progressive vision loss, which improved the patient’s vision. It was further confirmed that the Henle layer of SNIFR patients was susceptible to posterior vitreous membrane adhesion.

Вителлиформная макулярная дистрофия и возрастная макулярная дегенерация: сходство и различия при их выявлении

Background. Adult-onset vitelliform macular dystrophy is one of the pathologies that successfully masks as age-related macular degeneration. Purpose. To assess the incidence of adult-onset vitelliform macular dystrophy and its clinical manifestations. Material and methods. We analyzed frequency cases of adult-onset vitelliform macular dystrophy among 1000 patients aged 40 years and older who applied with various eye complaints. Results. Adult-onset vitelliform macular dystrophy was found in 2 patients – men 43 and 66 years old. In the macular area of both eyes of the 1st patient, rounded yellow lesions in the foveola, local detachment of neuroepithelium, optical dense material deposit on the outer segments of photoreceptors were detected (vitelliruptive stage of adult-onset vitelliform macular dystrophy). On the left eye of the 2nd patient in the foveola, a single rounded yellow focus of 200 µm was determined, optical dense vitelliform material presence between the layers of the pigment epithelium and neuroepithelium without signs of choroidal neovascularization was detected (vitelliform stage of adult-onset vitelliform macular dystrophy). Conclusion. The incidence of adult-onset vitelliform macular dystrophy among patients with various ocular pathologies was 0.2 %. Morphological changes in the macula consist in presence of deposits of vitelliform material, localized between the layers of neuroepithelium and retinal pigment epithelium. Keywords: adult-onset vitelliform macular dystrophy; age-related macular degeneration; optical dense vitelliform material

Выяснение причин отслойки нейроэпителия с целью постановки корректного диагноза у пациентов с патологией макулярной области

Purpose. To assess the difficulties of finding out true cause of detachment of neuroepithelium in patients with various retinal pathologies. Material and methods. 3 patients (3 eyes) aged 51 to 59 years with complaints of sensation of a “spot» in front of the eye, decreased vision and metamorphopsia. The best corrected visual acuity ranged from 0.4 to 0.5. Rounded local prominating lesion – zones of local detachment of neuroepithelium, zones of local atrophy or defects in retinal pigment epithelium (RPE) were determined in all 3 eyes in the posterior pole of the eye. Results. According to results of optical coherence tomography (OCT), all 3 eyes had local serous detachment of neuroepithelium from 250 to 270 µm, local inclusions characterized by hyperreflective and heterogeneous RPE layer, episodically located in its layers hyperreflective areas with point breach in the Bruch membrane (“hard» drusen). Irregular RPE elevations (“wavy pattern») with its local fibrovascular detachment were determined. According to the results of OCT angiography, hyperreflective zones of the presence of a neovascular network in the layer of choriocapillaries under the areas of fibrovascular detachment of RPE, coinciding with zones of hyperautofluorescence, were revealed in all 3 eyes. In paired eyes of all 3 patients, “hard» retinal drusen in the macular zone were detected. Conclusions. 1. All 3 eyes were diagnosed with the wet form agerelated macular degeneration due to: their belonging to the older age group, low corrected visual acuity, the presence of complaints of metamorphopsia, irregular elevation and local fibrovascular detachment of RPE, the presence of local hyperautofluorescence, and presence of drusen on the double eye. 2. The use of OCT angiography makes it possible to differentiate between central serous chorioretinopathy and age-related macular degeneration by detecting choroidal neovascularization. Keywords: central serous chorioretinopathy, wet AMD, detachment of neuroepithelium

Exudative age-related macular degeneration lesion components predicting microperimetric retinal sensitivity during anti-vascular endothelial growth factor treatment.

To analyse the effect of exudative age-related macular degeneration (eAMD) lesion components on retinal sensitivity during anti-vascular endothelial growth factor treatment. Visual acuity, fluorescein and indocyanine green (ICG) angiographies, autofluorescence images, microperimetries and optical coherence tomographies (OCTs) of 24 eyes of 24 patients were prospectively analysed in a 2-year study of pro-re-nata bevacizumab treatment for eAMD. Microperimetries were aligned with the OCTs, angiographies and autofluorescence images. Thicknesses of the neuroretina, pigment epithelial (RPE) elevation, neuroepithelial detachment (NED), subretinal tissue (SRT) and cystic intraretinal fluid were measured under each stimulus site, and areas of type 1 and type 2 macular neovascularizations (MNVs), ICG plaque, haemorrhage and RPE atrophy were identified. The effects and predictive values of lesion components on retinal sensitivity were analysed with multivariate mixed linear models for repeated measurements. The overall microperimetric retinal sensitivity increased during the first year (from 10.1 dB at baseline to 11.9 dB at 1 year; p = 0.021, Wilcoxon signed ranks), but remained the same during the second year (11.5 dB, p = 0.301). The baseline lesion components most strongly predicting deteriorated sensitivity at 1 year were RPE atrophy, the area of Type 2 MNV, intraretinal cysts, haemorrhage, Type 1 MNV and retinal thickening >350 μm. NED and RPE elevation had only small effects. At 2 years, the predictive values of the baseline lesion components remained quite unchanged. The most powerful predictors of retinal sensitivity loss during 2 years of treatment were RPE atrophy, areas of haemorrhage, the area of MNVs, intraretinal cysts and SRT. RPE elevation and NED had lesser effects.

Клиническая эффективность лечения диабетического макулярного отека в авитричных глазах путем применения анти-VEGF терапии

Purpose. To analyze clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in eyes with vitreous loss. Material and methods. 34 patients (38 eyes) with vitreous loss and DME were examined: on the background of pre-proliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) (the main group). The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injection of Lucentis 0.5 mg (IVIL) was carried out according to scheme «three monthly injections», then — to scheme «on demand». Results. Complete regression of DME in eyes with vitreous loss occurred in 74 % of cases; in eyes with native vitreous body — in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed, that number of IVIL was significantly less in patients with DME on the background of PPDR, than with PDR. Conclusions. The presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in treatment of DME is comparable in eyes with native vitreous body and vitreous loss. Keywords: diabetes mellitus, diabetic macular edema, pre-proliferative diabetic retinopathy, proliferative diabetic retinopathy, vitreous loss, Lucentis intravitreal injection

Офтальмологические проявления на заднем отрезке глаза после коронавирусной инфекции

An outbreak of SARS-CoV-2 coronavirus infection has caused 667 million cases. COVID-19 is a severe acute respiratory infection caused by the SARS-CoV-2 coronavirus. The virus primarily affects the respiratory system and causes from mild signs, respiratory infection, to a severe course, acute respiratory distress syndrome. Multiple ophthalmologic manifestations in both the anterior and posterior segment of the eye are increasingly reported in the literature. Purpose. To present clinical cases of postocular ophthalmic manifestations on the ocular fundus. Material and methods. Four clinical cases of ophthalmologic manifestations in the posterior segment of the eyes that developed after a coronavirus infection were presented. All patients underwent ophthalmological examination including visometry, anterior segment biomicroscopy, as well as ophthalmoscopy with non-contact Volk 78D lens, optical coherence tomography (OCT) of macular area and OCT in angioregim (DRI OCT Triton plus, Japan). Treatment and recommendations were individualized according to ophthalmological indications. Results. Stabilization of postocular ophthalmic manifestations in the posterior segment of the eye. There was an increase in maximum corrected visual acuity (MCOZ), reduction of macular edema, adherence of neuroepithelial detachment (ONE). Conclusion. It is necessary to pay attention to the complaints of the visual organ in patients with COVID-19 in the early stages of the disease and in the nearest months after recovery. Our clinical observations show the necessity of further study of pathogenesis, clinic and treatment methods of ocular complications associated with COVID-19. Keywords: coronavirus disease, postthrombotic retinopathy, macular neovascular membrane, central serous chorioretinopathy

Correlation between Morphological Characteristics of Macular Edema and Visual Acuity in Young Patients with Idiopathic Intermediate Uveitis.

Background and Objectives: Macular edema (ME) is a common complication of intermediate uveitis (IU). It is often responsible for a decrease in visual acuity (VA). Three distinct patterns of macular edema have been described in intermediate uveitis, namely, cystoid macular edema (CME), diffuse macular edema (DME), and serous retinal detachment (SRD). The current study aims to describe the characteristics of macular edema in young patients with idiopathic intermediate uveitis and to correlate its features with VA using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 27 eyes from 18 patients with idiopathic IU complicated by ME were included in this retrospective study. All patients underwent SD-OCT; data were gathered at the onset of ME. Best-corrected VA (BCVA) was correlated with the morphological features of ME. Results: BCVA was negatively correlated with Ellipsoid Zone (EZ) disruption (p = 0.00021), cystoid pattern (p = 0.00021), central subfield thickness (CST) (p < 0.001), and serous retinal detachment (0.037). Conclusions: In ME secondary to idiopathic IU, VA negatively correlates with Ellipsoid Zone disruption and increases in CST. Moreover, vision is influenced by the presence of cysts in the inner nuclear and outer nuclear layers and by the neuroepithelium detachment.

OCT classification of choroidal nevi

The study aims to determine the types of OCT patterns of CN and to evaluate their prognostic value. The study included 50 patients with CN (53 nevi). The height of 19 nevi evaluated with ultrasonography was 1.33±0.43 mm, diameter - 5.47±1.68 mm. CN is an area of local increase in reflectivity of the choroid; its widening and elevation of the tomographic section were observed in 72% of nevi. In more than half of all cases a distinct hyperreflective border was revealed between the CN and adjacent choroid. In two thirds of all cases the choriocapillaris layer was preserved and visualized mainly along the edge of lesion. Analysis of OCT scans showed distinct differences, which allowed designation of four OCT types of CN: 1) nevi with typical OCT pattern; 2) nevi with changes in retinal pigment epithelium (RPE); 3) nevi with neuroepithelial detachment; 4) nevi with atypical OCT pattern. Based on the analysis of OCT images of the determined types of nevi, it can be assumed that all of them initially had typical OCT pattern. With enlargement of the nevi and increase in the duration of its presence in the choroid, dystrophic processes in the adjacent retina and changes in RPE begin to occur. Disturbed pumping ability of the damaged RPE results in disruption of the trophism of adjacent retina, which leads to development of atrophic changes. Nevi with atypical OCT pattern should be considered as a sign of long-term benign process in the choroid that will cause atrophic changes in the choroid and adjacent retina, while nevi with changes in RPE and with neuroepithelial detachment - as a risk factor for transition to choroidal melanoma.

Trea tment of polypoid choroidal vasculopathy complicated by extensive subretinal hemorrhage. A case report

Polypoid choroidal vasculopathy (PCV) is a type of wet form of age-related macular degeneration (AMD). It is characterized by formation aneurysmal dilations of abnormal choroidal vessels (polyps) under the retinal pigment epithelium (RPE) in the choroid. The disease leads to a vision loss due to formation of serous retinal detachment, neuroepithelium detachment and RPE, subretinal hemorrhages, fibrosis, atrophy of RPE. The generally accepted treatment of PCV is antiangiogenic therapy.The purpose of this work is to present and to analyze the clinical case of polypoid choroidal vasculopathy treatment complicated by extensive subretinal hemorrhage.Description of the case. This clinical case of PCV in the right eye that is complicated by extensive subretinal hemorrhage on the background of antiangiogenic therapy in a 72-year-old man is presented. In addition to standard ophthalmological research methods, we performed optical coherence tomography (OCT) with Cirrus HD-OCT 5000 Zeiss (Carl Zeiss, Germany), angio-OCT with Optovue Solix High-Speed Spectral Optical Coherence Tomograph (Optovue, USA) and fundus photo registration with Topcon TRC-NW8F Retinal Camera (Topcon, Japan). The comprehensive surgical approach was applied to this patient, including posterior subtotal vitrectomy with our Stellaris PC microsurgical system (Baush&amp;Lomb, USA) and the prourokinase subretinal injection against the background of aflibercept antiangiogenic therapy and removal of a concomitant cataract with implantation of an intraocular lens (IOL).Discussion. The early treatment of this patient and at the right time procedure of microinvasive 25-G vitrectomy combined with prourokinase subretinal injection contributed to the resorption of hemorrhage in the shortest possible time and improved visual functions from 0.02 to 0.6.Conclusions. The presented comprehensive approach of PCV treatment and its complications made possible to provide social rehabilitation of the patient and to preserve high values of visual functions in the affected eye.

Evaluation of incidence of the adult-onset vitelliform macular dystrophy among patients in Far Eastern Federal District of Russia

BACKGROUND: Adult-onset vitelliform macular dystrophy is one of the pathologic conditions , which successfully masks as age-related macular degeneration.&#x0D; AIM: To assess the incidence of the adult-onset vitelliform macular dystrophy among patients of a major ophthalmological clinic in the Far Eastern Federal District of Russia.&#x0D; MATERIALS AND METHODS: We revealed the cases of adult-onset vitelliform macular dystrophy among 1000 patients aged 40 years and older who addressed for various ocular complaints.&#x0D; RESULTS: Adult-onset vitelliform macular dystrophy was found in 2 male patients aged 43 and 66 years. In the macular area of both eyes of the 1st patient, round yellow lesions in the foveola, local detachment of neuroepithelium, optically dense material deposits on the outer photoreceptor segments were detected (vitelliruptive stage of adult-onset vitelliform macular dystrophy). In the left eye of the 2nd patient, in the foveola, a single round yellow focus of 200 m was found, optically dense vitelliform material was detected between the pigment epithelium and neuroepithelium layers without any signs of choroidal neovascularization (vitelliform stage of adult-onset vitelliform macular dystrophy).&#x0D; CONCLUSIONS: The incidence of adult-onset vitelliform macular dystrophy among patients with various ocular conditions was 0.2%. Morphological changes in the macula consist in presence of deposits of vitelliform material, localized between the neuroepithelium and retinal pigment epithelium layers.

Seagull wings appearance on optical coherence tomography: A case of peripapillary detachment in pathologic myopia.

To report the case of a patient who presented with a peripapillary retinal detachment caused by pathological myopia. A 73-year-old female with a clinical history of high myopia was admitted to our ophthalmic department complaining of vision loss in her right eye. Her best-corrected visual acuity was 20/25 in the right eye and 20/400 in the left eye. The refractive error was -9.00 D in both eyes. The anterior segment and pupillary reflex were normal. Dilated fundus examination revealed myopic retinopathy in both eyes and a yellow peripapillary lesion, distinct from the myopic conus and encircling almost the whole optic disc, in her right eye. The left eye displayed macular atrophy with macular pigmentation due to a previous myopic choroidal neovascularization. Optical coherence tomography showed a localized retinal detachment in the peripapillary area, adjacent to the inferior edge of the optic disc, giving a strange "seagull wings" appearance. In case of peripapillary neuroepithelial detachment the presence of PDPM in high myopic patients should always be excluded. Further research is due in order to better understand this clinical entity's pathogenesis and prognosis.

Primary Sjögren’s syndrome-related Choroiditis in a Newly Diagnosed Older Adult

ABSTRACT Purpose To report a case of secondary bilateral choroiditis in a patient with primary Sjögren’s syndrome(pSS). Study Design Case report. Results A 69-year-old woman visited our hospital for consultation due to decreased visual acuity in both eyes for 1 month. At the first visit, best corrected visual acuity (BCVA) was 0.2 and 0.3 in her right and left eyes, respectively. Intraocular pressure values were 15 mmHg and 16 mmHg in her right and left eyes, respectively. Examination revealed edema of the eyelids and conjunctiva,and corneal fluorescence staining was positive. No inflammation in the anterior chamber or vitreous opacities were observed. Bilateral multiple retinal detachments were observed on the posterior fundus, and optical coherence tomography revealed bilateral multiple areas of retinal neuroepithelial detachment, choroidal thickening, and choroidal folds. No abnormal fluorescence leakage was observed on fundus fluorescein angiography or indocyanine green angiography. In addition, systematic manifestations included recurrent bilateral parotid gland enlargement. Labial gland biopsy revealed dilated glandular ducts, scattered interstitial glands, and lymphocytic foci. Salivary gland scintigraphy revealed severe impairment of glandular excretory function. Moreover, blood tests for anti-Ro/SSA and anti-La/SSBantibodies were positive. The patient was diagnosed with primary Sjögren’s syndrome. After 2 months treatment with oral prednisolone acetate combined with hydroxychloroquine, her BCVAimproved to 0.8 and 1.0 in the right and left eyes, respectively. The fundus also recovered to normal, and no recurrence was observed during the 1-year follow-up period. Conclusions The current case highlights that pSS, which usually manifests with dry eye and keratoconjunctivitis, may manifest with chronic choroiditis in both eyes as well. Based on our experience with this case, patients with clinically suspected bilateral choroiditis should be evaluated for pSS.

Spectral-domain optical coherence tomography characteristics of cystic retinal tuft

ObjectiveTo investigate the characteristics of cystic retinal tufts (CRTs) with 55° widefield spectral-domain optical coherence tomography.MethodsThis was a retrospective study. All subjects underwent a complete ocular examination, ultra-widefield (UWF) pseudocolor fundus photography and Spectral domain optical coherence tomography (SD-OCT) with a 55° widefield lens. The SD-OCT characteristics were analyzed in subjects with CRT.ResultsTwenty-six eyes of 25 subjects were scanned and 29 CRTs were analyzed for SD-OCT characteristics. On SD-OCT images, the CRTs exhibited hyperreflective irregular elevated lesions with internal hyporeflective cystoid cavities. Normal layers of the neuroepithelium could not be distinguished. The mean diameter of CRTs was 1022 microns (range, 117–3711 microns; standard deviation, 815 microns). There was vitreoretinal traction at the apex of CRTs. Among them, retinal tears in 24.14% (7/29), suspected retinal tears in 27.59% (8/29), and shallow neuroepithelium detachment in 31.03% (9/29).ConclusionsThe widefield SD-OCT imaging can provide detailed cross-sectional anatomic information of CRT and may guide clinical treatment.

Multimodal imaging of the course of retinal changes in acute posterior multifocal placoid pigment epitheliopathy with bilateral retinal detachment: a case report

BackgroundTo report a rare case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with a combination of serous retinal detachment, papilledema, and retinal vasculitis.Case presentationA 19-year-old male complained of floaters in both eyes with decreased vision for 4 days. The best corrected visual acuity of the right eye and the left eye were 1.1 and 0.9 (logMAR), respectively. In both eyes, inflammatory cells can be seen suspended within the vitreous, multiple yellow/white lesions can be seen near the macula, and retinal neuroepithelial detachment. Swelling of the optic disc with blurring of the disc margins, in the left eye. Optical coherence tomography (OCT): showed retinal detachment in both eyes. The patient received oral prednisone treatment. 1 week later, OCT showed absorption of subretinal fluid in the macula of both eyes his binocular vision improved to 0.1 (logMAR). During the subsequent 28-month follow-up, fundus fluorescein angiography and OCT revealed extensive and progressive pigment epithelial atrophy in both eyes, and abnormal retinal vascular perfusion in the right eye due to persistent retinal vasculitis. Although the patient's binocular visual acuity remained at 0.1 (logMAR).ConclusionsIn the present case of APMPPE with a combination of serous retinal detachment, papilledema, and retinal vasculitis, through the multimodal imaging, further confirming that the lesions were located in the choroid, while the pigment epithelial lesions were secondary changes.

Mucosal associated Lymphoid Tissue Lymphoma of the uvea: an analysis of 3 cases

BackgroundOcular mucosa-associated lymphoid tissue (MALT) lymphoma involving orbit and conjunctiva usually has an indolent clinical course with “salmon patch” mass as typical presentation. This study is to report a series of rare cases and investigate the clinical and pathological features of ocular MALT lymphoma that involved uveal tissue primarily and presented as posterior scleritis.MethodsThis retrospective, observational study was conducted at Beijing Tongren Hospital. From 2018 to 2020, 3 cases of 3 eyes (2 female patients and 1 male patient) with ocular MALT lymphoma that involved uveal tissue primarily and presented as posterior scleritis were included in the study. All patients had complaints of red eyes with blurred vision. The average age was 56.33 ± 2.08 years old and the average time from initial diagnosis to pathological diagnosis was 3.00 ± 1.73 months. Ophthalmic examinations including best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp microscope examinations, fundus photography, B-scan ultrasonography, ultrasound biomicroscope (UBM), optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were conducted. Systemic workups including orbital magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and blood autoimmune antibody tests were also conducted. Pathological tissue from patients were obtained through surgeries. Biopsy examinations were performed to accurately determine pathological diagnosis. All the information of clinical, imaging and pathological changes were collected and analyzed.ResultsAt the initial diagnosis, the BCVA of involved eyes decreased seriously while the IOP were normal. All involved eyeball showed extensive hyperemia and local thickening in the wall of eyeballs. B-scan ultrasonography showed mass with abundant blood and irregular cysts inside the eyeball wall and in the retrobulbar orbit, surrounding the ocular wall and optic nerve. UBM showed solid lesions with low and medium echo under the conjunctiva and inside the ciliary body of 2 cases. OCT showed posterior polar wavy rise of RPE and local neuroepithelial detachment in all cases. FFA and ICGA showed vascular abnormalities (patch-like strong fluorescence and fluorescence leakage) and local thickening in retina and choroid (Rectangle-like weak fluorescence below the macula). The posterior wall of the eyeball was thickened and enhanced in MRI. PET-CT also showed thickening of posterior wall of eyeballs and increased metabolic activity but there was no sign of autoimmune disease. All patients were diagnosed as MALT lymphoma through pathologic examinations of biopsy tissue.ConclusionsThe onset of primary ocular MALT lymphoma in uvea is hidden. The early clinical manifestations are lack of specificity and misleading. B-scan ultrasonography has characteristic manifestations and is valuable in diagnosis. However, pathological diagnosis through tissue biopsy is irreplaceable.