Development Of Subretinal Fluid Research Articles

Understanding choroidal nevus risk factors for transformation into melanoma

A choroidal nevus is a common intraocular tumor in the United States, found in approximately 5% of Caucasian adults. The three main risks of melanocytic choroidal nevus include vision loss from a subfoveal nevus, development of subretinal fluid, and transformation of nevus into melanoma, a malignant counterpart. We explore clinical risk factors that predict benign melanocytic choroidal nevus transformation into a malignant choroidal melanoma. Based on a large analysis of 2,355 cases that were monitored longitudinally using multimodal imaging, the most recent list of clinical features includes tumor Thickness greater than 2 mm on ultrasonography, subretinal Fluid on optical coherence tomography, Symptomatic vision loss 20/50 or worse, Orange pigment on fundus autofluorescence, Melanoma hollow on ultrasonography, and DIaMeter greater than 5 mm on fundus photography. These factors are remembered with a mnemonic of the capital letters TFSOM-DIM for “To Find Small Ocular Melanoma Doing Imaging.” Analysis of these factors demonstrated a Kaplan-Meier mean five-year risk of 1% with no risk factors, 11% with any one factor, 22% with any two factors, 34% with any three factors, 51% with any four factors, and 55% with any five factors. There was no patient with six risk factors. Of those with combinations of four risk factors, six of 15 combinations yielded a 70%-100% rate of transformation; of those with combinations of five risk factors, two of five combinations yielded a 70%-100% rate of transformation. Choroidal nevus carries a risk for evolving into melanoma, and understanding of clinical and imaging features predictive of this outcome is highly important.

RECURRENT ANTERIOR UVEITIS ASSOCIATED WITH MAJOR FLUCTUATIONS IN CHOROIDAL THICKNESS IN A PATIENT WITH PACHYCHOROID DISORDER.

To describe remarkable choroidal thickness fluctuations corresponding to episodes of recurrent anterior uveitis with subretinal fluid development when exceeding a choroidal thickness threshold. A patient with pachychoroid pigment epitheliopathy and unilateral acute anterior uveitis of the left eye was evaluated over a period of 3 years with multimodal retinal imaging including optical coherence tomography. Longitudinal changes in subfoveal choroidal thickness (CT) were measured and correlated with episodes of recurrent inflammation. Over the course of five recurrent episodes of inflammation in the left eye treated with oral antiviral and topical steroid therapy, subfoveal CT increased as much as 200 μm or more. By contrast, subfoveal CT in the fellow quiescent right eye was within normal limits and minimally changed throughout the follow-up. Increased CT occurred with each episode of anterior uveitis and decreased by 200 µ m or more during periods of quiescence in the affected left eye. Subretinal fluid and macular edema developed with a maximum CT of 486 μm and spontaneously resolved when CT decreased after treatment. In eyes with pachychoroid disease, anterior segment inflammation may lead to marked increases in subfoveal CT and the development of subretinal fluid at a threshold thickness value.

Spectral-Domain Optical Coherence Tomography-Based Morphofunctional Characterization of Dome-Shaped Maculopathy in Indian Population

Purpose. To study the clinicodemographic profile of dome-shaped maculopathy (DSM) eyes in the Indian population and characterization using spectral-domain optical coherence tomography (SD-OCT). Methods. This observational cross-sectional study included 25 eyes of 14 patients diagnosed with DSM. All eyes underwent SD-OCT for characterization of the dome profile and also to measure central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and dome height (DH) and to detect the presence of subretinal fluid (SRF). Results. The mean age of patients was 48.36 ± 14.23 years (range, 28–65 years). Eleven patients had bilateral involvement. Mean axial length of all eyes was 24.25 ± 1.95 mm and mean spherical equivalent −4.23 ± 3.79 DS. Overall, 11/25 eyes (44%) had round domes, 9/25 eyes (36%) had horizontal domes, and 5/25 eyes (20%) had vertical domes, with a mean dome height at fovea of 500.54 ± 291.58 µm. Vertical domes had higher DH compared to horizontal or combined domes p = 0.02 . Six eyes (6/25, 24%) showed the presence of SRF; 60% of vertical domes had SRF, and 22.2% of horizontal domes had SRF. The eyes having SRF had significantly higher CMT p = 0.017 and DH p = 0.001 , especially in horizontal domes p = 0.023 . The eyes with thicker SFCT tended to have higher DH and poorer visual acuity. Conclusion. Indian DSM eyes may have relatively lesser amounts of myopia. Choroidal thickening may play a role in development of DSM and may also be related to development of subretinal fluid in such eyes.

SAFETY PROFILE OF OCRIPLASMIN FOR SYMPTOMATIC VITREOMACULAR ADHESION: A Comprehensive Analysis of Premarketing and Postmarketing Experiences.

After the recent approval of ocriplasmin by the Food and Drug Administration, postmarketing safety concerns have been raised by the vitreoretinal community. The American Society of Retina Specialists Therapeutic Surveillance Committee was commissioned to monitor postmarketing drug-related and device-related adverse events. The purpose of this report is to analyze the postmarketing safety experience in the context of available premarketing safety data. Periodic aggregate safety reports consisting of premarketing, or clinical trial, data (n = 999 injections) and postmarketing reports through July 16, 2013 (n = 4,387 injections), were retrospectively analyzed by the TSC. The aggregate data were analyzed to classify adverse events, and the postmarketing safety data for each event type were compared with the premarketing data. Eight categories of adverse events were identified. Acute reduction in visual acuity attributable to either worsening of macular pathology or development of subretinal fluid, electroretinogram changes, dyschromatopsia, retinal tears and detachments, lens subluxation or phacodonesis, impaired pupillary reflex, and retinal vessel findings were reported in both the premarketing and postmarketing experiences. Ellipsoid zone (inner segment/outer segment) findings were only reported in the postmarketing experience. Rates of postmarketing reports were lower than in the premarketing data. Adverse events were generally transient, and characteristics of these adverse events were generally similar between the premarketing and postmarketing experience. Postmarket analyses are limited by significant underreporting, and in the case of ocriplasmin as a first in-class drug, they may not have captured safety events that have only more recently been identified. Nonetheless, postmarket analyses can identify the scope of potential safety events based on real-world experiences. Ocriplasmin administration should be guided by an appropriate and informed risk-benefit discussion with the patient. Ongoing active postmarket surveillance by all practitioners will continue to be critical to better understand this safety profile.

Finding the retinal hole.

A method of predicting the location of retinal holes has been formulated. It is based on the fact that the development of subretinal fluid, following the occurrence of a retinal tear, is governed by a limited number of anatomical factors and gravity. As a result, detachments form in a predictable manner around the tear or hole of their origin, and the shape of the detachment points to the position of the retinal hole. One thousand retinal detachments were analyzed, and they confirm this concept.