Exudative Detachment Research Articles

Unilateral Acute Idiopathic Maculopathy

This is a report of nine patients who experienced sudden, severe, unilateral central vision loss following a flulike illness. Each patient had an exudative detachment of the macula. All patients experienced a spontaneous resolution of the acute macular manifestations with near-complete recovery of vision. A characteristic "bull's-eye" appearance in the macula persisted. The acute manifestations of the disorder did not recur in any of the patients during the period of follow-up. The constellation of findings was suggestive of an inflammatory disease of the retinal pigment epithelium, but a specific causative agent could not be identified. The acute clinical and angiographic features, the natural course, and the residual pigment epithelial derangement were not consistent with any previously described disorder.

A combination therapy of half-dose verteporfin photodynamic therapy and intravitreal injection of ranibizumab for chronic central serous chorioretinopathy

Aim: To study the combination treatment consisting of half-dose verteporfin photodynamic therapy (PDT) and an intravitreal injection of ranibizumab as a potential treatment for patients with chronic central serous chorioretinopathy (CSC). Materials and methods: Six eyes of 6 patients were studied with fundus examination, fluorescein angiography, and optical coherence tomography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. Half-dose verteporfin PDT was applied to areas of choroidal hyperpermeability and, the following day, 0.5 mg/0.05 mL ranibizumab was injected intravitreally. The patients were observed to determine the anatomic and functional outcomes. Results: The combination therapy consisting of half-dose verteporfin PDT and intravitreal injection of ranibizumab was associated with complete resolution of the exudative macular detachments in all of the patients. Vision improved in the 6 eyes and remained unchanged during the follow-up examinations, for at least more than 6 months. At 4 weeks after treatment, the best corrected visual acuity had improved to 20/20 in 5 of the cases. None of the patients had any treatment-related side effects. Conclusion: The combination therapy consisting of half-dose verteporfin PDT and intravitreal injection of ranibizumab seems to result in the resolution of exudative detachments in patients with chronic CSC. This treatment caused a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and the number of patients in this study were limited, the encouraging results and lack of complications suggest the value of further study.

Intravitreal Pegaptanib in Ischemic CRVO Refractory Exudative Macular Detachment

Recent literature data reported evidence of the visual and/or anatomical benefits of all clinically available anti-VEGF drugs for the treatment of macular edema (ME) following Central Retinal Vein Occlusion (CRVO), up to 1-year followup. There are no randomized clinical trial data on anti-VEGF agents in ischemic CRVO-ME and the use of anti-VEGF agents to treat this condition. A 73-year old caucasian man, with a medical history of diabetes and systemic hypertension and an ophthalmic history of ischemic CRVO with cystoid macular edema was referred to our division on January 2011. The ophthalmic examination showed in right eye a visual acuity of 20/2000, a C2N1 cataract and an exudative macular detachment. On February 2011, a 0.5mg ranibizumab intravitreal injection (Lucentis®, Novartis, Basel, Switzerland) was carried out in the right eye. 15 and 25 days later the OCT showed no changes. On March 2011, we performed a 0.3mg pegaptanib sodium intravitreal injection (Macugen, Eyetech Pharmaceuticals, Inc. and Pfizer Inc, New York, NY) in the right eye and 15 days later the fluorescein angiography and the OCT examination showed reabsorption of subretinal fluid, complete disappearing of macular detachment and normalization of foveal profile, with a thickness of 240 μm and visual acuity of 20/400. Three months later, foveal profile and visual acuity were unchanged.In our refractory ischemic CRVO-ME patient, pegaptanib sodium showed prompt clinical response. In some cases, even if it is selective for the VEGF165 isoform only, pegaptanib sodium could represent a further possibility in such a therapeutic challenge.

Atypical unilateral maculopathy associated with acute exudative polymorphous vitelliform maculopathy-like yellowish deposits.

To report a case of atypical unilateral maculopathy associated with acute exudative polymorphous vitelliform maculopathy-like yellowish deposits. Observational case report of one patient. A 52-year-old man presented with reduced vision in the left eye. Findings resembling acute exudative polymorphous vitelliform maculopathy were noted with ophthalmoscopy, fluorescein angiography, and optical coherence tomography. Funduscopic examination revealed an exudative macular detachment with yellowish subretinal deposits inferior to the fovea. On fluorescein angiography, the perifoveal lesions were minimally hyperfluorescent, with no abnormal fluorescence in the central macula. The subretinal deposits were found to be hyperautofluorescent on fundus autofluorescence imaging. Optical coherence tomography confirmed a serous detachment of the retina with intraretinal cystic spaces. The right eye did not show any abnormalities except for an epiretinal membrane. We describe a case of atypical unilateral maculopathy associated with acute exudative polymorphous vitelliform maculopathy-like yellowish deposits.

Paradoxical response in ocular bartonellosis

IntroductionCat scratch disease is an infectious disease caused by thebacteria Bartonella henselae [1] and is transmitted by catscratches or exposure to cat saliva. The spectrum of itsocular manifestations includes Parinaud's oculoglandularsyndrome, iritis, vitritis, neuroretinitis, panuveitis, retinitisappearing as small white intraretinal infiltrates, and choroi-dal white lesions [1, 2]. B. henselae is reported to be themost common cause of neuroretinitis; typically character-ized by optic disk edema in association with a partial orcomplete macular star. The majority of infected patientspresenting with neuroretinitis reported in the literature aretreated with antibiotics. In some cases steroids were added.However several reports showed that even patients who didnot receive treatment had an excellent visual outcome [1].We describe here a paradoxical response to treatment in ayoung female presenting with bilateral neuroretinitis andinflammatory optic disk lesions.Case reportA 19-year-old healthy female presented with an abruptdeterioration of left eye vision of 1-day duration. For10 days prior to presentation, she was suffering from drycough; 5 days later she had intermittent fever up to 41°Cwith shaking chills. There was a history of contact with acat, but she denied being scratched. On admission, physicaland neurologic examinations were unremarkable. Ophthal-mologic assessment disclosed visual acuity of 4/4 in theright eye and 4/60 in the left eye. She had normal anteriorsegments and intraocular pressures. A left afferent pupillarydefect was noted. Funduscopy of the right eye showed asmall white optic disk lesion in its temporal aspect with adeep retinal white lesion along the superonasal arcade(Fig. 1). The left optic disk had blurred margins with biggerwhite lesions in its nasal and temporal aspects with anassociated localized vitreous opacity on its surface (Fig. 1).There was marked macular edema and two deep retinalwhite lesions along the superotemporal arcade and infer-onasal to the optic disk. Optical coherence tomography(OCT) revealed intraretinal fluid in the right papillomacularbundle and left exudative macular detachment (Fig. 2).Visual field examination showed right nasal step andsuperonasal arcuate defect while there was enlargement ofthe left blind spot with nasal step (Fig. 3). Work-uprevealed mild anemia with hemoglobin of 11.7 g% andleukocytosis of 14,800 (lymphocytes, 31%). Kidney andliver functions were within normal limits except for aslightly elevated lactate dehydrogenase at 768 (normalrange, 300–620 u/l). She had elevated erythrocyte sedi-mentation rate (ESR) (90 mm/h) and C-reactive protein(5.3 mg%; normal range, less than 1). Chest X-ray did notreveal any pathological findings, and CT scan and MRI ofthe head and brain showed mild thickening of the opticnerves bilaterally and hyperintense foci in the flairsequences in the intraocular aspects of the optic nerves,respectively. Cerebrospinal fluid cytology was normal.Serological tests were negative for HIV, syphilis, Brucella,Coxiella burnetti, toxoplasma, and toxocara. Serologicaltests for B. henselae revealed positive IgM titer at 75 units

Diffuse retinal injury from a non-penetrating TASER dart

To describe a non-penetrating TASER gun injury resulting in a small exudative retinal detachment but significant visual acuity and retinal function loss as demonstrated by electroretinography (ERG). A 39-year-old man presented to the emergency department with a TASER barb embedded in his right lower lid. A complete clinical ophthalmologic examination and surgical extrication were performed, as well as radiologic imaging and Ganzfeld electroretinography. No scleral penetration was observed on surgical exploration. Retinal examination showed a peripheral exudative detachment. Subsequent follow-up revealed progressive resolution of the detachment and improvement in visual acuity. The ERG showed a 63-70% decrease in rod a- and b-waves, while isolated cone responses were reduced by only 10%, with a minimal increase in implicit time. This case shows that periocular TASER injuries, even if apparently superficial, may result in significant ocular damage. ERG may be useful in the diagnosis of visual loss attributed to disturbance in photoreceptor function, in the absence of anatomically evident damage.

Spectral domain OCT and autofluorescence imaging of unilateral acute idiopathic maculopathy

To report imaging findings of unilateral acute idiopathic maculopathy (UAIM). In this observational case report, the Spectralis acquisition system (Heidelberg Engineering, Germany), which includes spectral domain optical coherence tomography (OCT), multiple autofluorescence (AF), fluorescein angiography (FA), and indocyanine green (ICG) angiography, was used for monitoring onset and evolution of UAIM. A well-defined, bullous macular lesion was evident on color pictures, infrared imaging (IR), and AF. Fluorescein angiography and ICG similarly showed early hypofluorescence of the lesion and, exclusively on FA, mild staining. Notably, the definition and limits of the detachment were clearly identifiable on late-phase ICG, and formed a hypocyanescent area. Spectral domain OCT disclosed severe retinal pigment epithelium (RPE) but not neurosensory detachment; the distinction between the photoreceptors inner/outer segment line was nonapparent for the entire length of the lesion. At 7-week follow-up, visual acuity improved to 20/20, with resolution of the exudative detachment. Autofluorescence and FA imaging indicated normalization, and only IR showed the boundaries of the lesion as still identifiable. Infrared imaging also showed a central granular feature, suggesting persistent choroid and pigment alteration. Indocyanine green angiography still evidenced the early hypofluorescent halo that became more evident in the late phases without any staining of the dye. Tomography depicted a reconstituted fovea, in which the outer limiting membrane and the inner/outer segment junction returned detectable. Comprehensive evaluation of UAIM by AF, FA, ICG, and spectral domain OCT disclosed involvement of RPE, the neuroretina, and the choroid in the pathogenesis of the disease. Despite functional recovery, choroidal rather than retinal alteration could persist.

Choroidal thickness following extrafoveal photodynamic treatment with verteporfin in patients with central serous chorioretinopathy

To evaluate the effect of verteporfin photodynamic treatment (PDT) on choroidal thickness in patients with central serous chorioretinopathy (CSC). Choroidal thickness was measured with enhanced depth imaging- optical coherence tomography (EDI-OCT) before and after verteporfin PDT (full-dose verteporfin, half-light dose) in 16 eyes in 16 patients with serous detachment of the fovea secondary to extrafoveal angiographic fluorescein leakage. Treatment was confined to the area of leakage, whereas choroidal thickness before and after treatment was assessed over a larger area of the fundus using OCT. Complete resolution of the serous detachment was seen in all 16 eyes within 1 month of extrafoveal PDT, while choroidal thickness in the area where PDT was applied decreased from 407 μm [mean; 95% confidence interval (CI(95) ) 356-458 μm] to 349 μm (mean; CI(95) 300-399 μm; p < 0.0001), and subfoveal choroidal thickness was reduced from 421 μm (mean; CI(95) 352-489 μm) to 346 μm (mean; CI(95) 278-414 μm; p = 0.0001). Initially, subfoveal choroidal thickness was significantly increased in the treated eye compared with the healthy fellow eye (mean 324 μm; CI(95) 273-376 μm; p = 0.0003), but after treatment, the difference was not significant. Photodynamic therapy of active CSC was followed by choroidal thickness reduction, not only locally but also at considerable distance from the treated area. Thus, the process that causes choroidal thickening in CSC appears to spread laterally within the choroid.

Effects of Green Diode Laser in the Treatment of Pediatric Coats Disease

To review the effect of green diode laser ablation therapy on retinal structure and functional outcome in patients with advanced Coats disease. Retrospective, interventional case series. Fourteen eyes of 13 patients with Coats disease were included in this study. Medical records, Retcam photographs (Clarity Medical Systems, Pleasanton, CA), and fluorescein angiograms were reviewed. All patients initially were treated with green diode laser (532 nm) ablation therapy to areas of the retinal telangiectasis associated with exudation. Main outcome measures included visual acuity, treatment outcome defined as complete resolution of telangiectatic lesions or exudative detachment, and macular status at the end of follow-up. Before treatment, 1 eye was at stage 2 (telangiectasis and exudation), 12 eyes were at stage 3 (exudative retinal detachment), and 1 eye was at stage 4 (total retinal detachment with glaucoma). Five eyes had highly detached retina of more than 4 mm. Median age at diagnosis was 51 months (range, 0.5 to 153 months). Median follow-up was 39.5 months (range, 15 to 70 months). Median number of green diode laser photocoagulation treatments was 2 (range, 1 to 5). After laser photocoagulation, 13 (93%) of 14 eyes had no active exudation. Functionally, 4 (29%) of 14 eyes had 20/50 or better visual acuity, 3 (21%) of 14 eyes had 20/60 to 20/200 visual acuity, 5 (36%) of 14 eyes had 20/400 to light perception visual acuity, and 2 (14%) of 14 eyes had no light perception visual acuity. No eye was phthisical or enucleated. Green diode laser therapy can be an effective treatment for advanced Coats disease, even in the presence of a moderate to severely elevated retinal detachment.

Regression of Serous Macular Detachment Due to Peripheral Exudative Hemorrhagic Chorioretinopathy following Intravitreal Bevacizumab

To describe a case of exudative macular detachment secondary to peripheral exudative chorioretinopathy with a favorable anatomic and visual outcome following treatment with intravitreal bevacizumab. The medical records of a patient with peripheral exudative chorioretinopathy were reviewed. Macular reattachment was achieved with a corresponding visual acuity improvement that was maintained over an uncomplicated 17-month clinical course. Bevacizumab may be an effective treatment option for exudative macular detachment secondary to peripheral exudative hemorrhagic chorioretinopathy.

Nodular posterior scleritis mimicking choroidal metastasis: a report of two cases

Posterior scleritis is a rare underdiagnosed condition that can potentially cause blindness. Its varied presentations lead to delayed or incorrect treatment. We present here the cases of two patients with nodular posterior scleritis mimicking a choroidal metastasis. Two female patients presented with a sudden unilateral visual loss associated with ocular pain. Fundus examination revealed temporomacular choroidal masses with exudative detachments that, due to angiographic presentation, were suggestive of choroidal metastasis. Systemic examinations were unremarkable. In the two cases, a local or general anti-inflammatory treatment led to the complete recovery of the lesions, which were, thus, considered nodular posterior scleritis. The diagnosis of nodular posterior scleritis has to be evoked in all patients presenting with a choroidal mass in fundus examination. It represents the principal curable differential diagnosis of malignant choroidal tumor.

Coats disease: clinical findings and prognosis

Abstract Purpose To review the clinical variations and natural course of Coats disease. Methods We reviewed our experience with clinical features, staging and progression of the disease. In 37 consecutive patients, Coats disease was diagnosed in 15 under the age of 4y and in 22 over the age of 4y. All 37 patients had unilateral disease. The referral diagnoses were Coats disease and retinoblastoma. Patients in both groups (&lt;4y and &gt;4y) were classified into Stages 1 to 5. Results 15 out of 37 patients were diagnosed under the age of 4y (mean age 2.1y) and were Stage 4 and 5 at diagnosis. In the older group (&gt;4y – mean age 7.1y) most cases were Stage 2 and 3; only one case was Stage 4. Most cases of the first group (&lt;4y) presented a rapid progression of the disease, while older children with earlier stages have been successfully treated. Conclusion Coats disease is much more aggressive in very young children (&lt;4y). Children diagnosed at an early age present a rapid progression to total exudative detachment, secondary glaucoma and phthisis. One of these cases presented Stage 5 disease at diagnosis with cholesterolosis of the anterior chamber. Older Children present a rather slow progression, a better response to treatment and a better visual prognosis.

Herbicide application increases nitrogen (15N) exudation and root detachment of Brachiaria decumbens Stapf

Current research shows that glyphosate herbicides can increase nitrogen exudation by plant roots and, as a consequence, favor pathogenic fungal colonization in soil. In Brazilian agroecosystems, the main herbicides used in conservationist systems for glyphosate substitution are glufosinate and paraquat. However, no studies have been developed that to evaluate the effects of these herbicides on nitrogen exudation by roots. This work was carried out with the objective of evaluating the exudation of nitrogen (15N) compounds and root detachment after the application of glyphosate, glufosinate-ammonium or paraquat on Brachiaria decumbens Stapf. The ammonium concentration in the plant’s tissues and the nitrogen (15N) recovery in the plant-solution system were also evaluated. The nitrogen left by the soil-solution system and the ammonium concentration in the plant’s tissues were increased after glyphosate or glufosinate application, but they were not modified by paraquat. Nitrogen compound exudation and root detachment were increased by the desiccation of Brachiaria decumbens Stapf by the use of the following herbicides: glyphosate, glufosinate-ammonium and paraquat. This increase demonstrated that the nitrogen exudation was not affected by a particular herbicide’s mode of action.

RetCam II Fluorescein Angiography to Guide Treatment and Diagnosis of Coats Disease.

Coats disease is a well-described clinical condition featuring peripheral leakage from telangiectatic vasculature, resulting in exudative retinal detachments and exudative deposits. It often affects pediatric patients, requiring examinations and treatments to be performed under anesthesia. It can be difficult to distinguish from retinoblastoma. The RetCam II is a wide-field fundus imaging system that can also obtain intraoperative fluorescein angiography. The case of a 5-year-old girl diagnosed with Coats disease is presented. She presented with an exudative detachment, a submacular nodule, and peripheral telangiectasis. An examination under anesthesia, including angiography, was performed. The angiograph revealed characteristic aneurysms as well as extensive areas of telangiectasis and ischemia not readily visible on examination. The angiogram allowed more diagnostic certainty and guided a more complete treatment than otherwise possible. We propose that fluorescein angiography with the RetCam II system can be a useful tool when examining and treating pediatric patients with Coats disease.

Unilateral Optic Atrophy Preceding Coats Disease in a Girl with Parry-Romberg Syndrome

Parry-Romberg syndrome (PRS) is a rare disease of unknown etiology and pathogenesis, characterized by progressive hemifacial atrophy. Diverse ocular manifestations were reported in association with PRS, including enophthalmos, lid retraction, blepharoptosis, restrictive strabismus, ocular motor nerve dysfunction, Horner syndrome, reduced corneal sensitivity, band keratopathy, episcleritis, uveitis, neuroretinitis, and retinal vasculitis. Descriptive case report. We report on the development of unilateral optic atrophy followed by ipsilateral Coats disease exudation and shallow retinal detachment in the posterior pole and inferior retina. Optic atrophy was not previously described in association with PRS. We describe the development of unilateral optic atrophy with subsequent CD, 5 years later , in a girl with PRS.

Sympathetic ophthalmia following vitreoretinal surgery

The objective is to discuss the characteristics of three patients who developed sympathetic ophthalmia following vitreoretinal surgery. The first case was a 29-year-old man who underwent placement of an encircling band, pars plana vitrectomy, foreign body removal, endolaser photocoagulation, transscleral cryotherapy, and silicone oil injection due to a retained foreign body 3 months after a corneoscleral rupture repair. He experienced visual loss in the fellow eye 2 months after the vitrectomy. An extensive exudative detachment was detected in the fellow eye. Sympathetic ophthalmia was diagnosed and systemic steroids together with azathioprine were initiated. The injured eye was enucleated as there was no useful vision. The other two cases were operated for rhegmatogenous retinal detachments. One underwent placement of an encircling band, pars plana vitrectomy, silicone oil injection, and endolaser photocoagulation with good anatomic outcome. However, 4 months later, the fellow eye experienced severe visual loss with disc swelling and hyperemia and exudative retinal detachment. Systemic steroid was sufficient to reverse the process and the visual acuity recovered. The other case underwent placement of an encircling band, subretinal fluid drainage, SF(6) injection and 360 degrees indirect laser photocoagulation. Two years later, he noted a sudden visual decrease in the fellow eye in which we detected a Harada-like extensive exudative detachment. Systemic steroid without immunosuppressive therapy rendered regression of the detachment and recovery of good visual acuity. Sympathetic ophthalmia may occur following vitreoretinal surgery either for trauma-related problems or rhegmatogenous retinal detachment. Since it may present with relatively mild anterior segment findings and mainly posterior segment involvement; any visual disturbance in the fellow eye of a patient with a history of perforating trauma or vitreoretinal surgery should be thoroughly evaluated for sympathetic ophthalmia.

Prospective Clinical Trial Evaluating the Efficacy of Photodynamic Therapy for Symptomatic Circumscribed Choroidal Hemangioma

To evaluate photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH). Prospective, multicenter, nonrandomized clinical trial. Thirty-one eyes of 31 patients with posterior pole CCH and symptoms caused by exudation into the macular area. Photodynamic therapy was applied by Zeiss laser. Intravenous verteporfin at 6 mg/m(2) body surface was administered before treatment, and light emitted at 689 nm for photosensitization. The treatment spot diameter was calculated on early-phase frames of pretreatment indocyanine green angiography. Fifteen minutes after starting the verteporfin infusion, the laser beam was applied to the retina at radiant exposure 50 J/cm(2) and exposure time 83 seconds. One to 4 treatments were applied at 12-week intervals over 1 year. Standardized evaluation was performed before and at 4-week intervals after each treatment, and at 3, 6, 9, and 12 months. All patients were followed for >or=12 months. The primary outcome measure was the absence of exudative retinal detachment at the 12-month follow-up visit on ophthalmoscopy, fluorescein angiography, and optical coherence tomography. Secondary measures were the visual acuity outcome, with best-corrected visual acuity determined by the Early Treatment for Diabetic Retinopathy Study chart, tumor thickness decrease on B-scan ultrasonography, and adverse events. Among the total, 82.8% of patients required 1, 13.8% 2, and 3.4% 3 PDTs to eliminate exudative retinal detachment. Visual acuity increased from a mean of 20/60 to 20/35 (P<0.001). Sixty-nine percent of patients demonstrated visual recovery (P<0.001). Cystoid macular edema regressed in all cases and exudative macular detachment disappeared in all but 2 cases. The CCH thickness decreased in all cases from a mean of 3.0 to 1.7 mm, with the most intense effect seen after 4 weeks of treatment (P<0.001). Visual fields showed resolution of central scotomas. There were no severe adverse events. Combining PDT with the standard age-related macular degeneration protocol is an effective treatment for CCH in terms of resolution of exudative subretinal fluid and recovery of VA. The authors have no proprietary or commercial interest in any materials discussed in this article.

Ultrasound Biomicroscopy after Vitrectomy in Eyes with Normal Intraocular Pressure and in Eyes with Chronic Hypotony

To analyze the ultrasound biomicroscopy (UBM) features of eyes with chronic hypotony after pars plana vitrectomy (PPV) and compare them with the UBM features of eyes with normal intraocular pressure (IOP) after PPV. This comparative (nonrandomized) interventional study included 64 eyes of 64 patients who underwent PPV. Group 1 included 20 eyes with less complex vitreoretinal diseases (VRD) that presented with normal IOP after PPV. Group 2 included 44 eyes with severe proliferative vitreoretinopathy (PVR) managed with PPV and silicone oil tamponade that presented with complete retina reattachment and chronic ocular hypotony. UBM was performed to study the anterior segment, ciliary body (CB), and peripheral retina. The UBM findings of the two groups were compared. In Group 1, 19/20 eyes presented with no CB alterations detected by UBM. In Group 2, 43/44 eyes presented with CB alterations that included tractional CB detachment (n=16); exudative CB detachment (n=11); tractional CB detachment/CB atrophy (n=7); CB hypotrophy (n=5); tractional CB detachment/exudative CB detachment (n=3); and CB edema (n=1). There was a strong relationship between IOP and CB findings revealed by UBM. Eyes with hypotony following PPV have CB abnormalities that can be detected by UBM. These CB alterations were not found in eyes with normal IOP after PPV in this series.

Half-Dose Verteporfin Photodynamic Therapy for Acute Central Serous Chorioretinopathy: One-Year Results of a Randomized Controlled Trial

<h3>Objective</h3> To evaluate the efficacy of photodynamic therapy (PDT) with half-dose verteporfin for treating acute central serous chorioretinopathy (CSC). <h3>Design</h3> Prospective, double-masked, placebo-controlled, randomized clinical trial. <h3>Participants and Controls</h3> Sixty-three eyes of 63 patients with acute symptomatic CSC of 3 months' duration or less were recruited. Forty-three eyes were randomized to indocyanine green angiography (ICGA)-guided PDT with half-dose (3 mg/m²) verteporfin and 21 eyes were randomized to placebo. <h3>Intervention</h3> Patients in the verteporfin group received an infusion of half-dose verteporfin over 8 minutes, followed by ICGA-guided PDT 10 minutes from the start of infusion. Laser was applied for 83 seconds covering the choroidal abnormalities observed in ICGA, with a maximum laser spot size of 4500 μm. <h3>Main Outcome Measures</h3> The primary outcome measure was the proportion of eyes with absence of subretinal fluid at the macula at 12 months. Secondary outcome measures included changes in mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), subjective symptoms, optical coherence tomography (OCT) results, central foveal thickness (CFT), and angiographic findings during the 12-month study period. <h3>Results</h3> Thirty-nine patients in the verteporfin group and 19 patients in the placebo group completed 12 months of follow-up. Thirty-seven (94.9%) eyes in the verteporfin group compared with 11 (57.9%) eyes in the placebo group showed absence of subretinal fluid at the macula at 12 months (<i>P</i> = 0.001). The mean logMAR BCVA at 12 months was significantly better in the verteporfin group compared with the placebo group: –0.05 and 0.05, respectively (<i>P</i> = 0.008). All 39 (100%) verteporfin-treated eyes had stable or improved vision, compared with 15 (78.9%) eyes in the placebo group (<i>P</i> = 0.009). The mean OCT CFT for the verteporfin group also was significantly lower compared with the placebo group at 12 months (<i>P</i> = 0.001). No ocular or systemic adverse event was encountered in the study. <h3>Conclusions</h3> Photodynamic therapy with half-dose verteporfin is effective in treating acute symptomatic CSC, resulting in a higher proportion of patients with absence of exudative macular detachment and better visual acuity compared with placebo. <h3>Financial Disclosures(s)</h3> Proprietary or commercial disclosure may be found after the references.

Hypotony Maculopathy in a Patient with HLA-B27-associated Uveitis

Purpose: To describe a patient with HLA-B27-associated anterior uveitis who developed hypotony maculopathy. Methods: Visual acuity, biomicroscopic slit-lamp examination, and fluorescein angiogram. Results: Following an episode of acute anterior nongranulomatous HLA-B27-associated uveitis, the patient developed decreased vision, choroidal folds, optic disc edema, and a serous exudative detachment characteristic of hypotony maculopathy. The intraocular pressure was noted to be 4 mmHg. Following therapy with topical 1% prednisolone acetate and 5% homatropine, both the intraocular pressure and retinal anatomy normalized. Conclusions: Hypotony maculopathy may be seen in patients with HLA-B27-associated uveitis and should be considered as a cause of vision loss in patients with this condition.