Fluorescein Angiographic Findings Research Articles

Fundus Fluorescein Angiography and Optical Coherence Tomography Angiography Findings in Diabetic Retinopathy and Diabetic Macular Edema

Diabetic retinopathy is an important public health issue as its prevalence has been increasing every year. It is one of the major causes of visual loss which can be preventable with early diagnosis and appropriate treatment. The fundus examination must be done in detail using mydriatics, and digital images must be recorded in all diabetic patients with special emphasis on the disease type (type I and type II), duration, and prognosis. Fluorescein angiography (FA) is a gold standard invasive retinal imaging technique for the diagnosis, monitoring, and evaluating the response of the treatment in diabetic patients, but FA has limitations due to possible side effects. Optical coherence tomography angiography (OCTA) is a recent, non-invasive, dye-free imaging technique that can be used in every visit. It has the capability to image all retinal and choroidal vascular layers (segmentation) and quantify macular ischemia in a short period of time which is beneficial for the patient, and the ophthalmologist. The aim of this review is to address the findings, advantages, and disadvantages of FA and OCTA in patients with diabetic retinopathy and diabetic macular edema.

PROPHYLACTIC PERIPHERAL LASER AND FLUORESCEIN ANGIOGRAPHY AFTER BEVACIZUMAB FOR RETINOPATHY OF PREMATURITY.

To report reactivation rate after bevacizumab treatment for retinopathy of prematurity (ROP) in eyes with classic ROP (CROP) versus aggressive posterior ROP (APROP) and to report peripheral fluorescein angiography findings in these eyes. Retrospective chart review was conducted on consecutive infants treated with bevacizumab for ROP, followed by fluorescein angiography and prophylactic laser to persistent avascular retina. Sixty-four eyes of 33 patients were included. Mean gestational age was 25 weeks with mean birth weight of 674 g. Mean follow-up was 125 weeks post-menstrual age (PMA). Reactivation requiring treatment after initial bevacizumab was more common in eyes with APROP (8/16) than with CROP (2/48; P < 0.0001). At mean 73 weeks PMA, eyes with APROP had more avascular retina (mean 4.4 disk diameters vs. 2.6 disk diameters; P = 0.0004) and higher percentage of leakage (11/11 eyes vs. 22/38 eyes; P = 0.01) on fluorescein angiography than in eyes with CROP. Unfavorable outcome occurred in 1 of 16 eyes with APROP and in no eyes with CROP. No eye that underwent prophylactic laser after bevacizumab had a poor structural outcome. In our study, bevacizumab-treated eyes with APROP have a higher likelihood of recurrence and larger area of persistent nonperfusion than in eyes with CROP. Treatment of ROP with bevacizumab followed by prophylactic laser has a low rate of unfavorable structural outcome.

Neurologic Complications of Acute Posterior Multifocal Placoid Pigment Epitheliopathy: A Case Series of 4 Patients.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a self-limited idiopathic inflammatory ophthalmologic condition with characteristic funduscopic and fluorescein angiography findings. It is typically characterized by a flu-like prodrome followed by monocular or binocular vision loss. Often, prognosis is excellent with complete or near-complete recovery of vision. Rarely, however, APMPPE is associated with neurologic complications, including meningitis, cerebral vasculitis, and stroke. Treatment in patients with central nervous system (CNS) involvement involves steroids and ultimately other immunosuppressive therapy, as there can be significant resulting morbidity and mortality otherwise. Evidence or guidelines regarding duration of treatment are lacking. We present 4 patients diagnosed with APMPPE who demonstrate the spectrum of neurologic sequelae associated with APMPPE. The first 2 cases highlight cerebrospinal fluid lymphocytic pleocytosis as an indicator of active CNS inflammation and the potential utility of serial lumbar punctures (LPs) to guide treatment duration. Cases 3 and 4 demonstrate the neurovascular complications seen in CNS vasculitis. Case 4 also highlights the potential use of magnetic resonance vessel wall imaging (VWI) as a noninvasive means for disease surveillance and treatment guidance. This case series emphasizes the importance of recognition by neurologists of APMPPE as an entity associated with strokes and cerebral vasculitis in order to provide appropriate and timely treatment. Active CNS inflammation warrants continued aggressive immunosuppressant treatment, and we propose that serial LPs and/or magnetic resonance VWIs may be effective tools to guide disease surveillance and subsequent treatment duration.

The role of fundus fluorescein angiography in classification and diagnosis of macular diseases: A hospital-based study

AIMS AND OBJECTIVES: The aims and objectives of this study is to assess the role of fundus fluorescein angiography (FFA) in classification and diagnosis of macular diseases. SETTING AND DESIGN: This was an 1-year hospital-based study conducted at KLES, Dr. Prabhakar Kore Hospital, Belagavi, Karnataka. METHODOLOGY: The present study was conducted in the Department of Ophthalmology, KLES, Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, on 66 participants from January 1st, 2016 to December 31st, 2016. METHODS: An 1-year hospital-based study was conducted on 66 patients who attended the outpatient department. A detailed history was obtained from all the patients and a thorough ocular and systemic examination were done. All the patients were examined by conventional methods of ophthalmoscopy (direct, indirect, and slit lamp examination with +90 D lens) followed by FFA. The clinical ophthalmoscopy and fluorescein angiography findings were analyzed and categorized. RESULTS: Sixty-six participants were analyzed and sub-divided into categories of age-related macular degeneration (ARMD), diabetic maculopathy, vascular occlusive disorders, Central Serous Chorioretinopathy (CSCR), inflammatory causes, macular dystrophy, and macular hole. FFA confirmed the diagnosis in 62% of the cases and altered the diagnosis in 38% of cases. It also classified the lesions in 64% of cases. CONCLUSION: FFA has played a major role in diagnosing wet ARMD. It was of immense value in diagnosis and classification of diabetic maculopathy cases. It is a superior diagnostic modality in differentiating macular edema from macular ischemia in vascular disorders. It provides definitive diagnosis in CSCR by detecting the exact site of leakage. It is of immense value in the diagnosis of macular edema in inflammatory diseases. FFA played an important role in the diagnosis of macular dystrophy and macular hole cases.

The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario.

Purpose:This study evaluated the effect of intravitreal dexamethasone implant (IDI; Ozurdex) injection for treating macular edema in patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).Methods:This prospective study included 40 eyes of 40 patients with nonischemic BRVO and 31 eyes of 31 patients with nonischemic CRVO who received IDI injection as the first-line treatment for macular edema. The best-corrected visual acuity (BCVA) value before and after the treatment; intraocular pressure; optic coherence tomography findings; and all ocular examination findings, including central foveal thickness (CFT) measurement and fluorescein angiography findings, were evaluated for each patient.Results:After the IDI injection, BCVA value increased (P < 0.001) and CFT value decreased (P < 0.001) in both groups. The recurrence rates of CFT elevation after the first and the second Ozurdex injections were 65.0% and 65.3%, respectively, in patients with BRVO and 70.9% and 68.1%, respectively, in patients with CRVO. A statistically significant correlation was observed between preinjection CFT value and postinjection recurrence of CFT elevation (P = 0.017).Conclusion:Treatment with the IDI injections resulted in significant short-term improvement in CFT and BCVA values in patients with clinically significant RVO-related macular edema. Moreover, we observed that high preinjection CFT value was associated with a risk of postinjection recurrence of CFT elevation.

Subthreshold Continuous Wave Autofluorescence-controlled Laser Treatment of Chronic Central Serous Chorioretinopathy.

Purpose:To investigate the therapeutic effect of clinically invisible subthreshold continuous wave autofluorescence-controlled laser treatment on visual acuity and macular status of patients with chronic central serous chorioretinopathy (CSCR).Methods:In this prospective case series, patients with clinical and fluorescein angiographic (FA) findings of CSCR and chronic visual loss (>6 months) were included. Complete ocular examination, FA, and optical coherence tomography (OCT) tests were performed. Each eye was subjected to a direct laser treatment of leakage points by 532 nm continuous wave low energy laser pulses, which were kept invisible by reducing the power to 70% of the threshold test spot. Considering the lack of visible effect on the retinal pigment epithelium (RPE), the laser effect was monitored by pre- and post -treatment infrared and autofluorescence images.Results:A total of 20 patients were included in this study, of whom 12 patients (9 male and 3 female patients) with an average age of 38 years had complete follow-up (Average: 3.5 months). The mean preoperative visual acuity was 20/80, which improved to 20/40 at the final visit. The mean preoperative central macular thickness (CMT) was 330 μm and the average final CMT in the last OCT test was 188 μm (P = 0.001).Conclusion:Subthreshold continuous wave autofluorescence-controlled laser treatment may be a good treatment for chronic CSCR to avoid the risks of retinal damage by clinically suprathreshold laser therapy.

Fundus fluorescein angiography of idiopathic central serous chorioretinopathy in the indigenous population of Manipur

Background: Idiopathic central serous chorioretinopathy is a chorioretinal disease characterized by localized leakage from the choroidal circulation causing serous retinal detachment affecting the macula. Aims: To document the leakage pattern using fundus fluorescein angiogram in idiopathic central serous chorioretinopathy in the indigenous people of Manipur. Materials and Methods: A prospective study was conducted in all patients with clinical diagnosis of central serous chorioretinopathy attending ophthalmology outpatient department of a tertiary care hospital in Manipur, Northeast India, within a period of 1 year starting from September 2015 to August 2016. After thorough clinical evaluation of the posterior segment and after ruling out the potential contraindications, patients were subjected to fundus fluorescein angiography (FFA). Results: Predominantly males (72%) and those mostly in their fifth decade of life were affected. Most of the patients were businessmen. The right eye was affected more (78%) than the left, with the most common presenting symptom being dark shadow or central haziness of vision in about 60% of patients. Betel nut consumption was found to be a very common food habit. Sensory retinal detachment (40%) was the most common fundus finding and depigmented patches (4%) were least commonly seen. Of the 50 eyes examined, FFA showed a single leak in 36, double and triple leaks in 7 eyes each, and no leak in 10 eyes. Inkblot pattern was the most common pattern of leakage (72%). Most common site of leakage in this study was the macular area (58%). Conclusion: Idiopathic central serous chorioretinopathy (ICSC) predominantly affects middle-aged males having a stressful life. Most of them present with dark shadow or a central area of haziness in the visual field which is mostly attributable to sensory retinal detachment at the macula. The most common fundus fluorescein angiographic finding is a single leak inkblot pattern in the macular area.

Characteristics and Visual Outcome of Refractory Retinal Vasculitis Associated With Antineutrophil Cytoplasm Antibody–Associated Vasculitides

To describe the clinical characteristics, therapies, visual outcomes, and prognoses of patients with retinal vasculitis associated with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). Retrospective case series. Patients diagnosed with retinal vasculitis associated with AAV and at least 6months of follow-up were included. Demographic data, systemic and ocular features, best-corrected visual acuity at the initial visit and latest visit, fluorescein angiography (FA) and indocyanine green angiography (ICGA) findings, therapy regimen, and outcome were collected from the Massachusetts Eye Research and Surgery Institution (MERSI) database from 2006 to 2017. Fourteen patients (22 eyes) were identified. Twelve had granulomatosis with polyangiitis (GPA) and 1 each had microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). FA showed that AAV affected small-to-medium-size retinal vessels. Seven cases (50%) had both vein/venule and artery/arteriole involvement. Four cases co-presented with choroidal vasculitis. All of them failed various immunomodulatory therapies prior to referral to MERSI. Six patients received rituximab plus prednisone as their final therapy and 5 of them achieved remission. Four patients who failed cyclophosphamide previously were induced into remission by rituximab. Patients were followed for 33.4 ± 25.5 (range 6-84) months. Nine of 14 patients (64.3%) achieved remission at their latest visit. Seventeen of 22 eyes (77.3%) met the criteria for a good (≥20/40) visual outcome. The majority of patients enjoyed a good visual outcome and achieved remission after aggressive treatment. Rituximab should be considered as an initial treatment for patients with refractory retinal vasculitis associated with AAV.

Retinal malperfusion in albuminuric Type 1 diabetes mellitus patients without clinical signs of diabetic retinopathy: a prospective pilot study

BackgroundTo report fluorescein angiography findings in a group of albuminuric Type 1 diabetes mellitus (T1DM) patients without diabetic retinopathy.MethodsFifteen albuminuric T1DM patients with normal/near normal estimated glomerular filtration rate without diabetic retinopathy underwent fluorescein angiography; presence of microaneurysms, vascular permeability changes and retinal malperfusion were evaluated.ResultsFluorescein angiography revealed microaneurysms, blood-retinal barrier breakdown and retinal ischemia in 10 (67%) and 11 (73%); 8 (53%) and 9 (60%); 2 (13%) and 5 (33%) of patients at baseline and follow up, respectively. Follow up time averaged 24.6 months, minimum follow up time was 20 months. Patients who presented retinal malperfusion had higher HbA1C and lower estimated glomerular filtration rate.ConclusionsMost albuminuric T1DM patients with a normal fundus exam had angiographic signs of diabetic retinopathy, some presenting retinal malperfusion. Retinal changes may be found with more sensitive testing in these patients, especially with impaired estimated glomerular filtration rate, even if the fundus exam is normal, and fluorescein angiography should be considered. These findings point to a homogenous presentation of the diabetic microangiopathies.

Comparison of digital color fundus imaging and fluorescein angiographic findings for the early detection of diabetic retinopathy in young type 1 diabetic patients

To compare the findings from digital 7-field color fundus (CF) photography and fundus fluorescein angiography (FFA) in young patients with diabetes mellitus (DM) type 1 without known diabetic retinopathy. In this prospective, observational cohort study, 54 type 1 diabetic patients were recruited. Participants had been diagnosed with diabetes mellitus (DM) for at least 6 years, had Best Corrected Visual Acuity of 20/25 or better and did not have any known retinal pathology. One hundred and seven eyes were analyzed. All patients underwent a complete ophthalmic examination in the Retina Service of a University Eye Clinic including digital CF imaging and FFA. The mean age of the patients was 18.6 years. Mean duration of DM was 11.3 years, and mean haemoglobin A1c (HbA1c) level was 8.6%. Of the 107 eyes, 8 eyes (7.5%) showed microvascular abnormalities on CF images, while FFA images revealed changes in 26 eyes (24.3%). Hence, 18 of the 26 eyes showing abnormalities on FFA did not show any abnormalities on CF images. Mean DM duration in the patient group with detectable microvascular changes was found to be significantly higher compared to patients without changes, while no difference in HbA1c levels, serum lipid levels or blood pressure was observed. Comparison of digital CF and FFA findings for the detection of diabetic microvascular changes in type 1 diabetic patients showed that FFA reveals more information about retinal vascular pathology for early detection of diabetic retinopathy.

Spectropathology-corroborated multimodal quantitative imaging biomarkers for neuroretinal degeneration in diabetic retinopathy.

IntroductionImage-based early detection for diabetic retinopathy (DR) needs value addition due to lack of well-defined disease-specific quantitative imaging biomarkers (QIBs) for neuroretinal degeneration and spectropathological information at the systemic level. Retinal neurodegeneration is an early event in the pathogenesis of DR. Therefore, development of an integrated assessment method for detecting neuroretinal degeneration using spectropathology and QIBs is necessary for the early diagnosis of DR.MethodsThe present work explored the efficacy of intensity and textural features extracted from optical coherence tomography (OCT) images after selecting a specific subset of features for the precise classification of retinal layers using variants of support vector machine (SVM). Fourier transform infrared (FTIR) spectroscopy and nuclear magnetic resonance (NMR) spectroscopy were also performed to confirm the spectropathological attributes of serum for further value addition to the OCT, fundoscopy, and fluorescein angiography (FA) findings. The serum metabolomic findings were also incorporated for characterizing retinal layer thickness alterations and vascular asymmetries.ResultsResults suggested that OCT features could differentiate the retinal lesions indicating retinal neurodegeneration with high sensitivity and specificity. OCT, fundoscopy, and FA provided geometrical as well as optical features. NMR revealed elevated levels of ribitol, glycerophosphocholine, and uridine diphosphate N-acetyl glucosamine, while the FTIR of serum samples confirmed the higher expressions of lipids and β-sheet-containing proteins responsible for neoangiogenesis, vascular fragility, vascular asymmetry, and subsequent neuroretinal degeneration in DR.ConclusionOur data indicated that disease-specific spectropathological alterations could be the major phenomena behind the vascular attenuations observed through fundoscopy and FA, as well as the variations in the intensity and textural features observed in OCT images. Finally, we propose a model that uses spectropathology corroborated with specific QIBs for detecting neuroretinal degeneration in early diagnosis of DR.

Follow-up to Age 4 Years of Treatment of Type 1 Retinopathy of Prematurity Intravitreal Bevacizumab Injection versus Laser: Fluorescein Angiographic Findings

To compare structural outcome at age 4 years of eyes treated with intravitreal injection of bevacizumab with fellow eyes treated with conventional laser photoablation in type 1 retinopathy of prematurity (ROP). Single, randomized, controlled trial. All inborn babies with type 1 zone 1 ROP at the Neonatal Intensive Care Unit of the Catholic University, Rome, from September 1, 2009, to March 31,2012. In 21 infants (42 eyes), 1 eye was randomized to receive an intravitreal injection of 0.5 mg bevacizumab; the fellow eye underwent conventional laser photoablation. Digital retinal imaging and fluorescein angiography (FA) were performed at an average of 4 years after treatment in follow-up after these studies performed at treatment and 9 months. Fluorescein angiograms were examined by 2 experts to document retinal and choroidal findings. Among the 20 bevacizumab-treated eyes available at 4 years of age, all showed abnormalities at the periphery (avascular area, vessel leakage, shunts, abnormal vessel branching, and tangles) or the posterior pole (hyperfluorescent lesions, absence of foveal avascular zone). These lesions were not observed in the majority of the lasered eyes. Among the 19 laser-treated eyes, leakage was noted in 1 eye, shunts and tangles were noted in 3 eyes, and macular abnormalities were noted in 3 eyes. Fluorescein angiography has shown potentially serious and long-term ocular effects that arepresent more commonly after treatment with bevacizumab for acute-phase ROP than after laser.

Use of wide‐field fluorescein angiography in the diagnosis and management of sarcoidosis uveitis

PurposeTo assess the utility of wide field (WF) fluorescein angiography versus conventional angiography in the diagnosis and management of Sarcoidosis posterior uveitis.MethodsTwenty‐three eyes of 12 patients diagnosed with Sarcoidosis disease who underwent WF fluorescein angiography imaging with the Heidelberg scanning laser ophthalmoscope HRA2 using the Staurenghi SLO contact lens between January 2016 and March 2017 were included in our study. Complete clinical and imaging records (WF fluorescein angiography and SD‐OCT) of the patients were retrospectively reviewed. A circle simulating the central 75‐degree field was drawn on WF fluorescein angiography images. We compared the WF fluorescein angiography findings within the circle and the complete image and assessed its impact on patient management.ResultsFourteen eyes of 23 (60.9%) were diagnosed with Sarcoidosis retinal vasculitis. WF fluorescein angiography revealed vasculitis not clinically evident in 9 of 14 eyes (64.3%). Predominant angiographic findings were diffuse vascular leakage in 6 eyes (26.1%), peripheral ischemia in 5 eyes (21.7%), vein sheathing in 12 eyes (52.2%) and multifocal hyperfluorescent spots in 8 eyes (34.8%). Ten eyes (43.5%) had no apparent retinal vasculitis but WF images have shown peripheral changes outside the circle. In four eyes (13%), WF fluorescein angiography showed the vasculitis to be much more extensive than usually seen by simulated conventional FA. WF fluorescein angiography influenced treatment decision in 9 eyes (39.1%).ConclusionsRetinal vasculitis (RV) may be difficult to detect either clinically or with conventional retinal imaging in Sarcoidosis disease. Wide‐field imaging is a useful tool in the diagnosis of RV associated to Sarcoidosis disease even in the absence of clinical retinal vasculitis and may influence management decisions.

Prevalence and Risk Factors for Nonexudative Neovascularization in Fellow Eyes of Patients With Unilateral Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy.

To determine the prevalence of subclinical nonexudative neovascularization and associated choroidal vascular changes in the fellow eyes of patients presenting with unilateral typical exudative AMD (tAMD) or polypoidal choroidal vasculopathy (PCV) using indocyanine green angiography (ICGA) and swept-source (SS) optical coherence tomography angiography (OCT-A). We recruited patients presenting with tAMD or PCV in a prospective clinical study. The diagnosis in the presenting eye was determined based on clinical, fluorescein angiography (FA), and ICGA findings. We evaluated the contralateral eye for presence of nonexudative neovascularization, choroidal hyperpermeability, and pachyvessels in the outer choroid, based on multimodal imaging which included ICGA, spectral-domain (SD) OCT and OCT-A. We measured subfoveal choroidal thickness in both eyes for each patient. We included 76 fellow eyes of 76 patients who presented with unilateral tAMD (n = 33) or PCV (n = 43). Nonexudative neovascularization was present in 18% eyes (14 eyes, 8 in tAMD group, 6 in PCV group; 7 on ICGA, 4 on OCT-A, 3 on both ICGA and OCT-A). Pachychoroid pigment epitheliopathy was present in 13 eyes with nonexudative neovascularization, and was the only risk factor associated with nonexudative neovascularization. Approximately one in five fellow eyes with unilateral tAMD and PCV have features of nonexudative neovascularization. The use of multimodal imaging including ICGA and OCT-A can identify these features. The presence of pachychoroid epitheliopathy should alert clinicians to the possibility of underlying neovascularization.

Fluorescein angiography findings in diffuse retinoblastoma: two case reports with clinicopathologic correlation

Whereas most retinoblastomas are seen as intraocular tumors, the diffuse infiltrating type is distinguished by a horizontal growth along the retina with minimal vertical growth. These findings can resemble other entities and present as a diagnostic challenge. Fluorescein angiography (FA) features of retinoblastoma have been described in the literature; however, to our knowledge, little information is available on the diffuse type. We present FA findings and the clinicopathlogic correlation of 2 patients with diffuse retinoblastoma. Changes observed on FA correlate with the vascular changes observed on histopathology and can therefore be helpful in the diagnosis of atypical retinoblastomas when the clinical presentation is equivocal.

The Use of Fluorescein Angiography to Evaluate Pediatric Abusive Head Trauma: An Observational Case Series

Background or Purpose: The evaluation of retinal hemorrhages in the setting of suspected abusive head trauma (AHT) has important medical, social, and legal implications. Challenges include late presentation after retinal hemorrhages have resolved and differentiating AHT-related retinal changes from mimicking pathologies. To date, angiographic evidence of peripheral retinal injury in AHT has been reported in small series, but further study is needed to determine the prevalence and long-term sequelae of these findings. The purpose of this study was to describe fluorescein angiography (FA) findings in pediatric patients with a history of definite AHT and demonstrate the potential utility of FA in evaluating cases of suspected abuse with late presentation. Methods: Retrospective case series of 10 eyes in 5 pediatric patients with a history of definite AHT. RetCam fundus photography images and digital FA were performed. Results: Peripheral retinal nonperfusion affected 10 of 10 eyes in patients with a history of definite AHT. These changes persisted after acute retinal hemorrhages had resolved. Conclusions: “Retinal surveys” using FA provide angiographic evidence of peripheral retinal nonperfusion that may be a sign of AHT. This series adds to the growing body of cases reporting similar AHT-related findings and additionally demonstrates the longevity of these pathologic changes after trauma, which has not been previously described. Fluorescein angiography may offer a distinct advantage in evaluating cases of suspected abuse with late presentation to medical care when pathognomonic retinal hemorrhages may no longer be present. Further study is needed to determine the prevalence and long-term sequelae of these findings.

The comparison of multimodal imaging findings of central serous chorioretinopathy patients in regard to the early anatomically treatment response to half-fluence photodynamic therapy: a retrospective case\u2013control study

Background To compare the multimodal imaging findings of chronic central serous chorioretinopathy (CSC) patients who are good or poor responders to low-fluence photodynamic therapy (PDT).MethodsRetrospective, interventional comparative study. The CSC patients who were admitted to our clinic for the first time between January 2013 and December 2015 were included in the study. Patients were treated with PDT only if they did not show any sign of resolution after at least 6 months from the initial signs of the disease. The patients who showed full or partial response to PDT after 3 months of treatment were accepted as good responders, those who did not show any sign of resolution were accepted as poor responders. The optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings were compared between the two groups.ResultsA total of 101 eyes of 101 patients were included: 76 eyes (75.2%) were considered as good responders and 25 eyes (24.8%) as poor responders. In regards to OCT and FA findings there was not a significant difference between the two groups for all of the evaluated findings (p > 0.05 for all). In regards to ICGA findings, there was a statistically difference in the percentage of intense midphase hypercyanescence (p < 0.0001).ConclusionsThe multimodal imaging findings of CSC patients were compared in regard to their PDT response. The presence of midphase hypercyanescence in ICGA seemed to be positive predictive factor for the PDT response in CSC patients.

Selective Localized Tenonplasty for Corneal Burns Based on the Findings of Ocular Surface Fluorescein Angiography.

To report the results of a selective localized tenonplasty procedure based on findings of ocular surface fluorescein angiography (FA). Six consecutive patients with severe chemical burns were included in this study. Using fluorescein angiogram images, patients underwent selective localized tenonplasty to cover the identified ischemic areas in FA. FA 1 week after surgery showed a perfused ocular surface in all eyes except for 1 quadrant of limbal ischemia in 1 eye. After the second tenonplasty, recirculation was also detected in that quadrant. None of the eyes perforated during the follow-up period. We observed acceptable outcomes in our patients after selective tenonplasty based on ocular surface angiography.

INFLIXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS INTERMEDIATE UVEITIS RESISTANT TO CONVENTIONAL IMMUNOMODULATORY THERAPY.

To examine the efficacy and safety of infliximab therapy in the treatment for noninfectious intermediate uveitis resistant to conventional immunomodulatory therapy. Forty-four eyes of 23 patients with resistant noninfectious intermediate uveitis who were treated with infliximab infusions for a minimum period of 3 months were included. Demographic data, clinical data, and fluorescein angiography and optical coherence tomography findings were collected from the Massachusetts Eye Research and Surgery Institution database between August 2005 and February 2014. Clinical response, improvement in ancillary test findings, and major side effects were evaluated. Nineteen patients (82.6%) achieved remission. The mean duration of treatment to induce remission was 3.99 ± 3.06 months (range, 2-14.7). Cystoid macular edema was the only complication observed during the course of the treatment in 1 eye (2.27%). One patient (4.3%) developed major side effects. None of the patients developed central or peripheral demyelinating neuropathies or multiple sclerosis. At 6 months after remission, logarithm of the minimum angle of resolution visual acuity (P = 0.006) and central macular thickness (P = 0.03) showed significant improvement in patients who achieved remission. A significant number of patients achieved remission on infliximab therapy. The incidence of major side effects in our cohort was low.

Progressive Massive Choroidal Neovascularization

Purpose: A small subset of patients with neovascular age-related macular degeneration (AMD) can have relentless progression of choroidal neovascularization (CNV) and subsequent disciform scarring (DS) with extension beyond the vascular arcades to the equator. We present the clinical courses of this severe phenotype of progressive massive CNV (PM-CNV). Methods: Retrospective case series of 14 eyes of 8 patients who presented with (1) massive DS encompassing the posterior pole and extending to the equator and (2) progressive DS expansion despite treatment between 2004 and 2015 at a tertiary referral center. Demographics, clinical and ocular characteristics, fluorescein angiographic findings, and treatment regimens were reviewed. Results: Baseline characteristics included a mean age of 73.0 years (range, 65.- 86.9 years) with 7 (87.5%) women. Six (75%) patients had bilateral PM-CNV. Mean follow-up was 10.5 years (range, 0.5-18.2 years). Ten (71.4%) eyes underwent intravitreal anti-vascular endothelial growth factor therapy, 3 (21.4%) intravitreal corticosteroid injections, and 3 photodynamic therapy. Most eyes (92.9%) demonstrated subretinal hemorrhage at the edge of the DS prior to DS expansion during treatment. Of the 6 patients with bilateral PM-CNV, 5 developed DS in 1 eye earlier than the subsequent eye (mean time, 63.6 months). Final visual acuity was ≤20/400 in all eyes (20/400 [n = 1]), count fingers (n = 5), hand motions (n = 5), and no light perception (n = 3). Conclusion: Progressive massive CNV is a profound reactivation of DS in some AMD eyes and is associated with severe, often bilateral, vision loss.