Focal Laser Photocoagulation Research Articles

Successful treatments of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome-related macular edema and exudation by intravitreal aflibercept injection in a senile patient: A case report.

The prevalence of idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is <1/1,000,000, and it tends to occur in young women. Panretinal photocoagulation, focal laser photocoagulation, peripheral cryopexy, vitrectomy, and corticosteroid therapy are the traditional treatments. We reported a case of a senile patient with IRVAN syndrome who presented with severe exudation in both eyes and macular edema in the left eye, successfully treated by serial intravitreal aflibercept injections. A 77-year-old Taiwanese woman complained of progressive blurred vision in the left eye and ocular examinations revealed a visual acuity of 20/125 in the left eye. Indirect fundoscopy and fluorescein angiography showed bilateral multiple aneurysms, vasculitis, optic nerve staining, and neovascularizations. In addition, optical coherence tomography demonstrated macular edema with subretinal fluid and exudations in the left eye. Monthly intravitreal injections of antivascular endothelial growth factor with aflibercept 2.0 mg were administered in the left eye. The visual acuity in the left eye improved to 20/50 after 18 months of treatment. Macular edema and subretinal fluid regressed. Furthermore, vessel leakage and optic disc staining also improved. This case is the first to demonstrate successful treatment of IRVAN syndrome-related central macular edema and exudations, in the absence of neovascularization, using a series of intravitreal aflibercept injections as monotherapy.

Autonomous screening for laser photocoagulation in fundus images using deep learning

BackgroundDiabetic retinopathy (DR) is a leading cause of blindness in adults worldwide. Artificial intelligence (AI) with autonomous deep learning algorithms has been increasingly used in retinal image analysis, particularly for...

Comparison between Focal Laser Photocoagulation and Intravitreal Bevacizumab Injection for Treating Chronic Central Serous Chorioretinopathy

Purpose: We compared the efficacy of focal laser photocoagulation and intravitreal bevacizumab injection in the treatment of chronic central serous chorioretinopathy.Methods: We conducted a retrospective analysis involving 46 eyes of 46 patients with chronic central serous chorioretinopathy who received focal laser photocoagulation (22 eyes) or intravitreal bevacizumab injection (24 eyes). Changes in best-corrected visual acuity (BVCA), central macular thickness, and rates of complete subretinal fluid (SRF) resolution and recurrence were compared over a 6-month period.Results: Although the focal laser photocoagulation and intravitreal bevacizumab injection groups demonstrated a significant reduction in central macular thickness at 6 months (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), no statistically significant differences were observed between these groups at the end of the follow-up period. Notably, a gradual improvement in BVCA was observed in both groups following initial treatment, with significant improvement seen at 6 months (&lt;i&gt;p&lt;/i&gt; = 0.049 and &lt;i&gt;p&lt;/i&gt; = 0.048 for the laser and injection groups, respectively). However, no statistically significant difference in BVCA improvement was observed between the groups. Complete SRF resolution was achieved in 22 eyes in the laser group and 23 eyes in the injection group. Although recurrence of SRF was observed in 9 and 13 eyes in the laser and injection groups, respectively, there was no statistically significant difference between the groups (&lt;i&gt;p&lt;/i&gt; = 0.229).Conclusions: Focal laser photocoagulation and intravitreal bevacizumab injection significantly improved anatomical and visual acuity outcomes in patients with chronic central serous chorioretinopathy. Although focal laser photocoagulation was associated with more rapid visual recovery and a lower recurrence rate compared to intravitreal bevacizumab injection, further studies are needed to evaluate its potential complications.

Effect of Focal Laser Photocoagulation on the Ganglion Cell Complex Thickness in Acute Central Serous Chorioretinopathy.

This study investigated the changes in the ganglion cell complex (GCC) of patients with acute central serous chorioretinopathy (CSC) following focal laser photocoagulation (FLP) and sought to determine its correlation with visual acuity (VA). Our retrospective study was conducted on 30 patients diagnosed with acute CSC between January 2015 and April 2022, who underwent FLP within 3 months of symptom onset. The study assessed GCC changes by measuring the thickness of its inner retinal layers-retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) using optical coherence tomography (OCT). GCC thickness was compared between the affected and unaffected eyes and a healthy control group. VA was also assessed at baseline and at 1, 3, and 6 months post-treatment. VA showed significant improvement from 0.20 ± 0.14 at baseline to 0.10 ± 0.12 logMAR at 6 months post-treatment (p = 0.003). There was no significant change in GCC thickness over the 6-month period. No significant differences in GCC thickness were observed when comparing CSC eyes with fellow eyes or with normal controls at any time point. Final VA was significantly related only to baseline VA, with no correlation found with other factors, including RNFL, GCL, and IPL thickness. In summary, for patients with acute CSC undergoing FLP, our findings indicate that there is no significant change in GCC thickness detectable by OCT before and after the resolution of subretinal fluid (SRF), despite improvements in VA post-laser treatment. This suggests that any potential impact of FLP on GCC thickness may be minimal and not discernible with the current measurement methods, such as OCT, emphasizing that VA improvements may be primarily associated with alterations in the outer retina rather than the inner retina. Further studies with extended follow-up durations are warranted to evaluate any potential long-term changes in GCC.

Management of Central Serous Chorioretinopathy (CSC) with Focal Laser Photocoagulation

Introduction : Central Serous Chorioretinopathy (CSC) is an idiopathic retinal disease, characterized by focal leakage from the choroidal vessels due to RPE changes resulted in serous detachment of the neurosensory retina. CSC is suspected to be a multifactorial disease. Treatment of CSC is indicated for cases with SRF persisting for more than 4 months, decreased visual acuity, history of recurrence or history of previous CSC in other side with poor visual outcome.&#x0D; Case Illustration : A 41-year-old man complained sudden blurry vision on left eye since 3 months ago, accompanied by decreased ability to see in the middle field. In the left eye there was decrease fovea reflex. Fundus Fluorescein Angiography showed Central Serous Chorioretinopathy (CSC). Laser Focal Photocoagulation was performed for a patient in this case.&#x0D; Discussion :&#x0D; Conclusion : Patient was treated with Laser Focal Photocoagulation and pharmacological acetazolamide with the aim of closing the leak in the RPE and increasing SRF absorption.

Choroidal Vessel and Stromal Volumetric Analysis After Photodynamic Therapy or Focal Laser for Central Serous Chorioretinopathy.

To utilize volumetric analysis to quantify volumetric changes in choroidal vessels and stroma after photodynamic therapy (PDT) and focal laser photocoagulation (PC) for central serous chorioretinopathy (CSCR). This retrospective, comparative study included 58 eyes (58 patients) with CSCR (PC, 33 eyes; PDT, 25 eyes) followed up with swept-source optical coherence tomography at 3 months after treatment. Three-dimensional (3D) choroidal vessel and stromal volumes in each area of the central 1.5-mm-diameter circle, the torus-shaped area with 6-mm-diameter circle excluding the area of the central 1.5-mm-diameter circle, and the treated area of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid centered at the fovea were analyzed using a deep learning-based method. Changes in volume at baseline and 1 and 3 months after treatment were compared. The mean patient age was 49.3 ± 10.5 years. In the central 1.5-mm-diameter circle, the mean vessel and stromal volume rates significantly decreased after the treatment in both the PDT and PC groups (P = 0.00029 and P = 0.0014, respectively), and significant differences between the PDT and PC groups of continuous variables within times were observed in both volumes (P = 0.024 and P = 0.037, respectively). In the torus-shaped area and treated area, the PDT and PC groups both showed similar decreases in vessel and stromal volume over time. In the 3D optical coherence tomography volumetric analysis, both PDT and focal PC reduced choroid vessel volume in eyes with CSCR. This new finding is useful in elucidating the pathogenesis and healing mechanisms of CSCR.

Multimodal imaging in radiation retinopathy following orbital metastasis

Background: Radiation retinopathy is a major cause of vision loss in patients receiving radiotherapy to the head and orbit. Diabetic retinopathy is included in the differential diagnosis owing to similar clinical features, including microaneurysms, cotton-wool spots, hard exudates, and macular edema. The only significant pathological difference is that radiation retinopathy spares pericytes, unlike diabetic retinopathy. Multimodal imaging helps diagnose and predict the prognosis of radiation retinopathy, which is presented in this case report.&#x0D; Case Presentation: A 55-year-old woman diagnosed with stage-4 metastatic breast carcinoma presented with gradual diminution of vision in the left eye (OS) over 5 months. Vision in the right eye was lost because of orbital radiotherapy for orbital metastasis. The patient underwent multiple sessions of chemotherapy and radiotherapy. Examination of the left eye revealed a best-corrected distance visual acuity (BCDVA) of 20/30. Fundus examination of the OS revealed multiple cotton-wool spots and retinal hemorrhages. Fundus fluorescein angiography (FFA) showed diffuse macular leakage with capillary nonperfusion. Multicolor imaging (MCI) with Spectralis™ revealed black dots in the blue and green reflectance images, corresponding to capillary dilatation on FFA. Darker dots were more evident in the infrared images. BCDVA improved to 20/20 in OS after tapering the dose of oral steroids for 2 months, with improvements in hemorrhages and cotton-wool spots. Focal laser photocoagulation was recommended for the treatment of persistent macular edema. The patient declined further treatment, was lost to follow-up, and passed away 6 months later.&#x0D; Conclusions: This case highlights the importance of multimodal imaging for the identification and classification of radiation retinopathy. MCI using SpectralisTM has been described for the first time in radiation retinopathy and can be used to complement existing imaging modalities. Future studies involving more patients and a longer follow-up duration may provide better results for the applicability of these imaging modalities in the clinical setting.

Surgical Treatment for Diabetic Macular Edema

Diabetic macular edema (DME) is defined as excess fluid accumulation within the retina in the macular area, and when it is centered on the fovea it is the most common cause of decreased visual acuity in patients with diabetic retinopathy. The development of diabetic macular edema is closely related to the duration of diabetes, poor glycemic control, and type 2 diabetes on insulin therapy. The first-line therapy in diabetic macular edema has been the intravitreal injection of anti-vascular endothelial growth factors (VEGF). Other treatment modalities are intravitreal corticosteroid injection and focal laser photocoagulation. However, the efficacy of intravitreal therapy may decrease significantly over time, especially in the presence of vitreomacular traction, tight posterior hyaloid, or epiretinal membrane (ERM). At this stage, pars plana vitrectomy (PPV) is preferred as an alternative treatment method in eyes with chronic DME resistant to intravitreal injections. The vitreous of diabetic patients contains high amounts of VEGF and Angiotensin 2, which cause DME, and cytokines such as interleukin-6 and ICAM-1. In addition, due to the enzymes, it contains, the vitreous causes cross-linking and thickening of the collagen fibers in its structure, causing tight adhesion and traction on the macula. The mechanism of action of pars plana vitrectomy in macular edema can be explained by removing the vitreous and vitreomacular tractions. Vitrectomy may also increase retinal oxygenation. Selection of the appropriate case is important. The undisturbed integrity of the outer retinal layers including the external limiting membrane(ELM) and the ellipsoid zone, no preoperative foveal ischemia, and performing surgery early before ELM is damaged, have been found to be related to better postoperative visual acuity gain. Further, prospective, randomized, controlled studies with large series including detailed parameters and long follow-up evaluating the efficacy of surgical treatment in diabetic macular edema are warranted.

Focal laser photocoagulation for central serous chorioretinopathy in a patient receiving tamoxifen for breast cancer

Breast cancer is the most common cancer among females in Taiwan. Tamoxifen is an important adjuvant therapy for breast cancer. Although tamoxifen maculopathy has been reported in case series, typical central serous chorioretinopathy (CSCR) was reported only in one case. Here, we present a 67-year-old postmenopausal female with left triple-positive breast cancer who received an adjuvant low-dose tamoxifen regimen with 10 mg twice daily for 7 years. She developed presumed tamoxifen-related CSCR and was successfully treated by focal laser.

Exudative vascular anomalous complex-like lesion of the peripapillary area.

Perifoveal exudative vascular anomalous complex is an uncommon retinal lesion of idiopathic origin characteristically described as an isolated, aneurysmal lesion of the perifoveal region. We report an unusual presentation of an exudative vascular anomalous complex-like lesion affecting the peripapillary area. A 69-year-old diabetic woman presented with blurred vision in her left eye for two months. Fundus examination of the left eye showed a small, reddish-orange lesion just supratemporal to the optic disc with perifoveal hard exudates and retinal thickening. Fundus fluorescein angiography demonstrated a peripapillary hyperfluorescent lesion with minimal leakage. Ocular coherence tomography showed an oval structure extending throughout the outer and inner plexiform and nuclear layers with a hyper-reflective wall accompanied by subfoveal and intraretinal fluid suggestive of an eVAC-like lesion in the peripapillary area. Intravitreal anti-vascular endothelial growth factor injection was given, and the lesion persisted even three weeks after the injection. Later, focal laser photocoagulation of the aneurysmal lesion was done. At 6 weeks follow-up, a complete resolution of the aneurysmal lesion with a marked decrease in retinal edema and an improvement of the visual acuity was observed. Exudative intraretinal aneurysmal lesions can occur in areas other than perifoveal area. OCT is an useful investigation for knowing their characteristics and the response to treatment. These aneurysmal lesions irrespective of their location can be called by the name eVAC-like or more aptly retinal capillary macro aneurysms (RCM).

Pneumatic Retinopexy with Focal Laser Photocoagulation for Myopic Foveoschisis with Macular Detachment.

To describe the clinical course and imaging of a case of myopic foveoschisis (MF) with macular detachment (MD), microbreak and epiretinal membrane (ERM) managed with pneumatic retinopexy (PR) and focal laser photocoagulation (FLP) of the microbreak. Retrospective Case Review of a highly myopic, phakic Caucasian man who developed vision loss due to MF with MD. 66 year old phakic man with a refractive error of -13.25-2.25x150 in his left eye (OS) and one month visual loss who was diagnosed with MF with MD, microbreak and ERM developed recurrent, isolated, posterior, partial macular detachment one month after PR. CMT was 901um. Repeat PR with supplemental FLP surrounding the inferior macular periarteriolar microbreak achieved re-attachment and improvement in the retinoschisis with return of visual acuity from 20/150 to baseline 20/40+ at 18 month follow-up. PR with FLP may provide an alternative to vitrectomy and MP for the repair of MF with MD and ERM.

The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review.

Background and Objectives: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with, the first-line treatment, anti-vascular endothelial growth factor (VEGF). Materials and Methods: A comprehensive literature search to identify studies that evaluated the efficacy of laser photocoagulation therapy in the management of DME was performed. The relevant findings of the efficacy of focal/grid laser therapy from data in randomized, controlled trials were synthesized, and the potential of new laser technologies, such as navigated laser systems, pattern scan lasers, and subthreshold lasers, was explored. The usefulness of multimodal imaging-guided laser therapy was also evaluated, with a focus on the potential contribution to anti-VEGF therapy. Results: Focal laser photocoagulation targeting microaneurysms remains an effective therapeutic approach to chronic refractory edema, despite the widespread use of anti-VEGF therapy. To achieve the best possible treatment outcomes, precise identification of microaneurysms is essential. This requires the use of multimodal imaging-guided, highly accurate, minimally invasive coagulation techniques. Subthreshold laser therapy can also reduce the frequency of anti-VEGF injections and minimize treatment burden. Conclusions: Further studies are needed to determine the optimal timing and settings for laser photocoagulation therapy and the potential of new laser technologies in the management of DME. Nevertheless, laser photocoagulation therapy plays an important role in the management of DME, in conjunction with anti-VEGF therapy.

Radiation Retinopathy: Pathogenesis, Diagnosis, and Treatment

Radiation retinopathy is chronic retinopathy that usually after radiotherapy with delayed onset (6 months-3 years) and slow progression. The primary vascular event is endothelial cell loss. Clinically affected individuals may be asymptomatic or may describe decreased visual acuity. Combining anamnesis, complete ophthalmologic examination, and multimodal imaging is essential for diagnosis. The ophthalmological examination may reveal signs of retinal vascular disease such as microaneurysms (the first structural change detected ophthalmoscopically), cotton wool spots, retinal hemorrhages, perivascular sheathing, capillary telangiectasia, macular edema, and optic nerve head edema. Optical coherence tomography can detect macular edema, intraretinal hyperreflective spots that may develop secondary to ischemia, disorganization in the inner retinal layers, and deterioration in the outer retina. Fundus fluorescein angiography helps detect capillary perfusion anomalies and other signs of vascular disease. Diabetic retinopathy, retinal vein occlusion, ocular ischemic syndrome, hypertensive retinopathy, Coats' disease, and parafoveal telangiectasia should be considered in the differential diagnosis, and sometimes these diseases may accompany radiation retinopathy. Currently, there is still no standard treatment for radiation retinopathy. Anti-vascular endothelial growth factors (anti-VEGF) and steroid therapy are among the effective treatment options. Retinal laser photocoagulation can be applied for neovascular complications. For macular edema, focal laser photocoagulation was less effective than anti-VEGF and steroid therapy in terms of functional gain.

Validity of focal laser photocoagulation followed by a single intravitreal ranibizumab injection for retinal artery macroaneurysm

Background To evaluate safety and efficacy of dual focal laser (DFL) followed by a single intravitreal ranibizumab injection for exudative retinal artery macroaneurysms (RAM). Methods Retrospective review of records of eyes with RAM; treated between February 2012 and November 2020; was done, to collect and analyze the following data: Treatment details, features of RAM, associated retinal disease, best-corrected visual acuity (BCVA), central macular thickness (CMT), signs of RAM involution, and possible complications. We enrolled cases that had been treated by Direct and perilesional focal laser, followed by a single intravitreal ranibizumab injection a few days later, and had been followed-up for at least 6 months. Outcome measures included: change in BCVA, change in CMT, and complications. Results 14 patients were enrolled. All cases were isolated RAM (without other retinal disease) with macular edema±hard exudates (100%). 12 cases (85.7%) were exudative, and 2 cases (14.3%) also had a hemorrhagic component (mixed type). Hemorrhagic macroaneurysms without exudation were not included in the study. RAM was fusiform in 12 cases (85.7%) and saccular in 2 cases (14.3%). RAM involved the upper temporal arcade in 10 cases (71.4%) and the lower temporal arcade in 4 cases (28.6%). RAM involved second order arteries in 10 cases (71.4%) and third order arteries in 4 cases (28.6%). Logarithm of the minimum angle of resolution (LogMAR) BCVA improved from an initial 0.71±0.35 to 0.27±0.26 at final follow-up. CMT was reduced from 417±82 μ to 285±31 μ at final follow-up. The mean interval between laser and ranibizumab injection was 3.2±2.9 days. The mean follow-up duration was 8.0±2.6 months. Involution/thrombosis- fibrosis of RAM was induced in all cases (100%). Conclusion Combined dual focal laser coagulation and single intravitreal ranibizumab injection for RAM are safe and effective, and may eliminate the need for repeated intravitreal injections. Isolated exudative macroaneurysms may be suitable for this combined approach.

Deep Learing Technique for Diabetic Retinopath Classification

Abstract: Strict control of blood glucose and blood pressure is critical for reduction of the incidence and progression of diabetic retinopathy (DR). Follow-up of patients with diabetes mellitus is protocol based and not based solely on the presence of symptoms. Staging of the level of DR (mild, moderate, or severe nonproliferative DR vs. proliferative DR, PDR) drives the follow-up interval. The most common cause of visual loss in diabetic patients is diabetic macular edema (DME). Detection of Eye Disorders Through Retinal Image Analysis Blood Vessel Segmentation, Optic Disc Segmentation and Fuzzy Logic Image Processing. Common Retinal Eye Disorders that has been solved in this project. The results of multicenter, randomized studies suggest that the best visual results for DME currently are achieved with intravitreal ranibizumab injections ± focal laser photocoagulation. Results using bevacizumab seem quite comparable to those with ranibizumab. In addition to treating DME, this approach also seems to reduce the likelihood of progression of DR. Selected patients also may benefit from intravitreal steroid treatment and focal laser therapy, but there is a relatively higher rate of glaucoma and cataract formation. An increase in intraocular pressure inside the retina led to the development of the neuro-degenerative eye condition known as glaucoma. Being the second largest cause of blindness worldwide, It can lead the person towards complete blindness if an early diagnosis does not take place. The architecture of CNN is cognate to that of the linking form of neurons in the brain of humans and was inspired by the suggestion of the visual cortex. The CNN algorithm has a faster prediction along with better accuracy.

Management of Central Serous Chorioretinopathy Using Focal Laser Photocoagulation: A Case Report

Introduction: Central serous chorioretinopathy (CSC) has the main symptoms of choroidal thickening, detachment of retinal pigment epithelium (RPE), and presence of subretinal fluid. Treatment of CSC is indicated for cases with SRF persisting for more than 4 months, decreased visual acuity, history of recurrence, or history of previous CSC in other eyes with poor visual outcome. This case report aims to describe the management of CSC using focal laser photocoagulation.&#x0D; Case presentation: A man, 41 years old, living in the city, came with complaints of sudden blurred vision in his left eye when he woke up 3 months ago. This complaint is accompanied by a decrease in the ability to see in the middle. There are no vision complaints such as flashes of light, no blurred vision such as tunnels or closed curtains, no red eyes, pain, or eye discharge. On ophthalmological examination, there was a decrease in visual acuity oculi sinistra (OS) 6/12, intraocular pressure within normal limits, and orthophoria. On examination of the posterior segment of the OS, a decreased positive foveal reflex was found. Fluorescent angiography fundus photo examination showed central serous chorioretinopathy OS. This patient was diagnosed with central serous chorioretinopathy oculi sinistra. Management is given to patients in the form of disease-related education, laser focal photocoagulation OS, clobazam 10 mg/24 hours, eye drops oxymetazoline HCl 1 drop in the left eye/8 hours.&#x0D; Conclusion: Treatment with laser focal photocoagulation is beneficial in the clinical improvement of cases of central serous chorioretinopathy.

Clinical-Therapeutic Orientation in Retinal Venous Obstruction

Retinal vein occlusion (RVO) is a retinal vascular disease that can affect the central retinal vein in central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO), which causes decreased vision (the second leading cause of blindness after diabetic retinopathy). CRVO is accompanied by retinomacular edema and retinal / peripapillary / iris neovascularization that cause serious complications: absolute neovascular secondary glaucoma, vitreous hemorrhage, retinal traction detachment, possibly present in both forms of CRVO. Branch retinal vein occlusion (BRVO) is often asymptomatic and can be diagnosed accidentally or by retinal control, and is 5 times more common than CRVO. CRVO prophylaxis is done by identifying and appropriate treatment of risk factors (multiple): hypertension, diabetes, smoking, obesity, Primary Open Angle Glaucoma (POAG), hypercoagulability. RVO treatment, the non-ischemic form, requires the treatment of macular edema with: intravitreal AntiVEGF - Ranibizumab, Aflibercept, Bevacizumab, repeatedly, cortisone therapy with intravitreal Triamcinolone or Dexamethasone implant, focal / grid laser photocoagulation and / or panretinal photocoagulation. In all cases of RVO, the non-ischemic form, the following are required: clinical surveillance, fluorescein angiography (FA), OCT for immediate detection of progression to the ischemic form. The treatment of RVO, ischemic form, is the treatment of macular edema with repeated intravitreal antiVEGF treatment, corticosteroids, focal laser photocoagulation, grid, pan-photocoagulation indicated in the treatment of exudative ischemic areas with neovessels proliferation. Panretinal photocoagulation (PRP) is an effective treatment for iris peripapillary retinal neovascularization and secondary complications. The current prognosis of RVO is improved by regular examination of OCT-SD, antiVEGF medication, intravitreal cortisone and laser photocoagulation that provide prophylactic and curative treatment of RVO and complications: vitreous hemorrhage, neovascular glaucoma, retinal traction detachment.

Focal Photocoagulation as an Adjunctive Therapy to Reduce the Burden of Intravitreal Injections in Macula Edema Patients, the LyoMAC2 Study

To assess the efficacy of focal photocoagulation of capillary macroaneurysms (CMA) to reduce the burden of intravitreal injections (IVI) in patients with macular edema (ME). Retrospective multicenter study in patients with diabetic ME or ME secondary to retinal vein occlusion (ME-RVO). CMA associated with ME were selectively photocoagulated. Patients were followed for one year after photocoagulation. 93 eyes of 76 patients were included in this study. At 6 months after the laser (n = 93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 2.52 to 1.52 at 6 months, p < 0.001). The mean BCVA remained stable (0.32 and 0.31 logMAR at baseline and 6 months, p = 0.95). At 12 months (n = 81/93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 4.44 to 2.95 at 12 months, p < 0.001), while the mean BCVA remained stable (0.32 and 0.30 logMAR at baseline and 12 months, p = 0.16). Focal laser photocoagulation of CMA seems to be effective and safe for reducing the burden of IVI in patients with ME. Their screening during the follow-up should be considered closely.

Photocoagulation for retinal hemangioblastoma in Von Hippel-Lindau disease

Introduction. Von Hippel?Lindau disease is a hereditary, autosomal dominant, tumor syndrome with a predisposition to developing various benign and malignant tumors. Retinal hemangioblastoma is often the presenting manifestation. We report a case of Von-Hippel?Lindau disease in a 13-year-old girl with bilateral eye involvement. Case outline. The patient was referred to the Eye Clinic, University Clinical Center of Serbia, with a diagnosis of Coats disease. Clinical examination revealed that best corrected visual acuity was 20/20 on her right eye, while her left eye showed counting fingers at 20 cm distance. Dilated fundoscopy of the right eye revealed multiple tortuous feeding vessels leading to orange-reddish, sharply demarcated multiple lesions on the far periphery of the upper retina, corresponding to retinal hemangioblastoma. the left eye showed edematous optic nerve head, tortuous retinal vessels, exudates, and retinal detachment including macula. Considering that the patient had multiple bilateral retinal hemangioblastomas and that her father had pathohistologically proven brain hemangioblastoma and numerous visceral tumors, Von Hippel?Lindau disease was assumed. Focal argon laser photocoagulation was performed in the region of all visible vascular tumors and feeding vessels in the right eye. The patient?s visual acuity remained unchanged five months after the disease detection. Conclusion. The importance of education about dominant inheritance pattern of Von Hippel?Lindau disease cannot be overemphasized. Role of an ophthalmologist is critical in early diagnosis of both retinal hemangioblastoma and Von Hippel?Lindau disease.

Laser photocoagulation of a hypofluorescent perifoveal exudative vascular anomalous complex/capillary macroaneurysm.

To report successful treatment of a hypofluorescent perifoveal exudative vascular anomalous complex (PEVAC)/capillary macroaneurysm. A 63 year old healthy gentleman had a perifoveal isolated aneurysmal lesion with white rim. Optical coherence tomography (OCT) showed cystoid macular edema (CME) with neurosensory detachment. The aneurysmal lesion was seen in the inner retina as a hyperreflective intraretinal structure with a heterogenous lumen suggestive of PEVAC/capillary macroaneurysm. OCT angiography showed a capillary loop and a slightly hyperreflective lesion at the tip of the loop in the superficial capillary plexus slab. Minimal reduction in edema was noted following one dose of intravitreal triamcinolone (2 mg). Fundus fluorescein angiography performed at 6 weeks demonstrated the capillary loop, but the aneurysmal lesion remained hypofluorescent with no definite leak in the late phase. Few perifoveal microaneurysms were seen in both the eyes. Six weeks later, focal laser photocoagulation of the aneurysmal lesion was performed, which resulted in complete resolution of macular edema at 1 month. There was no recurrence of macular edema till his recent follow up, which is 4 month post laser. PEVAC is typically described as unifocal lesion and is not associated with other retinal vascular abnormalities. But in this case, in addition to the lesion, perifoveal microaneurysms were seen in both the eyes. Despite the absence of leak on fundus fluorescein angiography, targeted focal laser photocoagulation resulted in complete resolution of macular edema at 1 month. Laser photocoagulation would be helpful even in hypofluorescent PEVAC/capillary macroaneurysms.