Fundus Fluorescein Angiography Research Articles

Angiographic features of pediatric stage 4 familial exudative vitreoretinopathy with radial retinal folds.

To describe vascular anomalies and nonperfusion areas (NPAs) of stage 4 familial exudative vitreoretinopathy (FEVR) with radial retinal folds (RFs) and analyze their potential clinical significance. Retinal detachment (RD) could exceed the RFs due to exudative, rhegmatogenous, or tractional factors, which we could call secondary RD. Fluorescein fundus angiography (FFA) and risk factors for progression to secondary RD of pediatric stage 4 FEVR patients with radial RFs were respectively explored. Fifty-eight eyes with RFs from 49 stage 4 pediatric FEVR patients were studied. Various angiographic changes were noted, including peripheral NPAs (93.1%), thinning retinal arteries (48.3%), straightened retinal vessels (34.5%), supernumerary vascular branching (32.8%), arteriovenous shunt (20.7%), aberrant circumferential vessels (13.8%), bulbous vascular endings (10.3%) and peripheral vascular dilation (6.9%). Nineteen (35.2%), 21(38.2%), and 14 (25.9%) of 58 eyes showed severe, moderate, and mild peripheral NPAs, respectively. The rate of secondary RDwas higher in eyes with severe peripheral NPAs (p = 0.004). The severity of the nonperfusion area (p = 0.040) was higher in eyes with exudation. Eight eyes (42.1%) with exudation and 12 eyes (30.8%) without exudation on color fundus pictures exhibited fluorescein leakage (p = 0.394). The rate of secondary RD was 26.3% in eyes with exudation, and 2.6% in eyes without exudation (p = 0.012). The majority of stage 4 FEVR eyes with RFs have severe peripheral NPAs. Exudation is related to more severe peripheral NPAs. Exudation and NPAs are predictive factors for secondary RD. What is known • Radial retinal folds are a typical clinical sign of FEVR, observed in 50.9% of FEVR patients, but little is known about the angiographic characteristics of these individuals. What is new • The severity of the nonperfusion area was graded into 3 levels. The severity of the nonperfusion area and hard exudation are risk factors for progression to total retinal detachment.

Novel Multimodal Imaging in Bilateral Diffuse Uveal Melanocytic Proliferation and Change in the Findings During Follow-up and Treatment.

To describe the advanced multimodal imaging findings of patients with bilateral diffuse uveal melanocytic proliferation (BDUMP) and the changes in these findings over time. Fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FA), spectral domain optical coherence tomography (OCT), B-scan ultrasonography (US), and ultrasound biomicroscopy (UBM) images of the patients diagnosed with BDUMP at a single institution between years 2006-2023 were evaluated. Sixteen eyes of 8 patients with BDUMP were included. The median age was 68 years (Range: 49 - 77 years), and the median follow-up time was 11 months (Range: 1 - 79 months). The most common fundus photography findings were pigmentary changes and diffuse orange pigment patches in the posterior pole. The giraffe/leopard pattern of hyperfluorescence on the posterior pole was the most prominent finding in FAF and FA. Different from previous reports, intraretinal hyperreflective foci, outer retinal tubulations, subretinal fibrosis, and bacillary layer detachment in OCT; optic disc hyperfluorescence, and peripheral vascular leakage in FA; 360° ciliary body thickening, and anterior rotation of the ciliary body in UBM were detected. We presented various novel multimodal imaging features of BDUMP that may warrant updating current diagnostic criteria and their changes over time. Our newly defined findings also suggest a possible inflammatory component to BDUMP pathogenesis, which may have implications for treatment.

Multimodal imaging features of retinal neovascularization in response to 3 anti-VEGF injections

ObjectiveTo analyze longitudinal changes of retinal neovessels (NV) in eyes with proliferative diabetic retinopathy (PDR) after 3 monthly intravitreal injections (IVI) of ranibizumab by means of different imaging modalities, particularly focusing on optical coherence tomography (OCT) and OCT–angiography (OCT-A) features. MethodsProspective, monocentric study, Luigi Sacco Hospital, Milan. Consecutive patients with PDR were enrolled. All patients underwent color fundus photography (CFP), fluorescein angiography (FA), SD-OCT, and OCT-A at baseline (t0) and after 3 monthly IVI of ranibizumab (t1). Neovessels (NVs) were classified as flat, elevated, flat-elevated, or table-top using OCT scans and further analyzed on FIJI. Qualitative and quantitative NV characteristics were evaluated. Vessel density (VD) was calculated as the mean of all the white pixels of the NV and expressed as a percentage of the area of the NV (VD = NV area × 100). ResultsThirty-six NVs in 10 patients were studied. The regression of NVs at t1 was partial in 66.7% of cases and complete in 33.3%. Table-top NV demonstrated more frequently a complete regression (P = .03). A significant reduction of the NV area, perimeter, and VD was observed at t1 (P < .001). NVs that showed a complete regression had higher mean VD values at t0 compared with NVs, which showed a partial regression (P = .02). Flat NVs had more frequently a complete vitreous attachment, while table-top showed more often a partial vitreous detachment with focal NV adhesion (P < .05). A complete regression was more often observed for NVs with a partial vitreous detachment and focal NV adhesion at t0 (10/12), while most of the NVs with a complete vitreous attachment showed a partial regression (18/24) (P < .001). ConclusionsThe table-top configuration of the neovessel, higher VD values at baseline, and the presence of a focal adhesion of the vitreous over the NV were factors associated with a higher risk of complete regression of the NV in response to 3 monthly IVI of ranibizumab.

A cross-sectional study of fundus lesion characteristics in patients with acute visual impairment caused by COVID-19 infection

To investigate the characteristics of acute visual dysfunction and fundus lesions in patients with COVID-19 pneumonia. A retrospective case series study was conducted. Data from 48 patients (96 eyes) with COVID-19 infection who presented to our ophthalmology department with acute onset visual disturbance between December 5, 2022, and February 28, 2023 were collected. Asymptomatic patients and those who had already recovered were excluded. Data collected included patient demographics, ophthalmic examinations, multicolor imaging (MCI), infrared autofluorescence (IR), spectral-domain optical coherence tomography (OCT), fundus fluorescein angiography (FFA). Of the 48 patients, 15 were male and 33 were female, with a mean age of 32 years. All patients had bilateral involvement. OCT showed hyperreflective signals in the outer plexiform layer and outer nuclear layer of the macular region in all 96 eyes of 48 patients (100%). Additionally, 66 eyes of 33 patients (68.8%) of eyes demonstrated abnormal reflectivity in the ellipsoid and interdigitation zones. MCI revealed petaloid or wedge-shaped hyperreflective areas in the macula in 46 (47.9%) of eyes, corresponding to hyporeflective areas on IR. Cotton-wool spots were observed in the peripapillary or posterior pole area in 54 (56.3%) of eyes. COVID-19 infection can lead to acute, bilateral, symmetric, and widespread retinal damage. Characteristic findings can be observed in ophthalmological examinations such as OCT, MCI, and IR.

Central retinal artery occlusion following surgery for thyroid eye disease: A case report.

Thyroid eye disease (TED) is the most common orbital disorder in adults and significantly affects patient health. Orbital decompression surgery is an important treatment option. Central retinal artery occlusion (CRAO) after orbital medial wall decompression is rare in patients with TED. Therefore, the earlier the identification and treatment, the more likely it is to reduce visual impairment. This paper examines a case of CRAO occurring postoperatively in a patient who underwent medial wall orbital decompression for TED. Central retinal artery occlusion. During the operation, the pupil was dilated, and eye massage and peribulbal injection of atropine were performed immediately. Fundus fluorescein angiography suggested the possibility of CRAO. Intravenous methylprednisolone 1000 mg, mannitol 50 g, ginkgo biloba extract 20 mL, nimodipine 20 mg tid, cobamamide 0.5 mg tid, and oral citicoline 0.2 g tid, along with periocular injection of atropine and hyperbaric oxygen therapy were also administered. Fifteen days after onset, the patient's retinal edema and retinal blood perfusion greatly improved. The patient's visual acuity recovered from counting fingers to 0.6. Retinal vascular obstruction is a serious threat to vision; therefore, early detection and treatment are very important.

A case of acute idiopathic maculopathy in both eyes with peripheral vascular occlusion

BackgroundThis study aimed to present a case of bilateral symmetric onset of acute idiopathic maculopathy after high fever with peripheral vascular occlusion.Case presentationA 54-year-old yellow female experienced acute binocular visual acuity decrease after 1 day of high fever, and binocular visual acuity decreased to index or anterior. OCT in the external hospital showed dome-shaped cortical detachment in the symmetrical macular area of both eyes with subretinal fluid, discontinuity in the ellipsoid zone and the chimera. The patient autonomously administered antibiotics and non-steroidal anti-inflammatory agents, including amoxicillin and ibuprofen. Following a three-day period, the patient’s visual acuity demonstrated significant improvement. Additionally, macular edema demonstrated a notable reduction as indicated by optical coherence tomography, while the presence of peripheral retinal vascular occlusions was also observed on fluorescein fundus angiography. At the onset of 6 days, oral hormone therapy was given in the outside hospital, with no significant improvement in visual acuity.23 days after the onset of the disease, the patient was admitted to our hospital, and was finally diagnosed as acute idiopathic maculopathy combined with the imaging findings of FFA, ICGA and OCT. During the follow-up, the visual acuity of both eyes improved spontaneously.ConclusionsThis case is a rare acute idiopathic macular lesion with bilateral involvement, accompanied by highly symmetrical peripheral retinal vascular occlusion in both eyes, which deepens our understanding of acute idiopathic maculopathy with a view to providing guidance for subsequent clinical practice.

A clinical study on the therapeutic effects of 577 nm micropulse laser photocoagulation treatment in early-stage CSCR patients

PurposeTo research the therapeutic effects of 577 nm micropulse laser photocoagulation (MLP) treatment in early-stage central serous chorioretinopathy (CSCR) patients.MethodsTwenty-two CSCR patients with 24 CSCR eyes were examined prior to MLP treatment. The examinations included best-corrected visual acuity (BCVA), fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and microperimetry. After MLP treatment, all the subjects were reviewed at 30 days. The BCVA, macular function on microperimetry, subretinal fluid (SRF) height of the macula on OCT, and choroid vascular density (VD) of the macular area on OCTA were compared before and after MLP treatment. The correlations between SRF height and visual function, choroid VD was analyzed separately.ResultsBCVA and macular function significantly increased and the SRF height of the macula significantly decreased after MLP treatment. BCVA and macular function were significantly negatively correlated with SRF height. The choroid VD was significantly increased after MLP treatment, and choroid VD in the leakage site part of the macula were significantly negatively correlated with the height of the SRF. A recurrent patient who received two MLP treatments also had a negative correlation between SRF and choroid VD during the course of disease.Conclusions577 nm MLP is safe and effective for early-stage CSCR patients, and treatment can restore macular structure and function. The increase in choroid VD of leakage site part after treatment is one of the key effects of MLP treatment for early-stage CSCR patients.

The safe lowest effective power of subthreshold micropulse laser treatment in Chinese patients with acute or chronic central serous chorioretinopathy.

To assess the safe, lowest effective laser power of subthreshold micropulse laser (SML) for treating acute and chronic central serous chorioretinopathy (CSC) in Chinese patients. Patients were distinguished with acute or chronic CSC based on focal or diffuse retinal pigment epithelium (RPE) leakage on fundus fluorescein angiography (FFA), with or without widespread RPE decompensation. Patients were categorized into five groups and treated with 577 nm yellow SML according to 50% titration power. The change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) were set as primary outcomes. A linear regression model assessed the correlation between different factors and outcome indicators. A total of 103 patients with 127 eyes (61 with acute CSC and 66 with chronic CSC) were enrolled. The baseline characteristics were balanced between the five groups (all p > 0.05). The decrease of CMT and the improvement of BCVA were related to the CMT at baseline (all p < 0.05). We found that the lowest effective laser power for acute CSC was 425 mW (-225.50 μm vs. -171.24 μm vs. -114.50 μm vs. -130.54 μm vs. -68.00 μm, p < 0.001), showing a significant CMT reduction at this power, but no significant increase in BCVA (-0.15 ± 0.10 logMAR vs. -0.20 ± 0.16 logMAR vs. -0.14 ± 0.11 logMAR vs. -0.17 ± 0.30 logMAR vs. -0.11 ± 0.14 logMAR, p > 0.05). For chronic CSC, the lowest effective laser power was 375 mW (p = 0.01), the change of CMT was significant in 375 mW (-93.91 ± 109.06 μm, -119.32 ± 105.56 μm, -88.67 ± 67.26 μm, -60.89 ± 106.86 μm, and -99.11 ± 157.32 μm, p = 0.04). The change of BCVA was similar trend (-0.54 ± 0.66 logMAR vs. -0.17 ± 0.23 logMAR vs. -0.10 ± 0.21 logMAR vs. -0.02 ± 0.30 logMAR vs. 0.05 ± 0.19 logMAR, p < 0.001). In this study, our results suggested 425 mW and 375 mW laser power is the lowest effective SML power for treating acute and chronic CSC in Chinese patients respectively, And the power of SML for chronic CSC requires lower power than acute CSC.

X-linked juvenile retinoschisis associated with an RS1 in-frame deletion and bilateral central serous chorioretinopathy.

To report the case of a patient with X-linked juvenile retinoschisis (XLRS), caused by an in-frame deletion of the RS1 gene, who presented visual loss due to bilateral central serous chorioretinopathy (CSC).Methods: Observational case report. A 34-year-old man, with type-A personality, presented with a one-month history of decreased visual acuity and metamorphopsia in his right eye. Funduscopic examination showed a dome-like foveal elevation in both eyes (OU), as well as subtle pigmentary changes of the retinal pigment epithelium with a tapetal reflex in the fovea. Spectral-domain optical coherence tomography revealed intraretinal cystic foveal changes and serous retinal detachment in OU. Fundus fluorescein angiography of OU showed a focal area of intense hyperfluorescence with leakage in late phases. Electroretinogram revealed a markedly attenuated b-wave and a diminished a-wave in photopic and scotopic phases. Genetic testing revealed a hemizygous c.282_284delCTT deletion in the RS1 gene, predicting a p.Ser95del change at the protein level. The patient was diagnosed with XLRS and central serous chorioretinopathy as a coexisting condition. Patient was observed during a 3-month period but showed no improvement. Therefore, subthreshold micropulse laser was applied, achieving complete resolution of signs and symptoms of CSC. CSC can be a cause of acute or subacute visual loss in patients with XLRS when other complications such as vitreous hemorrhage and retinal detachment have been excluded.

IDIOPATHIC RETINAL VASCULITIS, ANEURYSMS, AND NEURORETINITIS COMPLICATED BY CILIORETINAL ARTERY OCCLUSION: MULTIMODAL IMAGING AND 5-YEAR FOLLOW-UP.

To describe a multimodal imaging and a 5-year follow-up of a case of cilioretinal artery occlusion (CLRAO) in a 40-year-old woman with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome. Fundus photography, indocyanine green and fluorescein angiography, optical coherence tomography (OCT), OCT angiography (OCTA), and a literature review of retinal artery occlusions associated with IRVAN syndrome were performed. Fundus examination revealed bilateral blurred margins of the discs and peri-vascular hard exudates. Fluorescein angiography (FA) demonstrated peripheral capillary nonperfusion areas in both eyes (OU). It also revealed an aberrant cilioretinal artery in the right eye (OD). OCT showed attenuation of the inner retinal layers and disruption of the outer retinal layers secondary to CLRAO in OD. OCTA allowed a clear identification of macular hypoperfusion in OU. Laser photocoagulation, along with anti-VEGF and corticosteroid intravitreal injections, was administered in OU. Best-corrected visual acuity remained stable, with no evidence of progression or development of neovascularization after a 5-year follow-up. IRVAN syndrome may be complicated by CLRAO, resulting in poor final visual acuity despite reperfusion of the occluded artery. In such cases, multimodal imaging allows the identification of complications such as macular atrophy on OCT and hypoperfusion areas that may not be detected on FA on OCTA.

Intraretinal Microvascular Abnormalities in Eyes with Advanced Stages of Nonproliferative Diabetic Retinopathy: Comparison Between UWF-FFA, CFP, and OCTA-The RICHARD Study.

This study aimed to evaluate intraretinal microvascular abnormalities (IRMA) in eyes with advanced nonproliferative diabetic retinopathy (NPDR) using multimodal approach in co-located areas focusing on central retina (up to 50°) and to look at possible correlations between IRMA and other structural changes, like ischemia and presence of microaneurysms. The RICHARD study (NCT05112445) included 60 eyes from 60 patients with type2 diabetes with moderate-severe NPDR, diabetic retinopathy severity levels 43, 47, and 53 (DRSS). IRMA were defined as capillary tortuosity covering a minimum circular area of 300µm (calculated to correspond to the Early Treatment Diabetic Retinopathy Study standard photo 8A) and were identified using multimodal imaging with distinct fields of view (FoV): color fundus photography (CFP) using a Topcon TRC-50DX camera (Topcon Medical Systems, Japan), Optos California ultra wide field fundus fluorescein angiography (UWF-FFA) (Optos plc, UK), and swept-source optical coherence tomography angiography (SS-OCTA) (PLEX® Elite 9000, ZEISS, USA). Different areas of the retina were examined: central macula (up to 20°) and posterior pole (between 20° and 50°). Multimodal imaging was used to identify IRMA in co-located areas (FoV < 50°) including UWF-FFA, CFP, and SS-OCTA. In eyes with DRSS levels 47 and 53, IRMA were identified in both areas of the retina, while in eyes with DRSS level 43, IRMA were detected only outside of the central macula (FoV > 20°). Our results show that when evaluating the presence of IRMA (FoV < 50°), UWF-FFA detected 203 IRMA, SS-OCTA detected 133 IRMA, and CFP detected 104 IRMA. Our results also show that the presence of IRMA was positively associated with presence of microaneurysms. Identification of IRMA in eyes with advanced NPDR is better achieved by UWF-FFA than CFP and SS-OCTA. A statistically significant correlation was found between the presence of IRMA and the increase in number of microaneurysms. ClinicalTrials.gov, identifier NCT05112445.

Posterior short ciliary arteries ischemia following embolization of anterior ethmoid artery to treat dural arteriovenous fistulas: a case report

BackgroundThe Onyx™ Liquid Embolic System is a non-adhesive liquid embolic agent, which has been proved by the US FDA for embolization of lesions in the peripheral and neurovasculature since 2005. We reported a case of ischemic optic neuropathy after using Onyx-18 to embolize the anterior ethmoid arteries that feeding dural arteriovenous fistulas (DAVF).Case presentationA 57-year-old Asian male presented with anterior cranial fossa DAVF underwent embolotherapy by delivering Onyx-18 through a microcatheter into the anterior ethmoid arteries under angiography guidance. The interventional procedure was successful and no clear evidence was found pointing to untargeted occlusive embolus. But after the surgery the patient experienced delayed painless vision loss in the right eye (RE). The fundoscopy showed unilateral papilledema with pale optic disc in RE, accompanied by significant edema and thickening in the retinal nerve fiber layer (RNFL) of macula. The fundus fluorescence angiography showed that most of the optic disc in RE had postponed or absent fluorescence filling. Visual evoked potential (VEP) confirmed that the amplitude of the P100 component was decreased in RE without significant prolongation of the latency. The patient was diagnosed with anterior ischemic optic neuropathy, but immediate pulse steroid therapy failed to rescue his vision.ConclusionPreoperative evaluation of the patient’s hemodynamic status and fundus examination are essential for assessing the risk of ischemic ocular complications, and the non-adhesive liquid embolic agent Onyx-18 should be used cautiously during endovascular embolization of intracranial artery.

Uveal Effusion Syndrome Due to WNT10A Mutation.

Uveal effusion syndrome (UES) is an exudative detachment of ciliary body, retina and choroid. Various underlying causes leads to UES-like drugs (topiramate), inflammation and hypotony. Wnt gene involvement has never been associated with UES. We report a case of bilateral UES being misdiagnosed as Vogt-Koyanagi-Harada syndrome (VKH), with Wnt gene dysfunction as the underlying trigger. A 32-year-old male presented with diminution of vision in his left eye. He was found to have choroidal detachment with retinal detachment in his left eye. Choroidal detachment was noted in the right eye. Various ocular imaging including fundus fluorescein angiography and ocular coherence tomography was done. He was misdiagnosed as a case of VKH syndrome, for which he was treated with systemic immunomodulatory therapy. However, a subclinical response was made to revisit the diagnosis. Ultrasound biomicroscopy showed supraciliary effusion. Systemic and genetic evaluation led to the detection of Wnt10A pathway mutation. UES is an entity of diagnostic challenge. Careful and thorough systemic evaluation is required to clinch the diagnosis. We reported the first case of bilateral UES recalcitrant to corticosteroids, with Wnt10A gene mutation.

Ocular Toxoplasmosis: Advances in Toxoplasma gondii Biology, Clinical Manifestations, Diagnostics, and Therapy.

Toxoplasma gondii, an obligate intracellular parasite, is a globally prevalent pathogen capable of infecting a wide range of warm-blooded animals, including humans. Ocular toxoplasmosis (OT), a severe manifestation of T. gondii infection, can lead to potentially blinding complications. This comprehensive review delves into the current understanding of T. gondii biology, exploring its complex life cycle, diverse transmission routes, and strain diversity. This article provides an in-depth analysis of the clinical manifestations of OT, which can result from both congenital and acquired infections, presenting a spectrum of signs and symptoms. The review examines various diagnostic strategies employed for OT, including clinical examination, multimodal imaging techniques such as fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA), as well as laboratory tests including serology and molecular methods. Despite extensive research, the specific mechanisms underlying ocular involvement in T. gondii infection remain elusive, and current diagnostic options have limitations. Moreover, the treatment of active and recurrent OT remains a challenge. While existing therapies, such as antimicrobial agents and immunosuppressants, can control active infections, they do not offer a definitive cure or completely prevent recurrence. The clinical endpoints for the management of active and recurrent OT are also not yet well-established, and the available treatment methods carry the potential for adverse effects. This article highlights the need for future research to elucidate the pathogenesis of OT, investigate genetic factors influencing susceptibility to infection, and develop more sensitive and specific diagnostic tools. Enhancing global surveillance, implementing robust prevention strategies, and fostering multidisciplinary collaborations will be crucial in reducing the burden of OT and improving patient outcomes. This comprehensive review aims to provide a valuable resource for clinicians, researchers, and policymakers, contributing to a better understanding of T. gondii infection and its impact on ocular health.

Secondary Multiple Evanescent White Dot Syndrome in a patient with North Carolina Macular Dystrophy.

To describe a novel case of secondary multiple evanescent white dot syndrome in a patient with North Carolina Macular Dystrophy (NCMD). The patient was evaluated with ultra-widefield color and autofluorescence imaging, fluorescein angiography, and spectral-domain optical coherence tomography. A 43-year-old man with longstanding blurred vision in both eyes acutely developed glare in the right eye after an upper respiratory illness. He had chorioretinal atrophy in both eyes consistent with North Carolina Macular Dystrophy, which was later confirmed by genetic testing. He alsyo had white spots in the macula of the right eye consistent with secondary MEWDS. The diagnosis of secondary MEWDS was confirmed with fundus autofluorescence and fluorescein angiography, as well as a negative infectious workup. His symptoms and the retinal lesions had resolved by 11 weeks and after a short course of oral corticosteroids. Prior studies have suggested a link between disruption of the RPE/Bruch's membrane complex and secondary MEWDS. This report describes the first case of secondary MEWDS after NCMD and provides further support for this association.

Role of Plasma Angiopoietin-1 and VEGF Levels as Potential Biomarkers in Chronic Central Serous Chorioretinopathy with Macular Neovascularization.

To evaluate the plasma levels of angiopoietin-1 and vascular endothelial growth factor (VEGF) and their association with macular neovascularization (MNV) in patients with chronic central serous chorioretinopathy (cCSC). Correlations between plasma cytokine levels, CSC duration, and mean choroidal thickness (CT) were also investigated. Of the 59 patients with cCSC, 10 patients with MNV secondary to cCSC and 10 patients with cCSC without MNV were enrolled in the study. The control group included 15 healthy volunteers matched for age, sex, smoking status, and comorbidities. Chronic CSC was diagnosed based on typical findings on swept-source optical coherence tomography (OCT), fundus fluorescein angiography, and indocyanine green angiography. Additionally, all patients underwent OCT angiography to help detect MNV. Plasma angiopoietin-1 and VEGF levels were assessed using multiplex immunoassay. The plasma angiopoietin-1 levels differed between the 3 groups (p = 0.005). The angiopoietin-1 levels were lower in patients with cCSC with MNV than in controls (p = 0.006). There were no differences in the plasma VEGF levels between all the 3 groups (p = 0.329). The VEGF levels were negatively correlated with mean CT in cCSC patients with MNV (rho = -0.683, p = 0.042) but correlated positively with disease duration in patients with cCSC without MNV (rho = 0.886, p = 0.003). Our study confirms that MNV is a common complication of cCSC and provides new insights into the role of angiopoietin-1 in cCSC and MNV. Reduced angiopoietin-1 levels in cCSC patients, regardless of MNV status, highlight the importance of the Ang-Tie2 pathway in disease pathogenesis and may point to new therapeutic targets and future novel treatments to improve the management of these patients.

Acute Idiopathic Blind Spot Enlargement and Multiple Evanescent White Dot Syndrome

Acute idiopathic blind spot enlargement syndrome (AIBSES) and Multiple evanescent white dot syndrome (MEWDS) are diseases that fall within the same spectrum. They share common characteristics such as affecting young and middle-aged individuals, being mostly unilateral, causing damage to the outer layers of the retina, and leading to blind spot enlargement in the visual field. In AIBSES, lesions are more frequently located in areas adjacent to the optic disc, whereas in MEWDS, they are observed around the central and peripheral vascular arcades. Unlike MEWDS, in AIBSES, visual field improvement is not expected over time. Multimodal imaging methods, including optical coherence tomography, fundus autofluorescence, fundus fluorescein angiography, and indocyanine green angiography, play an important role in diagnosis and follow-up. In both conditions, the optic nerve can appear normal, but it can also be seen with slightly blurred boundaries and edema, and it should be considered in the differential diagnosis of optic neuropathy.

Choroidal Changes and Choroidal Neovascularization in Pathological Myopia

Among the complications of pathological myopia, myopic macular neovascularization (mMNV) is one of the most vision-threatening complications. Despite significant advances in understanding the epidemiology, pathogenesis, and natural history of the disease, there is no standard definition of mMNV. Although the sensitivity of mMNV diagnosis increases to 97% with the combined use of fundus fluorescein angiography and optical coherence tomography, multimodal imaging is valuable in differential diagnosis. Intravitreal anti-vascular endothelial growth factor therapy has become the standard and first-line treatment option for mMNV. Continued monitoring of patients is required to assess any progression or recurrence.

Branch retinal vein occlusion and peripheral nonperfusion associated with astrocytic hamartoma of the optic nerve head in a patient with tuberous sclerosis.

To report a case of branch retinal vein occlusion (BRVO) causing retinal neovascularization (NV) and vitreous hemorrhage associated with astrocytic hamartoma (AH) involving the optic nerve head in a patient with tuberous sclerosis complex (TSC). We review the natural history of the clinical presentation and posit its etiology. Electronic health records were reviewed for patient history and demographics and multimodal ophthalmic imaging including fundus photography, fluorescein angiography, and optical coherence tomography (OCT). Neovascularization emanating superiorly and inferiorly from a large AH of the optic nerve head was identified as the cause of a longstanding vitreous hemorrhage. Retinal nonperfusion was also found in superior peripheral quadrants, most notably distal to the superior NV. OCT was useful in visualizing small retinal AH in the fellow eye that was otherwise undetected on prior dilated fundus examinations. The patient was treated with intravitreal anti-VEGF and superior sectoral PRP in the involved eye. BRVO and associated NV may represent rare vision-threatening sequela of AH in TSC and manifested in this case with diffuse peripheral retinal nonperfusion secondary to BRVO-induced ischemia. OCT is a valuable resource in identifying and monitoring AH of the retina.

Bilateral serous retinal detachment in HELLP syndrome associated with post-partum sepsis and acute kidney injury: A case report

Serous retinal detachment (RD) can occur either during or after pregnancy, and is often associated with hypertensive disorders in pregnancy. A variant of pre-eclampsia–atypical pre-eclampsia–may present without proteinuria or hypertension. We report a case of a 26-year-old normotensive primigravida who developed sudden blurring of vision in both her eyes during puerperium. Fundoscopy revealed serous retinal detachment in both eyes. Optical coherence tomography (OCT) demonstrated sub-retinal fluid (SRF) in both eyes, and fundus fluorescein angiography (FFA) displayed leakage with pooling of dye all over the posterior pole. She responded well to oral and topical steroid eyedrops, and topical non-steroidal anti-inflammatory eyedrops. Her best-corrected visual acuity improved within a month, with resorption of subretinal fluid. Awareness about serous retinal detachment during/after pregnancy in the absence of hypertensive disorders is noteworthy. The visual prognosis is usually favorable, and this knowledge can allay fear and anxiety among patients.