Macular Folds Research Articles

Factors influencing the outcomes of trabeculectomy, conventional canaloplasty, and mitomycin C augmented canaloplasty.

To compare the efficacy, safety, and factors influencing the outcomes of trabeculectomy (TE), conventional canaloplasty (cCP), and mitomycin C augmented canaloplasty (mCP) in glaucoma patients. Intraocular pressure (IOP), the number of IOP-lowering eye drops, and surgery-related complications were evaluated at baseline and through 18months postoperatively. Correlations between patients' demographic data, ophthalmic and non-ophthalmic conditions, outcomes and complications were evaluated. 171 patients were included. IOP and IOP-lowering eye drops were significantly (p < 0.001) reduced 18months after TE, cCP, and mCP. At the 18-month follow-up, IOP and IOP-lowering eye drops were significantly lower following TE than cCP (p < 0.001, p = 0.010, respectively) and mCP (p = 0.010, p = 0.014). At the 18-month follow-up, complete success rates were significantly higher after TE compared to cCP and mCP for IOP ≤ 21, 18, and 16mmHg (p < 0.001). Qualified success rates for IOP ≤ 16mmHg were higher following TE than cCP and mCP (p = 0.023). In the TE group, clinical hypotony at any postoperative follow-up was positively correlated with previous intravitreal anti-vascular endothelial growth factor (VEGF)-therapy (p < 0.001), leukaemia (p = 0.002), and a spherical equivalent < -3 dioptres (p < 0.001). There were no significant correlations in the cCP and mCP groups. TE, cCP, and mCP led to a significant reduction in IOP and IOP-lowering eye drops during 18months of follow-up. At 18months of follow-up, IOP and IOP-lowering eye drops were significantly lower following TE compared to cCP and mCP. Anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment in the TE group. What is known • Trabeculectomy (TE) is considered the gold standard in the surgical management of glaucoma. However, TE involves extensive postoperative management and might be associated with severe surgery-related complications. What is new • In this study, intraocular pressure (IOP) and IOP-lowering eye drops were significantly lower following TE compared to conventional canaloplasty (cCP) and mitomycin C augmented canaloplasty (mCP) at a follow-up of 18months. • In patients undergoing TE, anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment.

Macular Outer Retinal Atrophy Following Vitrectomy and Hypotony: Two Cases.

To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy. Retrospective chart review of two patients' records between 2019 and 2023. Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week post-operatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the IOL dislocated and was exchanged with scleral fixation of a new IOL. On post-operative day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on post-operative day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable over years but resulted in reduced central vision. Hypotony following vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.

PERFLUOROCARBON LIQUID USE DURING VITRECTOMY FOR MACULA-OFF RETINAL DETACHMENT HAS NO IMPACT ON MACULAR FOLDS AND METAMORPHOPSIA.

To compare two drainage techniques in macula-off retinal detachment surgery: perfluorocarbon liquid (PFCL)-assisted drainage and partial subretinal fluid drainage without PFCL. This study investigated morphological and functional outcomes, focusing on metamorphopsia quantification. Eighty eyes with macula-off retinal detachment were retrospectively included. All underwent a 25-gauge pars plana vitrectomy. In the PFCL group, subretinal fluid drainage was performed using PFCL. In the partial subretinal fluid drainage (SRFD) group, subretinal fluid was partially drained through a preexisting retinal break without PFCL. A follow-up at 3 months and 6 months evaluated anatomical outcomes using optical coherence tomography, best-corrected visual acuity, and metamorphopsia quantified with M-charts. Reattachment rates were comparable in the PFCL group (97.5%) and the SRFD group (95%) ( P > 0.05). Mean best-corrected visual acuity (logMAR) was 0.23 ± 0.32 (PFCL group) and 0.15 ± 0.13 (SRFD group) ( P = 0.206). Metamorphopsia was reported by 19 patients (47.5%) in the PFCL group and by 12 patients (30%) in the SRFD group ( P = 0.332). The mean metamorphopsia score was similar in both groups (0.27 ± 0.12 in the PFCL group and 0.28 ± 0.11 in the SRFD group, P = 0.866). Morphological optical coherence tomography findings were comparable in both groups. Morphological and functional outcomes were similar in PFCL and SRFD groups. Metamorphopsia quantification scores did not improve with PFCL. While both of these techniques might be effective and could be recommended for primary macula-off retinal detachment management, potential PFCL toxicity should be kept in mind and its use dedicated to selected cases.

The use of intraluminal PRESERFLO stenting in avoiding early postoperative hypotony.

Postoperative hypotony following PRESERFLO MicroShunt (PMS) implantation is a frequent cause of complications such as choroidal detachment and hypotony maculopathy. This study aims at evaluating the impact of intraluminal stenting of the PMS during the early postoperative period. We retrospectively analyzed the data of 97 patients who underwent PMS implantation with intraoperative placement of a Nylon 10-0 suture as intraluminal stent (PStent) and compared the outcomes to those of an existing database of the traditional MicroShunt implantation technique (PTrad, n = 120). The primary outcome measure was the intraocular pressure (IOP) at one week postoperatively. As a secondary outcome measure, adverse hypotony, defined as an IOP ≤ 5mmHg with significant choroidal effusion and/or anterior chamber shallowing or the presence of macular folds was also assessed. Additionally, the time to stent removal and the IOP one week after stent removal were reported. Preoperative median IOP was 25.0 (20.5-30.3) mmHg in PStent and 25.0 (19.3-32.0) mmHg in PTrad (p = 0.62). One week after surgery, the median IOP dropped to 10.0 (8.0-13.0) mmHg in PStent and 7.0 (5.0-9.0) in PTrad (p < 0.01). At one month, the IOP was 12.0 (10.0-14.0) mmHg in PStent and 10.0 (8.0-11.0) mmHg in PTrad (p < 0.01). After 3months, both groups showed similar median IOP levels of 11.0 (8.0-13.5) mmHg and 10.0 (9.75-13.0) mmHg in PStent and PTrad, respectively (p = 0.66). The presence of adverse hypotony was significantly lower in PStent compared to PTrad (6.2% vs 15.8%, p < 0.05). In PStent the stent was removed after 30.0 (21.0-42.5) days. One week after stent removal the mean IOP drop was 6.1 ± 0.5mmHg (p < 0.01). In the early follow-up period, intraluminal stenting of the PMS appears to be safe and effective in controlling the IOP while reducing early postoperative hypotony. Surgical success is not compromised by stent placement. Based on our data, it is recommended to remove the suture two to six weeks after surgery for most patients with uncomplicated postoperative clinical findings.

Surgical repair of macular fold in X-linked retinoschisis initially misdiagnosed as familial exudative vitreoretinopathy

Purpose: To describe the presentation and surgical management of a young boy initially thought to have familial exudative vitreoretinopathy who was ultimately diagnosed with an unusually aggressive form of X-linked retinoschisis that included rapidly progressive bullous retinoschisis and tractional macular fold. Methods: Retrospective case report Results: A 19-month-old boy with straightening of major arcades, peripheral retinal ischemia, and in the left eye, a large macular fold was initially diagnosed as familial exudative vitreoretinopathy. During follow-up, he developed a rapidly progressive bullous retinoschisis in the left eye involving the inferior macula extending superiorly up to the macular fold. This revised the working diagnosis to X-linked retinoschisis, which was confirmed by genetic testing. Pars plana vitrectomy, inner flap retinectomy, unrolling of the macular fold and inner flap retinectomy, and C3F8 gas tamponade were performed. This resolved the macular fold. The patient showed good anatomical results without surgical complications up to 18 months of post-operative follow-up. Conclusions: X-linked retinoschisis can rarely present in young children with macular fold and peripheral ischemia, mimicking familial exudative vitreoretinopathy. Rapidly progressive bullous retinoschisis in this setting can be treated with pars plana vitrectomy, inner wall retinectomy, and removal of the vitreous traction to improve visual prognosis.

The two extremes of retinal fold management

Aims/Purpose: Retinal folds represent a debilitating complication following retinal detachment surgery. While some patients may experience partial retinal flattening with minimal or moderate improvement of visual function, many will go on to suffer severe permanent vision loss. The indication and timing of possible reintervention is still debated, particularly for how long after initial retinal fold formation there can still be a reasonable expectation of anatomical and functional improvement.Methods: We present the cases of two patients suffering debilitating postoperative macular folds at opposite ends of the intervention window, who were referred to the Jules Gonin Hospital at different postoperative timepoints following retinal detachment surgery. Patient Nr 1 was reoperated within 20 days of the initial surgery, patient Nr 2 10 months later. Retinal folds were confirmed by preoperative OCT and pre‐ and post‐op cyclotorsion was measured on fundus photography.Results: Patient Nr 1 recovered vision from CF to 0.2 logMar within 3 months, improving to 0.0 logMar after one year. Patient No 2 recovered from HM to 0.6 after 3 months and further to 0.5 logMar after one year. Most importantly, while patient Nr 1 had no more cyclotorsion, undisturbed binocular vision already on day one postoperatively, even to the absence of metamorphopsia during follow‐up, patient Nr 2 recovered slowly, also regaining binocularity without cyclotorsion, but with lasting metamorphopsia. During the video presentation, the different retinal elasticity at these differing timepoints can be demonstrated intraoperatively as well as different strategies to induce retinal separation so that the central retina can be reattached in a new, more physiological position.Conclusions: Our cases illustrate that early intervention can lead to a virtually symptom‐free result while even delayed intervention may still be able to achieve some improvement in visual function and the avoidance of monocularity.

Combined Internal Limiting Membrane Peeling and Subretinal Balanced Salt Solution Injection: A Novel Technique to Unfold Congenital Falciform Folds.

To describe a novel surgical technique to unfold congenital falciform folds. A retrospective, interventional case series was performed where a novel technique was applied to treat five cases of congenital falciform folds. Twenty-five-gauge vitrectomy was performed along with the removal of all vitreous adhesions. The internal limiting membrane was peeled from the macula and around the macular fold area. A Tano diamond-dusted membrane scraper was used to stretch the folded retina mechanically. Then, subretinal balanced salt solution was injected using a 38-gauge subretinal needle to create multiple blebs around the folded retina. Finally, 20% sulfur hexafluoride gas was used for tamponade. Follow-up was conducted for a minimum of 6 months. Vision improved from preoperative mean best-corrected visual acuity logMAR 1.44 (20/550) ± 0.32 to postoperative mean best-corrected visual acuity logMAR 0.75 (20/112) ± 0.17 ( P value = 0.0208) after intervention. There was a reduction in the macular fold. Postoperatively, a macular hole with retinal detachment developed in one of five (20%) eyes. The novel technique of vitrectomy with combined internal limiting membrane peeling and subretinal balanced salt solution injection is visually rewarding in treating congenital falciform folds.

Post trabeculectomy hypotonous maculopathy: Miraculous result with autologous blood injection in a young lad

A 28-year-old male patient was referred to us for the management of hypotonous maculopathy developed post trabeculectomy for angle recession glaucoma. After examination, the patient was advised cycloplegics, oral and topical steroids, but maculopathy had not settled even after treatment for 3 weeks and so scleral patch grafting was done. Post grafting also macular folds persisted and a part of the graft was exposed and so amniotic membrane grafting was done, still hypotony persisted with the development of neurosensory detachments. The over-filtration hypotonus maculopathy finally resolved with peri bleb injection of autologous whole blood.

Findings of optical coherence tomography and fundus autofluorescence of macular fold

Findings of optical coherence tomography and fundus autofluorescence of macular fold

Systematic Preserflo MicroShunt Intraluminal Stenting for Hypotony Prevention in Highly Myopic Patients: A Comparative Study.

Transient hypotony is the most common early complication after Preserflo MicroShunt (PMS) implantation. High myopia is a risk factor for the development of postoperative hypotony-related complications; therefore, it is advisable that PMS implantation in patients should be performed while employing hypotony preventive measures. The aim of this study is to compare the frequency of postoperative hypotony and hypotony-related complications in high-risk myopic patients after PMS implantation with and without intraluminal 10.0 nylon suture stenting. This is a retrospective, case-control, comparative study of 42 eyes with primary open-angle glaucoma (POAG) and severe myopia that underwent PMS implantation. A total of 21 eyes underwent a non-stented PMS implantation (nsPMS), while in the remaining eyes (21 eyes), PMS was implanted with an intraluminal suture (isPMS group). Hypotony occurred in six (28.57%) eyes in the nsPMS group and none in the isPMS group. Choroidal detachment occurred in three eyes in the nsPMS group; two of them were associated with the shallow anterior chamber and one was associated with macular folds. At 6 months after surgery, the mean IOP was 12.1 ± 3.16 mmHg and 13.43 ± 5.22 mmHg (p = 0.41) in the nsPMS and isPMS group, respectively. PMS intraluminal stenting is an effective measure to prevent early postoperative hypotony in POAG highly myopic patients.

Incidence and Progression of Chorioretinal Folds During Long-Duration Spaceflight

The primary contributing factor for development of chorioretinal folds during spaceflight is unknown. Characterizing fold types that develop and tracking their progression may provide insight into the pathophysiology of spaceflight-associated neuro-ocular syndrome and elucidate the risk of fold progression for future exploration-class missions exceeding 12 months in duration. To determine the incidence and presentation of chorioretinal folds in long-duration International Space Station crew members and objectively quantify the progression of choroidal folds during spaceflight. In this retrospective cohort study, optical coherence tomography scans of the optic nerve head and macula of crew members completing long-duration spaceflight missions were obtained on Earth prior to spaceflight and during flight. A panel of experts examined the scans for the qualitative presence of chorioretinal folds. Peripapillary total retinal thickness was calculated to identify eyes with optic disc edema, and choroidal folds were quantified based on surface roughness within macular and peripapillary regions of interest. Spaceflight missions ranging 6 to 12 months. Incidence of peripapillary wrinkles, retinal folds, and choroidal folds; peripapillary total retinal thickness; and Bruch membrane surface roughness. A total of 36 crew members were analyzed (mean [SD] age, 46 [6] years; 7 [19%] female). Chorioretinal folds were observed in 12 of 72 eyes (17%; 6 crew members). In eyes with early signs of disc edema, 10 of 42 (24%) had choroidal folds, 4 of 42 (10%) had inner retinal folds, and 2 of 42 (5%) had peripapillary wrinkles. Choroidal folds were observed in all eyes with retinal folds and peripapillary wrinkles. Macular choroidal folds developed in 7 of 12 eyes (4 of 6 crew members) with folds and progressed with mission duration; these folds extended into the fovea in 6 eyes. Circumpapillary choroidal folds developed predominantly superior, nasal, and inferior to the optic nerve head and increased in prevalence and severity with mission duration. Choroidal folds were the most common fold type to develop during spaceflight; this differs from reports in idiopathic intracranial hypertension, suggesting differences in the mechanisms underlying fold formation. Quantitative measures demonstrate the development and progression of choroidal folds during weightlessness, and these metrics may help to assess the efficacy of spaceflight-associated neuro-ocular syndrome countermeasures.

Medications Damaging Retinal Pigment Epithelium and Photoreceptor Complex-4: Pathogenesis, Diagnosis, and Treatment (Dideoxynosine, MEK Inhibitors, Sildenafil, Corticosteroids, Poppers/Alkyl Nitrate, Cisplatin, Carmustine)

Systemic, topical, and intravitreal medications could induce retinal toxicity. Disruption of the retina and retinal pigment epithelium, vascular damage, cystoid macular edema, retinal folds, crystalline retinopathy, uveitis, and miscellaneous are patterns of retinal toxicity. Medications that could generate permanent impairment, and damage RPE and photoreceptor cells are significant. This article outlines pathogenesis, current diagnosis, and treatments of widely used dideoxyinosine, MEK inhibitors, sildenafil, corticosteroids, poppers/alkyl nitrate, cisplatin, and carmustine causing RPE and photoreceptor cells damage.

Surgical management for macular folds after macular epiretinal membrane surgery: a report of two cases

Surgical management for macular folds after macular epiretinal membrane surgery: a report of two cases

Multimodal imaging in persistent fetal vasculature

AbstractPurpose: To describe the clinical manifestations of the persistence of the fetal vascular system and to show multimodal imaging findings in this disease.Methods: We presented two cases of persistent fetal vasculature. Thorough clinical examination and full multimodal imaging have been undertaken.Results: The first case is a 12‐year‐old girl who consulted for a visual impairment evolving for few years. Fundoscopy revealed a unilateral whitish vascular membrane attached to the optic disc towards the vitreous associated with retinal folds in interpapillomacular region as well as chorio‐retinal atrophy and nasal pigment migrations. B‐mode ultrasonography confirmed the presence of this membrane attached to the optic disc but does not reach the lens. Optical coherence tomography (OCT) showed a deficit of RNFL, especially in superotemporal and hyaloid condensation in the optic disc with macular folds. The second case is a 42‐year‐old patient who consulted for a presbyopia. Fundoscopy revealed membranous short band‐like lesion attached to the optic disc associated with retinal folds, better seen in the anerythral photograph which showed an alternation of grey and white bands.Conclusions: Multimodal imaging is of a paramount importance in diagnosing the fetal vascular system. It also allows the recognition of the form of this disease and thus the way to manage it.

Unilateral neuroretinitis as manifestation of syphilitic disease

AbstractPurpose: Syphilis is a systemic sexually transmitted disease caused by the spirochete Treponema Pallidum. Ocular symptoms indicate neurological compromise, corresponding to 5%–8% of syphilis cases. The clinic is varied and involvement of practically any of the ocular structures has been described. The most frequent presentation is uveitis, which can be posterior, intermediate, anterior or panuveitis, unilateral or bilateral, granulomatous or not. It is responsible for 1%–2% of uveitis cases. This clinical experience aims to reinforce the existence of this entity and the importance of early treatment and adequate control of symptoms.Methods: A 35‐year‐old man presented blurred vision in the left eye of sudden onset of 2 days of evolution. On examination, visual acuity of right eye 1.0 and left eye 0.05 according to decimal scale. Biomicroscopy shows Tyndall, without retrokeratic precipitates or synechiae. Transparent cornea and isochoric normoreactive pupils. The eye fundus shows obliterated papillae with fibrinoid‐like material, vasculitis, scattered haemorrhages and macular folds. Right eye without alterations. He reports the possibility of a risky sexual relationship. In serological tests, IgM for Syphilis is detected. He is admitted to the Infectious Diseases service for intravenous treatment with Benzylpenicillin 4 million Ul/ 4H.Results: One month later, inflammation of the anterior pole has disappeared, but the fundus shows persistent neuroretinitis with edema of the optic nerve, macular star exudates and a focus of vasculitis in the superior temporal artery. Ozurdex is indicated. One month later, he shows visual acuity of 1 in left eye, and reduced inflammation of the optic nerve, exudates and haemorrhages.Conclusions: Ocular syphilis is an entity that is still present, as well as the importance of actively searching for it. It is a potentially serious disease that affects young adults, with a good response to treatment if the diagnosis is made early.

Blindness in infants presenting with advanced and untreated ROP: a single-centre study in Pakistan

ABSTRACTPurposeTo describe the ocular features and characteristics of young children presenting with advanced, untreated retinopathy of prematurity and to determine appropriate screening guidelines for retinopathy of prematurity (ROP) in Pakistan.Material...

Применение технологии комбинированного лазерного воздействия в лечении макулярной ретинальной складчатости

Purpose. To evaluate the possibility of using the technology of combined laser treatment of macular retinal folds in the late postoperative period of rhegmatogenous retinal detachment (RRD). Methods: Patient Z., 62 years old complained of metamorphopsia and decreased visual acuity of the right eye. Diagnosis: Operated RRD in the right eye complicated with macular retinal folding; epiretinal membrane; avitria; pseudophakia. Upon admission and at all stages of dynamic observation the patient underwent a comprehensive ophthalmological examination: standard diagnostic tests included visometry for uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) and indirect ophthalmoscopy with MaxField indirect lens (Ocular Inc.; USA). In addition, optical coherence tomography was performed using Spectralis HRA + OCT platform (Heidelberg Engineering; Germany). Laser photocoagulation was delivered using a VISULAS Trion laser work station (Carl Zeiss; Germany) operating at 577 nm wavelength. Results. On examination 6 months after combined laser treatment the patient noted the absence of metamorphopsia in the right eye. As a result, an increase in UCVA from 0.05 to 0.2 was determined; BCVA remains stable – 0.7, “smoothing” of the retinal folds according to ophthalmoscopy, a decrease in the height of the retinal folds, restoration of the macular profile and architectonics of the retinal layers according to OCT. Conclusions. The proposed combined laser treatment of macular folds developing in the late postoperative period after RRD repair significantly improved the morphofunctional characteristics of the eye. The application of transpupillary laser surgery to ophthalmological practice broadens the arsenal of methods for noninvasive correction of RRD associated with macular retinal folds Key words: macular retinal folds; combined laser technology; rhegmatogenous retinal detachment; micropulse laser.

Posterior Scleritis Simulating a Vogt-Koyanagi-Harada Syndrome

A 35 years old patient presented with complaints of diminution of vision in the right eye with ocular pain without any redness nor other clinical signs. Ophthalmic examination revealed a best corrected VA of counting fingers in the right eye. Slit lamp examination of the RE was normal. Fundus evaluation revealed a grade II papillary edema with macular retinal folds (Figure 1).

Tilted disc syndrome (TDS): New hypotheses for posterior segment complications and their implications in other retinal diseases.

Tilted disc syndrome (TDS) is considered a congenital anomaly due to a delayed closure of the embryonic fissure. It is characterized by an oblique orientation of the axis of the optic disc, associated with other posterior pole anomalies such as inferior crescent, situs inversus and inferior staphyloma. The aim of this review was to summarize the data supporting the current hypotheses for the pathogenesis of TDS, and its anatomical and functional clinical consequences. Recent imaging techniques, such as magnetic resonance imaging, wide-field fundus imaging, and 2- and 3-D optical coherence tomography have provided a new perspective on TDS and its complications. Different abnormalities have previously been reported, both in the anterior and posterior segments. The focus was on vision-threatening chorioretinal changes or complications, including choroidal neovascularization and serous retinal detachments and their therapeutic options. Based on clinical observations, assumptions were proposed to understand the occurrence of complications such as chorioretinal degenerative changes, choroidal neovascularization and polypoidal choroidal vasculopathy, macular serous retinal detachment, myopic foveoschisis and chorioretinal folds. These hypotheses could be referred to as the curvature "breaking point" hypothesis, the uneven growth "tractional" hypothesis, the "container-content" imbalance hypothesis, and the "choroidal funnel" hypothesis. Because these complications could also occur in other contexts, understanding the pathogenesis of TDS complications could help to understand their pathophysiology.

Management of primary choroidal lymphoma presenting as extensive serous retinal detachment and salmon patch of bulbar conjunctiva: a case report

BackgroundWe describe the outcome of ultra-low-dose radiotherapy plus intravitreal methotrexate and rituximab injections for a patient with primary choroidal lymphoma who presented with nodular conjunctival salmon patches and extensive serous retinal detachment.Case presentationA 34-year-old Iranian man presented with a nodular patch of bulbar conjunctiva in the right eye, and 1+ vitritis. A nearly complete shallow serous retinal detachment, retinal folds, and multifocal yellow choroidal infiltrates were seen during a fundus examination of the right eye. Enhanced depth imaging optical coherence tomography revealed macular retinal folds and an uneven, undulating, “seasick” appearance of the choroidal surface with choriocapillaris compression, intraretinal and subretinal fluid, and clusters of optically dense material at the outer retinal level. An incisional biopsy of the conjunctival lesion confirmed the diagnosis of primary choroidal lymphoma with epibulbar involvement. The patient was treated with ultra-low-dose “boom-boom” radiation (4 Gy delivered in two fractions over two consecutive days) as well as intravitreal methotrexate and rituximab injections. After a year, the lesions had completely disappeared, with no adverse effects or recurrence.ConclusionUltra-low-dose (boom-boom) radiotherapy combined with intravitreal chemotherapy and/or immunotherapy may be an effective treatment for primary choroidal lymphoma with anterior epibulbar extension and diffuse subretinal fluid with favorable response and minimal side effects.