Macular Involvement Research Articles

Neuroretinitis: a comprehensive review on aetiologies, clinical manifestations, and treatment options.

Neuroretinitis connotes a descriptive clinical entity of optic disc oedema in association with macular exudates in a star configuration. Accordingly, it does not indicate a specific aetiology, although cat scratch disease caused by Bartonella henselae is the most common cause. Historically, the recognition of neuroretinitis dates to the early 20th century with the eventual understanding that the optic disc is the primary target of disease with secondary macular involvement. Neuroretinitis can be broadly divided into four categories: infectious, inflammatory, autoimmune and mimickers. The intention of this article is to review the various aetiologies of neuroretinitis with a focus on the etiopathogenesis, clinical manifestations, and management of B. henselae associated neuroretinitis and recurrent idiopathic neuroretinitis.

THE METHOD OF DOUBLE CONTRAST IN THE INTRAOPERATIVE DIAGNOSIS OF REGMATOGENIC RETINAL DETACHMENT

Usually, the recurrence rate of regmatogenic retinal detachment (ROS) after surgery ranges from 3% to 30%. In cases where the disease recurs after successful surgery, in 60% of cases the main factor is the progression of proliferative vitreoretinopathy (PVR), which makes it one of the most severe complications that can occur in the postoperative period. In addition, after removal or absorption of a tampon agent (in particular, endotamponade with silicone oil), recurrent retinal detachment may occur due to the inability to detect retinal rupture during surgery.Objective: this study is aimed at evaluating the effectiveness of diagnostic methods used during operations for regmatogenic retinal detachment. After completing the standard stages of central vitrectomy, the group of patients was divided into two equal groups: the first group included patients who received the double contrast method, and the second group (control) – patients who underwent the traditional surgical method.Results and discussion: in patients of the control group, there was a significant increase in the number of relapses of ROS. In addition, it was found that an increase in the number of retinal tears correlated with a greater likelihood of macular involvement; Statistical evaluation has shown that the absence of AST and tight adhesion of the posterior hyaloid membrane to the retina and small retinal tears increase the risk of recurrence of ROS due to the progression of PVR.

Delayed high-altitude retinal hemorrhages in well-acclimatized lowlanders: A hidden risk unveiled.

High-altitude retinal hemorrhage (HARH), a frequent entity of high-altitude retinopathy (HAR), is associated with acute exposure to high altitudes (HAs) with rapid ascent. However, the delayed occurrence of HARH in well-acclimatized individuals has received less attention. This study explored the prevalence and characteristics of HARH in individuals who were acclimatized to HA for extended periods, aiming to elucidate the physiological responses of the retina to chronic hypoxic conditions. We conducted an observational cross-sectional study involving 1,457 male participants who had resided at altitudes above 3353 meters (11,000 ft) in the Himalayan region for more than three months. Patients who had ocular or systemic diseases affecting the retina, chronic retinotoxic medication use or smoking were excluded. Participants underwent comprehensive ophthalmic examination, including the best corrected visual acuity test, dilated fundus examination and photography. A total of 1,457 males were screened, and the mean age was 34 ± 2 years. Of all the participants screened, 12 (0.82%) had HAR, with all cases occurring at altitudes above 4267 meters (14,000 ft). Seventy-five percent (75%) of the HAR patients had retinal hemorrhage and venous dilatation. Macular involvement and cotton wool spots were observed in 34% and 25% of HAR patients, respectively. Only four participants had foveal involvement with significant visual impairment. Delayed HARH in acclimatized individuals underscores the importance of long-term ocular monitoring for those exposed to HA, despite acclimatization, to prevent and manage potential visual impairments.

Myopic maculopathy progression: insights into posterior staphyloma and macular involvement.: Short title: Myopic maculopathy progression.

Purpose: To analyze the myopic maculopathy's progression pattern. Design: Retrospective, observational case series. Methods: 824 highly myopic eyes (axial length ≥26mm) of 430 patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain) with a minimum follow-up of 2 years. All patients underwent complete ophthalmologic examination, including multimodal imaging. Progression of myopic maculopathy was assessed according to ATN classification system at baseline and throughout the follow-up, as well as associated clinical features. Results: Progression of myopic maculopathy was described in 42% of eyes over a mean follow-up of 4.10±1.28 (range: 2.00 to 6.23) years. Compared to non-progressing eyes, myopic maculopathy progression correlated with worse best-corrected visual acuity (BCVA) at follow-up (p<0.05) and greater BCVA loss (p<0.01). There were no significant differences between groups in axial length, gender, and age (p>0.05). Eyes with posterior staphyloma (PS) and, particularly, those with macular PS showed significantly greater myopic maculopathy progression (p<0.01). The likelihood of myopic maculopathy's progression was 3.94 times higher (OR: 3.94±1.22, p<0.01) in eyes with PS compared to those without PS. Atrophic progression occurred in 21.9% of eyes, with diffuse to patchy atrophy being the most common pattern (54.17%). Tractional progression was observed in 22.8% of eyes, predominantly from non-traction to inner/outer foveoschisis (40%). Neovascular progression affected 11.4% of the eyes, most of them from no-neovascular component to macular lacquer cracks (40%). Conclusions: The study highlights significant myopic maculopathy progression over the natural course of the disease, compromising the BCVA as macular complications progress. Myopic maculopathy progression was significantly associated with PS and, especially, with those with macular involvement.

Modified pneumatic retinopexy with endoillumination for management of recurrent retinal detachment after failed scleral buckle

We report a modification of pneumatic retinopexy (PnR), incorporating endoillumination, for management of recurrent rhegmatogenous retinal detachment (RRD) after scleral buckle (SB). A 42-year-old gentleman underwent SB for treatment of left-eye RRD without macular involvement and not associated with posterior vitreous detachment. Preoperative best-corrected visual acuity (BCVA) was 6/12 in the left eye. Recurrence of RRD was noted at 1 month postoperatively, and the patient elected to undergo a modified rescue PnR, where endoillumination was adopted. BCVA improved to 6/9.5, and complete resolution of subretinal fluid was observed at 1 month postoperatively. There were no intraoperative complications, and there was no recurrence of RRD at 1-year follow-up. We conclude that modified rescue PnR with endo-illumination represents a safe and effective method to manage failed primary RRD following SB. It offers the advantage of enhancing the visualization of new or missed retinal breaks and represents a less invasive surgical approach when compared to revision SB or PPV.

Overlapping clinical features of persistent fetal vasculature and combined hamartoma of the retina and retinal pigment epithelium

PurposeTo investigate cases exhibiting overlapping features of persistent fetal vasculature (PFV) and combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) and to explore potential associations between these developmental ocular anomalies. MethodsThis retrospective, descriptive case series included 9 eyes of 8 patients aged 0-7 years with shared clinical features of PFV and CHRRPE. Diagnoses were established through clinical examination and intraoperative findings. ResultsAll eyes exhibited elevated pigmented retinal thickening, increased vascular tortuosity, and preretinal fibrotic/gliotic changes or epiretinal membranes. Macular involvement was observed in 56% of cases; peripapillary involvement, in 44%. Four eyes showed hyaloid stalklike fibrotic remnants extending from the lesion to the posterior lens surface, suggestive of PFV component; the other 5 harbored isolated CHRRPE. One patient presented with PFV in one eye and CHRPPE in the other. ConclusionsThis study reveals significant clinical overlap between PFV and CHRRPE, with some cases displaying features typically associated with the other condition. The presence of both diagnoses in the same patient further suggests a potential association between these entities. Further research, including molecular studies, is needed to explore this potential connection and deepen our understanding of ocular development.

Historical and practical aspects of macular buckle surgery in the treatment of myopic tractional maculopathy: case series and literature review

BackgroundUncorrected myopia is a leading cause of blindness globally, with a rising prevalence in recent decades. Pathological myopia, often seen in individuals with increased axial length (AXL), can result in severe structural changes in the posterior pole, including myopic tractional maculopathy (MTM). MTM arises from tractional forces at the vitreoretinal interface, leading to progressive macular retinoschisis, macular holes, and retinal detachment (RD). This study aims to outline preoperative evaluation and surgical indication criteria for MTM, based on the MTM staging system, and to share our Brazilian experience with three cases of macular buckle (MB) surgery, all with over a year of follow-up.MethodsWe conducted a retrospective analysis of three cases of MTM-associated RD treated with MB surgery, with or without pars plana vitrectomy. Preoperative evaluations included optical coherence tomography (OCT) and ultrasonography (USG) to assess the extent of macular involvement and retinal detachment. Surgical indications were determined based on the MTM staging system. The MB was assembled using customizable and accessible materials. Surgical procedures varied according to the specific needs of each case. An informed consent form regarding the surgical procedure was appropriately obtained for each case. The study was conducted with the proper approval of the institution’s ethics committee.ResultsAll three cases demonstrated successful retinal attachment during the mean follow-up of eighteen months. In the first case, combined phacoemulsification, vitrectomy, and MB were performed for MTM with macular hole and RD. The second case required MB and vitrectomy after two failed RD surgeries. In the third case, a macular detachment with an internal lamellar hole was treated with MB alone. These cases highlight the efficacy of MB surgery in managing MTM in highly myopic eyes.ConclusionsMB surgery is an effective treatment option for MTM-associated RD in highly myopic eyes, providing long-term retinal attachment. Our experience demonstrates that with proper preoperative evaluation and surgical planning, MB can be successfully implemented using accessible materials, offering a viable solution in resource-limited settings. Further studies with larger sample sizes are warranted to validate these findings and refine surgical techniques.

Optical coherence tomography angiography based prognostic factors and visual outcomes in primary rhegmatogenous retinal detachment after pars plana vitrectomy

PurposeTo evaluate the visual outcomes and changes in the retinal microcirculation in patients with primary rhegmatogenous retinal detachment (RRD) following successful pars plana vitrectomy (PPV).MethodsNine macula-on RRD and 23 macula-off RRD eyes were retrospectively evaluated. Clinical data was collected at admission and 3 months after PPV. Optical coherence tomography angiography (OCTA) was performed 3 months after PPV. Superficial vascular plexus data obtained with OCTA was compared between affected and fellow eyes and according to macular involvement. Quantitative measurements of the superficial retinal capillary associated with the preoperative and intraoperative factors were analyzed.ResultsOverall RRD inner vessel densities (IVD), full vessel densities (FVD), inner perfusion densities (IPD) and full perfusion densities (FPD) were significantly and positively correlated with best corrected visual acuity (BCVA)(p = 0.002, p = 0.006, p = 0.009, p = 0.023, respectively). In the macula-off RRD, IVD and FVD were significantly decreased compared with macula-on RRD (p = 0.014 and p = 0.034, respectively) and significantly correlated with a longer duration and larger extension of detachment. Higher differences of IVD and FVD between the fellow and affected eyes were significantly correlated with worse BCVA in the macula-off subgroup.ConclusionMacula-off RRD presented worse OCTA superficial vascular parameters compared with the macula-on group and fellow eyes, which were correlated with a poorer visual outcome and exacerbated by a longer duration and larger extension of the detachment. Macula-off RRD causes not only retinal structural damage but also a reduction in retinal perfusion despite successful anatomical repair.

Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease.

To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield's staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.

Retinal arterial macroaneurysm during hypertension and hypercholesterolemia: About a case at the CHU-IOTA

Arterial macroaneurysms are acquired ecstasies of the wall of a retinal arteriole, most often dependent on the superior temporal arch. We have carried out a description of the clinical appearance and management of a retinal arterial macro-aneurysm; A cardiovascular and diabetic check-up in collaboration with internists; The ophthalmological explorations focused on: Fluorescein angiography, Ocular ultrasound mode B, OCT. There was a subretinal hematoma on the path of the superior temporal artery surrounded by dry exudates, macular atrophy in the right eye. Fasting blood glucose at 10.90 mmol/l (1.96 g/l), total cholesterol 238.50 mg/dl (TN&lt;200), arteriosclerosis index of 6.64 (TN&lt;3.3), triglycerides 304.20 mg/l (TN&lt;150). After 5 years of follow-up, visual acuity rose to 4/10 in the right eye with healing of the lesion, but the assessment remained slightly disturbed. Cardiovascular pathologies are the main causes of retinal arterial macroaneurysms. Macular involvement is responsible for AVB, which can be permanent in the absence of adequate and early treatment. Keywords: Arterial macro-aneurysm, encysted hematoma, ectasia.

Clinical and genetic spectrum of coloboma: A proposal for a comprehensive approach to pediatric patients

Purposeto analyze pediatric coloboma cases to (1) identify ophthalmological and systemic associations, (2) establish the variables with the highest probability of reaching a genetic diagnosis and worse visual prognosis and (3) propose a clinical and genetical assessment protocol. Design and methodsDescriptive, retrospective and single-center study. Patients under 18 years of age diagnosed with iris, chorio-retinal and/or optic disc coloboma under follow-up by a reference Pediatric Ophthalmology Unit have been selected from January 2012 to December 2022. A comprehensive data collection and analysis was performed to evaluate phenotype, molecular and prognosis correlations. ResultsA total of 214 patients with a mean age of 11.3 years (6.8 SD) were included (57% female). Among them, 50.9% presented with bilateral coloboma and 66.8% with other ophthalmological alterations (28.5% with microphthalmia). Systemic involvement was observed in 28%, being neurological dysfunction (24.8%) and craniofacial dysmorphic features (18.2%) the most frequent. Molecular diagnosis was reached in 19.2% and clinical exome sequencing had the highest diagnostic yield (22.2%). Bilaterality, macula involvement, short stature and neurological, craniofacial dysmorphic, cardiovascular, and renal anomalies were associated with reaching a genetic diagnosis (p < 0.05). Patients with craniofacial dysmorphic features, hearing, neurologic, cardiac abnormalities or short stature had a worse visual prognosis according with a multivariate model (p < 0.05). A diagnosis and follow-up protocol was developed. ConclusionIt is imperative to ascertain diagnostic and prognostic indicators in individuals with coloboma to facilitate genetic counseling, mitigate potential complications, and enhance the overall well-being of patients and their families

Pneumatic retinopexy for primary rhegmatogenous retinal detachment: from a clinical trial to the real-life experience

BackgroundTo report real-world outcomes of patients with primary Reghmatogenous Retinal Detachment (RRD) treated with Pneumatic Retinopexy (PnR) according to the indications of the Pneumatic Retinopexy versus Vitrectomy for management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) trial.MethodsMulticenter, retrospective study. Patients treated with PnR for RRD between 2021 and 2023 and a follow-up of at least 6 months were included. Single-procedure anatomical success, final anatomical success, complications, causes of failures, best corrected visual acuity (BCVA) after surgery, and the vision-related quality of life using the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were reported.ResultsA total of 76 eyes of 76 patients were included. Mean age was 60 ± 8.1 years. Primary anatomic reattachment was achieved by 84.3% of patients and final anatomical reattachment after pars plana vitrectomy was obtained in 100% of patients. BCVA improved from 0.32 (20/40) to 0.04 (20/20) logMar (p < 0.001) at 6 months. The main cause of failure was related to the presence of additional (likely missed) retinal breaks (66.6% of cases). Also, primary PnR failure was more frequent in eyes of patients with older age, macular involvement, worse baseline BCVA, greater extent of the RRD, and increased duration from diagnosis to treatment. Overall, the mean NEI-VFQ 25 composite score was 93.9% ± 6.4 at 6 months.ConclusionsThe criteria of the PIVOT trial can be applied to real-world scenarios in the decision-making process for the treatment of primary RRD, with excellent anatomical and functional outcomes.

Visual prognosis in retinoblastoma patients with multimodality treatments: Visual Prognosis in Retinoblastoma Patients

PurposeThis study evaluates factors associated with globe preservation and long-term visual outcomes according to clinical characteristics and treatment modalities in intraocular retinoblastoma patients. DesignA retrospective review of medical records enrolled intraocular retinoblastoma patients between January 1, 2007, and June 30, 2020. Methods•Setting: Single-centered.•Patient or study population: Intraocular retinoblastoma patients treated at Ramathibodi Hospital, Bangkok, Thailand.•Main outcome measure: A statistically significant factor associated with visual prognosis corresponds to baseline characteristics, staging, anatomical involvement, and multimodal treatments. Results86 patients (124 eyes) were included. Median age of disease bilaterality onset was significantly younger than unilaterality. Three-quarters of patients were in advanced stages (groups D or E in either ICRB or IIRC and up to cT2a from AJCC). Globe salvage rate was 54.0 % (67 eyes). ICRB Groups D-E, IIRC Groups D-E, and AJCC cT2a and more advanced stages are the globe removal-associated independent risk factors (adjusted odds ratio [AOR] [95 % CI] = 7.40 [1.36, 40.09], 8.33 [1.55, 44.73], 14.73 [1.55, 139.79], respectively). Compared to other classification, IIRC provided the highest statistical correlation from univariate analysis. IIRC Groups A-C is a good visual acuity-associated independent risk factor (AOR [95 % CI] = 4.64 [1.05, 20.43] and P = 0.042). Macular involvement is a worse visual acuity-associated independent risk factor (AOR [95 % CI] = 0.14 [0.02, 0.82] and P = 0.03). Systemic chemotherapy (86.29 %) is the mainstay treatment in our study and is the only good visual outcome-associated treatment. Subgroup analysis of all eyes receiving systemic chemotherapy reveals statistically significant preventive factors for globe removal for tumor staging with ICRB and IIRC groups A-C and AJCC stages cT1a–cT1b (odds ratio [95 % CI] = 15.75 [4.38, 56.65], 15.67 [4.34, 56.53], 9.97 [2.75, 36.18], respectively; P=<0.001) and prevents the worse visual outcome in these stages, (odds ratios [95 % CI] = 4.57 [1.28, 16.27], 6.61 [1.74, 25.11], and 7.50 [1.86, 30.16], respectively; P =< 0.05). ConclusionsAll recent advanced clinical stagings are globe removal outcome-associated independent risk factors. IIRC staging is the best visual results predictor. IIRC Groups A-C were associated with a good visual outcome. Macular involvement tumors are strongly associated with poor visual outcome, despite successful globe preservation from multimodality treatment. Systemic chemotherapy remains a crucial globe-saving treatment and prevents worse vision–especially in ICRB and IIRC Groups A-C and AJCC stage cT1a-cT1b.

Automated interpretation of retinal vein occlusion based on fundus fluorescein angiography images using deep learning: A retrospective, multi-center study

PurposeFundus fluorescein angiography (FFA) is the gold standard for retinal vein occlusion (RVO) diagnosis. This study aims to develop a deep learning-based system to diagnose and classify RVO using FFA images, addressing the challenges of time-consuming and variable interpretations by ophthalmologists. Methods4028 FFA images of 467 eyes from 463 patients were collected and annotated. Three convolutional neural networks (CNN) models (ResNet50, VGG19, InceptionV3) were trained to generate the label of image quality, eye, location, phase, lesions, diagnosis, and macular involvement. The performance of the models was evaluated by accuracy, precision, recall, F-1 score, the area under the curve, confusion matrix, human-machine comparison, and Clinical validation on three external data sets. ResultsThe InceptionV3 model outperformed ResNet50 and VGG19 in labeling and interpreting FFA images for RVO diagnosis, achieving 77.63%–96.45% accuracy for basic information labels and 81.72%–96.45% for RVO-relevant labels. The comparison between the best CNN and ophthalmologists showed up to 19% accuracy improvement with the inceptionV3. ConclusionThis study developed a deep learning model capable of automatically multi-label and multi-classification of FFA images for RVO diagnosis. The proposed system is anticipated to serve as a new tool for diagnosing RVO in places short of medical resources.

Comparison of the therapeutic effects of photodynamic therapy, transpupillary thermotherapy, and their combination on circumscribed choroidal haemangioma

ObjectiveTo characterize the clinical and imaging features of circumscribed choroidal hemangioma (CCH), and to evaluate individualized treatment efficiency of photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or their combination, followed by retrobulbar injection of betamethasone on CCH resolvement. MethodsForty-nine patients with CCHs who underwent PDT, TTT or PDT+TTT treatments were retrospectively analyzed. Their treatment efficacy was compared by analyzing the change of best corrected visual acuity (BCVA), subretinal fluid (SRF) and CCH lesion characteristics. ResultsPDT, TTT and PDT+TTT were respectively administrated in 17, 11 and 21 patients. No significant difference in age, gender, affected eyes and tumor location across the three groups. Baseline BCVA were 0.41 ± 0.28, 0.62 ± 0.30 and 0.24 ± 0.24 for PDT, TTT and PDT+TTT groups, respectively (F = 6.572, P = 0.003). CCH treated by three strategies showed significant difference in maximum tumor basal diameter, SRF areas and macula involvement prior to the treatment (P < 0.05). Patients receiving PDT+TTT exhibited larger tumor basal diameter, more SRF, higher ratio of macular involvement than other groups. A total of 38 (77.6 %) cases had good visual acidity with final BCVA ≥0.5 after treatments. PDT and PDT+TTT treatment groups acquired more vision improvement (0.27 ± 0.23 and 0.31 ± 0.26) in BCVA than TTT group (0.09 ± 0.13). All SRF were resolved within two weeks of treatment and no recurrent SRF were found. ConclusionThe three treatments showed good performance in improving visual function and controlling SRF, and individualized treatment should be selected primarily by the tumor location, and then the tumor size and presence of SRF.

The Clinical and Mutational Spectrum of Bardet-Biedl Syndrome in Saudi Arabia.

The retinal features of Bardet-Biedl syndrome (BBS) are insufficiently characterized in Arab populations. This retrospective study investigated the retinal features and genotypes of BBS in Saudi patients managed at a single tertiary eye care center. Data analysis of the identified 46 individuals from 31 families included visual acuity (VA), systemic manifestations, multimodal retinal imaging, electroretinography (ERG), family pedigrees, and genotypes. Patients were classified to have cone-rod, rod-cone, or generalized photoreceptor dystrophy based on the pattern of macular involvement on the retinal imaging. Results showed that nyctalopia and subnormal VA were the most common symptoms with 76% having VA ≤ 20/200 at the last visit (age: 5-35). Systemic features included obesity 91%, polydactyly 56.5%, and severe cognitive impairment 33%. The predominant retinal phenotype was cone-rod dystrophy 75%, 10% had rod-cone dystrophy and 15% had generalized photoreceptor dystrophy. ERGs were undetectable in 95% of patients. Among the 31 probands, 61% had biallelic variants in BBSome complex genes, 32% in chaperonin complex genes, and 6% had biallelic variants in ARL6; including six previously unreported variants. Interfamilial and intrafamilial variabilities were noted, without a clear genotype-phenotype correlation. Most BBS patients had advanced retinopathy and were legally blind by early adulthood, indicating a narrow therapeutic window for rescue strategies.

Causes of Vision Loss Associated with Dengue Fever in Bihar, India - A Case Series.

The incidence and geographic distribution of dengue has increased dramatically in recent years across various parts of the world. Previously, ocular findings in dengue fever were considered rare. We report a spectrum of ocular manifestations presenting with vision loss in the last dengue epidemic in an eastern state of India. This is a retrospective interventional case series of patients with vision loss who were diagnosed with dengue eye disease in the 2022 epidemic. Systemic and ophthalmic examinations were completed on all patients and were analyzed. Fifteen patients had presented with vision loss. The mean age was 41.7 ± 10.8 years, and patients were mostly males. Three patients presented with panophthalmitis and orbital cellulitis. Eight patients were diagnosed with optic neuropathy. Four patients had macular involvement: macular chorioretinitis, macular subhyaloid hemorrhage, and macular hemorrhages in two patients. All patients with optic neuropathy gave a history of mild fever and had remained undiagnosed. The rest had been diagnosed with the more severe dengue hemorrhagic fever. Vision recovered partially or fully in patients with optic neuropathy and macular disease. No eye could be salvaged in any panophthalmitis patients. Thrombocytopenia (platelet count <100 × 109 per liter of blood) was significantly associated with ocular hemorrhage and panophthalmitis, but thrombocytopenia was not significantly seen in optic neuropathy. We conclude that optic neuropathy may be an underreported cause of vision loss in dengue fever. An eye examination is advocated in all patients with dengue eye disease.

Characteristics of pseudophakic retinal detachment and risk factors of recurrence

BackgroundThe present study was designed to gain knowledge about the prognostic factors and evolution of pseudophakic retinal detachment (PRD) and to analyse the main characteristics of PRD, such as the mean time to retinal detachment following cataract surgery, as well as the clinical factors associated with the risk of recurrence and worse anatomical and functional outcomes. MethodsThis was a retrospective monocentric study of 330 patients with PRD who underwent surgery between 2012 and 2020. All patients were pseudophakic and were referred for retinal detachment surgery at Donostia University Hospital (Terciary Hospital, Spain). ResultsThe mean age of the patients at the time of phacoemulsification was 63.06 ± 10.8 years, and 49.09% of them had moderate myopia [axial length (AL) (23.5–26.5 mm)]. In our series, macular detachment was evident in 69.09% (n = 228) of the patients. The mean time that elapsed between phacoemulsification and PRD surgery was 4.04 ± 4.17 years, which was reduced by half in the event of surgical complications (2.24 ± 2.65). The rate of PRD was 28.79%. The anatomical results in terms of retinal reapplication were better with the combination of vitrectomy and scleral buckling (83.1% vs. 70.5%) (p = 0,127) compared with vitrectomy. The variables associated with a higher risk of recurrence were male sex (hazard ratio (HR) = 1.75), macular detachment (HR = 2.00) and the presence of proliferative vitreoretinopathy (PVR) (HR = 3.21). ConclusionsPRD usually occurs within 4 years of phacoemulsification, although it may occur significantly earlier in the event of surgical complications. Macular involvement, PVR, and male sex are all associated with a higher risk of PRD recurrence.

Ruthenium-106 (106Ru) plaque brachytherapy for treatment of circumscribed choroidal hemangioma.

To describe the clinical and imaging features of circumscribed choroidal hemangiomas (CCH) and their treatment outcomes with Ruthenium-106 (106Ru) plaque brachytherapy. Retrospective study of 24 patients (24 eyes) diagnosed with CCH and treated with 106Ru plaque between 2017 and 2022. Analysis included pre- and post-treatment clinical and imaging features such as tumor regression, reduction in height, subretinal fluid (SRF) resolution, and change in best-corrected visual acuity (BCVA). The mean age at presentation was 36 years (range, 16-57). The most common tumor location was the temporal quadrant (n = 19) with macular involvement (n = 13). Associated features were macular SRF (n = 22) and inferior exudative retinal detachment (n = 10). Nineteen of the 24 patients underwent primary treatment, whereas 5 patients underwent plaque as a salvage treatment. The mean tumor apex dose was 40 Gy. At a median follow-up of 7.5 months (range 3-65 months), 18 eyes showed complete regression, whereas 6 eyes showed partial regression. The mean height decreased from 4.8 (SD 1.28) mm at presentation to 2.5 (SD 1.63) mm. Median BCVA improved from logMAR 1.2 (IQR 0.4-2) at baseline to logMAR 1.05 (IQR 0.1-1.95) (p = 0.4). Complete resolution of the macula and tumor SRF was observed in 15 (68%) and 13 (57%) eyes, respectively. The radiation-related complications observed were radiation maculopathy (4 eyes), retinopathy (1 eye), and vitreous hemorrhage (1 eye). Ruthenium-106 plaque brachytherapy is effective for CCH (> 3 mm height) as a primary and salvage treatment for tumors unresponsive to other modalities.

Prediction of Visual Outcome After Rhegmatogenous Retinal Detachment Surgery Using Artificial Intelligence Techniques.

This study aimed to develop artificial intelligence models for predicting postoperative functional outcomes in patients with rhegmatogenous retinal detachment (RRD). A retrospective review and data extraction were conducted on 184 patients diagnosed with RRD who underwent pars plana vitrectomy (PPV) and gas tamponade. The primary outcome was the best-corrected visual acuity (BCVA) at three months after the surgery. Those with a BCVA of less than 6/18 Snellen acuity were classified into a vision impairment group. A deep learning model was developed using presurgical predictors, including ultra-widefield fundus images, structural optical coherence tomography (OCT) images of the macular region, age, gender, and preoperative BCVA. A fusion method was used to capture the interaction between different modalities during model construction. Among the participants, 74 (40%) still had vision impairment after the treatment. There were significant differences in age, gender, presurgical BCVA, intraocular pressure, macular detachment, and extension of retinal detachment between the vision impairment and vision non-impairment groups. The multimodal fusion model achieved a mean area under the curve (AUC) of 0.91, with a mean accuracy of 0.86, sensitivity of 0.94, and specificity of 0.80. Heatmaps revealed that the macular involvement was the most active area, as observed in both the OCT and ultra-widefield images. This pilot study demonstrates that artificial intelligence techniques can achieve a high AUC for predicting functional outcomes after RRD surgery, even with a small sample size. Machine learning methods identified The macular region as the most active region. Multimodal fusion models have the potential to assist clinicians in predicting postoperative visual outcomes prior to undergoing PPV.