Neurosensory Retinal Detachment Research Articles

Leaking beehive honey sign an unusual case of central serous chorioretinopathy

Central serous chorioretinopathy is the fourth most common retinopathy after age-related macular degeneration, diabetic retinopathy and branch retinal vein occlusion. It’s usually unilateral and affect young or middle-aged men with M: F - 3:1 whereas female tend to be older. It’s a common ocular disease characterized by decompensation of the retinal pigment epithelium, which results in neurosensory retinal detachment, serous pigment epithelium detachment, and retinal pigment epithelium atrophy. Early identification and treatment are needed to prevent complications. Conclusion: Patients may require early intervention to prevent loss of photoreceptor layer integrity. Though Majority of cases are self-resolving, mineralocorticoid antagonists can be given for faster resorption of subretinal fluid. Photo Dynamic Therapy may be required for cases of chronic Central Serous Chorioretinopathy.

VKH disease in the elderly: Variations in clinical course as compared to VKH disease in adults.

To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) disease in elderly patients. Retrospective analysis of patients older than 50 years with VKH disease at two referral centers in India. Demographics, extraocular and ocular involvement, treatment, complications, and visual acuity outcomes were noted. In total, 69 patients (mean age at presentation: 56.4 ± 4.7 years) were analyzed; 6/69 patients had diabetes mellitus at presentation, and 10/69 had hypertension. Clinical signs included anterior chamber cells >2+ (29%), granulomatous keratic precipitates (23%), disc hyperemia (26%), neurosensory retinal detachment (34.7%), and "sunset-glow" fundus (52.1%). Patients were classified as probable (n = 50, 72.4%), incomplete (n = 18, 26%), and complete VKH (n = 1, 1.4%). The mean follow-up period was 20.2 ± 19.4 months. Improvement in mean BCVA of (0.63 LogMAR, 6 Snellen lines) was noted on the last follow-up. Patients receiving systemic steroids with immunosuppressants ( P < 0.0001) had better visual outcomes at final follow-up compared to steroids alone ( P = 0.103). Eight patients (11.6%) had complications due to systemic immunosuppressants, and 17 patients (24.6%) developed diabetes mellitus or had worsening of diabetes while on systemic corticosteroids. Few patients presented with systemic manifestations in our cohort. Those treated with steroids and concurrent immunosuppressants had better outcomes. However, therapy with immunosuppressants was encountered with major dose-limiting complications in a significant number of elderly patients with VKH syndrome.

Incidental multiple myeloma in a patient with neuroretinitis: a case report

BackgroundNeuroretinitis is classically defined as a clinical triad of unilateral, painless vision loss, accompanied by optic disc edema and characteristic macular star formation. The causes of neuroretinitis can be categorized as infectious, non-infectious, and idiopathic, therefore differential diagnosis and careful evaluation are required, owing to the various etiologies and masqueraders.Case presentationA 54-year-old woman presented to the clinic with blurred vision in both eyes. A complete ophthalmic examination revealed optic disc edema with blurred margins and macular exudates, intraretinal edema in the temporal peripapillary area, and subretinal fluid with neurosensory retinal detachment in the macular area. Systemic laboratory investigations showed no signs of infection or inflammation. However, bone marrow suppression was suspected based on the results of the complete blood count test, and the patient was diagnosed with multiple myeloma.ConclusionAlthough neuroretinitis is rarely accompanied by hematological malignancy, it is important to be mindful of the latter because ophthalmic manifestations are a common feature of hematological malignancies and lesions occur in nearly every ocular structure.

The additive effect of intravitreal dexamethasone combined with bevacizumab in refractory diabetic macular edema

PurposeTo evaluate the short-term structural and visual outcomes and side effects associated with intravitreal dexamethasone (IVD) combined with bevacizumab (IVB) in treating patients with diabetic macular edema (DME) and an inadequate response to anti-vascular endothelial growth factor (anti-VEGF) agents. MethodsIn this prospective interventional case series, a total of 81 eyes of 81 patients with type 2 diabetes mellitus (T2DM) and refractory DME were included and assigned to one of two groups: I) those receiving three monthly intravitreal injections of combined bevacizumab and dexamethasone (IVB+IVD) and II) those receiving three monthly intravitreal injections of bevacizumab alone (IVB). The primary outcome was the inter-group difference in central macular thickness (CMT); secondary outcomes included best-corrected visual acuity (BCVA), baseline optical coherence tomography (OCT) biomarkers, and intraocular pressure (IOP) one month after the last injection. ResultsReduction in CMT and improvement in BCVA were significantly greater in the IVB+IVD group than the IVB group (109.88±156.25 vs. 43±113.67, respectively, P=0.03; and −0.13±0.23 vs. −0.01±0.17, respectively, P=0.008). Presence of neurosensory retinal detachment (NSD) (P<0.001) and complete inner segment/outer segment junction (IS-OS) disruption (P=0.049) on baseline OCT scans were associated with further CMT reductions in response to IVD. Conversely, identifiable epiretinal membrane (ERM) (P=0.002) and multiple hyperreflective foci (>20) (P=0.049) were associated with smaller reductions in CMT. Vitreomacular traction correlated with worse visual outcomes in the IVB+IVD group (P=0.003). The intergroup IOP difference was not clinically significant. ConclusionIn patients with refractory DME, addition of IVD to the standard IVB regimen can improve visual and structural outcomes without increasing the risk of endophthalmitis, IOP rise, or intraocular inflammation. Patients with NSD are more likely to respond well to IVD. The presence of ERM may predict poor treatment response.

Bacillary Layer Detachment after Photodynamic Therapy for Central Serous Chorioretinopathy.

To report the clinical and optical coherence tomography (OCT) findings of a patient with chronic central serous chorioretinopathy (cCSC) who developed a short-term bacillary layer detachment after photodynamic therapy. A 56-year-old man presented with metamorphopsia and 20/100 visual acuity in his right eye. He was diagnosed with active, chronic central serous chorioretinopathy based on clinical findings and multimodal imaging. His visual problems and retinal findings persisted for three months before he was treated with half-fluence, half-dose verteporfin photodynamic therapy. The patient had a prominent decrease in his vision post-operatively. Two days after treatment, multimodal imaging showed a marked increase in exudation that merged preoperative neurosensory retinal detachments. A prominent subfoveal bacillary layer detachment was also present. The subretinal fluid and bacillary layer detachment resolved over the next eight weeks, with a return of visual acuity to its baseline level and normalization of retinal structures except for a small zone of subfoveal ellipsoid zone and interdigitation zone disruption. Half-fluence, half-dose verteporfin photodynamic therapy caused a fulminant increase in subretinal fluid and an associated subfoveal bacillary layer detachment. We hypothesize that cCSC-related chorioretinal dysfunction contributed to the severe PDT-induced local inflammatory reaction that caused the patient's bacillary layer detachment. Hyperacute choroidal exudation too fulminant for containment in subretinal space extended into and exceeded photoreceptor inner segment tensile strength, cleaving the myoid layer and/or dissecting it from the ellipsoid layer. This finding broadens the causality spectrum of bacillary layer detachments and vision losses that can follow photodynamic therapy.

Выбор тактики лечения пациентов с хронической формой центральной серозной хориоретинопатии, осложненной пахихориоидальной неоваскулопатией

Purpose. To identify the initial OCT parameters that allow determining the tactics of treating patients with chronic central serous chorioretinopathy complicated by pachychoroidal neovasculopathy. Material and methods. 73 patients (n = 73) with monolateral chronic form of central serous chorioretinopathy complicated by pachychoroidal neovasculopathy. All patients were given intravitreal angiogenesis inhibitors as initial therapy. Depending on the results of treatment, the patients were divided into groups: control – 39 (n = 39) patients with positive dynamics for the treatment used, the main group – 34 (n = 34) patients with the lack of the desired effect from intravitreal administration of angiogenesis inhibitors, who were treated of combined treatment with the connection of subthreshold micropulse laser exposure. Initial OCT parameters which were different for both groups were being found. Results. In the main group, exacerbation of central serous chorioretinopathy had a greater impact than subactive choroidal neovascularization 1, that determined the positive result of combined treatment. Characteristic for the main group of OCT predictors were the thickness of the choroid more than 470 µm, the area of choroidal neovascularization type 1 less than 0.27 mm², the height of detachment of the neurosensory retina more than 310 µm. The initial OCT parameters, typical for patients in the control group, were the subfoveolar thickness of the choroid less than 470 µm, the area of the choroidal neovascular membrane more than 0.27 mm², and the maximum height of neurosensory retinal detachment less than 310 µm. In patients of this group, the prevailing element of the current clinical condition was the activation of type 1 of pachychoroidal neovascular membrane, which determined the favorable functional results of anti-VEGF therapy. Conclusion. During the study, OCT parameters were identified that make it possible to timely determine the tactics of treating patients with a chronic form of central serous chorioretinopathy complicated by pachychoroidal neovasculopathy. Keywords: chronic central serous chorioretinopathy, pachychoroidal neovasculopathy, optical coherence tomography

A variant of combined treatment for chronic central serous chorioretinopathy complicated by type 1 choroidal neovascularization

Purpose: to evaluate the effectiveness of combined treatment of chronic central serous chorioretinopathy (CSCRP) complicated by type 1 choroidal neovascularization (CNV) by subthreshold micropulse laser exposure (SMILE) and intravitreal injection of angiogenesis inhibitors ( IIAI). Material and methods. 37 patients (20 men and 17 women) with monolateral chronic recurrent CSCRP complicated by type 1 CNV, aged 35 to 57 (ave. 43.6 ± 6.7 yrs.) at the moment of first referral, were divided into two groups. The retrospective group included 15 patients (15 eyes) whose first phase of treatment consisted in IIAI (up to 5 injections with an interval of one month). Those who showed no treatment effect were given a SMILE procedure one day before the 6th injection. If neurosensory retinal detachment persisted, the combined treatment (SMILE + IIAI) was repeated monthly until the neurosensory retina could be fully attached, whereupon the patients were transferred to monotherapy with anti-VEGF injections, gradually increasing the interval between the injections. The main group included 22 patients (22 eyes), whose treatment began with a single IIAI. If no neurosensory retinal detachment resorption occurred, the patients received a SMILE procedure one day before the second IIAI injection. The combined treatment was repeated monthly until neurosensory retinal detachment completely resorbed, then the treatment continued with IIAI alone with a gradual increase of intervals between the injections. Results. The number of IIAI in the main group (5 to 8, ave. 6.1 ± 0.8) was significantly lower than in the retrospective group (8 to 10, ave. 8.8 ± 0.77). Best corrected visual acuity increased in both groups, but the main group showed a better central photosensitivity, which is associated with the faster reattachment of neurosensory retina. By the end of the follow-up period, the area of type 1 CNV, and the thickness of the choroid were significantly lower in the main group as compared to the retrospective group. The combined treatment did not cause a single case of complication. Conclusion. The proposed combination of laser exposure followed by IIAI is a safe method for treating complicated forms of CSCRP, which quickens the resorption of subretinal fluid and reduces the number of treatment procedures.

ASSOCIATION BETWEEN CENTRAL SEROUS CHORIORETINOPATHY [CSCR] AND CORONARY HEART DISEASE [CHD] IN PATIENTS ATTENDING THE OUTPATIENT DEPARTMENT OF REGIONAL INSTITUTE OF OPHTHALMOLOGY KOLKATA: A CASE CONTROL STUDY

Introduction: Central serous chorioretinopathy [CSCR] a disease characterized by localized and serous detachments of neurosensory retina with or without focal pigment epithelial detachments[PEDs] and altered retinal pigment epithelium[RPE].The disease is usually idiopathic and often resolves spontaneously with visual recovery, although occasionally neurosensory retinal detachment persists or relapses and leads to permanent damage of the retinal pigment epithelium [RPE] and photoreceptors with subsequent visual impairment.Aims: In this Study CSCR patients and a control group were evaluated for the presence of CHD by means of Electrocardiogram [EKG], and echocardiogram and by further investigations if needed. Materials and Methods:The Institution based retrospective case control study. This Study was conducted from 12 months at Department of OPD at Regional Institute of Ophthalmology, [RIO] and Kolkata. Result: In our study, case group 25 [12.5%] patients had CHD and in control group, 12 [6.0%] patients had CHD which was statistically signicant [p=0.0248]. Conclusion: We concluded that association between Central Serous Chorioretinopathy (CSCR) and Coronary Heart Disease [CHD] was statistically signicant. CSCR had a signicantly higher CHD rate than those without CSCR, indicating that CSCR may be a potential risk factor for the development of CHD

Disproportionately large neurosensory retinal detachment in diabetic retinopathy as a sign of diabetic choroidopathy

Neurosensory retinal detachment (NSD) is a component of diabetic retinopathy. It is associated with other features like diffuse retinal thickening and cystoid macular edema (CME). The present report describes imaging features and the outcome of disproportionately large NSD in the left eye of a 61-year-old lady having proliferative diabetic retinopathy. The NSD was accompanied by minimal intraretinal edema and a choroidal filling defect on fluorescein angiography. There was near complete resolution of NSD with intravitreal ranibizumab. Disproportionately large NSD with minimal intraretinal cystic changes may be considered as a sign of diabetic choroidopathy.

Choroidal Vascularity Index versus Choroidal Thickness as Biomarkers of Acute Central Serous Chorioretinopathy

Introduction: The aim of this study was to analyze the choroidal vascularity index (CVI) versus choroidal thickness (CT) as biomarkers in acute central serous chorioretinopathy (CSCR). Methods: In this multicenter retrospective, cross-sectional, noninterventional study carried out at Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Jules-Gonin, Lausanne, Switzerland; and Pittsburg University, USA. 40 eyes from 40 patients with acute CSCR, 40 eyes from 40 patients with keratoconus (KC), and 40 eyes from 40 healthy patients were included. The variables analyzed were age, CT, CVI, and the presence of neurosensory retinal detachment. CT and the CVI were obtained from a 12-mm horizontal single-line B-scan (Triton SS-OCT, Topcon Co., Japan). Blinded measurements of the subfoveal CT were performed manually by two independent investigators. The images of the choroid were automatically binarized using a validated algorithm, and a percentage of vascularity was calculated. Results: There were no significant differences in age between the three groups (ANOVA, p = 0.092). There were statistically significant differences in CT and the CVI (ANOVA, p < 0.001). After Bonferroni correction, pairwise analysis between CSCR group against the KC group showed no significant differences in age and CT (p = 0.10 and p = 0.27, respectively). CVI was statistically greater among CSCR patients (p = 0.03). Conclusion: CT does not meet the criteria to be considered a biomarker of acute CSCR, while CVI may prove to be a more specific and reliable biomarker. Further studies with larger sample sizes, standardized procedures, and a wider representation of all CSCR stages are necessary to confirm the validity of CVI as biomarker in this disease. Further studies with larger samples are required in order to validate the use of CVI/CT correlation as a new biomarker.

Morphological integrity of the outer retinal layers and visual prognosis in chronic central serous chorioretinopathy after half-dose photodynamic therapy: a qualitative SD-OCT analysis.

The study aims to investigate the morphological integrity of the outer retinal layers (ORLs) (an ellipsoid layer (EL) + external limiting membrane) and visual prognosis in chronic central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) completely resorbed after half-dose photodynamic therapy (HD PDT) using enhanced-depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). This retrospective study included 40 eyes of 38 chronic CSCR patients treated with HD PDT between December 2012 and June 2016. However, only 34 eyes (85%) with complete SRF resorption 3months after HD PDT had their 6th and 12th month data analyzed. Morphological integrity of the ORLs was further analyzed in relation to best-corrected visual acuity (BCVA) and disease duration. Thirty-four eyes of 34 patients (male/female: 82.35/17.65%) with mean age of 49.90 ± 7.80 (32-61) years were studied. The mean logMAR BCVA improved significantly from 0.52 ± 0.31 at baseline to 0.34 ± 0.36 and 0.26 ± 0.26 at the 6th and 12th months after HD PDT, respectively (p < 0.001). The proportion of eyes with completely normal morphological ultrastructural integrity of the ORLs was 44.12% at the 6th month, which increased to 64.71% at the 12th month after HD PDT. However, the EL morphological disruption was associated with significantly lower mean logMAR BCVA 12months after HD PDT (p = 0.029). The disease duration had no effect on mean logMAR BCVA gain. Even after complete resorption of serous neurosensory retinal detachment after HD PDT in chronic CSCR, the ORLs, especially the EL, may not be anatomically restored. The EL morphological ultrastructural integrity seems to be the most important factor influencing visual prognosis.

Central serous chorioretinopathy and angioid streaks: coincidental?

BackgroundTo report an unusual case of central serous chorioretinopathy in a patient with angioid streaks.Case presentationThe authors describe a case report of a 26-year old male patient presenting acute scotoma and metamorphopsia in OD. He had been diagnosed with angioid streaks complicated with choroidal neovascularization and referred to us for treatment. The patient presented an ETDRS score of 85 letters (20/20) in OD and in OS. The anterior segment examination was unremarkable. Fundoscopy revealed bilateral angioid streaks (AS) and peau d’orange, as well as a small neurosensory retinal detachment in the macula of OD. A multimodal retinal analysis, including fundus photography, infra-red and fundus autofluorescence imaging, spectral-domain optical coherence tomography, optical coherence tomography angiography, fluorescein and indocyanine green angiography was performed. The diagnosis of central serous chorioretinopathy was made in the absence of any identifiable choroidal neovascularization. He was submitted to half-dose photodynamic therapy with verteporfin. One month later, he reported no visual complaints, his vision was 85 letters (20/20) in OD and a complete resolution of the sub-retinal fluid was registered. No signs of choroidal neovascularization were detected on the optical coherence tomography angiography (OCTA). A complete medical workup evaluation was made to exclude systemic diseases usually associated with AS.ConclusionsTo the authors’ knowledge, this is the second reported case of CSC associated with angioid streaks. The focal abnormalities in the Bruch’s membrane and the irregular vascular choriocapillary network associated with AS might predispose to CSC.

Alternative management of central serous chorioretinopathy using intravitreal metoprolol

BackgroundBeta-blockers may counteract the effect of catecholamines on central serous chorioretinopathy (CSC) pathology and accelerate the improvement of neurosensory retinal detachment. Oral propranolol has been associated with decreased duration of CSC in some studies. We describe two patients with visually symptomatic chronic CSC (cCSC) treated successfully with intravitreal metoprolol.Case presentationsAfter obtaining the patients’ informed consent, two eyes of two 43-year-old men diagnosed with cCSC treated unsuccessfully with oral spirolactone, micropulse laser and intravitreal anti‐vascular endothelial growth factor (anti-VEGF) agents were treated with one off-label intravitreal injection of metoprolol (50 µg/0.05 ml). Baseline (pre-injection) and follow-up examinations (at 1 month post-injection) included best-corrected visual acuity (BCVA), anterior and posterior segment biomicroscopy, fundus autofluorescence, spectral domain optical coherence tomography (Spectralis, Heidelberg), and electroretinogaphy (ERG) according to International Society for Clinical Electrophysiology of Vision (ISCEV) full-field scotopic and photopic standard protocols. ERG results at baseline (pre-injection) and at 1 month post-injection were compared using paired t-tests.ResultsThere was no significant difference in any of the ISCEV recommended ERG parameters with respect to a- and b-wave amplitude and implicit time, and oscillatory potentials maximal amplitude. BCVA improved in both patients. Neither patient developed clinical evidence of intraocular inflammation. Subretinal and/or intraretinal fluid had improved in both patients at 1 month after the metoprolol injection.ConclusionThese preliminary findings suggest that intravitreal metoprolol may be a safe alternative therapy for patients with cCSC.

Topical Nepafenac 0.1% or 0.3% for the Treatment of Central Serous Chorioretinopathy: A Case Series of Chronic and Recurrent Disease and Review of the Literature

Central serous chorioretinopathy (CSCR) is a disease involving leakage of serous fluid through the retinal pigment epithelium, resulting in neurosensory retinal detachment. The majority of acute CSCR cases resolve spontaneously. However, treatment options for chronic and recurrent cases are lacking. In this case series, topical nepafenac 0.1% and 0.3% were investigated as novel treatments for chronic and recurrent CSCR. We performed a retrospective case series analysis of six patients diagnosed with chronic recurrent CSCR. Data from patient medical records were collected, including age range, gender, subjective complaints, Snellen visual acuity (VA), clinical eye examination, central macular thickness (CMT) on optical coherence tomography, prior treatments, time of follow-up, and time to resolution of CSCR. The six cases of chronic and recurrent CSCR in this study were treated with 0.1% and/or 0.3% topical nepafenac. The mean age of the six cases was 52 years. There was an average gain in vision of 2.5 lines in Snellen VA, and a final Snellen VA of 20/20 was achieved in each case. The average time to complete resolution of CSCR was 3.33 months. The decrease in CMT ranged from 105 µm to 507 µm, with an average decrease of 240 µm, and subretinal fluid resolved completely in all the six cases.

Topical Nepafenac 0.1% or 0.3% for the Treatment of Central Serous Chorioretinopathy: A Case Series of Chronic and Recurrent Disease and Review of the Literature

Central serous chorioretinopathy (CSCR) is a disease involving leakage of serous fluid through the retinal pigment epithelium, resulting in neurosensory retinal detachment. The majority of acute CSCR cases resolve spontaneously. However, treatment options for chronic and recurrent cases are lacking. In this case series, topical nepafenac 0.1% and 0.3% were investigated as novel treatments for chronic and recurrent CSCR. We performed a retrospective case series analysis of six patients diagnosed with chronic recurrent CSCR. Data from patient medical records were collected, including age range, gender, subjective complaints, Snellen visual acuity (VA), clinical eye examination, central macular thickness (CMT) on optical coherence tomography, prior treatments, time of follow-up, and time to resolution of CSCR. The six cases of chronic and recurrent CSCR in this study were treated with 0.1% and/or 0.3% topical nepafenac. The mean age of the six cases was 52 years. There was an average gain in vision of 2.5 lines in Snellen VA, and a final Snellen VA of 20/20 was achieved in each case. The average time to complete resolution of CSCR was 3.33 months. The decrease in CMT ranged from 105 µm to 507 µm, with an average decrease of 240 µm, and subretinal fluid resolved completely in all the six cases.

Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies?

Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen–Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.

Central serous chorioretinopathy in uveitis patients after corticosteroid therapy: a report of 6 cases

Purpose. To report central serous chorioretinopathy (CSCR) in uveitis patients.Material and methods. A retrospective chart review of uveitis patients seen in a time frame of 20 years at the Centre for Ophthalmic Specialised Care, Lausanne, Switzerland. The ophthalmic and systemic features are presented.Results. Out of 1793 uveitis patients followed at the Centre for Ophthalmic Specialised Care, 6 patients (0.3%) developed CSСR following corticosteroid therapy due to uveitis. The mean age of patients was 40 ± 13.4 years, disease incidence was not associated with gender. In all 6 patients’ clinical disease was unilateral but subclinical signs were present in all fellow eyes. The mean duration of corticosteroid therapy before CSCR had occurred was 4.95 ± 4.0 months. The mean best-corrected visual acuity at the moment of CSCR was 0.6 ± 0.26 and 0.8 ± 0.17 after discontinuation of corticosteroids. Neurosensory retinal detachment and pigment epithelium detachment were observed in 3 eyes, respectively. During fluorescein angiography (FA), focal dye leakage and areas of alteration of RPE were observed in 6 out of 10 eyes. Diffuse hyperfluorescence of choroidal vessels observed by ICGA was detected in all eyes.Conclusion. Central serous chorioretinopathy should be suspected when functional and morphological deterioration occurs in uveitis patients receiving corticosteroid therapy with no signs of inflammation reactivation. This complication is extremely rare but serious condition which needs a prompt tapering and discontinuing of corticosteroids.

Contribution of Optical Coherence Tomography in the Diagnosis of Idiopathic Polypoidal Choroidal Vasculopathy in a Young Adult at Iota-Teaching Hospital

Introduction: Idiopathic polypoidal choroidal vasculopathy (IPCV) is a common cause of hemorrhage of the retinal pigmentary epithelium and neurosensory retinal detachment of oxidative origin. Its diagnosis is more easily made by Optical Coherence Tomography and Fluorescence Angiography or ICG. The aim of our work is to highlight the accuracy of OCT and AGF in the diagnosis of IPCV. We report a clinical case received in February 2019 in the vitreoretinal surgery and functional exploration of the visual apparatus department of the IOTA-Teaching Hospital. Case Report: A young man with a personal pathological history of arterial hypertension was referred to the department for macular OCT for central serous chorioretinitis. OCT and intravenous fluorescein angiography showed features of idiopathic polypoidal choroidal vasculopathy. The patient received anti-VEGF injections followed by significant visual improvement. Discussion: The pathogenesis of IPCV is not clearly elaborated, but it appears to be primarily due to an abnormality of choroidal vasculature. Conclusion: IPCV can occur in young subjects and leads to severe impairment of visual function. These severe visual impairments are resolved by the correct use of anti VEGF associated or not with the Argon laser.

English

BACKGROUND Optical Coherence Tomography (OCT) is a commonly used non invasive imaging instrument useful for the diagnosis and follow up of macular disorders, but it has its own share of drawbacks in the presence of media opacities like corneal oedema, dense cataract and vitreous haemorrhage. We wanted to study and interpret the various patterns of common macular diseases on optical coherence tomography. METHODS 100 patients having macular diseases with no other ocular pathology were selected by simple random sampling. The patients were studied and followed up from day 1 of OPD during the period from January 2019 to December 2019 in rural hospital at Latur. All patients suspected of any macular disorder by slit lamp bio-microscopy with 78D or 90D examination were subjected to OCT evaluation. RESULTS On observation, out of 100 cases of macular pathology, 44 % (44 patients) with age related macular degeneration(ARMD), diabetic macular oedema ( DME) 36 % (36 patients), central serous retinopathy (CSR) 10 % (10 patients), myopic maculopathy (MM) 7 % (7 patients), macular hole (MH) 3 % (3 patients) were found in our study. In ARMD patients our OCT findings were hard drusens in retinal pigment epithelium (RPE), detachment of neurosensory retina and retinal pigment epithelium whereas in patients of DME our OCT findings were cyst like hyporeflective spaces within the retina, with retinal thinning and loss of foveal depression. In patients of CSR our findings were separation of sensory retina from RP, in myopic maculopathy our OCT findings were presence of macular retinoschisis and in patients of MH our findings were showing attachment of the posterior hyaloids to the fovea, separation of a small portion of the sensory retina from RPE in the foveolar region and intraretinal cystic changes. CONCLUSIONS OCT plays a crucial role when added along with the clinical examination in the diagnosis and interpretation of common macular disorders. KEYWORDS Optical Coherence Tomography, Age Related Macular Degeneration, Macular Hole, Myopic Maculopathy

Vogt Koyanagi Harada Disease In Paediatric Age Group: Clinical Characteristics, Remission, Recurrences and Complications in Asian Indian Population

ABSTRACT Purpose To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) syndrome in paediatric patients. Study Design Retrospective chart analysis Methods: A retrospective Analysis of all patients ≤16 years with VKH syndrome was done. Clinical presentations, complications, recurrences and outcomes in cases of paediatric VKH were reviewed. Results 72 eyes of 36 patients with a mean age at presentation of 13.7 ± 2.34 years were assessed. Mean duration of symptoms and follow up were 9.88 ± 17.3 weeks and 55 months respectively. Clinical signs at presentation included anterior chamber cells >2+(34/72eyes, 47.2%), granulomatous keratic precipitates (6 eyes, 8.3%), posterior synechiae (35 eyes,48.6%), disc edema (46 eyes, 63.8%), neurosensory retinal detachments (44 eyes, 61.1%) and ‘sunset-glow’ fundus (9 eyes, 12.5%). Best corrected visual acuity (BCVA) at the time of presentation was 1.3logMAR or a Snellens equivalent of 20/400 which improved to 0.51logMAR (Snellens equivalent of 20/63) at last follow up. Remission was achieved in 61.1% cases. More than half of our patients developed one or more complications. Conclusion VKH in paediatric patients poses a challenge due to a delayed presentation and paediatric VKH patients have a worse visual acuity at the time of presentation as compared to adult age groups. Rates of remission may be low along with high risk of complications and hence there is a need for prolonged immunosuppression.