Neurosensory Retinal Detachment Research Articles

Intravitreal Ranibizumab for Acute Central Serous Chorioretinopathy

Background/Aims: To evaluate the effectiveness of intravitreal ranibizumab injection (IVRI) for acute central serous chorioretinopathy (CSC). Methods: Patients with symptomatic CSC of less than 3 months were prospectively recruited. Patients (n = 20/group) were randomly assigned to IVRI (0.5 mg/0.05 ml) or observation and followed for 6 months. logMAR best-corrected visual acuity (BCVA), fluorescein angiography, indocyanine angiography, and central foveal thickness (CFT) were assessed at baseline and at regular follow-ups. Results: All patients had increased BCVA, decreased CFT, and resolution of the neurosensory detachment. Complete resolution of neurosensory retinal detachment required more time in the observation group (13.0 ± 3.1 vs. 4.2 ± 0.9 weeks; p < 0.001). Mean BCVA and mean CFT improved significantly in both groups, but the changes were not significantly different between groups at 6 months. Conclusions: IVRI for acute CSC might hasten resolution of neurosensory detachment compared to observation alone. At 6 months, BCVA and CFT did not differ between IVRI and observation groups. Further studies are required to determine the long-term benefits of IVRI.

Characteristic SD-OCT Findings in Preeclampsia

High-resolution spectral-domain optical coherence tomography of a patient affected by acute macular edema secondary to preeclampsia is described. The particular optical coherence tomography pattern was characterized by bilateral macular edema with a tent-shaped organization, associated with massive neurosensorial retinal detachment. Many hyperreflective irregular dots were evident in the context of a subfoveal clear cystic lesion. A different hyperreflective irregularity was detected in the retinal pigment epithelium. The central role of spectral-domain optical coherence tomography among instrumental imaging procedures and for final successful diagnosis in this particular macular edema is emphasized.

Retinal involvement in nephrotic syndrome secondary to minimal change disease

Nephrotic syndrome is a kidney disorder characterized by loss of different plasmatic proteins resulting in different peripheral tissue edemas. No ocular complications have been reported in nephrotic syndrome secondary to primary glomerular disease. A 24-year-old woman was referred to emergency service for acute generalized edema, associated with bilateral visual impairment and metamorphopsia. A diagnosis of nephrotic syndrome was made. The patient was treated with diuretic therapy. At first ophthalmologic evaluation, the woman presented best-corrected visual acuity of 20/32 in the right eye and 20/40 in the left eye and a dome-shaped bilateral neurosensorial retinal detachment and macular edema studied with spectral-domain optical coherence tomography. The patient underwent furosemide treatment. At follow-up evaluation 6 days later, best-corrected visual acuity improved to 20/20 in both eyes and restoration of normal retinal anatomy was demonstrated. Sequestration of interstitial fluids, which leads to classic generalized edema in nephrotic syndrome, could be the origin of interstitial accumulation of fluids in the retinal layers.

Multiple retinal arterial macroaneurysms associated with submacular hemorrhage

To present the unusual case of multiple retinal arterial macroaneurysms (RAMs) associated with an extensive submacular hemorrhage. A 64-year-old hypertensive woman is presented including the clinical findings, fluorescein angiography, and optical coherence tomography. The patient presented with 20/200 vision due to a dense submacular hemorrhage in the right eye. Fluorescein angiography revealed 4 hyperfluorescent lesions along the inferotemporal arteriole corresponding to RAMs. Optical coherence tomography confirmed RAM rupture with no choroidal abnormality. The patient refused surgical intervention. At 3-month follow-up, vision had improved to 20/70 with partial resolution of the hemorrhage. However, vitreoretinal traction with neurosensory retinal detachment involving the macula had developed. Acquired RAMs are typically found as unilateral solitary lesions in older hypertensive women. The presence of 4 RAMs along the same arteriole has not been reported previously. Hypertensive patients should be examined regularly in order to detect potential RAMs early enough to permit treatment and prevent vision loss.

The Efficacy of Intravitreal Bevacizumab Injection in Patients with Acute Central Serous Chorioretinopathy

• Central serous chorioretinopathy (CSC) is one of the most common diseases of the posterior segment of the eye characterized by serous detachment of the neurosensory retina and frequently causes mild to moderate visual impairment. • The mechanism for the development of CSC remains unclear. It is likely that choroidal hyperpermeability is an early event in the development of symptomatic CSC where, under the appropriate circumstances, it may lead to retinal pigment epithelial detachment followed by neurosensory retinal detachment.

Spectral domain OCT versus time domain OCT in the evaluation of macular features related to wet age-related macular degeneration

BackgroundThe aim of this study was to compare the agreement between spectral domain optical coherence tomography (SD OCT) and time domain stratus OCT (TD OCT) in evaluating macular morphology alterations in wet age-related macular degeneration (AMD).MethodsThis retrospective study was performed on 77 eyes of 77 patients with primary or recurring subfoveal choroidal neovascularization secondary to AMD. All patients underwent OCT examination using Zeiss Stratus OCT 3 (Carl Zeiss Meditec Inc, Dublin, CA) and Opko OTI Spectral SLO/OCT (Ophthalmic Technologies Inc, Toronto, Canada). In all radial line scans, the presence of intraretinal edema (IRE), serous pigment epithelium detachment (sPED), neurosensory serous retinal detachment (NSRD), epiretinal membrane (EM), inner limiting membrane thickening (ILMT), and hard exudates (HE) were evaluated. The degree of matching was quantified by Kappa measure of agreement.ResultsThe percentage distribution of TD OCT findings versus SD OCT findings was: IRE 36.3% versus 77.9%, sPED 57.1% versus 85.7%, NSRD 38.9% versus 53.2%, EM 10.5% versus 26.3%, ILMT 3.8% versus 32.4%, and HE 6.4% versus 54.5%. The agreement was as follows: sPED: kappa value 0.15; NSRD: kappa value 0.61; IRE: kappa value 0.18; EM: kappa value 0.41; ILMT: kappa value 0.02; HE: kappa value 0.06.ConclusionThe agreement in the evaluation of macular lesions between the two techniques is poor and depends on the lesion considered. SD OCT allows better detection of the alterations typically related to choroidal neovascularization such as IRE, PED, ILM thickening, and HE. Consequently its use should be strongly considered in patients with wet AMD.

A Case of Idiopathic Central Serous Chorioretinopathy in a 12-year-old Male Treated with Bevacizumab

A 12-year-old male presented with a chief complaint of a 1-month-history of decreased visual acuity in his right eye. The patient had no past history of steroid use or other systemic diseases. On fundus examination, which included fluorescent angiography (FAG) and optical coherence tomography (OCT), the patient was diagnosed with idiopathic central chorioretinopathy, whose clinical course was monitored without any specific treatments. At the time of admission, the best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. On fundoscopy, a serous detachment of 1 disc diameter in size was observed in the posterior pole. According to the FAG and the OCT, serous neurosensory detachment was present. After two months of monitoring the clinical course, the best corrected visual acuity in the right eye was 0.8, and there was improvement of neurosensory retinal detachment. However, OCT detected recurrence after five months, and the corrected visual acuity was decreased to 0.6. Bevacizumab was then injected into the vitreous cavity. Complete resolution of the subretinal fluid resulted eight months later, and the corrected visual acuity improved to 1.0.

An Update in Laser and Pharmaceutical Treatment for Polypoidal Choroidal Vasculopathy.

Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelium detachment and neurosensory retinal detachment due to abnormal choroidal polypoidal lesions. Polypoidal choroidal vasculopathy is particularly prevalent in Asians and occurs in up to 30% of patients presenting with neovascular age-related macular degeneration. In recent years, various treatment modalities have been described in the literature for the treatment of PCV. This review article aims to provide an overview and to summarize the current nonsurgical treatment for PCV.

Apical atrophy of retinal pigment epithelial detachments in central serous chorioretinopathy.

To describe a presumed precursor stage of central serous chorioretinopathy (CSC). Two patients were identified during follow-up study of patients with CSC or CSC-related conditions. Two patients first seen with retinal pigment epithelial detachment subsequently developed findings compatible with CSC. A juxtafoveal retinal pigment epithelial detachment with apical atrophy of the retinal pigment epithelium with corresponding severe attenuation of the pigmentation of the retinal pigment epithelium was observed in both patients. One of the patients presented with a serous neurosensory retinal detachment with smokestack leakage 7 years after first being seen. The other patient was never seen with a neurosensory detachment. Isolated pigment epithelial detachment with apical retinal pigment epithelial atrophy may represent a precursor stage of CSC.

Neurosensory retinal detachment due to sunitinib treatment

Sir, Sunitinib is an oral inhibitor of various tyrosine kinases as well as vascular endothelial growth factor receptors 1 to 3.1, 2 Sunitinib is used to treat metastatic renal cell carcinoma (RCC). Here we describe, for the first time, a neurosensory retinal detachment due to sunitinib treatment.

Single-session combined photodynamic therapy with verteporfin and intravitreal anti-vascular endothelial growth factor therapy for chronic central serous chorioretinopathy: a pilot study at 12-month follow-up

To report the anatomic and functional outcomes of a single-session combined photodynamic therapy with verteporfin (PDT) and intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) in patients with chronic central serous chorioretinopathy (CCSCR). Retrospective interventional comparative case series of eyes with symptomatic CCSCR (duration ≥ 4 months) and macular neurosensory retinal detachment (MNSRD). The study group, eight eyes (six patients), received a single session of combined full-fluence PDT and IVT anti-VEGF [bevacizumab (2.5 mg), four eyes; pegaptanib sodium [0.3 mg], four eyes). A matched control group, ten eyes (seven patients), treated with full-fluence PDT alone, was included. All patients had 12 months of follow-up. The mean CCSCR duration was 12.5 ± 14.2 months (range: 4-47 months) in the study group. In the control group, the mean CCSCR duration was 15.3 ± 7.5 months (range: 4-24 months). In the study group, the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 0.6 (20/80) to 0.2 (20/30) (P = 0.011). Central macular thickness (CMT) measured by optical coherence tomography (OCT) decreased from 288.4 μ (range: 165-375 μ) at baseline to a CMT of 163.1 μ (range: 120-200 μ) (P = 0.005) at 12 months. In the control group, the mean logMAR BCVA improved from 0.7 (20/100) to 0.6 (20/80) (P = 0.43). CMT decreased from 332.9 μ (range: 171-495 μ) at baseline to a CMT of 213.1 μ (range: 133-307 μ) (P = 0.002) at 12 months. At 12 months, MNSRD resolved completely in eight eyes (100%) and in seven eyes (70%), in the study group and the control group respectively. In the control group, four eyes (40%) required more than one PDT session (mean: 2.6 sessions; range: 2-4) due to persistent MNSRD. Retinal pigment epithelium (RPE) atrophy changes but no leakage were seen by fluorescein angiography in all eight eyes (100%) in the study group, and in three out of ten eyes (30%) in the control group. No systemic adverse events were observed. Combined PDT and IVT anti-VEGF therapy seems to aid in the resolution of MNSRD in patients with CCSCR. Combination therapy was associated with a rapid reduction in MNSRD and improvement in BCVA with no recurrences at 12 months. However, combination therapy with full-fluence PDT has the potential to accelerate RPE atrophy, and this needs further study.

Value of Three-Dimensional Optical Coherence Tomography and Fundus Photochromy in Correlating the Fluorescein Leaking Sites of Acute Central Serous Chorioretinopathy

Objectives: This study was designed to investigate the value of 3-D optical coherence tomography (3-D OCT) combined with fundus photochromy in the diagnosis of acute central serous chorioretinopathy (CSCR). Subjects and Methods: 3-D OCT and fundus photochromy were performed on 30 patients (36 eyes) with acute CSCR. Fluorescein angiography (FA) was also performed to confirm the diagnosis and to obtain the fluorescein leakage sites. Results: 22 eyes presented neurosensory retinal detachment determined by 3-D OCT (28 leakage spots), 1 eye showed retinal pigment epithelium (RPE) detachment (2 leakage spots), and 13 eyes showed both neurosensory and RPE detachment (17 leakage spots). 3-D OCT showed significant changes in the RPE in 36 of 47 leakage spots (76.6%). Fundus photochromy showed white-gray changes in 22 of the 47 leakage spots (59.6%). 47 leakage spots were identified by FA in 36 eyes. The combination of 3-D OCT and fundus photochromy identified 42 of the 47 leakage spots (89.4%) spotted by FA. Conclusion: A combination of 3-D OCT and fundus photochromy offered a high identification rate of the leakage spots. The combination of the two noninvasive techniques may be used as an alternative diagnostic or evaluation tool for acute CSCR.

Epiteliopatía pigmentaria placoide posterior aguda de presentación atípica

Clinical case A 35-year-old male with rapid loss of vision of his left eye. He complained of a flulike syndrome one week before the beginning of the symptoms. At the left posterior pole there was a white-yellowish subfoveal lesion associated with a subfoveal cyst and neurosensory retina detachment. We decided to initiate treatment with systemic corticosteroids and the sight improved after 4 weeks. Discussion Acute posterior placoid pigment epitheliopathy is a disease that typically affects young and healthy adults. It is generally self-limiting and has good visual prognosis. Sometimes the disease includes atypical features such as serous detachment of the neurosensory retina. In these cases we consider that the use of systemic corticosteroids would be necessary.

Neurosensory retinal detachment secondary to torpedo maculopathy

Background Torpedo maculopathy has been characterized as a congenital retinal pigment epithelial (RPE) nevus. Case A 38-year-old black woman presented with a chief complaint of intermittent floating spots in the right eye of 7 months' duration. Dilated fundoscopy found a “torpedo-shaped” lesion, with the tip of the lesion pointing toward the temporal macula. Visual field testing found a paracentral nasal defect, and optical coherence tomography (OCT) found a sensory retinal detachment. Conclusion This lesion was unique because of the visibly detectable alterations seen in the photoreceptor layer of the retina and retinal pigment epithelium (RPE) in the setting of what was confirmed as a neurosensory retinal detachment. Torpedo maculopathy, although benign, may be visually devastating if its neurosensory etiopatholgy involves the macula. Even so, it rarely requires intervention.

Effects of photodynamic therapy with verteporfin for the treatment of chronic central serous chorioretinopathy: An uncontrolled, open-label, observational study

Background: Central serous chorioretinopathy is an idiopathic disorder that leads to serous neurosensory retinal detachment. The disorder is usually self-limited and resolves spontaneously; however, sometimes neurosensory retinal detachment persists. This form of the disorder is called chronic central serous chorioretinopathy (CCSC). Objective: The aim of this study was to assess the effects of photodynamic therapy (PDT) on visual acuity with full-dose verteporfin for CCSC. Methods: The eyes of patients with CCSC were included in the study. Ophthalmic examination including best-corrected visual acuity (BCVA), fundus examination, fluorescein angiography, and optical coherence tomography was performed before treatment and at 1, 3, 6, 9, and 12 months. PDT with full-dose verteporfin (6 μ/m 2 of body surface area) was applied only to areas of active leakage. BCVA was converted to a log of the minimum angle of resolution (logMAR) equivalent for statistical analysis. Central foveal thickness and BCVA between baseline and follow-up were compared. Results: Seventeen eyes of 16 patients (13 males, 3 females; mean [SD] age, 39.75 [7.51] years; mean duration of follow-up, 13.06 [1.82] months) were used in the study. The mean (SEM) logMAR BCVA was 0.26 (0.07) at baseline and 0.04 (0.02) at 12 months. Mean logMAR BCVA values at baseline (0.259) and after treatment (0.112, 0.053, 0.047, 0.041, and 0.041 at 1, 3, 6, 9, and 12 months, respectively) differed significantly ( P = 0.006, P = 0.005, P = 0.005, P = 0.005, and P = 0.005). There was a significant difference in the mean central foveal thickness at the final visit (169 μm) compared with the baseline value (383 μm; P < 0.001). BCVA decreased in one eye (20/20 vs 20/25) and persisted during follow-up; in the other 16 eyes, BCVA either increased (n = 10) or remained stable (n = 6). Conclusions: In this small, open-label study, patients with CCSC treated with a single course of PDT with full-dose verteporfin had significant improvement from baseline in BCVA and resolution of subretinal fluid accumulation and active leakage. Treatment was generally well tolerated, but one patient had worsening in BCVA.

The Short-term Effect of Intravitreal Bevacizumab for Treatment of Central Serous Chorioretinopathy

Purpose: To determine whether intravitreal bevacizumab is effective for the treatment of central serous chorioretinopathy. Methods: We retrospectively examined 42 eyes after intravitreal bevacizumab (1.25 mg) injection for central serous chorioretinopathy. After 1 month, improvement of vision and change in sensory retinal detachment were evaluated with a fundus examination and optical coherence tomography. Results: The mean duration of symptoms was 3.92.31 months. After intravitreal bevacizumab injection, mean best corrected visual acuity improved from 0.530.31 to 0.720.29 at 1 month. In addition, neurosensory retinal detachment disappeared in 32 patients (76.2%). Five patients among ten who did not show improvement of neurosensory retinal detachment underwent reinjection of bevaczumab, and three of those reinjected showed the resolution of neurosensory retinal detachment at another 1 month. No improvement was seen among the patients who did not undergo reinjection. Conclusions: Intravitreal bevacizumab injection appears to have a short-term benefit for the treatment of central serous chorioretinopathy.

A Case of Central Serous Chorioretinopathy Associated With Retinal Detachment Improved by Intravitreal Bevacizumab Injection

Purpose: To report a case of chronic central serous chorioretinopathy treated with an intravitreal injection of 2.5 mg of bevacizumab. Case summary: A 38-year-old male complained of visual disturbance in the right eye. He had a history of central serous chorioretinopathy which improved without treatment. Since the patient did not feel any ocular discomfort, he did not visit our clinic for approximately 11 months. At the time of presentation, fundus examination revealed exudative retinal detachment involving the macular area. Additionally, fluorescein angiography revealed multiple early phase hyperfluorescent lesions. Neurosensory detachment around the macula and increased central macular thickness were also observed using optical coherence tomography. Under the diagnosis of chronic central serous chorioretinoapthy, the patient was treated with 2.5 mg of intravitreal bevacizumab. Visual acuity improved two months after treatment, with improvement in both neurosensory retinal detachment and fluorescein leakage. No changes were observed at the six-month follow-up.

Atypical manifestations of acute posterior placoid pigment epitheliopathy

Clinical caseA 35-year-old male with rapid loss of vision of his left eye. He complained of a flulike syndrome one week before the beginning of the symptoms. At the left posterior pole there was a white-yellowish subfoveal lesion associated with a subfoveal cyst and neurosensory retina detachment. We decided to initiate treatment with systemic corticosteroids and the sight improved after 4 weeks. DiscussionAcute posterior placoid pigment epitheliopathy is a disease that typically affects young and healthy adults. It is generally self-limiting and has good visual prognosis. Sometimes the disease includes atypical features such as serous detachment of the neurosensory retina. In these cases we consider that the use of systemic corticosteroids would be necessary.

Clinical findings in unilateral acute idiopathic maculopathy

We report a case of unilateral acute idiopathic maculopathy (UAIM) with new clinical findings. A 34-year-old Japanese man had a neurosensory retinal detachment (approximately 5 disk diameters) with yellowish-white exudates at the macula in the left eye (visual acuity (VA) 0.4). Fluorescein angiography (FA) showed early hypofluorescent spots and late pooling in the subretinal space. Three weeks after onset, indocyanine green angiography (IA) showed numerous hypofluorescent spots at the lesion. Optical coherence tomography (OCT) showed subretinal fluids and an elevated choroidal lesion with low reflectivity, suggesting choroidal edema. The VA and fundus appearance spontaneously resolved without treatment three months after onset. The VA was 1.0 six months after onset. Irregular pigmentation remained at the macular lesion. The main UAIM pathology may be outer retinal layer and retinal pigment epithelial inflammation. FA, IA, and OCT suggested that choroidal inflammation may be involved in the pathogenesis of UAIM.

Combined therapy for retinal angiomatous proliferation with intravitreal triamcinolone and argon laser photocoagulation

The occurrence of retinal neovascularisation at the macula in age-related macular degeneration (AMD) was described by Hartnett et al.1 Yannuzzi et al coined the term “retinal angiomatous proliferation” (RAP) to...