Peripheral Exudation Research Articles

Idiopathic Peripheral Retinal Telangiectasia in Adults: A Case Series and Literature Review

Idiopathic peripheral retinal telangiectasia (IPT), often termed as Coats disease, can present in a milder form with the onset in adulthood. The goal of this case series study and literature review was to describe and classify different presenting forms and treatment of this entity and to review contemporary methods of its management. Six cases of adult onset IPT were described with the following phenotypes based on fundus ophthalmoscopy, fluorescein angiography, and optical coherence tomography findings: IPT without exudates or foveal involvement, IPT with peripheral exudates without foveal involvement, IPT with peripheral exudates and cystoid macular edema, and IPT with peripheral and macular hard exudates. Treatments applied in this series included observation, laser photocoagulation, and anti-vascular endothelial growth factor (VEGF) treatment with variable outcomes depending upon the extent of IPT, the aggressiveness of laser treatment, and the stringency of follow-up. The accompanying literature review suggests that ablative therapies, especially laser photocoagulation, remain the most effective treatment option in adult-onset IPT, with anti-VEGF therapy serving as an adjuvant procedure. Close follow-up is necessary to achieve and maintain reasonable good visual and morphological results.

Migration of fish bones into abdominal para\u2010aortic tissue from the duodenum after leading to duodenal perforation: a case report

BackgroundMigration of fish bones into abdominal para-aortic tissue after penetrating the junction of 3rd and 4th part of duodenum is incredibly rare.Case presentationA 68-year-old man was admitted to our hospital with persistent colic in the lower abdomen after eating fish two weeks ago. Abdominal computed tomography (CT) scan showed High density streaks along the anterior and lower edges of the 3rd part of duodenum with peripheral exudation and localized peritonitis. Esophagogastroduodenoscopy didn’t find foreign bodies and perforations in the digestive tract. Laparoscopic surgery and intraoperative endoscopy were made to detect foreign bodies and perforation site was found. After transition to open surgery, the fish bone was found in abdominal para-aortic tissue and removed without complications. Postoperative recovery is smooth, and the patient resumed normal diet and was discharged.ConclusionsIt is difficult to choose a treatment plan for foreign bodies at the 3rd part of the duodenum, because it is difficult to judge the damage caused by the foreign body to the intestine and the positional relationship with the surrounding important organs. Conservative treatment or surgical treatment both have huge risks. The handling of this situation will extremely test the psychology, physical strength and professional experience of the surgeon.

Peripheral exudative haemorrhagic chorioretinopathy: a widefield imaging study

AimsTo study widefield imaging features, analyse risk factors for progression and compare treatment modalities of peripheral exudative haemorrhagic chorioretinopathy (PEHCR).MethodsClinical and imaging data from each visit were collected, including near-infrared...

Treatment Outcome of Acquired Retinal Pigment Epithelial Tumors with Rhuthenium-106 Plaque Radiotherapy

Purpose:To report the clinical outcome of rhuthenium-106 plaque radiotherapy in acquired retinal pigment epithelial (RPE) tumors.Methods:In this interventional case series, two eyes of two patients with clinically diagnosed ocular-acquired RPE tumors including adenoma and adenocarcinoma underwent plaque radiotherapy with rhuthenium-106. The clinical findings and visual outcome of the patients were evaluated.Results:The first patient was a 44-year-old male, and the second was a 32-year-old female. The follow-up times were 24 and 32 months. The tumor was unilateral and hyperpigmented in both cases, located at juxtapapillary in one patient and on peripheral part of the retina in the other. Vitreous hemorrhage and peripheral exudation were obvious in one patient. Macular edema, epiretinal membrane, and retinal feeder vessels were also detected in the examination. The patients underwent plaque radiotherapy with rhuthenium-106 as the first step of management. The tumor has been stable until the last follow-up in both patients with globe preservation and acceptable visual acuity (5/10 for the first case and 4/10 for the second case).Conclusion:Rhuthenium-106 plaque radiotherapy might be a conservative therapy in the management of acquired RPE tumors and prevent early enucleation.

G.P.111 Exudative retinopathy in facioscapulohumeral muscular dystrophy: When to screen? When to monitor? When to treat?

Abstract Visual loss caused by exudative retinal detachment is a rare but preventable association of FSHD. Underlying peripheral retinal vascular telangiectasis is however very common. Focal retinal hypovascularity may be a developmental abnormality parallel to aberrations in myogenesis. Since asymptomatic telangiectasis appears likely to remain static for many years, the question arises as to proper practice in relation to indirect ophthalmoscopic screening of FSHD patients, particularly children, and if and when to treat visualized exudates, which may track from the retinal periphery to the posterior pole. Accumulated international experience has demonstrated the efficacy of unusually aggressive and frequent treatment, typically with Laser photocoagulation directed at leaking vessels, even when vision is significantly impaired. However, once macular damage is established, visual loss may be irreversible. In advanced stages, painful glaucoma may lead to enucleation. Family follow-up now underlines the particular importance of reviewing patients from FSHD families with a history of overt retinal vascular disease. Two members of one family lost vision unilaterally in mid-life; only one seen early enough to treat successfully. Retinal abnormalities are (like the myopathy) asymmetrical; bilateral visual loss is rare but real. It is concluded that (i) severe and early-onset FSHD patients with clinical deafness are more likely to have treatable retinal exudates, and should be monitored closely, especially in early childhood. (ii) Retinal disease may present before muscle disease. (iii) Atypical cases of Coats Disease (e.g. when bilateral, in women, or in older patients) may justify genetic testing, with caution, for FSHD. (iv) All FSHD patients should have one indirect ophthalmoscopy examination and report unexplained visual symptoms immediately. (v) Peripheral exudates should be monitored closely, but exudates threatening the macula will mandate urgent treatment.

Periphere, exsudative hämorrhagische Chorioretinopathie: Klinische und angiografische Befunde

Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a degenerative disease of the peripheral retina and choroid in the elderly. Although PEHCR is often seen by clinicians, this entity is underrepresented in the ophthalmological literature. This may be due to inconsistent naming. We present the clinical, ultrasonographic and angiographic findings of 11 eyes of 8 patients who were diagnosed with PECHR in our department between January 2006 and June 2008. In addition, we report the intra- and postoperative course of three eyes that have been vitrectomised because of a vitreous haemorrhage associated with PEHCR. The mean age of the patients is 83.5 years (range: 75 - 95). The mean follow-up is 11 months (range: 0 to 20). The clinical and angiographic signs were dependent on the stage of the disease and may be seen as small asymptomatic peripheral subretinal bleeding and exudation. In advanced stages, vitreous haemorrhage and exudative retinal detachment may be observed. The temporal periphery of the fundus appears to be more often affected than other locations. Three patients were affected bilaterally. Vitreous haemorrhage was the reason for presentation in three eyes (27 %) that were treated successfully by vitrectomy. Peripheral exudative hemorrhagic chorioretinopathy should be considered in the differential diagnosis of vitreous haemorrhage and peripheral subretinal tumors in the elderly.

Coats’ disease and bilateral cataract in a child with Turner syndrome: a case report

To report the first case in which Coats' disease was observed with infantile cataract in a girl with Turner syndrome (TS). We examined a 4-year-old female infant with TS who was referred with a diagnosis of leukocoria in the left eye. Examination under anaesthesia revealed a bilateral punctate cataract and left eye fundus showed vascular retinal abnormalities typical of Coats' disease. Cryotherapy was performed on the telangiectatic vessels and the child was followed up for a period of 12 months. Despite cryotherapy resulting in regression of the peripheral exudates, an exudative maculopathy persisted with poor visual outcome. We suggest that Coats' disease should be considered as a rare ocular manifestation in TS.

Subfoveal nodule in Coats’ disease

An atypical presentation of Coats' disease is reported with a prominent subfoveal nodule with peripheral retinal exudates. A 6-year old boy presented with 6/120 vision in the left eye associated with an elevated 1 mm subfoveal, circular lesion with peripheral exudates. The fluorescein angiogram showed peripheral retinal telangiectasias with leakage consistent with Coats' disease. The prominent subfoveal nodule is an uncommon initial presentation of Coats' disease and physicians should be aware of this atypical finding.

A Fluorescem Angiographic Study of Patients with Pars Planitis and Peripheral Exudation (snowbanking) before and after Cryopexy

Transconjunctival cryopexy of the vitreous base is clinically effective in patients with steroid nonresponsive pars planitis who have peripheral neovascularization. Cryoablation of the region previously has been thought to eliminate the areas of permeable neovascular tissue, thus removing the focus of exudation. The authors report the first study of patients with refractory pars planitis in which fluorescein angiography of the inferior pars plana snowbanks was performed both before and after cryopexy of the vitreous base. Twelve consecutive phakic eyes with pars planitis and prominent peripheral snowbanks had fluorescein angiograms of the pars plana. Clinical involvement was graded on the basis of visual acuity, levels of vitreous inflammation and cystoid macular edema, and on the extent of peripheral snowbanking. Transconjunctival cryopexy of the vitreous base was performed. Fluorescein angiography of the pars plana snowbanks was repeated 2 months after the procedure, and clinical involvement again was graded. Early hyperfluorescence with late leakage was present in all eyes and was limited to the area of the pars plana snowbanks. After cryopexy of the vitreous base, all eyes demonstrated hypofluorescence and diminution of late-phase dye leakage in the treated areas. Eighty-three percent of all eyes demonstrated clinical improvement, consistent with previously reported studies. Cryopexy of the vitreous base decreases peripheral exudation in patients with refractory pars planitis and snowbanking. This suggests that elimination of peripheral neovascular tissue may be directly related to clinical improvement in these patients.