Persistent Scotoma Research Articles

The Characteristics of White Dot Syndromes Following SARS-COV-2 Infection: A Systematic Review.

To review all studies reporting the occurrence of white dot syndromes (WDSs) following SARS-COV-2 infection. On May 12, 2023, we registered our protocol on PROSPERO [registration number: CRD42023426012]. Five different databases including PubMed, Scopus, Web of Science, Google Scholar, and Science Direct were searched up to May 2023. We included all studies that reported the symptoms of WDSs following SARS-COV-2 infection. The data was extracted using a uniform Excel extraction sheet. All statistical tests were conducted with a 95% confidence interval and a 5% error margin. A p-value of less than 0.05 was considered statistically significant. The publication bias of included studies was assessed using JBI Critical Appraisal Checklist for Case Reports and IHE Quality Appraisal Checklist for Case Series studies. This review included thirty-two studies involving forty-eight patients. Acute macular neuroretinopathy was the most common disease (70.8%) followed by multiple evanescent white dot syndrome (14.6%) with 58.3% of WDS after their first SARS-COV-2 infection, and paracentral acute middle maculopathy (4.1%). They were mostly unilateral (56.2%). The presenting symptoms were blurred vision (70.8%), visual field disturbance (68.7%), and photopsia (20.8%). About 35.4% of the patients improved by their treatment and future complications were persistent scotoma (4.2%) and macular edema (2.1%). White dot syndromes are very rare entities. Our findings suggest a possible association between white dot syndrome onset and SARS-COV-2 infection. We recommend ophthalmologists should be aware of this suggested association to deliver better management and patients' care.

Acute Macular Neuroretinopathy after SARS-CoV-2 Infection: An Analysis of Clinical and Multimodal Imaging Characteristics.

This study aimed to analyze clinical and multimodal imaging characteristics of acute macular neuroretinopathy (AMN) post-recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Retrospective observational study. Medical records and multimodal imaging of 12 AMN eyes of eight patients (six female and two male) with recent SARS-CoV-2 infection were retrospectively analyzed. Four patients (50%) presented with bilateral AMN. Fundus ophthalmoscopy revealed a reddish-brown lesion around the macula, and two eyes had cotton-wool spots at the posterior pole. Three eyes showed mild hypo-autofluorescence. All FFA images (7 eyes) showed no abnormal signs. On OCT scans, all eyes showed outer nuclear layer (ONL) thinning, 8 eyes (66.7%) showed ONL hyperreflectivity, 5 eyes (41.7%) showed outer plexiform layer (OPL) hyperreflectivity, 8 eyes (66.7%) showed interdigitation zone (IZ) disruption, 11 eyes (91.6%) showed ellipsoid zone (EZ) disruption, 2 eyes (16.7%) showed cotton-wool spots and inner plexiform layer (IPL) hyperreflectivity, 1 eye (8.3%) had intraretinal cyst and 1 eye (8.3%) had inner nuclear layer (INL) thinning. Persistent scotoma, ONL hyperreflectivity and IZ/EZ disruption as well as recovery of OPL hyperreflectivity were reported after follow-up in three cases. AMN post-SARS-CoV-2 mostly affected young females and could present unilaterally or bilaterally. Dark lesions on IR reflectance and outer retinal hyperreflectivity on OCT are useful in diagnosing AMN. OPL/ONL hyperreflectivity on OCT could disappear after follow-up, but ONL thinning and IZ/EZ could persist.

Persistent monocular visual loss in migraine patients.

The relationship between migraine and vision is complex. Besides migraine aura status and persistent visual aura without infarction, recognized by International Headaches Classification 3, cases of persistent monocular alterations have been described in migraineurs. To discuss the role of migraine as a risk factor for persistent monocular visual loss. We present five new cases of persistent monocular visual loss in migraineurs, discuss the differential diagnosis and possible relationship with migraine. Five young healthy patients are reported (three women) with a history of migraine (four with visual aura), that developed persistent monocular visual defects, four during an episode of migraine with aura. All patients were submitted to an extensive investigation. In three patients the scotoma was identified on automated perimetry; one of these patients had retinal hemorrhagic lesions, with fluorescein angiography revealing an isolated retinal vasculitis. In two patients fundoscopy revealed transient cotton wools spots. Except for the patient with retinal vasculitis, etiologic investigation was not conclusive. Monocular visual loss can occur in the setting of multiple pathologies that affect the eye and related structures. Although diseases requiring emergent intervention should always be excluded, we propose migraine should be considered as a contributing factor for unexplained monocular persistent scotoma.Monocular visual loss can occur in the setting of multiple pathologies that affect the eye and related structures. Although diseases requiring emergent intervention should always be excluded, we propose migraine should be considered as a contributing factor for unexplained monocular persistent scotoma.

Clinical features of acute macular neuroretinopathy

Objective To observe the clinical features of acute macular neuroretinopathy (AMN). Methods Six patients (11 eyes) with AMN were included in this study, with every 2-week follow-ups till six months. Among them, five had preceding dengue fever (83.3%), one had history of head trauma (16.7%). All patients received routine examination, fundus photography, infrared reflectance (IR) imaging, spectral-domain optical coherence tomography (SD-OCT) scanning and fluorescein fundus angiography (FFA) initially, and fundus photography, IR, SD-OCT during follow-up. Results Sudden onset of central/paracentral scotoma in one eye or both eyes was the main visual symptom. There were 1 eye with normal fundus, 2 eyes with wedge-shape lesions, 8 eyes with yellow-white or brown sheet lesion. IR imaging demonstrated localized areas of hypo-reflection in the macula. SD-OCT scanning through these areas revealed hyper-reflection in the photoreceptor layer and disruption of its normal reflective structures. Subsequent SD-OCT demonstrated that the hyper-reflection of the photoreceptor layer regressed gradually, followed by thinning of the outer nuclear layer. The external limiting membrane and ellipsoid zone became continuous; however, the interdigitation zone was not restored. There was no remarkable findings of the AMN lesions on FFA. The scotomas persisted in all 6 patients (11 eyes) by the last visit. Conclusions IR imaging demonstrated localized areas of hypo-reflection in the macula. SD-OCT revealed hyper-reflection in the photoreceptor layer in acute stage and the interdigitation zone was not restored in late stage. AMN has a relative poor prognosis with persistent scotomas through at least 6 months. Key words: Macula lutea/injuries; Retinal diseases/ diagnosis; Disease attributes

Scotoma analysis of 10-2 visual field testing with a red target in screening for hydroxychloroquine retinopathy.

ObjectiveTo quantify the variability of scotomas detected by 10–2 visual field (VF) testing with a red target in patients taking hydroxychloroquine without and with retinopathy.DesignRetrospective review of clinical charts and VFs.MethodsTwenty-four patients taking hydroxychloroquine without retinopathy, and eight patients taking hydroxychloroquine with retinopathy were tested in this study. Retinopathy was defined by annular scotomas on 10–2 VF testing with corroborative spectral domain optical coherence tomographic outer retinal changes and multifocal electroretinographic changes leading to cessation of hydroxychloroquine or chloroquine. Location and depth of scotoma points on 10–2 VF testing were recorded and their fates followed in serial, reliable 10–2 VFs performed with a red target over time. The main outcome measures for this study were the number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.ResultsA median of 3, interquartile range (IQR) (2, 5), scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR (77, 100), of these resolved on the subsequent field. For patients with retinopathy, a median of 50%, IQR (46, 79), resolved, a difference compared to patients without retinopathy that was significant (P=0.0158). The median percentage of scotoma points in the zone from 2° to 8° from fixation in eyes with retinopathy was 72%, IQR (54, 100), compared to 49%, IQR (40, 54), in eyes without retinopathy (P=0.0069). The number of persistent scotoma locations at the last visit was higher in eyes with retinopathy: 3, IQR (1, 3), versus 0, IQR (0, 1), in patients without retinopathy, P=0.0156.ConclusionPoint scotomas are common and variable in 10–2 VF testing with a red target for hydroxychloroquine retinopathy in subjects without retinopathy. Scotoma points in eyes with retinopathy are less variable. The annular zone 2°–8° from fixation was useful for distinguishing the significance of scotoma points. Discriminating eyes with retinopathy from eyes without retinopathy is probably easier using the 10–2 VF with a white target than a red target.

Scotoma analysis of 10-2 visual field testing with a white target in screening for hydroxychloroquine retinopathy.

ObjectiveTo quantify the variability of scotomas detected by 10-2 visual field (VF) testing in patients taking hydroxychloroquine without and with retinopathy.DesignRetrospective review of clinical charts and visual fields.SubjectsTwenty-one patients taking hydroxychloroquine without retinopathy, and nine patients taking hydroxychloroquine and one patient taking chloroquine with retinopathy.MethodsRetinopathy was defined by annular scotomas on 10-2 VF testing with corroborative spectral domain optical coherence tomographic outer retinal changes and multifocal electroretinographic changes leading to cessation of hydroxychloroquine or chloroquine. Location and depth of scotoma points on 10-2 VF testing were recorded and their fates followed in serial, reliable 10-2 VFs performed with a white target over time.Main outcome measuresNumber of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.ResultsA median of five, interquartile range (IQR) 3–8 scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR 63%–100% of these points resolve on the subsequent field. For patients with retinopathy, a median of 22%, IQR 10%–59% resolve. The median percentage of scotoma points in the zone 2–8 degrees from fixation in eyes with retinopathy was 79%, IQR 68%–85% compared to 60%, IQR 54%–75% in eyes without retinopathy (P=0.0094). Single-point scotomas were more common in eyes without than with retinopathy. Scotomas consisting of more than four contiguous scotoma points were generally indicative of retinopathy.ConclusionPoint scotomas are common and variable in 10-2 VF testing with a white target for hydroxychloroquine retinopathy in subjects without retinopathy. The annular zone 2 to 8 degrees from fixation was useful for distinguishing the significance of scotoma points. Scotomas with more contiguous scotoma points were more often associated with retinopathy.

Susac's syndrome

A 34-year-old right-handed woman, with frequent episodic headaches, typical of migraine with visual aura, presented in December 2010. Two months later, she reported episodes of transient numbness over the left...

Retinopatia solar após ritual religioso na cidade de Londrina

PURPOSE: To present a series of patients with solar retinopathy after direct solar observation during a religious ritual in Londrina City, Parana, Brazil. METHODS: 24 patients with visual alterations were evaluated after their participation in a religious ritual. Data of the initial and final visit after 6 months of follow-up are presented and include best corrected visual acuity, refraction, color fundus picture, macular biomicroscopy, Amsler's screen and contrast sensibility. RESULTS: A total of 24 cases was reported. Of these, 21 (87.5%) were females and 3 (12.5%) males. Age varied from 18 to 46 years. A total of 43 eyes were damaged. The lesion was bilateral in 19 (79.2%) patients and in 5 (20.8%) it was unilateral. The initial visual acuity ranged from 20/20 to 20/70, and the final visual acuity was 20/25 or better in 40 (93%) eyes. Of these, 33 (76.7%) eyes reached 20/20 or the last follow-up visit. Only 2 (4.6%) eyes presented alteration in the sensibility to contrast and 3 (6.9%) remained with persistent scotoma. CONCLUSION: This is the largest series of solar retinopathy after religious ritual. The cases herein presented showed a quite favorable evolution. However recovery of visual acuity is not complete, once scotoma and residual metamorphopsia persisted in a few patients.

Persistent scotomata after improvement of visual acuity in patients with cilioretinal artery occlusion

To evaluate changes in scotomata and visual acuity in patients with cilioretinal artery occlusion, we examined 1 patient with an associated central retinal vein occlusion and 2 with isolated cilioretinal artery occlusion. All patients underwent ophthalmic examination, including visual acuity, fundus photography, fluorescein angiography, and Humphrey perimetry tested for at least 6 months. Despite improvement in visual acuity and disappearance of retinal opacification after 1 month, scotomata remained 3 months after the initial examination.