Retinal Pigment Epithelium Irregularities Research Articles

Influence of vortex vein engorgement for photodynamic therapy in central serous chorioretinopathy

This study evaluates the efficacy of photodynamic therapy (PDT) in treating central serous chorioretinopathy (CSC) based on the number of engorged vortex vein draining macula visualized on ultra-widefield (UWF) indocyanine green angiography (ICGA). Thirty-six eyes of 36 patients with treatment-naïve CSC were included. Macula-draining vortex veins were assessed in each quadrant using UWF ICGA. The resolution of subretinal fluid (SRF), pigment epithelial detachment (PED), ellipsoid zone (EZ) disintegrity, and retinal pigment epithelium (RPE) irregularity were evaluated at 3 months after PDT. Visual and anatomical improvements were monitored for 12 months. Logistic regression analysis was performed to identify factors associated with poor visual outcomes. A higher number of macula-draining vortex vein was associated to persistent SRF (p = 0.004), PED (p = 0.001), EZ disintegrity (p = 0.011), and RPE irregularity (p = 0.001). Macula-draining vortex veins were also correlated with poor EZ restoration and limited best corrected visual acuity (BCVA) improvements. In multivariate analysis, the number of macula-draining vortex vein (B = 0.197, p = 0.047) was a risk factor for worse BCVA at 12 months. Increased macula-draining vortex vein was related with unfavorable anatomical and poor visual outcomes after PDT in CSC patients.

PERIVASCULAR FLOWER-BUD-LIKE LESIONS ON EN FACE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH VITREORETINAL LYMPHOMA.

To describe perivascular flower-bud-like lesions (PFBLs) as novel characteristics of vitreoretinal lymphoma on en face optical coherence tomography (OCT) angiography. A retrospective chart review was performed on 23 consecutive patients (35 eyes), who had biopsy-proven vitreoretinal lymphoma between January 2018 and March 2021. En face OCT angiography images were analyzed before and after intervention. PFBLs were initially identified on midretinal slabs of en face OCT angiography, and were further characterized by other imaging modalities. Perivascular flower-bud-like lesions were detected in 12 eyes (34.3%) of 8 patients, of which 8 eyes had best-corrected visual acuity of 20/40 or better. In 10 of the 12 eyes, PFBLs were detected within 6 months of symptom onset. On en face OCT angiography, PFBLs presented as punctate points or confluent bands surrounding retinal vessels, with arterial and venous involvement. In 4 of the 12 eyes, arteries were mainly affected. On OCT B-scans, PFBLs commonly appeared as hyperreflective full-thickness intraretinal lesions that colocalized with subretinal pigment epithelium deposits (3 eyes, 25%) and retinal pigment epithelium irregularities (4 eyes, 33.3%). However, PFBLs could not always be identified on other imaging modalities such as fundus photographs and fundus fluorescein angiography. In all eyes with follow-up, PFBLs attenuated or resolved months after receiving chemotherapy or diagnostic vitrectomy. PFBLs are characteristic imaging findings of vitreoretinal lymphoma and may facilitate an early diagnosis of vitreoretinal lymphoma, which would in turn lead to more timely and effective treatment.

Highly suspected primary intraocular lymphoma in a patient with rheumatoid arthritis treated with etanercept: a case report

BackgroundTo describe a case of highly suspected primary intraocular lymphoma (PIOL) in a patient using etanercept for the treatment of rheumatoid arthritis.Case presentationA 50-year-old female patient presented with decreased vision in her left eye that lasted for a week. She had a 15-year history of seropositive rheumatoid arthritis (RA), and had been taking weekly etanercept for the preceding 8 months. Funduscopic examination and SD-OCT showed a swollen ellipsoid zone (EZ) and a retinal pigment epithelium (RPE) irregularity of the right eye. We also noted EZ disruption and a RPE irregularity in the left eye. As subretinal infiltration was aggravated in the right eye after the initial treatment, we completed a vitrectomy. Vitreous cytology revealed PIOL with positive CD20 immunostaining. She was treated with serial intravitreal methotrexate injections and systemic chemotherapy. After the treatment, subretinal infiltration and subRPE deposits were decreased in the right eye with no evidence of recurrence in either eye.ConclusionsThis case suggests a potential relationship between immunosuppression with anti-TNFα medication, and increased risk for lymphoma, especially in patients with underlying rheumatologic disorders and especially in patients with suspected chronic refractory uveitis.

MORPHOLOGIC CHARACTERISTICS OF IDIOPATHIC JUXTAFOVEAL TELANGIECTASIA USING SPECTRAL-DOMAIN AND POLARIZATION-SENSITIVE OPTICAL COHERENCE TOMOGRAPHY

Idiopathic juxtafoveal telangiectasia (IJT) is characteristically associated with pigmentary changes. Polarization-sensitive spectral-domain optical coherence tomography (PS-SD-OCT) enables imaging of the retinal pigment epithelium (RPE) and similar melanin-containing structures based on specific polarization properties. This study examined IJT with the latest-generation SD-OCT and PS-SD-OCT, identifying pathophysiologically relevant characteristics of the retinal layers and RPE. Twenty-two eyes of 12 patients with IJT were examined by PS-SD-OCT, with special focus on RPE detection and segmentation. Furthermore, SD-OCT technology (Cirrus, Spectralis, and 3D-OCT-1000) was applied. Characteristics of the retinal layers and RPE were evaluated. A classification system based on OCT characteristics of IJT was suggested. Polarization-sensitive spectral-domain optical coherence tomography together with SD-OCT identified characteristic patterns of IJT, used to classify eyes into three distinct groups. Group 1 (5 eyes) revealed discrete alterations in the inner retinal layers; group 2 (12 eyes) showed irregularities of the junction between the inner and outer photoreceptor segments with outer retinal atrophy but an intact RPE. Group 3 (5 eyes) revealed RPE irregularities and loss in addition to intraretinal alterations and photoreceptor abnormalities. This study described characteristic morphologic changes in IJT based on PS-SD-OCT and SD-OCT. Morphologic changes were classified, possibly leading to an OCT-based grading scheme. The intensity images of SD-OCT verified intraretinal and photoreceptor irregularities in great detail, whereas PS-SD-OCT additionally showed RPE alterations.

DETECTION OF MORPHOLOGIC ALTERATIONS BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY BEFORE AND AFTER HALF-DOSE VERTEPORFIN PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY

To study the morphologic features of serous retinal detachment, the photoreceptor inner and outer segment junction line, retinal pigment epithelium irregularities, pigment epithelial detachment, and the subfoveal choroid before and after treatment of chronic central serous chorioretinopathy, using spectral-domain optical coherence tomography. We studied 17 eyes of 17 consecutive patients (all men) with chronic central serous chorioretinopathy. We performed photodynamic therapy (PDT) with half-dose (3 mg/m2) verteporfin. We studied morphologic features using spectral-domain optical coherence tomography before and at 1, 3, 6, and 12 months after PDT. Retinal detachment showed reattachment in 16 of the 17 eyes by 3 months after PDT. The inner and outer segment junction line could be visualized in 13 eyes at 6 months after PDT. Retinal pigment epithelium irregularities were confirmed in all 17 eyes before and during the year after PDT. Pigment epithelial detachment initially disappeared but then recurred in 5 eyes after PDT. Subfoveal highly reflective substances first lessened in intensity but then again became prominent in 2 eyes. The authors identified recurrent pigment epithelial detachment and/or retinal detachment during the 1-year period after PDT. Even if retinal detachment initially disappears, retinal pigment epithelium or choroidal morphologic changes can still develop. The effect of half-dose PDT for chronic central serous chorioretinopathy may thus be temporary.

Cyclooxygenase inhibitor improved an exudative lesion of choroidal neovascularization in age-related macular degeneration

To report a case in which a nonselective cyclooxygenase (COX) inhibitor improved an exudative lesion in age-related macular degeneration. A 64-year-old man had a complaint of metamorphopsia in the left eye. Visual acuity was 0.5 in the left eye. Fluorescein angiography and indocyanine angiography showed juxtafoveal occult choroidal neovascularization (CNV) in the left eye, and pegaptanib sodium 0.3 mg was administered once every 6 weeks. After 4 months, visual acuity improved to 0.8. After 8 months follow-up, optical coherence tomography (OCT) showed subretinal fluid (SRF) and retinal pigment epithelium (RPE) irregularity. Visual acuity was 0.4. We recommended further pegaptanib sodium injections, but the patient did not consent to the treatment. Onset of cellulitis of the left toe occurred 1 week before the scheduled visit after 9 months. The patient was treated with loxoprofen sodium (nonselective COX inhibitor) and cefdinir for 7 days. At 2 weeks after onset of cellulitis, SRF had disappeared and OCT showed improvement of RPE irregularity. A COX inhibitor had an effect on vascular permeability in CNV and may have improved exudative changes.

Short-Term Clinical Observation of Acute Retinal Pigment Epitheliitis Using Spectral-Domain Optical Coherence Tomography

We investigated the case of a young man with blurred vision in his left eye. His visual acuity was slightly decreased, and ophthalmoscopy disclosed a gray-white lesion in the macula. He had no systemic or ocular history. On the visual field test, the threshold sensitivity was decreased in the corresponding region. Spectral domain optical coherence tomography (OCT) demonstrated a disruption in the photoreceptor inner and outer segment (IS/OS) junction and undulation of the retinal pigment epithelium (RPE) with backscattering. We re-examined the patient after two weeks and after three months without any treatment. Visual acuity and visual field results were gradually normalized, and OCT demonstrated the recovery of continuity in the photoreceptor IS/OS junction, as well as decreased RPE irregularity with minimal backscattering. We used spectral domain OCT instead of time domain OCT (OCT3) so that we could provide better image resolution of the acute retinal pigment epitheliitis (ARPE). Finally, we observed recovery of the functional and anatomical changes in the ARPE patient with a resolution of the condition within three months following the initial examination, using OCT and visual field tests.

Anatomy and Function of the Macula in Patients after Retinectomy for Retinal Detachment Complicated by Proliferative Vitreoretinopathy

To investigate the anatomy and function of the macula in patients after retinectomy for retinal detachment complicated by proliferative vitreoretinopathy (PVR) grade C. A prospective study involving 25 patients operated with vitrectomy and retinectomy due to retinal detachment complicated by PVR grade C. Outcome measures included preoperative and postoperative best-corrected visual acuity (BCVA) at 6 months and the difference between preoperative and postoperative BCVA. Furthermore, the macular status was analyzed on postoperative optical coherence tomography (OCT) scans. Reattachment was observed in 96% (24/25) of patients. Median BCVA improved from 2.30 logMAR (range 1.00 to 2.69 logMAR) to 1.00 logMAR (range 0.38 to 2.90 logMAR). The change from preoperative visual acuity was statistically significant (p=0.0003, Wilcoxon signed rank test). Macular status with pathologies was observed in 75% of eyes on OCT (retinal pigment epithelium irregularities 37.5%, cystoid macular edema 33%, epiretinal membrane 8.3%, subretinal fluid 4%, and subretinal perfluorocarbon liquid 4%). These eyes had significantly worse final visual acuity (p=0.01, Wilcoxon rank sum test) compared to those with a clinically normal macula. The retinectomy size influenced neither visual acuity (p=0.06, Wilcoxon rank sum test) nor incidence of normal macular status (p=0.14, Fisher exact test). Even though retinectomy is an effective technique to reattach the retina in complicated cases of retinal detachment, the functional outcome was found to be influenced by abnormal macular status, observed in 75% of eyes. Moreover, 360-degree retinectomies did not show different anatomic or functional results vs subtotal ones.

3D Spectral Domain Optical Coherence Tomography Findings in Choroidal Tumors

To report the optical coherence tomographic features differentiating choroidal nevus from choroidal melanoma by 3D spectral-domain optical coherence tomography (SD-OCT) and OCT characteristics of other choroidal tumors. A total of 67 consecutive eyes with choroidal tumors including choroidal nevus (25 eyes), indeterminate choroidal melanocytic lesion (11 eyes), malignant melanoma (23 eyes), metastasis (4 eyes), hemangioma (2 eyes), and osteoma (2 eyes) were imaged with 3D SD-OCT (OCT-1000; Topcon Inc., Paramus, NJ). The images were analyzed for the presence or absence of SD-OCT findings such as retinal pigment epithelium (RPE)/choriocapillaris reflectivity, RPE irregularity, drusen, sub-RPE fluid, RPE thickness, subretinal deposit, subretinal fluid, intraretinal edema, retinal thickness, and photoreceptor inner and outer segment junction (IS/OS). Visualization of the choroidal tumor and its intrinsic reflectivity OCT features were also assessed. When compared with nevus, subretinal deposit, subretinal fluid, and intraretinal edema were detected significantly more frequently in the eyes with malignant melanoma (p<0.001). SD-OCT visualization of the tumor was limited only to the anterior aspect. Choroidal nevus, indeterminate lesions, melanoma, and metastatic lesions had variable intrinsic reflectivity pattern. Intrinsic features of hemangioma included choroidal hollowness whereas osteoma demonstrated high intrinsic reflectivity. SD-OCT provides useful information to observe and document the retinal and RPE changes secondary to choroidal tumors that help differentiate choroidal nevus from malignant melanoma. Improvements in the current OCT systems are needed to better characterize intrinsic features of choroidal tumors.

Spontaneous closure of retinal pigment epithelium microrip in the natural course of central serous chorioretinopathy

To study the natural course of changes observed in the retinal pigment epithelium (RPE) on spectral domain OCT transverse and RPE fit C-scans corresponding to the leakage point observed on fundus fluorescein angiograms in central serous chorioretinopathy (CSC). Thirteen patients with acute CSC were prospectively enrolled and followed up for 6 months. All were examined using Zeiss Cirrus HD-OCT Model 4000. Transverse and RPE fit C-scans corresponding to point of leakage were superimposed on an OCT fundus photograph and correlated with the leakage point on a fluorescein angiogram. The RPE alterations observed at the leakage point were noted at presentation and follow-up. Transverse and RPE fit C-scans showed an irregularity of RPE resembling a 'honeycomb' pattern in 11 (85%) eyes at the point corresponding to the fluorescein leakage site. These were observed as pigment epithelium detachment (PED) on Raster line scan. Six of these 11 eyes (54.5%) showed a disruption/breach in the RPE on transverse C-scan and on RPE fit C-scan. All eyes showed a resolution of subretinal fluid with a closure of microrip, and the honeycombed pattern at the leakage site was replaced with RPE hypertrophy. RPE microrips show spontaneous closure in the natural course of CSC.