Serous Pigment Research Articles

Type II Macular Telangiectasia Presenting as Bilateral Retinochoroidal Anastomosis.

Retinochoroidal anastamosis (RCA) is known to be associated with retinal angiomatous proliferans rather than idiopathic macular telangiectasia. The case report describes a rare association of bilateral RCA with type II idiopathic macular telangiectasia in an elderly woman. A 65-year-old female patient presented with decreased vision in both eyes to the ophthalmology clinic. She was diagnosed with bilateral large serous retinal pigment epithelial detachments (PED). Atypical association of PED with IMT led to additional imaging, including fluorescein angiography (FA), spectral-domain optical coherence tomography (SD-OCT), and indocyanine green angiography (ICGA). Multimodal imaging analysis revealed characteristic signs of RCA such as the so-called kissing sign on SD-OCT. The patient was not offered any treatment due to the poor prognosis associated with the condition. Although more commonly associated with retinal angiomatous proliferans (type III neovascular age-related macular degeneration), RCA can present in type II IMT Stage 5.

Comparison between Aflibercept, Ranibizumab intravitreal injection on Neovascular Age‐related macular degeneration patients

PurposeTo investigate the difference of optical coherence tomography (OCT) findings between aflibercept treatment group and ranibizumab treatment group.MethodsThis study include 63 patients (n = 63 eyes) diagnosed with treatment‐naïve neovascular AMD, and they were treated with aflibercept or ranibizumab monthly for 3 months. We compared the changes of the two groups between before the treatment and after the treatment with optical coherence tomography (OCT) findings such as serous pigment epithelium detachment, fibrovascular pigment epithelium detachment, subretinal fluid, intraretinal fluid, dense zone of outer retina, classic neovascularization, and hyper‐reflective dots. And we also compared the changes of BCVA and IS/OS length, ELM length, central foveal thickness with optical OCT between the two groups.ResultsThere were no significant differences between two groups before each treatments. Serous pigment epithelium detachments were disappeared 36% in aflibercept group, 5% in ranibizumab group, and there was significant difference between the two groups (p = 0.021). There was no significant changes such as BCVA change, OCT finding changes except for serous pigment epithelium detachment between the two groups.ConclusionsFor treatment of neovascular AMD patients, aflibercept might be more effective in serous pigment epithelium detachment than ranibizumab. Because there was no significant visual acuity improvement in serous pigment detachment improvement group in both two treatments, it might be necessary to study further about relationship between visual acuity and serous pigment detachment improvement.

The long‐term effect of intravitreal bevacizumab injection in central serous chorioretinopathy

PurposeTo study the effect of intravitreal bevacizumab injection in patients with idiopathic central serous chorioretinopathy.MethodsWe had performed retrospective review on the patients who had been diagnosed as idiopathic central serous chorioretinopathy and had regular follow‐up for at least 12 months from the first injection, either undergone intravitreal bevacizumab injection (107 eyes of 100 patients) or observed without injection (46 eyes of 40 patients). Changes in the visual acuity and the serous neurosensory retinal and retinal pigment epithelium detachment were evaluated through the results of best corrected visual acuity and optical coherence tomography measured at initial presentation, after 1, 3, 6, 9 and 12 months of the first injection.Results87 males and 13 females with mean age of 45.4 ± 7.6 years were recruited in the intravitreal bevacizumab injection (IVB) group, and 34 males and 6 females with mean age of 47.2 ± 9.8 years were recruited in the observation group. There was significant difference in the mean duration of retinal detachment to disappear between the IVB group (2.5 ± 0.2 months) and the observation group (4.3 ± 0.7 months). There was no significant difference in the best corrected visual acuity and the central macular thickness after 12 months follow‐up between the IVB group and the observation group.ConclusionsIntravitreal bevacizumab injection was more effective and faster treatment for resolution of sensory retinal detachment than observation during the 12 months of consecutive follow‐up. Therefore, intravitreal bevacizumab injection can be considered as a significant and safe treatment modality for central serous chorioretinopathy when the patients need prompt visual improvement, such as depending on the morbid eye or requiring binocular vision for occupational cause.

Non-responsiveness to intravitreal aflibercept treatment in neovascular age-related macular degeneration: implications of serous pigment epithelial detachment

The prognosis of neovascular age-related macular degeneration (AMD) has been improved by anti-vascular endothelial growth factor treatments, including intravitreal aflibercept (IVA) treatment. However, many patients remain incurable. In this study, we retrospectively evaluated non-responsiveness to IVA monotherapy at 12 months in 133 eyes of 133 AMD patients. Sixty-two patients were initially treatment-naive, and 71 had received other treatments before IVA (the treatment-switched group). Mean best-corrected visual acuity (BCVA) was improved in the treatment-naive group but not in the treatment-switched group, although mean central retinal thickness (CRT) decreased in both groups. The respective percentages of non-responders as determined by worsened BCVA in the treatment-naive and treatment-switched groups were 8.1% and 15.5%, and via fundus findings, they were 12.9% and 8.5%. Multivariate analyses adjusted for age, gender, CRT, and greatest linear dimension showed that serous pigment epithelial detachment (PED) at baseline was associated with non-responsiveness in both groups as determined by BCVA and by fundus findings, and fibrovascular PED measurements indicated no response as determined by fundus findings in the treatment-switched group. The results reported herein may assist the formulation of appropriate treatment protocols for AMD patients.

Morphologic features of retina pigment epithelial around fluorescein leakage sites in acute central serous chorioretinopathy before and after laser coagulation

Objective To observe the morphologic alterations of retina pigment epithelial around fluorescein leakage site using spectral-domain optical coherence tomography (SD-OCT) in acute central serous chorioretinopathy (CSC) before and after laser coagulation. Methods Twenty-four eyes of 24 consecutive patients with unilateral acute CSC who underwent laser photocoagulation (wave length: 561 nm, energy: 80 - 100 mW, spot diamteter: 100 μm, exposure time: 0.1 s) were enrolled in this retrospective study. The patients included 22 males and 2 females, with an average age of (39.2±7.2) years and an average duration of (1.1±0.6) months. The fluorescein leakage outside the foveal avascular zone and serous retinal detachment were found in all the eyes by fluorescein fundus angiography (FFA) and SD-OCT. Twenty-six leakage sites were observed in 24 eyes on FFA. There were 5 smoky leakage points (19.2%), 21 inky leakage points (80.8%). The retinal pigment epithelial (RPE) layer at leakage points were scanned by SD-OCT before and at 2 weeks, 2 months after treatment. SD-OCT showed that the RPE abnormalities were detected at all of the fluorescein leakage points, including serous pigment epithelial detachment (PED) in 16 leakage points (64.5%), protruding RPE in 5 leakage points (19.5%), and irregular RPE in 5 leakage points (19.2%). The morphologic alterations of RPE around fluorescein leakage point before and after laser coagulation were observed. Results At 2 weeks after laser photocoagulation, PED existed in 7 leakage points (26.9%), protruding RPE in 3 leakage points (11.5%), and irregular RPE in 16 leakage points (61.5%). At 2 months after laser photocoagulation, protruding RPE existed in 3 leakage points (11.5%), and irregular RPE in 5 leakage points (19.2%), including RPE defect in 2 leakage points. And there were undetectable RPE abnormalities in other 16 leakage points (61.5%). Conclusions In acute CSC, SD-OCT shows that morphologic features of the RPE layer are changed, including PED, protruding RPE , irregular RPE around the leakage point. After laser photocoagulation the abnormalities of RPE can also be altered from PED to irregular RPE , and RPE defect is observed in restricted regions. Key words: Central serous chorioretinopathy/therapy; Laser coagulation; Tomography, optical coherence; Diagnostic imaging

Effectiveness of Intravitreal Injection of Ranibizumab for Neovascular Age-Related Macular Degeneration with Serous Pigment Epithelial Detachment

BackgroundWe sought to observe the effectiveness of intravitreal injection of ranibizumab in treating neovascular age-related macular degeneration (nAMD) with serous pigment epithelial detachment (sPED).Material/MethodsA retrospective, noncomparative case series was performed. Twenty-3 eyes of 23 patients with sPED secondary to nAMD who had received intravitreal injections of ranibizumab were included in this study. All patients underwent best-corrected visual acuity (BCVA), synchronous fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) examinations. All patients were treated with pro re nata intravitreal injections after 3 loading doses of ranibizumab and were followed up for 12 months. The differences in the BCVAs, maximum PED heights, PED volumes and CFTs of the affected eyes were compared between the baseline and last visit.ResultsTwelve months after the first injection, improved visual acuity was observed in 16 of the 23 eyes. 4 eyes exhibited stable visual acuity, and 3 eyes exhibited impaired visual acuity. The mean post-injection logMAR BCVA was 0.58±0.05, which was much better than that at baseline (0.76±0.08; t=1.751, P=0.0869). The mean maximum PED height at baseline was 350.17±35.73μm and it was decreased to 238.87±36.87μm (t=2.192, P=0.0337) at the last visit. The mean PED volume after injection was 0.34±0.1 mm3, which was significantly decreased compared with that at baseline (0.81±0.21 mm3; t=2.021, P=0.0494).The mean CFT decreased, but this difference was not statistically significant (t=1.003, P=0.3211). None of the patients exhibited endophthalmitis, uveitis or RPE tears.ConclusionsIntravitreal injection of ranibizumab for the treatment of neovascular age-related macular degeneration with serous pigment epithelial detachment safely and effectively improved the patients’ visual acuities and decreased their PED heights volumes.

An automated framework for 3D serous pigment epithelium detachment segmentation in SD-OCT images.

Pigment epithelium detachment (PED) is an important clinical manifestation of multiple chorioretinal diseases, which can cause loss of central vision. In this paper, an automated framework is proposed to segment serous PED in SD-OCT images. The proposed framework consists of four main steps: first, a multi-scale graph search method is applied to segment abnormal retinal layers; second, an effective AdaBoost method is applied to refine the initial segmented regions based on 62 extracted features; third, a shape-constrained graph cut method is applied to segment serous PED, in which the foreground and background seeds are obtained automatically; finally, an adaptive structure elements based morphology method is applied to remove false positive segmented regions. The proposed framework was tested on 25 SD-OCT volumes from 25 patients diagnosed with serous PED. The average true positive volume fraction (TPVF), false positive volume fraction (FPVF), dice similarity coefficient (DSC) and positive predictive value (PPV) are 90.08%, 0.22%, 91.20% and 92.62%, respectively. The proposed framework can provide clinicians with accurate quantitative information, including shape, size and position of the PED region, which can assist clinical diagnosis and treatment.

Subthreshold Micropulse Yellow Laser (577 nm) Photocoagulation for Subfoveal Serous Pigment Epithelium Detachment

PurposeTo evaluate the efficacy of subthreshold micropulse yellow laser photocoagulation(SMYLP) for subfoveal serous pigment epithelial detachment(SPED).MethodsWe evaluated retrospectively 6 eyes of 5 patients with symptomatic subfoveal SPED treated with SMYLP. SMYLP was performed on the entire area of SPED with Supra 577Y Laser System(Quantel Medical). The SMYLP settings were 100 μm spot diameter, 20 ms duration, 15% duty cycle, 3 × 3 pattern. If SPED was not definitely restored, we applied laser again with more increased power at 1 or 2 months interval.ResultsAll patients were received 3 or 5 times bevacizumab or ranibizumab injections before SMYLP. The total follow‐up period was 26.5 (18–36) months, mean follow‐up period after laser application was 19.8 (15–32) months. Mean height of PED before treatment was 349.2 ± 53.22 μm. About 3 (2–4) sessions SMYLPs were performed. All eyes showed nearly complete resolutions of the PED for 5.6 (5–7) months, which were sustained during the follow‐up. Mean BCVA before treatment was 0.11 (0–0.22) logMAR and mean BCVA at final follow‐up was 0.07 (0–0.22) logMAR. After PED resolution, all patients had increased vision and metamorphopsia improvement. After PED resolution, usually there were seen in mild RPE atrophies in fundus and OCT image, and these atrophies were not aggravated.ConclusionsSMYLP for subfoveal SPED induced the resolution of SPED and symptom improvement. But after SPED resolution, mild RPE atrophy was detected. We think this finding was related to subsequent epithelial atrophy after resolution of SPED or laser damage. Prospectively, the study about long‐term efficacy and safety of this treatment will be needed.

Idiopathic multiple retinal pigment epithelial detachments – A case report

Retinal pigment epithelial detachment, often asymptomatic is a common retinal finding. Multiple serous retinal pigment epithelial detachment especially in a female is very uncommon. We describe a case of multiple retinal pigment epithelial detachments throughout the fundus in a 51-year old female otherwise asymptomatic. Indocyanine green angiography and fundus auto fluorescence showed abnormalities with a normal systemic work-up. This is the first report of an asymptomatic patient correlating angiogram with auto fluorescence in multiple serous retinal pigment epithelial detachments.

Focal choroidal excavation in patients with central serous chorioretinopathy.

To evaluate the prevalence and clinical features of focal choroidal excavation (FCE) in patients presenting with central serous chorioretinopathy (CSC). This is a retrospective consecutive case series of consecutive patients with CSC who were referred for spectral domain optical coherence tomography (SD-OCT) between January 2010 and December 2011. Medical records were reviewed and clinical features including presence of FCE in SD-OCT, fluorescence angiography (FA), and indocyanine green angiography (ICGA) were studied. Among the 116 CSC patients assessed, FCE was found in 11 eyes of 7 (6.0%) patients. FCE was associated with subretinal fluid in six eyes of six patients and serous pigment epithelial detachment in three eyes of two patients. The mean central subfield retinal thickness of CSC eyes with FCE was 283.7 μm, compared with 377.5 μm for CSC eyes without FCE (Mann-Whitney U-test, P=0.020). Five FCE eyes of five patients had focal leakage on FA. Choroidal hyperpermeability on ICGA was found in seven CSC eyes with FCE, with four eyes showing hypofluorescent spot corresponding to the FCE. After a mean follow-up of 16 months, visual acuity of all 11 eyes with FCE remained stable or improved at the last follow-up. FCE is not an uncommon feature in patients with CSC and might be associated with choroidal hemodynamic disturbances.

Effect of ranibizumab on serous pigment epithelial detachments associated with wet age-related macular degeneration

Objective To evaluate the effects of intravitreal ranibizumab therapy for serous pigment epithelial detachment (sPED) secondary to exudative age-related macular degeneration(eAMD). Methods Twenty-three eyes from 23 patients of eAMD with sPED were enrolled in this study. The best corrected visual acuity, ocular coherence tomography (OCT), maximum PED height from baseline, volume of PED and central fovea thickness(CFT)were collected monthly for these patients. And the patients were receiced intravitreal injection with ranibizumab of 0.5 mg of three consecutive monthly injections. Results No complications were observed during the study period. After 6 months follow-up, 17 eyes improved, 4 eyes unchanged and only 2 eye decreased. The best corrected visual acuity was from 0.77±0.39 up to 0.61±0.27(t=2.601, P 0.05). Conclusion Ranibizumab may be an effective treatment for improving vision and reducing the degree of PED in eAMD patients. Key words: Choroidal neovascularization/drug therapy; Macular degeneration/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use

Relationship of retinal morphology and retinal sensitivity in the treatment of neovascular age-related macular degeneration using aflibercept.

To relate the functional response to distinct morphological features of the retina during aflibercept treatment for neovascular AMD (nAMD). A total of 726 retinal locations in 22 consecutive eyes presenting with treatment-naive nAMD underwent a standardized examination with spectral-domain optical coherence tomography (SD-OCT) and topographic microperimetry (MP) at baseline, after 3 and 12 months of continuous intravitreal aflibercept therapy. The retinal sensitivity at each stimulus location was registered to the corresponding location on SD-OCT morphology. Subsequently, the microperimetric responses were evaluated with respect to the following underlying SD-OCT features: neovascular complex (NVC), subretinal fluid (SRF), intraretinal fluid (IRF), intraretinal cystoid space (IRC), serous pigment epithelium detachment (sPED), and fibrovascular pigment epithelium detachment (fPED). Baseline sensitivity was reduced to mean values of 1.8 dB in NVC, 2.2 dB in IRC, 2.8 dB in IRF, 2.6 dB in sPED, 3.6 dB in SRF, and 4.6 dB in fPED. Improvements in retinal sensitivity were most pronounced during the initial 3-month interval, when significant recovery was documented for SRF and sPED with +4.0/5.5 dB (P < 0.0001) and to a lesser extent for IRF, IRC, fPED, with +1.1, 1.7, 2.3 dB, respectively. From month 3 to 12, the additional benefit ranged from 0.3 to 1.0 dB (P > 0.05 for each category). Significant functional benefits following intravitreal aflibercept treatment could be detected over all defined morphological pathologies. The level of improvement varied dependent on the associated feature with the best prognosis for visual improvement in SRF and sPED and least with intraretinal fluid and particularly intraretinal cysts.

Automated 3-D retinal layer segmentation of macular optical coherence tomography images with serous pigment epithelial detachments.

Automated retinal layer segmentation of optical coherence tomography (OCT) images has been successful for normal eyes but becomes challenging for eyes with retinal diseases if the retinal morphology experiences critical changes. We propose a method to automatically segment the retinal layers in 3-D OCT data with serous retinal pigment epithelial detachments (PED), which is a prominent feature of many chorioretinal disease processes. The proposed framework consists of the following steps: fast denoising and B-scan alignment, multi-resolution graph search based surface detection, PED region detection and surface correction above the PED region. The proposed technique was evaluated on a dataset with OCT images from 20 subjects diagnosed with PED. The experimental results showed the following. 1) The overall mean unsigned border positioning error for layer segmentation is 7.87±3.36 μm , and is comparable to the mean inter-observer variability ( 7.81±2.56 μm). 2) The true positive volume fraction (TPVF), false positive volume fraction (FPVF) and positive predicative value (PPV) for PED volume segmentation are 87.1%, 0.37%, and 81.2%, respectively. 3) The average running time is 220 s for OCT data of 512 × 64 × 480 voxels.

Fibrovascular pigment epithelial detachment is a risk factor for long-term visual decay in neovascular age-related macular degeneretion.

The individual outcome of anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration is variable. To investigate the prognostic value of spectral domain optical coherence tomography structures for best-corrected visual acuity (BCVA) outcome, volumetric analysis of spectral domain optical coherence tomography structures was performed in neovascular age-related macular degeneration correlated with BCVA after 24 months. At the Department of Ophthalmology, University of Cologne, Germany, 75 patients with neovascular age-related macular degeneration were analyzed prospectively over 24 months. Patients received three initial consecutive monthly intravitreal ranibizumab injections followed by monthly spectral domain optical coherence tomography controls. Therapy was continued as a pro re nata regimen. Volumetric analysis of spectral domain optical coherence tomography images was performed using commercially available software (3D-Doctor). Subretinal tissue, subretinal fluid, serous pigment epithelial detachment, and fibrovascular pigment epithelial detachment (FPED) were identified. By contrast to all other structures, FPED did not respond to ranibizumab therapy. Volume of FPED at baseline and after the loading phase correlated most with impaired BCVA after 24 months (r = -0.0215, P = 0.9263 [subretinal tissue]; r = -0.3120, P = 0.0216 [subretinal fluid]; r = -0.0757, P = 0.6470 [serous pigment epithelial detachment]; r = -0.4182, P = 0.0111 (FPED baseline); r = -0.4768; P = 0.0002 [FPED after loading phase]). Of all identified structures, FPED was most deleterious for BCVA after 24 months. The knowledge about possible BCVA course can influence the decision for more intense treatment regimens.

Five‐year results of ICG‐Guided Photodynamic Therapy combined with intravitreal Ranibizumab for juxtapapillary polypoidal choroidal vasculopathy with macular involvement

AbstractPurpose Long‐term results of the treatment of 3 patients with juxtapapillary polypoidal choroidal vasculopathy complicated by a serous macular pigment epithelium detachment (PED) are presented.Methods Two women and one man (70, 77, and 84 years of age, respectively) presented with recent vision decrease in one eye. Decimal visual acuity (VA) of the affected eye was 0.2, 0.6, and 0.3, respectively. Fluorescein and ICG angiography as well as optical coherence tomography revealed juxtapapillary polypoidal choroidal vasculopathy and a large, dome‐shaped, serous macular PED.Results Selective ICG‐guided photodynamic therapy (PDT) with verteporfin directed to the juxtapapillary polyps was performed, followed by 3 monthly intravitreal injections of ranibizumab (Lucentis®), resulting in complete regression of the serous macular PED and in sustained VA increase. One month after the third injection, VA of the affected eye was 0.6, 0.9, and 1.0, respectively. One year later, VA of the affected eye was 0.7, 1.0, and 0.9, respectively. During 5 years of follow‐up, no recurrence of exudation was observed and VA remained the same.Conclusion The association of selective ICG‐guided juxtapapillary PDT with intravitreal injections of ranibizumab apparently led to scarring of the source of subretinal fluid, to protection of the adjacent normal choriocapillary network, and to protection against the VEGF spike described after PDT, thus enabling significant vision improvement. Combined treatment with ICG‐guided PDT and intravitreal ranibizumab is beneficial for juxtapapillary polypoidal choroidal vasculopathy with macular involvement, offering excellent long‐term results.

Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab

PurposeTo report the effects of aflibercept on eyes with large retinal pigment epithelial detachment (PED) associted with polypoidal choroidal vasculopathy (PCV).MethodsWe reviewed the medical records of patients with PEDs associated with PCV that were treated with aflibercept after intravitreal ranibizumab had failed.ResultsThree eyes of patients aged 72, 79, and 80 years were studied. Reflective material was seen in the PED along the outer surface of the retinal pigment epithelium (RPE) by spectral-domain optical coherence tomography (SD-OCT). A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED. In addition, one eye developed a retinal hemorrhage and a recurrent PED just after the third injection of aflibercept. The visual acuity in this eye decreased from 10/20 to 2/20.ConclusionThe reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization. Intravitreal aflibercept could be considered for large PEDs in eyes with PCV but should be carefully applied.

Grid laser photocoagulation in the treatment of serous avascular pigment epithelial detachment in age-related macular degeneration.

Purpose: Describe the outcomes of thermal laser photocoagulation in three cases of retinal pigment epithelium detachment associated to age-related macular degeneration. Methods: Three patients with avascular retinal pigment epithelium detachment were treated with green diode laser photocoagulation. Mild macular grid laser application, similar to the treatment of diabetic macular edema was performed after an unsuccessful intravitreal anti-angiogenic treatment. Results: After one year of the laser treatment, two cases reached anatomic resolution, with complete absorption of sub-epithelium serum fluid and improvement of the visual acuity. There was stability of the visual acuity and sub-epithelium fluid reduction, which, however, was partial in the third case. No complications related to the treatment occurred until the conclusion of this study. Conclusions: Macular photocoagulation in grid pattern produced regression of avascular serous pigment epithelium detachment associated with age-related macular degeneration in a short follow-up period. Although long term prospective studies with an increased sample are necessary, it is a method that can be applied in selected patients, with absence of sub-retinal neovascularization or sub-epithelium fibrovascular component.

Association between hyperacuity defects and retinal microstructure in polypoidal choroidal vasculopathy

Purpose:To improve our understanding of hyperacuity defects measured with preferential hyperacuity perimetry (PHP) by correlating PHP findings with the retinal microstructural changes visible on spectral-domain optical coherence tomography (OCT) in patients with polypoidal choroidal vasculopathy (PCV).Materials and Methods:Twenty-eight eyes of 28 patients with PCV were retrospectively reviewed. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (logMAR) testing, PHP, and OCT. The functional ‘PHP test score’ and ‘total volume of hyperacuity defect zone’ were also analyzed.Results:Patients were classified based on the hyperacuity defect by PHP, as follows: Hyperacuity defect (n = 17 eyes) group and hyperacuity intact (n = 11 eyes) group. The mean best-corrected visual acuity in the hyperacuity intact group (0.46 ± 0.39) was better than that in the hyperacuity defect group (0.82 ± 0.37) (P = 0.014). The presence of serous retinal detachment and retinal pigment epithelial detachment did not differ significantly between groups (P = 0.120 and P = 0.689, respectively). A disrupted photoreceptor layer was more common in the hyperacuity defect group compared with the hyperacuity intact group (P = 0.0001). Among 17 eyes with a hyperacuity defect, 9 eyes showing intra-retinal pathology (intra-retinal cyst or hard exudates) and had a significantly higher PHP test score and larger total volume of the hyperacuity defect zone than 8 eyes without intra-retinal pathology (P = 0.006 and P = 0.021, respectively).Conclusion:A hyperacuity defect in PCV was associated with photoreceptor disarrangement. Furthermore, PCV lesions on the inner retina that invaded the photoreceptor layer were associated with a more severe hyperacuity defect.

Three Cases of Focal Choroidal Excavation in the Macula Detected by Spectral-Domain Optical Coherence Tomography

Purpose: To report the clinical finding of 3 patients with focal choroidal excavation in the macula detected by spectral-domain optical coherence tomography (SD-OCT). Case summary: Five eyes of 3 patients with focal choroidal excavation detected by SD-OCT were enrolled in the present study. All patients had myopia (average refractive power -5.60 diopter). Two of the 3 patients had focal choroidal excavation in both eyes. All 5 eyes revealed foveal pigmentary changes on fundus examination. The excavation area in the autofluorescence image was hypofluorescent. Fluorescein angiographic finding was normal to various degrees of hyperfluoresence. Indocyanine green angiography revealed hypofluoresence at the excavation area. The excavation involoved from the retinal pigment epithelium layer to the external limiting membrane or outer nuclear layer and average choroidal thickness at excavation were statistically thinner than the uninvolved area based on SD-OCT (p = 0.002). Retinoschisis, serous pigment epithelial detachment and choroidal neovascularziation (CNV) were detected individually in 3 eyes. The other 2 eyes had no specific abnormalities. Conclusions: During the follow-up period, the choroidal excavation remained relatively stable in 4 of 5 eyes, but CNV developed in 1 eye. Therefore, intravitreal bevacizumab injection was performed. Longer follow-up periods are necessary to determine the etiology, clinical course and visual prognosis of eyes with focal choroidal excavation. J Korean Ophthalmol Soc 2014;55(6):941-946

An Unusual Case of Bilateral Multifocal Retinal Pigment Epithelial Detachment with Methanol-Induced Optic Neuritis

To describe an unusual case of methanol-induced optic neuritis with bilateral multifocal extrafoveal serous retinal pigment epithelial (RPE) detachment. Single case report. A 40-year-old male presented with acute bilateral loss of vision and history of consumption of adulterated alcohol. On examination, his vision was perception of light in the right eye and finger counting at 1-ft distance in the left eye. Pupillary reactions were sluggish. The optic discs were normal. An elevated lesion with subretinal serous fluid was present over macula adjacent to superior major vessel arcade in the right eye, which was confirmed as a large extrafoveal RPE detachment on fluorescein angiography. There were two more small RPE detachments in the right eye as well as in the left eye. All RPE detachments were extrafoveal in location. The patient was managed medically with intravenous methylprednisolone (1g) in 500ml of ringer lactate for three consecutive days. After three doses, visual acuity of both eyes was recorded as 20/20. We herein report an unusual case of bilateral multifocal extrafoveal serous RPE detachment in a patient of methanol-induced optic neuritis. RPE detachments may be due to the toxic effect of methanol metabolites.