To observe the efficacy of Anti-VEGF therapy for different patterns of optical coherence tomography of diabetic macular edema, and to explore the relationship between the integrity of the ellipsoid zone (EZ) and visual acuity outcomes. A total of 90 affected eyes with DME who received anti-VEGF therapy were enrolled in this study. The examination of BCVA was according to Early Treatment Diabetic Retinopathy Study, and the results were recorded as logarithm of the minimum angle of resolution (logMAR). Spectral-domain OCT was used to measure central macular thickness (CMT) and assess the integrity of the ellipsoid zone.All eyes were classified into three groups based on OCT patterns: diffuse retinal thickening (DRT group, 29 eyes), cystoid macular edema (CME group, 30 eyes), and serous retinal detachment (SRD group, 31 eyes). All patients received an intravitreal injection of 0.05ml (2.5mg) conbercept.Changes in BCVA and CMT among the three groups were compared and analyzed at baseline and at 3, 6, and 12 months after treatment. The length of the EZ defect was measured. Based on the extent of EZ disruption, eyes were classified into three grades (0, 1, and 2) to analyze the correlation between EZ integrity and visual acuity. In addition, factors influencing post-treatment visual acuity were analyzed. Compared with the central macular thickness (CMT) before treatment, the CMT of the affected eyes was significantly decreased in the diabetic retinal thickening (DRT) group (t = 6.506, 4.134, 7.782, P < 0.05), cystoid macular edema (CME) group (t = 15.407, 20.746, 24.749, P < 0.05) and serous retinal detachment (SRD) group (t = 9.580, 14.823, 16.931, P < 0.05), with statistically significant differences. Compared with the baseline, the best-corrected visual acuity (BCVA) of the affected eyes was significantly improved at 3, 6 and 12 months after treatment in the DRT group (t = 8.667, 17.050, 9.114, P < 0.05), CME group (t = 12.104, 11.583, 9.204, P < 0.05) and SRD group (t = 7.726, 9.310, 11.757, P < 0.05), with statistically significant differences. There were statistically significant differences in the LogMAR BCVA among the DRT, CME and SRD groups before treatment and at each time point after treatment (F = 11.379, 11.461, 15.282, 7.782, P < 0.05). A statistically significant difference was observed in the ellipsoid zone grading among the DRT, CME and SRD groups (χ²=21.179, P < 0.005). Compared with the baseline, the visual acuity was significantly improved at 3, 6 and 12 months after treatment in patients with ellipsoid zone grade 0 (t = 10.178, 12.375, 8.881, P < 0.05), grade 1 (t = 12.353, 13.914, 12.175, P < 0.05) and grade 2 (t = 5.154, 8.192, 8.712, P < 0.05) of LogMAR BCVA ellipsoid zone grading, respectively. Among the three ellipsoid zone groups, patients with ellipsoid zone grade 0 had the best visual acuity, while those with grade 2 had the worst visual acuity; statistically significant differences were found among the three groups before treatment and at 3, 6 and 12 months after treatment. The visual acuity at 12 months after treatment was significantly correlated with diabetic macular edema (DME) classification, ellipsoid zone defect grading, BCVA before treatment and CMT before treatment (r = 0.372, 0.547, 0.745, 0.309, all P < 0.05), while no significant correlations were found with age, duration of diabetes, glycosylated hemoglobin A1c (HbA1c), diabetic retinopathy (DR) stage and CMT at 12 months after treatment (r=-0.103, -0.035, 0.173, -0.026, 0.084, all P > 0.05). Anti-VEGF therapy could significantly improve the visual acuity of different patterns of DME, reduced the CMT, and had the best efficacy in the DRT group. There was relationship between the integrity of ellipsoid zone and the visual acuity outcomes.

This study reports two cases of Vogt-Koyanagi-Harada disease recurrence after laser treatment. Case 1 involved a woman in her late 70s with Vogt-Koyanagi-Harada disease that was controlled by adalimumab and steroid eye solution therapy. She presented with uveitis recurrence 4 weeks after undergoing neodymium:yttrium aluminum garnet laser posterior capsulotomy in both eyes. She was immediately treated with sub-Tenon triamcinolone acetonide injection in both eyes, which provided palliative relief. During the following year, she experienced further recurrences every 3-5 months. Case 2 involved a woman in her 40s with Vogt-Koyanagi-Harada disease and untreated type 2 diabetes. She had undergone pulse steroid therapy 3 months ago. She was prescribed insulin and oral diabetic medicine. The sudden glycemic control caused progression of her diabetic retinopathy, which was treated with retinal photocoagulation of the left eye. Three days later, there was recurrence of bilateral serous retinal detachment. She was immediately treated with sub-Tenon triamcinolone acetonide injection in both eyes, which improved serous detachment. Additional retinal photocoagulation was performed in both eyes 18 months later. These cases suggest that laser treatment triggers recurrence of Vogt-Koyanagi-Harada disease. Further investigation of this association is warranted.

ABSTRACT Clinical relevance Anterior segment morphometric parameters, including the iris, ciliary body, ciliary process and anterior sclera, re ect uveal vascular physiology and scleral biomechanics. These structures may help clinicians better understand disorders associated with altered ocular uid dynamics within the pachychoroid spectrum. Background Complex central serous chorioretinopathy is characterised by serous neurosensory retinal detachment and is commonly associated with pachychoroid features, including increased subfoveal choroidal thickness. However, the potential contribution of anterior uveal and scleral structures to its pathophysiology remains insu ciently de ned. Methods This study included 32 eyes with active complex central serous chorioretinopathy and 31 age- and gender-matched controls. Iris, ciliary body, and ciliary process thicknesses were measured using ultrasound biomicroscopy under standardised photo-pic conditions. Anterior scleral thickness was measured at 1, 2 and 3 mm posterior to the scleral spur using anterior segment optical coherence tomography. Subfoveal choroidal and central macular thickness were measured by spectral-domain optical coherence tomography. Correlations were analysed with false discovery rate correction. Results Ciliary body (0.93 ± 0.11 mm vs 0.78 ± 0.10 mm) and anterior scleral thickness (0.57 ± 0.06 mm vs 0.49 ± 0.05 mm) were signi cantly greater in complex disease than in controls (both p < 0.001). Subfoveal choroidal thickness (425.7 ± 83.8 µm vs 290.7 ± 68.5 µm) and central macular thickness (330.7 ± 74.0 µm vs 226.5 ± 18.8 µm) were also higher (p < 0.001). Anterior scleral thickness correlated with ciliary body (r = 0.494), ciliary process (r = 0.498) and subfoveal choroidal thickness (r = 0.509) (all p < 0.001). Temporal iris thickness correlated with temporal anterior scleral thickness (rs = 0.410; p = 0.006). Conclusion Active complex disease is associated with increased anterior uveal and scleral thickness, suggesting anterior segment involvement parallel to posterior pachychoroid changes.

Background: Lyme disease is a multisystem infectious disease caused by the spirochete Borrelia burgdorferi and transmitted by Ixodes ticks. Ocular involvement is uncommon but may affect several ocular structures including the retina, choroid, and optic nerve. We report a case of bilateral multifocal chorioretinitis with juxtafoveal serous retinal detachment associated with Lyme borreliosis documented using multimodal imaging. Case presentation: A 33‑year‑old woman presented with progressive painless visual decline in both eyes three months after a stay in a mountainous endemic area. Best corrected visual acuity was 8/10 in both eyes. Fundus examination revealed multiple yellow‑white punctiform lesions scattered in the posterior pole and mid‑peripheral retina, predominantly in the superior quadrants. Macular optical coherence tomography (OCT) demonstrated bilateral juxtafoveal serous retinal detachments associated with hyperreflective subretinal deposits and retinal pigment epithelium irregularities. Infectious work‑up excluded viral and syphilitic etiologies, while Lyme serology was positive. Cutaneous erythematous papular lesions on the lower limb supported systemic Lyme disease. The patient was treated with oral doxycycline for three weeks with complete visual recovery. Conclusion: Lyme borreliosis should be considered in the differential diagnosis of multifocal chorioretinitis associated with serous macular detachment, particularly in patients with exposure in endemic areas. Multimodal retinal imaging, especially OCT, plays a key role in identifying inflammatory macular changes and monitoring therapeutic response.

Retinal vein occlusion (RVO) is a common vascular disease that leads to vision loss due to macular edema (ME). This study investigated the role of autotaxin (ATX), a lysophospholipase D, in the pathogenesis of RVO. In mice, RVO was induced by intravenous administration of rose bengal followed by laser irradiation of retinal veins. ATX expression in the retina was evaluated using immunohistochemistry. Intravitreal ATX was administered, and retinal changes were assessed using fluorescence angiography and optical coherence tomography (OCT). In human retinal microvascular endothelial cells (HRMECs), intercellular barrier function was evaluated using transepithelial electrical resistance (TEER). In the murine RVO model, the ATX inhibitor HA130 was administered intravitreally, and retinal thickness was measured and compared using OCT. ATX expression was increased in retinal vessels in the RVO model. Intravitreal administration of ATX induced retinal edema and serous retinal detachment (SRD). ATX significantly disrupted the barrier integrity of HRMECs and promoted the expression of vascular endothelial growth factor (VEGF), which was ameliorated by HA130. Intravitreal administration of HA130 significantly reduced retinal thickening caused by retinal edema secondary to RVO and the elevated expression of intercellular adhesion molecule (ICAM)-1 in the retina. These findings suggest that ATX plays a critical role in RVO-induced ME by disrupting endothelial barrier integrity, potentially through the upregulation of VEGF in retinal endothelial cells and subsequent ICAM-1 upregulation in the retina.

To characterize choroidal circulation in the vortex veins in central serous chorioretinopathy. Single-center retrospective study. The study included 22 eyes with central serous chorioretinopathy from 22 patients with serous retinal detachment at the macula (18 men and four women, mean age 47.3 years). Ultra-widefield indocyanine green angiography was performed using Optos®California, and images were taken intermittently from the early to the late phase (> 20 min of contrast) to examine late images of the vortex veins. Findings in the affected and contralateral eyes were also compared. In 13 of the 22 eyes, the vortex veins were hypofluorescent in all quadrants and continuous with the vortex ampullae. In five eyes, only the asymmetric dilated vortex vein was hypofluorescent, and in four eyes, the vortex veins were not hypofluorescent. Of the 22 contralateral eyes examined, 20 eyes exhibited identical findings in the vortex veins to those observed in the affected eye. Of the four eyes that did not exhibit hypofluorescence of the vortex veins in the affected eye, two eyes had partial hypofluorescence of some vortex veins in the contralateral eye, showing different findings. In the late phase, some eyes showed hypofluorescence due to the washout of indocyanine green dye in the vortex veins and others did not, suggesting that obstruction of the scleral passage in the choroidal venous outflow is not the main cause of the syndrome.

While immune checkpoint inhibitors like the anti-PD-1 agent tislelizumab have revolutionized the treatment of cancer, they pose a risk of immune-related adverse events (irAEs). Vogt-Koyanagi-Harada (VKH)-like uveitis is a rare, vision-threatening ocular irAE that poses significant diagnostic and therapeutic challenges, often mimicking its idiopathic counterpart. Following ten cycles of adjuvant tislelizumab treatment, a 52-year-old female with a past medical history of esophageal cancer presented with acute monocular vision loss. Comprehensive ophthalmic evaluation revealed left optic disc edema, exudative retinal detachment, and characteristic serous retinal detachments on optical coherence tomography (OCT). Extensive systemic workup excluded infectious, neoplastic, and primary autoimmune etiologies. Notably, cerebrospinal fluid (CSF) analysis revealed a lymphocyte-dominant profile but no pleocytosis, a finding atypical for classic VKH disease. The uveitis responded markedly to systemic corticosteroid pulse therapy but flared unequivocally upon two subsequent tislelizumab infusions, establishing a clear drug-effect temporal relationship. After completing the planned 12 cycles of tislelizumab alongside a prolonged, carefully tapered oral corticosteroid regimen, the patient's ocular inflammation resolved completely. At one-year follow-up, visual acuity remained stable with no recurrence, demonstrating sustained remission after cessation of the inciting agent. This case strongly implicates tislelizumab as a trigger for VKH-like uveitis and highlights two critical learning points: the potential lack of CSF pleocytosis as a differentiating feature from primary VKH, and the risk of recurrence upon drug rechallenge. It underscores the necessity for close collaboration between oncologists and ophthalmologists to navigate the dual imperatives of cancer control and vision preservation. Not applicable.

To estimate the effect of prolonged serous retinal detachment (SRD) during the waiting period for photodynamic therapy (PDT) on clinical outcomes in patients with central serous chorioretinopathy (CSC). Retrospective case series. Consecutive patients with CSC who underwent PDT between January 2016 and August 2024. Patients whose SRD resolved spontaneously while awaiting PDT were excluded. We measured the best-corrected visual acuity (BCVA) and retinal layer thickness at baseline and on the day of PDT. We evaluated (1) the changes in these parameters during the waiting period and (2) the association between the duration of this period and the outcomes. Associations of the time-to-PDT with 12-month BCVA, SRD remission at 12 months, and changes in retinal layer thickness during the waiting period. Ninety-four patients (94 eyes) with CSC were included, with a mean age of 57.6 ± 12.2 years, a mean BCVA of 0.18 ± 0.24 logMAR (Snellen: 20/30), and a mean waiting period of 50.8 ± 50.2 days. The outer nuclear layer thinned significantly during the waiting period (mean reduction = 1.9 ± 4.4 μm, P = 3.4 × 10-5), and longer waiting times were associated with greater thinning (crude: β = -0.04, P = 3.5 × 10-6; adjusted: β = -0.04, P = 1.3 × 10-6). However, waiting duration was not significantly associated with 12-month treatment outcomes. Our findings suggest that caution is warranted against prolonged subretinal fluid exposure beyond 1 to 2 months, as it may induce outer nuclear layer thinning.

Current advances in dome-shaped macula and associated conditions.

Choroidal osteoma is a rare benign ocular tumor, with neovascular complications being even less common. The diagnosis is greatly facilitated by multimodal imaging techniques. However, treatment remains a challenge, as no standardized protocols exist, and current approaches rely primarily on intravitreal injections of anti-VEGF agents. We describe the case of a 45-year-old patient with no significant medical history who presented in 2020 with a progressive macular syndrome, characterized by decreased visual acuity and a central scotoma over several months. Ophthalmologic examination of the right eye was unremarkable, while the left eye showed reduced visual acuity of 3/10. The anterior segment was normal with a clear lens. Fundoscopy revealed a well-demarcated yellowish juxta-papillary subretinal lesion extending into the papillomacular area. Optical coherence tomography (OCT) demonstrated serous retinal detachment, intraretinal macular edema, and retinal pigment epithelial (RPE) detachments, along with a juxta-papillary eovascular membrane. A-scan ultrasonography confirmed the diagnosis of choroidal osteoma, showing a hyper-echogenic lesion with posterior shadowing. Retinal angiography and indocyanine green angiography (ICG) revealed occult neovascularization extending into the papillomacular area. The patient was treated with intravitreal anti-VEGF injections. Although the therapeutic response was gradual, injections every six weeks successfully maintained visual acuity at 7/10 and resolved the intra- and subretinal fluid. The management of neovascular complications in choroidal osteoma remains complex due to the absence of standardized treatment protocols. Anti-VEGF therapy shows promise, albeit with a slow response, and requires sustained long-term administration to optimize visual outcomes and preserve visual function.

Vogt-Koyanagi-Harada-like uveitis that presents with severe hyalitis has rarely been reported during anti-programmed death 1 therapy. A 70-year-old Chinese man presented with bilateral visual disturbances and vomiting after four cycles of serplulimab, an anti-programmed death 1 antibody, for metastatic lung carcinoma. His best corrected visual acuity was measured at 0.04 in the right eye and 0.02 in the left eye. A slit-lamp examination indicated severe hyalitis, while ocular ultrasound revealed focal serous retinal detachment. Magnetic resonance imaging demonstrated choroidal thickening and cerebrospinal fluid analysis indicated a mild lymphocytic elevation. Retinal fluorescein angiography exhibited focal pinpoint leakage and delayed hyperfluorescence at the optic disc. A diagnosis of Vogt-Koyanagi-Harada-like uveitis secondary to anti-programmed death 1 therapy was established. Following the discontinuation of anti-programmed death 1 treatment and 1-month course of oral prednisone at a dosage of 40mg per day, the patient's best corrected visual acuity improved to 0.6 in the right eye and 0.4 in the left eye. Corticosteroid treatment has proven effective for Vogt-Koyanagi-Harada-like uveitis. Currently, the optimal mode and dosage of corticosteroid therapy have not been clearly defined. Gathering more real-world cases of Vogt-Koyanagi-Harada-like uveitis associated with anti-programmed death 1 antibodies would be beneficial in developing therapeutic guidelines.

Introduction: IgM multiple myeloma is an extremely rare entity, accounting for less than 1% of all myelomas, and differs from Waldenström macroglobulinemia despite the shared secretion of monoclonal IgM. Its presentation with ophthalmologic involvement is exceptional and may threaten visual prognosis. Case Report: We report the case of a 38-year-old woman admitted for sudden bilateral visual acuity loss associated with headaches and constitutional symptoms. Ophthalmologic examination revealed bilateral retinal vein occlusion with papilledema and serous retinal detachment. Laboratory investigations showed profound aregenerative anemia, marked hyperproteinemia, hypercalcemia, and hyperviscosity syndrome. Serum protein electrophoresis demonstrated a massive monoclonal IgM spike. Bone marrow evaluation, including aspiration and biopsy, revealed 30% medullary plasmacytosis with CD138+ plasma cell infiltration, without diffuse lymphoplasmacytic proliferation. Testing for the MYD88 mutation, recommended to differentiate from Waldenström macroglobulinemia, could not be performed for financial reasons. Nevertheless, the overall findings supported a diagnosis of IgM multiple myeloma. The patient received chemotherapy according to the VCD protocol, with clinical, biological, and ophthalmologic improvement, followed by maintenance therapy with bortezomib and indication for autologous hematopoietic stem cell transplantation. Conclusion: Ophthalmologic involvement may reveal IgM multiple myeloma, highlighting the importance of systematic evaluation and prompt management to improve functional and overall prognosis.

Sildenafil use and risk of serous retinal detachment in men with erectile dysfunction in US.

Aims: The objective of this case presentation is to describe choroidal lymphoma and to promote a structured approach that has enabled us to resolve diagnostic ambiguities. Introduction: Choroidal lymphoma is a subtype of uveal lymphoma and is considered a rare condition. The literature on this subject is limited, which explains why many ophthalmologists are unfamiliar with this pathology. In this case report, we describe the case of a patient presenting with chronic decreased visual acuity in her right eye. The initial diagnosis was rhegmatogenous retinal detachment, which was revised to choroidal lymphoma after further investigations and histopathological confirmation. Case Presentation: We report the case of a 45-year-old woman with chronic decreased visual acuity in her right eye, which had been progressing for three years. She had no history of eye trauma or surgery and was in good general health. After the initial examination, the patient was considered to have a rhegmatogenous retinal detachment of the right eye, and vitreoretinal surgery was scheduled. However, the senior doctor noted some inconsistencies which led to further investigations with a pivotal role for ocular ultrasound, suggesting the possibility of choroidal lymphoma. This diagnosis was then confirmed by histopathological examination, and the systemic workup performed to search for extraocular involvement was negative. Discussion: The diagnosis of choroidal lymphoma is often complex because its symptoms can be similar to those of other eye conditions. Typical manifestations of fundus involvement include solid thickening of the choroid, serous retinal detachment, and anterior and/or posterior epibulbar extension. The diagnosis is confirmed by histopathology, supplemented by immunohistochemistry and flow cytometry. Non-Hodgkin B-cell lymphoma remains the most common type. Monitoring, radiotherapy, chemotherapy, and immunotherapy are the various treatment options for managing choroidal lymphoma, tailored to each individual case. Conclusion: Choroidal lymphoma is a rare condition and little known among ophthalmologists. Consequently, diagnosis is often delayed, as it is sometimes confused with other pathologies, such as rhegmatogenous retinal detachment, as illustrated in our case. A structured approach is essential when dealing with this misleading syndrome.

Visual outcomes, incidence and risk factors for RPE atrophy in myopic patients with dome-shaped macula and serous retinal detachment.

To examine the role of photodynamic therapy (PDT) in the treatment of retinal disease and the obstacles to use in the United States for evidence-based indications. Perspective essay. This article includes a historical summary, example case report, and relevant literature review. PDT has been approved by the US Food and Drug Administration for use in neovascular age-related macular degeneration (AMD), but has been superseded by anti-vascular endothelial growth factor drugs and is rarely used for this indication. It is regularly used in polypoidal choroidal vasculopathy (PCV) without reimbursement difficulty because PCV is acknowledged to be a form of AMD. It is effective for serous retinal detachment associated with choroidal hemangioma. Because this is a rare indication, insurers generally authorize its use. It is the most effective treatment for chronic central serous retinopathy (CSR), a relatively common indication; however, authorization from insurers is difficult to obtain, leading to avoidable loss of vision because patients often will not or cannot pay chargemaster prices. Many retina specialists eschew PDT because the expense in time and the laser does not balance the difficulties with reimbursement and the comparative advantage of allocating their time in other ways. In the United States, finding a retina specialist who performs PDT is challenging for patients with diseases for which it is indicated. Obtaining coverage for CSR is difficult for retina specialists treating patients with CSR in the United States, but not internationally. As a result, delayed or no treatment for cases indicated leads to avoidable loss of vision. A suggested solution is that insurers agree to cover PDT for chronic CSR at a rate equal to 1.3 times Medicare reimbursement for neovascular AMD.

Background: Vogt–Koyanagi–Harada disease (VKH) is a rare autoimmune disorder that attacks melanocyte-containing tissues, particularly the eyes, and can involve the central nervous system, hearing, and skin. VKH is one of the leading causes of non-infectious panuveitis in pigmented populations, and delayed diagnosis can lead to permanent visual impairment. Therefore, early detection and appropriate corticosteroid therapy are crucial to prevent long-term visual impairment. The purpose of this case report is to describe the clinical manifestations, supporting examinations, and response to high-dose corticosteroid therapy in a patient with suspected VKH disease. Case Illustration: A 39-year-old male presented with one week of progressive bilateral visual loss accompanied by fever, headache, and tinnitus. Examination revealed anterior chamber cells and flare, optic disc swelling, and serous retinal detachment. Optical coherence tomography confirmed subretinal fluid with septa formation. The patient was treated with high-dose intravenous methylprednisolone followed by oral tapering, resulting in significant visual improvement and stable recovery over one year. Conclusion: Early recognition of VKH disease and prompt initiation of high-dose corticosteroid therapy are crucial to control inflammation, prevent recurrences, and preserve long-term visual function.

We reported the clinical course of refractory childhood glaucoma associated with Sturge–Weber syndrome (SWS) treated with Baerveldt glaucoma implant (BGI). The patient was a 14‐year‐old male diagnosed with SWS after birth. He had previously undergone four trabeculotomies for glaucoma and vitrectomy for submacular hemorrhage from a diffuse choroidal hemangioma in his left eye. Before the BGI surgery, his intraocular pressure was 30 mmHg under full medications. The patient experienced extensive serous retinal and choroidal detachments on Postoperative Day 9. The cause may have been the increased leakage of serous fluid from the choroidal hemangioma and the high venous pressure in the episclera due to SWS. Retinal and choroidal detachments subsided within 8 days with conservative therapy. It is important to avoid postoperative hypotony for the treatment of secondary childhood glaucoma due to SWS.

Accurate and efficient classification of retinal fundus images plays a critical role in supporting the early diagnosis of ocular diseases. However, models relying on a single deep learning backbone often struggle to capture the multi-scale and heterogeneous characteristics of retinal lesions, leading to unstable performance across visually similar disease classes. To address this limitation, this study proposes a novelty feature-level fusion framework that integrates complementary representations from DenseNet121 and EfficientNetV2-s, followed by classification using XGBoost. The fusion pipeline extracts 1024-dimensional features from DenseNet121 and 1280-dimensional features from EfficientNetV2-s, which are concatenated into a unified 2304-dimensional feature vector. Experiments were conducted on a dataset of 10,247 retinal fundus images spanning six categories: Central Serous Chorioretinopathy, Diabetic Retinopathy, Macular Scar, Retinitis Pigmentosa, Retinal Detachment, and Healthy. The proposed fusion model achieved an accuracy of 91.60%, outperforming DenseNet121 XGBoost (91.31%) and EfficientNetV2-s XGBoost (89.70%). Moreover, the fusion strategy demonstrated improved class-level stability, particularly for visually similar retinal disorders where single-backbone models exhibited higher misclassification rates. This study contributes a lightweight yet effective multi-backbone feature-level fusion approach that enhances discriminative representation and classification stability without increasing model complexity. In addition, the use of XGBoost introduces a tree-based decision mechanism that is inherently more interpretable than conventional fully connected layers, offering potential advantages for clinical analysis. Overall, the results highlight the effectiveness of multi-backbone feature fusion as a reliable strategy for automated retinal disease classification.

ABSTRACTThe circumscribed choroidal hemangioma (CCH) is a benign congenital eye tumor whose etiology is not clear. A 41‐year‐old female patient came with a 2‐year history of slowly progressive deteriorating vision in her right eye. In the left eye, the best‐corrected visual acuity (BCVA) was 6/6, and counting fingers at 1 m in the right eye. The wide‐field fundus showed a yellow macular lesion with indistinct limits, which is a sign of serous retinal detachment. B‐scan ultrasonography revealed a clear‐cut choroidal lesion, high internal reflectivity, and visible intrinsic vascularity on color Doppler. OCT has shown a massive choroidal mass with damaged RPE and outer retinal layers, which has been obscured by serous retinal detachment. The chest x‐ray revealed bronchiectatic opacities, the CT scan revealed no lung lesions, and LFTs and RFTs were normal. The fluorescein angiography revealed a choroidal hemangioma with early vascularity and late hyperfluorescence. Nonetheless, the retinal team chose the option of observation instead of TTT, radiotherapy, or verteporfin photodynamic therapy due to the closeness of the lesion to the macula, low visual acuity, and lack of verteporfin PDT in Pakistan. To sum up, the present case demonstrates the significance of multimodal imaging in the proper diagnosis of choroidal hemangiomas and the necessity to pay close attention to patient‐specific factors when making treatment decisions, especially in limited resource settings.