Serous Retinal Pigment Epithelial Detachment Research Articles

Сравнительный анализ аваскулярных отслоек ретинального пигментного эпителия

Purpose. To study anatomical and functional parameters using optical coherence tomography in patients with avascular retinal pigment epithelium (RPE) detachment with age-related macular degeneration (AMD) and central serous chorioretinopathy (CSCR). Material and methods. 40 people with AMD and CSR were examined. Patients were divided depending on the type of RPE detachment: druzenoid – 10 patients, serous RPE detachment in AMD – 20 patients, serous RPE detachment in CSCR – 10 patients. Results. A comparative analysis revealed that serous avascular RPE detachment in AMD is characterized by the greatest height and width in relation to drusenoid RPE detachment and RPE detachment in CSCR. Avascular RPE detachment in CSCR are characterized by the smallest dimensions – both in height and width in relation to other avascular RPE detachments, and the greatest thickness of the choroid in relation to serous RPE detachment in AMD (p = 0.018). Conclusions. The identified features of avascular RPE detachment in AMD and CSCR allow us to choose an adequate tactics for managing patients. Key words: retinal pigment epithelium detachment, age-related macular degeneration, central serous chorioretinopathy

Дифференциальная диагностика аваскулярных и васкуляризированных отслоек ретинального пигментного эпителия при возрастной макулярной дегенерации

Purpose. Тo evaluate of differential diagnostic signs using optical coherence tomography in patients with avascular and vascularized serous retinal pigment epithelium detachment (RPE) in age-related macular degeneration (AMD). Material and methods. 40 people with AMD were examined. The patients were divided into two groups: avascular (20 patients) and vascularized (20 patients) serous RPE detachment. All patients underwent a standard ophthalmological examination and additional research methods: determination of the maximum corrected visual acuity using to the ETDRS (Early Treatment Diabetic Retinopathy Study) charts, OCT, OCT angiography. Results. Comparative analysis of OCT signs revealed that avascular serous RPE detachment is characterized by the presence of neuroepithelial detachment at the top of the RPE detachment (p = 0.002), neuroepithelial detachment is located within a triangle with the apex at the level of the inner limiting membrane of the retina, with a bisector drawn from the apex of the triangle through the point of maximum height RPE detachment and lateral sides that are tangent to the sides of the RPE detachment (p = 0.004). The presence of vascularized serous RPE detachment is characterized by intraretinal fluid (p = 0.002), prominence of the top of the RPE detachment (p = 0.009), thickness of the RPE at the top of the RPE detachment is greater than at the base (p = 0.006), hyperreflective layer under the RPE (p < 0.005), an increase in the hyperreflectivity of photoreceptors on the top of the RPE detachment relative to the base (p = 0.009). Conclusions. The identified differential diagnostic criteria make it possible to choose an adequate tactics for the treatment of patients with serous RPE detachment in age-related macular degeneration, depending on the identified form – vascularized or avascular. Keywords: retinal pigment epithelium detachment, age-related macular degeneration.

Efficacy of Intravitreal Bevacizumab in Chronic Central Serous Chorioretinopathy in Terms of Mean Reduction of Central Macular Thickness in Pakistani Patients

Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition described by serous neurosensory retinal detachment at the posterior pole, usually associated with serous retinal pigment epithelial detachment (PED). CSCR patients as a rule have good visual prognosis. In most of the patients, CSCR is self-limiting and patients regain the last visual acuity. However, some patients may have visual disability due to permanent RPE and photoreceptor damage. Objective: The objective of the study is to determine the effect of intravitreal Bevacizumab in cases of chronic central serous chorioretinopathy in terms of mean change in central macular thickness. Study Design: Interventional experimental study. Settings: The study was conducted in Department of Ophthalmology, Allied Hospital, Faisalabad Pakistan. Duration: 2 years from January 2017 to December 2018. Methodology: An aggregate of 95 cases were recruited for the study. Study included both male and female patients with diagnosis of chronic CSCR (at least 6month duration). Best corrected visual acuity, Intra Ocular Pressure on Goldman applanation Tonometer and Optical coherence tomography on Optovue were recorded of both eye of all patients. Before starting the treatment, informed consent was signed by every patient and they were called on the day of injection. Intravitreal off label Bevacizumab (1.25/0.05ml) was given through pars plana in operation theater under aseptic conditions. After injection topical antibiotic drops were given to patients for one week and patients called for follow up after one week, one month, 2 month and 3 months. Same parameters BCVA, IOP, Dilated fundus examine and OCT was recorded on every visit. The final outcome i.e., change in central macular thickness was recorded. Results: In this study, out of 95 cases, 53.68%(n=51) were between 30-45 years of age while 46.32%(n=44) were between 46-60 years of age, mean ± SD was calculated as 46.83+7.82 years, 74.74%(n=71) were male and 25.26%(n=24) were females. Pre-treatment mean central macular thickness was recorded as 344.77+14.61µ which reduced to 154.57+16.57 µ, mean difference was recorded as 190.2+21.46 µ, p value was 0.0001 showing a significant difference. Conclusion: We concluded that intravitreal Bevacizumab significantly reduced central macular thickness in cases of chronic central serous chorioretinopathy.

A Comparison Study of Polypoidal Choroidal Vasculopathy Imaged with Indocyanine Green Angiography and Swept-Source Optical Coherence Tomography Angiography

Indocyanine green angiography (ICGA) was compared with swept-source optical coherence tomography angiography (SS-OCTA) for the detection of polypoidal choroidal vasculopathy (PCV). Retrospective, cross-sectional. Patients with treatment-naïve PCV based on ICGA imaging underwent same-day SS-OCTA imaging at Kyung Hee University Medical Center between April 2017 and November 2018. ICGA and SS-OCTA images were graded independently. SS-OCTA images were graded using both flow and structural information. Images were graded for the number of polypoidal lesions and the total lesion area, which included both the polypoidal lesions and the branching vascular networks (BVNs). A total of 31 eyes from 30 patients were enrolled. Polypoidal lesions were identified in all eyes using both modalities, and there was agreement on the number of polypoidal lesions in 17 eyes (55%). In 12 eyes (39%), SS-OCTA graders identified a greater number of polypoidal lesions, and in 2 eyes (6%) ICGA graders identified more lesions. There was no significant difference in the lesion area measurements (standard deviation= 1.09, P= .08). The lesion with the largest difference in area measurements resulted from focal areas of atrophy, misdiagnosed as polypoidal lesions on ICGA, and a low-lying serous retinal pigment epithelial detachment erroneously identified as part of the BVN by ICGA graders. SS-OCTA imaging correctly diagnosed the focal areas of atrophy and the serous retinal pigment epitheial detachment. SS-OCTA imaging was comparable to ICGA for the diagnosis of treatment-naïve PCV. However, SS-OCTA might be better than ICGA in correctly identifying both polypoidal lesions and BVNs in treatment-naïve PCV.

Coexistence of retinal angiomatous proliferation and pachychoroid phenotype.

Retinal angiomatous proliferation (RAP) is usually seen in the eye with thin choroid and drusen.[12] Pachychoroid is the morphological description of the thick choroid.[3] We herein report two cases of RAP noted in eyes with pachychoroid. Case 1 Fundus photograph of the right eye of a 48-years-old gentleman with 6/18, N8 vision showed RPE alterations [Fig. 1a and b]. Spectralis SDOCT line scan showed intraretinal edema, hyperreflective spot, subfoveal choroidal thickness (CT) of 436μ and dilated large choroidal vessels. Line scan through the area of thickening showed serous RPE detachment and edema [Fig. 1c and d]. Early phase fluorescein angiogram (FA) showed hyperfluorescence at fovea [Fig. 2a]. Indocyanine angiogram (ICGA) showed hot spot [Fig. 2b]. Late phase FA [Fig. 2c] showed a leak whereas ICGA [Fig. 2d] showed hypercyanescence at fovea amidst diffuse hypercyanescence due to choroidal hyperpermeability. A diagnosis of pachychoroid phenotype with RAP was made.Figure 1: (a) Color fundus photograph of the right eye shows retinal pigment epithelium (RPE) alterations (black arrow). (b) Confocal scanning laser ophthalmoscopy based multicolor image shows greenish hue (yellow arrow) owing to thickening. RPE atrophy is highlighted as reddish hue (black arrow). (c) Spectral domain optical coherence tomography (SDOCT) line scan through the fovea shows intraretinal thickening (yellow arrow) and hyperreflective spot (red arrow). Subfoveal choroidal thickness is 436 μ. Dilated Haller's layer vessels (yellow stars) are seen. (d) SDOCT line scan slightly above fovea shows serous RPE detachment (red arrow) and intraretinal edema (yellow arrow)Figure 2: (a) Early phase fluorescein angiography (FA) image of right eye shows hyperfluorescence at fovea. (b): Early phase indocyanine angiography (ICGA) shows hot spot at fovea. (c): Late phase FA image shows hyperfluorescence increasing in area and intensitiy suggestive of leak from retinal angiomatous proliferation (RAP). (d): Late phase ICGA image shows diffuse hypercyanescence at macula due to choroidal hyperpermeability in pachychoroid eyes. RAP is seen as focal increased hypercyanescence at foveaCase 2 Fundus photography of left eye of a 62 years old gentleman with 6/18, N10 vision revealed RPE alteration at fovea [Fig. 3a and b]. SDOCT scan through fovea showed hyperreflective spots, subretinal fluid, and CT of 336μ. Line scan above fovea showed prominent hyperreflective spot with dilated large choroidal vessel layer [Fig. 3c and d]. Early FA image showed hyperfluorescence corresponding to hyperreflective spot and leak in late phase [Fig. 4a and b] suggestive of RAP in an eye with pachychoroid phenotype.Figure 3: (a) Color fundus photograph of left eye shows RPE alterations (black arrow). (b) Multicolor image shows greenish hue nasal to fovea owing to thickening (yellow arrow). (c): SDOCT line scan through fovea shows hyperreflective spot (yellow arrow) at the level of outer plexiform layer. There is small subretinal fluid (red arrow). Subfoveal choroidal thickness is 336 μ. (d) SDOCT line scan superior to fovea shows well defined hyperreflective spot (yellow arrow) and shallow RPE detachment along with dilated Haller's layer vessels (yellow star)Figure 4: (a) Early FA image of left eye shows hyperfluorescence nasal to fovea. (b) Hyperfluorescence increased in size and intensity and corresponded to the hyperreflective spot seen on SDOCT, suggestive of RAPDiscussion Thickening of RPE and drusen in eyes with RAP hamper the diffusion of VEGF from RPE to choroid, which disturbs choroidal autoregulation leading to attenuation of choriocapillaris.[24] Thin choroid reduces the transport of metabolites back to retina, accentuating the retinal ischemia, and leading to RAP.[2] Attenuation of choriocapillaris is sine qua non of pachychoroid phenotype.[5] The pachychoroid neovasculopathy (PNV) in these eyes is a result of ischemic environment in sub-RPE space owing to attenuation of choriocapillaris.[3] Attenuation of choriocapillaris is common pathology between RAP and pachychoroid. It may be possible for eyes with pachychoroid to develop type 3 neovascularization or RAP in the manner in which they develop PNV. This plausible explanation for RAP in pachychoroid eyes needs to be substantiated in a larger case series. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Evaluation of focal damage in the retinal pigment epithelium layer in serous retinal pigment epithelium detachment

The purpose of this study was to evaluate focal damage in the retinal pigment epithelium (RPE) layer in serous retinal pigment epithelium detachment (PED) with multi-contrast optical coherence tomography (OCT), which is capable of simultaneous measurement of OCT angiography, polarization-sensitive OCT and standard OCT images. We evaluated 37 eyes with age-related macular degeneration that had serous PED. Focal RPE damage was indicated by hyper-transmission beneath the RPE-Bruch’s membrane band in standard OCT images. Distribution of RPE melanin was calculated using the dataset from multi-contrast OCT. Twenty-four points with hyper-transmission were detected in 21 of the 37 eyes. Standard OCT images failed to show disruption of the RPE-Bruch’s membrane band at 5 of the 24 hyper-transmission points. Conversely, multi-contrast OCT images clearly showed melanin defects in the RPE-Bruch’s membrane band at all points. Areas of melanin defects with disruption of the RPE-Bruch’s membrane band were significantly larger than those without disruption. The volume of intraretinal hyper-reflective foci was significantly larger in eyes with hyper-transmission than that in eyes without hyper-transmission. Multi-contrast OCT is more sensitive than standard OCT for displaying changes at the RPE-Bruch’s membrane band when there are small areas of RPE damage.

Treatment of idiopathic choroidal neovascular membrane with ranibizumab - our experience.

To evaluate the anatomical and functional outcome of ranibizumab therapy in patients with idiopathic choroidal neovascularization (CNV). File and Methodology: The group consists of 6 patients. Patients were older 18 years but they were under 50 years of age. The monitoring period lasted 12 months. We confirmed active idiopathic CNV in subfoveal position with fluorescein angiography (FAg) and optical coherence tomography (OCT). The activity of idiopathic CNV we demonstrated with leakage of dye by FAg examination. The presence of serous retinal pigment epithelium detachment and / or subretinal fluid and / or intraretinal edema in the form of intraretinal cysts demonstrated activity of CNV on OCT scans. Adecrease of the visual acuity under 85 letters was observed at the ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart. After the initial administration of ranibizumab apro re nata regimen was used. We indicated repeated injection of ranibizumab in patients with signs of activity of idiopathic CNV on OCT scans or by FAg. Also we indicated repeated injection of ranibizumab in patients with new loss of visual acuity on the ETDRS visual acuity chart connected with signs of activity of CNV on OCT scans or by FAg. On average, we observed the gain of +11 letters on the ETDRS visual acuity chart after 12 months of the follow-up period. On average we observed reduction of central macular thickness -233μm. At the 12th month of follow-up we observed in all patients of our group only inactive scar without exudation. No serous retinal pigment eithelium detachment, subretinal fluid or intraretinal cysts were observed. Only 3 injections of ranibizumab were administered on average to each patient during the 12 months of the follow-up period. In our study, we observed the positive effect of ranibizumab on the course of idiopathic CNV. With ranibizumab treatment we achieved regression of CNV with resorption of macular edema in all patients of our group. With the disappearance of the activity of idiopathic CNV ranibizumab gives real hope to improve visual acuity.

Pathologic study of early manifestations of polypoidal choroidal vasculopathy and pathogenesis of choroidal neo-vascularization

PurposeTo describe the histopathologic features of an early case of presumably bilateral polypoidal choroidal vasculopathy (PCV) in two eyes obtained at autopsy from a patient with no prior ocular therapy. ObservationsThe choroid of both eyes at the macular and peripapillary regions was greatly thickened with dilated, thin walled choroidal venules intertwining with arteriosclerotic arterioles in the Sattler's layer of the choroidal vasculature. At the temporal and nasal equatorial regions of both eyes many of these congested venular channels abruptly disappeared and were replaced by loose connective tissue with loss of the normal choroidal stromal tissue and uveal melanocytes. A few remaining venules showed intraluminal sloughing of endothelial cells and deposition of fibrinous material networks suggesting occlusion of these choroidal venules. At this equatorial location, serous detachment of retinal pigment epithelium (RPE) appeared and a thin neovascular membrane with cords of endothelial cell invaded into the sub-RPE space. Anteriorly, the neovascular membrane expanded and bulged into the sub-retinal space with dilated neovascular capillaries in a “grape like” or polypoidal configuration. Conclusion and importancePolypoidal Choroidal Vasculopathy is a disease of the dilated and multi-layered choroidal venules. Occlusion of these choroidal vascular channels might give rise to choroidal stasis and ischemia leading to serous RPE detachment and a sub-RPE neovascular membrane. Gross dilatation of the choroidal venules and capillaries in the sub-RPE neovascular membrane leads to the characteristic “grape like” structures, a unique clinical feature in this disease entity. These pathologic features of PCV are different from the pathologic changes of neovascular age-related macular degeneration (nAMD). Consequently, PCV and nAMD are two distinct diseases. However, in the late stage of both entities, choroidal ischemia in both diseases, lead to sub-RPE neovascularization and subsequent sub-RPE and/or sub-retinal hemorrhage. These results in both entities showed comparable clinical and pathologic features that are frequently mistaken PCV as a sub-type of Neovascular AMD.

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.

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.

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.

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.

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.

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.

Efficacy of reduced-fluence photodynamic therapy for serous retinal pigment epithelial detachment with choroidal hyperpermeability

BackgroundVery few reports have addressed methods of treatment for idiopathic serous (IS) pigment epithelial detachment (PED).ObjectiveThe purpose of this report was to describe clinical courses of two patients with ISPED in whom reduced-fluence photodynamic therapy (RFPDT) was performed.Case reportsTwo patients (a 38-year-old woman and a 42-year-old man) were diagnosed with ISPED. In both patients, indocyanine green angiography revealed an area of choroidal vascular hyperpermeability including hyperfluorescent PED, which was evident at the subfoveal area. Both patients underwent RFPDT at an energy of 25 J/cm2. The PED was seen to have resolved 1 month after the treatment and visual acuity was maintained or improved. There was no posttreatment recurrence of PED after 6 months to 1 year, and no treatment-related adverse events were observed.ConclusionRFPDT may be an effective and safe method of treatment for ISPED with choroidal vascular hyperpermeability.

Macular Choroidal Thickness Measured by Swept Source Optical Coherence Tomography in Eyes with Inferior Posterior Staphyloma

To study the choroidal thickness in eyes with inferior posterior staphyloma (IPS) and to elucidate its role in the development of macular complications. The macular area of 42 eyes of 32 patients with IPS was studied prospectively with swept source optical coherence tomography at 1050 nm. Using a raster scan protocol with 512 × 128 A-scans, we produced a macular choroidal thickness map (6 × 6-mm(2)). Eyes with IPS showed relatively well-preserved choroid outside of the staphyloma but the inferior-nasal choroid within the staphyloma was thinned substantially. In addition, eyes with IPS often had a belt-shaped area with the thinnest choroid along the superior border of the staphyloma. As patient age increased, choroidal thinning progressed in the entire macular area. The macular choroidal thickness showed a close correlation with age (R(2) = 0.506, P < 0.001). On the superior border of the staphyloma, 13 eyes (30.9%) showed serous retinal detachment and/or pigment epithelial detachment without neovascularization, and eight (19.0%) showed neovascularization. Patients with neovascularization were older and had worse visual acuity (P < 0.001). Macular choroidal thickness in eyes with neovascular complications (76.5 ± 19.9 μm) was significantly reduced compared with that of eyes with no complication (133.0 ± 61.9 μm, P = 0.035). Eyes with IPS showed marked choroidal thinning along the superior border of the staphyloma. Reduction of the choroidal thickness progressed with age and seemed to be involved in the development of neovascularization associated with the IPS.

Clinical features of polypoidal choroidal vasculopathy with retinal pigment epithelium tears

Objective To observe the clinical features of polypoidal choroidal vasculopathy (PCV)with retinal pigment epithelium (RPE) tears.Methods Twelve patients of PCV with RPE tears (12 eyes)were enrolled in this study.The patients included eight males and four females,with a mean age of 58.6years (from 39 to 71 years old).All the patients were affected unilaterally,including eight right eyes and four left eyes.There were one eye with serous RPE detachment and 11 eyes with hemorhagic RPE detachment.All the patients were examined for fundus photography,fundus fluorescein angiography (FFA)and indocyanine green angiography (ICGA),three patients were examined for optical coherence tomography (OCT).The location of RPE tear was classified as within vascular arcade,on vascular arcade,and outside vascular arcade.The shape of tear was classified as crescent,semilunar,or irregular.The features of fundus,FFA,ICGA and OCT were observed.Results Fundus examination presents a gray lesion in all eyes.The location of tear were within vascular arcade in four eyes (33.3％),on vascular arcade in five eyes (41.7％) and outside vascular arcade in three eyes (25.0％).The shape of tears were crescent (one eye,8.3％),semilunar (ten eyes,83.3％) or irregular (one eye,8.3％).The RPE tear region present transimitted fluorescence of at the early stage of FFA and hyperfluorescence with a clear border at late stage.There was no leakage,and at the border of hyperfluorescence,blockage fluorescence of rolled and contracted RPE was present.In ICGA manifestation,transimitted fluorescence was found in RPE tear region at early stage,and a clear border was seen in nine eyes at late stage.There was also blockage fluorescence in ICGA of contracted RPE.In OCT manifestation,the RPE reflections were disappeared,and at the margin of tear,the contracted RPE present a dense rolled strong reflection.Conclusions In PCV patients,RPE tears are semilunar and usually located within or around the vascular arcade.Fundus angiograpby shows transimitted fluorescence at the RPE tear region,and curl blockage fluorescence at the edges.OCT shows RPE reflection is disappeared in the tear region and a strong reflection at the edges. Key words: Choroid diseases/diagnosis; Pigment epithelium of eye/injuries; Fluorescein angiography; Indocyanine green/diagnostic use

Spontaneous disappearance of serous retinal pigment epithelial detachment in elderly patients

Spontaneous disappearance of serous retinal pigment epithelial detachment in elderly patients

Spectral domain optical coherence tomography features of multiple subfoveal retinal pigment epithelial tears after intravitreal bevacizumab

Retinal pigment epithelial (RPE) tear has been described to occur spontaneously, after laser photocoagulation and in recent times, after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents. In the latter case, the rapid contraction of the choroidal vascular membrane underneath a serous RPE detachment is believed to be the underlying cause. Preservation of good visual acuity after the occurrence of RPE tear with continued use of intravitreal VEGF agents has been reported. In this case report, we describe the occurrence of multiple RPE tears with the use of intravitreal bevacizumab and also correlate the preservation of visual acuity with features seen on spectral domain optical coherence tomography.

Giant retinal pigment epithelial tear after laser photocoagulation for diabetic retinopathy

A 62-year-old man, who underwent focal laser photocoagulation in the left eye (OS) for diabetic retinopathy 2 years previously, complained of metamorphopsia OS. The left fundus had a semilunar retinal...