Subretinal Exudation Research Articles

Detection and Response Evaluation of Extramedullary and Medullary Blast Crisis in Chronic Myeloid Leukemia on 18F-FDG PET/CT.

FDG PET/CT imaging is usually not routinely undertaken in patients of chronic myeloid leukemia (CML). We present a case of CML on tyrosine kinase inhibitor treatment with disease control indicated by BCR-ABL1 quantitative reverse transcription-polymerase chain reaction, who underwent PET/CT for evaluation of recent onset vision deterioration with subretinal exudates on ophthalmological examination. PET CT detected FDG-avid sinonasal thickening and bilateral marrow lesions. These lesions on histopathological sampling, examination revealed extramedullary and intramedullary CML blast crisis. Patient was then treated with steroids and change of tyrosine kinase inhibitor for the CML blast crisis. FDG PET/CT done subsequently was able to demonstrate morphological and metabolic response in the lesions.

Dynamic Changes of Fundus and Predictors of Visual Prognosis in New-Onset Vogt-Koyanagi-Harada Disease

ABSTRACT Purpose To characterize the dynamic changes of fundus in Vogt-Koyanagi-Harada (VKH) disease through enhanced spectral-domain optical coherence tomography (EDI-OCT) and explore the predictors of visual prognosis. Methods In this retrospective cohort study, a total of 2152 VKH patients referred to our uveitis center from January 2013 to April 2022 were screened; 151 new-onset VKH patients (299 eyes) and 82 healthy controls (164 eyes) were included. The manifestations of fundus at baseline, 1 month, 3 months, and 12 months after treatment were analysed and their relevance to visual prognosis were evaluated. Results After retinal detachment (RD) (97.3%) and optic disc swelling (100%) presented at baseline, retinal reattachment (81.6%) and the granular hyperreflective depositions at the retinal pigment epithelium (RPE) (61.5%) were observed at month 1. The RPE and ellipsoid zone rearrangement accompanying interdigitation zone attenuation (57.9%) was noted finally. Choroidal thickness of patients was higher than that in the controls at baseline and month 1 (both P < 0.001). Best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) (P < 0.001; OR, 4.01), subretinal fibrinoid exudate (P < 0.001; OR, 3.9) and RPE folds (p = 0.001; OR, 2.39) at baseline, and the RD at month 1 (P < 0.001; OR, 3.42) were associated with visual prognosis. Conclusions New-onset VKH patients after treatment exhibited dynamic changes in the fundus especially the outer retina during a 12-month period. The BCVA, subretinal fibrinoid exudate, and RPE folds at baseline, and RD at month May 1, serve as predictors of visual prognosis.

UNRESOLVED QUESTIONS ABOUT COATS DISEASE: A CASE REPORT

Introduction : Coats disease (CD) is an idiopathic retinal vascular disorder accompanied by retinal telangiectasia with intraretinal and/or subretinal exudation without appreciable retinal or vitreal traction. The disease most common in young males and unilateral involvement. The etiopathogenesis of CD is unclear. However, previous studies have reported changes in inflammatory cytokines, and levels of VEGF in aqueous humor are also higher in patients with CD.&#x0D; Case Illustration : We reported a 19-year-old man with complaints of decreased vision, floaters, and uncomfortable feelings in his RE, since one year before presentation. Initial examination showed visual acuity of the RE was 0.5F2 and the LE was 1.0. Examination of posterior segment showed irregularly-dilated telangiectatic vessels and exudative RD. We performed an OCT examination in both eyes and the results showed extensive cystoid macular edema in the RE. Ultrasonography of the RE also showed an exudative RD. The patient was diagnosed with Coats disease grade 3 and planned to receive intravitreal anti-VEGF injection in RE. After the second injection, OCT examination results showed no improvement in the patient's eye condition. Until now, we’re still trying to find a suitable therapy and considering laser photocoagulation.&#x0D; Discussion : Previous studies showed that there was an improvement in some CD patients only with anti-VEGF injections, but some other patients didn’t improve and had to get other additional therapy with laser photocoagulation/cryotherapy. It’s related to the severity of the disease, where a disease with grade ?3, tends to require combination therapy with laser photocoagulation/cryotherapy.&#x0D; Conclusion : Intravitreal anti-VEGF injections alone don’t show improvement in CD grade?3.

RESOLUTION OF CHOROIDAL METASTASIS AND ASSOCIATED SUBRETINAL EXUDATION OF METASTATIC CUTANEOUS MELANOMA 15 DAYS AFTER TREATMENT WITH COMBINED TARGETED THERAPY.

To report a case of metastatic cutaneous melanoma to the choroid with rapid and complete resolution of associated choroidal elevation and subretinal fluid after initiation of combined targeted therapy. We describe a case of a 41-year-old man diagnosed with a metastatic cutaneous melanoma to the choroid of his right eye, for which treatment with dabrafenib/trametinib was initiated. A 41-year-old man with a past medical history of a BRAF V600E/V600E2/V600D mutated invasive superficial spreading cutaneous melanoma presented with acute metamorphopsia and blurred vision in his right eye. Examination revealed a best-corrected visual acuity (BCVA) of 20/22 and 2 elevated choroidal lesions temporal to the fovea with subretinal exudation to the fovea on fundoscopy. On repeat examination 3 days later, his vision had further decreased to 20/50 with an increase of subretinal fluid. Treatment with BRAF/MEK-inhibitor dabrafenib/trametinib was initiated, with complete resolution of the choroidal masses and subretinal exudation and improvement of the BCVA to 20/22 after only 15 days. Follow-up 8 weeks after start of therapy showed stable fundoscopic and tomographic findings, with further improvement of BCVA to 20/17 and no ocular side effects. A case of metastatic cutaneous melanoma to the choroid with choroidal elevation and subretinal exudation to the fovea, for which treatment with dabrafenib/trametinib was initiated. Rapid and complete resolution of choroidal metastasis and the associated subretinal exudation after initiation of combined targeted therapy was seen, without any ocular side effects.

Rapid Improvement in Lipid Maculopathy Following Faricimab Therapy in Recalcitrant Familial Exudative Vitreoretinopathy.

A monocular 22-year-old man with recalcitrant familial exudative vitreoretinopathy presented with progressive subretinal lipid exudation and lipid maculopathy that responded poorly to repeated aflibercept injections. The subretinal exudation started temporally and gradually progressed, involving the macula and the retinal periphery in all 4 quadrants. At the 22-month follow-up visit, macular and peripheral subretinal exudation persisted despite a total of 29 injections. Faricimab was then injected once every 2 weeks for a total of 3 injections, which resulted in rapid dramatic resolution of the macular and most of the peripheral subretinal exudation. No ocular or systemic adverse events were noted. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xxx-xxx.].

Congenital X-linked Retinoschisis and Familial Exudative Vitreoretinopathy: Pathogenesis, Diagnosis, and Treatment

Congenital X-linked retinoschisis (CXLRS) is characterized by symmetric bilateral macular involvement, usually beginning in the first decade of life and affecting males. In the fundus examination, a wheel pattern developing due to schisis areas is observed in the macula. Fundus examination and optical coherence tomography (OCT) are essential for diagnosis in the early stages of the disease and exhibit characteristic findings. Peripheral retinoschisis occurs in approximately 50% of cases, usually in the inferior temporal quadrant. Visual acuity usually deteriorates in the first and second decades of life, but then remains relatively stable until the fifth or sixth decade. There is no proven treatment for CXLRS so far, gene therapy studies are ongoing. Familial exudative vitreoretinopathy (FEVR) is a rare inherited vitreoretinal disorder characterized by abnormal or incomplete vascularization of the peripheral retina. The disease is frequently inherited as autosomal dominant and less frequently autosomal recessive or X-linked recessive. FEVR is manifested by bilateral involvement, which may be asymmetrical. Its distinctive features include the avascular peripheral retina and peripheral ischemia, retinal neovascularization, and subretinal exudation. Epiretinal membrane and tractional retinal detachment may also develop in some patients. Laser photocoagulation therapy is effective in patients with peripheral retinal ischemia and neovascularization. In this review, the pathogenesis, clinical features, and treatment methods in CXLRS and FEVR disease will be discussed.

Coats’ Disease: Pathogenesis, Diagnosis, and Treatment

Coats disease is an idiopathic nonhereditary condition retinal vascular disorder characterized by retinal telangiectasia with intraretinal and/ or subretinal exudation. Unilateral involvement in young males is the typical presentation with most cases being diagnosed in the first and second decade of life and, if untreated, can lead to total retinal detachment and secondary glaucoma, sometimes requiring enucleation. The most common presenting complaints include decreased vision, strabismus, and leukocoria. This article describes the clinical features, pathophysiology, classification and staging, complications, differential diagnosis, and the management of Coats disease.

Visual Recovery and Prognosis in the Treatment of Submacular Hemorrhage due to Polypoidal Choroidal Vasculopathy and Retinal Arterial Macroaneurysm: A Retrospective Study.

This study was carried out to evaluate the visual acuity (VA), complications, and prognosis of patients diagnosed with submacular hemorrhage (SMH) from polypoidal choroidal vasculopathy (PCV) and retinal arterial macroaneurysm (RAM) treated by pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (tPA), and air tamponade in vitreous cavity. It facilitates the development of generic treatment methods that can be widely used to improve vision and treat potential complications in patients with SMH, regardless of the underlying pathophysiological condition, such as PCV or RAM. In this retrospective study, SMH patients were divided into two groups based on their diagnosis: (1) polypoidal choroidal vasculopathy (PCV) and (2) retinal arterial macroaneurysm (RAM). The visual recovery and complications of patients with PCV and RAM after PPV + tPA (subretinal) surgery were analyzed. A total of 36 eyes of 36 patients were included: PCV (47.22%, 17/36) and RAM (52.78%, 19/36). The mean age of the patients was 64 years, and 63.89% of the patients (23/36) were female. The median VA was 1.85 logMAR before surgery, 0.93 and 0.98 logMAR at 1 and 3 months after surgery, respectively, indicating that most patients' vision improved after surgery. At the 1 and 3 months postoperative follow-up, each patient was diagnosed with rhegmatogenous retinal detachment at 1 month and 3 months postoperatively, and four patients had vitreous hemorrhage at 3 months postoperatively. Preoperatively, patients exhibited macular subretinal hemorrhage, retinal bulge, and exudation around the blood clot. Postoperatively, most patients showed dispersal of subretinal hemorrhage. Optical coherence tomography results revealed retinal hemorrhage involving the macula and hemorrhagic bulges under both the neuroepithelium and the pigment epithelium under the fovea preoperatively. After surgery, the air injected into the vitreous cavity was completely absorbed and the subretinal hemorrhage was dispersed. PPV combined with subretinal tPA injection and air tamponade in the vitreous cavity can facilitate modest visual recovery in patients with SMH due to PCV and RAM. However, some complications may occur, and their management remains challenging.

Retinoblastoma associated with total exudative retinal detachment: Treatment and outcomes.

To study the clinical presentation, treatment, and outcomes of eyes presenting with retinoblastoma (RB) and total retinal detachment (RD). Retrospective study of 50 eyes in 43 patients. Mean age at presentation was 15 months (median, 9 months). RB associated total RD was unilateral (n=36; 84%) or bilateral (n=7; 16%). The mean tumor basal diameter was 17 mm (median, 18 mm) and the mean tumor thickness was 13 mm (median, 12 mm). Associated features included subretinal seeds (n=26; 52%), vitreous seeds (n=13; 26%), and subretinal exudation in (n=4; 8%). Based on 8th edition of American Joint Committee on Cancer classification, the tumors were classified as cT2a (n=19; 38%), cT2b (n=28; 56%), or cT3c (n=3; 6%). Primary treatment included intravenous (n=48; 96%) or intra-arterial chemotherapy (n=2; 4%). Over a mean follow-up period of 30 months (median, 29 months; range, 7 to 62 months), RD resolved in 41 (82%) eyes, tumor recurrence was noted in 39 (78%) eyes, globe salvage was achieved in 35 (70%) eyes and one (2%) patient died due to metastasis. Relatively high tumor recurrence rate is noted in RB presenting with total RD. With appropriate treatment, 70% of the globes can be salvaged.

Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases

Indirect ophthalmoscopy and handheld retinal imaging are the most common and traditional modalities for the evaluation and documentation of the pediatric fundus, especially for pre-verbal children. Optical coherence tomography (OCT) allows for in vivo visualization that resembles histology, and optical coherence tomography angiography (OCTA) allows for non-invasive depth-resolved imaging of the retinal vasculature. Both OCT and OCTA were extensively used and studied in adults, but not in children. The advent of prototype handheld OCT and OCTA have allowed for detailed imaging in younger infants and even neonates in the neonatal care intensive unit with retinopathy of prematurity (ROP). In this review, we discuss the use of OCTA and OCTA in various pediatric retinal diseases, including ROP, familial exudative vitreoretinopathy (FEVR), Coats disease and other less common diseases. For example, handheld portable OCT was shown to detect subclinical macular edema and incomplete foveal development in ROP, as well as subretinal exudation and fibrosis in Coats disease. Some challenges in the pediatric age group include the lack of a normative database and the difficulty in image registration for longitudinal comparison. We believe that technological improvements in the use of OCT and OCTA will improve our understanding and care of pediatric retina patients in the future.

Characteristics and response of subretinal hyperreflective material to anti-vascular endothelial growth factor in myopic choroidal neovascularization

This retrospective study evaluated the characteristics and response of subretinal hyperreflective material (SHRM) to anti-vascular endothelial growth factor (VEGF) treatment in eyes with myopic choroidal neovascularization (CNV). The visual acuity (VA) was assessed at 3, 6, and 12 months after initiating anti-VEGF treatment in 116 patients (119 eyes) with SHRM and myopic CNV. Multimodal imaging, including color fundus photography, fluorescein angiography (FA), and optical coherence tomography angiography (OCT-A), were performed. We compared type 2 neovascularization (NV) (n = 64), subretinal hyperreflective exudation (SHE) (n = 37), NV with hemorrhage (n = 15), and fibrosis (n = 3). The type 2 NV group, and NV with hemorrhage groups showed significant VA improvement after 12 months of treatment (p < 0.05 in both groups); the SHE group failed to show improvement (p = 0.366). All groups showed a significant reduction in central foveal thickness after 12 months of treatment (all p < 0.05). The SHE group had a significantly higher incidence of interrupted ellipsoid zone than the other groups (p < 0.05). Myopic CNV can present as SHRM on OCT-A. Visual prognoses vary in different SHRM types. OCT-A and FA may help predict the outcomes of different subtypes of myopic CNV. SHE is predictive of outer retinal layer atrophy in patients with various SHRM types.

Навигационная лазерная коагуляция сетчатки при болезни Коатса у взрослых (клинический случай)

Purpose. To analyze the results of retina selective focal laser coagulation in adults Coats' disease on clinical case. Material and methods. A topographically-oriented laser treatment was performed on a patient with a rare form of unilateral Coats disease complicated by retinal edema using a modern navigation laser system «NAVILAS» and multimodal visualization. The follow-up period was 6 months. Results. Using the complex of modern diagnostic methods, the multiple vascular anomalies was revealed. Due to the selective laser coagulation the most identified macroaneurysm`s regression and exudation`s resorption with subsequent stabilization of visual functions during the observation period was achieved. Conclusion. The combined approach with modern imaging techniques and navigational planning of laser surgery makes it possible to informatively identify and accurately perform the treatment. Keywords: Coat's retinitis, vascular malformations, subretinal exudates, telangiectasia, focal laser coagulation, navigational laser surgery

Onion ring sign on spectral domain optical coherence tomography in diabetic macular edema: Its evolution and outcomes.

To report evolution and outcomes of hyperreflective crystalline deposit (HCD) on optical coherence tomography (OCT) in diabetic maculopathy (DM). Patients with DM showing HCD on OCT for the first time between June 2017 and May 2021 were included in the study. Demographic, ophthalmic and OCT features were documented and analysed. Factors leading to the development of HCD and its effect on the functional outcome were analysed and described in this study. Sixty cases of HCD were identified in 45 (males -33; females - 12) patients for the first-time during the defined study period. Mean age of the eligible patients was 61.53 ± 8.19 years. Average duration of diabetes was 13.82 ± 7.38 years. Mean visual acuity of these patients was 0.902 ± 0.438 logMAR units (Snellen equivalent = 20/160). Patients with HCD showed subretinal hard exudates, were on anti-cholesterol medications (n = 36, 80%) and showed reduced visual acuity (20/160) if the HCD involved the fovea. The median time taken for the development of HCD was 28 months. Mean follow-up duration of the study was 26.19 ± 27.98 months. Persistence of HCD in all cases (n = 42, 100%) was noted at the last follow-up visit. Horizontal, single or multi-layered HCDs on OCT in DM represent intraretinal or subretinal cholesterol crystal precipitates evolving from the hard exudates identical to the "onion ring sign" seen in neovascular AMD. HCDs or CCs depict deranged lipid metabolism, chronic vascular leakage and can lead to substantial visual impairment if the fovea gets involved.

Optic Nerve Head Melanocytoma Co-existing in a Case of Thyroid Eye Disease: Co-incidence or Cause?

Optic Nerve Head Melanocytoma (ONHM) is a rare benign pigmented tumour of the uveal tract, seen commonly at the optic nerve head. The tumour is associated with a few ocular and systemic conditions. It usually remains stationary and rarely (1-2%) undergoes a malignant transformation. With the progressive understanding of its benign nature with advancing imaging modalities, observation with regular follow-up is the mainstay of treatment. A 35-year-old female, presented with complaints of foreign body sensation in both eyes. She was a known case of graves’ disease under treatment with anti-thyroid drugs and beta blockers. Ocular examination revealed classic signs of thyroid eye disease. The left eye fundus revealed a large, black, globular tumour in the optic nerve head obscuring the entire disc and Ultrasound B scan revealed a tumour at the optic nerve head with high echogenicity. Optical Coherence Tomography (OCT) through the mass revealed a dome-shaped elevation with obscuration of underlying details due to heavy pigmentation, with no signs of subretinal exudation or edema. Thyroid profile was within normal limits. A diagnosis of left eye ONHM was made. The patient was started on tapering doses of systemic steroids and was regularly followed up to monitor the tumour growth for 18 months. This is the first reported case of ONHM co-existing with thyroid eye disease and this association could be coincidental or embryological. This case highlights the need for ophthalmologists to be familiar with this benign condition and for regular careful follow-up of such patients.

Exudative retinal detachment and optic disc swelling in the course of posterior scleritis: case study and literature review

Objectives: The objective of the present paper is to present a rare case of posterior scleritis with exudative retinal detachment and optic disc oedema.&#x0D; Materials: The paper discusses a case of a 28-year-old patient with unilateral posterior scleritis, exudative retinal detachment and optic disc oedema. The patient presented with reduced visual acuity and inflammation within his right eyeball coat.&#x0D; Test results: Upon admission, retinal detachment in all quadrants was diagnosed, with subretinal exudate, choroidal folds, but no pathology involving the anterior segment. B projection ultrasound revealed thickening of the posterior sclera of around 2.0 mm and complete retinal detachment in the right eye. Visual acuity results were OD = 1/50 Sc, OS = 45/50 Sc. Elevated intraocular pressure of the right eye was detected at 44.0 mmHg A CT scan of the orbits with contrast revealed significant asymmetry of the eyeballs (right 22 × 22 mm, left 21 × 21 mm) as well as posterior thickening of the right eyeball coat to 2.0 mm. On top of that, on the second day of the patient’s hospital stay, an ophthalmic exam showed obscured borders of the right optic nerve. Systemic treatment was initiated, comprising steroids, non-steroidal anti-inflammatory drugs and intraocular pressure lowering drugs. Additionally, topical treatment was provided with regard to the right eye. A number of laboratory tests were carried out to rule out systemic diseases that could have caused posterior scleritis. After discharge, the patient received follow up care from the hospital’s ophthalmology clinic and remained on topical and systemic steroids. Oral systemic steroid therapy was maintained over a period of a few months, with gradual dose reduction. At follow-up visits, his visual acuity remained stable at OD = 40/50 Sc, OS = 45/50 Sc.&#x0D; Conclusions: Posterior scleritis is a condition that requires prompt diagnosis and systemic treatment.

Focal laser photocoagulation treatment in polypoidal choroidal vasculopathy: Long‐term follow‐up

AbstractPurpose: To report the long‐term effect and safety of focal laser photocoagulation treatment (FLPT), in a case of polypoidal choroidal vasculopathy (PCV).Methods: We reviewed a 56‐month follow‐up (April 2017–January 2022) of a 54‐year‐old woman with PCV. The diagnosis was made using indocyanine green angiography (ICG‐A). The measured outcomes of the effect of FLPT were changes in best‐corrected visual acuity (BCVA), complications, regression, and recurrence of polypoidal lesions based on fundoscopy, B‐scan swept source optical coherence tomography (SS‐OCT) and ICG‐A.Results: At the time of diagnosis, the patient had extensive subretinal exudation and haemorrhage in the right eye (RE) related to foveal and juxtapapillary polypoidal lesions. She received 12 bevacizumab intravitreal injections and treatment was interrupted because of extensive macular fibrosis. In the left eye (LE), she had extrafoveal polypoidal lesions with a BCVA of 20/25. At 8 months follow‐up, a decrease in BCVA to 20/50 was noted. Therefore, a first round of FLPT associated with three bevacizumab intravitreal injections, was performed. Four months post‐FLPT, regression of the polypoidal lesions was obtained with a BCVA of 20/25. BCVA and multimodal imaging remained stable for 2 years. The left eye showed recurrence of extrafoveal polypoidal lesions 35 months after FLPT, with a BCVA of 20/50. A second round of FLPT was performed, with a regression of the polypoidal lesions after 1 month, and a stabilization of BCVA at 20/30. After 14 months, BCVA was 20/50, and no signs of recurrence were detected on multimodal imaging. No complications were observed after the two rounds of FLPT.Conclusions: FLPT can be efficient and safe in treating eyes with PCV with extrafoveal polypoidal lesions. In this case, it allowed us to obtain the regression of polypoidal lesions and to maintain visual acuity without serious hemorrhagic complications during the 56‐month follow‐up.

A case of Coats Disease presenting with Retinal Detachment in Bhutan

Coats disease is a rare retinal disease. It is characterised by abnormal dilatation of retinal capillaries (telangiectasia) and increased vascular permeability (intraretinal and subretinal exudation). In advanced stage of disease the patient can have exudative retinal detachment where the retina detaches from its normal attachment. In some cases there will be secondary increase in intraocular pressure if not treated on time. It has a unilateral presentation in most of the cases. This article describes about a four year old boy who presented with retinal detachment due to coats disease. The patient was managed effectively with external subretinal fluid drainage along with laser and cryotherapy. It is essential to rule out aggressive eye cancer (retinoblastoma) as both can have similar presentation.

TWO CASES OF VON HIPPEL-LINDAU SYNDROME-ASSOCIATED RETINAL HEMANGIOBLASTOMA TREATED WITH BELZUTIFAN.

To describe two cases of retinal hemangioblastoma regression following treatment with belzutifan in patients with von Hippel-Lindau syndrome. Clinical information was extracted from the charts and tumor imaging of two patients with von Hippel-Lindau-associated retinal hemangioblastoma. In Case 1, a 40-year-old man was treated with belzutifan for spine hemangioblastomas after diagnosis of a 2.0 × 2.0 × 1.3 mm left-eye retinal hemangioblastoma temporal to the macula associated with intraretinal edema, subretinal fluid, and mild retinal traction. In Case 2, a 66-year-old woman presented with a right eye 2.0 × 1.5 × 1.3 mm juxtapapillary lesion with subretinal fluid, intraretinal fluid, and nasal traction, and a 4.0 × 3.5 × 1.1 mm inferior midperiphery lesion with subretinal fluid, intraretinal fluid, and active exudation. She was treated for 2.5 years with belzutifan for renal cell carcinoma on the National Institutes of Health trial. The patient in case 1 demonstrated a 10% reduction in largest tumor diameter and 8% reduction in thickness, along with improving subretinal fluid, intraretinal edema, and retinal traction, after 4 weeks of treatment. After 2.5 years of treatment, the patient in Case 2 demonstrated similar margins of her now fibrotic-appearing juxtapapillary lesion with a 45% reduction in thickness, along with resolved subretinal fluid and greatly improved intraretinal fluid and traction. The inferior lesion demonstrated 12.5% reduction in largest diameter, 36% reduction in thickness, and was without active subretinal fluid or exudation. Neither patient demonstrated new lesions while on treatment. Belzutifan is a promising treatment for retinal hemangioblastoma with the potential for both rapid and sustained tumor regression.

A new antiproliferative drug for exudative age-related macular degeneration

Age-related macular degeneration (AMD) is one of the major reasons that cause irreversible vision loss among older people. Over the past two decades, vascular endothelial growth factor (anti-VEGF) inhibitors have been successfully used in the treatment of AMD. In this article, we study a new antivasoproliferative agent brolucizumab for the treatment of exudative AMD forms. The drug has demonstrated its high effectiveness in terms of a more rapid onset of therapeutic effect and the resolution of intraretinal and subretinal exudation.

Clinicopathological analysis of secondary retinal vasoproliferative tumor/reactive retinal astrocytic tumor successfully treated by endoresection.

To report the clinicopathological findings of retinal vasoproliferative tumor/reactive retinal astrocytic tumor (VPT/RRAT) with retinal vasculitis, treated by tumor resection. A retrospective single case report. A 29-year-old Japanese woman was referred with cystoid macular edema and retinal vasculitis in the right eye. Best-corrected visual acuity (BCVA) was 0.9. Fundus examination, optical coherence tomography, and fluorescein angiography demonstrated VPT/RRATs in the temporal retina surrounded by a subretinal exudate, serous retinal detachment and macular edema, and retinal vasculitis. Despite 3 months of oral prednisolone treatment, a full-thickness macular hole developed. Pars plana vitrectomy and endoresection of the VPT/RRATs were performed. Pathological and immunohistochemical analyses with anti-CD34 antibody, anti-glial fibrillary acidic protein (GFAP) antibody, anti-Ki67 antibody, and anti-vascular endothelial growth factor (VEGF) antibody were conducted on the excised tissue. Inflammation was evaluated by immunohistological staining with leucocyte common antigen (LCA), anti-CD3 antibody, and anti-CD20 antibody. After surgery, the macular hole closed, BCVA improved to 1.2, retinal vasculitis was ameliorated, and retinal exudate disappeared. There was no recurrence of VPT/RRAT or retinal vasculitis. Pathological examination showed that GFAP and VEGF were widely expressed, irrespective of the distribution of blood vessels. Ki67-positive proliferating cells were detected in the perivascular area. LCA-positive leukocytes and CD3-positive T cells were detected throughout the samples, whereas CD20-positive B cells were rarely detected. Endoresection of VPT/RRAT could be a good treatment option for secondary VPT/RRAT accompanied by retinal vasculitis. Pathological findings revealed for the first time that inflammatory cells infiltrate the tissue in secondary VPT/RRAT.