Ophthalmological and obstetric management in pregnant women with retinal disorders

Objectives: To analyze the clinical significance of ophthalmological assessment in pregnant women affected with degenerative retinal lesions, and the lesions’ clinical relevance in determining the obstetric management and delivery method.  Material and methods: 69 pregnant women affected with retinal degenerative lesions were included in our study. In each patient, the risk of ophthalmological complications during vaginal delivery was evaluated. After the woman’s delivery, alignment between the ophthalmological recommendations and the obstetric management were analyzed. Each case where the management plan differed from the clinical proceedings was thoroughly investigated to determine the cause.  Results: In 69 pregnant women the risk of ophthalmological complications was evaluated, and in 24 cases (35%) assessed as low, as medium in 37 cases (54%) and as high in 8 cases (11%). Among the 69 patients, 42 of women delivered vaginally and the remaining 27 underwent caesarean section. In the high-risk group, the rate of caesarean section was 87%, while in both the low- and medium-risk groups the rate of vaginal births was 75%. Two years of postnatal ophthalmological follow-up did not reveal any complications that could have been associated with the delivery.  Conclusions: Every pregnant woman should undergo ophtalmological examination to assess peripartum risk of complications and determine the method of delivery.

Clinical features, diagnosis and management of serpiginuos choroiditis

Classic serpiginous choroiditis (CSC) is a rare bilateral, multifocal, recurrent inflammatory disease of the choroid and retina observed mainly in young and middle-aged male patients. We present three cases of otherwise healthy men (ages 30, 52, and 54 years) with the diagnosis of CSC based on clinical and multimodal imaging findings. During the observation period, slow progression of the fundus changes was noted in each patient despite various individualized immunosuppressive treatments (corticosteroids, cyclosporin, cyclophosphamide, azathioprine) used. Progressive macular involvement was associated with a significant irreversible bilateral reduction in visual acuity. The aim of the study is to present the clinical features of CSC, possible diagnostic and therapeutic options, and to familiarize the reader with specific clinical cases

Correlation between Choroidal Neovascularization Shown by OCT Angiography and Choroidal Thickness in Patients with Chronic Central Serous Chorioretinopathy

Purpose. To assess the occurrence of choroidal neovascularization (CNV) secondary to chronic central serous chorioretinopathy (CSCR) using optical coherence tomography angiography (OCTA) and correlate these findings with choroidal thickness (CT). Materials and Methods. This retrospective study included 25 consecutive patients (43 eyes), mean age 48.12 ± 7.8 years, diagnosed with persistent CSCR. All patients underwent a complete ophthalmic examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography, and OCTA. Results. CNV was confirmed in 18.6% of eyes using FA and ICGA and in 25.6% of eyes using OCTA. All cases of CNV were associated with irregular retinal pigment epithelial detachment. CT was increased in the affected eyes (mean 491.05 ± 91.98), but there were no statistically significant correlations between CT and CNV and PED occurrence (p=0.661 and p=0.614, resp.) and between CT and duration of the disease (p=0.940). Conclusions. OCTA detected CNV more frequently than other imaging modalities. CNV coexisted with irregular PED in all cases. CT was increased in eyes with chronic CSCR, but without any correlation with CNV occurrence; therefore, CT cannot be considered as a predictor of CNV occurrence. Further studies with a larger number of patients are needed to confirm these findings

Focal Choroidal Excavation: Epidemiology, Clinical Characteristics and Multimodal Imaging Findings

Background: Focal choroidal excavation (FCE) is one of the pachychoroid spectrum diseases. It may be an isolated lesion or associated with other ophthalmological disorders. The aim of the study was to present the epidemiology, clinical features and multimodal imaging findings in FCE. Methods: This is a case series of 14 consecutive patients with a diagnosis of FCE, confirmed by multimodal imaging, from a review of the 5076 optical coherence tomography (OCT) scans in 2538 patients. Choroidal thickness (CT) was measured under the fovea and in the area of maximum choroidal thickening in the affected eye and under the fovea in the fellow eye. Results: The mean age of the subjects was 40 ± 13.58 years. FCE occurred unilaterally and was an isolated lesion in all cases. The fellow eye did not show any macular pathology in all patients. Twelve eyes presented conforming FCEs and two non–conforming FCEs. In 79% of cases, FCE was subfoveal. The mean maximum CT was 390 μm in the affected eye with the presence of pachyvessels. A total of 13 patients were asymptomatic, while one patient reported a visual disturbance due to neovascularization secondary to FCE. Of all the multimodal imaging techniques, optical coherence tomography (OCT) provided the most important data in the diagnosis of FCE. Conclusions: Our study confirmed that FCE is a rare ocular condition, but it may be more common in Caucasian population than previously known. Multimodal imaging methods, mainly OCT, are crucial in FCE diagnostics. Further studies are needed to expand the available knowledge about its etiology and clinical course

Focal Choroidal Excavation: Epidemiology, Clinical Characteristics and Multimodal Imaging Findings

Background: Focal choroidal excavation (FCE) is one of the pachychoroid spectrum diseases. It may be an isolated lesion or associated with other ophthalmological disorders. The aim of the study was to present the epidemiology, clinical features and multimodal imaging findings in FCE. Methods: This is a case series of 14 consecutive patients with a diagnosis of FCE, confirmed by multimodal imaging, from a review of the 5076 optical coherence tomography (OCT) scans in 2538 patients. Choroidal thickness (CT) was measured under the fovea and in the area of maximum choroidal thickening in the affected eye and under the fovea in the fellow eye. Results: The mean age of the subjects was 40 ± 13.58 years. FCE occurred unilaterally and was an isolated lesion in all cases. The fellow eye did not show any macular pathology in all patients. Twelve eyes presented conforming FCEs and two non–conforming FCEs. In 79% of cases, FCE was subfoveal. The mean maximum CT was 390 μm in the affected eye with the presence of pachyvessels. A total of 13 patients were asymptomatic, while one patient reported a visual disturbance due to neovascularization secondary to FCE. Of all the multimodal imaging techniques, optical coherence tomography (OCT) provided the most important data in the diagnosis of FCE. Conclusions: Our study confirmed that FCE is a rare ocular condition, but it may be more common in Caucasian population than previously known. Multimodal imaging methods, mainly OCT, are crucial in FCE diagnostics. Further studies are needed to expand the available knowledge about its etiology and clinical course

Inflammation classified as “haemorrhagic”, “with vascular sheathing”, “with a pre-existing scar” and “a focus away from the optic disc”.

<p>Inflammation classified as “haemorrhagic”, “with vascular sheathing”, “with a pre-existing scar” and “a focus away from the optic disc”.</p

Kaplan-Meier estimates of 3-years probability of recurrence free survival after first admission, overall and by potential risk factors.

<p>Kaplan-Meier estimates of 3-years probability of recurrence free survival after first admission, overall and by potential risk factors.</p

Hazard function (95% CI) derived from the final multivariate model.

<p>Hazard function (95% CI) derived from the final multivariate model.</p

Characteristics of patients included in the analysis of recurrences (N = 303 on first admission).

<p>Characteristics of patients included in the analysis of recurrences (N = 303 on first admission).</p