Chorioretinal Coloboma Complications: Retinal Detachment and Choroidal Neovascular Membrane

PURPOSE: To report the chorioretinal coloboma, and its association with increased risk of retinal detachment (RD) and choroidal neovascularization (CNV). METHODS: This retrospective case series included eyes with chorioretinal coloboma diagnosed between 1995 and 2014 with a focus on RD and CNV as related complications. Cases of CNV were managed with laser photocoagulation or intravitreal injection of bevacizumab. For eyes with CNV, therapeutic success was defined as resolution of the subretinal hemorrhage on fundus examination and resolution of the subretinal and intraretinal fluid on optical coherence tomography (OCT). For eyes with RD, anatomic success following surgical intervention was defined as attachment of the retina at the last follow-up visit. RESULTS: Fifty-one eyes of 31 patients with chorioretinal coloboma were identified for review. Bilateral chorioretinal coloboma was present in 64.5% of subjects. RD developed in 15 eyes (29.4%). Among 15 eyes with RD, 4 eyes (27%) had retinal breaks identified within the coloboma, 5 eyes (33%) had retinal breaks outside the coloboma, 2 eyes (13%) showed retinal breaks both inside and outside the coloboma, and in 4 eyes (27%) the causative retinal break was not localized. The overall rate of anatomic success after RD repair was 85.7%. CNV developed in 7 eyes (13.7%) and was located along the margin of the coloboma in all cases. CNV was bilateral in 2 of the 5 affected individuals (40%). CONCLUSION: RD and CNV were present in a high percentage of eyes with chorioretinal coloboma in these series. The frequent finding of retinal breaks outside the coloboma bed suggests that vitreoretinal interface abnormalities may play a role in development of RD in these eyes

Chorioretinal Coloboma Complications: Retinal Detachment and Choroidal Neovascular Membrane

PURPOSE: To report the chorioretinal coloboma, and its association with increased risk of retinal detachment (RD) and choroidal neovascularization (CNV). METHODS: This retrospective case series included eyes with chorioretinal coloboma diagnosed between 1995 and 2014 with a focus on RD and CNV as related complications. Cases of CNV were managed with laser photocoagulation or intravitreal injection of bevacizumab. For eyes with CNV, therapeutic success was defined as resolution of the subretinal hemorrhage on fundus examination and resolution of the subretinal and intraretinal fluid on optical coherence tomography (OCT). For eyes with RD, anatomic success following surgical intervention was defined as attachment of the retina at the last follow-up visit. RESULTS: Fifty-one eyes of 31 patients with chorioretinal coloboma were identified for review. Bilateral chorioretinal coloboma was present in 64.5% of subjects. RD developed in 15 eyes (29.4%). Among 15 eyes with RD, 4 eyes (27%) had retinal breaks identified within the coloboma, 5 eyes (33%) had retinal breaks outside the coloboma, 2 eyes (13%) showed retinal breaks both inside and outside the coloboma, and in 4 eyes (27%) the causative retinal break was not localized. The overall rate of anatomic success after RD repair was 85.7%. CNV developed in 7 eyes (13.7%) and was located along the margin of the coloboma in all cases. CNV was bilateral in 2 of the 5 affected individuals (40%). CONCLUSION: RD and CNV were present in a high percentage of eyes with chorioretinal coloboma in these series. The frequent finding of retinal breaks outside the coloboma bed suggests that vitreoretinal interface abnormalities may play a role in development of RD in these eyes

SURGICAL MANAGEMENT OF TRACTIONAL RETINOSCHISIS ASSOCIATED WITH VITREOUS HEMORRHAGE IN RETINOPATHY OF PREMATURITY.

PURPOSE: The tractional retinoschisis is a poorly understood, rare, and likely underappreciated entity in retinopathy of prematurity. The purpose of this article is to describe clinical findings and surgical management of tractional retinoschisis in retinopathy of prematurity, masquerading as Stage 4 retinopathy of prematurity retinal detachment. METHODS: A retrospective review of a single case with literature review and case discussion. RESULTS: In this report, we describe a child with retinopathy of prematurity and tractional schisis, who initially presented with vitreous hemorrhage and was effectively managed by vitrectomy and inner wall retinectomy. At 5 months after vitrectomy, the child demonstrated complete collapse of the retinoschisis with intact posterior pole and brisk light perception. CONCLUSION: Vitrectomy with or without inner wall retinectomy is effective in the management of tractional retinoschisis

Impaired Retinal Perfusion Resulting From Vitreoretinal Traction: A Mechanism of Retinal Vascular Insufficiency

BACKGROUND AND OBJECTIVE: To demonstrate vitreoretinal traction as a mechanism of abnormal retinal vascular perfusion. PATIENTS AND METHODS: Retrospective report of three cases demonstrating vitreoretinal traction concurrent with abnormal retinal perfusion. Subjects were retrospectively identified based on clinical records from two tertiary care retina subspecialty practices. All subjects underwent complete ophthalmic examination and ancillary testing as necessary for their standard clinical care. Vascular perfusion was assessed by one or more methods, including wide-field fluorescein angiography and optical coherence tomography angiography (OCTA). Vitreoretinal traction was assessed by clinical examination; intraoperative surgical observations; and fundus imaging, including wide-field, red-free, and color images as well as OCT. RESULTS: Three cases are shown in which vitreoretinal traction was clearly documented and correlated with abnormal retinal vascular perfusion. Abnormal vascular perfusion correlated with the distribution of vessels affected by vitreoretinal traction in all cases. Vascular perfusion normalized in all cases after surgery was used to relieve vitreoretinal traction. CONCLUSION: The authors demonstrate that vitreoretinal traction can alter retinal vascular perfusion in a reversible fashion. These results suggest that there can be a direct mechanical effect of vitreous traction on retinal vascular perfusion. Further advances in wide-field imaging, wide-field OCT, and OCTA will help better evaluate this cause of retinal vascular insufficiency

Spectral-Domain Optical Coherence Tomography in Older Patients With History of Retinopathy of Prematurity

BACKGROUND AND OBJECTIVE: To characterize the in vivo microstructural features of patients with history of retinopathy of prematurity (ROP). PATIENTS AND METHODS: A single-center, retrospective imaging case series during which a chart review was performed of consecutive patients with history of ROP who underwent spectral-domain optical coherence tomography (SD-OCT) with or without enhanced depth imaging. Eyes with time-domain OCT, no light perception, or uninterpretable SD-OCT images were excluded. Main outcome measures included best-corrected visual acuity (BCVA) and exploratory SD-OCT findings. RESULTS: A total of 186 eyes of 112 patients (mean age: 31.5 years; range: 8 years to 70 years) were imaged. Mean visual acuity was 20/150 (range: 20/20 to light perception). Mean foveal thickness (MFT) and subfoveal choroidal thickness (SCT) measured 270.93 µm ± 56.40 µm and 239.87 µm ± 73.00 µm, respectively. There was a negative correlation between ROP stage and MFT (Rho = -0.19; P = .027), but not with SCT (Rho = -0.03; P = .748). There were negative correlations between BCVA and MFT (Rho = -0.23; P \u3c .01) and SCT (Rho = -0.19; P = .04). Ellipsoid zone (EZ) abnormalities, inner retinal layer thickening, and presence of chorioretinal atrophy were associated with higher ROP stage (P \u3c .001) and poorer visual acuity (Rho = 0.59; P \u3c .001). The presence of retinoschisis (n = 36/186; 19%) was associated with poorer visual acuity (P \u3c .001), but did not correlate with higher ROP stage (P = .17). Epiretinal membrane-like dense hyaloidal organization and vitreoretinal interface abnormalities were seen in 69% (130/186) and 33% (63/186) of eyes, respectively, but were not associated with ROP stage (P = .87) or visual acuity (P = .54). After controlling for EZ abnormalities, foveal hypoplasia, macular schisis, inner retinal thickening, chorioretinal atrophy, and ROP stage, the independent risk factors for poorer visual acuity were EZ abnormalities (Beta = 0.38; P \u3c .001), chorioretinal atrophy (Beta = 0.18; P = .03), and ROP stage (Beta = 0.22; P \u3c .01). CONCLUSION: SD-OCT imaging identified a variety of microstructural abnormalities present in patients with history of ROP. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1086-1094.]

THE CUTTING EDGE OF RETINOPATHY OF PREMATURITY CARE: Expanding the Boundaries of Diagnosis and Treatment.

PURPOSE: To discuss the latest advances and controversies in the diagnosis and care of infants with retinopathy of prematurity (ROP). METHODS: Literature review. RESULTS: Retinopathy of prematurity remains a major global issue. Industrialized nations now treat profoundly premature infants with posterior and aggressive disease, and middle-income nations are experiencing ROP epidemics. Remote digital imaging may address the decreasing ratio of ROP providers to premature infants, in addition to improving patient care. Widefield angiography, optical coherence tomography, and the Wnt signaling pathway have provided new insights into ROP pathogenesis. Anti-vascular endothelial growth factor treatment is increasing in popularity, but the dearth of information to guide dosing, unpredictable reactivation, persistent vascular abnormalities, the crunch phenomenon, and the presently unknown effects of systemic vascular endothelial growth factor suppression remain issues to continue investigating. Neurodevelopmental delay has been raised as a potential consequence, but the evidence currently is weak. Vitrectomy is the treatment of choice for Stages 4 and 5. Illumination techniques, ab interno incisions, plasmin-assisted vitrectomy, staged surgery in the interest of corneal clearing for advanced Stage 5, and immediate sequential bilateral vitreoretinal surgery, are useful techniques. CONCLUSION: We are making progress in ROP management. Our goal as clinicians is to continue expanding the boundaries of our abilities to keep this blinding disease in check globally

Spectral-Domain Optical Coherence Tomography in Older Patients With History of Retinopathy of Prematurity.

BACKGROUND AND OBJECTIVE: To characterize the in vivo microstructural features of patients with history of retinopathy of prematurity (ROP). PATIENTS AND METHODS: A single-center, retrospective imaging case series during which a chart review was performed of consecutive patients with history of ROP who underwent spectral-domain optical coherence tomography (SD-OCT) with or without enhanced depth imaging. Eyes with time-domain OCT, no light perception, or uninterpretable SD-OCT images were excluded. Main outcome measures included best-corrected visual acuity (BCVA) and exploratory SD-OCT findings. RESULTS: A total of 186 eyes of 112 patients (mean age: 31.5 years; range: 8 years to 70 years) were imaged. Mean visual acuity was 20/150 (range: 20/20 to light perception). Mean foveal thickness (MFT) and subfoveal choroidal thickness (SCT) measured 270.93 µm ± 56.40 µm and 239.87 µm ± 73.00 µm, respectively. There was a negative correlation between ROP stage and MFT (Rho = -0.19; P = .027), but not with SCT (Rho = -0.03; P = .748). There were negative correlations between BCVA and MFT (Rho = -0.23; P \u3c .01) and SCT (Rho = -0.19; P = .04). Ellipsoid zone (EZ) abnormalities, inner retinal layer thickening, and presence of chorioretinal atrophy were associated with higher ROP stage (P \u3c .001) and poorer visual acuity (Rho = 0.59; P \u3c .001). The presence of retinoschisis (n = 36/186; 19%) was associated with poorer visual acuity (P \u3c .001), but did not correlate with higher ROP stage (P = .17). Epiretinal membrane-like dense hyaloidal organization and vitreoretinal interface abnormalities were seen in 69% (130/186) and 33% (63/186) of eyes, respectively, but were not associated with ROP stage (P = .87) or visual acuity (P = .54). After controlling for EZ abnormalities, foveal hypoplasia, macular schisis, inner retinal thickening, chorioretinal atrophy, and ROP stage, the independent risk factors for poorer visual acuity were EZ abnormalities (Beta = 0.38; P \u3c .001), chorioretinal atrophy (Beta = 0.18; P = .03), and ROP stage (Beta = 0.22; P \u3c .01). CONCLUSION: SD-OCT imaging identified a variety of microstructural abnormalities present in patients with history of ROP. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1086-1094.]