Presumed Idiopathic Central Serous Chorioretinopathy in a 12-Year-Old Girl

Idiopathic central serous chorioretinopathy (CSC) typically affects middle-aged males. To date, only one case of idiopathic CSC in a prepubertal subject has been reported. Atypical idiopathic CSC presentation may be challenging to diagnose. Exclusion of secondary causes of serous retinal detachment (SRD) is warranted. We describe the atypical case of a 12-year-old female with a circumscribed SRD that resolved spontaneously and with fluorescein angiography (FA) findings that were compatible with idiopathic CSC. Optical coherence tomography (OCT) and systemic assessment were performed to exclude other etiologies. FA demonstrated multiple focal leaks in early phases, with subretinal leakage and pooling in late phases. OCT showed a localized circumscribed retinal detachment. Complete blood count was within normal limits. Serum cortisol was normal (22.1 μg/dl) and mean arterial blood pressure was 100/60 mm Hg, thereby excluding secondary causes of CSC. This is the second reported case of idiopathic CSC in a prepubertal female and the first one documented by FA and OCT, as well as other studies to exclude secondary causes. Albeit rare, idiopathic CSC should be considered in the differential diagnosis of SRD in this (prepubertal) age group, after excluding secondary ocular or systemic etiologies

Optical coherence tomography characteristics of group 2A idiopathic parafoveal telangiectasis

PURPOSE: To describe the optical coherence tomography (OCT) characteristics of patients with group 2A idiopathic parafoveal telangiectasis (IPFT) and to correlate them with biomicroscopic and fluorescein angiographic (FA) findings based on Gass and Blodi staging classification for group 2A IPFT. METHODS: Fifty-two eyes of 26 consecutive patients with IPFT underwent biomicroscopic fundus examination, color fundus photography, FA, and OCT. Main outcome measures were OCT characteristics and their correlation with biomicroscopy and FA. RESULTS: The most common OCT findings that help differentiate between stages in group 2A IPFT are 1) highly reflective dots in the inner retina that correspond with microvessels seen by FA in Stage 1 (5 eyes [62.5%]); 2) the presence of hyporeflective intraretinal spaces in the absence of retinal thickening and highly reflective dots in the retina in Stage 2 (9 [81.8%] and 10 eyes [90.9%], respectively); 3) in Stage 3, both outer and inner retina exhibit areas of similar high reflectivity. In addition, the retinal pigment epithelium (RPE)/choriocapillaris complex is thickened or disrupted as evidenced by an area of high reflectivity (13 eyes [81.2%]); 4) a highly reflective area nasal or temporal to the fovea in the inner or outer retinal layers in Stage 4 suggesting RPE proliferation and migration (13 eyes [100%]); and 5) a fusiform thickening and duplication of the highly reflective RPE/choriocapillaris complex corresponding to choroidal neovascularization in Stage 5 (4 eyes [100%]). Our OCT characteristics correlated well with biomicroscopic and FA findings for Stages 4 and 5. However, the hyporeflective spaces that are evident on OCT could not be seen clinically at the slit lamp or on FA. In addition, our OCT findings on eyes with group 2A IPFT Stage 3 have not, to our knowledge, been previously described. CONCLUSIONS: Optical coherence tomography findings in group 2A IPFT were characteristic for each stage and may be helpful in making the diagnosis as well as defining the anatomical staging proposed by Gass and Blodi. Optical coherence tomography complements biomicroscopic and FA findings in the evaluation of group 2A IPFT. © The Ophthalmic Communications Society, Inc

Postoperative Multimodal Analysis in Successful Gas Displacement of a Submacular Hemorrhage

In this report, we describe a case of timely gas vitrectomy to displace a moderate submacular hemorrhage from the submacular space without tPA, release vitreoretinal traction along the borders of a posterior retinal tear, and analyze postoperative multimodal imaging findings in a 34-year-old male patient whose right eye was injured by a stone. The patient underwent a successful nontissue plasminogen activator gas vitrectomy 3 days after the accident. A multimodal evaluation with spectral-domain optical coherence tomography (SD-OCT), 10-2 and 30-2 campimetry, microperimetry, multifocal electroretinography (mfERG), and visual evoked potentials was performed 6 months after the accident. The multimodal imaging tests yielded abnormal foveal SD-OCT patterns, with a fibrous sealed tear in the retinal pigment epithelium. Campimetry showed low levels of retinal sensitivity; microperimetry and mfERG revealed a subnormal retinal response and a reduction in the N1 and P1 wave amplitudes. The visual evoked potential responses were normal. Multidisciplinary examination at 6 months postoperatively revealed a structurally and functionally abnormal macula. The retina remained attached. Our functional findings indicate that submacular hemorrhage should be treated in a timely manner to minimize photoreceptor damage

INDOCYANINE GREEN ANGIOGRAPHY FOR IDENTIFYING TELANGIECTATIC CAPILLARIES IN DIABETIC MACULAR EDEMA

International audienceAims: During diabetic macular oedema (DME), a spectrum of capillary abnormalities is commonly observed, ranging from microaneurysms to large microvascular abnormalities. Clinical evidence suggests that targeted photocoagulation of large microvascular abnormalities may be beneficial, but their detection is not done in a routine fashion. It was reported that they are better identified by indocyanine green angiography (ICGA) than by fluorescein angiography. Here, we investigated the prevalence and ICGA and optical coherence tomography (OCT) features of retinal microvascular abnormalities in a group of patients with DME.Methods: Observational study. The fundus photographs, ICGA and structural and angiographic OCT charts of 35 eyes from 25 consecutive patients with DME were reviewed.Results: 22 eyes (63%) had at least one focal area of microvascular abnormalities showing prolonged indocyanine green (ICG) staining (ie, beyond 10 mins after injection). In particular, all eyes (n=9) with circinate hard exudates showed foci of late ICG staining. These areas were either isolated globular capillary ecstasies or a cluster of ill-defined capillary abnormalities. They were located at a median distance of 2708 µm from the fovea (range: 1064-4583 µm). Their diameter ranged from 153 to 307 µm. During ICGA, 91% showed increased their contrast and apparent size in late frames, whereas 79% of microaneurysms showed reduced contrast on late frames. OCT angiography was not contributive for the detection of these lesions.Conclusion: Late ICG staining revealing large microvascular abnormalities is commonly observed during DME. Because of their specific angiographic and OCT features relative to microaneurysms, we propose to name them telangiectatic capillaries (TelCaps)

Radial optic neurotomy for central retinal vein occlusion: Results of the pan-american collaborative retina study group (pacores)

OBJECTIVE: To evaluate the complications after radial optic neurotomy (RON) for central retinal vein occlusion (CRVO). METHODS: Seventy-three consecutive patients (73 eyes) with CRVO who were treated with RON participated in a retrospective, uncontrolled, interventional, multicenter case series at 7 institutions from 6 countries. RESULTS: In the ischemic CRVO group (n = 53), 32% of eyes had an improvement in best-corrected visual acuity (BCVA) (mean, 5.5 lines), 35.8% had worse BCVA (mean, 6.4 lines), and 32% had BCVA that remained the same after RON. In the nonischemic CRVO group (n = 20), 50% of eyes had an improvement in BCVA (mean, 6.5 lines), 15% had worse BCVA (mean, 4.3 lines), and 35% had BCVA that remained the same after RON. Complications occurred in 71.2% of cases, including cataract in 17 eyes (23.2%), vitreous hemorrhage in 16 eyes (20.5%), persistent macular edema in 15 eyes (20.5%), neovascular glaucoma in 7 eyes (9.5%), anterior segment neovascularization in 5 eyes (6.8%), retinal detachment in 3 eyes (4.1%), and phthisis bulbi, choroidovitreal neovascularization, central retinal artery perforation, and optic nerve atrophy in 1 eye (1.3%) each. CONCLUSIONS: RON may improve visual acuity in some eyes with CRVO, but complications are common. In our series, surgery by itself did not seem to improve the outcome of CRVO when compared with its natural history. Copyright © 2008 by the Ophthalmic Communication Society Inc

Radial optic neurotomy for central retinal vein occlusion: Results of the pan-american collaborative retina study group (pacores)

OBJECTIVE: To evaluate the complications after radial optic neurotomy (RON) for central retinal vein occlusion (CRVO). METHODS: Seventy-three consecutive patients (73 eyes) with CRVO who were treated with RON participated in a retrospective, uncontrolled, interventional, multicenter case series at 7 institutions from 6 countries. RESULTS: In the ischemic CRVO group (n = 53), 32% of eyes had an improvement in best-corrected visual acuity (BCVA) (mean, 5.5 lines), 35.8% had worse BCVA (mean, 6.4 lines), and 32% had BCVA that remained the same after RON. In the nonischemic CRVO group (n = 20), 50% of eyes had an improvement in BCVA (mean, 6.5 lines), 15% had worse BCVA (mean, 4.3 lines), and 35% had BCVA that remained the same after RON. Complications occurred in 71.2% of cases, including cataract in 17 eyes (23.2%), vitreous hemorrhage in 16 eyes (20.5%), persistent macular edema in 15 eyes (20.5%), neovascular glaucoma in 7 eyes (9.5%), anterior segment neovascularization in 5 eyes (6.8%), retinal detachment in 3 eyes (4.1%), and phthisis bulbi, choroidovitreal neovascularization, central retinal artery perforation, and optic nerve atrophy in 1 eye (1.3%) each. CONCLUSIONS: RON may improve visual acuity in some eyes with CRVO, but complications are common. In our series, surgery by itself did not seem to improve the outcome of CRVO when compared with its natural history. Copyright © 2008 by the Ophthalmic Communication Society Inc

Optical coherence tomography characteristics of group 2A idiopathic parafoveal telangiectasis

"PURPOSE: To describe the optical coherence tomography (OCT) characteristics of patients with group 2A idiopathic parafoveal telangiectasis (IPFT) and to correlate them with biomicroscopic and fluorescein angiographic (FA) findings based on Gass and Blodi staging classification for group 2A IPFT. METHODS: Fifty-two eyes of 26 consecutive patients with IPFT underwent biomicroscopic fundus examination, color fundus photography, FA, and OCT. Main outcome measures were OCT characteristics and their correlation with biomicroscopy and FA. RESULTS: The most common OCT findings that help differentiate between stages in group 2A IPFT are 1) highly reflective dots in the inner retina that correspond with microvessels seen by FA in Stage 1 (5 eyes [62.5%]); 2) the presence of hyporeflective intraretinal spaces in the absence of retinal thickening and highly reflective dots in the retina in Stage 2 (9 [81.8%] and 10 eyes [90.9%], respectively); 3) in Stage 3, both outer and inner retina exhibit areas of similar high reflectivity. In addition, the retinal pigment epithelium (RPE)/choriocapillaris complex is thickened or disrupted as evidenced by an area of high reflectivity (13 eyes [81.2%]); 4) a highly reflective area nasal or temporal to the fovea in the inner or outer retinal layers in Stage 4 suggesting RPE proliferation and migration (13 eyes [100%]); and 5) a fusiform thickening and duplication of the highly reflective RPE/choriocapillaris complex corresponding to choroidal neovascularization in Stage 5 (4 eyes [100%]). Our OCT characteristics correlated well with biomicroscopic and FA findings for Stages 4 and 5. However, the hyporeflective spaces that are evident on OCT could not be seen clinically at the slit lamp or on FA. In addition, our OCT findings on eyes with group 2A IPFT Stage 3 have not, to our knowledge, been previously described. CONCLUSIONS: Optical coherence tomography findings in group 2A IPFT were characteristic for each stage and may be helpful in making the diagnosis as well as defining the anatomical staging proposed by Gass and Blodi. Optical coherence tomography complements biomicroscopic and FA findings in the evaluation of group 2A IPFT. © The Ophthalmic Communications Society, Inc.

ENDOPHTHALMITIS AFTER PARS PLANA VITRECTOMY Results of the Pan American Collaborative Retina Study Group

Purpose: To determine the incidence of endophthalmitis after 20-, 23-, and 25-gauge pars plana vitrectomies (PPVs).Methods: Retrospective comparative case series of consecutive patients who underwent 20-, 23-, or 25-gauge PPV at 11 centers from Latin America between 2005 to 2009. Pars plana vitrectomy cases were identified through a search of the billing records of each institution. Cases of PPV performed in the management of trauma, endophthalmitis, and combined PPV phacoemulsification cases were excluded. Endophthalmitis was diagnosed by clinical criteria regardless of the microbiologic results. the incidence of post-PPV endophthalmitis was compared between 20-, 23-, and 25-gauge PPVs.Results: A total of 35,427 cases of PPV were identified during the study period (n = 19,865 for 20 gauge, n = 10,845 for 23 gauge, and n = 4,717 for 25 gauge). the 5-year post-PPV endophthalmitis incidence rates were 0.020% (4 of 19,865), 0.028% (3 of 10,845), and 0.021% (1 of 4,717) for 20 gauge, 23 gauge, and 25 gauge, respectively (P = 0.9685).Conclusion: Small-gauge transconjunctival PPV does not appear to increase the rates of post-PPV endophthalmitis.RETINA 31: 673-678, 2011Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, VenezuelaInst Cirugia Ocular, San Jose, Costa RicaUniv Puerto Rico, Dept Ophthalmol, San Juan, PR 00936 USAClin Oftalmol Ctr Caracas, Caracas, VenezuelaFdn Oftalmol Los Andes, Santiago, ChileUniv Nacl Rosario, Fdn Oftalmol, Bogota, ColombiaUniv Buenos Aires, Dept Ophthalmol, Buenos Aires, DF, ArgentinaUniversidade Federal de São Paulo, Vis Inst, Dept Ophthalmol, São Paulo, BrazilClin Ricardo Palma, Lima, PeruHosp Univ Austral, Buenos Aires, DF, ArgentinaAsociac Evitar Ceguera Mexico, Mexico City, DF, MexicoFdn Conde Valenciana, Mexico City, DF, MexicoHosp Olhos, Araraquara, BrazilUniversidade Federal de São Paulo, Vis Inst, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc