Correlation between Macular Neovascularization (MNV) Type and Druse Type in Neovascular Age-Related Macular Degeneration (AMD) Based on the CONAN Classification

To investigate associations and predictive factors between macular neovascularization (MNV) lesion variants and drusen types in patients with treatment-naïve neovascular age-related macular degeneration (AMD). Methods: Multimodal imaging was retrospectively reviewed for druse type (soft drusen, subretinal drusenoid deposits (SDDs) or mixed) and MNV type (MNV 1, MNV 2, MNV 1/2 or MNV 3). The Consensus on Neovascular AMD Nomenclature (CONAN) classification was used for characterizing MNV at baseline. Results: One eye of each eligible patient was included (n = 191). Patients with predominant SDDs had an increased adjusted odds ratio (aOR) for MNV 2 (23.4453, p = 0.0025) and any type of MNV 3 (8.7374, p < 0.0001). Patients with MNV 1/2 had an aOR for predominant SDDs (0.3284, p = 0.0084). Patients with MNV1 showed an aOR for SDDs (0.0357, p < 0.0001). Eyes with SDDs only without other drusen types showed an aOR for MNV 2 (9.2945, p < 0.0001). Conclusions: SDDs represent a common phenotypic characteristic in AMD eyes with treatment-naïve MNV. The aOR for eyes with predominant SDDs to develop MNV 2 and MNV 3 was much higher, possibly due to their location in the subretinal space. The predominant druse type may help to predict which type of MNV will develop during the course of AMD

Stumme makuläre Typ-1-Neovaskularisation zirkulär um eine Atrophie in der OCTA

Die optische Kohärenztomografie-Angiografie (OCT-A) hat die Diagnose von makulären Neovaskularisationen (MNV) ohne Exsudation, sog. „stumme Membranen“ (charakterisiert durch eine Membran ohne assoziierte sub- oder intraretinale Flüssigkeit), in der Diagnostik der altersbezogenen Makuladegeneration (AMD) vereinfacht [1]. Während robuste evidenzbasierte Behandlungsrichtlinien bei der exsudativen AMD vorhanden sind, ist das optimale Management bei stummen Membranen noch nicht eindeutig klar

Optical Coherence Tomography of Retinal Granulomas in Presumed Ocular Sarcoidosis

Optical coherence tomography (OCT) findings in choroidal granulomas are well described in the literature [1] – [5]. They are described as round, hyporeflective areas or nodules within the choroidal stroma. OCT findings of retinal granulomas are less well described; only case reports have been published in cases of sarcoidosis or Blau syndrome [6], [7], [8]. The purpose of this case report is to depict OCT findings over time in a case of presumed ocular sarcoidosis with retinal granulomas

Retinal Vascular Events after mRNA and Adenoviral-Vectored COVID-19 Vaccines-A Case Series.

BACKGROUND To describe cases of retinal vascular events shortly after administration of mRNA or adenoviral-vectored COVID-19 vaccines. DESIGN Retrospective, multicenter case series. METHODS Six cases of retinal vascular events shortly after receiving COVID-19 vaccines. RESULTS A 38-year-old, otherwise healthy male patient presented with branch retinal arterial occlusion four days after receiving his second dose of SARS-CoV-2 vaccination with Comirnaty® (BioNTech®, Mainz, Germany; Pfizer®, New York City, NY, USA). An 81-year-old female patient developed visual symptoms twelve days after the second dose of SARS-CoV-2 vaccination with Comirnaty® and was diagnosed with a combined arterial and venous occlusion in her right eye. A 40-year-old male patient noticed blurry vision five days after his first dose of SARS-CoV-2 vaccination with Comirnaty® and was diagnosed with venous stasis retinopathy in his left eye. A 67-year-old male was diagnosed with non-arteritic anterior ischemic optic neuropathy in his right eye four days after receiving the first dose of Vaxzevria® (AstraZeneca®, Cambridge, UK). A 32-year-old man presented with a sudden onset of a scotoma two days after receiving the second dose of SARS-CoV-2 vaccination with Spikevax® (Moderna, Cambridge, UK) and was diagnosed with a circumscribed nerve fiber infarction. A 21-year-old female patient developed an acute bilateral acute macular neuroretinopathy three days after receiving the first dose of SARS-CoV2-vaccine Vaxzevria® (AstraZeneca®, Cambridge, UK). CONCLUSION This case series describes six cases of retinal vascular events shortly after receiving mRNA or adenoviral-vectored COVID-19 vaccines. The short time span between received vaccination and occurrence of the observed retinal vascular events raises the question of a direct correlation. Our case series adds to further reports of possible side effects with potential serious post-immunization complications of COVID-19 vaccinations

Incidental Unilateral Retinal Vessel Findings and Its Consequences

Peripheral retinal vascular abnormalities may present as difficult diagnostic challenges since the findings are not pathognomonic clinically or on imaging. This retrospective case report highlights this difficulty and shows the process of stepwise exclusion of differential diagnoses

Efficacy of Subthreshold Micropulse Laser for Central Serous Chorioretinopathy.

PURPOSE To evaluate the efficacy of a subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR). METHODS Retrospective clinical study conducted at the Departments of Ophthalmology at a university and a municipal hospital in Zurich, Switzerland. We enrolled acute and chronic CSCR patients with persistent subretinal fluid (SRF) treated with SML. Two treatment protocols (fluorescein/indocyanine green angiography or optical coherence tomography guided) were evaluated for efficacy after 3 and 6 months. The primary outcomes of the study were reduction and percentage of eyes with complete resolution of SRF 3 and 6 months after SML treatment. Secondary endpoints included changes in central subfield thickness (CST) and visual acuity (VA) after 3 and 6 months. RESULTS The study involved 37 eyes (35 patients, 48.6% chronic). A statistically significant reduction in SRF height and CST could be shown, irrespective of SRF duration, type of CSCR, or chosen guidance after 3 and 6 months: SRF - 40 µm (p  0.05). CONCLUSION The effectiveness of SML in CSCR is under continuous debate. Our study findings demonstrate structural but only little functional changes with SML. In view of the shortage of verteporfin for photodynamic therapy, SML remains an important therapeutic option for CSCR patients

Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52-88), median BCVA was 82.5 letters (range 75-93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort

Natural Course of Solar and Laser-Associated Retinal and Macular Injuries at a Primary Care Hospital in Switzerland

Background: Solar and laser-associated retinopathies are rare occurrences. The two retinopathies are both photo-induced but differ in the involved intensity and duration of exposure. The purpose of this study was to evaluate the clinical features and natural course of these two entities, with a focus on the changes in the outer retina over time. Patients and Methods: This retrospective analysis assessed patients with solar or laser maculopathy seen at the Department of Ophthalmology of the University Hospital Zurich in Switzerland over the last 10 years. Visual acuity (VA; Snellen) and optical coherence tomography (OCT) findings were reviewed and analyzed at baseline and last follow-up visit. Areas of damaged outer retina, identified on en face OCT images as hyporeflective areas, were tagged and compared between visits. Descriptive analysis was performed by calculating mean values ± standard deviation (SD). Statistical evaluation was done using the Wilcoxon signed rank test. A p value < 0.05 was considered statistically significant. Results: Five patients with solar retinopathy and six patients with laser-associated retinopathy were identified. In the solar retinopathy group, mean VA at baseline was 0.80 (SD ± 0.37) and improved to 0.90 (SD ± 0.36). This was not statistically significant (p = 0.066). In the laser-associated retinopathy group, mean VA at baseline was 0.89 (SD ± 0.18) and improved to 1.03 (SD ± 0.09), which was not statistically significant either (p = 0.063). At baseline, in OCT cross-sections, initial changes were observed in the interdigitation, myoid, and ellipsoid zone, as well as the outer nuclear layer and the Henle fiber layer. At follow-up, most cases presented an alteration in the residual ellipsoid zone, with the degree of the aforementioned alterations depending on the size of the initial defect. A decrease of the hyporeflective alterations measured in en face OCT scans was observed in both groups but was only statistically significant in the laser-associated retinopathy group (p = 0.018 versus p = 0.172). Conclusions: OCT can help to detect and monitor solar and laser-associated retinal injuries. Most injuries are minor, with good functional restitution. Minor changes in the ellipsoid zone often persist, even in cases with full visual recovery. // Hintergrund: Solare und laserassoziierte Retinopathien sind seltene Vorkommnisse. Beide Retinopathien sind fotoinduziert, mit aber sehr unterschiedlicher Expositionsdauer und Intensität. Ziel dieser Studie ist den natürlichen Verlauf dieser zwei Krankheitsbilder zu evaluieren mit speziellem Fokus auf die Alterationen in der äußeren Netzhaut. Patienten und Methoden: Es handelt sich um eine retrospektive Studie, welche Patienten mit solarer oder laserassoziierter Retinopathie an der Augenklinik des Unversitätsspitals Zürich über die letzten zehn Jahre einschließt. Visus (Snellen) und optische Kohärenztomografie-(OCT-)Aufnahmen bei erster und letzter Konsultation wurden überprüft und analysiert. Ergebnisse: Fünf Patienten mit solarer Retinopathie und sechs Patienten mit laserassoziierter Retinopathie konnten eingeschlossen werden. Bei der Gruppe der solaren Retinopathie stieg der Visus von 0,8 (SD ± 0,37) auf 0,90 (SD ± 0,36) an. Dies war nicht statistisch signifikant (p = 0,066). Bei der Gruppe der laserassoziierten Retinopathie stieg der Visus von 0,89 (SD ± 0,18) auf 1,03 (SD ± 0,09) an, ebenfalls nicht statistisch signifikant (p = 0,063). In der OCT konnten Alterationen in der Interdigitationszone, der ellipsoiden Zone und der äußeren Körnerzellschicht/Henle-Faser-Schicht gesehen werden. Fast alle Fälle zeigten einen persistierenden Defekt in der ellipsoiden Zone und teilweise auch eine Atrophie des retinalen Pigmentepithels. Beide Gruppen zeigten eine Abnahme der Fläche des hyporeflektiven Areals auf Niveau der ellipsoiden Zone in der En-face-OCT, dies war jedoch nur bei der Gruppe der laserassoziierten Retinopathien signifikant (p = 0,018 versus p = 0,172). Schlussfolgerungen: OCT unterstützt die Diagnostik bei solarer und laserassoziierter Retinopathie, insbesondere bei sehr milden Verletzungen. Bei beiden Krankheitsbilder handelt es sich meist um geringgradige Befunde mit guter Prognose. Auch in Fällen mit kompletter visueller Erholung kann häufig noch eine kleine Alteration in der ellipsoiden Zone persistieren

Correlation between Macular Neovascularization (MNV) Type and Druse Type in Neovascular Age-Related Macular Degeneration (AMD) Based on the CONAN Classification

To investigate associations and predictive factors between macular neovascularization (MNV) lesion variants and drusen types in patients with treatment-na&iuml;ve neovascular age-related macular degeneration (AMD). Methods: Multimodal imaging was retrospectively reviewed for druse type (soft drusen, subretinal drusenoid deposits (SDDs) or mixed) and MNV type (MNV 1, MNV 2, MNV 1/2 or MNV 3). The Consensus on Neovascular AMD Nomenclature (CONAN) classification was used for characterizing MNV at baseline. Results: One eye of each eligible patient was included (n = 191). Patients with predominant SDDs had an increased adjusted odds ratio (aOR) for MNV 2 (23.4453, p = 0.0025) and any type of MNV 3 (8.7374, p &lt; 0.0001). Patients with MNV 1/2 had an aOR for predominant SDDs (0.3284, p = 0.0084). Patients with MNV1 showed an aOR for SDDs (0.0357, p &lt; 0.0001). Eyes with SDDs only without other drusen types showed an aOR for MNV 2 (9.2945, p &lt; 0.0001). Conclusions: SDDs represent a common phenotypic characteristic in AMD eyes with treatment-na&iuml;ve MNV. The aOR for eyes with predominant SDDs to develop MNV 2 and MNV 3 was much higher, possibly due to their location in the subretinal space. The predominant druse type may help to predict which type of MNV will develop during the course of AMD