Focal foveal atrophy of unknown etiology: Clinical pictures and possible underlying causes

Background/PurposeFocal foveal atrophy is defined as the presence of a small, focal, ill-defined, hypopigmented foveal or juxtafoveal lesion, with the remaining retina unaffected. The purpose of this study was to report the clinical characteristics and optical coherence tomography (OCT) in patients with focal foveal atrophy of unknown etiology.MethodsThe study was a retrospective observational case series. Data collected included complete ocular examination results for best corrected visual acuity (BCVA), ophthalmoscopy, fundus photography, fluorescein angiography, color sense discrimination tests, visual field tests, and OCT examinations.ResultsTwenty-three eyes in 21 patients were examined. The mean patient age was 49.2 ± 15.4 years. The mean BCVA was 20/25. The 21 patients were divided into three groups according to OCT results. Group 1 eyes (n = 10) had intact inner and outer hyperreflective layers (HRLs), with the signal of the inner HRL corresponding to the junction between the inner and outer photoreceptor segments and the outer HRL corresponding to the retinal pigment epithelium (RPE). Group 2 eyes (n = 9) had small hyporeflective defects with defects in the inner HRL at the fovea but an intact outer HRL. Group 3 eyes (n = 4) had small hyporeflective defects in both the inner and outer HRLs at the fovea. Groups 3 eyes had significantly lower visual acuity compared to Group 1 eyes and Group 2 eyes. There was no significant difference in visual acuity between Group 1 and Group 2 eyes. There were no significant differences among the groups with respect to color vision or foveal thickness.ConclusionThis is the first report of clinical presentations for patients with focal foveal atrophy of unknown etiology. OCT aided in the diagnosis and assessment of the degree of retinal structural abnormalities, but the real etiology of foveal atrophy remains unclear

Optical Coherence Tomography in the Detection of Retinal Break and Management of Retinal Detachment in Morning Glory Syndrome

PURPOSE: To determine the efficacy of optical coherence tomography (OCT) in the management of retinal detachment in morning glory syndrome (MGS). DESIGN: Prospective, interventional case series. METHODS: Five eyes of five consecutive MGS patients who developed retinal detachment between August 2000 and June 2004 were enrolled and examined by OCT at presentation of retinal detachment. Four eyes were found to have a slit- like break at the margin of the excavation by careful OCT scanning 360 degrees around the excavation. All four eyes underwent pars plana vitrectomy, gas injection and postoperative laser photocoagulation. Postoperative OCT was performed to confirm the closure of the retinal break and reattachment of the retina. RESULTS: Optical coherence tomography detected a slit-like break at the margin of excavation in four of five patients. The retina reattached in all five eyes over the subsequent 3-50- months (average 28 months) follow-up period. Postoperative OCT showed retinal break closure at the margin of the excavation. In the one eye in which no retinal break could be detected by OCT, the retina was reattached after pars plana vitrectomy and removal of gel-like tissue. CONCLUSIONS : Optical coherence tomography is beneficial in the detection of subtle slit-like breaks at the margin of excavation in retinal detachment in MGS. It provides good guidance in subsequent surgery and is very helpful in confirming the closure of the retinal break

Treatment outcomes and predicting factors for diabetic macular edema treated with ranibizumab – One-year real-life results in Taiwan

Purpose: To report the one-year outcomes of diabetic macular edema (DME) treated with ranibizumab under a real-life setting in Taiwan, and to identify the prognostic factors. Methods: Between July 2013 and January 2015, 119 eyes receiving intravitreal ranibizumab for DME were retrospectively recruited. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured with optical coherence tomography were collected at baseline and at Month 3, 6, and 12. Linear regression was used to identify the predicting factors for changes in BCVA and CFT at Month 12. Results: The average number of ranibizumab given within one year was 4.36 ± 1.87. The BCVA (logMAR) improved from 0.74 ± 0.30 at baseline to 0.64 ± 0.37 at Month 12 (p = 0.002). A better improvement in BCVA at Month 3 was significantly correlated with a better visual improvement at Month 12 (p < 0.001). The existence of subretinal fluid at baseline (p = 0.02) and a greater reduction in CFT at Month 3 (p < 0.001) were both correlated with a greater reduction in CFT at Month 12. Previous subtenon injection of triamcinolone acetonide was associated with fewer additional IVR after Month 3 (odds ratio = 0.35, 95% CI = 0.14–0.89). Conclusion: Compared with existing prospective studies, the one-year real-life data in Taiwan showed fewer ranibizumab injections for DME and a less prominent yet still significant visual improvement. Both visual and anatomical improvements at Month 3 were correlated with the level of improvements at Month 12. Previous subtenon steroid injection might reduce the need of additional ranibizumab injections. Keywords: Diabetic retinopathy, Macular edema, Optical coherence tomography, Triamcinolone acetonide, Ranibizuma

Retinal Detachment in a Patient with Microphthalmos and Choroidal Coloboma

We report a rare case of retinal detachment with microphthalmos and choroidal coloboma. A 28-year-old man who had suffered from poor vision since early childhood was examined because of progressive deterioration of vision in his right eye. Examination of the anterior segment showed microphthalmos with microcornea and coloboma of the iris. Fundus examination revealed an inferior choroidal coloboma extending to the optic disc. The patient also had total bullous retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed, and the retina was reattached. Although rare, retinal detachment may develop in patients with microphthalmos and choroidal coloboma. Pars plana vitrectomy with additional scleral encircling buckle may be performed to treat this condition

Clinical characteristics and long-term evolution of lamellar macular hole in high myopia.

PURPOSE:To evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as the development of foveal detachment or full-thickness macular hole. METHODS:Patients with high myopia and LMH were retrospectively recruited. The clinical characteristics and various parameters of optical coherence tomography were identified at baseline and during follow-up visits. Cox regression analysis was used to evaluate the hazard ratios for foveal detachment and full-thickness macular hole. RESULTS:Among 112 eyes (98 patients), 64.3% were female; the mean axial length of all eyes was 29.6 ± 1.9 mm. The 'LMH without retinoschisis' group accounted for 39.3% of the eyes. Forty-two percent developed structural worsening within a median follow-up of 67 months. Multivariable regression on all cases showed elevated tissue inside the LMH (P = 0.003) protected against structural worsening while V-shaped LMH (P = 0.006) predicted it. In the "LMH with retinoschisis group", ellipsoid zone disruption (P = 0.035), and V-shaped LMH (P = 0.014) predicted structural worsening, while elevated tissue inside the LMH (P = 0.028) protected against it. In the "LMH without retinoschisis group", no associated factor was identified. CONCLUSIONS:LMHs in high myopia are unstable, especially those with V-shaped LMH. Elevated tissue inside LMHs have a protective effect against further structural worsening