Multimodal imaging of sarcoid choroidal granulomas

BACKGROUND: Enhanced-depth imaging optical coherence tomography (EDI-OCT) provides high-resolution imaging of the choroid. Herein, we report multimodal imaging, including EDI-OCT, of a case of sarcoid choroidal granulomas. FINDINGS: A 63-year-old female with biopsy-supported sarcoidosis presented with unilateral multifocal choroidal granulomas. Enhanced-depth imaging optical coherence tomography (EDI-OCT) demonstrated a homogenous hyporeflective choroidal lesion with choriocapillaris thinning and sparing of the surrounding choroid. The patient was started on oral steroids with a weekly taper schedule. Within 5 weeks, the choroidal lesions had clinically resolved with return of normal-appearing choroidal architecture on EDI-OCT. Indocyanine green angiography, however, demonstrated hypofluoresence at the sites of choroidal granulomas 11 months after the clinical resolution, suggesting a longstanding choroidal perfusion deficit undetected by OCT. CONCLUSIONS: Choroidal imaging via EDI-OCT provides detailed morphologic information of sarcoid granulomas and can accurately demonstrate structural resolution of the lesions

Idiopathic Unilateral Enlargement of the Extraocular Muscles in an Infant

The differential diagnosis for enlargement of the extraocular muscles (EOMs) generally includes infiltrative, inflammatory, and vascular processes. Herein, we report the unusual case of an infant who presented with unilateral restrictive strabismus secondary to idiopathic enlargement of the EOMs

Imaging human macular pigments with visible light optical coherence tomography and superluminescent diodes.

We demonstrate superluminescent diodes (SLDs) for visible light optical coherence tomography (OCT) of the human retina. SLDs are less costly than supercontinuum sources and have lower intrinsic excess noise, enabling imaging closer to the shot noise limit. While single SLDs are not broadband, they provide power concentrated at specific wavelengths relevant to retinal function. As a new, to the best of our knowledge, application, we image human macular pigments (MPs), which are thought to both aid vision and protect against advanced age-related macular degeneration. Using the unique depth-resolved capabilities of OCT, we localize MPs in depth to Henle's fibers beneath the foveal pit in the living human retina. Our approach reduces the cost of visible light OCT to nearly that of near-infrared (NIR) OCT while also providing information about clinically relevant MPs which cannot be measured in the NIR

Accidental Nd:YAG Laser–Induced Macular Hole in a Pediatric Patient

After being exposed to an industrial Nd:YAG laser, an 11-year-old boy developed a full-thickness macular hole in the right eye with resultant visual acuity of 20/100. Five months after the initial injury, the vision was stable and the hole was still present. The patient underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade with prone positioning. Three months postoperatively, visual acuity improved to 20/25 with closure of the macular hole; however, there was a focal photoreceptor deficit. A review of the English-language literature identified 15 eyes with similar macular hole injuries after Nd:YAG exposure. Three eyes were surgically managed. While all holes were successfully closed, only two experienced visual improvement

Binocular Diplopia Caused by an Epiretinal Membrane With Foveal Displacement

A 73-year-old woman presented with 3 years of monocular visual distortion and progressive binocular diplopia. She was found to have a comitant left hypertropia due to an epiretinal membrane causing inferior foveal drag. Displacement of the fovea from an epiretinal membrane is a likely under-recognized cause ocular cause of a comitant binocular diplopia

Binocular Diplopia Caused by an Epiretinal Membrane With Foveal Displacement

A 73-year-old woman presented with 3 years of monocular visual distortion and progressive binocular diplopia. She was found to have a comitant left hypertropia due to an epiretinal membrane causing inferior foveal drag. Displacement of the fovea from an epiretinal membrane is a likely under-recognized cause ocular cause of a comitant binocular diplopia

Outcomes and complications of pneumatic retinopexy over a 12-year period

To evaluate anatomic and clinical outcomes of pneumatic retinopexy for treatment of primary retinal detachment. Noncomparative, single-center, consecutive, interventional case series evaluating all patients treated between 2000 and 2012. Patients with less than 1 month of follow-up or coexisting neovascular age-related macular degeneration, uveitis, endophthalmitis, or prior posterior segment surgery were excluded. Sixty-three eyes of 63 patients with primary retinal detachment treated with pneumatic retinopexy were included. Median follow-up was 10.3 months. Single-operation success (SOS), defined as anatomic reattachment with pneumatic retinopexy alone, occurred in 40 eyes (63%). The retina was successfully reattached in 21 of the other 23 eyes (91%) with one additional surgery. There was no difference in visual acuity outcomes between SOS and additional surgical intervention (P = .85). New or missed breaks were identified in 19 of 63 eyes (30%). Postoperative subretinal fluid was observed in 22 of 63 eyes (35%) and persisted at last follow-up in two of 63 eyes (3%). At final follow-up, the retina was fully attached in 97% of eyes. Pneumatic retinopexy remains a reasonably successful option in the management of primary retinal detachment. No difference in best corrected visual acuity outcomes in eyes achieving SOS versus those requiring additional surgery was demonstrated