Relationship between nerve fiber layer hemorrhages and outcomes in central retinal vein occlusion

PURPOSE. To evaluate the depth and pattern of retinal hemorrhage in acute central retinal vein occlusion (CRVO) and to correlate these with visual and anatomic outcomes. METHODS. Retinal hemorrhages were evaluated with color fundus photography and fluorescein angiography at baseline and follow-up. Snellen visual acuity (VA), central foveal thickness (CFT), extent of retinal ischemia, and development of neovascularization were analyzed. RESULTS. 108 eyes from 108 patients were evaluated. Mean age was 63.6 ± 16.1 years with a predilection for the right eye (73.1). Average follow-up was 17.2 ± 19.2 months. Mean VA at baseline was 20/126 and 20/80 at final follow-up. Baseline (P = 0.005) and final VA (P = 0.02) in eyes with perivascular nerve fiber layer (NFL) hemorrhages were significantly worse than in eyes with deep hemorrhages alone. Baseline CFT was greater in the group with perivascular hemorrhages (826 ± 394 μm) compared to the group with deep hemorrhages alone (455 ± 273 μm, P < 0.001). The 10 disc areas of retinal ischemia was more common in patients with perivascular (80.0) and peripapillary (31.3) versus deep hemorrhages alone (16.1, P < 0.001). Neovascularization of the iris was more common, although this differrence was not significant, in the groups with peripapillary (14.3) and perivascular (2.0) NFL versus deep hemorrhages alone (0.0). CONCLUSIONS. NFL retinal hemorrhages at baseline correlate with more severe forms of CRVO, with greater macular edema, poorer visual outcomes, and greater risk of ischemia and neovascularization. This may be related to the organization of the retinal capillary plexus. The depth and pattern of distribution of retinal hemorrhages in CRVO may provide an easily identifiable early biomarker of CRVO prognosis. Copyright 2020 The Author

The treatment results of 167 patients with idiopathic macular hole [I•diyopatik maküla deligi olan 167 hastanin tedavi sonuçlari]

Purpose: To evaluate postoperative anatomical and visual results of patients with idiopathic macular hole (IMH). Materials and Methods: In this retrospective study, 167 patients aged between 44-79 years underwent 23 gauge transconjunctival pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Phacoemulsification and intraocular lens implantation were performed in 72 cases as additional operations. During the follow-up period, anatomical and functional success and complications were evaluated. Age, symptom duration, preoperative visual acuity, hole diameter and stage, lens status, operation type, paint and internal tamponade used in surgery were the factors, which were evaluated for their effects on anatomical and functional success. Results: The average duration of blurred vision and/or metamorphopsia of cases were 10.0±5.2 months. Twenty-seven (16.2%), eighty-six (51.5%) and fifty-four (32.3%) patients had stage 2, -3, and -4 macular hole, respectively. The closure rate following a single operation was 146/167 (87.4%). Postoperatively visual acuity was increased in 116 eyes (69.5%) while remaining the same in 47 (28.1%) and decreasing in 4 (2.4%) patients. As analyzed by multiple logistic regression model, symptom duration, hole diameter, and used paint were found to be associated with anatomical failure (odds ratios were: 1238, 1014 and 5.079, respectively; all p values, <0.05), symptom duration was detected to be the only factor causing functional failure (odds ratio: 1.082, p=0.15). Conclusion: Pars plana vitrectomy, ILM peeling and the use of intravitreal gas tamponade are standard and successful treatment in IMH surgery and provide satisfactory anatomical and functional results

SEROUS MACULAR DETACHMENT IN BEST DISEASE: A Masquerade Syndrome

PURPOSE: To describe the clinical and multimodal imaging findings of a series of cases of serous macular detachment (SMD) caused by Best disease (BD) masquerading as neovascular age-related macular degeneration or central serous chorioretinopathy that were inappropriately treated with intravitreal anti-vascular endothelial growth factor or laser therapy. This study will also present data to support age-related progressive choroidal thickening in BD patients, which may play a role in the development of SMD in this population. METHODS: Clinical examination and multimodal imaging findings, including color fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and optical coherence tomography-angiography, were reviewed and analyzed. Subfoveal choroidal thickness was also formally measured, and an age-related choroidal thickness analysis was performed and compared with a normal population. RESULTS: Twenty-six eyes of 13 patients (5 women) were included. Median age was 44 years. Nine patients presented with a history of SMD and subretinal fluid recalcitrant to various therapies, including intravitreal anti-vascular endothelial growth factor injections and photodynamic therapy. Best disease was subsequently diagnosed genetically in six patients and by detailed family history in seven. Mean logarithm of the minimum angle of resolution best-corrected visual acuity for all 26 eyes at last follow-up was +0.36 (Snellen equivalent of 20/46). Subfoveal choroidal thickness positively correlated with age for our cohort, increasing linearly at a rate of 25.6 µm per decade (R = 0.64; P < 0.001). Choroidal neovascularization was identified in four eyes on optical coherence tomography angiography, but these eyes did not respond to anti-vascular endothelial growth factor treatment. CONCLUSION: The diagnosis of BD should be considered in patients presenting with SMD and recalcitrant subretinal fluid masquerading as neovascular age-related macular degeneration or chronic central serous chorioretinopathy to avoid unnecessary treatment procedures. The positive correlation of subfoveal choroidal thickness with age in BD patients may be a factor in the pathogenesis and development of SMD in this population. Recognizing the multimodal imaging features of SMD associated with BD, described in detail in this study, will guide practitioners to the accurate diagnosis of BD and reduce the risk of unnecessary intraocular procedures with potential complications