Multimodal Imaging in a Case of Idiopathic Neuroretinitis

A 37-year-old woman presented with painful visual loss in the left eye for 2 weeks. The best-corrected visual acuity was 20/200. Ophthalmic examination of the left eye revealed vitreous cells, optic disc swelling, serous retinal detachment, and macular star-figure hard exudates. Swept-source optical coherence tomography showed both inner and outer retinas were swollen, the choroid was thickened, and the corresponding retinal pigment epithelium was elevated. Wide-field indocyanine green angiography disclosed multiple hypofluorescent spots in the mid-periphery. Taken together, an involvement of optic disc, entire retina, and choroid was considered in the current case

Peripheral Microvascular Abnormalities Detected by Wide-Field Fluorescein Angiography in Eyes with Branch Retinal Vein Occlusion.

Purpose: To evaluate the location of microvascular abnormalities using wide-field fluorescein angiography (WFFA) and investigate the impact on visual outcomes in eyes with branch retinal vein occlusion (BRVO). Methods: Forty of 39 patients (24 male and 15 female, average age of 71 years) were retrospectively reviewed. One patient had BRVO bilaterally. WFFA was performed in all patients to evaluate perfusion status and detect microvascular abnormalities. The areas on WFFA images were divided into three groups; Zone 1: posterior pole, Zone 2: mid periphery, and Zone 3: far periphery to document the presence of microvascular abnormalities. Scatter retinal photocoagulation (PC) was performed for retinal neovascularization (NV) and/or widespread NPAs. Results: The incidence of microvascular abnormalities in Zone 3 was significantly (P<0.0001) less than those in Zone 1 and Zone 2. The presence of larger NPAs in Zone 1, but not Zone 3, was associated with the incidence of NV and vitreous hemorrhage. Both the presence of peripheral lesions and application of PC did not affect the visual outcomes. Conclusion: The presence of peripheral abnormalities or scatter PC for NPAs did not affect the visual outcomes in eyes with BRVO

Structural and Functional Analyses of Retinal Ischemia in Eyes with Retinal Vein Occlusion: Relationship with Macular Edema or Microaneurysm Formation

Purpose: To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with retinal vein occlusion (RVO). Methods: Sixty eyes of 30 patients (27 eyes with branch [b]RVO, 3 with central RVO, and 30 fellow eyes) were retrospectively reviewed. Optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry were performed simultaneously to measure retinal thickness and sensitivity. The presence of ME or MA was also assessed using OCT and fluorescein angiography. Results: The mean retinal sensitivity in the nonperfused areas (NPAs) deteriorated, and this was significantly (r = –0.379, p = 0.0391*) and inversely correlated with duration from disease onset. ME and MA were unlikely to be observed around the area where the retinal sensitivity decreased. In the NPAs, the mean retinal thickness of the superficial capillary plexus (SCP) (p < 0.0001), deep capillary plexus (DCP) (p = 0.0323), and outer retina (p = 0.0008) were significantly thinner than those in the fellow eyes, respectively. Multivariate regression analysis revealed that the thicknesses of the DCP (β: 0.3107, p = 0.0007) and outer retina (β: 0.3482, p = 0.0001) were the independent correlative factors of the retinal sensitivity, but that SCP thickness was not. Conclusion: Deep retinal thinning in NPAs was correlated significantly with a decreased retinal sensitivity, which might be a negative predictor of ME and MA in eyes with RVO

Central Retinal Vein Occlusion after mRNA COVID-19 Vaccination

A 47-year-old man presented with visual loss in the right eye 8 h after the first dose of a coronavirus disease 2019 (COVID-19) vaccine developed by Pfizer/BioNTech (BNT162b2). The best corrected visual acuity (BCVA) was 20/200. Fundus examination showed dilated and tortuous retinal veins at the posterior pole, retinal hemorrhages throughout the fundus, and macular edema. Fluorescein angiography showed multiple hypofluorescent spots that appeared to be fluorescent block due to retinal hemorrhages and hyperfluorescent leakage from the retinal veins. The eye was diagnosed with central retinal vein occlusion (CRVO). For the treatment of macular edema, intravitreal injection of aflibercept (IVA) was administered and treated with one plus pro re nata regimen. Five IVAs were performed over a 10-month follow-up period, with resolution of macular edema, and the BCVA recovered to 20/20. The patient was young and had no history of diabetes mellitus, hypertension, or atherosclerotic diseases, and his blood tests showed no abnormal findings. Both antigen test and polymerase chain reaction test for COVID-19 were negative, and the antibody test was positive due to vaccination. The development of CRVO in this patient may have been related to COVID-19 vaccination, and the appropriate IVA treatment resulted in a good visual prognosis

Peripheral Microvascular Abnormalities Detected by Wide-Field Fluorescein Angiography in Eyes with Branch Retinal Vein Occlusion

Purpose: To evaluate the location of microvascular abnormalities using wide-field fluorescein angiography (WFFA) and investigate the impact on visual outcomes in eyes with branch retinal vein occlusion (BRVO). Methods: Forty of 39 patients (24 male and 15 female, average age of 71 years) were retrospectively reviewed. One patient had BRVO bilaterally. WFFA was performed in all patients to evaluate perfusion status and detect microvascular abnormalities. The areas on WFFA images were divided into three groups; Zone 1: posterior pole, Zone 2: mid periphery, and Zone 3: far periphery to document the presence of microvascular abnormalities. Scatter retinal photocoagulation (PC) was performed for retinal neovascularization (NV) and/or widespread NPAs. Results: The incidence of microvascular abnormalities in Zone 3 was significantly (P<0.0001) less than those in Zone 1 and Zone 2. The presence of larger NPAs in Zone 1, but not Zone 3, was associated with the incidence of NV and vitreous hemorrhage. Both the presence of peripheral lesions and application of PC did not affect the visual outcomes. Conclusion: The presence of peripheral abnormalities or scatter PC for NPAs did not affect the visual outcomes in eyes with BRVO.journal articl

Multimodal Imaging of Microvascular Abnormalities in Retinal Vein Occlusion

The technologies of ocular imaging modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have progressed remarkably. Of these in vivo imaging modalities, recently advanced OCT technology provides high-resolution images, e.g., histologic imaging, enabling anatomical analysis of each retinal layer, including the photoreceptor layers. Recently developed OCTA also visualizes the vascular networks three-dimensionally, which provides better understanding of the retinal deep capillary layer. In addition, ex vivo analysis using autologous aqueous or vitreous humor shows that inflammatory cytokine levels including vascular endothelial growth factor (VEGF) are elevated and correlated with the severity of macular edema (ME) in eyes with retinal vein occlusion (RVO). Furthermore, a combination of multiple modalities enables deeper understanding of the pathology. Regarding therapy, intravitreal injection of anti-VEGF drugs provides rapid resolution of ME and much better visual improvements than conventional treatments in eyes with RVO. Thus, the technologies of examination and treatment for managing eyes with RVO have progressed rapidly. In this paper, we review the multimodal imaging and therapeutic strategies for eyes with RVO with the hope that it provides better understanding of the pathology and leads to the development of new therapies