Retinoschisis in Coats Disease: Clinical Picture, Therapeutic Considerations, and Management Outcomes

2020 ◽  
pp. 247412642095430
Author(s):  
Nathan L. Scott ◽  
Linda A. Cernichiaro-Espinosa ◽  
Jonathan F. Russell ◽  
Timothy G. Murray ◽  
Sander R. Dubovy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Pigment ◽  
Case Series ◽  
Intravitreal Bevacizumab ◽  
Retinal Pigment Epithelial Cells ◽  
Clinical Feature ◽  
Exudative Retinal Detachment ◽  
Corrected Visual Acuity ◽  
Coats Disease ◽  
Best Corrected Visual Acuity

Purpose: Retinoschisis in inflammatory and exudative retinopathy is a known but rare entity. We describe the presentation and clinical and surgical outcomes of a series of patients with retinoschisis in the setting of Coats disease. Methods: This retrospective case series of patients with Coats disease recorded visual acuity and the number and type of treatments (eg, angiography-guided photocoagulation, intravitreal bevacizumab, sub-Tenon triamcinolone, or vitreoretinal surgery). Results: Eighteen of 133 patients with Coats disease were diagnosed with retinoschisis by color imaging. All (100%) of the areas of schisis or macrocyst were associated with dense subretinal exudation, whereas only 7 (38.8%) were associated with exudative retinal detachment. Initial best-corrected visual acuity in the schisis cohort was 1.14 ± 1.19 (Snellen equivalent, 20/276) vs 1.42 ± 1.40 (Snellen, 20/526) in those without ( P = .56). Final best-corrected visual acuity was 1.76 ± 1.37 (Snellen, 20/1150) and 1.45 ± 1.44 (Snellen, 20/563), respectively ( P = .43). The mean number of treatments in individuals with schisis was 4.8 ± 2.9 for angiography-guided photocoagulation, 4.5 ± 2.9 for intravitreal bevacizumab, and 1.7±1.2 for sub-Tenon triamcinolone. Intraocular surgery was required in 39% (7 of 18) of patients with schisis vs 22% (25 of 115) for patients without schisis ( P = .14). One eye required enucleation, and histopathology of the schisis pocket was obtained. Conclusions: The pathophysiology of retinoschisis in Coats disease is not completely understood. We propose that telangiectatic leakage, hypoxia, and toxicity to the retinal pigment epithelial cells play a role in cavity development, and therefore may represent a clinical feature of advanced or uncontrolled disease.

Detecting subclinical keratoconus by biomechanical analysis in tomographically regular keratoconus fellow eyes

2021 ◽  
pp. 112067212110637
Author(s):  
Victor A Augustin ◽  
Hyeck-Soo Son ◽  
Isabella Baur ◽  
Ling Zhao ◽  
Gerd U Auffarth ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Case Series ◽  
Biomechanical Analysis ◽  
Corvis St ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Best Corrected Visual Acuity ◽  
Fellow Eyes

Purpose To analyze the tomographically non-affected second eyes of keratoconus patients using the Corvis ST to detect any biomechanical abnormalities or subclinical keratoconus. Methods In this retrospective, single-center, consecutive case series 244 eyes of 122 keratoconus patients were analyzed between November 2020 and February 2021. Fourteen fellow eyes fulfilled the inclusion criteria and showed no clinical or tomographic signs of keratoconus. Main outcome measures included best-corrected visual acuity, tomographic and biomechanical analyses using Scheimpflug imaging: Pentacam and Corvis ST (Oculus, Wetzlar, Germany). Tomographic analyses included anterior and posterior simulated keratometry, K-Max, central corneal thickness, thinnest corneal thickness, Belin/Ambrosio Ectasia Display, and the ABCD grading system. For biomechanical analyses, the corneal biomechanical index (CBI) and tomographic biomechanical index were used. Results The mean best-corrected visual acuity was 0.01 ± 0.10 logMAR. Mean K-Max was 43.79 ± 1.12 D, mean central corneal thickness 529 ± 25 µm, mean thinnest corneal thickness 524 ± 23 µm, and mean Belin/Ambrosio Ectasia Display 1.0 ± 0.32. The mean CBI was 0.30 ± 0.21. Regular CBI values were found in six of 14 patients. The mean tomographic biomechanical index was 0.47 ± 0.22 with regular values observed in only two of 14 patients. No signs of tomographic or biomechanical abnormalities were shown in only one of 14 keratoconus fellow eyes, with regular ABCD, Belin/Ambrosio Ectasia Display, CBI and tomographic biomechanical index values. Conclusions Tomographically normal fellow eyes of keratoconus patients are rare. In these cases, a biomechanical analysis of the cornea may help detect a subclinical keratoconus. The tomographic biomechanical index was the most sensitive index to verify a mild ectasia.

Surgical management of a case of contractile peripapillary staphyloma with retinal detachment and macular hole

2020 ◽  
pp. 112067212092022
Author(s):  
Sofía H Vidal ◽  
Diego Bueso Ponce ◽  
Juan Esteban Unigarro ◽  
Sergio Arrascue Limo ◽  
Carlos Abdala Caballero
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Hole ◽  
Retinal Pigment ◽  
Silicon Oil ◽  
Corrected Visual Acuity ◽  
Intraocular Gas ◽  
Best Corrected Visual Acuity ◽  
Peripapillary Staphyloma

A healthy 4-year-old male presented a fundus examination with a unilateral contractile peripapillary staphyloma surrounded by redundant retina and retinal pigment epithelium atrophy. Five years later, best-corrected visual acuity decreased to hand motion due to a retinal detachment with macular hole. One month after first vitrectomy, scleral buckle and intraocular gas, retina re-detached. Second surgery was performed with silicon oil tamponade and lensectomy without intraocular lens (IOL). Subretinal silicon oil was detected at the third month of follow-up when vitrectomy, inferior retinectomy, and laser photocoagulation of temporal border of staphyloma with silicon oil tamponade were performed. The retina remained attached and best-corrected visual acuity was 20/600 with intraocular silicon oil. A fourth surgery was performed for emulsified silicon oil extraction replaced with intraocular gas. At 6 months of follow-up, the retina re-detached again. This is a challenging vitreoretinal surgery in which re-detachments were due to retinal folds around the contractile staphyloma that raised macular hole. This is the first report of the combined presentation of contractile peripapillary staphyloma, retinal detachment and macular hole with a long-time follow-up period of years.

scholarly journals Rapid progression of chorioretinal atrophy in punctate inner choroiditis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuka Kasuya ◽  
Yuji Inoue ◽  
Satoru Inoda ◽  
Yusuke Arai ◽  
Hidenori Takahashi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Epiretinal Membrane ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Japanese Woman ◽  
Rapid Progression ◽  
Chorioretinal Atrophy ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Abstract Background The chorioretinal inflammatory lesions occurring in punctate inner choroiditis evolve into punched-out atrophic scars. Typically, the progression is gradual. We report a case of highly myopic punctate inner choroiditis with rapid progression of chorioretinal atrophy. Case presentation A 48-year-old Japanese woman with high myopia presented with decreased visual acuity. Best-corrected visual acuity was 20/28 in the right eye and 20/16 in the left eye; axial length was 29.0 mm and 28.7 mm, respectively. Fundoscopy revealed an epiretinal membrane in the left eye. Three years later, the best-corrected visual acuity in the left eye had decreased to 20/33; at this time, the patient underwent vitrectomy with epiretinal membrane and internal limiting membrane peeling in this eye. Six months later, the best-corrected visual acuity in the left eye decreased suddenly to 20/100. Optical coherence tomography showed a nodule-like lesion in the outer retina with disruption of the retinal pigment epithelium and a focally thickened choroid, compatible with PIC. One month later, the choroidal thickness had decreased. The central chorioretinal atrophy expanded rapidly at a rate of 0.45 mm2/year over the next 3 years, and new areas of patchy focal chorioretinal atrophy developed in the perifovea. Conclusions Rapid progression of chorioretinal atrophy was observed in a patient with punctate inner choroiditis. Because punctate inner choroiditis is often associated with degenerative myopia, the retina is fragile and may be susceptible to mechanical damage. This case report alerts clinicians to the need for careful management of patients with punctate inner choroiditis, especially after vitrectomy.

scholarly journals Bevacizumab for Macular Serous Neuroretinal Detachment in Tilted Disk Syndrome

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Paolo Milani ◽  
Alfredo Pece ◽  
Luisa Pierro ◽  
Patrizio Seidenari ◽  
Paolo Radice ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Monthly Interval ◽  
Serous Macular Detachment ◽  
Corrected Visual Acuity ◽  
Total Observation ◽  
Tilted Disk ◽  
Best Corrected Visual Acuity

Background. Tilted disc syndrome (TDS) is a congenital anomaly characterized by “tilting” of the optic disc tipycally associated with myopic astigmatism, visual field defect, inferior staphyloma, and retinal pigment epithelium atrophy. Associated complications such as macular serous neuroretinal detachment are well described; however, ideal therapy for such complication is unknown.Methods. One interventional case report is hereby described. A patient affected by macular serous neuroretinal detachment-complicated tilted disk syndrome underwent a complete ophthalmic examination. Optical coherence tomography and fluorescein angiography were taken at baseline and at scheduled visits. Two intravitreal treatments of bevacizumab (avastin, 1.25 mg/0.05 mL) were performed at monthly interval.Results. At scheduled visit, one month after the second injection, OCT depicted persistence of neuroretinal detachment. Best-corrected visual acuity remain stable as well as metamorphopsia and functional discomfort.Conclusion. Clinical evidence of this brief interventional case report indicates that one patient affected by recent serous macular detachment-complicated TDS did not benefit from 2 consecutive monthly intravitreal Avastin treatments. Best-corrected visual acuity remained stable over a total observation period of 6 months.

scholarly journals Scleral buckle surgery for pseudophakic and aphakic retinal detachment in western Nepal

1970 ◽  
Vol 3 (2) ◽  
pp. 109-117
Author(s):  
RN Byanju ◽  
S Bajimaya ◽  
I Kansakar ◽  
A Melamud
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Case Series ◽  
Scleral Buckle ◽  
Retrospective Case ◽  
Repeat Surgery ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity ◽  
Aphakic Retinal Detachment

Introduction: Retinal detachment remains one of the most serious complications of cataract surgery. Treatment of this condition has represented a challenge for vitreoretinal surgeons. Scleral buckle (SB) surgery is one of the treatment options in pseudophakic and aphakic retinal detachment (RD). Aims: To find out the anatomical and visual outcome of SB in pseudophakic and aphakic RD. Subjects and methods: Retrospective case series of 46 consecutive eyes of 46 patients with RD (38 pseudophakic and 8 aphakic eyes) that had undergone conventional SB surgery were reviewed from patient files. Postoperative retinal status at 3 weeks, 6 weeks and 3 months were recorded to see the anatomical success rate after retinal reattachment surgery. Best corrected visual acuity (BCVA) at 3 months follow-up was noted. Results: The mean age of the patients was 54.28 ± 13.49 years. Forty eyes (86.9 %) had primary attachment by 6 weeks duration. Five eyes had undergone repeat surgery within a six-week duration (pars plana vitrectomy). Forty patients had follow-up visit to 12 weeks, achieving retinal attachment in 37 eyes (80.5 %). Best corrected visual acuity (BCVA) at 3 months was better than 6/60 in 18 eyes (39.1%), BCVA better or equal to 1/60 but less than 6/60 in 18 eyes (39.1%) and BCVA less than 1/60 in 4 eyes (8.7 %). Conclusion: Conventional scleral buckling has good outcome for pseudophakic and aphakic RD and can be useful for patients in peripheral eye hospitals where patients cannot afford high cost surgeries. Keywords: scleral buckle, pseudophakia, retinal detachment DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5261 Nepal J Ophthalmol 2011; 3(2): 109-117

scholarly journals Pengaruh Bevacizumab Intravitreal terhadap Best Corrected Visual Acuity dan Central Macular Thickness pada Diabetic Macular Edema

2020 ◽  
Vol 8 (4) ◽  
Author(s):  
Arini Ghaisa Atsari ◽  
Weni Helvinda
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Macular Thickness ◽  
Central Macular Thickness ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
One Way Anova ◽  
Best Corrected Visual Acuity

Diabetic Macular Edema (DME) adalah penyebab utama kebutaan pada populasi diabetes. Salah satu patogenesis pada DME adalah karena peningkatan ekspresi VEGF. Bevacizumab adalah anti-VEGF yang dapat meningkatkan Best Corrected Visual Acuity (BCVA) dan mengurangi Central Macular Thickness (CMT) pada pasien DME. Tujuan: Mengetahui persentase jenis kelamin, usia, durasi DM tipe II, BCVA dan CMT sebelum dan setelah injeksi pada bulan pertama dan bulan ketiga pada pasien DME serta menganalisis pengaruh intravitreal bevacizumab anti-VEGF terhadap BCVA dan CMT pada DME di Rumah Sakit M Djamil Padang. Metode: Penelitian ini adalah studi retrospektif analitik berdasarkan rekam medis dari 16 pasien DME yang telah injeksi bevacizumab intravitreal pada tahun 2017. Data dianalisis secara statistik menggunakan uji one way Anova dengan p < 0,05 dianggap signifikan. Hasil: Pasien terdiri dari 11 wanita (68,8%) dan 5 pria (31,2%). Jumlah usia pasien terbanyak antara 51-55 tahun (43,8%) dan durasi terlama yang diketahui DM tipe II adalah 5-10 tahun (50,0%). Rata-rata BCVA (logMAR) sebelum injeksi intravitreal bevacizumab adalah 0,95, bulan pertama setelah injeksi adalah 0,68, dan bulan ketiga setelah injeksi adalah 0,55. CMT rata-rata sebelum injeksi bevacizumab intravitreal adalah 427,62, bulan pertama setelah injeksi 359,59, dan bulan ketiga setelah injeksi 318,12. Simpulan: Terdapat pengaruh bevacizumab anti-VEGF intravitreal terhadap BCVA dan CMT di DME di Rumah Sakit M Djamil Padang.

scholarly journals Idiopathic multifocal choroiditis (MFC): aggressive and prolonged therapy with multiple immunosuppressive agents is needed to halt the progression of active disease. An offbeat review and a case series

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Ioannis Papasavvas ◽  
Piergiorgio Neri ◽  
Alessandro Mantovani ◽  
Carl P. Herbort
Keyword(s):  
Visual Acuity ◽  
Immunosuppressive Agents ◽  
Case Series ◽  
Enhanced Depth Imaging ◽  
Prolonged Treatment ◽  
Multifocal Choroiditis ◽  
Corrected Visual Acuity ◽  
Case Series Study ◽  
Best Corrected Visual Acuity

Abstract Background and purpose Idiopathic multifocal choroiditis (MFC) is part of the group of choriocapillaritis entities. The clinical definition of the disease has evolved with time. The aim of this article was to undertake a review on MFC, on its present-day appraisal and nomenclature and we also report a series of patients with emphasis on the clinical presentation and the importance of vigorous immunosuppressive management. Methods A review of the literature and a retrospective case series study which was performed in the Centre for Ophthalmic Specialised care (COS), Lausanne, Switzerland. Patients diagnosed from 1994 to 2020 with idiopathic multifocal choroiditis (MFC) treated with multiple immunosuppressants were included. Exclusion criteria were insufficient follow up and cases not treated with vigorous immunosuppressive therapy. Imaging analysis included spectral domain optical coherence tomography (SD-OCT) / enhanced depth imaging OCT (EDI-OCT), OCT angiography (OCT-A). Fluorescein and Indocyanine angiography (FA, ICGA) before and after the instauration of treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), routine ocular examination, laser flare photometry (LFP) were performed at presentation and follow-up. Immunosuppression comprised at minimum two among the following agents: prednisone, cyclosporine, azathioprine, mycophenolic acid or infliximab. Mean duration of therapy was calculated. Results 26 (52 eyes) of 2102 new patients (1.24%) were diagnosed with MFC. 25 (96%) patients were female and 1 (4%) was male. 43/52 (82%) eyes were myopic with a mean dioptre of − 5.87 ± 2.94, six (12%) eyes were hypermetropic with mean dioptres 2.0 ± 2.68 and three (6%) were emmetropic. 14/52 (27%) eyes had at least 1 anti-VEGF injection because of choroidal neovascularisation (CNVs), 1 eye had a phototherapy laser and 37/52 (71%) had no complication of CNVs during the follow-up. 5/26 (19%) fulfilled the inclusion criteria for our study. Mean age was 26.4 ± 9.3 years. Snellen best corrected visual acuity (BCVA) at presentation was 0.955+/-0.26. Mean follow up was 84+/-55 months. LFP at presentation was 6.34 ± 2.94 ph/ms. None of four patients with prolonged treatment and prolonged follow-up showed disease activity. One patient still under therapy after 4 months’ follow-up still showed an active neovascular membrane. Conclusion Treatment with multiple immunosuppressive agents was shown to stop the progression of the disease.

Large choroidal excavation in retinitis pigmentosa: A case report

2019 ◽  
Vol 30 (5) ◽  
pp. NP66-NP68 ◽  
Author(s):  
Pierluigi Iacono ◽  
Maurizio Battaglia Parodi ◽  
Mariacristina Parravano ◽  
Monica Varano
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Retinitis Pigmentosa ◽  
Retinal Pigment ◽  
Posterior Pole ◽  
Spectral Domain ◽  
Fundus Examination ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Purpose: To report the morphological and clinical features of a case of retinitis pigmentosa with large choroidal excavation. Methods: The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination and spectral-domain optical coherence tomography. Results: A 41-year-old woman affected by retinitis pigmentosa with genetic confirmation with mutation in RDH12 gene had a best-corrected visual acuity of 20/50 in both eyes. Dilated fundus examination revealed waxy pallor of the optic disc, diffuse narrowing of the retinal arterioles and a generalized retinal pigment epithelium mottling with bony spicule associated with diffuse retinal atrophy. At the posterior pole, an extended bilateral chorioretinal atrophy was evident with a partial sparing of the macular area. On spectral-domain optical coherence tomography, a bilateral large choroidal excavation could be clearly detected and it was associated with a diffuse retinal thinning at the posterior pole and a partial sparing of the fovea. Conclusion: Large choroidal excavation has been rarely reported. Although the pathogenetic mechanisms leading to the formation of large choroidal excavation are still a matter of debate, a combination of primary degenerative-inflammatory factors could be retained responsible for the large choroidal excavation development.

scholarly journals Navigation-Guided Endoscopy Combined with Deep Lateral Orbitotomy for Removal of Small Tumors at the Lateral Orbital Apex

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
GuangMing Zhou ◽  
Xin Ju ◽  
Bo Yu ◽  
YunHai Tu ◽  
JieLiang Shi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Vision Loss ◽  
Case Series ◽  
Pathological Examination ◽  
Orbital Apex ◽  
Corrected Visual Acuity ◽  
Lateral Orbitotomy ◽  
Before And After ◽  
The Mean ◽  
Best Corrected Visual Acuity

Purpose. To evaluate the efficacy, feasibility, and safety of the navigation-guided endoscopy combined with deep lateral orbitotomy for removal of small tumors at the lateral orbital apex.Design. A retrospective, noncomparative case series.Methods. Retrospective analysis of ten patients (10 eyes) with small tumors at the lateral orbital apex comprised navigation-guided endoscopy combined with deep lateral orbitotomy at the Eye Hospital of Wenzhou Medical University from November 2015 to November 2017. In each case, the indication of surgery was existing or imminent visual impairment due to the tumor. The removal was believed to be complete if the mass was removed intactly during the surgery. The tumor character was confirmed by pathological examination after surgery. Patients were followed up to 3 months after surgery. Best corrected visual acuity before and after surgery was compared.Results. All tumors were completely removed by the navigation-guided endoscopic approach. The mean preoperative best corrected visual acuity was 6/15 (95% confidence interval (95% CI) 6/40–6/8.5), and the mean postoperative best corrected visual acuity was 6/10 (95% CI 6/15–6/7.5). 5 of 7 (71%) patients with vision loss gained visual improvement in different degrees after surgery, and the rest of the patients had preoperative best corrected visual acuity. Visual field of all patients also improved. 8 cavernous hemangiomas and 2 schwannomas were confirmed postoperatively by pathology. 4 patients accompanied with limitation of eye abduction, which recovered spontaneously in an average of 4 weeks. No other serious complications occurred.Conclusions. Navigation-guided endoscopy combined with deep lateral orbitotomy seems to be a feasible, efficient, and safe approach for removing small tumors at the lateral orbital apex. This trial is registered withChiCTR1800019244.

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