Subthreshold micro-impulse laser coagulation of retinal detachment in children

Retinal detachment in children often requires multiple revisions. Despite active surgical treatment, subretinal fluid can persist for a long time in the macular region of the fundus. This leads to a decrease in visual acuity after surgery and an unsatisfactory functional result of treatment. In the absence of central vision, children develop amblyopia and secondary strabismus. Reoperations increase the risk of complications. Threshold laser coagulation leads to thermal burns of all layers of the retina with the formation of chorioretinal adhesion, which ensures adhesion of the retinal layers, but irreversibly damages the retinal neuroepithelium. Аs a result, the use of threshold laser coagulation in the macular zone is limited. The method of subthreshold micropulse diode laser ablation (STDLA) was developed on the basis of a clinical examination of 44 pediatric patients of the pediatric ophthalmology department of the Minsk Regional Children's Clinical Hospital, whose level of subretinal fluid in the posterior pole of the eyes remained for a long time after extrascleral surgery for retinal detachment. The proposed exposure parameters provide a selective effect on the cells of the retinal pigment epithelium with laser radiation in the micropulse mode without irreversible thermal denaturation of photoreceptors and without damage to the neuroepithelium in order to stimulate the resorption of subretinal fluid and correct transudative disorders. As a result, the adhesion of the retinal photoreceptor layer to the pigment epithelium is restored. The effectiveness of the method is confirmed by a decrease or complete disappearance of subretinal fluid, adhesion of neuroepithelium according to optical coherence tomography and leads to an increase in visual acuity. The proposed method made it possible to optimize the treatment of children with retinal detachment, to improve the anatomical and functional outcomes of treatment, which is of medical and socio-economic importance.

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Central Serous Chorioretinopathy – an Overview

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1531-5605 ◽

2021 ◽

Author(s):

Lieselotte Berger ◽

Virginie Bühler ◽

Suzanne Yzer

Keyword(s):

Visual Acuity ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Case Series ◽

Subretinal Fluid ◽

Laser Coagulation ◽

Blurred Vision ◽

Colour Perception ◽

Spontaneous Course

AbstractCentral serous chorioretinopathy (CSCR) is characterised by retinal serous detachment usually localised in the macular region. CSCR predominantly affects men between 30 and 50 years of age. Traditional classification differentiates between acute (duration shorter than 4 to 6 months) and chronic disease (duration longer than 4 to 6 months). The pathogenesis is multifactorial and current thinking assumes the presence of localised choroidal hyperpermeability with subsequent secondary changes in the retinal pigment epithelium (RPE). The symptoms of acute CSCR include central blurred vision, often with deterioration in visual acuity. Optical coherence tomography (OCT) reveals subretinal fluid (SRF) and/or single retinal pigment epithelial detachments. Fluorescein angiography (FA) usually shows a leaking point with absent or only minor RPE changes in the acute phase and indocyanine green angiography (ICG) highlights circumscribed areas of thickened and hyperpermeable choroid. Acute cases may show spontaneous resolution of SRF, but may also recur and/or become chronic. After the initial diagnosis, spontaneous remission is seen in about 70 to 80% of cases, with a recurrence rate of about 50%. Due to the favourable spontaneous course, it is recommended to wait for 4 to 6 months after the first symptoms manifest. Steroid therapy is considered as a major risk factor. Chronic cases are characterised by slow deterioration in visual acuity with reduced contrast and colour perception. There are extensive RPE changes, with secondary degenerative changes of the photoreceptors. The disease can by complicated by choroidal neovascularisation (CNV), especially in elderly patients. The literature lists a number of treatments: The leakage point (visible in the FA) can be treated by focal laser therapy, either micropulse laser or, if sufficiently distant from the fovea, by argon laser coagulation. Randomised trials in chronic CSCR demonstrated good outcomes with photodynamic therapy. With observation periods ranging from 3 to 6 months, several case series reports found improvement after systemic administration of mineralocorticoid receptor antagonists, carbonic anhydrase inhibitors or non-steroidal anti-inflammatory drugs. In the presence of secondary CNV, anti-VEGF treatment should be initiated. It is unclear whether the combination with PDT might be useful.

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Diagnosis and Monitoring of Choroidal Osteoma through Multimodal Imaging

Case Reports in Medicine ◽

10.1155/2014/393804 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Theodoros Empeslidis ◽

Usman Imrani ◽

Vasileios Konidaris ◽

Fizza Mushtaq ◽

Pandelis Fotiou ◽

...

Keyword(s):

Visual Acuity ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Interesting Case ◽

Choroidal Neovascularisation ◽

Optical Biopsy ◽

Fundus Fluorescein Angiography ◽

Choroidal Osteoma ◽

History Of

A 16-year-old Caucasian female with a 6-month history of decreased visual acuity and metamorphopsia in the left eye is reported. The fundus of the left eye revealed a well defined lesion in the macula region. Diagnosis of choroidal osteoma was established using spectral domain optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICG), and B-scan ultrasonography. Subretinal fluid (SRF) and retinal pigment epithelium (RPE) detachment were noted in the absence of obvious classic choroidal neovascularisation (CNV). The patient was followed up for over 13 months without any treatment in the interim and the lesion was noted to have enlarged but visual acuity and SRF had remained stable. We report an interesting case where subretinal fluid was noted in the absence of evident choroidal neovascularisation and provide an example of the imaging modalities application in the era of “optical biopsy.”

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Spontaneous Closure of the Macular Hole in a Patient with Acquired Vitelliform Lesion

Case Reports in Ophthalmology ◽

10.1159/000505315 ◽

2020 ◽

Vol 11 (1) ◽

pp. 16-21

Author(s):

Masanori Fukumoto ◽

Shou Oosuka ◽

Takaki Sato ◽

Teruyo Kida ◽

Tsunehiko Ikeda

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Rare Case ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Spontaneous Closure ◽

Retinal Reattachment

In this paper, we report an extremely rare case of spontaneous closure of a macular hole (MH) that developed in a patient in whom acquired vitelliform lesion (AVL) occurred after vitrectomy for atopic retinal detachment (ARD). A 32-year-old male developed ARD in both eyes, and retinal reattachment was achieved after vitrectomy. Five years after surgery, optical coherence tomography showed localized serous retinal detachment (SRD) and a granular lesion with a higher brightness in the subretinal fluid, thus leading to the diagnosis of AVL. One month later, an MH developed, and a follow-up examination performed 6 weeks later revealed that the MH had spontaneously closed and the SRD decreased. In the fovea, fluorescein angiography revealed a window defect due to atrophy of the retinal pigment epithelium (RPE). These findings in this present case suggest the possibility that RPE dysfunction was involved in the development of AVL and MH.

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Iron is neurotoxic in retinal detachment and transferrin confers neuroprotection

Science Advances ◽

10.1126/sciadv.aau9940 ◽

2019 ◽

Vol 5 (1) ◽

pp. eaau9940 ◽

Cited By ~ 8

Author(s):

Alejandra Daruich ◽

Quentin Le Rouzic ◽

Laurent Jonet ◽

Marie-Christine Naud ◽

Laura Kowalczuk ◽

...

Keyword(s):

Retinal Detachment ◽

Vision Loss ◽

Ex Vivo ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Predictive Marker ◽

Visual Recovery ◽

Neuroprotective Effects

In retinal detachment (RD), photoreceptor death and permanent vision loss are caused by neurosensory retina separating from the retinal pigment epithelium because of subretinal fluid (SRF), and successful surgical reattachment is not predictive of total visual recovery. As retinal iron overload exacerbates cell death in retinal diseases, we assessed iron as a predictive marker and therapeutic target for RD. In the vitreous and SRF from patients with RD, we measured increased iron and transferrin (TF) saturation that is correlated with poor visual recovery. In ex vivo and in vivo RD models, iron induces immediate necrosis and delayed apoptosis. We demonstrate that TF decreases both apoptosis and necroptosis induced by RD, and using RNA sequencing, pathways mediating the neuroprotective effects of TF are identified. Since toxic iron accumulates in RD, we propose TF supplementation as an adjunctive therapy to surgery for improving the visual outcomes of patients with RD.

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Pattern Dystrophies and Choroidal Neovascularization

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0053 ◽

2017 ◽

pp. 313-320

Keyword(s):

Visual Acuity ◽

Choroidal Neovascularization ◽

Middle Ages ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Pattern Dystrophy ◽

Good Visual Acuity ◽

Age Related

Pattern dystrophies are hereditary dystrophies that come from retinal pigment epithelium and located in the macula. The diagnosis is usually made around the middle ages. Pigment accumulations in the macula and around the macula, are seen bilaterally and symmetrical in the beginning, are sub-divided depending on pigment scattering pattern. These are adult-onset foveomacular vitelliform dystrophy, butterfly-like pattern dystrophy, reticular pattern dystrophy, and fundus pulverulentus. Usually in patients with pattern dystrophy have good visual acuity, after progression central visual acuity lessens with RPE atrophy or choroidal neovascularization development. In choroidal neovascularization secondary to age-related macular degeneration there is no typical pigmentation in the macula. On the other hand, in choroidal neovascularization related to pattern dystrophy, hemorrhage, and intra/subretinal fluid do not exist. Today choroidal neovascularization prognosis, which is treated with intravitreal anti-VEGF injections, is quite good. At least, one eye of the patients has satisfactory vision. Sometimes, in especially patients with isolated pattern dystrophy, not hereditary, there may be spontaneous regression of choroidal neovascularization.

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Unilateral Vogt-Koyanagi-Harada Disease: A Clinical Case Report

Case Reports in Ophthalmology ◽

10.1159/000441616 ◽

2015 ◽

Vol 6 (3) ◽

pp. 361-365 ◽

Cited By ~ 3

Author(s):

Arminda Neves ◽

Ana Cardoso ◽

Mariana Almeida ◽

Joana Campos ◽

António Campos ◽

...

Keyword(s):

Visual Acuity ◽

Case Report ◽

Retinal Detachment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Posterior Pole ◽

Exudative Retinal Detachment ◽

The Right ◽

Clinical Records ◽

Vkh Disease

Purpose: To report a case of a 20-year-old female with decreased visual acuity (VA) in the left eye (LE). Methods: This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of diagnostic tests. Results: A 20-year-old female presented with decreased VA in the LE for 3 days. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (RE) and 20/40 in the LE. Pupillary function, intraocular pressure, results of external segment examinations and slit-lamp biomicroscopy were normal, bilaterally. RE fundoscopy was normal, and in the LE it revealed papillitis and posterior pole exudative retinal detachment. Optical coherence tomography (OCT) confirmed the macular serous retinal detachment and showed thickening of the posterior choroid also revealed by orbital ultrasound and magnetic resonance imaging (MRI). Fluorescein angiography showed angiographic features typical of Vogt-Koyanagi-Harada (VKH) disease: disseminated spotted choroidal hyperfluorescence and choroidal multifocal hypofluorescence, multifocal profuse leakage in the retina with pooling, serous retinal detachment and optic disc hyperfluorescence. Serological testing for the diagnosis of infectious pathologies was negative, and the review of systems was normal. The patient received systemic steroids and cyclosporine. LE BCVA improved up to 20/20 at 18 months after the diagnosis, with complete reabsorption of subretinal fluid and normal retinal and choroidal thickness by OCT. Conclusion: Despite the unilateral involvement, the clinical and angiographic features were typical of VKH disease, and ophthalmologists should be aware to recognize this rare clinical variant of the disease.

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Acute exudative polymorphous vitelliform maculopathy during pembrolizumab treatment for metastatic melanoma: a case report

BMC Ophthalmology ◽

10.1186/s12886-021-02011-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ine Lambert ◽

Giuseppe Fasolino ◽

Gil Awada ◽

Robert Kuijpers ◽

Marcel ten Tusscher ◽

...

Keyword(s):

Retinal Detachment ◽

Checkpoint Inhibitors ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Anterior Segment ◽

Subretinal Fluid ◽

Additional Treatment ◽

Central Visual Field ◽

Immunomodulating Therapy ◽

Neurosensory Retinal Detachment

Abstract Background The use of immunomodulating therapy to treat various cancers has been on the rise and these immune checkpoint inhibitors are known to cause ocular side effects. In this article a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) is reported which developed during a first line treatment with pembrolizumab. Case presentation A 54-year-old woman was referred because of blurry vision in both eyes with a yellow spot in the central visual field of the left eye. These symptoms started after four treatments with pembrolizumab (a monoclonal antibody against the programmed cell death receptor-1) for a metastatic recurrent vaginal mucosal melanoma. Her best corrected visual acuity was 10/10 in both eyes with a correction of + 2.00 bilaterally. There were no inflammatory findings in the anterior segment or the vitreous. Fundoscopy revealed an attenuation of the foveal reflex with subtle yellow-white subretinal macular deposits (vitelliform lesions) in both eyes. Fluorescein angiography did not show staining or leakage in the mid-phase, neither a late staining. Spectral-domain optical coherence tomography of the macula illustrated bilateral neurosensory retinal detachment with a thick, highly reflective band at the outer photoreceptor segment. En face structural OCT at the level of the photoreceptors showed focal areas of increased signal corresponding to hyperreflective vitelliform material. The treatment with pembrolizumab was ceased immediately. During the following visits we slowly saw an improvement of the neurosensory retinal detachment. After almost four months a total resolution of the subretinal fluid was visualized in both eyes without the use of additional treatment, though the vitelliform deposits persisted. Conclusions The development of AEPVM in melanoma patients could be triggered by treatment with Pembrolizumab. Pembrolizumab has the potential to disturb indirectly the retinal pigment epithelium homeostasis with accumulation of lipofuscin deposits and subretinal fluid, both signs of AEPVM.

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Ocular findings among patients surviving COVID-19

Scientific Reports ◽

10.1038/s41598-021-90482-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ílen Ferreira Costa ◽

Livia Pimenta Bonifácio ◽

Fernando Bellissimo-Rodrigues ◽

Eduardo Melani Rocha ◽

Rodrigo Jorge ◽

...

Keyword(s):

Visual Acuity ◽

Pigment Epithelium ◽

Demographic Data ◽

Retinal Pigment ◽

Anterior Segment ◽

Posterior Pole ◽

Architecture Evaluation ◽

Severe Group ◽

The Mean ◽

The Right

AbstractTo describe the medium-term ophthalmological findings in patients recovering from COVID-19. Patients recovered from the acute phase of COVID-19 underwent a complete ophthalmological evaluation, including presenting and best-corrected visual acuity (BCVA), refractometry, biomicroscopy, tonometry, break-up time and Schirmer tests, indirect ophthalmoscopy, color fundus picture, and retinal architecture evaluation using optical coherence tomography. Socio-demographic data and personal medical history were also collected. According to the severity of systemic manifestations, patients were classified into mild-to-moderate, severe, and critical. Sixty-four patients (128 eyes) were evaluated 82 ± 36.4 days after the onset of COVID’s symptoms. The mean ± SD duration of hospitalization was 15.0 ± 10.7 days. Seven patients (10.9%) had mild-to-moderate, 33 (51.5%) severe, and 24 (37.5%) critical disease. Median [interquartile ranges (IQR)] presenting visual acuity was 0.1 (0–0.2) and BCVA 0 (0–0.1). Anterior segment biomicroscopy was unremarkable, except for dry eye disease, verified in 10.9% of them. The mean ± SD intraocular pressure (IOP) in critical group (14.16 ± 1.88 mmHg) was significantly higher than in severe group (12.51 ± 2.40 mmHg), both in the right (p 0.02) and left eyes (p 0.038). Among all, 15.6% had diabetic retinopathy, and two patients presented with discrete white-yellowish dots in the posterior pole, leading to hyporreflective changes at retinal pigment epithelium level, outer segment, and ellipsoid layers. The present study identified higher IOP among critical cases, when compared to severe cases, and discrete outer retina changes 80 days after COVID-19 infection. No sign of uveitis was found.

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Photodynamic Therapy with Verteporfin for Chronic Central Serous Chorioretinopathy: A Review of Data and Efficacy

Pharmaceuticals ◽

10.3390/ph13110349 ◽

2020 ◽

Vol 13 (11) ◽

pp. 349

Author(s):

Pierluigi Iacono ◽

Stefano Da Pozzo ◽

Monica Varano ◽

Mariacristina Parravano

Keyword(s):

Photodynamic Therapy ◽

Central Serous Chorioretinopathy ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Serous Retinal Detachment ◽

Subretinal Fluid ◽

Chronic Central Serous Chorioretinopathy ◽

Long Time ◽

Potential Damage ◽

Retinal Disorder

Central serous chorioretinopathy represents the fourth most frequent retinal disorder, occurring especially in young age. Central serous chorioretinopathy is mainly characterized by macular serous retinal detachment and although the clinical course moves frequently toward a spontaneous resolution, the subretinal fluid may persist for a long time, thus evolving to the chronic form, and leading to a potential damage of the retinal pigment epithelium and to photoreceptors. The photodynamic therapy with verteporfin plays an important role in the armamentarium among the many therapeutic options employed in this complex retinal disorder. In this review, the authors aim to summarize data of efficacy and safety of PDT focusing especially on mechanisms of action of the PDT and providing comparative outcomes with the alternative therapeutic approaches, including especially the subthreshold laser treatment.

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Epidemiology, Prevalence and Incidence of Rhegmatogenous Retinal Detachment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0153 ◽

2019 ◽

pp. 135-137

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

High Myopia ◽

Rhegmatogenous Retinal Detachment ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Cataract Extraction ◽

Common Type ◽

Associated Risk Factors

Rhegmatogenous retinal detachment is the most common type of retinal detachments and occurs when subretinal fluid accumulates between the neurosensorial retina and retinal pigment epithelium. Although often caused by vitreous liquefaction, cataract extraction, high myopia, inflammation, and trauma are other associated risk factors. In this article, epidemiology, prevalence, and incidence of rhegmatogenous retinal detachment are aimed to describe.

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