Three-dimensional locations of ruptured retinal arterial macroaneurysms and their associations with the visual prognosis

The aim of this retrospective, observational study was to examine the intraretinal locations of ruptured retinal arterial macroaneurysms (RMAs) and investigate the associations with the visual prognosis. Fifty patients (50 eyes) with untreated RMA rupture who visited the Department of Ophthalmology at Kyoto University Hospital (April 2014–July 2019) were included. The intraretinal position of the ruptured RMAs relative to the affected retinal artery was examined using optical coherence tomography (OCT) and color fundus photography (CFP). The relative RMA positions were anterior to (anterior type, 44%), at the same level as (lateral type, 20%), or posterior to (posterior type, 34%) the affected artery. At the initial visit, the posterior type showed greater subretinal hemorrhage thickness than did the lateral and anterior types (P = 0.016 and 0.006, respectively), and poorer visual acuity (VA) than did the anterior type (P = 0.005). At the final visit, the length of the foveal ellipsoid zone band defect was longer (P = 0.005) and VA was poorer (P < 0.001) for the posterior type than for the anterior type. The intraretinal positions of ruptured RMAs vary, affect the thickness of foveal subretinal hemorrhage and predict future damage to the foveal photoreceptors. The visual prognosis may be poor for posteriorly ruptured RMAs.

The role of optical coherence tomography in the diagnosis of the leukemic infiltration of the optic nerve and retina

Even though there are multiple diseases of the optic nerve and the retina in patients with hemoblastosis, their ophthalmoscopic picture is similar in many respects. The purpose of this study is to determine the role of optical coherence tomography (OCT) in the differential diagnosis of various manifestations of hemoblastosis in the fundus. Material and methods. From Jan. 2015 to Jan. 2019, 9 patients (5 men and 4 women aged 29 to 72) with hemoblastosis and lesions of the optic nerve and retina were examined. Results. 5 patients were diagnosed with leukemic infiltration of the optic nerve. The remaining 4 patients had, congestive optic discs (1), occlusion of the central retinal vein (1), anterior ischemic optic neuropathy (1), and bilateral occlusion of the central retinal artery with leukemic infiltration of eye membranes (1). The article describes the ophthalmoscopic pictures and OCT data for the specific diseases. Unlike other diseases of the optic nerve and retina, leukemic infiltration is characterized by a pronounced dense edema in the inner layers of the retina with shielding of the underlying outer layers of the retina. Conclusion. OCT is an important additional method for differential diagnosis of leukemic infiltration and other diseases of the optic nerve and retina in patients with hemoblastosis.

Transient central retina artery occlusion in patients undergone intravitreal anti-vascular endothelial growth factor injections

Purpose To evaluate the occurrence of transient central retinal artery occlusion following intravitreal anti-vascular endothelial growth factor injection. Methods Prospective, observational study of 807 patients (807 eyes) who were given intravitreal injections of ranibizumab or aflibercept to treat any cause of retinal vascular diseases between 1 January 2017 and 30 November 2018 at the Federal Fluminense University Hospital in Niteroi, and a private facility in Rio de Janeiro, Brazil. Patients who did not present transient central retinal artery occlusion were excluded. Results Among 4069 injections, only 18 patients (0.44%) presented transient central retinal artery occlusion, 14 mild cases (77.7%), and 4 severe cases (22.3%). The clinical factors associated with more severe cases of transient central retinal artery occlusion were the duration of the transient central retinal artery occlusion ( p = 0.001), number of prior injections ( p = 0.01), and a positive carotid Doppler test ( p = 0.01). Twelve cases (66.6%) had positive carotid artery obstruction (atheroma plaque size ≥70%) while 6 cases (33.3%) had negative carotid artery obstruction (atheroma plaque size <70%). The age group >60 years old ( p = 0.06), cup/disc ratio >0.6 ( p = 0.06), and pseudophakic lens status were also factors with association with transient central retinal artery occlusion, although did not meet criteria for statistical significance. The only patient who experienced a recurrent episode of transient central retinal artery occlusion had diabetic macular edema, positive carotid Doppler test, and cup/optic disc ratio >0.6. Conclusion Transient central retinal artery occlusion is a rare adverse event that can appear in patients with retinal vascular disease receiving anti-vascular endothelial growth factor therapy. The atheroma plaque size and the number of prior injections can be associated with the severity of the event.