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Purpose: To explore subretinal fluid (SRF) morphology in chronic central serous chorioretinopathy (cCSC) after one session of either high-density subthreshold micropulse laser (HSML) treatment or half-dose photodynamic therapy (PDT). Methods: We retrospectively obtained optical coherence tomography (OCT) scans from a subset of patients from a randomized controlled trial on treatment-naïve eyes with cCSC allocated to either HSML treatment or half-dose PDT. OCT scans were evaluated prior to treatment and 6–8 weeks post-treatment, where we measured maximum SRF height and width, calculated the maximum height-to-maximum width-ratio (maxHWR) and calculated the total SRF volume. Results: Forty-one eyes of 39 cCSC patients were included. SRF morphology ranged from flat to dome-shaped, quantified as maxHWR ranging between 0.02 and 0.12. SRF volume was median 0.373 μl (range: 0.010–4.425 μl) and did not correlate to maxHWR (rho = −0.004, p = 0.982). Half-dose PDT was superior to HSML treatment in complete SRF resolution (RR = 3.28, p = 0.003) and in morphological changes of SRF (Δ maximum height, p = 0.001; Δ maximum width, p

To assess the effect of fluid status at baseline (BL) and at the end of the loading phase (LP) of three different ranibizumab regimens: treat-and-extend (TE), fixed bimonthly (FBM) injections and pro re nata (PRN), in patients with neovascular age-related macular degeneration (nAMD).Post hoc analysis of the In-Eye study (phase IV clinical trial).Patients were randomized 1:1:1 to the three study arms and were treated accordingly. The presence and type of fluid, intraretinal fluid (IRF) or subretinal fluid (SRF) and the anatomical and visual outcomes were analysed.Best-corrected visual acuity (BCVA), the mean change from baseline BCVA (BL BCVA), and the proportion of eyes gaining more than 15 letters or losing more than five letters were analysed. Morphological characteristics including the subtype of choroidal neovascular membrane and the development of atrophy and fibrosis were also evaluated.Patients with SRF at LP had better visual outcomes than patients with IRF. The persistence of SRF did not affect the mean change from BL BCVA among the three treatment regimens. However, in patients with IRF mean change from BL BCVA was significantly lower in the FBM group. The presence of IRF at BL and at the end of the loading phase was associated with the development of fibrosis at the end of the study; this result was contrary to that observed for patients with SRF.While SRF is compatible with good visual and anatomical outcomes, IRF leads to worse results in patients with nAMD; our results suggest that patients with IRF have better outcomes when individualized treatment regimens are used (PRN or TE) in contrast with a FBM regimen.

Purpose Retinoschisis (RS), rhegmatogenous retinal detachment (RRD) and combined RS retinal detachment (RSRD) may resemble clinically and pose a diagnostic challenge. This study investigates the role of the fundus autofluorescence (AF) in differentiating RS, RRD and RSRD. Methods Fundus AF changes of 34 eyes diagnosed with RRD, 30 eyes with RS and 12 eyes with RSRD were retrospectively analysed. Ultra-widefield AF (UW-AF) image intensities obtained with the Optomap 200Tx were interpreted as hypo-, hyper- and isoautofluorescent or a mixed pattern with hypo- and hyperautofluorescence over and at the posterior margin (PM) of RRD, RS and RSRD. Results All RS eyes revealed isoautofluorescence over the area of RS, and nine eyes (30%) showed hypoautofluorescent PM. Among RRD, acute (≤2 weeks) and chronic (>2 weeks) RRD demonstrated distinct AF characteristics. Sixty-two per cent of RRD eyes had acute RRD. From those, 16 eyes (76%) demonstrated hypoautofluorescence over the detached area and 19 (90%) eyes with hyperautofluorescent PM. Sixty-two per cent of chronic RRD eyes demonstrated isoautofluorecence over the detached area. Eight RSRD eyes (67%) revealed hyperautofluorescence in the detached area. The positive predictive value (PPV) for hypoautofluorescence over the area of subretinal fluid (SRF) in RRD was 95%. The PPV for hyperautofluorescence over the area of SRF in RSRD was 100% and for isoautofluorescence for schitic area in RSRD and RS was 76%. Conclusion The UW-AF can be a useful non-invasive adjuvant tool to distinguish between RRD, RS and RSRD. Hypo- or hyperautofluorescence over the area of interest and hyperautofluorescent PM indicates the presence of SRF.

The historical literature on the treatment of rhegmatogenous retinal detachment (RRD) was reviewed from 1911 to the present, focusing on the role of intravitreal air and gas. The history of the pneumatic retinopexy (PnR) technique is described from its original roots to the current day procedure. The treatment of RRD has evolved tremendously over the past century. The introduction of intravitreal gas as a tamponade to reattach the retina was critical in the development of modern day PnR. Although PnR is not a new technique, relatively recent randomized trials have demonstrated the numerous advantages of this procedure compared to pars plana vitrectomy (PPV) and scleral buckle. From a historical perspective, PnR has its origin in 1911 when Ohm performed intravitreal air injection after external subretinal fluid drainage in an attempt to treat RRD. The evolution of the procedure was driven by the introduction and experience with inert expansile intravitreal gas injections, and several great surgeons made critical contributions to the development of the procedure. There is substantial controversy pertaining to the original description of PnR in the literature. Credit has generally been given to Hilton and Grizzard from the United States, although Alfredo Dominguez from Spain published the first description of the procedure and he went to great lengths in an attempt to be rightfully recognized for this. The first randomized trial in retinal detachment repair was led by Dr. Paul Tornambe, comparing PnR to scleral buckle and an additional randomized trial was subsequently carried out demonstrating functional advantages of PnR compared to PPV.

To assess the effect of clinical factors on the development and progression of atrophy and fibrosis in patients with neovascular age-related macular degeneration (nAMD) receiving long-term treatment in the real world.An ambispective 36-month multicentre study, involving 359 nAMD patients from 17 Spanish hospitals treated according to the Spanish Vitreoretinal Society guidelines, was designed. The influence of demographic and clinical factors, including the presence and location of retinal fluid, on best-corrected visual acuity (BCVA) and progression to atrophy and/or fibrosis were analysed.After 36 months of follow-up and an average of 13.8 anti-VEGF intravitreal injections, the average BCVA gain was +1.5 letters, and atrophy and/or fibrosis were present in 54.8% of nAMD patients (OR = 8.54, 95% CI = 5.85-12.47, compared to baseline). Atrophy was associated with basal intraretinal fluid (IRF) (OR = 1.87, 95% CI = 1.09-3.20), whereas basal subretinal fluid (SRF) was associated with a lower rate of atrophy (OR = 0.40, 95% CI = 0.23-0.71) and its progression (OR = 0.44, 95% CI = 0.26-0.75), leading to a slow progression rate (OR = 0.34, 95% CI = 0.14-0.83). Fibrosis development and progression were related to IRF at any visit (p 0.001). In contrast, 36-month SRF was related to a lower rate of fibrosis (OR = 0.49, 95% CI = 0.29-0.81) and its progression (OR = 0.50, 95% CI = 0.31-0.81).Atrophy and/or fibrosis were present in 1 of 2 nAMD patients treated for 3 years. Both, especially fibrosis, lead to vision loss. Subretinal fluid (SRF) was associated with good visual outcomes and lower rates of atrophy and fibrosis, whereas IRF yields worse visual results and a higher risk of atrophy and especially fibrosis in routine clinical practice.

International audience; PURPOSE: To report visual and anatomical outcomes and determine predictors of good visual acuity (VA) recovery after macula-off rhegmatogenous retinal detachment (RD). METHODS: Prospective multicentre study including 115 eyes from 115 patients successfully operated on for RD, with assessment of VA and spectral-domain optical coherence tomography (SD-OCT) macular images at 1, 3, 6 and 12 months after surgery. RESULTS: Over the follow-up period, VA significantly improved from median [IQR] 62 [46; 72] ETDRS letters at 1 month to 75 [67; 80] ETDRS letters at 12 months (p < 0.001) with a concomitant decreased number of eyes with any SD-OCT lesions (p < 0.001). The presence of subretinal fluid (SRF) significantly decreased (p < 0.001), as did the number of photoreceptor (PR) layer lesions (p = 0.04). At 12 months, lesions in the PR layer and poor VA recovery were significantly associated with a longer time to surgery (p = 0.007 and p < 0.001, respectively). The rate of patients without PR lesions increased from 40.9% at 1 month to 60.0% at 6 months and 73.9% at 12 months (p < 0.001). The incidence of epiretinal membrane (ERM) significantly increased (p < 0.001), while cystoid macular oedema (CME) remained stable over time. Visual acuity (VA) at 3 months postoperatively was a good reflection of final VA recovery (p < 0.001). CONCLUSION: Visual acuity (VA) improved in parallel with the decreasing number of eyes with SD-OCT lesions after macula-off rhegmatogenous RD. A long time to surgery was the only preoperative factor associated with poor VA recovery after retinal detachment surgery.

PURPOSE To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). METHODS This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. RESULTS The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. CONCLUSION Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.

Purpose To analyse ophthalmological adverse events associated with mitogen-activated protein kinase kinase (MEK) inhibition with pimasertib treatment for metastatic cutaneous melanoma (CM). Methods In this prospective observational, cohort-based, cross-sectional study, eight patients treated with the MEK inhibitor pimasertib received a complete ophthalmic examination. This included Early Treatment of Diabetic Retinopathy Study best-corrected visual acuity, visual field testing, colour vision testing, slit-lamp examination, applanation tonometry, indirect ophthalmoscopy, digital colour fundus photography and optical coherence tomography (OCT). In selected cases, fluorescein angiography was performed. Results Serous subretinal fluid (SRF) developed in all patients, within a time frame of 9-27 days after the start of treatment. The fovea was involved in six of eight patients (75%). None of the patients with foveal SRF [excluding a patient who developed a bilateral retinal vein occlusion (RVO)] experienced visual symptoms. Subretinal fluid (SRF) decreased or resolved in all patients, despite continuation of study medication in six of eight patients (75%). Complaints in the CM patient (13%) consisted of experiencing a dark fleck in the inferior part of the visual field of the right eye 1 week after the start of treatment, due to an RVO. Subsequent intravitreal bevacizumab treatment resulted in functional and anatomical improvement. Conclusion Patients with metastatic CM who are treated with the MEK inhibitor pimasertib are at high risk of development of ocular adverse events including serous retinopathy and possibly RVO, stressing the need of adequate ophthalmological follow-up including OCT during administration of pimasertib, despite the fact that SRF generally does not lead to ophthalmological complaints.

Background To report beta‐trace protein (β TP) levels in the subretinal fluid (SRF) of four patients with a macular detachment associated with optic disc pit (ODP). Methods Four patients with a serous retinal detachment involving the macula was operated by pars plana vitrectomy (PPV) with C2F6 gas tamponade and peeling of internal limiting membrane (ILM). Patients with a follow‐up period exceeding one year postoperatively were included in the study. The SRF was drained using a fine cannula without laser photocoagulation, and the samples were analysed using particle‐enhancing nephelometry. The levels of β TP were compared to 20 routine cerebrospinal fluid (CSF) samples. Results In four of the five samples from SRF had relatively low β TP levels, with a mean concentration of 6.6 mg/l (range 2.0 to 23.1 mg/l) compared to 16.0 mg/l (range 6.3‐26.8 mg/l) in CSF. The only SRF sample within the range corresponding to normal CSF was the first sample from patient 4, and the analysis of the renewed aspirate during the second operation was 2.8 mg/l. Postoperatively, the regression of SRF was slow, but regression of SRF in the foveal region took place in all cases; however, visual acuity (VA) was improved in only half of the patients. Conclusion The results from the analysed SRF regarding β TP concentration in these patients indicate that the SRF in ODP is not identical to CSF, as the concentrations of β TP differ.

Purpose We aimed to determine the correlation between optical coherence tomography (OCT)‐ and demographic features and baseline best corrected visual acuity (BCVA) in treatment‐naïve patients with retinal vein occlusion (RVO). Methods This was a cross‐sectional posthoc analysis of OCT images that included RVO patients from two prospective, open‐label, multicentre studies. The morphological grading was done manually, in the standardized setting of a reading centre. Main outcome measure was the estimated difference in Early Treatment Diabetic Retinopathy Study letters associated with each individual biomarker. Results Included were 381/301 treatment‐naïve patients with BRVO/CRVO. For BRVO, statistically significant correlations with BCVA were seen for a 100 µm increase in central subfield thickness (CST; −3.1 letters), intraretinal cysts at centre point (CP; +4.1), subretinal fluid (SRF) at CP (+3.0) and hyperreflective foci (HRF) at the central B‐scan (−2.2). In CRVO, a 100 µm increase in CST was associated with a loss of −3.4 letters. In the total cohort, 100 µm increase in CST, SRF at CP and HRF at the central B‐scan correlated with a difference of −3.2,+3.2 and −2.0 letters. A 10‐year increase in age and female gender yielded a −2.0 and −2.5 letter decrease in the total cohort. Adjusted multiple R 2 for the respective group was 18.3%/26.3%/23.5%. Conclusions Of all parameters studied, only CST and age were consistently associated with worse BCVA in treatment‐naïve RVO patients. Morphology on OCT explained only a modest part of functional loss in this patient cohort.

Purpose To describe the grey fovea sign of fovea-involving macular oedema or subretinal fluid accumulation in red-free fundus photography. Methods A test set of 91 digital fundus photographs of good quality from 100 consecutive eyes in 72 patients with diabetic retinopathy or central serous chorioretinopathy was composed by one of the investigators and evaluated by four masked observers. The photographs were graded as to whether a normal dark fovea was present or absent. The reference method was foveal thickness measurement using optical coherence tomography (OCT). Results Eyes graded as having a grey fovea on fundus photographs (n = 67) had a median foveal thickness of 279 μm (interquartile range 130 μm), whereas eyes graded as having a normal dark fovea (n = 24) had a median foveal thickness of 238 μm (interquartile range 44.5 μm, p = 0.025). Conclusion The absence of a dark fovea on red-free greyscale fundus photographs is a sign of foveal thickening or detachment that can be reliably recognized by graders when using OCT as the reference diagnostic method. Awareness of the grey fovea sign may facilitate fundus photographic screening for maculopathy because its absence is a reliable sign that no foveal oedema or detachment is present. Its presence may indicate that such conditions are present, but it can also be induced by various other conditions, for which reason it should prompt further investigations by OCT.

Item does not contain fulltext PURPOSE: To investigate whether patients who developed chronic central serous chorioretinopathy (cCSC) in association with corticosteroid treatment respond differently to photodynamic therapy (PDT) as compared to patients who have not used corticosteroids. METHODS: Clinical evaluation included visual acuity (VA), fundoscopy, optical coherence tomography (OCT), fluorescein and indocyanine green angiography. The main outcome measure was a complete resolution of subretinal fluid (SRF) on OCT after PDT. RESULTS: One hundred and twenty-three eyes (117 patients), including 35 steroid-associated cases (29%), who received PDT treatment with reduced settings for active cCSC were included. Complete resolution of SRF on OCT was seen in 69% of the steroid-associated cases and in 50% of the controls after PDT treatment (p = 0.062). At the final follow-up moment, 74% of the cases had a complete resolution of SRF compared to 60% in the control group (p = 0.142). The VA at the first visit after therapy showed an increase in both groups (mean VA before treatment; cases: 69 +/- 14 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, controls: 74 +/- 13 ETDRS letters, mean VA first visit after treatment; cases: 76 +/- 13 ETDRS letters, controls: 75 +/- 13 ETDRS letters). No significant differences were seen in response to PDT between the patients who continued corticosteroid treatment and those who ceased the use of corticosteroids. CONCLUSIONS: Photodynamic therapy appears to be equally effective in patients suffering from steroid-associated cCSC as compared to patients with cCSC who do not use corticosteroids. Continuation of corticosteroids at the time of PDT treatment does not seem to adversely affect PDT response.

Purpose Fluid on structural B scan OCT is currently the most important sign among all imaging modalities of neovascular AMD. Recently, OCT angiography biomarkers of activity of nAMD have been described. The aim of the study is to compare the appearance of OCT angiography of eyes with wAMD with intraretinal or subretinal fluid against those without fluid on Bscan OCT. Methods Retrospective cross sectional study.Fluid on Bscan OCT was classified as intraretinal fluid such as cysts and subretinal fluid as fluid under the retina. OCT angiography biomarkers of activity of nAMD were presence of secondary small vessel branching, peripheral arcades with anastomoses and presence of a dense net (DN). Inclusion criteria were: presence of neovessels on OCT angiography and sufficent images quality on both modalities. Presence of degenerative cysts and/or PED was an exclusion criteria. Results 59 eyes of 55 patients naive or treated for wet AMD were included (average age: 80 (SD ±7), min-max: 63-95). Subretinal fluid was present in 20% eyes (12/59), intraretinal fluid in 25% (15/59), a combination of both in 10% (6/59) and absence of subretinal or intraretinal fluid in 44% (26/59). DN was present in 30% (18/59), LN in 69% (41/59). Dense net was present in statistically significantly more of the uncontrolled eyes 45% (15/33) (p=0.009, fisher exact test.) Peripheral arcades with anastomoses were evident in 46% (12/26) of controlled eyes and 61% (20/33) of uncontrolled eyes. Small vessel branching was evident in 0% (0/26) of the controlled eyes and in 36% (12/33) uncontrolled eyes. Conclusions Dense net are significantly more prevalent in eyes with uncontrolled AMD; small vessel branching and peripheral loops are also more prevalent in these eyes. This suggest that OCT-A provides imaging of the morphology of choroidal CNV in AMD patients associated with disease activity.

Purpose The purpose of this study was to identify quantitatively measurable morphologic optical coherence tomography (OCT) characteristics in patients with an acute episode of central serous chorioretinopathy (CSC) and evaluate their correlation to functional and psychological variables for their use in daily clinical practice. Methods Retinal thickness (RT), the height, area and volume of subretinal fluid (SRF)/pigment epithelium detachments were evaluated using the standardized procedures of the Vienna Reading Center. These morphologic characteristics were compared with functional variables [best-corrected visual acuity (BCVA), contrast sensitivity (CS), retinal sensitivity/microperimetry, fixation stability], and patients' subjective handicap from CSC using the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25). Results Data from 39 CSC patients were included in this analysis. Three different SRF height measures showed a high negative correlation (r = -0.7) to retinal sensitivity within the central 9°, which was also negatively correlated with SRF area and volume (r = -0.6). The CS score and fixation stability (fixation points within 2°) showed a moderate negative correlation (r = -0.4) with SRF height variables. Comparison of the subjective handicap with morphological characteristics in spectral-domain (SD)-OCT showed SRF height had the highest correlation (r = -0.4) with the subjective problems reported and overall NEI VFQ-25 score. Conclusion In conclusion, SRF height measured in SD-OCT showed the best correlation with functional variables and patients' subjective handicap caused by the disease and therefore seems to be the best variable to look at in daily clinical routine. Even though area and volume also show a correlation, these cannot be so easily measured as height and are therefore not suggested for daily clinical routine.

Purpose: The ‘Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study’ (SPR study) is a randomized multicentre trial comparing primary vitrectomy (PV) and scleral buckling surgery (SB) for rhegmatogenous retinal detachment (RRD). This subanalysis was conducted to identify risk factors associated with anatomical outcomes. Methods: Relating the anatomical success results at the 1-year follow-up visit to pre- and intraoperative findings using multivariate statistical methods. Results: In the phakic subtrial, anatomical success was negatively associated with the number of breaks (p 1 clock hour (p = 0.0005) and intraoperative use of cryotherapy (p = 0.0484). It was positively associated with retinal breaks with irregular edges (p = 0.0353) and subretinal fluid drainage (p = 0.0155). In the pseudophakic/aphakic subtrial, anatomical success was negatively associated with the number of retinal breaks (p = 0.0004) and previous YAG capsulotomy (p = 0.0256), and the combined effect of the surgical procedure and intraoperative use of laser (p = 0.0229). Conclusion: Primary anatomical success is an important result for patients undergoing RRD surgery. Our data demonstrate that the final anatomical outcome is related to a higher preoperative number of breaks and cryotherapy in phakic eyes. Additional risk factors varied between phakic and pseudophakic subgroups. Our findings may be used to facilitate the prognosis of future patients with RRD.

Acta Ophthalmol. 2010: 88: e334–e340 Abstract. Purpose: Single-centre consecutive interventional case series by retrospective chart review to evaluate the efficacy of verteporfin (Visudyne™) photodynamic therapy (PDT) of retinal capillary haemangioma (RCH). Methods: Following an initial period of observation, six eyes of five patients with RCH (juxtapapillary 3 and extrapapillary (EP) 3) received 1–3 sessions of standard verteporfin PDT upon the development of progressive vision-threatening complications. Four of the five patients had von Hippel-Lindau (VHL) disease. Follow-up included documentation of best-corrected Snellen visual acuity (BCVA), tumour regression, and presence or absence of subretinal fluid (SRF) and/or lipid exudation as assessed by dilated fundus examination (DFE), fundus photos, and optical coherence tomography (OCT). These parameters were documented at 1 week, 1 month, and 3 months following each PDT session and up to 32 months following the first PDT. Results: All eyes showed favourable response to PDT as defined by tumour regression or stabilization as well as improvement of SRF and lipid exudation. BCVA improved or stabilized in three eyes. Three eyes required PDT retreatment for recurrent SRF. Epiretinal membrane (ERM) worsened in three eyes, requiring vitreoretinal surgery at a median of 6 months following PDT. Conclusions: PDT is a moderately effective treatment for juxtapapillary and EP RCH. In this series, PDT resulted in tumour regression or stabilization as well as in the improvement of SRF and lipid exudation in all cases. However, stabilization or improvement of visual acuity was observed in only 50 per cent of the cases. The treatment benefits may be limited by pre-existing macular changes and worsening of ERM. A larger prospective study is necessary to validate these findings.

Four patients with histologically verified uveal melanomas were examined with computed tomography (CT) scan. Ophthalmoscopy revealed a sharply deliminated tumour surrounded by a secondary retinal detachment. The clinically calculated size of the tumours corresponded well with the histological specimens. The CT-scan indicated a greater size of the tumours. The discrepancies were due to difficulties in differentiation between the tumour tissue and the subretinal fluid which have almost identical CT-numbers. By combining axial and coronal views it was possible to distinguish the tumour from the secondary retinal detachment.

Two babies presenting with unilateral leuko-coria were found to have total retinal detachment in one eye, associated with subretinal yellowish-white deposits. As no calcification was found and subretinal fluid aspiration yielded many fat-laden macrophages without any evidence of retinoblastoma cells in addition to a high level of cholesterol, the difinitive diagnosis of Coats' disease was made. Subsequently, retinal detachment surgery and cryotherapy were performed, in an attempt to preserve the affected eye.

Episcleral silicone rods are used as encircling elements in retinal detachment surgery. In order to reinforce the encircling effect and form a stable effective buckle, the episcleral silicone rod is combined with an Arruga suture or a fairly rigid teflon band. The Arruga string (a 2-0 supramid suture) is sewn, in a longitudinal direction, into a solid silicone rod (2 mm in diameter) or into a silicone half-cylinder (diameter 3 or 4 mm). Soft sponge-like rods can also be reinforced with a 2 mm broad teflon band, placed on the flat surface of the half-cylindrical silicone element. Drainage of subretinal fluid is usually performed in order to make room for the high circumferential buckle. Experience has shown that this modified encircling procedure is very useful in complicated cases of retinal detachment.

Surgical results and complications were studied retrospectively in 590 cases of retinal detachment in a population-based material of 538 patients. Of the 590 cases 96.3% were operated upon, and 22.9% of these underwent one or more re-operations. The technique used was cryo- or photocoagulation (100%) + scleral buckling or an encircling band (96%) + drainage of subretinal fluid (80%). The surgical complications were intraocular bleeding (13%), choroidal detachment (7%), and proliferative vitreo-retinopathy (5%). All complications were significantly more frequent after re-operations. Complete re-attachment was achieved in 78.1%. The re-attachment rate was significantly lower in aphakic cases (66.7%) than in phakic non-traumatic cases (80.8%). The visual acuity in re-attached cases was better than 0.5 in 33.7% and better than 0.1 in 72.2%.

Proteolytic activity was studied in subretinal fluid from 56 eyes with rhegmatogenous retinal detachment without vitreous or subretinal hemorrhage. Active plasmin (1.0–15.2 μg/ml) was found in 33 eyes and plasmin-inhibitor complexes in 3 eyes. Plasmin was detected more often in large detachments, but there was no clear correlation with the duration of the detachment or characteristics of the holes in the retina. It seems possible that plasmin in subretinal fluid may enhance release of cells from the pigment epithelium by degrading the extracellular matrix and contribute to the development of proliferative vitreoretinopathy.

Multiple linear regression-analysis of variance was used to define relationships between final visual acuity and several parameters in 31 patients with reattached primary rhegmatogenous retinal detachments. Older patient age, preoperative macular detachment, clinically visible macular lesions, greater detachment duration and extent, and higher subretinal fluid butyrylcholinesterase activity were all inversely related to final acuity. The relationship of each parameter to final acuity, in conjunction with and apart from all the other parameters, was defined. Collectively the parameters accounted for 85% of the variation about the mean of the clinically observed finally acuities. The parameters could be weighted to give a generally, reasonably accurate prediction of final acuity at the time of surgery. The findings are consistent with a pathophysiological sequence involving alterations in the choroidal circulation and the blood-ocular barrier of the posterior segment.

Purpose To assess the anatomic retinal and choroidal features of choroidal naevi using swept-source optical coherence tomography (SS-OCT) and enhanced-depth optical coherence tomography (EDI-OCT). DESIGN Observational case series. Methods Patients with choroidal lesions underwent clinical examination, B-scan ultrasound and imaging with SS-OCT and EDI-OCT. Location, dimensions, clinical and OCT retinal and choroidal features were recorded. Descriptive statistics were used. Results Case series included 31 patients. 27/31 naevi imaged were melanotic and 4/31 amelanotic with a an overall median thickness of 0.7 mm. Naevus configuration was plateau in 17/31 cases, dome in 10/31 cases and mixed in 4/31 cases. RPE and photoreceptor layer disruption were noted in 14/31 cases and 13/31 had no retinal changes. Subretinal fluid was noted in 6/31 cases. Bruch`s membrane was found intact in 26/31 cases on both modalities. Intrinsic hyperreflectivity was noted in 29/31 cases on EDI-OCT and 30/31 cases on SS-OCT with less optical shadowing. The posterior margin of the naevus was visualized in 11/31 cases with SS-OCT and in 6/31 cases with EDI-OCT. Intratumour vessels were visualized in 28/31 cases with SS-OCT and 23/31 cases with EDI-OCT. For both modalities choriocapillaris appeared compressed and abnormal in 20/31 cases. Conclusions These preliminary results indicate that imaging of choroidal naevi with SS-OCT enables better visualization of intratumour vessels and the posterior margin.

Purpose To evaluate and compare clinical outcomes for patients with acute central serous chorioretinopathy (CSCR) undergoing either focal laser photocoagulation (LPK), photodynamic therapy (PDT) or just observation. Methods In a retrospective, comparative case series study 73 patients (73 eyes) with acute central serous chorioretinopathy of at least 3 months’ duration were recruited. Out of 73 patients 51 were treated with LPK, 10 with half dose PDT and 12 patients have been in the observation group. Patients follow-ups were conducted every one to two months until complete subretinal fluid resorbtion on OCT was achieved. The main outcome measures were change in BCVA by Snellen and subretinal fluid (SRF) assessed by OCT (Zeiss Stratus OCT). Results The mean age of the patients was 47.76±8.43 years (range 24-65). 55 of 73 patients were male, 16 were female. The mean BCVA (by Snellen) at baseline was 0.81±0.23 in LPK group, 0.69±0.24 in PDT group and 0.88±0.15 in the non-treated group. At the last visit, comparing BCVA between LPK and PDT, LPK and non-treated group and PDT and non-treated group – there was no statistically significant differences between these groups, p

Purpose To evaluate the efficacy of bebacizumab according to baseline indocyanine green angiography (ICGA) findings for treatment of chronic central serous chorioretinopathy (CSC). Methods Twenty-two eyes of 22 patients with chronic CSC and symptoms for at least 3 months were treated with intravitreal injections of 1.25 mg (0.05 ml) bevacizumab. The mean follow-up was 12.5 months. The degrees of hyperfluorescence of ICGA included intense, weak , or no hyperfluorescence . Main outcomes measures were the resolution of the subretinal fluid and visual acuity. Results On the basis of ICGA, intense hyperfluorescence was found in 5 eyes (23%), diffusely weak hyperfluorescence in 6 eyes (27%), focally weak hyperfluorescence in 7 eyes (32%) and no hyperfluorescence in 4 eyes (18 %). The complete resolution rate of the subretinal fluid was higher in eyes with focally weak and no hyperfluorescence (4 eyes (57%) and 2 eyes (50%)) than in eyes with intense and diffuse weak hyperfluorescence (1 eye (20%) and 2 eyes(33%)). Visual acuty was increased in eyes with complete (n=9, 0.20) and partial (n=5, 0.11) resolution of the subretinal fluid. However, in eyes without response, visual acuity was rather decreased (n=8, -0.11). Conclusion The efficacy of bebacizumab in eyes with chronic CSC was heterogeneous according to baseline ICGA findings and seemed to be higher in eyes with lower choroidal permeability on ICGA.

Purpose To assess the efficacy of intravitreal aflibercept (2.0 mg) in patients with treatment-resistant neovascular age-related macular degeneration. Methods Retrospective analysis of eyes treated with aflibercept with persistent subretinal and/or intraretinal fluid despite a minimum of 14 previous treatments with intravitreal ranibizumab (0.5 mg). All patients were switched to intravitreal aflibercept (2.0 mg) and analyzed after 3 consecutive injections and at month 4 of treatment. Main outcome measures included change in visual acuity, central foveal thickness, and the height and diameter of the largest pigment epithelial detachment on spectral domain optical coherence tomography. Results Fifteen eyes of fifteen patients were analysed. The median number of previous injections of ranibizumab was 19 (IQR 15-22). At month four, the mean visual acuity and central retinal thickness (CRT) did not change significantly from baseline: logMAR 0.64 (95%CI- 0.45-0.83) and 0.65 (0.44-0.89; p=0.5); CRT 282 μm (233-333 μm) and 247 μm (201-293 μm; p=0.06). However, the maximum pigment epithelial detachment height improved significantly from 279 μm (95%CI 124-434 μm) to 195 μm (95%CI 65-326 μm) (p=0.03) and pigment epithelial detachment diameter decreased significantly from 2,515 μm (95%CI 1,705-3,3324μm) to 1,833 μm (95%CI 256-1,106 μm) (p = 0.002). Conclusion Intravitreal injections of aflibercept resulted in a significant improvement in the maximum height and width of the PED in eyes with a minimum of 14 previous injections of ranibizumab.

Purpose To investigate the relationship between the choroidal thicknesses of eyes of patients with age-related macular degeneration (AMD) and the outcomes of intravitreal ranibizumab injection. Methods We reviewed the medical records of 141 consecutive eyes (80 with typical neovascular AMD and 61 with polypoidal choroidal vasculopathy [PCV]) treated by intravitreal ranibizumab and 121 normal control eyes matched in terms of age and spherical equivalent (SE). Eyes of patients were divided into three subgroups with thin, medium and thick choroids. We investigated the relationships between choroidal thickness and treatment outcomes of intravitreal ranibizumab. Results In eyes with typical neovascular AMD, thin choroids were associated with older age (linear regression; p

e recently reported that 73.8%of subjects diagnosed withVogt–Koyanaga–Harada (VKH) dis-ease experienced recurrences (Erreraet al. 2011). Based on our experience,we believed that finding an exudativeretinal detachment (ERD) thatresponded to corticosteroids or othermedical treatment more than 1 yearafter onset is low. To better evaluatelate posterior recurrences, we reviewedthe records of a large series of 45patients with VKH disease from fourtertiary centres. The median follow-upduration was 34 months since initialpresentation.Late posterior segment relapses weredefined as posterior segment manifes-tations of inflammation occurring laterthan 52 weeks after first presentationof VKH (Garcia-Valenzuela et al.2000; Sachdev et al. 2008; Dolz-Marcoet al. 2011). The study adhered to thetenets of the Declaration of Helsinki.Relapsing ERDs were noted within10 months after presentation in 16(84%) of 19 subjects who experiencedsuch reactivation, with only four expe-riencing late ERDs, one of whom alsohad early relapses. Report of foursubjects with late ERDs relapses at amedian of 19 months (16–25 months).By examination and optical coher-ence tomography (OCT), subretinalfluid was limited localized areas ofsubmacular ERDs in all late posteriorsegment relapses (Fig. 1).Intravenous pulse therapy was usedwithin the first month for three of thefour subjects who experienced a lateposterior reactivation. In the fourthsubject, the diagnosis of VKH diseasewas made 3 months after the firstinflammatory signs, which caused adelay in the initiation of the correcttreatment. This latter subject had treat-ment with corticosteroids for only1 month, while the other three subjectsreceived an initial duration of systemiccorticosteroids for at least 6 months.In all four subjects, immunosuppres-sive therapy (infliximab, cyclosporin orinterferon) was initiated after the firstrelapse because response to therapywith corticosteroid at acceptable long-term doses was insufficient.All four subjects had been on immu-nomodulatory agents (cyclophospha-mide, infliximab and azathioprine),but these agents had been stopped 5to 13 months prior to the relapse.In one subject, the relapse occurredwhile he was taking 25 mg/day ofprednisone. He had responded to rein-troduction of high-dose corticotherapyfor an episode 6 months previously,and he was on tapering of therapy. Thesecond subject was receiving bothprednisone and cyclophosphamide.The third was on infliximab and low-dose oral corticosteroids at the time ofrelapse.In the experience at our institutionsthere were 4 late relapses (ERDs) of 45subjects with an incidence rate of 12cases per 1000 VKH affected person-years. Late relapses as ERDs occurredin patients receiving early intravenouspulse corticosteroids, and all four hadbeen on other corticosteroid-sparingimmunomodulatory therapy at somepoint. One possible explanation is thatthe need for more aggressive treatmentin our patients with late relapses ofVKH may be a marker of more severedisease. Early corticosteroid-sparingimmunomodulatory therapy might beuseful as first-line therapy to reduce thedevelopment of complications (AbuEl-Asrar et al. 2013). Although it is

Purpose To evaluate the efficacy of intravitreal bevacizumab injection (IVB) for the treatment of chronic, recurrent, or atypical central serous chorioretinopathy (CSC). Methods Forty-nine eyes of 49 patients who were diagnosed with chronic, recurrent, or atypcial CSC and treated with intravitreal injection of 1.25 mg/0.05 ml bevacizumab, were included for this retrospective study. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed at baseline, 3, 6, 9, and 12 months after initial IVB. Results Patients received the mean of 2.16±1.34 IVB during the mean follow-up period of 11.8±7.4 months, and 20.4% of patients had recurrent episode after initial resolution of subretinal fluid in this period. The mean baseline BCVA was 0.27±0.26 logarithm of minimum angle of resolution, and the mean baseline CMT was 353 ± 129 um. BCVA was significantly improved to 0.16 ± 0.18 (P = 0.005) and 0.14 ± 0.12 (P = 0.000) at 3 and 6 months, respectively. However, the improvement of BCVA was not significant at 9 months and 12 months. CMT was significantly reduced throughout the follow-up period and 216±101 um (P = 0.008) at 12 months. Conclusion Intravitreal bevacizumab injection may be an effective treatment option for patients with chronic, recurrent, or atypical CSC. Further prospective, long-term studies are warranted.

Purpose: To evaluate the effect of fluid accumulation on local visual function in inflammatory cystoid-macular-edema (ICME). Methods: This cross-sectional study applied optical-coherence-tomography over a 12 × 12 fovea-centered field in 50 patients with ICME and mapped the extent of fluid-filled spaces in various retinal layers, of subretinal-fluid and of diffuse-edema. Regression analysis examined effect of planimetric fluid-distribution on best-corrected-visual-acuity (BCVA) and mean microperimetric-sensitivity. Results: BCVA decreased with increasing central-neuroretinal-thickness (r = 0.52, p = 0.001), total central-retinal-thickness, including subneuroretinal-fluid (r = 0.41, p = 0.006), total cystoid-and-diffuse edema-area (r = 0.35, p = 0.036) and cystoid inner-nuclear-layer area (r = 0.39, p = 0.02). Mean retinal-sensitivity decreased with increasing diffuse edema-area (r = −0.86, p

Purpose To evaluate the efficacy of photodynamic therapy (PDT) to treat chronic central serous chorioretinopathy (CSC) and changes in neural retina (NR) thickness and best corrected visual acuity (BCVA) induced by PDT. Methods Non randomized, multicentric, interventional case series. 82 eyes of 72 patients with chronic CSC were treated by conventional PDT. LogMAR BCVA and central foveal thickness (CFT) measured by optical coherence tomography (OCT) before and after PDT, number of PDT treatments and complications were considered as outcome indicators. In 26 eyes LogMAR BCVA and OCT were evaluated before treatment and one year after PDT. 24 eyes from 24 patients with non chronic, non PDT treated forms of CSC were evaluated as a control group. Results BCVA changed from 0.53 before PDT to 0.48 at 6 months (p=0.007). Subretinal fluid disappeared in all the cases. CFT decreased from 325 µm, to 229 µm one month after PDT; to 206 µm at three months; and to 202µm at six months (p

Purpose To evaluate the 5-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV). Methods Forty-two eyes of 36 patients with PCV followed up for at least 60 months after PDT were retrospectively reviewed. The diagnosis of PCV was based on indocyanine green angiography (ICGA), showing branching vascular network with polypoidal components. All eyes were primarily treated with PDT, and retreated with PDT and anti-vascular endothelial growth factor (VEGF) injection or with only anti-VEGF injection. The recurrence of PCV was defined as the emergence of active polypoidal lesions observed with fluorescein angiography (FA) and ICGA. Retreatment was performed when leakage of fluorescein or subretinal fluid/intraretinal cyst on optical coherence tomography was noted during follow-up examiinations. Results During the mean follow-up duration, 73.64±13.47 months, the mean number of PDT was 2.21±1.62 times, and the mean number of anti-VEGF injection was 5.05±5.55 times. Recurrence was noted in 33 eyes (78.6%) during follow-up. The mean baseline BCVA was 0.78±0.48 logarithm of the minimum angle of resolution (logMAR), and the final BCVA at 60-month follow-up was 0.68±0.54 logMAR. On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%) by at least 0.3 logMAR, stable (mean BCVA change within 0.2 logMAR from baseline) in 23 eyes (54.7%), and decreased in 5 eyes (11.9%) by at least 0.3 logMAR. Conclusion After 5 years, 88.1% of patients showed stable or improved BCVA after PDT. Despite of high recurrence rate up to 78.6%, PDT was effective for 5 years, and seems to be a good option of treatment in PCV patients.

Purpose: To determine the effect of optical coherence tomography (OCT) B-scan density on the qualitative assessment of neovascular age-related macular degeneration (AMD). Methods: Data were collected from 59 patients imaged with Topcon 3D OCT-1000 (128 B-scans × 512 A-scans). Custom software was used to generate less dense subsets of scans: 1/16 (eight B-scans), 1/8 (16 B-scans), 1/4 (32 B-scans) and 1/2 (64 B-scans). At each B-scan density, scans were assessed for cystoid spaces, subretinal fluid (SRF), subretinal tissue (SRT) and pigment epithelium detachment (PED). For each sampling density, sensitivity, specificity and predictive values were calculated using the full volume scan (128 B-scans) as the reference standard. Results: For cystoid spaces, the detection sensitivity was 76.3% at 1/16 density; this rose to 89.5% with a 1/4 density. For SRF, the detection sensitivity was 75.0% at a 1/16 density; this increased to 91.1% with 1/4 density. For PED, even at the lowest sampling density (1/16) the detection sensitivity was 86.4%; this rose to 94.9% at 1/4 density. For SRT, detection sensitivity at a 1/16 density was 64.7% and only rose above 90% with the densest sampling subset (1/2). Conclusions: Use of scanning protocols with reduced sampling densities resulted in decreased detection of key features of neovascular AMD; despite this, a sampling density reduced to 1/4 appeared to allow accurate assessment for most features. Current management of neovascular AMD is dependent on qualitative assessment of OCT images; with the recent proliferation of OCT systems, optimization and standardization of scanning protocols may be of value.

Purpose In 2009 we have performed a retrospective study of 368 small uveal melanoma ( diameter less than 12 thickness less than 3 mm) Overall survival at 5 years was 92%and at 10 years 78% survival without metastasis at 5 years was 96% and at 10 years 93%. According to our data the smallest tumor associated with metastatic death was 5mm in diameter and 1,5 mm in thickness and 14 of the tumors had a diameter of less than 10 mm developed. Half of the metastatic patients developed metastasis 5 years or more after treatment. Methods According to the study performed by Gass and Shields the risk factors for growth of small melanocytic lesions are the presence of symptoms, subretinal fluid,proximity of ON , orange pigment , thickness of more than 2mm and diameter of more than 7 mm. Performing genetic test on small melanocytic lesions is not always usefull , as it has been shown that a good prognosis lesion can grow and change in a bad prognosis. Results Ophthalmologists are always trying to preserve vision as a rule. Nevertheless with possibly malignant lesions, the metastatic risk has to be considered before a therapeutic approach is decided. Factors like age of the patient, number of risk factors for growth and location of the tumor should be taken in account. Thus the practician should advise the patient and discuss and explain the decision. Conclusion We usually recommend treatment if there are at least two risk factors and if the patient is young and the lesion away from the posterior pole.In all different situations we usually recommend close follow up for suspicious lesions and treatment in case of documented growth.

Purpose To review possible causes and therapeutic options for persistent submacular fluid after retinal detachment surgery.Optical coherence tomography identifies persistent subretinal fluid (PSF) after apparently successful retinal detachment repair surgery in up to 94% of patients. PSF is associated with delayed recovery of visual function. Methods Based on the literature and the results of subretinal fluid analyses, we hypothesised that highly viscous PSF, which interferes with the normal function of the retinal pigment epithelium, can lead to these persistent blebs. We reviewed all reported interventions for PSF. We devised a novel surgical manoeuvre of subretinal lavage to dilute the subretinal fluid (SRF) during surgery. We expected that this would reduce the incidence of PSF. We report our experience with a modified surgical drainage technique in patients with long standing retinal detachments. Results No postoperative medical or surgical intervention has been proven to be effective in a series of patients. On the contrary, none of the patients undergoing modified drainage and lavage developed PSF. Conclusion In the absence of an effective cure, prevention appears to be a promising option.

Purpose: To evaluate the functional and anatomical outcome of patients undergoing autologous transplant of retinal pigment epithelium (RPE) and choroid after RPE tear secondary to age-related macular degeneration (AMD). Methods: Data from nine eyes of nine patients were analysed retrospectively. Examinations included fluorescein and indocyanine green angiography, fundus autofluorescence imaging, optical coherence tomography, microperimetry and determination of visual acuity (far and reading ability). Data regarding intraoperative and postoperative complications were recorded. Mean follow-up time was 18 months (range 4 months to 5 years). Results: After surgery, far visual acuity improved or remained stable (±3 lines) in three of nine eyes and for the near visual acuity in three of nine eyes. Visual acuity decreased postoperatively at the last follow-up in four eyes mainly because of postoperative complications, i.e. retinal detachment due to proliferative vitreoretinopathy, retinal artery occlusion, pucker and fibrosis of the graft. In one case, retinal stimuli were restored over the scotoma as seen in microperimetry. Conclusion: Autologous transplant of RPE and choroid is a therapy option for RPE tears. Retinal stimuli can be restored in selected cases. Numerous intra- and postoperative complications compromise the functional prognosis and outcome.

Purpose To unravel the physiopathology of persistent submacular fluid (PSF) after successful primary rhegmatogenous retinal detachment (RD) repair for macula-involving RD. To propose therapeutical and preventive measures for this phenomenon. Methods 9 eyes from 9 patients with macula-involving RD underwent RD repair: 6/9 eyes got buckle surgery and 3/9 eyes got 20 gauge pars plana vitrectomy. The cellular content of subretinal fluid was studied by electron microscopy and anti-Rhodopsin immunostaining. All eyes were followed further postoperatively for 12 months by spectral domain optical coherence tomography (SD-OCT) for detection of PSF. Results Three out of nine samples were cell rich with cell counts of 7304/mm2, 20 270/mm2 and 9092/mm2 on cytospin. Six out of nine samples contained less than 1500 cells/mm2 and were scored as scantily cellular. The cells in the samples were predominantly rhodopsin immunopositive and showed structural features of photoreceptors or photoreceptor fragments on electron microscopy. Postoperative SD-OCT scans demonstrating PSF in 3 eyes corresponded to the 3 cell rich peroperative subretinal samples. Conclusion Subretinal fluid obtained from patients with PSF is cell rich and contains predominantly photoreceptors and photoreceptor fragments. We speculate that a peroperative subretinal lavage might prevent postoperative PSF.

Purpose Time-domain optical coherence tomography (TD-OCT) became an important tool for the management of neovascular age-related macular degeneration (AMD). Recently, spectral-domain OCT (SD-OCT) became available with improved image resolution and scanning speed. The purpose of this study was to compare inter-observer agreement of SD-OCT versus TD-OCT image grading in patients with exudative AMD. Methods Thirty eyes with neovascular AMD were examined with 2 different OCT models. Three observers graded fast macular scans (FMS), cross hair scans (CHS) (both Stratus™ OCT), volume scans (VS), and radial line scans (RLS) (both Spectralis™ OCT) for the presence of various morphologic pathologies. Inter-observer agreement between OCT models was assessed by calculating intra-class correlation coefficients (ICC). Results In Stratus™ OCT highest agreement was found for subretinal fluid (ICC: 0.79), and in Spectralis™ OCT for intraretinal cysts (IRC) (ICC: 0.93). Spectralis™ OCT showed superior agreement for IRC and epiretinal membranes (ERM) (ICCStratus™ : for IRC 0.61; for ERM 0.56; ICCSpectralis™ : for IRC 0.93; for ERM 0.84). Lowest agreement was found for subretinal fibrosis (FIB) with an ICCStratus™ of 0.65, and an ICCSpectralis™ of 0.52. Spectralis™ Conclusion Increased image resolution of Spectralis™ OCT did not markedly improve the inter-observer agreement except for grading intraretinal cysts and epiretinal membranes.