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PURPOSE To present a new technique to treat refractory retinal detachment secondary to optic disc pit. METHODS An interventional case report. RESULTS A 25-year-old man with congenital optic disc pit had two failed vitrectomies involving laser around the optic disc, internal limiting membrane peel and flap to plug the disc pit, and gas tamponade to reattach the retina. With all options running out, a further vitrectomy with autologous retinal transplant and silicone oil tamponade was carried out to treat the refractory serous retinal detachment; the silicone oil was removed at 6 weeks after the last procedure. The retina remained successfully attached at 6 months post-surgery with the patient maintaining his baseline visual acuity. CONCLUSION The use of autologous retinal transplant is a new approach to treat refractory retinal detachment secondary to congenital optic disc anomalies, and adds to our options of dealing with this complex condition when first-line approaches have failed.

Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease.Observational case report.An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes.Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.

Purpose To describe a patient with a history of pre-B cell acute lymphoblastic leukemia (pre-B ALL) in remission, who developed recurrent alternating intraocular pre-B ALL manifesting with pseudohypopyon, uveal mass, and serous retinal detachment. In multiple instances this constellation of ocular findings preceded systemic leukemia recurrence. Method Case report. Results A 29-year old man with history of pre-B cell acute lymphoblastic leukemia, in remission following a hematopoietic stem cell transplant, presented with pseudo-hypopyon, uveal lesions, and serous retinal detachment of the right eye. Comprehensive workup for infectious and inflammatory etiologies was unremarkable, and a bone marrow biopsy revealed systemic recurrence of leukemia. One year later, while again in remission, the patient developed a pseudo-hypopyon, uveal mass, and serous retinal detachment of the other eye. Repeat bone marrow biopsy showed impending leukemia relapse, which occurred 1 month later. Orbital radiation resulted in complete ocular resolution. Conclusions The constellation of pseudohypopyon, serous retinal detachment, and uveal mass (pseudo-panuveitis) should be recognized as a harbinger for systemic pre-B ALL recurrence.

PURPOSE To present the first case of acute macular edema with serous retinal detachment after cataract surgery in a vitrectomized eye. METHODS A 63-year-old female patient, with history of pars plana vitrectomy and epiretinal membrane removal, underwent uneventful phacoemulsification surgery with injection of standard intracameral dose of cefuroxime (1 mg/0.1 mL of solution) at the end of the procedure. RESULTS First day after cataract surgery, visual acuity did not correlate with anterior segment findings, and funduscopic eye examination revealed acute macular edema with serous retinal detachment, which was confirmed by spectral domain optical coherence tomography. Fluorescein angiography showed no retinal or choroidal hyperpermeability. At 2-week follow-up visit, visual acuity had significantly improved, and there was complete resolution of macular edema and subretinal fluid. CONCLUSION The current case suggests that acute macular edema with serous retinal detachment after cataract surgery with standard cefuroxime prophylaxis can occur even in vitrectomized eyes. A high level of suspicious is needed when visual acuity does not correlate with anterior segment findings immediately after cataract surgery. Similar to reports from nonvitrectomized eyes, visual prognosis was favorable.

International audience; Purpose: To investigate cone density in the asymptomatic fellow eye of patients with unilateral central serous chorioretinopathy (CSCR). Methods: Seventeen asymptomatic fellow eyes of patients with unilateral CSCR and 17 eyes of aged-matched and gender-matched healthy controls underwent adaptive optics ophthalmoscopy. Cone density and spacing were assessed at the fovea. Clinical and multimodal imaging findings were also recorded. Results: In the CSCR group, the patient mean age was 48.9 ± 9.8 years. The mean (±SD) subfoveal choroidal thickness was 417.8 ± 125.2 mm. The foveal external limiting membrane and ellipsoid zone were intact in all patients. Adaptive optics fundus imaging showed a significant decrease in cone density at 2°of eccentricity nasal and temporal to the fovea in asymptomatic fellow eyes of patients with unilateral CSCR compared with controls (P = 0.001 and P = 0.027, respectively). No statistically significant difference in cone density was found at 4°of eccentricity nasal and temporal to the fovea between both groups. Conclusion: Asymptomatic fellow eyes of patients with unilateral CSCR showed a reduced density of foveal cones in the absence of a decreased visual acuity and photoreceptor line disruption on optical coherence tomography. These results suggest that the photoreceptors could be damaged independently of the occurrence of a serous retinal detachment.

PURPOSE Optic disk pit (ODP) is a rare congenital abnormality of the optic nerve head that can lead to a maculopathy characterized mainly by serous retinal detachment. Optic disk pit maculopathy (ODP-M) in children is rare, and at present, the best management is still unknown. Long-lasting ODP-M can lead to organic amblyopia and photoreceptor damage, whereas surgical treatments are invasive and have an uncertain prognosis. We present a case of spontaneous resolution of ODP-M in a child who was monitored morphologically and functionally during a 6-year follow-up. METHODS Between January 2010 and January 2016, we conducted follow-up examinations by fundus photography, optical coherence tomography, and microperimetry. RESULTS At the first visit, a 12-year-old girl was asymptomatic with a visual acuity of 20/20 in both eyes. Optic disk pit maculopathy was observed, and the progression was monitored by follow-up optical coherence tomography. A progressive anatomical improvement with a spontaneous resolution of ODP-M occurred over a 2-year period. However, at the last follow-up visit, microperimetry showed a loss of threshold values of visual sensitivity. CONCLUSION The combination of morphologic and functional evaluation over time can be useful to determine the best management of ODP-M, particularly in children for whom the conservative approach seems to be a valid alternative to surgery.

Purpose To describe resolution of a subfoveal choroidal cavern after half-dose verteporfin photodynamic therapy for persistent central serous chorioretinopathy. Methods Case report. Results A 43-year-old man was referred for treatment of chorioretinopathy in his left eye. On presentation, swept-source optical coherence tomography demonstrated a serous retinal detachment and a 161-μm-thick subfoveal choroidal cavern showing a characteristic tail of hypertransmission extending posteriorly. Subfoveal choroidal thickness measured 456 μm in the affected eye. Complete resolution of subretinal fluid and the subfoveal choroidal cavern were observed 3 months after half-dose verteporfin photodynamic therapy. Twelve months after treatment, subfoveal choroidal thickness had decreased further to 276 μm, and visual acuity had improved to 20/15. Conclusion After half-dose verteporfin photodynamic therapy for chorioretinopathy, resolution of subretinal fluid was accompanied by resolution of a subfoveal choroidal cavern at 3 months and a 39.5% reduction in subfoveal choroidal thickness at 1 year.

PURPOSE To report a 67-year-old woman with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, showing bilateral serous retinal detachment. The retinal lesion was evaluated by multimodal imaging using spectral domain optical coherence tomography and an adaptive optics (AO) camera. METHODS A case report. RESULTS Optical coherence tomography showed hyperreflective foci mainly in the inner retina in both eyes. The AO images showed many low-reflective dots in the right eye. Three months after hematological treatment, both hyperreflective foci in the optical coherence tomography images and the low-reflective dots in the AO images disappeared. CONCLUSION Low-reflective dots were detected in AO images of eyes with serous retinal detachment secondary to POEMS syndrome. AO cameras can detect retinal microstructures in living eyes.

Purpose To evaluate chronological changes in choroidal thickness in a patient with pachychoroid pigment epitheliopathy (PPE) who was later diagnosed with central serous chorioretinopathy (CSC) during follow-up. Methods Case report. Results A 43-year-old man complained of metamorphopsia in the left eye. Funduscopy showed several punctate white subretinal lesions at the macula, but no macular serous retinal detachment in the left eye. Retinal pigment epithelium abnormality without serous retinal detachment at the macula on optical coherence tomography and choroidal vascular hyperpermeability on indocyanine green angiography suggested PPE in the left eye. Macular lesions disappeared with no treatment. Twenty-five months after the initial visit, PPE recurred in the left eye. Thirty-five months after the initial visit, the patient was diagnosed with CSC in the left eye. Macular serous retinal detachment spontaneously resolved. In the eye with PPE and CSC, the choroid was consistently thicker than that in the fellow eye during follow-up. The choroid became thicker during the alternate onsets of PPE and CSC and thinner after regression of these diseases. Conclusion These results suggest that PPE and CSC overlap clinically and choroidal thickening is involved in the pathogenesis of both diseases.

PURPOSE To report the frequency, optical coherence tomography (OCT) findings, and visual and anatomic outcomes of patients with acute Vogt-Koyanagi-Harada disease presenting with the bacillary layer detachment (BLD) (intraretinal split at the photoreceptor inner segment myoid). METHODS This was a retrospective analysis of a consecutive series of patients with Vogt-Koyanagi-Harada disease having a minimum follow-up of 6 months. All patients had swept-source OCT, fluorescein angiography, and indocyanine green angiography performed at baseline. The characteristics of serial swept-source OCT were recorded and analyzed. RESULTS Sixty-two subjects (42 women; age: 34.2 ± 12 years) with Vogt-Koyanagi-Harada disease were included. 118 eyes (95.2%) had serous retinal detachment at presentation. 112 eyes (94.9%) showed the BLD at baseline. In 8 of 112 (7.1%) eyes with the BLD, the external limiting membrane at the anterior aspect of the BLD showed focal discontinuity. The interdigitation zone at the base of the BLD showed discontinuity in 53 of 112 (47.3%) eyes with the BLD. The ellipsoid zone could not be identified as a separate hyperreflective line at the base of the BLD in 102 of 112 eyes (91.1%). Bacillary layer detachments resolved within 3.4 ± 1.3 days after intravenous methylprednisolone therapy with improvement in the best-corrected visual acuity from 0.96 to 0.4 logarithm of the minimum angle of resolution (20/184 Snellen's equivalent) (P < 0.001). Resolution of serous retinal detachment was observed after 5.9 ± 2.6 days. CONCLUSION In eyes with acute Vogt-Koyanagi-Harada disease, the BLD is a common finding and represents a split in the photoreceptor layer at the inner segment myoid and can be differentiated from serous retinal detachment using swept-source OCT. In addition, resolution of the BLD and photoreceptor recovery can be evaluated using serial swept-source OCT.

PURPOSE To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant versus aflibercept in patients with treatment-naive diabetic macular edema with inflammatory biomarkers. METHODS Ninety-eight eyes of 62 treatment-naive patients with diabetic macular edema with serous retinal detachment and hyperreflective foci were enrolled. Each patient was randomized to receive either aflibercept or DEX implant treatment. The treatment protocol included 3 monthly injections of 2 mg of aflibercept as a loading phase in the anti-vascular endothelial growth factor group and 0.7 mg of DEX implant in the DEX group and then pro re nata treatment. Primary outcome measures were mean changes in visual acuity and central retinal thickness at the end of the 12-month follow-up. RESULTS Forty-eight eyes of 29 patients were received DEX implant, and 50 eyes of 33 patients received the aflibercept injection. Mean central retinal thickness decreased from 615.2 µm at baseline to 297.7 µm at 12 months in the DEX group (P < 0.001) and from 576.5 µm to 367.4 µm in the aflibercept group (P < 0.001). Except for the first month, mean central retinal thickness reduction was significantly higher in the DEX group (P < 0.05, Mann-Whitney U Test). Visual acuity improved significantly at the end of the follow-ups (46.3-52.7 Early Treatment Diabetic Retinopathy Study letters in the DEX group and 47.5-56.8 Early Treatment Diabetic Retinopathy Study letters in the aflibercept group at 12 months, P < 0.001, paired-sample t-test). Adjusting by baseline values, the increase in mean visual acuity during the 12-month follow-ups favored the aflibercept group (P < 0.01), 25% of the DEX-treated eyes and 42% of the aflibercept treated eyes experienced 10 or more Early Treatment Diabetic Retinopathy Study letters visual gain (P: 0.058). The DEX group received significantly fewer (2.6 vs. 7.2) injections (P: 0.001). CONCLUSION It was observed that the both of DEX implant and aflibercept were effective and safe in treatment-naive diabetic macular edema patients with inflammatory phenotype. Anatomical results were found to be better in the DEX group, and functional results were found to be better in the aflibercept group. In pseudophakic eyes, the functional superiority of aflibercept ceased to exist, and the low number of injections in the DEX implant group was seen as an advantage.

PURPOSE To report a case of acute posterior multifocal placoid pigment epitheliopathy occurring in temporal association with multiple immunizations in a previously healthy 25-year-old woman. METHODS Acute posterior multifocal placoid pigment epitheliopathy was diagnosed based on ophthalmological findings of bilateral placoid subretinal lesions complicated by a serous retinal detachment in the left eye. RESULTS Through HLA typing, the patient was found to possess the HLA-B*40 and HLA-DB1*15 alleles. She was treated with topical prednisolone acetate 1% and monitored for several months. The serous retinal detachment resolved, and visual acuity returned to normal. CONCLUSION This case report adds to the body of knowledge regarding possible atypical interplay between vaccines and specific T-cell receptors of the host immune system and adds Polio and Tetanus to the growing list of vaccines potentially triggering acute posterior multifocal placoid pigment epitheliopathy. Increased awareness of the presentation of acute posterior multifocal placoid pigment epitheliopathy and that it may arise after immunization may also improve evaluation of acute changes in visual acuity.

Purpose To describe the evolution of a case of adult-onset Coats disease and the results of treatment with intravitreal ranibizumab and laser photocoagulation. Methods Observational case report. Case report A 17-year-old girl presented with vision loss in her right eye (20/50) showing aneurysmatic and abnormal telangiectatic vessels associated with profuse lipid exudation and serous retinal detachment within the temporal posterior pole. The diagnosis of Coats disease was established and therapy with intravitreal injections of ranibizumab and photocoagulation was initiated achieving control of the exudative manifestations leading to restoration of visual acuity (20/20). Conclusion Treatment with antiangiogenic agents before laser photocoagulation may be useful for treatment of adult-onset Coats disease.

PURPOSE To describe a case of surgical repair of a total, combined traction-rhegmatogenous, retinal detachment with proliferative vitreoretinopathy after cryoablation of a retinal capillary hemangioblastoma. METHODS A case of a 47-year-old man presenting with a solitary, superotemporal retinal capillary hemangioblastoma in the right eye with serous retinal detachment and subfoveal fluid and exudates is reported. The hemangioblastoma was treated with cryoablation, but despite regression of the lesion, the patient developed a total combined traction-rhegmatogenous retinal detachment 6 weeks later. Vitrectomy, endolaser photocoagulation to tears adjacent to the original hemangioblastoma lesion, and silicone oil exchange was performed to repair the detachment. RESULTS Eighteen months after initial repair, the patient had silicone oil removal and cataract extraction with lens implantation. Final visual acuity improved from counting fingers to 20/50 with total retinal reattachment and regression of the retinal capillary hemangioblastoma. CONCLUSION Although uncommon, combined traction-rhegmatogenous retinal detachment can occur after cryoablation of a retinal capillary hemangioblastoma.

SIGNIFICANCE During the acute stage of central serous chorioretinopathy (CSC) with retinal elevation, the spectral domain optical coherence tomography (SD-OCT) estimate of ganglion cell layer complex thickness is reduced. Thickness returns to normal after resolution of the event. Measurement error is at least partially responsible for this effect. The reduction in ganglion cell layer complex thickness does not represent atrophy and is not predictive of a poor outcome. PURPOSE We investigated the effects of serous retinal detachment on the ganglion cell layer complex analysis (GCA) by SD-OCT in CSC patients during the acute episodes and after resolution of fluid. METHODS We retrospectively reviewed medical records of 30 patients who visited the hospital with a first episode of CSC. We analyzed GCA maps using SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) at the initial visit with serous retinal elevation and after the absorption of subretinal fluid. For repeatability analysis, we used the intraclass correlation and repeatability coefficient from two consecutive measurements 5 minutes apart in 12 patients. RESULTS At the initial visit, an average thickness of ganglion cell layer complex was thinner than that measured in the fellow eye (67.4 ± 27.4 μm), but after the absorption of subretinal fluid, it normalized to 87.0 ± 6.7 μm; the difference was statistically significant. The intraclass correlation and repeatability coefficient were low during the period of serous elevation but normalized after fluid resorption. Abnormalities of GCA resulted from the segmentation error of ganglion cell layer and inner plexiform layer during the acute phase of CSC. CONCLUSIONS Serous retinal detachment can affect the GCA and repeatability measurements of the GCA. Clinicians should consider this finding when using the GCA measurement in the diagnosis and management of the patients with retinal contour changes such as retinal elevation including CSC.

Purpose To report a case of hypertensive choroidopathy with detailed chorioretinal images obtained using swept source optical coherence tomography. Methods We report the case of a 36-year-old pregnant woman who presented with extensive bilateral exudative retinal detachments (visual acuity of hands movement bilaterally), high blood pressure, and severe alteration of the laboratory test results resulting in the diagnosis of HELLP syndrome. The baby was delivered by emergency cesarean section and the patient was hospitalized in the intensive care unit. Results Two weeks later, exudative retinal detachments improved substantially and bilateral Elschnig spots were present in the posterior fundus. Swept source optical coherence tomography revealed serous retinal detachment, multiple pigmentary epithelial detachments (PEDs), a thickened subfoveal choroid (437 and 466 μm), and fibrinous material between the neurosensory retina and retinal pigment epithelium in the B-scans of both eyes. En face swept source optical coherence tomography allowed a more precise evaluation of the multiple and confluent PEDs. Six weeks later, despite some focal areas of thickened retinal pigment epithelium, the serous retinal detachment, PEDs, and fibrinous material resolved bilaterally and visual acuity and choroidal thickness returned to normal range (361 and 366 μm). En face swept source optical coherence tomography revealed a dramatic improvement of PEDs in terms of extension and distribution. Conclusion Swept source optical coherence tomography detected serous retinal detachment, PEDs, increased subfoveal choroidal thickness, and fibrinous material under the neurosensory retina in the acute phase of hypertensive choroidopathy. En face OCT is useful for monitoring the evolution of confluent PEDs in hypertensive choroidopathy.

Background/purpose To report a case of unilateral choroidal detachment and serous retinal detachment in a patient with a history of untreated sarcoidosis. Methods Case report. The patient is a 67-year-old African American man with a history of nontreated sarcoidosis and prostate cancer. His prostate cancer was treated several years earlier with external beam radiation therapy. The patient presented with blurred visual acuity of 20/30 and floaters in the right eye. He was discovered to have several hypopigmented choroidal lesions, 360-degree choroidal detachment, and shallow serous retinal detachment in the right eye. Results The patient was treated with subtenons kenalog and oral prednisone with subsequent improvement of vision and resolution of choroidal and retinal detachment. Conclusion Ocular sarcoidosis can involve any part of the eye and its adnexal tissues and may cause uveitis, episcleritis, scleritis, eyelid abnormalities, conjunctival granuloma, optic neuropathy, lacrimal gland enlargement, and orbital inflammation. Most patients with ophthalmic sarcoidosis have evidence of systemic involvement at the time of the initial examination and have bilateral ocular presentation. We present here the unique case of a 67-year-old man with unilateral 360-degree choroidal detachment and serous retinal detachment as an ocular presentation of sarcoidosis.

PURPOSE:: To evaluate the effects of the subthreshold laser treatment as a therapeutic option in the treatment of serous retinal detachment secondary to dome-shaped macula. METHODS:: Prospective pilot study with 12-month follow-up. Each patient underwent a complete ophthalmologic examination, including best-corrected visual acuity, fluorescein angiography, indocyanine green angiography, and spectral domain optical coherence tomography. Eyes with persistent serous retinal detachment lasting for a minimum of 12 months and absence of best-corrected visual acuity improvement underwent subthreshold laser treatment in a single session. The laser spots were delivered in a contiguous mode, covering the area of hyperfluorescence recognized on indocyanine green angiography. The primary outcome measure was the best-corrected visual acuity changes at the 12-month examination. Secondary outcomes included changes in central foveal thickness (CFT) and number of eyes achieving a complete serous retinal detachment resolution. RESULTS:: Twelve eyes (8 patients) were included in the study. Best-corrected visual acuity changed from a baseline value of 0.8 ± 0.2 (±SD, logarithm of the minimum angle of resolution [Snellen equivalent: 20/125]) to 0.48 ± 0.1 (Snellen equivalent: 20/60, P = 0.001). Central foveal thickness decreased from 320 ± 52 μm to a final value of 266 ± 41 μm (P = 0.001). Serous retinal detachment reduced in all cases; however, just one eye (8.3%) showed a complete resolution at the 12-month examination. Fluorescein angiography and indocyanine green angiography showed that the hyperfluorescence had disappeared after subthreshold laser treatment. No adverse event was registered, including enlargement of atrophic alterations and choroidal neovascularization. CONCLUSION:: Subthreshold laser treatment can lead to improvements in visual acuity and central foveal thickness in myopic eyes with serous retinal detachment secondary to dome-shaped macula. Further studies are required to confirm our preliminary results.

To report a case of new-onset Vogt-Koyanagi-Harada disease treated with sub-Tenon injection of triamcinolone acetonide in a 16-week pregnant patient.Review of clinical records.A 33-year-old woman in her 16th week of pregnancy presented with bilateral serous retinal detachments associated with anterior chamber inflammation. Enhanced depth imaging optical coherence topography showed marked choroidal thickening. Headache and tinnitus developed 3 days later. The patient was diagnosed with incomplete Vogt-Koyanagi-Harada disease and treated with bilateral sub-Tenon triamcinolone acetonide injections. Within 2 weeks, the serous retinal detachments completely resolved with decreased choroidal thickness in both eyes. No recurrence of inflammation or choroidal thickening was noted over a follow-up of 13 months. The patient delivered a healthy baby at 41 weeks of pregnancy.Sub-Tenon triamcinolone acetonide injection may be an effective and safe treatment in pregnant women with new-onset Vogt-Koyanagi-Harada disease.

We present 3 cases of acute-onset cystoid macular edema (CME) with serous retinal detachment (RD) attributable to intracameral injection of a standard dose of cefuroxime at the end of uneventful cataract surgery. Other possible causes of CME, such as diabetic retinopathy, retinal vascular occlusion, uveitis, choroidal neovascularization, vitreomacular traction, and concomitant medications, were excluded. The clinical features seen in the spectral-domain optical coherence tomographic and angiographic patterns of this particular retinal disorder are compared with those reported in the literature. To our knowledge, this is the first reported spectral-domain optical coherence tomographic–documentation of a serous RD that extends beyond the vascular arcades secondary to intracameral cefuroxime administration. The pathogenetic mechanism that leads to this particular retinal abnormality is discussed. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Rationale Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology. GPA affects multiple ocular tissues, most commonly the orbit, conjunctiva, cornea, and sclera. Retinal and choroidal manifestations are rare in GPA, but they often include choroidal neovascularization (CNV). Patient concerns A 36-year-old man was diagnosed with GPA. He had been taking oral steroid treatment for 8 years. He experienced disease recurrence and the dose of oral prednisolone was increased after steroid pulse therapy. Fundus examination showed small retinal pigment epithelial detachment and serous retinal detachment (SRD). Optical coherence tomography (OCT) revealed a protruded lesion inside the SRD. Fluorescein angiography (FA) showed a small, dot-shaped fluorescein leakage in the SRD, and indocyanine green fluorescein fundus angiography showed choroidal vascular hyperpermeability that was consistent with the hyperfluorescence seen with FA. We had to determine whether the protruded lesion inside the SRD was CNV secondary to the inflammation due to GPA or whether it was central serous chorioretinopathy (CSC)-like condition caused by high-dose steroid treatment. Diagnoses We confirmed that the SRD was due to CSC but not CNV because the protruded lesion examined by B-scan OCT angiography (OCTA) showed no blood flow. Interventions We decided to reduce the dose of steroid. Outcomes Since the reduction of steroids, no sign of worsening in the protruded lesions with SRD has been observed. Lessons We therefore propose the effectiveness of this advanced function of OCTA for the examination of blood flow signal images to detect CNV.

Objectives To evaluate the short-term efficacy of triamcinolone acetonide versus bevacizumab for the treatment of diabetic, clinically significant, macular edema with different optical coherence tomography findings. Methods Fifty eyes of 45 consecutive patients with diabetic, clinically significant, macular edema were incorporated in this prospective interventional case series. Patients were divided into 3 groups according to findings on optical coherence tomography: 1) macular edema combined with serous retinal detachment (Group 1), 2) diffused macular thickening (Group 2), and 3) cystoid macular edema (Group 3). Patients from each group were treated with a single intravitreal injection of triamcinolone (IVTA) or 2 intravitreal injections of bevacizumab (IVB) with an interval of 6 weeks. Patients were observed at 6, 12, and 24 weeks after IVTA or the first IVB injection. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were examined at each visit. Repeated-measures analysis of variance was used to compare the efficacy of the treatment groups. Results In Group 1, IVTA showed more favorable effects on CRT reduction and BCVA improvement compared with IVB at 6, 12, and 24 weeks (P = 0.002, 0.001, 0.027 and P = 0.036, 0.001, 0.027), respectively. In Group 2, IVB had more CRT reduction than IVTA at 6 and 12 weeks (P = 0.013 and 0.036), although there was no significant difference in BCVA improvement between the 2 groups (P > 0.05). In Group 3, IVTA and IVB did not have significant effects on CRT reduction and BCVA improvement (P > 0.05). Conclusion The short-term efficacy of IVTA and IVB on treating clinically significant macular edema varied with different optical coherence tomography findings. In clinically significant macular edema combined with serous retinal detachment, IVTA may be more favorable than IVB in CRT reduction and BCVA improvement. In patients with diffused macular thickening, IVB may be better than IVTA in macular thickness reduction, although this does not translate to a significant improvement in BCVA.

To determine characteristics of diabetic macular edema patients with serous retinal detachment (SRD). We classified naïve diabetic macular edema (DME) patients with or without SRD, and compared their baseline characteristics; intravitreal bevacizumab (IVB) responsiveness; aqueous concentrations of IL (interleukin)-1β, -2, -8, -10, -17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF). In addition, factors associated with the existence of SRD were identified. Of the 64 DME patients, 14 had SRD. The average levels of aqueous VEGF and PlGF were significantly higher in the SRD group than in the control group (P = .022 and P = .041, respectively). The best-corrected visual acuity (BCVA) and central subfield thickness (CST) did not differ significantly between the 2 groups at baseline or after 3 consecutive monthly IVBs. In multivariate logistic regression analysis, the level of aqueous VEGF was the only factor associated with the existence of SRD (odds ratio: 1.03; P = .038). Rather than aqueous inflammatory cytokines, levels of aqueous VEGFs were associated with the occurrence of SRD in DME patients. In terms of prognosis, the existence of SRD was not related with BCVA or CST changes.

Purpose Sclerochoroidal calcification is a rare ocular condition characterized by multifocal, yellow-white elevated fundus lesions typically located in the superotemporal quadrant along the superior arcades. The pathology of calcification can be classified as dystrophic, metastatic, or idiopathic. Vision-threatening complications may arise, such as choroidal neovascular membrane and serous retinal detachment. The pathogenesis of sclerochoroidal calcification remains unclear. Case report A 72-year-old Caucasian male patient presented to the clinic for routine examination. Fundus evaluation revealed bilateral, multifocal, pale yellow elevated lesions in the superotemporal fundus. Ultrasonography showed a focal area of hyper-reflectivity located in the posterior retina of both eyes, and optical coherence tomography showed an intact retina overlying the elevated lesions in the choroid. Systemic evaluation for dystrophic and metastatic calcification was negative, and the patient was diagnosed with idiopathic sclerochoroidal calcification. Conclusions It is important to distinguish sclerochoroidal calcification from other conditions to prevent unnecessary intervention. Calcification of body tissues warrants a systemic evaluation, including screening for calcium and phosphorous levels, to rule out underlying systemic disease. If a biochemical abnormality is discovered, it can be appropriately treated with supplements. If calcification is deemed idiopathic, then annual dilated examinations are recommended to monitor the fundus lesions. Visual prognosis for sclerochoroidal classification is good, as the lesions are typically located away from the macula and foveal encroachment is rare.

PURPOSE To evaluate the prevalence of macular complications in tilted disk syndrome by spectral domain optical coherence tomography (OCT). METHODS A monocentric retrospective study of consecutive patients with tilted disk syndrome, whose eyes were examined by spectral domain OCT (Cirrus; Zeiss) and fundus photography. RESULTS Fifty consecutive patients (39 women and 11 men; age range, 41-96 years) with uni- or bilateral tilted disk syndrome were enrolled. All affected eyes (n = 92) were imaged by spectral domain OCT and fundus photography. Fluorescein and/or indocyanine green angiography were performed in 33 patients (66%). Macular anomalies or complications were observed in 71 eyes (77.1%). Specifically, retinal pigment epithelial changes were described in 34 eyes (36.9%), choroidal neovascularization in 24 eyes (26%), and macular serous retinal detachment in 16 eyes (17.3%). Epiretinal membrane in 9 eyes (9.7%), myopic foveoschisis in 5 eyes (5.4%), and lamellar macular hole in 3 eyes (3.2%) were also detected relatively frequently by spectral domain OCT. Surprisingly, fovea plana was observed in 5 eyes (5.4%). Eleven eyes, complicated by choroidal neovascularization, were treated with ranibizumab, with a mean visual gain of 7.9 letters on Early Treatment Diabetic Retinopathy Study chart. CONCLUSION Tilted disk syndrome can be associated with potentially severe macular complications. Spectral domain OCT allowed the recognition of additional macular changes associated with tilted disk syndrome, such as epiretinal membranes, myopic foveoschisis, and fovea plana.

To report an original case of retinal pigment epithelial (RPE) tears in acute Vogt–Koyanagi–Haradadisease. Observational case report of a patient who presented with RPE tears in acute Vogt–Koyanagi–Harada disease, who underwent clinical examination, fluorescein and infracyanine green angiographies, and optical coherence tomography evaluation. A 42-year-old woman presented with bilateral serous retinal detachment related to Vogt–Koyanagi–Harada disease. Eight days after high-dose systemic corticosteroids, she developed bilateral RPE tears. At the 15-month follow-up, visual acuity was 20/20 in both eyes. The RPE tears are rarely observed in acute Vogt–Koyanagi–Harada disease. The RPE tears were likely caused by acute inflammation of the choroidal stroma.

Purpose. To describe the optical coherence tomography (OCT) features of multifocal vitelliform macular dystrophy (VMD). Methods. Five patients (10 eyes) with multifocal VMD were examined by slit lamp biomicroscopy, fundus photography, and OCT. Results. Serous retinal detachment was present in the macular area in all eyes. A hyperreflective inner/outer segment interface was observed in the macula in nine of them. High reflectivity was homogeneous in six eyes of three patients with no prominent macular lesion. Retinoschisis-like changes could be clearly seen in four eyes evaluated by high-resolution OCT. A hyporeflectivity corresponded to the inner nuclear layer in two eyes. In four eyes with prominent macular lesions, a hyperreflective area between the hyporeflective outer nuclear layer and the hyperreflective retinal pigment epithelium layer was detectable. Conclusions. Although the fundus appearance of multifocal VMD is quite variable, OCT features of the disease are rel- atively uniform. Optical coherence tomography could help the pathological interpretation and facilitate the diagnosis of VMD. (Optom Vis Sci 2013;90:94Y99)

Purpose: To investigate how combined cystoid spaces and serous retinal detachment affect photoreceptor status and visual acuity at final visit in macular edema associated with branch retinal vein occlusion. Methods: Forty-seven consecutive eyes from 47 patients with macular edema associated with branch retinal vein occlusion treated with intravitreal bevacizumab injection were retrospectively reviewed. Foveal pathomorphology on optical coherence tomography images were divided into two groups: those in which combined foveal cystoid spaces and serous retinal detachment were observed at least once (C+S(+)) and those in which they were not observed (C+S(−)). The relationship between foveal pathomorphology and photoreceptor status and logarithm of the minimum angle of resolution at final visit was investigated. Results: Sixteen eyes were categorized as C+S(+), and the final visual acuity of C+S(+) group was significantly worse than that of C+S(−) group compared with no difference at baseline. Intriguingly, combined foveal pathomorphologies during the course were significantly associated with the absence of external limiting membrane and the junction of inner and outer segments at last visit. Using multivariable analysis, final logarithm of the minimum angle of resolution was significantly related to baseline logarithm of the minimum angle of resolution, diabetes, and C+S(+). Conclusion: Combined foveal cystoid spaces and retinal detachment during follow-up predict the disrupted foveal photoreceptors and concomitant poor final visual acuity in branch retinal vein occlusion treated with intravitreal bevacizumab injection.

Purpose The purpose of this was to describe the clinical improvement of chronic central serous chorioretinopathy in a patient treated with rifampin for tuberculosis. Methods A 54-year-old Hispanic man with a distant history of pulmonary tuberculosis presented with reduced vision in the right greater than left eye for over 1 year. He had diffuse chorioretinopathy in both eyes and a serous retinal detachment in his right eye. The findings were most consistent with chronic central serous chorioretinopathy, although tuberculosis -related choroiditis could not be excluded. Treatment with multidrug antituberculosis medications, including rifampin, resulted in the reduction in leakage and resolution of subretinal fluid. Fluid recurred on cessation of all medications and resolved again with retreatment. Monotherapy with rifampin maintained the absence of fluid. Discussion This case represents the first report of chronic central serous chorioretinopathy responding to systemic therapy with rifampin. We hypothesize that the clinical response observed is secondary to induction of cytochrome P450 with increased hepatic metabolism of endogenous corticosteroids and a reduction in systemic cortisol levels.

PURPOSE To evaluate the hyperreflective foci in branch retinal vein occlusion and central retinal vein occlusion depicted by spectral-domain optical coherence tomography (OCT). METHODS Consecutive series of 73 eyes of 73 patients with retinal vein occlusion (58 branch retinal vein occlusion and 15 central retinal vein occlusion) who had Spectralis OCT images obtained were retrospectively reviewed, comparing color fundus photographs and fluorescein angiography. RESULTS Hyperreflective foci were detected in 54 eyes (74.0%) by spectral-domain OCT, and hard exudates were detected in 17 eyes (23.3%) by color fundus photography. Hard exudates on the color photographs corresponded to the confluence of hyperreflective foci mainly around the outer plexiform layer in the unaffected areas on the spectral-domain OCT images, whereas fine hyperreflective foci were scattered in all retinal layers of the affected areas (P < 0.001). Most eyes with hyperreflective foci attached to the inner side of the external limiting membrane also had serous retinal detachment (P < 0.001). Compared with diabetic macular edema, we did not find subfoveal hard exudates in retinal vein occlusion. CONCLUSION Hyperreflective foci delineated on spectral-domain OCT suggest the pathogenesis regarding the flow of extravasated blood constituents in retinal vein occlusion.

BACKGROUND Sympathetic ophthalmia is a rare, bilateral, diffuse granulomatous uveitis that usually occurs after open globe injury or intraocular surgery. To our knowledge, findings of this condition using spectral-domain optical coherence tomography have not been previously described. METHODS Case report. RESULTS A case of sympathetic uveitis after a tectonic corneal-scleral keratoplasty because of a fungal keratitis is reported. Spectral-domain optical coherence tomographic images revealed a multilobular serous retinal detachment in the sympathizing eye. The subretinal space was divided by thin septa into compartments filled with subretinal fluid and some high reflective compounds. CONCLUSION Spectral-domain optical coherence tomographic imaging noninvasively demonstrated a multilobular serous retinal detachment in the sympathizing eye, sharing the same features previously reported in patients with Vogt-Koyanagi-Harada syndrome.

PURPOSE To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. METHODS The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. RESULTS The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). CONCLUSION An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Purpose To report cases of intraocular inflammation after intracameral injection of a very high dose of cefuroxime at the end of uneventful cataract surgery. Setting Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France. Design Case series. Methods Patients were followed on an outpatient basis and were examined postoperatively at 1 and 5 days and 6 weeks. Central macular thickness, angiography, central corneal thickness (CCT), endothelial cell density (ECD), and electroretinography (ERG) were analyzed to evaluate ocular toxicity. Results One day postoperatively, the mean corrected distance visual acuity (CDVA) was 0.95 logMAR ± 0.40 (SD). All the cases had moderate anterior inflammation. Retinal optical coherence tomography scans systematically showed extensive macular edema (mean 843.2 ± 212.7 μm) associated with a large serous retinal detachment. Fluorescein angiograms showed diffuse leakage without abnormal retinal perfusion. At 5 days, the mean CDVA improved significantly to 0.52 ± 0.29 logMAR ( P P =.005). At 6 weeks, the mean CDVA reached 0.09 ± 0.06 logMAR. Modifications in CCT and ECD were similar to those observed after uneventful phacoemulsification. The macular thickness (mean 288.4 ± 22.6 μm) and profile returned to normal in all patients, although ERG recordings showed reduced rod photoreceptor cell function ( P Conclusions Intracameral injection of high doses of cefuroxime induced anterior and posterior inflammation. Without surgical intervention, the final visual outcome was satisfactory in all cases. Long-term retinal function, however, must be assessed through repeated ERG recordings. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

This study aimed to explore predictors of long-term stabilization of polypoidal choroidal vasculopathy (PCV) lesions and vision in response to injection of intravitreal ranibizumab (IVR). The treated eyes had a baseline best corrected visual acuity (BCVA) of at least 0.6 (logarithm of the minimal angle of resolution (logMAR) 0.22). We treated 45 eyes showing BCVA between 0.6 (logMAR 0.22) and 1.0 (logMAR 0), with IVR for 3 consecutive months. All eyes were confirmed to have subfoveal PCV prior to starting this treatment regimen. Additional IVR was administered at the subsequent monthly visits, if necessitated by evidence of persistent PCV, for up to 23 months after the first ranibizumab injection. The subjects were then carefully followed-up for 24 months, allowing detailed retrospective evaluation of changes in mean BCVA, central retinal thickness (CRT), serous retinal detachment (SRD), hemorrhage, and polypoidal lesion numbers. The relationships between retreatment and each of the baseline characteristics and SRD development during follow-up were analyzed. The mean logMAR BCVAs were 0.111 ± 0.076, 0.068 ± 0.206 (P = .0033) and 0.115 ± 0.265 (P = .27) at baseline and at 12 and 24 months, respectively. At 24 months, 87% of eyes had BCVA of 20/40 or better. Not requiring retreatment between 12 and 23 months was found to be significantly associated with the absence of retinal pigment epithelial detachment (RPED) at baseline (odds ratio: 0.262 (95% confidence interval (CI): 0.073–0.946). The rates of retreatment from 12 to 23 months were significantly higher in eyes with SRD at 6 and 12 months than in those without SRD (P = .004 and P

The purpose of this study was to evaluate the effect of intravitreal injection of bevacizumab on subretinal fluid associated with choroidal osteoma.In this retrospective noncomparative case series, eyes with serous retinal detachment involving the macula were treated with intravitreal injection of bevacizumab (1.25 mg/0.05 mL) and carefully followed-up with complete ophthalmic examination, including angiography and optical coherence tomography. The changes in best-corrected visual acuity and central foveal thickness were assessed by optical coherence tomography.Six eyes received intravitreal injection of bevacizumab for serous retinal detachment. Only one eye had choroidal neovascularization associated with serous retinal detachment. The mean number of injections for the 6 eyes was 2.0 during the mean follow-up period of 11.3 months. The median logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.70 (Snellen equivalent, 20/100) at baseline to 0.30 (Snellen equivalent, 20/40; P = 0.043) at the final visit. The optical coherence tomography result also showed a significant reduction in central foveal thickness with a median central foveal thickness of 357.0 microm at baseline and 169.50 microm at the final visit (P = 0.028). The treatment was well tolerated, without ocular or systemic adverse events.Intravitreal injection of bevacizumab for serous retinal detachment secondary to choroidal osteoma resulted in both visual and anatomical improvements.

PURPOSE The purpose of this study was to examine indocyanine green angiography of eyes with central serous chorioretinopathy (CSC). METHODS We retrospectively studied the medical records of 39 patients (41 eyes) with active CSC who were

Purpose: We report the management of a young woman with preeclampsia of pregnancy who developed bilateral Purtscher-like retinopathy and serous retinal detachment subsequently complicated by macular hole and tractional retinal detachment. Methods: The best-corrected visual acuity was 20/1000 bilaterally. Fundus examination showed a picture of Purtscher-like retinopathy bilaterally and a macular hole in the right eye. Fluorescein angiography showed areas of capillary dropout and Elschnig spots bilaterally. Optical coherence tomography confirmed the macular hole in the right eye and a shallow serous retinal detachment bilaterally. Systemic and laboratory workup was unremarkable. Triamcinolone acetonide (4 mg/0.1 mL) was injected intravitreally in the left eye; vitrectomy was advised for the right eye. However, when the patient returned after 4 months, the right eye had developed a macular tractional retinal detachment. Vitrectomy, membrane peeling, and gas tamponade were performed. Results: When the patient returned 4 months after the intravitreal injection in the left eye, best-corrected visual acuity had improved to 20/40 with complete resolution of serous retinal detachment in that eye. Best-corrected visual acuity in the right eye remained at 20/1000 but with anatomic deterioration. One month after vitrectomy for the macular hole and tractional retinal detachment in the right eye, best-corrected visual acuity improved to 20/240 with normalizing foveal contours. Status quo was observed in both eyes for the next 8 months. Final best-corrected visual acuity was 20/200 in the right eye and 20/40 in the left eye. Conclusion: An unusual combination of Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy and its complication-macular hole with tractional retinal detachment-were managed by surgery and pharmacotherapy.

Purpose To study the retinal structural changes associated with a retinal arterial macroaneurysm and their association with visual prognosis. Methods We studied retrospectively the medical records of 44 eyes of 44 patients with a retinal arterial macroaneurysm; all eyes showed hemorrhagic and/or exudative changes of the fovea with a visual disturbance. The retinal structural changes were examined by optical coherence tomography (OCT). Results At the initial visit, 30 eyes (68%) showed severe hemorrhagic complications. In eyes with subretinal hemorrhage beneath the fovea, retinal structure was relatively preserved at the initial visit. At the final visit, however, foveal structure was often degenerated, especially in its outer aspect, with limited visual recovery. The 14 eyes (32%) with minimal hemorrhagic complications showed an extensive exudative change caused by the aneurysm. In 13 of these eyes, OCT examination revealed extensive retinal edema, predominantly in the outer retina. Retinal edema beneath the fovea caused a focal serous retinal detachment in 12 eyes. Eight eyes with extensive exudative change showed an accumulation of hard exudates in the macular area, and visual recovery of these eyes was often limited. Conclusion Subretinal hemorrhage or extensive exudative change from a retinal arterial macroaneurysm can cause destruction of the foveal outer photoreceptor layer, resulting in a poor visual outcome.

PURPOSE: To evaluate the differences in the optical coherence tomographically determined macular morphology in eyes with polypoidal choroidal vasculopathy (PCV) from eyes with exudative age-related macular degeneration (AMD) quantitatively. METHODS: The medical records of 208 eyes of 203 Japanese patients with PCV or exudative AMD who were newly treated for choroidal neovascularization were reviewed. The six linear, low-resolution, high-speed scans of 6 mm were analyzed using a manually assisted computer algorithm, which allowed us to manually draw spline lines arbitrarily on the images so that the subretinal fluid and neurosensory retina could be segmented. The thickness of the neurosensory retina and height of the serous retinal detachment (SRD) within the central 3-mm and 6-mm areas were calculated. RESULTS: SRDs were observed in 53% (63/119) of the eyes with exudative AMD and in 78% (69/89) of the eyes with PCV (P < 0.001). The height of the SRD was 21.9 +/- 3.7 microm (+/-SEMs) in eyes with exudative AMD and 56.3 +/- 7.4 microm in eyes with PCV (P < 0.001). The thickness of the neurosensory retina was 300.0 +/- 5.2 microm in eyes with exudative AMD and 275.8 +/- 4.7 microm in eyes with PCV (P < 0.001). CONCLUSION: Eyes with PCV are characterized by a higher incidence of SRDs, greater SRD height, and less intraretinal edema than eyes with exudative AMD.

To investigate the causes of macular serous retinal detachment without hemorrhage at the macula in patients 40 years and older.Seventy-one eyes of 71 consecutive Japanese patients 40 years and older with the disease were examined using optical coherence tomography, digital simultaneous fluorescein and indocyanine green angiographies with a confocal laser scanning system.Of 71 eyes, 17 eyes (24%) had central serous chorioretinopathy, including three eyes with chronic central serous chorioretinopathy, 40 eyes (56%) had polypoidal choroidal vasculopathy (PCV), 10 eyes (14%) had occult choroidal neovascularization secondary to age-related macular degeneration, one had Harada disease, and another had retinal macroaneurysms. In two eyes, the diagnosis could not be established because of difficulty differentiating among chronic central serous chorioretinopathy, PCV, and occult choroidal neovascularization. Thirty-eight of 59 (64%) eyes of patients in the sixth decade of life and older had PCV.Polypoidal choroidal vasculopathy is a primary cause of macular serous retinal detachment without hemorrhage in Japanese patients over 50 years of age. Since clinical and fluorescein angiographic findings are indistinguishable among central serous chorioretinopathy, PCV, and occult choroidal neovascularization, indocyanine green angiography might help to establish a more definitive diagnosis.

PURPOSE To describe a case of spontaneous resolution of retinal angiomatous proliferation (RAP) in a patient with age-related macular degeneration. METHODS A 67-year-old woman complained about progressive visual loss in the right eye. Visual acuity was 20/50 in the right eye and 20/20 in the left eye. Detailed ophthalmoscopic examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography of the right eye were performed. RESULTS Fundus examination of the right eye revealed a small extrafoveal hemorrhage with a few hard exudates around a serous retinal elevation. Fluorescein angiography showed late-phase staining with an area of hyperfluorescence interpreted as occult neovascularization. The middle-phase indocyanine green angiograms showed a focal "hot spot" with late intraretinal leakage. Optical coherence tomography performed through the hot spot shown by indocyanine green angiography demonstrated a localized area of increased intraretinal reflectivity and subfoveal optically empty areas corresponding to serous retinal detachment. The patient was diagnosed with stage II RAP. Treatment was recommended, but the patient was lost to follow-up. Five months later, the patient returned to our department with visual acuity of 20/30 in the involved eye. Spontaneous resolution of the angiographic leakage shown by both fluorescein angiography and indocyanine green angiography and restoration of the normal retinal layers by optical coherence tomography were observed. CONCLUSIONS To our knowledge, this is the first known case in which angiographic and optical coherence tomography findings depicted the spontaneous regression of RAP.

PURPOSE To describe the clinical characteristics of macular complications on the border of an inferior staphyloma associated with tilted disk syndrome. METHODS We reviewed retrospectively the medical records of 32 consecutive eyes of 20 patients with tilted disk syndrome and an inferior staphyloma lying across the macula. RESULTS In 21 (66%) eyes, fluorescein angiography showed window defects on the border of the staphyloma, where the early phase of indocyanine green angiography showed hypofluorescence due to atrophy of the choriocapillaris. On the late phase of indocyanine green angiography, 19 eyes (59%) showed hyperfluorescence along the border of the staphyloma, which often extended beyond the area of the window defect. Of the 32 eyes, 25 (78%) had macular complications: polypoidal choroidal vasculopathy in 7 (22%), classic choroidal neovascularization in 1 (3%), focal serous retinal detachment without polypoidal choroidal vasculopathy or choroidal neovascularization in 13 (41%), and atrophy of the retinal pigment epithelium alone in 4 (13%). Visual acuity in eyes with polypoidal choroidal vasculopathy or choroidal neovascularization was significantly worse than that in eyes with other complications (P < 0.001). CONCLUSIONS Eyes with tilted disk syndrome often have macular complications on the border of the inferior staphyloma, which can cause severe visual loss.

Purpose: To describe the autofluorescence features of orange pigment (intracellular lipofuscin) overlying small presumed choroidal melanomas. Methods: The diagnostic testing results (fluorescein angiography, optical coherence tomography, and fundus autofluorescence imaging) for two patients with pigmented choroidal melanoma and two patients with nonpigmented choroidal melanoma were reviewed. Results: Clinically, the intracellular lipofuscin pigment appeared brown overlying the nonpigmented melanoma (two cases) and orange overlying the pigmented melanoma (two cases). Fluorescein angiography demonstrated that the lipofuscin pigment displayed fluorescein blockage in all four cases. Optical coherence tomography revealed serous retinal detachment in all four cases. Fundus autofluorescence imaging showed discrete, bright hyperautofluorescence of the orange pigment separated by hypoautofluorescent voids. The melanoma was isoautofluorescent. Conclusions: Intracellular lipofuscin overlying small choroidal melanomas shows discrete and bright hyperautofluorescence. The brightness correlates directly with the clinically visible orange pigment.

Purpose: To describe eight patients with active toxoplasmic retinochoroiditis (RC) who had features suggestive of acute choroidal ischemia. Methods: A retrospective review of the clinical records of 23 consecutive patients with acute toxoplasmic RC was performed. All patients underwent detailed ophthalmic examination at presentation and throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography, and indocyanine green (ICG) angiography. Results: Of 23 patients, 8 (34.8%) had a large area of retinal whitening surrounding a small focus of RC. Fluorescein as well as ICG angiography showed a well demarcated geographic area of early choroidal hypofluorescence that extended beyond the clinical borders of the white retinal lesion, particularly by ICG angiography. Associated findings for these 8 patients included old retinochoroidal scars (7 [87.5%]), serous retinal detachment (3 [37.5%]), retinal hemorrhages (1 [12.5%]), and multiple satellite dark dots by ICG angiography (6 [75%]). Seven of eight patients were treated using a combination of antitoxoplasmic drugs and corticosteroids. All findings seen at the acute stage resolved in 2 weeks to 6 weeks. A small atrophic retinochoroidal scar replaced the active toxoplasmic lesion and was surrounded with mild or moderate retinal pigment epithelium changes that were associated with decreased final visual acuity in 2 patients (25%). Conclusion: Patients with toxoplasmic RC may develop features suggestive of choroidal ischemia that can result in a transient or permanent decrease in vision. Choroidal ischemia can only be suspected clinically, and fluorescein angiography and ICG angiography are required to establish the definitive diagnosis.

Purpose: To report the successful resolution of an endophytic optic disk hemangioma (ODH) by photodynamic therapy. Methods: Case report. Results: A 48-year-old man presented with endophytic ODH in his right eye. His best-corrected visual acuity was 1.2 in the right eye, but there was a serous retinal detachment with exudations extending from the tumor. Two intravitreal injections of bevacizumab were given with an interval of 6 months; however, the size of the ODH continued to increase and the best-corrected visual acuity decreased from 1.2 to 0.2. One year after the last injection of bevacizumab, 2 sessions of photodynamic therapy were performed with an interval of 4 months. The follow-up examination 2 years after the second photodynamic therapy showed that the ODH was reduced in size and its activity was low. The best-corrected visual acuity remained at 0.3. Conclusion: The findings indicate that photodynamic therapy can be an effective therapy for eyes with an ODH.

Purpose The authors report the physiopathogenetic features of bilateral serous neurosensory retinal detachments occurring in patients who have undergone organ transplantation. Methods The clinical and photographic findings of four patients who have undergone renal (3 cases) and liver (1 case) transplantation in whom bilateral serous retinal detachment developed early after surgery were reviewed. The patients were processed for clinical symptoms, visual acuity evaluation, slitlamp and fundus examinations, tonometry and fluorescein angiography. Results Ocular examination, in patients complaining of blurred vision and metamorphopsia, revealed loss of visual acuity, bullous serous neurosensory retinal detachment with retinal pigment epithelial detachments in fundus examination and areas of dye leakage in fluorescein angiography, despite tonometry and slitlamp examination were unremarkable. These alterations were spontaneously resolved with the normalization of renal function. Conclusion The only common factor in each of the four patients resulted in alterations of the kidney function. This finding provides further evidence that renal failure may cause alterations in electrolytes extracellular distribution, leading to the formation of serous neurosensory retinal detachments.

To evaluate the incidence of serous retinal detachment (SRD) secondary to a branch retinal vein occlusion (BRVO) by using optical coherence tomography (OCT).Fourteen eyes of 14 patients with a BRVO underwent a detailed history, ophthalmoscopic examination, and fluorescein angiographic evaluation. They were also studied with OCT.The 14 patients included eight women and six men with a mean age of 73.6 +/- 10.5 years (range, 55-90 years). Four eyes were found to have cystoid macular edema by fluorescein angiography, whereas 10 cases were detected by OCT. SRD involving any portion of the macula was found in 10 (71.4%) of the 14 eyes, and SRD extending into the fovea was found in six (42.9%) eyes. Two (14.3%) of the 14 patients also showed a subfoveal hemorrhage that appeared to have gravitated inferiorly through the SRD to the dependent portion of the detachment.That few patients with SRD secondary to a BRVO discovered by ophthalmoscopy have been reported in the literature would suggest that this is an uncommon complication. The authors found with OCT that SRD commonly occurs in BRVO. In addition, subretinal hemorrhage may occur in the context of BRVO, and the authors propose that blood gravitates through the subretinal fluid to settle behind the retina.

Background Ocular manifestations of Lyme disease are uncommon. There has not been a documented case of serous retinal detachment and chorioretinal folds because of Lyme disease that have resolved after only antibiotic treatment. Methods (case report) A 69-year-old white man with a history of recent tick bites presented with a gradual decrease in visual acuity in the left eye. Initial visual acuity was 3/200 in the left eye. Examination revealed an inferior, serous, macula-off retinal detachment. Chorioretinal folds were also noted. Lyme screening antibody test (enzyme-linked immunosorbent assay) was positive and a confirmatory Western blot was immunoglobulin M negative and immunoglobulin G positive. Results Oral amoxicillin (500 mg 3 times daily for 2 weeks) was given followed by intravenous ceftriaxone (2 g daily for 4 weeks). After two weeks of ceftriaxone, fundus examination and ultrasonography showed complete reattachment of the macula and periphery, and only mild residual chorioretinal folds remained on fluorescein angiogram. Conclusion We suggest that Borrelia burgdorferi infection led to choroidal inflammation with secondary chorioretinal folds and a serous retinal detachment, which resolved with antibiotic therapy alone. This supports the suspicion of an intraocular infection, perhaps involving the choroid, as opposed to a secondary autoimmune reaction.

PURPOSE: To evaluate alterations in the retinal vasculature overlying pigment epithelial detachments (PED) in exudative age-related macular degeneration (ARMD) using indocyanine green and fluorescein angiography. METHODS: Forty-one patients (41 eyes) with a clinical diagnosis of exudative ARMD with PED underwent simultaneous fluorescein and indocyanine green angiography, also under high (10 degrees ) magnification. Vascular abnormalities in the retina were compared between patients with vascularized (n = 34, group 1) and nonvascularized (n = 7, group 2) PED on indocyanine green angiography and correlated with the size of the PED and the presence of serous retinal detachment. RESULTS: In all, 67 vascular abnormalities were found by indocyanine green angiography and only 22 by fluorescein angiography; this finding was statistically significant (P < 0.0001). The finding of retinal vasculopathy (32 patients in group 1 and two patients in group 2) was directly correlated with the presence of choroidal neovascularizations (P = 0.002). There was also a direct correlation between the presence of choroidal neovascularization and size of the PED (P = 0.03). The number of retinal vascular findings was not significantly correlated with serous elevation of the retina. CONCLUSIONS: Retinal vasculopathies may be observed in eyes with PED and are detectable by indocyanine green and fluorescein angiography.