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Ultra-widefield fundus autofluorescence imaging reveals abnormalities in degenerative retinoschisis that allow for the identification of an associated neurosensory detachment confirmed by spectral domain optical coherence tomography., Purpose: To determine whether neurosensory retinal detachment complicating degenerative retinoschisis (RS) can be reliably detected with ultra-widefield fundus autofluorescence evaluation. Methods: Consecutive patients diagnosed with RS who had ultra-widefield fundus autofluorescence imaging were included in this retrospective case series. According to the fundus autofluorescence patterns, we divided the eyes into two groups: 1) eyes with RS and a hyperautofluorescent leading edge and 2) eyes with RS and without hyperautofluorescence. Peripheral spectral domain optical coherence tomography images at the level of RS were obtained. Results: Thirty-eight eyes that met eligibility criteria were identified. Review of ultra-widefield fundus autofluorescence demonstrated 21/39 (55%) eyes with distinctive hyperautofluorescence over the area of RS (Group A) and 17/38 (45%) eyes without any form of hyperautofluorescence (Group B). Spectral domain optical coherence tomography images confirmed the presence of full-thickness neurosensory retina separation from the underlying retinal pigment epithelium in the areas of hyperautofluorescence in 10/10 eyes (100%) from Group A. None (0/11; 0%) of the eyes from Group B showed full-thickness neurosensory retina separation on the spectral domain optical coherence tomography imaging of the retina–RS interface. Conclusion: Hyperautofluorescent findings suggest the presence of a neurosensory retinal detachment. Retinal detachment associated with RS can be reliably detected on ultra-widefield fundus autofluorescence and may be a useful diagnostic imaging modality.

Purpose:Pediatric macular holes occur often related to trauma and rarely require surgical intervention. The purpose of the present study was to evaluate outcomes of microincisional vitrectomy surgery.Methods:A multicenter retrospective consecutive case series was conducted of pediatric patients undergoing surgery for macular hole repair.Results:A total of 31 eyes from 8 centers were included in this study. The mechanism of macular hole development was blunt trauma in 30 eyes (97%) and industrial laser in 1 eye (3%). The rate of anatomic closure after primary vitrectomy was 81% (25 eyes); the final anatomic closure rate after a secondary vitrectomy was 94% (29 eyes). There was a statistically significant improvement in visual acuity from initial presentation (20/164) to final follow-up (20/100) ( P = .009).Conclusions:Microincisional vitrectomy surgery for pediatric macular holes results in substantial anatomic success and modest improvement in visual acuity.

This case series documents a greater incidence of degenerative lamellar macular holes subtype in advance stages of age-related macular degeneration., Purpose: To investigate whether age-related macular degeneration (AMD) has an influence on the prevalence and anatomical characteristics of lamellar macular holes (LMHs). Methods: Clinical records and spectral-domain optical coherence tomography images of 756 eyes of 423 consecutive patients diagnosed with AMD were reviewed and analyzed. Spectral-domain optical coherence tomography was used to identify degenerative or tractional LMH subtypes and assess their morphology. The clinical and optical coherence tomography findings of AMD eyes with LMH were compared with those of a control group of eyes with LMH without AMD from a previously published report. Results: Lamellar macular holes were identified in 25 eyes of 23 patients (3.3%; 25 of 756). Seventeen of 25 eyes (68%) presented with degenerative LMH and underlying late neovascular AMD. Mean best-corrected visual acuity was worse in eyes with AMD and LMH eyes than in those with AMD and no LMH (20/230 vs. 20/98; P = 0.02). The mean outer diameter was greater in the group with degenerative LMH with concomitant AMD than in the control group of degenerative LMH without AMD (1,323.9 ± 999.1 µm vs. 905.9 ± 356.8 µm, respectively; P = 0.01). Conclusion: The incidence of degenerative LMH increased in advanced forms of AMD, whereas the presence of tractional LMH subtype may be unrelated to AMD evolution.

Purpose: To date, little attention has been directed to retinal photoreceptor migration after traumatic macular hole surgical repair in the pediatric population. The purpose of this study was to evaluate optical coherence tomography (OCT) findings in the foveae of pediatric patients with history of traumatic macular hole surgical repair. Methods: Retrospective case series of 3 eyes in 3 pediatric patients with traumatic macular hole surgical repair. Spectral domain OCT images were obtained pre- and postoperatively. Results: We report 3 cases of restoration of the ellipsoid zone with good visual acuity outcomes following macular hole closure. Conclusion: Optical coherence tomography findings of an intact ellipsoid zone may be a predictor of visual acuity and explain better surgical outcomes in the pediatric population.

Background Pediatric retinal disorders, although uncommon, can be challenging to assess in the clinic setting and often requires an exam under anesthesia. The purpose of our study was to evaluate the use of ultra-wide field retinal imaging in children without sedation in an outpatient clinic. Methods We performed a retrospective case series of patients 18 years or younger who received ultra-wide field imaging over a one year period. The age, gender, and clinical course were documented. Color fundus and red-free images were reviewed to assess field of view. Ultra-wide field autofluorescence (UWF-FAF) was evaluated for abnormal autofluorescence patterns and ultra-wide field fluorescein angiography (UWF-FA) was assessed for angiographic phase and field of view. Results A total of 107 eyes of 55 patients with a mean age of 11.1 years (SD 3.7 years, range 3–18 years) were evaluated. Twenty-seven (49%) patients were male. The most common diagnosis was retinopathy of prematurity (7 of 55 patients, 12.7%) followed by trauma (7.4%), Coats disease (7.4%), and rhegmatogenous retinal detachment (7.4%). The number of quadrants visualized anterior to the equator correlated with patient age (r = 0.4, p Conclusions We demonstrated that UWF imaging is obtainable in children as young as 3 years old without sedation. UWF fundus photography, UWF-FAF and UWF-FA were useful clinical adjuvants to examination and provide additional information for documenting and monitoring pediatric retinal diseases.

Purpose To assess the feasibility of imaging extremely low birth weight infants, defined as infants born weighing less than 1000 g or before 27 weeks of gestational age, with an arm-mounted optical coherence tomography angiography (OCTA) device. Methods Cross-sectional case series conducted at a single site in-patient academic center. Subjects included infants who had been born premature and met ROP screening criteria. Birth history such as gestational age and birth weight were collected. Subjects were imaged with OCTA in a supine position during ROP screening and treatment. Segmental errors were manually corrected and FAZ area was calculated from the superficial and deep capillary plexus (SCP, DCP) layers. Main outcomes measures were foveal avascular zone (FAZ) area, ROP stage and treatment. Results Seven ELBW infants were included with an average gestational age of 25 weeks (range = 23-4/7 to 26 weeks) and average postmenstrual age of 54.7 weeks (range = 43–80 weeks) at the time of imaging. Average birth weight was 615 g (range 500–680 grams). Thirteen eyes had ROP treatment including primary laser, anti-vascular endothelial growth factor injection with delayed laser, and scleral buckle. Six infants were imaged under general anesthesia and one infant was imaged without sedation. Average FAZ area was 0.17 mm2 (range = 0.03 mm2–0.37 mm2) in the SCP and 0.04 mm2 (range 0 mm2–0.09 mm2) in the DCP. FAZ area correlated positively to the ratio of outer retinal layer thickness to inner retinal layer thickness at the foveal center in the SCP and DCP (r2 = 0.48, p = 0.02; r2 = 0.46, p = 0.02) and negatively with inner retinal layer thickness in the SCP (r2 = 0.56, p = 0.008). Conclusions and Importance Arm-mounted OCTA was feasible in ELBW infants and provided information about the developing fovea. Measurement of FAZ area and retinal thickness using this modality may be used to study the effects of ELBW, peripheral ROP and ROP treatment on foveal development.

Purpose: We report the case of a 77-year-old man with no history of keratoconus or other ectatic disorders who presented with corneal hydrops in the setting of a corneal ulcer. The risk factors, pathogenesis and treatment options of corneal hydrops are discussed. Method: This is an observational case report study. Results: A 77-year-old man presented with a 1-day history of severe pain, redness, mucous discharge and photophobia in the right eye. A slit-lamp examination of the right eye showed an area of focal corneal edema and protrusion. Within the area of edema and protrusion, there was an infiltrate with an overlying epithelial defect consistent with an infectious corneal ulcer. The Seidel test showed no leakage, so a clinical diagnosis of corneal hydrops associated with nonperforated corneal ulcer was made. With appropriate antibiotic treatment, the corneal ulcer and hydrops both resolved over a 1-month period. Conclusion: Corneal hydrops can occur in the setting of corneal infections.

Purpose To report the Optical Coherence Tomography Angiography (OCTA) results as a novel non-invasive diagnostic modality which provides useful information regarding the status of blood flow in diabetic retinopathy. The current study is a long-term follow-up of eyes of patients with proliferative diabetic retinopathy managed with panretinal photocoagulation. Observations Two patients with proliferative diabetic retinopathy (PDR) were treated with panretinal photocoagulation (PRP) in both eyes in the early 1980s. Fluorescein angiography performed at the baseline visit and follow-up Optical Coherence Tomography Angiography performed at 30 years after initial PRP treatment showed remarkable stability of the perifoveal capillary network. Visual acuity initially and at last follow-up remained 20/25 or better in these patients. Conclusions and importance Fluorescein angiography and Optical Coherence Tomography Angiography demonstrated that the integrity of the perifoveal capillary network remained remarkably stable at 30 years. Similarly, the visual outcomes were stable inspite of advanced PDR at baseline.

Pediatric retinal detachments (RDs) are unique in etiology, anatomy, and prognosis compared with the adult population. The mechanisms of pediatric RD include tractional (TRD), rhegmatogenous retinal detachment, traumatic, and other types, such as exudative or hemorrhagic. This study examined visual and anatomical outcomes of pediatric RD undergoing surgical repair at a single university referral center.A retrospective consecutive case series of patients clinically diagnosed and undergoing surgery for RD between birth and 15 years of age from 2002 to 2013 at a single academic institution.A total of 206 patients (231 eyes) were included in this study, of which 25 (12%) had bilateral RD. Of those patients, 67 (29%) had TRD (retinopathy of prematurity, persistent fetal vasculature, or familial exudative vitreoretinopathy), 51 (22%) had rhegmatogenous retinal detachment (myopia, X-linked retinoschisis, or Stickler syndrome), 60 (26%) had traumatic RD, and 53 (23%) were due to other types of RD, such as Coats disease or coloboma. Presenting best-corrected visual acuity better than 20/200 correlated with better final best-corrected visual acuity (P0.0001). Anatomical success was strongly correlated with visual acuity outcome (P0.00001) and was significantly more likely in rhegmatogenous retinal detachment versus TRD (78% vs. 39%, P0.05). The rates of obtaining a final best-corrected visual acuity20/200 were poorer in TRD (10%) compared with rhegmatogenous retinal detachment (39%, P0.01) or traumatic RD (28%, P0.05).Visual and anatomical outcomes varied among categories of RD. Rhegmatogenous retinal detachments were associated with the best outcomes (anatomical success and globe conservation), whereas TRDs generally had poorer visual and anatomical outcomes.

Ocular manifestations related to atopic dermatitis include keratoconus, keratoconjunctivitis, cataract, and retinal detachment. The authors report three cases of retinal detachment associated with atopic dermatitis. Although the pathogenesis is poorly understood, chronic blunt trauma may play a role in the development of retinal detachment. In addition, retinal detachments associated with atopic dermatitis may have lower rates of successful retinal detachment repair. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:513–517.]

A woman in her early 40s presented to the emergency department with multiple scotomas in both eyes and auditory changes in her left ear. On examination, her visual acuity was 20/25 in both eyes. A fundoscopic examination revealed multiple areas of retinal whitening consistent with ischemia secondary to multiple branched retinal artery occlusions (BRAOs). Fluorescein angiography revealed multiple areas of vascular filling defects and hyperfluorescence of the arterial wall of the arterioles (Figure 1A-C). Hyperfluorescence of the arterioles without associated BRAOs, as seen superonasal to the disc and inferotemporally in the left eye on a fluorescein angiographic image (Figure 1D), are classic signs of Susac syndrome. On a T1-weighted fluid-attenuated inversion recovery sequence magnetic resonance imaging scan, scattered hyperintense foci were present in the periventricular white matter and corpus callosum (Figure 2). Branched retinal artery occlusions can occur with many illnesses, but when associated with white matter lesions, hearing loss, and a lack of thromboembolic disease, they suggest the diagnosis of Susac syndrome. The patient started intravenous methylprednisolone sodium succinate, followed by oral prednisone, with improvement of her symptoms.

Nikisha Kothari, Ajay E Kuriyan, Harry W Flynn JrDepartment of Ophthalmology, Bascom Palmer Eye Institute, MillerSchool of Medicine, University of Miami, Miami, FL, USAAbstract: We report three patients with subretinal bands associated with retinal detachment in chronic retinal detachments who underwent successful retinal reattachment. Subretinal bands before and after surgery can be identified on clinical examination and spectral domain optical coherence tomography. Removal of subretinal bands is not mandatory to achieve retinal reattachment.Keywords: subretinal bands, retinal detachment, optical coherence tomography

Retinal arterial macroaneurysm (RAM) is the outpouching of the wall within the first three orders of the arterial tree. Leakage may occur from the aneurysm or from the surrounding capillaries. If the aneurysm ruptures, then hemorrhage at all levels is possible.

Mutations in the β-globin gene result in erythrocytes that undergo sickling in response to hypoxic, acidotic, and hyperosmolar conditions. Sickled erythrocytes are not pliable thereby resulting in mechanical occlusion of arterioles. Arteriolar occlusion is at the core of sickle cell retinopathy as it causes both nonproliferative and proliferative disease.

A 48-year-old woman noted progressive, painless visual loss in her left eye. She was diagnosed with bilateral optic nerve sheath meningiomas (ONSMs), extending across the planum sphenoidale. Radiation was offered, but the patient declined. She has been followed for more than 27 years with stable visual function and neuroimaging findings. Bilateral ONSMs, although usually described as aggressive in nature, may follow a stable clinical course.

Incisions used for orbital floor exploration continues to remain a topic of controversy. Historically, 3 incisions have been used for orbital floor repair: transconjunctival, subciliary, and subtarsal. Past studies have attempted to stratify the superiority of one incision over the others. Insufficient level of evidence and inconsistent methodology have lead to inconclusive data. Our authors performed a systematic review of literature to assess the quality of evidence in literature and recommend guidelines for incisions for repairing orbital fractures. Thirty-one articles were identified, comprising a total of 4688 incisions. Technique along with individual benefits and complication profiles for each incision is reviewed. Objectivity and follow-up time intervals are necessary parameters for evaluating incisions for orbital floor exploration to further define guidelines.