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Purpose: To compare the superficial (FAZ-S) and deep foveal avascular zones (FAZ-D) of non-infectious anterior and posterior uveitis to healthy controls, using optical coherence tomography angiography (OCTA)., Methods: OCTA was performed on 74 eyes: 34 eyes with non-infectious posterior uveitis (with (post+CME) and without macular edema (post-CME)), 11 eyes with non-infectious anterior uveitis (with (ant+CME) and without macular edema (ant-CME)), and the control group which included 29 healthy eyes., Results: Eyes suffering from non-infectious posterior uveitis presented with significantly larger FAZ-D when compared to healthy controls, both in the presence or in the absence of macular edema (p < 0.001). In the presence of macular edema, eyes presenting with anterior uveitis (ant+CME) also showed significantly larger FAZ-S (p = 0.03) and FAZ-D (p < 0.001), when compared to healthy controls. In the absence of macular edema, eyes with anterior uveitis cannot be distinguished from controls (p > 0.6)., Conclusion: The deep retinal foveal avascular zone seems to be enlarged in eyes presenting with non-infectious posterior uveitis, both in the presence or absence of macular edema.

Purpose: To evaluate the changes of outer retinal tubulations (ORTs) as seen on spectral-domain optical coherence tomography (SD OCT) in eyes with neovascular age-related macular degeneration (AMD) where treatment was switched from intravitreal ranibizumab to intravitreal aflibercept., Methods: This was a prospective study of eyes diagnosed with neovascular AMD and previously treated with >6 intravitreal ranibizumab injections and switched to aflibercept, conducted at a single centre (Department of Ophthalmology at Pitié Salpetriere Hospital, Paris VI University) from January to July 2015. Before and after treatment was switched from ranibizumab to aflibercept, SD-OCT was used to evaluate the presence of ORTs. Additional assessments in this patient group included best-corrected visual acuity (BCVA), fluorescein angiography (FA), indocyanine green angiography (ICGA). Changes in pigment epithelium detachments (PED), presence of intraretinal cysts, and presence of subretinal fluid (SRF) were also noted., Results: Twenty-four eyes of 24 consecutive patients (15 female/nine male, mean age 70 years) diagnosed with neovascular AMD and previously treated with >6 intravitreal ranibizumab injections and switched to aflibercept were included in the analysis. After receiving aflibercept, patients were followed for a mean of 6.1 months. Prior to treatment switch, 97 % of eyes showed ORTs, while after treatment switch to aflibercept, at the end of the study period, 75 % had ORTs (p =  0.219). Changes in BCVA (LogMAR) were not statistically significant (1.16 ± 0.44 to 1.18 ± 1.06, p =  0.12), however, a significant reduction in central macular thickness (CMT) (from 406 μm ± 112 to 263 μm ± 68, p =  0.001), PED (from 70.8 % to 41.7 % , p =  0.016), presence of intraretinal cysts (from 83.3 % to 33.3 %, p =  0.002) and SRF (from 91.7 % to 25 %, p = 0.001 ) were noted., Conclusion: After switching from ranibizumab treatment to aflibercept, ORTs remained present in 75 % of eyes, and significant reductions in CMT, PED, and SRF, and presence of intraretinal cysts were observed.

Purpose: To determine the presence of clinicopathological correlations for primary intraocular non-Hodgkin lymphoma (NHL)in fluorescein angiographies (FA), indocyanine green (ICGA) angiographies, and optical coherence tomography (OCT) images., Design: Comparative retrospective interventional case series., Methods: Institutional practice. All serial patients who underwent vitreous sampling for cytological analysis over a 70-month period were reviewed. Clinical, angiographic, and tomographic findings present prior to tissue diagnosis were re-evaluated in a masked fashion., Results: Cytological analysis of 256 vitreous specimens from 244 patients was performed. The final diagnoses were infections in 42 cases (17.2%) and immune-mediated diseases in 34 cases (13.9%). In 59 cases (24.2%), neoplastic disease was present, and 53 (21.7%) of these were primary intraocular NHL. OCT images showed nodular hyperreflective lesions in the retinal pigment epithelium (RPE) of both intraocular NHL and nonintraocular NHL patients. Clusters of numerous hypofluorescent small lesions revealed by FA that corresponded to punctate whitish lesions in the fundus and rare round clustered hypofluorescent lesions revealed by ICGA were associated with intraocular NHL diagnosis. The positive predictive value was 88.9% and the negative predictive value was 85%. The odds ratio risk was 45.22., Conclusion: The presence of clusters of round stable hypofluorescent lesions in FA that are scarce in ICGA, with corresponding RPE hyperreflective nodular lesions on OCT, warrants obtaining biopsies for cytology, immunostaining, and molecular biology exams.

Purpose: Susac syndrome is a rare microangiopathy of the brain, retina, and cochlea that mainly affects young women. We studied the management of this disease using retinal fluorescein and indocyanine green angiographies., Methods: Retrospective, observational case series of seven patients with Susac syndrome identified in ophthalmology and internal medicine departments. We reviewed medical, ophthalmologic, and angiographic records at study enrollment and during long-term treatment. Mean follow-up was 37 months. Best-corrected visual acuity, intraocular inflammation score, ophthalmoscopy data, automated perimetry score, and fluorescein and indocyanine green angiographic features were analyzed with the results of cerebral magnetic resonance imaging and spinal fluid analysis and ENT signs., Results: Retinal fluorescein angiography showed focal nonperfused retinal arterioles with hyperfluorescent walls in all cases. Indocyanine green angiography showed normal choroidal circulation. Retinal vasculitis was uncontrolled in a patient treated with steroids. Improvement of retinal arteriole perfusion occurred during immunosuppressive treatment with cyclophosphamide., Conclusion: Absence of intraocular inflammation and focal, labile nonperfused retinal arterioles with integrity of choroidal circulation are monomorphic ophthalmologic features that could immediately suggest the diagnosis of Susac syndrome. Early ophthalmologic examination aided by retinal fluorescein angiography could be useful for managing cases of unexplained neurologic symptoms in women.

Objective: To report features of retinal fluorescein (FA) and indocyanine green (ICGA) angiography and optical coherence tomography (OCT) at successive stages of Vogt-Koyanagi-Harada (VKH) disease., Methods: FA and ICGA were systematically performed in cases of VKH disease, at admission, 1 month later, and at the end of the follow-up. In addition, the most recent patients underwent OCT. In the follow-up, the clinical evolution and extent of treatment were related to the angiographic and tomographic features., Results: FA and ICGA showed a diffuse delayed choroidal perfusion, including a delayed arterial, choriocapillar, and venous filling. This delayed choroidal perfusion involved the posterior pole and the hole periphery. The classically described serous retinal detachments were slowly filled from numerous pin points that could correspond to leakage through areas of damaged retinal pigment epithelium due to the choroidal ischemia. An uneven background choroidal fluorescence visible at the mid phase of ICGA was the result of multiple hypofluorescent round lesions in the choroidal stroma. Choroidal folds appeared hypofluorescent in FA and hyperfluorescent in ICGA. Some of these angiographic findings were present at the very early neurologic stage of the disease. Moreover, under treatment, a persisting altered choroidal perfusion could increase the incidence of retinal detachment relapses., Discussion: Various pathological conditions are characterized by choroidal involvement and serous retinal detachment. Angiographical findings may be helpful in the diagnosis., Conclusion: FA coupled with ICGA can be an useful tool in the early diagnosis of VKH disease as well as during the tapering of immunosuppressive drugs.

Objective: Birdshot chorioretinopathy (BC) is an ocular inflammatory disease involving both the retina and the choroid. The study goal was to evaluate indocyanine green angiographic features in BC to assess choroidal involvement., Design: Retrospective, observational case series., Participants: Fifty-two patients with BC documented with at least 1 concomitant fluorescein and indocyanine green angiogram., Intervention: Indocyanine green angiography (ICGA) was performed according to a standard protocol used for inflammatory disorders., Main Outcome Measure: Indocyanine green angiographic signs were correlated with fundus photographs, fluorescein angiography, degree of inflammatory activity, and stage of disease., Results: In active disease, three main features were observed. The principal finding, found in 100% of patients, was the presence of hypofluorescent dark dots during the intermediate phase of angiography; their evolutionary pattern was twofold, becoming either isofluorescent or remaining hypofluorescent at the late phase of angiography. The other two signs were fuzzy, indistinct choroidal vessels and late-diffuse choroidal hyperfluorescence. In chronic longlasting disease, the characteristic finding was the presence of hypofluorescent dark dots that persisted in the late phase of disease and is theorized to correspond either to chorioretinal atrophy (irregular geographic pattern) or to persistent choroidal granulomas (round oval form)., Conclusions: Consistent ICGA findings in 52 patients allowed the authors to establish a fairly precise ICGA semiology for BC. This procedure enabled the authors to assess choroidal involvement, and, in selected cases, it also was found to be of diagnostic help and useful to monitor therapeutic intervention.

Objective: Indocyanine green angiography (ICGA) detects fluorescence produced by the ICG molecule in the near infrared wave lengths showing choroidal vascular structures. Indocyanine green angiography may prove useful in the workup of uveitis with choroidal involvement. The authors' purpose was to test a standardized ICGA protocol for posterior uveitis to gather systematic and comparable data and to design a schematic approach for the interpretation of angiographic signs., Design: The proposed ICGA procedure included the search for preinjection fluorescence. In the early phase of ICGA (until +/- 2-3 minutes postinjection), posterior pole frames were taken to detect abnormalities in the retinal and choroidal arteriovenous circulation patterns. During the intermediate phase (12 +/- 3 minutes), posterior pole frames and eight 360 degrees panorama frames were taken to detect fluorescence abnormalities in the background impregnation of the choroid, the same sequence being repeated in the late phase (40 +/- 10 minutes). A cohort of more than 300 patients was analyzed in this standard fashion in 2 centers. PARTICIPANTS AND MAIN OUTCOME MEASURE: Determination of ICGA features and the proposed schematic approach for ICGA interpretation were based on the analysis of 109 cases of posterior uveitis with a well-determined diagnosis., Results: For uveitis, the intermediate and late phases of ICGA were found to yield the most valuable information showing either ICG hyperfluorescence or hypofluorescence or both. The ICG hyperfluorescence, always reflecting increased leakage or staining but not window defects because there is no pigment epithelium screen in ICGA, could originate either from increased leakage of the choriocapillaris, the large choroidal, or the retinal vessels. The characteristic ICG hypofluorescent dark dots indicating impairment of physiologic impregnation of the choroid could take at least five different patterns., Conclusion: To date, ICGA features still are difficult to interpret. The proposed standardized ICGA protocol and schematized interpretation for posterior uveitis will help determine ICGA semiology for these disorders and might give new insights into their pathophysiology.

Since 1996, major advances in the treatment of AIDS have markedly changed the incidence and the prognosis of CMV retinitis. Highly active antiretroviral therapy (HAART) is a combination of nucleoside reverse transcriptase inhibitors and protease inhibitors. This new therapeutic strategy is highly efficient in reducing the HIV viral load and increasing CD4+ T-lymphocyte count. These biological effects are associated with an improvement of immune functions. Clinically, the completely quiescent CMV retinitis and the unusual prolonged relapse-free interval suggest a certain restoration of immune functions, making possible the discontinuation of maintenance therapy. For most authors, the decision to stop anti-CMV maintenance therapy is based on a CD4+ cell count >100 cells/μl with a low HIV viral load for at least four months. The improvement of CMV retinitis on HAART may also be associated with an intraocular inflammation called immune recovery vitritis. For some patients, this vitritis may be associated cystoid macular edema and an epiretinal membrane responsible for visual loss. [ABSTRACT FROM AUTHOR]