Search

AIMS: To assess hyperreflective foci (HF) number in angioid streaks (AS) by means of spectral-domain optical coherence tomography (SD-OCT). METHODS: Observational and cross-sectional study. Sixty-two eyes with AS and 62 controls underwent best-corrected visual acuity (BCVA), fundoscopy, and SD-OCT. HF were assessed on the horizontal scan of a six-line radial OCT, in the fovea (1500-μm diameter) and parafovea (500 μm external to the fovea), and sub-classified as retinal or choroidal, small or large. Eyes were distributed in one of four groups, as carrying foveal AS without choroidal neovascularization (CNV) (14 eyes), extra-foveal AS without CNV (14), active CNV (20), and inactive CNV (14). Primary outcome was HF assessment in AS. Secondary outcomes included their correlations with BCVA. RESULTS: AS-affected eyes had higher HF numbers. Our sub-analysis revealed that patients with active CNV had a larger number of retinal and choroidal HF than all the other groups, whereas retinal and choroidal foci were significantly increased in inactive CNV only with respect to controls. Interestingly, patients with foveal AS showed HF number increase in the choroid and fovea. BCVA deterioration positively correlated with the total HF number found in the fovea and the choroid. CONCLUSION: HF are significantly increased in patients with AS. Despite being especially evident in active CNV, the increasing number in eyes without CNV might suggest new pathogenetic aspects of the disease.

Introduction: Disorders of vitreoretinal interface represent a rare complication of intravitreal dexamethasone implant injection. Our report describes a new mechanism resulting in cystic roof collapse and emphasizes the importance of a strict optical coherence tomography evaluation during therapy with dexamethasone injection in order to prevent this rare complication. Purpose: To describe the rupture of the cystic roof following treatment with sustained-release dexamethasone implant intravitreal injection (Ozurdex; Allergan, Irvine) for macular edema. Case report: A 71-year-old woman with a known history of macular edema secondary to central retinal vein occlusion in her right eye presented to our ophthalmology department complaining of vision loss after she underwent the fourth dexamethasone injection. Diffuse retinal hemorrhages and a reddish foveal lesion with hyperpigmented borders were observed on dilated fundus examination. On the other hand, spectral domain optical coherence tomography (Spectralis HRA + OCT, Heidelberg Engineering, Germany) revealed the roof dismantlement of a previously documented cyst, giving rise to a lamellar macular hole, with a stable epiretinal membrane in close proximity. On a 12-month follow-up, no anatomical or functional changes were observed. Conclusion: This report depicts a new mechanism leading to macular hole as a complication of numerous intravitreal dexamethasone injections, resulting in cystic roof collapse. Although we acknowledge the rarity of this complication, our case emphasizes the role of constant spectral domain optical coherence tomography evaluation of the vitreoretinal interface, even in long-standing macular edema without marked signs of vitreous traction.

Background: Retinitis Pigmentosa (RP) represents a retinal dystrophy with an extremely complex pathogenesis further worsened by the impairment of the retinal vascular supply. The main goal of this study was to identify different vascular patterns in RP, by means of optical coherence tomography angiography (OCTA). Methods: A total of 32 RP patients (16 males, 50%, mean age 45.93 ± 11.4) and 32 healthy age-matched controls (16 males, 50%, age 42.8 ± 11.2). High resolution OCT and OCTA images were obtained from all participants. Several quantitative parameters were extracted both from structural OCT and OCTA images. A post-hoc analysis assessed the relationship between the quantitative OCTA parameters adopted and the following measures: best corrected visual acuity (BCVA), central macular thickness (CMT) and retinal nerve fiber layer (RNFL). Results: Mean LogMAR BCVA was 0.24 ± 0.32 for RP patients and 0.0 ± 0.0 for controls (p &lt, 0.01). CMT, choroidal thickness and RNFL were statistically different between RP and controls (p &lt, 0.01). OCTA parameters showed strong alterations of the retinal vascular network in RP (all p &lt, 0.01). Several statistically significant correlations were also found. Furthermore, a vessel tortuosity cut-off of 4.80 and a vessel rarefaction cut-off of 0.62 enabled the RP cohort to be divided into two significantly different sub-groups in terms of BCVA, RNFL and CMT. Conclusions: Quantitative OCTA parameters help identify vascular abnormalities in RP, separating two different vascular patterns.

Purpose: To describe a case of Ellis–van Creveld syndrome with concomitant Usher syndrome. Methods: A 24-year-old lady with a diagnosis of Ellis–van Creveld syndrome came to our attention in 2015 complaining of nyctalopia. She underwent yearly ophthalmologic examinations, including visual acuity, dilated fundoscopy, optical coherence tomography and colour fundus photography. Results: On the day of her first examination, her visual acuity was 20/20, whereas fundus examination revealed diffuse peripheral retinal atrophy with pigmented bone spicules, waxy pallor of the disc and macular sparing in both eyes, compatible with retinitis pigmentosa. Due to the severe retinitis pigmentosa phenotype for the age and the concomitant neurosensory hearing loss, ancillary electrophysiological and genetic tests were requested. At the end of follow-up, visual function remained stable, with electroretinogram tests confirming the peripheral dysfunction. Interestingly, next generation sequencing test revealed a mutation in USH2A gene, suggestive of an overlapping Usher syndrome. On optical coherence tomography angiography, all plexuses appeared altered, with some degree of impairment also in the choriocapillaris of the spared macula. Conclusion: Our report emphasizes the advantage of new genetic tests to investigate atypical presentations of known retinal disorders found in syndromic settings. In addition, we speculate that the underlying ciliopathy might possibly aggravate the phenotype of this case of Usher syndrome.

Torpedo maculopathy is characterized by a congenital, unilateral, and torpedo-shaped chorioretinal lesion with unclear pathogenesis and evolution. Although the optical coherence tomography angiography (OCTA) characteristics have already been defined in literature, the authors describe for the first time the presence of choroidal neovascularization (CNV) on the temporal edge of this lesion in a 36-year-old woman with a history of altered visual field in her left eye. The authors' investigation supports the hypothesis of an aberrant choroidal circulation underlying the pathogenesis of this condition, and proves the advantage conferred by OCTA in CNV detection over the other angiographic techniques. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:e210–e213.]

Purpose To describe a case of bilateral choroidal neovascularization (CNV) in multifocal choroiditis (MFC) associated with dabrafenib and trametinib chemotherapy for metastatic melanoma. Case We present a case of a 57-year-old man with MFC who underwent combination therapy with dabrafenib plus trametinib for metastatic melanoma. The patient presented to our ophthalmology department complaining of bilateral vision loss of 2 days’ duration. He underwent multimodal imaging showing a MFC reactivation complicated by bilateral CNV. The patient underwent 3 ranibizumab injections in the right eye and 7 ranibizumab injections in the left eye. Anatomical and functional improvement has been observed. Conclusions This report emphasizes the importance of strict ophthalmologic follow-up in patients with metastatic melanoma treated with dabrafenib plus trametinib since rare severe ocular toxicities can occur, especially in patients with a history of uveitis.

Purpose To report the case of a 61-year-old woman with pancreas divisum and an asymptomatic chorioretinal coloboma in its 2 forms: complete and partial. Methods Case report. Results Dilated fundus examination and photograph revealed a complete and partial coloboma in the right eye. Swept-source optical coherence tomography and swept-source optical coherence tomography angiography (SS-OCTA) were performed. Swept-source optical coherence tomography angiography disclosed the complete coloboma as a black, round, avascular area surrounded by normal vascular tissue in every plexus (i.e., superficial, deep, and choriocapillary). Although irregular and attenuated, the vascular network of the partial coloboma was appreciable in each layer, indicating some degree of vascular preservation. Conclusions Chorioretinal coloboma has been linked to several ocular and systemic conditions. To our knowledge, no association between coloboma and pancreas divisum has been reported. In addition, chorioretinal coloboma has not been previously characterized by means of SS-OCTA.

A 53-year-old women, 20/20 visual acuity in both eyes, showed after dilated fundus examination myelinated retinal nerve fibers (MRNF) on 360 around optic disk in left eye, sparing the macula (A). Swept source optical coherence tomography (SS-OCT) scanning line centered on the optic nerve head (B), showed two vitreous pockets (*) entrapped between highly hyperreflective MRNF and posterior hyaloid; posterior hyaloid appears thickened by hyperreflective tissue that can be interpreted as residual of innermost layer of myelin remained attached after posterior hyaloid separation.