Morphologic Changes in Acute Central Serous Chorioretinopathy Using Spectral Domain Optical Coherence Tomography

PURPOSE: To investigate morphologic changes of acute central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy. METHODS: This retrospective study included 63 eyes of 63 patients with unilateral acute CSC. All patients underwent simultaneous SD-OCT and fluorescein angiography examination using Spectralis HRA+OCT. RESULTS: The external limiting membrane could be seen on SD-OCT, although the junction between photoreceptor inner and outer segments (IS/OS) was not detected in all eyes with retinal detachment (RD). However, IS/OS became visible after resolution of serous RD in 51 eyes (81.0%). SD-OCT images at the leakage sites showed a bump of retinal pigment epithelium (RPE) in in 47 cases (68.1%) and pigment epithelial detachment (PED) in 22 of 69 leakage sites (31.9%). In 14 of 69 leakage sites (20.3%), highly reflective areas suggesting fibrinous exudate were observed in the subretinal space. In nine leakage sites (13.0%), sagging or dipping of the posterior retinal layer was seen. Abnormal RPE changes such as RPE bump and PED were observed in 12 of 22 fellow eyes (54.5%). CONCLUSIONS: A variety of morphologic changes could be identified on SD-OCT, and those findings may contribute more information to our understanding of the pathophysiology of CSC.

Spontaneous Resolution of Intravitreal Steroid-Induced Bilateral Cytomegalovirus Retinitis

A 73-year-old woman underwent vitrectomy and intravitreal triamcinolone acetonide (IVTA) of the right eye and cataract surgery with IVTA of the left eye, for bilateral diabetic macular edema. The patient presented with visual loss in both eyes three-months postoperatively. The fundoscopic examination revealed white-yellow, necrotic peripheral lesions in the superotemporal quadrant of both eyes. Although bilateral acute retinal necrosis was suspected, azotemia resulting from diabetic nephropathy limited the use of acyclovir. Antiviral treatment was not started. A sample of the aqueous humor for polymerase chain reaction (PCR) analysis was obtained. One week later, the PCR results indicated the presence of cytomegalovirus (CMV). Since the retinal lesions did not progress and did not threaten the macula, the patient was followed without treatment for CMV. The retinal lesions progressively regressed and completely resolved in both eyes by six months of follow-up. Patients with IVTA-induced CMV retinitis may not require systemic treatment with ganciclovir.

Spectral Domain OCT Findings of Asymptomatic Fellow Eyes in Central Serous Chorioretinopathy

PURPOSE: To investigate morphologic changes in the asymptomatic fellow eye of central serous chorioretinopathy (CSC) using spectral domain optical coherence tomography (SD OCT). METHODS: The present retrospective study included 55 asymptomatic fellow eyes of 55 patients with acute CSC. All patients underwent SD OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA), and the results were analyzed. RESULTS: Sixteen eyes (29.1 %) with normal FA also showed normal SD OCT; however, 70% of the eyes showed choroidal hyperpermeability or punctate hyperfluorescent spots on ICGA. Window defects on FA were observed in 25 eyes (45.5%), and they were represented as a corrugation or bump in the retinal pigment epithelium (RPE) on SD OCT. Retinal pigment epithelial detachments (PEDs) were observed in six eyes (10.9 %) on FA and were represented as PEDs on SD OCT. Leakages on FA were observed in ten eyes (18.2%) and were represented as normal, serous retinal detachment, and a corrugation or bump of RPE on SD OCT. CONCLUSIONS: Greater information regarding morphologic changes and pathophysiology of CSC can be obtained by investigating SD OCT findings in the asymptomatic fellow eyes of acute CSC.

Effects and Prognostic Factors of Intravitreal Bevacizumab Injection on Choroidal Neovascularization from Age-Related Macular Degeneration

PURPOSE: To investigate the effects and prognostic factors related to intravitreal injection of bevacizumab on patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: The medical records of patients who received 3 consecutive intravitreal injections of bevacizumab (1.25 mg/0.05 ml, 6 weeks interval) for subfoveal choroidal neovascularization secondary to age-related macular degeneration and followed up for more than 12 months were reviewed (a total of 31 eyes; male, 20; mean age, 72.3+/-7.5 years). Baseline best corrected visual acuity, foveal thickness, and total macular volume were compared with those after 1, 4, and 12 months. The therapeutic effects were investigated with regard to factors such as age, sex, initial visual acuity, lesion size, subtypes of choroidal neovascularization, pigment epithelial detachment, submacular hemorrhage, and previous history of photodynamic therapy. RESULTS: Initial visual acuity (logMAR), foveal thickness, and total macular volume were 0.74+/-0.49, 320+/-88 microm and 9.50+/-2.99 mm3, respectively. Visual acuity improved to 0.68+/-0.61 (p=0.012), and foveal thickness and total macular volume decreased to 218+/-69 microm and 6.32+/-0.71 mm3 (p<0.001), respectively, at 12 months. Visual improvement was achieved less often in patients who were 75 years or older and who had lesions 3 disc areas or greater and relatively good initial vision at 12 months. CONCLUSIONS: Intravitreal bevacizumab injection has beneficial effects for patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration with regard to function and anatomy. However, it should be noted that visual improvement may be limited in older patients with larger lesions and good initial vision.

Best Disease With Old-age Onset Misdiagnosed as Chronic Central Serous Chorioretinopathy: A Case Report

PURPOSE: To report a case of Best's disease with old-age-onset with unusual clinical features. CASE SUMMARY: A 68-year-old woman with a six-month history of using oral steroids complained of decreased vision in both eyes. Fundus examination revealed a circular area of macular elevation measuring approximately 1.5 disc diameter size in both eyes. Optical coherence tomography (OCT) showed serous retinal detachment, but pigment epithelial detachment was seen only on fluorescein angiography and indocyanine green angiography. The patient received a diagnosis of chronic central chorioretinopathy with choroidal neovascularization. Photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injections were prescribed as treatment, but were ineffective. For a definitive diagnosis, we performed an electro-oculogram (EOG) and the result was abnormal with an Arden ratio below 1.5 in both eyes. A final diagnosis of Best's disease was established. Spectral domain OCT findings at the last visit showed a clearly visible RPE split and a low reflective space between the split RPE layers, as well as a high reflectivity corresponding to the subretinal material. CONCLUSIONS: We report a case of Best's disease with old-age onset with unusual clinical features and abnormal EOG findings. Spectral domain OCT was helpful in evaluating the disease. Treatment with PDT and IVB was not effective.

Repeatability and Agreement of Macular Thickness Measurement Using Time Domain OCT and Spectral Domain OCT in Normal Subjects

PURPOSE:To compare the repeatability and agreement of macular thickness measurements using time domain (TD) optical coherence tomography (OCT) and spectral domain (SD) OCT in normal subjects. METHODS: Thirty-four normal subjects were included. Three consecutive macular measurements were taken with TD OCT and SD OCT. Total and regional macular thickness and total macular volume obtained by the two OCTs were compared. Within-subject standard deviation (Sw), coefficient of variation (CVw), and the intraclass correlation coefficient (ICC) were calculated to evaluate repeatability. The agreement was examined with Bland Altman plots. The correlation was also evaluated with Pearson correlation coefficients and multiple regression analysis. RESULTS: Sw for foveal thickness, total macular thickness, and total macular volume were 11.53 microm, 7.58 microm, and 0.48 mm3 for TD OCT and 6.69 microm, 2.55 microm, and 0.09 mm3 for SD OCT, respectively. The values for SD OCT were consistently lower, and this result was statistically significant. The range of the respective CVw and ICC values were 1.10~2.78% and 0.78~0.96% for TD OCT, and 0.29~0.94% and 0.92~0.99% for SD OCT, respectively. The SD OCT showed better repeatability for macular thickness measurements(all with p< or =0.001). The spans of 95% limits of agreement for foveal thickness, total macular thickness, and total macular volume were 67.94 microm, 29.01 microm, and 0.98 mm3, respectively. The Pearson correlation coefficient of foveal thickness, total macular thickness, and total macular volume between the two OCT's was statistically significant. CONCLUSIONS: Although both OCTs are reliable for macular thickness measurements, SD OCT shows better repeatability compared with TD OCT. Although macular thickness measurements obtained from the two OCTs can not be used interchangeably due to low agreement by different standards of measurement, there was a statistically significant correlation between the two OCT's.

Four Cases of Pars Plana Vitrectomy for Treatment of Symptomatic Lamellar Macular Holes

PURPOSE: To report the results of pars plana vitrectomy for the treatment of symptomatic lamellar macular holes. CASE SUMMARY: Pars plana vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) stripping was performed for the treatment of lamellar holes in four patients who complained of vision loss or metamorphopsia. In three out of four patients, fluid-gas exchange with 14% C3F8 was performed and patients were instructed to maintain aprone position for 7 days after surgery. Postoperatively, the improvement of visual acuity, foveal contour, and disappearance of metamorphopsia were achieved in three patients. However, full-thickness macular hole (FTMH) developed in one patient after vitrectomy. Repeated fluid-gas exchange was performed and the patient was instructed to maintain a prone position, however, the FTMH did not close. CONCLUSIONS: In patients with visual loss or metamorphopsia, vitrectomy with ERM and ILM stripping appears to be a beneficial treatment. FTMH developed after surgery in one patient, therefore further study is needed to elucidate the prognostic factors for the development of FTMH.