La tomografía de coherencia óptica en el diagnóstico y evolución de la coroidopatía lúpica. Reporte de caso

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune que afecta múltiples órganos incluidos los ojos. Entre las manifestaciones oculares del LES se encuentra la coroidopatía lúpica (CL), afección poco frecuente, pero de importantes repercusiones visuales si no se trata oportunamente. Se presenta el caso de una paciente de 41 años que desarrolló una CL durante la reducción de su terapia corticoesteroidea para el LES, estudiada con angiofluoresceinografía retiniana y tomografía de coherencia óptica (OCT) para el diagnóstico y seguimiento de su compromiso ocular. Tanto las fugas del colorante como los desprendimientos serosos de retina cedieron con el tratamiento de altas dosis de prednisona, pero recurrieron en dos oportunidades a pesar del control de la enfermedad de fondo. Se enfatizan las características clínicas para permitir su reconocimiento, resaltando el uso de la OCT para su diagnóstico y seguimiento luego del tratamiento.

SUMMARY Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs including the eyes. Among the ocular manifestations of SLE is lupus choroidopathy, a rare condition but with significant visual repercussions if not treated promptly. We present the case of a 41-year-old woman who developed a lupus choroidopathy during the reduction of the dose of corticosteroid therapy for SLE, studied with retinal angiofluoresceinography and OCT for the diagnosis and follow-up of her ocular involvement. Both the dye leaks and the serous retinal detachments resolved with the treatment of high doses of prednisone but recurred twice despite the control of the underlying disease. The clinical characteristics are emphasized to allow its recognition, highlighting the use of optical coherence tomography (OCT) for its diagnosis and follow-up after treatment.

Analysis of influence factors and prevalence of macular choroidopathy in middle-aged and elderly patients with high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To analyze the prevalence and influence factors of macular choroidopathy secondary to high myopia, so as to better understand the development of macular choroidopathy in patients with high myopia.<p>METHODS: The current study carried out a retrospective analysis on highly myopic patients aged 40 and above(2016-01/2019-07). A total of 232 patients(461 eyes)with high myopia were included. The fundus images and OCT results of all patients were evaluated to divide the cases into two main categories, non-choroidopathy 99 patients(255 eyes)and choroidopathy 133 patients(206 eyes), with choroidopathy including choroidal atrophy and choroidal neovascularization. The statistical analysis on the prevalence of different disorders and the multivariate regression between the influence factors were performed.<p>RESULTS: The prevalence of macular choroidopathy was 36.0%(166 eyes), of which, the prevalence of choroidal atrophy was 19.5%(90 eyes), and the prevalence of choroidal neovascularization was 16.5%(76 eyes). Multivariate Logistic regression analysis showed that axial length was the influence factor of choroidal atrophy(P<0.01), age and axial length were the influence factors of choroidal neovascularization(all P<0.01), gender, age and axial length were the influence factors of choroidopathy(all P<0.01).<p>CONCLUSION: Choroidal atrophy and choroidal neovascularization were prone to occur in patients with high myopia, and the prevalence was higher in women. In addition, the prevalence increased with the increase of age and diopter.

A preliminary study of choroidal vascular index in patients with diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the differences of the choroidal vascularity index between type 2 diabetes with diabetic retinopathy and non-diabetes patients.<p>METHODS: A retrospective cross-sectional study was performed at Beijing Friendship Hospital. Enhanced depth imaging spectral-domain optical coherence tomography(EDI-OCT)scans of 68 eyes of 68 type 2 diabetes who with diabetic retinopathy were compared with those of right eyes of 34 age- and gender-matched healthy controls. The choroidal images were binarized into luminal areas(LA)and stromal areas(SA). CVI was defined as the ratio of LA to total circumscribed subfoveal choroidal area. Mean choroidal thickness, mean retinal thickness and mean CVI between patients and controls were compared using <i>t</i>-test. <p>RESULTS: There were no significant differences in total circumscribed subfoveal choroidal area(0.53±0.14mm2 <i>vs</i> 0.49±0.15mm2), LA(0.35±0.09mm2 <i>vs</i> 0.32±0.10mm2), SA(0.17±0.05mm2 <i>vs</i> 0.17±0.06mm2), or subfoveal choroidal thickness(347.9±76.9μm <i>vs</i> 325.9±92.9μm)between patients with DR and controls(<i>P</i>>0.05). However, there was a significantly lower CVI in patients with diabetes as compared to controls(64.33%±3.25% <i>vs</i> 67.04%±2.46%, <i>P</i><0.001). The critical value was 63.59%.<p>CONCLUSION: CVI is a kind of biological indicators which can directly reflect the changes of choroidal internal structure, and it is more stable and reliable than SFCT. For type 2 diabetic patients who with diabetic retinopathy, CVI is lower than that of healthy people.

The application of optical coherence tomography angiography in diabetic microangiopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Diabetic retinopathy and diabetic nephropathy are the two most common and serious microvascular complications in diabetic patients, and they are the main causes of blindness and end-stage renal disease. Retinal blood vessels are the common damage targets of early diabetes and the only living blood vessels in the human vascular system that can be directly observed in naked eye. The changes in their morphological structure or function directly or indirectly reflect the microvascular lesions caused by diabetes. Especially, in recent years, the development of optical coherence tomography angiography(OCTA), a new and non-invasive technology, has made its breakthroughs in angiography resolution, vascular depth and vascular morphology, and it can provide objective quantitative data. It has certain application value in diabetic microangiopathy. Therefore, the purpose of this paper is to review OCTA and its application in diabetic microangiopathy.

Research progress in punctate inner choroidopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Punctate inner choroidopathy(PIC)is an infrequent idiopathic chorioretinopathy, frequently affecting young myopic women. There are multiple, small, round, yellow-white or gray punctate lesions in the retinal pigment epithelium and the choroidal lining, in the absence of anterior ocular segment or the vitreous body inflammation. In general, most patients have good prognosis and a few patients will be caused severe vision loss if complicated by choroidal neovascularization(CNV)and subretinal fibrosis. This article reviews the etiology, pathogensis, clinical manifestations, diagnosis and differential diagnosis and treatment of PIC.

A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome

PURPOSE: To report a delayed onset of multiple evanescent white dot syndrome in a patient with punctate inner choroidopathy. CASE SUMMARY: A 23-year-old female complained about sudden visual loss in the right eye. Best-corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. In fundus examination and optical coherence tomographic images, subfoveal choroidal neovascularization (CNV) with hemorrhage was observed in the right eye, accompanied by multiple lesions of atrophic pigmentation on the posterior pole in both eyes. We diagnosed the patient as punctate inner choroidopathy (PIC) and CNV in the right eye, and treated her using three monthly intravitreal injections of bevacizumab (Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL). The CNV regressed and the BCVA improved to 20/20. Two years later, she complained of visual impairment in her left eye. The BCVA was 20/40. Fundus photography revealed numerous small white dots around the posterior pole and optic disc. Disruption of the photoreceptor layer was seen in optical coherence tomography images. Small white dots were observed as multiple hyperfluorescent dots in fluorescein angiography and hypofluorescent spots in indocyanine green angiography. An enlarged blind spot was observed in the visual field. We diagnosed her as multiple evanescent white dot syndrome (MEWDS). One month after systemic steroid treatment, the multiple white dots disappeared and the BCVA improved to 20/20. CONCLUSIONS: We determined that PIC and MEWDS, which belong to the white dot syndrome, could occur in a patient at different times.

Recurrence of Punctate Inner Choroidopathy with an Intravitreal Dexamethasone Implant

PURPOSE: To report a case of punctate inner choroidopathy (PIC) treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment. CASE SUMMARY: A 23-year-old highly myopic female who presented with PIC in her right eye was treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment including facial edema and sleep disturbances. Three months after the implant she complained of severe acute visual disturbances in her right eye. Her visual acuity was classified as hand movement. Choroidal neovascularization (CNV) was observed on optical coherence tomography and indocyanine green angiography revealed more multiple hypofluorescent lesions compared to the initial visit. Six months after the systemic steroid and intravitreal bevacizumab injection treatments, visual acuity in right eye improved and the CNV disappeared. CONCLUSIONS: This report describes a case of PIC after, treatment with an intravitreal dexamethasone implant due to the side effects of systemic steroid treatment, which recurred with complications.

Ocular Manifestations of Systemic Lupus Erythematosus / 한양의대학술지

Systemic lupus erythematosus (SLE) is a complex connective tissue disease involving multiple organs including various ocular structures including the eyelid, orbit, ocular adnexa, sclera, cornea, retina, uvea, and optic nerve. Keratoconjunctivitis sicca is the most common ocular manifestation resulting in patients that suffer from dry eye symptoms, whereas severe vaso-occlusive lupus retinopathy is the most vision-threatening condition associated with the disease. SLE is a serious systemic disease that may first present with ocular manifestations. In addition, ocular manifestations are often associated with severe systemic inflammation and can be a marker for systemic prognosis. Thus, it is important for ophthalmologists to be aware of the association of visual disorders with SLE to detect and treat the ocular manifestations of SLE.

Management of Relapsed Inflammatory Choroidal Neovascularization in Punctate Inner Choroidopathy after Bevacizumab

PURPOSE: To report a rare case of relapsed inflammatory choroidal neovascularization (CNV) in a young female patient after intravitreal bevacizumab (IVB) treatment for subfoveal CNV secondary to punctate inner choroidopathy (PIC). CASE SUMMARY: A 25-year-old myopic female presented with PIC complicated by subfoveal CNV in the right eye. Her lesion initially responded to three monthly 1.25 mg IVB injections, but the lesion recurred two months after the final injection, and the size of the lesion was larger than that observed before treatment. Further treatment with systemic steroids and IVB resulted in successful anatomic and visual improvement. CONCLUSIONS: This report presents a rare case of relapsed inflammatory CNV in a young female patient after IVB treatment for subfoveal CNV secondary to PIC. Systemic steroid and IVB were performed after relapse, which successfully improved and maintained vision for longer than 18 months.

A Case of Focal Laser Photocoagulation Added to Systemic Immunomodulatory Therapy for Bilateral Lupus Chorioretinopathy

PURPOSE: To report a patient diagnosed with bilateral lupus chorioretinopathy who received focal laser photocoagulation. CASE SUMMARY: A 20-year-old female presented with decreased vision in her left eye. She had been treated with systemic corticosteroids, immunosuppressants, plasmapheresis and hemodialysis during systemic lupus erythematosus flare-up. Retinal hemorrhage and cotton wool spots were observed in both eyes on funduscopic examination. Optical coherence tomography showed bilateral serous retinal detachment. Flurorescein angiography (FA) revealed multiple leakages of dye in both maculae. Despite improvements of the systemic disease, subretinal fluid was not resolved. Focal laser photocoagulation was applied to multiple leakage spots identified on FA in both eyes and serous detachment improved. After several months, additional focal laser photocoagulation was performed because there was a small amount of subretinal fluid, which was completely resolved.

Pulse cyclophosphamide therapy in the management of patients with macular serpiginous choroidopathy.

Purpose: To evaluate safety and efficacy of intravenous pulse cyclophosphamide (CyP) in acute macular serpiginous choroiditis (SC). Methods: Patients with acute macular SC with lesions threatening and/ or involving fovea were enrolled. All patients received CyP (1 g/m2) for 3 days followed by high‑dose oral steroids (1.5 mg/kg) tapered over 6 months and monitored for visual acuity, response to treatment and systemic side effects. Results: Eight patients (seven unilateral and one bilateral) with median age of 27 years (range: 13-40 years) were recruited. Mean visual acuity at presentation was 0.71 ± 0.35 logarithm of the minimum angle of resolution while postpulse visual acuity was 0.40 ± 0.32. Final mean visual acuity at 1‑year was 0.31 ± 0.23 (P ≤ 0.05). Three eyes had recurrence and 3 patients developed transient hair loss with no other adverse effect. Conclusion: Intravenous CyP provides rapid resolution of lesion activity and thereby helps in maintaining good functional acuity.

AnaIysis of choroid radiographic characteristics of diabetics / 国际眼科杂志(Guoji Yanke Zazhi)

· AlM: To observe the characteristic of choroidal circulation in diabetics and investigate its changes as well as the relationship between it and the development and progression of diabetic retinopathy ( DR) . ·METHODS:All 45 diabetics were divided into 3 groups:no diabetic retinopathy ( NDR), nonproliferative diabetic retinopathy ( NPDR ) , proliferative diabetic retinopathy ( PDR);and 20 health people were selected to be control group.All subjects were examined by FFA and indocyaine green angiography ( lCGA ) ( Heidelberg retina tomography, Germany ) at the same time. The characteristics of angiograph results were comparatively observed and the feature of diabetic choroidapathy were analyzed. · RESULTS: ( 1 ) There were no significant differences between DR groups and control group in the central retinal artery ( CRA ) filling time.There were significant decreases of the choroidal artery filling time in DR groups, compared to the control group (P ·CONCLUSlON:lCGA may be a useful adjunct to FFA in the evaluation of choroidal vascular changes in DR.The research provides that the diabetic choroidal circulation was abnormal before the occurrence of DR, which fully proved the presence of diabetic choroidopathy.

Relationship between subfoveal choroidal thickness and both choroidal hemodynamic index and glycosylated hemoglobin in diabetic subjects / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the relationship between the subfoveal choroidal thickness ( SFCT) and both choroidal hemodynamic index and glycosylated hemoglobin in diabetic subjects.METHODS:Seventy-eight type 2 diabetic patients (156 eyes) from ophthalmology and endocrinology ward of our hospital were enrolled in this study, including 39 females and 39 males, with a mean age of (59. 8±6. 2)years. According to early treatment diabetic retinopathy study ( ETDRS) grading method, all samples were divided into diabetic retinopathy ( DR ) group, mild or moderate nonproliferative diabetic retinopathy group, severe nonproliferative diabetic retinopathy ( NPDR) group and proliferative diabetic retinopathy ( PDR ) group. The SFCT and choroidal hemodynamic index were measured by enhanced depth imaging optical coherence tomography ( EDl-OCT ) and Color Doppler lmaging. Recording glycosylated hemoglobin content of all samples. Using multivariate linear regression to analyse the relationship between the SFCT and both choroidal hemodynamic index and glycosylated hemoglobin.RESULTS: The end diastolic velocity ( EDV ) was significant higher and the SFCT was significant thinner in no diabetic retinopathy ( NDR) group than other groups. There was no significant difference of peak systolic velocity ( PSV ) between four groups. The resistance index ( Rl) was significant higher in severe NPDR group than NDR group and mild or moderate group, the Rl in PDR group was hihgest than other group with statistically significance. The SFCT was correlated positively ( b =0. 540,P<0. 001) with the glycosylated hemoglobin. No significant correlation was found between the SFCT and the choroidal hemodynamic index (DR,P=0. 341;PSV,P=0. 770;EDV,P=0. 131;Rl,P=0. 084).CONCLUSlON: Our results suggest that there is no significant correlations between the SFCT and the choroidal hemodynamic index; glycosylated hemoglobin is one of the factors that affect the SFCT in diabetic patients.

Unilateral Punctate inner choroidopathy with choroidal neovascular membrane in a young male.

Punctate inner choroidopathy (PIC), first described by Watzke et al., in 1984, is a disease of young, relatively healthy, myopic women characterized by small yellow‑white lesions of the inner choroid and retinal pigment epithelium (RPE).[1] The chorioretinal lesions seen in PIC tend to be small and acutely no larger than 500 μm. Acute lesions heals to atrophic scars and develop more pigmentation with time. Choroidal neovascular membranes (CNVM) develops in more than half of these individuals. We describe a case of PIC occurring in a young adult male with CNVM. The clinical characteristics, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) findings are described.

Assessment of choroid in diabetes mellitus patients by using integrated backscatter / 中华超声影像学杂志

Objective Objective To investigate the relationship between choroidopathy and integrated backscatter(IBS) of choroid in diabetes mellitus(DM) patients.Methods Eighty DM patients of 158 eyes were divided into 3 groups by the course of diabetic retinopathy(DR)-DM patients without DR group,DM patients with the background DR,DM patients with the proliferative DR.80 normal persons of 160 eyes were the control group.Their IBS values were measured on nose side,temple side and middle side of choroid by HP Sonos 5500,and the correction IBS values(IBS％) were calculated.Results With the deterioration of DR,the IBS and IBS％ of choroid increased.The statistical significance difference were found in various groups(P ＜ 0.01).Conclusions With the deterioration of diabetic choroidopathy,the IBS and IBS％ increased.The IBS technique is useful method to assess the diabetic choroidopathy.

Flare up of choroiditis and choroidal neovasculazation associated with punctate inner choroidopathy during early pregnancy.

A 28-year-old, healthy female, who had a recent repeated history of miscarriage, presented with bilateral choroidal neovascular membranes (CNVM), for which she received photodynamic therapy with three doses of lucentis, at intervals of one month each, to which she responded. After five months, the patient again presented with complaints of diminution of vision since 15 days. She had a history of miscarriage two days before presenting to our clinic. CNVM was scarred at this time and the fundus picture showed multiple small punctate spots around the fovea at the level of the choroid, which showed early hyperfluroscence on fundus fluorescein angiography, suggestive of punctate inner choroidopathy. She was advised systemic steroids, to which she responded dramatically.

Serpiginous choroidopathy

Objective@#To describe a case of serpiginous choroidopathy.@*Methods@#This is a case report.@*Results@#A 61-year-old female with a 22-year history of gradual blurring of vision in the left eye sought consultation. Ten months prior, her left vision worsened, described as central scotoma that progressed inferiorly. Best-corrected vision was 20/20 (right) and counting fingers at 1 foot (left). Inferior hemifield scotoma was documented on Amsler grid testing of the left eye. Anteriorsegment findings were unremarkable. Retinal examination through a clear media revealed multiple contiguous hypopigmented patches radiating from the peripapillary area extending to the periphery in both eyes with extension to the superior fovea on the left. Fluorescein angiogram showed progressive faint hypofluorescence of the hypopigmented patches in both eyes with involvement of the superior fovea on the left. No active vessel leakage was noted. No treatment was given and regular Amsler monitoring was advised. Follow-up 3 and 6 months after revealed stable visual acuity and fluorescein angiogram (FA) findings. @*Conclusions@#This is a case of serpiginous choroidopathy with inactive pattern. There was unilateral decrease in central vision, scotoma, and retinal pigment epithelial atrophy in a serpentine pattern originating from the disc with macular involvement in one eye. FA aids in the diagnosis and monitoring of inflammatory activity as the presence of active leakage on the borders. Goals of management include monitoring, prevention of recurrences and progression, and rapid control of sequela with potential use of immunosuppressive therapy.

Clinical Features of Punctate Inner Choroidopathy in Korea

PURPOSE: To characterize the clinical presentation and visual prognosis of punctate inner choroidopathy in Korean patients. METHODS: Eleven patients (seventeen eyes) with punctate inner choroidopathy (PIC) and four (six eyes) with multifocal choroiditis with panuveitis (MCP) were analyzed retrospectively. RESULTS: The mean age of the PIC patients was 32.2 +/- 9.3 years and the mean refractive error was -4.79 +/- 3.18 diopters. In all PIC eyes, fundus photographs showed multiple yellowish white punctate lesions and punched-out scars at the level of the inner retina and choroid. There was no significant difference between the mean initial visual acuity (0.67 +/- 0.40) and the mean final visual acuity (0.56 +/- 0.41). The major cause of visual deterioration was choroidal neovascularization (CNV) which developed in 4 eyes. In PIC, the lesions were located in the more posterior retina and the incidence of CNV was higher than in MCP. CONCLUSIONS: PIC affects young women with moderate myopia and shows the characteristic chorioretinal lesion. Although the eye with PIC usually maintains stable vision after initial attack, CNV may cause complications and significant visual loss.

Clinical Progressive Analysis of Serous Retinal detachment due to Hypertensive Choroidopathy in Toxemia of pregnancy

Hypertensive choroidopathy is seen in patients suffering from acute ypertension such as pregnancy-induced hypertension, renal disease, connective tissue disease, and accelerated essential hypertension, which can affect the visual acuity in many ways. Especially, retinal detachment is the most important factor in visual prognosis, so understanding its clinical course is important to the ophthalmologist. We diagnosed the 257 severe preeclampsia and eclampsia patinents at the Soonchunhyang University Hospital from January 1987 to Auguest 1996, and found 19 cases of serous retinal detachment. The fluorescein angiography showed delayed perfusion of the choriocapillaris in the earlyphase and marked pooling of dye in subretinal space in the late phase. The results of this study revealed that serous retinal detachment occured mostly binoculary (83.3%); the extent of the pathologic region ranged from 2.11DD to 7.2DD (mean 4.06DD); total bullous retinal detachment was found in one case; the duration of reattachment ranged from 8 to 43 days (mean 9.95days); and the recovery interval of visual acuity was between 21 to 35 days(average interval 18.5 days). Of 12 cases followed up 11 cases showed normal visual acuity, normal visual field and retinal reattachment without the macular degeneration.

Punctate Inner Choroidopathy

Punctate inner choroidopathy is a clinical disorder of unknown etiology that affects the retinal pigment epithelium and inner choroid resulting in visual loss. Punctate inner choroidopathy is characterized by multiple tiny punctate yellowish-white lesions in the deep retina of posterior pole. There is often an associated serous retinal detachment and subretinal neovascular membrane. The lesions are characterized by small punctate hyperfluorescent in the early phase and leak or stain in the late phase by fluorescein angiography. The authors experienced a case of suspected punctate inner choroidopathy associated with decreased visual acuity in a 24 year-old female and reviewed the available literatures regrading the disease.