Photoreceptor assessment using adaptive optics in resolved central serous chorioretinopathy / Avaliação dos fotorreceptores com adaptive optics na coriorretinopatia serosa central cicatrizada

ABSTRACT We present a case of a patient with resolved central serous chorioretinopathy (CSC) in the left eye with persistent mild visual alterations 4 years after the resolution of the disease. Left eye exam revealed a best corrected visual acuity of 20/25 and a slight change of macular pigmentation. Optical coherence tomography revealed only minor irregularities in the topography of retinal pigment epithelium and Bruch's membrane. Adaptive optics (AO) optics demonstrated lower density, spacing, and changes in the photoreceptor mosaic pattern in the left eye than in the right eye, suggesting that CSC may cause damage to cones after clinical recovery. We conclude that AO can provide additional information to assist in the treatment and follow-up of patients with CSC or other macular pathologies.

RESUMO Apresentamos o relato de caso de paciente com coriorretinopatia serosa central (CSC) cicatrizada em olho esquerdo e queixa de discreta alteração visual, mesmo após quatro anos da resolução do quadro. O exame do olho esquerdo apresenta melhor acuidade visual corrigida de 20/25 e discreta alteração de pigmentação macular. Tomografia de coerência óptica (OCT) apresentou apenas pequenas irregularidades em topografia de EPR e Bruch. Foi realizado exame com Adaptive Optics (AO), evidenciando valores inferiores de densidade, espaçamento e alterações no padrão de mosaico dos fotorreceptores em olho esquerdo quando comparado com olho direito, sugerindo que a CSC pode causar danos em cones, mesmo após uma recuperação considerada satisfatória. Concluímos que o AO é uma tecnologia que traz novas informações para auxiliar o tratamento e seguimento dos pacientes com CSC ou outras patologias maculares.

Evaluation of inner segment/outer segment junctions in different types of epiretinal membranes / Avaliação da junção segmento interno/segmento externo em diferentes graus de membranas epirretinianas

ABSTRACT Purpose: This study was conducted to evaluate the relationships of inner/outer segment (IS/OS) junction disruption, macular thickness, and epiretinal membrane (ERM) grade with best-corrected visual acuity (BCVA), as well as the relationship between IS/OS junction disruption and ERM grade. Methods: Fifty-four eyes of 54 patients with different grades of ERM were retrospectively reviewed. Patients were classified into three groups by ERM grade according to retinal striae and vessel distortion: grade/group 1, visible membranes without retinal striae or vessel distortion; grade/group 2, mild to moderate macular striae or vessel straightening; and grade/group 3, moderate to severe striae and vascular straightening. Correlations of BCVA with age, central retinal thickness, ERM grade, and IS/OS disruption as well as of IS/OS disruption, central macular thickness, and BCVA with ERM grade were evaluated. Results: Twenty-nine (53.7%) eyes exhibited IS/OS junction disruption. Groups 1 and 2 differed significantly with respect to BCVA (p=0.038), but groups 2 and 3 did not (p=0.070). Central macular thickness was significantly greater in group 2 than in group 1 (p=0.031) and in group 3 than in group 2 (p=0.033). Groups 1 and 2 differed significantly in terms of IS/OS disruption (p=0.000), but groups 2 and 3 did not (p=0.310). Conclusions: The IS/OS junction appears to be disrupted during the early stages of ERM. Grade 3 ERM is associated with a significantly higher incidence of IS/OS disruption.

RESUMO Objetivo: Este estudo foi realizado para avaliar a relação entre a interrupção da junção segmento interno/segmento externo (IS/OS), espessura macular e grau de membrana epirretiniana (ERM), com a melhor acuidade visual corrigida (BCVA), e a relação entre a interrupção da junção IS/OS com a severidade da ERM. Métodos: Cinquenta e quatro olhos de 54 pacientes com diferentes graus de ERM foram avaliados retrospectivamente. ERMs foram classificadas, de acordo com as estrias de retina e a distorção dos vasos, em 3 grupos: grupo 1 foram membranas visíveis sem estrias retinianas ou distorção dos vasos, grupo 2 membranas com estrias maculares discretas a moderadas ou retificação dos vasos, e grupo 3 membranas com estrias moderadas a graves e retificação vascular. A correlação da BCVA com a idade, espessura central da retina, severidade da ERM e interrupção da junção IS/OS foram avaliadas. A relação de interrupção da junção IS/OS, a espessura macular central e acuidade visual com a severidade da ERM também foram avaliadas. Resultados: Vinte e nove olhos (53,7%) apresentavam interrupção da junção IS/OS. A BCVA foi diferente entre ERMs grupo 1 e grupo 2 (p=0,038), a diferença entre o grupos 2 e 3 não foi estatisticamente significativa (p=0,070). A espessura macular central foi estatisticamente maior no grupo 2, quando comparado ao grupo 1 (p=0,031) e maior no grupo 3 quando comparado ao grupo 2 (p=0,033). A diferença entre o grupo 1 e grupo 2 em relação à interrupção da junção IS/OS foi estatisticamente significativa (p=0,000), ao passo que a diferença entre o grupo 2 e do grupo 3 não foi estatisticamente significativa (p=0,310). Conclusões: As junções IS/OS parecem estar interrompidas nos estágios iniciais da ERM. O grau 3 de ERM têm uma maior incidência significativa de interrupção da junção IS/OS.

Inner and outer segment junction (IS/OS line) integrity in ocular Behçet's disease / Integridade da junção do segmento ınterno e externo (linha IS/OS) na doença de Behçet ocular

Purpose: In this study, we examined the spectral domain optical coherence tomography (OCT) findings of ocular Behçet's disease (OB) in patients with inactive uveitis. Specifically, we analyzed the inner and outer segment junction (IS/OS line) integrity and the effect of disturbed IS/OS line integrity on visual acuity. Methods: Patient files and OCT images of OB patients who had been followed-up between January and June of the year 2013 at the Dicle University Eye Clinic were evaluated retrospectively. Sixty-six eyes of 39 patients were included the study. Results: OCT examination of the patients with inactive OB revealed that approximately 25% of the patients had disturbed IS/OS and external limiting membrane (EML) line integrity, lower visual acuity (VA), and lower macular thickness than others. Linear regression analysis revealed that macular thickness was not an independent variable for VA. In contrast, the IS/OS line integrity was an independent variable for VA in inactive OB patients. Conclusion: In this study, we showed that the IS/OS line integrity was an independent variable for VA in inactive OB patients. Further prospective studies are needed to evaluate the integrity of the IS/OS line in OB patients. .

Objetivo: Neste estudo, examinamos os achados da tomografia de coerência óptica (OCT) de domínio espectral na doença de Behçet ocular (OB) em pacientes com uveíte inativa. Especificamente, analisamos a integridade da junção dos segmentos interno e externo (linha IS/OS) e o efeito da alteração da integridade da linha IS/OS na acuidade visual. Métodos: Avaliamos retrospectivamente os prontuários e as imagens de OCT dos pacientes com OB examinados entre janeiro e junho de 2013 na Dicle University Eye Clinic. Sessenta e seis olhos de 39 pacientes foram incluídos no estudo. Resultados: Análise das imagens de OCT dos pacientes com OB inativa revelou que aproximadamente 25% dos pacientes tinham alterações da integridade da linha IS/OS e da membrana limitante externa (ELM), e apresentavam acuidade visual (VA) e espessura macular menor do que os outros. A análise de regressão linear revelou que a espessura macular não é uma variável independente para VA. Por outro lado, a integridade da linha IS/OS foi uma variável independente para VA em pacientes com OB inativa. Conclusão: Neste estudo, nós mostramos que a integridade da linha IS/OS foi uma variável independente para a VA em pacientes com OB inativa. Precisamos de mais estudos prospectivos para avaliar a integridade da linha IS/OS em pacientes com OB. .

Intravitreal Anti-vascular Endothelial Growth Factor versus Observation in Acute Central Serous Chorioretinopathy: One-year Results

PURPOSE: To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) compared with observation for treating acute central serous chorioretinopathy (CSC). METHODS: A retrospective study of 36 patients with acute CSC, including 21 patients treated with anti-VEGF (anti-VEGF group) and 15 patients with observation (observation group). Patients in the anti-VEGF group received a single dose of bevacizumab or ranibizumab at baseline. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) were assessed. The integrity of the foveal inner segment/outer segment (IS/OS) line at 12 months was also analyzed. RESULTS: Resolution of SRF was achieved in 20 of 21 eyes in the anti-VEGF group and in 12 of 15 eyes in the observation group (p = 0.151). Mean BCVA and CFT were not different between the two groups at 12 months (p > 0.05). The amount of change in BCVA, however, differed significantly between the groups (p = 0.044). Final OCT more frequently detected the foveal IS/OS line in the anti-VEGF group than in the observation group (p = 0.012). CONCLUSIONS: In terms of BCVA, anti-VEGF and observation only had similar therapeutic effects in acute CSC patients. In some patients, however, the rapid resolution of SRF by anti-VEGF might reduce the risk of photoreceptor degeneration and improve long-term visual acuity.

Predictive Findings of Visual Outcome in Spectral Domain Optical Coherence Tomography after Ranibizumab Treatment in Age-related Macular Degeneration

PURPOSE: To investigate which spectral domain optical coherence tomography (SD-OCT) findings predict visual outcome after anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (NV-AMD). METHODS: We reviewed the medical records of patients with treatment-naive NV-AMD who underwent three or more consecutive anti-VEGF injections. The patients were divided into three groups according to their changes of visual acuity (VA); improved (group I), static (group S), or worsened (group W). We assessed the incidences and values of all available SD-OCT findings of these groups, compared these findings between the three groups and compared the initial values with the post-treatment values. RESULTS: Better initial VA and longer external limiting membrane (ELM) length were associated with less change in VA after anti-VEGF treatment. The initial VA was mildly correlated with initial photoreceptor inner and outer segment junction (IS/OS) length and initial ELM length. The final VA was also mildly correlated with the final IS/OS length and the final ELM length. VA was significantly changed after anti-VEGF treatment in groups W and I. With regard to incidence, disruption of the IS/OS (IS/OS-D), disruption of the ELM (ELM-D) and ELM length differed significantly between the three groups, particularly ELM-D. The incidences of IS/OS-D and ELM-D in group I were significantly lower than those in groups S and W, and those in group S were also lower than those in group W. The ELM length in group I was significantly longer than it was in groups S and W, and the ELM length in group S was longer than that for group W. However, these three findings did not change after the anti-VEGF treatment. CONCLUSIONS: Initial IS/OS-D, ELM length and particularly ELM-D can be useful predictors of the visual outcome after anti-VEGF treatment in NV-AMD patients.