Transient reversal of macular ischemia with intravitreal steroid implant injection in a case of radiation maculopathy

Diabetic retinopathy (DR) is a well-known risk factor in the development of radiation maculopathy (RM). Steroids have been shown to improve the vision and reduce the macular thickness in patients with RM. This observational case report highlights altered course of DR after a course of radiotherapy for orbital lymphoma, after a single dose of intravitreal dexamethasone implant showed a dramatic revascularization of the ischemic macula, with a significant reduction in the size of ischemic area. This appears to be the first case in literature corroborating the favorable effect on steroids on retinal vasculature, seen angiographically.

Unilateral hemorrhagic maculopathy: An uncommon manifestation of hand, foot, and mouth disease.

Hand, foot, and mouth disease (HFD) is a common systemic infection occurring in childhood or immunocompromised adults caused by enteroviruses, the most common being coxsackievirus A16 and enterovirus 71. It is characterized by maculopapular eruptions over the hands and feet and ulcerative stomatitis. Ocular involvement is a rare complication and commonly manifests as inflammatory macular pathology. We report a case of HFD in an immunocompetent adult male with unilateral ocular involvement presenting as hemorrhagic maculopathy and its management with complete anatomical and functional recovery.

Indocyanine green angiography in posterior uveitis.

Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.

Cilioretinal artery occlusion following intranasal cocaine insufflations.

Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse.

Quantitative evaluation of experimental choroidal neovascularization by confocal scanning laser ophthalmoscopy: fluorescein angiogram parallels heparan sulfate proteoglycan expression

The objective of the present study was to develop a quantitative method to evaluate laser-induced choroidal neovascularization (CNV) in a rat model using Heidelberg Retina Angiograph 2 (HRA2) imaging. The expression of two heparan sulfate proteoglycans (HSPG) related to inflammation and angiogenesis was also investigated. CNV lesions were induced with argon laser in 21 heterozygous Zucker rats and after three weeks a fluorescein angiogram and autofluorescence exams were performed using HRA2. The area and greatest linear dimension were measured by two observers not aware of the protocol. Bland-Altman plots showed agreement between the observers, suggesting that the technique was reproducible. After fluorescein angiogram, HSPG (perlecan and syndecan-4) were analyzed by real-time RT-PCR and immunohistochemistry. There was a significant increase in the expression of perlecan and syndecan-4 (P < 0.0001) in retinas bearing CNV lesions compared to control retinas. The expression of these two HSPG increased with increasing CNV area. Immunohistochemistry demonstrated that the rat retina damaged with laser shots presented increased expression of perlecan and syndecan-4. Moreover, we observed that the overexpression occurred in the outer layer of the retina, which is related to choroidal damage. It was possible to develop a standardized quantitative method to evaluate CNV in a rat model using HRA2. In addition, we presented data indicating that the expression of HSPG parallels the area of CNV lesion. The understanding of these events offers opportunities for studies of new therapeutic interventions targeting these HSPG.

Comparision of Results of Electroretinogram, Fluorescein Angiogram and Color Vision Tests in Acute Central Serous Chorioretinopathy

PURPOSE: This paper investigates the correlation of the electroretinogram (ERG) with fluorescein angiography (FAG) and the color vision test among those who have acute central serous chorioretinopathy (CSCR). METHODS: The study was performed with 30 patients who had one CSCR-affected eye but the other unaffected. RESULTS: ERG showed that the b-wave amplitudes in the affected eyes decreased significantly compared to those in the unaffected eyes (P<0.05) and that there were no significant changes in a-wave or implicit time. FAG revealed that the b-wave amplitude decreased significantly when the leaking point was within a distance of 1/4 disk diameter from the fovea center, compared to when it was more distant (P<0.05). The amplitude also reduced significantly when the size of retinal detachment was more than 1 disk diameter compared to when it was less (P<0.05). The affected eyes which showed abnormality in color vision test decreased significantly a- and b-waves compared to the unaffected eyes in the test (P<0.05). CONCLUSIONS: In acute CSCR patients, the correlation of ERG with FAG showing size of retinal detachment, the location of leaking point and the color vision test was statistically significant. Therefore, ERG could be used to assess the affecting degree of the disease.

A Case of Crystalline Retinopathy

Crystalline retinopathy is a tapetoretinal degeneration characterized by glistening yellow intraretinal crystals in the posterior pole, chorioidal sclerosis, and corneal crystalline dystrophy. We have recently encountered a 36 year-old female patient with bilateral intraretinal crystalline depositions who presented with a complaint of visual disturbance in her right eye for the last six months. Typical fundus findings of crystalline deposition in the posterior pole, tapetoretinal dysfunctions in the electrophysiologic tests and choriocapillaris filling defects in the fluorescein angiogram suggest that this the disorder is a widespread choriocapillaris and tapetoretinal disorder. There are no significant abnormal findings in serologic and radiologic examinations.