Angiographic and Tomographic Prognostic Factors of Chronic Central Serous Chorioretinopathy Treated with Half-Dose Photodynamic Therapy.

AIMS: To identify the angiographic and tomographic prognostic factors of chronic central serous chorioretinopathy (CSC) treated with half-dose photodynamic therapy (PDT). METHODS: This is a consecutive series of 61 eyes with chronic CSC treated with half-dose PDT from January 1, 2009 to October 31, 2016. RESULTS: The mean logMAR best-corrected visual acuity (BCVA) improved from 0.47 to 0.31 at 3 months (p < 0.001). From multivariate regression, the final BCVA was significantly associated with the baseline BCVA (p = 0.003), a diffuse hyperfluorescence pattern on indocyanine green angiography (ICGA) (p = 0.024), posttreatment shallow irregular pigment epithelium detachment (PED) (p = 0.022), and disruption of the ellipsoid zone (p = 0.007). A diffuse hyperfluorescence pattern on ICGA was associated with a 77.4 times risk of subretinal fluid persistence after treatment (p = 0.009). CONCLUSION: A poor baseline BCVA, diffuse hyperfluorescence ICGA pattern, shallow irregular PED, and disruption of the ellipsoid zone indicate poor prognosis.

The efficacy of latent tuberculosis treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test: 6-year experience in a tuberculosis endemic region.

PURPOSE: To assess the efficacy of latent tuberculosis (TB) treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test. METHODS: This is a consecutive case series of all T-SPOT.TB positive latent TB patients with presumed tuberculous uveitis managed with anti-tuberculous therapy (ATT) from 1 January 2000 to 31 December 2015. Patients with active TB or other known causes of uveitis, immunocompromised states and those followed up < 12 months were excluded. Descriptive statistics and hypothesis testing were performed, with a significance level of p < 0.05 taken. RESULTS: Among the 75 T-SPOT.TB tests performed for uveitis, 14 cases were enrolled. Mycobacterium tuberculosis was isolated in none of the sputum and intraocular samples. Most cases had posterior uveitis (10/14 cases, 71.4%) and/or intermediate uveitis (9/14 cases, 64.3%). Vasculitis was predominantly occlusive. The mean presenting best-corrected visual acuity (BCVA) was 0.18, improving to 0.44 at 6 months (p = 0.03) and 0.40 at 12 months. (p = 0.03). At 1 year, remission of uveitis was achieved in 92.9%, in which none of them recurred at the last follow-up. High-dose systemic steroid was required in 50% of patients. Only 1 patient was steroid dependent at 18 months. The BCVA improvement in patients treated with or without steroid was comparable. CONCLUSION: In a TB-endemic region with wide Bacille Calmette-Guerin vaccination coverage, ATT for immunocompetent uveitis patients with latent TB identified from T-SPOT.TB test can improve vision, induce long-term steroid-free remission, and prevent recurrence and systemic reactivation of TB in those who require steroid.

Differential microvascular assessment of retinal vein occlusion with coherence tomography angiography and fluorescein angiography: a blinded comparative study.

PURPOSE: To compare the imaging of retinal vein occlusion (RVO) with optical coherence tomography angiography (OCTA) and fluorescein angiography (FA) and evaluate their roles in clinical management. METHODS: RVO patients who underwent imaging with both FA and OCTA from 1 June 2015-31 December 2015 were enrolled. An independent retinal specialist blinded from patient identity assessed the FA and OCTA reports. The pixel counting technique was used for FAZ size measurement. A significant level of p < 0.05 was taken for correlation and agreement analysis. RESULTS: On OCTA, the mean FAZ size was 0.382 ± 0.152 mm2 and 0.606 ± 0.136 mm2 for the superficial and deep retinal layers, respectively, with significant correlation (p = 0.004). On FA, the mean FAZ size was 0.352 ± 0.158 mm2, better correlated with OCTA at the superficial (p = 0.062) than the deep retinal layer (p = 0.122). Between FA and OCTA, good agreement was found for microaneurysms (100%, p = 0.001) and venous congestion (83.33%, p = 0.028), but not capillary non-perfusion (p = 0.217) and venous tortuosity (p = 0.546). OCTA also revealed more capillary non-perfusion than FA (91.67 vs. 58.33%). The presenting best-corrected visual acuity was significantly correlated with capillary non-perfusion on OCTA (p = 0.001). CONCLUSION: OCTA and FA are complementary tools in RVO assessment. While OCTA is more precise in the assessment of FAZ and capillary non-perfusion, FA offers better vascular imaging of the peripheral retina.

Optical coherence tomography angiography wide-field montage in branch retinal vein occlusion before and after anti-vascular endothelial-derived growth factor injection.

The wide-field montage technique of optical coherence tomography angiography provides good delineation of the improvement in microvascular disturbance associated with branch retinal vein occlusion after treatment with anti-vascular endothelial-derived growth factor injection. It may be further evaluated for the assessment of treatment progress in patients with retinal vein occlusion.

Is it necessary to cover the macular hole with the inverted internal limiting membrane flap in macular hole surgery? A case report.

BACKGROUND: To report a case of late closure of idiopathic full-thickness macular hole (FTMH) after vitrectomy with the inverted internal limiting membrane (ILM) technique. CASE PRESENTATION: A 68-year-old lady with a stage IV FTMH underwent pars plana vitrectomy with 25 gauge plus transconjunctival system, ILM peeling and gas tamponade. The inverted ILM flap technique was adopted, except that no extra surgical manipulation was used to cover the macular hole with the ILM flap. Surgical outcome was monitored with serial optical coherence tomography (OCT). Complete closure of the FTMH with resolution of intraretinal cystic changes was confirmed on OCT at 16 months postoperatively. Visual acuity improved from a baseline level of 0.1 to 0.4. CONCLUSION: Idiopathic macular hole closure could be delayed to beyond 1 year following the inverted ILM flap technique, especially if the macular hole was not covered with the ILM flap. Not all macular holes that fail to close in the early postoperative period need to be re-operated and there may be no risk of further visual deterioration.