Foveal and Extrafoveal Effects of Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy: A Cohort Study.

PURPOSE: To compare the efficacy and safety of foveal and extrafoveal half-dose photodynamic therapy (HD-PDT) for chronic Central Serous Chorioretinopathy (cCSC). METHODS: This retrospective, cohort study included cCSC eyes submitted to HD-PDT on foveal (F) or extrafoveal (E) areas. Patients were evaluated at baseline and 12 weeks after treatment for best corrected visual acuity (BCVA) and the following spectral-domain optical coherence tomography (SD-OCT) subfoveal parameters: central macular thickness (CMT), outer nuclear layer, external limiting membrane, ellipsoid zone, interdigitation zone, choroidal thickness and subretinal fluid (SRF). RESULTS: F group comprised 33 eyes (47.1%) and E group comprised 37 eyes (52.9%). Both groups showed an improvement of BCVA after HD-PDT with no significant differences in final BCVA (p = .41). CMT and SRF showed a significant improvement after HD-PDT in both groups, but the rate of disruption of the external retinal layers remained stable. During follow-up, SD-OCT parameters and the rate of anatomical success showed no significant differences regarding the treatment location. No major sequelae were noticed. CONCLUSION: Foveal and extrafoveal applications of HD-PDT for cCSC showed comparable efficacy and safety.

Anatomical and functional results of ILM peeling vs. non-peeling in macula-off rhegmatogenous retinal detachment.

PURPOSE: To compare anatomical and functional results between internal limiting membrane (ILM) peeling and non-ILM peeling in macula-off rhegmatogenous retinal detachment (RRD). METHODS: We completed a retrospective cohort study of patients who underwent pars plana vitrectomy (PPV) due to macula-off RRD. ILM peeling (P) versus non-ILM peeling (NP) groups were compared regarding best-corrected visual acuity (BCVA), anatomical success, endotamponade, concomitant scleral band placement and BCVA gain for epiretinal membranes (ERM) resubjected to PPV. Statistical significance was considered when p < 0.05. RESULTS: PPV was conducted in 352 patients, among which 43.5% (n = 153) were in the P group and 55.6% (n = 196) were in the NP group. Both groups had significant BCVA improvement during the study period (p < 0.001), but with no significant difference between them. Anatomical success was similar between P (84.2%) and NP (87.2%) groups. No difference was found with regard to endotamponade (p = 0.07) or concomitant scleral band placement (p = 0.43). The NP group developed subsequent ERM more frequently (p = 0.004), but BCVA gains for eyes requiring repeat PPV for ERM were not found (p = 0.14). CONCLUSIONS: Although ERM formation and greater anatomical success are reasons to support the use of ILM peeling in RRD, we did not observe any anatomical or functional difference regarding ILM peeling or functional gain with secondary ERM peeling.

Outer retinal layers as predictors of visual acuity in retinitis pigmentosa: a cross-sectional study.

PURPOSE: To evaluate the integrity of the outer retinal layers-outer nuclear layer (ONL), external limiting membrane (ELM), ellipsoid (EZ), and interdigitation band (IZ)-using spectral-domain optical coherence tomography and estimate their effect on visual acuity in retinitis pigmentosa (RP). METHODS: A cross-sectional study was performed in the Ophthalmology Department of Hospital de Braga, Portugal. Patients with RP followed in the Hospital de Braga during January to August 2017 were included. Exclusion criteria were lack of data, macular edema due to RP, and concomitant retinal, optic nerve, or corneal disease that could interfere with visual acuity. Age, sex, time from diagnosis, phakic status, ONL thickness, and presence or absence of foveal ELM, EZ, and IZ were correlated to the best-corrected visual acuity (BCVA). RESULTS: Forty-eight eyes were analyzed. There was a strong and positive correlation in BCVA between both eyes (p < .001*). ONL thickness was decreased in 95.8%. The EZ was the most absent layer (79.2%), followed by IZ (70.8%) and ELM (45.8%). A positive family history (p = .04*) and increased time from diagnosis (p = .037*) correlated with worse BCVA. A thicker ONL (p = .001*) and the presence of subfoveal ELM (p < .001*), EZ (p < .001*), and IZ (p = .02*) are correlated with better BCVA. There was a strong and positive correlation between the number of layers affected and a lower BCVA (p < .001). The presence of EZ was a significant predictor of BCVA (p = .02*). CONCLUSIONS: The status of the outer retinal layers seems to influence BCVA. The status of the EZ was the most important predictor of BCVA but the ONL, ELM, and IZ may have a cumulative effect in the progression of visual loss.

Ophthalmologic Manifestations of Wolfram Syndrome: Report of 14 Cases.

PURPOSE: The aim of this study was to describe ophthalmological abnormalities in 14 cases of Wolfram syndrome belonging to 9 different families. METHODS: Patients were submitted to a complete ophthalmological, neurological, otorhinolaryngological, urological, and genetic evaluation. RESULTS: Our sample comprised 14 Caucasian patients belonging to 9 different families. Their ages ranged from 10 to 38 years. The mean duration of known disease was 11.3 ± 8.7 years. Genetic confirmation was obtained in 7 families. There was a parental consanguinity history in 2 families. Five families were homozygous for a mutation of exon 8 of the WFS1 gene (Chr. 4), and 2 patients were heterozygous. Diabetes mellitus was the first manifestation in all except 1 patient. The mean age at diagnosis was 8.7 years (range 3-22). None had diabetic retinopathy. The mean age at diagnosis of optic atrophy was 11.1 years (range 8-35). The best-corrected visual acuity ranged from counting fingers to 20/50. CONCLUSIONS: Association of optic atrophy with insulin-dependent diabetes mellitus should raise the suspicion of Wolfram syndrome.

Functional impairment with minimal macular damage in femtosecond laser plasma injury: case report.

A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

Functional impairment with minimal macular damage in femtosecond laser plasma injury: case report / Comprometimento funcional com dano macular mínimo em lesão com plasma de laser de femtosegundo: relato de caso

A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

Uma paciente de 26 anos foi examinada 24 horas após observar a formação de plasma induzido por laser em um processo de produção de nanopartículas, referindo escotoma central bilateral. A avaliação oftalmológica incluiu observação dilatada da retina, angiofluoresceinografia e tomografia de coerência óptica (OCT). Na primeira avaliação, a acuidade de 20/20 no olho direito e 20/25 no olho esquerdo. A avaliação oftalmológica revelou mudanças de coloração da região macular de ambos os olhos. A tomografia de coerência óptica mostrou uma interrupção central da camada de fotorreceptores em ambos os olhos, e a angiografia fluoresceínica foi normal. Nas consultas subsequentes a acuidade sempre foi 20/20 em ambos os olhos. Os achados da tomografia de coerência óptica anormais desapareceram em menos de cinco meses, mas as queixas subjetivas de escotoma no olho esquerdo permaneceram. Cuidado extra deve ser tomado para este tipo de experiência, por exemplo, reduzindo o tempo em que a retina é diretamente exposta à radiação de plasma.