Subretinal hyporeflective globule: A novel OCT finding in central serous chorioretinopathy.

PURPOSE: To describe the subretinal hyporeflective globule in cases of central serous chorioretinopathy (CSC). METHODS: A retrospective analysis of consecutive cases of CSC presenting to a tertiary eye care center in eastern India was conducted. Subretinal hyporeflective globules were identified as small globular lesions below the external limiting membrane/ellipsoid zone, but above the RPE layer. They had a hyperreflective border with a hyporeflective core and a clear posterior tail of hyper-transmission. RESULTS: The present study analyzed 137 eyes of 137 patients. Eighty (58.4%) eyes had acute disease at presentation, 48 (35%) eyes had chronic disease, and eight (5.8%) eyes had resolved CSC. Subretinal hyporeflective globules were seen in 27 (21.8%) eyes, of which choroidal caverns were seen in seven (5.1%) eyes. Twenty-five eyes with chronic CSC and only two eyes with acute CSC had subretinal hyporeflective globules. Three eyes with resolved CSC had subretinal hyporeflective globules. CONCLUSION: We describe subretinal hyporeflective globule as a novel optical coherence tomography (OCT) finding in cases of CSC and describe its clinical correlates.

Interpretable Compositional Representations for Robust Few-Shot Generalization.

We propose Recognition as Part Composition (RPC), an image encoding approach inspired by human cognition. It is based on the cognitive theory that humans recognize complex objects by components, and that they build a small compact vocabulary of concepts to represent each instance with. RPC encodes images by first decomposing them into salient parts, and then encoding each part as a mixture of a small number of prototypes, each representing a certain concept. We find that this type of learning inspired by human cognition can overcome hurdles faced by deep convolutional networks in low-shot generalization tasks, like zero-shot learning, few-shot learning and unsupervised domain adaptation. Furthermore, we find a classifier using an RPC image encoder is fairly robust to adversarial attacks, that deep neural networks are known to be prone to. Given that our image encoding principle is based on human cognition, one would expect the encodings to be interpretable by humans, which we find to be the case via crowd-sourcing experiments. Finally, we propose an application of these interpretable encodings in the form of generating synthetic attribute annotations for evaluating zero-shot learning methods on new datasets.

Vitamin C supplementation for the treatment of osteoarthritis: perspectives on the past, present, and future.

According to the US Centers for Disease Control and Prevention (CDC), an estimated 14% of adults in the United States have either been diagnosed with osteoarthritis (OA) or have symptoms suggestive of the disease. The CDC also points out that the incidence of OA has been gradually increasing over the past 30 years. What is more worrisome is that this trend is going to accelerate due to the aging demographics of the United States and the increasing prevalence of obesity seen in the country. The need for better preventive treatments and efficacious therapeutics are direly needed to combat this public health crisis. Among the possible treatments being hypothesized, antioxidant supplementation has become one of the most widely studied over the past decade due to its ability to attenuate reactive oxygen species (ROS) formation within chondrocytes, a critical step in the pathogenesis of this disease. Vitamin C has emerged as among the most promising of the antioxidant group, with many animal and human studies having been conducted in recent years. Although many of the studies have shown encouraging results in terms of preventing OA, others have reached opposite conclusions, thus making the data controversial. However, after reviewing several of these studies, we hypothesize that certain parameters may not have been properly considered during data collection. In the end, more randomized placebo-controlled trials in humans are desperately needed in order to fully understand whether vitamin C therapy is efficacious in treating and/or preventing OA.

Multilayered retinal pigment epithelial detachment: an optical coherence tomography angiography perspective.

A new entity termed multilayered pigment epithelial detachment is seen to occur with the use of multiple intravitreal anti-VEGF agents. A distinct appearance of a spindle-shaped elevation with bands of hyporeflective and hyperreflective tissue is seen on optical coherence tomography. We describe a novel finding on optical coherence tomography angiography which includes a large type 1 choroidal neovascular membrane underlying this elevation. A large vascular network is seen. It is thought to be protective in nature and may prevent further degeneration.

Surgical management of a large retinal cyst in X-linked retinoschisis with internal drainage: Report of an unusual case.

Although X-linked retinoschisis is a common retinal degeneration condition, the presence of a large retinal cyst obscuring the visual axis in an infant is a rare presentation. Herein, we describe such a case of a child who presented to us with the diagnosis of retinal detachment in both the eyes. However, following multimodal imaging and electrophysiology, the child was found to have bilateral juvenile retinoschisis with a large retinoschisis cyst involving the visual axis seen intraoperatively in the left eye. A limbal approach followed by lensectomy was used to excise the inner retinal layer of the cyst. The intracystic fluid was then drained and the stretched retinal vessels were endocauterized and severed without causing any iatrogenic outer retinal breaks and retinal detachment. The correct diagnosis and meticulous preoperative planning of the surgical procedure helped us manage this challenging case with a favorable anatomical and functional outcome.

Multimodal imaging of angioid streaks.

Angioid streaks (AS) are irregular crack-like dehiscences in Bruch's membrane that are often associated with atrophic degeneration of the overlying retinal pigment epithelium. We herein report multimodal imaging of AS. Multicolor imaging highlighted AS in dark orange color. AS were better visualized in infrared reflectance as compared to green reflectance and blue reflectance. Peau d'orange appearance was seen as alternating dark and bright patches on color fundus photography with corresponding hyporeflective and hyperreflective patches on infrared reflectance. Comet lesions showed increased signal on infrared reflectance and hyperautofluorescence. Multicolor imaging is a non-invasive imaging modality which helps in clearly delineating these lesions.

Validation of multicolor imaging signatures of central serous chorioretinopathy lesions vis-a-vis conventional color fundus photographs.

Purpose: The current study compares the ability of multicolor imaging (MCI) to detect the lesions of central serous chorioretinopathy against conventional color fundus photographs (CFP). Methods: It was a retrospective, observational case series of 93 eyes of 58 patients of central serous chorioretinopathy who underwent MCI and CFP. MCI and spectral-domain optical coherence tomography (SD-OCT) were performed using Spectralis SD-OCT system (HRA + OCT). CFP was obtained using FF 450 Plus fundus camera (Carl Zeiss Meditec, Jena, Germany). SD-OCT was considered gold standard for subretinal fluid (SRF) and retinal pigment epithelium detachment (PED). CFP was considered confirmatory investigation for fibrin and blue autofluorescence image (BAF) was considered gold standard to detect retinal pigment epithelium (RPE) atrophy. Results: CFP could detect SRF in 41 (44.1%) eyes. MCI detected SRF in 43 (46.2%) eyes. The sensitivity and specificity of MCI to detect SRF were 70.7% and 94.3%, respectively. PED was detected by CFP in 21 (22.6%) eyes and MCI in 27 (29%) eyes. The sensitivity and specificity of MCI to detect PED were 70% and 97.7% respectively. CFP could pick RPE atrophy in 52 (55.9%) eyes whereas MCI was picked it in 78 (83.9%) of eyes. Conclusion: Both MCI and CFP were inferior to a gold standard in identifying the SRF, PED, and RPE atrophy. However, MCI was better than CFP in comparison with gold standard for these clinical findings in CSC. Thus, MCI seems to be a more valuable imaging tool compared to CFP.

A novel hybrid approach for automated detection of retinal detachment using ultrasound images.

Retinal detachment (RD) is an ocular emergency, which needs quick intervention to preclude permanent vision loss. In general, ocular ultrasound is used by ophthalmologists to enhance their judgment in detecting RD in eyes with media opacities which precludes the retinal evaluation. However, the quality of ultrasound (US) images may be degraded due to the presence of noise, and other retinal conditions may cause membranous echoes. All these can influence the accuracy of diagnosis. Hence, to overcome the above, we are proposing an automated system to detect RD using texton, higher order spectral (HOS) cumulants and locality sensitive discriminant analysis (LSDA) techniques. Our developed method is able to classify the posterior vitreous detachment and RD using support vector machine classifier with highest accuracy of 99.13%. Our system is ready to be tested with more diverse ultrasound images and aid ophthalmologists to arrive at a more accurate diagnosis.

Focal choroidal excavation and giant choroidal cavern in an eye with pachychoroid.

Focal choroidal excavation (FCE) is a localized excavation of the choroid, which can be diagnosed by enhanced depth optical coherence tomography (OCT). Choroidal caverns are focal cavitation areas in the choroid which appear hyporeflective on OCT. These are angular or round, empty spaces with posterior tail of hypertransmission. A 47-year-old female presented to us for a routine eye check-up. The best-corrected visual acuity was 20/20 in both the eyes. On fundus examination, a localized pigmented lesion was seen in the right eye inferior to the optic disc, while the fundus of the left eye was normal. Spectral-domain OCT scan through the lesion showed an FCE and a giant cavern with a posterior tail of hypertransmission. The diameter of the cavern was 977 µ ×264 µ, with a subfoveal choroidal thickness (SFCT) of 360 µ. The SFCT of the other eye was 300 µ. Coexistence of FCE and cavern in an eye with thickened choroid is not yet reported in the literature, and their coexistence provides possible insight into the formation of FCE and caverns in the setting of thickened choroid.

Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature.

We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.

Acute macular neuroretinopathy after blunt ocular trauma: A rare association.

Acute macular neuroretinopathy (AMN) is a deep retinal ischemic manifestation. It has been reported after the use of sympathomimetics, childbirth, bee sting, oral contraceptives, flu-like illness, intravenous contrast agents and bodily trauma not directly involving the eyes. We report a case of AMN following blunt ocular trauma. An 18-year-old male presented with an acute history of blurring of vision following blunt trauma to the right eye. Spectral domain optical coherence tomography (SD-OCT) showed hyperreflectivity of the outer nuclear layer with ellipsoid layer disruption. This report highlights AMN as a manifestation of blunt trauma, presence of which may be an indicator of poor visual prognosis.

Utility of multicolor optic disc photography in evaluation of glaucomatous optic disc in myopic eyes: A novel approach.

Interpretation of optic disc cupping and neuroretinal rim is challenging in myopic eyes because of large, shallow, and tilted disc, myopic crescent, and macular degeneration. Color and red-free optic disc photographs do not reveal the cup/disc ratio often in myopic eyes. We report characteristics of multicolor optic disc photography in three myopic eyes. All eyes underwent multicolor imaging Spectralis SDOCT system (Heidelberg Engineering, Germany). Owing to use of three laser lights in a confocal design, multicolor optic disc photography was able to delineate the neuroretinal rim and optic cup more clearly than color and red-free optic disc photographs.