ABSTRACT
Purpose: To describe the clinical and multimodal imaging features in a case of resolution of pre-macular fibrosis after photodynamic therapy (PDT) of retinal hemangioblastoma (RH) not related to von-Hippel-Lindau (VHL). Observations: A 25-year-old man presenting with blurred vision and central metamorphopsia in his left eye (LE) due to macular epiretinal membrane secondary to a peripheral RH. The patient had a comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), wide-field fundus photography and autofluorescence (FAF), wide-field optical coherence tomography (OCT) and OCT angiography (OCTA), fluorescein angiography (FA) and indocyanine green angiography (ICGA) and ocular ultrasound. Baseline BCVA was 20/200 in his LE, and it improved to 20/40 nineteen months after anti-VEGF and photodynamic therapy were performed. The treatment led to a progressive shrinkage of the tumor and associated intraretinal exudation, and to a progressive resolution of the epiretinal membrane. Conclusions and importance: Treatments performed on the peripheral retina may result in changes at the level of the vitreo-retinal interface in the macular region. In our patient, after an intravitreal anti-VEGF associated with PDT, a posterior vitreous detachment (PVD) was induced resulting in auto-peeling of the macular epiretinal membrane secondary to a peripheral RH. An accurate assessment of the macular area by OCT is highly recommended in the first days following treatments.
ABSTRACT
PURPOSE: To evaluate the effect of two different A-scan rates on qualitative and quantitative parameters on optical coherence tomography angiography images in a clinical setting. METHODS: Subjects undergoing a comprehensive ophthalmic examination were scheduled for optical coherence tomography angiography imaging using a new SPECTRALIS device allowing for 85 and 125 kHz scan rate. Consecutive registered 20° × 20° optical coherence tomography angiography images using both speeds were acquired using the follow-up tool. The acquisition time and the quality values of each scan were extracted and analyzed. The image quality was also graded in pairs by two independent graders. RESULTS: Two-hundred and one eyes of 128 consecutive patients (67 males, 52.3%) were included. Mean acquisition time significantly decreased from 56.92 ± 24.6 seconds on the 85 kHz images to 39.39 ± 15.5 seconds on the 125 kHz images (P < 0.001). The percentage change in acquisition time showed a mean decrease of 28.47%. Mean Q value significantly decreased from 32.97 ± 2.8 dB on the 85 kHz images to 31.43 ± 2.6 dB on the 125 kHz images (P < 0.001). Overall, 92.5% of images were graded as equal or better at 125 kHz A-scan rate. CONCLUSION: The use of optical coherence tomography angiography in daily clinical practice may require higher A-scan rates for an optimal workflow. Increased speed may also reduce image sensitivity and thus image quality could be compromised. In this study, 125 kHz scan rate using SPECTRALIS showed significant benefit with reduction on the acquisition time and no clinically significant differences on image quality analysis. Further studies evaluating qualitative and quantitative data in specific retinal conditions and using other devices are required to confirm these results.
Subject(s)
Retinal Diseases , Tomography, Optical Coherence , Male , Humans , Angiography , Eye , WorkflowABSTRACT
PURPOSE: To highlight the importance of swept-source anterior segment optical coherence tomography (SS-ASOCT) in the peri-surgical management of cataract in uveitis. To describe a case of fibrinoid syndrome in uveitis treated with recombinant tissue plasminogen activator (rtPA). METHODS: SS-ASOCT was performed at each follow-up before and after cataract surgery to assess anterior chamber inflammation and assist the clinical management of the patient. RESULTS: A patient with idiopathic autoimmune uveitis was scheduled for cataract surgery. SS-ASOCT allowed to correctly plan the surgery timing. The patient developed a severe fibrinoid syndrome. Postsurgical SS-ASOCT allowed to distinguish between anterior chamber cells and fibrin thus guiding the timing for rtPA intracameral injection. Visual acuity improved from 20/400 the day after the surgery to 20/40. CONCLUSION: SS-ASOCT allowed a precise assessment of the inflammatory components (cellular vs fibrinoid) after cataract surgery. Intracameral rtPA was safe and effective in the treatment fibrinoid syndrome in uveitis.
ABSTRACT
Purpose: To describe the clinical and multimodal imaging findings, including optical coherence tomography (OCT), and OCT angiography (OCTA) in a case presenting with acute fovealitis after COVID-19 infection, and its differential diagnosis. Observations: A 39-year-old man presenting with acute central metamorphopsia in his right eye (OD) right after positive test for COVID-19 underwent comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), color fundus (CF) examination, optical coherence tomography (OCT), OCT angiography (OCTA), fundus autofluorescence (FAF) and fluorescein angiography (FA). Baseline BCVA was 20/40 in his OD and fundus examination showed small inferior juxtafoveal hemorrhages with no other vascular abnormalities or peripheral changes. The OCT B-scans revealed a central focal defect of the ellipsoid and interdigitation zones associated with foveal and perifoveal columnar hyperreflectivities involving the photoreceptor layers, the external limiting membrane and outer nuclear layer up to the outer plexiform layer with preservation of the retinal pigment epithelium-Bruch's membrane complex. Both FAF and FA images were unremarkable. Over three months follow-up, the findings progressively resolved, and BCVA improved to 20/20. Conclusions and importance: The presence of hyperreflective material at the fovea in association with adjacent hemorrhages, the absence of alterations of the retinal pigment epithelium in OCT, OCTA, FAF and FA suggested the diagnosis of acute fovealitis in COVID-19 context. The presence of these findings highlights the importance of detailed ophthalmic evaluation in symptomatic patients with COVID-19 positive test.
