AN ATYPICAL CASE OF SOLAR MACULOPATHY.

PURPOSE: To present a case of atypical solar maculopathy. METHODS: Case report. RESULTS: A 7-year-old boy who viewed an eclipse 17 months earlier had macular findings blending features of solar and laser pointer maculopathies. The right macula clinically had a central 1,000-µm, slightly irregular round area of pigmentary changes and a tiny outer macular optical coherence tomography defect. In addition, the superior fovea had a hyperreflective mound-like retinal pigment epithelial detachment extending into the outer retina. The left macula contained several, more typical solar maculopathy lesions. CONCLUSION: We describe a unique case of solar maculopathy displaying typical optical coherence tomography findings in both eyes along with a unilateral laser pointer-like hyperreflective retinal pigment epithelial detachment.

AN ATYPICAL CASE OF OPTIC DISK PSEUDO-DUPLICATION WITH PROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To present a unique case of optic disk pseudo-duplication with proliferative diabetic retinopathy. METHODS: Case report. RESULTS: A 63-year-old white diabetic man presented with an apparent duplicated optic disk in the superonasal midperiphery of his left eye. A large flat frond of neovascularization fanned out from this structure. Optical coherence tomography scanning showed a noncolobomatous scar with a large plume of blood vessels sprouting from the choroid, thru the retina and branching out into the vitreous. Magnetic resonance imaging scanning revealed a normal left globe and orbit with a single optic nerve. The neovascularization regressed after panretinal photocoagulation and anti-vascular endothelial growth factor therapy. CONCLUSION: We describe a unique case of proliferative diabetic retinopathy associated with pseudo-duplication of the optic disk. This case is unique in the peripheral location of the pseudo-duplication, the presence of spontaneous choroidovitreal neovascularization in proliferative diabetic retinopathy, and the appearance of neovascularization elsewhere mimicking neovascularization of the duplicated disk.

REVISED CLASSIFICATION OF THE OPTICAL COHERENCE TOMOGRAPHY OUTER RETINAL BANDS BASED ON CENTRAL SEROUS CHORIORETINOPATHY ANALYSIS.

PURPOSE: To evaluate the optical coherence tomography (OCT) imaging findings in recent onset neurosensory retinal detachments induced by central serous chorioretinopathy and to attempt to corroborate these findings with proposed anatomical correlates. METHODS: Retinal detachments due to central serous chorioretinopathy of less than 3 months' duration and the surrounding area were scanned with OCT. The imaging of the outer retinal bands was evaluated according to proposals by Cuenca et al and the IN•OCT Consensus classification. RESULTS: Optical coherence tomography findings in 11 eyes (11 patients) with CSC showed that all hyperreflective bands above Band 4 were variably continuous within the outer portion of the serous detachment. We then attempted to reconcile inconsistencies in current explanations for the outer retinal bands to propose changes to the outer retinal OCT nomenclature. CONCLUSION: Our patients' OCT findings support the current standard that Band 3 is an outer retinal structure and that Band 4 represents the retinal pigment epithelium/Bruch complex. Confusion exists regarding whether the interdigitation zone extends halfway up or for the full length of the outer segments, and the hyporeflective band between Bands 3 and 4 has yet to receive an appropriate term. We therefore propose a modification to the IN•OCT Consensus classification by renaming the trilaminar hyporeflective, hyperreflective, and hyporeflective bands between Bands 2 and 4 as the outer segment-interdigitation zone complex consisting of the inner, middle, and outer segment-interdigitation zone, respectively.

The outer Bruch membrane layer: a previously undescribed spectral-domain optical coherence tomography finding.

PURPOSE: To report a previously undescribed spectral-domain optical coherence tomography finding, the outer Bruch membrane layer. METHODS: Prospective case descriptions. RESULTS: Patients with variable macular abnormalities were examined with spectral-domain optical coherence tomography scanning. All had areas of either retinal pigment epithelial elevation or atrophy with an underlying hyperreflective band that we interpret as the outer Bruch membrane layer. CONCLUSION: The outer Bruch membrane is a consistent optical coherence tomography finding in areas of absent, atrophic, or elevated retinal pigment epithelium.

Long-term filtration and visual field outcomes after primary glaucoma triple procedure with and without mitomycin-C.

OBJECTIVE: To evaluate the long-term effectiveness of glaucoma management in patients undergoing primary glaucoma triple procedure (PGTP) with and without adjunctive subconjunctival mitomycin-C (MMC). DESIGN: Case-controlled study. PARTICIPANTS: Of the 203 eyes of 203 primary open-angle glaucoma (POAG) patients who had undergone PGTP and in whom reliable Humphrey visual fields had been obtained both before and after surgery at 13.5 +/- 8.9 and 27.9 +/- 8.9 months, 124 of the 144 eyes that received MMC during surgery were matched to the other 59 eyes that did not with respect to cup-to-disc ratio and risk factors for filtration failure in addition to other variables. MAIN OUTCOME MEASURES: Both preoperative and postoperative intraocular pressure (IOP), Humphrey visual fields and their global indices, number of glaucoma medications, and best-corrected visual acuity (BCVA). RESULTS: There were no significant differences in demographics between the two groups (P > 0.05 for each). Whereas both the control and the MMC groups attained significant decreases of mean IOP (18.5 +/- 5.7 mmHg-;15.6 +/- 4.6 mmHg, P = 0.0014; 19.3 +/- 7.0 mmHg-13.7 +/- 4.9 mmHg, P = 0.0001) and mean number of medications (2.1 +/- 1.3-1.3 +/- 1.3, P = 0.0001; 2.3 +/- 1.2-1.0 +/- 1.3, P = 0.0001) at 36 months after surgery, the MMC group had significantly lower mean IOP than the control group at all postoperative visits (P < 0.05 for each). The MMC group also tended to have less medical dependency after surgery than the control group. There was no significant difference in postoperative BCVA between the two groups. Patients in both groups had mean visual acuity of 20/30 or better. There was a significant worsening of corrected pattern standard deviation (CPSD) in the control group (3.97 +/- 3.18-5.17 +/- 3.36, P = 0.001) compared with no significant change in the MMC group (5.07 +/- 4.11-5.23 +/- 3.36, P = 0.93). The mean deviation did not change significantly in either group. CONCLUSIONS: The long-term glaucoma management in POAG patients with cataract undergoing PGTP indicates a successful outcome in final IOP, medical dependency, and BCVA. Furthermore, the MMC group had better IOP control and stable visual fields (CPSD), whereas the control group had a significant worsening of CPSD.