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1.
Br J Ophthalmol ; 2024 May 10.
Article in English | MEDLINE | ID: mdl-38729765

ABSTRACT

BACKGROUND/AIMS: To evaluate the diagnostic accuracy of spectral-domain optical coherence tomography (SD OCT) combined with OCT angiography (OCTA) for myopic myopic macular neovascularisation (MNV) activity. METHODS: Both eyes of patients with myopic MNV diagnosed with fluorescein angiography (FA), SD OCT and OCTA were assessed by unmasked investigators. The images were deidentified and randomised before graded by masked investigators, who determined the presence of active myopic MNV by using SD OCT together with OCTA without FA and by FA alone, respectively. The findings of masked investigators were compared with unmasked investigators. RESULTS: 213 eyes of 110 patients comprising 499 imaging episodes were eligible for grading. For diagnosing new-onset myopic MNV without FA, combined use of SD OCT and OCTA had a sensitivity of 0.94, specificity of 0.84 and area under the curve (AUC) of 0.92. FA had a sensitivity of 0.52 (p<0.01), specificity of 0.80 (p=0.38) and AUC of 0.66 (p<0.01). For recurrent myopic MNV, the combination of SD OCT and OCTA had a sensitivity of 0.98, specificity of 0.78 and AUC of 0.88. FA had a sensitivity of 0.50 (p=0.04), specificity of 0.76 (p=0.85) and AUC of 0.63 (p=0.01). Myopic traction maculopathy was more frequently associated with recurrent myopic MNV (p<0.01). CONCLUSION: SD OCT with dense volumetric scan was highly sensitive for diagnosing myopic MNV. The addition of OCTA improved the diagnostic specificity without FA. Monitoring of the longitudinal changes on SD OCT and judicious use of FA is a reliable surveillance strategy for myopic MNV.

2.
Retina ; 43(12): 2134-2138, 2023 Dec 01.
Article in English | MEDLINE | ID: mdl-35512285

ABSTRACT

PURPOSE: To report the outcomes of the Peeling and Internal Limiting Membrane Reposition (PAIR) technique in myopic foveoschisis. METHODS: A retrospective case series of eyes with myopic foveoschisis that underwent vitrectomy and PAIR. Visual acuity, fundus photographs, and optical coherence tomography measurements were obtained and analyzed. Data are presented as medians (ranges). RESULTS: A total of seven eyes underwent PAIR and were followed up for 339 days (188-436 days). No intraoperative complications were noted. One eye exhibited postoperative macular hole formation, but the hole was healed through fluid-gas exchange. At the last follow-up, the visual acuity had improved from 20/66 (20/332-20/40) to 20/40 (20/100-20/25), and the central foveal thickness had decreased from 576 µ m to 269 µ m. A repositioned internal limiting membrane (ILM) was observed in six of the eyes, and inner retinal dimples were noted in only two eyes. However, retinal wrinkles under the repositioned or perifoveal ILM were noted in five eyes. CONCLUSION: The PAIR technique relieved traction, restored the ILM, and achieved functional and morphological improvement in eyes with myopic foveoschisis. Limited occurrence of inner retinal dimples and retinal thinning was noted, but retinal wrinkles occurred, likely due to ILM contracture.


Subject(s)
Epiretinal Membrane , Myopia, Degenerative , Retinal Perforations , Retinoschisis , Humans , Retinoschisis/diagnosis , Retinoschisis/surgery , Retinoschisis/etiology , Retrospective Studies , Basement Membrane/surgery , Retina/surgery , Vitrectomy/methods , Retinal Perforations/diagnosis , Retinal Perforations/surgery , Retinal Perforations/etiology , Tomography, Optical Coherence/methods , Myopia, Degenerative/complications
3.
Br J Ophthalmol ; 106(1): 106-112, 2022 01.
Article in English | MEDLINE | ID: mdl-33055087

ABSTRACT

AIMS: To determine longitudinal differences in foveal thickness in preschool-aged patients with or without a history of type I retinopathy of prematurity (ROP). METHODS: A study of 201 eyes, including 32 laser±intravitreal bevacizumab (IVB)-treated eyes, 37 IVB-treated eyes, 14 spontaneously regressed ROP eyes, and 118 age-matched controls were enrolled in this study. The retinal thicknesses (full, inner and outer) were measured in the foveal area at 6-month intervals four consecutive times by optical coherence tomography. RESULTS: The foveal thicknesses among the four groups were similar at all four visits (all p>0.05) after gestational age (GA) adjustment and remained similar with no differences after the full retinal thickness was divided into inner and outer thicknesses (all p>0.05). The full and outer foveal thicknesses of premature children increased over time (0.17 µm/month and 0.17 µm/month; p=0.0001 and 0.0003, respectively), but the inner foveal thickness remained unchanged with time (0.002 µm/month; p=0.09). Moreover, the positive correlation with best-corrected visual acuity was stronger for outer foveal thickness than for inner foveal thickness (γ=0.281, p<0.0001 and γ=0.181, p<0.0001, respectively). CONCLUSION: The thickness of fovea in laser±IVB-treated, IVB-treated, regressed ROP and preterm eyes showed no difference after GA adjustment. The whole and outer foveal thicknesses increased with time in preschool-aged children over a 1.5-year follow-up period, but the inner foveal thickness remained unchanged with time.


Subject(s)
Retinopathy of Prematurity , Bevacizumab/therapeutic use , Child, Preschool , Gestational Age , Humans , Infant, Newborn , Laser Coagulation/methods , Longitudinal Studies , Prospective Studies , Retinopathy of Prematurity/diagnosis , Retinopathy of Prematurity/drug therapy , Retinopathy of Prematurity/surgery , Tomography, Optical Coherence/methods , Vascular Endothelial Growth Factors , Visual Acuity
4.
Cureus ; 13(6): e16071, 2021 Jun.
Article in English | MEDLINE | ID: mdl-34367742

ABSTRACT

Trichophyton species is a dermatophytic fungus commonly found in the skin, nails, hair, and other organic matters such as palm trees and soil. We report a rare case of a 23-year-old man who had a penetrating injury to the eye from the leaves of a palm tree and subsequently developed exogenous endophthalmitis. Culture from the vitreous tap revealed Trichophyton sp as the causative organism. Early vitrectomy and adequate intravitreal injection of amphotericin B resulted in good visual outcomes in an otherwise blinding condition. This is the first reported case of exogenous endophthalmitis secondary to Trichophyton species. Early diagnosis and prompt treatment may help improve visual outcomes.

5.
Am J Ophthalmol ; 232: 70-82, 2021 12.
Article in English | MEDLINE | ID: mdl-34116008

ABSTRACT

PURPOSE: To assess the diagnostic accuracy of optical coherence tomography angiography (OCTA) compared with multimodal imaging for choroidal neovascularization (CNV) in central serous chorioretinopathy (CSC) eyes and to determine the features that predicted CNV. DESIGN: Prospective cross-sectional study. METHODS: Consecutive CSC patients were recruited from retina clinic. The reference standard for CNV was determined by interpretation of multimodal imaging with OCTA, structural OCT line scan, fluorescein angiography (FA), indocyanine green angiography (ICGA), ultra-widefield fundus photography and fundus autofluorescence (FAF). Two independent masked graders examined OCTA without FA and ICGA to diagnose CNV. Univariate and multivariate analyses were performed to evaluate factors associated with CNV. RESULTS: CNV was detected in 69 eyes in 64 out of 277 CSC patients according to reference standard. The two masked graders who examined OCTA had sensitivity of 81.2% (95% Confidence Interval [CI], 71.9%-90.4%) and 78.3% (95% CI, 68.5%-88.0%), specificity of 97.3% (95% CI, 95.9%-98.8%) and 96.2% (95% CI, 94.5%-98.0%), positive predictive values of 82.4% (95% CI, 73.3%-91.4%) and 76.1% (95% CI, 66.1%-86.0%), and negative predictive values of 97.1% (95% CI, 95.6%-98.7%) and 96.7% (95% CI, 95.0%-98.3%). Their mean area under the receiver operating characteristic curve (AUC) was 0.88 with good agreement (Kappa coefficient 0.80 [95% CI, 0.72-0.89]). Flat irregular pigment epithelial detachment on structural OCT, neovascular network on OCTA and ill-defined late leakage on FA significantly correlated with CNV in CSC from multiple regression (P < 0.001, P < 0.001 and P = 0.005, respectively). CONCLUSIONS: There is discordance between OCTA and multimodal imaging in diagnosing CNV in CSC. This study demonstrated the caveats in OCTA interpretation, such as small extrafoveal lesions and retinal pigment epithelial alterations. Comprehensive interpretation of OCTA with dye angiography and structural OCT is recommended.


Subject(s)
Central Serous Chorioretinopathy , Choroidal Neovascularization , Central Serous Chorioretinopathy/diagnosis , Choroid/diagnostic imaging , Choroidal Neovascularization/diagnostic imaging , Cross-Sectional Studies , Fluorescein Angiography , Humans , Indocyanine Green , Multimodal Imaging , Prospective Studies , Retrospective Studies , Tomography, Optical Coherence
6.
Eur J Ophthalmol ; 31(5): NP83-NP87, 2021 Sep.
Article in English | MEDLINE | ID: mdl-32460537

ABSTRACT

INTRODUCTION: The Epstein-Barr virus is a rare causative pathogen identified in the posterior segment. The majority of cases were presented with a serious condition of acute retinal necrosis, and most of these eyes had poor outcomes. The clinical features and effective treatment options for this condition are still unclear.Case description: A 10-year-old boy with leukaemia and receiving immunosuppressive regimen presented with decreasing visual acuity to counting fingers in his left eye for 2 weeks. Fundus examination revealed disc swelling, retinitis, retinal exudates and haemorrhages. Aqueous polymerase chain reaction was positive for Epstein-Barr virus DNA but negative for cytomegalovirus, herpes simplex virus and varicella zoster virus DNA. Systemic acyclovir and intravitreal ganciclovir injection were administered. Seven months later, retinitis resolved with remnant retinal fibrosis, and visual acuity improved to 20/500. CONCLUSION: Epstein-Barr virus is rarely identified as a sole pathogen in retinitis. Peripapillary predilection might be another type of presenting feature apart from the more-commonly reported peripheral acute retinal necrosis.


Subject(s)
Epstein-Barr Virus Infections , Eye Infections, Viral , Retinal Necrosis Syndrome, Acute , Retinitis , Antiviral Agents/therapeutic use , Child , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/drug therapy , Eye Infections, Viral/diagnosis , Eye Infections, Viral/drug therapy , Herpesvirus 4, Human/genetics , Humans , Male , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Retinitis/diagnosis , Retinitis/drug therapy
7.
Am J Ophthalmol ; 223: 296-305, 2021 03.
Article in English | MEDLINE | ID: mdl-32950511

ABSTRACT

PURPOSE: To compare the outcomes between using a nasal and a temporal inverted internal limiting membrane (ILM) flap both assisted by a novel technique in repairing a full-thickness macular hole (FTMH). DESIGN: Retrospective interventional case series. METHODS: Thirty-nine eyes from 39 patients with a FTMH <600 µm were included from a single institution. All patients underwent vitrectomy using a semicircular single-layered ILM inverted flap assisted by a sub-perfluorocarbon liquid injection of ophthalmic viscoelastic device (OVD) technique. Best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography were used to compare outcomes between nasal (n = 19) and temporal (n = 20) groups. RESULTS: At 6 months postoperatively, all FTMHs closed and BCVA were significantly improved. Overall, 36 eyes (92%) achieved U-shaped closure, and ellipsoid zone restoration was noted in 24 eyes (62%). An ILM flap was present in 29 eyes (74%) and 86% remained single-layered. There were significantly more deep inner retinal dimples in the temporal group (35%) compared with 5% in the nasal group (P = .04), but these were unrelated to BCVA. Significant retinal thinning in the temporal outer sub-field was noted in the temporal group and was negatively correlated with BCVA (rho [ρ]: - .53; P = .03). No significant postoperative retinal displacement was noted in either group. CONCLUSIONS: The technique of using sub-perfluorocarbon liquid injection of OVD secured single-layered flaps intraoperatively and postoperatively. Both the nasal and temporal inverted ILM flaps repaired FTMH and improved visual acuity. However, both temporal macular thinning and deep inner retinal dimples were significantly greater in the temporal group.


Subject(s)
Basement Membrane/surgery , Endotamponade/methods , Fluorocarbons/administration & dosage , Retinal Perforations/surgery , Surgical Flaps , Vitrectomy/methods , Female , Follow-Up Studies , Humans , Injections, Intraocular , Male , Middle Aged , Retinal Perforations/diagnosis , Retrospective Studies , Tomography, Optical Coherence/methods , Treatment Outcome
8.
Cureus ; 12(9): e10297, 2020 Sep 07.
Article in English | MEDLINE | ID: mdl-33047087

ABSTRACT

We report a case of optic disc drusen (ODD) associated with peripapillary polypoidal choroidal vasculopathy (PCV). A 62-year-old Malay lady presented with both eye ODD and the left eye associated with peripapillary subretinal hemorrhage. Ultrasound B-scan and red-free photography confirmed the optic nerve head drusen findings bilaterally. Optical coherence tomography (OCT) of the left eye showed sharply elevated peripapillary pigment epithelial detachment with subretinal fluid. The presence of peripapillary polyps with branching vascular network in indocyanine green angiography of the left eye further confirmed the diagnosis of PCV and excluded choroidal neovascularization (CNV) secondary to ODD. Subsequently, the patient was treated with a combination of verteporfin photodynamic therapy with three monthly intravitreal ranibizumab injections. Three months after the combined treatment, OCT showed completely resolved subretinal fluid. ODD can cause compression of the subretinal vessels at the optic disc that results in retinal ischemia and release of vascular endothelial growth factor, which may trigger the development of CNV or PCV. The rarity of this combination makes it interesting to study more cases of ODD with PCV. Importantly, a thorough evaluation in distinguishing the PCV from the CNV that mimics it is crucial for early detection and prompt intervention. In this case, indocyanine green angiography (ICGA) is the diagnostic method to differentiate the PCV from CNV secondary to ODD.

9.
BMC Ophthalmol ; 20(1): 116, 2020 Mar 21.
Article in English | MEDLINE | ID: mdl-32199465

ABSTRACT

BACKGROUND: To evaluate the feasibility of a surgical technique using a sub-perfluoro-n-octane (PFO) injection of ocular viscoelastic device (OVD) to stabilize inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD). METHODS: This study was a retrospective, consecutive, interventional case series. Patients who underwent MHRD surgery with sub-PFO injection of OVD to stabilize inverted ILM flap onto the macular hole (MH) were reviewed. The color fundus and optical coherence tomography (OCT) images were collected and evaluated. The best-corrected visual acuity (BCVA) before and after surgery were compared as the functional outcome. RESULTS: The study included 8 eyes of 8 consecutive patients (mean age: 61.8 ± 7.1 years; mean follow-up period: 9.0 ± 2.5 months). All eyes (100%) achieved successful MH closure; 7 eyes (87.5%) demonstrated complete retinal reattachment, and 1 eye (12.5%) had minimal residual subretinal fluid parafoveally. Of the 8 patients, 7 patients (87.5%) had achieved improvement in BCVA after the primary surgery, whereas 1 eye remained stable. The average BCVA before and after the surgery at the last visit improved from 20/843 (1.63 ± 0.48 logMAR) to 20/200 (1.00 ± 0.39 logMAR) (P = 0.016). Anatomically, near-normal foveal contour was noted in five (62.5%) eyes at the final follow-up. CONCLUSIONS: The use of sub-PFO injection of OVD in MHRD surgery could stabilize inverted ILM flaps, achieve good anatomical results and improve postoperative BCVA.


Subject(s)
Basement Membrane/surgery , Endotamponade/methods , Epiretinal Membrane/surgery , Fluorocarbons/administration & dosage , Retinal Detachment/surgery , Retinal Perforations/surgery , Surgical Flaps , Aged , Aged, 80 and over , Basement Membrane/diagnostic imaging , Basement Membrane/physiopathology , Epiretinal Membrane/diagnostic imaging , Epiretinal Membrane/physiopathology , Female , Follow-Up Studies , Humans , Intravitreal Injections , Male , Middle Aged , Retinal Detachment/diagnostic imaging , Retinal Detachment/physiopathology , Retinal Perforations/diagnostic imaging , Retinal Perforations/physiopathology , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity/physiology , Vitrectomy
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