Subject(s)
Arterial Occlusive Diseases/etiology , Endocarditis/complications , Ophthalmic Artery/pathology , Retinal Artery Occlusion/etiology , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/pathology , Endocarditis/diagnosis , Fatal Outcome , Heart Failure/complications , Heart Failure/microbiology , Humans , Male , Middle Aged , Retinal Artery Occlusion/diagnosis , Streptococcal Infections/complications , Streptococcal Infections/diagnosisABSTRACT
INTRODUCTION: Central serous chorioretinopathy (CSCR) is a retinal disease characterized by a serous retinal detachment (SRD) responsible for a macular syndrome in young patients, often in the context of stress. In our study, we aimed to describe through multimodal analysis the clinical, angiographic and tomographic characteristics of CSCR while identifying prognostic factors and highlighting functional-anatomic correlations. METHODS: We conducted a retrospective, descriptive and analytic study over a period of 6 years on 35 eyes of 34 patients with CSCR. The simultaneous analysis of clinical exams and imaging allowed for correlation between the anatomic lesions and visual function. RESULTS: A correlation was found between the leakage point on angiography and pigment epithelial detachments (PED) in 8 eyes (28.5%), and retinal pigment epithelial (RPE) irregularities in 6 eyes (21.4%) on optical coherence tomography (OCT). Factors associated with poor functional outcome were: poor initial visual acuity, greater subretinal fluid height (P=0.054), presence of highly reflective dots on OCT within the SRD (P<0.05) and the number of PED's (P=0.008). CONCLUSION: Although CRSC often a resolves spontaneously, the functional prognosis can be affected by macular sequellae. A comprehensive assessment of the anatomical lesions is essential to detect poor prognostic factors.
Subject(s)
Central Serous Chorioretinopathy , Adult , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/etiology , Central Serous Chorioretinopathy/pathology , Disease Progression , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Tomography, Optical Coherence , Young AdultABSTRACT
INTRODUCTION: Foveoschisis is a rare condition in highly myopic eyes, characterized by intra-retinal cleavage associated with abnormalities of the vitreous cortex and occasionally cortical retraction. The natural history of foveoschisis is unpredictable. The functional prognosis is often favorable after surgical treatment. MATERIALS AND METHODS: We report 7 cases of macular retinoschisis in highly myopic eyes. We describe the optical coherence tomographic features as well as associated signs. The correlation with visual acuity was assessed. RESULTS: Foveoschisis was undetected on clinical exam and visualized only on optical coherence tomography (OCT) in 4 cases. Mean central foveal thickness was 540 , mean visual acuity was 1/10P10. The thicker the macula was, the worse was the visual acuity. The presenceor absence of serous retinal detachment did not affect visual acuity, whereas an epiretinal membrane or retraction of the vitreous cortex appeared to induce visual loss. CONCLUSION: OCT has been demonstrated to be particularly useful for the diagnosis of visual loss in the high myope, notably in the case of foveoschisis. Anatomic-functional correlations in high myopic foveoschisis are not yet well clarified. Posterior pole retinal detachment and macular hole are the most serious complications.
Subject(s)
Myopia/complications , Retinoschisis/complications , Adult , Aged , Humans , Male , Middle Aged , Myopia/diagnosis , Myopia/surgery , Retinoschisis/diagnosis , Retinoschisis/surgery , Retrospective Studies , Severity of Illness Index , Tomography , Visual AcuityABSTRACT
INTRODUCTION: Multifocal choroidal ischemia is a complication of severe hypertension, notably in preeclampsia. It is a rare phenomenon due to multiple choriocapillaris occlusions. CLINICAL OBSERVATIONS: We report the cases of two patients, age 28 and 32 years, 34 and 26 weeks since last menstrual period, respectively. The first had controlled preeclampsia under treatment. The second had developed Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome complicated by in utero fetal death. Both patients reported visual loss. Comprehensive ophthalmological examination and fluorescein angiography confirmed the diagnosis of multifocal choroidal ischemia, in the acute stage in the first patient and cicatricial in the second. CONCLUSION: Acute choroidal ischemia is an ocular vascular syndrome which must be ruled out by systematic examination in any preeclamptic patient, so as to make the diagnosis and begin treatment early.
Subject(s)
Choroid/blood supply , Ischemia/complications , Pre-Eclampsia , Adult , Female , Humans , Ischemia/diagnosis , PregnancyABSTRACT
PURPOSE: To evaluate intraocular pressure parameters and the role of other ocular risk factors in the progression of primary open angle glaucoma. PATIENTS AND METHODS: We performed a retrospective analysis of long-term glaucomatous progression in 140 patients (280 eyes) with primary open angle glaucoma (POAG) between 1998 and 2009. After analyzing their disease progression, the eyes of our patients were divided into two groups: group 1 (G1) consisted of eyes with worsening of their POAG, and group 2 (G2) consisted of the eyes that remained stable. The indicators of progression studied were factors associated with glaucomatous optic neuropathy, other ocular risk factors, and treatment-related risk factors. RESULTS: We found 188 eyes with stable visual fields (G2) and 92 eyes with glaucoma progression (G1), for a progression rate of 32.9%. Mean intraocular pressure (IOP) at diagnosis was statistically higher in the cases with progression, 22.78 mmHg vs. 19.9 mmHg for stable cases (P=0.03; OR=5.25). Higher final intraocular pressure (IOP) was also associated with progression (16.82 mmHg for G1 vs. 14.85 mmHg for G2; P=0.051). IOP less or equal to 12.75 mmHg was identified as the target pressure for our population. Progressed eyes also showed a statistically higher diurnal peak IOP (23.13 mmHg vs. 19.87 mmHg for G2; P=0.007). Long term IOP fluctuation was also predictive of progression (4.43 mmHg for G1 vs. 2.31 mmHg for G2; P=0.003). Eyes with initial visual field defect more than 8.2dB had 4.8 times the risk of progression (P=0.07). However, eyes diagnosed in an early glaucoma stage had four times the chance of maintaining a stable visual field (P=0.003). Statistically significant risk factors between the two groups also included: pseudoexfoliation (OR=2.84; P=0.05), cornea less than 505 µ (OR=10.89; P=0.005), topical beta blockers (P=0.003), and more than two topical medications (OR=3; P=0.003). CONCLUSION: It is currently known that IOP lowering contributes to glaucoma stabilization. However, this single criterion remains insufficient, as other, particularly ocular, factors have been implicated in glaucoma progression. Identification of these risk factors allows for a better therapeutic approach toward these patients, so as to preserve their vision and quality of life.
