Peripheral and macular polypoidal choroidal vasculopathy: A retrospective comparative case series.

PURPOSE: To compare clinical and imaging features and treatment outcomes between eyes having peripheral polypoidal choroidal vasculopathy (PCV) and macular PCV. METHODS: In this retrospective comparative case series, confirmed cases of peripheral and macular PCV cases on indocyanine green angiography (ICGA) were included. The various demographic features, imaging characteristics and clinical course between cases with peripheral and macular PCV were compared and analysed. RESULTS: Fifteen eyes of 12 patients and 22 eyes of 20 patients were diagnosed with peripheral PCV and macular PCV respectively based on polyps seen on ICGA. Mean age at presentation in peripheral and macular PCV groups were 76.3 ± 8.78 and 69.1 ± 8.64 years respectively (p = 0.038). Mean logMAR visual acuity in the peripheral and macular PCV group was 0.423 ± 0.568 and 0.535 ± 0.513 respectively (p = 0.595). Peripheral subretinal hemorrhage was noted commonly in the peripheral PCV group (n = 10, 66%) and hard exudates were common in the macular PCV (19, 86%) group. Subfoveal choroid was significantly thinner in peripheral PCV group compared to macular PCV group (215.2 ± 39.94 vs 283.3 ± 50.08; p = 0.001). At final follow-up visit, 50% eyes (n = 11) in macular PCV group were still active and 87% (n = 13) eyes in the peripheral PCV showed an inactive disease (p = 0.035). CONCLUSION: Peripheral and macular PCV cases are two separate clinical entities having distinct pathogenesis, clinical and imaging features and treatment outcomes. Further studies are needed for understanding the pathomechanism in these distinct disease entities.

Retinal arcades in posterior microphthalmos: biometric correlation.

CLINICAL RELEVANCE: Posterior microphthalmos (PM) is a rare developmental disorder characterised by high hyperopia, short axial length, presence of retinal papillomacular fold and relatively normal anterior segment findings. BACKGROUND: The purpose of the study was to compare the retinal arcade distance from fovea between PM cases and to correlate axial shortening in PM eyes with imaging findings. METHODS: This retrospective, comparative case series included 24 eyes of 12 patients with PM as cases and an equal number of age- and sex-matched controls. Retinal findings on optical coherence tomography (OCT), OCT-angiography, Multicolour® image, axial length and corneal biometry were computed, compared and correlated between two groups. RESULTS: Retinal papillomacular fold was noted in all 24 PM eyes. Retinal arcade narrowing was noted in PM (p < 0.001). The central retina (p < 0.001) and choroid (p = 0.003) was thick in PM. Corneal biometry showed shorter axial length (p < 0.001), high keratometry readings (p < 0.001) and small corneal diameters (p = 0.011) in PM. Vessel density (p = 0.031) on OCTA was denser and foveal avascular zone area (p = 0.033) reduced in PM. Strong negative correlation of axial length with spherical equivalent (r = > -0.804;p < 0.001), vessel density (r = > -0.803; p = <0.001) and K1 (r = > -0.76; p < 0.001) and K2 (r = > -0.67; p = 0.001) keratometry readings was noted in PM. Significant positive correlation was noted between axial length and anterior chamber depth (r = 0.75; p < 0.001), foveal avascular zone area (r = 0.56; p = 0.033) and corneal diameter (r = 0.65; p = 0.001). Vessel density on OCT-angiography correlated positively with central corneal thickness (r = 0.552;p = 0.005) and corneal powers K1 (r = 0.709; p = 0.001) and K2 (r = 0.56; p = 0.004) and negatively with corneal diameter (r = > -0.521; p = 0.033). CONCLUSION: Increased choroidal thickening and retinal vascular arcade narrowing were two important, interesting observations noted with PM. Intercorrelation between the axial length, OCT, OCT-angiography and corneal biometry helped in understanding the pathogenesis and the structural and vascular changes in PM eyes.

Vitiligo Iridis in a Patient With a History of Smallpox.

This case report describes a diagnosis of vitiligo iridis in a patient in their late 50s who was noted to have bilateral atrophic patches on the iris during routine ophthalmic care.

Topographic changes in contralateral eye of a case of Terrien's marginal degeneration.

A woman in her late twenties presented with blurring of vision in the right eye for 6 years. Retinoscopy showed a scissoring reflex in the right eye with best spectacle-corrected visual acuity of 20/40 in the right eye and 20/20 in the left eye. Slit-lamp examination of the right eye showed superior crescentic thinning with conjunctivalisation and lipid deposition while the left eye was normal. Corneal topography of the right eye showed inverse crab-claw pattern suggestive of Terrien's marginal degeneration (TMD) and the left eye showed inferior steepening with posterior elevation and thinning suggestive of keratoconus-like topography. This case shows that evaluation of the other apparently normal eye with 20/20 vision might show changes on topography in cases of unilateral TMD and needs follow-up to assess any further progression.

A case of acute endothelial corneal transplant rejection following immunization with ChAdOx1 nCoV-19 coronavirus vaccine.

A 28-year-old female who underwent an uneventful femtosecond laser enabled keratoplasty (FLEK) in her left eye presented with pain, redness, and blurring of vision in the operated eye two weeks after getting immunized with COVID-19 vector vaccine (ChAdOx1 nCoV19 Vaccine Recombinant COVISHIELD, AstraZeneca). Slit-lamp examination showed donor stromal edema with Descemet's membrane folds and Khodadoust line (KP's on endothelium) with anterior chamber cells and flare. The patient was diagnosed with acute corneal graft rejection and advised hourly topical steroids with cycloplegics and oral steroids. The patient responded to treatment and there was progressive reversal of graft rejection with the patient achieving best spectacle-corrected visual acuity (BSCVA) of 20/30 after five weeks of treatment. Our case highlights possible immune corneal graft rejection after COVID19 vaccination and the need to step up topical steroids before vaccination.

BRIDGE ARCH-SHAPED SUBRETINAL FLUID IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Evolution and Outcomes.

PURPOSE: To study factors leading to bridge arch-shaped subretinal fluid (SRF) on optical coherence tomography in wet age-related macular degeneration and evaluate its anatomical and functional outcomes. METHODS: In this single-center, retrospective study, patients with bridge arch-shaped SRF and choroidal neovascular membrane (CNVM) were included. RESULTS: Overall, 623 eyes in 431 patients with chronic CNVM were identified, and 24 eyes (4%) in 21 patients showed bridge arch-shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type-1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean early treatment diabetic retinopathy letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch-shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti-vascular endothelial growth factor injections given before developing bridge arch-shaped SRF was 6.5 ± 7.09. During the development of bridge arch-shaped SRF, visual acuity reduced by -20.57 ± 31.13 letters (P = 0.033) and fibrotic Type-2 CNVM (n = 18, 75%) was noted. Retinal pigment epithelium tear was noted in 8 eyes (33%). At the final visit, further reduction in visual acuity of -7.136 ± 13.73 early treatment diabetic retinopathy letters (P = 0.011) after developing bridge arch-shaped SRF was seen. Mean number of injections given after developing bridge arch-shaped SRF was 4.76 ± 3.76. CONCLUSION: Bridge arch-shaped SRF is an uncommon finding seen in eyes with Type-2 chronic CNVMs. Presence of retinal pigment epithelium breach and tear and nonaggressive treatment regimen with intravitreal anti-vascular endothelial growth factor injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favorable therapeutic response.

Is Type 2 Macular Telangiectasia a Bilateral and Symmetrical Disease Entity?

Purpose: To study the inter-eye asymmetry in cases diagnosed with type 2 macular telangiectasia (MacTel). Methods: Herein, type 2 MacTel cases were staged as per Gass and Blodi classification with multiple imaging techniques. Based on disease stage symmetry, two groups identified. Group 1: Symmetrical stage and Group 2: Asymmetrical stage MacTel disease. Prevalence, demography, and clinical features of MacTel cases showing inter-eye asymmetry were analyzed. Results: Two hundred and eighty eyes of 140 patients diagnosed clinically with type 2 MacTel (84-Group 1 and 56-Group 2) were evaluated. Eighty-nine (64%) were female, and the median age of the entire cohort was 62.5 years (inter-quartile range: 57.0-68.75). MacTel disease with asymmetric stage was seen in 56 (40%) of the 140 patients. At presentation, a two-stage difference was noted in 46% (n = 26) of the patients with asymmetrical MacTel disease. A 10% conversion from symmetrical to asymmetrical disease stage was noted at the final visit. Of the 280 eyes evaluated for type 2 MacTel disease, 12 (4%) eyes showed no findings suggestive of MacTel on clinical examination and fluorescein angiography, optical coherence tomography (OCT), and OCT angiography when available and were labeled as unilateral type 2 MacTel disease. Conclusions: Type 2 MacTel can show inter-eye disease stage asymmetry. Unilateral type 2 MacTel disease is a distinct stage in MacTel which would need further evaluation and consideration while staging.