Safety of 6000 intravitreal dexamethasone implants.

PURPOSE: To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. METHODS: Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. RESULTS: A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. CONCLUSION: This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.

Multicolor imaging in central serous chorioretinopathy - a quantitative and qualitative comparison with fundus autofluorescence.

Central serous chorioretinopathy (CSCR) is characterised by choroidal hyperpermeability which results in neurosensory detachments (NSD) along with numerous retinal pigment epithelium (RPE) alterations such as RPE atrophy. Fundus autofluorescence (FAF) demonstrates the functionality of the RPE while multicolor imaging(MCI), by means of its three incident wavelengths, provides insight into clinical changes at various levels of the retina and choroid in CSCR. This study compares various clinical findings in CSCR (NSD, subretinal deposits, RPE atrophy, pigment epithelial detachments (PED) and pachyvessels) on the above mentioned imaging modalities both qualitatively and quantitatively. MCI showed higher mean cumulative area of RPE atrophic patches (6.3 ± 6.02 vs 5.7 ± 5.7 mm2, p = 0.046), PED (1.3 ± 1.4 vs 1.1 ± 1.2 mm2, p = 0.068) and NSD (17.2 ± 11.4 vs 15.7 ± 10.7 mm2, p = 0.033). MCI demonstrated better defined lesions (NSD, PED, RPE atrophy) and more number of eyes with PED and pachyvessels in comparison to FAF.Both investigations had a 100% sensitivity in detecting NSD and 100% specificity for sub retinal deposits. This study demonstrates the ability of MCI to quantitatively and qualitatively define various clinical features in CSCR and the advantages it holds over FAF. MCI can hence be considered as a useful imaging modality in documenting and monitoring various structural changes in eyes with CSCR.

Evaluation of Choroidal Layer Thickness in Central Serous Chorioretinopathy.

PURPOSE: To evaluate medium and large choroidal vessel layer thickness (MCVT and LCVT, respectively) in eyes with acute and chronic central serous chorioretinopathy (CSC) in comparison with age-matched controls. METHODS: The study included 96 eyes of 96 patients with CSC, including 53 eyes with acute CSC, 43 eyes with chronic CSC, and 30 eyes of 30 age-matched normal subjects. Manual measurements of subfoveal choroidal thickness (SFCT), MCVT, and LCVT at subfoveal and 750 µm nasal and temporal to the fovea locations were made on enhanced depth imaging optical coherence tomography (EDI-OCT) of the macula in all subjects using ImageJ software (National Institutes of Health, Bethesda, MD, USA). RESULTS: SFCT in acute CSC was significantly larger than that in healthy eyes (P = 0.0001). SFCT in acute CSC did not differ significantly from that in chronic CSC eyes. Subfoveal LCVT and MCVT in acute CSC eyes were greater than those in healthy eyes (P = 0.02 and P = 0.03, respectively). Mean SFCT and MCVT in chronic CSC eyes were significantly larger than those in control eyes (P = 0.01 and P = 0.04, respectively). No significant difference in LCVT was observed between chronic and control eyes. CONCLUSION: Choroidal vasculature is altered in both acute and chronic CSC. SFCT, MCVT, and LCVT are higher in eyes with acute CSC. The thickening of medium choroidal vessels is still detectable in chronic CSC compared to control eyes.

Predictors of Outcome During Eplerenone Therapy in Chronic Central Serous Chorioretinopathy:A Prospective, Open-Label Pilot Clinical Study.

BACKGROUND AND OBJECTIVE: To assess the treatment response and predictive factors following eplerenone treatment in chronic central serous chorioretinopathy (CSCR). PATIENTS AND METHODS: A prospective, nonrandomized study involving fixed-dose eplerenone was conducted in 22 eyes of 11 consecutive patients with bilateral chronic CSCR. The changes in subretinal fluid (SRF), central macular thickness (CMT), and best-corrected visual acuity (BCVA) were analyzed. RESULTS: A significant reduction in SRF was observed in 13 of 16 eyes with baseline SRF (81.25%) at 3 months (P < .04), with complete resolution in six eyes (37.5%) at 3 months and in 10 eyes (62.5%) at 6 months (P < .006). Baseline BCVA was a significant predictor of final BCVA (P < .001), whereas 3-month SRF height was a weak but significant predictor of the 6-month height (r2 = 0.53; P = .002). CONCLUSION: When treated with eplerenone, chronic CSCR shows a significant reduction in SRF, with baseline BCVA and 3-month SRF height being important predictive factors. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:479-486.].

Comparison of photodynamic therapy and navigated microsecond laser for chronic central serous chorioretinopathy.

OBJECTIVES: To compare the visual and anatomical outcomes after photodynamic therapy (PDT) and navigated microsecond laser (nMSL) for chronic central serous chorioretinopathy (CSCR). METHODS: This retrospective study included eyes with chronic CSCR who underwent either PDT or nMSL with a minimum of 6 months' follow-up. Eyes with a history of treatment with any other modalities in the past or during 6 months post PDT or microsecond laser follow-up were excluded. Primary outcome measures included change in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome measures included changes in subretinal fluid, hyper-reflective foci, cystic spaces, subfoveal choroidal thickness, and outer retinal structure integrity. RESULTS: Forty-five eyes of 39 subjects (PDT group-23 eyes, nMSL group-22 eyes) with chronic CSCR were analyzed. At 6 months' follow-up, the nMSL group had significantly higher improvement in visual acuity compared to the PDT group (0.12 ± 0.24 vs -0.02 ± 0.20 (p = 0.039)). Reduction in central macular thickness was significantly higher in nMSL group compared to the PDT (85.5 ± 93.26 vs 24.47 ± 73.18 microns (p = 0.02)). Thirteen (59%) eyes in nMSL group had complete resolution of the SRF at 6 months compared to 5 (21.7%) eyes in PDT group. There was no significant difference in rest of the anatomical features between the groups. CONCLUSIONS: nMSL seems to be superior over PDT in improving visual and anatomical outcomes at 6 months and can be considered as a cheap alternative to PDT in treatment of CSCR.

YOUNGEST REPORTED CASE OF MACULAR TELANGIECTASIA (MAC TEL) TYPE 2.

PURPOSE: To report the occurrence of macular telangiectasia (Mac Tel) Type 2 in a 28-year-old lady. METHODS: Retrospective case report. RESULTS: A 28-year-old obese diabetic lady presented with mild blurring of vision and reading difficulty for 2 months. Clinical examination revealed the presence of myopic refraction and features suggestive of macular telangiectasia Type 2 on fundus evaluation. Fundus fluorescein angiography and optical coherence tomography confirmed the diagnosis of Mac Tel Type 2, Stage 3. As there was no evidence of subretinal neovascular membrane, she was advised to follow-up regularly. CONCLUSION: Mac Tel Type 2 or idiopathic juxtafoveal telangiectasia is a condition commonly reported in middle age or elderly people. Presentation in a young individual alerts us to the possibility of this condition occurring at an early age and also stresses on the need for meticulous examination to detect subtle signs of the condition in the young.

Postvitrectomy macular hole undergoing delayed closure after 28 months.

Case report of a 70-year-old male who developed full thickness macular hole (MH) following vitrectomy for vitreomacular traction syndrome. The further intervention was deferred due to the unwillingness of the patient for the second surgery. Periodic follow up of the patient, revealed improvement in visual acuity with the closure of the MH after 28 months.

CHARACTERIZATION OF MACULAR CHOROIDAL THICKNESS IN ISCHEMIC AND NONISCHEMIC DIABETIC MACULOPATHY.

PURPOSE: To evaluate changes in macular choroidal thickness in eyes with ischemic and nonischemic diabetic maculopathy. METHODS: Cross-sectional study of enhanced depth imaging optical coherence tomography of patients with diabetes. The diabetic eyes were divided into 3 groups: 1) eyes with no diabetic retinopathy (NDR); 2) those with diabetic retinopathy without macular ischemia (DR/MI-); and 3) those with diabetic retinopathy and macular ischemia (DR/MI+). RESULTS: This analysis included 261 eyes of 160 patients. Eighty-eight eyes belonged to the NDR, 90 to the DR/MI-, and 83 to the DR/MI+ group. The choroidal thickness was significantly reduced in the DR/MI+ group as compared with the other 2 groups in the subfoveal region (NDR: 285.94 ± 80.38 µm, DR/MI-: 311.22 ± 94.55 µm, DR/MI+: 216.06 ± 58.41 µm; P < 0.001), nasally and temporally (P < 0.01). Between the NDR and DR/MI- groups, the choroidal thickness was significantly reduced nasally (P = 0.02) in the NDR group, but not subfoveally (P = 0.1) and temporally (P = 0.2). Notably, no statistically significant difference in central macular thickness was found between the DR/MI- (328.68 ± 103.28 µm) and DR/MI+ (341.99 ± 130.63 µm) groups (P = 1), although it was found to significantly increase in both these groups as compared with the NDR group (264.03 ± 27.74 µm; P < 0.001). CONCLUSION: In diabetic maculopathy, an overall significant reduction was observed in macular choroidal thickness in eyes in ischemic stage as compared with nonischemic stage. In vivo evaluation of choroidal structural changes in the form of choroidal thickness may possibly be intuitive in understanding the pathogenesis of progression of diabetic maculopathy from nonischemic to ischemic stage, and associated functional damage.

"VACUOLE" SIGN ADJACENT TO RETINAL PIGMENT EPITHELIAL DEFECTS ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN CENTRAL SEROUS CHORIORETINOPATHY ASSOCIATED WITH SUBRETINAL FIBRIN.

PURPOSE: To report spectral domain optical coherence tomography features in central serous chorioretinopathy associated with subretinal fibrin. METHOD: Retrospective observational case series of patients with central serous chorioretinopathy with subretinal fibrin imaged with spectral domain optical coherence tomography. RESULT: Twenty-three eyes of 23 patients (19 males and 4 females), with mean age of 39.09 ± 5.8 years were included in the study. Subretinal fibrin clinically ranged from localized well-defined areas to extensive ill-defined areas. Along with the presence of subretinal hyperreflectivity (n = 23, 100%), corresponding to fibrin, spectral domain optical coherence tomography also revealed the presence of the retinal pigment epithelial (RPE) defects (n = 23, 100%) in all eyes with an adjacent well-defined hyporeflective vacuole. In 19 eyes wherein fundus fluorescein was performed, the RPE defects and vacuoles corresponded to the site of RPE leak. Serous pigment epithelial detachments (n = 18, 78.2%), multiple RPE defects in the same eye (n = 5), and multiple RPE defects in same pigment epithelial detachment (n = 1) were few other interesting features observed. CONCLUSION: The presence of a hyporeflective vacuole amid the hyperreflective fibrin adjacent to RPE defects probably indicates the site of constant fluid egress and is an important sign of disease activity especially in cases where fundus fluorescein angiography is not possible.

Phacoantigenic Reaction Masquerading as Postoperative Endophthalmitis in a Silicone Oil-filled Eye.

A 72-year-old phakic male with immature cataract underwent vitrectomy with silicone oil injection in his left eye for rhegmatogenous retinal detachment. The surgery was uneventful except for lens touch during vitrectomy. Two weeks postoperatively, he presented with circumcorneal congestion, hypopyon, and absent fundal glow suggestive of postoperative endophthalmitis. The patient was managed conservatively as he refused further intervention. Five weeks later, ocular inflammation subsided following posterior dislocation of the cataractous lens, thus revealing the error in our initial diagnosis. Following surgical intervention, the inflammation gradually settled. However, the eye progressed to the prephthisical stage. Phacoantigenic reaction following lens touch during vitreoretinal surgery is very rare. Hence, surgeons should maintain a high index of suspicion in similar case, and prompt intervention is warranted to prevent further complications.

Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study.

CONTEXT: Ocular complications due to diabetes mellitus (DM) were on the rise despite good literacy levels in South India. AIMS: To assess the knowledge and attitude toward DM and diabetic retinopathy of the general population in a suburban town of South India. SETTINGS AND DESIGN: Door-to-door population survey in suburban town of South India in May 2013. MATERIALS AND METHODS: A 30-point questionnaire was prepared and the data were collected and analyzed to determine statistically the knowledge, attitude, and practice (KAP) scores of the general and diabetic population and also to determine significant demographic associations. RESULTS: In this study, 6211 people (3528 [56.8%] women and 2683 [43.2%] men) with a mean age of 55.6 ± 11.7 years (range 21-98 years) were included. Good knowledge and positive attitude were observed in 3457 (55.6%) and 3280 (52.8%) people. Among 1538 (25.4%) people known to have DM, only 619 (40.7%) had good knowledge, 828 (53.8%) had a positive attitude, and 886 (57.6%) had good practice patterns. Although half of them followed general diabetic care, only 9.6% had undergone screening for retinopathy. Literacy showed a significant association with good KAP (P < 0.001 each) in general population and those with DM. Overall, women had significantly better knowledge (P < 0.001). CONCLUSIONS: Better literacy, especially among women, is contributory to better public awareness; however, the trend for poor practice patterns needs to be radically changed with aggressive public motivation emphasizing on the necessity of retinopathy screening and periodic follow-ups.

Real-time in vivo micromorphology and histopathology of choroidal osteoma using enhanced depth imaging.

Choroidal osteoma is a usually unilateral benign tumor of the choroid composed of mature bone. Optical coherence tomography (OCT) has been used to image osteoma for several years. With the advent of enhanced depth imaging (EDI) feature of spectral-domain OCT (SD-OCT), better visualization of the morphology of choroidal lesions has been possible. Herein we present a case of choroidal osteoma in a 45-year-old woman, wherein in vivo morphology of the choroidal osteoma had been visualized using EDI technique of SD-OCT before and after performing photodynamic therapy. EDI OCT has proven to be a valuable noninvasive imaging modality, almost comparable to histopathological examination, for diagnosing choroidal osteomas and for providing an insight into the in vivo micromorphological changes occurring during the course of the disease.

An insight into the pathogenesis of optic disc pit-associated maculopathy with enhanced depth imaging.

IMPORTANCE: Optic disc pit with associated maculopathy is a known entity. However, controversy exists regarding the source of subretinal fluid in these cases. In our series, we attempted to analyze the morphologic changes seen in the optic disc pit and evaluate the source of subretinal fluid. OBSERVATIONS: In this prospective observational case series of 4 patients with optic pit maculopathy, a complete ophthalmic evaluation, with fundus color photography and enhanced depth imaging spectral-domain optical coherence tomography scanning of the optic disc, was carried out between January 2013 and November 2013. The optical coherence tomographic section was mapped with infrared image and color photography, and the characteristics of the retina and optic nerve head were analyzed. All the cases had outer layer retinal schisis; 2 of them had associated serous macular detachment while inner retinal schisis was present in 3 cases. A hyporeflective tract was observed in our study connecting the retinal schisis cavity and gap in the lamina cribrosa corresponding to the optic pit. CONCLUSIONS AND RELEVANCE: In our study, we demonstrated the connectivity between retinal schisis and the gap in the lamina cribrosa present in the optic disc pit, supporting the hypothesis of cerebrospinal fluid as the source of subretinal fluid.