CHOROIDAL NEVI WITH FOCAL CHOROIDAL EXCAVATION AND POLYPOIDAL CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To report two cases of choroidal nevi associated with focal choroidal excavation (FCE) and polypoidal choroidal neovascularization (PCN). METHODS: Report of two patients with choroidal nevi showing FCE and PCN who underwent multimodal imaging including color fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain optical coherence tomography, swept-source optical coherence tomography, and optical coherence tomography angiography. RESULTS: Two patients presented with choroidal nevi associated with FCE and PCN. In the first case, a 74-year-old woman, the nevus had sharp margins, a deep FCE, surrounding drusen, and subretinal exudation at its inferior edge due to PCN that responded well to intravitreal anti-vascular endothelial growth factor therapy. In the second case, a 64-year-old woman, the nevus had ill-defined margins, a shallow FCE, and angiographic evidence of PCN without associated exudation. CONCLUSION: There have been several reports showing an association of either choroidal nevi or FCE with PCN. To our knowledge, there have been no previous reports of FCE identified within choroidal nevi, with or without associated PCN. Since, in one of our cases, the FCE was not apparent on clinical examination, the prevalence of FCE within nevi may be underdiagnosed.

IMAGING OF PIGMENT EPITHELIAL DETACHMENTS WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

PURPOSE: To investigate the utility of optical coherence tomography angiography (OCTA) for detecting pathologic vascularization within pigment epithelial detachments (PEDs). METHODS: This was a retrospective, cross-sectional, consecutive case series. Multimodal imaging (structural OCT, fluorescein, and indocyanine green angiography) was used as the gold standard to classify PEDs as nonvascularized or vascularized. Optical coherence tomography angiography imaging of the PED was subsequently and independently evaluated to classify PEDs as vascularized or nonvascularized. Specifically, OCTA images were evaluated for the presence of abnormal flow on cross-sectional OCTA and the presence of a vascular complex on en face OCTA. Comparisons between OCTA and the gold standard were determined. RESULTS: Sixty-four eyes of 49 patients were evaluated. A total of 18 eyes were classified as nonvascularized PED, and 46 eyes were classified as vascularized PED using the gold standard. Optical coherence tomography angiography was found to have a sensitivity of 76%, specificity of 61%, positive predictive value of 83%, and negative predictive value of 50% for detecting vascularized PEDs. False positive cases in the nonvascularized PED group were due to projection or flow artifacts from hyperreflective material overlying the PED. False negative cases were seen in eyes with minimal exudation on structural OCT and also those manifesting retinal pigment epithelial tears. CONCLUSION: Our proposed two-step approach of OCTA interpretation, first using cross-sectional OCTA and then en face OCTA, may allow the detection of vascularization within PEDs and, in some cases, reduce the need for conventional angiography. Increased awareness about potential artifacts and limitations of OCTA may help clinicians interpret OCTA more accurately.

A Perspective on the Nature and Frequency of Pigment Epithelial Detachments.

PURPOSE: To describe and compare the clinical and imaging characteristics of pigment epithelial detachments (PEDs) in age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and central serous chorioretinopathy (CSC) as seen in a clinical setting of a tertiary retinal practice. DESIGN: A perspective supported by clinical and imaging characteristics of a consecutive cohort of patients with strictly defined PEDs. RESULTS: One hundred seventy-four eyes of 113 patients with PEDs were studied with comprehensive clinical retinal examination and multimodal imaging; PEDs were differentiated into nonvascularized and vascularized forms with 3 main underlying etiologies: AMD (76%), PCV (9%), and CSC (3%). AMD was the most common diagnosis, with both nonvascularized PEDs (drusenoid and serous) and vascularized PEDs (type 1 and type 3 neovascularization) associated with drusen and a thin choroid. PCV patients had large, vascularized, peaked PEDs associated with polyps and a variable choroidal thickness, while CSC patients had a thick choroid and predominantly nonvascularized, serous PEDs with an overlying neurosensory detachment. The combined clinical and imaging characteristics form a profile for each PED subtype related to their underlying disease. However, atypical features noted in 11% of patients may complicate the underlying diagnosis. CONCLUSION: Typical phenotypic manifestations of PEDs and other features seen with multimodal imaging were associated with specific underlying etiologies. As suggested by our study, identification of these features help clinicians to determine the precise underlying etiology and manage both vascularized PEDs, where evidence-based treatment exists, and nonvascularized PEDs, where current treatment is not supported by convincing evidence.

Regression of macular drusenoid retinal pigment epithelial detachments after plaque radiation therapy.

The authors describe a case in which drusenoid retinal pigment epithelial detachments (DRPEDs) melted after plaque radiation therapy for an unrelated choroidal melanoma. The patient had a history of bilateral macular DRPEDs prior to palladium-103 plaque therapy. The choroidal melanoma was located in the temporal macula. The central fovea was calculated to receive an incidental radiation dose of 34 Gy. Six months after treatment, an ipsilateral, unilateral reduction of DRPEDs was first noted by comparative fundus photography and optical coherence tomography. From his initial evaluation to his last follow-up, the patient's visual acuity slightly improved from 20/20 to 20/16.

High-density lipoprotein cholesterol levels in middle-school children: association with cardiovascular risk factors and lifestyle behaviors.

To examine factors associated with low high-density lipoprotein cholesterol (HDL-C) levels among middle school children. HDL-C levels were the primary outcome of interest. A total of 1,104 middle-school children (mean age 11.6 years, 51.2% female) were included in this analysis, of whom 177 (16%) had an HDL-C level ≤40 mg/dL. More than half of those with low HDL-C were overweight or obese (62.2%) and had greater systolic and diastolic blood pressure, triglyceride (TRG) levels, and low-density lipoprotein cholesterol levels compared with children with an HDL-C level >40 mg/dL. Among those with an HDL-C ≤ 40 mg/dL, 35% also had body mass index ≥85% and TRG levels ≥150 mg/dL. Exercise habits were significantly associated with HDL-C level, whereas sedentary behaviors, such as screen time, were not significantly associated with HDL-C level. Fruit and vegetable intake was also not significantly associated with HDL-C level. Children with low HDL-C levels are more likely to be overweight and to have other physiological indicators of increased cardiovascular risk. Further research is needed to determine if school-based interventions can result in long-term improvements in HDL-C.

Recovery heart rate: an indicator of cardiovascular risk among middle school children.

Recovery heart rate (RHR) has been used in adults to evaluate cardiovascular (CV) fitness, but less is known about RHR in children. Data from 1,276 participants in Project Healthy Schools, a school-based intervention in southeast Michigan, were collected. In addition, to demographic characteristics, physiologic factors examined included body mass index (BMI), lipid and glucose levels, blood pressure, and HR. Information on diet, physical activity, and sedentary behavior was collected through self-report. RHR was determined by measurement of HR after a 3-minute step test. Using quartiles of RHR as a marker of fitness, associations with demographic, physiologic, and behavioral factors were explored using χ(2) and Student t tests. Compared with children in the lowest quartile of RHR (i.e., most fit), those in the upper quartile of RHR (i.e., least fit) had greater mean LDL cholesterol (93.0 vs. 86.7 mg/dL; P = 0.02) and lower mean HDL cholesterol (50.9 vs. 55.9 mg/dL; P < 0.001). Children in the upper 95 % of BMI had greater mean RHR compared with those in the normal BMI range (116.6 vs. 100.3 kg/m(2)). Children in the upper quartile of RHR reported fewer days of vigorous to moderate exercise per week compared with children in the lowest quartile of RHR [4.8 vs. 4.1 (P < 0.001) for moderate exercise and 3.6 vs. 3.0 (P = 0.001) for vigorous exercise]. Among middle school children, RHR appears to be associated with physiologic parameters and health behaviors. RHR may be useful for identifying children at increased risk for developing CV risk factors.

Role of sodium channels in propagation in heart muscle: how subtle genetic alterations result in major arrhythmic disorders.

Sodium channels play a crucial role in initiation, propagation, and maintenance of cardiac excitation throughout the heart. Indeed, dysfunctional sodium channels have been shown to be responsible for several inherited cardiac electrical disorders, such as Long QT and Brugada syndromes (BrS), potentially leading to fatal arrhythmic events. Genetic approaches and functional experiments using heterologous systems have enabled the characterization of the molecular determinants involved in these disorders and their consequences on ion channel function. The improved understanding of the mechanisms leading to these cardiac arrhythmic events represents a first step in the development of therapeutic treatments.