Transscleral filtration revealing a chorioretinal coloboma.

PURPOSE: We report the case of a 19-year-old patient who presented with an ocular hypotony due to a transscleral filtration through an isolated congenital chorioretinal coloboma in his right eye. OBSERVATIONS: The initial examination showed a decimal best corrected visual acuity (BCVA) decreased to 0.7 and a marked hypotony. A localized infero-nasal chemosis and a conjunctival hyperemia were observed. The fundus examination showed chorioretinal folds and an edematous disc. In the infero-nasal retinal periphery, a chorioretinal coloboma was seen with a full-thickness scleral defect. Ultrasound biomicroscopy showed the area of the coloboma through which the percolation of fluid occurred. CONCLUSIONS AND IMPORTANCE: A favorable outcome was observed within 6 weeks and BCVA improved to 1.0 three months later. The intraocular pressure (IOP) increased to 11 mmHg, but the bleb-like filtration could still be seen together with some persistent chorioretinal folds. Ultrasound Biomicroscopy (UBM) imaging was helpful to understand the mechanism of this uncommon complication of a coloboma.

Descemet Membrane Endothelial Keratoplasty After Failed Penetrating Keratoplasty.

PURPOSE: To demonstrate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) performed after previous penetrating keratoplasty (PK) failure and to describe primary outcomes. METHODS: Twenty-eight eyes of 28 patients who underwent DMEK after primary PK failure between January 2013 and November 2017 were included in this single-center retrospective study. Best spectacle-corrected visual acuity, endothelial cell density, and the recipient's central corneal thickness were recorded preoperatively and at 1, 3, and 6 months after surgery. RESULTS: The main indications for primary PK were keratoconus (32%), Fuchs dystrophy (18%), and pseudophakic bullous keratopathy (14%). After a 6-month follow-up, best spectacle-corrected visual acuity was significantly improved in 26 patients (93%) with a mean gain of +0.59 ± 0.47 LogMAR (P < 0.0004). Mean pachymetry reduction was 110 ± 108 µm (P < 0.00003) at 6 months. Mean endothelial cell density was 2016 ± 288 cells/mm (P < 0.006), (24% decrease compared with preoperative values). Graft detachment (>1/3) was observed in 14 cases (50%) and rebubbling was needed (100% effective) during the first 2 weeks after surgery. Elevated intraocular pressure was reported in 5 cases. No early graft rejections were reported. CONCLUSIONS: In case of previous PK failure, DMEK is an alternative treatment to re-PK. A longer follow-up to ensure the long-term viability of the graft is needed.

Sensitivity and specificity of optical coherence tomography angiography (OCT-A) for detection of choroidal neovascularization in real-life practice and varying retinal expertise level.

PURPOSE: To evaluate the diagnostic accuracy of OCT angiography (OCT-A) detecting or predicting choroidal neovascularization (CNV), by ophthalmologists of disparate degrees of skills in retinal diseases, using spectral domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) as a standard reference. METHODS: Retrospective observational case series. Patient presenting maculopathy and complete imaging were included. FA, SD-OCT, OCT-A and FA coupled to SD-OCT images were graded independently for presence or absence of CNV by ophthalmologists with varying expertise levels. RESULTS: Overall sensitivity of OCT-A was 85.62% (95% CI 79.04-90.76%) and specificity was 81.51% (95% CI 73.36-88.03). Sensitivity of FA was 74.51% (95% CI 66.84-81.20), and specificity was 82.35% (95% CI 74.30-88.73). Sensitivity of FA + SD-OCT was 92.72% (95% CI 87.34-96.30), and specificity was 90.91% (95% CI 84.31-95.37). CONCLUSION: OCT-A has good sensitivity and specificity for the detection of CNV in all expertise level groups. OCT-A may soon become a routine tool for CNV diagnosis and follow-up.