1/13. Silent occult choroidal vascular abnormalities.PURPOSE: To describe clinically occult choroidal vascular abnormalities that can be revealed by indocyanine green (ICG) angiography. methods: Out of approximately 2,700 patients who underwent ICG angiography, a lesion was incidentally observed in eight eyes of eight patients. In five patients, the ICG study included a second examination taken during artificially induced intraocular hypertension. Examinations were repeated in six patients over a follow-up period ranging from 4 months to 3 years. RESULTS: On ICG angiogram, the choroidal vasculopathy appeared as a round-oval hyperfluorescent area 2-4 disk diameters in size that was located at the temporal vascular arcades in six eyes, at the inferomacular region in one eye, and above the optic disk in one eye. The lesions were not identifiable with funduscopic, fluorescein angiographic, or ultrasonographic examination. The lesions filled at the same time as the choroidal arteries and lost fluorescence in mid-late phase of the ICG angiogram. The ICG series taken during induced intraocular hypertension showed the hyperfluorescent areas originated from choroidal arterial abnormalities giving rise to confluent hyperfluorescent patches. Draining vessels connecting the choroidal vasculopathy with a vortex vein were evidenced in three eyes. A sector of apparent choroidal hypoperfusion downstream from the lesion was present in three eyes. During the follow-up period, the lesions remained occult and with an unchanged ICG angiographic pattern in all patients. CONCLUSION: Some silent occult choroidal vascular abnormalities may be incidentally revealed by ICG angiography. These must be distinguished from ICG imaging of concomitant chorioretinal disorders.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/13. Polypoidal choroidal vasculopathy masquerading as central serous chorioretinopathy.OBJECTIVE: To differentiate polypoidal choroidal vasculopathy (PCV) from central serous chorioretinopathy (CSC). DESIGN: A retrospective, observational case series. PARTICIPANTS: Thirteen patients originally diagnosed with CSC proved to have PCV after more extensive evaluation and follow-up. methods: A clinical and angiographic review of patients with manifestations of CSC, including macular detachment. MAIN OUTCOME MEASURES: Demographic data, funduscopic examination, and fluorescein and indocyanine green (ICG) angiographic findings. RESULTS: Thirteen patients initially suspected of having CSC were ultimately diagnosed as having PCV. These eyes had exudative macular detachments secondary to a small caliber, polypoidal choroidal vascular abnormality or so-called polypoidal choroidal neovascularization. The clinical manifestations in the fundus varied. They included multiple, variably sized serous pigment epithelial detachments, neurosensory retinal detachment, lipid deposition, patchy atrophy of the pigment epithelium and indistinct staining from decompensation of the posterior blood-retinal barrier on fluorescein angiography. In reality, the suspected PEDs proved to be polypoidal lesions of PCV when imaged with ICG angiography. CONCLUSIONS: The clinical diagnosis of CSC or PCV generally poses little challenge to the experienced retinal specialist. However, in CSC with persistent and/or recurrent exudation, a myriad of retinal pigment epithelial changes may evolve that make it difficult to differentiate these two entities. In such patients, ICG angiography is useful in differentiating CSC from PCV. An accurate clinical diagnosis is important since each of these entities, CSC and PCV, may differ in terms of their risk factors, natural course, and visual prognosis.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/13. Intraocular involvement in multifocal fibrosclerosis.OBJECTIVE: To report the clinical and histopathologic findings of intraocular involvement in a patient with multifocal fibrosclerosis and the response of the patient's choroidal masses to external beam radiotherapy. DESIGN: Case report with clinicopathologic correlation of enucleated eyes. methods: The patient was studied by clinical observation, contact B- and A-scan ultrasonography, orbital magnetic resonance imaging, fluorescein angiography, indocyanine green angiography, choroidal biopsy, and gross and histopathologic examination of the enucleated eyes. Tissue obtained at an earlier laparotomy was also reviewed. External beam radiotherapy was used when high-dose corticosteroid and low-dose methotrexate therapy failed to decrease the size of the choroidal masses or improve the patient's vision. MAIN OUTCOME MEASURES: Changes in the clinical and ultrasonographic size of the choroidal masses, the clinical appearance of these masses, and the patient's visual acuity in response to external beam radiotherapy were monitored premortem. Histopathologic findings in the enucleated eyes were compared with the changes in previous abdominal and choroidal biopsy specimens and with tissue alterations reported in multifocal fibrosclerosis. RESULTS: biopsy of the choroidal mass revealed a fibrosclerosing process similar to that found in the abdomen. The patient received external beam radiotherapy with disappearance of the masses. Fibrosclerosing changes similar to those seen in the abdomen were observed replacing the choroid in the enucleated eyes. CONCLUSIONS: Multifocal fibrosclerosis may involve the choroid with histopathologic changes similar to those that have been described in other locations in the body. External beam radiotherapy may be an effective treatment for intraocular involvement by multifocal fibrosclerosis.- - - - - - - - - - ranking = 2keywords = size (Clic here for more details about this article) |
4/13. Choroidal granulomas in systemic sarcoidosis.PURPOSE: To evaluate the clinical course, including response to therapy, of patients with macular and peripapillary choroidal granulomas secondary to systemic sarcoidosis. methods: This is a retrospective case study and literature review. Nine patients with choroidal granulomas were identified. Eight patients had a tissue biopsy confirming sarcoidosis; one was diagnosed from clinical history and typical gallium scan. Ocular examinations included fundus examination, fluorescein angiography, and visual field examination. Eight patients had magnetic resonance imaging (MRI) scans looking for intracranial granulomas. Treatment consisted of oral prednisone in eight patients (one with concomitant subconjunctival triamcinolone); one patient received no treatment because of good vision and granuloma in the nasal retina. Variables studied included visual acuity (VA), response of granulomas to treatment, time to recurrence, and associated anterior segment findings. RESULTS: Eight of nine patients had a solitary lesion whereas one had multifocal involvement. The granulomas ranged in size from one half to four disk diameters. Eight patients had blurry vision; one was asymptomatic. All nine patients had hilar adenopathy and/or pulmonary parenchymal disease. No patient had nonocular neurologic symptoms and in eight patients who underwent MRI examination no intracranial granulomas were detected. Of the eyes that were treated (n = 8) all had decrease in the size of the choroidal mass at an average of 4 months of treatment. Two had complete resolution. Mean follow-up was 29.2 months. At the time of initial diagnosis only one patient had an active anterior uveitis. Five of nine patients had at least one recurrence. Mean time to recurrence was 7.6 months after discontinuing oral prednisone. The VA at presentation ranged from 20/30 to 20/300. Final VA was 20/30 or better in all patients. CONCLUSIONS: Choroidal granulomas related to systemic sarcoidosis respond well to oral corticosteroids. They may recur but good vision can be maintained. They are not typically associated with concomitant iritis and also do not appear to be associated with intracranial granulomas.- - - - - - - - - - ranking = 2keywords = size (Clic here for more details about this article) |
5/13. Choroidal effusion and hypotony caused by severe anterior lens capsule contraction following cataract surgery.PURPOSE: The case report describes a case of severe anterior capsular contraction associated with choroidal effusion. CASE REPORT: An 81 year old female with primary open angle glaucoma underwent routine phacoemulsification cataract surgery. Eight weeks following surgery the anterior capsule opening had reduced to 3 mm in size. intraocular pressure was found to be 4 mmHg and B scan ultrasound revealed a large choroidal effusion. Anterior capsulotomy with Nd:YAG laser was performed. At review, two weeks later, the choroidal effusion had resolved and visual acuity had recovered. DISCUSSION: The Nd:YAG laser radial relaxing capsulotomies helped relieve the capsular contraction and associated traction on the ciliary body.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/13. Visual improvement following trans-Tenon's retrobulbar triamcinolone acetonide infusion for polypoidal choroidal vasculopathy.PURPOSE: To report a case of polypoidal choroidal vasculopathy (PCV) that was successfully treated by sub-Tenon's infusion of triamcinolone acetonide (TA). methods: A 56-year-old Japanese man had PCV in his left eye with vision of 20/32. fluorescein angiography demonstrated a hyper-fluorescent spot, and indocyanine green angiography showed marked leakage of dye from the polypoidal vessel. Optical coherence tomography showed anterior protrusion of highly reflective layers and subretinal fluid. RESULTS: The patient underwent trans-Tenon's retrobulbar infusion of 12 mg TA. Subsequently, the reddish-orange lesion decreased in size and elevation with complete resolution of the serous retinal detachment, and visual acuity improved to 20/20. visual acuity remained good through a 15-month follow-up during which the patient was free of endophthalmitis and elevated intraocular pressure. CONCLUSIONS: Trans-Tenon's retrobulbar TA infusion is potentially effective in treating PCV.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
7/13. Intravitreal triamcinolone acetonide for choroidal granuloma in sarcoidosis.PURPOSE: To report the clinical course of intravitreal triamcinolone acetonide on choroidal granuloma secondary to sarcoidosis that was refractory to systemic prednisolone DESIGN: Interventional case report. methods: A 29-year-old Chinese man with sarcoidosis presented with isolated posterior segment involvement in his left eye as retinal periphlebitis, retinal granulomas, and choroidal granuloma. Retinal periphlebitis and retinal granulomas responded well to oral corticosteroid but not the choroidal granuloma. It gradually grew in size and caused a drop in left-eye vision to 20/70. Intravitreal triamcinolone acetonide (4 mg) was injected three times in total. RESULTS: The choroidal mass began to shrink in size after the second injection and completely regressed after the third. The choroidal granuloma became a scar, with no angiographic leakage. The patient's visual acuity improved and remained stable at 20/40 at the last follow-up, 6 months after the last injection. CONCLUSIONS: Given the encouraging results, further study on intravitreal triamcinolone acetonide for macular and peripapillary choroidal granulomas secondary to systemic sarcoidosis is warranted.- - - - - - - - - - ranking = 2keywords = size (Clic here for more details about this article) |
8/13. Transpupillary thermotherapy in the treatment of central serous chorioretinopathy.A 40-year-old man had persistent central serous chorioretinopathy at the foveal region for 20 months. The pretreatment best-corrected visual acuity was 0.3. The leaking point was close to the fovea, making the use of argon laser photocoagulation treatment unsafe. Transpupillary thermal therapy with diode laser (power setting = 120 mW, spot size = 1.2 mm, and duration = 60 seconds) was performed to cover the whole detached area. The subretinal fluid decreased 1 week later. fluorescein angiography 2 months later revealed neither further leakage nor any subretinal fluid. After 3 months of follow-up, best-corrected visual acuity improved to 0.4. Transpupillary thermal therapy may be a useful alternative for the treatment of chronic, persistent central serous chorioretinopathy at the fovea.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/13. Granulomatous anterior uveitis presenting with acute posterior multifocal placoid pigment epitheliopathy.Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) has been described as a posterior segment inflammatory disorder of young adults of unknown etiology. Granulomatous anterior uveitis in association with APMPPE has only rarely been reported in the literature. We report a patient who presented with clinical and angiographic findings consistent with APMPPE in addition to granulomatous anterior uveitis with mutton-fat keratic precipitates and Koeppe nodules. This latter finding has not been emphasized as a possible feature of APMPPE.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/13. Photoreceptor dysfunction in central areolar choroidal dystrophy.Central areolar choroidal dystrophy (CACD) is a rare, bilateral, autosomal dominant macular dystrophy. Early in the course of the dystrophy, there is fine, symmetric mottling of the retinal pigment epithelium in the macula, often in a bull's-eye pattern. This progresses to geographic atrophy of the macula without noticeable drusen or flecks. This article describes the funduscopic, angiographic, and electrophysiologic findings in three patients with three generations of a pedigree with CACD. Generalized photoreceptor dysfunction was present in the oldest patient and manifested by delayed electroretinographic implicit timing. Age-related generalized photoreceptor abnormality is hypothesized in CACD.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
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