Fabio Bom Aggio

Purpose: The purpose of this study was to describe clinical, angiographic, and tomo-graphic prognostic factors in central serous chorioretinopathy. Methods: This is a prospective uncontrolled case series. Forty-six eyes (43 patients) with clinical and angiographic findings consistent with central serous chorioretinopathy were included. Clinical data regarding age, sex, duration of symptoms, associated conditions, and best-corrected visual acuity (BCVA) were collected at baseline. Optical coherence tomography was performed at baseline, monthly until fluid resolution occurred, and at the end of the follow-up. Results: Mean follow-up was 22.8 months. Mean baseline and final logarithm of the minimum angle of resolution BCVA were 0.3 and 0.12 (P < 0.0001), respectively. Statistically significant correlations were observed between the baseline BCVA as well as duration of symptoms and final BCVA. Angiographic patterns were not significantly correlated with the visual outcome. Shorter periods of subfoveal fluid during the follow-up were correlated with better visual acuity. Mean foveal thickness after fluid resolution was 178 ± 22 μm. Both baseline and final BCVA were strongly correlated with the foveal thickness after fluid resolution. Conclusion: Initial BCVA may be a reliable predictor of the visual outcome in central serous chorioretinopathy. Eyes with worse BCVA may have an increased risk of foveal atrophy. Fluid persistence on optical coherence tomography may be associated with worse visual prognosis.

PURPOSE: To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS: Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS: The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION: Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.OBJETIVO: Investigar os efeitos da fototrombose mediada por indocianina verde sobre a neovascularização de coróide secundária a estrias angióides. MÉTODOS: Seis olhos de 5 pacientes com média de 70 anos de idade tinham o diagnóstico de neovascularização de coróide secundária a estrias angióides. O tratamento foi indicado para neovascularização de coróide ativa, avaliada pelo vazamento na angiofluoresceinografia e pela presença de fluido intra ou sub-retiniano pela tomografia de coerência óptica. Os pacientes receberam tratamento inicial com indocianina verde, e a seguir foram re-tratados conforme necessário com 3, 6 e 9 meses. Nessas ocasiões avaliava-se o vazamento e a espessura foveal. A angiografia com indocianina verde foi realizada inicialmente e sempre que o re-tratamento era considerado, nos casos em que havia aumento de vazamento pela angiofluoresceinografia nas visitas de seguimento. RESULTADOS: O tempo médio de seguimento foi de 13,3 meses. Todos os olhos atingiram um seguimento de pelo menos 12 meses. Dois olhos foram submetidos a re-tratamento. Três olhos apresentaram melhora e três olhos apresentaram estabilização da acuidade visual. Todos os pacientes apresentaram diminuição final do vazamento e da espessura foveal. CONCLUSÃO: Indocianina verde é procedimento factível para o tratamento de neovascularização de coróide secundária a estrias angióides. A análise das lesões mostrou melhora anatômica na maioria dos casos desta série. Mais estudos são necessários para avaliar os resultados a longo prazo deste tratamento.Universidade Federal de São Paulo (UNIFESP) Departamento de OftalmologiaUNIFESP Departamento de OftalmologiaUNIFESP, Depto. de OftalmologiaUNIFESP, Depto. de OftalmologiaSciEL

Universidade Federal de São Paulo, Vis Inst, São Paulo, BrazilUniv São Paulo, Dept Ophthalmol, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Vis Inst, São Paulo, BrazilWeb of Scienc

Background Photodynamic therapy with verteporfin (PDT) significantly reduces the risk of vision loss in patients with exudative age-related macular degeneration (AMD). Indocyanine green-mediated photothrombosis (IMP) and transpupillary thermotherapy (TTT) may also be beneficial for selective cases of exudative AMD. However, a substantial subset of patients responds poorly to these treatments. Intravitreal bevacizumab (IVB) has been recently used in the treatment of exudative AMD, showing both visual and anatomic improvement in the majority of cases. Methods This interventional retrospective case series reports the effects of IVB in 17 eyes with subfoveal neovascular AMD that had undergone repeated PDT (combined or not with triamcinolone acetonide) or PDT followed by either IMP or TTT with poor results. The main outcome measures were visual acuity and tomographic signs of intra/subretinal fluid, as well as central retinal thickness. Results Most patients received a single IVB injection. The mean follow-up was 4.47 months. The mean logMAR visual acuity changed from 1.17±0.40 to 1.06±0.44 (P=0.17). The mean central retinal thickness decreased from 404.05±245.26 to 280.23±143.14 μm (P=0.032). At the end of the study, lack of tomographic signs of intra/subretinal fluid was noted in four (23.5%) eyes. No ocular or systemic side effects were identified. Conclusions Short-term results with IVB for the treatment of exudative AMD have been promising. However, the chronic retinal and pigment epithelium changes frequently present in eyes that underwent multiple previous treatments may limit complete visual recovery. To our knowledge, this is the first report on the use of IVB for this particular group of AMD patients.

Background Unilateral acute idiopathic maculopathy (UAIM) is a rare entity, in which an inflammatory process involves the macular retinal pigment epithelium (RPE) and outer retina. It represents a wide spectrum of ocular findings not consistently present in all patients, which may lead to difficulties in the recognition of the condition. Methods This observational case report presents the third-generation optical coherence tomography (StratusOCT) and multifocal electroretinogram (mfERG) findings in a 31-year-old woman with UAIM in the acute phase as well as two months later, and discusses the role of StratusOCT in the diagnosis. Results In the acute phase, StratusOCT demonstrated abnormal heterogeneous hyperreflectivity and thickening at the level of the outer retina and RPE in the foveal region. Two months after the initial presentation, StratusOCT examination showed a subfoveal area of homogeneous hyperreflectivity that extended from the RPE to the outer retinal layers with posterior shadowing, and sparse points of hyperreflectivity at several different levels of the neurosensory retina, including its superficial layers. The foveal retinal thickness during the acute phase was thicken compared with that after resolution. Seven days after the initial evaluation, mfERG showed severely reduced N1–P1 amplitudes with normal latencies in the region corresponding to the affected area of the papillomacular bundle and fovea. Two months later, mfERG results were normal. Conclusions StratusOCT provided valuable information, allowing for the exclusion of other disorders that might mimic UAIM. mfERG findings were consistent with transient outer retinal dysfunction as the cause of visual loss. We are unaware of previous reports of UAIM studied by these methods and could find no reference to them in a computerized search using MEDLINE.

Purpose To report the STRATUS optical coherence tomography (STRATUSOCT) findings in a patient with unilateral coloboma-like excavation of the optic disc without pit but secondary retinoschisis, as well as to discuss the possible involved pathophysiologic mechanisms. Methods Observational case report. STRATUSOCT findings in a 66-year-old woman with a coloboma-like excavation of the optic disc without pit but secondary retinoschisis encompassing the macular region, along with evidence of a mild epiretinal membrane superonasal to the disc were evaluated. Results STRATUSOCT showed signs of a connection between the perineural space and the inner retinal layers on the temporal optic disc border, as well as schisis-like changes extending from the disc to the macula, with cystoid degeneration and two lamellar holes in their nasal portion. Conclusion The use of third generation OCT afforded an enhanced visualization of retinal structures, revealing signs of fluid at several distinct levels, as well as deep and superficial inner breaks apart from the schisis cavity. We are unaware of such previous reports, and could find no reference to them in a computerized search using MEDLINE. In addition, our study supports a common pathomechanism for the development of macular complications in optic pits and colobomas.

Purpose: To report a case of simultaneous bilateral central retinal vein occlusion (CRVO) associated with multiple myeloma. Methods: A 65-year-old woman had sudden, painless loss of vision in both eyes for 20 days. Ophthalmologic examination revealed bilateral CRVO. Appropriate medical workup was conducted, and multiple myeloma was diagnosed as the underlying cause. Results: Clinical support and chemotherapy effectively controlled paraprotein production, leading to improvement of both systemic and ocular alterations. Conclusions: Many conditions have been noted to be associated with CRVO. Based on a Medline search, this is the first report of simultaneous bilateral CRVO as the first manifestation of multiple myeloma, illustrating the need for a primary care ophthalmologist to be involved in the basic assessment for associated underlying diseases in retinal disorders.