Background To report an unusual case of central serous chorioretinopathy in a patient with angioid streaks. Case presentation The authors describe a case report of a 26-year old male patient presenting acute scotoma and metamorphopsia in OD. He had been diagnosed with angioid streaks complicated with choroidal neovascularization and referred to us for treatment. The patient presented an ETDRS score of 85 letters (20/20) in OD and in OS. The anterior segment examination was unremarkable. Fundoscopy revealed bilateral angioid streaks (AS) and peau d’orange, as well as a small neurosensory retinal detachment in the macula of OD. A multimodal retinal analysis, including fundus photography, infra-red and fundus autofluorescence imaging, spectral-domain optical coherence tomography, optical coherence tomography angiography, fluorescein and indocyanine green angiography was performed. The diagnosis of central serous chorioretinopathy was made in the absence of any identifiable choroidal neovascularization. He was submitted to half-dose photodynamic therapy with verteporfin. One month later, he reported no visual complaints, his vision was 85 letters (20/20) in OD and a complete resolution of the sub-retinal fluid was registered. No signs of choroidal neovascularization were detected on the optical coherence tomography angiography (OCTA). A complete medical workup evaluation was made to exclude systemic diseases usually associated with AS. Conclusions To the authors’ knowledge, this is the second reported case of CSC associated with angioid streaks. The focal abnormalities in the Bruch’s membrane and the irregular vascular choriocapillary network associated with AS might predispose to CSC.
Purpose. This study aimed to evaluate the long-term effectiveness of intravitreal anti-vascular endothelial growth factor (VEGF) injections in the treatment of choroidal neovascularization (CNV) associated with angioid streaks. Methods. Multicenter retrospective cohort study, including eyes with CNV secondary to angioid streaks treated with anti-VEGF injections, were performed. Best-corrected visual acuity (BCVA) in ETDRS letters; qualitative and quantitative (foveal thickness) OCT parameters; anti-VEGF type; and number of injections were collected at baseline and at 3, 6, 12, 24, 36, 48, 60, and 72 months. Results. Thirty-nine eyes from 29 patients, 17 (58.6%) females, were included. The mean follow-up time was 69.4 ± 34.5 months. BCVA was 59.3 ± 23.3 letters at baseline and 63.7 ± 21.9 letters at 48 months. At 3 months, BCVA improved 6.9 ± 11.7 letters ( P = 0.003 ). Then, BCVA remained stable. The mean foveal thickness decreased from 343.3 ± 120.2 μm at baseline to 268.3 ± 65.4 at 48 months ( P = 0.021 ). The mean number of injections was 4.6 ± 2.1 at 12 months, decreasing to 1.7 ± 2.4 injections between 36 and 48 months ( P = 0.093 ). Conclusion. This real-world study suggests that the functional and morphologic response to anti-VEGF therapy for CNV related to angioid streaks is generally satisfactory and maintained in the long term.
<b><i>Purpose:</i></b> The objective of this study wasto assess the prevalence of complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) in patients with unilateral exudative age-related macular degeneration (AMD) of the fellow eye and establish if the presence of non-exudative macular neovascularization (NE-MNV) influences the prevalence of RPE and outer retinal atrophy in eyes with AMD. <b><i>Methods:</i></b> This is an observational cross-sectional study of 68 patients with unilateral exudative AMD. Demographic and clinical data were collected, and multimodal retinal imaging was performed in all patients. Two groups of patients were defined according to the presence (NE-MNV) or absence (no NE-MNV) of NE-MNV in the study eye. We compared the prevalence of tomographic cRORA and fundus autofluorescence (FAF) geographic atrophy (GA) and differences in cRORA greatest linear diameter (GLD) and GA area between groups. <b><i>Results:</i></b> Globally, cRORA was present in 11 eyes (16.2%), FAF GA was present in 10 eyes (14.7%), and NE-MNV was present in 10 eyes (14.7%) of patients with unilateral exudative AMD of the fellow eye. The overall cRORA GLD was 1,950.64 ± 1,428.31 μm, and the mean area of GA was 9.25 ± 7.50 mm<sup>2</sup>. Regarding comparisons between groups, cRORA was present in 9 eyes (15.5%) without NE-MNV and in 2 eyes (20%) with NE-MNV (<i>p</i> = 0.66). Tomographic signs of atrophy were more frequent in eyes with NE-MNV (50% vs. 24.1% in eyes without NE-MNV; <i>p</i> = 0.008). No significant differences were found in cRORA GLD (<i>p</i> = 0.30) between groups. Eyes with NE-MNV and eyes without NE-MNV had a similar prevalence of FAF GA (2 eyes out of 10 and 8 eyes out of 58, respectively; <i>p</i> = 0.64). Eyes with NE-MNV had a smaller mean area of GA (2.07 ± 0.24 mm<sup>2</sup> vs. 11.05 ± 7.34 mm<sup>2</sup><i>; p</i> = 0.01). <b><i>Conclusion:</i></b> In our study, the presence of NE-MNV was not associated with the prevalence of cRORA and/or FAF GA. Nonetheless, eyes with NE-MNV presented smaller areas of GA, which suggests that this type of neovascularization may prevent the progression of RPE and outer retinal atrophy. Longitudinal studies are required to confirm these preliminary results.
PurposeTo evaluate microvascular abnormalities of patients with Alport syndrome AS using optical coherence tomography angiography (OCT‐A) quantitative biomarkers.MethodsCross‐sectional, prospective evaluation of consecutive patients with AS and healthy subjects. AS diagnosis was performed by genetic test. All participants underwent a retinal vasculature evaluation by spectral domain optical coherence tomography (SD‐OCT) and OCT‐A of the macula. Quantitative analysis included: whole vascular density (VD, %), foveal avascular zone area (FAZ, mm2), fractal dimension (FD) and lacunarity (LAC).ResultsNinety‐four eyes were included in this study, 45 eyes from patients with AS and 49 eyes from healthy subjects. The pathogenic mutation in the COL4A5 gene on the chromosome X was found in 14 patients the pathogenic autosomal recessive mutations in the COL4A3 gene were found in 9 patients. Quantitative evaluation demonstrated a significant difference between AS and healthy subjects on LAC of the SCP and DCP (p < 0.001 and p < 0.001, respectively) and on FD in the DCP (p < 0.001).ConclusionThe DCP Alport patients have a higher vessel nonuniformity than DCP of healthy subjects. We hypothesize that endothelial cells lesion in the setting of low resistance at the DCP circuit that could lead to long‐term structural disorganization.
Purpose: To evaluate choroidal thickness progression over time in patients with exudative age‐related macular degeneration (AMD) and its relation with anti‐VEGF treatment. Methods: Retrospective observational case series. Study group included patients observed between January 2022 and April 2022 at Ophthalmology Department of Hospital de São João, Porto, Portugal, diagnosed with bilateral exudative AMD (eAMD) or unilateral eAMD and intermediate AMD (iAMD) in contralateral eye with a minimum follow up of 2 years. Subfoveal choroidal thickness was measured in each of the studied eyes using cross‐sectional spectral domain optical coherence tomography images, obtained every year during follow‐up period. Statistical analysis was performed to correlate choroidal thickness variation with number of intravitreal injections. Results: 66 eyes with eAMD and 20 eyes with iAMD from 43 patients (mean age, 81.15 ± 6.10 years) followed during 7.15 ± 2.65 years. eAMD eyes were treated with 54.83 (range 6–100 injections) anti‐VEGF intravitreal injections. Choroidal thickness of eyes with eAMD decreased 56.65 ± 11.66 μm over the follow up period (p < 0.001) at a rate of 6.49 μm per year. Choroidal thickness of eyes with iAMD decreased 29.30 ± 22.07 μm over the follow up period (p > 0.2) at a slower rate of 0.68 μm per year. In the subgroup of patients with unilateral eAMD and contralateral iAMD (n = 20), choroidal thickness changes were significantly different between the two eyes (p < 0.001). Number of intravitreal injections correlated inversely with choroidal thickness in eyes with eAMD (r = −0.232; p < 0.001). Conclusions: A significant thinning of choroid in eyes with eAMD and an inverse correlation with number of anti‐VEGF injections was observed, suggesting the influence of prolonged anti‐VEGF suppression on choroidal thickness decrease. Further studies with a higher number of eyes are needed to validate our results.
.PurposeThe development of accurate methods for retinal layer and fluid segmentation in optical coherence tomography images can help the ophthalmologists in the diagnosis and follow-up of retinal diseases. Recent works based on joint segmentation presented good results for the segmentation of most retinal layers, but the fluid segmentation results are still not satisfactory. We report a hierarchical framework that starts by distinguishing the retinal zone from the background, then separates the fluid-filled regions from the rest, and finally, discriminates the several retinal layers.ApproachThree fully convolutional networks were trained sequentially. The weighting scheme used for computing the loss function during training is derived from the outputs of the networks trained previously. To reinforce the relative position between retinal layers, the mutex Dice loss (included for optimizing the last network) was further modified so that errors between more “distant” layers are more penalized. The method’s performance was evaluated using a public dataset.ResultsThe proposed hierarchical approach outperforms previous works in the segmentation of the inner segment ellipsoid layer and fluid (Dice coefficient = 0.95 and 0.82, respectively). The results achieved for the remaining layers are at a state-of-the-art level.ConclusionsThe proposed framework led to significant improvements in fluid segmentation, without compromising the results in the retinal layers. Thus, its output can be used by ophthalmologists as a second opinion or as input for automatic extraction of relevant quantitative biomarkers.
Purpose: To evaluate choroidal thickness (CT) progression in patients with Age‐related macular degeneration (AMD) according to different phenotypes. Methods: Retrospective review of patients followed on AMD outpatient clinic from our hospital. Subfoveal CT was measured recurring to cross‐sectional spectral‐domain optical coherence tomography (SD‐OCT) images. Annual measurements were performed for each patient. Demographics, visual acuity and number of intra‐vitreal treatments were also collected. Results: One hundred and seventeen eyes from 87 patients (mean age 81.6 ± 6.6 years) were included. Intermediate AMD (group 1) was present in 14 eyes, exudative AMD (group 2) in 83 eyes, and atrophic AMD (group 3) in 14, while six eyes did not present any relevant pathology (group 4). Significant CT reduction was evident during the follow‐up of all the groups (p < 0.001, CT at beginning vs 5‐year follow‐up). No statistical differences in initial or 5‐years CT were noted between the groups (p = 0.123 and p = 0.126, respectively). After 5 years, CT presents a further significant annual reduction in AMD eyes (p < 0.001) while eyes without signs of AMD stabilize. The degree of choroidal thinning seems to vary between groups, especially during the 5 to 10 years follow‐up. At 10‐years follow‐up (N = 65), CT is statistically different among groups (p = 0.04) with atrophic AMD showing the lowest CT (mean CT 149.0 ± 38.0 μm, CT variation −42.7 ± 35.4 μm) and healthy eyes the lowest reduction (mean CT 313 ± 43.5 μm, CT variation −9.6 ± 9.2 μm). CT variation correlates with macular retinal thickness and the number of intravitreal injections in group 2 (p < 0.01). Visual acuity did not correlate with CT (p = 0.07) although thinner choroids present better visual acuities. Conclusions: AMD eyes showed a significant choroidal thinning during the follow‐up, more marked in atrophic AMD. Macular retinal thickness seems to be a predictor of CT. Further studies, with a higher number of eyes are needed to validate our results.
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