Purpose: The aim of this study was to evaluate the correlations between fundus autofluorescence and morphologic parameters as well as visual function in patients with diabetic macular oedema treated with intravitreal ziv-aflibercept. Methods: A total of 34 eyes of 20 patients with untreated diabetic macular oedema received an intravitreal injection of ziv-aflibercept at baseline, and 1 and 2 months later. The baseline, 1-month, and two-month best corrected visual acuity determination, contrast sensitivity, spectral domain optical coherence tomography, mean central macular thickness, mean macular cube volume, mean macular cube average thickness, and fundus autofluorescence (decreased, normal, or increased; and single or multiple spots) were measured. Correlation analysis with a determination of Spearman’s rank correlation coefficient, regression analysis, agreement between investigators, and Friedman’s test were used for statistical analyses. Results: A direct correlation was observed between baseline fundus autofluorescence and macular cube average thickness at 1 month (r = 0.51, p = 0.020) and between fundus autofluorescence at 1 month and baseline macular cube average thickness (r = 0.50, p = 0.021). Regression analysis showed a coefficient of determination of 0.29 (p = 0.016) between baseline fundus autofluorescence and macular cube average thickness at 1 month. Conclusion: In patients with diabetic macular oedema, the pretreatment baseline degree of foveal fundus autofluorescence might be helpful in predicting macular cube average thickness in patients undergoing treatment with intravitreal ziv-aflibercept in the short term.

Patient: Female, 27Final Diagnosis: Vogt Koyanagi Harada DiseaseSymptoms: Headache • vision lossMedication: —Clinical Procedure: —Specialty: OphthalmologyObjective:Unusual clinical courseBackground:The aim of this study was to describe the case of a 27-year-old woman who developed Vogt-Koyanagi-Harada (VKH) disease in the 13th week of pregnancy, who was treated with high-dose oral corticosteroids and azathioprine due to its persistent course.Case Report:A 27-year-old East Indian woman in her 13th week of pregnancy presented with bilateral decreased visual acuity and metamorphopsia due to bilateral serous retinal detachments and was diagnosed with Vogt-Koyanagi-Harada (VKH) disease. Multimodal imaging, including blue light fundus autofluorescence (FAF), structural spectral domain optical coherence tomography (SD-OCT), en-face OCT, and OCT angiography (OCT-A), was performed at presentation and follow-up, being particularly helpful for identifying recurrences. Her treatment consisted of high-dose corticosteroid therapy, and azathioprine had to be added as an adjuvant due to the aggressive behavior of the disease. She gave birth to a healthy baby at 31 weeks of gestation and remained with 20/20 vision at 8 weeks postpartum.Conclusions:To the best of our knowledge, this is the first report on the use of azathioprine in VKH disease during pregnancy with a successful outcome. Multimodal imaging avoiding the use of fundus fluorescein angiography is key in the diagnosis and follow-up of VKH disease in pregnant women.

Introduction: Patients with diabetic macular edema can develop fundus autofluorescence alterations; thus far, these alterations have been more widely studied with scanning or confocal laser systems. Objective: To describe and classify fundus autofluorescence abnormal patterns in patients with diabetic macular edema using the fundus autofluorescence system with a flash camera. Method: Observational, retrospective, cross-sectional, descriptive study. Fundus autofluorescence digital images of non-comparative cases with untreated diabetic macular edema, obtained and stored with a flash camera system, were assessed. Inter-observer variability was evaluated. Results: 37 eyes of 20 patients were included. Lens opacity was the most common cause of inadequate image quality. Five different fundus autofluorescence patterns were observed: decreased (13%), normal (40%), single-spot hyper-autofluorescent (17 %), multiple-spot hyper-autofluorescent (22 %) and plaque-like hyper-autofluorescent (8 %). The kappa coefficient was 0.906 (p = 0.000). Conclusions: Different fundus autofluorescence phenotypic patterns are observed with flash camera systems in patients with diabetic macular edema. A more accurate phenotypic classification could help establish prognostic factors for visual loss or for the design of clinical trials for diabetic macular edema.

Purpose. To report a case of hemiretinal artery occlusion in a child with dextrocardia, visceral heterotaxia, and secondary polycythemia. Methods. Complete clinical examination, fundus photography, and retinal fluorescein angiography were performed. Laboratory testing included complete blood cell count, homocysteine, protein c, protein s, activated protein s, methyltetrahydrofolate and homocysteine activator genes, factor leiden V gene, antithrombin III, and activated protein c resistance. In addition, transthoracic and transesophageal echocardiogram and cardiac catheterism were performed. Results. We report an 11-year-old boy with a sudden, painless visual loss in his right eye. His past medical history is remarkable for a congenital cardiac disease. He presented with vision of light perception in the right eye and a relative afferent pupillary defect. Fundus findings included a macular cherry-red spot and inferior hemiretinal whitening consistent with hemiretinal artery occlusion. Laboratory testing showed increased red blood cell (RBC) count, hemoglobin, and hematocrit. The patient was treated with four phlebotomies with improvement of RBC count and after one month reperfusion of the retina and a visual acuity of 20/200 were observed. Thrombophilia and cardiac screening were negative, except for secondary polycythemia. Conclusion. Hemiretinal artery occlusion is extremely rare in children and is often associated with congenital cardiac disease and hypercoagulative states.

Objective: To assess the association between fundus autofluorescence (FAF) and optical coherence tomography (OCT) and fluorescein angiography (FA) parameters in patients with diabetic macular edema (DME). Methods: Study design: non-comparative case series. Thirty-seven eyes of 20 patients with DME were included. Patients underwent best-corrected visual acuity and contrast sensitivity determination, assessment of central subfield thickness (CST), macular volume (MV), and macular cube average thickness (MCAT) by spectral-domain OCT, as well as FAF and FA imaging. SD-OCT EMD and foveal FAF patterns (decreased, normal, increased single-spot, and increased multiple-spot) were evaluated. Fisher exact test, interobserver variability, and Kruskall-Wallis test were used for statistical analysis. Results: A statistically significant difference was observed between the four FAF foveal patterns in the MV (p = 0.03), and in the MCAT groups (p = 0.01). Post-hoc analysis with the U-Mann-Whitney test showed a statistically significant difference between decreased FAF and normal FAF patterns, and between decreased FAF and increased multiple-spot FAF patterns (p < 0.05) in the MV and MCAT groups. Foveal capillary leakage by FA was observed in a higher proportion of eyes in the increased single-spot and multiple-spot FAF patterns (p = 0.03). Conclusions: Flash camera FAF shows changes regarding MV, MCAT, and the presence of foveal capillary leakage in patients with DME. It is relevant to establish the value of FAF in the assessment of DME.

Introducción: Los pacientes con edema macular diabético pueden presentar alteraciones en la autofluorescencia retiniana, que hasta el momento han sido analizadas más con sistemas de láser de barrido o confocales. Objetivo: Describir y clasificar los patrones anormales de autofluorescencia retiniana en pacientes con edema macular diabético mediante el sistema de autofluorescencia retiniana con cámara de flash. Método: Estudio observacional, retrospectivo, transversal y descriptivo. Se evaluaron imágenes digitales de autofluorescencia retiniana de casos no comparativos con edema macular diabético no tratado, obtenidas y almacenadas con el sistema de cámara de flash. Se evaluó la variabilidad interobservador. Resultados: Se incluyeron 37 ojos de 20 pacientes. La opacidad de medios fue la causa más común de calidad inadecuada de imagen. Se observaron cinco diferentes patrones de autofluorescencia retiniana: disminuida (13 %), normal (40 %), hiperautofluorescente unifocal (17 %), hiperautofluorescente multifocal (22 %) e hiperautofluorescente en placa (8 %). El coeficiente kappa fue de 0.906 (p = 0.000). Conclusiones: En pacientes con edema macular diabético se presentan diferentes patrones fenotípicos de autofluorescencia retiniana con los sistemas de cámara de flash. Una clasificación fenotípica más precisa pudiera ayudar a establecer factores pronósticos de pérdida visual o al diseño de ensayos clínicos relativos a edema macular diabético.

Purpose: To report a case of central retinal artery occlusion in a patient with macular telangiectasia Type 2 using multimodal imaging. Methods: Observational case report. Results: A 58-year-old woman who presented with acute painless unilateral vision loss was diagnosed with central retinal artery occlusion in her right eye with macular telangiectasia Type 2 findings in both eyes. Fundus examination revealed retinal whitening with unusual cherry-red spot plus small crystalline deposits in the temporal macula. Surprisingly, spectral domain optical coherence tomography of the contralateral eye showed characteristically intraretinal hyporreflective spaces, whereas optical coherence tomography angiography exhibited microvascular abnormalities in the deep capillary plexus. At follow-up, a pseudolamellar macular hole was noticed in the affected eye with no recovery of best-corrected visual acuity. Conclusion: This case describes an onset of central artery occlusion in a patient with underlying macular telangiectasia Type 2 and suggests that it had a possible role in the acceleration of its natural course. The utility of multimodal imaging lies on better accuracy in diagnosis as well as prognosis, management, and monitoring of the disease.

angiografía con fluoresceína (FA) en pacientes con edema macular diabético (EMD). Métodos: El diseño del estudio fue una serie de casos no comparativa. A 37 ojos de 20 pacientes con EMD se les realizó la determinación de la agudeza visual mejor corregida y la sensibilidad al contraste, y la determinación del grosor foveal central, grosor promedio macular (GPM), volumen macular (VM) y patrones de EMD mediante OCT de dominio espectral (OCT-DE). Se tomaron imágenes de AF y de FA. Se evaluó el patrón de AF foveal (disminuida, normal, aumentada unifocal y aumentada multifocal). Se efectuó prueba exacta de Fisher, variabilidad interobservador y prueba de Kruskall-Wallis como análisis estadístico. Resultados: Se encontró una diferencia estadísticamente significativa entre los cuatro patrones de AF en el VM (p = 0.03) y en el GPM (p = 0.014). El análisis post hoc mostró, en el VM, una diferencia estadísticamente significativa entre el patrón de AF disminuida y el de AF normal (p < 0.05), así como entre el patrón de AF disminuida y el de AF aumentada multifocal (p < 0.05). La fuga de la red capilar perifoveal por FA se presentó en mayor proporción en los patrones de AF aumentada tanto uni como multifocal (p = 0.032). Conclusiones: Existen cambios en la AF con cámara de flash, en pacientes con EMD asociados con el GPM, el VM y a la fuga de red capilar perifoveal. Es importante establecer el valor de la AF en la evaluación del EMD.