Purpose The aim of this study was to determine whether choroidal thickness (CT) increases at the time of exudative recurrence in diabetic patients with unilateral diabetic macular oedema (DME) treated with intravitreal injections of anti‐VEGF or dexamethasone. Methods A real‐life, prospective, two‐centre study was conducted over a 9‐month period investigating diabetic patients presenting with unilateral DME treated with anti‐VEGF or dexamethasone intravitreal injections, and CT was measured manually, using the enhanced depth imaging module of the spectral domain optical coherence tomography. Choroidal thickness (CT) was measured in the morning, in both the affected and healthy eye of each patient at two timepoints: when the macula was ‘dry’ (T0) and at the time of exudative recurrence (T1). Results A total of 51 patients with unilateral DME were included. Mean CT in the affected eye was significantly thicker at the time of exudative recurrence (210.8 ± 44.1 μm at T0 versus 238.0 ± 49.0 μm at T1, p < 0.001). There was no significant variation in CT in the fellow eye (214.4 ± 52.3 µm at T0 versus 218.9 ± 53.4 µm at T1, p = 0.53). The type of intravitreal injection, the number of injections and the CT at T0 had no influence on the change in CT. Conclusion This study found that CT increased significantly in the affected eye at the time of recurrence of DME treated with anti‐VEGF or dexamethasone injections. Choroidal thickness (CT) could constitute an interesting new indicator for monitoring patients with DME.
PurposeRetinal astrocytic hamartomas (RAH) are rare benign tumors found mainly in patients with phacomatosis. In these cases, RAH is a major diagnosis criteria.MethodsWe report the cases of two patients with 2 different clinical presentations.ResultsThe case 1 is an asymptomatic man without medical history. A voluminous white retinal lesion is discovered incidentally. The ultrasound shows intratumoral calcifications and autofluorescence imaging shows hyperautofluorescent calcified beads. Characteristic moth‐eaten spaces are seen on the SD‐OCT. The final diagnosis is isolated RAH.The case 2 is a 56 year old woman suspected of neurofibromatosis (NF) type 2. The fundoscopy found in both eyes a peripapillary whitish flat retinal lesion with blurred edges located on the surface of the retina. There is no autofluorescence nor hyperfluorescence. The diagnosis of plane RAH (= type 1) is made given the context.ConclusionsRAH must be known because of the impact on phacomatosis diagnosis. RAH are associated with Tuberous Sclerosis Complex in about 55% of cases and with NF type 1 and type 2 in 15% of cases. Nevertheless in 1/3 of cases it occurs in healthy subjects. Three types of RAH have been described (plan (case 1), multinodular (case 2) and intermediate). Classical appearance (=type II) is a yellowish nodular ‘mulberry‐like’ tumor. It is autofluorescent and hyperfluorescent in late frames of angiography. However, there are less typical presentations which is reported in case 2 and which makes discuss differential diagnosis.RAH can be a difficult diagnosis for which the clinical history and the multimodal imaging are essential. Neurological opinion and cerebral imaging should complete the investigation to search other diagnosis criteria of phacomatosis before concluding in an isolated form.
PurposeMacular ganglion cell layer (GCL) analysis in OCT spectralis is increasingly used in ophthalmology in the detection and monitoring of chronic glaucoma.MethodsAn analysis of GCL in SD‐OCT (Spectralis®) is reported in 7 patients with no chronic glaucoma: 3 patients with maculopathy and 4 patients with neurological pathology.Maculopathies were as follows: atrophic age related macular degeneration, occluded central venous branch of the retina, epiretinal membrane surgery.The neurological pathologies include: multiple sclerosis, stroke complicated hemianopsia lateral homonymous, macro‐ pituitary adenoma complicated bitemporal hemianopia and acute anterior ischemic optic neuropathy.A thickness map in microns correlated to a color scale is confronted with the multimodal imagery and visual field.ResultsAll patients have localized or diffuse thinning GCL. Structural damage correlated to the functional damage in neurological pathologies. Maculopathies are also involved in GCL damage and should not be confused with an original glaucomatous damage.ConclusionsGCL abnormalities are not specifics for chronic glaucoma, we can find them in maculopathies, central nervous system pathologies and optic neuropathies.
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