Purpose: Since its first description by Chang et al. in 1995, the diagnosis of Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome has been based on the findings of Fundus Fluorescein Angiography (FFA). Our purpose was to describe the utility of optical coherence tomography angiography (OCT-A) in its diagnosis and management. Case description: A 40-year-old female presented with bilateral blurred vision. Her best corrected visual acuity was at 8/10. Fundus examination revealed blurred disc margins, perivascular exudates, arterial sheaths and retinal hemorrhages bilaterally. FFA showed staining of the optic disc with dye leakage in the right eye, a punctuate hyperfluorescence of the temporosuperior artery in the left eye, bilateral vascular sheathing and capillary dropout. OCT-A showed simultaneous presence of papillary aneurysm and neovascularization of the optic nerve head in the right eye, a papillary aneurysm in the left eye and bilateral capillary non-perfusion. Our patient was diagnosed with IRVAN syndrome. Oral steroids associated with panretinal laser photocoagulation and intravitreal injection of bevacizumab in the right eye resulted in vanishing of the papillary neovascularization with no recurrence on OCT-A at 10-month follow-up. Conclusions: OCT-A is an additional tool to FFA for visualization of arterial macroaneurysms and retinal neovascularization without the interference of dye leakage. It well demarcates nonperfused areas and ensures follow-up of retinal neovascularization. Its limitations are the limited field of view and the low sensitivity in detecting arteriolar dilations. Thus, OCT-A is unable to outplace FFA but should be considered alternately with it for non-invasive follow-up of IRVAN syndrome.

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Aim: To report an uncommon case of optic disc and multiple choroidal metastases secondary to breast cancer, assessed with swept source optical coherence tomography (SS-OCT), fluorescein (FA), and infracyanine (ICGA) angiographies. Methods: Observational case report. Case presentation: A 40-year-old woman with history of left breast carcinoma presented with blurred vision in her right eye (RE). Her visual acuity was 1/20 in the RE and 10/10 in the left eye. Fundus examination of the RE showed a large yellowish elevation of the posterior pole and a particular whitish nodular papillary cluster protruding from the optic disc into the vitreous. Infrared imaging enhanced the papillary nodular infiltrates. Characteristic findings of choroidal metastasis were noted within the macular lesion on SS-OCT and ICGA. SS-OCT showed specific “lumpy bumpy” irregularity of the anterior surface of the choroid and elevated hyperreflective nodular lesions of the optic disc associated to peripapillary subretinal fluid. The papillary lesions appeared as a bunch of hypofluorescent dots on both FA and ICGA, and ultra-wide field FA was helpful clearly delimiting the large macular lesion. Besides, comprehensive imaging and especially ICGA could detect two asymptomatic choroidal metastases in a systematic assessment of the fellow eye. Conclusion: Optic disc metastases are extremely rare. Their diagnosis can be easily done on fundus examination when presenting with characteristic whitish cluster nodular infiltrates of the optic disc. However multimodal imaging remains very useful for the assessment of the local extension of the lesion and for diagnosing associated asymptomatic choroidal lesions gone unnoticed at the fundus examination.

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PURPOSE: The purpose of this study was to analyze the retinal vasculature of diabetic eyes without clinical retinopathy in order to detect microvascular abnormalities, comparing them to that of healthy nondiabetic control eyes. METHODS: This is a prospective, cross-sectional study including 40 patients (76 eyes). Twenty patients (40 eyes) were diabetics with no diabetic retinopathy group (NDRG). The twenty other patients (36 eyes) were nondiabetic and constituted the control group (CG). Images were obtained using the AngioVue optical coherence tomography angiography (OCTA) software of RTVue XR spectral-domain OCT device. We performed 3 mm × 3 mm and 6 mm × 6 mm scans to evaluate the foveolar avascular zone (foveal) size, a remodeling of the FAZ, microaneurysms, vessel tortuosity, and superficial vascular density. All statistics were performed using IBM SPSS statistics (version 21). RESULTS: The average FAZ size was 314.6 ± 15.3 μm in the NDRG versus 291.5 ± 14.1 in the CG. The difference was not significant ( P = 0.56). FAZ remodeling was noted in 40% of eyes in the NDRG and in 2.8% of eyes in the CG ( P = 0.0001). Flow alteration zones (nonperfusion zones) were seen in 77.5% in the NDRG ( P = 0.0001). Microaneurysms were present only in the NDRG (70% of eyes). Parafoveolar vascular density was 52.8% ± 0.7% in the NDRG and 54.1% ± 0.25% in the CG but without significant difference ( P = 0.206), and vascular tortuosity was significantly present in the NDRG with 32.5% of eyes versus 11.1% of eyes in the CG ( P = 0.003). CONCLUSION: OCTA is a promising tool to identify microvascular changes in the diabetic retina before clinically visible retinopathy occurrence. It may identify in the future individuals at risk of developing retinopathy and therefore those needing a better balance of diabetes.

PurposeTo report a case of a patient with Peters plus syndrome (PPS) who underwent combined synechiolysis, penetrating keratoplasty, and trabeculectomy.MethodsA four‐year‐old female with bilateral central opacified cornea was referred to our department for corneal transplantation. Slit‐lamp examination demonstrated horizontal nystagmus, bilateral central corneal opacity and iridocorneal adhesion without lenticular involvement, which is characteristic of type I Peters anomaly. Intraocular pressure was 22 mmHg in the right eye and 26 mmHg in the left eye. Posterior segment ultrasonography showed no vitreous or retinal abnormalities. General and systemic examination revealed short stature and developmental delay without any other abnormality. The diagnosis of PPS was clinically made. The patient underwent combined synechiolysis, penetrating keratoplasty, and trabeculectomy of her left eye that was more affected.ResultsSix months postoperatively, corneal graft was clear with normal depth anterior chamber and normal intraocular pressure. For the right eye, the patient was put on antiglaucomatous eye drops while waiting for corneal transplantationConclusionsGlaucoma was proven to be a significant risk factor for graft failure and rejection after penetrating keratoplasty for Peters anomaly(1). In this case, combined surgeries were performed to allow better visual outcome and intraocular pressure control.Bibliography1. Dolezal KA, Besirli CG, Mian SI, Sugar A, Moroi SE, Bohnsack BL. Glaucoma and Cornea Surgery Outcomes in Peters Anomaly. Am J Ophthalmol 2019;208: 367–375.