Isolated cotton-wool spots of unknown etiology: management and sequential spectral domain optical coherence tomography documentation

Abstract

Cotton-wool spots (CWSs) are common retinal manifestations of many diseases including diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome. Clinically they appear as whitish, fluffy patches on the retina and eventually fade with time. In this study, spectral domain optical coherence tomography (SD-OCT) with mapping was used to demonstrate in vivo the characteristics of an isolated CWS in a 59-year-old patient as well as its appearance immediately after ophthalmoscopic resolution. Presented here is the work-up and management of this clinical problem for the ophthalmologist. The authors propose that SD-OCT could be a valuable research tool in characterizing and following the dynamic CWS changes at individual retinal layer level, with potential clinical applications as a screening or diagnostic tool in CWS-related diseases.

Letter to the editor: partial central retinal artery occlusion offers a unique insight into the ischemic penumbra

“…The three cases illustrated by Kurimoto and colleagues demonstrate retrograde transport block and penumbral sentinel formation in eyes with partial CRAO in exemplary fashion. 1 In another recent report in Clinical Ophthalmology, 42 a solitary parapapillary CWS, interpreted as an “isolated” lesion, was in fact a boundary sentinel signaling orthograde axoplasmic transport block related to cilioretinal arterial occlusion.…”

Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy

“…In the modern era of high resolution OCT, it should be possible to distinguish focal ischaemic lesions from boundary markers, but careful attention will need to be paid to the entire clinical picture. For example, ostensibly novel OCT findings in an eye with "isolated" macular CWSs were reported recently, but the lesions in question were undoubtedly sentinels of cilioretinal infarction (Ioannides et al, 2011;McLeod, 2012). Of further concern is the analogy currently being drawn between CWS formation and the peri-venous middle-retinal infarction seen in hypoperfusion maculopathy (Yu et al, 2014b(Yu et al, , 2015.…”

Evaluation of Eye Care and Ocular Findings in Critically Ill Covid-19 Patients

“…Marinho et al detected microhemorrhages and cotton wool spots along the retinal arcade in 4 of 12 patients (19). But since cotton wool spots can be identified in a wide range of diseases (20,21) and the comorbidities of patients that could lead to this condition were not specified, it was stated that it is impossible to definitively determine whether these were pathological cotton wool spot conditions (22). In the present study, one patient with a cotton wool spot and retinal haemorrhage in the temporal side of the optic disc had diabetes mellitus, but there were no findings of diabetic retinopathy other than this haemorrhage.…”