Relationship between Choroidal Thickness and Visual Field Impairment in Acute Zonal Occult Outer Retinopathy

Abstract

Purpose To evaluate sequential changes in choroidal thickness at the affected area in patients with acute zonal occult outer retinopathy (AZOOR). Methods This retrospective observational case series included 14 affected eyes and 6 unaffected fellow eyes from 10 AZOOR patients with impaired macular area. Using enhanced depth imaging optical coherence tomography, choroidal thicknesses at the subfovea and at nasal and temporal sites 1000 μm away from the fovea were manually measured at baseline and 3 and 6 months thereafter. Changes in the choroidal thicknesses and the average threshold at the affected area on Humphrey perimetry were compared during the 6-month follow-up. Results In AZOOR eyes, the average threshold at the affected area significantly increased over time, while outer retinal structure ameliorated. The mean choroidal thicknesses at all the sites measured significantly decreased at 3 and 6 months compared with baseline values in AZOOR eyes, but not in fellow eyes. There was an inverse correlation between the changing rates of the average threshold and the subfoveal choroidal thickness at 6 months from baseline. Conclusion The current data suggest that choroidal thickness at AZOOR-affected area significantly decreased with regression of AZOOR and this anatomical change correlated with the functional recovery.

Changes in blood flow velocity and thickness of the choroid in a patient with leukemic retinopathy

“… 12 , 20 These circulatory and morphologic patterns in choroiditis and CSC may be called the inflammatory pattern and sympathetic pattern, respectively. 16 Interestingly, unilateral acute idiopathic maculopathy, 16 a series of diseases in the acute zonal occult outer retinopathy complex, 13 , 15 , 21 , 22 , 23 , 24 and acute posterior multifocal placoid pigment epitheliopathy 25 also showed inflammatory patterns. Because the pattern of choroidal flow and thickness changes in the present case was similar to that of choroiditis, it may be termed as a “pseudo-inflammatory” pattern, which is also supported by the previous histopathological observations.…”

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

“…Studies have demonstrated that visual functions in AZOOR patients improved spontaneously, [ 24 ] whereas systemic steroid treatment showed benefits to visual outcome as well [ 12 , 24 ]. Meanwhile, improvement of visual field defects was correlated with choroidal thickness reduction, [ 27 ] possibly implying “inflammatory” pattern in the choroid in the acute stage [ 28 ]. Our AZOOR case is the first to show improved VA and recovery of the IS/OS junction after IVI of Ozurdex.…”

Acute zonal occult outer retinopathy complex disease: Lessons learned about choroid, photoreceptors, and retinal function

“…Because the choriocapillaris supplies nutrients and oxygen to the photoreceptors, it has been recently suggested that there is a correlation between disturbance of the choroidal circulation and photoreceptors impairment in AZOOR. 18 In the affected areas, choroidal thickness (CT) significantly decreased with regression of AZOOR and this correlates with the improvement in visual function and outer retinal structure. Our patient had no significant differences in subfoveal CT between the AZOOR eyes and the fellow unaffected eyes at baseline, although the mean subfoveal CT were 11 microns greater in the affected eyes.…”

“…Our patient had no significant differences in subfoveal CT between the AZOOR eyes and the fellow unaffected eyes at baseline, although the mean subfoveal CT were 11 microns greater in the affected eyes. Hashimoto et al 18 speculated two mechanisms underlying the reduction in choroidal thickness in AZOOR eyes: choroidal thinning during the clinical course or transient choroidal thickening at the acute stage. They deduced that inflammation-related transient choroidal thickening with impaired circulation might be the pathogenesis of AZOOR as well as the other syndromes with outer retinal impairment, such as MEWDS, AMN, PIC, MFC etc., at the active stage.…”