Cp Herbort

Classification of choroiditis based on inflammatory lesion process rather than fundus appearance: enhanced comprehension through the ICGA concepts of the iceberg and jellyfish effects.

Choroidal inflammatory diseases have been classically grouped under the term of white dot syndromes (WDS), a term only based on the appearance (white-yellow dots) of inflammatory fundus lesions. This purely descriptive and vague terminology, regrouping a pot-pourri of posterior inflammatory conditions, probably came into use because the precise exploration of the choroid was not possible, and also because many of the diseases were rare and not well understood. Since the availability of indocyanine green angiography (ICGA) that allows one to explore the choroidal compartment, it became possible to understand the lesion mechanism of choroiditides and to classify this group of diseases according to their pathophysiological behaviour. It was our aim to show here that the term WDS is applied to and encompasses inflammatory conditions that are characterized by completely different lesion mechanisms and should therefore be classified separately from each other. ICGA made it possible to differentiate two types of choroiditides, including on the one hand inflammatory diseases of the choroidal stroma and on the other hand inflammatory diseases of the choriocapillaris. Unfortunately, twenty years after its advent, ICGA is still not used routinely in uveitis centres and the traditional inappropriate but overall useless term of WDS is still used, maintaining the confusion about these diseases. The aim of this work was (i) to illustrate that meaningful exploration of choroidal inflammation, mostly occult and inaccessible to usual investigations, has to be performed using ICGA, (ii) to insist on the crucial importance of ICGA in the management of choroiditis and (iii) to enhance the comprehension of the ICGA-based classification of choroiditis, by using the demonstrative and striking analogue concepts of iceberg and jellyfish effects.

Discrepancy between Visual Acuity and Microperimetry in AMD Patients: Visual Acuity Appears as an Inadequate Parameter to Test Macular Function

BACKGROUND Best corrected visual acuity (BCVA) of 0.8 or above in AMD patients can sometimes correspond to poor macular function inducing a serious visual handicap. Microperimetry can be used to objectivize this difference. PATIENTS AND METHODS A retrospective study was undertaken on 233 files of AMD patients of whom 82 had had a microperimetry. BCVA was compared with microperimetry performance. All examinations were performed in an identical setting by the same team of 3 persons. RESULTS Among the 82 patients included, 32 (39.0%) had a BCVA equal to or above 0.8 even though their microperimetry performance was lower than 200/560 db. 10 of them (12.2% of total) had an even poorer microperimetry below 120/560 db indicating poor macular function. CONCLUSIONS More than a third of the AMD patients had a bad or very bad microperimetry performance in parallel with a good visual acuity. Microperimetry is a valuable tool to assess and follow real macular function in AMD patients when visual acuity alone can be misleading.

Spectral Domain Optical Coherence Tomography for the Characterization of Kyrieleis Exudates Involving Both the Fovea and Retinal Vessels.

In 1933 and 1950, Kyrieleis first described the presence of segmental white lesions in the walls of retinal arterioles in a case of ocular tuberculosis [1], [2]. These lesions are rarely seen and their pathophysiology remains debated although a relationship with infectious and inflammatory conditions has been proposed [3]. We report a patient who presented these lesions not only around retinal vessels very much alike those described in the original article but also involving the macular area and retinal veins. Since the patient suffered from dense vitreous haze as a result of an ocular toxoplasmosis relapse, this finding was revealed only after vitrectomy.

SLO Fundus Imaging Is the Most Sensitive Modality of Multimodal Imaging for Macular Microembolisms with Subtle Signs

Background. Microemboli of fat or other material into the terminal macular retinal circulation can be difficult to diagnose. We report 2 cases that showed subtle signs where SLO fundus imaging was most sensitive to precisely outline the limits of the inner retina infarction. Patients and Methods. Multimodal imaging analysis was performed including fundus photography, fluorescein angiography, indocyanine green angiography, Optical Coherence Tomography and SLO fundus imaging of 2 cases with suspected infarction of the inner retina. Cases. A 30-year-old man reported a grey central spot OD a few days after being squeezed between two cars with a sacrum fracture. Vision was 0.2 OD, and 1.0 OS. Examination was unremarkable and fluorescein angiography was normal. Octopus visual field showed a tiny central scotoma OD. Microperimetry showed decreased central sensitivity OD > OS. The only sign was a dark area on the SLO fundus picture indicating a subtle infarction of the inner retina (OD > OS) with nothing visible on the OCT. Resolution of lesions on the SLO picture ODS occurred in parallel with improvement of microperimetry and visual acuity. A 32-year-old woman suspected to take IV drugs had a sudden drop of vision to 0.4 OD and count fingers at 6 feet OS. Signs included macular hemorrhages and non perfusion on FA. The striking sign was a large dark area on the SLO picture precisely delineating the more extensive infarcted area of internal retina corresponding to OCT hyperreflectivity, visible in this case. Conclusions. Macular ischemia due to microemboli can show obvious fundus signs as hemorrhages, cotton wool spots and non perfusion or can present in a subclinical fashion. The SLO picture has a higher image contrast and higher resolution compared to conventional fundus photography and so can precisely delineate ischemic changes of the inner retina causing the unexplained visual loss.

Imaging and scleritis

Abstract not provided

Practical & quiz cases V

Abstract not provided

Imaging : techniques and indications

Abstract not provided