Dimitrios Panagiotidis

Retinal disorders in preeclampsia studied with optical coherence tomography

PURPOSE To report optical coherence tomography (OCT) of retinal disorders in preeclampsia. DESIGN Observational case report. METHODS A 24-year-old woman developed hypertension (190/100 mm Hg), proteinuria, and generalized edema in the 34th week of pregnancy. Soon after undergoing a cesarean section, she noted severe impairment of vision in both eyes. RESULTS Ten days after delivery, OCT showed a diffuse intraretinal edema that was still present but in a minor degree 2 months later. Eight months after delivery, macular edema had resolved, but the highly reflective band of retinal pigment epithelium (RPE) and choriocapillaris was thickened with focal elevations corresponding to the Elschnig spots. CONCLUSION In the acute phase of preeclampsia, OCT revealed a diffuse increase in macular thickness. Two months after delivery, macular edema still existed but in a minor degree. Eight months after the first examination, OCT depicted restoration of the contour of the fovea. Moreover, OCT showed the characteristic RPE focal elevations and abnormalities corresponding to the Elschnig spots.

Comparison of the nerve fiber layer of type 2 diabetic patients without glaucoma with normal subjects of the same age and sex.

Background The retinal nerve fiber layer (RNFL) thickness in patients with diabetes mellitus type 2 was compared to normal subjects of similar age and sex, having first excluded any risk factors for glaucoma. The correlation between the RNFL thickness and the severity of diabetic retinopathy was investigated at its primary stages and with other ocular and diabetic parameters. Methods A prospective, case series study was carried out. Twenty-seven diabetic patients without diabetic retinopathy, 24 diabetic patients with mild retinopathy, and 25 normal, age-matched subjects underwent a complete ophthalmological examination and imaging with scanning laser polarimetry for the evaluation of the RNFL. Multivariate analysis was applied in order to investigate the correlation between RNFL and diabetic parameters, such as age, duration of diabetes, insulin therapy, levels of glycosylated hemoglobin; and ocular parameters, such as cup to disc ratio, levels of normal intraocular pressure, and central corneal thickness. Results The mean inferior average of RNFL and the temporal-superior-nasal-inferior-temporal standard deviation were statistically significantly lower in both diabetic groups, and the nerve fiber index was higher (P=0.04) compared to the normal group. There was no statistically significant difference between the diabetic groups. The factor analysis showed no significant correlation between the RNFL and the previously mentioned diabetic and ocular parameters. Conclusion The existence of diabetes should be seriously considered in evaluating the results of scanning laser polarimetry. Multivariate analysis for RNFL was used for the first time.

Cataract-related acute vitreomacular traction syndrome

Purpose To report the acute and transient (within 10 days) presentation of vitreomacular traction following routine cataract surgery. Methods This is a case series of 5 patients with no evidence of posterior vitreous detachment preoperatively who presented with acute vitreomacular traction following routine cataract surgery. All patients presented the first postoperative day with dramatically reduced visual acuity. The patients underwent optical coherence tomography and if necessary fundus fluorescein angiography. Images were suggestive of vitreomacular syndrome. Results In all 5 cases, there was spontaneous resolution of the traction within 10 days. The latter was probably related to the development of posterior vitreous detachment due to the uncomplicated cataract surgery. In 2 cases there were significant retinal pigment epithelium changes and decreased retinal thickness following the resolution of the traction leaving permanent metamorphopsia and slightly decreased visual acuity. Conclusions Cataract-related acute vitreomacular traction is a rare phenomenon and not well-recognized; however, it resolves spontaneously within 10 days.

Long-Term Changes of Macular Thickness after Pars Plana Vitrectomy in Optic Disc Pit Maculopathy: A Spectral-Domain Optical Coherence Tomography Study.

ABSTRACT Purpose: To evaluate macular thickness (MT) changes, using spectral domain optical coherence tomography (SD-OCT) in patients with optic disc pit (ODP) maculopathy after pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling. Procedures: Our retrospective study included nine patients with ODP maculopathy, treated with either PPV (n = 5) or PPV with ILM peeling (n = 4). All participants, who had a mean long-term follow-up of 33.4 ± 7.0 months, underwent a complete ophthalmological examination and SD-OCT. Due to the preoperative macular elevation, the postoperative MT in the operated patients was compared with that of fellow eyes and with normative data. Results: A significant reduction in MT was noticed in all macular sectors of the operated cases at the last examination. The reduction was more evident in the group of PPV with ILM peeling. At the last examination of the follow-up, there was a statistically significant improvement regarding BCVA in both groups in comparison with baseline, while the two groups did not differ significantly in between (p = 0.245). Conclusions: In the long-term follow-up period, our study demonstrated a significant reduction in MT in patients with ODP maculopathy treated with PPV, which was more profound in those cases where PPV included ILM peeling. 

Choriocapillaris’ alterations in the presence of reticular pseudodrusen compared to drusen: study based on OCTA findings

PurposeTo evaluate the qualitative changes of choriocapillaris in the presence of reticular pseudodrusen (RPD) and compare them with conventional small drusen due to dry age-related macular degeneration (AMD).ProceduresParticipants in this study were 59 patients with non-neovascular AMD, presenting either RPD (23 patients) or drusen (36 patients) of similar size. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography.ResultsThe morphology of RPD in SD-OCT was depicted either as conical or as amorphous in shape. Both types were found to affect the ellipsoid zone. The presence of RPD was associated with choriocapillaris’ reduced blood flow signal (non-perfusion), while the same but less intense choriocapillaris’ non-perfusion appearance was noticed in the presence of drusen of the same size. In 13% of patients with RPD, ghost-like vessels were observed in the non-perfusion area of choriocapillaris, while in none patients with drusen ghost vessels were present. In all 23 patients with RPD, the choriocapillaris non-perfusion was correspondent to the location of RPD. Additionally, in about 35% of them, choriocapillaris’ impairment was also observed, covering areas outside RPD.ConclusionsMorphological impairment of choriocapillaris was more intense in patients with RPD than in those with conventional drusen of the same size. The existence of ghost vessels in the area of choriocapillaris’ density defect suggested that choriocapillaris’ alterations may occur in patients with RPD.

Spontaneous development of macular ischemia in a case of racemose hemangioma

Purpose To report a rare case of racemose hemangioma which developed spontaneous macular ischemia. Methods A 32-year-old healthy Caucasian lady presented complaining of recent deterioration of vision in her left eye. At presentation, her best corrected visual acuity (BCVA) was 20/20 in her right eye and counting fingers in her left eye (LE). Fundus examination and fluorescein angiography were performed. The patient had regular follow-up appointments over a period of 8 years. Results Fundus examination and fluorescein angiography revealed findings consistent with arteriovenous communications of the retina or racemose hemangioma, in the posterior pole of the LE with the presence of macular ischemia. Complete and systemic examination was unremarkable, excluding the possibility of Wyburn-Mason syndrome. Eight years after presentation, findings and BCVA in the LE have remained stable, with no extension of the retinal ischemia or development of neovascularization. Conclusion Although extensive retinal ischemia has been reported to result in complications such as retinal or iris neovascularization, in our case the macular ischemia has not expanded further over a period of 8 years. However, due to this macular ischemia the patient unfortunately lost her central vision.

Choriocapillaris Vascular Density Changes in Patients with Drusen: Cross-Sectional Study Based on Optical Coherence Tomography Angiography Findings

IntroductionThe purpose of this study was to investigate the extent and morphology of the choriocapillaris’ density defect in patients with drusen in non-neovascular age-related macular degeneration (AMD).MethodsParticipants in this study were 36 patients with non-neovascular AMD and drusen. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain-optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA).ResultsIn all studied cases, the presence of drusen was associated with choriocapillaris’ reduced blood flow signal of different extent and severity. Three types of choriocapillaris’ non-perfusion were observed, along with an association between the size of drusen and the morphology of choriocapillaris’ density defect. Moreover, the extent of choriocapillaris’ density change has been related to ellipsoid zone disruption and therefore to visual impairment.ConclusionsOur study showed that in patients with drusen due to non-neovascular AMD, there is choriocapillaris’ impairment of different morphology in OCTA, which is mainly related to the size and location of the drusen.