Maria-Andreea Gamulescu

Optical coherence tomography findings in idiopathic juxtafoveal retinal telangiectasis.

PurposeTo describe optical coherence tomography (OCT) findings in patients with juxtafoveal retinal telangiectasis (JRT).MethodsFourteen consecutive patients (28 eyes) with JRT (12 patients with JRT type II, one with JRT type I and one with JRT type III) were examined using fluorescein angiography (FA) and OCT.ResultsDespite prominent leakage in FA, macular oedema was absent in all 26 eyes with type II JRT. In contrast to that, in patients with type I and type III JRT, cystoid macular oedema was evident. In 14 of 28 eyes (all with type II JRT), a single foveal cyst was found in OCT. It varied significantly in size and was associated with visual acuity decrease. An intraretinal hyperreflective lesion was seen in eight of 28 eyes and flattening of the fovea in three eyes.ConclusionsFoveal cyst, absent macular oedema, intraretinal hyperreflective lesions and foveal flattening were the most common OCT findings in patients with JRT type II. These may represent progressive loss of retinal tissue, possibly due to Müller cells degeneration, and provide additional diagnostic criteria for JRT.

Lack of therapeutic effect of ranibizumab in fellow eyes after intravitreal administration.

PURPOSE In patients with exudative age-related macular degeneration (AMD), intravitreal anti-vascular endothelial growth factor (VEGF) therapy can lead to stabilization and even improvement of visual acuity in the treated eye, as proven by multiple studies. Some case reports, however, also suspect an effect in the untreated fellow eye. METHODS Prospective case series of 26 patients treated with intravitreal ranibizumab injections in both eyes because of bilateral exudative AMD. In all patients, central retinal thickness (CRT) was measured by optical coherence tomography (OCT) in both eyes: before first treatment of the first eye, as well as 2 weeks later, just before first treatment of the second eye. RESULTS While mean CRT was significantly reduced in the treated first eye 2 weeks after intravitreal injection from 369.46 microm (+ or - 170.88) to 275.04 microm (+ or - 113.04), P = 0.0005, mean CRT in the untreated fellow eye increased significantly: from 349.08 microm (+ or - 118.93) to 403.46 microm (+ or - 173.14) 2 weeks later, P = 0.017. CONCLUSIONS A therapeutic effect of ranibizumab in the untreated fellow eye could not be demonstrated. Overall, mean CRT in the untreated eye increased as would be expected for the normal course of this disease.

Predictive Factors in OCT Analysis for Visual Outcome in Exudative AMD

Background. Reliable predictive factors for therapy outcome may enable treating physicians to counsel their patients more efficiently concerning probability of improvement or time point of discontinuation of a certain therapy. Methods. This is a retrospective analysis of 87 patients with exudative age-related macular degeneration who received three monthly intravitreal ranibizumab injections. Visual acuity before initiation of intravitreal therapy and 4–6 weeks after last intravitreal injection was compared and related to the preoperative visualisation of continuity of the outer retinal layers as assessed by OCT: external limiting membrane (ELM), inner photoreceptor segments (IPS), junction between inner and outer segments (IS/OS), and outer photoreceptor segments (OPS). Results. Visual acuity increased in 40 of 87 (46.0%) patients, it remained stable in 25 (28.7%), and 22 (25.3%) patients had decreased visual acuity four to six weeks after triple intravitreal ranibizumab injections. No statistically significant predictive value could be demonstrated for grade of continuity of outer retinal layers concerning visual acuity development. Conclusions. In our series of AMD patients, grade of continuity of outer retinal layers was not a significant predictive value for visual acuity development after triple ranibizumab injections.

Low Endogenous Recanalization in Embolic Central Retinal Artery Occlusion—The Retrobulbar “Spot Sign”

Central retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery (“spot sign”).

High-Resolution Color-Coded Sonography in Angiolymphoid Hyperplasia With Eosinophilia Presenting as Temporal Arteritis

A 37-year-old white man presented with extensive and mildly painful swelling of both superficial temporal arteries (STAs) (Figure, upper left). The condition was progressive for 4 weeks, and the patient had mild night sweats. He noticed a circadian rhythm with less prominent STA swelling in the morning. No other deficits, including claudicatio masticatoria, visual symptoms, or (any) neurological symptoms, were reported. High-resolution color-coded sonography (Siemens Sequoia, 15L transducer, Mountain View, Calif) revealed highly enlarged STA bilaterally, with a diameter of up to 9 mm and sinusoidal intraluminal vessels with arteriovenous blood flow velocities (Figure, middle, and Movie in the online-only Data Supplement) and some areas with a hypoechoic rim (“halo” sign). Furthermore, swelling of the occipital arteries and enlarged cervical lymph nodes were found. Clinical chemistry revealed eosinophilia of 17% with an almost unremarkable blood sedimentation rate (20 mm/2 hour), whereas other lab parameters, including leukocyte …

Exudative retinal detachment in macular hole surgery using platelet concentrates – a case report

Abstract. Introduction: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. Case report: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. Conclusion: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.

A new era in the treatment of age-related macular degeneration: from Factor X to antiangiogenesis

Age-related macular degeneration has become the most common cause of visual loss leading to legal blindness in the industrialised world. This progressive disorder of the posterior pole of the eye involves the retinal pigment epithelium, its basal membrane (Bruchs membrane), as well as the choriocapillaris and retina. Multiple factors are thought to be involved, including oxidative damage, retinal pigment epithelium cell lysosomal dysfunction, immunological responses to extracellular matrix proteins and an imbalance between pro- and antiangiogenic cytokines. While little therapeutic options are available for the atrophic form of the disease, several treatment modalities have been developed for the exudative form of age-related macular degeneration. The first therapeutic interventions consisted in laser photocoagulation of choroidal neovascular membranes in the 1970s. In the late 1990s, photodynamic therapy with the photosensitiser verteporfin was the first step towards a more specific therapy, allowing treatment of subfoveal choroidal neovascular membranes without causing retinal damage. However, visual acuity tended to slowly deteriorate despite therapy in most patients. With the new antiangiogenic drugs available today and more in the pipeline to come, the probability to maintain or gain visual acuity has dramatically increased. This review gives an overview of the recent therapeutic advances in age-related macular degeneration with emphasis on antiangiogenic drugs, and will discuss available and future therapeutic concepts.

Application of Orbital Sonography in Neurology

Color-coded duplex sonography is a well established non-invasive method for vascular and parenchymal examination in a wide range of neurological disorders including stroke, cerebral venous thrombosis and degenerative diseases, amongst others. Considering development, cell types and vascular structures as well as pathology and pathophysiology, high similarities and interactions exist between the central nervous system (CNS) and the eye.

Vascular networks in retinal arterial macroaneurysms.

Retinal arterial macroaneurysms (MA) are a rare pathology, often associated with old age, arterial hypertension, artherosclerosis, and retinal vein occlusions. Here, we present two unusual cases of MA in patients with arterial hypertension, that displayed small vascular networks at the site of the MA on angiography. Resulting exudative changes and the networks themselves regressed after laser treatment, and visual acuity improved. Those vascular networks might represent collateral vessels forming as a rare sequel after spontaneous occlusion of the MA.

Spectral Domain Optical Coherence Tomography Allows the Unification of Clinical Decision Making for the Evaluation of Choroidal Neovascularization Activity

Purpose: This prospective observational clinical study investigated the benefits of spectral domain optical coherence tomography for specialists and residents in the management of neovascular age-related macular degeneration (AMD). Procedures: The study involved 49 eyes of 44 patients. Patients were advised to present for reevaluation 4 weeks after the administration of the loading dose of vascular endothelial growth factor (VEGF)-inhibitors (3 intravitreal injections every 4 weeks after diagnosis). They were examined by residents (3–4 years’ experience in ophthalmology) and specialists (> 5 years’ experience). Each examiner evaluated the clinical situation and the spectral domain optical coherence tomography (SD-OCT) scan. After each evaluation, the examiners independently stated if further anti-VEGF treatment was recommended. The “true outcome” was defined as the specialist decision based on clinical evaluation and SD-OCT. Results: Specialists and residents did not significantly differ in their accuracy in deciding on the correct treatment (p = 0.705 and p = 1), with or without the aid of SD-OCT. Both groups benefited from using SD-OCT to support their recommendations (p = 0.001 and p = 0.0002) and achieved a similar level of accuracy (p = 1 for difference). Conclusions: Residents benefited more than specialists by using SD-OCT to substantiate their recommendation on how to manage exudative AMD after the administration of the loading dose.