Torpedo maculopathy is characterized by a congenital, unilateral, and torpedo-shaped chorioretinal lesion with unclear pathogenesis and evolution. Although the optical coherence tomography angiography (OCTA) characteristics have already been defined in literature, the authors describe for the first time the presence of choroidal neovascularization (CNV) on the temporal edge of this lesion in a 36-year-old woman with a history of altered visual field in her left eye. The authors' investigation supports the hypothesis of an aberrant choroidal circulation underlying the pathogenesis of this condition, and proves the advantage conferred by OCTA in CNV detection over the other angiographic techniques. [ Ophthalmic Surg Lasers Imaging Retina. 2018;49:e210–e213.]
ABSTRACT PURPOSE: To determine the correlation between microperimetry and imaging findings in extensive macular atrophy with pseudodrusen-like appearance (EMAP). MTHODS: This cross-sectional, observational study included 44 consecutive EMAP patients (88 eyes) and 30 healthy subjects (60 eyes). Both groups underwent visual acuity assessment, mesopic and scotopic microperimetry, fundus photography, autofluorescence, optical coherence tomography (OCT) and OCT angiography. Retinal sensitivity (RS) was also subdivided in macular (0-4°) and para-macular areas (8-10°). Scotopic sensitivity loss was defined as the difference between scotopic and mesopic sensitivities for each tested point. Eyes with EMAP were further classified into the 3 stages described by Romano et al: 19 eyes in stage 1, 31 in stage 2, 38 in stage 3. RESULTS: Mesopic and scotopic RS were significantly reduced in EMAP patients compared with controls, particularly in the macular area (all p<0.001). Mesopic RS progressively declined in more advanced EMAP stages (all p<0.01), but no scotopic differences were observed between stages 2 and 3 (p=0.08). Remarkably, scotopic sensitivity loss was significantly higher in stage 1 (p<0.05). On multivariate analysis, mesopic dysfunction was associated with larger atrophic areas (p<0.01), foveal involvement (p=0.03) and fibrosis (p=0.02). Conversely, no independent variable was associated with a reduced scotopic RS (all p>0.05). CONCLUSIONS: Our findings highlight that EMAP patients suffer from a severe cone- and rod-mediated dysfunction on microperimetry. The predominant rod impairment in the early cases (stage 1) emphasizes the importance of dark-adapted scotopic microperimetry as clinical endpoint and suggests a defective transportation across the RPE-Bruch’s membrane complex in its pathogenesis.
To report the incidence and risk factors for fibrosis at 10 years in a large cohort of persons with neovascular age-related macular degeneration (nAMD).Retrospective, multicenter, cohort study.We included 225 naive nAMD eyes that underwent intravitreal anti−vascular endothelial growth factor treatment over 10 years of follow-up at two Italian referral centers. Demographic and clinical data were reviewed at baseline and on an annual basis. Onset of fibrosis was defined by clinically assessing photographs, fundus descriptions, or fluorescein angiograms. Optical coherence tomography (OCT) scans of fibrosis were inspected by an external reading center and graded as subretinal pigment epithelium (RPE), mixed, or subretinal.The mean age at baseline was of 72.1 ± 6.9 years. The incidence rate of fibrosis was estimated to be 8.9 per 100 person-years, with a cumulative incidence of 62.7% at 10 years. Fibrotic lesions were sub-RPE in 46.1%, mixed in 29.8%, and subretinal in 22.7%.Independent factors associated with fibrosis included the following: larger central subfield thickness variation (P < .001), submacular hemorrhages (P = .008), higher number of injections (P = .01), and worse baseline visual acuity (VA) (P = .03). Type 2 macular neovascularization was significantly associated with mixed and subretinal fibrosis.VA significantly declined over 10 years (−16.4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters), particularly in eyes with mixed and subretinal fibrosis (P < .001).We identified a 62.7% cumulative incidence of fibrosis in a large nAMD cohort at 10 years. Fibrosis was more common with frequent reactivations and lower baseline VA; its onset had a significant impact on final VA. This supports the hypothesis that nAMD patients should be promptly treated with proactive regimens.
Abstract Background To compare the change in lesion area over 4 years of follow-up in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents using either a proactive or a reactive regimen in routine clinical practice. Methods This was a multicentre, retrospective comparative study. Totally, 202 treatment-naïve nAMD eyes (183 patients) received anti-VEGF therapy according to a proactive ( n = 105) or reactive ( n = 97) regimen. Eyes were included if they had received anti-VEGF injections for a period of at least 4 years and had baseline fluorescein angiography and annual optical coherence tomography (OCT) imaging. Two masked graders independently delineated the lesion’s margins from serial OCT images and growth rates were calculated. Results At baseline, the mean [SD] lesion area was 7.24 [5.6] mm 2 in the proactive group and 6.33 [4.8] mm 2 in the reactive group respectively ( p = 0.22). After four years of treatment, the mean [SD] lesion area in the proactive group was 5.16 [4.5] mm 2 showing a significant reduction compared to the baseline ( p < 0.001). By contrast, the mean [SD] lesion area kept expanding in the reactive group during the follow-up and was 9.24 [6.0] mm 2 at four years ( p < 0.001). The lesion area at 4 years was significantly influenced by treatment regimen, baseline lesion area, and proportion of visits with active lesions. Conclusions Eyes treated using a reactive strategy had an increased lesion area and worse visual outcomes at 4 years. By contrast, the proactive regimen was associated with fewer recurrences of active disease, shrinkage of the lesion area, and better vision at four years.
Today, mycotic infections in immunocompromised patients are mainly caused by Candida spp. and Aspergillus spp. The patients most sensitive to these infections are those with some kind of cell-mediated immunity quantitative or qualitative alteration (i.e., blood-related cancer, primary or secondary neutropenia, immunosuppressive disease or therapy, etc.). Candida infection in the immunosupressed patient comprises a wide range of serious diseases such as candidemia, chronic disseminated candididasis, endocarditis, meningitis and endophthalmitis. Therefore, infection by Candida spp. is considered secondary to the technological and medical advances which extend the life of patients with chronic diseases.
Purpose: To assess foveal and parafoveal vasculature at superficial capillary plexus (SCP), deep capillary plexus, and choriocapillaris using optical coherence tomography angiography in the fellow eyes of patients with Coats disease. Methods: Observational and prospective case series. Thirteen patients with unilateral Coats and 14 healthy age- and sex-matched controls were consecutively recruited at Manchester Royal Eye Hospital and the Department of Ophthalmology of San Raffaele Hospital. Both groups underwent complete ophthalmologic examination, including optical coherence tomography angiography (Topcon Corp) 3 mm × 3 mm scans. Images were imported into ImageJ software and binarized; foveal avascular zone area was manually outlined and vessel density analyzed in inner (foveal) and outer (parafoveal) areas of SCP, deep capillary plexus, and choriocapillaris. Results: Fellow eyes disclosed a significant increase in the foveal vessel density of SCP ( P = 0.04); in particular, superior and temporal quadrants showed more marked alterations ( P = 0.02 and 0.04, respectively). Analysis of foveal avascular zone area revealed a significant enlargement in the SCP ( P = 0.04). No correlation was found between fellow eyes and the stage of affected eyes. Conclusion: Fellow eyes of Coats patients carry quantitative foveal vascular alterations at SCP. These may represent markers of altered inner blood–retinal barrier, due to a bilateral defect in midcapillary angiogenesis.
To report the incidence and risk factors for fibrosis at 10 years in a large cohort of persons with neovascular age-related macular degeneration (nAMD).Retrospective, multicenter, cohort study.We included 225 naive nAMD eyes that underwent intravitreal anti-vascular endothelial growth factor treatment over 10 years of follow-up at two Italian referral centers. Demographic and clinical data were reviewed at baseline and on an annual basis. Onset of fibrosis was defined by clinically assessing photographs, fundus descriptions, or fluorescein angiograms. Optical coherence tomography (OCT) scans of fibrosis were inspected by an external reading center and graded as subretinal pigment epithelium (RPE), mixed, or subretinal.The mean age at baseline was of 72.1 ± 6.9 years. The incidence rate of fibrosis was estimated to be 8.9 per 100 person-years, with a cumulative incidence of 62.7% at 10 years. Fibrotic lesions were sub-RPE in 46.1%, mixed in 29.8%, and subretinal in 22.7%. Independent factors associated with fibrosis included the following: larger central subfield thickness variation (P < .001), submacular hemorrhages (P = .008), higher number of injections (P = .01), and worse baseline visual acuity (VA) (P = .03). Type 2 macular neovascularization was significantly associated with mixed and subretinal fibrosis. VA significantly declined over 10 years (-16.4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters), particularly in eyes with mixed and subretinal fibrosis (P < .001).We identified a 62.7% cumulative incidence of fibrosis in a large nAMD cohort at 10 years. Fibrosis was more common with frequent reactivations and lower baseline VA; its onset had a significant impact on final VA. This supports the hypothesis that nAMD patients should be promptly treated with proactive regimens.
