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Medicine Apr 2024The bullous variant of central serous chorioretinopathy (CSC) is a severe form of chronic CSC. Patients with the bullous variant of CSC have an increased risk of...
RATIONALE
The bullous variant of central serous chorioretinopathy (CSC) is a severe form of chronic CSC. Patients with the bullous variant of CSC have an increased risk of experiencing multiple pigment epithelial detachments (PEDs) and retinal pigment epithelium (RPE) tears. Photodynamic therapy (PDT) is a treatment for the bullous variant of CSC. RPE tear is a possible postoperative complication of PDT for eyes with PEDs. To our knowledge, no cases of giant RPE tears following PDT for the bullous variant of CSC have been reported previously. This case report presents the first instance of a giant RPE tear after half-time PDT for the bullous variant of CSC, accompanied by a series of images depicting the tear development.
PATIENT CONCERNS
A 63-year-old male patient presented with rapidly deteriorating vision in his left eye over a 3-month period. He also reported a previous episode of vision loss in his right eye 2 years prior. Best-corrected visual acuity (BCVA) in the left eye was 0.2.
DIAGNOSIS
The right eye was diagnosed with chronic non-bullous CSC, while the left eye was diagnosed with the bullous variant of CSC with a large PED.
INTERVENTIONS
Half-time PDT was administered to the left eye.
OUTCOMES
One month after half-time PDT, a giant RPE tear exceeding 3 clock-hours in size was confirmed in the lower temporal quadrant of the left eye. Three months after the initial half-time PDT, a second half-time PDT was performed owing to recurrent retinal detachment. Two months after the second half-time PDT, the retinal detachment resolved, and BCVA improved to 0.4, 6 months after the second half-time PDT.
LESSONS
In cases where the bullous variant of CSC is complicated by extensive PED, clinicians should consider the potential development of a giant RPE tear as a treatment complication.
Topics: Male; Humans; Middle Aged; Central Serous Chorioretinopathy; Retinal Detachment; Photochemotherapy; Visual Acuity; Retinal Perforations; Fluorescein Angiography; Retinal Pigments; Tomography, Optical Coherence; Photosensitizing Agents; Retrospective Studies
PubMed: 38640292
DOI: 10.1097/MD.0000000000037855 -
Alternative Therapies in Health and... Apr 2024Diabetic macular edema (DME) is one of the primary causes of decreased visual acuity in patients with diabetic retinopathy (DR). Rapid, effective, and safe treatment of...
BACKGROUND
Diabetic macular edema (DME) is one of the primary causes of decreased visual acuity in patients with diabetic retinopathy (DR). Rapid, effective, and safe treatment of DME is important to ensure patients' vision.
OBJECTIVE
In this study, we observed the efficacy and safety of internal limiting membrane (ILM) peeling in conjunction with subretinal injection of balanced salt solution (BSS) in treating refractory DME.
METHODS
A prospective, non-case-control study. Patients diagnosed with refractory DME in our hospital between October 2021 and June 2022 were included. All patients received 23G PPV in conjunction with internal limiting membrane removal and subretinal injection of BSS. During and after surgery, intravitreal injections of an anti-VEGF drug were administered. We compared and analyzed the best-corrected visual acuities (BCVA), central macular thickness (CMT), recurrence rate, complications, and other observation indicators.
RESULTS
The investigation included 32 patients (32 eyes). The BCVA at each time point after surgery was significantly higher than it was before the surgery (P < .001). One month after the surgery, the BCVA was significantly higher than it was before surgery and one week after the surgery. Postoperative CMT was statistically significantly lower than before surgery, and the difference was statistically significant (P < .001). One month after surgery, CMT was significantly lower than before and one week after surgery, and the difference was statistically significant (P < .001). Still, there was no significant difference between three and six months after surgery. Three times of intravitreal injections of anti-VEGF drugs were administered. At the most recent follow-up, DME recurred in three eyes (9.4%). During the follow-up period, no complications such as vitreous hemorrhage, retinal detachment, macular epiretinal membrane, or macular hole were observed.
CONCLUSION
Subretinal injection of BSS can be an effective treatment for refractory DME and is recommended for clinical use.
PubMed: 38639628
DOI: No ID Found -
Heliyon Apr 2024The Nd:YAG laser is widely used in various aspects of work and life. Currently, it has become a popular cosmetic technique in beauty salons. The laser can be dangerous...
BACKGROUND
The Nd:YAG laser is widely used in various aspects of work and life. Currently, it has become a popular cosmetic technique in beauty salons. The laser can be dangerous when it flashes into people's eyes.
CASE PRESENTATION
A 34-year-old female sustained a 1064-nm Q-switched Nd:YAG laser injury to her left eye. One month after the injury, she presented to our clinic with best-corrected visual acuity (BCVA) of 20/250 and a full-thickness macular hole on the optical coherence tomography (OCT). The patient received pars plana vitrectomy, internal limiting membrane peeling and sterile air injection 3 months after the injury. OCT showed closure of the hole 9 days postoperatively. After a 3-month follow-up, her BCVA improved to 20/100.
CONCLUSIONS
This case report comprehensively introduces the whole progression of a cosmetic laser-induced macular hole from formation to recovery. Due to the potential threats of the laser and its irreversible damage to the retina and choroid, sufficient education should be given before performing any laser devices, especially those without professional knowledge.
PubMed: 38638955
DOI: 10.1016/j.heliyon.2024.e28466 -
Journal of Surgical Case Reports Apr 2024A 62-year-old man with a 30-year-old photographically documented idiopathic full-thickness macular hole and visual acuity of 6/45 developed an acute macula-on...
Successful anatomical closure of a photographically documented 30-year-old idiopathic full-thickness macular hole following surgery for concurrent repair of an acute macula-on rhematogenous retinal detachment.
A 62-year-old man with a 30-year-old photographically documented idiopathic full-thickness macular hole and visual acuity of 6/45 developed an acute macula-on rhegmatogenous retinal detachment in his left eye. A pars plana vitrectomy, internal limiting membrane peeling around the macular hole, fluid-air exchange, endolaser retinopexy around the peripheral retinal break and perfluoropropane (C3F8) internal tamponade were performed to repair the detached retina and macular hole. One month postoperatively, the patient developed a large peripheral circumferential retinal tear with shallow retinal detachment which necessitated scleral buckling, repeat vitrectomy, endolaser photocoagulation and C3F8 tamponade. The retina was successfully re-attached and the macula hole was closed. Three years post-vitrectomy, the repaired 30-year-old macular hole remained closed although the visual acuity remained unchanged at 6/45. In summary, we describe the successful anatomical closure of a 30-year-old idiopathic full-thickness macular hole which we believe to be the longest duration photographically documented macular hole closed following surgery.
PubMed: 38633563
DOI: 10.1093/jscr/rjae231 -
BMC Ophthalmology Apr 2024Kidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy... (Review)
Review
BACKGROUND
Kidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy and light-chain deposition disease. However, pigment epithelium tears associated with membranous nephropathy have not been reported or systematically analysed.
CASE PRESENTATION
A 68-year-old man presented with decreased right eye visual acuity. Optical coherence tomography (OCT) revealed cystic macular edema, localized serous detachment of the retina and loss of the outer retinal structure in the right eye and retinal pigment epithelium detachment (PED) combined with serous detachment of the retina in the left eye. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) revealed giant RPE tears in the right eye and exudative age-related macular degeneration in the left eye. The patient also suffered from severe membranous nephropathy-autoimmune glomerulonephritis. Renal biopsy immunofluorescence revealed a roughly granular pattern, with immunoglobulin G (IgA), immunoglobulin G (IgG), IgM, complement C3(Components 3), λ light chain and κ light chain subepithelial staining.
CONCLUSIONS
It is hypothesized that severe membranous nephropathy caused immune complex deposition on the surface of Bruch membrane, resulting in weakened adhesion between the RPE and Bruch membrane and impaired RPE pump function, combined with age-related macular degeneration, leading to giant RPE tears in the right eye. Close attention should be given to the ocular condition of patients with membranous nephropathy to facilitate timely treatment and avoid serious consequences.
Topics: Male; Humans; Aged; Retinal Pigment Epithelium; Glomerulonephritis, Membranous; Macular Degeneration; Fluorescein Angiography; Retinal Perforations; Retinal Detachment; Tomography, Optical Coherence; Epithelium; Immunoglobulin G
PubMed: 38632537
DOI: 10.1186/s12886-024-03426-5 -
Case Reports in Ophthalmology 2024Post-vitrectomy cystoid macular edema (CME) can lead to failure of macular hole (MH) closure. We report 2 cases of failure of MH closure due to post-vitrectomy CME,...
INTRODUCTION
Post-vitrectomy cystoid macular edema (CME) can lead to failure of macular hole (MH) closure. We report 2 cases of failure of MH closure due to post-vitrectomy CME, which were successfully treated using sub-Tenon triamcinolone acetonide (STTA) injection.
CASE PRESENTATIONS
Case 1 involved a 72-year-old male patient with a Gass Stage 3 MH in the right eye. He underwent pars plana vitrectomy (PPV), internal limiting membrane translocation, and sulfur hexafluoride (SF6) gas injection with cataract surgery in his right eye. The MH did not close postoperatively; further, CME developed at the edge of the MH. Accordingly, the patient underwent an STTA injection. Approximately 2 weeks after the STTA injection, the CME disappeared and the MH closed, which has remained closed 1 year after PPV. Case 2 involved a 78-year-old female patient with Gass Stage 3 MH in the left eye. The patient underwent the same surgical procedure as that performed in case 1. Further, she presented with failure of MH closure caused by CME; therefore, an STTA injection was performed. Approximately 6 weeks after STTA injection, the CME disappeared and the MH closed; further, there was maintained improvement of best-corrected visual acuity for 6 months.
CONCLUSIONS
STTA injection could be considered before reoperation in cases involving failure of MH closure due to postoperative CME.
PubMed: 38618210
DOI: 10.1159/000538026 -
Scientific Reports Apr 2024This study aimed to automatically detect epiretinal membranes (ERM) in various OCT-scans of the central and paracentral macula region and classify them by size using...
This study aimed to automatically detect epiretinal membranes (ERM) in various OCT-scans of the central and paracentral macula region and classify them by size using deep-neural-networks (DNNs). To this end, 11,061 OCT-images were included and graded according to the presence of an ERM and its size (small 100-1000 µm, large > 1000 µm). The data set was divided into training, validation and test sets (75%, 10%, 15% of the data, respectively). An ensemble of DNNs was trained and saliency maps were generated using Guided-Backprob. OCT-scans were also transformed into a one-dimensional-value using t-SNE analysis. The DNNs' receiver-operating-characteristics on the test set showed a high performance for no-ERM, small-ERM and large-ERM cases (AUC: 0.99, 0.92, 0.99, respectively; 3-way accuracy: 89%), with small-ERMs being the most difficult ones to detect. t-SNE analysis sorted cases by size and, in particular, revealed increased classification uncertainty at the transitions between groups. Saliency maps reliably highlighted ERM, regardless of the presence of other OCT features (i.e. retinal-thickening, intraretinal pseudo-cysts, epiretinal-proliferation) and entities such as ERM-retinoschisis, macular-pseudohole and lamellar-macular-hole. This study showed therefore that DNNs can reliably detect and grade ERMs according to their size not only in the fovea but also in the paracentral region. This is also achieved in cases of hard-to-detect, small-ERMs. In addition, the generated saliency maps can be used to highlight small-ERMs that might otherwise be missed. The proposed model could be used for screening-programs or decision-support-systems in the future.
Topics: Humans; Epiretinal Membrane; Tomography, Optical Coherence; Retrospective Studies; Visual Acuity; Neural Networks, Computer
PubMed: 38605115
DOI: 10.1038/s41598-024-57798-1 -
Journal of Clinical Medicine Mar 2024Mutations in Topoisomerase I-binding RS protein (TOPORS) have been previously documented and have been described to result in pathological autosomal dominant retinitis...
Mutations in Topoisomerase I-binding RS protein (TOPORS) have been previously documented and have been described to result in pathological autosomal dominant retinitis pigmentosa (adRP). In our study, we describe the various genotypes and clinical/phenotypic manifestations of TOPORS-related mutations of our unique patient population in Rural Appalachia. The medical records of 416 patients with inherited retinal disease at the West Virginia University Eye Institute who had undergone genetic testing between the years of 2015-2022 were reviewed. Patients found to have pathologic RP and mutations related to TOPORS were then analyzed. In total, 7 patients (ages 12-70) were identified amongst three unique families. All patients were female in our study. The average follow-up period was 7.7 years. A mother (70 yr) and daughter (51 yr) had a novel heterozygous nonsense point mutation in TOPORS c.2431C > T, p.Gln811X (Exon 3) that led to premature termination of the desired protein resulting in early onset vision loss, cataract formation, and visual field restriction. The mother developed a full-thickness macular hole which was successfully repaired. Five other patients were found to have previously described TOPORS mutations. Visual field loss was progressive with age in both cohorts. Seven patients at our institution were identified to have mutations in TOPORS resulting in autosomal dominant retinitis pigmentosa. Two patients were found to have novel truncating mutations in the TOPORS gene resulting in profound night blindness and visual field loss, recurrent macular edema, and in one individual, epiretinal membrane formation leading to a macular hole which was able to be successfully repaired.
PubMed: 38592336
DOI: 10.3390/jcm13051498 -
Scientific Reports Apr 2024To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal...
To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal proliferation (EP), this retrospective cohort study classified patients into two groups based on whether EP was completely peeled (peeling group, n = 25 eyes), or embedded into the hole (embedding group, n = 31 eyes) during surgery. Preoperative characteristics and postoperative outcomes, including best-corrected visual acuity and the length of the disrupted external limiting membrane and ellipsoid zone, were compared. Preoperative features including visual acuity and hole size did not differ between the two groups. All studied eyes achieved closure of the macular hole postoperatively. Visual acuity significantly improved at 3, 6, and 12 months postoperatively in both groups. The visual acuity 1-month after surgery was better in the embedding group than that in the peeling group (0.28 ± 0.29 vs. 0.50 ± 0.42 logarithm of the minimum angle of resolution, P = 0.016), although the difference was not noted after 3 months postoperatively. The embedding group showed shorter disruption of the external limiting membrane than the peeling group postoperatively (62.6 ± 40.2 μm vs. 326.2 ± 463.9 μm at postoperative 12 months, P = 0.045). In conclusion, the embedding technique during surgical repair of a FTMH with EP facilitates recovery of the outer foveal layers and promotes earlier restoration of visual function.
Topics: Humans; Retinal Perforations; Retrospective Studies; Epiretinal Membrane; Vitrectomy; Tomography, Optical Coherence; Cell Proliferation; Basement Membrane
PubMed: 38589441
DOI: 10.1038/s41598-024-58449-1 -
Translational Vision Science &... Apr 2024The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using...
PURPOSE
The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using artificial intelligence (AI).
METHODS
Optomap UWF images of the database were annotated to four groups by two retina specialists: (1) retinal breaks without detachment, (2) retinal breaks with retinal detachment, (3) retinal detachment without visible retinal breaks, and (4) a combination of groups 1 to 3. The fundus image data set was split into a training set and an independent test set following an 80% to 20% ratio. Image preprocessing methods were applied. An EfficientNet classification model was trained with the training set and evaluated with the test set.
RESULTS
A total of 2489 UWF images were included into the dataset, resulting in a training set size of 2008 UWF images and a test set size of 481 images. The classification models achieved an area under the receiver operating characteristic curve (AUC) on the testing set of 0.975 regarding lesion detection, an AUC of 0.972 for retinal detachment and an AUC of 0.913 for retinal breaks.
CONCLUSIONS
A deep learning system to detect retinal breaks and retinal detachment using UWF images is feasible and has a good specificity. This is relevant for clinical routine as there can be a high rate of missed breaks in clinics. Future clinical studies will be necessary to evaluate the cost-effectiveness of applying such an algorithm as an automated auxiliary tool in a large practices or tertiary referral centers.
TRANSLATIONAL RELEVANCE
This study demonstrates the relevance of applying AI in diagnosing peripheral retinal breaks in clinical routine in UWF fundus images.
Topics: Humans; Retinal Detachment; Retinal Perforations; Artificial Intelligence; Deep Learning; Photography
PubMed: 38564203
DOI: 10.1167/tvst.13.4.1