Faculty Bibliography

PURPOSE: To investigate the autofluorescence characteristics in patients with central serous chorioretinopathy. DESIGN: Observational case series. PARTICIPANTS: Thirty consecutive patients examined in a private referral practice. METHODS: Patients were imaged with autofluorescence photography, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). The mean and standard deviation (SD) of the grayscale values from a 100-pixel-diameter circle centered on the fovea were obtained and normalized with the level of autofluorescence of the posterior pole. RESULTS: There were 30 patients, 23 male (76.7%) and 7 female (23.3%), with a median visual acuity (VA) of 20/25 and a range of 20/15 to 20/400. Stepwise linear regression that included individual fixed effects found that normalized central macular autofluorescence (P < 0.001), pigment mottling in the fovea (P = 0.045), subfoveal fluid detected by OCT (P = 0.033), and the SD of the central macular autofluorescence (P = 0.025) produced a highly significant model (R2 = 0.92, P < < 0.001) predicting VA. Increasing levels of autofluorescence were correlated with accumulation of material on the outer surface of the retina as seen by OCT. Decreased central macular autofluorescence, particularly in those eyes with central geographic retinal pigment epithelial atrophy, was associated with poor VA. CONCLUSIONS: This study established that autofluorescence changes occurring in central serous chorioretinopathy with explicit patterns can be measured in a noninvasive manner, and this information can be used to estimate the damage induced by central serous chorioretinopathy with a high degree of statistical significance. We hypothesize that the material on the outer surface of the elevated retina may represent accumulation of photoreceptor outer segments secondary to the lack of direct apposition and phagocytosis by the retinal pigment epithelium

PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) that had areas of retinal pigment epithelial loss. DESIGN: Observational case report. METHODS: A 67-year-old woman with a history of uterine cancer presented with 4 months of bilateral visual loss. RESULTS: Although B-scan ultrasonography revealed both small shallow serous retinal and choroidal detachments in the periphery, the choroid was normal in thickness. Fluorescein angiography revealed numerous nummular-shaped areas of transmission defects suggesting retinal pigment epithelium loss. Autofluorescence photography showed complete absence of autofluorescence in these nummular areas, and optical coherence tomography showed segmental areas with lack of any signal from affected areas of the retinal pigment epithelium, suggesting complete loss of retinal pigment epithelium cells. CONCLUSIONS: Although the fundus findings in BDUMP have been attributed to the proliferation of uveal melanocytic cells in the outer choroid in previous papers, our patient had nummular areas of loss of the retinal pigment epithelium as the apparent reason for visual decline

PURPOSE: To report anatomic and visual improvement after vitrectomy with removal of adherent plaques of vitreous and gas tamponade in highly myopic eyes with detachments over posterior staphylomata. METHODS: Eyes with retinal detachment over staphylomata were treated with vitrectomy and vitreous cortex removal. Adherent plaques of vitreous were invariably found on the detached retina and were easier to identify with the aid of intraocular triamcinolone. Removal of the vitreous plaques and placement of long-acting gas affected surgical repair. Outcome measures included best-corrected visual acuity and retina reattachment confirmed by biomicroscopic appearance and optical coherence tomography findings. RESULTS: Six eyes of five consecutive patients were treated. The mean preoperative best-corrected visual acuity was 20/100, and the mean time of documented detachment was 21 months. The internal limiting membrane was not removed in any patient. After surgery, all patients' retinas remained attached during the mean follow-up period of 19.1 months. At the end of the follow-up period, the mean best-corrected visual acuity was 20/60, an improvement that was statistically significant (P = 0.027). CONCLUSION: Retinal detachment over staphylomata in highly myopic eyes appears to be tractional from unresolved forces caused by adherent plaques of vitreous. Removal of the vitreous, without removing the internal limiting membrane, can reattach the retina and lead to anatomic and visual acuity improvements

PURPOSE: To examine the 12-month results of a group of patients treated with combined photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Noncomparative case series. PARTICIPANTS: Twenty-six eyes of 26 patients with CNV secondary to AMD. Thirteen with CNV, without restriction to type, were not treated with prior PDT (newly treated group). Thirteen patients with prior PDT therapy who experienced visual loss while being treated with PDT alone comprised the remainder (prior PDT group). METHODS: Patients with CNV were treated with PDT, immediately followed by an intravitreal injection of 4 mg of triamcinolone acetonide. Visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction. Need for retreatment was based on fluorescein angiographic evidence of leakage at 3-month follow-up intervals. MAIN OUTCOME MEASURES: Visual acuity and retreatment rate. RESULTS: In the newly treated group, the mean acuity change was an improvement of 2.5 lines (last observation carried forward [LOCF], +2.4 lines; P = 0.011, Wilcoxon signed ranks test, as compared with baseline acuity) for patients completing the 12-month follow-up. In the prior PDT group, the mean change was an improvement of +0.44 lines (LOCF, +0.31 lines; P = 0.53). Retreatment rates were 1.24 for the newly treated group and 1.2 for the prior PDT group over the first year. Ten patients (38.5%) developed an intraocular pressure (IOP) of >24 mmHg during follow-up, a threshold used to institute pressure reduction therapy. No patient developed endophthalmitis. CONCLUSION: Although the number of patients in this pilot study was limited, the improvement of acuity and the reduced treatment frequency in these patients suggest that combination therapy with PDT and intravitreal triamcinolone acetonide, particularly when used as first-line therapy, merits further investigation. Elevated IOP seems to be the most frequent early side effect of the treatment