Faculty Bibliography

BACKGROUND/PURPOSE: To report the swept-source optical coherence tomography (SS-OCT) findings in a case of acute toxoplasmosis chorioretinitis. METHODS: A 35-year-old male presented with acute blurry vision and floaters in his left eye. Ophthalmic examination, color photographs, spectral-domain OCT (SD-OCT), enhanced depth imaging OCT (EDI-OCT), SS-OCT and wide-field fluorescein angiography images were obtained to diagnose and follow the subsequent changes of toxoplasmosis chorioretinitis over a 2-month period. RESULTS: Initial imaging with different modalities of SD- and EDI-OCT including radial vitreous scans and horizontal high-speed B-scan raster lines demonstrated thickening of the posterior hyaloid and acute vitreous cells emanating from the retinal blood vessels, thickening and disorganization of the retinal layers within the chorioretinal lesion, and increased sub-lesional choroidal thickness, respectively. SS-OCT demonstrated all of these same findings in a single 12-mm B-scan. Topical steroids were initiated and imaging over the next 2 months showed separation of the posterior hyaloid, decrease in vitreous cell, and atrophy of the chorioretinal lesion. CONCLUSION: We report the first SS-OCT images of an acute case of toxoplasmosis chorioretinitis. SS-OCT can visualize the choroidal, retinal, and vitreous changes in a single scan, compared with the different imaging algorithms required with SD-OCT.

PURPOSE: Hemophagocytic syndrome (HS) is a rare disease with a spectrum of ocular findings. The authors report a unique funduscopic presentation of HS in a neonate and a discussion of diagnosis, typical features, management, and outcome. METHODS: Single case report with retrospective analysis of the published literature of patients with HS and ocular findings from 1950 to present using the key terms hemophagocytic, lymphohistiocytosis, ocular, and ophthalmic. Literature search from 1950 to the present was performed through PubMed/MEDLINE and the Cochrane database. Requirement for inclusion was that the article or abstract was written in English. RESULTS: A 4-week-old neonate with HS demonstrated bilateral discrete white dots within the retina, which resolved incompletely over the course of the next months but showed increased pigmentation. CONCLUSION: With so few documented ophthalmic cases of HS in existence, the ocular findings at this point can be seen as diverse and variable. However as more cases are reported, hopefully this will allow for increased recognition of the ophthalmic manifestations and sequelae and in turn lead to improved treatment of this disease.

IntroductionParacentral acute middle maculopathy (PAMM) has been described as an ischemic lesion of the middle retinal layers with a characteristic lamellar hyper-reflective placoid appearance in the acute phase and thinning of the involved retinal layers in the chronic phase. Optical coherence tomographic angiography (OCTA) is a novel and non-invasive technique for imaging retinal capillary vasculature with en face segmentation capabilities.MethodCase series. We describe two patients with PAMM who underwent clinical examination and multimodal imaging including OCTA.ResultsIn the first patient, who presented with PAMM secondary to acute cilioretinal artery occlusion, OCTA demonstrated reduction in flow in the deep capillary plexus (DCP). One month later, OCTA revealed a flow void due to thinning of the GCL, INL, and OPL and paradoxical apparent ONL thickening. Similar findings of focal retinal lamellar ectopia were seen in the second patient, who had an incidentally detected chronic PAMM lesion.ConclusionsOCTA images the superficial and deep capillary plexi independently. PAMM is characterized by acute and chronic attenuation of the DCP flow signature. Focal lamellar ectopia in PAMM is discussed.Eye advance online publication, 18 September 2015; doi:10.1038/eye.2015.180.

PURPOSE: Macular pigments are preferentially concentrated in the central fovea, an area devoid of vasculature. We hypothesized that there may be a link between the macular pigment profile and the size and structural characteristics of the foveal avascular zone (FAZ). METHODS: Two-wavelength autofluorescence method was used to quantify macular pigment optical density (MPOD) and the radius at half peak of MPOD, which was defined as the retinal eccentricity where the MPOD value was 50% of the peak value. Volumetric spectral-domain optical coherence tomography (OCT) images of the macula were obtained from 32 subjects. The equivalent radius of the FAZ was determined using data generated from OCT angiography. Generalized estimating equations were used to test the hypothesis that there are interrelationships among the central foveal thickness, peak MPOD, the radius at half peak of MPOD and the equivalent radius of the FAZ. RESULTS: The equivalent radius of the FAZ was highly correlated with the radius at half peak of MPOD (P < .001). The equivalent radius of the FAZ was a significant predictor for central foveal thickness (P < .001). The significant predictor for peak MPOD was central foveal thickness (P = .004). Eyes with larger FAZs were more likely to have a secondary peak in their MPOD spatial profile in a zone ranging from 0.5 to 1.0 degrees from the foveal center. CONCLUSIONS: The spatial distribution of macular pigment is related to the size of the FAZ, in addition to the central foveal thickness. It is possible that xanthophyll pigment accumulation in the macula serves functions, such as attenuation of shorter wavelengths of light, that would have been provided by the light-filtering characteristics of blood vessels.

PURPOSE: To demonstrate the presence of prevascular vitreous fissures (PVF) and posterior vitreous cisterns in vivo and correlate with the degree of vitreous degeneration (VD). METHODS: This was a cross-sectional study using Topcon Deep Range Imaging OCT-1 Atlantis 3D swept source optical coherence tomography for acquiring scans of posterior vitreous covering an 18 x 18-mm area in 104 eyes of 52 healthy volunteers without posterior vitreous detachment. RESULTS: We observed that increasing age was associated with higher VD grades (P < 0.05). Prevascular vitreous fissures, characterized by areas of lower optical density overlying the retinal blood vessels, were identified in 93 (89%) eyes, and the presence of PVF correlated with lower VD grades (P < 0.05). Presence of cisterns correlated with higher VD grades (P < 0.05). All eyes with absence of PVF were found to have established cisterns. Prevascular vitreous fissures were connected with cisterns in 44 of the 71 (62%) eyes with cisterns, while the base of the cistern was directly above retinal blood vessels in 38 (54%) eyes, which suggests that the cisterns could be derived from PVF. CONCLUSION: Swept source optical coherence tomography imaging can identify PVF and cisterns occurring in the context of age-related VD, and PVF appeared to be possible precursors of cisterns.