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Purpose To evaluate the retinal periphery in patients with idiopathic juxtafoveal telangiectasis or macular telangiectasis type 2 (MacTel2), using widefield fluorescein angiography (WFA). Methods Single-center, retrospective, observational case series of 50 eyes of 50 patients with MacTel2 and 50 eyes of 50 age-matched controls. Results Thirty-seven eyes in the MacTel2 group (74%) showed peripheral capillary nonperfusion or dropout, compared to 37 eyes in the control group (74%, p=1.0). Morphologically, the MacTel2 group trended towards having a higher proportion of pruning-type capillary dropout (44%) compared to controls (28%), but this was not statistically significant (p=0.12). Patients with MacTel2 had a higher incidence of microaneurysms compared to controls (MacTel2 56%; Controls 42%; p=0.048), independent of age or systemic risk factors. There was no difference in the incidence of venous-venous shunts (MacTel2 10%; Controls 10%; p=1.0), arteriovenous shunts (MacTel2 14%; Controls 18%; p=0.60), venous tortuosity (MacTel2 60%; Controls 66%; p=0.58), or arterial tortuosity (MacTel2 54%; Controls 68%; p=0.20), which was mild in the majority of cases. Conclusions We note a high incidence of peripheral vascular and retinal findings in both patients with MacTel2 and age-matched controls, using WFA. Patients with MacTel2 had significantly more microaneurysms, independent of age or other systemic risk factors.Summary SUMMARY:: We note a high incidence of peripheral retinal vascular findings in both patients with macular telangiectasis type 2 and age-matched controls. Patients with MacTel2 had significantly more microaneurysms compared to controls, independent of age or other systemic risk factors.

Case report An 11 year-old girl with progressive muscle weakness due to dermatomyositis and hemophagocytic lymphohistiocytosis in which multiple cotton exudates, venous tortuosity and flame hemorrhages are detected in the funduscopic examination, leading to the diagnosis of Purtscher-like retinopathy. Discussion Purstcher's retinopathy is a microvascular disorder with clinical signs of probable thrombotic origin. Its treatment is controversial, with systemic corticosteroids being the most widespread choice.

Introduction: Certain changes occur in high altitude which can be organic, motor or functional. This study was conducted to find out ocular morbidity at high altitude in Nepal. Methods: A cross sectional study was conducted at four different places at altitudes of 2710 m (Jomsom), 2900 m (Kagbeni), 3500 m (Jharkot) and 3800 m (Muktinath) of Mustang district of Nepal using convenient sampling method. A total of 222 subjects (444 eyes) were included. They were examined for vascular engorgement and tortuosity, arteriovenous ratio changes, retinal hemorrhages, cataract, pterygium, color vision and intraocular pressure. The motor changes like esodeviation and exodeviation were studied. Results: Of the total 222 participants, 164 (77.5%) were more than 40 years of age and 58 (22.5%) were less than 40 years. The male to female ratio was 1:1.1. The duration of stay at high altitude was >10 years in 96.6%, >15 years 88.3% and >20 years 83.8%. The prevalence of cataract was 19.8% and pseudophakia 17.1%. Other organic changes like venous engorgement, arterio-venous ratio changes and venous tortuosity was also found at high altitude. There was no significant change in intraocular pressure at high altitude. Esodeviation was present in 14%. The prevalence of pterygium was present in 39.6%. Similarly, the prevalence of red green color vision deficiency was 45.1%. Conclusion: Cataract, pterygium, red green color vision deficiency, esodeviation, venous engorgement and venous tortuosity were found to be prevalent at high altitude of Nepal.

This funduscopic image shows right eye optic disc swelling, retinal haemorrhage, and venous tortuosity (arrows), all suggestive of central retinal vein occlusion; and a lack of retinal perfusion over …

Purpose. To evaluate the capacity of OCT angiography (OCTA) for detecting infraclinical lesions in parafoveal capillaries in diabetic patients without diabetic retinopathy (DR). Methods. This prospective observational cross-sectional case-control study analyzed the superficial and deep capillary plexuses (SCP and DCP) on macular OCTA scans (3 × 3 mm) centered on the fovea. We compared 22 diabetic patients (34 eyes included) without DR diagnosis on color fundus photographs, with 22 age- and gender-matched nondiabetic controls (40 eyes included). Qualitative analysis concerned morphological ischemic capillary alterations. Quantitative analysis measured foveal avascular zone (FAZ) size, parafoveal capillary density, and enlargement coefficient of FAZ between SCP and DCP. Results. Neither the qualitative nor quantitative parameters were significantly different between both groups. No microaneurysms or venous tortuosity was observed in any of the analyzed images. On the SCP, the mean FAZ area was 0.322 ± 0.125 mm2 in diabetic patients and 0.285 ± 0.150 mm2 in controls, P=0.31. On the DCP, the mean FAZ area was 0.444 ± 0.153 mm2 in cases and 0.398 ± 0.138 mm2 in controls, P=0.20. Conclusion. OCTA did not detect infraclinical qualitative or quantitative differences in parafoveal capillaries of diabetic patients without DR in comparison with nondiabetic controls.

Retinopathy of prematurity (ROP), a vasoproliferative retinal disease affecting premature infants, is a leading cause of childhood blindness throughout the world. Plus disease, defined as venous dilatation and arteriolar tortuosity within the posterior retinal vessels greater than or equal to that of a standard published photograph, is the most critical finding in identifying treatment-requiring ROP. Despite an internationally accepted definition of plus disease, there is significant variability in diagnostic process and outcome, producing variable levels of reported intra- and interexpert agreement. Several potential explanations for poor agreement have been proposed, including attention to undefined vascular features such as venous tortuosity, focus on narrower or wider field of view, unfamiliarity with digital images, the magnification and apparent severity of the standard photograph, and cut-off point differences among experts as to the level of tortuosity and dilation sufficient for “plus disease” along a continuum. Moreover, differences in diagnostic consistency among groups of experts separated both geographically and chronologically have been reported. These findings have implications for clinical care, research, and education, and highlight the need for a more precise definition of plus disease and objective diagnostic methods for ROP.

Experimental methods that allow examination of the intact vascular network of large organs, such as the human placenta are limited, preventing adequate comparison of normal and abnormal vascular development in pregnancy disease. Our aims were (i) to devise an effective technique for three-dimensional analyses of human placental vessels; (ii) demonstrate the utility of the technique in the comparison of placental vessel networks in normal and fetal growth restriction (FGR) complicated pregnancies. Radiopaque plastic vessel networks of normal and FGR placentas (n = 12/group) were created by filling the vessels with resin and corroding the surrounding tissues. Subsequently, each model was scanned in a microCT scanner, reconstructed into three-dimensional virtual objects and analysed in visualisation programmes. MicroCT imaging of the models defined vessel anatomy to our analyses threshold of 100 µm diameter. Median vessel length density was significantly shorter in arterial but longer in venous FGR networks compared to normals. No significant differences were demonstrable in arterial or venous tortuosity, diameter or branch density. This study demonstrates the potential effectiveness of microCT for ex-vivo examination of human placental vessel morphology. Our findings show significant discrepancies in vessel length density in FGR placentas. The effects on fetoplacental blood flow, and hence nutrient transfer to the fetus, are unknown.

The aim of this paper was to evaluate the angioarchitectural factors that can induce concurrent cavernous malformation (CM) in the territory of developmental venous anomaly (DVA). From January 2006 to December 2007, 21 patients with 23 CMs in the territory of DVA were retrospectively analyzed (M; F = 12; 9, mean age = 53.3). Gadovist®-enhanced three-dimensional spoiled gradient-echo images on a 3 T magnetic resonance (MR) scanner were used. We investigated the presence of angioarchitectural factors: factor 1, the angulated course of curved medullary or draining vein in the distal portion of CM; factor 2, narrowing of distal draining vein; factor 3, severe medullary venous tortuosity. These were also analyzed for control group of 23 subjects (M; F = 11; 12, mean age = 46). Factor 1 was demonstrated in 22 cases (97%) and the CM occurred in a position of 90° or less of an abrupt angulated medullary or draining vein in 15 cases (65%) of the study group. Factor 2 was found in 13 cases (57%) with the diameter reduction of 50% or more in five cases. The mean ratio of diameter reduction was 0.53. Factor 3 was found in 17 cases (74%). Analyzing the independent factors, the p values for factors 1 and 3 were

Aim The aim of this study was to evaluate the fundus changes in thalassemic patients in Giza and Fayoum Governorates. Patients and methods Thirty thalassemic patients recruited from the Pediatric Hematology Clinic in Fayoum University Hospital, Misr University Hospital, and NILES Pediatric Clinic were included in the present study. All patients underwent complete ophthalmic examination and laboratory investigations. Results The mean age was 10.7±5.9 (6–36) years. There were 20 male patients (66.7%), with a mean duration of disease of 7.1±7.1 years (3 months to 36 years). Patients were classified on the basis of hemoglobin (Hb) level into two groups: 7 g/dl or less (thalassemia major) and greater than 7 g/dl (thalassemia intermediate and thalassemia minor). There was a significant correlation between cup/disc (C/D) ratio and Hb level (P

Retinopathy in patients with haematological malignancy is a common finding, characterised by venous tortuosity, retinal haemorrhages, cotton wool spots and white‐centred haemorrhages (Roth spots).1...

We developed and evaluated the performance of a novel computer-based image analysis system for grading plus disease in retinopathy of prematurity (ROP), and identified the image features, shapes, and sizes that best correlate with expert diagnosis.A dataset of 77 wide-angle retinal images from infants screened for ROP was collected. A reference standard diagnosis was determined for each image by combining image grading from 3 experts with the clinical diagnosis from ophthalmoscopic examination. Manually segmented images were cropped into a range of shapes and sizes, and a computer algorithm was developed to extract tortuosity and dilation features from arteries and veins. Each feature was fed into our system to identify the set of characteristics that yielded the highest-performing system compared to the reference standard, which we refer to as the "i-ROP" system.Among the tested crop shapes, sizes, and measured features, point-based measurements of arterial and venous tortuosity (combined), and a large circular cropped image (with radius 6 times the disc diameter), provided the highest diagnostic accuracy. The i-ROP system achieved 95% accuracy for classifying preplus and plus disease compared to the reference standard. This was comparable to the performance of the 3 individual experts (96%, 94%, 92%), and significantly higher than the mean performance of 31 nonexperts (81%).This comprehensive analysis of computer-based plus disease suggests that it may be feasible to develop a fully-automated system based on wide-angle retinal images that performs comparably to expert graders at three-level plus disease discrimination.Computer-based image analysis, using objective and quantitative retinal vascular features, has potential to complement clinical ROP diagnosis by ophthalmologists.

Purpose To evaluate the change in visual acuity and retinal appearance in patients after early initiation of intravitreal bevacizumab treatment for central retinal vein occlusion (CRVO). Design Retrospective, interventional case series. Methods Patients with CRVO of fewer than three months' duration receiving intravitreal bevacizumab as primary treatment were evaluated. Patients received an intravitreal 1.25 mg (0.05 ml) bevacizumab injection. Changes in visual acuity, central macular thickness, venous tortuosity and diameter, and optic disk edema were noted. Results Six eyes of five consecutive patients with CRVO treated with intravitreal bevacizumab injection were reviewed retrospectively. The patients did not have other ocular conditions that could have compromised visual acuity. The mean baseline visual acuity was 20/428 (logarithm of the minimum angle of resolution [logMAR] units, 1.33). The mean follow-up period was 12 months (range, seven to 15 months), and the number of bevacizumab injections ranged from four to 10. The patients showed a statistically significant decrease in optic nerve head swelling, venous tortuosity, and venous diameter, with the largest proportion of change occurring within one month of the first bevacizumab injection. The mean visual acuity at last follow-up was 20/53 (logMAR units, 0.42; P = .035, as compared with baseline). In no patient did collateral vessels at the optic nerve head develop. Conclusions The patients experienced a dramatic improvement in the visual acuity and clinical fundus appearance, without collateral vessel formation. These findings are difficult to explain with current theories of the pathophysiologic features of CRVO. These findings also suggest early initiation of anti–vascular endothelial growth factor (VEGF) treatment should be studied in a larger trial for CRVO.

[Figure][1] [![Graphic][3] ][3] A newborn, first child of consanguineous parents was admitted to intensive care because of persistent pulmonary hypertension. The diagnosis of arterial tortuosity syndrome (ATS) was suspected due to severe tortuosity of the aorta (A) and pulmonary

• The incidence of clinically apparent retinal changes in 35 anemic patients and 35 age- and sex-matched control subjects was studied. Retinal photographs of all subjects were obtained. From these, all vascular and extravascular retinal lesions were noted. No retinal abnormalities were observed in the control subjects. Seven (20%) of the anemic patients exhibited extravascular lesions. There was no relationship detected between the occurrence of these changes and the severity or the cause of the anemia. Employing the assumption that true venous length for a given net distance traveled correlates with the degree of venous tortuosity, venous length over a standard radial distance from the optic disc was assessed with a curvometer. A significant negative correlation was determined between venous length and the level of hematocrit, thereby implying that retinal venous tortuosity is directly related to severity of anemia.

To the Editor. —In their article, Hupp et al 1 reviewed their experience with retrobulbar optic nerve decompression in a variety of clinical settings. The longest follow-up period in their series was nine years. In their review of the literature, they referred to a case of pseudotumor cerebri in which we reported successful reversal of visual loss following bilateral optic nerve decompression. 2 We are now able to provide follow-up information 13 years later. Although the patient was an extremely poor complier in terms of medications and weight reduction and despite persistently raised intracranial pressure, she had visual acuities of 20/25 OU with full kinetic visual fields when last seen, in April 1986. Both discs were flat and pink with very mild blurring of the nasal margins and some residual venous tortuosity. This excellent long-term result confirms our belief that optic nerve decompression is valuable in protecting visual function in