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PURPOSE: To describe the use of anti-osteoclastic medications (i.e., bisphosphonates and receptor activator of nuclear factor kappa beta (RANK) ligand inhibitors) in treating choroidal osteoma. METHODS: A 42-year-old male with bilateral posterior choroidal osteomas showed extensive outer retinal atrophy in the right eye secondary to decalcification of a choroidal osteoma and progressive extension of retinal pigment epithelial atrophy in the left eye encroaching on the macula with subtle changes in the choroidal osteoma. Bisphosphonates (i.e., oral alendronate 70 mg weekly) or RANK ligand inhibitors (i.e., subcutaneous denosumab 60 mg every six months) were initiated to prevent calcium resorption. RESULTS: After the introduction of more directed therapy, there was stabilization of the patients condition over the next nine years while under bisphosphonate treatment, followed by a switch to RANK ligand inhibitor therapy and later bisphosphonate treatment again. This was made evident through stability in fundus photography, enhanced depth imaging optical coherence tomography, and B-scan ultrasonography regarding outer retinal layers thickness, and choroidal osteoma thickness and calcification. CONCLUSION: Anti-osteoclastic therapy using bisphosphonates or RANK ligand inhibitors could be a new treatment paradigm to prevent resorption of choroidal osteomas and prevent the subsequent atrophy of outer retinal layers. SUMMARY STATEMENT: A patient with bilateral posterior choroidal osteomas was treated with bisphosphonates and RANK ligand inhibitors to prevent osteoma resorption in the better-seeing left eye. This has led to stability over six years of outer retinal layers thickness, choroidal osteoma thickness, and choroidal osteoma calcification.

Purpose: To describe the use of anti-osteoclastic medications (i.e., bisphosphonates and receptor activator of nuclear factor kappa beta (RANK) ligand inhibitors) in treating choroidal osteoma. Methods: A 42-year-old male with bilateral posterior choroidal osteomas showed extensive outer retinal atrophy in the right eye secondary to decalcification of a choroidal osteoma and progressive extension of retinal pigment epithelial atrophy in the left eye encroaching on the macula with subtle changes in the choroidal osteoma. Bisphosphonates (i.e., oral alendronate 70 mg weekly) or RANK ligand inhibitors (i.e., subcutaneous denosumab 60 mg every six months) were initiated to prevent calcium resorption. Results: After the introduction of more directed therapy, there was stabilization of the patient's condition over the next nine years while under bisphosphonate treatment, followed by a switch to RANK ligand inhibitor therapy and later bisphosphonate treatment again. This was made evident through stability in fundus photography, enhanced depth imaging optical coherence tomography, and B-scan ultrasonography regarding outer retinal layers thickness, and choroidal osteoma thickness and calcification. Conclusion: Anti-osteoclastic therapy using bisphosphonates or RANK ligand inhibitors could be a new treatment paradigm to prevent resorption of choroidal osteomas and prevent the subsequent atrophy of outer retinal layers. Summary statement: A patient with bilateral posterior choroidal osteomas was treated with bisphosphonates and RANK ligand inhibitors to prevent osteoma resorption in the better-seeing left eye. This has led to stability over six years of outer retinal layers thickness, choroidal osteoma thickness, and choroidal osteoma calcification.

Purpose: To study the corelation between outer retinal layer thickness (ORL), outer photoreceptor segment thickness (PROS), and central macular thickness (CMT) with best-corrected visual acuity (BCVA) in patients having clinically significant macular edema (CSME) and compare these parameters with normal patients. Methods: This was a prospective, nonrandomized, observational, comparative study done during the period of January to May 2019. The study included 60 eyes of 36 patients. The patient population was segregated into two Groups: Group I (30 normal eyes of 15 normal patients) and Group II (30 eyes of 21 diabetic patients) with CSME. The comparison between ORL, PROS, and CMT was made between both the groups, and the correlation between ORL thickness, PROS thickness, and CMT with BCVA in Group II was studied. Results: The mean age in Group I was 52.6+10.66 years, and 53.42+8.15 years in Group II. The male/female ratio was 1.1:1 in Group I and 4:3 in Group II. The mean CMT was greater in Group II (330.13 ± 37.01) than in Group I (222.20 ± 12.30). The mean ORL thickness was greater in Group I (97.73 ± 6.92) than in Group II (80.63 ± 9.03). The PROS thickness was statistically significant in Group I (35.05 ± 3.4) than in Group II (28.57 ± 3.53). There was a strong correlation between BCVA and ORL thickness (r = −0.580, P < 0.001) and more strong correlation between BCVA and PROS thickness in Group II (r = −0.611, P < 0.000). There was a moderate correlation between BCVA and CMT (r = 0.410, P < 0.025), and all results were statistically significant. Conclusion: Both ORL and PROS thickness were greater in healthy normal eyes than in eyes with CSME. BCVA was strongly correlated with PROS and ORL thickness and moderately associated with CMT.

Purpose: To study the corelation between outer retinal layer thickness (ORL), outer photoreceptor segment thickness (PROS), and central macular thickness (CMT) with best-corrected visual acuity (BCVA) in patients having clinically significant macular edema (CSME) and compare these parameters with normal patients. Methods: This was a prospective, nonrandomized, observational, comparative study done during the period of January to May 2019. The study included 60 eyes of 36 patients. The patient population was segregated into two Groups: Group Ι (30 normal eyes of 15 normal patients) and Group ΙΙ (30 eyes of 21 diabetic patients) with CSME. The comparison between ORL, PROS, and CMT was made between both the groups, and the correlation between ORL thickness, PROS thickness, and CMT with BCVA in Group ΙΙ was studied. Results: The mean age in Group I was 52.6+10.66 years, and 53.42+8.15 years in Group II. The male/ female ratio was 1.1:1 in Group I and 4:3 in Group II. The mean CMT was greater in Group ΙΙ (330.13 ± 37.01) than in Group Ι (222.20 ± 12.30). The mean ORL thickness was greater in Group Ι (97.73 ± 6.92) than in Group ΙΙ (80.63 ± 9.03). The PROS thickness was statistically significant in Group Ι (35.05 ± 3.4) than in Group ΙΙ (28.57 ± 3.53). There was a strong correlation between BCVA and ORL thickness (r = -0.580, P < 0.001) and more strong correlation between BCVA and PROS thickness in Group ΙΙ (r = -0.611, P < 0.000). There was a moderate correlation between BCVA and CMT (r = 0.410, P < 0.025), and all results were statistically significant. Conclusion: Both ORL and PROS thickness were greater in healthy normal eyes than in eyes with CSME. BCVA was strongly correlated with PROS and ORL thickness and moderately associated with CMT. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between outer retinal layer thickness (ORLT) and visual acuity (VA) in patients with retinal vein occlusion (RVO) after resolution of macular edema (ME) with intravitreal injections. Material and Methods: The study included patients who received loading dose of intravitreal ranibizumab (IVR) forME secondary to unilateral RVO and had no ME in optical coherence tomography (OCT) obtained on month 12. The contralateral eyes of the patients were employed as control. ORLT was measured using automated segmentation feature in OCT. The RVO and control groups were compared regarding ORLT and relationship between ORLT and VA was assessed within RVO group. A p value <0.05 was considered as statistically significant. Results: The study included 156 eyes of 78 patients. Of the patients, 70.5% had branch RVO and 29.5% had central RVO. There was a significant increase in mean VA on month 12 in the RVO group compared to the baseline (p -0.01). In the RVO group, dexamethasone (DEX) implant was given to 59% of the patients in addition to IVR. In RVO group, ORL thickness in M, N1, S1 and S2 segments were significantly lower than the control group (p <0.05, all values). The ORL thickness in M, N1, T1, T2, S1 and S2 segments were significantly lower in eyes received at least one DEX implant compared to eyes received no DEX implant (p <0.05, all values). There was a significant correlation between the mean VA value in the RVO group on month 12 and ORL thickness in segment M (p <0.01). Conclusion: In RVO patients, subfoveal ORLT measured after resolution of ME is thinner in occlusion eyes than in healthy eyes. The significant ORLT decrease in eyes with DEX than in eyes received DEX implant compared to those received no DEX implant can be explained by the fact that DEX was given to patients with a more severe course of ME. The decrease in subfoveal ORLT resulting in lower VA suggested that RVO can lead to photoreceptor and/or retinal pigment epithelium degeneration in the long term. [ABSTRACT FROM AUTHOR]