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Purpose: To describe a case of choroidal neovascularization (CNV) and chorioretinal scarring in a patient with melanoma-associated retinopathy after ipilimumab/nivolumab combination immune therapy for malignant melanoma., Methods: Retrospective case report with fundus photography, fluorescein angiography, optical coherence tomography, and electroretinography., Results: A 65-year-old woman presented with symptoms of photopsia and visual field loss. She had previously undergone ipilimumab/nivolumab combination chemotherapy treatment for malignant melanoma 14 months earlier coinciding with the onset of her visual symptoms. Fundus photography showed bilateral atrophic chorioretinal lesions and peripheral retinal pigment epithelial changes. Fluorescein angiography revealed retinovascular leakage in both eyes with CNV in the right eye. Optical coherence tomography showed a pigment epithelial detachment with subretinal fluid and subretinal hyperreflective material consistent with occult CNV. Visual field testing showed generalized visual field loss in both eyes. Bloodwork discovered an elevated angiotensin-converting enzyme. Electroretinography revealed abnormal peripheral rod and cone function with impairment of the photoreceptor and inner nuclear layer. Serum Western blot was positive for 60 kDa antiretinal autoantibody. After a single bevacizumab injection in the right eye, CNV resolved and visual acuity improved from 20/50 before the injection to 20/25 3 months after the injection. Visual acuity in the left eye deteriorated for months to counting fingers but then improved to 20/100 on follow-up examinations., Conclusion: Ipilimumab and nivolumab have been associated with immune-related ocular adverse effects. We report a case of combination therapy presenting with chorioretinal scarring and subsequent CNV in a patient with melanoma-associated retinopathy, a rare yet important adverse effect.

Purpose : To describe a case of multiple disseminated choroidal tuberculomas in a patient of early-phase Vogt-Koyanagi- Harada (VKH) disease being treated with Azathioprine. Methods : A retrospective chart review. Results : A 55-year-old female, a diagnosed case of VKH disease, was being treated with oral steroids and Azathioprine. During one of her follow-up visit, she was detected with multiple subretinal granulomas with surrounding fluid in both eyes. Fundus fluorescein angiography (FFA), Indocyanine green angiography (ICGA) and Optical Coherence Tomography (OCT) favored the presence of choroidal granulomas and Positron emission Tomography (PET) scan revealed lesions in spleen as well. She was started on anti-tubercular therapy along with oral steroids. She responded very well to treatment and her choroidal granulomas resolved in follow-up. Conclusion : Disseminated tubercular granulomas can rarely occur with the use of oral Azathioprine and poses caution for its use in cases requiring long-term immunosuppressants.

Purpose: To report the occurrence of bilateral choroidal detachments due to the use of ipilimumab and pembrolizumab immunochemotherapeutics to treat widely metastatic cutaneous melanoma and to raise awareness about this potentially vision-threatening adverse drug event., Methods: A 77 year-old man presented with acute onset, painless, and bilateral blurry vision. He had started ipilimumab and pembrolizumab 2 weeks prior for Stage IV metastatic cutaneous melanoma., Results: Clinical examination revealed bilateral choroidal detachments. After discussion with the patient's medical oncologist, the patient discontinued both medications and began oral prednisone to expedite visual recovery. The choroidal detachments subsequently resolved, and visual acuity improved 2 weeks later., Conclusion: Ipilimumab and pembrolizumab have been reported both in monotherapy and in combination to cause a wide variety of ophthalmic adverse events. This is the first report of choroidal detachments as a complication.

A 66-year-old male patient presented to the ophthalmology department with bilateral blurred vision, which had persisted for 1 week. Due to a pulmonary melanoma metastasis, the patient received a combination treatment with dabrafenib and trametinib. At the first presentation visual acuity was 1.2 on the right and 1.0 on the left. A normotensive intraocular pressure was measured in both eyes. Fundoscopy showed bilateral white, areolar alterations in the choroid and choroid folds and in the left eye a bullous choroidal detachment. Bilateral neurosensory detachment and subretinal fluid were found in optical coherence tomography (OCT). After reduction of the local treatment for pressure reduction and under local and systemic anti-inflammatory treatment, the choroidal swelling was progressive, the visual acuity dropped to 0.5 in the right and to 0.1 in the left eye. A significant regression of the findings occurred only after pausing the treatment with trametinib. Visual acuity rose to 1.0 (left) and 0.8 (right). The OCT showed a dry macula on the right and a small amount of residual subretinal fluid in the left eye.

This article reports a case of choroidal folds and central serous chorioretinopathy-like maculopathy induced by corticosteroid treatment. The patient was a 70-year-old woman who presented with decreased visual acuity in the right eye. She had a history of rheumatoid arthritis and was prescribed 20 mg leflunomide and 16 mg corticosteroid daily. Fundoscopy indicated bilateral macular edema and the presence of choroidal folds. Retinal imaging supported choroidal folds and central serous chorioretinopathy-like maculopathy. Corticosteroid therapy was discontinued, and the patient was followed up. Complete regression of the maculopathy was observed at 8-month follow-up examination.

Preclinical and clinical evidences show that aldosterone and/or mineralocorticoid receptor (MR) over-activation by glucocorticoids can be deleterious to the retina and to the retinal pigment epithelium (RPE)-choroid complex. However, the exact molecular mechanisms driving these effects remain poorly understood and pathological consequences of chronic exposure of the retina and RPE/choroid to aldosterone have not been completely explored. We aimed to decipher the transcriptomic regulation in the RPE-choroid complex in rats in response to acute intraocular aldosterone injection and to explore the consequences of systemic chronic aldosterone exposure on the morphology and the gene regulation in RPE/choroid in mice. High dose of aldosterone (100 nM) was intravitreously injected in Lewis rat eyes in order to yield an aldosterone dose able to induce a molecular response at the apical side of the RPE-choroid complex. The posterior segment morphology was evaluated in vivo using optical coherence tomography (OCT) before and 24 h after aldosterone injection. Rat RPE-choroid complexes were used for RNA sequencing and analysis. Uninephrectomy/aldosterone/salt (NAS) model was created in wild-type C57BL/6 mice. After 6 weeks, histology of mouse posterior segments were observed ex vivo. Gene expression in the RPE-choroid complex was analyzed using quantitative PCR. Acute intravitreous injection of aldosterone induced posterior segment inflammation observed on OCT. RNA sequencing of rat RPE-choroid complexes revealed up-regulation of pathways involved in inflammation, oxidative stress and RNA procession, and down-regulation of genes involved in synaptic activity, muscle contraction, cytoskeleton, cell junction and transporters. Chronic aldosterone/salt exposure in NAS model induces retinal edema, choroidal vasodilation and RPE cell dysfunction and migration. Quantitative PCR showed deregulation of genes involved in inflammatory response, oxidative stress, particularly the NOX pathway, angiogenesis and cell contractility. Both rodent models share some common phenotypes and molecular regulations in the RPE-choroid complex that could contribute to pachychoroid epitheliopathy in humans. The difference in inflammatory status relies on different intraocular or systemic route of aldosterone administration and on the different doses of aldosterone exposed to the RPE-choroid complex., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: To report two cases of ciliochoroidal effusion after the usage of topiramate., Cases: Two middle-aged women experienced sudden onset of acute glaucoma and acquired myopia after taking topiramate. Ultrasound biomicroscopy demonstrated bilateral ciliochoroidal effusion and angle closure. The A-scan ultrasonography revealed shallow anterior chamber and thick lens. After the treatment and drug withdrawal, intraocular pressure, refractive status and angle anatomy returned to normal and there was resolution of ciliochoroidal effusion. During the clinical course, the anterior chamber depth (ACD) increased from 2.02 to 3.30 mm (1.28 mm of changes) OD and from 1.94 to 3.36 mm (1.42 mm of changes) OS. The lens thickness (LT) became thinner from 4.53 to 4.31 mm (0.22 mm of changes) OD and from 4.59 to 4.30 mm (0.29 mm of changes) OS in the first case. In the second case, the ACD increased from 2.33 to 3.07 mm (0.74 mm of changes) OD and from 2.30 to 3.05 mm (0.75 mm of changes) OS. The LT became thinner from 4.42 to 4.27 mm (0.15 mm of changes) OD and from 4.38 to 4.26 mm (0.12 mm of changes) OS. The forward displacement of the lens-iris diaphragm contributed more to the shallowness of the anterior chamber than the thickening of the lens itself (only accounting for 20%)., Conclusion: Topiramate-induced bilateral acute angle closure glaucoma and myopic shift was due to ciliochoroidal effusion which resulted in thicker lens and shallow anterior chamber. The later was mainly due to anterior displacement of the lens-iris diaphragm.

We describe a case of indapamide-induced bilateral choroidal effusion, first time reported in pseudophakic patient, associated with no change in visual acuity and stable refraction.A 70-year-old man was referred for ophthalmic assessment, with binasal visual field defect for 2 days. He had been started on treatment with indapamide 3 weeks earlier. His ophthalmic history included bilateral cataract surgery and intraocular lens implant. Fundal examination revealed bilateral choroidal effusions; B-scan ultrasonography was used to measure the extent of the choroidal detachment and the anterior chamber depth. Discontinuation of indapamide resulted in spontaneous resolution of choroidal effusion after 3 days. Our case is the first in the literature that describes bilateral choroidal effusion induced by indapamide in a pseudophakic patient. The lack of myopic shift likely resulted in a later presentation, enhancing the theory that lens thickening and/or accommodative spasm may play a crucial role in pathophysiology., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Case-Report: The author presents case report of acute induced myopia with mild intraocular pressure elevation by young patient using trazodone. The presentation is completed with the documentation of anterior chamber depth and angle changes by using and after discontinuation of trazodone., Conclusion: Acute transient myopia may be rare side effect of systemic used drugs in predisposed patients. Early and correct diagnosis is very important, because induced myopia may be accompanied by acute angle-closure glaucoma or supraciliary choroidal effusion. The only correct treatment in this case is discontinuation of the drug. Key words: acute angle-closure glaucoma, acute myopia, antidepressants, side effects, trazodone.

Purpose: To describe a case of acute bilateral transient myopia, retinal folds, and island of choroidal delay associated with oral administration of Cefalium, a medication commonly prescribed in Brazil for migraine that combines acetaminophen 500 mg, caffeine 40 mg, dihydroergotamine mesylate 1 mg, and metoclopramide hydrochloride 10 mg., Methods: A 21-year-old woman with bilateral blurred vision 1 day after the use of Cefalium. The main outcomes measures were BCVA, ocular fundus, ocular coherence tomography, and angiography findings., Results: The patient developed bilateral myopia, retinal folds, and focus choroidal delay 1 day after the administration of oral cefalium. Ocular fundus examination and ocular coherence tomography revealed retinal folds in the internal surface of the retina. Angiography showed focus areas of hypofluorescence in both eyes. Seven days after Cefalium was suspended, all clinical symptoms had resolved, with full recovery from the abnormal findings on ocular fundus, ocular coherence tomography, and angiography., Conclusion: This is the first report that identified and described bilateral transient myopia, retinal folds, and focus choroidal delay secondary the use of Cefalium.

Introduction: Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection., Case Report: The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy., Discussion: Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab., (Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Sulpha drugs are widely employed in medicine for various diseases and disorders. During the last several decades, numerous papers had been published on supra ciliary and posterior choroidal effusion likely presenting as an idiosyncratic effect of these drugs especially of acetazolamide. In each publication, the effusion was associated with either an acute angle-closure glaucoma or transitory myopia or both of these as leading symptoms. In the current publication, authors report on two cases where the acetazolamide-induced choroidal effusion was an accidental finding without either a myopic shift in refraction or an acute elevation in intraocular pressure. To our best knowledge, ours is the first report in the literature describing this unusual, "silent" form of a sulpha drug-induced choroidal effusion. Since the choroidal involvement may vary in size and location, and is not necessarily associated with acute glaucoma and myopia, one can assume that a considerable amount of acetazolamide-related ocular side-effects will not be discovered. The above case report aims to draw the attention of other specialities to the need for ophthalmic examination for their patients taking sulpha drugs with acute visual deterioration. Orv Hetil. 2017; 158(50): 1998-2002.

Pachychoroid pigment epitheliopathy (PPE) is considered to be a forme fruste of central serous chorioretinopathy. Tamoxifen (Soltamax; Midatech Pharma, Raleigh, NC) has an anti-estrogenic effect on cytoplasmic estrogen receptors. Serum total testosterone, cortisol, and cortisone levels increase during tamoxifen therapy. Tamoxifen may cause hormone disturbance leading to the development of disorders in the pachychoroid spectrum. The authors present two cases of PPE associated with tamoxifen therapy. A 65-year-old woman (Patient 1) and a 52-year-old woman (Patient 2) had a recent history of tamoxifen therapy. PPE lesions were seen in both eyes of Patient 1 and in the right eye of Patient 2. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:838-842.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To report a case of posterior ciliary artery occlusion after posterior subtenon injection., Methods: Clinical examination and fundus fluorescein angiography was performed to confirm diagnosis. A 49-year-old female who was on treatment for bilateral chronic sclerokeratouveitis was given posterior subtenon injection for cystoid macular edema., Results: Posterior ciliary artery occlusion occurred after posterior subtenon injection., Conclusion: Choroidal vascular occlusion is a rare complication of posterior subtenon injection.

Background: Choroidal detachment (CD) is often observed at an early period particularly after trabeculectomy and glaucoma drainage implant surgery. However, topical antiglaucoma eye drop-induced CD is a rare complication. Here, we report a case of topical bimatoprost-induced late-onset CD after trabeculectomy and review the literature., Case Report: A 74-year-old man who suffered from primary open-angle glaucoma underwent his initial trabeculectomy with mitomycin-C in the right eye. Before the surgery, his intraocular pressure (IOP) was 20 to 22 mm Hg with bimatoprost 0.03%, dorzolamide 1%, and brimonidine 0.1% and his best corrected visual acuity (BCVA) was 0.9. The mean deviation in Humphrey Visual Field Analyzer (24-2 program) was -27.83 db. After successful trabeculectomy, IOPs were 11 to 16 mm Hg without any medication. Eight months after the surgery, we restarted bimatoprost to further reduce the IOP in the right eye, which was 15 mm Hg. At a hospital visit 2 months later, he complained of blurred vision that had persisted for the past 1 month; his IOP had decreased to 9 mm Hg. His BCVA was 0.04 and 3 quadrant CD was found. We discontinued bimatoprost and started him on betamethasone 0.1% 4 times per day. However, CD marginally changed after 1 week, with IOP at 7 mm Hg; thus, we performed scleral drainage for CD. After 3 weeks of drainage, CD completely disappeared. IOP increased to 16 mm Hg and BCVA was 0.7. However, 3 months after the drainage, IOP increased to 29 mm Hg, and needling revision was thus performed. After the surgery, IOP remained at 14 to 16 mm Hg without any glaucoma medication and CD recurrence. A review of the literature showed that various antiglaucoma medications induce CD, regardless of the preceding glaucoma surgery and that CD is usually resolved by withdrawing the medication and administering topical steroids. However, most previous studies have shown the recurrence of CD by rechallenging the same drug., Conclusion: In our case, topical bimatoprost induced late-onset CD after trabeculectomy. Early scleral drainage may be a good option to quickly resolve drug-induced CD and prevent its recurrence. Therefore, it must be kept in mind that various antiglaucoma medications induce CD., Competing Interests: The authors have no financial disclosures and no conflicts of interest to declare.

Purpose: To report nine new cases of retinal degeneration secondary to didanosine toxicity and to summarize the previously reported cases in the literature., Methods: This was a multicenter, retrospective, observational case study from seven institutions. Medical records of patients who demonstrated well-demarcated severe midperipheral chorioretinal degeneration and who were previously treated with didanosine therapy were collected and the following information was reviewed: age, gender, medical history, detailed medication history including current and previous antiretroviral use, ocular and retinal examination findings, and multimodal imaging findings with optical coherence tomography, fundus photography, wide-field fundus autofluorescence, and wide-field fluorescein angiography. When available, findings with electrophysiology testing and automated perimetry were also collected and reviewed. A literature review was also performed to collect all reported cases of chorioretinal degeneration secondary to didanosine toxicity., Results: Nine patients were identified who had findings consistent with peripheral retinal toxicity secondary to didanosine use. Eight of the 9 patients were men, and the median age was 54 years at the time of presentation (mean: 55 years, range, 42-71 years). Snellen distance acuity ranged from 20/20 to 20/32. At least three of the cases in the series demonstrated progression of the peripheral retinal pigment epithelium and photoreceptor atrophy despite didanosine cessation. A review of the literature revealed 10 additional cases of didanosine toxicity. Seven of the 10 cases were in men (70%), and the average age was 26 years with a wide range (2-54 years). Chorioretinal findings were very similar to this cohort., Conclusion: Herein, we report the largest series of nine cases of peripheral chorioretinal degeneration secondary to didanosine toxicity in adults. When combined with the cases in the literature, 19 cases of didanosine toxicity, 4 of which occurred in children, were collected and analyzed. Three of the new cases presented showed clear progression of degeneration despite didanosine cessation. Newer nucleoside reverse transcriptase inhibitors may potentiate mitochondrial DNA damage and lead to continued chorioretinal degeneration.

A 79-year-old woman was referred for rapid onset of painless bilateral vision loss. Anterior segment exams revealed bilateral spontaneous hyphema and fibrin accumulation. Observation of the posterior chamber by B-scan ultrasound showed vitreous hemorrhage and choroidal detachment bilaterally. No evidence of additional intraocular inflammation was present. Laboratory work-up for hematologic abnormalities was unremarkable. These hemorrhagic events were suspected to be a complication from taking the novel anticoagulant, dabigatran etexilate (Pradaxa; Boehringer, Ingelheim, Germany). She initially underwent non-surgical therapy, which included immediate cessation of dabigatran, and administration of topical and systemic steroids. The lack of response to medical therapy in the left eye led to surgical treatment of vitreous and persistent subcapsular hemorrhage via pars planar vitrectomy with capsulectomy., (Copyright 2016, SLACK Incorporated.)

Background: We report changes of choroidal structure determined by binarization of enhanced depth imaging optical coherence tomographic (EDI-OCT) images after treatment for primary intraocular lymphoma (PIOL)., Methods: Five eyes of four patients with PIOL were examined by EDI-OCT before and 6 months after intravitreal methotrexate injections. In addition, 15 eyes of 15 normal individuals controlled by age and refractive error were examined by EDI-OCT. Binarization of the EDI-OCT images was performed using publicly accessible software (ImageJ). The examined area of the subfoveal choroid was 1,500 μm wide, and the dark areas that represented the luminal areas were traced by the Niblack method. Wilcoxon signed rank test was used to determine the significance of changes in the subfoveal choroidal thickness, interstitial area, and luminal area. Mann-Whitney U test was used to compare the parameters in the eyes with pretreatment PIOL and normal control eyes., Results: The subfoveal choroidal thickness was significantly decreased after treatment (P = 0.0431). In the binarized images, the interstitial area was significantly decreased after treatment (P = 0.0431), while the luminal area was not significantly changed (P = 0.8927). After delayed onset of PIOL, increased interstitial area, thickened choroid and unchanged luminal area were observed in one eye. The interstitial area and choroidal thickness were significantly increased in the eyes with pretreatment PIOL compared with the normal control eyes (P = 0.0207, P = 0.0495, respectively), while the luminal area was not significantly different (P = 0.2752)., Conclusions: After treatment for PIOL, the EDI-OCT images showed a thinner choroid, and binarization of the EDI-OCT images showed significantly decreased interstitial areas compared with the luminal areas. The binarized EDI-OCT images can provide useful information on choroidal structure in eyes with PIOL, and combining these images with intraocular interleukin levels or fundus autofluorescence images should provide valuable information for determining the PIOL activity.

Case Report: A 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used., Discussion: The uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology., (Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To alert clinicians of the possibility of reversible drug-induced occult hypotony and choroidal effusion following the long-term use of pergolide., Methods: Annotations were made while the case was observed. The clinical records of the patient were reviewed retrospectively., Results: A 74-year-old Caucasian male with primary open-angle glaucoma presenting with reduced vision in both eyes and an inflamed right eye. Examination revealed bilateral hypotony, right anterior chamber inflammation, and right choroidal effusion. The right intraocular inflammation resolved completely after a short course of topical and oral antibiotics in addition to topical steroids. Nevertheless, the bilateral hypotony and right choroidal effusion persisted. Only the discontinuation of pergolide allowed the complete resolution of the patient's presenting symptoms and signs., Conclusions: Pergolide is known to cause pericardial and pleural effusion, and generalized oedema. However, its association with choroidal effusion and hypotony has never been reported.

Purpose: To describe a case of choroidal ischemia in a neonate after single, bilateral, intravitreal bevacizumab (IVB) injection for severe zone 1 aggressive posterior retinopathy of prematurity (AP-ROP)., Methods: A six-week-old baby, born at a gestation age of 28 weeks and birth weight of 1.08 kg, presented at a postconceptional age of 34 weeks for ROP screening. On examination, both eyes revealed engorged iris new vessels with poorly dilating pupils. Retinal examination showed media haze, severe zone 1 APROP with confluent new vessels, severe plus disease, and early vitreous condensation at the edge of new vessels for 12 clock hours. The child was treated bilaterally, with single IVB injection before laser. After 16 hours, hypotony and exudative retinal detachment with patches of choroidal whitening suggestive of choroidal ischemia were seen., Results: The child was treated with topical steroids and cycloplegic drops and exudative retinal detachment resolved on the tenth day. Initial resolution of new vessels showed recurrence after two weeks and was treated with laser photocoagulation. Stable retinopathy status was noted up to six months follow-up., Conclusion: Choroidal ischemia secondary to a single IVB injection for the treatment of AP-ROP could be an unusual complication which raises the concern of its use as a monotherapy in neonates.

Purpose: Environmental tobacco smoke (ETS) is widely regarded as a major modifiable risk factor for age-related macular degeneration (AMD). Yet, precisely how it exerts its pathologic effects is poorly understood. Since early-stage AMD is characterized by choroidal capillary loss, this study examined the effect of sidestream smoke (SS), the major component of ETS, on the viability of choroidal endothelial cells (EC), with an emphasis on the role of aberrant cell and basement membrane (BM) architecture in mediating SS-induced response., Methods: Chorioretinal ECs (RF/6A) were treated with SS, and cell viability and architecture were analyzed by colorimetric assay and actin cytoskeletal organization, respectively. The structure of RF/6A EC-secreted BM was examined by immunofluorescence for collagen IV and immunoblotting for lysyl oxidase (LOX), a collagen-crosslinking enzyme. Finally, fresh RF/6A ECs were cultured on decellularized SS-treated BM to evaluate its active role in EC dysfunction., Results: The RF/6A EC viability decreased progressively with increasing SS dose, which correlated strongly with a significant decline in actin cytoskeleton-dependent EC spreading. Sidestream smoke also caused marked disruption of the RF/6A EC-secreted BM that was accompanied by suppression of LOX expression. Further, fresh, non-SS-treated RF/6A ECs exhibited a significant loss in viability and actin cytoskeletal organization when cultured on SS-treated corrupt BM., Conclusions: These findings indicate that aberrant physical cues in the form of EC and BM architecture likely have an important role in choriocapillaris dysfunction seen in SS-associated early AMD and implicate choroidal BM as a potential target for AMD management strategies., (Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.)

Purpose: To investigate the effect of nicotine on choroidal thickness using optical coherence tomography (OCT)., Design: Prospective, case-control study., Methods: Sixteen young, healthy subjects and 16 age and gender matched control cases were included in this study; 4 mg nicotine gum was given to the study group and placebo gum to the control group. All participants underwent OCT scanning with a high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1 h following nicotine or placebo administration. The measurements were taken in the morning (10:00-12:00 hours) to avoid diurnal fluctuation., Results: The median foveal choroidal thickness at baseline was 337.00 μm (IQR 84.50), which decreased to 311.00 μm (IQR 78.00) at 1 h following oral nicotine intake (p=0.001). The median choroidal thickness was also significantly decreased at five other extrafoveal points (p<0.05 for all). In the control group, the median baseline choroidal thickness at the fovea was 330.50 μm (IQR 104.25), and was 332.00 μm (IQR 103.75) at 1 h (p=0.271)., Conclusions: Nicotine causes a significant decrease in choroidal thickness following oral intake. This acute decrease might be a result of reduced ocular blood flow due to the vasoconstrictive effect of nicotine.

A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis., (Copyright 2013, SLACK Incorporated.)

Purpose: To present the case of a 28-year-old man with acetazolamide-induced bilateral choroidal effusion after uneventful surgery of the second eye in delayed sequential bilateral insertion of an implantable collamer lens for hyperopia., Methods: Case report., Results: Surgery of the left eye was uneventful, and the implantable collamer lens was implanted 3 weeks later in the right eye. Twenty-four hours after surgery, the patient presented with bilateral shallow anterior chamber, vault 0, and myopic shift (-8 diopters) in both eyes. B-scan ultrasound showed choroidal thickening in both eyes, which was consistent with choroidal effusion syndrome. A causal relationship was suspected with oral acetazolamide, which had been prescribed after surgery. When the drug was stopped, the condition improved slowly and resolved completely within 5 days., Conclusions: Choroidal effusion should be included in the differential diagnosis of shallow anterior chamber after implantation of an implantable collamer lens., (Copyright 2013, SLACK Incorporated.)

Idiosyncratic reactions to a large number of drugs have been reported to cause choroidal detachment and secondary angle-closure glaucoma (ACG). We report a case of bilateral acute ACG and peculiar choroidal effusion following administration of oral acetazolamide immediately after cataract surgery. Few cases of acute secondary ACG with choroidal effusion and anterior shift of the lens-iris diaphragm have been associated with acetazolamide compared with other sulfonamides. As far as we are aware, posterior involvement with retinal folds and papillary edema due to acetazolamide has not been described before.

Purpose: We report the case of a patient with acute bilateral transient myopia, secondary angle-closure glaucoma, and choroidal detachment associated with oral administration of methazolamide., Case: A 51-year-old man developed bilateral transient myopia and secondary angle-closure glaucoma with choroidal detachment after oral administration of methazolamide. Both eyes presented a shallow anterior chamber and elevated intraocular pressure. Ultrasound biomicroscopy revealed annular ciliochoroidal effusion and diffuse thickening of the ciliary body. Angiography showed many scattered islands of hypofluorescence in both eyes., Observations: Methazolamide was stopped and prednisolone given orally. Eight days after treatment initiation, clinical symptoms and signs had resolved. The abnormal findings on ultrasound biomicroscopy and angiography disappeared by 2 months., Conclusions: Methazolamide can induce bilateral transient myopia, angle-closure glaucoma, and choroidal detachment. Prompt identification of the causative medications and subsequent discontinuation can induce rapid resolution of angle closure.

Purpose: Minoxidil is one of the drugs approved for the treatment of androgenetic alopecia. This article presents a case of central serous chorioretinopathy after application of topical minoxidil solution., Methods: We examined a 37-year-old man who complained of a positive relative scotoma, metamorphopsia and impaired dark adaptation involving the right eye. The patient reported an 8 month history of daily topical use but denied previous treatment with other drugs. Dilated fundus examination of right eye revealed central swelling located over the macula. Optical coherence tomography showed the presence of subretinal fluid. Fluorescein angiography disclosed one focal hyperfluorescent spot in the foveal area with minimal pigmentary changes limitated to that area. The patient was diagnosed with central serous chorioretinopathy (CSC) potentially related to an 8 month topical minoxidil solution administration. One month after the drug was discontinued, normal findings were found upon reexamination. The patient reported no previous episode of CSC., Conclusion: Major systemic side effects from topical solution of minoxidil are rare. To our knowledge, this is the first reported case of a central serous chorioretinopathy associated with long-term use of this drug.

Purpose: To report two cases of choroidal detachment induced by topical bimatoprost., Observations: Two males, aged 95 (case 1) and 74 years (case 2), were referred to our department for massive choroidal detachment. Case 1 was a one-eyed patient, and the affected eye of case 2 had undergone trabeculectomy 2 years previously. Both affected eyes were pseudophakic and treated for 6 months with topical bimatoprost/timolol fixed combination for open angle glaucoma (case 1) and pseudoexfoliation glaucoma (case 2). In both cases, symptoms appeared immediately after starting the drops and progressively worsened thereafter. In both affected eyes, moderate conjunctival hyperemia was noted, anterior segment examination and intraocular pressure were normal, and fundus examination revealed a massive choroidal detachment. This diagnosis was confirmed by B-scan ultrasonography. An adverse effect of bimatoprost was suspected, and the drug was discontinued, leading to the complete resolution of the choroidal detachment within 3 weeks in both eyes., Conclusion: Choroidal detachment is a rare adverse effect which is not specific to bimatoprost but which has been also reported with the other prostaglandin analog drops. Its exact cause remains unclear, but is probably linked to the combination of enhanced uveoscleral outflow and pro-inflammatory properties. In all cases, the discontinuation of the prostaglandin analog led to the complete resolution of the choroidal detachment within 3 weeks., (Copyright © 2012. Published by Elsevier Masson SAS.)

The relationship between systemic corticosteroids and central serous chorioretinopathy (CSCR) has been well established; however, there also appears to be an association with intranasal corticosteroids. A search of the English literature revealed only three reported cases of CSCR linked to intranasal corticosteroid use, and in each, clinical improvement was observed after cessation of the steroid agent. We present an additional case of bilateral CSCR resulting from intranasal corticosteroid use and review the literature regarding this uncommon side effect. Otolaryngologists, as frequent prescribers of these medications, should be aware of their myriad side effects, including ophthalmologic conditions such as CSCR., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Purpose: The purpose of this study is to investigate immediate changes in the blood retinal barrier (BRB) after the infusion of triolein emulsion., Materials and Methods: Triolein emulsion was infused into the carotid artery of 12 cats to induce experimental fat embolism. The injection of fluorescein dye into the carotid artery followed immediately. Early retinal vascular flow was recorded by a fluorescein angiography (FA) video, and then a FA photograph was obtained up to 30 min after the injection. Leakage of the dye in the choroidal or retinal vessels was evaluated., Results: In the early phase, multifocal non-perfuse areas were noted in all cats due to embolism by triolein emulsion, which was released by blood perfusion in the late phase. Perfusion defects persisted in the retina of five cats and in the choroid of four cats. Leakage of the dye through the retinal vessels was seen in five cats (42%) in the early phase and in nine cats (75%) in the late phase. In the choroid, leakage of the dye was seen in seven cats (58%) in the early phase and in all cats (100%) in the late phase., Conclusions: The inner and outer BRB was opened immediately after infusion of triolein emulsion into the carotid artery. Embolism by triolein emulsion was readily resolved due to the liquid nature of triolein.

Background: Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients., Methods: The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit., Results: Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula., Conclusion: Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

We present an interventional case report of a 76-year-old man who developed bilateral angle-closure glaucoma with extensive choroidal detachment following administration of oral acetazolamide immediately after routine cataract extraction and intraocular lens implantation. Rapid clinical improvement occurred after acetazolamide was stopped and high-dose intravenous steroid therapy was given. Although extremely rare, this adverse effect should be considered in patients who develop acute bilateral angle-closure glaucoma and choroidal effusion after cataract surgery., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this report was to describe a case of choroidal detachment after an uneventful intravitreal injection using a 30-gauge needle., Methods: An 88-year-old patient with acute onset of neovascular age-related macular degeneration developed a choroidal detachment after an uneventful intravitreal injection in the infero-temporal aspect of the fundus., Results: The patient described no symptoms related to the chorioretinal detachment. Additional intravitreal injections were required to treat an active subfoveal choroidal neovascularization. These injections were placed at the contralateral side in the supero-nasal quadrant. She was closely watched on a 2-week follow-up schedule. The choroidal detachment remained asymptomatic for the patient and resolved spontaneously, and the best corrected visual acuity improved from 0.2 to 0.63 during a 6-month follow-up. A mild hyperpigmentation remained at this location., Conclusion: Asymptomatic choroidal detachments may occur after intravitreal injection. Although treatment was not needed, additional injections should be avoided in the same quadrant until the detachment has resolved.