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Purpose: To report unusual presentations of type 2A idiopathic macular telangiectasia (IMT). Methods: A retrospective analysis of disease presentation was conducted in 32 patients with type 2A IMT. All patients underwent a complete ophthalmological examination, including spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA). Results: Three out of 32 study patients showed the simultaneous presentation of type 2 IMT and other retinal diseases. In the first patient, the ophthalmological examination revealed a proliferative IMT associated with late-onset Stargardt disease. The second patient presented bilateral nonproliferative IMT and chronic serous chorioretinopathy in the left eye. The examination of the third patient revealed basal laminar drusen and soft drusen associated with IMT in both eyes. Conclusions: Type 2 IMT may represent an unusual presentation of Stargardt disease, chronic serous chorioretinopathy and basal laminar drusen. These presentations are most likely coincidental and highlight the importance of FA, ICGA and SD-OCT in the diagnosis and treatment of such cases.

Purpose: To compare the ability of spectral domain optical coherence tomography (SD-OCT), blue light fundus autofluorescence (FAF), and near-infrared fundus autofluorescence (NIR-FAF) to evaluate foveal involvement in geographic atrophy as a result of age-related macular degeneration. Methods: All consecutive patients with geographic atrophy underwent FAF (excitation lambda = 488 nm; emission lambda > 500 nm), NIR-FAF (excitation lambda = 787 nm; emission lambda > 800 nm), and simultaneous SD-OCT scanning (Spectralis HRA + OCT; Heidelberg Engineering). Two readers independently graded foveal involvement on FAF, NIR-FAF, and SD-OCT and measured the width of foveal sparing. In eyes with an intergrader agreement of foveal sparing by at least one among FAF, NIR-FAF, and SD-OCT, microperimetry (Spectral OCT/SLO; OPKO-OTI) was analyzed. Results: A total of 158 eyes (83 patients; 53 women, 30 men, mean age 69.2 +/- 4.8 years) with geographic atrophy were included. Spectral domain OCT showed the highest intergrader agreement of foveal involvement (k = k' = 0.8, P = 0.001 vs. k = k' = 0.7, P = 0.01 for NIR-FAF and k = k' = 0.5, P = 0.01 for FAF). In 74 eyes (46.8%) foveal sparing was present according to interobserver agreement. Width of the foveal sparing was larger on SD-OCT than on NIR-FAF and FAF (1,334 +/- 943 mu m vs. 1,228 +/- 912 mu m, P < 0.001 and 1,201 +/- 922 mu m, P < 0.001, respectively). Retinal fixation was predominantly central and stable in 97.3% of eyes with foveal sparing. Conclusion: Spectral domain OCT is an appropriate imaging modality for evaluating the presence and extent of foveal sparing, followed by NIR-FAF and FAF. RETINA 33:482-489, 2013

Purpose To evaluate the efficacy of intravitreal triamcinolone in refractory pseudophakic cystoid macular edema. Design A prospective, interventional case series. Methods Three eyes of three patients with longstanding pseudophakic cystoid macular edema following uncomplicated cataract surgery, refractory to any medication, were treated with 8 mg of intravitreal triamcinolone. All three eyes were evaluated before injection and throughout follow-up with the Early Treatment Diabetic Retinopathy Study’s visual acuity chart, fluorescein angiography, and macular mapping using optical coherence tomography. Results A month after intravitreal triamcinolone injection, a dramatic decrease in macular thickness was noted by optical coherence tomography in all three eyes (from a mean of 502–233 μm). Mean improvement in visual acuity was 3.7 Snellen lines. Two to 4 months after triamcinolone injection, however, the edema recurred in all cases, to the same degree as before the injection, combined with a decrease in vision. Two eyes underwent a second injection of triamcinolone, and macular thickness decreased, but the edema again recurred 3 months after injection. Conclusion Intravitreal injection of triamcinolone induces striking regression, within 1 month, of chronic refractory macular edema. This regression appears to be transient, however, even after a second injection.

PURPOSE: To describe the characteristics and evolution of macular retinoschisis in high myopia observed by optical coherence tomography (OCT). DESIGN: A consecutive, retrospective, observational case series. METHODS: Twenty-one highly myopic eyes (mean refractive error, −15.2, range −6 to −25) of 17 patients presenting with the unusual feature of macular thickening without a macular hole and associated with a posterior staphyloma were examined by biomicroscopy and OCT. Ten patients (13 eyes) were followed up for 12 months or more. RESULTS: On biomicroscopy, the macula of all 21 eyes had a microcystic appearance without macular hole. In all eyes, OCT showed that retinal thickening was mainly due to an extensive hyporeflective space splitting the neuroretina into a thick inner layer and a thin outer layer. We called this condition outer retinoschisis. In six cases, inner splitting, termed inner retinoschisis, was also present. The macular profile exhibited a foveal cyst in 10 eyes, a lamellar hole in six, and a foveal detachment in six. In four of the 21 eyes, a hyperreflective preretinal structure resembling the posterior hyaloid was stretched over the retinoschisis, causing foveal traction. Two of these four eyes subsequently evolved into a full-thickness macular hole. CONCLUSION: Macular retinoschisis is not uncommon in highly myopic eyes with staphyloma and is better characterized by OCT than by biomicroscopy. Intraretinal splitting occurs in both the outer and inner layers of the retina, leading to the formation of cystoid spaces. In most cases, the condition is fairly stable in terms of visual acuity and retinal thickness and change occurs slowly over time. However, a macular hole may occur when the retinoschisis is associated with tangential traction of the posterior hyaloid.

PURPOSE: To report the outcome of epiretinal membrane (ERM) surgery in young patients. DESIGN: Interventional case series study. METHOD: A retrospective review of 20 young patients who had undergone vitrectomy and epiretinal membrane removal. All patients had a preoperative examination, including fundus biomicroscopy, red free photographs, and fluorescein angiography. RESULTS: Nine patients were males and 11 females (age: 7–26 years; mean: 16.3 years). Follow up ranged from 4–96 months (mean: 21.2 months). The 20 patients comprised 13 cases of idiopathic ERM, six cases in which ERM was associated with ocular inflammation and one case of combined hamartoma of the retina and retinal pigment epithelium (RPE). In 13 cases, the ERM was especially white, thick, and opaque, with localized constriction and severe retinal distortion. Final best-corrected visual acuity (VA) was significantly better than preoperatively (20/50 vs. 20/112), ( P = 0.0002). Mean improvement in VA was 4.25 lines and 17 patients gained two or more lines. This improvement was better in secondary than idiopathic ERM (6 lines vs. 3.3). During follow up, five cases of recurrence were observed (25%). In another case, postoperative persistent ocular hypertension required filtering surgery. CONCLUSION: The characteristics of ERM in young patients are quite different in many cases from those in adults in terms of thickness and adherence. Removal of ERM in young patients is feasible and safe although the membrane may focally adhere strongly to retinal vessels. VA usually improves significantly after surgery, but recurrences are more frequent than in adults.

PURPOSE: To report the morphologic data of adult-onset foveomacular vitelliform dystrophy (AFVD) provided by third-generation optical coherence tomography (OCT 3). DESIGN: Observational case report. METHODS: An 85-year-old woman presenting with AFVD underwent fundus biomicroscopy, fluorescein angiography, and OCT examination. RESULTS: Fundus examination disclosed a round, elevated yellowish lesion, centered by a pigmented spot, in the macula of the left eye. Examination with OCT disclosed an area of hyperreflectivity located between the retinal pigment epithelium layer and the photoreceptor layer, compatible in size with the yellowish elevated lesion. The hyperreflective line corresponding to the photoreceptor layer was elevated by the material and separated from the retinal pigment epithelium layer. CONCLUSIONS: In AFVD, examination with OCT 3 demonstrates elevation of the photoreceptor layer by the material and supports the previous hypothesis that the material is located between the photoreceptor and the retinal pigment epithelium layer.

Purpose To describe the different morphological features in adult onset foveomacular vittelliform dystrophy (AOFVD) using high-resolution spectral domain optical coherence tomography (OCT). Design Prospective observational case series. Methods Complete ophthalmologic examination, including spectral domain OCT, was performed in 49 consecutive AOFVD patients (60 eyes). Results In 28/60 eyes, spectral domain OCT showed hyper-reflective clumps within the outer plexiform and outer nuclear layers. In 9/60 eyes, the photoreceptor inner segment/outer segment (IS/OS) interface appeared highly reflective like a shell all around the vitelliform material, and appeared irregular and discontinued in 27/60 eyes. The Verhoeff membrane was clearly visible at the border of the lesion, disappeared over the vitelliform lesion in 20/60 eyes, became thickened and less defined on the outer aspect of the lesion in 11/60 eyes, appeared without noticeable alterations in 10/60 eyes and not well defined in 19/60 eyes. The vitelliform material appeared as a highly reflective dome-shaped lesion (homogeneous in 14/60 eyes and heterogeneous in 36/60 eyes) located between the photoreceptor layer and the retinal pigment epithelium (RPE). In 10/60 eyes, the macular lesion appeared as hypo/a-reflective. The RPE appeared irregular in 14/60 eyes, with hyper-reflective mottling on its inner aspect. We observed discrete RPE detachments in 29/60 eyes. Conclusions We hypothesise that early changes involve the layer between RPE and the IS/OS interface, first with vitelliform material accumulation beneath the sensory retina, and then with IS/OS alterations, pigments migration towards inner layers and fluid accumulation. These changes come with RPE alterations such as hypertrophy or sub-RPE deposits.

Background/aim: Retinal flecks are commonly observed in both Stargardt disease and fundus flavimaculatus (FFM). The aim was to determine the precise localisation of these flecks within the retinal layers using Stratus optical coherence tomography (OCT). Methods: A prospective observational case series. A complete ophthalmological examination, including autofluorescence, fluorescein angiography (FA), and Stratus OCT (Carl Zeiss) was performed in 49 eyes of 26 consecutive patients with FFM. Six to 12 Stratus OCT linear scans focused on the retinal flecks were performed in each eye. Results: The age at presentation ranged from 23 years to 71 years and visual acuity ranged from 20/20 to 20/400. Hyper-reflective deposits classified into two types were observed on Stratus OCT: type 1 lesions (94% of eyes) presented as dome-shaped deposits located in the inner part of the retinal pigment epithelium (RPE) layer and type 2 lesions (86% of eyes) presented as small linear deposits located at the level of the outer nuclear layer and clearly separated from the RPE layer. Conclusions: Stratus OCT is a non-invasive instrument that provides new information on the location of flecks in FFM. The location of type 2 lesions is quite unusual among macular dystrophies; OCT may therefore be useful in the diagnosis of retinal flecks in some cases of FFM.

Purpose To determine the natural evolution and surgical indications of myopic foveoschisis (MF), which are still poorly documented, and the factors that predict poor prognosis. Design Retrospective observational case series. Methods Twenty-nine operated and nonoperated cases of MF (29 eyes of 23 patients) were studied. All eyes underwent repeated examinations, including optical coherence tomographic (OCT) recordings, during a mean follow-up of 31.2 months. Special attention was paid to the evolution of visual acuity (VA) and to the thickness of foveoschisis. Results Mean refraction was −14.4 diopters, and mean axial length was 29.1 mm. OCT scans revealed that the foveoschisis was associated with macular anomalies: a premacular structure in 13 (44.8%) of 29 eyes, a foveal detachment in 10 (34.5%) of 29 eyes, and a lamellar macular hole in six (20.7%) of 29 eyes. Isolated foveoschisis was found in four eyes (13.8%). During follow-up, foveoschisis and VA worsened in 20 eyes and remained stable in nine. Ten of the 20 eyes that worsened had a premacular structure. A macular hole occurred in nine eyes, six of which had previously exhibited foveal detachment. Eleven eyes with foveoschisis underwent surgery, which improved VA significantly ( P = .04, Wilcoxon test), but three eyes developed a macular hole. Conclusions MF may remain stable for many years without affecting VA. However, when it is combined with the presence of a premacular structure, the risk of a decrease in VA increases. When it is combined with foveal detachment, a macular hole seems to develop frequently, whether or not surgery is performed.

Purpose To report a case of severe macular burn as a complication of transpupillary thermotherapy treatment for occult choroidal neovascularization. Design Interventional case report. Methods A 65-year-old man developed a severe macular burn following transpupillary thermotherapy treatment. Results Before treatment, fluorescein angiography and indocyanine green angiography showed a progressive, ill-defined leakage corresponding to the presence of occult choroidal neovascularization. One month after treatment, fundus examination disclosed macular atrophy. The early phases of fluorescein angiography and indocyanine green angiography showed that the macular choroidal filling time had worsened dramatically. At the late phase of indocyanine green angiography, the initial hyperfluorescence of choroidal neovascularization was replaced by a persistent, markedly hypofluorescent area. Conclusion Prolonged choroidal filling may be a risk factor for macular burn and choroidal occlusion after transpupillary thermotherapy. In such cases, we suggest that transpupillary thermotherapy should be considered with caution and, when applied, that its intensity should be reduced.

Purpose To classify the preoperative and postoperative optical coherence tomography (OCT) findings for subfoveal choroidal neovascularization (CNV) related to high myopia and multifocal choroiditis (MFC) and to correlate these findings with surgical outcome. Methods Ten consecutive patients presenting with subfoveal CNV related to either MFC or degenerative myopia were evaluated. Each patient underwent a biomicroscopic examination, fluorescein and indocyanine green angiographies, as well as OCT before and after surgical removal of CNV. Four different parameters were considered in the analysis of all OCT scans: tissue reflectivity, location of the CNV band, presence or absence of a separation zone, and reflectivity underneath the retinal pigment epithelium (RPE) band. Results For all six eyes with MFC, OCT showed a hyperreflective band anterior to the RPE with a separation zone and an optically clear zone underneath the RPE. Visual acuity improved in all six eyes. For the degenerative myopia group (4 eyes), OCT revealed findings similar to those observed for MFC for 1 eye, which had a favorable postoperative outcome. The remaining three myopic eyes with different OCT patterns had poor postoperative outcomes. Conclusion Optical coherence tomography can provide preoperative clues for submacular surgery. Eyes with CNV located anterior to and separated from the RPE that have an "optically clear zone" underneath are the best candidates for surgical removal. Such a feature was correlated with a good postoperative outcome.

To report the outcome of epiretinal membrane (ERM) surgery in young patients.Interventional case series study.A retrospective review of 20 young patients who had undergone vitrectomy and epiretinal membrane removal. All patients had a preoperative examination, including fundus biomicroscopy, red free photographs, and fluorescein angiography.Nine patients were males and 11 females (age: 7-26 years; mean: 16.3 years). Follow up ranged from 4-96 months (mean: 21.2 months). The 20 patients comprised 13 cases of idiopathic ERM, six cases in which ERM was associated with ocular inflammation and one case of combined hamartoma of the retina and retinal pigment epithelium (RPE). In 13 cases, the ERM was especially white, thick, and opaque, with localized constriction and severe retinal distortion. Final best-corrected visual acuity (VA) was significantly better than preoperatively (20/50 vs. 20/112), (P = 0.0002). Mean improvement in VA was 4.25 lines and 17 patients gained two or more lines. This improvement was better in secondary than idiopathic ERM (6 lines vs. 3.3). During follow up, five cases of recurrence were observed (25%). In another case, postoperative persistent ocular hypertension required filtering surgery.The characteristics of ERM in young patients are quite different in many cases from those in adults in terms of thickness and adherence. Removal of ERM in young patients is feasible and safe although the membrane may focally adhere strongly to retinal vessels. VA usually improves significantly after surgery, but recurrences are more frequent than in adults.

Objectif Evaluer les resultats du traitement par photocoagulation laser et par chirurgie des masses telangiectasiques peripheriques. Materiels et Methodes Etude retrospective incluant 27 patients (9 hommes et 18 femmes). Les criteres recueillis ont ete l’acuite visuelle, la presence d’une exsudation lipidique intra ou sous-retinienne, d’un decollement de retine exsudatif, d’un œdeme maculaire cystoide (OMC), ou d’une fibrose pre-retinienne avant et apres le traitement. Le traitement a consiste a photocoaguler au laser vert l’ensemble des telangiectasies retiniennes peripheriques responsables de l’exsudation. Le laser a ete realise soit a la lampe a fente, soit lorsqu’il etait impossible ou insuffisant au cours d’une vitrectomie combinee a une dissection des membranes epiretiniennes. Resultats L’âge moyen des patients au diagnostic etait de 41 ans (10 a 70). 27 % des patients presentaient une masse telangiectasique peripherique secondaire. Le laser externe a ete suffisant pour traiter 12/27 patients. Dans ce groupe, la duree moyenne de suivi a ete de 3 ans (6 mois a 10 ans). L’acuite visuelle moyenne est passee de 20/40 (CLD a 20/20) avant traitement a 20/32 (CLD a 20/20) a la fin du suivi. Tous les patients ont eu une amelioration ou une stabilisation de leur acuite visuelle. La regression de l’exsudation peripherique a ete complete dans 8/12 cas. 15/27 patients ont ete traites par vitrectomie. Dans ce groupe, le delai moyen de suivi a ete de 15 mois (6 mois a 7 ans). Les indications chirurgicales ont ete : la presence d’une MEM (9 cas), d’un decollement de retine exsudatif etendu (3 cas), d’une composante rhegmatogene s’associant au decollement de retine exsudatif (1 cas), ou d’une hemorragie du vitre empechant la realisation d’un laser externe (2 cas). L’acuite visuelle moyenne est passee de 20/125 (CLD a 20/50) avant la chirurgie a 20/50 (CLD a 20/20) a la fin du suivi. L’acuite visuelle a ete stabilisee ou amelioree dans tous les cas. La chirurgie a permis une reapplication et une disparition complete des exsudats dans 12/15 cas. Les seules complications postoperatoires ont ete 2 decollements de retine rhegmatogenes traites avec succes par une seconde intervention. Discussion Le laser peut etre realise par voie externe. Quand cela n’est pas possible, ou quand il existe une MEM associee, la chirurgie est indiquee. Conclusion La photocoagulation au laser des anomalies vasculaires des masses telangiectasiques peripheriques est un traitement efficace, qui permet de faire regresser l’exsudation.

Introduction Les VPC restent une entite encore mal connue. Il n’y a toujours pas de consensus sur son traitement. Le but de ce travail est d’evaluer l’aspect anatomique et fonctionnel des VPC apres traitement par Ranibizumab. Materiels et Methodes Un examen complet associant une angiographie a la fluoresceine, en ICG au SLO et un OCT Spectral Domain ont ete pratiques aux 20 patients. Le traitement par injections intra-vitreennes de Ranibizumab a ete effectue toutes les 4 a 6 semaines. La duree de suivi est de 6 mois en moyenne. Resultats 65 % des 20 patients sont de sexe feminin. L’âge moyen est de 75 ans. L’acuite visuelle initiale est de 20/63 en moyenne et elle est legerement amelioree a la fin du suivi, (20/50). Une diminution majeure de la diffusion est constatee chez la plupart des patients apres traitement. Cette amelioration se maintient au fil du temps tant que le traitement est administre. La mesure de l’OCT montre une diminution de l’epaisseur retinienne dans la plupart des cas, mais sans retour complet a la normale. Le soulevement de l’EP reste visible malgre l’occlusion des polypes et leur disparition sur les examens angiographiques. Des recidives semblent se manifester a l’arret du traitement. Discussion Le traitement par injections intra-vitreennes de Ranibizumab, en premiere intention, montre des resultats encourageants tant sur la fonction visuelle que sur l’aspect anatomique des VPC. Conclusion Seuls des controles complets avec l’ensemble des examens determineront la frequence des traitements, le calendrier de surveillance et le traitement de relai.