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PurposeCases of sudden loss of central vision in eyes with silicone oil in situ and after oil removal have been described. The aim of this review is to present current data on silicone oil toxicity to the neuronal aspects of the retina as well as the Cleveland Clinic Abu Dhabi experience with this retinopathy (maculopathy).MethodsA PubMed review using the terms “silicon oil” and/or “toxicity” and/or “ganglion cell” and/or “nerve fiber” was conducted to identify case reports, case series, and original articles presenting toxicity from silicon oil. Timing of visual loss, as well as SD-OCT data and RNFL/GCC analysis, was collected. Selected cases were pooled from Cleveland Clinic Abu Dhabi Vitreoretinal database to further reinforce the findings.ResultsTwenty-four papers were identified (case/series/articles). The earliest papers that met our criteria seemed to report vision loss at the time of or after silicone oil removal; however, more recent studies have described such toxicity from 1 to 6 months after tamponade with silicone oil in situ. Since the first description of central visual loss from silicone oil, all researchers describe a thinning of perifoveal ganglion cells measured with SD-OCT, while there is no concordance as far as RNFL changes, with some authors describing a thinning and others a thickening, but neither was ever clearly associated with visual loss. The correlation between SD-OCT hyperreflective goblets in the inner retina and histological description of intraretinal oil droplets migration seems to suggest instances of silicone oil penetration in the retinal layers.ConclusionIn a small percentage of cases who underwent retinal tamponade with silicone oil, ganglion cells can suffer a direct damage either from particles of oil that migrate in the retina or from direct contact with it. Indirect damage may be caused by phototoxicity due to the transparent nature of silicon oil or by inflammatory damage from cytokines sandwiched between oil and retina.

Abstract As optical coherence tomography angiography is revolutionizing the ophthalmology world, the uveitis community is learning to understand where and how this new powerful imaging tool fits into the management of the panorama of ocular inflammations and infections. A non-invasive method of studying the retinal and choroidal vasculature, OCTA allows for the assessment of vessel density changes during active and inactive uveitis making it the natural imaging application of choice in uveitis clinical trials. However, these data and results are of limited utility to the ophthalmologists who are looking to apply OCTA in their everyday uveitis clinic. If employed strategically, OCTA can be a powerful tool for the uveitis specialist to evaluate iris involvement in viral uveitis; to assess the integrity of the vascular layers in the settings of white dot syndromes; to distinguish inflammatory choroidal neovascularization from outer retinal avascular inflammatory material; and to diagnose and follow infectious choroidal granulomas and satellite foci of chorioretinal inflammation without the need to administer dyes. The present review will analyze all the recent publications that apply OCTA in uveitis to offer the reader a guide on how to maximize the utility of this imaging modality in a clinical practice.

PurposeTo review the multimodal imaging patterns of Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC).MethodsA systematic review.ResultsSyphilis has started to attract the attention of researchers once again due to recent surges, with The World Health Organization (WHO) reporting around 12 million new cases per year. When left untreated, syphilis has a mortality rate of 8–58%, with a higher death rate in males. Eye manifestations occur both in secondary and tertiary stages of syphilis, although ocular involvement may occur at any stage of the disease.Syphilis has been always recognized as “the great mimicker” since it can have multiple clinical patterns of presentation.However, Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC) represents the typical pattern of the disease and can be easily distinguished.In addition, the advent of modern technologies and the progress made in multimodal imaging have provided more details on its identikit: the pattern of pre-retinal, retinal, retinochoroidal and optic nerve involvement can be identified before going through the laboratory work-up for a correct and appropriate investigation of the disease.ConclusionThis review highlights the peculiar pattern of ASPPC, by reporting the diagnostic process made by all the imaging techniques used for a correct multimodal imaging assessment.

PurposeTo compare the ability of wide-field optical coherence tomography angiography (WF-OCTA) to that of ultra-wide field fluorescein angiography (UWF-FA) and ultra-wide-field color fundus photography (UWF-CP) to detect retinal neovascularization (NV) in eyes with proliferative diabetic retinopathy (PDR).MethodsIn this cross-sectional study, naïve patients with active PDR underwent UWF-FA and UWF-CP using the Optos 200Tx and WF-OCTA with 12 × 12 mm fields of five visual fixations using the PLEX Elite 9000. NV was defined on OCTA when the co-registered B-scan with flow overlay of the vitreoretinal interface (VRI) segmentation showed extraretinal proliferation. Three masked readers examined the UWF-FA, UWF-CP, and WF-OCTA independently for the presence of NV. Statistical analysis was performed to compare the diagnostic accuracy of the 3 wide-field imaging modalities using OCT B-scan as the reference standard.ResultsIn 82 eyes with PDR, neovascularization of the disc (NVD) was detected in 13 eyes by UWF-CP, 35 eyes with UWF-FA, and 37 eyes with OCTA using the VRI slab. Upon review of the 2500 OCT B-scans with superimposed flow overlay of each eye, NVD was confirmed in 37 eyes. The sensitivity and specificity of NVD detection were 35.1% and 97.8%, respectively for UWF-CP; 94.6% and 100%, respectively, for UWF-FA; and 100% and 100% for WF-OCTA. One hundred ninety-six foci of neovascularization elsewhere (NVE) were identified with the OCT B-scan with superimposed flow overlay. UWF-CP analysis was able to detect 62 foci of NVE of the 196 confirmed by B-scan (31.6% detection rate). An additional 11 foci of NVE seen on UWF-CP were not confirmed by B-Scan (15% false positive rate). There were 182 foci of NVE identified by UWF-FA (detection rate 91.3%), while WF-OCTA detected 196 retinal NVEs (detection rate 100%). The rate of false positives for both UWF-FA and WF-OCTA was low (< 2%).ConclusionWF-OCTA can identify NV that is not evident in UWF-CP and represents a faster and safer alternative to UWF-FA for surveillance of PDR with comparable diagnostic accuracy.

PurposeRetinal manifestations are present in 10% of patients with systemic lupus erythematosus (SLE) and consist of vascular changes that can be sight-threatening. Optical coherence tomography angiography (OCTA) is a novel imaging modality that detects movement inside the blood vessels without dye injection and transforms this movement into an angiographic map. The aim of this study is to describe subclinical vessels changes in the eyes of patients with SLE but no retinal manifestations.MethodsIn this cross-sectional study, 15 patients with SLE but no clinical ophthalmic manifestations were scanned through OCTA of the iris and at the level of the macula. Qualitative aspects of the iris vessels, and measure of the foveal avascular zone (FAZ) and vessel density were compared to a cohort of 15 normal controls.ResultsPatients with SLE, even in the absence of ophthalmic manifestations, present a qualitative increase in the iris vessels flow, and enlargement of the FAZ (0.22 ± 0.12 mm2) and a decrease in the vascular density (11.221 ± 1.933 mm−1) of the superficial capillary plexus on OCTA that cannot be highlighted clinically.DiscussionOCTA can be used in a noninvasive way to detect subclinical vascular changes in patients with SLE. How this information will influence the follow-up and management of these cases will require further prospective studies with a collaborative effort between ophthalmologists and rheumatologists.

PurposeTo review the multimodal imaging patterns of posterior syphilitic uveitis.MethodsA systematic review.ResultsThe percentage of syphilis has started to increase again: The World Health Organization has reported 12 million new cases of syphilis each year. In addition, syphilis was responsible for 0.3% of deaths globally in 2002. Eye manifestations happen prevalently in secondary and tertiary stages of syphilis, even though ocular involvement can occur in all stages. Syphilis has the nickname: “the great imitator” since it has no unique clinical presentation, even though posterior uveitis is considered the most common form. Syphilis is known as “the great imitator,” making its diagnosis in the presence of posterior uveitis particularly challenging as it presents similarly to other ocular conditions such as acute retinal necrosis. However, with the advent of multimodal imaging some particular patterns of pre-retinal, retinal, retinochoroidal and optic nerve involvement from syphilis can be identified to guide the diagnosis and the laboratory workup.ConclusionThis review highlights the various patterns of pre-retinal precipitates, multifocal retinitis, retinochoroiditis (confluent and placoid) and optic neuritis caused by syphilis, the appropriate laboratory work to be obtained and the treatment to be initiated.

Background/aimsMacrophage-like cells (MLCs) contribute to retinal immune homeostasis and support neuronal function. This study aimed to investigate the relationship between MLCs and ganglion cell layer (GCL) thickness in healthy eyes, assessing potential influences of age and sex.MethodsThis retrospective study included 97 eyes of 49 healthy individuals. GCL thickness was measured using spectral-domain optical coherence tomography (OCT), while MLCs were identified and counted from 6×6 mm swept-source OCT-angiography images processed with FIJI software. MLCs were quantified in four macular quadrants (superior, inferior, nasal and temporal). Correlation, stratified analyses and quadratic regression models were applied to explore associations between GCL thickness and MLC count, incorporating age and sex as covariates.ResultsCorrelation coefficients between GCL thickness and MLC count were negative but weak. ANOVA revealed significant differences across GCL quartiles for MLC count in the inferior (p=0.013) and temporal (p=0.005) quadrants. Post hoc analyses demonstrated that MLC count peaked at moderate GCL thickness and declined at lower or higher thicknesses. Quadratic regression confirmed a bell-shaped relationship. Including age and sex-improved model fit: older age correlated with higher MLC count in the inferior quadrant, and sex differences were observed in the temporal quadrant. However, model R² values remained modest (<10%).ConclusionIn healthy eyes, MLC distribution shows a non-linear, bell-shaped association with GCL thickness, peaking at moderate GCL values. Age and sex further modulate MLC count. These findings suggest a tightly regulated neuroimmune environment in the healthy retina and may provide a baseline for detecting early neuroinflammatory or neurodegenerative changes.

Autoimmune retinopathy (AIR) refers to a group of rare autoimmune retinal degenerative diseases presumably caused by cross-reactivity of serum autoantibodies against retinal antigens. The pathogenesis of AIR remains largely presumptive and there are a significant number of antiretinal antibodies that have been detected in association with AIR. The diagnosis of AIR is largely based on the demonstration of antiretinal antibodies in the serum along with suggestive clinical features and ancillary investigations. A high index of suspicion along with early diagnosis and treatment may play a critical role to lower the risk of irreversible immunological damage to the retinal cells in these patients. A multi-disciplinary approach for complete management and evaluation is helpful in such conditions. Various therapeutic options have been described for the treatment of AIR, though there is no consensus on standard treatment protocol.