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Advances in imaging and molecular diagnostics of ocular tuberculosis and selected observations from the Collaborative Ocular Tuberculosis Study (COTS)
摘要： Introduction: Ocular tuberculosis (TB) is a rare extra-pulmonary manifestation with protean clinical manifestations. Ocular TB as a cause of potentially blinding disease has been recently recognized by ophthalmologists as well as pulmonologists. In the past decade, there has been a great leap in our understanding of the disease pathogenesis, clinical and imaging features, as well as therapeutic challenges and disease complications. Areas covered: In this expert review, an emphasis has been laid on the recent advances in ocular imaging including wide-field fundus imaging, fluorescein angiography and autofluorescence, enhanced-depth optical coherence tomography, optical coherence tomography angiography, among others, as well as progress in the field of diagnostics such as polymerase chain reaction and other nucleic acid amplification tests. Findings from the Collaborative Ocular Tuberculosis Study (COTS), a multicentric study on ocular TB, have been explained in details. Expert opinion: Due to rapid advances in the field of fundus imaging and laboratory testing, it has become possible to recognize the pathological alterations observed in ocular TB. With further research, it may be possible to generate a consensus on the diagnosis and management of this entity in the future.
关键词： Tuberculosis,optical coherence tomography,choroiditis,fluorescein angiography,serpiginous-like choroiditis,indocyanine green angiography,uveitis
更新于2025-09-23 15:23:52
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Comparison of fluorescein angiographic findings in type 1 and type 2 retinopathy of prematurity with intravitreal bevacizumab monotherapy and spontaneous regression
摘要： Purpose To investigate the extent of vascularization of the peripheral retina and vascular development patterns in patients with type 1 retinopathy of prematurity (ROP) treated with intravitreal injection of bevacizumab (IVB) and compare fluorescein angiography (FA) findings of them to those seen in patients with type 2 ROP who have recovered spontaneously. Methods Between May 2014 and September 2016, patients with type 1 ROP who had a single 0.025 ml (0.625 mg) IVB were evaluated as study group. On the other hand, type 2 ROP patients with stage 2 or stage 3 ROP in zone II without plus disease on indirect ophthalmoscopy were not treated and included as a control group. The progression of ROP and vascularization of retina were evaluated by FA under sedation analgesia in all patients. Results Sixty-two eyes of 31 premature infants were included in the study: 36 eyes/18 patients were treated for type 1 ROP and 26 eyes/13 patients were followed conservatively with the diagnoses of type 2 ROP. In the last FA examination among the study group, vascular terminal was in zone II in 8 eyes/4 patients (22.22%) and in zone III in 28 eyes/14 patients (77.78%). Vascular terminal was in zone III in all eyes of the control group (100%). We noted circumferential vessels in 12 eyes/8 patients (33.3%) and 7 eyes/5 patients (26.92%) in the study and control groups, respectively. Abnormal branching was noticed in 13 eyes/7 patients (46.42%) in the control group, whereas it was not detected in the study group. Arteriovenous shunts were noted in 1 eye of a patient in the study group and in 5 eyes/4 patients in the control group. In 6 eyes/3 patients among the study group, we performed laser photocoagulation to the avascular retina because of profound vascular leakage. Conclusion Peripheral vascular abnormalities probably occur as a result of ROP itself because similar FA findings were detected both in type 1 and type 2 ROP patients with or without treatment, although significantly less in IVB-treated group. Retinal vascularization usually reaches the farthermost limits with time even though it slows down in eyes treated with IVB, indicating the importance of a longer follow-up.
关键词： Fluorescein angiography,Bevacizumab,Peripheral vascular abnormalities,Retinopathy of prematurity
更新于2025-09-23 15:23:52
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New Parametric Imaging Method with Fluorescein Angiograms for Detecting Areas of Capillary Nonperfusion
摘要： Fluorescein angiography (FAG) is currently the most useful diagnostic modality for examining retinal circulation, and it is frequently used for the evaluation of patients with diabetic retinopathy, occlusive diseases, such as retinal venous and arterial occlusions, and wet macular degeneration. This paper presents a method for objectively evaluating retinal circulation by quantifying circulation-related parameters. Methods: This method allows the semiautomatic preprocessing and registering of FAG images. The arterial input function is estimated from the registered set of FAG images using gamma-variate fitting. Then, the parameters can be computed by deconvolution on the basis of truncated singular value decomposition, and they can finally be presented as parametric color images in a combination of three colors, red, green, and blue. Results: After the estimation of arterial input function, the parameters of relative blood flow and mean transit time were computed using deconvolution analysis based on truncated singular value decomposition. Conclusions: The parametric color image is helpful to interpret the status of retinal blood circulation and provides quantitative data on retina ischemia without interobserver variability. This system easily provides the status of retinal blood circulation both qualitatively and quantitatively. It also helps to standardize FAG interpretation and may contribute to network-based telemedicine systems in the future.
关键词： Fluorescein Angiography,Ophthalmology,Computer-Assisted Diagnosis,Eye Disease,Biomedical Engineering
更新于2025-09-23 15:22:29
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Multimodal imaging based biomarkers predictive of early and late response to anti-VEGFs during the first year of treatment for neovascular age-related macular degeneration
摘要： Purpose. — To evaluate baseline predictive markers of early and late anatomical response to anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD). Methods. — The records of the nAMD patients who underwent intravitreal ranibizumab or aflibercept treatment, received the 3 monthly loading doses, and completed a follow-up period of 12 months were included retrospectively. The anatomical treatment response at month 3 (early) and between month 3 and 12 (late) was classified as good, intermediate or poor. Baseline demographic, fluorescein angiography, and optical coherence tomography findings were compared among the three groups. Results. — One hundred and ten eyes (74.3%) showed good, 18 (12.2%) showed intermediate and 20 (13.5%) showed poor anatomical response at month 3, and 114 eyes (77.0%) showed good, 27 (18.2%) showed intermediate and 7 (4.7%) showed poor anatomical response between month 3 and month 12. Of the evaluated parameters, drug type (better in aflibercept), showed a statistically significant difference in regards to anatomical outcomes at both the early and late periods (P = 0.02 and P = 0.03). The greatest linear dimension of choroidal neovascularization (CNV) and presence of peaked pigment epithelial detachment (PED) were important factors for early anatomical anti-VEGF treatment response. Conclusion. — Larger CNV and the presence of a peaked PED appeared to be associated with a good early response, and the drug type seemed to be associated with both early and late poor anatomical response of anti-VEGF treatment in nAMD patients. Aflibercept appears to be more effective than ranibizumab in regards to the percentage of patients with better anatomical response in both the early and late treatment periods.
关键词： Optical coherence tomography,Ranibizumab,Age-related macular degeneration,Aflibercept,Fluorescein angiography
更新于2025-09-23 15:22:29
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Autofluorescence and spectral-domain optical coherence tomography of optic disk melanocytoma
摘要： The authors report fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (OCT ) findings of two consecutive patients who presented with optic disk melanocytoma (ODM). A retrospective study was performed by reviewing medical records and ophthalmic imaging examinations. Optical coherence tomography findings were sloped and brightly reflective anterior tumor surface, adjacent retinal desorganization and abrupt posterior optical shadowing. Vitreous seeds were found in one patient. Fundus autofluorescence revealed outstanding hypoautofluorescence at the tumor area and isoautofluorescence at the remaining retina. Optical coherence tomography findings of the reported cases are consistent with those reported in the reviewed literature. Fundus autofluorescence has been used in the assessment of choroidal melanocytic tumors, but not yet in melanocytomas. We assume that this is the first report of these findings and believe that when its pattern has become clearly defined, fundus autofluorescence will be a useful tool to avoid misdiagnosis in suspicious cases and for follow-up.
关键词： Melanoma/diagnosis,Female,Adult,Male,Case reports,Optic nerve neoplasms/diagnosis,Fluorescein angiography,Humans,Tomography, optical coherence
更新于2025-09-23 15:22:29
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Peripheral retinal nonperfusion using widefield imaging with von Hippel-Lindau disease
摘要： Background: To describe a case of von Hippel-Lindau disease with peripheral retinal nonperfusion. Case presentation: A 66-year-old female with known cerebellar and midbrain hemangioblastomas was evaluated for a retinal hemangioblastoma in the right eye. She underwent widefield fluorescein angiography, which showed hyperfluorescence localized to the hemangioblastoma surrounded by peripheral retinal nonperfusion in the same quadrant. Conclusions: Further widefield imaging studies are required to determine if peripheral retinal nonperfusion is a common finding in von Hippel-Lindau disease.
关键词： Nonperfusion,Tumor,Fluorescein angiography,Hemangioblastoma,von Hippel-Lindau,Eye
更新于2025-09-23 15:21:21
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Efficacy of navigated focal laser photocoagulation in diabetic macular edema planned with en face optical coherence tomography versus fluorescein angiography
摘要： Aim To analyze the efficacy of navigated focal laser photocoagulation (FLP) of microaneurysms in diabetic macular edema (DME) planned using en face optical coherence tomography (OCT) as against fluorescein angiography (FA). Methods Twenty-six eyes of 21 DME patients (12 males, 9 females, 69.5 ± 12.3 years) with mean BCVA of 0.52 ± 0.44 LogMAR were included. En face OCT images of deep capillary plexus slab and FA images were used to plan FLP targeting of leaky microaneurysms. The primary outcome measures were central retinal thickness (CRT) and macular volume. The secondary outcome measure was best-corrected visual acuity (BCVA). Results The difference in the change of CRT and macular volume between en face OCT and FA-planned FLP after 1 month and at the end of follow-up was not statistically significant (p > 0.05), except for a higher CRT reduction in the en face OCT-planning group (p = 0.007) at the end of mean follow-up of 2.6 ± 0.9 months. There was no difference in BCVA change between the two planning options (p = 0.42). Conclusion En face OCT is a non-inferior alternative for FA in the planning of navigated FLP of microaneurysms in DME.
关键词： Navigated laser,Optical coherence tomography,Diabetic macular edema,Focal laser photocoagulation,Optical coherence tomography angiography,Fluorescein angiography,Microaneurysms
更新于2025-09-23 15:19:57
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SEVERE RECURRENT FIBROVASCULAR PROLIFERATION AFTER COMBINED INTRAVITREAL BEVACIZUMAB INJECTION AND LASER PHOTOCOAGULATION FOR AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY
摘要： To describe the clinical features of severe recurrent fibrovascular proliferation after combined intravitreal bevacizumab injections and laser photocoagulation for aggressive posterior retinopathy of prematurity. This retrospective, nonrandomized case series reviewed the medical and ophthalmic records in the referral hospital and our hospital. Four patients (seven eyes) with aggressive posterior retinopathy of prematurity. The patients were referred for vitrectomy with/without lensectomy for recurrent fibrovascular proliferation with a tractional retinal detachment after combined intravitreal bevacizumab injections and laser photocoagulation. Three patients were born at 22 weeks or 23 weeks’ gestational age and one patient at 29 weeks’ gestational age. Preoperatively, fluorescein angiography images showed all eyes had tractional retinal detachment from regrowth of fibrovascular proliferation 3 months to 5 months after the intravitreal bevacizumab injection and abnormal retinal vasculature; four eyes had a broad ischemic retina. Postoperatively, four eyes had retinal attachment and three eyes a total retinal detachment. Neovascular glaucoma developed in five of the seven eyes during the clinical course. Severe fibrovascular proliferation may recur due to widespread retinal ischemia with capillary dropout and abnormal vasculature after failed combined intravitreal bevacizumab and laser photocoagulation therapy as the initial treatment for aggressive posterior retinopathy of prematurity. Careful follow-up is important especially after anti–vascular endothelial growth factor treatment, with recognition that severe reactivation is possible.
关键词： intravitreal bevacizumab injection,vitrectomy,retinopathy of prematurity,fluorescein angiography,stage 5 ROP,vascular endothelial growth factor,stage 4 ROP,fibrovascular proliferation,laser photocoagulation,ROP surgery
更新于2025-09-12 10:27:22
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New Interpretation of Multimodality Fundus Imaging for Retinal Cavernous Hemangioma
摘要： Objective: The aim of this study was to investigate the multimodality imaging features of retinal cavernous hemangiomas (RCHs). Materials and Methods: The clinical data of three patients with RCH were reviewed and the imaging findings were analyzed. Results: The color photographs of the fundus showed bead-like vesicles in the retina. Some vesicles showed plasma erythrocyte separation—with plasma on the top and erythrocytes at the bottom—which was consistently detected as high spontaneous fluorescence on fundus fluorescence angiography. Other vesicles were surrounded by thick walls and fibrous tissue, showing high spontaneous fluorescence, although they did not show any changes on fluorescence angiography. Optical coherence tomography (OCT) could not discriminate the different characteristics of the vesicles, but could clearly discriminate the appearance of the vesicles and their location on the retina, as well as other structural features. Conclusions: Fundus color photography, fundus fluorescein angiography, and OCT can aid in acquiring a better understanding of the structural features of cavernous hemangioma and its relationship with retinal vessels.
关键词： fluorescein angiography,fundus color photography,Fundus autofluorescence,Retinal cavernous hemangioma,OCT
更新于2025-09-10 09:29:36
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An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management
摘要： Inflammatory choroidal neovascular membranes are challenging to diagnose and manage. A number of uveitic entities may be complicated by the development of choroidal neovascularization leading to a decrease in central visual acuity. In conditions such as punctate inner choroidopathy, development of choroidal neovascularization is extremely common and must be suspected in all cases. On the other hand, in patients with conditions such as serpiginous choroiditis, and multifocal choroiditis, it may be difficult to differentiate between inflammatory choroiditis lesions and choroidal neovascularization. Multimodal imaging analysis, including the recently introduced technology of optical coherence tomography angiography, greatly aid in the diagnosis and management of inflammatory choroidal neovascularization. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy.
关键词： Posterior uveitis,angiography,Choroiditis,Uveitis,Fluorescein angiography,Optical coherence tomography angiography,EDI-OCT,Indocyanine green,Inflammatory choroidal neovascularization
更新于2025-09-09 09:28:46