Choroidal neovascular membranes secondary to intraocular tuberculosis misdiagnosed as neovascular age-related macular degeneration

2017 ◽  
Vol 28 (2) ◽  
pp. 216-224 ◽  
Author(s):  
Alessandro Invernizzi ◽  
Aniruddha Agarwal ◽  
Maura Di Nicola ◽  
Fabio Franzetti ◽  
Giovanni Staurenghi ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Multimodal Imaging ◽  
Age Related Macular Degeneration ◽  
Enhanced Depth Imaging ◽  
Fundus Photography ◽  
Imaging Features ◽  
Neovascular Amd ◽  
Age Related ◽  
Intraocular Tuberculosis

Purpose: Intraocular tuberculosis (IOTB) can be complicated by choroidal neovascularization (CNV). However, when the CNV development is not accompanied by clear signs of inflammation, the etiology can be missed, especially in countries nonendemic for tuberculosis. We describe the clinical and imaging features of CNVs presenting as the first sign of IOTB initially misdiagnosed as exudative age-related macular degeneration (AMD). Methods: A retrospective review of clinical and imaging data of patients initially misdiagnosed with neovascular AMD later diagnosed with inflammatory CNV secondary to IOTB at tertiary referral centers was conducted. Features of fundus photography, fluorescein angiography, indocyanine green angiography, and enhanced depth imaging optical coherence tomography were analyzed. Distinguishing features between neovascular AMD and IOTB-associated CNV were evaluated. Results: Five patients over 55 years of age, erroneously diagnosed with exudative AMD, were included in the study. Multimodal imaging analysis allowed identification of peculiar choroidal alterations such as choroidal granulomas or choroiditis suggestive for posterior uveitis. Systemic workup for granulomatous uveitis including immunologic investigations such as tuberculin skin test or QuantiFERON TB Gold® and radiologic investigations revealed tubercular etiology in all the cases, allowing correct diagnosis and management of the uveitis and related CNV. Conclusions: Choroidal neovascularization represents a rare and unusual presenting sign of IOTB that can be misleading especially when it occurs in the elderly living in countries with low prevalence of the disease. Multimodal imaging can be helpful and should be employed, especially in atypical cases of CNV, in order to avoid misdiagnosis and/or diagnostic delays.

scholarly journals Noninvasive multimodal imaging in diagnosing polypoidal choroidal vasculopathy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingyuan Yang ◽  
Mingzhen Yuan ◽  
Erqian Wang ◽  
Song Xia ◽  
Youxin Chen
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Multimodal Imaging ◽  
High Sensitivity ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Diagnostic Strategy ◽  
Imaging Features ◽  
Imaging Methods ◽  
Age Related ◽  
Choroidal Vasculopathy

Abstract Purpose To investigate the diagnostic accuracy of noninvasive multimodal imaging methods in diagnosing polypoidal choroidal vasculopathy (PCV) and distinguishing PCV from typical neovascular age-related macular degeneration (nvAMD). Methods Retrospective study. Imaging features of noninvasive multimodal imaging methods, including fundus photography (FP), B-scan optical coherence tomography (OCT), en face OCT, OCT angiography, and autofluorescence, of 103 eyes with PCV or typical nvAMD were reviewed. Diagnostic strategy was established based on imaging features and was validated in other 105 eyes with PCV or typical nvAMD. Results Features of subretinal orange nodule on FP, thumb-like PED on OCT, notched PED on OCT, bubble sign on OCT, and Bruch’s membrane depression under serosanguinous PED on OCT were more common. When the diagnostic strategy of using at least 2 of 5 features was performed, there is 0.88 sensitivity and 0.92 specificity for diagnosing PCV. The results of the validation test further confirmed the diagnostic strategy with 0.94 sensitivity and 0.93 specificity. Conclusions Noninvasive multimodal imaging, especially FP and B-scan OCT, provide high sensitivity and specificity for diagnosing PCV and distinguishing PCV from typical nvAMD, when at least 2 of 5 suggestive imaging features are present.

scholarly journals Choroidal neovascularization activity and structure by optical coherence tomography angiography in age related macular degeneration

2021 ◽  
Vol 6 (6-1) ◽  
pp. 12-18
Author(s):  
M. A. Kovalevskaya ◽  
O. A. Pererva
Keyword(s):  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Vascular System ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Type I ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related

Background. In economically developed countries, age-related macular degeneration (AMD) is the leading cause of visual disability among the population of the older age group. The main criterion for the anti-VEGF treatment of neovascular AMD is the activity of choroidal neovascularization (CNV), which is determined by its confi guration. The search for optimal criteria for quantifying the state of the macular region in order to decide on the appointment of anti-VEGF therapy continues.Aim: improving the effi ciency of diagnosis and treatment of AMD based on the assessment of the configuration of vascular system on the “Key to Diagnosis II” platform.Material and methods. The study included 341 patients: 64 % (218 patients, 267 eyes) with non-neovascular AMD, 36 % (123 patients, 174 eyes) – with neovascular AMD. 56 patients (58 eyes) had active type I CNV. Group 1A – active CNV before treatment (9 patients, 9 eyes), group 1B – non-active CNV after treatment with antiVEGF (9 patients, 9 eyes); control group – 10 patients (10 eyes) without AMD. Analysis of OCT-angio images of choriocapillaries included the isolation of CNV, its area, fractal dimension (Df) and the complexity of the vascular system (CVS) counting.Results. Group 1A: Df – 1.5871 ± 0.05, CVS – 2.29 ± 0.29, area – 11734 ± 4866; group 1B: Df – 1.6462 ± 0.08, CVS – 1.65 ± 0.18, area – 6797 ± 3818; control: Df – 1.9167 ± 0.06, CVS – 1, area – 0. Significant differences were found for CVS (p = 0.0003). Df correlates with the CNV area (p = 0.7) and is probably an unreliable parameter due to incomplete visualization of active CNV.Conclusions. CVS is a quantitative biomarker for determining the activity of type 1 CNV in patients with AMD and can serve as a parameter for convolutional neural networks training for automated analysis of OCT angiography images based on the “Key to Diagnosis II” platform

scholarly journals Subthreshold Exudative Choroidal Neovascularization Associated With Age-Related Macular Degeneration Identified by Optical Coherence Tomography Angiography

2020 ◽  
Vol 4 (5) ◽  
pp. 377-385
Author(s):  
Miin Roh ◽  
Joan W. Miller ◽  
Karen W. Jeng-Miller ◽  
Jay C. Wang ◽  
Inês Laíns ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Pigment Epithelial Detachment ◽  
Optical Coherence ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Age Related

Purpose: This article describes the clinical and multimodal imaging characteristics of subthreshold exudative choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). Methods: Among 3773 patients with AMD, 8 eyes (6 patients) were identified with the clinical phenotype of interest. Dilated fundus examinations, color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA) were performed. Results: OCT typically showed a moderately reflective irregular pigment epithelial detachment with overlying subretinal fluid (SRF). Traditional FA did not show leakage and ICGA showed no definitive neovascular network or hot spots. However, OCTA clearly demonstrated a CNV within the pigment epithelial detachment. The majority of our cases (7 of 8) did not receive antivascular endothelial growth factor (anti-VEGF) injections, and visual acuity remained stable over the available follow-up period of 1 to 10 years. Conclusions: CNV is often associated with SRF and vision loss in AMD, usually requiring frequent anti-VEGF injections. OCTA allowed us to better identify CNV not readily detected on FA and ICGA. Although some have suggested early clinical intervention with anti-VEGF injections in any case with fluid and confirmed CNV on OCTA, we describe a subset of AMD patients with SRF who may be better managed by observation. These cases may represent a more indolent, mature, and stable vascular network.

scholarly journals Switching of an inhibitor of vascular endothelial growth factor in the treatment of resistant to ranibizumab neovascular form of age-related macular degeneration. Case study

2016 ◽  
Vol 9 (3) ◽  
pp. 69-76
Author(s):  
Nanuli V Ivanova ◽  
Oleg G Rasin ◽  
Aleksey V Savchenko ◽  
Olga A Litvinenko
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Retinal Thickness ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Membrane Area ◽  
Anti Vegf ◽  
Age Related

Aim: To analyze the spontaneous reattachment of retinal pigment epithelium (RPE) after replacing the anti-VEGF drug - ranibizumab, with aflibercept in the treatment of neovascular AMD based on the example given in our clinical study. Material and methods. We carried out a retrospective analysis of the patient’s history with exudative detachment of RPE due to choroidal neovascularization in age-related macular degeneration. This patient was treated with anti-angiogenic treatment in the form of monthly IVI ranibizumab. At the time of treatment, the visual acuity of the left eye was 0.3 with sph + 1,5D = 0,5, in the fundus of the eye there was a high exudative detachment of RPE in the macular region common to the vascular arcades. The edges were determined by the detachment of the neuroepithelium and abundance of hard drusen. Using optical coherence tomography, (OCT) we saw that the center of the macula of the left eye had a high detachment of RPE, local detachment of the neuroepithelium at the edge of the RPE detachment and an abundance of hard drusen. The foveola was flattened, and beneath it, the RPE was detached in the center - thickness of 247 microns (m). After the seventh injection of ranibizumab, we used OCT to assess the condition of the retina. The retinas condition was almost the same as before. The thickness in the central zone was 251 m, detachment of neuroepithelium was not seen, the dome of the RPE detachment circuit was unchanged and visual acuity improved to 0.7 with a maximum correction. We then replaced ranibizumab with another anti-angiogenic drug - aflibercept. Results and discussion. Two weeks on from our control examination, we noticed there was a smooth bubble detachment of the RPE and a retinal prominence over the choroidal neovascular membrane area (CNM). The OCT scan indicated minimal RPE detachment, resorption of the exudate, presence of subretinal spindle - shaped formation near the temporal side (CNM? Scar?). Retinal thickness was 178 m at the fixation point. Intravitreal injections were stopped. Visual acuity increased to 0.8 and remained stable for 5 months, but there were signs of renewed activity of choroidal neovascularization. According to OCT, the thickness in the central parts of the retina increased to 230 m, there were intraretinal cysts and increased spindle - shaped formation under the RPE. After 10 months of IVI aflibercept, acute vision decreased to 0.5, the thickness at the point of fixing increased to 250 m, subretinal formation increased and oozing of fluid was observed mainly parafoveal, which explains the high visual acuity. We then administered IVI ranibizumab. Two weeks later, the retinal thickness was 169 m, visual acuity improved to 0.8, but 1 month later we found that the retinal thickness had increased once more and decreased to 0.7. After 3 months after IVI ranibizumab, retinal thickness at the fixation point reached 286 m and visual acuity dropped to 0.5. Conclusion. In our practice, we face patients with neovascular AMD, who respond badly to ranibizumab. For such patients, it is important to replace ranibizumab with a better, more therapeutically effective anti-VEGF drug with anti-vaso proliferative properties. Aflibercept is an effective substitute for ranibizumab which was shown in this clinical case.

scholarly journals Pathogenesis in Wet-Form (Neovascular) Age-Related Macular Degeneration

2017 ◽  
pp. 173-177
Keyword(s):  
Oxidative Damage ◽  
Macular Degeneration ◽  
Chronic Inflammation ◽  
Choroidal Neovascularization ◽  
Complement System ◽  
Molecular Targets ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Age Related ◽  
The Complement System

The understanding of the pathogenesis of the development of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) continues to evolve. Epidemiological, histopathological, and biochemical evidence indicates that neovascular AMD is associated with oxidative damage, lipofuscin accumulation, chronic inflammation, and mutation in the complement system. Molecular targets have been identified that serve as the basis for developing new, better treatments for neovascular AMD.

scholarly journals Age-Related Macular Degeneration Staging by Color Fundus Photography vs. Multimodal Imaging—Epidemiological Implications (The Coimbra Eye Study—Report 6)

2020 ◽  
Vol 9 (5) ◽  
pp. 1329 ◽  
Author(s):  
Cláudia Farinha ◽  
Maria Luz Cachulo ◽  
Rita Coimbra ◽  
Dalila Alves ◽  
Sandrina Nunes ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Multimodal Imaging ◽  
Fundus Autofluorescence ◽  
Epidemiological Data ◽  
Population Based ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Age Related ◽  
Staging Systems

Epidemiology of age-related macular degeneration (AMD) is based on staging systems relying on color fundus photography (CFP). We aim to compare AMD staging using CFP to multimodal imaging with optical coherence tomography (OCT), infra-red (IR), and fundus autofluorescence (FAF), in a large cohort from the Epidemiologic AMD Coimbra Eye Study. All imaging exams from the participants of this population-based study were classified by a central reading center. CFP images were graded according to the International Classification and Grading System for AMD and staged with Rotterdam classification. Afterward, CFP images were reviewed with OCT, IR, and FAF and stage update was performed if necessary. Early and late AMD prevalence was compared in a total of 1616 included subjects. In CFP-based grading, the prevalence was 14.11% for early AMD (n = 228) and 1.05% (n = 17) for late AMD, nine cases (0.56%) had neovascular AMD (nAMD) and eight (0.50%) geographic atrophy (GA). Using multimodal grading, the prevalence increased to 14.60% for early AMD (n = 236) and 1.61% (n = 26) for late AMD, with 14 cases (0.87%) of nAMD and 12 (0.74%) of GA. AMD staging was more accurate with the multimodal approach and this was especially relevant for late AMD. We propose that multimodal imaging should be adopted in the future to better estimate and compare epidemiological data in different populations.

scholarly journals Serum 25-hydroxy vitamin D levels in age-related macular degeneration

2021 ◽  
Author(s):  
Antonio Pérez Serena ◽  
Daisy Paola Martínez Betancourt ◽  
Fernando González del Valle ◽  
Jose María Ruiz Moreno
Keyword(s):  
Vitamin D ◽  
Macular Degeneration ◽  
Healthy Subjects ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Control Group ◽  
Neovascular Amd ◽  
Age Related ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D

Abstract Purpose The aim of this study was to determine the 25-hydroxy vitamin D (25(OH)D) levels in age-related macular degeneration (AMD) patients. Methods Age-related macular degeneration (AMD) patients were classified into four groups: early AMD (N =10), intermediate AMD (N=12), advanced atrophic AMD (N=19) and advanced neovascular AMD (N=52) after undergoing fundus photography. Serum 25(OH)D levels of all subjects were evaluated. From a random control group of 326 patients whose 25(OH)D levels had been measured, a group of 93 were selected to match the age range of the AMD group. We measured 25(OH)D levels during the same period to rule out seasonal variation. Results A total of 93 AMD patients (36 males and 57 females) and 93 healthy individuals (39 males and 54 females) were enrolled in this study with the mean age of 78.96±8.46 vs. 78.80±8.35, respectively. The patients affected by AMD had statistically significant lower 25(OH)D levels (15±10 ng/mL) than the healthy subjects control group (21±14 ng/mL) (p = 0.004). However, the median 25(OH)D levels in early AMD, intermediate AMD, advanced atrophic AMD and advanced neovascular AMD (12.5±7.3; 15±11; 15±8 and 17±11.5, respectively) were not statistically significant (p = 0.442). Conclusion This study shows that patients affected by AMD had lower vitamin D levels compared to healthy subjects. Further research is necessary to investigate the possible association between 25(OH)D levels and AMD.

Characteristics of Pentosan Polysulfate Sodium–Associated Maculopathy and Similarities With Other Maculopathies Commonly Managed in a Retina Practice

2021 ◽  
pp. 247412642110202
Author(s):  
Collin Ohning ◽  
George Skopis ◽  
Joshua Levinson ◽  
Sundeep Kasi
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Retinal Imaging ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Pentosan Polysulfate ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Best Corrected Visual Acuity

Purpose: This work describes characteristics of pentosan polysulfate sodium (PPS)–associated maculopathy and its similarities with common maculopathies in a retina practice cohort. Methods: Thirty-two patients were identified through electronic medical record query who were exposed to PPS. One patient was excluded for lack of retinal imaging. Thirty-one patients (62 eyes) were included. A retrospective review was used to obtain patient characteristics, examination findings, and retinal imaging of the study patients. Classification into “likely,” “unlikely,” or “possible” to have PPS-associated maculopathy groups was based on the fundus photography and retinal imaging. Main outcome measures were best-corrected visual acuity, age, sex, diagnosis of reason for referral, allocation into designated maculopathy group, and presence of choroidal neovascularization. Results: Of 31 patients (62 eyes), the median age was 70 years (range, 24-104 years) and the majority were women (87%). Mean best-corrected visual acuity was 0.3 ± 0.4 logMAR at presentation. The most common reason for referral was age-related macular degeneration (29%). Maculopathy grades were “likely” (29%, 9 total patients), “possible” (26%, 8 total patients), or “unlikely” (45%, 14 total patients). Choroidal neovascularization was noted in 9.7% of all eyes and 11% of eyes in the “likely” group. The “possible” and “likely” groups had older ages of presentation ( P < .05) compared with the “unlikely” group. Conclusions: A high percentage (55%) of patients with a history of chronic PPS exposure showed features of “likely” or “possible” maculopathy. Similarities with common maculopathies such as age-related macular degeneration and the importance of screening and recognizing at-risk patients are highlighted.

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