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Camiel J F Boon - One of the best experts on this subject based on the ideXlab platform.
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serous business delineating the broad spectrum of diseases with Subretinal Fluid in the macula
Progress in Retinal and Eye Research, 2021Co-Authors: Elon H C Van Dijk, Camiel J F BoonAbstract:A wide range of ocular diseases can present with serous Subretinal Fluid in the macula and therefore clinically mimic central serous chorioretinopathy (CSC). In this manuscript, we categorise the diseases and conditions that are part of the differential diagnosis into 12 main pathogenic subgroups: neovascular diseases, vitelliform lesions, inflammatory diseases, ocular tumours, haematological malignancies, paraneoplastic syndromes, genetic diseases, ocular developmental anomalies, medication-related conditions and toxicity-related diseases, rhegmatogenous retinal detachment and tractional retinal detachment, retinal vascular diseases, and miscellaneous diseases. In addition, we describe 2 new clinical pictures associated with macular Subretinal Fluid accumulation, namely serous maculopathy with absence of retinal pigment epithelium (SMARPE) and serous maculopathy due to aspecific choroidopathy (SMACH). Differentiating between these various diseases and CSC can be challenging, and obtaining the correct diagnosis can have immediate therapeutic and prognostic consequences. Here, we describe the key differential diagnostic features of each disease within this clinical spectrum, including representative case examples. Moreover, we discuss the pathogenesis of each disease in order to facilitate the differentiation from typical CSC.
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photodynamic therapy in chronic central serous chorioretinopathy with Subretinal Fluid outside the fovea
Graefes Archive for Clinical and Experimental Ophthalmology, 2017Co-Authors: Elon H C Van Dijk, Greet Dijkman, Camiel J F BoonAbstract:Purpose To assess the efficacy of photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC), in whom Subretinal Fluid (SRF) was solely present outside the foveal area.
Anat Loewenstein - One of the best experts on this subject based on the ideXlab platform.
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notion of tolerating Subretinal Fluid in neovascular amd understanding the fine print before the injection pause
British Journal of Ophthalmology, 2021Co-Authors: Ashish Sharma, Anat Loewenstein, Francesco Bandello, Nikulaa Parachuri, Nilesh Kumar, Baruch D Kuppermann, Carl D Regillo, Usha ChakravarthyAbstract:The last decade has seen a paradigm shift in the management of neovascular age-related macular degeneration (nAMD) with the introduction of biologicals that inhibit vascular endothelial growth factor (VEGF). These agents, similar to biologicals have imposed a major burden on all healthcare systems. Patients are not only financially strained by the cost of intravitreal injections that require repeated administrations but multiple visits to the hospital compromise quality of life. The recognition of this burden has to some extent led to a shift in the dosing strategy from fixed monthly (of ranibizumab) or 8-weekly dosing (of aflibercept) to pro-re-nata and treat-and-extend (T&E) protocols.1 After the three initial loading doses, re-injection decisions are made based on the presence of Fluid on optical coherence tomography (OCT). The OCT is a tool that demonstrates structural changes in the macular retina arising from leakage in the nAMD lesion or occurring as part of the sequelae of chronicity of the pathology. Leakage of Fluid and blood constituents representing lesion activity is interpreted by detecting signs (biomarkers) seen on OCT. The presence of clear hypo-reflective regions within the intraretinal layers is considered to represent Fluid accumulation. Depending on the location of these regions of hypo-reflectivity, they can be compartmentalised into intraretinal Fluid (IRF), Subretinal Fluid (SRF) and Subretinal pigment epithelial Fluid. Multiple post hoc analyses of major trials such as the Comparison of AMD Treatments Trials (CATT) and VIEW 2 have shown that presence of IRF, either foveal or extra-foveal during the …
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non neovascular age related macular degeneration with Subretinal Fluid
British Journal of Ophthalmology, 2020Co-Authors: Assaf Hilely, Anat Loewenstein, Dinah Zur, Bailey K Freund, Eric H Souied, Riccardo Sacconi, Enrico Borrelli, Enrico Peiretti, Claudio Iovino, Yoshimi SugiuraAbstract:Purpose To evaluate the various patterns of Subretinal Fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes. Methods This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes. Results Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of Fluid over the apex of the drusenoid PED, pocket of Fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying Fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with Fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy. Conclusion Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.
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effect of baseline Subretinal Fluid on treatment outcomes in vivid dme and vista dme studies
Ophthalmology Retina, 2019Co-Authors: Jeanfrancois Korobelnik, Anat Loewenstein, Jennifer J Arnold, Todd A Katz, Dilsher S Dhoot, Giovanni StaurenghiAbstract:Purpose To evaluate the effect of baseline Subretinal Fluid (SRF) on treatment outcomes with intravitreal aflibercept injection (IAI) versus laser treatment in patients with diabetic macular edema (DME) in the VIVID and VISTA studies. Design Post hoc analysis of 2 randomized controlled trials. Participants Eight hundred seventy-two patients with DME. Methods We randomized patients to receive IAI 2 mg every 4 weeks (2q4), IAI 2 mg every 8 weeks after 5 monthly doses (2q8), or laser. Main Outcome Measures Effect of presence or absence of baseline SRF on visual outcomes in the integrated dataset at weeks 52 and 100. Results Mean best-corrected visual acuity (BCVA) gains in the 2q4, 2q8, and laser arms at week 52 were +14.5, +11.0, and –2.3 letters, respectively, (those with baseline SRF) and +10.3, +10.6, and +2.5 letters, respectively, (those without). At week 100, mean gains were +13.5, +10.9, and −2.3 letters (those with baseline SRF) and +10.6, +10.0, and +2.7 letters (those without). The treatment effect for IAI versus laser from baseline to week 52 of 100 was greater for patients with baseline SRF versus those without (nominal P Conclusions This post hoc analysis demonstrated the visual outcome benefits of IAI over laser, regardless of baseline SRF status. A greater treatment effect of IAI was observed in patients with baseline SRF versus those without; however, no meaningful impact of baseline SRF status on treatment outcomes with IAI was demonstrated, indicating that the differential effects of laser might have been the driving force behind the different treatment outcomes in both groups.
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Subretinal Fluid optical density and spectral domain optical coherence tomography characteristics for the diagnosis of circumscribed choroidal hemangioma
Ophthalmologica, 2019Co-Authors: Dinah Zur, Ari Leshno, Adiel Barak, Matias Iglicki, Shahar Frenkel, Noa Cohen, Alla Khoury, Mauricio Martinez Cartier, Iris Moroz, Anat LoewensteinAbstract:PURPOSE To investigate spectral domain-optical coherence tomography (SD-OCT) features of untreated circumscribed choroidal hemangioma (CCH), and the optical density (OD) of the associated Subretinal Fluid (SRF). PROCEDURES This international retrospective multicenter study conducted at 5 tertiary retina referral centers included 34 patients with symptomatic CCH imaged on SD-OCT. CCH surface, size, and overlying retinal changes and OD ratio (ODR) were evaluated. RESULTS The mean ODR of the SRF was 0.808 ± 0.287. Tumor base measured on ultrasound correlated significantly with the ODR (p = 0.012). ODR values in cases of CCH were similar to those of choroidal metastasis, but significantly lower than those of choroidal melanoma (p = 0.006). Thirty-two out of 34 cases (94%) presented with a regular smooth choroidal surface. OCT demonstrated SRF overlying the CCH in 29 eyes (85%). The presence of SRF correlated significantly with a larger basal tumor diameter (p = 0.035). OCT displayed sub- and intraretinal hyperreflective foci, correlating with both larger maximal retinal thickness overlying the tumor (p = 0.031) and the amount of SRF (p = 0.016) in 29 eyes (85%). CONCLUSION CCH displays typical findings on SD-OCT. ODR is a new important tool in the differential diagnosis of choroidal tumors and should be considered for enhancing the accuracy of diagnosing CCH. This benefit is especially relevant for cases in which the presentation of CCH is atypical.
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Optical Density of Subretinal Fluid in Retinal Detachment.
Investigative Ophthalmology & Visual Science, 2015Co-Authors: Ari Leshno, Amit Weinberg, Adiel Barak, Anat Loewenstein, Meira NeudorferAbstract:PURPOSE: To investigate the changes over time in optical density (OD) characteristics of Subretinal Fluid (SRF) in rhegmatogenous retinal detachment (RRD) and their clinical relevance. METHODS: The study included patients with first-onset RRD and no history of intraocular illness who underwent optical coherence tomography (OCT) and whose OCT scans showed sufficient SRF for sampling (08/2013-09/2014). The highest quality B-scan (as graded by the OCT image acquisition software) containing SRF was analyzed. Optical density measurements were obtained using ImageJ. Optical density ratios (ODRs) were calculated as SRF OD divided by vitreous OD. Time from onset of RRD was determined by first signs of visual loss as described in the patient's anamnesis. Patients were divided into three groups by RRD duration: acute (≤1 week), subacute (between 1 week and 1 month), and chronic (>1 month). RESULTS: Thirty-five eyes (34 patients) met the inclusion criteria. The ODR measurement was significantly associated with RRD duration. The ODR had a significant (P < 0.0001) association with the 3-month postoperative visual acuity (VA). Vitreous OD did not differ significantly between the three groups. CONCLUSIONS: The increase over time in the ODR of the SRF in RRD might reflect a change in SRF composition and state of the retina. This, together with a significant association between preoperative ODR values and postoperative VA suggest its potential as a biological prognostic marker.
Bailey K Freund - One of the best experts on this subject based on the ideXlab platform.
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non neovascular age related macular degeneration with Subretinal Fluid
British Journal of Ophthalmology, 2020Co-Authors: Assaf Hilely, Anat Loewenstein, Dinah Zur, Bailey K Freund, Eric H Souied, Riccardo Sacconi, Enrico Borrelli, Enrico Peiretti, Claudio Iovino, Yoshimi SugiuraAbstract:Purpose To evaluate the various patterns of Subretinal Fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes. Methods This retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes. Results Forty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of Fluid over the apex of the drusenoid PED, pocket of Fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying Fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with Fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy. Conclusion Non-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.
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localized choroidal thickness variation and pigment epithelial detachment in dome shaped macula with Subretinal Fluid
Ophthalmic Surgery and Lasers, 2015Co-Authors: Avnish A Deobhakta, Adam H Ross, John Helal, Andre Maia, Bailey K FreundAbstract:The objective of this report is to demonstrate that individuals with dome-shaped macula can develop persistent Subretinal Fluid due to abrupt changes in the thickness of the choroid, making it unlikely to be reported. Additionally, these patients often have pigment epithelial detachments, suggestive of possible choroidal neo-vascularization. These two qualities can often lead to persistent Subretinal Fluid that is refractory to treatment.
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retention of good visual acuity in eyes with neovascular age related macular degeneration and chronic refractory subfoveal Subretinal Fluid
Saudi Journal of Ophthalmology, 2014Co-Authors: Kavita V Bhavsar, Bailey K FreundAbstract:Purpose To describe the clinical characteristics of a subset of eyes with neovascular age-related macular degeneration (NVAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy which retain good visual acuity despite chronic, persistent subfoveal Subretinal Fluid (SRF).
Irmela Mantel - One of the best experts on this subject based on the ideXlab platform.
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refractory Subretinal Fluid in patients with neovascular age related macular degeneration treated with intravitreal ranibizumab visual acuity outcome
Graefes Archive for Clinical and Experimental Ophthalmology, 2015Co-Authors: Liuna Jang, Christina Gianniou, Aude Ambresin, Irmela MantelAbstract:To investigate the functional outcome of eyes with neovascular AMD (nAMD) and Subretinal Fluid (SRF) refractory to treatment with ranibizumab. Retrospective chart review of consecutive treatment-refractory SRF in nAMD despite monthly ranibizumab injections during 12 months or more. Data were evaluated for baseline characteristics, location of the refractory SRF, mean visual acuity (VA) change, number of injections, and timepoint of first complete disappearance of SRF. Forty-five eyes in 44 patients (mean age of 76 years) were included. The mean follow-up was 32.4 months (range 12–73 months). The mean number of injections was 11.6 in the first year and 27.5 over follow-up. The refractory SRF was located subfoveally in 66.7 %. In 12 eyes (26.7 %), complete absorption of SRF was found after a mean of 22.6 months (range, 13–41 months). Mean VA increased by 10.4, 8.2, and 8.6 letters by month 12, 24, and 36, respectively. Neovascular AMD with SRF refractory to monthly retreatment with ranibizumab may still allow good and maintained visual improvement, even if the Fluid is located subfoveally. SRF may progressively absorb under continuous monthly treatment. The necessity to treat refractory SRF with monthly injections could be questioned and would need future investigations.
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refractory intraretinal or Subretinal Fluid in neovascular age related macular degeneration treated with intravitreal ranizubimab functional and structural outcome
Retina-the Journal of Retinal and Vitreous Diseases, 2015Co-Authors: Christina Gianniou, Ali Dirani, Liuna Jang, Irmela MantelAbstract:Purpose:To investigate the visual acuity results of eyes with neovascular age-related macular degeneration and refractory Fluid despite monthly treatment with ranibizumab, and to investigate differences between refractory Subretinal Fluid and intraretinal cystic changes.Methods:Retrospective chart r
Maria Luz Amaroquierza - One of the best experts on this subject based on the ideXlab platform.
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Subretinal Fluid from anterior ischemic optic neuropathy demonstrated by optical coherence tomography
Archives of Ophthalmology, 2008Co-Authors: Thomas R Hedges, Laurel N Vuong, Alberto Gonzalezgarcia, Carlos E Mendozasantiesteban, Maria Luz AmaroquierzaAbstract:Objective To demonstrate the development of subfoveal Fluid associated with optic disc swelling from nonarteritic anterior ischemic optic neuropathy. Methods Optical coherence tomographic studies obtained during a 3-year period (October 1, 2003, to December 30, 2006) from 76 patients who developed ischemic optic neuropathy from 2 institutions were evaluated. The presence or absence, and the distribution, of Subretinal Fluid was determined. Results Seventy-six patients underwent macular optical coherence tomography within 4 weeks of developing sudden loss of vision in one eye, decreased visual acuity, a visual field defect, a relative afferent pupillary defect, and optic disc swelling with peripapillary hemorrhages. Eight patients had apparent Subretinal Fluid extending into the subfoveal space. Visual acuity improved in 5 of the 8 patients as the subfoveal Fluid resolved. Conclusions Subretinal Fluid develops in some patients with nonarteritic anterior ischemic optic neuropathy and may contribute to some of the visual loss associated with this condition. Furthermore, resolution of the Subretinal Fluid could account for some of the visual improvement that can follow anterior ischemic optic neuropathy.
