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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 6 | Issue 2
Page Nos. 27-56

Online since Wednesday, February 19, 2020

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REVIEW ARTICLE  

Central serous chorioretinopathy: Recent trends p. 27
Abhishek Das, Prapti Chheda
DOI:10.4103/erj.erj_1_20  
Central serous chorioretinopathy (CSCR) belongs to pachychoroid spectrum of diseases, and the pathogenesis is still not fully understood. It is associated with multiple systemic factors. It is characterized by the collection of fluid between the retinal pigment epithelium (RPE) and the neurosensory retina. It mostly affects young men under perceived stress. The involvement of corticosteroids is undisputed although their exact role has not been clarified; other parts of the underlying mechanism of CSCR have been mainly elucidated by imaging techniques, such as fluorescein and indocyanine green angiography. The course is usually self-limiting and in most cases resolves spontaneously within a 3–6-month period, with visual acuity usually recovering to 20/30 or better. However, chronic CSC may develop as a consequence of recurrences or persistent neurosensory detachment and can result in progressive RPE atrophy and permanent visual loss. We used search terms such as “central serous retinopathy,” “central serous chorioretinopathy,” “CSCR,” “management,” and “treatment” and also the keywords of each type of treatment on PubMed and Medline to retrieve articles for this systematic review.
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ORIGINAL ARTICLES Top

Correlation between visual acuity and diabetic macular ischemia using optical coherence tomography angiography p. 33
Lydia Maged Louis, Alaa Eldin Fayed, Mohamed Salah Helal, Ahmed Mohammed Habib, Mohammed Hanafy Hashem, Sherif Nabil Embabi
DOI:10.4103/erj.erj_8_19  
Context: Diabetic macular ischemia affects visual function to a variable degree. Aims: This study aims to find whether parameters of ischemia measured on optical coherence tomography angiography (OCTA) correlate with best spectacle-corrected visual acuity (BCVA). Settings and Design: A cross-sectional study was done on 33 eyes with diabetic retinopathy (DR) and 11 nondiabetic control eyes. Subjects and Methods: A 3 mm × 3 mm OCTA images of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and full-thickness retinal slabs were obtained and used to measure foveal avascular zone (FAZ) area and circularity index (CI) manually. Statistical Analysis Used: Statistical comparison between the diabetic and control groups and correlation with BCVA was calculated. Results: CI was significantly higher in controls in each of the SCP (P > 0.001), ICP (P > 0.05), DCP (P = 0.005), and full retinal thickness (P < 0.05) slabs. Compared to the moderate nonproliferative DR group, the control group had a smaller FAZ (P = 0.04) and higher CI (P = 0.01) in the DCP slab. Neither the FAZ area nor the CI was significantly correlated with BCVA in any of the slabs. Conclusions: OCTA can detect a measurable degree of ischemia in diabetic eyes compared to controls. CI is the most sensitive parameter for this purpose. The DCP shows the earliest affection with increasing grades of DR. FAZ area and CI are not good indicators of VA.
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Vitreous tumor necrosis factor-alpha level in patients with wet type of age-related macular degeneration p. 38
Hegan Rabie Abdel Tawwab, Mohamed Ahmed Attya, Riham Assem El Essawy, Mohamed Amin Zayed
DOI:10.4103/erj.erj_10_19  
Aim of Study: The aim of the study was to compare the level of tumor necrosis factor (TNF)-α in vitreous samples of naïve wet age-related macular degeneration (AMD) patients and normal individuals, in an attempt to evaluate its role in the disease development. Materials and Methods: A prospective case–controlled study was conducted on 50 eyes –25 naïve wet AMD eyes as “Cases” and 25 eyes without AMD as “Controls.” Vitreous samples were collected by manual aspiration using a 25G needle attached to a 3 ml syringe directed toward the mid-vitreous cavity. The samples were collected, frozen, and stored at − 20°C. The level of TNF-α was assessed using enzyme-linked immunosorbent assay kits. Results: Vitreous TNF-α level was higher in naive wet AMD patients (4.07 ± 0.93 [2.80–6.60] pg/ml; mean ± standard deviation [minimum–maximum]) than patients without AMD (3.54 ± 0.60 [2.60–5.00] pg/ml; P = 0.019). There was no significant difference in vitreous TNF-α level between different choroidal neovascularization subtypes among studied patients (P = 0.460). Conclusion: The levels of TNF-α were shown to be significantly higher in vitreous samples of patients with naïve wet AMD as compared to normal individuals. These results may shed light on the role of TNF-α in the pathogenesis of wet AMD.
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Macular microvaculature evaluation using optical coherence tomography angiography in patients with high myopia p. 43
Walaa M. Elsherif, M. Tarek A. Moustafa, Heba R. Attaallah, Rabei M. Hassanien
DOI:10.4103/erj.erj_12_19  
Background: Myopia is one of the common refractive error. Optical Coherence Tomography Angiography (OCTA) is a non-invasive investigation of microvasculature of the retina. Aim: To evaluate the OCTA study of the FAZ area and vascular density (VD) at superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) in myopic patients versus healthy controls and their correlations to axial length (AL), best corrected visual acuity (BCVA) and spherical equivalent (SE). Setting and Design: Prospective cross-sectional comparative study. Methods and material 75 eyes of 54 patients, group A are 50 eyes with high myopia and group B are 25 eyes of age matched healthy controls. OCTA images were obtained, analyzed and compared using SPSS v.12 in both groups. Results: Foveal thickness was significantly increased in the myopic group (259.7±23.9) P=0.025, while the paravfoveal thickness was decreased (305.9±18.5) P < 0.001. Both superficial and deep FAZ area were increased in group A. The foveal VD at SCP was significantly higher in Group A (30.3±5.2) P=0.006. The whole image DCP VD was significantly lower (44.5±5.4) P < 0.001. Regarding CC, there was a significant difference in both foveal and parafoveal VD (66.1±4.9) (66.5±4.6) P=0.006 and 0.017, respectively, with both being higher in group A. The study also showed the importance of the CD at DCP and CC being negatively correlated with LogMAR BCVA and positively with the SE, while foveal thickness was positively correlated with the AL. Conclusion: OCTA is a valid and fast technique that could give insights about microvascular changes in myopia.
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Treatment of macular edema caused by leber's miliary aneurysms using intravitreal aflibercept and peripheral laser photocoagulation p. 52
Ahmed M Abdelhadi
DOI:10.4103/erj.erj_13_19  
Purpose: This study aims to determine if intravitreal aflibercept (IVA) is effective in the treatment of macular edema (ME) caused by Leber's miliary aneurysm (LMA), augmented with peripheral laser photocoagulation for the abnormal vessels. Subjects and Methods: This prospective interventional noncomparative case series included 6 eyes of 6 patients with a clinical diagnosis of LMA, based on fluorescein angiography and optical coherence tomography (OCT) findings. Laser photocoagulation was performed to the aneurysms, except those near the fovea. Three to five IVA injections were needed to dry off the macula. Serial color fundus photography and OCT were performed to measure treatment efficacy. Results: After 3–5 IVA, the ME responded marvelously in all patients. One patient had recurrent ME 3 months later, for which an additional 2 IVA was needed. Again one session of ablative laser for diseased vessels was enough for all except for one patient who needed supplemental laser therapy 4 months later. Improved visual acuity was noted in all cases without reported ocular or systemic complications. Conclusion: IVA with peripheral laser ablation appears to be an effective treatment for patients with LMA, as it has the potential to improve final visual acuity.
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