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Mrejen S.,Vitreous Retina Macula Consultants of New York | Mrejen S.,Luesther rtz Retinal Research Center | Sarraf D.,University of California at Los Angeles | Sarraf D.,Greater Los Angeles Healthcare Center | And 4 more authors.
Retina | Year: 2013

PURPOSE:: To describe the spectrum of pigment epithelial detachments (PEDs) occurring mainly in age-related macular degeneration and central serous chorioretinopathy and also in other inflammatory, neoplastic and iatrogenic, retinal, and systemic disorders. METHODS:: Pigment epithelial detachments are divided into drusenoid, serous, vascularized, or mixed categories. RESULTS:: The clinical presentation, classification, and natural history of PEDs are reviewed as illustrated with multimodal imaging combining traditional and novel imaging techniques, including fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and spectral domain optical coherence tomography. Most PEDs occur because of pathophysiologic mechanisms taking place below the retinal pigment epithelium that are difficult to identify with conventional imaging modalities. Enhanced depth imaging optical coherence tomography and indocyanine green angiography allow a better analysis of the subretinal pigment epithelium compartment. CONCLUSION:: The differentiation between various kinds of PEDs is essential because each PED type is a distinct entity that has a specific pathogenesis, natural history, prognosis, and optimal treatment strategy. © by Ophthalmic Communication Society Inc. Source


Kuehlewein L.,Doheny Eye Institute | Kuehlewein L.,Stein Eye Institute | Sadda S.R.,Doheny Eye Institute | Sadda S.R.,Stein Eye Institute | And 3 more authors.
Eye (Basingstoke) | Year: 2015

PurposeTo study the precise structural aspects of a type 2 neovascular membrane in a patient with age-related macular degeneration (AMD) using optical coherence tomography (OCT) angiography and perform sequential quantitative analysis of the membrane after ranibizumab therapy.Patients and methodsSplit-spectrum amplitude-decorrelation (SSADA) OCT angiography macular cubes (3 × 3 mm) were acquired with a light source centered at 840 nm, a bandwidth of 45 nm, and an A-scan-rate of 70 000 scans per second. Visible pathologic vessels were outlined manually on average intensity projection en face images, and the area of the lesion and the vessel density were measured at baseline and follow-up.ResultsAt baseline, the neovascular lesion measured 4.12 mm 2 and the vessel density was 19.83 mm -1. Four weeks after the first, and 2 and 4 weeks after the second ranibizumab injection, OCT angiography revealed a progressively smaller vascular lesion (2.32, 1.77 and 1.64 mm 2), and vessel density (10.24, 8.52 and 7.57 mm -1), although the large central trunks of the lesion were unchanged.ConclusionsIn this study, an obvious reduction in size and vessel density of the neovascular lesion was noted after treatment with ranibizumab using SSADA OCT angiography technology. Microvascular components can be delineated with precision, suggesting that this technique may be useful for the management of patients with neovascular AMD in a clinical setting as well as for future clinical trials. © 2015 Macmillan Publishers Limited. Source


Pang C.E.,Vitreous | Pang C.E.,Luesther rtz Retinal Research Center | Shah V.P.,Vitreous | Shah V.P.,New York University | And 5 more authors.
American Journal of Ophthalmology | Year: 2014

Purpose To describe the spectrum of ultra-widefield autofluorescence (AF) and indocyanine green (ICG) angiographic findings in central serous chorioretinopathy (CSC). Design Retrospective observational case series. Methods In 37 patients, 65 eyes with CSC from 2 vitreoretinal clinical practices were imaged using ultra-widefield AF and 24 of these eyes with ultra-widefield ICG angiography. Images were correlated with clinical findings and spectral-domain optical coherence tomography (OCT). Results In 37 (57%) eyes, a variety of altered AF patterns, including gravitational tracts, extended beyond the posterior 50 degrees of retina. Hyper-AF corresponded to areas of subretinal fluid (SRF) on spectral-domain OCT and was found to persist in 44 (70%) eyes for up to 8 years despite resolution of SRF. These areas corresponded to outer retinal atrophy with viable retinal pigment epithelium (RPE) on spectral-domain OCT and may be explained by the unmasking of normal background RPE AF. Ultra-widefield ICG angiography revealed dilated choroidal vessels and choroidal hyperpermeability in areas corresponding to altered AF on ultra-widefield AF in all 24 eyes. In 20 (83.3%) eyes, dilated vessels were observed in association with 1 or more congested vortex veins ampullas, suggesting that outflow congestion may be a contributing factor to the pathogenesis of CSC. Conclusions Ultra-widefield AF and ICG angiography in CSC revealed more widespread disease in a single image than with standard field imaging and may be useful for identifying peripheral areas of previous or ongoing SRF and choroidal hyperpermeability that can assist in the diagnosis of CSC, surveillance of recurrent disease and treatment of active disease. © 2014 by Elsevier Inc. All rights reserved. Source


Pang C.E.,Vitreous Retina Macula Consultants of New York | Pang C.E.,Luesther rtz Retinal Research Center | Sarraf D.,University of California at Los Angeles | Sarraf D.,Greater Los Angeles Healthcare Center | And 3 more authors.
Retina | Year: 2015

Purpose: To describe the spectral domain optical coherence tomography characteristics of extreme choroidal thinning in high myopia and demonstrate its compatibility with good visual acuity. Methods: This was a retrospective observational case review of nonconsecutive myopic patients with extreme choroidal thinning, defined as a subfoveal choroidal thickness of 20 m or less as measured with spectral domain optical coherence tomography. Clinical features, such as visual acuity, axial length, and spectral domain optical coherence tomography characteristics including choroidal and retinal thicknesses in four quadrants were analyzed. Results: Thirty-six eyes of 20 patients with extreme choroidal thinning were included. Mean subfoveal choroidal thickness was 13.9 ± 6.0 m, mean age was 71 years (range, 32-85 years), mean axial length was 30.7 ± 2.2 mm, and mean follow-up duration was 44.7 ± 15.4 months. Of these, 25 eyes (70%) had visual acuity of 20/40 or better (mean visual acuity was 20/30), whereas the remaining eyes had mean visual acuity of 20/193. All eyes with extreme choroidal thinning had prominent choroidal vessels seen under the macula documented on color fundus photography and near-infrared reflectance imaging. All eyes with visual acuity poorer than 20/40 had fovea-involving choroidal neovascularization and/or atrophy. In the 25 eyes with good visual acuity, the mean choroidal thickness was thinnest at the nasal zone, followed by inferior, superior, and temporal zones (P 0.01); and there was no detectable decrease in choroidal thickness over time. The mean retinal thickness was thinner in the fovea and parafoveal zones when compared with highly myopic eyes without extreme choroidal thinning. Conclusion: Extreme choroidal thinning in myopic eyes is compatible with good visual acuity of 20/40 or better, may be present in a wide age range, and may not demonstrate any progressive decline over up to 70 months of follow-up; suggesting that choroidal thickness alone is not a reliable indicator of visual function. Source


Schneider B.,Greater Los Angeles Healthcare Center | Ercoli L.,University of California at Los Angeles | Siddarth P.,University of California at Los Angeles | Lavretsky H.,University of California at Los Angeles
American Journal of Geriatric Psychiatry | Year: 2012

BACKGROUND: Vascular burden is known to contribute to geriatric depression and cognitive impairment. The objective of our study was to evaluate the relationship between vascular burden and pattern of cognitive impairment in older adults with depression. METHODS: Ninety-four community-dwelling older adults (mean age = 70.8 years; SD = 7.63) diagnosed with major depression were recruited to participate in the tai chi complementary use study aimed to improve antidepressant response to an antidepressant medication. All participants received comprehensive evaluations of depression, apathy, and vascular risk factors, and completed a battery of cognitive measures of memory, cognitive control, verbal fluency, and attention. RESULTS: The severity of vascular burden was significantly correlated with depression severity and impaired performance on measures of cognitive control (i.e., inhibition/mental flexibility), and attention, but not memory or verbal fluency. Neither the severity of comorbid apathy nor medical illness burden was related to cognitive impairment. CONCLUSIONS: Vascular burden in older depressed adults contributes to cognitive impairment, particularly in domains of attention and cognitive control. Our findings suggest that aggressive treatment of vascular risk factors may reduce risk for further cognitive decline in depressed older adults. © 2012 American Association for Geriatric Psychiatry. Source

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