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INTRODUCTION: The association of outer foveal microdefect and LES or hydroxychloroquine use has not been established in current literature. CASE REPORT: We present the first reported case of bilateral outer foveal microdefect ina a patient with systemic lúpus erythematosus using hydroxycloroquine. DISCUSSION/CONCLUSION: While it is not possible to definitively attribute the described findings in our patient to HCQ use, it is important to be aware of the possibility that the outer foveal microdefect may be caused by this medication. Therefore, patients on chronic HCQ therapy should be informed about the risk of potential visual adverse effects, so that appropriate interventions can be implemented if necessary.

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PURPOSE: In this study, we report a case of a young adult with X-linked juvenile retinoschisis (XLRS) with a rare pathogenic variant in the RS1 gene (c.522 + 2 T > A). METHODS: Ophthalmological evaluation, optical coherence tomography, full-field and multifocal electroretinograms and extensive genetic screening of genes related to visual loss were carried out in the participant. RESULTS: Clinical ophthalmological exams revealed a mild to moderate impairment of visual acuity. Retinal imaging showed bilateral foveal schisis, as well as normal a-wave, reduction in the b-wave amplitudes in dark- and light- adapted full-field electroretinograms, and abnormal oscillatory potentials. We found also diffuse amplitude reduction in multifocal electroretinogram arrays. A canonical splice variant was identified in the RS1 gene (c.522 + 2 T > A). CONCLUSION: A rare pathogenic variant of the RS1 gene was associated with diffuse retinal involvement (central and peripheral retina), probably in inner retina, and mild to moderate visual acuity impairment. The phenotypical characterization of rare mutations is relevant to provide information about the disease.

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PURPOSE: This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes. METHODS: This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery). RESULTS: This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed. CONCLUSION: The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 µm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible.

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PURPOSE: To describe four eyes of three patients with presumed acute fovealitis to expand the clinical variants of this recently described disorder. METHOD: The patients underwent a comprehensive ophthalmic examination, including multimodal imaging and electrophysiological tests. RESULTS: Three female patients aged from 18 to 24 years presented sudden central visual disturbances in one or both eyes. The visual acuity ranged from 20/25 to 20/70 in the affected eyes. All of them showed a subtle yellowish lesion in the foveola. Fundus autofluorescence and fluorescein angiography were unremarkable. Optical coherence tomography disclosed focal disarrangement of the outer retinal layers restricted to the fovea and hyperreflective lesions above the external limiting membrane. Multifocal electroretinography responses were attenuated. The electrooculogram response was normal. All patients recovered normal visual acuity and the outer retinal layers. CONCLUSION: Attenuated multifocal electroretinography foveal response and normal electrooculogram are newly described clinical findings in patients with acute fovealitis.

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ABSTRACT Purpose: to compare the Subfoveal choroidal thickness (SFCT) and Retinal Nerve Fiber Layer Thickness (RNFL) of amblyopic and normal fellow eyes. Design: Prospective, cross-sectional, observational case series. Methods: Forty patients age 12 to 41 years (mean 23.73 ± 6.42) with unilateral amblyopia were studied. Among them, 11(28.2%) patients had amblyopia secondary to strabismus and 29(71.8 %) had anisometropic amblyopia. Optical coherence tomography (OCT) of the peripapillary RNFL thickness of amblyopic and fellow eyes was performed. RNFL thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. Also, subfoveal choroidal thickness (SFCT) was measured using spectral domain optical coherence tomography (SD-OCT). Results: Mean global RNFL thickness of the amblyopic and fellow eyes was 104.48 microns and 102.83 microns, respectively. The difference between the two groups was not statistically significant (p>0.05%). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the amblyopic and normal fellow eyes showed no statistically significant difference (p>0.05%). However, the SFCT of amblyopic eye was 11 or more microns thicker than the fellow eye and this was statistically significant different (p<0.05%). Conclusions: This study demonstrated SFCT in amblyopic eyes was significantly thicker than the normal fellow eyes. The amblyopic process may involve the choroid, but not the prepapillary NFL.

RESUMO Objetivo: comparar a espessura da coroide subfoveal (CSF) e da camada de fibra nervosa retinal (CFNR) de olhos amblíopes e normais. Design: série de casos prospectivos, transversais e observacionais. Métodos: Quarenta pacientes com idade entre 12 e 41 anos (média 23,73 ± 6,42) com ambliopia unilateral foram estudados. Entre eles, 11 (28,2%) pacientes apresentavam ambliopia secundária a estrabismo e 29 (71,8%) apresentavam ambliopia anisometrópica. Foi realizada tomografia de coerência óptica (TCO) da espessura da CFNR peripapilar do olho amblíope e do outro olho. As medidas de espessura da CFNR foram realizadas nos quadrantes superior, inferior, nasal e temporal na região peripapilar. Além disso, a espessura da coroide subfoveal (CSF) foi medida através de tomografia de coerência óptica de domínio espectral (TCO-DE). Resultados: A espessura média global da CFNR do olho amblíope e do outro olho foi de 104,48 mícrons e 102,83 mícrons, respectivamente. A diferença entre os dois grupos não foi estatisticamente significativa (p > 0,05%). As espessuras dos quadrantes superior, inferior, nasal e temporal da camada de fibras nervosas da retina entre o olho amblíope e o normal não apresentaram diferença estatisticamente significativa (p > 0,05%). No entanto, a CSF do olho amblíope foi 11 mícrons mais espessa (ou mais) do que a do outro olho - essa diferença foi estatisticamente significativa (p < 0,05%). Conclusões: Este estudo demonstrou que a CSF dos olhos amblíopes foi significativamente mais espessa do que a dos olhos normais. O processo amblíope pode envolver a coroide, mas ele não envolve a CFNR peripapilar.

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PURPOSE: To characterize the distribution of the foveal avascular zone circularity and its correlation with parafoveal vessel density, in subjects with and without diabetes. METHODS: Observational, descriptive, cross-sectional, and prospective study; subjects without diabetes (Group 1), with diabetes without retinopathy (Group 2), or with diabetic retinopathy (Group 3) were included. Means of foveal avascular zone circularity and parafoveal vessel density were compared between groups (Kruskal-Wallis) and their correlation was calculated with Spearman's Rho test. RESULTS: Seventy-seven eyes; central vessel density mean was higher in Group 1 than in Group 2 and higher in Group 2 than in Group 3; inner and complete vessel density means were also higher in Group 2 than in Group 3. The mean of the foveal avascular zone circularity did not differ between groups, and in Group 3 it had a positive correlation with central (0.45), inner (0.56), and complete (0.53) vessel densities. CONCLUSIONS: Circularity does not differ between subjects with diabetes, with and without retinopathy, and has only a low correlation with parafoveal vessel density in people with diabetic retinopathy, which does not allow anticipating a reduction of vessel density in this disease.

OBJETIVO: Caracterizar la distribución de la circularidad de la zona avascular foveal y su correlación con la densidad vascular perifoveal, en sujetos con y sin diabetes. MÉTODO: Estudio observacional, descriptivo, transversal y prospectivo; se incluyeron sujetos sin diabetes (Grupo 1), con diabetes sin retinopatía (Grupo 2) y con retinopatía diabética (Grupo 3). Los promedios de circularidad de la zona avascular foveal y de la densidad vascular parafoveal se compararon entre grupos (Kruskal-Wallis), y se calculó su correlación mediante la prueba Rho de Spearman. RESULTADOS: Se estudiaron 77 ojos. El promedio de la densidad vascular central fue mayor en el Grupo 1 que en el Grupo 2, y mayor en el Grupo 2 que en el Grupo 3. Los promedios de la densidad vascular interna y completa también fueron mayores en el Grupo 2 que en el Grupo 3. El promedio de la circularidad de la zona avascular foveal no difirió entre grupos, y en el Grupo 3 tuvo una correlación positiva con la densidad vascular central (0.45), interna (0.56) y completa (0.53). CONCLUSIONES: La circularidad no difiere entre sujetos con y sin diabetes, con y sin retinopatía, y solo tiene una baja correlación con la densidad vascular parafoveal en sujetos con retinopatía diabética, lo cual no permite anticipar una reducción de la densidad vascular en esta enfermedad.

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Purpose: The purpose of this study was to assess projection-resolved optical coherence tomography angiography (PR-OCTA) vessel density (VD) and foveal avascular zone (FAZ) in determining severity within diabetic retinopathy (DR) and their accuracy in identifying high-risk DR patients. Methods: This was a retrospective study with 72 eyes of 52 DR patients, assessing the VD and FAZ area of the superficial capillary plexus (SCP) and deep vascular plexus (DVP), for both 3 × 3-mm and 6 × 6-mm scans between the DR groups (mild to moderate, severe and proliferative DR [PDR]). For accuracy, the severe and PDR groups were merged, representing the high-risk DR group for receiver operator characteristic analysis. VD of OCTA images with and without PR were compared. Results: In mild to moderate, severe, and PDR groups, there were 31, 21, and 20 eyes, respectively. PR-OCTA improved VD analysis only in the DVP and particularly in advanced DR stages (P = 0.042). In the 3 × 3-mm PR scans, all superficial and deep parameters were significantly different between severe and PDR groups (P ≤ 0.020), but only the mean VD of SCP and DVP was also significant between the mild to moderate and severe groups (P ≤ 0.007). In the 6 × 6-mm scans, the superficial VD, deep VD, and superficial FAZ were significantly different between the severe and PDR groups (P ≤ 0.029). The superficial VD and deep VD of the 3 × 3-mm scans were good parameters for detecting high-risk patients (area under the curve = 0.829 and 0.895, respectively). Conclusions: PR-OCTA improved VD analysis of DVP. The 3 × 3-mm SCP and DVP VD were the most accurate in detecting high-risk DR.

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BACKGROUND: Visual improvement after photocoagulation in focal diabetic macular edema is more frequent when temporal perifoveal area is not affected; functional status before treatment could be worse in eyes with perifoveal temporal thickening. The correlation between visual acuity and foveal sensitivity (usually significant), would allow to compare macular function. OBJECTIVE: To compare the correlation between retinal sensitivity and visual acuity in eyes with diabetic macular edema, with and without temporal perifoveal thickening. METHOD: Non-experimental, retrospective, comparative, cross-sectional study in type 2 diabetics with macular edema. The correlation between foveal sensitivity and visual acuity was compared in eyes without temporal perifoveal thickening (group 1) and eyes with it (group 2). Multiple regression analysis was used to identify the contribution of foveal sensitivity to the changes of visual acuity; other variables were: center point thickness, center field thickness, temporal perifoveal thickness and macular volume. RESULTS: 60 eyes in group 1, 29 eyes in group 2. Mean sensitivity did no differ between groups (30.0 ± 0.59 vs. 28.4 ± 1.05 dB; p = 0.2), but the correlation between sensitivity and visual acuity did it (group 1, rho: -0.41; group 2, rho: -0.25). In group 1, foveal sensitivity was the only explaining variable of the regression model (beta: -0.52), in group 2 no one explaining variable was included and temporal perifoveal thickness had a negative correlation with foveal sensitivity (rho: -0.60). CONCLUSIONS: Temporal perifoveal thickening reduces the correlation between foveal sensitivity and visual acuity in eyes with diabetic macular edema.

OBJETIVO: Comparar la correlación entre la sensibilidad foveal y la agudeza visual en ojos con edema macular diabético, con y sin engrosamiento temporal perifoveal, característica asociada con mala respuesta terapéutica. MÉTODO: Estudio observacional, prospectivo, comparativo, transversal, en diabéticos con edema macular. Se comparó la correlación entre la sensibilidad foveal y la agudeza visual entre ojos sin (grupo 1) y con (grupo 2) engrosamiento temporal perifoveal (Rho de Spearman). Mediante regresión múltiple se determinó la contribución de la sensibilidad a los cambios de agudeza visual. Se evaluaron también los grosores del punto central y temporal perifoveal, y el volumen macular. RESULTADOS: 60 ojos del grupo 1, 29 ojos del grupo 2. El promedio de sensibilidad no difirió entre grupos (30.0 ± 0.59 vs. 28.4 ± 1.05 dB; p = 0.2), pero la correlación entre sensibilidad y agudeza visual sí (grupo 1, rho: −0.41; grupo 2, rho: −0.25). En el grupo 1, la sensibilidad fue la variable explicativa de la agudeza visual (beta: −0.52); en el grupo 2, ninguna variable se incluyó en el modelo y el grosor temporal perifoveal correlacionó inversamente con la sensibilidad (rho: −0.60). CONCLUSIONES: el engrosamiento temporal perifoveal reduce la correlación entre la agudeza visual y la sensibilidad foveal en ojos con edema macular diabético.

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PURPOSE: To compare choroidal thickness (CT) measurements in preeclamptic and healthy women in the third trimester of pregnancy using optical coherence tomography. METHODS: This cross-sectional study included 148 eyes of 74 women, divided into two groups: 27 healthy pregnant women in the third trimester (control group) and 47 age-matched pregnant women in the third trimester with preeclampsia (PE group). Of the 47 subjects in preeclampsia group, 26 were classified as having mild PE and 21 as having severe PE. Choroidal thickness was measured at ten different locations: at the fovea and every 500 µm from the fovea up to 2500 µm temporally and up to 2000 µm nasally. RESULTS: Comparing CT of both groups, choroid always tended to be thicker in subjects with preeclampsia in comparison with healthy pregnant women, with statistical significance in nasal measures. Dividing PE group according to disease severity, women with severe preeclampsia tended to have thicker choroids in comparison with mild preeclamptic and healthy pregnant women. Choroid was also significantly thicker in preeclamptic patients with serous retinal detachment (SRD) in comparison with preeclamptic patients without SRD (P < 0.01 in all macular points). CONCLUSION: Our study showed that choroid tends to be thicker in patients with preeclampsia, with statistical significance only in nasal measures. In patients with SRD, however, choroid is markedly thicker at all points analyzed. From these findings we can hypothesize that preeclampsia can cause a choroidal thickening, which begins in the peripapillary area. As the imbalance increases, the entire choroid becomes thickened.

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During the routine ophthalmologic examination of a 38-day old female infant, indirect ophthalmoscopy revealed a dense hemorrhage on the fovea and a couple of superficial hemorrhages in the nasal retina of the left eye. No hemorrhage was observed in the right eye. A hand-held spectral domain optical coherence tomography (SD-OCT) was used at the time of diagnosis. The hemorrhage at the nasal retina resolved in the first week of follow-up, and the foveal hemorrhage resolved 12 weeks after birth. Spectral domain optical coherence tomography was repeated once the foveal hemorrhage had resorbed, and it showed that the foveal contour had reformed without any sequelae. This case suggests that birth-related foveal hemorrhages do not cause any disturbance in the foveal architecture.

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