Purpose: To report a case of bilateral Choroidal osteoma with SRNM in a young female.Methods and Material: A 19 years old female presented with decreased visual acuity in the left eye. In funds examinational peripapillary: subretinal yellow-orange tumor was fund in both eyes. We found subretinal hemorrhage in left eye.Result: Echography showed typical findings usually described for Choroidal osteoma in both eyes which are pseudo-optic nerve appearance in B Scan and high reflectively in A Scan. There was an ill-defined SRNM on fluoresecin angiography and rediopaqe density on C.T. Scan.Conclusion: Choroidal osteoma is an exceedingly rare tumor which usually involves unilaterally and has a female predilection. It usually has a minimal tendency for growth and qccasionally has Neovascularization.This case was especially exceptional due to its bilaterally, its large size in one affected eye, and its Neovascular characteristics.

Purpose: To report the imaging characteristics of various clinical features in idiopathic macular telangiectasia (MacTel 2) on multicolor imaging (MCI) and compare its accuracy vis‑ à ‑ vis color fundus photograph (CFP) and fluorescein angiography (FA). Methods: In this retrospective observational study, 54 eyes of 27 patients with MacTel 2 were included after institutional review board approval. Multimodal imaging with CFP, optical coherence tomography (OCT), MCI, and FA was done. Images were analyzed to identify and describe the clinical findings in MacTel 2. Sensitivity, specificity, and positive and negative predictive values were computed for the various imaging modalities in MacTel 2. Results: In this study, the MCI identified all the different clinical features of MacTel 2 in 100% of cases. The confocal blue reflectance (BR) image was more sensitive than CFP (100% vs. 96. 3%) in identifying the loss of retinal transparency in MacTel 2. For other clinical features such as right‑ angled vessels, superficial retinal crystals, and retinal pigment epithelial hyperplasia/plaques, the sensitivity of BR, and green reflectance (GR) image, was comparable to that of CFP. Confocal infrared reflectance (IR) images showed poor sensitivity in identifying the non-proliferative features in MacTel 2 (P < 0. 001). Loss of retinal transparency was not picked up on IR image. Other features such as right‑ angled vessels, superficial retinal crystals, and pigment plaques were seen in 20%, 4. 6%, and 26. 3% of cases, respectively. However, confocal IR images were superior to FA (100% vs. 47%) and CFP (100% vs. 15%) in identifying the extent and location of subretinal Neovascular Membrane. The confocal BR and GR images were unable to identify the Choroidal Neovascular Membrane (P < 0. 001). Conclusion: MCI is a useful and non-invasive imaging modality to identify the clinical features in MacTel 2. MCI can be used as a complementary imaging tool to CFP, FA, and OCT.

Introduction: Age-related Macular Degeneration (AMD) is one of the most important causes of irreversible blindness in the developed world and prevents the affected person from performing simple tasks such as reading, driving and facial recognition. In the AMD, new blood vessels grow underneath the retina in a process called Choroidal Neovascularisation (CNV). There is much interest in the quantification of the angiographic features of CNV, as these parameters are used as markers for monitoring the response to CNV treatment. To date, the techniques used in angiographic analysis are based on subjective interpretation by experienced clinicians. The goal of the present study was to propose an automatic algorithm for determining the extent of CNV.Materials and Methods: The proposed algorithm was used to analyze indocyanine angiograms of 12 patients with CNV. The angiograms were acquired by a confocal scanning laser ophthalmoscope. The algorithm included an adaptive Wiener filtering technique, a top-hat morphology method and a new thresholding technique based on a modification of Otsu’s method. The area of each lesion was obtained and compared with a subjective evaluation of CNV. Finally, each area was expressed in square millimeters by making a cylindrical tube filled with indocyanine green.Results: The CNV area was determined by the proposed algorithm and an observer. No significant differences were observed between the two data sets (p>0.05).Discussion and conclusion: This study demonstrates that the proposed algorithm based on a modification of Otsu’s method can be used to measure the area of CNV.

Purpose: To present a documented case of development of focal Choroidal excavation (FCE) in non-Neovascular age related macular degeneration (AMD). Methods: An 86-year-old female with pachy-choroid was followed clinically for non-Neovascular AMD. Successive optical coherence tomography (OCT) scans were reviewed with tracking software. Results: Over the course of follow-up development of a FCE adjacent to a pachy-vessel along with disappearance of the pachy-vessel was documented in OCT. Conclusions: This case is a documented development of FCE in an eye with pachy-choroid features. The possible mechanism in this scenario may be thrombosis of pachy-vessels.

Inflammatory Choroidal Neovascularization (iCNV) is an infrequent but an important cause of visual morbidity in patients with non-infectious uveitis and mostly occurs in intermediate or posterior uveitis. Punctate inner choroiditis, Vogt-Koyanagi-Harada disease and multifocal choroiditis are among the leading causes of uveitis entities resulting in iCNVs. The diagnosis and management of iCNVs still remain a challenge. Use of multimodal imaging techniques such as fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT) and OCT-angiography may be necessary for the diagnosis of iCNVs. The treatment algorithm is not straightforward for iCNV. While control of the active inflammation with steroids and/or immunosuppressive agents is a key to success, various adjunctive treatment modalities such as thermal laser photocoagulation, photodynamic therapy and surgical Membrane removal were also co-administered previously. Nowadays, vascular endothelial growth factor (VEGF) inhibitors have become the most commonly administered adjunctive treatment option as they provide better anatomical and functional outcome and the recurrence rate of CNV is relatively low. We hereby reviewed important clinical studies and case series on anti-VEGF administration in iCNVs and briefly overviewed their results...

Purpose: To present a case of gigantic idiopathic angioid streaks. Case Report: A young male presented with macular Choroidal Neovascular Membrane (CNVM) and peripheral retinal hemorrhages secondary to angioid streaks. Swept source optical coherence tomography (SSOCT) and ultrawide field imaging were performed. The latter revealed extension of the angioid streaks up to the equator in both eyes. SSOCT showed breaks in the retinal pigment epithelium-Bruch’ s Membrane complex in the area of peripheral retinal hemorrhages. The patient was extensively worked up for systemic associations, and the only significant finding was a long history of steroid abuse in the past. Conclusion: Advanced imaging techniques helped to diagnose angioid streaks in this patient. The possible role of steroid abuse in accentuating the presentation of angioid streaks may be explored further.

Background: Optical coherence tomography angiography (OCTA) is an advanced imaging modality that provides high resolution images at the level of different retinal layers. This study aime to evaluate Choroidal Neovascular Membranes (CNVMs) secondary to age-related macular degeneration (AMD) quantitatively and qualitatively, according to their classification, morphological features, and flow areas, using OCTA. Methods: In this descriptive, comparative, cross-sectional study, CNVMs were divided into 2 groups according to their classification as type 1 or type 2 Neovascularization. Mixed CNVMs were excluded from the study. The size (mm2) and the flow area (mm2) of the CNVMs were calculated via OCTA and the presence of the perivascular halo and loop anastomoses were analyzed. The morphological appearance of the CNVMs were classified as: medusa, sea-fan, lacy-wheel, glomerular, dead tree, and mature vascular networks. Results: Of the 85 eyes assessed for eligibility, 45 eyes of 34 individuals with CNVM were enrolled in this retrospective study. Twenty-eight eyes had type 1 and 17 eyes had type 2 CNVMs. The mean size and flow area were greater in type 1 than in type 2 CNVMs (mean ± standard deviation [SD], 6. 69 ± 4. 54 and 3. 61 ± 3. 56 mm2 versus 3. 04 ± 1. 98 and 1. 77 ± 1. 62 mm2; P = 0. 044 and 0. 046, respectively). Among the 22 eyes with type 1 CNVMs and the 9 eyes with type 2 CNVMs, 31 eyes had exudative Membranes. Among the eyes with exudative CNVMs, 22 eyes had a perivascular halo and 22 eyes had loop anastomoses; this was significantly more than in the non-exudative eyes (P = 0. 042 and 0. 041, respectively). The lacy-wheel (38. 7%) and dead tree (71. 4%) patterns were the most frequent morphological appearance of the CNVMs in the exudative and non-exudative Membranes, respectively. Conclusions: OCTA provides objective documantation about CNVMs. A perivascular dark halo around CNVMs could be a criterion to define exudative Membranes activity.

Purpose: To compare the outcomes of photodynamic therapy (PDT) combined with intravitreal bevacizumab (IVB) with versus without intravitreal triamcinolone (IVT) in Neovascular age‑related macular degeneration (AMD).Methods: Eighty-four eyes with active CNV secondary to AMD with no prior treatment were enrolled and followed for 1-year. Eligible eyes were randomly assigned to either PDT/IVB or PDT/IVB/IVT. The main outcome measure was change in best-corrected visual acuity (BCVA).Results: Mean patient age was 71 ± 9 years. BCVA changes from baseline were statistically significant in both study arms at all follow‑p intervals, however no significant difference was observed between the two groups regarding BCVA changes at week 12 (95% CI: -.11-.12 LogMAR) and other time points (all P>0.6). Mixed model analysis revealed a significant effect from age (P<0.001), pigment epithelial detachment (P=0.009) and baseline BCVA (P<0.001) on visual improvement. Significant central macular thickness (CMT) reduction occurred at all‑time points as compared to baseline in both groups which was comparable between the study arms. There was no significant difference between the study arms in terms of retreatment rate (P=0.1) and survival to the first repeat IVB injection (P=0.065).Conclusion: Additional low-dose IVT to a PDT/IVB regimen for Neovascular AMD provided no beneficial effects in terms BCVA or CMT, yet demonstrated a trend toward extending the injection‑free period.

Backgrond: Hemorrhagic Choroidal Neovascularization in patients with age-related macular degeneration (AMD) is a serious complication that if left untreated may cause severe consequences in patients’ visual acuity. Although there is not a standard treatment for this condition, intravitreal tissue plasminogen activator (t-PA) with gas is a classic and highly enthusiastic approach. Using this treatment, however, may become in vain in long term because of the progression of the underlying pathology. So, some authors have proposed using anti-vascular endothelial growth factor (anti-VEGF) agents such as Avastin in these patients. The aim of this study is to compare outcomes of treatment with intravitreal t-PA or t-PA plus Avastin.Materials and Methods: A total of 43 patients with AMD-related hemorrhagic Choroidal Neovascularization were randomized in two groups, receiving either intravitreal 1.25 Avastin (n=21) or intravitreal 1.25 Avastin plus 50 microgram t-PA (n=22). Visual acuity (using LogMar) and central macular thickness were measured at months 2 and 6 post-treatment and compared between the two groups.Findings: Thirteen males and 9 females with the median age of 74 years (combined treatment group) were compared with 12 males and 9 females with the median age of 73 years (single treatment group) (p=0.89 and 0.81, respectively).Median percent changes in visual acuity were 4.3% decrease in the combined treatment group and 8.6% in the single treatment group at month 2 and 10% in both groups at month 6. Visual acuity ameliorated significantly in both groups 6 months after treatment, but there was no significant difference between the two groups in this regard (p=0.93 and p=0.96 at months 2 and 6 post-treatment). Median percent changes in central macular thickness were 16.9% decrease in the combined treatment group and 16.8% in the single treatment group at month 2 and 19.1% in combined treatment and 18.2% in single treatment group at month 6. Central macular thickness decreased significantly in both groups 6 months after treatment, but again there was no significant difference between the two groups in this regard (p=0.97 and p=0.79 at months 2 and 6 post-treatment).Conclusion: Both therapeutic approaches were effective in treating AMD-related hemorrhagic Choroidal Neovascularization after six months, but there was no significant difference between the two methods in this regard.