ObjectiveTo observe and analyze the image characteristics of eyes with choroidal osteoma using swept-source OCT (SS-OCT).MethodsSeventy-three eyes of 61 patients with choroidal osteoma were enrolled in the study, including 17 males (20 eyes) and 44 females (53 eyes) with an average age of 33.5±12.7 years. Single tumor was found in 71 eyes and multiple tumors were found in 2 eyes. All patients received examinations of slit lamp ophthalmoscope, color fundus photography, fundus autofluorescence, fluorescein angiography and/or indocyanine green angiography, B-scan ultrasonography and/or computerized tomography. Tumor features were characterized using SS-OCT.ResultsAmong 75 tumors of 73 eyes, the osteoma was completely calcified in 7 tumors, completely decalcified in 5 tumors and all the other tumors were composed of calcified and decalcified portions. SS-OCT revealed normal inner retina in all the calcified areas of tumors and abnormal outer retina including external limiting membrane, ellipsoid zone, interdigitation zone and RPE in some cases. Whereas the outer retina and RPE showed abnormality in the decalcified areas of all cases. The choriocapillaris was invisible in all cases and most of the medium and large caliber vessels showed thinning or nonvisibility. Choroidal osteoma revealed a sponge-like appearance (n=39), loofah sponge appearance (n=11), lamellar pattern (n=10), mixed (n=12) and irregular patterns (n=5). Other unique features included horizontal lamellar lines (n=71), hyperreflective horizontal lines (n=47) and hyporeflective tubules (horizontal:n=39, vertical:n=42, circular:n=41) within choroidal osteoma. Hyperreflective tumor-like tissues were also detected above the disrupted Bruch’s membrane. The sclero-choroidal junction was detectable in all tumors and a posterior ciliary vessel penetrating the sclera was also seen.ConclusionsSS-OCT clearly reveals characteristic appearances of choroidal osteoma as sponge-like, loofah sponge, lamellar pattern, mixed and irregular patterns, with unique features of horizontal lamellar lines, hyperreflective horizontal lines and hyporeflective tubules within osteoma. Hyperreflective tumor-like tissues were detected to grow above the disrupted Bruch’s membrane.
ObjectiveTo observe the clinical and multimodal imaging features of eyes with acute macular neuroretinopathy (AMN) associated with the coronavirus disease 2019 (COVID-19). MethodsA retrospective study. From December 20, 2022 to January 17, 2023, a total of 29 patients (58 eyes) with COVID-19-associated AMN admitted to Department of Ophthalmology of Eye and ENT Hospital, Shanghai Medical College were included in the study. All the affected eyes underwent the best corrected visual acuity, color fundus photography, infrared fundus photography (IR), short-wavelength autofluorescence (SW-AF), near-infrared autofluorescence (NIL-AF), optical coherence tomography (OCT), and OCT angiography (OCTA). All patients were administered microcirculation-improving oral medication with 12 cases receiving adjunctive low-dose corticosteroid therapy. Follow-ups were conducted 1 to 3 months after the initial diagnosis, with a total of 19 cases (38 eyes) completing the one-month follow-up. ResultsOut of the 29 cases, there were 9 males (18 eyes) and 20 females (40 eyes), all of whom experienced bilateral eye involvement. The age of the patients ranged from 12 to 47 years, with an average age of (29.9±9.5) years. The time from the onset of fever to the appearance of ocular symptoms was (2.52±2.01) days. Among the 58 affected eyes, there were 5 cases with retinal cotton wool spots, 2 cases with optic disc edema, and 1 case with parafoveal branch retinal vein occlusion. All affected eyes exhibited deep reddish-brown macular dark spots. IR revealed wedge-shaped, wedge-like, or "petaloid-like" dark areas involving the fovea and parafovea. SW-AF examination showed no obvious abnormality in 39 eyes. Weak autofluorescence dark area were consistent with IR in 19 eyes. NIR-AF examination showed spot-like or flaky self-fluorescent dark areas. OCT examination showed strong reflex lesions spreading vertically upward from the retinal pigment epithelium (RPE) layer in the macular area in the acute stage, showing typical "bean seedling" sign. OCTA revealed reduced blood flow density in the deep capillary plexus (DCP) of 50 eyes. En-face OCT displayed lesion areas that corresponded to the dark areas seen in IR. One month after the initial diagnosis, the condition improved in 18 eyes (47.4%, 18/38). Among the 5 eyes with cotton wool spots, regression of these spots was accompanied by loss of nerve fiber layer in 4 eyes. In cases with optic disc edema, the edema subsided. The "bean sprout" sign disappeared in all affected eyes, and the lesions became localized. The ellipsoid zone and/or interdigitation zone in the lesion areas were discontinuous. ConclusionsCOVID-19-related AMN is characterized by distinctive features. IR fundus reveals wedge-shaped, wedge-like, or petaloid dark areas involving the fovea and parafovea. OCT displays strongly reflective lesions with vertical spread above the RPE. OCTA shows reduced blood flow density in the DCP of the retina.