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      An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management

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          Abstract

          Inflammatory choroidal neovascular membranes are challenging to diagnose and manage. A number of uveitic entities may be complicated by the development of choroidal neovascularization leading to a decrease in central visual acuity. In conditions such as punctate inner choroidopathy, development of choroidal neovascularization is extremely common and must be suspected in all cases. On the other hand, in patients with conditions such as serpiginous choroiditis, and multifocal choroiditis, it may be difficult to differentiate between inflammatory choroiditis lesions and choroidal neovascularization. Multimodal imaging analysis, including the recently introduced technology of optical coherence tomography angiography, greatly aid in the diagnosis and management of inflammatory choroidal neovascularization. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy.

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          A review of optical coherence tomography angiography (OCTA)

          Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.
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            Intraocular tuberculosis--an update.

            The lack of any uniform diagnostic criteria for intraocular tuberculosis, in either immunocompetent or immunocompromised individuals, has contributed to the confusion regarding diagnosis and management. However, recent studies addressing the clinical significance of purified protein derivative test results, computerized tomography of the chest, and molecular diagnostic procedures have provided a new approach to establishing the diagnosis of ocular tuberculosis. The current review focuses on the diagnostic modalities used for the clinical management of intraocular tuberculosis, with the emphasis on diagnostic criteria, various clinical features, and treatments recommended in recent publications. Furthermore, the current review addresses the diagnostic criteria for intraocular tuberculosis, the spectrum of tuberculosis in patients with AIDS and in those on anti-tumor necrosis factor agents, and management of drug-resistant tuberculosis.
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              Optical coherence tomography: imaging of the choroid and beyond.

              Seventy percent of the blood flow to the eye goes to the choroid, a structure that is vitally important to the function of the retina. The in vivo structure of the choroid in health and disease is incompletely visualized with traditional imaging modalities, including indocyanine green angiography, ultrasonography, and spectral domain optical coherence tomography (OCT). Use of new OCT modalities, including enhanced depth imaging OCT, image averaging, and swept-source OCT, have led to increased visualization of the choroidal anatomy. The correlation of these new anatomical findings with other imaging modalities results increases understanding of many eye diseases and recognises of new ones. The status of the choroid appears to be a crucial determinant in the pathogenesis of diseases such as age-related choroidal atrophy, myopic chorioretinal atrophy, central serous chorioretinopathy, chorioretinal inflammatory diseases, and tumors. Extension of these imaging techniques has provided insights into abnormalities of the sclera and optic nerve. Future developments will include blood flow information, 3D rendering of various ocular structures, and the ability to evaluate changes in 3D structural information over time (4D imaging). Copyright © 2013 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                + 91 172 275 6111 , vishalisara@yahoo.co.in
                Journal
                J Ophthalmic Inflamm Infect
                J Ophthalmic Inflamm Infect
                Journal of Ophthalmic Inflammation and Infection
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1869-5760
                12 September 2018
                12 September 2018
                2018
                : 8
                : 13
                Affiliations
                [1 ]ISNI 0000 0004 1767 2903, GRID grid.415131.3, Advanced Eye Center, Department of Ophthalmology, , Postgraduate Institute of Medical Education and Research (PGIMER), ; Sector 12, Chandigarh, 160012 India
                [2 ]Eye Clinic, Department of Biomedical and Clinical Science “L. Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy
                [3 ]ISNI 000000041936754X, GRID grid.38142.3c, Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, , Harvard Medical School, ; Boston, MA USA
                [4 ]GRID grid.240988.f, National Healthcare Group Eye Institute, , Tan Tock Seng Hospital, ; Singapore, Singapore
                [5 ]ISNI 0000 0000 9168 0080, GRID grid.436474.6, Moorfields Eye Hospital, NHS Foundation Trust, ; London, UK
                [6 ]ISNI 0000 0001 0706 4670, GRID grid.272555.2, Singapore Eye Research Institute, ; Singapore, Singapore
                Article
                155
                10.1186/s12348-018-0155-6
                6135736
                30209691
                8323871e-e6d0-438e-977c-fc115b60afa7
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 4 January 2018
                : 4 September 2018
                Categories
                Review
                Custom metadata
                © The Author(s) 2018

                Ophthalmology & Optometry
                inflammatory choroidal neovascularization,uveitis,posterior uveitis,choroiditis,indocyanine green angiography,fluorescein angiography,optical coherence tomography angiography,edi-oct

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