Search Results (45)

Background/Objectives: Granulomatous uveitis comprises a clinically heterogeneous group of inflammatory disorders, including ocular sarcoidosis, Vogt–Koyanagi–Harada disease, sympathetic ophthalmia, tuberculosis-associated uveitis, and syphilitic uveitis. Because these entities may share overlapping posterior segment findings, clinical examination alone is often insufficient for differential diagnosis, particularly when choroidal, retinal, or retinal vascular involvement predominates. Methods: This review provides a clinically oriented overview of multimodal imaging in granulomatous uveitis, including optical coherence tomography (OCT), enhanced-depth imaging OCT, swept-source OCT, OCT angiography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and ultrawidefield imaging. Results: Emphasis is placed on imaging patterns that help localize the predominant anatomic compartment of inflammation, distinguish major etiologies, identify diagnostic pitfalls, and assess disease activity over time. By integrating current evidence with representative multimodal imaging findings, we propose an anatomic and decision-oriented framework for interpreting granulomatous posterior segment inflammation. Conclusions: Particular attention is given to the distinction between active inflammation and irreversible structural damage, as this distinction may influence treatment escalation or tapering, timing of elective surgery, local corticosteroid therapy, and the need for diagnostic sampling in infectious or masquerade-like presentations. Full article

Background: Multiple evanescent white dot syndrome (MEWDS) is usually acute and self-limited, whereas multifocal choroiditis (MFC)/punctate inner choroidopathy (PIC) is relapsing; overlap can obscure early diagnosis and requires longitudinal multimodal imaging. Methods: We report a 4-year follow-up of a 31-year-old woman with fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT), plus a systemic/neurologic/rheumatologic work-up. Treatment included intravenous methylprednisolone for presumed optic neuritis, followed by topical, periocular, intravitreal, and systemic corticosteroids, later escalated to adalimumab and an intravitreal dexamethasone implant. Because foveal granularity could not be documented, baseline was termed “MEWDS-like”. Diagnostic labelling was benchmarked against Standardization of Uveitis Nomenclature (SUN) criteria, and choroidal neovascularization (CNV) was assessed at each relapse by OCT and FA. Results: The right eye initially showed a MEWDS-like pattern with wreath-like FA lesions and disc leakage, hyperautofluorescent FAF lesions, focal ellipsoid zone disruption on SD-OCT, and multifocal ICGA hypofluorescent spots. A relapse at 6 months with peripapillary inflammatory foci and recurrent cystoid macular edema supported reclassification to a unilateral MFC/PIC-spectrum phenotype. At 2 years, the fellow eye developed mild vitritis, peripapillary hyperautofluorescence, peripapillary/arcade leakage on FA, delayed peripapillary filling on ICGA, and cystoid macular edema, establishing sequential bilateral MFC; no CNV developed and anti-vascular endothelial growth factor (anti-VEGF) therapy was not required. Complications included steroid-induced ocular hypertension and cataract surgery. Conclusions: The purpose of this report is to highlight longitudinal imaging “red flags” that supported reclassification from a MEWDS-like phenotype to a sequential bilateral MFC/PIC-spectrum disease. Full article

Diabetes mellitus (DM) is a debilitating chronic disorder that results in ocular microvascular complications, including diabetic retinopathy (DR) and diabetic macular edema (DME). Early detection and timely intervention for DR and DME are crucial for improving visual outcomes in affected patients. Ophthalmic imaging plays a vital role in the screening, diagnosis, and management of DR and DME. In this review, a comprehensive overview of the imaging modalities frequently utilized in the assessment of DR and DME, encompassing both structural and functional imaging techniques are presented. The key imaging findings that are associated with the various stages of DR and DME are underscored and their diagnostic utility in assessing disease progression and visual function are evaluated. Additionally, we discuss emerging imaging biomarkers that are currently under investigation, which hold significant potential for improving the diagnostic and prognostic capabilities of imaging for DR and DME patients. Finally, the advent of new imaging methods, such as ultrawide-field imaging (UWFI) and deep learning models, which have markedly improved the detection of retinal pathologies are considered. Full article

Syphilis is a systemic infection with a broad spectrum of ocular involvement that can affect every segment of the eye. Clinical presentations range from interstitial keratitis, conjunctivitis, episcleritis, and scleritis to anterior, intermediate, and posterior uveitis; acute syphilitic posterior placoid chorioretinitis; retinitis; retinal vasculitis; neuroretinitis; optic neuritis; exudative retinal detachment; and optic nerve dysfunction. These manifestations may occur at any stage of infection and are frequently nonspecific, contributing to diagnostic delays. Diagnosis requires a high index of suspicion and is established by combined non-treponemal and treponemal serologic testing, with cerebrospinal fluid analysis when neurosyphilis is suspected. Multimodal imaging, including optical coherence tomography, fluorescein angiography, fundus autofluorescence, and visual field testing, enhances the detection of subclinical and atypical diseases. Management mandates prompt intravenous penicillin G, with adjunctive corticosteroids to mitigate Jarisch–Herxheimer reactions and control inflammation; ceftriaxone or doxycycline serve as alternatives for penicillin-allergic patients. Long-term follow-up with serial serologies and neurologic evaluation is essential to detect relapse or progression to neurosyphilis. Despite effective therapy, diagnostic delays contribute to irreversible visual loss in a significant proportion of cases. This review integrates current knowledge on ocular syphilis, emphasizing its varied presentations and the importance of early recognition to prevent vision-threatening complications, and calls for multidisciplinary, mechanism-based research to optimize outcomes. We conducted a literature search in Pubmed and Embase for articles published between 2000 and 2025, using the terms “ocular syphilis,” “syphilitic uveitis,” and “neurosyphilis,” with a focus on epidemiology, clinical features, diagnostics, therapeutics, and co-infections. Full article

Maximal safe surgical resection remains a critical component of glioblastoma (GBM) management, improving both survival and quality of life. However, complete tumor removal is hindered by the infiltrative nature of GBM and its proximity to eloquent brain regions. Fluorescence-guided surgery (FGS) has emerged as a valuable tool to enhance intraoperative tumor visualization and optimize resection outcomes. Currently used fluorophores such as 5-aminolevulinic acid (5-ALA), fluorescein sodium (FS), and indocyanine green (ICG) have distinct advantages but are limited by suboptimal specificity, shallow tissue penetration, and technical constraints. 5-ALA and SF often yield unreliable signals in low-grade tumors or infiltrative regions and also pose challenges such as phototoxicity and poor depth resolution. In contrast, near-infrared (NIR) fluorescence imaging represents a promising next-generation approach, providing superior tissue penetration, reduced autofluorescence, and real-time delineation of tumor margins. This review explores the mechanisms, clinical applications, and limitations of currently approved FGS agents and highlights future directions in image-guided neurosurgery. Full article

Stem cell therapy has emerged as a promising approach for treating various retinal diseases, particularly degenerative retinal diseases such as geographic atrophy in age-related macular degeneration (AMD), retinitis pigmentosa (RP), and Stargardt disease. A wide variety of imaging techniques have been employed in both preclinical and clinical settings to assess the efficacy and safety of stem cell therapy for retinal diseases. These techniques can be classified into two categories: methods for imaging stem cells and those for the overall morphology and function of the retina. The techniques employed for stem cell imaging include optical imaging, magnetic resonance imaging (MRI), and radionuclide imaging. Additional imaging techniques include fundus photography, fluorescein angiography, and fundus autofluorescence. Each technique has its own advantages and disadvantages, and thus, the use of multimodal imaging can help to overcome the shortcomings and achieve a more comprehensive evaluation of stem cell therapy in retinal disease. This review discusses the characteristics of the main techniques and cell-labeling techniques applied in stem cell therapy, with a particular focus on the applications of multimodal imaging. Furthermore, this review discusses the challenges and prospects of multimodal imaging in stem cell therapy for retinal disease. Full article

Macular Telangiectasia (MacTel) is a rare retinal vascular disorder, with Type 3a MacTel being a distinct form characterized by retinal ischemia with the classical findings of MacTel, such as juxtafoveal telangiectasis, right-angled venules, and deep capillary plexus involvement without central nervous system findings. This case presents a novel X-shaped lesion pattern and ischemic features, expanding the known imaging spectrum of MacTel. A 53-year-old male with diabetes and a history of aripiprazole use presented with persistent blurred vision, a black curtain sensation, and metamorphopsia in the right eye. Visual acuity was 0.8 in the right eye and 1.0 in the left. A multimodal imaging approach, including fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FFA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA), was used to evaluate structural and vascular abnormalities. Fundus examination revealed an X-shaped hypopigmented lesion with central pigmentation. FAF showed hypoautofluorescence, indicating chronic RPE loss, and no loss of foveal autofluorescence was observed. FFA demonstrated progressive hyperfluorescence with perifoveal aneurysmal and telangiectatic vessels, along with a slightly enlarged foveal avascular zone (FAZ), suggesting ischemic involvement. OCT revealed intraretinal cysts, a disruption of the ellipsoid zone and external limiting membrane, pigment epithelial detachment, and increased choroidal backscattering. OCTA confirmed right-angled venules, aneurysmal telangiectatic vessels, and localized ischemia predominantly affecting the deep capillary plexus. This case highlights a rare variant of Type 3a MacTel with a unique X-shaped lesion. The presence of juxtafoveal telangiectasis, vascular occlusion, right-angled venules, and deep capillary plexus changes supports the diagnosis. Multimodal imaging played a critical role in characterizing the disease and differentiating it from other macular disorders, contributing to an expanded understanding of the clinical and imaging spectrum of MacTel. Full article

Background/Objectives: To investigate the role of multimodal imaging, including ultra-widefield fundus autofluorescence (UWFAF), in diagnosing and monitoring syphilitic chorioretinitis, focusing on the detection of placoid appearance and white dots/spots. We aim to classify syphilitic chorioretinitis as a white dot syndrome, given evident features in the context of recent case reports and previously unavailable multimodal imaging. Methods: This single-institution study was conducted as a consecutive, observational case series. Five eyes from three patients were diagnosed with syphilitic chorioretinitis using multimodal imaging, including ultra-widefield pseudocolor fundus photography and intravenous fluorescein angiography, UWFAF, and swept-source optical coherence tomography, upon laboratory results. Results: In all five eyes with serologically confirmed syphilitic chorioretinitis, UWFAF revealed hyperautofluorescent white dots and spots scattered in the fundus, a finding minimally apparent with fluorescein angiography. Two eyes did not show evidence of classic placoid lesions. The hyperautofluorescence resolved after standard neurosyphilis treatment with intravenous course of penicillin. Conclusions: The presence of dots and spots identified through UWFAF may indicate syphilitic chorioretinitis and support its classification as a white dot syndrome. Based on the presence of hyperautofluorescent placoid lesions in some but not all cases with dots and spots, this study highlights the utility of multimodal imaging, including the more recent availability of UWFAF, in diagnosing syphilitic chorioretinitis. Future research is needed to determine whether the dots and spots in syphilitic chorioretinitis represent direct spirochete infiltration or a secondary inflammatory response. Full article

Machine learning has transformed ophthalmology, particularly in predictive and discriminatory models for vitreoretinal pathologies. However, generative modeling, especially generative adversarial networks (GANs), remains underexplored. GANs consist of two neural networks—the generator and discriminator—that work in opposition to synthesize highly realistic images. These synthetic images can enhance diagnostic accuracy, expand the capabilities of imaging technologies, and predict treatment responses. GANs have already been applied to fundus imaging, optical coherence tomography (OCT), and fluorescein autofluorescence (FA). Despite their potential, GANs face challenges in reliability and accuracy. This review explores GAN architecture, their advantages over other deep learning models, and their clinical applications in retinal disease diagnosis and treatment monitoring. Furthermore, we discuss the limitations of current GAN models and propose novel applications combining GANs with OCT, OCT-angiography, fluorescein angiography, fundus imaging, electroretinograms, visual fields, and indocyanine green angiography. Full article

Background/Objectives: The interphotoreceptor matrix proteoglycans 1 and 2 (IMPG1 and IMPG2) are two interdependent proteoglycans of the interphotoreceptor matrix (IPM). Mutations in IMPG1 or IMPG2 are linked to retinal diseases such as retinitis pigmentosa (RP) and vitelliform macular dystrophy (VMD), yet the specific mutations responsible for each condition remain undefined. This study identifies mutations in IMPG1 and IMPG2 linked to either RP or VMD. It also provides an in-depth in silico analysis of these mutations’ structural and functional impact on protein domains, alongside a detailed examination of the corresponding disease phenotypes. Methods: From a cohort of 480 patients with inherited retinal diseases (IRDs), we identified seven patients with mutations in IMPG1 or IMPG2. Multimodal imaging was performed to assess the clinical phenotypes, including fundus photography, fundus autofluorescence, fluorescein angiography, and spectral domain optical coherence tomography (SD-OCT). We provide structure modeling and analysis of each variant. Results: Our findings indicate a prevalence of 1.45% of IRD patients being affected by IMPG mutations; two were diagnosed with RP and five with VMD. One VMD patient carried a novel IMPG1 p.Asp423Glu mutation. Most patients exhibited heterozygous mutations, and one RP patient presented a compound heterozygous mutation in IMPG2. Conclusions: This work describes a novel mutation and expands our understanding of the specific IMPG protein domains implicated in RP and VMD. Furthermore, it establishes, for the first time, the prevalence of IMPG mutations in an IRD population. Full article

Objectives: The main objective of this study was to report and investigate the characteristics and longitudinal changes in dark-without-pressure (DWP) fundus lesions in patients with autoimmune diseases using multimodal imaging techniques. Methods: In this retrospective observational case series, five patients affected by ocular and systemic autoimmune disorders and DWP were examined. DWP was assessed by multimodal imaging, including color fundus photography (CFP), near-infrared reflectance (NIR), blue reflectance (BR), blue autofluorescence (BAF), optical coherence tomography (OCT), OCT-angiography (OCT-A), fluorescein angiography (FA) and indocyanine green angiography (ICGA), and functional testing, including standard automated perimetry (SAP) and electroretinography (ERG). Follow-up examinations were performed for four out of five patients (range: 6 months–7 years). Results: DWP fundus lesions were found in the retinal mid-periphery and were characterized by the hypo-reflectivity of the ellipsoid zone on OCT. DWP appeared hypo-reflective in NIR, BR and BAF, and exhibited hypo-fluorescence in FA in two patients while showing no signs in one patient. ICGA showed hypo-fluorescent margins in one patient. SAP and ERG testing did not show alterations attributable to the DWP lesion. Follow-up examinations documented rapid dimensional changes in DWP even in the short term (1 month). Conclusions: This study suggests a possible association between autoimmune diseases and DWP. New FA and ICGA features were described. The proposed pathogenesis hypotheses may operate as a basis for further investigation of a lesion that is still largely unknown. Large population studies would be necessary to confirm whether there is a higher incidence of DWP in this patient category. Full article

Diffuse low-grade gliomas are infiltrative tumors whose margins are not distinguishable from the adjacent healthy brain parenchyma. The aim was to precisely examine the results provided by the intraoperative use of macroscopic fluorescence in diffuse low-grade gliomas and to describe the new fluorescence-based techniques capable of guiding the resection of low-grade gliomas. Only about 20% and 50% of low-grade gliomas are macroscopically fluorescent after 5-amino-levulinic acid (5-ALA) or fluorescein sodium intake, respectively. However, 5-ALA is helpful for detecting anaplastic foci, and thus choosing the best biopsy targets in diffuse gliomas. Spectroscopic detection of 5-ALA-induced fluorescence can detect very low and non-macroscopically visible concentrations of protoporphyrin IX, a 5-ALA metabolite, and, consequently, has excellent performances for the detection of low-grade gliomas. Moreover, these tumors have a specific spectroscopic signature with two fluorescence emission peaks, which is useful for distinguishing them not only from healthy brain but also from high-grade gliomas. Confocal laser endomicroscopy can generate intraoperative optic biopsies, but its sensitivity remains limited. In the future, the coupled measurement of autofluorescence and induced fluorescence, and the introduction of fluorescence detection technologies providing a wider field of view could result in the development of operator-friendly tools implementable in the operative routine. Full article

Herein, we propose an analytical approach based on intermolecular fluorescent resonant energy transfer (FRET) pairs for the visualization of specific enzyme activity in model biomembranes and in living cells. Cell visualizations with fluorescent confocal laser microscopy usually rely on fluorescent probes, such as Fluorescein isothiocyanate (FITC), Alexa488, Tetramethylrhodamine isothiocyanate (TRITC) and many others. However, for more specific tasks, such as the detection of certain enzymatic activity inside the living cell, the toolbox is quite limited. In the case of enzyme-hydrolases for example, the choice is limited to organic molecules comprising a fluorescent dye (typically, 4-methylumbelliferone (MUmb) or 7-amino-4-methylcoumarin (AMC) derivatives) and a fluorescence quencher, bound via an enzyme-sensitive linker—so that when the linker is degraded, the fluorescent signal increases. Unfortunately, both MUmb and AMC are quenched and have a relatively low quantum yield in cells, and their excitation and emission ranges overlap with that of intracellular fluorophores, often producing a strong background noise. R6G, on the other hand, has excellent quantum yield apart from intracellular fluorophores, but there are no efficient quenchers that could be chemically linked to R6G. Herein, we show that R6G is able to form intermolecular FRET pairs with MUmb or AMC, with the latter serving as fluorescence donors. This yields a combination of R6G’s excellent fluorescence properties with a possibility to use an enzyme-sensitive linker in MUTMAC or AMC derivatives. This phenomenon was initially discovered in a model system, reversed micelles, where the donor, the acceptor, and the enzyme are forced to be in close proximity to each other, so that proximity could serve as an explanation for the intermolecular FRET effect. Surprisingly enough, the phenomenon has been reproduced in living cells. Moreover, we were able to create working intermolecular donor–acceptor FRET pairs for several different enzymes, including chymotrypsin, phosphatase, and asparaginase. This appears counterintuitive, as besides the overlap of the emission spectra of the donor and the absorption spectra of the acceptor, there are other criteria for the FRET effect, including the convergence of two fluorophores at a distance of about 1–10 nm, and the orientation of their dipoles at a certain angle, which is difficult to imagine in a bulk system like a living cell. We hypothesize that FRET-enabling donor–acceptor interaction may be taking place at the inner surface of the lipid bilayer, to which both donor and acceptor molecules would likely have an affinity. This hypothesis would require a more detailed investigation. Therefore, we have shown that the method suggested has good potential in the visualization of enzyme functioning inside living cells, which is often a challenging task. Shifting of the fluorescence signal to the long-wavelength region would increase the signal selectivity, making it easily distinguishable from autofluorescence. Full article

Background: Macular telangiectasia (MacTel), also known as idiopathic juxtafoveolar telangiectasis (IJFTs), involves telangiectatic changes in the macular capillary network. The most common variant, MacTel type 2, has distinct clinical features and management strategies. Methods: This study offers a comprehensive review of MacTel and focuses on a series of three patients diagnosed with MacTel type 2 in our clinic. A meticulous ophthalmological evaluation, augmented by high-resolution imaging techniques like optical coherence tomography (OCT), OCT angiography (OCT-A), fundus autofluorescence (FAF), fluorescein angiography (FA), and adaptive optics (AOs) imaging, was conducted. Results: The findings revealed normal anterior segment features and a grayish discoloration in the temporal perifoveal area on fundus examination. OCT exhibited hyporeflective cavities in the inner and outer neurosensory retina, along with other changes, while OCT-A identified retinal telangiectatic vessels in the deep capillary plexus. FAF demonstrated increased foveal autofluorescence, while FA initially detected telangiectatic capillaries followed by diffuse perilesional leakage in the later phase. Adaptive optics images showed the cone mosaic pattern. Notably, one patient developed a macular hole as a complication, which was successfully managed surgically. Conclusion: This study underscores the challenges in diagnosing and managing MacTel, emphasizing the importance of a multidisciplinary approach and regular follow-ups for optimal outcomes. Full article

Purpose: we aimed to report on the optical coherence tomography angiography (OCTA) outcomes of eight patients with optic disc pit maculopathy (ODP-M) who were treated with 23-gauge pars plana vitrectomy (PPV). Methods: We examined sixteen eyes of eight patients—eight eyes with ODP-M and eight healthy fellow eyes. Fundus color photography, fundus autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), and OCTA were performed. The vascular density, choriocapillaris blood flow (CCBF), and foveal avascular zone (FAZ) were analyzed using OCTA. Moreover, the correlation between the best-corrected visual acuity (BCVA) and macular OCTA parameters was assessed. Results: Compared with the healthy fellow eyes, the eyes with ODP-M preoperatively were found to have decreased BCVA, superficial capillary plexus (SCP) vascular density (i.e., total, foveal, parafoveal, and perifoveal), deep capillary plexus (DCP) vascular density (i.e., total, parafoveal, and perifoveal), and CCBF but a significantly increased FAZ (p < 0.05). When the eyes with ODP-M were analyzed pre- and postoperatively at month 12 after surgery, the BCVA, SCP vascular density (i.e., perifoveal), and CCBF had significantly increased, and the FAZ had significantly decreased (p < 0.05). When the eyes with ODP-M were compared with the healthy fellow eyes postoperatively at month 12, the BCVA, SCP, and DCP vascular density parameters had increased, along with CCBF, and the FAZ had decreased in eyes with ODP-M, though not to the levels of the healthy fellow eyes (p < 0.05). Moreover, a positive correlation was found between the postoperative BCVA and SCP total vascular density (p < 0.05). Conclusion: The BCVA and macular OCTA parameters improved in eyes with ODP-M at month 12 following surgery. However, the BCVA and OCTA of the eyes operated on did not reach the levels of the healthy fellow eyes, possibly due to impaired choroidal blood flow (CBF) recovery and the presence of a larger FAZ. In summary, OCTA seems to be useful for assessing qualitative and quantitative perioperative microvascular changes. Full article