The THAI Journal of OPHTHALMOLOGY

Choroidal Vascularity Index Changes after Treatment of Persistent Central Serous Chorioretinopathy with either Spironolactone or Half-Dose Photodynamic Therapy

Wongsiri Taweebanjongsin — 2025-12-26

Purpose: To evaluate choroidal vascularity index (CVI) changes after treatment with either spironolactone or half-dose photodynamic therapy (PDT).

Design: Retrospective study

Methods: We enrolled 34 patients with subretinal fluid accumulation persisting for more than 3 months due to central serous chorioretinopathy (CSC); 16 patients were treated with spironolactone and 18 with PDT. We reviewed the central OCT-B scans at baseline and 1 and 3 months after treatment. We defined the CVI as the percent of vascular/luminal pixels over the total number of pixels and compared the results between the treatment groups.

Results: The baseline CVIs were 60.33% in the spironolactone treatment group and 60.51% in the PDT group. After treatment, the CVI remained similar in the spironolactone group, but it increased significantly one month (63.35%) and three months (63.56%, R = 0.004, 0.001) after the PDT. The total and luminal choroidal areas were both decreased after PDT, but only the stromal area was significantly decreased at one and three months (R = 0.001and P < 0.001, respectively). By month three, the subfoveal choroidal thickness (SFCT) had decreased by 30.32 µm (R = 0.013) in the PDT group and by 18.88 µm (R = 0.195) in the spironolactone group.

Conclusion: After CSC treatment, the choroid remained virtually unchanged following the spironolactone therapy, whereas the choroidal thickness was significantly reduced and the CVI increased following PDT. These anatomic changes in the choroid following PDT may explain why the effects of PDT are more durable and potent than those of spironolactone for CSC.

Effects of Dexamethasone Implant on Contralateral Central Foveal and Subfoveal Choroidal Thickness in Unilateral Uveitic Macular Edema

Mukaddes Damla Ciftci — 2025-12-26

Objectives: To investigate the effect of intravitreal dexamethasone implant application on retinal and choroidal thickness of contralateral eye of the patients with uveitic macular edema.

Materials and Methods: This study included 17 patients with non-infectious uveitic macular edema treated with intravitreal dexamethasone implantation. The central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) measurement taken by swept-source optical coherence tomography were evaluated retrospectively at the pre- and postinjection 1^st, 3^rd, 6^th months, and its relationship with visual acuity was investigated.

Results: Four (23.5%) of the patients had intermediate, 3 (17.6%) had anterior and 10 (58.8%) of them had panuveitis. The mean CFT and SFCT of the eyes with intravitreal implants were 494.3 171.1 and 346.1 68.8 μm respectively. A statistically significant reduction in CFT was observed at the 1^st (318.1 65.0, p < 0.001), 3^rd (314.2 74.2, p < 0.001), and 6^th (320.6 77.1, p < 0.001) months following intravitreal injection. There was a statistically significant decrease of SFCT from the baseline in the 1^st month (203.9 62.1 μm, p < 0.001), 3^rd month (222.1 61.6 μm, p = 0.002) and 6^th month (224.3 72.6 μm, p = 0.023) after the injection. The mean CFT of contralateral eyes was 205.8 55.0 μm before injection and did not change significantly post-injection. The mean SFCT of the contralateral eyes before the injection was 311.2 72.9 μm. Decrease in SFCT of the contralateral eyes at 1^st month (288.6 68.5 μm)(p = 0.02) was statistically significant. No significant change was observed in visual acuity after injection in contralateral eyes.

Conclusion: Decrease in the choroidal thickness of the contralateral eyes of patients was so limited and temporary that they did not reflect on their visual acuity. Therefore, it was thought that this may be secondary to the small amount of systemic absorption of intravitreal dexamethasone

Acute Unilateral Isolated Ptosis as a Complication of Frontal Sinusitis: A Case Report

Busayanut Puangsricharoen — 2025-12-26

ABSTRACT

Objective: Acquired upper-eyelid ptosis can be traumatic, mechanical, neurogenic, or myogenic in origin. However, oculomotor nerve or cranial nerve (CN) III palsy caused by frontal sinusitis is extremely rare. The purpose of this report is to document an unusual case of frontal sinusitis in a 15-year-old boy with acute unilateral ptosis as the sole presenting sign of CN III palsy.

Case report: A 15-year-old Thai boy presented with a 2-day history of left-sided upper-eyelid ptosis preceded by a 1-week history of influenza A infection. His pupils were equivalent in size bilaterally, and extraocular muscles exhibited full motility. Magnetic resonance imaging of the brain and orbit revealed fluid opacification and mucosal thickening, predominantly in the left frontal sinus, with no levator palpebrae superioris abnormalities. The case was diagnosed as frontal sinusitis associated with CN III palsy. The ptosis had completely resolved by the fifth day of intravenous levofloxacin.

Conclusions: Frontal sinusitis can lead to palsy of the superior branch of CN III presenting with only isolated ptosis. This case highlights a potential complication of acute sinusitis and raises awareness of a rare differential diagnosis in isolated, unilateral ptosis. Diagnostic neuroimaging may assist in managing such atypical cases.

Adult Orbital Xanthogranuloma: A Case Report

Paphitchaya Temphattharachok — 2025-12-26

Objectives: To report a rare case of adult orbital xanthogranuloma (AOX).

Methods: We describe a 39-year-old Thai woman with progressive bilateral eyelid swelling and for 5 years and
yellowish discoloration of the left lower eyelid for 2 years.

Results: An earlier biopsy of the left lacrimal gland at another hospital showed dacryoadenitis. She received
oral prednisolone with good initial response, but symptoms recurred after discontinuation. At presentation, she had
bilateral eyelid swelling, yellowish discoloration of the left lower eyelid, bilateral lacrimal glands enlargement, and
right eye proptosis, without infection. Orbital computed tomography (CT) demonstrated mildly enhancing infiltrative
soft tissue in both periorbital regions and lacrimal glands, without bony destruction. A repeat biopsy of the yellowish
lesion revealed foamy macrophages and small lymphoid cells. No systemic involvement was identified. Clinical and
histopathological findings supported a diagnosis of AOX, the rarest subtype of adult orbital xanthogranulomatous
disease (AOXGD AXDO). Oral corticosteroid therapy was initiated.

Conclusions: AOX is a rare orbital disorder that should be considered in the differential diagnosis of orbital
disease. Systemic evaluation is essential due to potential associations in other subtypes. Although various treatment
approaches have been reported, no standard therapy exists. Further studies are required to clarify disease mechanisms
and management.

Specific Ocular Findings Leading to the Diagnosis of Early-Onset Neurofibromatosis Type 2

Pittaya Phamonvaechavan — 2025-12-26

Background: Neurofibromatosis type 2 (NF2) genetic disorder primarily characterized by the central nervous system tumors, including intracranial schwannomas and meningiomas.Diagnosis is often delayed due to variable presentations, especially in pediatric patients where ophthalmologic abnormalities may be the earliest sign.

Case Presentation: A 4-year-old boy referred for ocular evaluation due to multiple café-au-lait macules. Initial examination revealed reduced visual acuity, bilateral iris mammillation, and left retinal hamartoma, raising suspicion of NF2. Despite glasses being prescribed, the patient was lost to follow-up and returned at age 8 with left eye visual deterioration. Subsequent examination identified a flame-like epiretinal membrane (ERM) in the right eye and a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) in the left eye. Magnetic Resonance Imaging (MRI) confirmed multiple cranial nerve schwannomas and a left optic nerve sheath meningioma (ONSM), confirming the NF2 diagnosis at age 10.

Discussion: Pediatric NF2 can present with distinctive ocular findings: cortical cataracts, ERMs, CHRRPE, and ONSMs, which may precede neurological symptoms. Early recognition of NF2 ocular signs is crucial for timely diagnosis and management, potentially reducing morbidity.

Conclusion: This case highlights importance of thorough ophthalmologic evaluation in NF2 children. Early diagnosis can guide appropriate multidisciplinary management, improving prognosis in pediatric NF2 patients.