Giraffe or leopard spot chorioretinopathy as an outstanding finding: case report and literature review.

PURPOSE: Presentation of two typical cases with characteristic leopard retinopathy secondary to bilateral diffuse uveal melanocytic proliferation (BDUMP) and idiopathic uveal effusion syndrome (IUES) and brief review of the literature about leopard spot retinopathy. CASE REPORT: A 43-year-old women, who was a known case of ovarian carcinoma, referred with gradual bilateral visual loss. In ophthalmic examination, subretinal fluid, multiple patchy subretinal hyperpigmented lesions and leopard spot chorioretinopathy were evident in her both eyes. Fluorescein angiography showed multiple nummular hyperfluorescent lesions surrounded by zones of hypofluorescence. Spectral domain optical coherence tomography revealed increased retinal thickness, subretinal fluid and RPE irregularities in both eyes. Enhanced depth imaging OCT (EDI-OCT) showed bilateral subfoveal choroidal thickening. During next 2-year follow-up, she underwent cataract surgery and later on developed neovascular glaucoma in her both eyes. The second case was a 45-year-old man who had developed decreased visual acuity in his left eye for 3 years. Anterior segment examination was unremarkable, and both eyes had normal intraocular pressure. No vitreous inflammation was observed. Fundoscopy revealed diffuse exudative retinal detachment in his left eye. Fluorescein angiography showed leopard spot retinopathy of posterior pole, and EDI-OCT disclosed subfoveal choroidal thickening. After exclusion of other causes of exudative retinal detachment and with diagnosis of IUES, he underwent intravitreal triamcinolone injection (2 mg) which improved his final vision to 20/40. CONCLUSION: Leopard spot retinopathy is an uncommon but clinically distinct manifestation of various disorders. BDUMP may present with leopard spot retinopathy, anterior uveal tract involvement and neovascular glaucoma. As EDI-OCT showed involvement and increased thickening of choroid in both cases of BDUMP and IUES, it may be better to consider such cases as leopard chorioretinopathy and categorize these entities as a member of pachychoroid pigment retinopathy disorders.

Distribution of the anterior, posterior, and total corneal astigmatism in healthy eyes.

PURPOSE: To evaluate the magnitude and axis orientation of the anterior, posterior, and total corneal astigmatism in normal healthy eyes of an Iranian population. METHODS: In a prospective cross-sectional study, ophthalmic and anterior segment parameters of 153 healthy eyes of 153 subjects were evaluated by Galilei dual Scheimpflug analyzer. The magnitude and axis orientation [with-the-rule (WTR), against-the-rule (ATR), and oblique] of the anterior, posterior, and total corneal astigmatism measurements (ACA, PCA, and TCA) were compared according to the age, sex, and other ophthalmic parameters. RESULTS: The mean ± SD age of the study population was 30 ± 5.9 years. The mean magnitude was 1.09 ± 0.76 diopters (D) for ACA, 0.30 ± 0.13 D for PCA, and 1.08 ± 0.77 D for TCA. Males had a significantly higher magnitude of PCA than females (p = 0.041). Most eyes had a WTR anterior astigmatism and an ATR posterior astigmatism. The WTR astigmatism had a higher mean magnitude compared to the ATR and oblique astigmatism in all the astigmatism groups, with a significant difference in the ACA and TCA groups (p < 0.05). PCA magnitude exceeded 0.50 D in only 7.8% of the subjects. ACA, PCA, and TCA were significantly correlated with each other and also had a significant correlation with the anterior and posterior maximum corneal elevation measurements (p < 0.001). CONCLUSION: The results of this study although are limited due to the small number of participants and confined to our demographics, provided information regarding a population that was not described before and may be helpful in obtaining optimum results in astigmatism correction in refractive surgery or designing new intraocular lenses.

Agreement between total corneal astigmatism calculated by vector summation and total corneal astigmatism measured by ray tracing using Galilei double Scheimpflug analyzer.

PURPOSE: To evaluate the agreement between total corneal astigmatism calculated by vector summation of anterior and posterior corneal astigmatism (TCAVec) and total corneal astigmatism measured by ray tracing (TCARay). METHODS: This study enrolled a total of 204 right eyes of 204 normal subjects. The eyes were measured using a Galilei double Scheimpflug analyzer. The measured parameters included simulated keratometric astigmatism using the keratometric index, anterior corneal astigmatism using the corneal refractive index, posterior corneal astigmatism, and TCARay. TCAVec was derived by vector summation of the astigmatism on the anterior and posterior corneal surfaces. The magnitudes and axes of TCAVec and TCARay were compared. The Pearson correlation coefficient and Bland-Altman plots were used to assess the relationship and agreement between TCAVec and TCARay, respectively. RESULTS: The mean TCAVec and TCARay magnitudes were 0.76±0.57D and 1.00±0.78D, respectively (P<0.001). The mean axis orientations were 85.12±30.26° and 89.67±36.76°, respectively (P=0.02). Strong correlations were found between the TCAVec and TCARay magnitudes (r=0.96, P<0.001). Moderate associations were observed between the TCAVec and TCARay axes (r=0.75, P<0.001). Bland-Altman plots produced the 95% limits of agreement for the TCAVec and TCARay magnitudes from -0.33 to 0.82D. The 95% limits of agreement between the TCAVec and TCARay axes was -43.0 to 52.1°. CONCLUSION: The magnitudes and axes of astigmatisms measured by the vector summation and ray tracing methods cannot be used interchangeably. There was a systematic error between the TCAVec and TCARay magnitudes.

Mean Posterior Corneal Power and Astigmatism in Normal Versus Keratoconic Eyes.

PURPOSE: To compare mean posterior corneal power and astigmatism in normal versus keratoconus affected eyes and determine the optimal cut-off points to maximize sensitivity and specificity in discriminating keratoconus from normal corneas. METHODS: A total of 204 normal eyes and 142 keratoconus affected eyes were enrolled in this prospective comparative study. Mean posterior corneal power and astigmatism were measured using a dual Scheimpflug camera. Correlation coefficients were calculated to assess the relationship between the magnitudes of keratometric and posterior corneal astigmatism in the study groups. Receiver operating characteristic curves were used to compare the sensitivity and specificity of the measured parameters and to identify the optimal cut-off points for discriminating keratoconus from normal corneas. RESULTS: The mean posterior corneal power was -6.29 ± 0.20 D in the normal group and -7.77 ± 0.87 D in the keratoconus group (P < 0.001). The mean magnitudes of the posterior corneal astigmatisms were -0.32 ± 0.15 D and -0.94 ± 0.39 D in the normal and keratoconus groups, respectively (P < 0.001). Significant correlations were found between the magnitudes of keratometric and posterior corneal astigmatism in the normal (r=-0.76, P < 0.001) and keratoconus (r=-0.72, P < 0.001) groups. The mean posterior corneal power and astigmatism were highly reliable characteristics that distinguished keratoconus from normal corneas (area under the curve, 0.99 and 0.95, respectively). The optimal cut-off points of mean posterior corneal power and astigmatism were -6.70 D and -0.54 D, respectively. CONCLUSION: Mean posterior corneal power and astigmatism measured using a Galilei analyzer camera might have potential in diagnosing keratoconus. The cut-off points provided can be used for keratoconus screening.

Stereoacuity after Wavefront-guided Photorefractive Keratectomy in Anisometropia.

PURPOSE: To determine changes in stereoacuity in anisometropic myopic eyes after photorefractive keratectomy (PRK). METHODS: Myopic patients with at least 1 diopter (D) of anisometropia in sphere, astigmatism, or spherical equivalent who were referred to our hospital for excimer refractive surgery were enrolled as a prospective sequential interventional case series. All patients underwent wavefront-guided photorefractive keratectomy (WFG-PRK) using the Technolas Perfect Vision (217z) Excimer laser machine. Changes in binocular stereoacuity were evaluated using the TNO and Butterfly stereoacuity tests before and at 2 weeks, 1 month, and 3 months after the operation. RESULTS: Between January and November 2015, a total of 98 eyes of 49 patients (71.4% men) with a mean age of 28 ± 5.5 years, mean myopia of -3.32 ± 1.74 D, and mean astigmatism of 1.3 ± 1.3 D were enrolled in this study. Preoperative mean stereoacuity values were 102 ± 103.44 and 56.8 ± 41 seconds of arc (s/arc)as measured by the TNO and Butterfly stereoacuity tests. Mean stereoacuity improved to 90 ± 110.52 s/arc (P = 0.009) and 56.5 ± 41.3 s/arc (P = 0.80), respectively, 6 months after WFG-PRK. Overall improvement in stereoacuity was 10.2% and 6.12% according to the TNO and Butterfly stereoacuity tests, respectively. CONCLUSION: Stereoacuity improves after WFG-PRK for treatment of anisometropic myopia. This improvement is more accurately detectable by the TNO than the Butterfly stereoacuity test.

Adjunctive triamcinolone acetonide for Ahmed glaucoma valve implantation: a randomized clinical trial.

PURPOSE: To evaluate the effect of intraoperative sub-Tenon injection of triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. METHODS: In this triple-blind randomized clinical trial, 104 eyes with refractory glaucoma were randomly assigned to conventional AGV (non-TA group) or AGV with adjunctive triamcinolone (TA group). In the TA group, 10 mg TA was injected in the sub-Tenon space around the AGV plate intraoperatively. Patients were followed for 1 year. The main outcome measure was intraocular pressure (IOP). Other outcome measures included best-corrected visual acuity (BCVA), occurrence of hypertensive phase (HP), peak IOP, number of antiglaucoma medications, and complications. RESULTS: A total of 90 patients were included in the final analysis. Mean IOP was lower in the TA group at most follow-up visits; however, the difference was statistically significant only at the first month (p = 0.004). Linear mixed model showed that mean IOP was 1.5 mm Hg lower in the TA group throughout the study period (p = 0.006). Peak postoperative IOP was significantly lower in the TA group (19.3 ± 4.8 mm Hg versus 29 ± 9.2 mm Hg, p = 0.032). Rates of success (defined as 6 < IOP <21 mm Hg) were similar in both groups at 12 months. There was no difference in the occurrence of the HP between the 2 groups (p = 0.123). Loss of BCVA >2 lines was more common in the non-TA group (p = 0.032). CONCLUSIONS: Adjunctive intraoperative TA injection during AGV implantation can blunt peak IOP levels and reduce mean IOP up to 1 year. Visual outcomes also seem to be superior to standard surgery.

Descemet Stripping Automated Endothelial Keratoplasty in Fuchs' Endothelial Dystrophy versus Pseudophakic Bullous Keratopathy.

PURPOSE: To compare clinical and confocal scan outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK) performed for Fuchs' endothelial dystrophy (FED) versus pseudophakic bullous keratopathy (PBK). METHODS: This retrospective comparative study included 47 consecutive eyes of 39 patients with the diagnosis of FED (n = 29, group 1) or PBK (n = 18, group 2) that underwent DSAEK. Clinical outcomes were compared between the study groups. At the final follow-up examination, confocal microscopy was used to measure and compare central corneal and graft thickness as well as endothelial cell density and morphology between the two groups. RESULTS: Mean age at the time of surgery was 65.2 ± 11.8 and 69.4 ± 12.5 years in groups 1 and 2, respectively (P = 0.27). Follow-up period was 23.6 ± 14.0 months in group 1 and 25.6 ± 15.7 months in group 2 (P = 0.79). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 until postoperative month 6. Afterwards, the two study groups were comparable in this regard. At the final follow-up examination, spherical equivalent refractive error was + 0.39 ± 1.46 diopters (D) in group 1 and + 0.80 ± 1.47 D in group 2 (P = 0.45). Postoperative keratometric astigmatism was 1.02 ± 0.83 D and 2.36 ± 0.67 D, respectively (P < 0.001). Mean central graft thickness was 98.0 ± 33.3 µm in group 1 and 107.6 ± 28.0 µm in group 2 (P = 0.45). No statistically significant difference was observed between the two groups in terms of the postoperative endothelial cell density. CONCLUSION: The outcomes of DSAEK surgery were comparable between FED and PBK. All grafts were clear despite the lower than normal endothelial cell counts.

The impact of immunohistochemical markers of Ki-67 and p53 on the long-term outcome of growth hormone-secreting pituitary adenomas: A cohort study.

BACKGROUND AND OBJECTIVES: The tumoral biomarkers have a rather well known effect upon the tumor control period of several types of malignant lesions. The aim of this study was to evaluate the impact of immunohistochemical (IHC) markers of Ki-67 and p53 on the long-term outcome of growth hormone (GH)-secreting pituitary adenomas treated surgically. MATERIALS AND METHODS: We conducted and followed a cohort of 47 consecutive patients with GH-secreting pituitary adenomas referred to our department during a 4 year period for trans-sphenoidal microsurgical adenomectomy. The expression levels of Ki-67 and p53 were determined by IHC study of the tissue samples. Periodical pituitary magnetic resonance imaging (MRI), visual field studies and hormonal evaluations (GH and insulin-like growth factor-1 [IGF-1]) performed during the follow-up period were the outcome measures. RESULTS: The level of Ki-67 expression was higher among patients with postoperative residual tumor (3.5 vs. 1.7%) and those with a hormonal recurrence (4.3 vs. 1.6%). The p53 expression level was remarkably higher in patients with radiological recurrence (18 vs. 6.3%). Patients with invasive features (i.e. cavernous sinus and suprasellar invasion) had significantly higher p53 and Ki-67 values and higher IGF-1 levels during the follow-up period. The patients younger than 30 years of age and those with mixed GH-prolactin secreting adenomas had significantly higher hormonal remission and lower radiological recurrence rates. CONCLUSION: Each of the biomarkers, Ki-67 and p53, along with patient's age and mixed GH-prolactin secretion showed a kind of correlation with each of aspects of the clinical, hormonal and radiologic outcome of GH-secreting pituitary adenomas in this series.

Agreement between total corneal astigmatism calculated by vector summation and total corneal astigmatism measured by ray tracing using Galilei double Scheimpflug analyzer / Concordancia entre el astigmatismo corneal total calculado mediante sumación vectorial, y el astigmatismo corneal total medido mediante trazado de rayos utilizando un analizador Galilei de doble cámara Scheimpflug

Purpose: To evaluate the agreement between total corneal astigmatism calculated by vector summation of anterior and posterior corneal astigmatism (TCAVec) and total corneal astigmatism measured by ray tracing (TCARay). Methods: This study enrolled a total of 204 right eyes of 204 normal subjects. The eyes were measured using a Galilei double Scheimpflug analyzer. The measured parameters included simulated keratometric astigmatism using the keratometric index, anterior corneal astigmatism using the corneal refractive index, posterior corneal astigmatism, and TCARay. TCAVec was derived by vector summation of the astigmatism on the anterior and posterior corneal surfaces. The magnitudes and axes of TCAVec and TCARay were compared. The Pearson correlation coefficient and Bland-Altman plots were used to assess the relationship and agreement between TCAVec and TCARay, respectively. Results: The mean TCAVec and TCARay magnitudes were 0.76 ± 0.57 D and 1.00 ± 0.78 D, respectively (P < 0.001). The mean axis orientations were 85.12 ± 30.26◦ and 89.67 ± 36.76◦, respectively (P = 0.02). Strong correlations were found between the TCAVec and TCARay magnitudes (r = 0.96, P < 0.001). Moderate associations were observed between the TCAVec and TCARay axes (r = 0.75, P < 0.001). Bland-Altman plots produced the 95% limits of agreement for the TCAVec and TCARay magnitudes from -0.33 to 0.82 D. The 95% limits of agreement between the TCAVec and TCARay axes was -43.0 to 52.1◦. Conclusion: The magnitudes and axes of astigmatisms measured by the vector summation and ray tracing methods cannot be used interchangeably. There was a systematic error between the TCAVec and TCARay magnitudes

Objetivo: Evaluar la concordancia entre el astigmatismo corneal total calculado mediante suma de los vectores del astigmatismo corneal anterior y posterior (TCAVec), y el astigmatismo corneal total medido mediante trazado de rayos (TCARay). Métodos: Este estudio incluyó a un total de 204 ojos derechos de 204 sujetos normales. Los ojos se midieron utilizando un analizador Galilei de doble cámara Scheimpflug. Los parámetros medidos incluyeron el astigmatismo queratométrico simulado utilizando el índice queratométrico, el astigmatismo corneal anterior utilizando el índice refractivo corneal, el astigmatismo corneal posterior, y TCARay. TCAVec se calculó mediante la suma de los vectores del astigmatismo en las superficies corneales anterior y posterior. Se compararon las magnitudes y ejes de TCAVec y TCARay. Se utilizaron el coeficiente de correlación de Pearson y los diagramas de Bland-Altman para valorar la relación y concordancia entre TCAVec y TCARay, respectivamente. Resultados: Los valores medios de las magnitudes TCAVec y TCARay fueron 0,76 ± 0,57 D y 1 ± 0,78 D, respectivamente (P < 0,001). Las orientaciones medias del eje fueron 85,12 ± 30,26 grados y 89,67 ± 36,76 grados, respectivamente (P = 0,02). Se encontraron fuertes correlaciones entre las magnitudes de TCAVec y TCARay (r = 0,96, P < 0,001). Se observaron asociaciones moderadas entre los ejes de TCAVec y TCARay (r = 0,75, P < 0,001). Los diagramas de Bland-Altman establecieron un 95% de límite de acuerdo para las magnitudes de TCAVec y TCARay de -0,33 a 0,82 D. Los límites de acuerdo del 95% entre los ejes de TCAVec y TCARay fueron de -43 a 52,1 grados. Conclusión: Las magnitudes y ejes de los astigmatismos medidos mediante suma de vectores y trazado de rayos no pueden intercambiarse. Se produjo un error sistemático entre las magnitudes de TCAVec y TCARay