Agreement between optical coherence and Scheimpflug tomography: Vault measurements and reproducibility after implantable collamer lens implantation.

PURPOSE: To evaluate the agreement between Scheimpflug tomography (Pentacam, Oculus) and anterior segment optical coherence tomography (AS-OCT, RTVue 100, Optovue) as well as the reproducibility of each technique in assessing the lens-ICL distance (vault) after implantable collamer lens (ICL) implantation. METHODS: The vault was measured manually with Scheimpflug tomography and AS-OCT. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to determine the reproducibility of measurements and the agreement between them. Multivariate regression analysis was performed to identify predictors of differences in vault measurements between devices. RESULTS: 80 eyes of 46 ICL patients were analyzed. Mean patient age was 33.8±7.4 years (range, 21 to 51), and 27 (59%) were women. The preoperative spherical equivalent refraction ranged from -26 to 8.5 diopters (D). The mean vault measured by AS-OCT was 558.8±240.2µm (range, 162 - 1220) vs. 430.1±215.3µm (range, 0 to 1070) by Pentacam. AS-OCT yielded vault values, on average, 128.1±64.6µm higher than the Pentacam (range, -22 to 293µm). The ICC values for consistency and absolute agreement were 0.960 and 0.928, respectively. Reproducibility of vault measurements was excellent for both devices (ICC≥0.946). Four parameters-vault, pupil diameter (PD), PD differences between devices, and preoperative spherical equivalent refraction-were significant predictors of differences in vault measurements (adjusted-R2=0.412; P<0.001). CONCLUSIONS: Agreement between AS-OCT and Pentacam for vault measurement was good. Vaults were higher when measured by AS-OCT. These differences are clinically relevant, and therefore these devices cannot be used interchangeably to measure vault.

Assessment of changes in the macula and optic nerve head using optical coherence tomography in patients with attention deficit hyperactivity disorder. / Evaluación de los cambios en la mácula y en el nervio óptico mediante tomografía de coherencia óptica en pacientes con trastorno por déficit de atención e hiperactividad.

INTRODUCTION: To assess if there are any differences in macular and papillary thickness using optical coherence tomography (OCT) in patients with attention deficit hyperactivity disorder (ADHD) compared with a control group, including if there are differences between ADHD patients with and without treatment. METHODS: Prospective observational study including 92 eyes of 46 patients divided into 2 groups: 46 eyes of 23 patients with ADHD, and a control group of 46 eyes of 23 healthy patients. The group of patients with ADHD was subdivided into those on treatment with methylphenidate (n=28) and those not on treatment (n=18). The macular thickness, the ganglion cell complex (GCC), and the retinal nerve fibre layer (RNFL) at the papillary level were measured in 12 sectors. RESULTS: A lower central macular thickness was observed in the ADHD patients than in the controls (257.4±20µm versus 267.5±20µm, P=.013), with no differences observed in the GCC (P=.566), or in the RNFL (P=.095). There were no differences in the patients with ADHD with and without treatment, as regards macular thickness and the GCC (P=.160 and P=.375 respectively), but a lower foveal thickness (P=.018) and RNFL in 5/12 sectors at the papillary level (P=.033) were observed in those without treatment. CONCLUSIONS: A lower macular thickness was observed in patients with ADHD than in controls. In addition, patients with ADHD without treatment had a lower thickness of the fovea and RNFL than those patients on treatment.

Open angle glaucoma secondary to endogenous cortisone due to pituitary microadenoma in a young patient, a case report. / Glaucoma de ángulo abierto secundario a cortisona endógena por microadenoma hipofisario en un paciente joven, a propósito de un caso.

CASE REPORT: A 31-year-old male was referred for evaluation after being diagnosed with Cushing syndrome secondary to a pituitary microadenoma. He presented with a reduced visual acuity and high intraocular pressure (IOP) of 48mmHg in both eyes. The examination with biomicroscopy showed normal anterior segment, increased cup to disc ratio, and open angle. There was a moderate-advanced involvement in the visual field. The patient was diagnosed with glaucoma secondary to endogenous corticosteroids, and medical treatment was initiated pending the removal of the adenoma. The IOP did not return to normal after the incomplete removal of the adenoma, so a trabeculectomy was performed to control the IOP. As conclusions: In the case of an ocular hypertension with pituitary tumour, secondary glaucoma to endogenous cortisone should be suspected. Early treatment of the tumour is necessary to bring the cortisone and IOP levels back to normal. Late diagnosis or incomplete treatment of these tumours may lead to not obtaining adequate IOP control.

Ocular hypertension as a cause of cilioretinal artery obstruction in the young patient, about a case. / Hipertensión ocular como causa de obstrucción de arteria ciliorretiniana en el paciente joven, a propósito de un caso.

CLINICAL CASE: A 16-year-old patient seen in the Emergency Department due to loss of visual acuity (VA) in the left eye (LE), and oppressive headache of 1 day onset. The patient was on treatment with topical corticosteroids for viral conjunctivitis. The VA was 1.00 in the right eye and 0.05 in LE. The intraocular pressure was 42mmHg in both eyes. In the LE, the funduscopy revealed retinal ischaemic oedema in the papillomacular bundle. The optical coherence tomography angiography (OCT-A) showed an obstruction of the cilioretinal artery. The systemic study was normal, the cardiac and supra-aortic trunks ultrasound was normal, with ocular hypertension secondary to corticosteroids being the only causative agent identified. This case shows that in the event of an obstruction of the cilioretinal artery, a systemic study should be performed in order to identify possible embolic phenomena. Ocular hypertension is one of the possible causes that may be responsible for this condition.

Agreement between Fourier-domain and swept-source optical coherence tomography used for optic nerve head measurements.

PURPOSE: To assess the correlation between optic nerve head measurements generated by Fourier-domain (FD) and swept-source (SS) optical coherence tomography (OCT) both in healthy Caucasian subjects and patients with primary open angle glaucoma (POAG). MATERIALS AND METHODS: This was a cross-sectional study of the right eyes of 118 subjects. In each participant, the measurements of disc area, cup to disc ratio (CDR), vertical cup to disc ratio (VCDR), rim area and rim volume were performed consecutively by FD-OCT and then SS-OCT. Participant age, gender and spherical equivalent were also recorded. Agreement between the two devices was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS: The study sample consisted of 95 healthy eyes and 23 eyes with glaucoma. Mean participant age was 48.6±20.0 years, 54.2% were female, and mean spherical equivalent was -1.6±3.0 diopters. FD-OCT and SS-OCT measurements were respectively: mean disc area 1.79±0.3 vs 1.83±0.3 mm2 (ICC=0.71), mean CDR 0.38±0.2 vs 0.33±0.2 (ICC=0.91), mean VCDR 0.58±0.2 vs 0.52±0.2 (ICC=0.92), mean rim area 1.05±0.4mm2 vs 1.03±0.5mm2 (ICC=0.29), and mean rim volume 0.14±0.11 vs 0.21±0.17mm3 (ICC=0.53). Good agreement between the devices was noted for rim area and rim volume in glaucoma subjects (ICC=0.76 and 0.68 respectively), while weak agreement was observed for these variables in healthy subjects (ICC≤0.50). CONCLUSIONS: The CDR and VCDR measurements provided by FD and SS OCT showed excellent agreement for the overall sample. When the devices were used for rim measurements, agreement was excellent only in the POAG patients.

Update on the usefulness of optical coherence tomography in assessing the iridocorneal angle. / Actualización de la utilidad de la tomografía de coherencia óptica para el estudio del ángulo iridocorneal.

The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses.

Severe ocular side effects with acetazolamide: case report. / Reacción ocular adversa a la acetazolamida: a propósito de un caso.

CLINICAL CASE: A 44-year-old woman arrived in the emergency department complaining of decreased visual acuity (VA) in oculus uterque (OU) of 4hours onset. Signs of myopia, increased intraocular pressure (IOP) in OU, and a narrow grade II anterior chamber (AC) were observed. In the posterior segment ultrasound scan, a choroidal peripheral detachment is evident, and a lenticular thickness of 4.05mm is measured in the anterior segment of the right eye (OD) and 4.00mm in the left eye (OS). On treatment with oral with naproxen (non-steroidal anti-inflammatory drug), and acetazolamide for migraine. The acetazolamide is suspended and topical treatment is started with timolol and brimonidine every 12hours, with prednisolone and ayclopentolate every 8hours. In the follow-up, a gradual reduction of myopia and lens thickness is observed, as well as anterior chamber expansion. In the last control, the patient had a sphere of -0.75 diopters (D) in OD and -0.25 D in OS. IOP was 15mmHg in OU and AC was grade III. The ultrasound showed a lens thickness of 3.59mm in OD and 3.61mm in OS. CONCLUSION: This was an iatrogenic case of acute angle closure induced by an anterior displacement of the irido-lenticular complex, secondary to the use of acetazolamide. The treatment of this condition involves suspending the drug responsible and applying topical corticosteroids, hypotensive and cycloplegic eye drops, with the aim of lowering the eye pressure and the degree of myopia due to the re-positioning of the irido-lenticular complex.