Retinal findings of COVID-19 patients using ocular coherence tomography angiography two to three months after infection: Ocular appearance recovered COVID-19 patient.

PURPOSE: The aim of this study was to evaluate the ocular disorders in COVID-19 patients, two to three months after infection. METHODS: In this cross-sectional, historically controlled study, fifty-one COVID-19 patients were compared with thirty-seven age, and gender-matched healthy individuals. After complete ophthalmological examination, all participants underwent peripapillary and macular optical coherence tomography, and optical coherence tomography angiography (OCTA) measurements (OptoVue Inc, Freemont, CA, USA). RESULTS: The time between the initial onset of symptoms, and ophthalmologic examination was 63.31±15.21 (40-95 days). Ophthalmic examination of all the recovered COVID-19 patients was within normal range. None of the peripapillary and macular OCTA parameters were significantly different between the two groups with pairwise comparisons, but after adjusting for age, gender, axial length, and signal strength index (SSI), recovered COVID-19 eyes showed a significant increase in peripapillary retinal nerve fiber (RNFL) thickness, superficial, and deep macular vessel densities in parafoveal and perifoveal regions compared with healthy control eyes (p<= 0.05). Inner retinal thickness overall is higher in recovered COVID-19 eyes compared to healthy eyes after adjustment. CONCLUSION: Patients with moderate-intensity SARS-CoV-2 pneumonia had altered peripapillary and macular vessel density compared to healthy subjects. Further investigation is warranted to analyze the correlation of these changes with disease severity as well as evolution of these changes over time.

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in patient during pregnancy.

PURPOSE: To report the clinical course of a woman treated with intravitreal bevacizumab during pregnancy. CASE REPORT: A 27-year-old female with poorly controlled diabetes and a history of two previous miscarriage was referred to our hospital with sudden deterioration in visual acuity (VA) in her right eye. Ocular findings revealed severe Proliferative Diabetic Retinopathy (PDR) complicated with preretinal hemorrhages in her right eye, and after maximal Panretinal Photocoagulation (PRP) bilaterally, she was treated with intravitreal injection of bevacizumab (IVB) into the right eye. Twenty four hours after the bevacizumab injection, she reported vaginal bleeding, and ultrasound confirmed a 12-week pregnancy of which the patient was unaware. The patient suffered from pregnancy loss. CONCLUSION: Use of intravitreal anti-VEGF by pregnant woman may only be justified if the potential benefit outweighs the potential risk to the fetus and only if clearly needed. Intravitreal bevacizumab during pregnancy in women with a history of miscarriage should be used with caution.

Effects of Neck Radiation on Result of Doppler Sonography of Carotid Arteries in Head and Neck Cancer Patients.

PURPOSE: The aim of this study was to assess the effects of neck radiation on the results of Doppler sonography of carotid arteries in head and neck cancer patients. METHODS: In this prospective, cross-sectional study, 25 consecutive patients with head and neck cancers were assessed for carotid artery stenosis (CAS) by carotid color Doppler sonography before external radiotherapy and six months after external radiotherapy. Main outcome measures were peak systolic velocity (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), ICA/common carotid (CCA) ratios, and degree of stenosis. RESULTS: The age of the enrolled patients at the initiation of radiotherapy was 57.9±11.8 years (mean±SD; range, 43-91 years), and only 4 (16%) of the 25 patients were female. The findings showed significant changes in the plaque degree and stenosis degree, and plaque size before and after external radiotherapy (P<0.05). Changes in degree of stenosis were significantly correlated with age (p=0.021). CONCLUSION: After neck irradiation changes in the carotid artery may occur and cause subsequent neurologic events.

Comparing aspheric ablation profile with standard corneal ablation for correction of myopia and myopic astigmatism, a contralateral eye study.

The purpose of this study is to compare visual outcomes of myopic refractive surgery, using tissue saving (TS), a standard ablation profile by a Technolas 217z100, and aberration smart ablation (ASA), an aspheric algorithm by a MEL 80 excimer laser in two eyes of one patient. In this prospective interventional paired-eye controlled study, a total of 100 eyes of 50 participants with myopia with or without astigmatism underwent thin-flap Femto-LASIK, using a Femto LDV femtosecond laser (Ziemer Ophthalmic Systems AG, Port, Switzerland). For each patient, one eye was randomly treated with tissue-saving algorithm (TS group) by the Technolas 217z100 excimer laser and the other eye was treated with optimized smart ablation profile (ASA group) by the MEL 80 excimer laser. Outcome measures were uncorrected distance visual acuities (UDVAs), corrected distance visual acuities (CDVAs), manifest refraction, higher-order aberrations (HOAs), contrast sensitivity, and patient satisfaction 12 months after surgery. At 12 months postoperative, "45 subjects returned with mean" UDVA was - 0.02 ± 0.08 Logarithm of mean angle of resolution (LogMAR) for TS group and - 0.02 ± 0.09 LogMAR for ASA group (P = 0.91). Of the TS eyes, 42/45 (93.3%) and 32/45 (71.1%) were within ± 0.5 D and ± 0.25 D of target refraction, respectively, and of the ASA eyes, 41/45 (91.1%) and 30/45 (66.6%) were within ± 0.5 D and ± 0.25 D of target refraction, respectively. No statistically significant differences were observed between groups in HOAs changes and contrast sensitivity function. Aspheric and non-aspheric LASIKs using the two different excimer lasers provide similar results in myopic and myopic astigmatism patients.

Efficacy of neodymium-doped yttrium aluminum garnet laser iridotomies in primary angle-closure diseases: superior peripheral iridotomy versus inferior peripheral iridotomy.

PURPOSE: To evaluate the efficacy and safety of superior peripheral iridotomy versus inferior peripheral iridotomy in the treatment of primary angle-closure glaucoma (PACG) in phakic patients. METHODS: In this randomized, prospective, paired-eye comparative study, patients with primary angle closure or primary angle-closure suspects were recruited and randomized to receive neodymium-doped yttrium aluminum garnet (Nd:YAG) laser peripheral iridotomy (LPI) superiorly in one eye and inferiorly in the other eye. Patients were masked to the location of treatment in each eye. The main outcome measures were patency of iridotomy, intraocular pressure (IOP), complications and visual symptoms at each postoperative visit during a 1 year follow-up. RESULTS: A total of 164 patients were recruited, of whom 150 (91.46%) completed the study. The mean age was 58.85 ± 6.4 years. Average IOP measurements before LPI was 22.85 ± 7.53 and 23.62 ± 8.32 in superior LPI and inferior LPI eyes respectively. After LPI, average IOP was 25.14 ± 2.73 and 20.97 ± 2.72 in superior LPI and inferior LPI eyes respectively. Inferior LPIs required less use of mean total laser energy to perforate the tissue (p = .05) and resulted in a significantly lower incidence of iris bleeding at the time of treatment (p = .004), lower IOP elevation following treatment (p = .002), lower incidence of focal corneal damage (p = .002) and a lower post-laser iritis (p = .04). All the 300 iridotomies were patent at 12 month follow up. CONCLUSION: The inferior LPI appeared to be an efficient method of preventing pupil block with fewer complications. Visual symptoms following inferior LPI are similar to superior LPI.

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in unrecognised early pregnancy.

The use of intravitreal vascular endothelial growth factor (VEGF) inhibitor medications has widened considerably to include indications affecting females of reproductive age. Our patient was inadvertently exposed to bevacizumab within the first trimester when placental growth and fetal organogenesis take place and patient suffered pregnancy loss. There is insufficient information to suggest that such use is safe, nor is there definitive evidence to suggest that it causes harm. We advise that ophthalmologists discuss pregnancy with women of childbearing age undergoing intraocular anti-VEGF injections and in pregnant woman counselling is needed to explain the potential risks and benefits.

Intravitreal bevacizumab for treatment of choroidal neovascularization secondary to toxoplasmic retinochoroiditis: a case series.

PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab (Avastin) in treatment of choroidal neovascularization (CNV) secondary to toxoplasmic retinochoroiditis. DESIGN: Prospective case series. METHODS: Four patients affected by CNV secondary to inactive toxoplasmic retinochoroiditis received 1.25 mg intravitreal bevacizumab and were followed for at least six months. Patients underwent a full ophthalmic examination and fluorescein angiography (FA) and optical coherence tomography (OCT), revealing an active subfoveal CNV close to an old chorioretinal scar. All the patients were positive for toxoplasma immunoglobulins. Outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) and any adverse event related to the therapy. RESULTS: CNV regressed at eight weeks of follow-up and remained stable at six months of follow-up. Best-corrected visual acuity improved from mean 0.05 to 0.25. After six months, the BCVA improved in all patients (p < 0.05) and CMT decreased from 396 +/-7 micron to 253+/-17 micron. Metamorphopsia was resolved in all cases. CONCLUSIONS: Intravitreal bevacizumab seems to be an effective treatment for the long-term control of juxta/subfoveal CNV secondary to toxoplasmic retinochoroiditis. Further trials are mandatory to validate the data of our case series.

Visual outcomes of topography-guided excimer laser surgery for treatment of patients with irregular astigmatism.

The aim of this study was to evaluate the efficacy, safety, and predictability of topography-guided treatments to enhance refractive status following other corneal surgical procedures. In a prospective case series study, 28 consecutive eyes of 26 patients with irregular astigmatism after radial keratotomy, corneal transplant, small hyperopic and myopic excimer laser optical zones, and corneal scars were operated. Laser-assisted in situ keratomileusis (LASIK) (n = 8) and photorefractive keratectomy (PRK) (n = 20) were performed using the ALLEGRETTO WAVE excimer laser and topography-guided customized ablation treatment software. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest and cycloplegic refraction, and corneal topography with asphericity were analyzed in 12 months follow-up. Uncorrected visual acuity (UCVA) changed from 0.2 ± 0.2 or (20/100 ± 20/100) to 0.51 ± 0.31 or (20/40 ± 20/60) in the LASIK group (P = 0.01) and from 0.34 ± 0.16 or (20/60 ± 20/120) to 0.5 ± 0.23 or (20/40 ± 20/80) in the PRK group (P = 0.01). Refractive cylinder decreased from -3.2 ± 0.84 diopters (D) to -2.06 ± 0.42 D in the LASIK group (P = 0.07) and from -2.25 ± 0.39 D to -1.5 ± 0.23 D in the PRK group (P = 0.008). Best corrected visual acuity did not change significantly in either group. Topography-guided treatment is effective in correcting the irregular astigmatism after refractive surgery. Topography-guided PRK can significantly reduce irregular astigmatism and increase the UCVA and BCVA.

Visual outcomes of Femto-LASIK for correction of residual refractive error after corneal graft.

PURPOSE: To evaluate the outcomes of the Femto-LASIK method in the treatment of refractive errors following penetrating keratoplasty (PK) at the Persian Eye Clinic, Isfahan, Iran METHODS: In a prospective, non-comparative case series, 34 consecutive symptomatic eyes of 34 patients after corneal graft, were operated on. Tissue-saving (TS) Femto-LASIK (n = 16), and Zyoptix Personalized Treatment Advanced (PTA) Femto-LASIK (n = 18) were performed using the Bausch & Lomb Technolas 217z excimer laser and Zyoptic algorithm. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, contrast sensitivity, and HOAs were evaluated preoperatively and 12 months after enhancement treatment. RESULTS: At 12 months, the mean preoperative myopic spherical equivalent refraction (SE) decreased from -6.50 ± 2.8 D to -1.6 ± 1.8 D, and mean hyperopic SE from +3.2 ± 2.20 D to 0.37 ± 1.2 D. The safety index was 1.42 (1.2 in the TS group and 1.5 in the PTA group). In the TS group, 100% of eyes achieved 20/80 or better UCVA and 50%, 20/40 or better and in the PTA group, 100% of eyes achieved 20/80 or better UCVA and 77.7%, 20/40 or better. The efficacy index was 1.08 (0.9 in TS group and 1.21 in the PTA group). Patients obtained statistically significant lower values of root mean square (RMS) of HOAs with spherical aberrations (p < 0.05). CONCLUSIONS: Femto-LASIK method with Zyoptic programs after PK was safe, effective, and predictable for correction of spherical and cylindrical components of the refractive error.

Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran.

Toxoplasmosis is the most common cause of posterior uveitis in the world. This study described the clinical characteristics and visual outcome of 193 patients with ocular toxoplasmosis at Feiz Hospital (Isfahan, Iran) during the last six years. The setting and design used was a retrospective non-comparative observational case series. In this study, 193 patients with ocular toxoplasmosis (111 female, 82 male) were enrolled. The distribution of symptoms and fundoscopic findings were studied. The most-reported chief complaint was blurred vision in 96 % (184 patients) and floaters in 13.47 % (25 patients) of cases and most frequent clinical manifestations were chorioretinitis 98.48 % (190 patients), macular scars 50.7 % (98 patients), and atrophic optic papilla two (1.03 %) patients. Primary retinal lesions were observed in 16 (8.2 %) and combination of active lesions and old retinochoroidal scars in 177 (91.7 %) of the patients. Retinal detachment occurred in 11 (5.69 %) patients. Bilateral involvement was found in 27 % of patients. Blindness was 0.05 % after treatment. Recurrence rate was 14.5 %. In conclusion, ocular toxoplasmosis substantially varies among patients with different age, gender, site of lesion and other factors. Suddenly blurred vision, floater, and pain could be caused by Toxoplasma gondii. Flashing, may necessitate a more precise peripheral fundus examination.

Postlaminectomy lumbar pseudomeningocele with nerve root entrapment: a case report with review of literature.

Pseudomeningocele is a rare but well-recognized complication of lumbar surgery. Most of the patients tolerate the presence of the cyst well, however, some present with back pain and spinal claudication, presumably due to neural compression. We report a case who presented with radicular symptoms and signs after disk surgery. The cause of his pain was nerve root herniation into large pseudomeningocele. The diagnosis was made by magnetic resonance imaging. The patient underwent surgery for the pseudomeningocele with reduction in the nerve root into the dural canal and primary closure of the dural defect. Postoperative results were gratifying.