Quality of Life (QoL) in Non-Acute Vogt-Koyanagi-Harada Disease (VKHD) at Two Time Points 24 Months Apart.

AIMS: To investigate the changes in quality-of-life (QoL) metrics at a 24-month interval in non-acute VKHD patients and their association with inflammation, treatment, and visual function. METHODS: SF-36 and VFQ-25 questionnaires were administered at two 24-month-apart moments to 22 non-acute VKHD patients followed for ≥12 months since acute disease onset. "Improvement," "unchanged," or "worsening" in questionnaires scores (difference >5-point) between M1 and M2 and their associations were sought. RESULTS: Absence of systemic treatment or optic disc hyperfluorescence was associated with improved general health (SF-36). Improvement in binocular contrast sensitivity resulted in better ocular pain score; absence of anterior uveitis relapse, stable fundus findings, no use of cyclosporine or no intravitreal injections resulted in unchanged/better dependency score; no intravitreal injections resulted in unchanged/better mental health score (VFQ-25). CONCLUSION: Stability/improvement in QoL scores was associated with controlled inflammation, better visual function, and no need for treatment. Subclinical inflammatory signs did not impact QoL scores.

Fingerprint sign in Vogt-Koyanagi-Harada disease: a case series.

BACKGROUND: The tomographic finding, which has been called the "fingerprint sign" in en face reconstructions, seems to be the result of a variety of processes that cause distension of the outer plexiform layer (OPL) and the Henle fiber layer (HFL). The aim of this paper is to describe the appearance of concentric rings at the OPL/HFL interface visualized using en face reconstructions of cross-sectional optical coherence tomography images of patients with Vogt-Koyanagi-Harada disease. METHODS: Retrospective analysis of images of six eyes of three patients obtained by cross-sectional OCT imaging and en face reconstruction at the level of the OPL/HFL interface. RESULTS: All eyes presented with a dentate or saw-tooth pattern of the OPL/HFL interface on cross-sectional OCT with corresponding concentric rings on en face OCT reconstruction, consistent with the recently published "fingerprint sign". Initial OPL/HFL interface changes were observed between the first and fourth months after treatment and resolution of VKHD associated serous retinal detachments. These OPL/HFL interface changes have persisted for many years following the resolution of the active inflammation. CONCLUSIONS: Changes in the OPL/HFL interface can be identified following successful treatment of VKHD. These included both a dentate or saw-tooth pattern on cross-sectional imaging and concentric rings or the "fingerprint sign" on en face reconstructions. These changes persisted for many years despite disease quiescence.

Incidence of and Risk Factors for Steroid Response After Cataract Surgery in Patients With and Without Glaucoma.

PRECIS: Steroid response after cataract surgery was more frequent in glaucoma patients than nonglaucoma patients. Longer axial length and more preoperative medications were risk factors for steroid response in glaucoma patients. PURPOSE: The aim was to evaluate incidence and risk factors for topical steroid response after uneventful cataract surgery in patients with and without glaucoma. SETTING: Academic glaucoma clinics. DESIGN: This was a retrospective review. PARTICIPANTS: Consecutive patients with and without glaucoma and no prior incisional glaucoma surgery undergoing cataract surgery between March 2007 and September 2016. All patients routinely received topical prednisolone acetate 1% postoperatively. METHODS: Pertinent clinical information was recorded. Steroid response was defined as intraocular pressure >50% above the baseline intraocular pressure measurement, occurring at or after the second postoperative week. RESULTS: We included 472 eyes of 472 nonglaucoma patients and 191 eyes of 191 glaucoma patients. Ten (2.1%) nonglaucoma eyes and 16 (8.4%) glaucoma eyes were diagnosed as steroid responders (relative risk=3.72; 95% confidence interval: 1.71-8.07; P<0.001). Logistic regression showed that for nonglaucoma, longer axial length (AL) and younger age were associated with a higher incidence of steroid response (P≤0.003), while for glaucoma patients, longer AL and more preoperative medications were associated with steroid response (P≤0.030). An AL ≥26 mm was associated with steroid response for both groups (P≤0.024). CONCLUSION: Although glaucoma patients were 3.72 times more likely to have steroid response after uneventful cataract surgery, the incidence of steroid response with prednisolone acetate 1% was relatively low after phacoemulsification in both nonglaucoma and glaucoma eyes. Steroid response was associated with longer AL in both groups and with more preoperative medications in glaucoma patients.

Pseudophakic adult with progressive optic disc tilt and axial length elongation.

PURPOSE: To describe a case of progressive optic disc tilt in a pseudophakic Asian adult associated with an increase in axial length. OBSERVATIONS: A 28-year-old man presented with high myopia in the right eye with an axial length of 30.4 mm and refraction of -13.75 diopters (D) spherical equivalent (SE). The refraction was plano sphere after LASIK and LASIK enhancement. The left eye was blinded by retinal detachment after phacoemulsification. Six years later, the right eye axial length was 31.65 mm when he underwent phacoemulsification with intraocular lens placement for nuclear sclerosis, after which the refraction was -0.50 D SE. The right eye refraction changed progressively over 13 years after cataract surgery to -4.00 D SE, at which time the axial length was 33.69 mm. A notable increase in optic disc tilt and peripapillary atrophy was evident on comparison of fundus photographs taken 11 years apart. CONCLUSIONS: Although progressive optic disc tilt in conjunction with increasing axial myopia in pediatric populations has been documented, it has not been reported in adults but may occur. Scleral stretching due to axial length elongation associated with loss of accommodation after cataract surgery and worsening peripapillary atrophy are possible causes of this finding.

Macular Vascular Microcirculation in Eyes With Open-angle Glaucoma Using Different Visual Field Severity Classification Systems.

PRECIS: We found significant differences in macular vascular microcirculation between normal and glaucomatous eyes using optical coherence tomography angiography (OCTA). Macular vascular microcirculation changes also showed significant correlations with visual field (VF) severity classification systems. PURPOSE: To correlate VF severity defined by different classification systems and macular vascular microcirculation in eyes with glaucoma using OCTA. PATIENTS AND METHODS: Twenty normal and 58 open-angle glaucoma (OAG) eyes were scanned using a swept-source OCTA (Plex Elite 9000) and macular vascular microcirculation was measured by calculating the overall blood flux index (BFI) and vessel area density (VAD) over the entire 6×6 mm area excluding the big retinal vessels. Glaucomatous eyes were staged into severity groups based on 4 VF severity classifications: Hodapp-Parrish-Anderson scale, Glaucoma Severity Staging system, ICD-10 glaucoma staging definitions, and VF mean deviation. Central 10-degree VF mean sensitivity (CMS) was calculated based on 24-2 VF. One-way analysis of variance was used to analyze the differences and correlation between macular vascular microcirculation and other clinical parameters. RESULTS: Glaucomatous eyes had significantly lower ganglion cell and inner plexiform layer BFI and VAD (P<0.0001) compared with normal eyes. In OAG patients, BFI and VAD were significantly higher in mild OAG compared with severe OAG with all VF disease severity classification systems (P<0.001). Glaucoma Severity Staging had the highest correlation with changes in macular vascular microcirculation metrics (r=0.734 for BFI; r=0.647 for VAD) and VF CMS had highest correlation with macular vascular microcirculation metrics (r=0.887 for BFI; r=0.903 for VAD). CONCLUSION: Macular vascular microcirculation metrics detected by OCTA correlate with disease severity in glaucomatous eyes. VF CMS, calculated from only 12 tested central 10-degree points, correlated best with macular OCTA.

Surgical correction of retinal folds involving the fovea.

BACKGROUND AND OBJECTIVE: Retinal folds are a rare complication after retinal detachment repair. Surgery is required if the fovea is involved. There are few surgical reports in the literature, describing various surgical approaches. PATIENTS AND METHODS: The authors employed a surgical technique to treat retinal folds involving the fovea in a 59-year-old woman. Perimacular subretinal blebs were created with a 41-gauge cannula in conjunction with fluid-air exchange to coalesce the fluid at the macula. Perfluorocarbon liquid was injected to flatten the retina, and subretinal fluid drainage was performed through a peripheral retinotomy. RESULTS: The macula was successfully unfolded during surgery. Visual acuity improved from 20/800 to 20/50. After 3 months, mild changes at the outer nuclear layer were observed on optical coherence tomography, and autofluorescence showed tracks of hypoautofluorescence where the forced infusion of liquid started. CONCLUSION: The authors describe an effective surgical approach for the correction of retinal folds involving the fovea. Prompt treatment as well as gentle surgical manipulation are key points to obtain an improvement in visual acuity.

Active surveillance of Hansen's Disease (leprosy): importance for case finding among extra-domiciliary contacts.

Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae.