Cardiometabolic factors and risk of non-arteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis of the literature is to evaluate the association between cardiometabolic risk factors (hypertension, diabetes mellitus, hypercholesterolemia/dyslipidemia, HDL cholesterol, LDL cholesterol, lipoprotein(a), and triglycerides) and non-arteritic anterior ischemic optic neuropathy (NAION). METHODS: Pertinent publications were identified through a systematic search in PubMed and EMBASE databases, without language restrictions. The pooled odds ratios (OR) and standardized mean differences (SMD), with their 95% confidence intervals (95% CI) were estimated using random effects (DerSimonian Laird) models, as appropriate. A set of subgroup analyses and meta-regression analysis models were performed. RESULTS: Twenty-one studies (including 1560 patients with NAION and 2292 controls), examining the association between NAION and cardiometabolic risk factors, were eligible for the systematic review and meta-analysis. Hypertension (pooled OR = 1.50; 95% CI: 1.16-1.94), diabetes mellitus (pooled OR = 1.71; 95% CI: 1.33-2.21), and hypercholesterolemia/dyslipidemia (pooled OR = 2.00; 95% CI: 1.53-2.62) were associated with NAION. Among the components of dyslipidemia, higher serum triglycerides were associated with NAION, with a medium effect size (SMD = + 0.58, 95% CI: + 0.12 to + 1.04), whereas synthesis of four studies reporting on HDL and LDL cholesterol did not reveal any significant associations. A significant association between NAION and higher serum lipoprotein(a) levels (pooled OR = 2.88; 95%CI: 1.01-8.21) was also noted. CONCLUSIONS: This systematic review and meta-analysis found that NAION was associated with cardiometabolic factors, suggesting that vascular dysfunction may be implicated in the pathogenesis of the disease. Our findings may alert health care providers to try modifying these risk factors for NAION prevention.

Optic disk pit maculopathy: current management strategies.

INTRODUCTION: Optic disk pit (ODP) is a rare congenital abnormality of the optic nerve head and can lead to visual impairment when macular detachment occurred. Recent advances in retinal imaging brought new insights into the pathophysiology of the disease, while new therapeutic options have been also described. METHODS: We made a comprehensive search of the literature regarding the current treatment modalities for the treatment of ODP maculopathy. RESULTS: Although there have been reported some cases of spontaneous resolution, current management of ODP maculopathy involves several surgical approaches. The most commonly used treatment alternative for ODP maculopathy management is vitrectomy, either alone or in combination with other treatment modalities, such as gas tamponade or laser photocoagulation. Other options, such as scleral buckling and inner fenestration, are also used, based on the recent findings about pathophysiology of the disease. CONCLUSION: The management of ODP maculopathy remains challenging. Even though there are further advances in the understanding of the disease pathophysiology, the applied treatment is not single and therapeutic modalities differ in the success rate, related to the anatomical and functional results.

Complications of intravitreal ocriplasmin for vitreomacular traction and macular hole: a prospective spectral-domain optical coherence tomography study.

OBJECTIVE: The purpose of this study was to evaluate the safety of intravitreal ocriplasmin prospectively, reporting potential complications in patients with vitreomacular traction (VMT) alone or associated with macular hole (MH). MATERIALS AND METHODS: Participants in this prospective, multicenter study, were 24 patients with VMT (17 with VMT alone and seven with MH combined with VMT). All patients were treated with a single ocriplasmin injection and followed-up prospectively at baseline, day 7, 28 and the last examination of the follow-up for each patient (mean ± SD: 64.2 ± 24.4 d, range: 40-145 d). Best-corrected visual acuity (BCVA) was assessed, and spectral-domain optical coherence tomography was performed at each visit while the percentage of resolution of VMT and the association with various potential adverse events were recorded and analyzed. RESULTS: 66.7% of patients presented VMT release at the end of the follow-up, while 28.6% exhibited MH closure. Severe adverse events, such as enlargement of preexisting MH and formation of lamellar MH, were observed in one and four cases, respectively and remained till the end of the follow-up. Moderate adverse events, such as ellipsoid zone disruption and subretinal fluid development, became evident seven days after injection, in four cases. Formation of cystoid macular edema (CME), not evident at baseline, was noticed in three cases at day 28 after injection. Mild adverse events, like vitreous floaters, photopsias, eye pain and foreign body sensation, were noticed at day 7 and resolved till the end of the follow-up. CONCLUSIONS: Mild and moderate adverse events occurred mainly during the first week of the follow-up, while severe adverse events, such as the lamellar MH formation and CME at day 28 post injection were seen.

Macular buckling in optic disc pit maculopathy in association with the origin of macular elevation: 13-year mean postoperative results.

PURPOSE: To discuss the anatomical and functional results in cases of optic disc pit maculopathy (ODP-M) with a follow-up of at least 11 years after scleral buckling procedure (SBP). METHODS: We studied 12 eyes with ODP-M treated with SBP, in a long-term follow-up of 12.8 ± 1.5 years after surgery. All patients underwent best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography, B-scan ultrasonography, and optical coherence tomography at baseline and 6-12 months, 2 years and at least 11 years postoperatively. RESULTS: Complete macular reattachment was noticed between 6 and 12 months postoperatively. The BCVA improved significantly at the first postoperative examination. Further improvement was noticed at the second examination, while BCVA remained almost stable at the last examination. Foveal restoration of ellipsoid layer (inner segment/outer segment) was noted in 10 out of 12 cases. The existing vitreous strands remained unchanged during the follow-up. Vitreous traction gradually disappeared (4/5 eyes). Circulation in short/long posterior ciliary arteries was unaffected, while neither recurrences nor complications were observed during the follow-up period. Association of the scleral sponge to the scleral sheath of the optic nerve remained unchanged during the follow-up. CONCLUSIONS: A total of 12.8 ± 1.5 years after treatment, all the studied cases retained the successful anatomical and functional results that they had 2 years postoperatively, without inducing cataract during the follow-up period. The SBP seems to act equally well as a barrier either obstructing the entrance of fluid from the vitreous cavity or blocking the circulation of subarachnoid cerebrospinal fluid into the retina.

Evolution of vitreomacular adhesion to acute vitreofoveal separation with special emphasis on a traction-induced foveal pathology. A prospective study of spectral-domain optical coherence tomography.

PURPOSE: To investigate the evolution of vitreomacular adhesion (VMA) to acute vitreofoveal separation with particular emphasis on cases involving the underlying fovea. METHODS: In this observational case series, of 192 cases in the VMA stage, 51 progressed to acute vitreofoveal separation; this subgroup was divided into those with normal separation (Group I) and those with co-existing macular findings (Group II). All patients were examined using spectral domain-optical coherence tomography (SD-OCT) at regular three-month intervals. We recorded the best-corrected visual acuity (BCVA), the vitreomacular angle of the VMA (nasally and temporally), the horizontal diameter of the VMA, the macular thickness, the integrity of the photoreceptor layer and of the external limiting membrane. The Amsler grid test was used in the intermediate examinations in cases where patients developed symptoms. RESULTS: Out of the 51 cases in the VMA stage, 45 (88.2%) progressed to normal spontaneous vitreofoveal separation, while six (11.8%) developed findings of the fovea, such as macular thinning (two cases), an anomalous foveal contour (two cases), a macular tissue defect (one case) and vitreous separation from only the temporal side of the VMA in one case. Foveal findings were the same during the follow-up period in all but one case in which improvement was noted. Differences in BCVA between baseline measurements, those made immediately after vitreofoveal separation, and those made during final examination were not statistically significant. For the whole sample of our study (51 cases), the mean observation time at the VMA stage was 21.8 ±10.6 months, while the mean follow-up time after vitreofoveal separation was 9.7 ±4.9 months. In cases that developed incidents from the fovea, the mean observation time from the baseline to the last examination before vitreofoveal separation was 16.5 ±11.2 months and the mean follow-up time from the diagnosis of vitreofoveal separation to the final examination was 8.5 ±4.4 months. CONCLUSIONS: VMA, excepting its progression to vitreomacular traction or spontaneous release, in a subset of patients can also cause findings associated with the fovea, concomitantly with vitreofoveal separation. Vitreofoveal separation can induce unilateral anatomic distortion of the fovea accompanied by symptoms, such as metamorphopsia or micropsia.

Spontaneous resolution of vitreomacular traction demonstrated by spectral-domain optical coherence tomography.

PURPOSE: To evaluate the natural course of idiopathic vitreomacular traction (VMT) with spectral-domain optical coherence tomography (SDOCT) from the vitreomacular adhesion (VMA) stage to the spontaneous resolution of VMT. DESIGN: Prospective observational case series. METHODS: We studied the natural course of idiopathic VMT in 46 eyes (46 patients), divided into those that proceeded to spontaneous VMT resolution (12 cases) and those that remained at the VMT stage (34 cases). All patients were examined with SDOCT at regular 3-month intervals. We recorded the vitreomacular angle of VMA nasally and temporally, the horizontal diameter of VMA, macular thickness, visual acuity, photoreceptor layer, and external limiting membrane. RESULTS: In the 12 eyes that proceeded to spontaneous resolution, the vitreous adhesion angle had a mean increase of 38 degrees at VMT, compared to the angle at the VMA stage. In the 34 eyes that remained at the VMT stage, the mean angle of traction increased by only 1 degree throughout follow-up. In all 46 patients, the angle at the VMT stage was significantly associated with traction resolution (nasally P = .001, temporally P < .001). The likelihood of resolution was more than 99% lower for patients with a VMT diameter >400 µm compared with that of eyes with a VMT diameter <400 µm. Patients with broad-type VMT remained at the same stage, whereas patients with V-type VMT had 80% probability of resolution. CONCLUSIONS: Spontaneous VMT resolution is negatively associated with the horizontal adhesion diameter. The strength of the traction exerted by the vitreous on the fovea seems to be positively related to the size of the vitreomacular angle.

Photoreceptor layer changes overlying drusen in eyes with age-related macular degeneration associated with vitreomacular traction.

PURPOSE: To investigate by spectral-domain optical coherence tomography (SD-OCT) changes of photoreceptor layers over drusen in cases of dry type age-related macular degeneration associated with vitreomacular traction (VMT). METHODS: Clinical examination, fluorescein angiography, fundus photography, and SD-OCT data were retrospectively studied for a consecutive series of 27 patients with drusen, pseudodrusen, and VMT. Control groups of 32 patients with VMT without drusen and 34 patients with drusen and pseudodrusen without VMT were also studied. RESULTS: The examination revealed disruption of the line corresponding to the inner segment ellipsoid (ISel), previously called inner segment/outer segment junction, of photoreceptor layer, and development of cystoid edema in significantly higher incidence in VMT associated with drusen group. 22 out of 32 eyes with VMT and drusen (68.75%) had disrupted ISel, compared to 8 out of 37 (21.6%) control eyes with drusen only and to 12 out of 37 (32.4%) control eyes with VMT only. Chi-square analysis showed significant association between drusen and pseudodrusen on fovea, VMT, and localization of ISel disruption. The changes of the ISel were mainly found in the area that corresponded to VMT. The SD-OCT revealed drusen throughout the macula and discontinuation of ISel only in the fovea in 4 of 32 (12.5%) eyes with VMT, whereas none of 37 control eyes with drusen only had similar appearance. CONCLUSIONS: The drusen in association with the cystoid macular edema induced by vitreous traction contribute to the photoreceptor layer defect overlying drusen in the fovea. In addition, the number of drusen and pseudodrusen was increased in the area of the vitreous traction compared to the peripheral retina.

Evolution of a juxtapapillary von Hippel-Lindau tumour examined by optical coherence tomography.

PURPOSE: The aim was to report the evolution of a case of von Hippel-Lindau (VHL) juxtapapillary retinal capillary haemangioblastoma (RCH) by optical coherence tomography (OCT3). CASE REPORT: The progress of a 24-year-old man suffering from VHL disease with a juxtapapillary haemangioblastoma and a small peripheral lesion was followed for 26.4 months with fundus photographs and OCT of the optic nerve head using the optic nerve head rim volume, ranging from 1.106 to 1.895 mm(3). Visual acuity remained 6/6 throughout. CONCLUSIONS: OCT can be a useful tool in the follow up and decision-making of patients with small retinal capillary haemangioblastoma of the optic nerve.

Restoration of the photoreceptor layer and improvement of visual acuity in successfully treated optic disc pit maculopathy: a long follow-up study by optical coherence tomography.

PURPOSE: To investigate by optical coherence tomography (OCT) the evolution of the photoreceptor layer and its association with best-corrected visual acuity (BCVA) in optic disc pit (ODP) maculopathy after successful surgical treatment. METHODS: Fourteen eyes of 14 patients were included in this study, and followed up from 36 to 95 months (mean 57.36 ± 18.32 months). The follow-up period started at the time of complete subretinal fluid absorption. Examination was performed by time-domain OCT before and after treatment. Spectral-domain OCT was used after treatment. Parameters assessed were type of elevation, central foveal thickness, time elapsed from onset to treatment, type of treatment, BCVA, and inner segment outer segment (IS/OS) junction line. The IS/OS junction was characterized after treatment as intact, interrupted, or absent (not distinguishable). RESULTS: Significant restoration of the IS/OS junction line was first noticed between 6 and 12 months after fluid absorption (p = 0.02; Wilcoxon signed rank test). Restoration was continuous up to the 24th month of postoperative examination after fluid absorption (p = 0.14; Wilcoxon signed rank test). BCVA was 0.99 ± 0.38 logMar before treatment, 0.81 ± 0.26 logMar (p = 0.011; paired t-test) immediately after fluid absorption and 0.61 ± 0.33 logMar (p = 0.026; one-way ANOVA) 24 months after fluid resolution. BCVA was significantly positively correlated with the integrity of the IS/OS junction line during follow-up (Pearson r = 0.775; p < 0.001). CONCLUSIONS: The IS/OS junction restoration cannot be detected immediately after fluid resolution in the majority of cases. It became evident 6-12 months later and was completed 24 months after fluid absorption. Improvement in BCVA was noticed only during the first 2 years of follow-up. No significant changes were noticed in BCVA or the IS/OS line after 2 years. Among the studied variables, the final photoreceptor layer condition and BCVA immediately after fluid absorption are the main factors predicting final BCVA after successful surgical treatment of ODP maculopathy.

Spontaneous closure of lamellar macular holes studied by optical coherence tomography.

PURPOSE: To document and study the spontaneous closure of lamellar macular holes (LMH) by optical coherence tomography (OCT). METHODS: Two women with LMH, 62 and 71 years old, respectively, were followed up with fundoscopy, fundus photography and OCT. RESULTS: In both patients spontaneous closure of LMH was observed 11 and 21 months after baseline examination, respectively. The foveal thickness in case 1 increased from 84 µm at baseline to 162 µm at the final examination. The foveal thickness in case 2 increased from 48 µm at baseline to 148 µm at the final examination. The foveal contour was also restored in both eyes. The foveal morphology was preserved in both eyes during the follow-up period. CONCLUSION: In both patients the spontaneous closure of LMH could be attributed to the shrinkage of the hole or the release of the tension on the retinal surface, which followed the complete posterior vitreous detachment and separation of epiretinal membrane from the retina.

Hemodialysis-induced alterations in macular thickness measured by optical coherence tomography in diabetic patients with end-stage renal disease.

BACKGROUND/AIMS: To evaluate changes in macular thickness measured by optical coherence tomography (OCT) during a hemodialysis (HD) session in diabetic patients with end-stage renal disease. METHODS: 72 eyes of 36 diabetic patients with and without macular edema were evaluated before and immediately after an HD session. Average and maximum macular thicknesses in the central disk (6 mm in diameter) and total macular volume were measured. RESULTS: In the eyes with diabetic macular edema, maximum macular thickness within the central disk of 6 mm, and mainly in its peripheral parts, was significantly reduced by 31.18 ± 4.18 µm after HD (p < 0.001). Average macular thickness and total macular volume were also significantly reduced (p = 0.003 and 0.015, respectively). In diabetic eyes without edema, maximum macular thickness decreased significantly by 11.21 ± 1.98 µm after HD (p < 0.001), while average macular thickness and total macular volume decreased slightly (p = 0.034, p = 0.043). Best-corrected visual acuity failed to change. We found a significant association of macular thickness changes with osmolality reduction and the presence of macular edema. CONCLUSION: HD decreases macular thickness in diabetic patients with macular edema, while there exists a less-pronounced effect in diabetic eyes without edema.

The photoreceptor layer as a prognostic factor for visual acuity in the secondary epiretinal membrane after retinal detachment surgery: imaging analysis by spectral-domain optical coherence tomography.

PURPOSE: To study the prognostic factors that influence best-corrected visual acuity (BCVA) outcome in patients with secondary epiretinal membrane (ERM) after retinal detachment surgery. DESIGN: Retrospective case series. METHODS: Forty-two patients with ERM were divided into macula-on and macula-off groups based on the macular status before retinal detachment surgery and were studied using the same spectral-domain optical coherence tomography device. Several variables, including the integrity of the external limiting membrane (ELM), the status of the photoreceptor inner segment/outer segment (IS/OS) junction line, and central foveal thickness were evaluated in 17 treated and 25 untreated patients. Linear regression analysis was used to determine the best combination of all variables affecting BCVA. RESULTS: Final BCVA was significantly better in macula-on and macula-off eyes with intact ELMs and IS/OS junction lines (0.35 ± 0.18 logarithm of the minimal angle of resolution [logMAR] and 0.51 ± 0.17 logMAR, respectively) than in macula-off eyes with disrupted or absent ELMs and IS/OS junction lines (0.83 ± 0.17 logMAR and 1.04 ± 0.05 logMAR, respectively; P < .001, analysis of variance). Final BCVA also was better in the treated group than in the controls (0.55 ± 0.31 logMAR and 0.73 ± 0.26 logMAR, respectively; P = .05, t test). ELM and IS/OS junction line integrity were the main variables significantly affecting the final BCVA outcome (ß = 0.42; P = .006, linear regression analysis). Disruption of the ELM and IS/OS junction line was observed in 21 of the 42 cases studied. CONCLUSIONS: ERM secondary to retinal detachment surgery is accompanied by a high incidence (50%) of IS/OS junction line and ELM disruption. Among the variables studied, the condition of the IS/OS junction layer and the ELM are the main factors that predict final BCVA after ERM peeling.

The significance of the external limiting membrane in the recovery of photoreceptor layer after successful macular hole closure: a study by spectral domain optical coherence tomography.

PURPOSE: To evaluate the external limiting membrane (ELM) by spectral domain optical coherence tomography (SDOCT) and its correlation with the inner segment/outer segment (IS/OS) line in patients with successful macular hole surgery. PROCEDURES: Forty-five eyes were divided into 3 groups according to the interval between surgery and first examination. In the first group the interval was between 6 and 12 months, in group 2 it was >12 months and ≤ 24 months, and in group 3 it was >24 months. The IS/OS and ELM of participants' eyes were postoperatively assessed using SDOCT in 2008 and 12 months later. RESULTS: A statistically significant association between the integrity of the ELM and the IS/OS junction line was observed in postoperative examinations in all 3 groups. Eyes with a complete IS/OS junction line had an intact ELM. Between the first and the second examinations, a significant improvement in best-corrected visual acuity (BCVA) was noted only in group 1. A positive statistical association was also observed in group 1 between restoration of the IS/OS junction line and improvement in BCVA over follow-up. CONCLUSIONS: The restoration of the IS/OS junction line is directly related to the integrity of the ELM.

Association of the preoperative photoreceptor layer defect as assessed by optical coherence tomography with the functional outcome after macular hole closure: a long follow-up study.

BACKGROUND: to evaluate the correlation between the extent of the inner/outer segment (IS/OS) defect preoperatively and improvement in postoperative best-corrected visual acuity (BCVA) associated with IS/OS line restoration. METHODS: forty-six eyes (46 patients) with successfully operated idiopathic full-thickness macular holes were studied using Stratus OCT3 with a mean follow-up of 34.7 months (range 24-60 months). The preoperative extent of the IS/OS junction defect, macular hole base diameter (MHBD) and BCVA were studied before surgery. The degree of IS/OS line restoration, macular thickness and BCVA were measured after treatment. RESULTS: the mean preoperative MHBD and IS/OS defect size were 783 and 1,973 µm, respectively. Postoperative continuity of the IS/OS junction was observed in 11 of 46 cases 12 months after treatment. In the remaining 35 patients, the IS/OS line was interrupted at 12 months of follow-up. The size of the preoperative IS/OS defect line was negatively correlated with the size of the postoperative IS/OS line and BCVA at 6 months and 12 months only (p < 0.0001). In all 46 eyes, the mean BCVA before and 12 months after treatment was 10 and 36.7 letters, respectively. BCVA remained almost unchanged after the first postoperative year of observation. CONCLUSIONS: the degree of reorganization of the photoreceptor layer after successful macular hole closure varies and is mostly related to the preoperative extent of the IS/OS defect line and the MHBD. A small-sized IS/OS preoperative defect favors improvement and restoration of the IS/OS line after treatment. The IS/OS junction line and BCVA are mostly restored during the first 12 months after treatment.

Exemestane-induced corneal epithelial changes.

We report a case of corneal epithelial changes that occurred as ocular side effects of treatment with exemestane, a selective steroidal aromatase inhibitor. A 55-year-old woman presented to our outpatient department for routine eye examination. Clinical examination revealed bilateral corneal gray-white bands appearing as intraepithelial microcysts. Her past medical history included breast cancer, for which she underwent chemotherapy and subsequent treatment with exemestane. She was followed up for 1 year, during which the clinical picture of the cornea remained unchanged in both eyes and visual acuity remained unaffected. A causal connection seems to be possible between systemic treatment with exemestane and persisting corneal intraepithelial cysts.