A New OCT Finding in Purtscher-Like Retinopathy.

The authors report a new spectral-domain optical coherence tomography (SD-OCT) appearance observed in two patients with Purtscher-like retinopathy. In this prospective case series of three eyes of two patients with Purtscher-like retinopathy, the patients were assessed with biomicroscopy, fluorescein angiography (FA), and SD-OCT. The last examinations of the patients were performed at 3 months and 12 months, respectively. Both patients presented with decreased visual acuity. Fundus examination revealed a whitish-appearing parafoveal retina and scattered cotton-wool spots in the posterior retina. FA showed hypofluorescent spots that correspond to the cotton-wool spots and retinal hemorrhages seen clinically. SD-OCT scan of cotton-wool spots showed focal hyperreflectivity in the nerve fiber and the ganglion cell layers. SD-OCT scan of the macula in both patients showed hyperreflective areas in the inner plexiform, inner nuclear, outer plexiform, and outer nuclear layers. Hyperreflective areas disappeared during follow-up of the patients. Retinal thinning was observed in these areas after resolution. These findings are in accordance with histopathological findings and support the microvascular embolization theory in pathophysiology of Purtscher-like retinopathy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:64-69.].

Chloroquine and hydroxychloroquine retinopathy-related risk factors in a Turkish cohort.

To evaluate the role of previously reported risk factors on developing retinopathy in patients treated with chloroquine (CQ) and hydroxychloroquine (HCQ). Ophthalmologic examination, visual field testing, and spectral domain-optical coherence tomography were performed in 31 patients treated with CQ and HCQ. Toxicity diagnosis was proven by electrophysiological assessment. The risk factors reported by the American Academy of the Ophthalmology (AAO) were compared between patients with (n = 5) and without toxicity (n = 26) findings. Risk score was calculated for each patient. CQ daily overdose per actual body weight was significantly higher in affected patients. There was no statistically significant difference between groups concerning risk score, estimated cumulative dose of CQ, daily dose of HCQ and CQ per lean body weight, daily overdose of CQ per lean body weight and actual body weight (>3 mg/kg). The cumulative dose of HCQ was significantly higher in non-affected patients. The risk factors reported by the AAO might not be applicable to all CQ- and HCQ-treated patients. Different risk factors not yet reported may play a role in the development of CQ and HCQ retinopathy.

HIV-related eye disease in patients presenting to a tertiary care government hospital in Turkey.

AIM: To document the ocular involvement in HIV-infected individuals in Turkey and to compare the findings with those from other centers throughout the world. METHODS: In this cross-sectional study, patients with HIV infection being monitored in a tertiary hospital in Istanbul were enrolled. Ocular examination was performed, and the prevalence of ocular manifestations determined. RESULTS: In total, 93 patients were enrolled, of whom 37.6% had ocular pathology. HIV retinopathy was the most frequent retinal finding, affecting 8.6% of the enrolled patients, but none of the affected individuals had any ophthalmic complaints. There were no ocular lesions suggestive of cytomegalovirus (CMV) retinitis. DISCUSSION: In contrast to the case in the developed world, sight-threatening infections are uncommon in Turkish HIV(+) patients. The reasons for this are not clear, but it is possible that there are some genetic or environmental protective factors against CMV retinitis in the population studied.

The relationship between optical coherence tomography patterns, angiographic parameters and visual acuity in age-related macular degeneration.

To assess the relationships between visual acuity (VA), fluorescein angiographic parameters and optical coherence tomography (OCT) patterns in exudative age-related macular degeneration (AMD). Fifty eyes with confirmed diagnosis of new exudative AMD who underwent fluorescein angiography (FA) and OCT evaluation were reviewed retrospectively. The greatest linear diameter of lesion (GLD) by FA and central foveal thickness (CFT) by OCT were measured. The OCT scans were evaluated for the presence of diffuse retinal thickening (D), cystic spaces (C), subretinal fluid (S) and pigment epithelial detachment (P) and five OCT patterns were detected (D + S; C; C + S; P + C + S; P + D + S). Angiographic classification of choroidal neovascularizations was performed. Correlations were statistically significant for VA and CFT in all patients whereas VA and GLD correlation was statistically significant only in predominantly classic and minimal classic lesions. The lowest VA values were detected in patients with COCT pattern and/or predominantly classic lesion type by FA. The OCT and FA findings when evaluated simultaneously may provide information regarding visual function in AMD.

Screening for retinopathy of prematurity in a tertiary hospital in Istanbul: incidence and risk factors.

PURPOSE: To study the incidence and risk factors of retinopathy of prematurity (ROP) in premature infants examined in a tertiary hospital in Istanbul. METHODS: Data of infants screened for ROP from April 2007 to September 2009 were retrospectively reviewed. Possible risk factors and eye examinations were recorded and analyzed using the chi-square test and univariate and multivariate regressions. RESULTS: ROP was detected in 177 (34.3%) of the 517 infants enrolled in the study; 64 had mild ROP (77.4%) and 38 had severe ROP (22.6%). The mean gestational age and birth weight of patients who were treated for ROP were 28.6 ± 2.3 and 1,143.5 ± 337.4, respectively. Two of these infants had a gestational age of 32 g or greater and three had a birth weight of 1,500 g or greater. The multivariate regression analyses showed gestational age, birth weight, sepsis, respiratory distress syndrome, and length of oxygen therapy as independent predictors of ROP. CONCLUSION: The incidence of ROP observed in this study was higher than that in developed countries and relatively more mature infants were affected. Criteria including gestational age of less than 34 weeks or birth weight of less than 2,000 g would have identified all infants who were at risk.

A cluster of acute-onset postoperative endophthalmitis over a 1-month period: investigation of an outbreak caused by uncommon species.

AIM: To report the clinical course, treatment response and prognosis of eight cases which developed acute-onset postoperative endophthalmitis over a 1-month period. METHODS: 8 patients who were operated on over a period of 1 month and developed acute postoperative endophthalmitis were evaluated. Five of the patients had cataract surgery, one had cataract surgery combined with silicone extraction, and two patients had pars plana vitrectomy (PPV). Clinical patterns were observed, intraocular cultures were obtained, and the source of the organisms causing the epidemic was investigated. All patients had intravitreal antibiotic injections, three had PPV, and in two patients anterior chamber irrigation was performed. RESULTS: Vitreous cultures showed Cellulosimicrobium cellulans in three cases and Stenotrophomonas maltophilia in one case. Four of the cases were culture negative. Stenotrophomonas maltophilia were also isolated from unused bottles of irrigating solutions. The final visual acuity of the patients ranged between HM and 7/10. All three patients with Cellulosimicrobium cellulans had a final visual acuity of ≥ 5/10. The available irrigating solutions were changed, and the endophthalmitis did not recur. CONCLUSIONS: The authors are unaware of any previous reports of postoperative endophthalmitis associated with Cellulosimicrobium cellulans. Prompt management with microbiological support, intravitreal antibiotics and PPV when needed were the key to good visual outcomes in this endophthalmitis outbreak.

Idiopathic Hypertrophic Cranial Pachymeningitis Associated With Intermediate Uveitis.

The authors report a case with idiopathic hypertrophic cranial pachymeningitis associated with intermediate uveitis. The patient complained of decreased vision in both eyes, especially the right. Ophthalmic examination revealed right optic disc pallor, bilateral vitritis, and cystoid macular edema. Magnetic resonance imaging revealed marked enhancement of a dural lesion. The macular edema responded well to medical treatment. Intermediate uveitis has not yet been reported in the context of idiopathic hypertrophic cranial pachymeningitis.

Visual performances with monofocal, accommodating, and multifocal intraocular lenses in patients with unilateral cataract.

PURPOSE: To compare the visual performance of patients with unilateral cataract following implantation of monofocal, accommodating, refractive, and diffractive multifocal intraocular lenses (IOL). DESIGN: Prospective nonrandomized clinical trial. METHODS: Eighty-seven patients with unilateral cataract were enrolled in 4 groups for phacoemulsification and IOL implantation. Twenty-four patients had monofocal (Alcon Acrysof) (group 1), 21 patients had accommodating (Human Optics 1CU) (group 2), 22 patients had diffractive multifocal (Tecnis ZM900) (group 3), and 20 patients had refractive multifocal (AMO Rezoom) (group 4) IOL implantations. Ages of patients were between 40 and 70. Parameters analyzed at the 18th postoperative month were subjective refractions, monocular and binocular distance, intermediate and near uncorrected visual acuities, monocular distance and near best-corrected visual acuities, monocular distance-corrected intermediate and near visual acuities, stereopsis, visual complaints, and spectacle dependency. RESULTS: No significant difference was observed between distance and near best-corrected visual acuities of IOL groups, and between intermediate visual acuities of groups 2, 3, and 4. Groups 3 and 4 had statistically better near vision than the other groups (P < .05). No significant difference was observed between near visual acuities of groups 3 and 4. Number of patients with better stereoscopic function, spectacle independence, and complaints of halo in groups 3 and 4 was significantly higher than in other groups (P < .05). CONCLUSIONS: Multifocal IOLs provide better stereopsis, higher spectacle independence rates, and satisfactory functional vision over a broad range of distances in presbyopic patients with unilateral cataract compared with the monofocal and accommodating IOLs.

Detecting retinal vigabatrin toxicity in patients with partial symptomatic or cryptogenic epilepsy.

PURPOSE: Detecting retinal vigabatrin toxicity in patients with partial symptomatic or cryptogenic epilepsy can be challenging because of preexisting visual field defects secondary to a structural abnormality in the brain or lack of collaboration. The aim of this study was to measure the retinal nerve fiber layer thickness (RNFLT) with optic coherence tomography (OCT), as well as contrast sensitivity, color vision, and perimetry, in patients with partial symptomatic or cryptogenic epilepsy on vigabatrin, and to determine the efficacy of these tests as markers of vigabatrin-related retinal damage in these subgroups of epileptic patients. METHODS: The study involved 38 patients with either partial symptomatic or cryptogenic epilepsy and 16 healthy individuals comprising the control group. At the time of the study, 14 of the patients were using vigabatrin, 10 were receiving sodium valproate monotherapy, and 14 were on carbamazepine monotherapy. All the participants underwent RNFLT imaging with OCT, contrast sensitivity, color discrimination assessment, and perimetry. RESULTS: The average 360 degrees RNFLT of the vigabatrin group was significantly lower when compared to the other groups. The average RNFLT of all quadrants except the temporal one in the vigabatrin group was also significantly reduced. There was no difference in the mean deviation, contrast sensitivity, and color discrimination between the study groups, but they were all significantly lower than the control group. CONCLUSIONS: RNFLT measurement with OCT can efficiently identify vigabatrin toxicity in patients with partial symptomatic and cryptogenic epilepsy. Perimetry, contrast sensitivity, and color discrimination assessment might be inconclusive in these particular subgroups of epileptic patients.