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Purpose: To examine the prevalence and distribution of fluid within a cohort of eyes with acute central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (AION) using optical coherence tomography (OCT). Methods: A retrospective analysis of patient records and OCT imaging. Patients presenting with acute CRAO or AION who had available macular OCT imaging and no co-morbidities known to cause macular fluid were included in the analysis. Baseline characteristics, visual acuity (VA), and fluid presence and distribution among the retinal layers were recorded. Results: In the 16 eyes with acute CRAO, fluid was noted in 5 eyes (31%), which was mainly subretinal (3 eyes) or intraretinal located within the outer retinal layers (3 eyes). Only one eye had inner retinal cysts. Of the 11 eyes with acute AION, fluid was present in 8 eyes (73%). Subretinal fluid was noted in 4 eyes and extended to the foveal area in 3 of them, and outer retinal versus inner retinal cysts were noted in 6 versus 3 eyes, respectively. None of the eyes showed hard exudate deposition. In the small subset of eyes with CRAO and macular fluid that were followed-up, VA improved, while in eyes with AION, VA remained stable. Conclusion: Macular fluid on OCT is not an uncommon feature of acute CRAO and AION and is mainly distributed within the outer retinal layers or subretinal space. Fluid is an understudied feature of retinal and optic nerve head infarction and may have a role in predicting neuronal damage extent and visual outcome.
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Purpose: To evaluate the efficiency, safety, and stability of a revised tissue-saving treatment protocol in a cohort having pellucid marginal degeneration (PMD). Methods: A retrospective cohort study was conducted on patients with PMD and no previous treatments. A revised protocol of topo-guided photorefractive keratectomy to be followed by customized phototherapeutic keratectomy and then corneal crosslinking was evaluated by comparing the pre and postoperative outcomes regarding visual (subjective refraction) and topographic (using data from Sirius CSO topography software) outcomes. Results: There were both statistically significant and clinically relevant improvements in the postoperative parameters, where each of the unaided and corrected visual acuity, spherical equivalent, refractive cylinder, K readings, topographic cylinder, inferior minus superior difference at the 2- and 4- mm diameters, coma aberration, and higher order aberrations were significantly better postoperatively (all p values were less than 0.01, except for maximum k readings where the p-value was 0.017). The safety and efficacy indices for the surgical procedure were remarkably high (1.53 ± 0.70 and 0.90 ± 0.32, respectively). Conclusion: Our proposed tissue-saving protocol (which showed satisfactory results in keratoconus cases according to a previously published article by our research team) has proven its successful outcomes (both topographically and visually) in cases of PMD, which is a rare ectatic entity with guarded prognosis using the available conventional ectasia treatment modalities.
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PURPOSE: To compare the postoperative outcomes following implantation of KERATACx ring segments (Imperial Medical Technologies Europe GmbH) in patients having eccentric keratoconus with three different topographic patterns. METHODS: This retrospective cohort study was conducted at Maadi Eye Subspeciality Center, Cairo, Egypt. The study included patients with keratoconus who had implantation of KERATACx ring segments. Three groups were segregated based on topographic keratoconus patterns using the Sirius CSO Topographer (CSO Italia): type I ectasia where the cone coincides with the corneal flat axis, type II ectasia in which the cone coincides with neither the steep nor the flat axis and lies between the two axes, and type II ectasia for cones coinciding with the corneal steep axis. The visual and topographic outcomes were compared preoperatively and postoperatively for the three enrolled groups. RESULTS: This study enrolled 92 eyes of 92 patients and had a mean ± standard deviation follow-up of 16.9 ± 9.2 months. The patients' medical records revealed that night vision complaints and halos around the light were experienced the most by the type III ectasia group (31.25%). For the type III ectasia group, four topographic indices and one visual parameter did not show statistically significant differences between the preoperative and postoperative data (inferior-superior difference at 2- and 4-mm diameter, coma aberration, higher order aberrations, and uncorrected distance visual acuity), contrary to the type I and II ectasia groups, which showed significant improvements in all evaluated parameters. CONCLUSIONS: The type III morphological pattern of ectasia is the least likely to benefit from KERATACx ring segments implantation. [J Refract Surg. 2024;40(9):e625-e634.].