One-year follow up of a tobacco alcohol optic neuropathy case with atypical course: Conventional assessment and Laser speckle flowgraphy.

PURPOSE: To describe the unexpected one-year course of a probable Tobacco Alcohol Optic Neuropathy (TAON) and the unprecedented Laser Speckle Flowgraphy (LSFG) assessment. CASE REPORT: A 49-year-old Caucasian man with no family history of visual impairment referred because of unilateral and painless visual acuity (VA) decrease in the right eye (RE). Also, color vision and visual evoked potentials were unilaterally altered. Optical coherence tomography (OCT), instead, revealed bilateral thinning of the macular ganglion cell inner plexiform layer. Funduscopy, intraocular pressure, pupillary shape/reactivity and ocular motility were normal. Blood testing revealed macrocytic/normochromic anemia and low levels of vitamin B2 and folic acid. The patient admitted heavy tobacco and alcohol intake for many years. After an initial compliance to the prescribed regimen, the patient quitted the vitamin intake and resumed his smoking and drinking habits. After a 13-month follow up the VA further reduced in the RE; the fellow eye preserved normal visual function despite the bilateral and progressive alterations of the OCT assessment. Both eyes underwent LSFG examination. All the conventional nets evaluated by the instrument (i.e., Mean Tissue, Mean All and Mean Vascular perfusion) were lower in the RE. CONCLUSIONS: Based on patient's behavior, visual deficiencies and laboratory findings, we assumed that the patient suffered from TAON. Also after one year, however, a deep discrepancy between the strictly unilateral, progressive VA impairment and the bilateral, symmetrical OCT alterations persisted. The LSFG data clearly indicate that the perfusion of the two eyes differed, especially referring to tissular vascularization in the optic nerve head area of the RE.

In vivo evaluation of DSAEK interface with scanning-laser confocal microscopy.

BACKGROUND: Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) allows selective replacement of the endothelium. Post-operative haze and particles can affect the interface quality and, ultimately, visual outcome. In this study, we evaluated DSAEK interface with in vivo laser confocal microscopy (LCM) in order to: (i) correlate interface status with best corrected visual acuity, and (ii) with time from surgery; (iii) correlate interface particle number with best corrected visual acuity. Host-donor interface was imaged and graded using a published reflectivity scale. Particles at the interface were counted. METHODS: 18 eyes of 16 patients (6 males and 10 females); mean age: 74 ± 8.3 years which underwent DSAEK were examined by means of in vivo laser confocal microscopy between 1 and 24 months after surgery. Host-donor interface was imaged and graded using a published reflectivity scale. Particles present at the interface were counted. RESULTS: Interface reflectivity was 2.17 ± 1.2 and significantly correlated with visual acuity (Spearman correlation coefficient -0.83; P < 0.001), and with time after surgery (Spearman correlation coefficient -0.87; P < 0.001). Visual acuity was 0.67 ± 0.27. The number of particles was 205 ± 117.8; no correlation was found between this number and visual acuity (Spearman correlation coefficient -0.41; P = 0.15). CONCLUSION: DSAEK interface imaged with LCM is helpful in diagnosing poor host-donor interface quality in DSAEK surgery. A good quality interface is related to a better visual acuity. Moreover, the quality of the interface appears to improve as time passes from the surgery. Interface quality is related with visual acuity and improves with time from surgery. LCM should be considered as an added tool in post-DSAEK follow-up of patients. Finally, our study shows that the presence of particles does not influence visual outcome.