Binocular Visual Field and Vision-Related Quality of Life in Patients With Hemianopia.

BACKGROUND: Hemianopias can have a severe impact on functional ability and quality of life (QoL). Binocular visual field (VF) analysis is clinically more relevant to visual function than monocular VF. The aim is to analyze the binocular VF of patients with hemianopias and its association with the monocular VF and to assess the QoL of these patients through questionnaires specifically related to vision compared with healthy controls. METHODS: The case-control study included patients with hemianopias and controls. Sex, age, general history, etiology, location of the lesion, and time since the lesion appeared were recorded. Monocular VF and Esterman binocular VF were performed. VF defect, mean defect (MD), and Esterman scores were recorded. Visual Activities Questionnaire (VAQ-33) and Visual Function Questionnaire (VFQ-25) questionnaires were administered. RESULTS: Twenty patients with hemianopia and 22 healthy controls were included. The Esterman score in homonymous hemianopia patients (n = 17) correlated with best eye MD (r = -0.62, P = 0.01), worst eye MD (r = -0.70, P = 0.002), and average MD (r = -0.68, P = 0.003). Compared with healthy control subjects, patients with homonymous hemianopia had significantly lower VFQ-25 score and in 10/12 subscales (all P < 0.001). VAQ-33 scores revealed lower overall and subscales scores with the exception of light/dark adaptation (P = 0.08). Correlations were found between monocular and binocular VF scores and general vision (r = -0.55), peripheral vision (on both questionnaires, r-range -0.75 to 0.47), VFQ-25 and VAQ-33 overall scores (r = -0.59, -0.49 and 0.50), and glare disability (r = 0.53 and 0.67). CONCLUSIONS: Hemianopic VF defects involve a major alteration in the patients' vision-related QoL.

Spectrum of Headaches Associated With SARS-CoV-2 Infection: Study of Healthcare Professionals.

BACKGROUND: Series of patients with SARS-CoV-2 infection report headache in 6%-15% of cases, although some data suggest that the actual frequency is higher, and that headache is not associated with fever. No study published to date has analyzed the characteristics of headache in these patients. OBJECTIVE: To analyze the characteristics of COVID-19 related headaches. METHODS: We conducted a survey of Spaniard healthcare professionals who have been infected by SARS-CoV-2 and presented headache during the course of the disease. The survey addressed respondents' medical history and headache characteristics, and we analyzed the association between both. RESULTS: We analyzed the responses of a sample of 112 healthcare professionals. History of migraine was reported by 20/112 (17.9%) of respondents, history of tension-type headache by 8/112 (7.1%), and history of cluster headache was reported by a single respondent; 82/112(73.2%) of respondents had no history of headache. Headache presented independently of fever, around the third day after symptom onset. The previous history of migraine was associated with a higher frequency of pulsating headache (20% in patients with previous migraine vs 4.3% in those with no history of migraine, P = .013). CONCLUSION: Headache is often holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Because the characteristics of the headache and the associated symptoms are heterogeneous in our survey, we suggest that several patterns with specific pathophysiological mechanisms may underlie the headache associated with COVID-19.

Retinal Nerve Fiber Layer Analysis in Children With Migraine With and Without Aura Using Optical Coherence Tomography: A Case-Control Study.

PURPOSE: To evaluate retinal nerve fiber layer (RNFL) thickness in children with migraine, with and without aura, compared to healthy controls using optical coherence tomography (OCT). METHODS: In this cross-sectional case-control study, patients with a diagnosis of migraine with aura (MwA) or without aura (MwoA) were considered and healthy children were included as controls. Age, sex, duration of migraine, number of episodes per month, duration of episodes, and use of prophylactic treatment with magnesium were recorded. All patients underwent complete ophthalmologic, neurologic, and pediatric examination. Optic nerve OCT images were obtained using Heidelberg Spectralis OCT (Heidelberg Engineering) and mean global RNFL thickness and the average thickness for each sector were noted. RESULTS: Thirty-seven children were included: 17 with migraine (9 MwoA and 8 MwA) and 20 controls, the mean age being 13.8 ± 2.9 (range: 8 to 16) and 13.4 ± 2.5 (range: 7 to 16) years, respectively. No significant differences in RNFL thickness were found when comparing all patients who had migraine with healthy controls. However, children with MwA showed statistically significant reductions in RNFL thickness in the temporal (mean difference: 7.83; 95% CI: 0.52 to 15.14, P = .027) and inferior-temporal (mean difference: 16.06; 95% CI: 1.95 to 30.16, P = .027) sectors compared to patients with MwoA. None of the other sectors showed statistically significant differences between groups (all P > .05). In the migraine group, negative correlations were detected between the number of episodes per month and RNFL thickness in the nasal-superior quadrant (r = -.420; P = .021). CONCLUSIONS: Children with MwA may present a decrease in RNFL thickness, which is associated with the number of episodes per month. [J Pediatr Ophthalmol Strabismus. 2023;60(3):196-202.].

Optical coherence tomography angiography of choroidal nodules in neurofibromatosis type-1: A case series.

PURPOSE: To describe optical coherence tomography angiography (OCTA) findings in the retina and choroid of patients with neurofibromatosis type 1 (NF1). METHODS: We describe a series of four patients diagnosed with NF1 and choroidal nodules who underwent a comprehensive ophthalmic evaluation including a retinal multimodal imaging study based on retinography, near-infrared reflectance imaging (NIR), enhanced depth imaging (EDI) optical coherence tomography (OCT) and OCTA. RESULTS: Patients were three women and one man aged 36-47 years. In all patients, the choroidal nodules were not visible in retinographies but easily detectable with NIR, appearing as multiple bright patches. On OCTA, we observed reduced vessel density in the choriocapillaris in zones where choroidal nodules appeared in OCT images. In one patient, a corkscrew vessel was visible in the superficial capillary plexus. CONCLUSION: Choriocapillaris vessel density was reduced in zones where choroidal nodules occur in NF1 patients. Further work is needed to clarify the clinical relevance of this finding.

Multimodal Imaging, OCT En Face, and OCT Angiography of an Anomalous Retinal Artery: Case Report and Review of the Literature.

The purpose is to study for the first time the vascular plexuses and the retinal nerve fiber layer and raphe of a patient with a very uncommon anatomical variation: an anomalous retinal artery supplying the whole macula. We used multimodal imaging, en face spectral-domain optic coherence tomography, and spectral-domain optic coherence tomography angiography. One patient presented in his left eye a very unusual anatomical variation of macular vascularization. A retinal artery deriving from the inferior temporal retinal artery irrigated the whole macula. The formation of the papillomacular bundle and the temporal raphe nerve fiber layer has been attributed to the earlier development of the central retina and to the existence of 2 distinct watershed zones. However, there are very uncommon anatomical variations of the retinal vasculature in which large retinal vessels cross the raphe and could influence the morphology and structure of the nerve fiber layer of the posterior pole. We review the literature on the subject and document for the first time an anomalous artery that irrigates the whole macula, normal thickness and morphology of the nerve fiber layer, and the temporal raphe.

Correlation Between Retrograde Trans-Synaptic Degeneration of Ganglion Cells and Optical Coherence Tomography Angiography Following Ischemic Stroke.

Objective Following nerve injury, the projection of posterior visual pathway lesions into the macular ganglion cell layer (GCL) region indicates retrograde trans-synaptic degeneration (RTSD) as a mechanism of functional damage. Our purpose is to assess GCL damage and the impacts of ischemic brain lesions affecting the visual pathway on macular microvascularization in patients with stroke. Methods In a case-control study, we examined 15 ischemic stroke patients who showed visual field defects and 50 healthy controls using the high-resolution optical coherence tomography (OCT) techniques such as spectral domain-OCT (SD-OCT) to measure retinal nerve fiber layer (RNFL) and GCL thicknesses, and OCT angiography (OCTA) to assess damage to the macular microvasculature. Results In the cases, the correlation was detected among the site of vascular damage, visual field defect, retinal GCL thinning, and normal RNFL thickness. Further observations were significant reductions in macular thickness, GCL thickness, outer retinal layer vascular density, and vascular area in deeper retinal layers (p < 0.05). Conclusion Our findings suggest that ocular microvasculature abnormalities could serve as diagnostic and/or prognostic markers in patients with stroke and support the described use of GCL thickness as an image marker of visual pathway RTSD after brain injury.

Agreement between rebound (Icare ic200) and applanation tonometry (Perkins) in patients with primary congenital glaucoma.

PURPOSE: To examine agreement between intraocular pressure (IOP) measurements made using the rebound tonometer Icare ic200 (RT200) and the Perkins handheld applanation tonometer (PAT) in patients with primary congenital glaucoma (PCG). The impacts of several covariables on measurements using the two devices were also assessed. MATERIALS AND METHODS: Intraocular pressure measurements were made in a single session in 86 eyes of 86 patients with PCG (46 under anaesthesia, 40 in the office). The order was RT200 then PAT. The variables age, central corneal thickness (CCT), corneal state and anaesthesia were recorded in each patient. Data were compared by determining interclass correlation coefficients (ICC) for each tonometer and representing the differences detected as Bland-Altman plots. Effects of covariables were assessed through univariate and multivariate regression. RESULTS: Mean IOP difference between tonometers (RT200 minus PAT) was 1.26 mmHg (95%: 0.22-2.31). Absolute agreement (ICC) was 0.73 (95% CI: 0.62-0.82). Lower and upper limits of agreement (95%) were -8.06 mmHg (95% CI: -9.87 to -6.25) and 10.59 mmHg (95% CI: 8.77-12.40), respectively. The tonometers showed systematic differences (a = -4.63 mmHg; 95% CI: -9.11 to -1.44) and proportional differences; for each mmHg increase in PAT-IOP, the RT200 reading increased by 1.28 mmHg (b = 1.28; 95% CI: 1.12-1.53). None of the variables tested as predictors were able to explain differences between the tonometers. CONCLUSIONS: Despite the good overall agreement between both tonometers, caution should be taken in high values of IOP, considering the interchangeability of its readings as systematic and proportional differences appear to exist between both methods.

Corneal densitometry and biomechanical properties in patients with primary congenital glaucoma.

OBJECTIVE: To describe corneal densitometry, topographic measurements, and biomechanical properties in patients with primary congenital glaucoma (PCG) and healthy patients. To examine correlations between variables and determine their glaucoma diagnostic capacity. METHODS: This was a cross-sectional, case-control study conducted in 50 eyes of 50 patients with PCG (G1) and 40 eyes of 40 healthy patients (G2). The variables determined in each participant were: intraocular pressure, best corrected visual acuity (BCVA), corneal densitometry, topographic data using the Pentacam HR-Scheimpflug imaging system (Oculus Optikgerate GmbH, Wetzlar, Germany), and corneal hysteresis (CH) and corneal resistance factor (CRF) using the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Depew, NY). RESULTS: Overall densitometry was significatively higher in the PCG group (G1: 17.94 ± 4.99 vs G2: 13.25 ± 1.96, p < 0.001). CH (G1: 8.02 ± 11.35 vs G2: 11.35 ± 1.42, p < 0.001) and CRF (G1: 9.48 ± 2.83 vs G2: 10.77 ± 1.34, p < 0.001) were lower in the glaucoma group. Mean posterior, central, and anterior elevation and mean keratometry were higher in G1 (p < 0.05). In the PCG group, overall densitometry showed significant correlation with CH (r = -0.321, p = 0.028) and with BCVA (r = -0.498, p = 0.002). AUCs (areas under the curve) for CH and overall densitometry were high (0.839 and 0.899 respectively) and the best overall densitometry; CH and CRF cutoffs were 14.0, 9.3 and 9.2 respectively. CONCLUSION: Densitometry is increased, and biomechanical corneal properties are decreased in patients with PCG. Densitometry and visual acuity showed a negative and significant correlation, so this measurement could be used as an indirect parameter of BCVA in the clinical practice.

Cataract extraction in patients with primary congenital glaucoma.

OBJECTIVE: To assess incidence and risk factors of cataract extraction in patients with primary congenital glaucoma, surgical outcome, and complications. MATERIAL AND METHOD: Retrospective cohort study, in which 108 patients with primary congenital glaucoma were included. Data collected were need for cataract extraction and at what age, intraocular pressure at diagnosis of primary congenital glaucoma, required antiglaucomatous surgeries, possible mutation in the CYP1B1 gene, and final visual acuity. Among the patients who required cataract extraction were visual acuity, intraocular pressure, and complications, evaluated preoperatively and postoperatively. The data were analysed with STATA. RESULTS: A total of 198 eyes of 108 patients were included, with a median follow-up of 8 years (range: 5-53). In all, 32 eyes (16.2%) of 24 patients (22%) required cataract extraction. The median age for cataract extraction was 12.94 years (interquartile range: 2.42-22). The main identified risk factors associated with cataract extraction were antiglaucomatous surgeries (hazard ratio 1.48, p < 0.001) and valvular implant (hazard ratio 2.78, p < 0.001). Lens was implanted in 30/32 eyes and the main complications were intraocular pressure decontrol (n = 13), capsular fibrosis (n = 7), corneal decompensation (n = 4), lens subluxation (n = 4), and endophthalmitis (n = 1). Visual acuity improvement was observed after cataract extraction in 66.67% of eyes. CONCLUSIONS: There is a high incidence of cataract surgery in patients with primary congenital glaucoma, but generally outside of pediatric age. A greater risk of cataract extraction was identified in those patients with a greater number of antiglaucomatous surgeries, especially after valvular implantation. Despite the high rate of complications related to cataract extraction in primary congenital glaucoma, good visual improvement was observed after surgery.

Late-onset severe diffuse lamellar keratitis associated with uveitis after LASIK in a patient with ankylosing spondylitis.

PURPOSE: To report a case of diffuse lamellar keratitis (DLK) associated with acute anterior uveitis that occurred 3 years after uneventful LASIK in a patient with a history of ankylosing spondylitis and recurrent acute anterior uveitis. METHODS: A 36-year-old man presented with pain and decreased vision in the left eye. Left eye visual acuity was 20/100. He had undergone bilateral LASIK 3 years prior to presentation to treat moderate myopia. RESULTS: Slit-lamp examination revealed aqueous flare and cells, vertical corneal folds, and cell aggregates at the central interface. Flattening and thinning of the cornea were observed with Pentacam (Oculus Optikgeräte GmbH). Diffuse lamellar keratitis stage III was diagnosed and intensive corticosteroid and anticollagenolytic treatment was started with satisfactory results. CONCLUSIONS: Acute anterior uveitis may be a predisposing factor for late-onset DLK after LASIK surgery. Indication of LASIK in patients at high risk of developing recurrent flares of acute anterior uveitis, such as those with spondyloarthropathies, should be carefully considered.

Changes in corneal biomechanical properties after 24 hours of continuous intraocular pressure monitoring using a contact lens sensor.

OBJECTIVE: This study was designed to assess changes in corneal topography and biomechanics after intraocular pressure (IOP) monitoring using the Triggerfish contact lens sensor (CLS). METHODS: For this prospective study, 30 eyes of 30 subjects: 14 healthy subjects (G1) and 6 glaucoma patients (G2), were recruited for 24 hours of continuous IOP monitoring using the CLS. The following measurements were taken before CLS fitting and after lens removal: maximum keratometry (Kmax), mean keratometry (MK), and corneal astigmatism (Cyl) measured through Pentacam corneal topography, and the corneal biomechanical variables corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA). RESULTS: Pentacam data revealed significant changes after CLS removal in Kmax (+3.14 ± 2.46 D, p = 0.002), MK (+0.52 ± 0.63 D, p = 0.02), and Cyl (+0.48 ± 0.53 D, p = 0.019) in G1; and Kmax (+1.38 ± 1.43 D, p = 0.002) in G2. The changes observed were more pronounced in G1 than in G2 but differences were not significant. The ORA results indicated higher CH (11.35 ± 2.42 vs 8.17 ± 2.09) and CRF (10.3 ± 2.03 vs 9.1 ± 1.81) before lens fitting in G1 than G2, while no significant changes were produced after CLS removal in either group. CONCLUSIONS: The use of CLS for IOP monitoring over 24 hours caused topographic changes in both healthy subjects and glaucoma patients. No changes were produced in corneal biomechanics.

Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.

During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.

Uvemaster: A Mobile App-Based Decision Support System for the Differential Diagnosis of Uveitis.

Purpose: To examine the diagnostic accuracy and performance of Uvemaster, a mobile application (app) or diagnostic decision support system (DDSS) for uveitis. The app contains a large database of knowledge including 88 uveitis syndromes each with 76 clinical items, both ocular and systemic (total 6688) and their respective prevalences, and displays a differential diagnoses list (DDL) ordered by sensitivity, specificity, or positive predictive value (PPV). Methods: In this retrospective case-series study, diagnostic accuracy (percentage of cases for which a correct diagnosis was obtained) and performance (percentage of cases for which a specific diagnosis was obtained) were determined in reported series of patients originally diagnosed by a uveitis specialist with specific uveitis (N = 88) and idiopathic uveitis (N = 71), respectively. Results: Diagnostic accuracy was 96.6% (95% confidence interval [CI], 93.2-100). By sensitivity, the original diagnosis appeared among the top three in the DDL in 90.9% (95% CI, 84.1-96.6) and was the first in 73.9% (95% CI, 63.6-83.0). By PPV, the original diagnosis was among the top DDL three in 62.5% (95% CI, 51.1-71.6) and the first in 29.5% (95% CI, 20.5-38.6; P < 0.001). In 71 (31.1%) patients originally diagnosed with idiopathic uveitis, 19 new diagnoses were made reducing this series to 52 (22.8%) and improving by 8.3% the new rate of diagnosed specific uveitis cases (performance = 77.2%; 95% CI, 71.1-82.9). Conclusions: Uvemaster proved accurate and based on the same clinical data was able to detect more cases of specific uveitis than the original clinician only-based method.

Normative database for separate inner retinal layers thickness using spectral domain optical coherence tomography in Caucasian population.

PURPOSE: Develop the first normative database of the thickness of every inner retinal layer in the macular area in a healthy, Caucasian population between 18 to 87 years old, using Spectralis Optical Coherence Tomography (OCT). METHODS: On this transversal, observational study, 300 patients between 18 to 87 years old and without an ophthalmological condition were recruited. Macular OCT scans were performed on all patients (Spectralis OCT, Heidelberg Engineering). An axial length measurement, and keratometry were performed using an optical biometer. The volume and thickness of the different macular sectors of the inner retinal layers (retinal nerve fiber layer (RNFL), ganglion cells layer (CGL) and inner plexiform layer (IPL)) were analyzed with the Spectralis OCT segmentation software. An eye was randomly selected for each patient. RESULTS: 297 patients (179 females and 118 males) were included in the study. The mean age was 56.07 years (range: 40.50-72). The multivariate analysis showed a positive correlation between the RNFL thickness and the axial length (p < 0.001). The mean central retinal thickness was 278.2 µm (range: 266-291), the mean central RNFL thickness was 12.61 µm (range: 11-14), the mean central CGL thickness was 17.63 µm (range: 14-21) and the mean central IPL thickness was 22.02 µm (range: 20-25). The multivariate analysis showed a negative correlation between age and CGL thickness and inner IPL thickness (p< 0.001). CONCLUSION: This study provides a normative database of the volume of each of the inner retinal layers on a Caucasian population.

Structural and biomechanical corneal differences between patients suffering from primary congenital glaucoma and healthy volunteers.

PURPOSE: To determine whether a set of ocular morphometric and biomechanical variables are able to discriminate between healthy volunteers and patients suffering from primary congenital glaucoma (PCG). METHODS: Case-control study in which 66 patients with PCG and 94 age-matched healthy subjects were evaluated using ocular response analyser (ORA) to record corneal biomechanical properties. Topographic corneal variables were obtained using the Pentacam in both groups. To determine the ability to discern between both groups, a multivariate binary logistic model was constructed. The outcome was the diagnosis of PCG and the predictors; the corneal variables analysed along with their first-term interactions. Sensitivity and specificity of this model along with the area under the receiver characteristic operating curve (AUC of ROC) were determined. RESULTS: The best model to discriminate between both groups included the following predictors: corneal hysteresis (CH), corneal resistance factor (CRF), posterior maximum elevation (PME), anterior maximum elevation (AME) and central corneal thickness (CCT). This model, for a cut-point of 50%, presents a sensitivity of 86.67%, a specificity of 86.89% and an AUC of the ROC curve of 93.16% [95% confidence interval (CI): 88.97-97.35]. The adjusted odds ratios of those predictors which showed a significant discriminating capacity were as follows: for CH, 0.27 (95% confidence interval: 0.15-0.46); for CRF, 2.13 (95% CI: 1.33-3.40); for PME, 1.06 (95% CI: 1.01-1.12); and for AME, 1.35 (95% CI: 1.10-1.66). CONCLUSION: Corneal hysteresis (CH), CRF, PME and AME are able to discern between patients with PCG and healthy controls. This fact suggests that there are structural and biomechanical differences between these groups.

Dependence of dynamic contour and Goldmann applanation tonometries on peripheral corneal thickness.

AIM: To determine the effects of peripheral corneal thickness (PCT) on dynamic contour tonometry(DCT) and Goldmann applanation tonometry (GAT). METHODS: A cross-sectional study. We created a software which calculates the corneal contour (CC) as a function of the radius from the corneal apex to each pixel of the contour. The software generates a central circumference with a radius of 1 mm and the remainder of the cornea is segmented in 5 rings concentric with corneal apex being its diameter not constant around the corneal circumference as a consequence of the irregular CC but keeping constant the diameter of each ring in each direction of the contour. PCT was determined as the mean thickness of the most eccentric ring. Locally weighted scatterplot smoothing (LOWESS) regression was used to determine the pattern of the relationship between PCT and both DCT and GAT respectively. Thereafter, two multivariable linear regression models were constructed. In each of them, the dependant variable was intraocular pressure (IOP) as determined using GAT and DCT respectively. In both of the models the predictive variable was PCT though LOWESS regression pattern was used to model the relationship between the dependant variables and the predictor one. Age and sex were also introduced control variables along with their first-degree interactions with PCT. Main outcome measures include amount of IOP variation explained through regression models (R2) and regression coefficients (B). RESULTS: Subjects included 109 eyes of 109 healthy individuals. LOWESS regression suggested that a 2nd-degree polynomial would be suitable to model the relationship between both DCT and GAT with PCT. Hence PCT was introduced in both models as a linear and quadratic term. Neither age nor sex nor interactions were statistically significant in both models. For GAT model, R2 was 17.14% (F=9.02; P=0.0002), PCT linear term B was -1.163 (95% CI: -1.163, -0.617). PCT quadratic term B was 0.00081 (95% CI: 0.00043, 0.00118). For DCT model R2 was 14.28% (F=9.29; P=0.0002), PCT linear term B was -0.712 (95% CI: -1.052, -0.372), PCT quadratic term was B=0.0005 (95% CI: 0.0003, 0.0007). CONCLUSION: DCT and GAT measurements are conditioned by PCT though this effect, rather than linear, follows a 2nd-degree polynomial pattern.