Extraocular Muscle Volumetry for Assessment of Thyroid Eye Disease.

BACKGROUND: In this study we evaluate the diagnostic accuracy of extraocular muscle volumetry in detecting thyroid eye disease and to compare the results with simple measurements of maximal medial rectus (MR) diameter. METHODS: Cross-sectional study that included 47 eyes of 47 patients with thyroid eye disease and 47 healthy controls. Patients underwent slitlamp examination and imaging consisting of computed tomography scans. Image segmentation and volume measurements were performed by 2 independent researchers. Intraobserver and interobserver reliability testing was also conducted. RESULTS: Total extraocular muscle volume was 7.31 ± 1.88 cm3 and medial volume was 2.38 ± 0.73 cm3 in the study group. In this group, the maximum measured diameter of the MR was 6.67 ± 0.35 mm. MR volume was statistically associated with maximum MR diameter (r = 9.78; P < 0.001). Both MR volume and maximum MR diameter measurements showed good predictive efficacy as shown using receiver operator characteristic curve analysis. CONCLUSIONS: Complications of thyroid eye disease are often sight threatening, and timely diagnosis is crucial for the management of the entity and its sequelae. The results of this study imply that simple measurements of maximum MR diameter are sensitive enough to establish diagnosis.

Association between HPV detection in swab samples and tissue specimens and ophthalmic pterygium recurrence.

PURPOSE: To investigate the presence of HPV on the ocular surface after surgical excision of HPV infected pterygia and the possible correlation of HPV with pterygium postoperative recurrence. MATERIALS AND METHODS: Both exfoliative pterygium swab samples and respective tissue specimens were received and analyzed with real-time PCR for the detection of HPV-infected pterygia. In addition, swab samples from patients that had HPV-infected pterygia with no recurrence after 1 year of follow-up, as well as swab samples from patients with healthy conjunctiva, were analyzed. RESULTS: Forty eyes with pterygium of 40 patients and 40 eyes with normal conjunctiva were included in the study. HPV virus was detected in the tissue specimens of 11 patients (27.5%) and in the swabs of 9 patients (22.5%). The HPV subtypes detected were 33, 39, 45, 56, 59, 66, and 68. The swab test had sensitivity of 81.82% and 100% specificity. In 15 (43%) patients, a bare sclera technique was used for pterygium removal and eleven of these patients showed recurrence of the disease. Surgical excision with use of autologous conjunctival graft was performed in twenty patients and five of them had recurrence. Patients with recurrent disease were 12.41 times more likely to have an HPV-infected pterygium (p = 0.031). Furthermore, from the 11 HPV positive patients, six had no recurrence, 1 year after surgery. In five of them, a swab sample was taken from the site of the surgical excision 1 year after surgery and real-time PCR was negative for HPV presence. CONCLUSION: Persistence of HPV infection seems to be correlated with postoperative pterygium recurrence. Further investigation with the use of the minimally invasive proposed swab technique may contribute in the understanding of pterygium pathogenesis and in the development of a more efficient treatment planning.

Clinical and Social Features of Patients with Eye Injuries Admitted to a Tertiary Hospital: A Five-Year Retrospective Study from Crete, Greece.

Eye injuries are a major cause of visual disability worldwide and may present a burden to both quality of life of the sufferers and healthcare services. The aim of this study was to extract and triangulate information on the demographic, clinical, and social features of eye-injured adult patients admitted to a tertiary hospital in Greece. The design was a five-year retrospective study of eye-injured adult patients, admitted to the General University Hospital of Heraklion, Crete (GUHH), the single tertiary referral hospital on the island. Drawing the profile of eye-injured patients may add to future health planning. Data collected from 1 January 2015 to 31 December 2019, such as sociodemographic features and clinical information, were extracted. One hundred twenty-eight patients were included. Of those, there was no available information on activity during injury for 6 patients, 78 (60.9%) had work-related ocular injuries, and 44 (34.4%) had non-work-related ocular injuries. Patients with no current formal employment, those who were retired, and formally unemployed and manual force workers had the higher rates of work-related injuries. The most common work-related injuries were closed globe injuries, specifically contusions, while ruptures and penetrating wounds were the most frequent of the open globe injuries. Within the univariate analyses, work-related eye injuries were significantly associated with male gender, middle age, and the place related to daily work activity. Determinants of poor final visual acuity (VA) were the initial VA, the type of injury (p < 0.0001), the distance of the place of residence from the hospital, and the time to hospital admission (p < 0.013). In a multivariate analysis, referred patients and those with open globe injuries arrived at hospital after a two-hour interval compared with those who were not referred and those with closed globe injuries (p ≤ 0.05). A reduction in the time to hospital admission deserves further attention. The interconnection of community and health system services through a capacity increase and networking needs further research in order to obtain targeted and viable access for eye-injured patients.

Ocular trauma, visual acuity related to time of referral and psychosocial determinants, during COVID­19 pandemic: A prospective study.

The aim of the present study was to explore the associations between visual outcomes of ocular injury patients in a tertiary hospital unit with clinical and demographic variables and to evaluate the psychosocial impact of the injury on the patients. An 18-month prospective study of 30 eye-injured adult patients was conducted in the General University Hospital of Heraklion, Crete, a tertiary referral hospital. All severe eye injury case information was prospectively collected between February 1, 2020 and August 31, 2021. Best corrected visual acuity (BCVA) was labelled not poor (>0.5/10 or >20/400 on the Snellen scale, <1.3 in LogMAR scale) and poor (≤0.5/10 or ≤20/400 on the Snellen scale, ≥1.3 on the LogMAR equivalent). Data regarding participants' perceived stress levels, by using Perceived Stress Scale 14 (PSS-14), were collected prospectively, one year after study end. Out of 30 ocular injury patients selected, 76.7% were men and most of them were self-employed and private or public sector workers (36.7%). Not poor final BCVA was related to not poor initial BCVA [odds ratio (OR) 1.714; P=0.006]. No statistical associations were found between visual outcome and demographic or clinical factors, but not poor final BCVA was associated with improved self-reported psychological condition of the sufferers, as examined by a questionnaire sheet developed to collect information for study purpose (8.36/10 vs. 6.40/10; P=0.011). No patient reported job loss or changed work status following the injury. Not poor initial BCVA was a significant predictor for not poor final visual outcomes (OR 1.714; P=0.006). Patients with not poor final BCVA expressed higher levels of positive psychology (8.36/10 vs. 6.40/10; P=0.011) and less fear of eye injury repetition (64.0 vs. 100.0%; P=0.286). Not poor final BCVA was associated with low PSS-14 scores one year after study end (77.3 vs. 0.0%, P=0.003). Collaboration between ophthalmologists, mental health professionals and primary care team may be important in order to help patients to cope with the psychosocial burden sequel to eye trauma.

Case Report: Intracranial Hypertension Secondary to Guillain-Barre Syndrome.

Guillain-Barre Syndrome (GBS), a common cause of acute flaccid paralysis, is characterized by a rapidly progressive, usually symmetric weakness of the extremities. Headache and intracranial hypertension (ICHT) are very rare complications of GBS. Herein we report our current case of an obese girl with typical signs of GBS associated with autonomic dysfunction, cranial nerve deficits and increased intracranial pressure (ICP). We also perform a systematic study presenting and discussing previous case reports of GBS associated with ICHT, papilledema or hydrocephalus, highlighting the differences of the current case compared to previous studies. Although intracranial hypertension is a rare complication of pediatric GBS, clinicians should promptly detect it. Obesity may be a predisposing factor, given the strong association between idiopathic intracranial hypertension (IIH) and weight gain. Neurological evaluation, fundus examination and low threshold for intracranial imaging should be an integral part of medical practice in case of obesity, headache or visual changes in GBS patients.

Corneal Stromal Demarcation Line Depth Following Standard and a Modified High Intensity Corneal Cross-linking Protocol.

PURPOSE: To compare the corneal stromal demarcation line depth using anterior segment optical coherence tomography (AS-OCT) after corneal cross-linking (CXL) using two different treatment protocols: the standard Dresden protocol (30 minutes with 3 mW/cm(2)) and a modified high intensity protocol (7 minutes with 18 mW/cm(2)), corresponding to a total surface dose of 5.4 and 7.5 J/cm(2), respectively. METHODS: This prospective, comparative, interventional case series included 29 keratoconic patients (32 eyes). All patients underwent CXL using the same high intensity ultraviolet-A (UV-A) irradiation device (CCL-365; Peschke Meditrade GmbH, Huenenberg, Switzerland). Sixteen eyes were treated for 30 minutes with 3 mW/cm(2) according to the standard Dresden protocol, whereas 16 eyes were treated with a novel modified high intensity CXL protocol for 7 minutes with 18 mW/cm(2) of UV-A irradiation intensity. One month postoperatively, corneal stromal demarcation line depth was measured by two independent observers using AS-OCT. RESULTS: There was no significant difference in corneal stromal demarcation line depth between observer measurements for both groups (P = .645, Dresden protocol group; P = .715, high intensity group). Mean corneal stromal demarcation line depth was 341.81 ± 47.02 µm for the Dresden protocol group and 313.37 ± 48.85 µm for the high intensity protocol group. There was no statistically significant difference (P = .104) in the corneal stromal demarcation line depth between the two groups. Mean endothelial cell density did not change significantly in either group (P = .090, Dresden protocol group; P = .103, high intensity group). No intraoperative or postoperative complications were noted. CONCLUSIONS: Corneal stromal demarcation line depth using UV-A irradiance with 3 mW/cm(2) for 30 minutes and 18 mW/cm(2) for 7 minutes was similar. It seems that the current modified accelerated CXL protocol provided the same treatment depth as the standard Dresden protocol.

Diffuse lamellar keratitis in the femtosecond-assisted LASIK flap tunnel.

Here we report a case of a 29-year-old myopic female who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) and, on the first postoperative day slit-lamp examination revealed a dense, white, granular reaction with the presence of some blood droplets (stage I diffuse lamellar keratitis [DLK]) in her left eye, specifically localized into the femtosecond LASIK flap tunnel (not extended to the flap interface). The patient received intensive treatment with topical corticosteroids and 5 days later the granular reaction had completely resolved. A new site of DLK, ie, the flap tunnel, in femtosecond-assisted LASIK is presented. DLK into the flap tunnel could be managed with corticosteroids if detected early, without affecting the flap interface.

Evaluation of corneal stromal demarcation line depth following standard and a modified-accelerated collagen cross-linking protocol.

PURPOSE: To compare the corneal stromal demarcation line depth using anterior segment optical coherence tomography (AS-OCT) after corneal collagen cross-linking (CXL) using 2 different treatment protocols: the standard Dresden protocol (30 minutes with 3 mW/cm(2)) and a modified-accelerated protocol (14 minutes with 9 mW/cm(2)). DESIGN: Prospective, comparative study. METHODS: Forty-three keratoconic patients (52 eyes) were enrolled. All patients underwent CXL using the same high-intensity ultraviolet-A (UV-A) irradiation device. Twenty-six eyes were treated for 30 minutes with 3 mW/cm(2) according to the standard Dresden protocol (Group 1), while 26 eyes were treated with a novel modified-accelerated CXL protocol for 14 minutes with 9 mW/cm(2) of UV-A irradiation intensity (Group 2). One month postoperatively, corneal stromal demarcation line depth was measured by 2 independent observers using AS-OCT. RESULTS: Corneal stromal demarcation line depth was assessed with no significant difference between observer measurements for both groups (P = .676 for Group 1 and P = .566 for Group 2). Mean corneal stromal demarcation line depth was 337.00 ± 46.46 µm for Group 1 and 322.91 ± 48.28 µm for Group 2. There was no statistically significant difference (P = .243) in the corneal stromal demarcation line depth between the 2 groups. CONCLUSIONS: Corneal stromal demarcation line depth using UV-A with 3 mW/cm(2) for 30 minutes and 9 mW/cm(2) for 14 minutes was similar. A modified-accelerated protocol of 14 minutes of CXL provided the same treatment depth as the classic Dresden protocol.

Corneal stroma demarcation line after standard and high-intensity collagen crosslinking determined with anterior segment optical coherence tomography.

PURPOSE: To use anterior segment optical coherence tomography (AS-OCT) to compare corneal stroma demarcation line depth after corneal collagen crosslinking (CXL) with 2 treatment protocols. SETTING: Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. DESIGN: Prospective comparative interventional case series. METHODS: Corneal collagen crosslinking was performed in all eyes using the same ultraviolet-A (UVA) irradiation device (CCL-365). Eyes were treated for 30 minutes with 3 mW/cm(2) according to the standard Dresden protocol (Group 1) or for 10 minutes with 9 mW/cm(2) of UVA irradiation intensity (Group 2). One month postoperatively, 2 independent observers measured the corneal stroma demarcation line using AS-OCT. RESULTS: Sixteen patients (21 eyes) were enrolled. Group 1 comprised 7 patients (9 eyes) and Group 2, 9 patients (12 eyes). The mean corneal stroma demarcation line depth was 350.78 µm ± 49.34 (SD) (range 256.5 to 410 µm) in Group 1 and 288.46 ± 42.37 µm (range 238.5 to 353.5 µm) in Group 2; the corneal stroma demarcation line was statistically significantly deeper in Group 1 than in Group 2 (P=.0058, t test for unpaired data). CONCLUSION: The corneal stroma demarcation line was significantly deeper after a 30-minute CXL treatment than after a 10-minute CXL procedure with high-intensity UVA irradiation.