Dependence of corneal hysteresis on non-central corneal thickness in healthy subjects.

OBJECTIVE: To evaluate the dependence of corneal hysteresis (CH) on non-central corneal thickness. METHODS: Cross-sectional study of 1561 eyes of 1561 healthy volunteers with IOP less than 21mmHg, open angles on gonioscopy and no prior eye surgeries or local or systemic diseases. Pentacam-Scheimpflug technology was employed to segment the cornea into 6 circular zones centered on the apex (zones 1-6) and to determine the mean corneal thickness of these areas. CH was measured with ORA. Univariate and multivariate linear regression models adjusted for age and sex were created to model the dependence of CH on corneal thickness in zones 1 to 6. RESULTS: In the univariate linear regression models, we found that CH was dependent on mean corneal thickness of zone 1 (B=0,004; R2=0.95%; P<0.001), zone 2 (B=0,004; R2=0.57%; P=0.002), zone 4 (B=0,005; R2=1.50%; P<0.001) and zone 6 (B=0,003; R2=0.92%; P<0.001). Similar results were obtained in the multivariate model (R2=3.46%; P<0.001). CONCLUSION: This study suggests a significant dependence of CH on non-central corneal thickness. The model of corneal thickness segmentation into circular zones centered on the corneal apex is able to explain 3.47% of the variation in CH measurements.

Assessment of the perception of healthcare barriers and the impact of intravitreal injections on neovascular age-related macular degeneration.

AIM: To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD). METHODS: Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies. RESULTS: The mean age was 80.4 ±â€¯7.0 years and visual acuity (VA) was 75.2 ±â€¯12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ±â€¯1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ±â€¯0.9 and 4.3 ±â€¯1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home. CONCLUSION: The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit.

Assessment of vision-related quality of life and depression and anxiety rates in patients with neovascular age-related macular degeneration.

PURPOSE: To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD). METHODS: A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered. RESULTS: Fifty-five patients with nAMD participated with a mean age of 80.9 ± 6.6 years-old (range 67-93) and a mean VA in the best eye of 73.5 ± 12.7 letters (range 44-95). The global VFQ-25 mean score was 57.4 ± 21.9 being 38.9 ± 13.2 for the general vision and 42.0 ± 19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R = 0.608; P < .001), but no correlation was observed with general health (P = .936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R = -0.438). CONCLUSION: This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms.

Reproducibility of SD-OCT inner macular layer thickness measurements in children with primary congenital glaucoma.

PURPOSE: To examine the reproducibility of spectral domain optical coherence tomography (SD-OCT) segmented ganglion cell complex and circumpapillary retinal nerve fiber layer (cpRNFL) measurements in children with primary congenital glaucoma (PCG) in comparison with healthy children. METHODS: 12 children with PCG (G1) and 24 healthy children (G2) were recruited. The following SD-OCT measurements (Spectralis, Heidelberg Engineering) were made in one eye per child: total macular thickness (MT), thicknesses in several subfields and volumes of the three inner macular layers, macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) and cpRNFL thickness. In a single day, an expert operator obtained 3 circumpapillary and 3 macular measurements in each participant to determine intraoperator variability. Intraoperator repeatability was defined by the coefficient of variation (CoV) and intraclass correlation (ICC). RESULTS: ICC was excellent in both groups for cpRNFL measurements (G1 ICC=0.950 and G2 ICC=0.995) and for MT was excellent in G1 (ICC=0.957) and moderate in G2 (ICC=552). For the inner macular layer measurements, all ICCs were better in PCG group (mRNFL-ICC: 0.915 vs. 0.765; ICC-GCL: 0.584 vs. 0.263 and ICC-IPL: 0.979 vs. 0.742; G1 and G2 respectively). Greater CoV were recorded for macular measurements (from 0.71% to 9.82%) compared to cpRNFL measurements (from 0.52% to 1.50%). CONCLUSION: In children with PCG, Spectralis SD-OCT showed excellent intrasession repeatability for cpRNFL, MT, mRNFL and IPL measurements and moderated for GCL measurements. For all macular measurements, ICC were higher in children with PCG than healthy children.

Multimodal imaging in optic nerve melanocytoma: Optical coherence tomography angiography and other findings.

PURPOSE: To evaluate optical coherence tomography (OCT), fundus autofluorescence (FAF) imaging and optical coherence tomography angiography (OCTA) as diagnostic tools in optic disc melanocytoma (ODM) and study the differences in peripapillary and macular vascular density in eyes with ODM using OCTA. METHODS: Patients with ODM were enrolled in this case series. Each patient underwent evaluation of best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, fundus photography, standard visual field testing, spectral domain OCT, ultrasound B-scan examination, FAF, fluorescein angiography and OCTA. RESULTS: Eight patients (three males and five females) with ODM (9 eyes) were enrolled. The largest ODM presented a nodular appearance with a hyper-reflective tumor surface and a posterior optical shadow on OCT. FAF images showed hypoautofluorescence of the tumor with well-defined outlines. Analysis of optic nerve vascular area showed decreased values in the radial peripapillary capillary plexus (3 of 5) and the outer retinal plexus (4 of 5) in the eyes with ODM. In contrast, the ODM eyes had a higher macular vascular area in the deep capillary plexus in 4 of 6 patients. CONCLUSIONS: ODM may be associated with changes in peripapillary and macular perfusion, with an increase in peripapillary vascularization being a possible risk factor for growth. OCTA might be a helpful objective method in the analysis of changes in flow in patients with ODM.

Herpetic optic neuritis associated with herpetic keratitis.

PURPOSE: To report a case of herpetic optic neuritis associated with herpetic keratitis. METHODS: A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium. RESULTS: Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved. CONCLUSIONS: The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites.

[Acute angle-closure glaucoma resulting from treatment with nebulised bronchodilators]. / Bloqueo angular agudo tras broncodilatadores nebulizados.

CASE REPORT: A 78-year-old woman, with an acute exacerbation of chronic obstructive airways disease, was treated with nebulised ipratropium bromide and salbutamol. Twenty hours after beginning this treatment, she developed acute angle-closure glaucoma (AACG) in her left eye which resolved rapidly with appropriate treatment. DISCUSSION: Nebulised ipratropium bromide and salbutamol increases the intraocular pressure and may cause an AACG in susceptible patients (those with a shallow anterior chamber, hypermetropia, or chronic angle-closure glaucoma). Increased vigilance in such patients treated with these bronchodilators may avoid this adverse effect. Ensuring the mask is correctly fitted, using a T-piece or unvented nebuliser and protective eye wear, are some of the many recommendations made to minimize the development of AACG in these patients.

Foreign body embedded in the iris after cataract surgery.

CASE REPORT: a 75-year old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analysed and described as an inert structure made of plastic. DISCUSSION: The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favoured its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure.

Acute glaucoma in a patient with an Artisan® due to trabecular blockage after combined intravitreal treatment for macular oedema.

CASE REPORT: We present a 71-year-old patient with an Artisan(®) implant and macular oedema associated with unsatisfactory response to repeated intravitreal corticosteroids. An intravitreal Trigon(®) and Avastin(®) combined injection was given, and acute glaucoma developed. Anterior chamber washout was performed to resolve the rise in intraocular pressure. In spite of an excellent macular response, this was only temporary, and the corneal endothelium, which had remained competent so far, suffered irreversible damage. DISCUSSION: The combination of both treatments, along with the particular anatomic features in these patients, may have been precipitating factors in this unfortunate outcome.

Evaluación de la percepción de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravítreas en la degeneración macular asociada a la edad neovascular / AEvaluación de la percepción de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravítreas en la degeneración macular asociada a la edad neovascular

Propósito Evaluar la percepción de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravítreas en los pacientes con degeneración macular asociada a la edad neovascular (DMAEn). Métodos Estudio transversal de 108 pacientes con DMAEn en tratamiento con inyecciones intravítreas mediante un cuestionario de 26 preguntas (puntuación del 1 al 5) divididas en 3 bloques: 1)enfermedad y su tratamiento con inyecciones; 2)barreras en la asistencia sanitaria, y 3)nuevas tecnologías. Resultados La edad media fue 80,4±7,0 años y la agudeza visual (AV) de 75,2±12,4 letras. Las principales barreras en la asistencia sanitaria fueron los largos tiempos de espera en consulta (72%), seguida por otras comorbilidades (10%). El 63% de los pacientes dedican entre 3 y 5h para acudir a la consulta. Se apreció una ansiedad notable debida a las inyecciones (2,8±1,3), estando presente en el 71% el día antes. Se observó un gran miedo a la ceguera y a dejar de ser independientes (4,4±0,9 y 4,3±1,1), sin existir diferencias en relación con la AV, la edad o el sexo (p≥0,135). El 28% de los pacientes refieren que les cuesta bastante o mucho la asistencia a consulta, presentando el 69% del total un gran interés en tener un aparato diagnóstico en el domicilio. Conclusiones La DMAEn y su tratamiento suponen una importante carga asistencial para los pacientes, existiendo un gran miedo a la ceguera y a perder su independencia, siendo la principal barrera el largo tiempo de espera en consulta (AU)

Aim To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD). Methods Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1)the disease and its treatment with injections; 2)healthcare barriers, and 3)new technologies. Result The mean age was 80.4±7.0 years and visual acuity (VA) was 75.2±12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5hours to attend their clinical visit. Significant anxiety due to the injections (2.8±1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4±0.9 and 4.3±1.1), with no differences in relation to VA, age or sex (P≥.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home.Conclusion The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit (AU)

Evaluación de la calidad de vida y la presencia de síntomas de depresión y ansiedad en pacientes con degeneración macular asociada a la edad neovascular / Assessment of vision-related quality of life and depression and anxiety rates in patients with neovascular age-related macular degeneration

Propósito Evaluar la calidad de vida relacionada con la visión, así como la presecia de síntomas de depresión y ansiedad en los pacientes con degeneración macular asociada a la edad neovascular (DMAEn). Métodos Se realizó un estudio transversal de pacientes con DMAEn en tratamiento con inyecciones intravítreas de antiangiogénicos. Los pacientes realizaron 2 cuestionarios validados: el cuestionario de función visual (VFQ-25, cuya puntuación varía de 0 a 100) y la Escala hospitalaria de ansiedad y depresión (HADS). Se registraron la edad, el sexo y la agudeza visual (AV) en la escala Early Treatment Diabetic Retinopathy Study. Resultado Se incluyeron 55 pacientes con DMAEn con una edad de 80,9±6,6 años (rango 67 a 93) y una AV en el mejor ojo de 73,5±12,7 letras (rango 44 a 95). La puntuación global media en el VFQ-25 fue de 57,4±21,9, siendo 38,9±13,2 para la visión general y 42,0±19,5 para la salud general. La AV se correlacionó con la puntuación global de la escala VFQ-25 (R=0,608; p<0,001), pero no con la salud general (p=0,936). Mediante la escala HADS se detectó un 27,2% y un 25,5% de pacientes con síntomas de depresión y ansiedad respectivamente. Se observó una correlación negativa entre las puntuaciones del HADS y VFQ-25 para el dominio de visión general (R=–0,438). Conclusiones Este estudio muestra el impacto en la calidad de vida y función visual en los pacientes con DMAE neovascular, presentando en un porcentaje considerable de los casos síntomas de depresión y ansiedad (AU)

Purpose To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD). Method A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered. Result Fifty-five patients with nAMD participated with a mean age of 80.9±6.6 years-old (range 67 to 93) and a mean VA in the best eye of 73.5±12.7 letters (range 44 to 95). The global VFQ-25 mean score was 57.4±21.9 being 38.9±13.2 for the general vision and 42.0±19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R=.608; P<.001), but no correlation was observed with general health (P=.936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R=–0.438). Conclusions This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms (AU)

Cuerpo extraño enclavado en iris después de cirugía de catarata / Foreign body embedded in the iris after cataract surgery

CASO CLÍNICO: Mujer de 75 años intervenida de catarata en ojo izquierdo, que presentaba a las 24 h una agudeza visual de 0,8. En la biomicroscopia destacaba un cuerpo extraño anclado al iris en sector nasal coincidente con la incisión principal de la facoemulsificación, que fue retirado en un segundo acto quirúrgico. Fue analizado e informado como estructura inerte de naturaleza plástica. DISCUSIÓN: Planteamos el posible origen de la presencia del resto plástico en el postoperatorio de la cirugía de la catarata. En este caso su naturaleza inerte no desencadenó mayor inflamación intraocular. Además, la estructura rígida favoreció su anclaje al iris evitando otras complicaciones. Deben extremarse las medidas preventivas en la cirugía de la catarata revisando incluso los instrumentos y accesorios al terminar la cirugía

CASE REPORT: a 75-year old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analysed and described as an inert structure made of plastic. DISCUSSION: The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favoured its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure

Glaucoma agudo en paciente con Artisán ® por bloqueo trabecular tras tratamiento combinado intravítreo por edema macular / Acute glaucoma in a patient with an Artisan® due to trabecular blockage after combined intravitreal treatment for macular oedema

Caso clínico: Se presenta el caso de un varón de 71 años con Artisán® y edema macular asociado con insuficiente respuesta a corticoides intravítreos. Se decidió tratamiento combinado con Trigón® y Avastin® intravítreos y desarrolló un glaucoma agudo, que resolvió tras lavado urgente de cámara anterior. A pesar de la excelente respuesta macular, esta fue únicamente transitoria y el endotelio corneal, competente hasta ese momento, sufrió daños irreversibles. Discusión: La combinación de ambos tratamientos, junto con la anatomía especial en estos pacientes, pudieron ser factores precipitantes de este desafortunado resultado(AU)

Case report: We present a 71-year-old patient with an Artisan® implant and macular oedema associated with unsatisfactory response to repeated intravitreal corticosteroids. An intravitreal Trigon® and Avastin® combined injection was given, and acute glaucoma developed. Anterior chamber washout was performed to resolve the rise in intraocular pressure. In spite of an excellent macular response, this was only temporary, and the corneal endothelium, which had remained competent so far, suffered irreversible damage. Discussion: The combination of both treatments, along with the particular anatomic features in these patients, may have been precipitating factors in this unfortunate outcome(AU)

Bloqueo angular agudo tras broncodilatadores nebulizados / Acute angle-closure glaucoma resulting from treatment with nebulised bronchodilators

Caso clínico: Mujer de 78 años, con un cuadro de reagudización de enfermedad pulmonar obstructiva crónica tratada con bromuro de ipratropio y salbutamol nebulizados. Tras 20 horas desde el inicio del tratamiento, la paciente desarrolló un glaucoma agudo de ángulo cerrado (GACA) en el ojo izquierdo que respondió rápidamente al tratamiento médico adecuado. Discusión: El bromuro de ipratropio y el salbutamol nebulizados, aumentan la presión intraocular y pueden desencadenar un GACA en pacientes predispuestos (cámara anterior estrecha, hipermétropes, glaucoma crónico de ángulo estrecho). Una mayor precaución en los pacientes tratados con estos broncodilatadores, podría evitar este efecto adverso indeseable. Además, la correcta aplicación de la mascarilla facial, el uso de terminales en T y gafas de protección, son algunas medidas a tomar para prevenir un GACA en estos pacientes

Case report: A 78-year-old woman, with an acute exacerbation of chronic obstructive airways disease, was treated with nebulised ipratropium bromide and salbutamol. Twenty hours after beginning this treatment, she developed acute angle-closure glaucoma (AACG) in her left eye which resolved rapidly with appropriate treatment. Discussion: Nebulised ipratropium bromide and salbutamol increases the intraocular pressure and may cause an AACG in susceptible patients (those with a shallow anterior chamber, hypermetropia, or chronic angle-closure glaucoma). Increased vigilance in such patients treated with these bronchodilators may avoid this adverse effect. Ensuring the mask is correctly fitted, using a T-piece or unvented nebuliser and protective eye wear, are some of the many recommendations made to minimize the development of AACG in these patients