Follow-up of Nonarteritic Anterior Ischemic Optic Neuropathy With Optical Coherence Tomography Angiography.

BACKGROUND: Peripapillary and macular microvasculature alterations after nonarteritic ischemic optic neuropathy (NAION) have been investigated in several studies. We aimed to explore the vascular changes from acute NAION (aNAION) to chronic NAION (cNAION). METHODS: This prospective observational study composed of 16 eyes with aNAION and 40 healthy age-matched controls. Eyes with NAION were followed up for more than 6 months after acute event. Optical coherence tomography angiography (OCTA) was used to evaluate peripapillary and macular vessel densities (VDs). The customized software was used for calculating deep retinal VD to attenuate the large superficial vessel projection effect. RESULT: The mean age of patients with NAION and controls was 56.13 ± 13.2 and 54.46 ± 15.5 years, respectively (P = 0.195). Radial peripapillary capillary density was significantly lower in both eyes with aNAION and eyes with cNAION than healthy eyes. Peripapillary capillary density decreased significantly from the acute to the chronic phase of NAION with values of 41.77 ± 4.05% and 34.35 ± 7.30%, respectively (P < 0.001). The mean superficial macular VD was 46.83 ± 3.47% in aNAION and 44.49 ± 4.50% in cNAION eyes with no significant difference between them (P = 0.252), but both were lower than control eyes. Deep macular VD was not affected in aNAION and cNAION eyes compared with control eyes. Correlation analysis in eyes with cNAION revealed that there were significant correlations between peripapillary nerve fiber layer and the capillary density (r = 0.772, P < 0.001) and between ganglion cell complex thickness and corresponding superficial macular VD. CONCLUSIONS: Although a decrease in peripapillary capillary density in aNAION eyes with active disc edema progressed when evaluated in the cNAION state, progressive VD loss was not observed in the macular area, suggesting a nonprogressive nature of macular vessel involvement in NAION.

Fungal keratitis: An overview of clinical and laboratory aspects.

Mycotic keratitis or keratomycosis is a fungal infection with global distribution. The dominant aetiology of this disease varies based on geographical origin, socioeconomic status, and climatic condition. Generally, Aspergillus spp. and Fusarium spp. are common in tropical and subtropical regions and Candida spp. are dominant in temperate areas. Demonstration of fungal elements in microscopic examination besides the isolation of fungi in culture is the gold standard of laboratory diagnosis. As the culture is a time-consuming procedure, other approaches such as in vivo confocal microscopy which produces real-time imaging of corneal tissue and molecular techniques have been developed to facilitate rapid diagnosis of fungal keratitis. The first choice of treatment is topical natamycin, although topical amphotericin B is the best choice for Aspergillus and Candida keratitis. Regarding the diversity of fungal aetiology and the emergence of drug resistance in some genera and species, proper identification using molecular methods and antifungal susceptibility testing could provide useful data. Furthermore, as the better efficacy of combination therapy in comparison to monotherapy is reported, in vitro determination of interactions between various drugs seem informative. This review aims to provide a general and updated view on the aetiology, risk factors, epidemiology, clinical and laboratory diagnosis, and management of fungal keratitis.

Implementation of thyroid eye disease registry in Iran: rationale and research protocol.

BACKGROUND: To describe the implementation of a registry system for patients with thyroid eye disease (TED) in Iran to obtain more information about its nature, prevalence, and annual incidence, as well as extend insight into the etiology, pathogenesis, and eventually make an accurate prognosis of different medical or surgical treatment methods. METHODS: After receiving approval from the Disease Registry Committee of Iran University of Medical Sciences (IUMS) in 2019 and the Ministry of Health and Medical Education (MOHME) in 2020, the protocol was introduced in three consecutive phases at regional, provincial and national levels. The establishment of a registry committee in Rassoul Akram Hospital, one of the medical centers affiliated to IUMS, was the first step to organizing the registry project's main core. The steering committee included six subgroups of required subject fields. The members are experts in developing a guideline, providing a new dataset, drawing an outline for the next steps, and structuring user-friendly software through several panel discussion meetings. The data is collected from clinical and para-clinical/imaging findings, laboratory evaluations, and their selected treatment strategy, retrospectively and prospectively. RESULTS: The purpose is to broaden our knowledge about the profile of TED; accordingly, data related to patients' demographics, thyroid gland disease (status, duration, treatments, and function tests), general medical and ocular history, along with visual/ocular exams resulting TED status are collected and recorded in a 2- language software. The web-based software system is accessible at https://orc.iums.ac.ir . To maintain data security, prioritized user access was defined for different members. Furthermore, diverse methods, such as employing trained staff and utilizing software validation rules, were implemented to control data quality in every step of data collection, entry, and registration. Medical records of retrospective subjects were also evaluated and entered after accuracy verification. CONCLUSION: Iran's TED registry provides practitioners with comprehensive data on natural history and phenotype variations in clinical features and outcomes. It facilitates patient recruitment and, consequently, earlier diagnosis on a large scale which helps improve treatment and quality of life for patients.

Infectious keratitis: trends in microbiological and antibiotic sensitivity patterns.

OBJECTIVES: To report the spectrum and trends of isolated microorganisms and their antibiotic susceptibility profile in patients with infectious keratitis in a 6-year period at a referral centre in Tehran. METHODS: The microbiology records of all corneal scrapings with a diagnosis of infectious keratitis were reviewed. RESULTS: A total of 6282 corneal scrapings were performed during the study period, of which 2479 (39.5%) samples were culture positive. Pseudomonas aeruginosa was found to be the most common causative agent in patients with keratitis, although Streptococcus pneumonia was the most prevalently isolated microorganism in patients older than 50 years. Fusarium sp. was the most common responsible pathogen in patients with fungal keratitis. The prevalence of bacterial keratitis due to gram positive microorganisms increased over time, however the number of Pseudomonas keratitis decreased in the second half of the study. Gram negative organisms showed a good sensitivity to levofloxacin, however, 34.1% of S. aureus isolates and 29.7% of coagulase negative staphylococci were resistant to this antibiotic. The odds of ciprofloxacin and levofloxacin resistance increased 1.25 and 1.15 for each 1-year increase in culture date, respectively (P < 0.001, P = 0.004). CONCLUSIONS: We documented an increasing trend in the percentage of gram positive bacteria. Levofloxacin monotherapy might still be a good option in patients with gram negative bacterial keratitis, however owing to increasing resistance of staphylococci to fluoroquinolones, a regimen consisting of a combination of fortified antibiotics may be more effective in staphylococcal keratitis.

Macular Vascularity in Ischemic Optic Neuropathy Compared to Glaucoma by Projection-Resolved Optical Coherence Tomography Angiography.

PURPOSE: To compare macular vasculature in patients with primary open-angle glaucoma (POAG) and atrophic nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: Prospective, cross-sectional study. METHODS: Thirty-seven eyes with moderate and advanced POAG, 19 eyes with atrophic NAION, and 40 eyes of normal subjects were imaged using optical coherence tomography angiography (OCT-A). Macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thicknesses were measured in addition to macular superficial and deep vasculature after projection removal using custom software. RESULTS: Linear models showed that while averaged peripapillary RNFL and macular GCC were not different between NAION and POAG eyes, both were significantly thinner than control eyes. Whole image macular superficial vessel density was significantly lower in NAION and glaucoma eyes (P = .003 and <.001, respectively) than in normal eyes, with lower vessel density in glaucoma than in NAION eyes (P = .01). Whole image and parafoveal deep macular vessels in glaucoma eyes (21.0%±8.7%, 24.4%±9.6%) were significantly lower than in control eyes (27.4%±8.6%, 31.9%±10.6%) (P = .01 and P = .01, respectively). No significant differences in deep vessels were observed between NAION and control eyes. Glaucomatous eyes had lower temporal and inferior parafoveal deep vasculature values than NAION eyes (P = .007 and .03, respectively). CONCLUSIONS: In NAION and POAG with similar RNFL and macular damage, macular OCT-A shows less involvement of superficial and deep vascular plexus in NAION in contrast to POAG, which might show a primary vascular insult in addition to secondary vascular damage due to ganglion cell damage.

Pachydermoperiostosis: A clinicopathological description.

PURPOSE: To report a case of pachydermoperiostosis (PDP) and a review of the literature. METHODS: A 32-year-old man was referred to our clinic with bilateral eyelid swelling and blepharoptosis. On examination, marked blepharoptosis was noted, and his eyelids were found to be floppy. Systemic examination was significant for clubbing of digits, coarse acromegalic facial features, and furrowing and oiliness of the skin of scalp and forehead. RESULTS: The patient was diagnosed as a case of PDP. On the brain MRI, the pituitary gland was enlarged, and the border of clivus was irregular. Pituitary and thyroid hormone levels were normal. He underwent bilateral lateral tarsal strip (LTS) procedure to address the eyelid laxity. Histopathologic examination revealed marked sebaceous gland hyperplasia with mucin deposition in the dermis. CONCLUSION: Floppy eyelid syndrome, clubbing, and acromegaloid face are main features that could lead to the diagnosis of PDP.