The effect of systemic and topical ophthalmic medications on choroidal thickness: A review.

The choroid plays an important role in various ocular pathologies and retinal blood supply. There is a knowledge gap on how the choroid is affected by systemic and topical medications. Systemic medications that affect microvasculature elsewhere in the body can also affect the microvasculature of the choroid. This review summarizes current knowledge on associations between systemic and topical medications and changes in choroidal thickness (CT). This review included 71 studies on mydriatics/cycloplegics, intraocular pressure (IOP)-lowering therapies, antihypertensives, adrenergic antagonists, statins, corticosteroids, hydroxychloroquine, isotretinoin, hormonal contraceptives, phosphodiesterase inhibitors, antipsychotics, antineoplastic agents, ethanol, caffeine and nicotine. IOP-lowering therapies, atropine eye drops, and systemic administration of ß blockers and ethanol are associated with a significant increase in CT. Cyclopentolate and phenylephrine are associated with a CT reduction. Systemic medications that decrease CT include caffeine and nicotine. Tropicamide, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids, hydroxychloroquine and hormonal contraceptives have mixed findings. CT increase associated with IOP-lowering therapies is possibly achieved by enhancing aqueous humour flow to the choroid thus elevating choroidal blood flow and thickness. CT changes appear to be independent from systemic blood pressure changes, suggesting that a significant association with an antihypertensive could be due to an idiosyncratic drug property. Statins and candesartan decrease macrophage accumulation and intercellular adhesion molecule 1 expression in the choroid. The choroid and its response to various disease processes and systemic medication can be further investigated to improve patient care, particularly in patients with choroid and retina pathologies.

TAP AND INJECT VERSUS PARS PLANA VITRECTOMY FOR POSTPROCEDURAL ENDOPHTHALMITIS: A Meta-analysis.

PURPOSE: To compare the visual outcomes after prompt pars plana vitrectomy (PPV) with tap biopsy and intravitreal antimicrobial injection to treat postinjection and postsurgery endophthalmitis. METHODS: The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Ovid Embase databases were searched for articles published between January 2010 and November 2020. Two independent reviewers selected articles and extracted data. We analyzed data in RevMan 5.3 and assessed methodological quality using the Cochrane ROBINS-I tool. The mean improvement in visual outcome was compared between PPV and intravitreal antimicrobial injection as a relative risk of improving ≥2 lines and a mean logarithm of the minimal angle of resolution difference in improvement. RESULTS: Fifteen retrospective case series (1,355 eyes), of which 739 eyes (55%) received intravitreal antimicrobial injection and 616 (45%) received PPV as initial treatment, were included. The overall relative risk of improving 2 or more lines in PPV in comparison with intravitreal antimicrobial injection was 1.04 (95% CI 0.88-1.23; P = 0.61; I2 = 0%) with a mean difference of 0.04 (95% CI -0.18 to 0.27; P = 0.69; I2 = 0%). The results stayed robust when subgroup analysis based on causative procedure for endophthalmitis was performed. CONCLUSION: Intravitreal antimicrobial injection is noninferior to PPV for the treatment of postcataract operation, postinjection, and post-PPV endophthalmitis.

Search for Face Identity or Expression: Set Size Effects in Developmental Prosopagnosia.

The set size effect during visual search indexes the effects of processing load and thus the efficiency of perceptual mechanisms. Our goal was to investigate whether individuals with developmental prosopagnosia show increased set size effects when searching faces for face identity and how this compares to search for face expression. We tested 29 healthy individuals and 13 individuals with developmental prosopagnosia. Participants were shown sets of three to seven faces to judge whether the identities or expressions of the faces were the same across all stimuli or if one differed. The set size effect was the slope of the linear regression between the number of faces in the array and the response time. Accuracy was similar in both controls and prosopagnosic participants. Developmental prosopagnosic participants displayed increased set size effects in face identity search but not in expression search. Single-participant analyses reveal that 11 developmental prosopagnosic participants showed a putative classical dissociation, with impairments in identity but not expression search. Signal detection theory analysis showed that identity set size effects were highly reliable in discriminating prosopagnosic participants from controls. Finally, the set size ratios of same to different trials were consistent with the predictions of self-terminated serial search models for control participants and prosopagnosic participants engaged in expression search but deviated from those predictions for identity search by the prosopagnosic cohort. We conclude that the face set size effect reveals a highly prevalent and selective perceptual inefficiency for processing face identity in developmental prosopagnosia.

The impact of central sparing on the word-length effect in hemianopia.

Studies suggest that a word-length effect of up to 160 ms/letter distinguishes hemianopic dyslexia from pure alexia. However, partial preservation of central vision is common in right hemianopia, but its effects on single-word reading are unknown. Eighteen healthy subjects read single words with a gaze-contingent right hemianopia simulation that varied the degree of central sparing. Mean reading onset time declined with small degrees of central sparing, but the word-length effect did not decrease until sparing exceeded 3.15°. We next evaluated the effects of font size. Effects of central sparing were constant when expressed in number of letters, with a decline in word-length effect beginning as sparing approached 4 letters. We conclude that the effects of central sparing on mean reading onset time and the word-length effect are distinct. We provide diagnostic word-length criteria for discriminating between pure alexia and hemianopic dyslexia with various degrees of central sparing.

ATYPICAL PROLIFERATIVE RETINOPATHY AS THE PRESENTING FEATURE OF CHRONIC MYELOID LEUKEMIA IN A PATIENT WITH DIABETES MELLITUS.

PURPOSE: To describe a case of proliferative retinopathy as the presenting manifestation of chronic myeloid leukemia in a patient with poorly controlled diabetes mellitus (DM). Undiagnosed chronic myeloid leukemia in a patient with pre-existing poorly controlled DM is rarely encountered but must be recognized to treat appropriately with systemic chemotherapy. Significant fundus finding overlaps with DM making the recognition of chronic myeloid leukemia challenging. METHODS: Case report. RESULTS: Fundoscopy revealed scattered dot-blot hemorrhages, venous beading, and numerous Roth spots in all quadrants, in both eyes. In the right eye, there was also a vitreous hemorrhage with evidence of neovascularization near the inferior arcade. Intravenous fluorescein angiography showed significant peripheral capillary nonperfusion without evidence of exudation in both eyes. No macular edema was observed on optical coherence tomography. A review of systems and physical examination was negative for constitutional symptoms, lymphadenopathy, organomegaly, and other symptoms. Retinal findings prompted a complete blood count, which revealed significant leukocytosis. A bone marrow biopsy confirmed a diagnosis of chronic myeloid leukemia. Systemic chemotherapy and pan-retinal photocoagulation successfully normalized the leukocyte count and resolved the vitreous hemorrhage and neovascularization. CONCLUSION: The presence of numerous Roth spots in all quadrants, extensive areas of capillary nonperfusion on intravenous fluorescein angiography, and neovascularization in the absence of exudation or macular edema should prompt investigations to rule out hematologic disorders.

The role of the upper and lower face in the recognition of facial identity in dynamic stimuli.

Studies with static faces find that upper face halves are more easily recognized than lower face halves-an upper-face advantage. However, faces are usually encountered as dynamic stimuli, and there is evidence that dynamic information influences face identity recognition. This raises the question of whether dynamic faces also show an upper-face advantage. The objective of this study was to examine whether familiarity for recently learned faces was more accurate for upper or lower face halves, and whether this depended upon whether the face was presented as static or dynamic. In Experiment 1, subjects learned a total of 12 faces--6 static images and 6 dynamic video-clips of actors in silent conversation. In experiment 2, subjects learned 12 faces, all dynamic video-clips. During the testing phase of Experiments 1 (between subjects) and 2 (within subjects), subjects were asked to recognize upper and lower face halves from either static images and/or dynamic clips. The data did not provide evidence for a difference in the upper-face advantage between static and dynamic faces. However, in both experiments, we found an upper-face advantage, consistent with prior literature, for female faces, but not for male faces. In conclusion, the use of dynamic stimuli may have little effect on the presence of an upper-face advantage, especially when the static comparison contains a series of static images, rather than a single static image, and is of sufficient image quality. Future studies could investigate the influence of face gender on the presence of an upper-face advantage.

A Stepwise Approach to the Surgical Management of Hemorrhagic Choroidal Detachments.

Purpose: This work describes a stepwise surgical approach to draining choroidal detachments and 2 cases for which this approach was used. Methods: The first step involves insertion of an anterior chamber maintainer and a nonvalved 23- or 25-gauge trocar cannula at the highest peak of hemorrhagic choroidal detachment (as determined using B-scan ultrasonography), 6 to 8 mm from and angled 20° to 30° toward the limbus. The second step involves removal of the trocar to expose the sclerotomy. Alternatively, the second step can be insertion of a second trocar. The third step involves the creation of a small focal peritomy around the preexisting sclerotomy and enlargement of the preexisting sclerotomy into a radial sclerotomy. Progression between steps only occurs if prior steps did not provide adequate drainage. Results: Two cases of appositional hemorrhagic choroidal detachments in hypotonic eyes were successfully resolved by this stepwise approach. In case 1, a choroidal detachment developed after a corneal ulcer perforation. The hemorrhagic choroidal detachment in case 1 was resolved with steps 1 and 2, and an unnecessary scleral cutdown was avoided. In case 2, a choroidal detachment developed after a trabeculectomy. The detachment in case 2 required progression to step 3, extension of the trocar insertion site into a radial sclerotomy. Conclusions: This stepwise approach should be considered to reduce excessive manipulation of the globe and conjunctiva in hemorrhagic and serous choroidal detachments that warrant surgical intervention.

Effects of Internal Limiting Membrane Peel for Idiopathic Epiretinal Membrane Surgery: A Systematic Review of Randomized Controlled Trials.

PURPOSE: The purpose of this study was to compare functional and anatomical outcomes after epiretinal membrane (ERM) peeling with internal limiting membrane (ERM/ILM) peeling and without for the treatment of idiopathic ERM. DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive search of Cochrane CENTRAL, MEDLINE Ovid, and Embase Ovid for randomized controlled trials comparing ERM/ILM with ERM was performed. Two independent reviewers selected papers and extracted data. Methodological quality was assessed using the Cochrane Risk of Bias (RobVis) tool. Data was analyzed using RevMan 5.3. Quality of body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Seven studies reporting 387 eyes overall were included. A total of 207 eyes (53%) received ERM/ILM. A total of 180 (47%) received ERM. Post-operative visual acuities (logMAR) were not significantly different between ERM/ILM and ERM, with a mean difference (MD) of 0.02 (95% confidence interval [CI]: -0.04 to 0.09; P = .45; I2= 42%; n = 101) at 1 month; 0.03 (95% CI: -0.01 to 0.06; P = .11, I2 = 15%; n = 299; High Certainty of Evidence) at 3 months; 0.01 (95% CI: -0.03 to 0.04; P = .72; I2 = 21%; n = 317; High Certainty of Evidence) at 6 months; and 0.01 (95% CI: -0.02 to 0.04; P = .49; I2 = 39%; n = 234) at 12 months post-operatively. ERM/ILM was significantly associated with lower ERM recurrence at 6-12 months with a relative risk of 0.16 (95% CI: 0.04-0.64; P = .01; I2 = 0%; n = 155; Moderate certainty of evidence) and an increased central macular thickness (micrometers) at 12 months with an MD of 20.53 (95% CI: 4.96-36.09; P = .01; I2 = 12%; n = 234). CONCLUSIONS: ERM/ILM and ERM result in similar visual acuity despite subtle differences in anatomical outcomes (central macular thickness). ERM/ILM is associated with a significantly lower rate of ERM recurrence at 6-12 months post-operatively and should be considered where recurrence prevention is the treatment priority.

Choroidal thickness in patients with cardiovascular disease: A review.

The choroid is a vascular network that supplies the bulk of the retina's oxygen and nutrient supply. Prior studies have associated changes in the thickness of the choroid with the presence of various cardiovascular diseases. This is the first review that summarizes current knowledge on the relationship between choroidal thickness and cardiovascular diseases while highlighting important findings. Acute hypertension increases choroidal thickness. Chronic hypertension and heart failure may decrease choroidal thickness, but controversy exists. Both coronary artery disease and carotid artery stenosis result in decreased choroidal thickness and blood flow. Carotid endarterectomy may reverse these changes. Choroidal thickening in early stages of carotid stenosis may arise from mechanisms compensating for ischemia. Hyperlipidemia is linked to choroidal thickening, while caffeine intake is linked to choroidal thinning. The effects of smoking and exercise are mixed. Changes in choroidal thickness have been linked to cardiovascular disease. Clarity regarding these changes could lead to the use of choroidal thickness changes as a noninvasive screening or prognostic test for pathological cardiovascular changes. Future studies should also investigate the effect of cardiovascular disease treatments on the choroid.

Dopamine replacement remediates risk aversion in Parkinson's disease in a value-independent manner.

INTRODUCTION: Clinical evidence suggests that Parkinson's Disease (PD) patients are risk averse. Dopaminergic therapy has been reported to increase risk tolerance, but the underlying mechanisms are unclear. Some studies have suggested an amplification of subjective reward value, consistent with the role of dopamine in reward value coding. Others have reported value-independent risk enhancement. We evaluated the value-dependence of the effects of PD and its therapy on risk using tasks designed to sensitively measure risk over a wide range of expected values. METHOD: 36 patients with idiopathic PD receiving levodopa monotherapy and 36 healthy matched controls performed two behavioural economic tasks aimed at quantifying 1) risk tolerance/aversion in the gain frame and 2) valuation of potential gains relative to losses. PD patients performed the tasks on and off their usual dose of levodopa in randomized order; controls performed the same tasks twice. RESULTS: Relative to the controls, unmedicated PD patients showed significant value-independent risk aversion in the gain frame, which was normalized by levodopa. PD patients did not differ from controls in their valuation of gains relative to losses. However, across both tasks and regardless of medication, choices of the patients were more determined by expected values of the prospects than those of controls. CONCLUSION: Dopamine deficiency in PD was associated with risk aversion, and levodopa promoted riskier choice in a value-independent manner. PD patients also showed an increased sensitivity to expected value, which was independent of levodopa and does not appear to result directly from dopamine deficiency.