Retinal structural changes in preterm children without retinopathy of prematurity.

PURPOSE: The aim of this study was to compare all retinal layers' thickness in full-term and preterm children without retinopathy of prematurity (ROP). METHODS: Cross-sectional study including two groups of patients: group 1 children with history of preterm gestation without ROP (gestational age < 37 weeks) and group 2 healthy children with history of full-term gestation. All subjects underwent an ophthalmic examination including spectral domain-optical coherence tomography. After automatic retinal segmentation, each retinal layer thickness (eight separate layers and overall thickness) was calculated in all nine Early Treatment Diabetic Retinopathy Study areas. Demographic, systemic, gestational, and birth data were collected. Generalized additive regression models were used to analyze the data. RESULTS: Fifty-one children (51 eyes) were recruited, 19 full-term and 32 preterm children, mean age at ophthalmic examination of 10.58 (4.21) and 14.13 (3.16), respectively. In multivariable analysis, the preterm group's retinal thickness was significantly decreased in total retina nasal outer sector, ganglion cell layer (GCL), and inner plexiform layer (IPL), specifically GCL temporal outer (p = 0.010), GCL superior outer (p = 0.009), IPL temporal outer (p = 0.022), and IPL superior outer (p = 0.004), when compared with full-term group. From the variables compared only with birth head circumference that influenced the models, a non-linear association was identified and consequently modeled with splines through a generalized additive model. CONCLUSION: This study suggests that preterm children without ROP have structural retinal alterations, mostly in GCL and IPL in outer areas of the macula. Therefore, it is crucial to question gestational history since these retinal changes may be found later in life leading to useless investigation.

Identifying Clinical Predictors of Proliferative Sickle Cell Retinopathy.

PURPOSE: To identify systemic and/or ophthalmologic predictors of proliferative sickle retinopathy. METHODS: Cross-sectional study comparing clinical, laboratory, and structural choriorretinal aspects between sickle cell disease patients with and without proliferative retinopathy. Patients underwent complete systemic and ophthalmologic evaluation. Enhanced depth spectral domain optical coherence tomography with choroidal binarization and optic coherence tomography angiography were performed and choriorretinal vascular components were compared. RESULTS: Forty-five eyes from 45 sickle cell patients were included. Ninety-one percent of patients were diagnosed with sickle cell retinopathy, 29% with proliferative retinopathy. Mean corpuscular volume, lactate dehydrogenase, and percentage of fetal hemoglobin were reduced in the subgroup of patients with proliferative retinopathy when compared with patients without proliferative retinopathy (p ≤ 0.001; p = 0.04; p ≤ 0.001, respectively). The best predictor of proliferative retinopathy was mean corpuscular volume (AUC = 0.842; p = 0.001), followed by the percentage of fetal hemoglobin (AUC = 0.763, p = 0.009) and lactate dehydrogenase (AUC curve = 0.706; p = 0.039). No differences were found between groups in the quantitative analysis of retinal vascularization using OCTA and choroidal vascularization using OCT (p ≥ 0.05). CONCLUSION: Fetal hemoglobin and mean corpuscular volume may be good predictors of proliferative sickle retinopathy. The association between proliferative retinopathy and reduced levels of lactate dehydrogenase and mean corpuscular volume points to hypoxia and not hemolysis as a possible driving force in its pathophysiology.

Anterior chamber depth, lens thickness and intraocular lens calculation formula accuracy: nine formulas comparison.

BACKGROUND/AIMS: To investigate the influence of anterior chamber depth (ACD) and lens thickness (LT) on 9 intraocular lens (IOL) power calculation formulas accuracy, in patients with normal axial lengths. METHODS: Retrospective case series, including patients having uncomplicated cataract surgery with insertion of a single IOL model, divided into three groups according to preoperative ACD. Each group was further subdivided into three subgroups, according to the LT. Using optimised constants, refraction prediction error was calculated for Barrett Universal II, Emmetropia Verifying Optical (EVO) V.2.0, Haigis, Hill-RBF V.2.0, Hoffer Q, Holladay 1, Kane, PEARL-DGS and SRK/T formulas. Mean prediction error, mean and median absolute error (MedAE) and the percentage of eyes within ±0.25D, ±0.50D and ±1.00D were also calculated. RESULTS: The study included 695 eyes from 695 patients. For ACD ≤3.0 mm and ≥3.5 mm, mean prediction error of SRK/T, Hoffer Q and Holladay 1 was significantly different from 0 (p<0.05). PEARL-DGS, Kane, EVO V.2.0 and Barrett Universal II were more accurate than the Hoffer Q in ACD ≤3.0 mm (p<0.05). Kane, PEARL-DGS, EVO V.2.0 and Barrett Universal II revealed the lowest variance of mean and MedAE by ACD and LT subgroup. Haigis and Hill-RBF V.2.0 were significantly influenced by LT, independently of the ACD, with a myopic shift with thin lenses and a hyperopic shift with thick lenses (p<0.05). CONCLUSION: New generation formulas, particularly Kane, PEARL-DGS and EVO V.2.0, seem to be more reliable and stable even in eyes with extreme ACD-LT combinations.

Central retinal artery occlusion from Streptococcus gallolyticus endocarditis.

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for Streptococcus gallolyticus in the context of a bacteremia and native mitral valve vegetation identified on transoesophageal echocardiography. CRAO of embolic origin was admitted in the context of an infective endocarditis. CRAO can be the first manifestation of a potentially fatal systemic condition and thus multidisciplinary approach is warranted with close collaboration between ophthalmologists and internists in order to provide proper management and the best possible treatment.

Optic neuropathy due to chronic lymphocytic leukemia: The first manifestation of the disease.

PURPOSE: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the western world. The involvement of the central nervous system (CNS) or the optic nerve in CLL, however, is rare. We report a case of a previously untreated patient with CLL whose first manifestation of the disease was a progressive visual loss caused by optic neuropathy. OBSERVATIONS: Clinical manifestations, optical coherence tomography (OCT), and automated visual fields pointed to the diagnosis of neuropathy. Leukemic involvement of the CNS was confirmed after cells suggestive of CLL were found by cerebrospinal fluid analysis. Optic nerve infiltration is thought to be the cause of this optic neuropathy, and the clinical course and treatment are described herein. CONCLUSIONS: When readily diagnosed, optic nerve infiltration is a rare, yet manageable complication of CLL.