Demographics and etiologic characteristics of non-glaucomatous optic atrophy: a single-center cross-sectional study from Turkey.

BACKGROUND: Optic atrophy is an end-stage pathology of optic nerve diseases that is characterized by optic nerve pallor and vision loss. Because of its sight-threatening effects, understanding its epidemiology and etiology is crucial. In this study, we aimed to determine the epidemiologic features of optic nerve pathologies which lead to optic atrophy. METHODS: This is a cross-sectional study in which, medical records of optic atrophy patients who were followed up in our clinic between 1999 and 2020 were evaluated. Three hundred and sixty eyes of 226 patients were included in the study. Demographic data were received from the patients' files. Patients with glaucomatous optic atrophy, consecutive optic atrophy and patients with less than a year follow-up were excluded from the study. RESULTS: The most frequent reason of optic atrophy was central nervous system diseases (27.43%) followed by secondary non-arteritic ischemic optic neuropathy (26.99%). The most frequent etiology of optic atrophy was non-arteritic ischemic optic neuropathy in males and central nerve system-related pathologies in females. The highest presentation age (mean 63.6 ± 17.85 years) was observed in arteritic ischemic optic neuropathy and central nerve system-related optic atrophy had the lowest presentation age (median 14 years, IQR [34]). CONCLUSION: Central nerve system diseases and non-arteritic ischemic optic neuropathies were the most common causes of non-glaucomatous and non-consecutive optic atrophy in Turkey. Better understanding of underlying etiologies of optic atrophy may lead us to take precautions timely for irreversible optic nerve dysfunction which is an important reason of blindness.

Astrocytic outer retinal layer thinning is not a feature in AQP4-IgG seropositive neuromyelitis optica spectrum disorders.

BACKGROUND: Patients with anti-aquaporin-4 antibody seropositive (AQP4-IgG+) neuromyelitis optica spectrum disorders (NMOSDs) frequently suffer from optic neuritis (ON) leading to severe retinal neuroaxonal damage. Further, the relationship of this retinal damage to a primary astrocytopathy in NMOSD is uncertain. Primary astrocytopathy has been suggested to cause ON-independent retinal damage and contribute to changes particularly in the outer plexiform layer (OPL) and outer nuclear layer (ONL), as reported in some earlier studies. However, these were limited in their sample size and contradictory as to the localisation. This study assesses outer retinal layer changes using optical coherence tomography (OCT) in a multicentre cross-sectional cohort. METHOD: 197 patients who were AQP4-IgG+ and 32 myelin-oligodendrocyte-glycoprotein antibody seropositive (MOG-IgG+) patients were enrolled in this study along with 75 healthy controls. Participants underwent neurological examination and OCT with central postprocessing conducted at a single site. RESULTS: No significant thinning of OPL (25.02±2.03 µm) or ONL (61.63±7.04 µm) were observed in patients who were AQP4-IgG+ compared with patients who were MOG-IgG+ with comparable neuroaxonal damage (OPL: 25.10±2.00 µm; ONL: 64.71±7.87 µm) or healthy controls (OPL: 24.58±1.64 µm; ONL: 63.59±5.78 µm). Eyes of patients who were AQP4-IgG+ (19.84±5.09 µm, p=0.027) and MOG-IgG+ (19.82±4.78 µm, p=0.004) with a history of ON showed parafoveal OPL thinning compared with healthy controls (20.99±5.14 µm); this was not observed elsewhere. CONCLUSION: The results suggest that outer retinal layer loss is not a consistent component of retinal astrocytic damage in AQP4-IgG+ NMOSD. Longitudinal studies are necessary to determine if OPL and ONL are damaged in late disease due to retrograde trans-synaptic axonal degeneration and whether outer retinal dysfunction occurs despite any measurable structural correlates.

Retinal Optical Coherence Tomography in Neuromyelitis Optica.

BACKGROUND AND OBJECTIVES: To determine optic nerve and retinal damage in aquaporin-4 antibody (AQP4-IgG)-seropositive neuromyelitis optica spectrum disorders (NMOSD) in a large international cohort after previous studies have been limited by small and heterogeneous cohorts. METHODS: The cross-sectional Collaborative Retrospective Study on retinal optical coherence tomography (OCT) in neuromyelitis optica collected retrospective data from 22 centers. Of 653 screened participants, we included 283 AQP4-IgG-seropositive patients with NMOSD and 72 healthy controls (HCs). Participants underwent OCT with central reading including quality control and intraretinal segmentation. The primary outcome was thickness of combined ganglion cell and inner plexiform (GCIP) layer; secondary outcomes were thickness of peripapillary retinal nerve fiber layer (pRNFL) and visual acuity (VA). RESULTS: Eyes with ON (NMOSD-ON, N = 260) or without ON (NMOSD-NON, N = 241) were assessed compared with HCs (N = 136). In NMOSD-ON, GCIP layer (57.4 ± 12.2 µm) was reduced compared with HC (GCIP layer: 81.4 ± 5.7 µm, p < 0.001). GCIP layer loss (-22.7 µm) after the first ON was higher than after the next (-3.5 µm) and subsequent episodes. pRNFL observations were similar. NMOSD-NON exhibited reduced GCIP layer but not pRNFL compared with HC. VA was greatly reduced in NMOSD-ON compared with HC eyes, but did not differ between NMOSD-NON and HC. DISCUSSION: Our results emphasize that attack prevention is key to avoid severe neuroaxonal damage and vision loss caused by ON in NMOSD. Therapies ameliorating attack-related damage, especially during a first attack, are an unmet clinical need. Mild signs of neuroaxonal changes without apparent vision loss in ON-unaffected eyes might be solely due to contralateral ON attacks and do not suggest clinically relevant progression but need further investigation.

Cohort profile: a collaborative multicentre study of retinal optical coherence tomography in 539 patients with neuromyelitis optica spectrum disorders (CROCTINO).

PURPOSE: Optical coherence tomography (OCT) captures retinal damage in neuromyelitis optica spectrum disorders (NMOSD). Previous studies investigating OCT in NMOSD have been limited by the rareness and heterogeneity of the disease. The goal of this study was to establish an image repository platform, which will facilitate neuroimaging studies in NMOSD. Here we summarise the profile of the Collaborative OCT in NMOSD repository as the initial effort in establishing this platform. This repository should prove invaluable for studies using OCT to investigate NMOSD. PARTICIPANTS: The current cohort includes data from 539 patients with NMOSD and 114 healthy controls. These were collected at 22 participating centres from North and South America, Asia and Europe. The dataset consists of demographic details, diagnosis, antibody status, clinical disability, visual function, history of optic neuritis and other NMOSD defining attacks, and OCT source data from three different OCT devices. FINDINGS TO DATE: The cohort informs similar demographic and clinical characteristics as those of previously published NMOSD cohorts. The image repository platform and centre network continue to be available for future prospective neuroimaging studies in NMOSD. For the conduct of the study, we have refined OCT image quality criteria and developed a cross-device intraretinal segmentation pipeline. FUTURE PLANS: We are pursuing several scientific projects based on the repository, such as analysing retinal layer thickness measurements, in this cohort in an attempt to identify differences between distinct disease phenotypes, demographics and ethnicities. The dataset will be available for further projects to interested, qualified parties, such as those using specialised image analysis or artificial intelligence applications.

Effect of Hemifacial Spasm on Intraocular Pressure Measurement.

PURPOSE: To evaluate the effect of hemifacial spasm (HFS) on intraocular pressure (IOP) measurement. METHODS: Twenty-four consecutive patients with HFS and 25 age- and gender-matched randomly selected eyes of healthy volunteers underwent corneal pachymetry and IOP measurements using Goldmann applanation tonometer (GAT) and noncontact tonometer (NCT). IOP measurements were performed before (during HFS) and 2 weeks after Botox injections in HFS patients and in healthy volunteers without Botox injections. RESULTS: There was no statistical difference between involved eye side and uninvolved eye side of HFS patients in measured central corneal thickness. Similarly, no difference was found between involved eye side of HFS patients and controls. There were no statistically significant differences comparing IOP values before treatment and levels measured at 2 weeks of Botox injections, either with GAT (p = 0.33, 0.11) or NCT (p = 0.80, 0.43) devices in the involved eyes and uninvolved eyes of patients with HFS, respectively. There were also no significant differences in these parameters (GAT (p = 0.63) and NCT (p = 0.54)) in controls. CONCLUSIONS: Contractions in facial muscles may not lead to significant increase in IOP in HFS patients. This result may help clinical decision making in the treatment of glaucoma patients with HFS. This trial is registered with NCT03390803.

Corneal Biomechanical Properties in Obstructive Sleep Apnea Syndrome.

OBJECTIVES: To investigate the corneal biomechanical properties and anterior segment parameters in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Fifty-four eyes of 54 patients with OSAS and 20 eyes of 20 healthy subjects were included. Patients with mild and moderate OSAS (Respiratory Disturbance Index [RDI] <30) enrolled in group 1, those with severe OSAS (RDI≥30) in group 2 and controls in group 3. Corneal biomechanical properties including corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured with ocular response analyzer. Maximum (Kmax), minimum (Kmin), and mean simulated (SimKm) keratometry values, corneal astigmatism (CA), and central corneal thickness (CCT) were evaluated with Pentacam Scheimpflug imaging. RESULTS: The mean CH and CRF were significantly lower in group 2. The mean CH was 10.9±1.4 mm Hg in group 1, 10.1±1.1 mm Hg in group 2, and 12.1±1.2 mm Hg in group 3 (P<0.001). The mean CRF was 11.1±1.8 mm Hg in group 1, 9.9±1.1 mm Hg in group 2, and 12.2±1.2 mm Hg in group 3 (P<0.001). The CH and CRF values were similar between the groups 1 and 3 (P=0.867 and P=0.743). Corneal-compensated intraocular pressure, IOPg, Kmax, Kmin, SimKm, CA, and CCT values were not statistically different among the three groups. CONCLUSIONS: Patients with severe OSAS had lower CH and CRF values. The lower CH and CRF values in the severe group were possibly related to changes of the structural properties in the cornea.

Eye Injuries from Pencil Lead: Three Cases.

Corneal stromal and/or penetrating ocular injuries from pencils and pencil lead are more common in childhood and may lead to intraocular infection or severe intraocular sterile inflammatory reaction. Herein we report 3 children with ocular trauma due to pencil lead injuries. The first case had corneal stromal injury caused by a pencil. In the second case, a pencil perforated the cornea and contacted the iris. In the third case, pencil lead perforated both the cornea and iris and reached the vitreous through the lens zonules. Intracameral triamcinolone (2 mg/0.05 mL) was injected after the pencil lead was removed from the eyeball. Topical anti-inflammatory and cycloplegic drops were prescribed. In conclusion, corneal and especially penetrating ocular injuries from pencil lead may have a good prognosis with the use of appropriate anti-inflammatory and prophylactic antibiotic treatment and follow-up.

Corneal Viscoelastic Properties in Patients with Angioid Streaks.

PURPOSE: The aim of this study is to investigate the possible corneal biomechanical changes in patients with angioid streaks and to understand if the calcified and thickened Bruch's membrane associated with angioid streaks influences elasticity of the eye and intraocular pressure. MATERIALS AND METHODS: Twelve eyes of 12 patients with angioid streaks (six males and six females) and 12 eyes of 12 age- and sex-matched healthy volunteers were enrolled in the study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOPg) were measured with an Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured with an ultrasound pachymeter. RESULTS: Mean CRF and IOPg values in eyes with angioid streaks (12.10 ± 1.27 and 17.76 ± 2.73, respectively) were significantly higher than those in matched control eyes (10.70 ± 1.28 and 14.67 ± 2.72, respectively; p = 0.01 for CRF, p = 0.007 for IOPg). There was no statistically significant difference between eyes with angioid streaks and matched control eyes in measured CH, IOPcc and CCT values (p = 0.29, p = 0.09 and p = 0.86, respectively). CONCLUSIONS: This study revealed that angioid streaks can affect corneal biomechanical properties by increasing CRF, as compared to the healthy eyes. Increased CRF means increased resistance for effect of IOP on eye so it can be speculated that these patients tend to be more protected for glaucoma.

Comparison of retinal nerve fiber layer and macular thickness measurements with Stratus OCT and OPKO/OTI OCT devices in healthy subjects.

AIM: To compare retinal nerve fiber layer (RNFL) and macular thickness measurements obtained with the Stratus optical coherence tomography (OCT) and OPKO/OTI OCT devices. METHODS: Included in the study were 59 eyes of 30 participants. All measurements for each eye were done on the same day with both devices. Student's paired t-tests were used to compare the central macular thickness and RNFL measurements of the Stratus OCT and OPKO/OTI OCT. Pearson correlation was used to assess the relationship between the devices. Coefficient of variation (COV) was calculated to assess intersession repeatability. RESULTS: Using both the Stratus OCT and OPKO/OTI OCT, respectively, the measured mean average RNFL thicknesses were 98.9±11.1 µm and 115.1±9.6 µm (P=0.001), and the measured mean central retinal thicknesses (CRT) were 196.2±18.8 µm and 204.5±21.1 µm (P<0.001). Measured by the two devices, the RNFL thickness values were correlated in all quadrants, as were the retinal thickness values except the inferior outer sector. COV for average RNFL and CRT thickness were 2.9% and 4.6% for Stratus OCT, and 2.1% and 4.2% for OPKO/OTI OCT, respectively. CONCLUSION: We found good reproducibility of RNFL and retina thickness measurements for both Stratus OCT and OPKO/OTI OCT devices. However, even though the two OCT systems provided statistically correlated results, the values for both RNFL and macular thickness were statistically different. RNFL and macular thickness measurements with the OPKO/OTI OCT were higher than that of the Stratus OCT; therefore, the two OCT systems cannot be used interchangeably for the measurements of RNFL and macular thickness.

Exodeviation following monocular myopic regression after laser in situ keratomileusis.

We report a 44-year-old woman with intermittent left exotropia of 35 prism diopters at distance who initially exhibited alignment of both eyes after bilateral laser in situ keratomileusis (LASIK). The exophoria was not preserved due to myopic regression in the dominant eye. An uneventful LASIK treatment was performed to correct -11.00 -0.50 x 130 in the right eye and -13.50 -1.50 x 145 in the left eye. The aim was to achieve emmetropia in both eyes. Although an examination revealed exophoria at near and distance during the 6 months following refractive surgery, the tropic aspect of the divergent deviation appeared in the right eye following the myopic regression. Laser in situ keratomileusis is an effective option to achieve binocular visual quality in myopic anisometropic patients. However, myopic regression after LASIK may disrupt the binocular visual quality.

Repair of Descemet's membrane detachment after viscocanalostomy.

We report an alternative descemetopexy technique in a case of Descemet's membrane detachment after viscocanalostomy, possibly caused by high-molecular-weight viscoelastic material.