Functional and perfusion changes associated with silicone oil tamponade after macula-off rhegmatogenous retinal detachment surgery: an optical coherence tomography angiography/microperimetry study.

PURPOSE: The current study utilizes microperimetry and optical coherence tomography angiography (OCTA) to assess the optic nerve head vasculature, retinal microvasculature, and retinal sensitivity before and after silicone oil (SO) removal. METHODS: This prospective observational case series study involved 30 eyes subjected to silicone oil endotamponade. Microperimetry and OCTA were utilized to assess the vascular density (VD) of the macula and optic nerve head, as well as the retinal sensitivity (RS), of the participants preoperatively and 1 month following SO removal. The correlation between the various parameters of OCTA and microperimetry was evaluated. RESULTS: There was a significant improvement in the postoperative best-corrected visual acuity (BCVA) (p-value < 0.001) and the postoperative total RS, which was 6.38 ± 2.34 dB as compared to a mean preoperative total RS of 5.04 ± 2.06 dB (p-value < 0.001) and showing a significant increase in all rings. However, there was no significant difference in the pre and postoperative macular VD. On the other hand, there was a significant increase in the postoperative VD of the whole disk and the peripapillary capillary plexus, p-values < 0.001 and 0.002, respectively. CONCLUSION: The removal of SO resulted in significant improvements in retinal sensitivity, vision, and optic nerve perfusion. However, no significant change was observed in macular VD. CLINICAL TRIALS: gov Identifier: NCT04928196.

The efficacy of anti-TNF-α agents in the treatment of juvenile idiopathic arthritis-associated uveitis in a pediatric cohort.

Purpose: Biologic therapy has shown promising control in children with often intractable juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U). Methods: This is a retrospective cohort study of 35 eyes of 35 children who received biologics for JIA-U. Pretreatment and posttreatment data (at 3, 6, 9, 12, 18, 24, and >24 months) were analyzed to determine functional success (stable/improved visual acuity), quiescence success (≤0.5 cells in the anterior chamber), complete steroid success (termination of systemic, periocular therapy and decreased topical drops to ≤2/day) or systemic steroid success (termination of systemic steroids only), and complete success (all of the above). Results: This study included 35 eyes up to 12 months and 21 eyes beyond 24 months. Steroid-sparing, functional, and quiescence success showed a rate of success of 52.43%, 77%, and 91%, respectively, at 12 months and 66.67%, 85.7%, and 76.2%, respectively, beyond 24 months. Complete success was 34.29% at 12 months, peaking at 18 months (65.62%) and reached 57.14% beyond 24 months. In their final follow-up, the best corrected visual acuity (BCVA) remained the same in 45.71%, improved in 37.14%, and worsened in 17.14% children. Conclusion: Biologic therapy is effective in JIA-U, especially in termination of systemic steroids, stabilization of vision, and maintaining quiescence.

Macular and Optic Nerve Microvascular Alteration in Relation to Axial Length, by Optical Coherence Tomography Angiography (OCTA).

Aim: To study the effect of axial length (AL) on quantitative characterization of macular and optic nerve microvasculature using optical coherence tomography angiography (OCTA) in healthy individuals. Methods: A cross-sectional study where participants were divided into 3 groups according to AL; A: ≤22.5 mm, B: 22.6-24.5 mm, C: >24.5 mm. Superficial vascular density (SVD), deep vascular density (DVD), foveal avascular zone (FAZ), and radial peripapillary capillary density (RPCD) were calculated using OCTA. Pearson correlation was run to identify the relation between AL and study parameters. Results: One hundred and twelve eyes of 56 participants (20 males, 36 females) were included. Mean FAZ was 0.33 ± 0.15 mm2, 0.27 ± 0.1 mm2 and 0.28 ± 0.2 mm2 in Groups A, B, and C, respectively (p value 0.073). No significant difference was found between 3 groups, as regards superficial foveal density and vessel density inside the disc. Deep foveal density was significantly lower in Group A in comparison to Groups B and C (p value 0.021 and 0.005, respectively). As for other parameters of SVD, DVD and RPCD, no significant difference was observed between Groups A and B; however, the same parameters were significantly lower in Group C when compared to Group A and B. AL was found to be negatively correlated to FAZ (r -0.191, p value 0.043) and most of parameters of SVD, DVD, and RPCD (p value < 0.0001). Conclusion: Most of optic nerve and macular microvascular parameters were significantly lower in eyes with longer axial lengths when compared to those with shorter axial lengths. Moreover, most of these parameters were negatively correlated with AL.

Consequences of COVID-19 on Uveitis Patients from Their Own Perspective: A Questionnaire-based Study.

PURPOSE: Given their immunocompromised status, uveitis patients should be particularly careful during the COVID-19 pandemic. Treatment compliance and adherence are among the most important patient-related determinants of treatment success.To assess the effect of the COVID-19 pandemic on the management of uveitis patients from their own perspective. METHODS: A questionnaire was performed on uveitis patients at Cairo University Hospital in the period between June and August 2020. RESULTS: Overall, 150 responses were received. Almost 20% patients stopped their medications. A total of 61.7% patients reported no fears regarding getting infected with the novel coronavirus. In addition, 54% patients found medical services easily, 26% patients received them through telemedicine, and 34% patients reported worsening of their ocular condition. CONCLUSIONS: COVID-19 has caused a decrease in uveitis patient compliance with follow-ups, leading to worsening of their ocular condition. Economic and psychological effects of COVID-19 pandemic on any chronic patient should be addressed to prevent further deterioration as the pandemic continues.

Post-remission retinal microvascular and choroidal thickness changes in eyes with Behcet's disease posterior uveitis: an OCTA longitudinal study.

PURPOSE: To investigate the retinal microvascular and choroidal thickness changes in eyes with active Behcet's disease posterior uveitis and post-remission. PATIENTS AND METHODS: A prospective longitudinal observational analytic study where patients with active Behcet's posterior uveitis (BU) were assessed by optical coherence tomography angiography (OCTA) and enhanced depth imaging OCT during activity and after remission, for retinal microvascular and subfoveal choroidal thickness (SFCT) changes. RESULTS: 26 eyes of 20 patients were included. With remission of active posterior uveitis, capillary density in both layers increased, only being significant in the superficial capillary plexus (SCP) 1.81 ± 3.57% (p = 0.025), while the foveal avascular zone (FAZ) area increased by 0.036 ± 0.069 mm (p = 0.023). CONCLUSION: OCTA can be used to monitor the activity of Behcet's posterior uveitis. Comparing the retinal microvascular changes during activity and after remission, the superficial capillary plexus was found to be more indicative of the activity status, while the deep capillary plexus and foveal avascular zone area-being more irreversible-are more useful as prognostic indicators. Subfoveal choroidal thickness, on the other hand, proved to be a consistent indictor of visual function; however, its change doesn't accurately reflect the activity status.

Anterior chamber granuloma: conservative treatment versus surgical intervention.

PURPOSE: A distinct pattern of granulomatous anterior uveitis, with white anterior chamber (AC) granuloma, has been reported in certain endemic areas. The aim of this work was to compare the outcome of conservative treatment to surgical intervention for the treatment of large AC granulomas presenting with moderate-severe anterior uveitis. The secondary outcome is ultrasound biomicroscopy (UBM) characterization of AC granulomas. METHODS: This is a prospective randomized interventional study including 41 eyes of 39 patients with active AC granuloma ≥3 mm (flare & cells ≥ +2). Patients were randomly assigned to either conservative treatment in the form of topical prednisolone and cycloplegic drops with orbital floor (transseptal) injection of Triamcinolone acetonide (20 eyes) or surgery in the form of granuloma excision and AC wash (21 eyes). As a perioperative care, topical steroids and cycloplegic drops were given few days before surgery and tapered gradually over 6 weeks. Patients were followed up at first day, 2 weeks, 1 and 3 months. RESULTS: Thirty-seven patients were males, and 2 were females (13.0 ± 3.5 years). After 2 weeks, disappearance/healing of granuloma was achieved in 20 eyes in the surgical group versus 2 eyes in the conservative group (p < 0.0001). This effect was maintained throughout the follow-up period, for the surgical group and reached up to 70%, for the medical group. At every follow-up, BCVA was better in the surgical group, but this was only statistically significant at 1 and 3 months. The granuloma appeared as a homogenous hyperreflective lesion in examined eyes (16 eyes of 15 patients). CONCLUSION: Surgical treatment of large granulomas leads to a more complete and rapid resolution of inflammation.

Reporting the Undiagnosed Cases of Hepatitis B and Hepatitis C Viruses among Patients Undergoing Elective Eye Surgery in a Specialized Eye Hospital in Egypt.

INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) and their long-term sequelae are considered a major health issue in Egypt. The aim of this study is to determine the prevalence of undiagnosed hepatitis B virus (HBV) and hepatitis C virus (HCV) among patients admitted for elective eye surgery in a specialized eye hospital in Cairo, Egypt. MATERIALS AND METHODS: This cross-sectional study was conducted in a specialized eye hospital, Cairo, Egypt. The study included consecutive patients admitted for elective eye surgery in the period from April 2015 to June 2016. Age, sex, and procedure done were recorded for all patients. All the subjects were screened for HBV and HCV by rapid chromatography immunoassay; if positive, the results had to be confirmed by ELISA. RESULTS: 3067 patients admitted for elective eye surgery were included in the study. The mean age of the patients was 50.85 ± 19.77 years. There were 1592 (51.9%) males and 1475 (48.1%) females. The prevalence of preoperative positive HBV and HCV was 7/3067 (0.2%) and 381/3067 (12.4%), respectively. CONCLUSION: Given the high prevalence of HBV and HCV infection in our population in general and in this study specifically, all patients admitted for surgery should be screened for both viruses.

Assessment of Corneal and Tear Film Parameters in Rheumatoid Arthritis Patients Using Anterior Segment Spectral Domain Optical Coherence Tomography.

PURPOSE: To study the corneal changes in rheumatoid arthritis (RA) patients in vivo, using spectral domain anterior segment optical coherence tomography (AS-OCT). METHODS: A case-control study was done on 43 RA patients and 40 controls. The disease activity score (DAS28-ESR) was calculated and all participants had lower tear meniscus, corneal thickness, and epithelial thickness evaluation using AS-OCT. RESULTS: The lower tear meniscus height (LTMH) and the lower tear meniscus area (LTMA) were significantly lower in the RA patients than in controls (p < 0.001). RA patients also had a significantly thinner central corneal thickness (p = 0.02) and their epithelium was found to be thinner in the superotemporal peripheral sector. CONCLUSIONS: The LTMH and LTMA are significantly reduced in RA patients, despite the absence of clinical diagnosis of dry eye. RA patients have thinner corneal thickness and epithelial thickness than controls, which did not correlate with either disease duration or activity.