Conspicuous Peripheral Retinal Hemorrhages with a Relatively Preserved Posterior Pole in Immune Thrombocytopenic Purpura.

BACKGROUND: Immune thrombocytopenic purpura (ITP) is a rare auto-antibody mediated disease of isolated thrombocytopenia (<100,000/µL) with normal haemoglobin levels and leukocyte counts. Only a small number of ITP cases have been reported with accompanying ophthalmological findings. Herein, we report an ITP case with demonstrative retinal haemorrhages. CASE PRESENTATION: A fifty-five-year-old woman with a known history of type 2 diabetes mellitus was referred to our clinic with blurred vision. After detailed anamnesis and clinical assessment, she was diagnosed as primary ITP in haematology department, and systemic steroid (1.5mg/kg) therapy was initiated. During her follow-up, a concomitant peripheral facial paralysis (PFP) emerged. In the course of follow-up, her platelet counts increased gradually, the retinal haemorrhages regressed partially, and the PFP recovered completely. CONCLUSION: ITP is a rare haematologic disease that sometimes manifests with additional systemic involvements, and this disease should be remembered in the differential diagnosis of unusual retinal haemorrhages, which might be the only presenting feature.

Evaluation of corneal densitometry values with Pentacam in cases of ocular hypertension and pseudoexfoliative glaucoma.

BACKGROUND: Examination of corneal densitometry measurements using the Pentacam Scheimpflug imaging system in cases of pseudoexfoliative glaucoma (PEXG) and ocular hypertension (OHT). METHODS: The study included 50 eyes of 29 PEXG patients, 25 eyes of 16 OHT patients, and 76 eyes of 38 healthy control subjects followed in the glaucoma clinic. Corneal densitometry values of all cases were measured using the Scheimpflug imaging system (Pentacam, Oculus, Germany). Corneal densitometry was assessed based on 4 concentric radial zones (0-2 mm, 2-6 mm, 6-10 mm, and 10-12 mm) and depths (anterior, central, posterior, and total) within the Scheimpflug imaging system. The results were statistically analyzed. RESULTS: Corneal densitometry values examined between the OHT and control groups were higher in OHT and statistically significant (p < 0.05). Corneal densitometry values examined between the PEXG and control groups were higher in PEXG and statistically significant (p < 0.05). In comparison between the PEXG and OHT groups, corneal densitometry values in the central 0-2 mm, 2-6 mm, and 6-10 mm; posterior 0-2 mm and 2-6 mm radial zones were higher in PEXG and statistically significant (p < 0.05). CONCLUSIONS: It was observed that elevated intraocular pressure levels in OHT cases could lead to changes in the cornea, consequently increasing corneal densitometry values. The higher corneal densitometry values in PEXG cases compared to OHT were attributed to the accumulation of pseudoexfoliative material in the cornea. Based on our study, corneal densitometry could serve as a potential biomarker for early glaucoma detection in OHT cases and could be employed to assess corneal transparency during the follow-up of PEXG cases.

Macula and optic disc vessel density analyses in systemic lupus erythematosus with optical coherence tomography angiography.

To evaluate the optical coherence tomography angiography (OCT-A) findings in patients with systemic lupus erythematosus (SLE). Twenty-eight eyes of 28 patients with SLE and 27 eyes of 27 age and sex matched healthy controls were enrolled in this cross-sectional study. The vessel densities in the macula and optic disc were evaluated using the OCT-A (Optovue, Inc., Freemont, CA). Foveal retinal thickness, retinal vascular density in superficial capillary plexus (SCP), deep capillary plexus, and choriocapillaris, foveal avascular zone (FAZ), acircularity index, foveal vessel density (FD), and non-flow area in the superficial retina, the capillary and all-vessels density in the peripapillary area and the inside-disc area were automatically measured using Angiovue software of OCT-A and compared between the groups. The foveal, parafoveal and perifoveal retinal vessel densities in the superficial and deep capillary plexus and choriocapillaris were similar between groups. FAZ area, FAZ perimetry, acirculatory index, FD and non-flow area did not show a statistically significant difference. The vessel density in the inside disc area was significantly lower in patients with SLE (46.3 ±â€…3.8%) compared to the control group (49.1 ±â€…4.8%) (P = .02). Our results demonstrate significant decrement in vessel density in the inside-disc area in patients with SLE. The lower vessel density measurement in the inside-disc area might be associated with early neurologic vascular impairment in SLE. Further studies are required to determine the clinical relevance of this finding.

Evaluation of optic coherence tomography findings in patients with inflammatory bowel disease.

BACKGROUND: Ocular complications are known to appear in inflammatory bowel disease (IBD). Among these, posterior segment complications can lead to substantial morbidity. The aim of the study is to evaluate the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and macula thickness measurement in patients with IBD. METHODS: A total of 118 patients with IBD (42 Crohn's disease (CD), 76 ulcerative colitis (UC)) and 52 healthy subjects were included in the study. RNFL, GCIPL, and macula thickness were measured using spectral-domain optical coherence tomography (SD-OCT). RESULTS: The central macular thickness was increased, mean and all superior quadrants of GCIPL thickness measurements were significantly decreased, but RNFL thickness wasn't changed in CD compared to healthy subjects. Although the central macular thickness increased, no change was observed in mean RNFL and GCIPL in UC compared to healthy subjects. Mean RNFL, GCIPL, and macular thickness did not differ during the remission and active phases of the disease in IBD. There was no difference in RNFL, GCIPL, and macular thicknesses in CD patients in terms of the location and behavior of the disease. A significant thickness increase was found in extensive type UC for inferior RNFL value compared to the left side and proctitis. CONCLUSIONS: IBD may cause an increase in macular thickness. This finding may be related to the inflammation or ischemia of the retina. The use of SD-OCT in ophthalmologic examination in patients with IBD may enable early detection of retinal changes and alert the clinician to complications of IBD.

Comparison of the vessel density measurements of the macula, optical disc, and peri-papillary region between ocular hypertension patients and healthy controls.

OBJECTIVE: To evaluate Optical Coherence Tomography Angiography (OCT-A) findings in patients with Ocular Hypertension (OHT) and compare them with healthy individuals. METHODS: Thirty-four patients with ocular hypertension (OHT) and 22 healthy individuals were included in the study. Foveal thickness, retinal vascular density in superficial and deep capillary plexus and choriocapillaris, foveal avascular zone (FAZ), acircularity index (AI), foveal vessel density (FD), non-flow area, capillary and all vessel densities in the peripapillary area and the disc were automatically measured using the Angiovue software of OCT-A and compared between groups. RESULTS: The comparison of the macular OCT-A findings did not reveal a significant difference between the two groups in terms of central macular thickness, superficial and deep capillary plexus vessel density (p>0.05). The foveal avascular zone width was significantly higher in OHT subjects compared to the control group (0.30±0.08 µ and 0.25±0.11 µ, respectively; p = 0.04). The comparison of optic nerve OCT-A findings revealed that the whole-field vessel density (wVD) (p = 0.007), peripapillary vessel density (pVD) (p = 0.001), inferior, superior and temporal radial peripapillary capillary plexus vessel density (p = 0.006, p = 0.008, p = 0.02) and the mean retinal nerve fiber layer thickness (p = 0.02) were significantly lower in the OHT group. CONCLUSIONS: Our findings suggest that the decrement in the optic disc vascular density and foveal avascular zone width was significantly higher in OHT subjects. The possible effect or role of these microvascular changes in terms of glaucoma development should be examined through further studies.

The optical coherence tomography angiography findings of rheumatoid arthritis patients taking hydroxychloroquine.

PURPOSE: The aim of this study is to measure retinal vessel density and thickness of the macula by optical coherence tomography angiography in patients with rheumatoid arthritis taking hydroxychloroquine. METHODS: The study included 40 patients with rheumatoid arthritis taking hydroxychloroquine and 20 age-, gender-, and axial length-matched control subjects. Patients were divided into two groups according to the duration of hydroxychloroquine use. Twenty four of the patients were taking hydroxychloroquine for more than 5 years (Group 1), and the rest of 16 were taking hydroxychloroquine for less than 5 years (Group 2). A total of 20 age- and gender-matched volunteers with similar axial length were selected as Group 3. All of the patients underwent optical coherence tomography angiography, and 3 mm × 3 mm scanning mode was chosen for analyzing vascular density and morphological characteristics on the choriocapillaris layer. In addition, Humphrey visual field 10-2 was evaluated in each subject. RESULTS: The temporal deep vascular density was measured as 48.13% ± 8.5% in Group 1, 54.42% ± 10.3% in Group 2, and 60.35% ± 13.1% in Group 3. Deep temporal and deep hemi-inferior vascular density was significantly lower in Group 1 in comparison with Group 3 (p = 0.041 and p = 0.046, respectively). Visual field testing was normal in all patients. CONCLUSION: The optical coherence tomography angiography findings showed that the parafoveal deep temporal and deep hemi-inferior vascular plexus density was reduced in patients taking hydroxychloroquine for more than 5 years despite having normal perimetry. This observation, which can be obtained only through optical coherence tomography angiography, may be relevant to the early findings of hydroxychloroquine toxicity.

Chronic Meningitis Complicating Intracranial Hypertension in Neurobrucellosis: A Case Report.

In neurobrucellosis, even though meningitis is encountered frequently, chronic intracranial hypertension is a rare manifestation. Early diagnosis and treatment is very important for the prevention of permanent visual loss secondary to poststasis optic atrophy in these cases. We report a case that presented with permanent visual loss secondary to intracranial hypertension in neurobrucellosis. Our goal is to draw attention to the consideration of neurobrucellosis in cases with papilla stasis, even in the absence of neurological findings in endemic areas.

Effects of levodopa on retina in Parkinson disease.

PURPOSE: To evaluate the effects of levodopa on retina, we assessed retina with optical coherence tomography (OCT) in Parkinson disease (PD). METHODS: Thirty-five patients with PD (17 with levodopa monotherapy, 18 untreated) and 11 healthy controls were included in this cross-sectional study. Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn & Yahr (H&Y) staging scale were used for the evaluation of disease severity. All retinal scans were performed using OCT. RESULTS: Total UPDRS and motor subscores were lower in untreated patients compared to patients with treated PD (p = 0.013, p = 0.033, respectively). There was no significant difference in the range of H&Y stages between the untreated and treated PD groups (p = 0.342). The average retinal nerve fiber layer thickness of the untreated (106.76 ± 10.55 µm) and treated (104.62 ± 8.23 µm) patients with PD were significantly thinner than those of controls (115.60 ± 9.11 µm) (p<0.005). However, there was no significant difference between the untreated and patients with treated PD (p = 0.780). No significant difference in mean values of average thickness of ganglion cell complex layer was observed among controls, patients with untreated PD, and patients with treated PD (p = 0.304). CONCLUSIONS: Although the disease in patients with treated PD was more severe than in the untreated group, no significant difference in the thickness of retina was found between the 2 groups. Therefore, we thought that levodopa might have a protective effect on retina in patients with PD.

Nonarteritic anterior ischemic optic neuropathy as the presenting manifestation of primary antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis or pregnancy morbidity. Ocular involvement in APS includes a broad spectrum of manifestations involving anterior and posterior segment or the presence of neuroophthalmologic features. Nonarteritic anterior ischemic optic neuropathy (NAION) is a very rare finding, and in this report a case having NAION as the prevailing sign of APS is presented. A middle-aged women who presented with visual disturbances in her left eye (LE) and turned out to have the diagnosis of primary APS with the help of rheumatological investigations is discussed. She was treated with oral steroids for NAION in her LE. With systemic and rheumatological work-up, primary APS was diagnosed, and hydroxychloroquine, coumadin, and aspirin were started, after which she remained stable under control. Due to the important diagnostic and therapeutic implications of APS, it should be considered in the differential diagnosis of NAION, particularly when the etiology is uncertain.

Structural and functional comparison of the persistent and resolved amblyopia.

PURPOSE: To assess structural or functional differences of the retina among subjects with persistent and resolved amblyopia. METHODS: Fourteen eyes with persistent amblyopia that did not reach normal visual acuity (VA) levels (≤0.1 LogMAR) despite amblyopia treatment, 18 eyes with resolved amblyopia, and 16 eyes of 16 normal subjects were included. All subjects underwent optical coherence tomography (OCT), pattern visual evoked potential (PVEP), and pattern electroretinography (PERG) evaluation. RESULTS: There was no significant difference in foveal thickness, foveal volume, macular volume, ganglion cell layer thickness, and total and sectorial retinal nerve fiber layer measurements among three groups (p > 0.05). Foveolar thickness was significantly increased in both resolved and persistent amblyopia groups compared with the control group (p = 0.031). However, there was no difference between amblyopic groups (p = 0.98). Although, in the PVEP study, N75 implicit time was found significantly prolonged in both amblyopia groups (p = 0.046), there were no significant differences in P100 implicit time and amplitude among the groups (p > 0.05). PERG amplitude of the persistent group was significantly lower than that of the control group (p = 0.003). There were no significant differences in P50, N95 implicit times among groups (p > 0.05). CONCLUSIONS: In our study, the only significant difference between persistent and resolved amblyopia groups was the initial VA. Neither OCT nor electrophysiological examinations were found to be useful in order to explain why some cases were resistant to the treatment for amblyopia.

Bilateral total optic atrophy due to transdermal methanol intoxication.

In this case report, we document a 54-year-old woman with total bilateral optic nerve atrophy after local application of methanol containing spirit. Almost all the reported cases of methanol intoxication in the literature are caused by oral ingestion. In this rare case, we present transdermal absorption of methanol that may cause irreversible blindness in addition to intracerebral lesions.