Swept Source Optical Coherence Tomography Analysis of a Selected Eye's Anterior Segment Parameters in Patients with Pseudoexfoliation Syndrome.

BACKGROUND: Pseudoexfoliation syndrome (PEX) is a systemic, age-related disorder characterized by the production and accumulation of pseudoexfoliation material. To date, detailed characteristics have not been published regarding the iridocorneal angle and cornea in patients with pseudoexfoliation syndrome determined through swept source optical coherence tomography (SS-OCT). METHODS: A total of 150 eyes of patients with pseudoexfoliation syndrome (ages 69-86 years) and 166 eyes in a control group (ages 54-79 years) were analyzed. RESULTS: The central corneal thickness in the PEX group was 549.56 µm and was slightly (insignificantly) higher than that of the control group (540.56 µm). The anterior chamber of the eye was visibly shallower in patients with PEX syndrome than in those of the control group (2.49 mm vs. 3.07 mm; p < 0.001). The Fourier analysis parameters of the cornea showed multiple differences between the PEX and control groups. With respect to iris area, the parameters showed statistically significant differences between the PEX and control groups in all four quadrants of the eye. No statistical significance was found in the PEX group for the iridocorneal angle parameters, or corneal and lens parameters depending on gender and age. CONCLUSIONS: PEX syndrome is characterized by a significant impact on the anterior eye segment, including higher anterior and posterior keratometric values, lower anterior chamber depth, higher iris thickness, and narrower angle parameters. The characteristic anterior eye segment features of PEX syndrome can be detected using SS-OCT, which could potentially assist clinicians in properly managing the disease.

Idiopathic Epiretinal Membrane: Microvasculature Analysis with Optical Coherence Tomography and Optical Coherence Tomography Angiography.

BACKGROUND: The present study examined the relationships among macular microvasculature, retinal structure, and epiretinal membrane (ERM) and explored the utility of optical coherence tomography (OCT) angiography (OCTA) in idiopathic ERM assessment. METHODS: The study sample comprised 276 eyes of 276 patients. A total of 154 eyes with ERM and 122 normal (control) eyes were analyzed. Only one eye of each participant was randomly selected for posterior segment imaging. Each patient underwent OCT and OCTA. Images were analyzed with AngioTool 0.6. RESULTS: Foveal avascular zone was significantly smaller in the ERM group (p = 0.044). Average retinal thickness and foveal thickness were significantly higher in the ERM group (both p = 0.001). Moreover, 64 (41.5%) patients exhibited no metamorphopsia, while 46 (29.8%) and 44 (28.7%) patients exhibited moderate and extensive metamorphopsias, respectively. Meanwhile, FAZ was negatively correlated with central retinal thickness in the ERM group. The vessel area (p = 0.0017) and vessel percentage area (p = 0.044) were significantly greater in the ERM group. CONCLUSIONS: Changes observed in the superficial plexus in OCTA are related to the severity of metamorphopsia and can be further evaluated to support decision making regarding the surgical management of idiopathic ERM.

Peripheral Retinal Degenerations and Idiopathic Epiretinal Membrane: Analysis with Ultra-Wide-Field Scanning Laser Ophthalmoscopy.

BACKGROUND: The present study examined the relationships among retinal structure, peripheral retinal abnormalities, and epiretinal membrane (ERM) and explored the utility of ultra-wide-field laser scanning ophthalmoscopy in idiopathic ERM assessment. METHODS: The study sample comprised 276 eyes of 276 patients. Ultra-wide field fundus imaging was performed without mydriasis using Optos California. Each patient underwent a Goldmann three-mirror contact lens fundus examination. RESULTS: Ultra-wide field laser scanning ophthalmoscopy revealed peripheral retinal degeneration in 84 (54.54%) eyes in the ERM and in 28 (22.95%) eyes in the control group. Goldmann three-mirror contact lens examination revealed peripheral retinal degeneration in 96 (62.33%) eyes in the ERM group and 42 (34.42%) eyes in the control group. Ultra-wide field ophthalmoscopy enabled the detection of nearly 87% of all peripheral retinal lesions in patients with ERM, but it cannot replace fundus examination with a Goldmann triple mirror or ophthalmoscopy with scleral indentation. CONCLUSIONS: In most patients, idiopathic ERM coexisted with changes in the peripheral retina. Some of these changes promote retinal detachment. Thus, surgeons should consider the risk of retinal tear during vitrectomy, which increases the scope of surgery and may adversely affect prognosis. Although ultra-wide field imaging is a valuable diagnostic method, it is not a substitute for Goldmann three-mirror contact lens fundus examination or ophthalmoscopy with scleral indentation.

Detailed corneal and genetic characteristics of a pediatric patient with macular corneal dystrophy - case report.

BACKGROUND: Corneal dystrophies are a group of rare, inherited disorders that are usually bilateral, symmetric, slowly progressive, and not related to environmental or systemic factors. The majority of publications present the advanced form of the disease with a typical clinical demonstration. The initial signs and symptoms of different epithelial and stromal corneal dystrophies are not specific; therefore, it is very important to establish the early characteristic corneal features of these disorders that could guide the diagnostic process. CASE PRESENTATION: The main purpose of this study was to report the differential diagnosis of a pediatric patient with bilateral anterior corneal involvement suspected of corneal dystrophy. An 8-year-old male patient presented with asymptomatic, persistent, superficial, bilateral, diffuse, anterior corneal opacities. Slit lamp examination results were not specific. Despite the lack of visible stromal involvement on the slit lamp examination, corneal analysis based on confocal microscopy and optical coherence tomography revealed characteristic features of macular corneal dystrophy (MCD). The diagnosis of MCD was confirmed by CHST6 gene sequencing. The early corneal characteristic features of MCD, established based on the findings of this case report, include corneal astigmatism (not specific), diffuse corneal thinning without a pattern of corneal ectasia (specific), and characteristic features on confocal microscopy (specific), including multiple, dark, oriented striae at different corneal depths. CONCLUSIONS: The clinical examination should be complemented with corneal imaging techniques, such as confocal microscopy and optical coherence tomography. In patients suspected of corneal dystrophy, genetic testing plays an important role in establishing the final diagnosis.

Swept Source Optical Coherence Tomography Analysis of the Selected Eye's Anterior Segment Parameters.

BACKGROUND: The present study determined the mean reference values of the anterior segment parameters of the selected eye using swept source optical coherence tomography (SS-OCT) in healthy Caucasian participants. METHODS: A total of 166 volunteers (age 54-79 years), women (n = 92) and men (n = 74), were analyzed. One eye of each subject was randomly selected for anterior segment imaging. The anterior segment of the eye was scanned with CASIA2. The analyzed anterior segment parameters were divided into three groups, namely parameters of the cornea, lens, and angle. RESULTS: The OCT (e.g., Ks, Kf, pKf, pKs, and central corneal thickness) and Fourier parameters of the cornea were significantly different between females and males. The iridocorneal angle was the smallest in the upper quadrant for all distance from the apex of the angle (250, 500, and 750 µm). CONCLUSIONS: Therefore, SS-OCT enables the analysis of parameters of the cornea, anterior chamber, lens, and iridocorneal angle, highlighting its clinical utility. Sex-specific differences in the analyzed parameters should be taken into account during the diagnosis of corneal diseases. The configuration of the filtration angle is an important marker during glaucoma diagnosis and drainage implant surgery. Measurements with CASIA 2is characterized by very good repeatability.

Corneal Analysis with Swept Source Optical Coherence Tomography in Patients with Coexisting Cataract and Fuchs Endothelial Corneal Dystrophy.

This study focused on defining the characteristic features of keratometry and pachymetry elevation maps based on swept source optical coherence tomography (SS OCT) in Fuchs endothelial corneal dystrophy (FECD) eyes with a coexisting cataract. 70 eyes of 35 patients diagnosed with FECD and a coexisting cataract and 70 control eyes were included in this prospective, controlled, observational, cross-sectional study. Features characteristic of intermediately affected eyes included an increased corneal thinnest thickness (CTT) (p = 0.01), 3 and 6 mm asymmetry (p < 0.0001), higher order Fourier indices (p < 0.05 and p ≤ 0.0001, respectively), chord µ, and a posterior Ectasia Screening Index (pESI) (p < 0.01). The lack of agreement between the anterior and posterior elevation map and a significant area of negative values in the posterior map were detected. In advanced FECD eyes, our study additionally revealed decreased posterior keratometry steep (Ks), keratometry flat (Kf), keratometry average (AvgK), eccentricity (Ecc), an increased corneal apex thickness (CAT), and decreased 3 and 6 mm posterior spherical indices (p < 0.0001 for all of the above). Characteristic features of subclinical FECD, independent of the corneal thickness, can be detected by SS OCT and should be considered during the preoperative assessment of patients with a coexisting cataract.

Seven-Year Analysis of Microbial Keratitis Tendency at an Ophthalmology Department in Poland: A Single-Center Study.

This study aimed to analyze the frequency, drug susceptibility, and drug resistance of pathogens causing microbial keratitis (a corneal inflammation) in the Clinical Department of Ophthalmology, Medical University of Silesia, Katowice. Despite intensive treatment, severe inflammation causes irreversible blindness in ∼7% of cases and eye loss (evisceration or enucleation of the eyeball) in ∼1% of cases at our hospital. The choice of a targeted drug depends on the culture result and drug resistance of the microorganism. This was a retrospective observation study. Conjunctival swabs and corneal scrapes were collected between January 1, 2013, and December 31, 2019, in the tertiary reference center for keratitis. The collected data included the type of material received, culture result, and antimicrobial susceptibilities. Of the 2482 samples analyzed, 679 were positive and 1803 were negative. Of the total pathogens isolated, 69.9% were Gram-positive bacteria, 20.8% were Gram-negative bacteria, and 7.1% were fungi. A significant increase in the number of Gram-positive methicillin-resistant Staphylococcus aureus and a partial increase in the number of Gram-negative beta-lactams-resistant bacteria were observed. All fungal species were sensitive to amphotericin B, 82.81% were sensitive to voriconazole, and 56.25% were sensitive to fluconazole. Dual drug therapy (levofloxacin and tobramycin) was the first-line treatment. Drug susceptibility testing of the cultured microorganisms is necessary to initiate targeted treatment. Increased drug resistance was observed in this study. In the present study, most bacteria were sensitive to fluoroquinolones. Ciprofloxacin therapy remains the recommended empirical treatment in microbial keratitis. According to our study, voriconazole remains a first-line antifungal drug, when a fungal infection is suspected.

In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography Analysis of the Microcystic Keratitis.

PURPOSE: To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of bilateral acute microcystic epitheliopathy after daily soft contact lens wear. METHODS: IVCM and AS-OCT were used in the course of the bilateral epitheliopathy of a 23-year-old patient at the acute stage of the disease and at recovery after four days of treatment. The images were analyzed and compared. RESULTS: On AS-OCT of the right eye, general hyperreflectivity and the increased thickness of the central corneal epithelium to 150 µm with numerous hyporeflective small, oval cysts were revealed and resolved completely at day 4 after diagnosis and treatment. AS-OCT scans of the left eye revealed oval shaped, hyperreflective material within the corneal epithelium. IVCM of both eyes showed numerous microcysts of different sizes filled with hyperreflective material mostly within superficial epithelial layers. Epithelial cells showed a polymorphism along with disruption of a cytoarchitecture. Basal epithelial cells and anterior stroma showed inflammatory changes. Posterior corneal stroma and endothelium presented normal morphology. CONCLUSIONS: Microcystic keratitis appeared as localized microcystic inflammation of epithelium on AS-OCT, which was confirmed by IVCM. Both IVCM and AS-OCT are helpful diagnostic instruments in case of cystic inflammation of corneal epithelium.