Evaluation of Ganglion Cell-Layer Complex and Macular Vessel Density in Amblyopic Eyes with Optical Coherence Tomography Angiography.

Purpose: This study aimed to compare and quantify the ganglion cell complex (GCC), macular thickness, and vessel density (VD) in amblyopic eyes and their corresponding fellow eyes using optical coherence tomography angiography (OCTA). Methods: This cross-sectional study analyzed 32 unilateral amblyopic patients, examining both of their eyes. The study assessed parameters such as GCC thickness, macular thickness (total, inner, and outer layers), and VD in the optic nerve and macular region using spectral-domain OCTA. Results: This study analyzed data from 30 unilateral amblyopic patients with a mean age of 28.7 ± 18.3 years. Amblyopic eyes had lower mean best-corrected visual acuity compared with healthy eyes. However, no significant differences were found in retinal nerve fiber layer (RNFL) thickness, GCC thickness, and overall retinal thickness between amblyopic and fellow eyes when accounting for factors such as axial length and signal strength index. In patients older than 30 years, amblyopic eyes had a higher global loss volume (GLV) compared with fellow eyes (p = 0.02). In addition, blood VD within the optic disc and superficial/deep capillary plexuses in different macular regions were significantly lower in amblyopic eyes compared with fellow eyes. Conclusions: This study found significant differences in VD and the GLV index between amblyopic eyes and healthy eyes, particularly in older patients. However, there were no notable differences in macular thickness and RNFL thickness. Further research is needed to determine the clinical relevance of these findings.

Comparison of Toric Implantable Collamer Lens and Toric Artiflex Phakic IOLs in Terms of Visual Outcome: a Paired Contralateral Eye Study.

PURPOSE: This study sought to compare the postoperative visual outcomes of toric implantable collamer lens (T-ICL) with toric Artiflex (T-Artiflex) lenses. DESIGN: Alternating treatment, contralateral eye matched clinical study. METHODS: This study compared 82 eyes of 41 patients with T-ICL lenses in one eye and toric Artiflex implantation in the contralateral eye to correct myopic astigmatism. Safety, efficacy, predictability, astigmatic vector changes, contrast sensitivity, endothelial cell count, and possible adverse events were assessed at least 12 months postoperatively. RESULTS: After a mean follow-up of 12 months, the safety index was mean 1.40 ± 0.70 in the T-ICL group and 1.20 ± 0.21 in the T-Artiflex group. Furthermore, their mean efficacy indexes were 1.24 ± 0.42 and 1.08 ± 0.23, respectively (P = .029). A total of 39 eyes (95%) in the T-ICL group and 41 eyes (100%) in the T-Artiflex group were within ±1.00 diopter (D) of emmetropia and 33 eyes (80%) and 34 eyes (83%) were within ±0.5 D of emmetropia, respectively. Vector analysis revealed mean index of success as large as 0.25 ± 0.22 in the T-ICL group and 0.24 ± 0.15 in the T-Artiflex group. Postoperative contrast sensitivities were equal in both groups under mesopic conditions for any given spatial frequency. There was an endothelial loss of 2.18% and 1.95% in the T-ICL and T-Artiflex groups, respectively. There were no significant complications in any of the groups. CONCLUSIONS: Both lenses showed promising results in terms of safety, efficacy, and predictability for correction of myopic astigmatism. As shown in this paired-eye study, most outcomes were almost identical, and neither of these lenses were clinically superior to the other.

Intravitreal bevacizumab versus ranibizumab: Effects on the vessels of the fellow non-treated eye.

PURPOSE: To evaluate the effects of anti-vascular endothelial growth factors (anti-VEGF) on the vessels of the non-treated eyes following intravitreal injections. METHODS: In this prospective, non-randomized trial, a total of 38 patients were recruited. 21 patients received ranibizumab, and 17 patients received bevacizumab. Fundus photography was carried out at baseline immediately before injection and at 3 days, 7 days, and one month after the injections. Using image analysis software, measurements were summarized as the central retinal artery equivalent (CRAE) and central retinal vein equivalent. RESULTS: In non-treated eyes, CRAE decreased significantly from 153.23 ± 15.20 µm before injection to 148.77 ± 17.21 µm 3 days after intravitreal bevacizumab (P = 0.004). There was no significant difference in CRAE, between the pre-injection baseline, one week, and one month after intravitreal bevacizumab injection in non-treated eyes (P > 0.05). No significant difference was noted in CRAE in the non-treated eyes of the ranibizumab group at any post-injection visit (P = 0.1). CONCLUSION: A significant transient narrowing effect of bevacizumab on retinal arterioles in the fellow non-treated eyes on the third day after intravitreal injection may show that plasma concentrations of these drugs are sufficient to spread the effect to the other eye.

Comparison of densitometric profile after deep lamellar keratoplasty with two different techniques for treatment of keratoconus.

PURPOSE: To compare densitometric outcome of two techniques of deep lamellar keratoplasty using Pentacam HR corneal densitometry software. METHODS: Postoperative outcomes of 31 patients with big bubble (BB) and 28 patients with Melles (M) surgery for the treatment of keratoconus were evaluated. Data were gathered at least 3 months after the removal of all sutures including demographic data, uncorrected distance visual acuity (UCDVA), best spectacle-corrected visual acuity (BSCVA), refraction and endothelial cell count. Moreover, the Scheimpflug images were taken by Pentacam® HR to assess keratometric profile, densitometric outcomes in different depths and zones of the cornea and central corneal thickness. Anterior segment OCT was performed in ten cases of M group. RESULTS: Thirty-one eyes with BB and 27 eyes M surgery were enrolled. Comparison of densitometric profile between groups revealed no statistical significance in zone 0-2 mm, zone 2-6 mm and zone 10-12 mm in all depths (all P values > 0.05). Zone 6-10 mm of M group had lower densitometric readings (more transparent) in anterior, central and posterior layers of the cornea in comparison with BB group (all P < 0.05). Also no statistical difference was found in UCDVA, BSCVA, spherical or cylindrical refractive error, and spherical equivalent, keratometric readings, endothelial cell count and central corneal thickness in two groups (all P values > 0.05). CONCLUSION: Densitometric profiles were identical in both methods in visually important zones so as visual and refractive outcomes.

Natural Honey-Induced Acanthamoeba keratitis.

Natural honey in spite of its usefulness is known to contain certain microorganisms. In the present study, we describe a case of Acanthamoeba keratitis after using topical honey administered by a traditional medicine therapist. A 32-year-old male came with red eye and blurred vision. The pain and other symptoms became more severe after the 1st week, with appearance of radial perineuritis at the cornea. A repeated interview revealed that 1 week before appearance of ocular symptoms, the patient had instilled a drop of natural honey in his left eye. Confocal microscopic cornea imaging demonstrated cyst and trophozoite of Acanthamoeba in the corneal stroma.

Comparison of OKULIX ray-tracing software with SRK-T and Hoffer-Q formula in intraocular lens power calculation.

PURPOSE: To compare the performance of OKULIX ray-tracing software with SRK-T and Hoffer Q formula in intraocular lens (IOL) power calculation in patients presenting with cataract. METHODS: In this prospective study, 104 eyes of 104 patients with cataract who underwent phacoemulsification and IOL implantation were recruited. Three IOL brands were used and for all eyes, IOL power calculation was performed using SRK-T, Hoffer Q formula and also OKULIX ray-tracing software. For all patients, axial length and keratometry data was obtained with IOLMaster 500 device and IOL power was determined using Hoffer Q and SRK-T formula. The IOL powers were also calculated using the OKULIX ray-tracing software combined with CASIA AS-OCT and IOLMaster 500 device. Optically measured axial length of eyes were inserted to OKULIX software from IOLMaster 500 device, and anterior and posterior tomographic and corneal pachymetry data was imported from CASIA AS-OCT into the OKULIX.The performance of each calculation methods was measured by subtracting the predicted postoperative refraction from the postoperative manifest refraction spherical equivalent (MRSE). For each of the 3 methods, the mean absolute prediction error was determined, too. RESULTS: The mean value absolute prediction error by OKULIX, SRK-T and Hoffer Q formulas, respectively, were 0.42 (±0.03), 0.36 (±0.02) and 0.37 (±0.02). The mean absolute prediction error by OKULIX had no significant difference between three IOL groups (P = 0.96), and it was confirmed that there was no meaningful statistically difference in mean absolute prediction error between the OKULIX, SRK-T and Hoffer Q formula. (P = 0.25). Also in each group of implanted IOLs, all three formulas worked with the same accuracy. The prediction error using OKULIX were within ±0.50 diopter in 63.5% of eyes and within ±1.00 diopter in 94.2% of eyes. CONCLUSION: OKULIX ray-tracing IOL power measurements provides reliable and satisfactory postoperative results, which are comparable to other 3rd generation formulas of SRK-T and Hoffer Q.

Astigmatic treatment with photorefractive keratectomy: Investigations of non-keratometric ocular astigmatism.

PURPOSE: To evaluate the effect of non-keratometric ocular astigmatisms on visual and refractive outcomes after photorefractive keratectomy (PRK) for correction of myopic astigmatisms. METHODS: Seventy one eyes of 36 subjects were enrolled in this study. Patients underwent PRK for treatment of myopia. Subjects were evaluated for refractive error, keratometry, and visual acuity before and six months after surgery. Pre- and post-op non-keratometric astigmatisms were calculated by vectorial analysis of the difference between the corneal plane refractive astigmatism and keratometric astigmatism. Astigmatic analysis explored the contribution of non-keratometric astigmatisms. RESULTS: The pre-op spherical equivalent (SE) was -6.27 ± 1.48 with 1.16 ± 1.02 diopters of corneal plane refractive astigmatism and 1.44 ± 0.47 diopters keratometric astigmatism. Post-op values were -0.60 ± 0.85, 0.56 ± 0.47, and 1.06 ± 0.57, respectively, 6 months after surgery. Pre- and post-op non-keratometric astigmatisms were 0.76 ± 0.41 and 0.76 ± 0.46, respectively, (P = 0.976) with significant correlation (r = 0.37, P = 0.002). Pre-op non-keratometric astigmatisms correlated to the pre-op SE (r = -0.25, P = 0.04). Pre-op non-keratometric astigmatisms had significant correlation with keratometric difference vector of astigmatic correction (r = 0.369, P = 0.002). Post-op non-keratometric astigmatisms correlated to keratometric induced astigmatism (r = 0.334, P = 0.006), keratometric index of success (r = 0.571, P < 0.001), and post-op keratometric astigmatism (r = 0.736, P < 0.001). CONCLUSIONS: Higher or lower non-keratometric ocular astigmatisms did not have any effect on refractive and visual outcome after PRK. PRK effectively corrected total refractive astigmatism through correction of keratometric astigmatism and additional adjustment to compensate for non-keratometric ocular astigmatisms.

Tonic Pupil, a Paraneoplastic Neuro-Ophtalmological Disease Associated with Occult Breast Cancer.

Here, we present a case of tonic pupil associated with occult breast cancer as a paraneoplastic neuro-ophthalmology syndrome. A 45-year-old woman developed progressive photophobia and blurred vision due to unilateral Adie's tonic pupil. Magnetic resonance image of her brain and neurological examination (including deep tendon reflexes) were normal at first visit. Follow-up examinations performed by ophthalmologist every 6 month without any change in her condition. After 2 years, patient discovered a mass in her breast which identified to be malignant after diagnostic procedures. Despite surgical and medical treatment for cancer, no change in the ocular condition was happened.

Noninvasive Ventilation in Mustard Airway Diseases.

BACKGROUND: Noninvasive ventilation (NIV) has been shown to improve numerous clinical measures in subjects with COPD, including gas exchange, exercise tolerance, dyspnea, hospitalizations, health-related quality of life (HRQOL), and functional status. Although useful for classical COPD, NIV has not been validated specifically as a treatment option for mustard airway disease. Our aim was to assess the efficacy of NIV in subjects with severe mustard airway disease. METHODS: This study was performed over the course of 12 months on 20 subjects with severe mustard airway disease (Global Initiative for Chronic Obstructive Lung Disease criteria). Subjects were selected from the pulmonary clinic of Baqiyatallah Hospital in Tehran, Iran. Body mass index, lung function, dyspnea, exercise tolerance, HRQOL, sleep quality, and hospitalization measures were assessed before and after NIV treatment. RESULTS: NIV improved HRQOL (P = .03) and sleep quality (P = .06) in very severe subjects and reduced hospitalizations (P = .003) and exacerbations (P = .01) in severe subjects. Chest imaging studies showed that these subjects had heterogeneous airway disease, the main finding of which was bronchiolitis obliterans. CONCLUSIONS: NIV can be used as an effective new palliative method in the treatment of mustard airway disorders. Subjects with very severe and severe disease benefitted differently from NIV.

Nasal chondroma presenting as hypertelorism.

PURPOSE: To report a rare case of nasal chondroma presenting as hypertelorism. CASE REPORT: We report a case of a 16-year-old boy with a large calcified mass arising from the posterior nasal cavity presenting as hypertelorism. Surgical excision was done, and the histopathological examination revealed a chondroma. The hypertelorism resolved postoperatively. CONCLUSIONS: Nasal chondroma may also present innocuously as hypertelorism as in this case.

Accutome PachPen handheld ultrasonic pachymeter: intraobserver repeatability and interobserver reproducibility by personnel of different training grades.

To assess the intra-observer repeatability and inter-observer reproducibility of central corneal thickness (CCT) measurements of PachPen (Accutome, Inc., Pennsylvania, USA), a hand-held, portable ultrasonic pachymeter when used by an ophthalmic nurse compared to an ophthalmologist. Ophthalmology Clinic, University of Malaya Medical Center In this prospective study, CCT was measured in 184 eyes of 92 healthy subjects, first by a corneal surgeon experienced in ultrasound pachymetry (Observer 1) followed by an ophthalmic nurse new to the procedure (Observer 2). Nine measurements were obtained from each eye by each observer, independently. Measurements were compared between the observers. Coefficients of repeatability and reproducibility were calculated. The Bland-Altman plot was used to assess agreement between observers. Mean age of the study population was 54.3 ± 15.2 years old and consisted of 43.5% male. Mean CCT as measured by Observers 1 and 2 were 528.3 ± 32.9 and 530.7 ± 33.3 µm, respectively. Observer 1 showed higher repeatability of measurements compared to that of Observer 2 (coefficient of repeatability 3.46 vs. 5.55%). The measurements by both observers showed high correlation (0.96) and good agreement (mean difference -2.4 µm; 95% limits of agreement -21.4, 16.7 µm). Coefficient of reproducibility of measurements between observers was 5.08%. Accutome PachPen hand-held ultrasound pachymeters gives excellent intra-observer repeatability and inter-observer reproducibility by personnel of different training grades.

3 Tesla magnetic resonance imaging noise in standard head and neck sequence does not cause temporary threshold shift in high frequency.

High acoustic noise level is one of the unavoidable side effects of 3 T magnetic resonance imaging (MRI). A case of hearing loss after 3 T MRI has been reported in this institution and hence this study. The objective of this study was to determine whether temporary threshold shift (TTS) in high frequency hearing occurs in patients undergoing 3 T MRI scans of the head and neck. A total of 35 patients undergoing head and neck 3 T MRI for various clinical indications were tested with pure tone audiometry in different frequencies including high frequencies, before and after the MRI scan. Any threshold change from the recorded baseline of 10 dB was considered significant. All patients were fitted with foamed 3 M earplugs before the procedure following the safety guidelines for 3 T MRI. The mean time for MRI procedure was 1,672 s (range 1,040-2,810). The noise dose received by each patient amounted to an average of 3,906.29% (1,415-9,170%). The noise dose was derived from a normograph used by Occupational Noise Surveys. This was calculated using the nomograph of L eq, L EX, noise dose and time. There was no statistically significant difference between the hearing threshold before and after the MRI procedures for all the frequencies (paired t test, P > 0.05). For patients using 3 M foamed earplugs, noise level generated by 3 T MRI during routine clinical sequence did not cause any TTS in high frequency hearing.

Refractive outcomes comparison between the Lenstar LS 900® optical biometry and immersion A-scan ultrasound.

To determine the accuracy of intraocular lens (IOL) calculations in eyes undergoing phacoemulsification cataract surgery with IOL implantation using immersion A-scan ultrasound (US) and Lenstar LS 900(®) biometry. In this prospective study, 200 eyes of 200 patients were randomized to undergo either Lenstar LS 900(®) or immersion A-scan US biometry to determine the IOL dioptric power prior to phacoemulsification cataract surgery. Post-operative refractive outcomes of these two groups of patients were compared. The result showed no significant difference between the target spherical equivalent (SE) and the post-operative SE value by the Lenstar LS 900(®) (p value = 0.632) or immersion A-scan US biometry (p value = 0.438) devices. The magnitude of difference between the two biometric devices were not significantly different (p value = 0.868). There was no significant difference in the predicted post-operative refractive outcome between immersion A-scan US biometry and Lenstar LS 900(®). Based on the results, the immersion A-scan US technique is as accurate as Lenstar LS 900(®) in the hands of an experienced operator.

Association between Ocular Pseudoexfoliation and Sensorineural Hearing Loss.

Background. Our study aimed to investigate an association between ocular pseudoexfoliation (PXF) and sensorineural hearing loss (SNHL) and to compare them with age and sex matched controls without pseudoexfoliation. Method. This was a case-control study of 123 patients which included 68 cases with PXF (at least one eye) and 55 controls without pseudoexfoliation. Pure-tone audiometry (PTA) was done for these patients at sound frequencies taken as important for speech comprehension, that is, 250 Hertz (Hz), 500 Hz, 1000 Hz, and 2000 Hz. Results. There were 41 patients with pseudoexfoliation syndrome (PXE) and 27 with pseudoexfoliative glaucoma (PXEG). The majority of patients with hearing loss (60%; n = 51) were PXF patients and the remaining 40% (n = 34) were controls. Below average hearing thresholds were significantly higher in the pseudoexfoliation group compared to the control group (P = 0.01; odds ratio (OR), 3.00; 95% confidence interval (CI), 1.25-7.19). However, there was no significant difference in the mean hearing threshold levels between the three groups (PXE, PXEG, and controls) in either ear (ANOVA, right ear: P = 0.46 and left ear P = 0.36). Conclusion. Our study found an association between PXF and SNHL, confirming that PXF can involve organs in the body other than the eye.

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma.

PURPOSE: To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity. METHODS: In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp-Anderson-Parish classification. Pearson's correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity. RESULTS: Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70 ± 46.28 mm(3); 167.40 ± 45.36 mm(3)) than in the mild glaucoma group (264.03 ± 78.53 mm(3); 264.76 ± 78.88 mm(3)) and the control group (297.80 ± 71.45 mm(3); 296.56 ± 71.02 mm(3)). Moderate correlation was observed between: RNFL thickness and ON volume (r = 0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r = 0.60, p < 0.001). ON volume below 236 mm(3) was 96 % sensitive and 80 % specific for the detection of severe glaucoma. CONCLUSIONS: MRI measured optic nerve volume is a reliable method of assessing glaucomatous damage beyond the optic nerve head. A value of 236 mm(3) and below can be used to define severe glaucoma.

Neonatal herpes simplex virus type-1 central nervous system disease with acute retinal necrosis.

We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

Retinal nerve fiber layer structure abnormalities in schizophrenia and its relationship to disease state: evidence from optical coherence tomography.

PURPOSE: We determined structural retinal nerve fiber layer (RNFL) changes in schizophrenia patients and established if the structural changes were related to the duration of the illness using spectral-domain optical coherence tomography (SD-OCT). METHODS: We recruited a total of 30 schizophrenic patients and 30 age-matched controls in the study. The schizophrenic patients were subdivided further to acute (n = 5), chronic (n = 13), and long-term chronic (n = 12) subgroups depending on their duration of illness. Using SD-OCT, the peripapillary RNFL thickness, macula thickness, and macula volume measurements of schizophrenic patients and the control subjects were measured and compared at each location. RESULTS: Schizophrenic patients showed a statistically significant reduction in overall peripapillary RNFL thickness (cases, 94.70 ± 9.88 µm; controls, 103.53 ± 6.53 µm; P < 0.001), macula thickness (cases, 269.26 ± 12.59 µm; controls, 284.83 ± 9.76 µm; P < 0.001), and macula volume (cases, 9.61 ± 0.45 mm(3); controls, 10.17 ± 0.35 µm; P < 0.001). Chronic and long-term chronic schizophrenic patients were found to have significant peripapillary RNFL thinning, macula thinning, and reduction of macula volume when compared to controls (P < 0.001). There also was a statistically significant reverse correlation (P < 0.05) of peripapillary RNFL thickness (r = -0.36), macula thickness (r = -0.38), and macula volume reduction (r = -0.36) with the duration of schizophrenic illness. CONCLUSIONS: These results indicate that RNFL and macula thickness, as well as macula volume measurements are reduced in schizophrenic patients. The degree of thinning and reduction was more significant in the chronic phase of the disease and correlated with the duration of illness. These findings demonstrate that SD-OCT can be a useful tool for the diagnosis and monitoring the progression of this disease.

Intravitreal bevacizumab for radiation-induced cystoid macular oedema in patients with nasopharyngeal carcinoma: a clinical series.

AIMS: To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma. METHODS: Five patients were recruited. The length of time from the last external beam radiation therapy to presentation ranged from 12 months to 15 years. Intravitreal bevacizumab (1.25 mg/0.05 ml) was given and repeated monthly injections were administered until best corrected visual acuity (BCVA) improved to 6/9 or until 3 further injections did not show further improvement in BCVA. BCVA was measured and fundus photography, optical coherence tomography (OCT) and fluorescein angiography were performed at baseline. BCVA and OCT were recorded at each monthly visit. The duration of follow-up ranged from 6 months to 2 years. RESULTS: Five patients (7 eyes) were recruited. At the final visit, 3 eyes (71.4%) showed reduction in the central subfield thickness (CST; mean reduction of 17.6%, range 9-149 µm) with improvement in BCVA, whilst 2 eyes worsened in terms of CST and final BCVA. Another 2 eyes remained altered in BCVA despite slight improvement in CST. CONCLUSION: The use of intravitreal bevacizumab in this group of patients showed variable response in terms of CST and BCVA outcome but remains a viable option to treat this challenging condition.