Discrimination of glaucomatous from non-glaucomatous optic neuropathy with swept-source optical coherence tomography.

OBJECTIVE: To assess the ability of optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (pRNFL), and macular ganglion cell layer (GCL) thickness measurements with swept-source optical coherence tomography (SS-OCT), to discriminate between glaucomatous and non-glaucomatous optic neuropathy (GON and NGON). METHODS: This retrospective cross-sectional study involved 189 eyes of 189 patients, 133 with GON and 56 with NGON. The NGON group included ischemic optic neuropathy, previous optic neuritis, and compressive, toxic-nutritional, and traumatic optic neuropathy. Bivariate analyses of SS-OCT pRNFL and GCL thickness and ONH parameters were performed. Multivariable logistic regression analysis was employed to obtain predictor variables from OCT values, and the area under the receiver operating characteristic curve (AUROC) was calculated to differentiate between NGON and GON. RESULTS: Bivariate analyses showed that the overall and inferior quadrant of the pNRFL was thinner in the GON group (P=0.044 and P<0.01), while patients with NGON had thinner temporal quadrants (P=0.044). Significant differences between the GON and NGON groups were identified in almost all the ONH topographic parameters. Patients with NGON had thinner superior GCL (P=0.015), but there were no significant differences in GCL overall and inferior thickness. Multivariate logistic regression analysis demonstrated that vertical cup-to-disc ratio (CDR), cup volume, and superior GCL provided independent predictive value for differentiating GON from NGON. The predictive model of these variables along with disc area and age achieved an AUROC=0.944 (95% CI 0.898-0.991). CONCLUSIONS: SS-OCT is useful in discriminating GON from NGON. Vertical CDR, cup volume, and superior GCL thickness show the highest predictive value.

Vitrectomy with subretinal tissue plasminogen activator (r-TPA) and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for submacular hemorrhages treatment: Retrospective analysis of 22 cases.

BACKGROUND: Macular hemorrhages are a severe complication of other retinal pathologies, such as age-related macular degeneration (AMD) or macroaneurysms. Their therapeutic approach is not standardized, and can vary from observation to surgical treatment. MATERIAL AND METHODS: Retrospective analysis of 22 cases of macular hemorrhage, treated with vitrectomy associated to subretinal rTPA and intravitreal anti-VEGF over a period of 5 years. RESULTS: 22 eyes of 22 patients were included, of which 12 (52%) were women. The mean age at diagnosis was 84.4 years. 13 patients were pseudophakic (54.1%) and 19 (86.36%) had previous ophthalmological comorbidities. The etiology of the macular hemorrhage was AMD in 19 patients (86.36%). The mean of best VA corrected at diagnosis was 24.55 (Early Treatment Diabetic Retinopathy Study score -ETDRS), with a statistically significant improvement to 36.78 3 months after surgery (p = 0.011). With an average of 23.5 months of follow-up, no differences in prognosis associated with the etiology or size of the hemorrhage were observed. CONCLUSION: The treatment of macular hemorrhages by vitrectomy, subretinal rTPA and antiVEGF improves the visual prognosis of affected patients.

Vitrectomía asociada a activador tisular del plasminógeno (rTPA) subretiniano e inyección intravítrea de anti-VEGF como tratamiento de hemorragias submaculares: análisis retrospectivo de 22 casos / Vitrectomy with subretinal tissue plasminogen activator (r-TPA) and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for submacular hemorrhages treatment: Retrospective analysis of 22 cases

Introducción: Las hemorragias maculares suponen una complicación severa de otras patologías retinianas, como la degeneración macular asociada a la edad (DMAE) o los macroaneurismas. El abordaje terapéutico de las mismas no se encuentra estandarizado, pudiendo variar desde la observación hasta el tratamiento quirúrgico.Material y métodosAnálisis retrospectivo de 22 casos de hemorragia macular, tratados mediante vitrectomías asociada a rTPA subretiniano y antiVEGF intravítreo durante un período de cinco años.ResultadosSe incluyeron 22 ojos de 22 pacientes, de los que 12 (52%) eran mujeres. La edad media al diagnóstico fue de 84,4 años. Del total de pacientes, 13 eran pseudofáquicos (54,1%) y 19 (86,36%) presentaban comorbilidades oftalmológicas previas. La etiología de las hemorragias maculares fue DMAE en 19 pacientes (86,36%). La media de mejor agudeza visual (AV) corregida al diagnóstico fue de 24,55 (puntuación Early Treatment Diabetic Retinopathy Study - ETDRS), con una mejoría estadísticamente significativa a 36,78 a los tres meses de la cirugía (p=0,011). Con un promedio de 23,5 meses de seguimiento, no se observaron diferencias en el pronóstico asociadas a etiología o tamaño de la hemorragia.ConclusiónEl tratamiento de las hemorragias maculares mediante vitrectomía, rTPA subretiniano y antiVEGF mejora el pronóstico visual de los pacientes afectos. (AU)

Background: Macular hemorrhages are a severe complication of other retinal pathologies, such as age-related macular degeneration (AMD) or macroaneurysms. Their therapeutic approach is not standardized, and can vary from observation to surgical treatment.Material and methodsRetrospective analysis of 22 cases of macular hemorrhage, treated with vitrectomy associated to subretinal rTPA and intravitreal anti-VEGF over a period of 5 years.Results22 eyes of 22 patients were included, of which 12 (52%) were women. The mean age at diagnosis was 84.4 years. 13 patients were pseudophakic (54.1%) and 19 (86.36%) had previous ophthalmological comorbidities. The etiology of the macular hemorrhage was AMD in 19 patients (86.36%). The mean of best VA corrected at diagnosis was 24.55 (Early Treatment Diabetic Retinopathy Study score -ETDRS), with a statistically significant improvement to 36.78 3 months after surgery (p = 0.011). With an average of 23.5 months of follow-up, no differences in prognosis associated with the etiology or size of the hemorrhage were observed.ConclusionThe treatment of macular hemorrhages by vitrectomy, subretinal rTPA and antiVEGF improves the visual prognosis of affected patients. (AU)

Macular optical coherence tomography for screening of pathology prior to cataract surgery: An approach based on tele-evaluation.

BACKGROUND: To assess the benefit of macular spectral-domain optical coherence tomography (SD-OCT) as a part of the routinary preoperative study of patients undergoing cataract surgery. METHODS: A prospective single-center study study was performed. Consecutive patients with normal biomicroscopic funduscopy, moderate cataract and no history of ophthalmological pathologies were enrolled. All patients underwent macular SD-OCT. The obtained images were analysed by a general ophthalmologist and two retina specialists. Incidence of macular pathology and its relation to age and comorbidities were assessed. RESULTS: Eight-hundred and thirty-six eyes of 419 patients were enrolled in this study. All images were analysed telematically by a general ophthalmologist. Forty-nine eyes were excluded due to insufficient quality of the obtained images. Abnormal images were observed in 156 eyes (18.6%), including age-related macular degeneration in 68 (8.2%), epiretinal membrane (ERM) in 67 (8.0%), cystoid macular edema in 3 eyes (0.4%), among others. Diagnostics with severe impact on patient visual prognosis were observed in 16 eyes (3.82%) from 12 patients. The relationship between incidence of macular pathologies and age or comorbidities was not statistically significant. To assess accuracy of the first observer, images were subsequently analysed by two retinologists. The kappa index of concordance was 0.80 and 0.85. CONCLUSIONS: Implementing a systematic macular SD-OCT as a preoperative test prior to cataract surgery would improve quality of postoperative visual prognosis information. A general ophthalmologist would be suitable to screen for pathology through macular OCT images.

Amblyopia due a dentigerous cyst. Case report and literature review.

PURPOSE: The goal of this article is to present an infrequent clinical case and to review the available literatura, with an emphasis on ophthalmological symptoms. METHODS: We present the case of a 4-year-old girl with a large dentigerous cyst on the maxillary bone, who had long-standing unilateral epiphora associated with progressive ocular dystopia, facial asymmetry and ipsilateral amblyopia. A multidisciplinary approach was taken by the maxillofacial surgery, ophthalmology and optometry teams. This included systemic antibiotic administration, surgical cyst drainage and amblyopia treatment. The literature review was carried out in the MEDLINE database through the free electronic access to PubMed in March 2020. RESULTS: At the 6-month follow-up, the patient was asymptomatic. The most common symptoms of dentigerous cysts are epiphora 36.8%, ocular dystopia 31.2%, diplopia 21.1%, proptosis, nasolacrimal duct obstruction and blurred vision at 10.5%. Amblyopia has not been reported. CONCLUSIONS: Dentigerous cysts are benign odontogenic cysts, which can be found in the jaw and less frequently on the maxillary bone. They are usually asymptomatic, and the occurrence of ophthalmic complications is very infrequent. Multidisciplinary management is essential to avoiding long-term morbidity of maxillary dentigerous cysts and should include an ophthalmologist.