Accuracy of 10 MHz ultrasonography for evaluation of posterior lens capsule in traumatic cataract.

PURPOSE: To investigate the performance of 10 MHz ultrasonography in detecting posterior lens capsule defects before traumatic cataract surgery. METHODS: This retrospective analysis includes patients with traumatic cataracts who underwent cataract surgery. Preoperative 10 MHz ultrasonography was performed to evaluate whether the posterior lens capsule was defective or intact, and the results were compared to the intraoperative findings. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa were calculated. RESULTS: The study included 140 eyes of 140 patients. There were 68 eyes with closed-globe injuries and 72 eyes with open-globe injuries. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa of 10 MHz ultrasonography was 86.76%, 90.28%, 89.39%, 87.84%, 88.57% and 0.771, respectively. The accuracy was 86.11% and 91.18% in open-globe and closed-globe injury groups, respectively. CONCLUSION: The accuracy of 10 MHz ultrasonography in evaluating the posterior lens capsule in traumatic cataracts is high. Preoperative 10 MHz ultrasonography would help to make an appropriate surgical plan.

VITRECTOMY WITH SUBRETINAL INJECTION OF RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR FOR SUBMACULAR HEMORRHAGE WITH OR WITHOUT VITREOUS HEMORRHAGE.

PURPOSE: To evaluate the outcomes and prognostic factors of pars plana vitrectomy combined with subretinal injection of recombinant tissue plasminogen activator for submacular hemorrhage (SMH) patients with or without vitreous hemorrhage (VH). METHODS: Sixty-four eyes of 64 patients with SMH underwent pars plana vitrectomy with subretinal injection of recombinant tissue plasminogen activator. Best-corrected visual acuity, SMH displacement, and postoperative complications were analyzed. Predictive factors of the final best-corrected visual acuity were determined using multivariant linear regression. RESULTS: There were 26 eyes with VH and 38 eyes without VH best-corrected visual acuity significantly improved in both VH group (from 2.27 ± 0.40 to 1.25 ± 0.70 logarithm of the minimum angle of resolution) and non-VH group (from 1.76 ± 0.55 to 0.85 ± 0.65 logarithm of the minimum angle of resolution). Complete displacement of SMHs was observed in 47 (73.43%) eyes. Postoperative complications included recurrent SMH (4.69%), recurrent VH (10.94%), rhegmatogenous retinal detachment (3.13%), and epiretinal membrane (4.68%). Treatment-naive condition, early surgery, and younger age were significantly associated with better final best-corrected visual acuity ( B = 0.502, 0.303, and 0.021, respectively, with all P < 0.05). CONCLUSION: Pars plana vitrectomy combined with subretinal recombinant tissue plasminogen activator injection is an effective treatment for SMH patients with and without VH.

Vitreomacular Interface Disorders in Proliferative Diabetic Retinopathy: An Optical Coherence Tomography Study.

Vitreomacular interface plays an important role in the pathogenesis and progression of proliferative diabetic retinopathy (PDR). This study investigated the prevalence and risk factors of vitreomacular interface disorders (VMID) in PDR. The macular optical coherence tomography (OCT) scans of 493 eyes from 378 PDR patients were retrospectively reviewed to detect VMID, including vitreomacular adhesion (VMA), vitreomacular traction (VMT), epiretinal membrane (ERM), lamellar hole-associated epiretinal proliferation (LHEP), and macular hole (MH). The associations between VMID and baseline factors, intraretinal structure, and visual acuity were analyzed. The prevalence was 78.9% for ERM, 13.4% for VMT, 4.8% for MH, 2.2% for LHEP, and 2.0% for VMA, respectively. On multivariable analyses (odds ratio, 95% confidence interval), fibrovascular proliferation (FVP) was positively associated with MH (8.029, 1.873-34.420), VMT (3.774, 1.827-7.798), and ERM (2.305, 1.460-3.640). High-risk PDR was another risk factor of ERM (1.846, 1.101-3.090). Female gender was positively associated with MH (3.836, 1.132-13.006), while vitreous hemorrhage was negatively associated with MH (0.344, 0.133-0.890). Eyes with all VMID subtypes showed more frequent macular cysts and tractional retinal detachment with poorer visual acuity (p ≤ 0.001). Therefore, the prevalence of VMID was considerably high, indicating that this distinct entity should be considered in interventions for PDR.

METAGENOMIC NEXT-GENERATION SEQUENCING DETECTS PATHOGENS IN ENDOPHTHALMITIS PATIENTS.

PURPOSE: To investigate the utility of metagenomic next-generation sequencing (mNGS) in identifying the pathogens in endophthalmitis. METHODS: In this prospective study, 36 cases of endophthalmitis were recruited. All patients received surgical treatment and intraocular drug lavage. The samples of vitreous or aqueous humor were extracted for mNGS and microbiological culture. The diagnostic performance of pathogens was compared between mNGS and culture. RESULTS: The positive rates of mNGS and culture were 88.89% (32/36) and 27.78% (10/36), respectively. There was a statistically significant difference between mNGS and culture (Chi-square = 27.657; P < 0.01). Staphylococcus epidermidis, Streptococcus pneumoniae, and Klebsiella pneumoniae were the most pathogenic bacteria in traumatic, postoperative, and endogenous endophthalmitis, respectively. The concordance of pathogen identified by mNGS and culture was 70% for culture-positive cases. Antibiotic resistance genes were identified in 9 cases. There was a marginal correlation between the final visual acuity and the microbial sequence read (Spearman correlation coefficient = 0.498; P = 0.05). CONCLUSION: Metagenomic next-generation sequencing has a higher positive rate of identifying pathogens in endophthalmitis than in culture. It can also provide information on antibiotic resistance and visual prognosis. However, caution must be taken when interpreting the results of mNGS because they may not be concordant with culture.

Optical coherence tomography biomarkers of photoreceptor degeneration in retinitis pigmentosa.

PURPOSE: Several parameters on optical coherence tomography (OCT) have been suggested as biomarkers for photoreceptor degeneration in retinitis pigmentosa (RP). This study is to compare the spatial distribution of the changes of OCT biomarkers in RP patients. METHODS: OCT line scans of the horizontal meridian were conducted in 22 eyes of 22 RP patients and 30 eyes of 30 healthy controls. Longitudinal reflectance profiles were obtained using ImageJ at every 5 pixels. The following parameters on OCT were quantitatively measured: (1) relative optical intensity (ROI) of ellipsoid zone (EZ) and interdigitation zone (IZ); (2) thickness of outer nuclear layer (ONLT), photoreceptor (PRT), inner segment (IST) and outer segment (OST). The variations of these parameters across different regions were analyzed. RESULTS: From fovea to perifoveal region, all the OCT biomarkers declined before disappeared, except IST and IZ-ROI. There was no identifiable declining zone for the IST and IZ-ROI between the normal and disappeared zones in some patients. The most central biomarker was the reduction of OST and IZ-ROI, followed by the PRT, EZ-ROI, then IST and finally ONLT. All these biomarkers had significant correlations with best-corrected visual acuity, except ONLT. CONCLUSION: In retinitis pigmentosa, EZ-ROI, IZ-ROI, PRT, OST, IST and ONLT are valuable biomarkers of photoreceptor degeneration. Changes of OST and IZ-ROI are located most centrally and may be the early biomarkers.

Reduced Photoreceptor Outer Segment Layer Thickness and Association with Vision in Amblyopic Children and Adolescents with Unilateral High Myopia.

PURPOSE: To quantitatively compare reflectivity and other morphological changes of the photoreceptors of normal eyes with amblyopic eyes using the longitudinal reflectance profile (LRP) on swept-source optical coherence tomography (SS-OCT) images in children and adolescents with unilateral high myopia. The relationships between OCT parameters and visual acuity were investigated. METHOD: Twenty-six amblyopes with unilateral high myopia and 34 age-, axial length- and spherical equivalent-matched normal controls were recruited. All participants underwent SS-OCT and detailed ophthalmic investigations. The reflectivity of the outer retinal and photoreceptor outer segment layer thickness were quantified by LRP using ImageJ software. All parameters were measured at three selected regions: at the fovea, 1 mm nasal to the fovea and 1 mm temporal to the fovea. Differences between the groups were evaluated. RESULTS: The mean choroidal thickness was thinner in amblyopic eyes compared with controls (165.19 ± 59.02 µm vs 214.97 ± 66.41 µm at the fovea; 128.77 ± 57.06 µm vs 161.54 ± 57.37 µm at 1 mm nasal to the fovea; 188.13 ± 59.51 µm vs 219.87 ± 61.78 µm at 1 mm temporal to the fovea, P < .05). The amblyopic eyes had higher reflectivity of the ellipsoid zone at 1 mm nasal to the fovea only (85.41 ± 25.78 vs 70.76 ± 18.69, P = .02). The mean length of the photoreceptor outer segment (OS) layer was significantly greater in the control eyes than in the amblyopic eyes at all three regions (20.19 ± 1.89 vs 18.70 ± 2.23 at the fovea, P = .006; 16.06 ± 1.47 vs 15.07 ± 1.30 at 1 mm nasal to the fovea, P = .008; 15.81 ± 1.58 vs 14.56 ± 1.87 at 1 mm temporal to the fovea, P = .006). The shortened OS length was associated with poorer visual acuity. CONCLUSION: The results of this study revealed that the amblyopes with unilateral high myopia had thinner choroidal thickness and shortened OS thickness compared to normal controls. The findings indicate that abnormal anatomic changes in the amblyopic children and adolescents with unilateral high myopia were not only due to high myopia but more likely due to a combination of high myopia and amblyopia.

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema.

AIM: To analyze the correlation between macular morphology and function in eyes with diabetic macular edema (DME). METHODS: Fifty-five eyes with different visual acuity (VA) of 32 patients who suffered from DME were analyzed using multifocal electroretinography (mfERG) and optical coherence tomography (OCT). The parameters of mfERG including implicit times and response amplitude were compared to those of 50 normal eyes of 36 age-matched subjects. Correlation analysis was performed between VA, the parameters of mfERG including implicit times and response amplitude, and the central macular thickness (CMT). RESULTS: The amplitude of N1 and P1 were significantly decreased and their latency were significantly increased in five ring regions of the retina in patients with DME. There was statistically significant correlation between logMAR BCVA and P1 amplitude densities in rings 1-4 (r=-0.306, -0.536, -0.470, -0.362; P=0.023, <0.01, <0.01, 0.007 respectively), N1 amplitude in ring 2 and ring 3 (r=-0.035, -0.286; P=0.019, 0.034 respectively). There was poor correlation between the CMT and best-corrected visual acuity (BCVA; r=0.288, P=0.033), but there was no significant correlation between CMT and amplitude or implicit time of N1 and P1 (P>0.05) in the central macular ring. Multiple stepwise regression analysis showed that P1 amplitude density in ring 2 was the only contributor to the VA. CONCLUSION: It seems to be more appropriate of combining use of mfERG with OCT for the evaluation of macular function in eyes with DME.

Reduced photoreceptor outer segment layer thickness in mild commotio retinae without ellipsoid zone disruption.

PURPOSE: To quantitatively investigate the reflectivity and structure of the outer retinal layers on spectral-domain optical coherence tomography (SD-OCT) in commotio retinae. METHODS: Nineteen patients with acute macular commotio retinae and 19 age-matched normal controls were examined using SD-OCT. Longitudinal reflectance profiles (LRP) were obtained using Image J. The reflectivity of outer retinal layers was measured at the fovea, 1 mm nasal to fovea and 1 mm temporal to fovea. The reflectivity ratios of outer retinal layers divided by the outer nuclear layer (ONL) were calculated for normalization. Photoreceptor outer segment layer thickness was also measured. The results were compared between the patients and controls. RESULTS: The reflectivity ratio of ellipsoid zone/ONL and outer segment/ONL was higher in commotio retinae than in controls only at fovea (12.66 ± 4.73 vs 9.67 ± 3.34, p = 0.041; 7.70 ± 2.20 vs 3.73 ± 1.63, p < 0.001, respectively) but not at 1 mm nasal or temporal to the fovea. Photoreceptor outer segment layer thickness was significantly shorter in commotio retinae compared to controls at all three locations (19.64 ± 3.05 vs 25.16 ± 3.53, 16.95 ± 4.02 vs 20.00 ± 3.00, and 15.42 ± 3.22 vs 20.05 ± 2.48, respectively, all p < 0.05). CONCLUSIONS: Quantitative measurement of SD-OCT images revealed that shortening of photoreceptor outer segment is an additional, and potentially better, biomarker for commotio retinae on top of increased reflectivity.

Prognostic factors associated with visual outcome of salvageable eyes with posttraumatic endophthalmitis.

The purpose of this study is to evaluate the prognostic factors associated with visual outcomes in the salvageable eyes with posttraumatic endophthalmitis. We retrospectively reviewed the medical records of all patients diagnosed with posttraumatic endophthalmitis in our hospital between 2008 and 2015. The following information was collected: age, sex, etiology, past medical history, clinical manifestations, wound location, microbiology, blood leukocyte counts, types of interventions, initial visual acuities and final visual acuities. Univariate and multivariate analyses were used to explore the factors associated with final best-corrected visual acuity. In total, 98 eyes of 98 patients were included in our study. Fifty-seven eyes underwent vitrectomy, 27 of them had silicone oil tamponade, 38 eyes received intravitreal ceftazidime only and 3 eyes received intracameral ceftazidime. In univariate analysis, poor initial visual acuity, presence of intraocular foreign body, number of intravitreal injections, retinal detachment and Zone 3 injury were associated with poor visual outcome. In multivariable analysis, poor initial visual acuity, presence of intraocular foreign body and number of intravitreal injections were independently associated with poor visual outcome. The silicone oil group had fewer repeated intravitreal injections than the group without oil tamponade. We concluded that the visual outcome of salvageable eyes with posttraumatic endophthalmitis is associated with initial visual acuity, presence of intraocular foreign body and number of intravitreal antibiotic injections.

Relationship between Optical Intensity on Optical Coherence Tomography and Retinal Ischemia in Branch Retinal Vein Occlusion.

Branch retinal vein occlusion (BRVO) may be complicated with retinal ischemia in some cases. The purpose of the current study is to investigate the relationship between optical intensity on optical coherence tomography (OCT) and retinal ischemia in BRVO. Twenty-seven eyes diagnosed with BRVO without macular edema were classified into two groups based on the presence or absence of retinal ischemia. The optical intensity of inner retinal layers and photoreceptor inner segment ellipsoid zone/retinal pigment epithelium layer (ISe/RPE) in the affected and unaffected regions were measured on OCT. Their ratio (Optical intensity ratio, OIR) was calculated and compared between affected and unaffected region. In the retinal ischemia group, the optical intensity of inner retinal layers was higher in the affected region compared to the unaffected region while the optical intensity of ISe/RPE was low. The OIR was significantly higher in the affected region compared to control (0.83 ± 0.17 vs 0.68 ± 0.09, p < 0.001). However, in the non-ischemic group, there was no significant difference between the affected and unaffected region. The BCVA was moderately correlated with OIR of affected region (r = 0.489, p = 0.010). Our study suggests that optical intensity ratio on OCT is correlated with retinal ischemia in BRVO.

Longitudinal Evaluation of Wound Healing after Penetrating Corneal Injury: Anterior Segment Optical Coherence Tomography Study.

PURPOSE: Ocular imaging can enhance our understanding of wound healing. We report anterior segment optical coherence tomography (ASOCT) findings in penetrating corneal injury. METHODS: Serial ASOCT was performed after repair of penetrating corneal injury. Internal aberrations of wound edges were labeled as "steps" or "gaps" on ASOCT images. The wound type was characterized as: type 1: continuous inner wound edge or step height ≤ 80 µm; type 2: step height > 80 µm; type 3: gap between wound edges; and type 4: intraocular tissue adherent to wound. Surgical outcomes of different wound types were compared. RESULTS: 50 consecutive patients were included (6 females, 44 males; mean age 33 ± 12 years). The average size of wound was 4.2 ± 2.6 mm (type 1, 8 eyes; type 2, 27 eyes; type 3, 12 eyes; type 4, 3 eyes). At the end of 3 months, 70% (n = 35) of the wounds were type 1. At the end of 6 months, all type 1 wounds had healed completely, whereas about half of type 2 (48.1%) and type 3 (50%) wounds had recovered to type 1 configuration. The wound type at baseline affected the height of step (p = 0.047) and corneal thickness at 6 months (p = 0.035). CONCLUSIONS: ASOCT is a useful tool for monitoring wound healing in cases with penetrating corneal injury. Majority of the wound edges appose between 3 and 6 months after trauma. In our study, baseline wound configuration affected the healing pattern.

Risk factors for endophthalmitis requiring evisceration or enucleation.

Endophthalmitis has devastating sequelae resulting in blindness and even loss of eyeball. Although the prognosis of endophthalmitis has much improved with the advances of antibiotics and vitreoretinal surgery, of the number of patients that required evisceration or enucleation is still significant. We retrospectively reviewed the charts of 210 eyes of 210 patients with endophthalmitis andcompared the group that required evisceration or enucleation with those that received salvaging therapies. Regression analysis was used to identify the risk factors for evisceration or enucleation. Thirty eyes (14.3%) underwent enucleation or evisceration. The group of eviscerated or enucleated eyes were older (58.7 vs. 42.2 years, p < 0.001), had more women (56.7% vs. 22.2%, p = 0.003), had poorer initial visual acuity (2.79 vs. 2.10 LogMAR, p < 0.001), and had longer duration before intervention (18.03 vs. 5.74 days, p = 0.031). The most common primary indications for endophthalmitis were infections from corneal ulcer (50.0% vs. 4.4%, p < 0.001) andfrom endogenous source (23.3% vs. 5.6%, p < 0.001). Less common indications were trauma (26.7% vs. 67.8%, p < 0.001) and postoperative (6.7% vs. 22.2%, p = 0.049) endophthalmitis. After adjusting for confounding factors, corneal ulcer-related endophthalmitis, endogenous endophthalmitis and initial visual acuity were the independent risk factors for evisceration or enucleation.

CORRELATION OF OPTICAL INTENSITY ON OPTICAL COHERENCE TOMOGRAPHY AND VISUAL OUTCOME IN CENTRAL RETINAL ARTERY OCCLUSION.

PURPOSE: To investigate the relationship between optical coherence tomography (OCT) characteristics at baseline and visual outcome in central retinal artery occlusion (CRAO). METHODS: The medical charts and OCT images of patients with central retinal artery occlusion with follow-up for more than 90 days were reviewed. Optical intensities of inner retinal layers, outer nuclear layers, and photoreceptor/retinal pigment epithelium were measured using Image J software. Optical intensity ratio was calculated as the optical intensity of inner retinal layers divided by that of photoreceptor/retinal pigment epithelium. Retinal thickness over the nine early treatment diabetic retinopathy study regions was automatically calculated by OCT software. The relationship between best-corrected visual acuity at the last follow-up and OCT characteristics were analyzed using Spearman correlation. RESULTS: Fifteen eyes of 15 central retinal artery occlusion patients were included, with mean follow-up of 327.1 ± 184.1 days. The final best-corrected visual acuity was mildly or moderately correlated with retinal thicknesses, and strongly correlated with the optical intensity of photoreceptor/retinal pigment epithelium (r = -0.707, P = 0.003) and optical intensity ratio (r = 0.825, P < 0.001). CONCLUSION: Optical intensity ratio on OCT is highly correlated with visual prognosis in central retinal artery occlusion. It may be a potential biomarker of retinal ischemia.

Prediction of spontaneous closure of traumatic macular hole with spectral domain optical coherence tomography.

It has been known that some traumatic macular holes can close spontaneously. However, knowledge about the types of macular hole that can close spontaneously is limited. In this retrospective study, we investigated patients with traumatic macular hole who were followed-up for at least 6 months without any surgical intervention. Clinical data and spectral domain optical coherence tomography (SD-OCT) images were compared between groups with and without macular hole closure. Overall, 27 eyes were included. Spontaneous closure of macular hole was observed in 10 (37.0%) eyes. The holes with spontaneous closure had smaller minimum diameter (244.9 ± 114.4 vs. 523.9 ± 320.0 µm, p = 0.007) and less intraretinal cysts (10% vs. 76.5%, p = 0.001) compared to the holes that did not close spontaneously. The area under the curve of receiver operative characteristic was 0.812 and 0.832 for minimum diameter of macular hole and presence of intraretinal cysts respectively. Multivariate logistic regression showed that the presence of intraretinal cysts was an independent predictive factor for closure of macular holes. The group with spontaneous macular hole closure had a high chance of visual improvement. Our study suggests that the absence of intraretinal cysts on SD-OCT can predict spontaneous closure of traumatic macular hole.