Structural and functional outcomes after treatment of uveitic macular oedema: an optical coherence tomography and multifocal electroretinogram study.

BACKGROUND: The aim was to evaluate the correlation between the anatomical and functional outcomes before and after treatment of uveitic macular oedema. METHODS: Thirty-three eyes of 33 patients with uveitic macular oedema were included in the present study. Visual acuity (VA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were measured before and after treatment of the macular oedema. Correlation analyses between VA, OCT and mfERG parameters were performed. RESULTS: The VA and mfERG measurements showed statistically significant improvement after treatment of the macular oedema (p < 0.01) and OCT-measured central foveal thickness decreased significantly from 434 ± 135 µm before treatment to 267 ± 92 µm after treatment (p < 0.001). Correlation analyses showed that uveitic central foveal thickness before treatment was correlated with mfERG N1 response amplitude of area 1 (Spearman's r = -0.62, p < 0.001). VA (logMAR) after treatment had a negative correlation with the mfERG N1 response amplitude of area 1 (Spearman's r = -0.56, p = 0.001). Also, there was no correlation between the final VA and pre-treatment OCT and mfERG measurements. CONCLUSION: This study deals with cystoid macular oedema associated with recurrent uveitis. In cystoid macular oedema, the value of mfERG before treatment is related to the central foveal thickness and VA. In contrast, after treatment the decrease of macular thickness is not always followed by an improvement of mfERG and VA. This supports the view that in uveitic macular oedema, the decrease in macular thickness after treatment may not be used as a predictor of improvement of macular function.

Bilateral simultaneous anterior ischemic optic neuropathy associated with sildenafil.

We report a case of simultaneous bilateral nonarteritic anterior ischemic optic neuropathy (NAION) due to sildenafil use. A 55-year-old man with an unremarkable medical history presented simultaneous bilateral NAION 8 months after continuous use of sildenafil 4-5 times a month. At presentation, visual acuity (VA) was 0.7 in the right eye (RE) and 0.9 in the left eye (LE). The visual field showed an inferior altitudinal defect in both eyes and a fundus examination revealed prominent optic disc edema in the RE and a crowded optic disc in the LE. The patient was counseled to discontinue sildenafil, and 3 weeks later VA was 1.0 in both eyes and the optic disc edema in the RE was resolved. However, a visual field defect remained in the RE. Three months later, visual fields were unchanged. To the best of our knowledge, this is the first reported case of simultaneous bilateral NAION due to sildenafil use.

New ophthalmic features in a family with triple A syndrome.

We report three subjects of a Greek family affected by triple A syndrome (AAAS). All patients underwent complete ophthalmic examination, full-field electroretinogram (ERG), visual evoked responses (VER), optical coherence tomography (OCT) and molecular analysis of the AAA gene. All patients had alacrima. In two of them, the proband and her brother, bilateral optic atrophy was assessed and the VER were pathological. In contrast, the ERG was normal. OCT showed a decrease of the retinal nerve fiber layer. The third case had only alacrima and the optic nerves were normal. The molecular genetic study of the AAAS gene revealed a homozygous missense mutation p.Ala167Val. To our knowledge this is the first time a family with AAAS has been investigated using OCT, VER and ERG. Our findings illustrate that the retina is not involved. There is also an interfamilial variability concerning the involvement of the optic nerves.

Optical coherence tomography and multifocal electroretinogram study in human immunodeficiency virus-positive children without infectious retinitis.

BACKGROUND: The aim was to evaluate the macular structure and function in children with human immunodeficiency virus (HIV) disease without cytomegalovirus retinitis or visual symptoms. METHODS: Thirty-eight eyes of 19 HIV-positive children (Group A) were examined. Group B included 20 (40 eyes) age- and sex-matched control subjects. Each individual underwent a complete ophthalmic examination, optical coherence tomography (OCT) scan and multifocal electroretinogram (mfERG) recording. RESULTS: In all patients, visual acuity and colour vision testing were normal. The mean foveal thickness in groups A and B was 190.28 ± 26.58 (SD) µm and 169.47 ± 10.17 µm, respectively (p = 0.0002). In Group A, the mean retinal response density of the fovea (area 1) was 19.87 ± 10.16 nV/deg(2) and the latency was 38.56 ± 1.18 ms. In the parafoveal area (area 2), the mean retinal response density was 10.82 ± 2.34 nV/deg(2) and the mean latency was 36.52 ± 1.73 ms. In the perifoveal area (area 3), the mean retinal response density was 10.83 ± 0.90 nV/deg(2) and the mean latency was 36.36 ± 1.90 ms. In Group B, the mean retinal response density of area 1 was 22.02 ± 0.9 nV/deg(2) and the mean latency was 32.56 ± 1.25 ms. In area 2, the mean retinal response density was 12.23 ± 0.55 nV/deg(2) and the mean latency was 30.84 ± 1.22 ms. Finally, in the perifoveal area (area 3), the mean retinal response density was 12.74 ± 0.44 nV/deg(2) and the mean latency was 29.7 ± 11.09 ms. The differences in amplitude and latency were statistically significant. CONCLUSION: Increased foveal thickening and significant decrease of the electrical activity of areas 1, 2 and 3 were found in HIV-positive children. These findings suggested some subclinical dysfunction of the photoreceptors and the inner retinal layers of the fovea in HIV-positive children with normal vision and without ocular disease.

Morphologic changes and functional retinal impairment in patients with Parkinson disease without visual loss.

PURPOSE: To investigate the anatomic and electrophysiologic changes of the macula and the optic nerve in patients with Parkinson disease (PD) without visual impairment. METHODS: Thirty-two eyes of 16 patients with PD (group A) without visual impairment were tested. Visual acuity was 20/20 or better and visual fields as well as color vision testing results were normal. Also, no retinal lesions were assessed. Patients in group B (40 eyes of 20 patients) were age- and sex-matched control subjects. All study participants underwent a comprehensive ophthalmic examination, multifocal electroretinogram (mfERG) recording, and optical coherence tomography (OCT) scan. Thickness of retinal nerve fiber layer (RNFL) along a 3.4-mm-diameter circle centered on the optic nerve head was evaluated using third-generation OCT. RESULTS: The mean P1-response density amplitude of ring 1 of mfERG was 136.69 nV/deg2 in patients with PD and 294 nV/deg2 in control subjects and the difference was highly significant. On the contrary, these values in ring 2 and 3 did not differ statistically between controls and patients with PD. The mean inferior and temporal RNFL thickness was significantly lower in patients with PD than in control subjects (p<0.0001 and p=0.0045, respectively). CONCLUSIONS: In patients with PD with normal vision, we found a decrease in the electrical activity of the fovea as well as in the thickness of the RNFL. Multifocal electroretinogram and OCT scan objectively detect early subclinical PD-associated visual functional impairment.

Central Serous Chorioretinopathy after Rhinoplasty.

We report a case of central serous chorioretinopathy after rhinoplasty for deviation of the nasal septum in a 23-year-old Caucasian man. The patient complained of deterioration of vision in the right eye 4 days after rhinoplasty. At presentation, visual acuity of the right eye was 6/9 with metamorphopsia. Fluorescein angiography revealed a focal retinal pigment epithelium leakage and optical coherence tomography an increase in macular thickness to 245 µm. The left eye was normal. One month after the operation, without any treatment, visual acuity returned to 6/6, the leakage of the retinal pigment epithelium disappeared and the macular thickness returned to 183 µm. To the best of our knowledge, central serous chorioretinopathy after rhinoplasty has not been previously reported. This case report shows a possible association between the postoperative stress and central serous chorioretinopathy. Moreover, it widens the spectrum of drugs associated with the occurrence of the disease.

A clinical study of annular cyclitis.

PURPOSE: To investigate six cases of annular cyclitis. METHODS: All patients with impairment of visual acuity underwent complete ophthalmologic examination, color fundus photography, laboratory tests and fluorescein angiography. Indocyanine green (ICG) angiography and B-scan ultrasonography were also performed in three cases in order to diagnose the disease. RESULTS: All patients presented a unilateral or bilateral granulomatous uveitis, associated with inflammatory annular cyclitis. They had a shallow anterior chamber, a mildly elevated intraocular pressure (under 25 mm Hg) and an annular serous retinal detachment. A resolution was observed after specific therapy associated with systemic prednisolone therapy and antiglaucomatous drops. CONCLUSION: This is the first description of an observational study of six patients with inflammatory annular cyclitis.

Tilted disc syndrome: an OCT and mfERG study.

PURPOSE: To evaluate retinal thickness and function in eyes with tilted disc syndrome with optical coherence tomography (OCT) and multifocal electroretinogram (mfERG). METHODS: Twenty-one eyes of 12 patients (4 males and 8 females) with tilted disc were studied with OCT3 and mfERG and compared with 40 eyes of 20 age and sex-matched control subjects. The thickness of the fovea and the thickness of retinal nerve fibre layer (RNFL) along a 3.4-mm-diameter circle centred on the optic nerve head were evaluated using OCT3. The macular cone function was tested by mfERG. RESULTS: The OCT-derived RNFL thickness was significantly decreased in the superior area of eyes with tilted disc with a mean value equal to 106.47 microm (SD 24.1). The mean response amplitude density of the fovea (11.75 nV/deg(2)) and parafovea (8.22 nV/deg(2)) was significantly lower in eyes with tilted disc than in normal eyes. CONCLUSION: OCT and mfERG can be objective tools for assessing anatomical and functional damage of the macula. Our results suggest that in tilted disc syndrome even without visual impairment the optic nerve and the macula show dysfunction not visible by other means.

Clinical and multifocal-electroretinographic findings of congenital tilted disc syndrome associated with choroidal neovascularization: a case report.

PURPOSE: To report a case of a tilted disc syndrome associated with choroidal neovascularization. METHODS: A 55-year-old male patient presented with blurred vision and metamorphopsia of the left eye. He underwent complete ophthalmologic examination, fluorescein angiography, optical coherence tomography (OCT) and multifocal-electroretinogram (mf-ERG). RESULTS: All features are consistent with a tilted disc syndrome complicated with a small neovascular membrane. OCT confirmed the presence of a serous retinal detachment. Mf-ERG confirmed a decrease of electrical activity of the photoreceptors in area 1 (fovea). The patient refused to be treated. CONCLUSION: Macular serous retinal detachment due to subretinal leakage is a rare complication of tilted disc syndrome. To the author's knowledge, this is the first time a tilted disc syndrome with choroidal neovascularization is documented by means of OCT and mf-ERG. These are the only objective tools in order to assess objectively the anatomical and functional damage accordingly.

Management of large traumatic zonular dialysis with phacoemulsification and IOL implantation using the capsular tension ring.

PURPOSE: To report our results and to evaluate the longterm effect of capsular tension ring (CTR) insertion in eyes with large traumatic zonular dialysis that underwent phacoemulsification with posterior chamber (PC) intraocular lens (IOL) implantation. METHODS: This prospective study included 17 eyes of 17 consecutive patients with cataract and large traumatic zonular dialysis (range 80-160 degrees determined pre-or intraoperatively). After insertion of a CTR, phacoemulsification with foldable acrylic PC IOL implantation was performed. Posterior capsule rupture, vitreous loss, best corrected visual acuity (BCVA), intraocular pressure (IOP) in the pre- and postoperative periods and postoperative IOL decentration were recorded. RESULTS: The mean follow-up period was 25.9 months (range 15-35 months). Capsule collapse did not occur in any eye with a CTR. Postoperatively, four eyes developed raised IOP that responded well to medical therapy. An improvement in BCVA was observed in all eyes except one because of co-existing fundus pathology. No IOL was found to be decentrated at the end of the follow-up period, apart from one eye in which the PC IOL was dislocated due to a postoperative trauma, in which an anterior chamber IOL was implanted. CONCLUSIONS: In cases of cataract associated with large traumatic zonular dialysis, implanting a CTR before or during phacoemulsification with an in-the-bag PC IOL is relatively safe technique with a high success rate. The CTR was found to be efficient in preventing IOL decentration in eyes with traumatic zonular deficiency.