The Short-term Effects of Artificial Tears on the Tear Film Assessed by a Novel High-Resolution Tear Film Imager: A Pilot Study.

PURPOSE: The purpose of this study was to investigate the effects of artificial tears (AT) on the sublayers of the tear film assessed by a novel tear film imaging (TFI) device. METHODS: The mucoaqueous layer thickness (MALT) and lipid layer thickness (LLT) of 198 images from 11 healthy participants, 9 of whom had meibomian gland disease, were prospectively measured before and after exposure to 3 different AT preparations (Refresh Plus; Retaine [RTA]; Systane Complete PF [SYS]), using a novel nanometer resolution TFI device (AdOM, Israel). Participants were assessed at baseline and at 1, 5, 10, 30, and 60 minutes after instilling 1 drop of AT during 3 sessions on separate days. Repeated-measures analysis of variances were used for comparisons with P < 0.05 considered significant. RESULTS: For all ATs, the mean MALT was greatest 1 minute after drop instillation, with an increase of 67%, 55%, and 11% above the baseline for SYS, Refresh Plus, and RTA, respectively. The SYS formulation demonstrated the highest percentage increases in mean MALT and LLT at most postdrop time points. The MALT differences were significantly higher in the SYS than in the RTA ( P = 0.014). After 60 minutes, no AT group demonstrated statistically significant changes in MALT or LLT compared with baseline. CONCLUSIONS: We report, for the first time, the effects of AT on MALT and LLT using a high-resolution TFI. A substantial acute mean MALT increase occurs 1 minute after AT instillation with all agents tested, but there were clear differences in response and durability, suggesting the benefits of choosing specific AT according to the needs of each patient.

The Short-term Effects of Artificial Tears on the Tear Film Assessed by a Novel High-Resolution Tear Film Imager: A Pilot Study.

PURPOSE: The purpose of this study was to investigate the effects of artificial tears (AT) on the sublayers of the tear film assessed by a novel tear film imaging (TFI) device. METHODS: The mucoaqueous layer thickness (MALT) and lipid layer thickness (LLT) of 198 images from 11 healthy participants, 9 of whom had meibomian gland disease, were prospectively measured before and after exposure to 3 different AT preparations (Refresh Plus; Retaine [RTA]; Systane Complete PF [SYS]), using a novel nanometer resolution TFI device (AdOM, Israel). Participants were assessed at baseline and at 1, 5, 10, 30, and 60 minutes after instilling 1 drop of AT during 3 sessions on separate days. Repeated-measures analysis of variances were used for comparisons with P < 0.05 considered significant. RESULTS: For all ATs, the mean MALT was greatest 1 minute after drop instillation, with an increase of 67%, 55%, and 11% above the baseline for SYS, Refresh Plus, and RTA, respectively. The SYS formulation demonstrated the highest percentage increases in mean MALT and LLT at most postdrop time points. The MALT differences were significantly higher in the SYS than in the RTA (P = 0.014). After 60 minutes, no AT group demonstrated statistically significant changes in MALT or LLT compared with baseline. CONCLUSIONS: We report, for the first time, the effects of AT on MALT and LLT using a high-resolution TFI. A substantial acute mean MALT increase occurs 1 minute after AT instillation with all agents tested, but there were clear differences in response and durability, suggesting the benefits of choosing specific AT according to the needs of each patient.

3-D OCT imaging of hyalocytes in partial posterior vitreous detachment and vaso-occlusive retinal disease.

Purpose: To describe the spatial distribution and morphologic characteristics of macrophage-like cells called hyalocytes in the posterior vitreous cortex of a patient with unilateral partial posterior vitreous detachment (PVD) using coronal plane en face optical coherence tomography (OCT). Observations: A 54-year-old male with sickle cell disease (HbSC genotype) presented with a partial PVD in one eye. Rendered volumes of a slab extending from 600 µm to 3 µm anterior to the inner limiting membrane (ILM) revealed hyperreflective foci in the detached posterior vitreous cortex suspended anterior to the macula, likely representing hyalocytes. In the fellow eye without PVD, hyperreflective foci were located 3 µm anterior to the ILM. The morphology of the cells in the eye with PVD varied between a ramified state with multiple elongated processes and a more activated state characterized by a plump cell body with fewer retracted processes. In the same anatomical location, the hyperreflective foci were 10-fold more numerous in the patient with vaso-occlusive disease than in an unaffected, age-matched control. Conclusions and Importance: Direct, non-invasive, and label-free techniques of imaging cells at the vitreoretinal interface and within the vitreous body is an emerging field. The findings from this case report suggest that coronal plane en face OCT can be used to provide a detailed and quantitative characterization of cells at the human vitreo-retinal interface in vivo. Importantly, this case report demonstrates that 3D-OCT renderings can enhance visualization of these cells in relation to the ILM, which may provide clues concerning the identity and contribution of these cells to the pathogenesis of vitreo-retinal diseases.

Optical coherence tomography angiography as predictor of visual outcomes in retinal vein occlusion treated with antiangiogenic therapy.

PURPOSE: Evaluate optical coherence tomography angiography (OCT-A) features in retinal vein occlusions (RVO) associated with visual outcomes after anti-VEGF. METHODS: Analytical observational study performed in eyes with macular edema secondary to RVO treated with anti-VEGF, with at least 6 months of follow-up. Bradley et al. classification of macular ischemia was used. Logistic regression analysis was used to investigate associations between final best-corrected visual acuity (BCVA) and OCT-A. RESULTS: A total of 62 eyes, 61 subjects, mean age of 70 ± 12,6 years were included. Median follow up time 21,2 months (IQR 24.8), 53,2% had central retinal vein occlusion (CRVO) and 46,8% branch retinal vein occlusion (BRVO). Median BCVA pre-treatment was 0,84 logMAR (IQR 0,83) and post-treatment 0,47 logMAR (IQR 0,52). BCVA improved at the end of follow-up (p = 0,01), as well as central retinal thickness (CRT) (p = 0,02). Regarding capillary densities (CD), there was a decrease for both plexus, Superficial CD (p = 0,01) and Deep CD (p = 0,01), being more involved the superficial plexus. The lower the capillary density in both plexus, the worse BCVA, Superficial CD (r - 0,27, p = 0,03) and Deep CD (r - 0,29, p = 0,02). Media FAZ pre-treatment was 0,30 mm2 (IQR 0,23), with enlargement to 0,37 mm2 (IQR 0,32) (p = 0,01) post-treatment. Preservation of External Limiting Membrane/ Ellipsoid Zone (ELM/EZ) was seen in 60% of subjects (n = 37). The majority had grade 3 macular ischemia. Variables that best explain visual results were, baseline visual acuity (p = 0,01), pre-treatment CRT (p = 0,02) and pretreatment foveal superficial CD (p = 0,02). CONCLUSIONS: Variables that best explain final vision after anti-VEGF were baseline visual acuity, CRT and foveal superficial CD.

Flavoprotein fluorescence elevation is a marker of mitochondrial oxidative stress in patients with retinal disease.

Purpose: Recent studies of glaucoma, age-related macular degeneration, and diabetic retinopathy have demonstrated that flavoprotein fluorescence (FPF) can be utilized non-invasively as an indicator of mitochondrial oxidative stress in the retina. However, a comprehensive assessment of the validity and reliability of FPF in differentiating between healthy and diseased eyes across multiple disease states is lacking. Here, we evaluate the sensitivity and specificity of FPF in discriminating between healthy and diseased eyes in four leading causes of visual impairment worldwide, one of which has not been previously evaluated using FPF. We also evaluate the association between FPF and visual acuity. Methods: A total of 88 eyes [21 eyes of 21 unaffected controls, 20 eyes from 20 retinal vein occlusion (RVO) patients, 20 eyes from 20 diabetic retinopathy (DR) patients, 17 eyes from 17 chronic exudative age-related macular degeneration (exudative AMD) patients, and 10 eyes from 10 central serous retinopathy (CSR) patients] were included in the present cross-sectional observational study. Eyes were imaged non-invasively using a specially configured fundus camera OcuMet Beacon® (OcuSciences, Ann Arbor, MI). The macula was illuminated using a narrow bandwidth blue light (455 - 470 nm) and fluorescence was recorded using a narrow notch filter to match the peak emission of flavoproteins from 520 to 540 nm. AUROC analysis was used to determine the sensitivity of FPF in discriminating between diseased eyes and healthy eyes. Nonparametric Kruskal-Wallis Tests with post-hoc Mann Whitney U tests with the Holm-Bonferroni correction were performed to assess differences in FPF intensity, FPF heterogeneity, and best corrected visual acuity (BCVA) between the five groups. Spearman rank correlation coefficients were calculated to assess the relationship between FPF and BCVA. Results: AUROC analysis indicated that FPF intensity is highly sensitive for detecting disease, particularly for exudative AMD subjects (0.989; 95% CI = 0.963 - 1.000, p=3.0 x 107). A significant difference was detected between the FPF intensity, FPF heterogeneity, and BCVA in all four disease states compared to unaffected controls (Kruskal-Wallis Tests, p = 1.06 x 10-8, p = 0.002, p = 5.54 x 10-8, respectively). Compared to healthy controls, FPF intensity values were significantly higher in RVO, DR, exudative AMD, and CSR (p < 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). Spearman rank correlation coefficient between FPF intensity and BCVA was ρ = 0.595 (p = 9.62 x 10-10). Conclusions: Despite variations in structural retinal findings, FPF was found to be highly sensitive for detecting retinal disease. Significant FPF elevation were seen in all four disease states, with the exudative AMD patients exhibiting the highest FPF values compared to DR, CSR, and RVO subjects. This is consistent with the hypothesis that there is elevated oxidative stress in all of these conditions as previously demonstrated by blood studies. FPF intensity is moderately correlated with the late-in disease-marker BCVA, which suggests that the degree of FPF elevation can be used as a metabolic indicator of disease severity.

Central serous chorioretinopathy imaging biomarkers.

PURPOSE: To identify the factors predicting the visual and anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) through 12 months. METHODS: Patients with diagnosis of CSCR, either acute or chronic, were included in this multicentric, retrospective study. Demographic factors; systemic risk factors; central macular thickness (CMT), subfoveal choroidal thickness (SFCT), linear extent of ellipsoid zone (EZ) and interdigitation zone damage on optical coherence tomography; details of leak on fluorescein angiography and indocyanine green angiography were included as predictors of anatomical and visual outcomes. Regression analysis was performed to correlate the changes in best corrected visual acuity (BCVA) and resolution of disease activity. RESULTS: A total of 231 eyes of 201 patients with a mean age (49.7±11.8 years) were analysed. A total of 97 and 134 eyes were classified as acute and chronic CSCR. BCVA (0.35±0.31 to 0.24±0.34; p<0.001), baseline optical coherence tomography (OCT) parameters including CMT (p<0.001), subretinal fluid (SRF) height (p<0.001) and SFCT (p=0.05) showed a significant change through 12 months. Multivariate regression analysis showed change in CMT (p≤0.01) and SRF height at baseline (p=0.05) as factors predictive of good visual outcome. Logistic regression analysis revealed changes in both CMT (p=0.009) and SFCT (p=0.01) through 12 months to correlate with the resolution of disease. CONCLUSION: OCT parameters such as changes in both CMT and SFCT along with subfoveal EZ damage can be predictive of disease resolution whereas changes in CMT and baseline SRF height correlate well with changes in BCVA through 12 months.

Characteristics of Pediatric Glaucoma in a Latin American Reference Center.

AIM: To describe the clinical and epidemiological characteristics of children with pediatric glaucoma (PG) treated in an ophthalmologic national reference center. MATERIALS AND METHODS: A retrospective study of patients diagnosed with PG in a national ophthalmologic reference center was made, between 2005 and 2015. Clinical findings, type of treatment, and the follow-up were evaluated. RESULTS: A total of 89 patients (145 eyes) were included. The median age of diagnosis was 2.0 years. The most frequent type of glaucoma was primary PG with 67.4% of affected patients, primary congenital glaucoma (PCG) being more frequent (69 eyes) than juvenile open-angle glaucoma (JOAG 36 eyes). Secondary PG accounted for 32.6% of the cases (40 eyes). At least one surgical procedure was needed in 56.6% of all studied eyes, and 10.7% of eyes had more than two surgical procedures. Even more, eyes with PCG had surgery in 88.4% of cases. On the contrary, eyes with JOAG did not require surgery. In the last assessment, the distribution of cases according visual acuity did not show differences. However, it is important to note that patients with secondary PG maintained a good vision only in 17.9% of cases. CONCLUSION: Pediatric glaucoma is a heterogeneous group of diseases, and due to its low incidence, descriptive reports of large cohorts are not available. This study has a well-detailed report of PG characteristics in a national reference center. The frequency of JOAG in the present study was significantly higher than that reported in other studies. Also, clinical characteristics of all glaucoma described have some differences from data published. CLINICAL SIGNIFICANCE: There are few studies that describe characteristics of PG. This study is an important tool to analyze the characteristics of PG in an effort to better know the disease. HOW TO CITE THIS ARTICLE: Saavedra C, Rios HA, Belalcazar S, et al. Characteristics of Pediatric Glaucoma in a Latin American Reference Center. J Curr Glaucoma Pract 2020;14(1):10-15.

Lens changes in cardiovascular catheterization laboratories staff / Cambios en el cristalino en personal de laboratorio de cateterismo cardiovascular

Abstract Objective: To determine the association between occupational ionizing radiation exposure in the cardiovascular catheterization laboratories staff and development of lens changes. Methods: A cross-sectional study was made. Participants were recruited at the XIII Colombian Conference of Interventional Cardiology and SOLACI conferences in Bogotá - Colombia 2017. Informed consent was obtained from all study participants. Demographics and clinical data were collected. Associated lens changes were determined according to the ionizing radiation exposure status. Results: A total of 89 subjects (178 eyes) participated in the study. In general, the mean age was 40 years old, ranging from 19 to 78 years old. Distribution according gender was 55.3% male and 44.7% female. 31 subjects (62 eyes) were deemed to have not occupational exposure to radiation and 58 subjects (116 eyes) with a history of occupational radiation exposure. Exposed eyes had twice risk for present subcapsular posterior lens opacity compared to non-exposed eyes. The subjects with older age and physician role were associated to the presence of lens opacity, with a p value 0.001 in both cases. Likewise, exposed subjects with any lens opacity had a high mean occupational lifetime, with a p 0.001. Conclusions: This study confirms a statistically significant increase in radiation-associated subcapsular lens changes in the eyes of interventional cardiology staff compared to unexposed controls.

Resumen Objetivo: Determinar la asociación entre la exposición a radiación ionizante en el personal de las salas de cateterismo cardiovascular y el desarrollo de cambios en el cristalino. Métodos: Se hizo un estudio transversal. Los participantes fueron reclutados en el XIII Congreso Colombiano de Cardiología Intervencionista y las Conferencias SOLACI en Bogotá - Colombia 2017. Se obtuvo el consentimiento informado de todos los participantes. Se recolectaron datos demográficos y clínicos. Se determinó la asociación entre los cambios en el cristalino y la exposición a la radiación ionizante. Resultados: Un total de 89 sujetos (178 ojos) participaron en el estudio. En general, la edad promedio fue de 40 años, con edades comprendidas entre los 19 años y 78 años. La distribución según el género fue del 55,3% en hombres y el 44,7% en mujeres. Se consideró que 31 sujetos (62 ojos) no tenían exposición ocupacional a la radiación y 58 sujetos (116 ojos) presentaban exposición ocupacional a esta. Los ojos expuestos tenían dos veces el riesgo de presentar opacidad subcapsular posterior del cristalino en comparación con los ojos no expuestos. Los sujetos de mayor edad y con rol de médico se asociaron a la presencia de opacidad del cristalino, con un valor p de 0.001 en ambos casos. Del mismo modo, los sujetos expuestos con cualquier opacidad del cristalino tenían una vida laboral más larga, con una p 0.001. Conclusiones: Este estudio confirma un aumento estadísticamente significativo en la presencia de cambios en el cristalino en el personal de las salas de cateterismo cardiovascular en comparación con los controles no expuestos.