Assessment of area and structural irregularity of retinal layers in diabetic retinopathy using machine learning and image processing techniques.

Diabetes retinopathy prevention necessitates early detection, monitoring, and treatment. Non-invasive optical coherence tomography (OCT) shows structural changes in the retinal layer. OCT image evaluation necessitates retinal layer segmentation. The ability of our automated retinal layer segmentation to distinguish between normal, non-proliferative (NPDR), and proliferative diabetic retinopathy (PDR) was investigated in this study using quantifiable biomarkers such as retina layer smoothness index (SI) and area (S) in horizontal and vertical OCT images for each zone (fovea, superior, inferior, nasal, and temporal). This research includes 84 eyes from 57 individuals. The study shows a significant difference in the Area (S) of inner nuclear layer (INL) and outer nuclear layer (ONL) in the horizontal foveal zone across the three groups (p < 0.001). In the horizontal scan, there is a significant difference in the smoothness index (SI) of the inner plexiform layer (IPL) and the upper border of the outer plexiform layer (OPL) among three groups (p < 0.05). There is also a significant difference in the area (S) of the OPL in the foveal zone among the three groups (p = 0.003). The area (S) of the INL in the foveal region of horizontal slabs performed best for distinguishing diabetic patients (NPDR and PDR) from normal individuals, with an accuracy of 87.6%. The smoothness index (SI) of IPL in the nasal zone of horizontal foveal slabs was the most accurate at 97.2% in distinguishing PDR from NPDR. The smoothness index of the top border of the OPL in the nasal zone of horizontal slabs was 84.1% accurate in distinguishing NPDR from PDR. Smoothness index of IPL in the temporal zone of horizontal slabs was 89.8% accurate in identifying NPDR from PDR patients. In conclusion, optical coherence tomography can assess the smoothness index and irregularity of the inner and outer plexiform layers, particularly in the nasal and temporal regions of horizontal foveal slabs, to distinguish non-proliferative from proliferative diabetic retinopathy. The evolution of diabetic retinopathy throughout severity levels and its effects on retinal layer irregularity need more study.

Pachychoroid neovasculopathy versus macular neovascularization in age-related macular degeneration with and without shallow irregular pigment epithelial detachment.

To compare the choroidal neovascular features of individuals with pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) with and without shallow irregular pigment epithelial detachment (SIPED). Using optical coherence tomography angiography, the choroidal neovascular complexes of 27 patients with PNV, 34 patients with nAMD and SIPED, and 15 patients with nAMD without SIPED were analyzed with FIJI and AngioTool software. PNV compared to nAMD with SIPED had a greater vessel percentage area (P = 0.034), junction density (P = 0.045), average vessel length (P < 0.001), and fractal dimension (P < 0.001). PNV, compared to nAMD without SIPED, had a greater total vessel length (P = 0.002), total number of junctions (P < 0.001), junction density (P = 0.034), and fractal dimension (P = 0.005). nAMD with SIPED, compared to nAMD without SIPED, had greater vessel area, total number of junctions, total vessel length, and average vessel length (all P values < 0.001). Patients with nAMD plus SIPED and individuals with nAMD without SIPED have similar fractal dimension values (P = 0.703). Biomarkers of choroidal neovascular complexity, such as fractal dimension, can be used to differentiate PNV from nAMD with or without SIPED.

Central retinal vein and artery occlusion associated with sildenafil: a case report and review of the literature.

BACKGROUND: Sildenafil is a selective phosphodiesterase type 5 inhibitor used for the treatment of erectile dysfunction and pulmonary hypertension. It is available over the counter in many countries. While there have been a few reports of retinal vascular occlusion following sildenafil consumption, most cases have other comorbidities as risk factors for the disease, and the exact causal role of this drug in these conditions remains unclear. CASE PRESENTATION: We present the case of a healthy 32-year-old Iranian man who developed combined central retinal vein occlusion and retinal artery occlusion following sildenafil exposure. The patient underwent a hypercoagulative state workup for possible underlying risk factors. Additionally, we conducted a literature search on PubMed using the keywords: retinal vein occlusion AND Sildenafil OR Viagra, retinal artery occlusion AND Sildenafil OR Viagra, retinal vascular occlusion AND Sildenafil OR Viagra. To obtain more objective results in the reviews, we employed an adverse drug reaction possibility algorithm. The patient was found to be otherwise healthy, and ancillary tests were unremarkable. A literature review identified seven reports of retinal vascular occlusion following sildenafil use. In most of these cases, the role of sildenafil was not clearly established. To the best of our knowledge, our case achieved the highest score based on the algorithm compared with previous reports. CONCLUSION: Sildenafil may be associated with severe retinal vascular accidents in otherwise healthy young individuals.

Presumed Bietti crystalline dystrophy with optic nerve head drusen: a case report.

BACKGROUND: Bietti crystalline dystrophy is primarily a retinal dystrophy caused by a CYP4V2 mutation and typically presents with crystalline retinal deposits in the posterior fundus. CASE PRESENTATION: We present the case of an otherwise healthy 39-year-old Iranian woman with no family history of ocular disease who suffered with progressive vision loss that had started 2 years prior to presentation. Ocular examination revealed blurry optic nerve head margin and diffuse retinal crystalline deposit in both eyes. Spectral domain optical coherence tomography images showed retinal crystals, located mostly in outer retinal layers, with some areas of outer retinal tubulation and attenuation of outer retinal layers. Crystalline deposits were better visualized on near-infrared images as hyperreflective spots. Fundus autofluorescence images showed hyperautofluorescence areas on optic nerve head consistent with optic nerve head drusen and large hypoautofluorescence areas in posterior retina consistent with retinal pigment epithelium atrophy. Cystinosis was ruled out by blood testing. CONCLUSION: Bietti crystalline dystrophy may be associated with optic nerve head drusen.

The Effect of Acute Rises in Intraocular Pressure after Intravitreal Bevacizumab Injection on the Peripapillary Retinal Nerve Fiber Layer Thickness and the Role of Anterior Chamber Paracentesis.

PURPOSE: To evaluate acute changes in intraocular pressure (IOP) and their short-term effects on the peripapillary retinal nerve fiber layer (RNFL) thickness after intravitreal bevacizumab (IVB) injection. METHODS: Fifty-eight eyes of 37 patients with treatment-naïve diabetic macular edema or exudative age-related macular degeneration were included in the study. Patients were divided into two groups, and the participants of each group received 3 monthly injections of IVB. IOP was measured right before the injection, immediately after the injection, and 5 min and 20 min after each injection. Peripapillary, RNFL thickness was measured before the injection and 1 month after the third injection. In the second group, anterior chamber (AC) paracentesis was performed before IVB injection. RESULTS: IOP values after injection in all sessions were significantly higher in the first group (P < 0.001). The peripapillary RNFL thickness changes 1 month after the third injection was not statistically significantly different in each group (P = 0.816 and 0.773 for the first and second groups, respectively). CONCLUSION: AC paracentesis is an effective modality to reduce the acute rise in IOP. The effect of acute IOP elevation on the peripapillary RNFL thickness was not statistically significant.

Histological and ultrasonographic alterations in skin and soft tissue in upper eyelid excised blepharoplasty due to ipsilateral eyebrow tattooing: (preliminary findings).

BACKGROUND: Eyebrow tattooing (ET) is a relatively common cosmetic procedure for middle-aged women which can hide age-related ptosis. AIMS: We aimed to evaluate the periocular soft tissue changes following ET and its effects on upper eyelid blepharoplasty (UEBL). PATIENTS/METHODS: In this non-randomized prospective case-controlled study, 28 subjects recruited, 14 with ET for at least 5 years and 14 without ET. Eyebrows ultrasonography was performed to measure the periocular soft tissue thickness including skin and subcutaneous tissue on the medial and lateral side of the eyebrow. Then, UEBL was performed with extended eyelid skin incisions. So, the excised tissues being evaluated histopathologically. RESULTS: The mean age of patients was 50.6 ± 0.6 and 51.2 ± 5.59 years in non-eyebrow tattooing (NET) and ET groups, respectively (P = .78). In the ET group, soft tissue thickness was, respectively, equal to 5.90 ± 1.10 and 6.3 ± 0.95 mm on the lateral and medial side of the eyebrow, which were significantly thicker compared to the NET group (4.68 ± 0.69 and 4.78 ± 0.56 mm, respectively)(P = .001). Histopathological findings were ranging from edema-congestion to chronic inflammation and dermal fibrosis which were more frequently seen in ET group. However, this difference was statistically significant only for dermal fibrosis (P = .02). Surgical wound complications were observed in 3 patients who were in the ET group (P = .22). CONCLUSION: Subjects with eyebrow tattooing, as compared to a control group, showed a thicker eyebrow skin on ultrasonography and higher upper eyelid dermal fibrosis on histopathological examination.

Lacrimal Drainage System Problems After Rhinoplasty.

BACKGROUND: To report case series of permanent nasolacrimal system problems following rhinoplasty METHODS: The documents of patients with epiphora and history of rhinoplastic surgery were reviewed. The data of patients with permanent epiphora (continued over 3 months or started after 3 months of post-rhinoplasty surgery) and lacrimal drainage system (LDS) problems were analyzed for demographics, the result of diagnostic probing and irrigation, findings of orbital and paranasal sinuses CT scan, abnormalities in nasal endoscopy, treatment, and follow-up data. RESULTS: Forty-three patients with epiphora and history of rhinoplasty were referred to our clinic. Ten of them had permanent epiphora and LDS problems. In these patients, the mean time between rhinoplasty and initial symptoms of LDS problems was 10.3 ± 15.1 (range, 0-45 months) and the mean time between rhinoplasty and the LDS surgery was 22.2 ± 19.5 months (range 4-60 months). Diagnostic probing and irrigation test revealed canalicular stenosis in four (40%) patients, pus reflux in four (40%), clear reflux without passage in four (40%), and partial nasolacrimal duct obstruction (NLDO) in two (20%) of patients. DCR was performed in eight (80%) patients. Therapeutic probing and lacrimal intubation were performed in two (20%) patients. CONCLUSION: A permanent injury of the LDS is one of the important complications of the rhinoplastic surgery that should be managed based on the onset and duration of the symptoms and the location of the injury. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical, Radiological and Histopathological Features of Patients With Lacrimal Gland Enlargement.

BACKGROUND: The purpose of this study was to describe the radiologic and histopathologic features of lacrimal gland in patients presenting with lacrimal gland enlargement. METHODS: We retrospectively retrieved the data of patients with lacrimal gland enlargement in Farabi Eye Hospital between 2012 and 2017. These data included demographics, the patients' facial photographs, orbital CT-scans, and histopathological findings of lacrimal gland biopsies. RESULTS: Forty-seven patients (15 men and 32 women) were enrolled in this study with a median age of 37.9 years (range, 15-79 years). Histopathologic diagnoses were chronic dacryoadenitis in 26 cases (55.32%), IgG4-related disease in 6 patients (12.77%), two cases of acute dacryoadenitis, two cases of non-necrotizing granulomatous inflammation, two cases of Non-Hodgkin's B-cell lymphoma, two cases of adenoid cystic carcinoma and two cases of mixed tumor (4.26% each), as well as one case of conjunctival epithelial cyst, and one case of benign lymphoid tissue and fibrofatty tissue (2.13%). In two samples (4.26%), biopsy revealed normal lacrimal glands. Interestingly, in two cases with relapsing lacrimal gland enlargement, different histopathologic diagnoses were found in biopsies taken from each lacrimal gland at different times. The average size of enlarged lacrimal glands was 19.67 mm × 7.06 mm on axial CT scan and 19.44 mm × 6.20 mm on coronal CT scan. CONCLUSION: Tissue biopsy is needed for diagnosis of lacrimal gland enlargement because it is difficult to distinguish the type of the lacrimal gland pathology based solely on clinical or radiological presentation.

Herpes Zoster Ophthalmicus and Limbal Ischemia in A Patient with History of Ocular Graft-Versus-Host Disease.

PURPOSE: To report a rare complication of herpes zoster ophthalmicus (HZO). METHODS: A 27-year-old man with a history of graft-versus-host disease (GVHD) presented with pain and redness in his left eye along with vesicular eruptions on the same side of the forehead from 40 days earlier. RESULTS: In this case report, we present a case of HZO with severe limbal ischemia in a patient with ocular GVHD. The patient was administered with intensive topical preservative-free lubrication, topical preservative-free antibiotics, topical autologous serum 20%, topical non-preservative steroid (methylprednisolone 1%), and oral valacyclovir 1 g twice daily. The patient underwent amniotic membrane patch surgery on bulbar conjunctiva and cornea, lateral tarsorrhaphy, and punctal occlusion for the left eye. CONCLUSION: In this report, severe and extensive limbal ischemia caused by herpes zoster virus in an immunocompromised patient is reported.

Solitary neurofibroma of the orbit with intracerebral extension associated with ocular surface melanocytoma: a case report.

Solitary or isolated neurofibroma is uncommonly observed in the orbit. Neurofibromas typically involve peripheral nerves and occasionally the cranial nerves. A 29-year-old man presented with recent onset left eye proptosis and exotropia. Physical examination was positive for hyperpigmented lesions of the ipsilateral ocular surface and hard palate. Imaging revealed an infiltrative orbital mass with extension through superior orbital fissure into the brain. There was also bone defect of greater sphenoid wing. Medial orbitotomy was performed to obtain biopsies of the orbital mass and the pigmented ocular surface lesions. Histopathologic diagnosis of neurofibroma was confirmed for the former and melanocytoma for the latter. His symptoms and examinations remained stable during the follow up. This case is unique due to several features, including extensive intracerebral spread of orbital neurofibroma in a patient without definite diagnosis of neurofibromatosis type 1 and association with ipsilateral ocular surface melanocytoma and palatal pigmented lesions. ABBREVIATIONS: CT: computed tomography; GFAP: glial fibrillary acid protein; MRI: magnetic resonance imaging; NF-1: neurofibromatosis type 1.