Iridian anterior segment OCT in rubella uveitis syndrome and cytomegalovirus anterior uveitis: a comparative study.

PURPOSE: To compare iris affectation in cytomegalovirus anterior uveitis (CMVAU), rubella virus-associated uveitis (RVU), and healthy contralateral eyes, using swept-source anterior segment optical coherence tomography (SS-AS-OCT). MATERIALS AND METHODS: A comparative, transversal, retrospective study examining 60 eyes from 30 patients-18 eyes (17 patients) with CMVAU, 14 eyes (13 patients) with RVU, and 28 healthy eyes-was performed. Six-millimeter cross-sectional SS-AS-OCT B-scans were obtained in each iris quadrant. Images were exported to ImageJ®. Qualitative and quantitative analyses were done: stromal thickness (ST), smooth index (SI), and optical density (OD) of pigment epithelium. Comparisons between measurements and clinical-demographic parameters were performed using SPSS®. RESULTS: Qualitative analysis showed extensive damage in iris stroma but was unable to differentiate between both uveitis. RVU eyes had a lower mean ST (315.72 µm ± 42.4) compared to those with CMVAU (348.6 µm ± 46) (p = 0.047) and a lower ST in the upper (338.9 µm ± 38.52)/(386.25 µm ± 47.2) (p = 0.005) and temporal (281.5 µm ± 57.3)/(326.43 µm ± 62.3) (p = 0.016) quadrants. Mean (0.94 ± 0.02)/(0.9 ± 0.03) (p = 0.001), temporal (0.94 ± 0.02)/(0.89 ± 0.03) (p < 0.001), and nasal SI (0.094 ± 0.02)/(0.9 ± 0.04) (p = 0.005) were higher in RVU. OD was similar in both uveitis. In healthy eyes, mean ST (376.8 µm ± 39.7) was higher and mean SI was lower (0.87 ± 0.04) than in RVU (p < 0.001) and CMVAU eyes (p = 0.032). Mean OD was higher in healthy eyes (911 ± 130) than in CMVAU eyes (800 ± 200) (p = 0.037). CONCLUSIONS: The quantitative analysis of the SS-AS-OCT iris images allows for the differentiation between healthy eyes and those with CMVAU and RVU, as well as between both uveitis.

Immediate sequential bilateral cataract surgery in adults with Down's syndrome.

PURPOSE: To describe the cataract surgery outcomes in 34 adult patients with Down's syndrome in our center between 1996 and 2019. SETTING: Clinical practice, tertiary hospital in Madrid, Spain. DESIGN: Retrospective, descriptive study in which 34 patients with Down's syndrome who underwent cataract surgery in our center between 1996 and 2019 were included. METHODS: Socio-demographic and clinical data such as the type of cataract, the keratometry and biometry, the type of surgery, the IOL material, and the complications before and after surgery were recovered. RESULTS: Fifty-four eyes of 34 patients (23 female, 11 male, mean age 49 ± 8 years) underwent cataract surgery with general anesthesia. Immediately sequential, bilateral cataract surgery was performed in 18 patients (90% of bilateral cases). White cataract was found in 11 eyes (20.4%). Phacoemulsification technique was used in 51 eyes, extracapsular technique in 2 eyes (3.7%), and intracapsular technique in 1 eye (1.85%) (the only aphakic eye after surgery). The mean Km was 48.73 ± 4D, and the mean axial length was 25.2 ± 2.5 mm. The most frequent ocular comorbidity was myopia (27 eyes, 50%) followed by strabismus (11 eyes, 20.4%) and keratoconus (10 eyes, 18.5%). Posterior capsular rupture as a complication during surgery was found in 3 eyes (5.5%). The mean preoperative visual acuity was 0.8 ± 0.2 logMAR, and the mean postoperative visual acuity was 0.5 ± 0.18 logMAR. CONCLUSIONS: Phacoemulsification technique can be performed in adults with Down's syndrome with an acceptable rate of complications. The lack of patient cooperation, the ocular comorbidities and the challenging biometric estimation must be considered in surgical planning. It seems reasonable to perform immediately sequential, bilateral cataract surgery when possible, in order to reduce the exposure to general anesthesia.

Bilateral Acute Depigmentation of the Iris: Findings in Anterior Segment Swept-Source Optical Coherence Tomography.

Objective: To describe the clinical and Anterior Segment Swept-Source Optical Coherence Tomography (AS-SS OCT) findings in Bilateral Acute Depigmentation of the Iris (BADI).Design: Retrospective descriptive study of three clinical cases.Results: Three women diagnosed with BADI shared a history of bacterial infections treated with moxifloxacin. The AS-SS OCT showed damage from the collarette to the root of the iris, without affecting the pupillary area. In the affected areas, the anterior edge had lost its homogeneous hyper-reflectivity. The stroma was thinned and showed a patchy and diffused hyper-reflectivity. The pigmentary epithelium appeared unaffected.Conclusions: AS-SS OCT findings, not previously described, locate the damage in BADI in the anterior edge and iridian stroma, areas which are rich in melanocytes and permeable to aqueous humor.