Functional and perfusion changes associated with silicone oil tamponade after macula-off rhegmatogenous retinal detachment surgery: an optical coherence tomography angiography/microperimetry study.

PURPOSE: The current study utilizes microperimetry and optical coherence tomography angiography (OCTA) to assess the optic nerve head vasculature, retinal microvasculature, and retinal sensitivity before and after silicone oil (SO) removal. METHODS: This prospective observational case series study involved 30 eyes subjected to silicone oil endotamponade. Microperimetry and OCTA were utilized to assess the vascular density (VD) of the macula and optic nerve head, as well as the retinal sensitivity (RS), of the participants preoperatively and 1 month following SO removal. The correlation between the various parameters of OCTA and microperimetry was evaluated. RESULTS: There was a significant improvement in the postoperative best-corrected visual acuity (BCVA) (p-value < 0.001) and the postoperative total RS, which was 6.38 ± 2.34 dB as compared to a mean preoperative total RS of 5.04 ± 2.06 dB (p-value < 0.001) and showing a significant increase in all rings. However, there was no significant difference in the pre and postoperative macular VD. On the other hand, there was a significant increase in the postoperative VD of the whole disk and the peripapillary capillary plexus, p-values < 0.001 and 0.002, respectively. CONCLUSION: The removal of SO resulted in significant improvements in retinal sensitivity, vision, and optic nerve perfusion. However, no significant change was observed in macular VD. CLINICAL TRIALS: gov Identifier: NCT04928196.

VKH with APECED in a Two-Year-Old Child: A Rare Concomitant Diagnosis in an Unprecedented Age.

PURPOSE: To present a case of Vogt Koyanagi Harada (VKH) associated with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) in a two-year-old. CASE PRESENTATION: A two-year-old type 1 diabetic with hypothyroidism presented with impaired fixation. Ocular examination revealed right vitritis, choroiditis, a hyperemic disc, and an area of exudative detachment. At the same time, there was no fundus view in the left eye, and ultrasonographic assessment revealed vitritis and a thickened choroid. Patient developed sunset glow fundus with alopecia, poliosis and vitiligo and a diagnosis of complete VKH with APECED was made. CONCLUSION: APECED is a rare endocrine disorder and has been reported to be associated with VKH twice. Likewise, VKH is commonly present in much older patients; this is the first time ever to be diagnosed in a two-year-old child.

Macular vascular features of different types of diabetic macular edema using ocular coherence tomography angiography- a comparative study.

BACKGROUND: To compare the microvascular features of different subtypes of diabetic macular edema (DME) by optical coherence tomography angiography (OCTA). METHODS: A cross-sectional study including treatment-naive patients with DME. Eyes were divided according to optical coherence tomography determined morphology into two groups: cystoid macular edema (CME) and diffuse retinal thickening (DRT), with further subdivision according to the presence of subretinal fluid. All patients underwent 3 × 3 and 6 × 6 mm OCTA scans of the macula to compare the foveal avascular zone (FAZ) area, vascular density (VD) of the superficial (SCP) and deep (DCP) capillary plexus and choriocapillaris flow (CF). Laboratory findings (HbA1C and triglyceride levels) were also correlated with the OCTA findings. RESULTS: The study included 52 eyes, 27 had CME and 25 had DRT. There were no significant differences between the VD of the SCP (p = 0.684) and DCP (p = 0.437), FAZ of SCP (p = 0.574), FAZ of DCP (p = 0.563) and CF (p = 0.311). Linear regression analysis revealed that DME morphology was the strongest predictor for BCVA. Other significant predictors included HbA1C and triglyceride levels. CONCLUSION: The morphology of DME, irrespective of SRF, was most significantly correlated with BCVA in treatment-naive patients and CME subtype could be an independent predictor of poor BCVA in patients with DME.

The efficacy of anti-TNF-α agents in the treatment of juvenile idiopathic arthritis-associated uveitis in a pediatric cohort.

Purpose: Biologic therapy has shown promising control in children with often intractable juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U). Methods: This is a retrospective cohort study of 35 eyes of 35 children who received biologics for JIA-U. Pretreatment and posttreatment data (at 3, 6, 9, 12, 18, 24, and >24 months) were analyzed to determine functional success (stable/improved visual acuity), quiescence success (≤0.5 cells in the anterior chamber), complete steroid success (termination of systemic, periocular therapy and decreased topical drops to ≤2/day) or systemic steroid success (termination of systemic steroids only), and complete success (all of the above). Results: This study included 35 eyes up to 12 months and 21 eyes beyond 24 months. Steroid-sparing, functional, and quiescence success showed a rate of success of 52.43%, 77%, and 91%, respectively, at 12 months and 66.67%, 85.7%, and 76.2%, respectively, beyond 24 months. Complete success was 34.29% at 12 months, peaking at 18 months (65.62%) and reached 57.14% beyond 24 months. In their final follow-up, the best corrected visual acuity (BCVA) remained the same in 45.71%, improved in 37.14%, and worsened in 17.14% children. Conclusion: Biologic therapy is effective in JIA-U, especially in termination of systemic steroids, stabilization of vision, and maintaining quiescence.

Non-penetrating deep sclerectomy with the sub flap (Ahmed's) suture: a 12-month comparative study.

PURPOSE: To assess the IOP-lowering effect of adding a mattress suture (Ahmed's suture) to non-penetrating deep sclerectomy (NPDS), in patients with open angle glaucoma over a 12-month follow-up period. METHODS: This is a randomized controlled study comparing 52 eyes with a sub-flap Ahmed's suture modified NPDS (group A) and 51 with a conventional NPDS (group B). Success of surgery was categorized as complete success if the IOP remained between 6 and 18 mmHg without medications and as qualified if topical medications were required. RESULTS: The post-operative IOP at the 1st week, 3rd, 6th, 9th & 12th months follow ups in group A were significantly lower (7.3 ± 2.1, 12.0 ± 2.3, 12.6 ± 2.7, 13.6 ± 3.4 & 13.8 ± 3.8 mmHg) than in B (9.2 ± 1.9, 14.0 ± 3.1, 14.8 ± 2.9, 15.4 ± 2.6 & 15.7 ± 2.7 mmHg) (p = 0.001, p = 0.001, p = 0.002, p = 0.027 & p = 0.029 respectively). The percentage of IOP reduction after 1 year was significantly higher in group A than in group B (49% vs. 36.5%). At the end of the 12-month follow-up, 81% of group A and 69% of group B were considered as complete success. Multivariate regression analysis showed lower 1st week post-operative IOP was associated with better outcome. CONCLUSION: In conclusion, the Ahmed's suture, a simple, novel and economic modification, maintains lower IOP levels and has a higher success rate over conventional DS, as it is 30% more effective in reducing the IOP.

Evaluation of the retinal and choroidal microvasculature changes in cases of sarcoid and tuberculosis-associated posterior uveitis using OCT angiography.

PURPOSE: Using optical coherence tomography angiography (OCTA) to evaluate retinal microvascular changes in sarcoid and tuberculous (TB) posterior uveitis. METHODS: Cross-sectional observational study includes 30 eyes. FFA and OCTA images were acquired. OCTA images were analyzed for areas of capillary hypo-perfusion, disorganization of the superficial and deep capillary plexuses (SCP and DCP) and intraretinal cystoid spaces and for measuring the size of the foveal avascular zone and vessel density (VD) in the SCP and DCP. RESULTS: A total of 11 eyes were associated with TB and 19 with sarcoidosis. By OCTA, 100% had areas of capillary non-perfusion, 36.7% choroidal voids, 30% disorganization of the SCP and DCP and 26.6% intraretinal cystoid spaces. The VD of the DCP was significantly lower in the TB group. On comparing OCTA and FFA, parafoveal ischemia was detected more frequently on OCTA and macular edema more frequently on FFA (P = < 0.001). The BCVA was not significantly correlated with the VD of the SCP or DCP. CONCLUSION: OCTA can be used in detection of early microvascular changes, segmenting retinal layers and localizing abnormalities. The presence of these changes may aid in the diagnosis of TB and sarcoid uveitis, for prognosis, follow-up and may be the only choice when FFA is contraindicated.

Safety and Efficacy of Black Tea Extract in the Treatment of Acute Bacterial Conjunctivitis: A Rabbit Model.

PURPOSE: To determine the safety and efficacy of black tea extract in the treatment of bacterial conjunctivitis in a rabbit model and compare it with that of gatifloxacin drops. METHODS: Black tea extract was tested in vitro on bacterial cultures of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Forty-two rabbit eyes were cultured with either MRSA (n=21) or P. aeruginosa (n=21) and further divided into a control group (n=5), a tea group (n=8) treated with black tea extract, and a gatifloxacin group (n=8) treated with 0.3% gatifloxacin eye drops. Conjunctival swabs were collected on the third and fifth days. RESULTS: The tea extract successfully inhibited the growth of both organisms at a concentration of 400 mg/mL. Rabbits in the treatment groups showed a reduction in the clinical index on day 2 (P<0.01), unlike the control group (P=0.1), for both organisms. Resolution of conjunctivitis was achieved on days 4 and 5 in the tea and gatifloxacin groups, respectively. On days 3 and 5, while the control group still showed considerable bacterial growth, the tea and gatifloxacin groups showed its inhibition. CONCLUSION: Tea extract has antimicrobial effects similar to those of gatifloxacin in a rabbit model of conjunctivitis.

Behçet uveitis: Current practice and future perspectives.

Described as early as Hippocrates in his "Third Book of Endemic Diseases," Behçet's Disease (BD), also known as "The Silk Road Disease" following its initial demographics, consists of a triad of recurrent oro-genital ulcers and associated uveitis. Current demographics and rising percentages of patients seen far beyond the Silk Road in Ocular Inflammatory Disease and Uveitis Clinics list BD uveitis as one of the frontliners of non-infectious autoinflammatory eye diseases. Clinical features of BD and juvenile-onset BD are detailed alongside various approaches in classification and suggested algorithms for diagnosis that are outlined in this review. With the ongoing Human Microbiome Project and studies such as the MAMBA study, the role of the human microbiome in BD is highlighted in the pathophysiology of BD to include the current research and literature perspective. Furthermore, with the advancement of recent diagnostic and investigative techniques, especially in the field of Optical Coherence Tomography (OCT), disease-related characteristics are updated to encompass SD, EDI and OCT-angiography characteristics of BD. Having entered the era of biologic therapy, the role of various specific cytokine-blocking biologic drugs, such as TNF-α inhibitors (e.g., adalimumab, infliximab), interferon α-2a inhibitors, IL-6 and IL-1 inhibitors are presented and contrasted alongside the conventional immunosuppressant drugs and the classic old gold standard: corticosteroids (systemic or local). Finally, with the ongoing SARS-CoV-2 pandemic, it was not possible to conclude the review without reviewing the latest evidence-based literature reporting BD morbidity in this era, the observed pattern and treatment recommendations as well as those related to reported post-vaccine complications and emergence of BD.