The Effect of Upper Eyelid Blepharoplasty on Corneal Tomography and Epithelial Profile.

Introduction: Upper tarsal mechanical forces influence corneal epithelial thickness profile, which could modulate corneal astigmatism. Upper eyelid blepharoplasty reduces upper tarsal strength and may have an impact on ocular surface. The aim of this study is to evaluate the effect of upper eyelid blepharoplasty on corneal epithelial thickness profile, astigmatism and aberrations. Methods: Patients with dermatochalasis underwent bilateral upper eyelid blepharoplasty. Anterior segment optical coherence tomography (AS-OCT) (Zeiss Cirrus 5000 HD-OCT) and Pentacam (Oculus, Wetzlar Germany) were performed before surgery and in the 8th postoperative week. Corneal epithelial thickness, keratometry, aberrations and asphericity were considered for statistical purposes. Only right eyes were considered. A p-value lower than 0.05 was considered significant. Results: Thirty eyes of 30 patients were included. The degree of astigmatism did not change after surgery (0.95D vs 0.83D, p=0.23). The difference between preoperative and postoperative steepest axis was 3.1° (p=0.04) with a tendency to change toward the vertical meridian. Mean epithelial thickness was higher in the inferior region both pre- and postoperatively and did not change. ET in the superior octant was lower (42 µm vs 45 µm, p<0.01) and the difference between inferior and superior octants (I-S) was higher (7 µm vs 3 µm, p<0.001) before surgery. There were no statistically significant changes in corneal aberrations (p=0.52) and asphericity (p=0.41) after surgery. Conclusion: Our results support that upper tarsus pressure influences epithelial thickness profile and, consequently, the corneal steepest keratometry. These results lead us to postulate that upper eyelid blepharoplasty may influence biometric and keratometric measurements.

Strabismus and Health Related Quality of Life in a pediatric Portuguese population.

Introduction: Strabismus is a common condition among children, and its psychosocial impact has been demonstrated in recent years. The interest in a more comprehensive approach was enhanced by the recognition of health as a four-dimensional concept, arising the term Health-related Quality of Life. Therefore, we aim to evaluate the influence of strabismus in Health-Related Quality of Life of a Portuguese pediatric population. Material and Methods: Case-control prospective transversal study enrolling children between 5 and 12 years old. All had a complete orthoptic and ophthalmological evaluation, followed by an interview with a legal representative to answer the Pediatric Quality-of-Life Inventory 4.0, proxy-version. Results: Seventy-one children were included, 35 in the control group (CG) and 36 in the strabismus group (SG). In the SG, 30 (83.3%) patients had esotropia, 20 (55.6%) had more than 10 prismatic diopters and 26 (72.2%) were already surgically treated. Overall, SG was not statistically different from the CG, showing only mild inferior performance (p > .05). Furthermore, children with exotropia, higher deviations, none or gross stereoacuity and treatment-naïve, scored worse, especially in emotional, social, educational and psychosocial scores although not statistically significant (p > .05). Conclusion: This is the first prospective study addressing HRQoL and strabismus in a pediatric Portuguese population. It would be relevant to further address this issue in order to delineate more effective and global treatment strategies, not only considering ophthalmological goals but also the well-being of both children and guardians.

Discrimination between falls and blows from the localization and the number of fractures on computed tomography scans of the skull and the trunk.

The distinction between falls and blows is a common and difficult task in forensic sciences. One of the most often used criteria to address this issue is the hat brim line (HBL) rule, which states that fall-related injuries do not lie above the HBL. Some studies, however, have found that the use of HBL rule is not so relevant. This study assesses the aetiologies, the number of fractures, and their location on the skull and the trunk in a sample of 400 individuals aged 20-49 years, which were CT scanned after traumas. This may facilitate the interpretation of such injuries in skeletonized or heavily decomposed bodies in which soft tissues are no longer available. Our aim is to improve the distinction rate between falls and blows by combining several criteria and assessing their predictability. Skeletal lesions were analysed using retrospective CT scans. Cases selected comprise 235 falls and 165 blows. We registered the presence and the number of fractures in 14 skeletal anatomical regions related to the two different aetiologies. We showed that the HBL rule should be used with caution, but there is nevertheless a possibility of discussing the aetiology of blunt fractures. Possibly, parameters like the anatomical location and the number of fractures by region can be used to distinguish falls and blows.

Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome.

Purpose: To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED). Methods: This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value <0.05. Results: The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p<0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p<0.01) and lower TMH (211.2 ± 68.4 µm vs 217.2 ± 60.1µm; p<0.01) than the control group, whereas SICCA OSS and OSDI were higher (p<0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 µm vs 43.1± 2.3 µm, p<0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p<0.01), and superior epithelium thickened (p<0.01) in the SS-DED group. Conclusion: Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.

Tobacco effects on ocular surface, meibomian glands, and corneal epithelium and the benefits of treatment with a lipid-based lubricant.

PURPOSE: Our aim was to evaluate the ocular surface in chronic smokers and to assess the benefit of sodium hyaluronate (SH) versus semi-fluorinated alkane (SFA) eyedrops on tear film, meibomian glands, and corneal epithelial thickness (CET). METHODS: This prospective randomized single-blinded study included smokers, who applied one eyedrop of Hyabak® on one eye (SH group) and one eyedrop of EvoTears® on the fellow eye (SFA group) 4 times daily for 2 months, and age-matched non-smokers. Ocular surface parameters, including tear film break-up time (TBUT) test and corneal fluorescein staining (CFS) score, lipid layer thickness (LLT), meibography (LipiView®), and CET measurements (Zeiss Cirrus HD-5000®), were assessed at baseline and after treatment. RESULTS: Seventy-eight eyes were included in the smokers group (39 in the SH subgroup and 39 in the SFA subgroup) and 42 eyes in the control group. At baseline, the smokers group had a higher prevalence of dry eye (100% vs 0%, p < 0.001) and of meibomian gland dysfunction (MGD) and lower CET measurements than controls (p < 0.05). TBUT, CFS, and LLT (controls vs SFA group: 64.02 ± 1.87 nm vs 49.56 ± 4.33 nm, p = 0.05) improved in the SFA subgroup after treatment, but not in the SH subgroup, and became equivalent to those of controls. Prevalence of dry eye decreased in the smokers group after treatment (controls vs SH group vs SFA group: 0% vs 12.82% vs 16.26%, p > 0.05). Meibomian gland morphological parameters and CET did not improve after treatment (p < 0.05). CONCLUSIONS: Smoking is associated with dry eye, MGD, and corneal epithelial thinning that seem to be only partially reversible with topical lubricants, preferably SFA.

Corneal Epithelium Asymmetry in Children With Atopy: The Effect of Hand Dominance.

Purpose: To evaluate the effect of eye rubbing on the epithelial thickness profile in tomographically normal corneas by AS-OCT and to compare right and left eyes in right-handed children. Methods: Thirty right-handed boys (mean age 11.2 years) with ocular allergy and history of eye rubbing were evaluated using Scheimpflug (Pentacam HR, Oculus Wetzlar, Germany) and anterior segment optical coherence tomography. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared between right and left eyes with a non-parametric Mann-Whitney test. A p-value lower than 0.05 was considered for statistical significance. Results: No eyes had topometric nor tomographic criteria for keratoconus. The min-max ET was lower in right eyes (-2.8 µm vs -3.5; p = 0.02). The difference between inferior and superior (I-S) octants was lower in right eyes (1.1 µm vs 1.9 µm; p = 0.03) as a result of inferotemporal thinning. The highest ET difference was registered between nasal and temporal octants and was more pronounced in the right eyes (2 µm vs 3.1 µm; p < 0.001). Conclusion: AS-OCT analyses reveal different epithelial thickness patterns between the eyes in young atopic patients, likely eye rubbers. Inferior and temporal epithelial thickness seem to be more affected by thinning in the eye on the side of the dominant hand.

Interobserver variability in MRI measurements of mesorectal invasion depth in rectal cancer.

PROPOSE: To assess the interobserver variability in MRI measurements of mesorectal invasion depth (MID) in rectal adenocarcinomas primarily staged as T3, by determining the level of interobserver agreement in the differentiation of individual T3 substages and of T3a-b vs. T3c-d disease, between readers with different levels of expertise. METHODS: A retrospective analysis of 60 patients classified by MRI as having T3 rectal cancers was performed. Each patient underwent MR examination in a 1.5 T machine and the standard imaging protocol included a high-resolution axial T2-weighted sequence in which the measurements were determined by independent radiologists (readers A and B, with 15 years and 1 year of experience, respectively). The rectum was further divided into quadrants and each reader selected the quadrant where the measurement was taken. The patients were grouped according to the MID (T3a < 1 mm; T3b 1-5 mm; T3c > 5-15 mm; T3d > 15 mm) and the interobserver reliability was tested using Cohen's kappa. RESULTS: Population included 40 males and 20 females with a median age of 65.9 years. Interobserver agreement on individual substage differentiation (T3 a, b, c and d) was moderate (K = 0.428) and in the quadrant evaluation the level of agreement was also moderate (K = 0.414). Nevertheless, the interobserver reliability for the differentiation between stages T3a-b vs. T3c-d was substantial (K = 0.697). CONCLUSIONS: There is no considerable interobserver variability when distinguishing T3a-b from T3c-d tumors, regardless of the quadrant where the MID is measured. Therefore, assessment of MID, for that purpose, is a reproducible MR parameter, irrespectively of the readers' experience.

Peritoneal disease: key imaging findings that help in the differential diagnosis.

The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant condition to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review, we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis.We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.

Impact of Graves Disease on Ocular Surface and Corneal Epithelial Thickness in Patients With and Without Graves Orbitopathy.

PURPOSE: Our aim was to assess ocular surface and tear film stability and corneal epithelial thickness (CET) in patients with Graves disease (GD) with and without Graves orbitopathy (GO). METHODS: This study included healthy age-matched controls and patients with GD. Symptoms (Ocular Surface Disease Index questionnaire) and signs (schirmer test and tear breakup time test) of dry eye disease were determined, according to the International Dry Eye Workshop II criteria of DED. CET map was also assessed. RESULTS: Twenty-four eyes were included in the control group, with a mean age of 41.00 ± 13.65 years, and 34 in the GD group, 18 with GO and 16 without GO, with a mean age of 44.44 ± 13.95 and 45.75 ± 10.59 years, respectively. All patients with GO had inactive disease (mean clinical activity score: 1.33 ± 0.69). Patients with GD had higher proportion of clinical diagnosis of dry eye disease (GO vs. GD without GO vs. controls: 77.77% vs. 75.00% vs. 4.17%), with higher Ocular Surface Disease Index (GO vs. GD without GO vs. controls: 15.44 vs. 15.06 vs. 9.88) and lower tear breakup time test (GO vs. GD without GO vs. controls: 6.33 s vs. 7.25 s vs. 11.63 s). Superior CET was lower in patients with GD (P < 0.05). No differences were found between patients with and without GO (P > 0.05). CONCLUSIONS: GD negatively influenced ocular surface and CET, with a higher level of eye dryness and corneal thinning regardless of GO status, suggesting that subclinical chronic inflammation may play a role in the pathogenesis of tear film and ocular surface stability.

Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens.

PURPOSE: To assess the clinical outcomes and patient satisfaction of the Tecnis Eyhance, an advanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL. DESIGN: Retrospective case-control study. METHODS: This study included 120 eyes of 60 patients (30 patients in each group) who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (Tecnis PCB00), as a control group, or advanced monofocal IOLs (Tecnis Eyhance ICB00). Ophthalmological evaluation included the measurement of binocular corrected distance visual acuity (CDVA), monocular and binocular uncorrected distance visual acuity (UDVA), and uncorrected intermediate VA (UIVA). In addition the binocular defocus curve was analyzed. Furthermore a subjective questionnaire (Catquest-9SF) was used to assess vision and life quality. RESULTS: The average binocular UDVA was 20/22 in the ICB00 group and 20/20 in the PCB00 model (p = 0.62). The average monocular UIVA was 20/32 in the ICB00 group and 20/40 in the control group (p < 0.001). We found the binocular UIVA, had a mean value of 20/30 in the ICB00, compared to 20/40 in the control group (p < 0.001). The reported dysphotopsia was not significantly different between both groups (p = 0.56). Regarding the life quality questionnaire, the ICB00 group showed less difficulty in activities requiring intermediate vision. CONCLUSION: Our results demonstrated a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control group, without compromising distance visual acuity. We also found a greater capability for intermediate distance activities (namely for computer use and reading price tags) when comparing ICB00 patients with the control group.

Safety of intravitreal triamcinolone and its impact on optic nerve morphology in patients treated for diabetic macular edema.

PURPOSE: To assess the impact of one intravitreal injection (IVT) of Triamcinolone Acetonide (TA) on intraocular pressure (IOP) and optic nerve structural parameters in patients treated for Diabetic Macular Edema (DME). METHODS: This retrospective study included patients with DME that were naïve to intraocular steroids and underwent one IVT of TA of 4 mg/0.1 mL and age-matched controls with DME without criteria for IVT. Patients records were reviewed for IOP (at baseline and a month after IVT) and optic nerve parameters measured by optical coherence tomography (up to 6 months before and 6 months after IVT). Exclusion criteria included glaucoma and treatment with hypotensive agents. RESULTS: Twenty-six eyes were included in the Control Group and 29 in the IVT Group, with a mean age of 65.10 ± 10.08 and 67.30 ± 4.71 years, respectively (p = 0.06). At baseline, IOP and optic nerve measurements were equivalent between groups (p > 0.05). One month after IVT, mean IOP measurements in IVT Group were higher than those of controls (17.84 ± 4.50 vs 11.59 ± 3.09 mmHg, p < 0.001). Ocular hypertension (OHT) developed in 17.24% of cases and reversed with topical medication. After one IVT, vertical cup/disc ratio was higher (0.57 ± 0.25 vs 0.60 ± 0.14, p = 0.04) and retinal nerve fiber layer thickness was globally lower (mean: 91.03 ± 4.25 vs 81.33 ± 19.10 µm, p = 0.001) in the IVT Group. CONCLUSION: Our results confirmed that intravitreal TA results in IOP increase. This seems to negatively affect optic nerve morphology, even in patients without OHT or adequately treated with hypotensive agents.

Retinal vascular impairment in patients newly diagnosed with obstructive sleep apnea syndrome.

BACKGROUND: To evaluate retinal morphological and vascular parameters in patients recently diagnosed with obstructive sleep apnea syndrome (OSAS) and determine the correlation between retinal vascular density and the severity of OSAS. METHODS: We performed a retrospective study on the retinal vasculature of patients with OSAS and age-match healthy controls. OSAS was confirmed by full-night cardiorespiratory polygraphy. Patients were divided into three groups according to disease severity given by apnea-hypopnea index (AHI) i.e., mild, moderate or severe. Retinal thicknesses and vascular density were compared among groups, for both the macula and optic disc. Correlation between vascular density and clinical features were also assessed. RESULTS: The study included 30 eyes of patients with OSAS and 12 controls. No differences were found regarding retinal thickness in both the macula and the optic disc between OSAS patients and controls. In contrast, significant differences were found in the peripapillary vessel density between groups versus control patients. The greatest difference being between severe OSAS and controls (49.4% ± 2.1 versus 40.4% ± 4.2 respectively, p=0.01). Peripapillary vessel density was found to significantly and negatively correlate with AHI (p=0.02; r= -0.74) and directly correlate with the lowest percutaneous oxygen saturation (p=0.02; r= 0.58). CONCLUSIONS: This study indicates that OSAS is associated with retinal microvasculature impairment, that seems to mainly affect the optic disc. This suggests that microvascular damage increases with the increasing severity of OSAS. As such, prospective trials are needed to clarify if this vascular peripapillary damage precedes glaucomatous optic neuropathy in OSAS patients.

Non-Paralytic Pontine Exotropia as a Predominant Sign of Brainstem Infarction - A Case Report.

The association of internuclear ophthalmoplegia (INO) with exotropia in the contralateral eye is a rare finding, known as non-paralytic pontine exotropia (NPPE). We report a case of an 80-year-old woman with acute onset of diplopia on admission who presented with left eye exotropia with left-beating nystagmus whilst fixating with the right eye and inability to adduct the right eye on left gaze. Brain magnetic resonance imaging showed two small areas of vertebrobasilar territory ischaemic stroke, one beneath the inferior portion of the aqueduct and another in the right occipital lobe. Our case highlights an interesting clinical manifestation of brainstem infarction that, along with ocular motility examination, allowed us to review its pathophysiology, including the influence of the contralateral paramedian pontine reticular formation stimulation in the mechanism of contralateral exotropia in NPPE. The fast clinical resolution of these cases can explain the scarcity of NPPE reports.

Corneal Epithelial Thickness Profile in Healthy Portuguese Children by High-Definition Optical Coherence Tomography.

INTRODUCTION AND OBJECTIVE: To evaluate corneal epithelial thickness (ET) and corneal thickness (CT) profiles in healthy eyes of Portuguese children and provide information to establish the first normative Caucasian database for these age group. METHODS: Sixty healthy eyes of 60 children aged between 8 and 18 were evaluated using the Cirrus high-definition optical coherence tomography device. The average ET and CT were assessed using Cirrus Review Software with predefined concentric corneal ring-shaped zones. Specific regions of ET (central, superior, inferior, temporal, nasal, superonasal, inferotemporal, superotemporal and inferonasal) were also assessed. The mean ET, the mean CT and the difference of ET in corresponding octants were compared by gender. Correlations between central epithelial thickness (CET), age and refractive error were evaluated. RESULTS AND DISCUSSION: The average ET was lower in the peripheric zones, whereas the average CT was higher. ET was thinner in the superior area than in the inferior (p<0.05). ET was thicker in boys than in girls (p<0.05), but CT did not differ. CET was not correlated with older age or refractive error. CONCLUSION: Optical coherence tomography analysis of ET reveals that it is thinner in the periphery, where the CT is thicker. Unlike CT, ET seems to be influenced by gender. ET profile proved to be a useful tool in keratoconus diagnosis and subclinical keratoconus detection in adults. As epithelial changes occur early in the disease and keratoconus is more aggressive in pediatric population, a normative database of ET profile could contribute to enhance early recognition of the disease in this age group.

The effect of insulin pump therapy in retinal vasculature in type 1 diabetic patients.

BACKGROUND/OBJECTIVES: Continuous subcutaneous insulin infusion (CSII) is a treatment for type 1 diabetes that improves metabolic control and reduces micro and macrovascular complications. The aim of this study was to compare the effect of CSII versus traditional multiple daily injections (MDI) therapy on retinal vasculature. METHODS: We performed a prospective study with type 1 diabetic patients with no prior history of ocular pathology other than mild diabetic retinopathy. The patients were divided into two groups according to their therapeutic modality (CSII vs MDI). The retinal nerve fiber layers thickness and vascular densities were compared between groups in both macula and optic disc. The correlations between vascular density and clinical features were also determined. Statistical significance was defined as p < 0.05. RESULTS: The study included 52 eyes, 28 in the insulin CSII group. The mean age was 36.66 ± 12.97 years, with no difference between groups (p = 0.49). The mean glycated hemoglobin (HbA1c) was found to be lower in the CSII group (7.1% ± 0.7 vs 7.5% ± 0.7 p < 0.01). The parafoveal vascular density was found to be higher in the CSII group (42.5% ± 0.4 vs 37.7% ± 0.6, p < 0.01). We found an inverse correlation between HbA1c value and parafoveal vascular densities (p < 0.01, r = -0.50). CONCLUSION: We found that CSII provided better metabolic control than MDI and this seemed to result in higher parafoveal vascular density. As lower vascular density is associated with an increased risk of diabetic retinopathy, these results suggest that CSII could be the safest therapeutic option to prevent retinopathy.

Preliminary Clinical Outcomes of a New Enhanced Depth of Focus Intraocular Lens.

PURPOSE: To assess the preliminary clinical outcomes and patient satisfaction of the new enhanced depth of focus (EDOF) LuxSmart™ intraocular lens IOL and to compare with a conventional monofocal IOL (Akreos™) in patients who had undergone bilateral cataract surgery. METHODS: Twelve patients underwent bilateral LuxSmart IOL implantation, and twelve underwent bilateral Akreos IOL implantation. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66cm, uncorrected near visual acuity (UNVA) at 40cm and defocus curve were assessed. Patients-reported visual function was inquired by Catquest-9SF. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered for statistical significance. RESULTS: The mean IOL power was +21.90D in LuxSmart group and +22.30D in Akreos. Monocular UDVA (p = 0.32) and CDVA (p = 0.52) did not differ between groups. The average binocular UIVA (0.18 ± 0.12 logMAR vs. 0.30 ± 0.13 logMAR, p < 0.001) and UNVA (0.38 ± 0.14 logMAR vs. 0.44 ± 0.17 logMAR, p = 0.02) were higher in LuxSmart IOL group. No patients reported disabling photic phenomena in either group. CONCLUSION: This study shows that new LuxSmart EDOF IOL achieved higher performance for intermediate and near vision compared with a conventional monofocal IOL, without increasing the risk of dysphotopsias. LuxSmart may be an attractive and safe option for patients who desire spectacle independence for distance and intermediate vision after cataract surgery.

Long-term macular vascular density measured by OCT-A in children with retinopathy of prematurity with and without need of laser treatment.

PURPOSE: To assess long-term vascular density measured by optical coherence tomography angiography (OCT-A) in former preterm children with history of retinopathy of prematurity (ROP) with and without need of laser treatment. METHODS: This observational study included former preterm children that developed ROP stage 2 or 3. Infants were divided in two groups according to previous need of laser treatment, and underwent a complete ophthalmologic evaluation, including assessment of macular morphologic and vascular parameters by OCT-A. RESULTS: Fifteen eyes were included in group 1 (laser-requiring ROP) and 19 in group 2 (non-treated ROP). Group 1 had lower mean gestational age and birth weight values than group 2 (p < 0.001 and p < 0.001, respectively). Best corrected visual acuity (BCVA) was lower in group 1 (0.08 ± 0.04 logMAR vs 0.04 ± 0.07 logMAR, p = 0.03). Laser-requiring ROP had lower vascular parameters, especially of central and internal vascular density (9.15 ± 2.75 vs 10.52 ± 0.86 mm-1, p = 0.05; 13.74 ± 1.00 vs 15.86 ± 0.64 mm-1, p = 0.05; respectively), and lower avascular zone circularity (0.58 ± 0.06 vs 0.76 ± 0.02, p < 0.001). Mean macular thickness was higher in group 1 (300.50 ± 10.50 vs 281.11 ± 2.50 µm, p = 0.05). Best corrected visual acuity (BCVA) was correlated with superficial vascular density (p < 0.05). CONCLUSION: Laser-requiring ROP seems to result in a decrease of long-term BCVA, which is at least partially attributed to a decrease in superficial macular vascular density. However, prematurity degree was more pronounced in children that required treatment, which might have influenced our results.

New Insights in Vanishing White Matter Disease: Isolated Bilateral Optic Neuropathy in Adult Onset Disease.

BACKGROUND: Vanishing white matter disease (VWMD) is a rare disease affecting cerebral white matter. The adult form is even rarer and manifests with motor symptoms, behavioral problems, and dementia. There is no treatment and progression is inevitable. We describe a case with atypical manifestations and an unusual course. METHODS: Description of a 42-year-old man with VWMD complaining of progressive visual loss in the right eye. RESULTS: The patient's visual acuity was 20/60, right eye, and 20/25, left eye, with pale optic nerves bilaterally. MRI showed atrophy of the corpus callosum, diffuse rarefaction of cerebral white matter including the anterior and posterior visual pathways. CONCLUSION: Our patient had no further symptoms besides loss of visual acuity, which is rare in patients with VWMD of the same age and genetic mutation.