RELATIONSHIP BETWEEN INTEGRITY OF HENLE FIBERS AND VISUAL ACUITY IN MYOPIC FOVEOSCHISIS.

BACKGROUND: To analyze the relationship between Henle fiber (HF) integrity and visual acuity in highly myopic eyes with foveoschisis. METHODS: Three hundred and fifty-eight highly myopic eyes were included in this study and divided into three groups according to the Triton optical coherence tomography results. Group 1 included 19 eyes with myopic foveoschisis where the inner and outer retina were connected by a columnar structure in the HF layer at the foveolar area. Group 2 included 17 eyes with myopic foveoschisis where the columnar structure was disrupted in the HF layer at the foveolar area. Group 3 included 322 eyes without myopic foveoschisis or other ocular disease. Clinical and optical coherence tomography findings were obtained and compared. RESULTS: Eyes with vitreomacular traction, arteriolar traction, and longer axial length were more likely to have myopic foveoschisis with intact columnar structure in the HF layer (odds ratio [OR], 12.84; P = 0.001; OR, 7.63; P = 0.04; OR, 2.03; P = 0.03) and with disrupted columnar structure in the HF layer (OR, 65.21; P = 0.001; OR, 6.60; P = 0.02; OR, 2.63; P = 0.01). Moreover, eyes with disrupted columnar structure in the HF layer presented a lower best-corrected visual acuity (P = 0.001), longer axial length (P = 0.001; P = 0.009), higher central foveolar thickness (P = 0.001; P = 0.02), and a higher prevalence of vitreomacular traction (P = 0.001; P = 0.04) than control or integrity HF eyes. Furthermore, worse best-corrected visual acuity was related to myopic foveoschisis with disrupted columnar structure in the HF layer (P < 0.01). CONCLUSION: The integrity of HF in patients with myopic foveoschisis appears to play an important role in visual acuity.

Evolution of corneal epithelial remodeling after myopic laser in situ keratomileusis surgery measured by anterior segment optical coherence tomography combined with Placido disk.

PURPOSE: To investigate patterns of short- and long-term variations in corneal epithelial thickness (CET) after myopic laser in situ keratomileusis (LASIK) using anterior segment optical coherence tomography (AS-OCT) combined with Placido disk-based topography. METHODS: In this retrospective study, 36 subjects (72 eyes) who underwent LASIK myopic surgery and 53 healthy subjects (106 eyes) who served as controls were enrolled. AS-OCT (MS-39) was performed in all patients before, 1 day, 1 month, and 6 months after surgery. Statistical analysis was performed to analyze CET changes over time after LASIK and to detect patterns of definitive CET remodeling compared to healthy subjects. Multivariate analysis was performed to look for possible predictors of final CET. RESULTS: There was no statistically significant difference between groups in terms of demographic and anterior segment parameters (all P > 0.05). After LASIK, all sectors and rings got thicker over time (1.62-8.32 µm; P < 0.01). Except for the central sector, all areas achieved the thickest CET value one day after surgery with a progressive epithelial thinning between 1 and 6 months of follow-up. Changes on CET occurred independently of the grade of myopia before LASIK or final refraction (P > 0.05). None of the clinical variables studied, including diopters corrected, were found to be correlated with final CET (P > 0.05). CONCLUSION: Independent of anterior segment parameters and diopters corrected, CET becomes thicker after LASIK surgery. Central and inner ring sectors thicken more than those more peripheral. CET remodeling after myopic LASIK should be taken into consideration when planning refractive surgery.

FACE MASK CONTAMINATION DURING COVID-19 PANDEMIA. A STUDY ON PATIENTS RECEIVING INTRAVITREAL INJECTIONS.

PURPOSE: To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks. METHODS: Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples. RESULTS: The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/µL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44). CONCLUSION: Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.

Correlation between retinal nerve fibre layer thickness and white matter lesions in Alzheimer's disease.

OBJECTIVES: Early diagnosis in Alzheimer's disease (AD) is crucial in order to implement new therapeutic strategies. The retina is embryologically related to the brain. Thus, the possible usefulness of optical coherence tomography (OCT) in the early detection of AD is currently being studied. Our aim was to study the relationship between retinal nerve fiber layer (RNFL) thickness and AD. METHODS: We undertook an observational, analytical, cross-sectional study with consecutive sampling of 32 patients with AD or mild cognitive impairment and a group of healthy controls (C). The total number of eyes studied was 64. An ophthalmological and a comprehensive neuropsychological evaluation were performed in all participants. Quantification of white matter lesions and study of atrophy of the hippocampus by cerebral magnetic resonance were also performed. RESULTS: We observed a significant linear trend towards a thinning of RNFL as the degree of cognitive deterioration increased, in the superior and temporal quadrants of the retina. A significant correlation was also noted between the mean thickness of the RNFL of the left temporal quadrant and occipital white matter lesions (r = -0.579, p = 0.038). CONCLUSIONS: OCT could be a safe, rapid noninvasive tool providing useful biomarkers in the early detection of cognitive deterioration and AD.

Outcomes of Medial Rectus Recession With Adjustable Suture in Acute Concomitant Esotropia of Adulthood.

PURPOSE: To review and analyze the surgical outcomes of bilateral medial rectus recession with adjustable suture in acute concomitant esotropia of adulthood (ACEA). METHODS: The charts of all adults diagnosed as having ACEA between 2004 and 2017 were reviewed. Best corrected visual acuity, refractive error, ocular alignment measured in prism diopters (PD), and stereopsis were examined at presentation, 1 day postoperatively, and final follow-up visit (median: 10 months; range: 4 to 144 months). All patients underwent bilateral medial rectus recession using adjustable suture surgery and topical anesthesia. Statistical analysis was used to calculate surgical dose-responses and to study possible correlations with clinical parameters. RESULTS: Fifteen patients diagnosed as having ACEA were included. The mean age was 39.2 ± 10.7 years, and the mean refractive errors in the right and left eyes were -3.97 ± 2.87 and -3.60 ± 2.74 diopters (D), respectively. Average esotropia deviations at near and distance were 22.7 ± 7.2 and 23.0 ± 7.5 PD. All patients improved with medial rectus recession (mean: 12.0 ± 2.2 mm) with a final mean deviation of 0.7 ± 1.8 PD. The mean dose-responses at 1 day postoperatively and final visit were 1.86 ± 0.58 and 1.83 ± 0.43 PD/mm, respectively. There was a significant positive correlation between surgical dose-responses at 1 day postoperatively and final visit and preoperative deviation (R2 = 0.55; P < .001; R2 = 0.66; P < .001), whereas there were no significant correlations with age, sex, refractive error, BCVA, or stereopsis (all P > .05). CONCLUSIONS: Good postoperative and final outcomes are achieved with large medial rectus recessions in ACEA. A larger dose-response can be expected in large preoperative deviations, independent of other clinical and ocular parameters. [J Pediatr Ophthalmol Strabismus. 2019;56(2):101-106.].

Ganglion Cell Complex Analysis as a Potential Indicator of Early Neuronal Loss in Idiopathic Intracranial Hypertension.

Reliable visual field testing is the gold standard in identifying future vision loss in patients with Idiopathic Intracranial hypertension (IIH). However, when field performance is unreliable, GCC analysis may be useful. We evaluated IIH patients over three visits: initial visit, follow-up visit and a third visit, almost 1 year later. We evaluated mean deviation (MD), GCC and RNFL at presentation and the second visit and compared it to the mean deviation (MD) on fields at the third visit. As early as the second visit, GCC loss correlated with visual field results seen at the third visit.

FACTORS ASSOCIATED WITH SEROUS RETINAL DETACHMENT IN HIGHLY MYOPIC EYES WITH VERTICAL OVAL-SHAPED DOME.

PURPOSE: This study investigated factors associated with persistent serous retinal detachment in highly myopic eyes with vertical oval-shaped domes. METHODS: Twenty-eight highly myopic patients (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmologic examinations, including axial-length measurement and fluorescein angiography. Spectral domain optical coherence tomography scans through the fovea measured choroidal thicknesses, macular bulge height, and vitreoretinal interface factors. RESULTS: No studied variables (age, sex, spherical equivalence, axial length, vitreomacular traction, epiretinal membrane, and internal limiting membrane detachment) except higher macular bulge height (P = 0.03) and a reduced macular choroidal thickness (P = 0.02) were associated with the risk of serous retinal detachment. No statistically significant differences in best-corrected visual acuity were observed between the study and control groups. Serous retinal detachment always occurred at the top of the inward incurvation of the macula and was characterized by multiple hyperfluorescent granular patches on fluorescein angiography. CONCLUSION: A higher macular bulge height and a reduced macular choroidal thickness might be important factors in the development of serous retinal detachment in patients with vertical oval-shaped domes.

Comparison of long-term clinical evolution in highly myopic eyes with vertical oval-shaped dome with or without untreated serous retinal detachment.

BACKGROUND: To compare the long-term clinical evolution of highly myopic eyes with vertical oval-shaped dome associated with or without untreated serous retinal detachment. METHODS: Twenty-eight patients with high myopia (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmological examinations, including optical coherence tomography at baseline every 6 months for 2 years. Fluorescein angiographies were performed in cases with serous retinal detachment to rule out choroidal neovascularisation. RESULTS: There were no statistical differences in baseline age, sex, spherical equivalence or axial length between the two groups. Serous retinal detachment always occurred at the top of the inward macular incurvation. Moreover, no statistically significant differences in mean best-corrected visual acuity were observed during the 24-month follow-up period in the study and control groups and between the two groups at all time points. The mean central foveal thickness was significantly higher in the study group at each visit (p=0.001, in all cases). At the final follow-up visit, complete resolution of the serous retinal detachment was achieved in 1 of the 11 study group's eyes. CONCLUSIONS: Serous retinal detachment is a complication associated with vertical oval-shaped domes that seems to remain stable in terms of visual function over time without treatment.

Susac's syndrome: isolated retinal artery occlusion after 10 years of remission.

Susac's syndrome, or microangiopathy of the retina, inner ear, and brain, is a rare condition characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. The complete triad has been documented in 85% of reported cases. At clinical onset, the most common manifestations are central nervous system symptoms, followed by visual symptoms and hearing disturbances. Although the clinical course of Susac's syndrome is usually self-limiting, fluctuating, and monophasic, clinical polycyclic and chronic courses have also been described. Likewise, recurrences of the full triad after more than 10 years of remission have been reported. We describe a 21-year-old woman who presented with branch retinal artery occlusions and magnetic resonance imaging findings compatible with Susac's syndrome without objective hearing loss. After 10 years of remission, the patient complained of visual field loss due to new retinal ischemia. Neither other symptoms nor neuroimaging or audiometry pathologic findings were found during the clinical course.

Análisis de las diferencias cuantitativas en el grosor de la capa de fibras nerviosas retiniana entre la tomografía de coherencia óptica de dominio-tiempo y de dominio-espectral en pacientes con esclerosis múltiple remitente recurrente / Analysis of the quantitative differences in the thickness of the retinal nerve fibre layer between time-domain and spectral-domain optical coherence tomography in patients with relapsing-remitting multiple sclerosis

Introducción. La tomografía de coherencia óptica (OCT) es una herramienta cada vez más extendida en el estudio de las enfermedades neurodegenerativas. Objetivos. Analizar y correlacionar el grosor de la capa de fibras nerviosas retiniana (CFNR) mediante OCT de dominio-tiempo y dominio-espectral en pacientes con esclerosis múltiple (EM) remitente recurrente, con y sin antecedente de neuritis óptica (NO). Sujetos y métodos. Estudio transversal del grosor medio y por cuadrantes de la CFNR en 15 sujetos libres de enfermedad, 28 con EM sin historia previa de NO y 18 con antecedentes de NO. La exploración oftalmológica completa incluía la medición de la CFNR mediante tomógrafos de dominio-tiempo y dominio-espectral. Resultados. Existen diferencias estadísticamente significativas entre ambos tomógrafos al comparar el grosor medio de la CFNR en el grupo control (p = 0,000), el grupo con antecedentes de NO (p = 0,000) y el grupo sin NO (p = 0,000). Hemos obtenido una fuerte correlación, estadísticamente significativa y directamente proporcional entre el grosor medio de la CFNR medido con ambos tomógrafos en el grupo control (rho = 0,842; p = 0,000), y los grupos de ojos sin NO (rho = 0,91; p = 0,000) y con NO (rho = 0,902; p = 0,000). Conclusiones. Existe una fuerte correlación en la medición del grosor de la CFNR entre ambos tomógrafos en pacientes con EM, con y sin antecedente de NO. La OCT de dominio-tiempo cuantifica grosores mayores, por lo que ambos tomógrafos se demuestran eficaces en el estudio de la EM, aunque los resultados no son intercambiables ni extrapolables (AU)

Introduction. Optical coherence tomography (OCT) is a tool that is increasingly more commonly used in the study of neurodegenerative diseases. Aims. To analyse and correlate the thickness of the retinal nerve fibre layer (RNFL) by means of time-domain and spectraldomain OCT in patients with relapsing-remitting multiple sclerosis (MS), with and without a history of optic neuritis (ON). Subjects and methods. We conducted a cross-sectional study of the thickness (mean and by quadrants) of the RNFL of 15 disease-free subjects, 28 with MS with no prior history of ON and 18 with a history of ON. The full ophthalmologic examination included measurement of the RNFL by means of time-domain and spectral-domain tomography. Results. Statistically significant differences are found between the two tomography scans on comparing the mean thickness of the RNFL of the control group (p = 0.000), the group with a history of ON (p = 0.000) and the group without ON (p = 0.000). We obtained a strong, statistically significant and directly proportional correlation between the mean thickness of the RNFL measured with the two types of tomography in the control group (rho = 0.842; p = 0.000), and the groups of eyes without ON (rho = 0.91; p = 0.000) and with ON (rho = 0.902; p = 0.000). Conclusions. There is a strong correlation between the two tomography scans in the measurement of the thickness of the RNFL in patients with MS, with and without a history of ON. Time-domain OCT quantifies greater thicknesses, and therefore both types of tomography have proven to be effective in the study of MS, although the results cannot be interchanged or extrapolated (AU)

Susac's syndrome: isolated retinal artery occlusion after 10 years of remission / Síndrome de Susac: oclusão isolada da artéria retiniana após 10 anos de remissão

ABSTRACT Susac's syndrome, or microangiopathy of the retina, inner ear, and brain, is a rare condition characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. The complete triad has been documented in 85% of reported cases. At clinical onset, the most common manifestations are central nervous system symptoms, followed by visual symptoms and hearing disturbances. Although the clinical course of Susac's syndrome is usually self-limiting, fluctuating, and monophasic, clinical polycyclic and chronic courses have also been described. Likewise, recurrences of the full triad after more than 10 years of remission have been reported. We describe a 21-year-old woman who presented with branch retinal artery occlusions and magnetic resonance imaging findings compatible with Susac's syndrome without objective hearing loss. After 10 years of remission, the patient complained of visual field loss due to new retinal ischemia. Neither other symptoms nor neuroimaging or audiometry pathologic findings were found during the clinical course.

RESUMO A síndrome de Susac, ou a micro angiopatia da retina, do ouvido interno e do cérebro, é uma condição rara caracterizada pela tríade clínica de encefalopatia, oclusão de ramo da artéria retiniana e perda de audição neuro-sensorial. A tríade completa é documentada em 85% dos casos registrados. No início dos sinais clínicos, a manifestação mais comum relaciona-se ao sistema nervoso central, seguida por sintomas visuais e distúrbios auditivos. Apesar do curso clínico da síndrome de Susac ser usualmente auto limitante, variável e monofásico, cursos clínicos policíclicos e crônicos têm sido também descritos. Do mesmo modo, recorrências da tríade completa após mais de 10 anos de remissão têm sido relatadas. Descrevemos o caso de uma mulher de 21 anos que apresentava oclusões de ramos da artéria retiniana e imagens por ressonância magnética compatíveis com a síndrome de Susac, sem comprometimento objetivo da audição. Dez anos após a remissão, a paciente queixou-se de perda de campo visual devido a uma nova isquemia da retina. Nenhum outro sintoma, ou neuroimagem ou achado audiométrico patológico foi observado durante o curso clínico.

Two- and three-dimensional topographic analysis of pathologically myopic eyes with dome-shaped macula and inferior staphyloma by spectral domain optical coherence tomography.

PURPOSE: To investigate the posterior anatomical structure of pathologically myopic eyes with dome-shaped macula and inferior staphyloma using spectral domain optical coherence tomography (SD-OCT). METHODS: Our database of 260 pathologically myopic eyes was analyzed retrospectively to identify patients with dome-shaped macula and inferior staphyloma. All patients underwent vertical and horizontal SD-OCT scans across the central fovea, with three-dimensional macular map reconstruction. Best-corrected visual acuity, axial length, and choroidal thickness measurements were recorded. The macular bulge height was also analyzed in eyes with dome-shaped macula. In the three-dimensional images, the symmetry and orientation of the main plane of the inward incurvation of the macula were examined. RESULTS: Twenty-eight (10.7%) of the 260 pathologically myopic eyes had dome-shaped macula of one of three different types: a round radially symmetrical dome (eight eyes, 28.5%), a horizontal axially symmetrical oval-shaped dome (15 eyes, 53.5%), or a vertical axially symmetrical oval-shaped dome (five eyes, 17.8%). The macular bulge height was significantly greater in horizontal oval-shaped dome eyes (p = 0.01, for each comparison). Inferior posterior staphylomas were observed in ten (3.8%) of the 260 pathologically myopic eyes with asymmetrical macular bends. CONCLUSIONS: Vertical and horizontal OCT sectional scanning in combination with three-dimensional macular map reconstruction provides important information for understanding the posterior anatomical structure of dome-shaped macula and inferior staphyloma in pathologically myopic eyes.

Analysis of peripapillary choroidal thickness in non-arteritic anterior ischaemic optic neuropathy.

PURPOSE: To analyse peripapillary choroidal thickness (PCT) in non-arteritic ischaemic optic neuropathy (NAION). METHODS: 28 patients diagnosed with NAION (37 affected and 19 unaffected eyes) and 38 disease-free control individuals (38 eyes) were analysed using enhanced-depth imaging of spectral-domain optical coherence tomography. A vertical and a horizontal raster scan centred on the optic nerve were obtained per eye. PCT was measured at the superior, inferior, nasal and temporal quadrants from the posterior edge of the retinal pigment epithelium to the choroid-sclera junction at 500 µm intervals up to 2000 µm away from the optic nerve. Statistical analysis was used to compare average PCT and to correlate PCT with other ocular and systemic parameters. RESULTS: Mean PCT in NAION eyes and control group was 148.18±42.68 µm and 182.90±59.81 µm, respectively (p=0.005). Except for inferior PCT (p=0.158), superior, nasal and temporal PCT were significantly thinner in the NAION eyes than in the control group (p=0.006, 0.002 and 0.046). Thinner PCT, adjusted for refractive error, was associated with the diagnosis of NAION (p=0.048). Similarly, unaffected contralateral eyes showed a significant thinner PCT compared with the control group (p=0.024). Diagnosis of NAION was negatively associated with PCT in NAION eyes (p=0.008; OR 0.98; 95% CI 0.97 to 0.99) and in their contralateral unaffected eyes (p=0.043; OR 0.98; 95% CI 0.97 to 0.99). CONCLUSIONS: Eyes affected by NAION and contralateral unaffected eyes showed significantly thinner PCT compared with disease-free control eyes after adjusting for refractive error.

Retinal pseudoangiitis after intravitreal triamcinolone.

We present a case of a 40-year-old woman with a fundus image similar to frosted retinal angiitis after undergoing pars plana vitrectomy and intravitreal triamcinolone injection. The patient with diabetic retinopathy was referred to our hospital with vision loss in her right eye secondary to vitreous haemorrhage. After pars plana vitrectomy and injection of triamcinolone acetonide a funduscopy examination revealed deposits of triamcinolone along the retinal vessels simulating a frosted retinal angiitis. Triamcinolone deposits along blood vessels could be the result of the reabsorption process of these crystals by the perivascular macrophages. Further studies are needed.