Evaluation of retinal vascular and structural alterations in pediatric idiopathic intracranial hypertension patients without papilledema.

PURPOSE: The aim of this study was to evaluate retinal structural and microvascular alterations using optical coherence tomography-angiography (OCTA) in pediatric idiopathic intracranial hypertension (IIH) patients with regressed papilledema. METHODS: This study included 40 eyes of 21 IIH patients and 69 eyes of 36 healthy controls. Radial peripapillary capillary (RPC) vessel density and peripapillary retinal nerve fiber layer (RNFL) thickness were evaluated by XR Avanti AngioVue OCTA (Optovue, Fremont, CA, USA). The data were obtained from measurement zones that are automatically divided into two equal hemispheres (superior and inferior) and eight quadrants (superior-temporal, superior-nasal, inferior-temporal, inferior-nasal, nasal-superior, nasal-inferior, temporal-superior, temporal-inferior). Initial cerebrospinal fluid (CSF) pressure, grade of papilledema, and duration of follow-up were recorded. RESULTS: There were significant differences in RPC vessel densities and RNFL thicknesses between the study groups (p Ëƒ 0.05). Significantly higher RPC vessel density measurements were observed in the patient group for the whole image, peripapillary, inferior-hemi, and whole nasal quadrants (p < 0.05). Except for the temporal-superior, temporal-inferior, inferior-temporal, and superior-temporal quadrants, the RNFL in all regions was significantly thicker in the IIH group than in the control group (p Ë‚ 0.001). CONCLUSIONS: RNFL thickness and RPC vessel density were significantly different between the IIH patient and control groups, suggesting that retinal microvascular and subclinical structural changes that were potentially secondary to CSF pressure can persist after the resolution of papilledema. However, our results should be confirmed by further longitudinal studies investigating the progress of these alterations to determine their effects on peripapillary tissues.

Evaluation of ocular microvascular characteristics in smokers and patients with chronic obstructive pulmonary disease using an optical coherence tomography angiography.

PURPOSE: To investigate retinal microvascular changes in patients with chronic obstructive pulmonary disease (COPD) using optical coherence tomography angiography (OCTA) and to compare these values with those of smokers and healthy non-smokers. METHODS: This study was performed on 38 eyes of 38 patients with COPD, 30 eyes of 30 smokers, and 31 eyes of 31 healthy non-smokers. Foveal avascular zone (FAZ) area, superficial (SCP) and deep (DCP) capillary plexus (whole image, fovea, parafovea, and perifovea) and radial peripapillary capillary (RPC) vessel densities (whole image, peripapillary, and inside disc) were evaluated via OCTA device (Optovue, Fremont, CA, USA). The forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio and FEV1 values of patients with COPD were recorded. RESULTS: There were statistically similar values in smoking pack-years between the smoker and COPD groups (p = 0.059). Entire SCP and DCP vessel densities were significantly different among the all groups (p < 0.05); for these parameters, the control group had the highest and the COPD group had the lowest vessel density values. Significantly decreased RPC vessel densities in all regions were detected in the COPD group compared with the other groups. Multiple regression analysis showed significant positive correlations between the FEV1 and the SCP, DCP, and RPC vessel densities (for all, p < 0.05). CONCLUSIONS: This study detected lower vessel densities in patients with COPD than in smokers and healthy controls and reported decreased vessel density measurements with increasing COPD severity. COPD patients with or without a history of smoking may benefit from higher prioritization in terms of ophthalmic screening to prevent ocular complications.

Quantitative OCT angiography of the retinal and choroidal vascular circulation in pediatric patients with neurofibromatosis type 1.

PURPOSE: To investigate retinal and choroidal microvascular changes in neurofibromatosis type 1 (NF1) pediatric patients using optical coherence tomography angiography (OCTA). METHODS: This study was performed on 21 eyes of 21 NF1 patients and 30 eyes of 30 healthy subjects. Foveal avascular zone (FAZ) parameters, including area, perimeter, acircularity index, and foveal density, were measured using OCTA. Superficial (SCP) and deep (DCP) capillary plexus and radial peripapillary capillary (RPC) vessel densities and choriocapillaris flow were also evaluated. Choroidal nodules and thickness were detected using infrared reflectance and enhanced-depth imaging OCT. RESULTS: No significant differences were observed for FAZ parameters or SCP and RPC vessel densities between groups. DCP vessel densities in the perifovea were significantly lower in the NF1 group than in the control group (P = 0.001). A significantly lower choriocapillaris flow area (P < 0.001) and increased subfoveal and nasal perifoveal choroidal thickness (P < 0.001) were observed in the NF1 group. Choriocapillaris flow area tended to be inversely related to the number of choroidal nodules in the NF1 group. CONCLUSIONS: Perifoveal DCP vessel density and choriocapillaris flow significantly differed between NF1 patients and controls, suggesting that retinal and choroidal vascular microcirculation is affected in the former, potentially by choroidal nodules. Further longitudinal studies are required to determine the effects of these differences on circulation in the posterior segment of the eye.

Evaluation of the radial peripapillary capillary density in unilateral branch retinal vein occlusion and the unaffected fellow eyes.

Background: Given that unilateral branch retinal vein occlusion (BRVO) and glaucoma share common systemic vascular risk factors, the fellow eyes of patients with BRVO may be at increased risk of glaucoma. Objectives: To analyze the radial peripapillary capillary density (RPCD) in eyes with unilateral BRVO and their unaffected fellow eyes using optical coherence tomography angiography (OCTA). Design: Cross-sectional, prospective study. Methods: The study included 120 eyes of 80 patients: 40 affected eyes of BRVO, 40 fellow eyes of BRVO, and 40 control eyes. The RPCD, retinal nerve fiber layer thickness (RNFLT) were analyzed using OCTA. Results: RPCDs in the whole image, peripapillary region, all the hemispheres, and quadrants were statistically lower in the affected eyes than in both the fellow and control eyes (p < 0.05 for all). RPCD values in the whole image and the peripapillary region were significantly lower in the fellow eyes than in the control eyes (p = 0.013, and p = 0.021, respectively). RNFLTs in the peripapillary region, inferior hemisphere and inferior quadrant were significantly lower in the affected eyes than in the control eyes (p < 0.05 for all). No significant differences were detected between the fellow eyes and the control eyes in term of RNFLT values in any regions (p > 0.05 for all). Conclusion: Lower RPCD values despite similar RNFLT values were observed in the fellow eyes of patients with unilateral BRVO compared with healthy controls. These results may indicate the shared vascular mechanisms and risk factors that account for the development of BRVO and glaucoma.

The histopathological findings in excised upper eyelids of patients with dermatochalasis following collagen cross-linking treatment.

PURPOSE: To evaluate the histopathological effects of collagen cross-linking (CCL) on excised skin samples of patients undergoing upper eyelid blepharoplasty due to dermatochalasis. METHODS: This study examined 74 excised eyelid skin samples from 37 dermatochalasis patients. Following an upper eyelid blepharoplasty, CCL with hypotonic riboflavin (0.1%) was applied. Both treated (right eyelid, CCL group) and untreated eyelid specimen (left eyelid, non-CCL group) sections were stained with hematoxylin-eosin and Masson's trichrome. The sections were evaluated for the following parameters: the collagen status (parallel, oblique, and perpendicular), the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers. RESULTS: There were no statistically significant differences in the collagen status, the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers between the CCL and non-CCL groups (p > 0.05 for all). Although the lack of statistically significant differences, the structure of the treated eyelid collagen fibers was more parallel in 48% of the participants than in the untreated ones. For male patients, a statistically significant shorter distance between collagen fibers was observed in the CCL group (8.05 ± 2.04 µm) compared to the non-CCL group (9.97 ± 2.33 µm) (p = 0.042). CONCLUSION: In this study, more parallel collagen structures and tightly packed collagen fibers were detected in eyelid samples following CCL treatment. The authors note that the results of this study may be promising for further research, so the effect of CCL therapy on the eyelid may be an interesting subject for the treatment of non-severe or surgically inadequately corrected dermatochalasis.

Psychosocial Improvements in Children and Their Parents Following Strabismus Surgery.

PURPOSE: To evaluate the psychosocial effects of strabismus surgery, the authors investigated the psychiatric symptoms and quality of life of children with strabismus and their parents. METHODS: Children with strabismus between 6 and 18 years old (n = 39) and their parents (n = 39) were included. Psychiatric problems and the health-related quality of life were assessed with the Child Behavior Checklist and Pediatric Quality of Life Inventory, respectively. The State-Trait Anxiety Inventory for Children and Beck Anxiety Inventory were administered to children and parents, respectively. All assessments were conducted before and 3 months after strabismus surgery. RESULTS: Compared with preoperative assessments, children with strabismus had significantly fewer psychiatric problems and a better quality of life after the surgery (P < .001). Following surgery, decreased symptom levels of anxiety scores were also obtained from children and their parents (P < .001). The amount of ocular realignment was directly correlated with improvement in social and attention problems among children (r = 0.354 and r = 0.324, respectively; P < .05). CONCLUSIONS: Successful strabismus surgery has positive effects on psychosocial functioning and quality of life in children and their families. Surgical interventions seem beneficial for the management of strabismus in improving both physical and mental health. [J Pediatr Ophthalmol Strabismus. 2022;59(4):261-268.].

The Effect of Pathological Retinal Changes on Retinal Capillary Circulation in Myopic Patients.

Objectives: Myopia is a common ocular disorder worldwide, leading to degenerative changes in the retina which is highly susceptible to vascular impairment. The aim of the study was to investigate the effects of pathological retinal changes on the retinal capillary structures using optical coherence tomography angiography (OCTA) in myopic patients. Methods: Thirty-two patients with high myopia (HM), 29 patients with pathological myopia (PM), and 38 healthy subjects with emmetropia (EM) were enrolled in this study. OCTA was performed to measure the following parameters: Foveal avascular zone (FAZ) area; FAZ perimeter; FAZ acircularity index (AI); and superficial, deep, and radial peripapillary capillary (RPC) vessel densities. Axial length (AL), spherical equivalent, and anterior chamber depth were evaluated. Results: Significant differences in the mean AL values were observed between the EM group and the other groups (p<0.001 for all); however, no significant differences were observed between the HM and PM groups (p=0.135). Significant differences in FAZ parameters, except for AI, were found among the three groups (p<0.05 for all). In all regions, except for the fovea and inside disc, the capillary plexus vessel densities were significantly lower in the PM group than in the other groups and were lower in the HM group than in the EM group (p<0.05 for all). Conclusion: Significant differences identified in capillary densities between the HM and PM groups, both of which present similar AL measurements, suggest that pathological retinal findings have significant effects on retinal perfusion independent of the effect of AL.

Quantitative investigation of the effect of surgically induced hypoparathyroidism on cataract development.

INTRODUCTION: Although cataract formation is known in hypoparathyroidism, lens clarity and its correlation with clinical parameters have not been investigated quantitatively before in patients with hypoparathyroidism. The aim of this study was to compare the crystalline lens clarity of patients with surgically induced hypoparathyroidism and healthy subjects. MATERIALS AND METHODS: Forty female patients with surgically induced hypoparathyroidism and 38 age-matched healthy female subjects were enrolled in this study. Scheimpflug corneal topography was performed to measure lens density (LD) and thickness (LT). Serum calcium, inorganic phosphorus, parathyroid hormone (PTH) levels, and disease duration were recorded. RESULTS: No statistically significant difference was observed between the hypoparathyroidism and control groups in the Pentacam densitometry zones 1-2-3, LT, and average and maximum LD (p > 0.05 for all). Nine blue-dot-like, two cortical, and two posterior subcapsular cataracts were detected in the hypoparathyroidism group. The frequency of total and blue-dot-like cataracts was significantly higher in the hypoparathyroidism group than in the control group (p = 0.008 and p = 0.002, respectively). In the hypoparathyroidism group, a significant correlation was observed between the maximum LD and the hypoparathyroidism duration (ß = 0.420, p = 0.017), and the maximum LD and serum PTH level (ß = -0.332, p = 0.049). CONCLUSION: The clarity of the crystalline lens may decrease in surgically induced hypoparathyroidism patients depending on the disease duration and PTH levels. Additionally, this study detected an increased frequency of blue-dot-like cataract in the patient group, which may be due to the effect of hypoparathyroidism.

Evaluation of the neuronal and microvascular components of the macula in patients with diabetic retinopathy.

PURPOSE: To investigate whether abnormal retinal microcirculation correlates with retinal neuronal changes in untreated diabetic eyes without macular edema. METHODS: This study enrolled 29 diabetic patients without diabetic retinopathy (DR), 18 patients with mild non-proliferative diabetic retinopathy (NPDR), 15 patients with moderate NPDR, 14 patients with severe NPDR, 27 patients with proliferative diabetic retinopathy (PDR), and 25 healthy control subjects. Pattern electroretinography (PERG) and optical coherence tomography angiography (OCT-A) tests were performed. RESULTS: Differences in the mean values for the area, acircularity index, and perimeter of foveal avascular zone were statistically significant between the healthy control group and the diabetic patients (P < 0.05 for all). P50 and N95 amplitudes were statistically significantly lower in the PDR group compared to diabetic patients without DR, control, and moderate NPDR groups (P < 0.05 for all). The whole retina vessel densities in superficial and deep capillary plexus were lower in the PDR group compared to the diabetic patients without DR and control group (P < 0.05 for all). There were statistically significant positive correlations between the amplitudes of the P50 and N95 waves with the vessel densities. CONCLUSION: The existence of significant correlations between PERG and OCT-A parameters in diabetic patients has shown that vascular and neuronal changes in the macula affect each other in diabetic patients.

Evaluation of the optic nerve head vessel density in patients with limited scleroderma.

OBJECTIVES: To investigate the optical coherence tomography angiography (OCTA) parameters of the optic nerve head and peripapillary retina and to assess macular and peripapillary retinal nerve fiber layer (RNFL) thickness by using spectral-domain optical coherence tomography (SD-OCT) in patients with limited scleroderma and to compare these results with those of healthy control subjects. MATERIALS AND METHODS: 42 patients with a confirmed diagnosis of limited scleroderma and 32 age- and sex-matched healthy control subjects were included in the study. OCTA was performed for the radial peripapillary capillary plexus (RPCP) whole image, inside disc, and peripapillary vessel densities in all participants with XR Avanti AngioVue OCTA (Optovue, Fremont, California, USA). OCT images were obtained with Spectralis OCT with eye-tracking dual-beam technology (Heidelberg Engineering GmbH, Heidelberg, Germany), and peripapillary RNFL thickness was evaluated with circle program. The data from the right eyes of all participants were used for statistical analysis. RESULTS: No significant difference was found between the radial RPCP whole image, inside disc, and peripapillary vessel density values or the RNFL parameters of the scleroderma patients when compared with the controls (p > 0.05 for all). CONCLUSION: Decreased peripapillary vessel density on OCTA, which can be an early sign of glaucoma, could not be observed in scleroderma patients in this study. However, further long-term studies are still needed to identify glaucoma tendency in patients with scleroderma before clinically detectable glaucoma.

Evaluation of Corneal and Lenticular Parameters in Iron Deficiency Anemia.

OBJECTIVES: The aim of this study was to investigate the effects of iron deficiency anemia on corneal and lenticular densitometry. METHODS: Thirty-two patients with iron deficiency anemia and 38 healthy participants were enrolled. The Pentacam HR imaging system (Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to record keratometry, corneal densitometry (12-mm corneal diameter), lens densitometry measurements. Endothelial parameters were evaluated using specular microscopy. RESULTS: The corneal densitometry values in the anterior 0-2 mm and 2-6 mm zone were significantly higher in the iron deficiency anemia group than in the control group (p=0.044 and p=0.021, respectively). There was a statistically significant difference in the mean values of the standard deviation and maximum lens densitometry measurements of the iron deficiency anemia group when compared with the control group (p=0.012 and p=0.011, respectively). There were statistically significant correlations between the anterior 2-6 mm zone corneal densitometry and ferritin, iron, and total iron binding capacity (r=-0.275, r=-0.243, r=0.240, respectively). However, ferritin, iron, and total iron binding capacity showed no significant correlation with the lens densitometry values (p>0.05 for all). CONCLUSION: Iron deficiency anemia had several effects on corneal and lenticular densitometry measurements. Evaluation of the corneal and lenticular changes at an ophthalmology clinic might be recommended for patients with iron deficiency anemia.

Evaluation of radial peripapillary capillary density in patients with newly diagnosed iron deficiency anemia.

PURPOSE: To investigate the effects of iron deficiency anemia (IDA) on radial peripapillary capillary vessel density (RPCvd) and retinal nerve fiber layer (RNFL) thickness. METHODS: Forty patients with IDA, and 46 healthy participants, were enrolled in this study. Optical coherence tomography angiography was used to determine RNFL thickness and RPCvd measurements. In addition, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ferritin laboratory values were evaluated. RESULTS: Analysis of retinal regions (whole images, peripapillary, superior-hemi, inferior-hemi, inferior-nasal, inferior-temporal, temporal-inferior, temporal-superior, superior-nasal) showed that RPCvd values were significantly lower in patients with IDA compared to the control group values (p < 0.05 for all). However, there were no significant differences in RNFL thickness values between the IDA patient group and the control group (p > 0.05 for all). In addition, there were significant positive correlations between RPCvd values and hematological values for Hb, HCT, MCV, MCH, MCHC, and ferritin. CONCLUSION: It is important to identify changes in retinal vascularity to prevent possible ocular problems in patients with IDA. Specifically, the significant positive correlations between RPCvd values and hematological values suggest that anemia treatment is important for optic nerve perfusion.

Pupillary and Anterior Chamber Changes Following Upper Eyelid Blepharoplasty.

PURPOSE: This study investigated the preoperative and postoperative pupillary and anterior chamber (AC) characteristics of patients undergoing upper eyelid blepharoplasty. METHODS: This prospective, cross-sectional study examined 32 eyes from 20 dermatochalasis patients. Following a detailed ophthalmological examination, quantitative pupillometry and Scheimpflug corneal topography were used to evaluate the pupil and AC characteristics of eyes on the day of operation and postoperative days 1 and 7. Static and dynamic pupillometry characteristics, including scotopic, mesopic, low photopic, and high photopic pupil diameter (PD), resting diameter, amplitude, latency, duration, and velocity of pupil contraction, and latency, duration, and velocity of pupil dilation, were measured. Additionally, AC volume, depth, and angle parameters were analyzed. RESULTS: There were significant differences between scotopic, mesopic, and resting PD and the amplitude of pupil contraction. Pairwise comparisons showed that postoperative day 1 scotopic, mesopic, and resting PD and amplitude of pupil contraction measurements were significantly higher than preoperative measurements (p = 0.008, p < 0.001, p = 0.006, and p = 0.033, respectively). Additionally, scotopic and resting PD were significantly lower on postoperative day 7 compared with postoperative day 1 (p = 0.001 and p = 0.041, respectively). However, there were no significant differences in AC parameters. CONCLUSIONS: This study revealed that static and dynamic pupil measurements changed following blepharoplasty, with postoperative increased PD occurring particularly under low-light conditions. Therefore, low-light environments should be avoided following blepharoplasty, and patients with angle-closure risk factors should be closely monitored in the early postoperative period.

Intracranial Mass Lesion in a Patient Being Followed up for Amblyopia

A 12-year-old boy being followed up for amblyopia presented to our hospital with visual disturbance in the left eye. The patient's best corrected visual acuity on Snellen chart was 1.0 in the right eye and 0.3 in the left eye. Increased horizontal cup-to-disc ratio was detected on dilated fundus examination. Retinal nerve fiber layer measurement showed diffuse nerve fiber loss and visual field test showed bitemporal hemianopsia. Magnetic resonance imaging revealed a lesion that filled and widened the sella and suprasellar cistern and compressed the optic chiasm. The patient was operated with transcranial approach. The pathologic examination revealed craniopharyngioma.

Normative Data Assessment of Peripapillary and Macular Vessel Density and Foveal Avascular Zone Metrics Using Optical Coherence Tomography Angiography in Children.

PURPOSE: To quantify the vessel density of the macula and optic disc and foveal avascular zone (FAZ) in healthy children and to evaluate the effects of age, gender, axial length, body mass index (BMI), and refractive errors on vessel density and FAZ. METHODS: This study enrolled 92 eyes of 92 participants (42 boys and 50 girls). Optical coherence tomography angiography (OCTA) was performed using AngioVue (Avanti; Optivue). FAZ area, nonflow area, superficial and deep vessel density, FAZ perimeter, acircularity index of FAZ, foveal density, and radial peripapillary capillary vessel density were analyzed by gender. Correlations between the investigated OCTA parameters and age, axial length, and BMI were evaluated. RESULTS: Girls had significantly larger nonflow and FAZ area than boys (P = .01 and .02). Superficial and deep vessel density at the fovea was significantly higher in boys compared to girls (P = .01 and .03). Inferior temporal and superior temporal Radial peripapillary capillary vessel densities were significantly higher in girls than boys (P = .01 and .03). No significant difference was found in the macular and optic disc vessel density measurements within refractive groups (P > .05, for all). Regarding the correlation of age with FAZ and vessel density parameters, only nonflow area was positively correlated with age (r = 0.22, P = .03). CONCLUSIONS: This study provides normative data for children. Although boys had greater foveal vessel density, girls had greater FAZ area and nonflow area. Refractive status of the eye and BMI did not influence the OCTA parameters. Although nonflow area was positively correlated with age, other parameters were steady within the ages of 7 to 18 years. [J Pediatr Ophthalmol Strabismus. 2020;57(6):388-398.].

Evaluation of the optic nerve head vessel density in the patients with asymmetric pseudoexfoliative glaucoma: an OCT angiography study.

PURPOSE: To evaluate vascular microcirculation changes of the optic nerve head (ONH) in the patients with asymmetric pseudoexfoliative glaucoma (XFG) using optical coherence tomography angiography (OCTA) and to compare vessel density (VD) results with healthy individuals. METHODS: This prospective study enrolled 120 eyes in total. The eyes were divided into 3 groups: 40 glaucomatous and 40 non-glaucomatous fellow eyes without clinically pseudoexfoliation material (XFM) of patients with asymmetric XFG, and 40 healthy eyes as controls. The optic disc region was evaluated with OCTA (Optovue, Inc., Fremont, CA). VD was assessed as the ratio of the area formed by the vessels in 3 different regions: (1) inside disc; (2) in the peripapillary area defined as a 1-mm wide elliptical annulus around the disc; and (3) in the whole image defined as a 4-mm wide papillary region. RESULTS: There were significant decreases in VD values of all regions in XFG eyes compared to fellow and control eyes (p < 0.05 for all comparisons). The mean VD values of peripapillary area and whole image were lower in the non-glaucomatous fellow eyes compared with control eyes (p = 0.011 and p = 0.015, respectively). The receiver operating characteristic analysis for differentiating fellow eyes from healthy eyes had highest area under the curve and sensitivity at 90% specificity for superior-hemi (0.811, 65.2%), followed by ppVD (0.775, 61.8%) and whole image (0.743, 55.9%). CONCLUSIONS: OCTA as a novel imaging may be a valuable structural test in diagnosis and follow-up of glaucoma.

Is there a relationship between hypoparathyroidism and retinal microcirculation?

PURPOSE: To investigate the retinal microvasculature in patients with surgically induced hypoparathyroidism who have no clinical evidence of retinopathy and to compare these data with those of healthy control subjects. METHODS: Forty patients with a confirmed diagnosis of permanent hypoparathyroidism and no clinical evidence of retinopathy and 37 age- and sex-matched healthy control subjects were included in the study. After complete ophthalmological examination, all patients underwent optical coherence tomography angiography measurement (Optovue Inc., Fremont, California, USA) to assess the foveal avascular zone (FAZ) area; FAZ perimeter; acircularity index of FAZ; foveal density-300; radial peripapillary capillary plexus (RPCP) vessel density; superficial, middle and deep capillary plexus vessel densities (SCP, MCP and DCP). The data from the right eyes of all participants were used for statistical analysis. RESULTS: The SCP and MCP vessel densities were significantly lower, and the RPCP whole image and peripapillary vessel densities were significantly higher than those in healthy control subjects (p < 0.05 for all). The DCP vessel densities of patients with surgically induced hypoparathyroidism were not significantly different from those of healthy control subjects (p > 0.05 for all). No significant difference was found in the FAZ area, FAZ perimeter, acircularity index of FAZ, foveal density-300 measurements between patients and controls (p > 0.05 for all). CONCLUSIONS: Reduced retinal vessel density in patients with surgically induced hypoparathyroidism supports the hypothesis that parathyroid hormone is associated with regulation of vascular homeostasis, including macular microcirculation. Increased perfusion in the peripapillary area may suggest an early subclinic effect of hypoparathyroidism.

Analysis of retinal and choroidal microvasculature in systemic sclerosis: an optical coherence tomography angiography study.

BACKGROUND: To investigate the retinal and choroidal microvasculature in patients with systemic sclerosis (SSc) who have no clinical evidence of retinopathy and to compare these structures with those of healthy control subjects. METHODS: Forty-five patients with a confirmed diagnosis of SSc and no clinical evidence of retinopathy and 45 age- and sex-matched healthy control subjects were included in the study. After complete ophthalmological examination, all patients underwent optical coherence tomography angiography (OCTA) measurement (Optovue Inc., Fremont, California, USA) to assess the foveal avascular zone (FAZ) area; FAZ perimeter; acircularity index of FAZ; foveal density-300; superficial and deep capillary plexus vessel densities; and choriocapillaris flow area at 1, 2, and 3 mm radius. The data from the right eyes of all participants were used for statistical analysis. RESULTS: The superficial capillary plexus vessel density of the whole image, fovea, parafovea and perifovea, and the deep capillary plexus vessel density of the fovea were significantly lower than those in healthy control subjects (p < 0.05 for all). No significant difference was found in the FAZ area, FAZ perimeter, acircularity index of FAZ, foveal density-300 and choriocapillaris flow area measurements between patients and controls (p > 0.05 for all). CONCLUSIONS: We demonstrated the ability of OCTA to reveal early retinal microvascular alterations in patients with SSc without any clinical evidence of retinopathy. Reduced vessel density in SSc patients supports the hypothesis of widespread vascular injury, including ocular microcirculation.

Optic nerve involvement in ocular toxoplasmosis: 12 year data from a tertiary referral center in Turkey / Acometimento de nervo óptico na toxoplasmose ocular: um relato de 12 anos de um centro de referência terciário na Turquia

ABSTRACT Purpose: To evaluate the prevalence, clinical characteristics, and types of optic nerve involvement in patients with ocular toxoplasmosis. Methods: For this retrospective cross-sectional study, we examined all patients with active ocular toxoplasmosis referred to our Uveitis Section during the last 12 years, and we included patients with optic nerve involvement in the study. The primary outcome was the prevalence of optic nerve involvement, and secondary outcomes included the types of optic nerve involvement and the final best-corrected visual acuity after treatment. Results: The prevalence of optic nerve involvement was 14.4%, with the leading cause being the activation of a juxtapapillary lesion (70.5%). We found papillitis in two eyes and neuroretinitis in two eyes (11.7% for each). We only detected one optic nerve involvement secondary to a distant active lesion (5.8%). Sixteen patients (94.1%) had unilateral ocular toxoplasmosis. The overall final best-corrected visual acuity after treatment was 10/10 (LogMAR = 0.0) excluding the three patients with a juxtapapillary scar involving the macula. Conclusions: Optic nerve involvement was common in patients with ocular toxoplasmosis. The main type of optic nerve involvement was caused by activation of an old juxtapapillary lesion. Treatment was quickly effective, but the best-corrected visual acuity was dependent on the presence of a scar in the papillomacular bundle.

RESUMO Objetivos: Avaliar a prevalência, características clínicas e tipos de acometimento do nervo óptico em pacientes com toxoplasmose ocular. Métodos: Para este estudo retrospectivo transversal, examinamos todos os pacientes com toxoplasmose ocular ativa encaminhados ao nosso Setor de Uveíte nos últimos 12 anos, e incluímos pacientes com comprometimento do nervo óptico no estudo. O resultado primário foi a prevalência do envolvimento do nervo óptico, e os resultados secundários incluíram os tipos de envolvimento do nervo óptico e a acuidade visual final melhor corrigida após o tratamento. Resultados: A prevalência de acometimento do nervo óptico foi 14,4%, sendo a principal causa a ativação de uma lesão justapapilar (70,5%). Encontramos papilite em dois olhos e neuroretinite em dois olhos (11,7% para cada um). Apenas detectamos um comprometimento do nervo óptico secundário a uma lesão ativa distante (5,8%). Dezesseis pacientes (94,1%) apresentavam toxoplasmose ocular unilateral. A acuidade visual final com melhor correção após o tratamento foi 10/10 (LogMAR= 0,0) excluindo os três pacientes com uma cicatriz justapapilar envolvendo a mácula. Conclusões: O comprometimento do nervo óptico foi comum em pacientes com toxoplasmose ocular. O principal tipo de comprometimento do nervo óptico foi causado pela ativação de uma lesão justapapilar antiga. O tratamento foi rapidamente eficaz, mas a acuidade visual final com melhor correção foi dependente da presença de uma cicatriz no feixe papilomacular.