Optical coherence tomography angiography as predictor of visual outcomes in retinal vein occlusion treated with antiangiogenic therapy.

PURPOSE: Evaluate optical coherence tomography angiography (OCT-A) features in retinal vein occlusions (RVO) associated with visual outcomes after anti-VEGF. METHODS: Analytical observational study performed in eyes with macular edema secondary to RVO treated with anti-VEGF, with at least 6 months of follow-up. Bradley et al. classification of macular ischemia was used. Logistic regression analysis was used to investigate associations between final best-corrected visual acuity (BCVA) and OCT-A. RESULTS: A total of 62 eyes, 61 subjects, mean age of 70 ± 12,6 years were included. Median follow up time 21,2 months (IQR 24.8), 53,2% had central retinal vein occlusion (CRVO) and 46,8% branch retinal vein occlusion (BRVO). Median BCVA pre-treatment was 0,84 logMAR (IQR 0,83) and post-treatment 0,47 logMAR (IQR 0,52). BCVA improved at the end of follow-up (p = 0,01), as well as central retinal thickness (CRT) (p = 0,02). Regarding capillary densities (CD), there was a decrease for both plexus, Superficial CD (p = 0,01) and Deep CD (p = 0,01), being more involved the superficial plexus. The lower the capillary density in both plexus, the worse BCVA, Superficial CD (r - 0,27, p = 0,03) and Deep CD (r - 0,29, p = 0,02). Media FAZ pre-treatment was 0,30 mm2 (IQR 0,23), with enlargement to 0,37 mm2 (IQR 0,32) (p = 0,01) post-treatment. Preservation of External Limiting Membrane/ Ellipsoid Zone (ELM/EZ) was seen in 60% of subjects (n = 37). The majority had grade 3 macular ischemia. Variables that best explain visual results were, baseline visual acuity (p = 0,01), pre-treatment CRT (p = 0,02) and pretreatment foveal superficial CD (p = 0,02). CONCLUSIONS: Variables that best explain final vision after anti-VEGF were baseline visual acuity, CRT and foveal superficial CD.

Clinical patterns and risk factors in scleritis: a multicentric study in Colombia.

PURPOSE: This study aims to describe the clinical characteristics of scleritis in a large cohort of Colombian patients and identify factors associated with the clinical presentation. METHODS: Retrospective case series of patients with scleritis from 2015 to 2020. Clinical records were obtained from seven uveitis referral centers in Colombia. Patients with a diagnosis of episcleritis were excluded. RESULTS: We evaluated 389 patients with scleritis (509 eyes). There was a female predominance (75.6%) with a mean age of 51 ± 15 years. Most cases were noninfectious (94.8%) and unilateral (69.2%). The most frequent type of inflammation was diffuse anterior scleritis (41.7%), followed by nodular scleritis (31.9%) and necrotizing scleritis (12.3%). Systemic autoimmune diseases were found in 41.3% of patients, the most common being rheumatoid arthritis (18.5%) and granulomatosis with polyangiitis (5.9%). Polyautoimmunity was found in 10.4% of those with a systemic autoimmune disease. The most frequent treatment was systemic steroids (50.9%), followed by systemic NSAIDs (32.4%). Steroid-sparing immunosuppression was required in 49.1% of patients. Systemic autoimmune diseases were more common in patients with necrotizing scleritis and those older than 40 years of age. Best-corrected visual acuity of 20/80 or worse at presentation was more common in necrotizing scleritis and subjects with associated uveitis, ocular hypertension, or who were over 40 years of age. CONCLUSIONS: This is the first study in Colombia and the largest in Latin America describing the clinical characteristics and presentation patterns of scleritis. The most common presentation was in females, with unilateral, anterior diffuse noninfectious scleritis. Systemic autoimmune diseases and polyautoimmunity were frequent, as was the need for steroid-sparing immunosuppression. Age over 40 and necrotizing scleritis were associated with higher odds of having a systemic autoimmune disease and worse visual acuity at presentation.

Results of Follow-up in Pediatric Keratoconus Treated With Intracorneal Ring Segments Implantation Alone or in Combination With Corneal Cross-linking.

PURPOSE: To report visual and topographic outcomes of pediatric keratoconus with intracorneal ring segments (ICRS) implantation alone or in combination with accelerated corneal cross-linking (A-CXL). METHODS: A descriptive, retrospective observational study was performed. Medical records of patients younger than 18 years at Fundación Oftalmológica Nacional in Bogotá, Colombia, were reviewed. Demographic data, follow-up time, preoperative and postoperative uncorrected (UCVA) and best corrected (BCVA) visual acuity, manifest refraction, and tomography were evaluated. SPSS software (version 22.0; SPSS, Inc) was used for analysis. RESULTS: Twenty-six eyes of 19 patients with a mean age of 16.5 ± 1.8 years were analyzed, and 16 were boys (84.2%). Median follow-up time was 39.6 months (inter-quartile range [IQR] = 30). Fifteen patients (78.9%) had a history of allergic conjunctivitis. Sixteen eyes (61.5%) received ICRS implantation with A-CXL and 10 eyes (38.4%) received ICRS implantation only. Global results (including ICRS implantation with A-CXL and ICRS implantation only) were: (1) median UCVA of 0.90 logarithm of the minimum angle of resolution (logMAR) (IQR = 0.85) preoperatively improved to 0.54 logMAR (IQR = 0.70) postoperatively; (2) median BCVA of 0.43 logMAR (IQR = 0.39) preoperatively improved to 0.30 logMAR (IQR = 0.26) postoperatively; and (3) median spherical equivalent of -5.37 diopters (D) (IQR = -5.28) preoperatively improved to -4.12 D (IQR = -3.57) postoperatively. There was a reduction in half of the sphere and cylinder. The median maximum keratometry was 54.40 D (IQR = 7.4) preoperatively and 49.80 D (IQR = 5.3) postoperatively. The median asphericity was -1.18 (IQR = 0.70) preoperatively and changed to -0.75 (IQR = 0.68) postoperatively. No patient presented with complications before or after surgery. CONCLUSIONS: ICRS implantation only or in combination with A-CXL induced visual and topographic improvement in patients with keratoconus, which was maintained throughout the follow-up time. It seems to be a safe procedure to delay or avoid corneal transplantation in the pediatric population. [J Pediatr Ophthalmol Strabismus. 2022;59(2):118-127.].

Hallazgos periféricos en pacientes con degeneración macular relacionada con la edad avanzada / Peripheral findings in patients with age-related macular degeneration

Objetivo: Explorar la asociación entre la presencia de cambios degenerativos en la periferia retiniana de pacientes con diagnóstico clínico de Degeneración Macular Relacionada con la Edad (DMRE), evaluados con fotografía de fondo de ojo a color (FP), angiografía fluoresceínica (FA) y autofluorescencia (FAF), y las etapas más avanzadas de la enfermedad. Métodos: Estudio descriptivo, transversal con intención analítica, en el cual se evaluaron las imágenes de campo amplio obtenidas mediante FP, FA, y FAF con oftalmoscopía de láser confocal con la Optomap 200TX, de todos los pacientes con diagnóstico clínico de DMRE, para un total de 94 pacientes (188 ojos) que aceptaron participar en el estudio, y que acudieron a la Clínica Oftalmológica de Antioquia (CLOFAN) entre agosto y septiembre del 2016, con diagnóstico clínico de DMRE. La variable desenlace fue presencia de DMRE avanzada. Resultados: Se incluyeron imágenes de 130 ojos de 70 pacientes. La edad media fue 72,1 años (DE±9,5 años). El 20,8% de los pacientes eran pseudofáquicos. El 52,9%, 32,9% y 37,1% tenían historia de HTA, dislipidemia y hábito tabáquico positivo, respectivamente. Se observó una asociación estadísticamente significativa entre DMRE avanzada y el antecedente de DMRE en la familia (p<0,05, OR=2,4, IC=1,1-6,2), la presencia de cambios degenerativos en la periferia en FP (p<0,001, OR=5,71, IC=1,8-17,7), FA (p<0,05, OR=3,1, IC=0,9-10,1) y FAF (p<0,001,OR=10,52, IC=0,63-8,13). En el análisis multivariado solo la presencia de lesiones en FP se mantuvo asociada significativamente con la presencia de DMRE avanzada. Conclusiones: La presencia de cambios degenerativos en periferia se asocian 4,71 veces más con la DMRE avanzada, y por tanto, la presencia de éste tipo de lesiones podría ser predictora de progresión. Se requieren estudios prospectivos que permitan determinar causalidad y contribuir a la comprensión de la patogénesis de la DMRE.

Purpose: To explore the association between the presence of degenerative changes in the retinal periphery of patients with clinical diagnosis of AMD, evaluated with color fundus photography (FP), fluorescein angiography (FA) and autofluorescence (FAF), and the more advanced stages of the disease. Methods: A descriptive, cross-sectional study with analytical intent, in which wide fi eld images obtained by PF, AF, and FAF using confocal laser ophthalmoscopy with Optomap 200TX, all patients with a clinical diagnosis of AMD, for a total of 94 patients (188 eyes) who attended the Clínica oftalmológica de Antioquia (CLOFAN) between August and September of 2016, with clinical diagnosis of AMD, were analyzed. Th e outcome variable was advanced age related macular degeneration. Results: Images of 130 eyes of 70 patients were included. Th e mean age was 72.1 years (SD ± 9.5 years). It was observed that 20.8% were pseudophakic. 52.9%, 32.9% and 37.1% had a history of hypertension, dyslipidemia and a positive smoking habit, respectively. Th ere was a statistically signifi cant association between advanced AMD and family history of AMD (p <0.05, OR=2.4, CI=1.1-6.2), the presence of degenerative changes in the FP (P <.001, OR=5.71, CI=1.8-17.7), FA (p <0.05, OR=3.1, CI=0.9-10.1) and FAF (p <0.001, OR=10.52, CI=0.63-8.13). In the multivariate analysis only the presence of lesions in FP remain signifi cantly associated with the presence of advanced AMD. Conclusions: Th e presence of degenerative changes in periphery are associated 4.71 times more with advanced AMD, and therefore, the presence of this type of lesions could be predictive of progression. Prospective studies are required to determine causality and contribute to the understanding of the pathogenesis of AMD.

Medida del grosor central coroideo con tomografía óptica coherente de imagen de profundidad mejorada (EDI OCT) en ojos contralaterales de pacientes con coriorretinopatía serosa central (CSC) / Central choroidal thickness measured by enhanced depth imaging (EDI OCT) in fellow eyes of subjects with central serous chorioretinopathy (CSC)

Diseño: Estudio descriptivo y trasversal. Objetivos: Medición del grosor coroideomacular en el ojo contralateral (ojo sano) de pacientes con coriorretinopatía serosa central (CSC), utilizando tomografía óptica coherente de imagen de profundidad mejorada (EDI OCT). Pacientes y métodos: Fueron evaluados 32 ojos de 16 pacientes voluntarios, con diagnostico de coriorretinopatía serosa central (CSC) aguda. Ambos ojos fueron sometidos a estudio de tomografía óptica de dominio espectral con profundidad mejorada (EDI SD-OCT) con el Tomógrafo RTVue® (Optovue, USA). Se realizó escaneo horizontal de alta definición a través de la fóvea, tanto en el ojo afectado, como en el sano contralateral. Se realizaron 5 medidas del grosor coroideo. El promedio del grosor coroideo fue calculado y comparado, entre los ojos con CSC y el ojo contralateral. Resultados: El promedio de edad fue de 40+/-7 (rango entre 29 y 56 años). Quince de los 16 ojos sintomáticos eran derechos. Dos mujeres y 14 hombres. La media del grosor coroideo en el ojo sintomático fue de 470.4+/-35.7µm, y en el ojo contralateral el grosor fue de 413.4+/-47.1µm. La relación entre ambos ojos mostró una alta correlación (0,979) y una correlación estadísticamente significativa (p<0.001). Conclusión: La tomografía óptica coherente de dominio espectral con profundidad mejorada, es una herramienta útil en evaluar el grosor coroideo en pacientes con CSC, donde el grosor coroideo también aparece aumentado en el ojo contralateral.

Design: Descriptive and cross-sectional study. Objective: To measure macular choroidal thickness in fellow eyes of patients with central serous chorioretinopathy, using enhanced depth imaging optical coherence tomography (EDI OCT). Patients and methods: This is a descriptive, cross-sectional study. A total of 32 eyes of 16 patients were evaluated. Sixteen volunteers with acute central serous corioretinopathy (CSC) diagnosis underwent high-definition scanning using SD-OCT (RTVue®, Optovue, USA) with enhanced depth imaging technique (EDI OCT) in both eyes. One horizontal scan across the fovea was selected for each affected and healthy eye, five choroidal thickness measurements were taken. The average choroidal thickness was also calculated and compared among eyes with CSC and fellow eyes. Results: Mean age was 40+/-7 years (range between 29 and 56 years old). Fifteen of 16 symptomatic eyes where right eyes. Two women and 14 men were involved. The mean choroidal thickness in symptomatic eyes was 470.4+/-35.7 µm, and the fellow eyes thickness was 413.4+/-47.1 µm. The matching shows a high correlation (0,979) between paired samples and statistical signifi cance of its correlation (p<0.001). Conclusions: Enhanced depth imaging spectral-domain optical coherence tomography is a helpful tool for assessing choroidal thickness in fellow eyes of patients with CSC, where the choroid is as thickened as in affected eyes.

Atrofia coroidea relacionada con la edad en pacientes hispanos: serie de casos / Age-related choroidal atrophy in hispanics patients: a case series

Propósito: describir los hallazgos y la medición del grosor coroideo subfoveal utilizando tomografía óptica coherente de imagen de profundidad mejorada (EDI OCT), en paciente hispanos con sospecha clínica de atrofia coroidea relacionada con la edad (ARCA). Métodos: estudio descriptivo y trasversal en 17 pacientes con impresión clínica de ARCA, basados en: disminución de la agudeza visual de reciente aparición, alteraciones pigmentarias en la macula, apariencia de fondo de ojo atigrado y atrofia peripapilar a pesar de no ser miope. A todos se les realizó examen oftalmológico completo, que incluía: Agudeza visual mejor corregida (BCVA), biomicroscopía con lámpara de hendidura y evaluación del fondo de ojo bajo dilatación. A estos pacientes se les realizó fotografía digital del fondo de ojo y tomografía óptica coherente de imagen de profundidad mejorada (EDI OCT). Se realizó un total de 5 mediciones del grosor coroideo en el área macular en cada ojo. Resultados: se evaluaron 26 ojos de 14 pacientes, con una edad media de 70,86 años (DS± 8,46 años). El 57.14% fueron mujeres y el 42.86% hombres. El promedio de la agudeza visual fue 20/47 (0,38 LogMAR), el 80.2% presentaron manifestación binocular. La media del grosor coroideo fue 119,53 µm (DS±49,68µm). No hubo correlación estadísticamente signifi cativa entre la BCVA y grosor coroideo (P=0.407). Conclusión: la atrofia coroidea relacionada con la edad es una condición que puede presentarse en pacientes hispanos de edad avanzada. Afecta igualmente a hombres y mujeres, es usualmente bilateral y el grado de adelgazamiento de la coroides no predice la agudeza visual final.

Purpose: to describe the findings and measure the subfoveal choroidal thickness with Enhanced Depth Imaging (EDI) OCT in hispanics subjects with clinical impression of age-related choroidal atrophy (ARCA). Methods: a descriptive and cross-sectional study of 17 subjects with clinical impression of ARCA: based on recently decreased visual acuity, pigmentary alterations in the macula, a tessellated fundoscopic appearance, and peripapillary atrophy despite being not myopic. All patients had a comprehensive ocular examination, including BCVA, biomicroscopic and fundus examination. They underwent color fundus photography and EDI OCT. A total of 5 measurements were took of each eye. Results: twenty six eyes were included from 14 patients, with a mean age 70,86 years (SD ± 8,46 years). The 57,14% were female and 42.86% male. The mean visual acuity was 20/47 (0,38 LogMAR Equivalent), 80.2% had bilateral disease. The mean choroidal thickness was 119,53 µm (SD ± 49,68 µm). There was no statistically significant correlation between BCVA and choroidal thickness (p =0,407). Conclusions: the ARCA is a condition that can be present in elderly Hispanics subjects. Affects equally male and female, it is usually bilateral and the degree of choroidal thinning does not predict the final visual acuity.