Temporal retinal thickness in eyes with glaucomatous visual field defects using optical coherence tomography.

PURPOSE: To evaluate the temporal macular retinal thickness in normal, early, and advanced glaucomatous eyes using optical coherence tomography 3 (OCT-3) and correlate the superior-to-inferior retinal thickness (S/I RT) ratio with corresponding field defects in early and advanced glaucoma patients. PATIENTS AND METHODS: Forty normal eyes, 40 eyes with early glaucomatous visual field defects, and 33 eyes with advanced visual field defects were included. All participants underwent complete ocular and visual field examinations and OCT-3 imaging on the same day. A 3×3 mm area temporal to the foveal reflex was scanned with the OCT-3 using 6 horizontal, equally spaced raster lines. Retinal thickness was evaluated at points 500 µm apart for each line and S/I RT ratio computed between similar points above and below the fovea for each patient. One-way ANOVA was used to compare S/I RT ratio between the normal, early, and advanced glaucoma eyes. RESULTS: Average retinal thickness increased progressively, as points temporal to the fovea were scanned. There was a statistically significant difference between the average superior and inferior retinal thickness at points 1500, 2000, and 2500 µm temporal to the fovea in both early and advanced glaucoma eyes (P<0.05) with corresponding significant differences in the S/I RT ratios, when compared with the normal participants (P<0.017). CONCLUSIONS: OCT-3-generated S/I RT ratios were successfully able to reproduce the structural damage in eyes with early and advanced glaucoma field defects and can complement optic disc scanning protocols in diagnosing glaucoma at an early stage.

n-Butyl cyanoacrylate-induced multiple retinal arteriolar occlusions.

We report a case of multiple retinal arteriolar occlusions due to delayed embolisation of N-butylcyanoacrylate glue, initially injected in the external carotid artery for the management of Carotid body tumour. Ocular massage and anterior chamber paracentesis were unfruitful and patient suffered irreversible visual loss in the affected eye. Embolisation of N-butyl cyanoacrylate glue into the retinal vasculature after intratumoral injection should be kept in mind as a rare but possible complication by radiologists and ophthalmologists.

Role of topical nepafenac in prevention and treatment of macular edema after vitreoretinal surgery.

PURPOSE: To evaluate the effects of topical nepafenac in patients undergoing vitreoretinal surgery. METHODS: One hundred and twenty eyes of 120 patients undergoing vitreoretinal surgery were randomized to receive either topical nepafenac 0.1% (60 eyes) or placebo (60 eyes) in this investigator-masked, randomized, comparative case series. Eyes were evaluated for Day 1 postoperative inflammation and 2-, 4-, 6-, and 8-week postoperative retinal thickness and best-corrected visual acuity. RESULTS: Mean Day 1 inflammation grades of 0.95 ± 0.6 and 1.78 ± 0.7 were noted in patients taking nepafenac and placebo, respectively (P = 0.002). The nepafenac and placebo groups had mean central macular subfield thickness of 228.44 ± 29.27 µm and 236.21 ± 29.44 µm at 4 weeks (P = 0.172) and 205.35 ± 25.25 µm and 205.37 ± 24.90 µm at 8 weeks (P = 0.971), respectively. At 1 month, there was no statistically significant difference in the mean visual acuity between the nepafenac group (0.55 ± 0.16 decimal units) and placebo group (0.52 ± 0.17 decimal units). CONCLUSION: Topical nepafenac was safe and reduced postoperative pain and inflammation in patients undergoing vitreoretinal surgery. However, its effect on reducing postoperative macular edema and improving visual acuity as compared with that of the standard postvitrectomy therapeutic regimen was equivocal.

PAX6 gene analysis in irido-fundal coloboma.

PURPOSE: To screen the paired box gene 6 (PAX6) gene in irido-fundal coloboma. METHODS: The entire coding region of PAX6 including intron-exon boundaries was amplified from cases (n=30) and controls (n=30). All sequences were analyzed against the ensemble sequence (ENSG00000007372) for PAX6. RESULTS: DNA sequence analysis of patients and controls revealed a total of three nucleotide changes (g.31815391Cytosine>Thymine; Glycine72Glycine and g.31812215Thymine>Guanine) of which one was neutral/synonymous change and the remaining two were intronic changes. Of these 3 changes, 2 were novel and one was already reported change. All these changes were non-pathogenic, according to in silico analysis. CONCLUSIONS: In our study no pathogenic PAX6 mutation were identified. This suggests involvement of other coloboma genes. This study expands the SNP spectrum of PAX6, only rare variations which are not causative have been found. Since this is a pilot study in the north Indian population, results should be confirmed in different populations by similar studies. Familial cases are required for determining the underlying genetic loci accounting for this clinical phenotype and may lead to better understanding of disease pathogenesis.

Intravitreal bevacizumab (avastin) for circumscribed choroidal hemangioma.

Circumscribed choroidal hemangiomas are rare ophthalmic entities that cause diminution in vision due to accumulation of subretinal and/or intraretinal fluid in the macular area. Various treatment options ranging from conventional laser to photodynamic therapy have been employed to destroy the tumor and reduce the exudation; however, either the inability to penetrate through the exudative fluid or the collateral retinal damage induced by these treatment modalities make them unsuitable for lesions within the macula. We evaluated the role of intravitreal bevacizumab, a pan-vascular endothelial growth factor (VEGF) inhibitor, in reducing the sub- and intraretinal fluid in three patients with circumscribed choroidal hemangiomas. All the patients had complete resolution of the serous retinal detachment that was maintained till at least 12 months after the first injection. Intravitreal bevacizumab may be used in combination with thermal laser or photodynamic therapy in treating circumscribed choroidal hemangiomas with subretinal fluid.

Immunization and nutritional profile of cases with atraumatic microbial keratitis in preschool age group.

PURPOSE: To evaluate the role of protein energy malnutrition and immunization profile in cases of atraumatic microbial keratitis in preschool children. DESIGN: Retrospective case analysis. METHODS: Case records of all children 5 years of age and younger with atraumatic microbial keratitis treated at the Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India, between January and December 2006 were reviewed retrospectively. Main parameters evaluated were age, degree of protein-energy malnutrition, immunization profile, microbiologic profile, and final outcome. RESULTS: Fifty-four consecutive children were enrolled during the study period. The mean age was 33.69 ± 21.91 months (range, 3 to 60 months). Mean weight on presentation was 10.57 ± 3.87 kg (range, 4 to 17 kg), with an average protein-energy malnutrition grade of 1.77 ± 0.74. The immunization for age was complete in 43 (80%) children. Severe protein-energy malnutrition was associated with the occurrence of bilateral keratitis (P < .001) and incomplete immunization (P < .001). Positive bacterial culture results were obtained in 44 (82%) cases, with Staphylococcus species being the most prevalent isolate (33/44; 75%). Cases requiring emergency corneal transplantation (24%) were associated with severe protein-energy malnutrition (P < .00) and bilaterality (P < .00). In multivariate analyses, cases without severe protein-energy malnutrition were 36% less likely to undergo any kind of surgical intervention (odds ratio, 0.64; 95% confidence interval, 0.04 to 0.91). CONCLUSIONS: Our study highlights the association of protein-energy malnutrition and immunization profile with the occurrence of atraumatic microbial keratitis in preschool children. Most of these cases required corneal transplantation surgery to preserve the ocular integrity and to restore vision.

Tuberculosis: an extremely unusual cause of orbital wall erosion.

We present the case report of a 10-year-old girl who presented to us with a painless swelling involving the left infraorbital region. The swelling was diagnosed to be tubercular in origin with erosion of the zygomatic, maxillary and frontal bones constituting the inferior and lateral walls of the left orbit. The patient responded well to antitubercular chemotherapy. A discussion of the case and a literature review of causes of orbital erosion is presented.

Brilliant blue G-assisted peeling of the internal limiting membrane in macular hole surgery.

Dye-assisted internal limiting membrane (ILM) peeling and gas tamponade is the surgery of choice for idiopathic macular holes. Indocyanine green and trypan blue have been extensively used to stain the ILM. However, the retinal toxicity of indocyanine green and non-uniform staining with trypan blue has necessitated development of newer vital dyes. Brilliant blue G has recently been introduced as one such dye with adequate ILM staining and no reported retinal toxicity. We performed a 23-gauge pars plana vitrectomy with brilliant blue G-assisted ILM peeling in six patients with idiopathic macular holes, to assess the staining characteristics and short-term adverse effects of this dye. Adequate staining assisted in the complete removal of ILM and closure of macular holes in all cases. There was no evidence of intraoperative or postoperative dye-related toxicity. Brilliant blue G appears to be safe dye for ILM staining in macular hole surgery.

Intravitreal bevacizumab in choroidal neovascularization associated with congenital choroidal and optic nerve coloboma in children: long-term improvement in visual acuity.

Choroidal neovascular membranes are a rare cause of decreased vision in children with congenital choroidal and optic nerve colobomas. We report on the regression of coloboma-related choroidal neovascular membranes in 2 children treated with intravitreal bevacizumab. Visual acuity remained improved in both children 2 years after the last injection.

Early-onset atypical ischemic maculopathy after bone marrow transplantation.

Typical ischemic retinal microvascular changes after bone marrow transplantation is a well-established entity and is seen in up to 7% of allogenic transplant recipients. Such cases are characterized by symmetric presence of cotton wool spots, retinal hemorrhages, and multiple microaneurysms and have a good visual prognosis. In this report we describe a case of atypical ischemic maculopathy with poor visual recovery after bone marrow transplantation.

Bilateral vitreous hemorrhage in a child due to isolated platelet factor 3 availability defect.

Vitreous hemorrhage is an uncommon cause of decreased vision in children. We report a 3-year-old child with bilateral vitreous hemorrhage secondary to an isolated platelet factor 3 (PF-3) availability defect. Prophylactic infusion of platelet-rich plasma followed by pars plana vitrectomy in both eyes resulted in an excellent surgical and visual outcome. This report emphasizes the importance of exhaustive hematological and platelet function studies in a child presenting with bilateral vitreous hemorrhage and its implications on the management of present and future bleeding episodes.

Inherited partial aniridia, microcornea with high myopia and Bergmeister's papilla: a new phenotypic expression.

We describe a rare case of familial partial aniridia with high myopia and Bergmeister papilla in five members of a family. Cataract surgery was performed on the proband wherein a brown black spherophakic lens was extracted.

Evaluation of optical coherence tomography and heidelberg retinal tomography parameters in detecting early and moderate glaucoma.

PURPOSE: To evaluate the relationship between optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) parameters by optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy (Heidelberg retinal tomography; HRT; Heidelberg Engineering, Heidelberg, Germany) in early and moderate glaucoma and to compare several OCT-based automated classifiers with those inbuilt in HRT for detection of glaucomatous damage. METHODS: This cross-sectional study included 60 eyes of 60 patients with glaucoma (30 early and 30 moderate visual field defects) and 60 eyes of 60 healthy subjects. All patients underwent Fast Optic Disc and Fast Peripapillary RNFL scans on the OCT and then HRT evaluation of the ONH during the same visit. Glaucoma variables obtained from OCT and HRT analyses were compared among the groups. Receiver operator characteristic (ROC) curves generated by performing linear discriminant analysis (LDA), artificial neural networks (ANNs), and classification and regression trees (CART) on OCT-based parameters were compared with the Moorfield regression analysis (MRA), R Bathija (RB), and FS Mickelberg (FSM) functions in the HRT, to classify eyes as either glaucomatous or normal. RESULTS: No statistically significant difference was found in the disc area measured by the OCT and HRT analyses within each study group (P > 0.05). The areas under ROC curves were 0.9822 (LDF), 0.9791 (CART), and 0.9383 (ANN) as compared with 0.859 (FSM), 0.842 (RB) and 0.767 (MRA). CONCLUSIONS: OCT-based automated classifiers performed better than HRT classifiers in distinguishing glaucomatous from healthy eyes. Such parameters should be integrated in the OCT to improve its diagnostic abilities.