Evaluation of Metabolite Changes in the Occipital Cortex of Patients with Idiopathic Infantile Nystagmus or Bilateral Ametropic Amblyopia by Magnetic Resonance Spectroscopy.

PURPOSE: To evaluate the effects of idiopathic infantile nystagmus (IN) and bilateral ametropic amblyopia on metabolites in the occipital cortex by magnetic resonance spectroscopy. METHODS: The children included in this prospective study were divided into three groups. Group 1 consisted of 11 patients with idiopathic IN, group 2 consisted of 10 patients with bilateral ametropic amblyopia and group 3 consisted of nine normal children. A single-voxel magnetic resonance spectroscopy examination was performed by placing a region of interest on the occipital cortex of each participant. N-acetyl aspartate (NAA), creatine (Cr) and choline (Cho) concentrations were measured in the occipital cortex. This was followed by calculating and comparing the NAA/Cr and Cho/Cr ratios between the three groups. The Kruskal-Wallis test, Mann-Whitney U-test, and chi-square test were used for statistical analysis. RESULTS: There was no statistically significant difference in NAA/Cr ratios between patients with idiopathic IN and normal children, but there was a statistically significant difference between these groups when Cho/Cr ratios were compared; the ratio was higher in the idiopathic IN group. There were no statistically significant differences in NAA/Cr or Cho/Cr ratios between patients with bilateral ametropic amblyopia and normal children. CONCLUSIONS: Our findings suggest that the neurochemical profile of the occipital cortex is partially affected by idiopathic IN, but not by bilateral ametropic amblyopia.

The results of 25-gauge vitreoretinal surgery for optic disc pit-associated maculopathy: a report of three cases and mini-review of the literature.

PURPOSE: We report the outcomes of three consecutive patients with optic disc pit-associated maculopathy who were treated with 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling, fluid-air exchange, barrage endolaser, and sulfur hexafluoride (SF6) gas tamponade. CASE REPORT: Patients with optic disc pit-associated maculopathy were treated with 25-gauge pars plana vitrectomy followed by ILM peeling, fluid-air exchange, barrage endolaser, and gas tamponade with 20 % SF6. All patients were asked to maintain a facedown position for 3 days postoperatively. This technique resulted in complete retinal reattachment after 25-gauge vitrectomy, ILM peeling, fluid-air exchange, barrage endolaser, and 20 % SF6 gas injection. The best-corrected visual acuity (BCVA) improved in all three patients and successful anatomical results were achieved. There wasn't any macular detachment in all cases at 20th week follow-up. CONCLUSIONS: Our outcomes suggest that 25-gauge vitrectomy with ILM peeling, fluid-air exchange, barrage endolaser, and SF6 gas tamponade appears to be an effective treatment option for optic disc pit-associated maculopathy.

The Origin of Subretinal Fluid in Optic Disc Pit Maculopathy.

A surgical approach for the drainage of fluid leaking over the pit in optic disc pit maculopathy is described, and a theory of the origin of fluid is discussed. In two cases, complete fluid-air exchange was performed. The air infusion pressure was decreased to 5 mm Hg, and the collected fluid was drained by raising the infusion pressure to 25 mm Hg. The fluid inside the back-flush needle was routed via a microcentrifuge tube. Biochemical analyses of the fluids were conducted in order to find their origin. Results of the first and second case were comparable to normal cerebrospinal fluid (CSF) levels (chloride: 125 mmol/L, 122 mmol/L; sodium: 146 mmol/L, 147 mmol/L; potassium: 2.8 mmol/L, 3.0 mmol/L; protein: 29 mg/dL, 18.4 mg/ dL; and glucose: 60 mg/dL, 57 mg/dL, respectively). These findings suggest that the origin of subretinal fluid found in the submacular space in optic disc pit maculopathy is CSF.

Association of Disease Activity with Serum and Tear IL-2 Levels in Behçet Disease.

PURPOSE: To investigate the association of Behçet disease activity with serum and tear interleukin-2 levels. METHODS: The study was designed as a prospective case control study. The study population consisted of 45 patients with Behçet disease and 24 age and sex-matched healthy participants. Behçet disease patients were classified as active (24 patients) or inactive (21 patients) according to disease activity. Serum and tear interleukin-2 levels were determined using the enzyme-linked immunosorbent assay method. RESULTS: The mean serum and tear interleukin-2 levels of the active disease, inactive disease, and control groups were 17.04 ± 5.02 and 32.61 ± 16.53 pg/mL; 15.20 ± 4.68 and 29.61 ± 8.30 pg/mL; and 14.22 ± 4.18 and 28.89 ± 8.73 pg/mL, respectively. There was no statistically significant difference between the groups with respect to all measured data. CONCLUSIONS: There was no significant difference in serum or tear IL-2 levels between Behçet patients and controls; there was no association of disease activity with serum and tear IL-2 levels.

Comparison of Visual Field Parameters in Early and Advanced Stages of Multiple Sclerosis Patients Without a History of Optic Neuritis.

This study compared the visual field parameters of multiple sclerosis patients without optic neuritis in early versus advanced stage of the disease. Patients were divided into two groups: group 1 (early stage, n = 14) constituted of patients with Expanded Disability Status Scale scores <3 and group 2 (advanced stage, n = 13) constituted of patients with Expanded Disability Status Scale scores ≥3. Mean visual acuities in both groups were similar (p = 0.674). Mean sensitivity, mean defect, loss of variance, reliability factor parameters (Octopus 101 perimeter) of groups 1 and 2 were 24.17 ± 3.62, 21.81 ± 3.04; 4.14 ± 3.05, 6.49 ± 2.58; 21.61 ± 22.17, 33.31 ± 18.67; and 1.57 ± 2.79, 2.59 ± 3.09, respectively. Compared with group 1, mean sensitivity was significantly lower in group 2 (p = 0.013). Mean defect (p = 0.004) and loss of variance (p = 0.042) parameters in group 2 were significantly higher than in group 1. Mean reliability factor was similar between two groups (p = 0.211). Multiple scleorisis may alter visual field parameters without severe loss of visual acuity by possibly involving optic pathways other than optic nerve.

Comparison of time domain and spectral domain optical coherence tomography in measurement of macular thickness in macular edema secondary to diabetic retinopathy and retinal vein occlusion.

Purpose. To evaluate macular thickness, agreement, and intraclass repeatability in three optical coherence tomography (OCT) devices: the time domain (TD) Stratus OCT and two spectral domain (SD) OCTs, Spectralis and Cirrus SD-OCT, in eyes with macular edema secondary to diabetic retinopathy (DR) and retinal vein occlusion (VO). Methods. In a prospective observational study at a university-based retina practice, retinal thickness tomography was performed simultaneously for fifty-eight patients (91 eyes) with DR and VO employing a time domain and two spectral domain OCTs. Agreement in macular measurements was assessed by constructing Bland-Altman plots. Intraclass repeatability was assessed by intraclass correlation coefficients (ICCs). Results. Based on the Bland-Altman plots for central macular thickness, there was low agreement between the measurements of Cirrus SD-OCT and Stratus OCT, Spectralis OCT and Stratus OCT, as well as Spectralis OCT and Cirrus SD-OCT among DR and RVO patients. All three devices demonstrated high intraclass repeatability, with ICC of 98% for Stratus OCT, 97% for Cirrus SD-OCT, and 100% for Spectralis OCT among DR patients. The ICC was 97% for Stratus OCT, 79% for Cirrus SD-OCT, and 91% for Spectralis OCT among RVO patients. Conclusion. There are low agreements among interdevice measurements. However, intraclass repeatability is high in both TD and SD-OCT devices.

The effect of anisometropic amblyopia on retrobulbar blood flow parameters. Anisometropic amblyopia and retrobulbar blood flow.

To look for a correlation between or the effect of anisometropia amblyopia on retrobulbar blood flow parameters. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the ophthalmic artery (OA), central retinal artery (CRA), and temporal posterior ciliary artery (tPCA) were measured with color Doppler imaging, and systolic/diastolic ratio, resistivity index (RI), and pulsatility index (PI) were computed in 42 patients with anisometropic amblyopia. The mean PSV of OA, CRA, and tPCA in amblyopic and fellow eyes were 62.69 ± 24.04, 62.64 ± 20.18; 9.28 ± 3.71, 10.27 ± 4.18; 10.81 ± 4.59, 11.28 ± 4.91, respectively. The mean EDV of OA, CRA, and tPCA in amblyopic and fellow eyes were 15.87 ± 11.31, 14.52 ± 6.54; 2.48 ± 1.17, 2.62 ± 2.06; 3.04 ± 2.34, 3.14 ± 2.18, respectively. The mean RI of OA, CRA, and tPCA in amblyopic and fellow eyes were 0.76 ± 0.08, 0.76 ± 0.08; 0.72 ± 0.08, 0.74 ± 0.95; 0.72 ± 0.09, 0.72 ± 0.08, respectively. The mean PI of OA, CRA, and tPCA in amblyopic and fellow eyes were 1.77 ± 0.42, 1.81 ± 0.46; 01.58 ± 0.42, 1.59 ± 0.43; 1.54 ± 0.43, 1.58 ± 0.49, respectively. There was no statistically significant difference in any of the measured parameters between the amblyopic and fellow eyes. Anisometropic amblyopia did not cause any change in retrobulbar blood flow in amblyopic eyes.

Sequential presentation of bilateral Brown syndrome.

Brown syndrome, characterized by a limitation of elevation in adduction and positive forced duction testing, is usually unilateral but occurs bilaterally in 10% of all cases. It may present as a congenital condition in one eye and develop in the other eye with no apparent cause. We present a case of bilateral Brown syndrome in which the right eye became involved within 1 year of surgery on the left eye for congenital Brown syndrome.

Characterization of macular lesions in punctate inner choroidopathy with spectral domain optical coherence tomography.

PURPOSE: Punctate inner choroidopathy (PIC) is an ocular inflammatory disease. Spectral domain optical coherence tomography (SD-OCT) allows detailed visualization of retinal and choroidal structures. We aimed to describe the retinal changes on SD-OCT associated with PIC lesions localized in the macula. METHODS: Retrospective case series: PIC lesions not associated with choroidal neovascularization (CNV) and captured by macular SD-OCT scans were identified and characterized. RESULTS: Twenty-seven PIC lesions from seven patients (eight eyes) were identified and classified into four categories according to disease activity and temporal changes. Among clinically inactive patients, two main patterns were noted on OCT: (1) retinal pigment epithelium (RPE) elevation with sub-RPE hyper-reflective signals and (2) localized disruption of outer retinal layers with choroid and Bruch's membrane (BM) generally spared. Clinically active patients demonstrated lesions with intact BM with RPE elevation that fluctuated with disease activity and sub-RPE hyper-reflective signals. Photoreceptor-associated bands on SD-OCT (PRs) were not visible during active disease, but returned to normal visibility when lesions were clinically stable. Seven lesions in patients without clinically detected activity demonstrated alteration of RPE elevation. CONCLUSION: SD-OCT can provide detailed structural characteristics of PIC lesions. RPE elevation is noted in many lesions while BM and choroid are spared. Photoreceptor-associated bands on SD-OCT appear compressed during clinically active stages and are visible during stabilization. OCT may provide information on activity not detected clinically.

Mycophenolate mofetil and fundus autofluorescence in the management of recurrent punctate inner choroidopathy.

PURPOSE: To compare the frequencies of attacks before and after immunomodulatory therapy (IMT) with mycophenolate mofetil (MMF) in recurrent punctate inner choroidopathy (PIC) and to report fundus autofluorescence (FAF) findings. METHODS: Eight patients who had at least two recurrent episodes of increased activity before MMF and 12 months of documented clinical course before and after MMF were included. The frequencies of attacks before and after MMF were compared. FAF images evaluated. RESULTS: Before MMF, the 8 patients experienced 19 attacks of recurrent disease activity; during MMF therapy, 3 (38%) patients experienced 6 recurrent episodes. The attack frequencies were 1.09 ± 0.75 before and 0.23 ± 0.32 during treatment (p = .036). Among the 6 patients who had FAF, surrounding hyperautofluorescent halo was detected in 4 and recurrence occurred in 2 who did not show any changes on the intensity during treatment. CONCLUSION: In the index study, the employment of MMF has decreased frequency of attacks in recurrent PIC. FAF may be employed to monitor and predict the response to treatment.

Importance of proper diagnosis for management: multifocal choroiditis mimicking ocular histoplasmosis syndrome.

PURPOSE: The study aims to evaluate a series of patients with initial diagnosis of ocular histoplasmosis syndrome (OHS) with progression and response to treatments consistent with multifocal choroiditis (MFC). METHODS: Retrospective review of nine patients referred for management of recurrent OHS lesions. Serology panel was conducted to rule out autoimmune and infectious causes. RESULTS: Clinical examination revealed multiple small, punched-out peripheral chorioretinal scars, and peripapillary atrophy. Histoplasma antigen/antibody was negative in all patients. Fluorescein angiography and optical coherence tomography confirmed active inflammation in five patients. Immunomodulatory therapy (IMT) was initiated to control active inflammation. While on IMT, visual acuity stabilized or improved in three patients with no recurrence of CNV or lesion activities over the follow-up period. CONCLUSIONS: MFC may initially masquerade as OHS. Clinical characteristics of recurrent MFC and absence of histoplasma titer may lead to consideration of IMT and other proper treatments for MFC.

Nodular sclerochoroidopathy simulating choroidal malignancy.

A 55-year-old man who had multiple subretinal and choroidal yellowish lesions and episcleral nodules for 1.5 years was diagnosed as having nodular sclerochoroidopathy after developing classic features of posterior scleritis with choroidal and serous retinal detachment. Long-term therapy with steroids in combination with mycophenolate mofetil resulted in regressed posterior scleritis and nodular lesions, as well as improved visual acuity. Nodular sclerochoroidopathy should be suspected in patients with subretinal and choroidal lesions and should be distinguished from choroidal neoplasm.

Intercellular adhesion molecule inhibitors as potential therapy for refractory uveitic macular edema.

PURPOSE: To describe the bioactivity of an intercellular adhesion molecule inhibitor (efalizumab) in a patient with refractory uveitic macular edema. METHODS: A 55-year-old man presented with idiopathic autoimmune uveitis and associated macular edema, which could not be controlled by regional and systemic corticosteroid and selected immunomodulatory therapy. Efalizumab was administered as subcutaneous injections. RESULTS: After 37 weekly injections of efalizumab, the uveitic macular edema was successfully eliminated. Six months following discontinuation of efalizumab, there were no signs of recurrent inflammation. CONCLUSION: Further investigation of the role of intercellular adhesion molecule inhibitors in the management of uveitic macular edema is indicated.

Vitreous vascular endothelial growth factor level during gestation.

PURPOSE: To evaluate the vitreous VEGF level alterations and its correlation with its plasma level if any, in gestation. METHODS: The blood and vitreous sampling procedures were performed before, during (20-23 days of gestation), and after gestation (2 months after birth) from seven White New Zealand rabbits. Blood samples were centrifuged then supernatants and vitreous samples were stored at -80 degrees C until assay. Measurements of serum and vitreous VEGF(165) were done by ELISA. RESULTS: The median plasma and vitreous VEGF(165) concentrations were 36.61 pg/ml (range 19.17-40.30), 14.92 pg/ml (range 8.95-15.20); 58.30 pg/ml (range 32.60-11.53), 20.51 pg/ml (range 11.94-21.26); and 35.30 pg/ml (range 27.30-39.60), 13.05 pg/ml (range 9.33-16.04) before, during and after gestation, respectively. Both the plasma and the vitreous VEGF(165) concentration during gestational period were significantly higher than pre-gestational period (P = 0.028, P = 0.018) and post-gestational period (P = 0.043, P = 0.028). The intravitreal VEGF(165 )concentrations appeared to correlate with plasma VEGF(165) levels (r = 0.940, P = 0.002) only in the gestational period. CONCLUSION: Vitreous VEGF levels increase in positive correlation with plasma VEGF during pregnancy. Further prospective studies are needed to support this finding.

Spontaneous corneal perforation in a patient with lamellar ichthyosis and dry eye.

We report spontaneous corneal perforation in a patient with lamellar ichthyosis. The patient presented with complaints of pain, redness, diminished vision, and discharge in her right eye for 15 days. Visual acuities were light perception in the right and 20/400 in the left eye. Cicatricial ectropion in both lower eyelids and 2 mm perforation site in the center of the right cornea were observed. Lamellar ichthyosis was suspected because of scaling and excessive dryness of entire body skin and was confirmed by skin biopsy. Amniotic membrane transplantation and transient tarsorraphy was performed and systemic anti-ichthyosis therapy was started. The follow-up visits were not possible because of patient inconsistency. In patients with cicatricial ectropion secondary to ichthyosis, corneal health should be closely monitored because of the perforation risk.

Diagnosis of anomalous lacrimal ductule with the aid of salivary gland scintigraphy.

A 4-year-old boy presented with the complaint of fluid discharge from a 0.5-mm diameter opening at the lateral side of the right outer canthus during crying. The need for general anesthesia for contrast radiography prompted the authors to conducted salivary gland scintigraphy, which demonstrated radioactivity of the collected fluid. Salivary gland scintigraphy can be used as a diagnostic tool in cases with anomalous lacrimal ductule without the use of general anesthesia.

Investigation of human papillomavirus and Epstein-Barr virus DNAs in pterygium tissue.

PURPOSE: Recent studies postulated the presence of a probable relationship between pterygium and neoplasia. This study aimed to investigate the role of two oncogenic viruses, human papillomavirus (HPV) and Epstein-Barr virus (EBV), in the development of conjunctival pterygia. METHODS: Polymerase chain reaction was used to identify the presence of HPV and EBV in 30 primary and 10 recurrent pterygia samples. Twenty conjunctival samples obtained from patients undergoing cataract surgeries were used as the control group. Patient groups had similar sex, race, and age distribution to eliminate bias. For exploration of HPV in groups, two different PCR methods (in-house PCR with two different primer sets and one real-time PCR method) were studied. The presence of EBV was shown by real-time PCR method. RESULTS: HPV was identified in none of the pterygia and control group patients. However, EBV was detected in 3 out of 30 (10%) primary pterygia patients and in none of the recurrent pterygia and control patients. CONCLUSIONS: Up to now, HPV has been blamed as the major viral pathogen in the etiopathogenesis of pterygium. The current results suggest that EBV may also be involved in the pathogenesis of pterygium, but further larger studies with larger cohorts are required to confirm this hypothesis.

Detection of the regression on hydroxychloroquine retinopathy in optical coherence tomography.

Hydroxychloroquine (HCQ) that is widely used in the treatment of the connective tissue disorders can cause retinopathy. The fundus examination of a patient with systemic lupus erythematosus receiving HCQ revealed left incomplete bull's eye and pigmentary changes in macula in the right eye. Repeated visual field tests showed the paracentral and peripheral defects in the right eye and the pericentral ring scotoma in the left eye. Optical coherence tomography (OCT) scans revealed the photoreceptor loss, retina pigment epithelium (RPE) irregularities, and a cyst-like hypo reflective space over RPE layer on the nasal perifoveal region in the left eye. On the ophthalmoscopic examination, the perifoveal pigmentation was not altered after the discontinuation of HCQ. However, the bilateral visual field defects were improved and the photoreceptor destruction and cyst-like hyporeflective space disappeared in the left eye. Mild RPE irregularities remained in both eyes as revealed by OCT scans. Even if OCT is used to evaluate the regression of HCQ retinopathy, it only shows advanced stage of retinopathy.

The protective role of Visudyne eyeglass against VEGF synthesis after photodynamic therapy with verteporfin.

PURPOSE: We aimed to determine the extent of protection provided by Visudyne eyeglass against vascular endothelial growth factor (VEGF) synthesis following photodynamic therapy (PDT). METHODS: Three groups with 14 rabbits in each were established. These consisted of a control (dextrose infusion) group, an infusion (verteporfin infusion) group and an irradiation (verteporfin infusion + irradiation) group. One eye in each animal was closed with Visudyne eyeglass and the other by eyelid sutures. The rabbits were exposed to daylight for 30 mins at 2 and 48 hours after the infusion was administered. Half the animals in each group were killed on day 5. The remaining animals were killed on day 10. Levels of VEGF in homogenized retina and choroids were analysed with an ELISA (enzyme-linked immunosorbent assay). RESULTS: Mean VEGF levels, in pg/mg protein, on days 5 and 10 in the control + glass, control + suture, infusion + glass, infusion + suture, irradiation + glass and irradiation + suture subgroups were, respectively: 1.69 +/- 0.67, 1.91 +/- 0.44; 1.75 +/- 0.69, 1.93 +/- 0.53; 2.30 +/- 0.77, 3.47 +/- 2.02; 1.90 +/- 1.00, 2.93 +/- 0.16; 4.39 +/- 2.74, 13.63 +/- 5.25; 3.38 +/- 1.05, 7.37 +/- 2.12. On day 10, VEGF levels were significantly higher in the infusion and irradiation groups compared with the control group (p < 0.05). There were no statistically significant differences between glass and suture samples on days 5 and 10 in the infusion group, or on day 5 in the irradiation group. However, on day 10, the mean VEGF level in eyes closed with Visudyne eyeglass in the irradiation group was significantly higher than in sutured eyes (p = 0.011). CONCLUSIONS: Visudyne eyeglass offers full protection against VEGF increases caused by verteporfin infusion but is only partially protective in eyes exposed to sensitizing light.