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2.
Ophthalmic Res ; 63(1): 8-12, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31454807

RESUMO

BACKGROUND: Notwithstanding the significant advances in automated imaging techniques in the past 2 decades, subjective evaluation of the optic disc still remains an important part of glaucoma propaedeutic. In places with limited resources and a high demand for ophthalmic care, anatomical evaluation of glaucoma cases often relies solely on slit-lamp-based fundus biomicroscopic examination, which is frequently performed without mydriasis. OBJECTIVE: The aim of this study was to compare metrics related to fundus biomicroscopy examination of the optic nerve head and peripapillary retinal nerve fiber layer (pRNFL) with and without mydriasis. MATERIAL AND METHODS: Healthy individuals, patients with early glaucoma, and glaucoma suspects were prospectively enrolled. Patients were examined before and after mydriasis by three glaucoma specialists, who estimated patients' vertical cup-to-disc ratio (CDR) and evaluated the presence of glaucomatous signs: laminar dot sign, disc hemorrhage, disc saucering, disc notching, peripapillary atrophy, localized pRNFL defect, and loss of the ISNT pattern. Main outcome measures were the intra-observer comparison, the inter-observer agreement, and the abilities to identify glaucomatous signs before and after mydriasis. RESULTS: Thirty patients (60 eyes) were enrolled (mean age, 62.3 ± 11.6 years). Considering the evaluation of the three examiners, the mean vertical CDR increased from 0.41 to 0.44 (p = 0.02), and the median of the coefficient of variation of the measures was reduced from 0.24 to 0.11 (p = 0.01) after mydriasis. Regarding the inter-observer agreement evaluation, the kappa coefficient values ranged from 0.64 to 0.72 before mydriasis and from 0.71 to 0.77 after mydriasis. Dot sign and disc notching were better identified through fundoscopic examination with mydriasis compared to the nonmydriatic examination (p < 0.01). CONCLUSION: Our results suggest that fundus biomicroscopy should be performed with mydriasis whenever possible, as it yells a better intra- and inter-observer agreement and improves the detection of glaucomatous signs. Moreover, examiners seem to underestimate CDR values without mydriasis. Further investigation is warranted to validate these findings by general ophthalmologists and in different populations.


Assuntos
Fundo de Olho , Glaucoma/diagnóstico por imagem , Midríase/fisiopatologia , Oftalmoscopia/métodos , Disco Óptico/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Estudos Prospectivos , Células Ganglionares da Retina/patologia
3.
Eur J Ophthalmol ; 30(1): NP21-NP24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30409043

RESUMO

PURPOSE: To evaluate the role of multimodal imaging in the diagnosis and monitoring of patients with osteogenesis imperfecta complicated with choroidal neovascularization. CASE REPORT: A 28-year-old man, diagnosed with osteogenesis imperfecta, was referred 2 months after the appearance of central scotoma and metamorphopsia in the right eye. The patient underwent a complete ophthalmological evaluation including visual acuity examination as well as ophthalmoscopy, spectral-domain optical coherence tomography, optical coherence tomography angiography, fundus autofluorescence imaging, fluorescein angiography and microperimetry. Complete examination revealed macular lacquer crack with subretinal haemorrhage. A further investigation with spectral-domain optical coherence tomography and fluorescein angiography revealed the presence of choroidal neovascularization without clear activity associated to the lacquer crack. After a 1-month follow-up, both visual acuity and retinal sensitivity improved spontaneously. CONCLUSION: Collagen deficiency of osteogenesis imperfecta leads to fragility of the Bruch's membrane; tension forces probably act at this level determining ruptures with bleeding and choroidal neovascularization formation. Multimodal imaging and functional evaluation are needed to assess retinal alterations in patients with osteogenesis imperfecta, whereas treatment of choroidal neovascularization should be reserved only for active lesion to prevent evolution and visual acuity decrement.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Imagem Multimodal , Osteogênese Imperfeita/diagnóstico por imagem , Adulto , Neovascularização de Coroide/etiologia , Angiofluoresceinografia/métodos , Humanos , Masculino , Oftalmoscopia/métodos , Imagem Óptica , Osteogênese Imperfeita/complicações , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia
4.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 639-648, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671197

RESUMO

Ultra-widefield fundus imaging (UWFI) is a relatively new technology capable of capturing 200° images of the retina. Since vision changes can be irreversible in diabetic retinopathy (DR), recognition of prognostic biomarkers in the peripheral retina may prove invaluable toward optimizing the management and reducing the societal burden of this blinding disease. Following a bibliographic review using Pubmed, OVID Medline, Embase, and the Cochrane Library, the current review systematically examined 13 studies that compared UWFI to conventional screening techniques such as seven standard field (7SF) Early Treatment In Diabetic Retinopathy Study (ETDRS) and non-mydriatic multifield fundus photography (NMFP), as well as their scientific level of evidence. Overall, UWFI had good agreement with 7SF ETDRS and NMFP, and moderate agreement with dilated fundus examination. Seven additional studies were examined that considered the significance of peripheral lesions found on UWFI. These studies demonstrated that UWFI captured additional DR pathology in the peripheral retina that may not be evident if evaluation is limited to the posterior pole and may be relevant to patient outcomes. Future directions include but are not limited to the potential of UWFI to track the progression of DR with treatment. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:639-648.].


Assuntos
Retinopatia Diabética/diagnóstico por imagem , Oftalmoscopia/métodos , Fotografação/métodos , Progressão da Doença , Diagnóstico Precoce , Humanos
5.
Ann Saudi Med ; 39(5): 328-336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580703

RESUMO

BACKGROUND: Diabetic retinopathy (DR) is considered the fifth leading cause of visual impairment worldwide and is associated with a huge social and economic burden. OBJECTIVE: Describe the practicality of non-mydriatic funduscopic screening photography for the detection of DR among patients with type 1 and type 2 diabetes. DESIGN: Cross-sectional hospital-based study. SETTING: Diabetes center, Riyadh. PATIENTS AND METHODS: Between July and December 2017, patients with diabetes and aged ≥18 years were selected by systematic random sampling from the University Diabetes Center. Fundoscopic eye examination was performed using the TRC-NW8 non-mydriatic camera, which performs ocular coherence tomography (OCT) to detect macular edema. Using telemedicine, pictures were graded by a retinal-specialized ophthalmologist using the international clinical DR disease severity scale. Patients were classified according to the type and severity of DR. MAIN OUTCOME MEASURES: Detection and classification of DR. SAMPLE SIZE: 978 Saudi patients with diabetes. RESULTS: Of 426 (43.5%) patients with DR, 370 had nonproliferative DR and 55 had proliferative DR. Nineteen (1.9%) had macular edema. The most important risk factors for DR were longer diabetes duration and poor glycemic control. Both older age and insulin use contributed to the higher prevalence of DR and macular edema. DR was more common among type 1 patients at 55.4% compared with 49% among type 2 patients. In addition, more females had macular edema (57.1% versus 42.9% among males). Nine patients with macular edema (47.3%) had hypertension while 154 of 426 patients with DR (36.2%) had hypertension. CONCLUSION: Non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes. LIMITATIONS: Conducted in a single center. CONFLICT OF INTEREST: None.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Telemedicina/métodos , Adulto , Idoso , Estudos Transversais , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia/métodos , Fotografação , Prevalência , Arábia Saudita/epidemiologia , Adulto Jovem
6.
Zhonghua Yan Ke Za Zhi ; 55(10): 763-768, 2019 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-31607065

RESUMO

Objective: To screen the retinopathy in HIV/AIDS patients with both non-mydriatic ultra-wide-field (UWF) retinal imaging and mydriatic fundus examinations with the Superfield lens and a slit lamp biomicroscope, and to evaluate the consistency of two methods and provide reference for future clinical screening work and even technological innovation (such as telemedicine screening and artificial intelligence). Methods: Cross sectional study. One hundred and fifty-eight eyes of 80 HIV-positive patients from the Ophthalmology Department of Beijing Youan Hospital were enrolled in this prospective observational study. All patients underwent comprehensive ophthalmological examination. A single image was obtained from each eye using the UWF fundus imaging system (Daytona, Optos, Dunfermline, UK), and then a dilated fundal examination with the Superfield lens was conducted by another expert. The possible type and location of the lesion with these two methods was recorded respectively. The consistency was compared using the detection rate and Kappa value. Results: Fifty-two patients (65%) had fundus changes, and 28 patients (35%) were normal. Seventy-nine eyes (50%) were normal and 79 eyes (50%) had fundus lesions. Sixty-one eyes (77.2%) had HIV-related fundus lesions, while 18 eyes (22.8%) had non-HIV-related fundus lesions. Fifty-two eyes (65.8%) suffered posterior or posterior involving lesions, and 27 eyes (34.2%) suffered isolated peripheral lesions. The detection rate of UWF retinal imaging and slit lamp biomicroscopy with the Superfield lens was 17.7% (28/158) and 18.4% (29/158) (P=1.000>0.05) for HIV-related microvascular retinopathy, 8.2% and 8.2% (13/158) (χ(2)=158.00, P=1.000) for cytomegalovirus retinitis (CMVR), 36.1% and 36.1% (57/158) (χ(2)=71.066, P=1.000) for HIV-related fundus lesions, 41.8% (66/158) and 47.5% (75/158) (χ(2)=63.514, P=0.136) for fundus lesions, 33.5% (53/158) and 31.0% (49/158) (χ(2)=108.268, P=0.388) for posterior/posterior involving lesions, and 6.4% (10/158) and 16.5% (26/158) (χ(2)=42.001, P=0.000) for isolated peripheral lesions, respectively. In general, the consistency of these two methods was moderate in detecting fundus lesions (Kappa=0.630), HIV-related fundus lesions (Kappa=0.671), HIV-related microvascular retinopathy (Kappa=0.551), and isolated peripheral lesions (Kappa=0.450). According to the fundus location, the two methods showed high consistency in the detection of posterior/posterior involving lesions (Kappa=0.826>0.75) and perfect consistency for CMVR (Kappa=1.0). Conclusions: The UWF retinal imaging system and the Superfield lens showed reasonable consistency in fundus screening in HIV/AIDS patients, especially for CMVR, or lesions in the posterior pole. (Chin J Ophthalmol, 2019, 55:763-768).


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Infecções por HIV/complicações , Oftalmoscopia/métodos , Retina/diagnóstico por imagem , Síndrome de Imunodeficiência Adquirida/virologia , Estudos Transversais , Fundo de Olho , Infecções por HIV/virologia , Humanos , Oftalmoscópios , Estudos Prospectivos , Reprodutibilidade dos Testes , Retina/patologia , Sensibilidade e Especificidade
7.
Invest Ophthalmol Vis Sci ; 60(13): 4120-4128, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574536

RESUMO

Purpose: To investigate fundus autofluorescence (FAF) and other fundus manifestations in congenital aniridia. Methods: Fourteen patients with congenital aniridia and 14 age- and sex-matched healthy controls were examined. FAF images were obtained with an ultra-widefield scanning laser ophthalmoscope. FAF intensity was quantified in the macular fovea and in a macular ring surrounding fovea and related to an internal reference within each image. All aniridia patients underwent an ophthalmologic examination, including optical coherence tomography and slit-lamp biomicroscopy. Results: Mean age was 28.4 ± 15.0 years in both the aniridia and control groups. Fovea could be defined by subjective assessment of FAF images in three aniridia patients (21.4%) and in all controls (P = 0.001). Mean ratio between FAF intensity in the macular ring and fovea was 1.01 ± 0.15 in aniridia versus 1.18 ± 0.09 in controls (P = 0.034). In aniridia, presence of foveal hypoplasia evaluated by biomicroscopy correlated with lack of foveal appearance by subjective analyses of FAF images (P = 0.031) and observation of nystagmus (P = 0.009). Conclusions: Aniridia patients present a lower ratio between FAF intensity in the peripheral and central macula than do healthy individuals. Both subjective and objective analyses of FAF images are useful tools in evaluation of foveal hypoplasia in aniridia.


Assuntos
Aniridia/diagnóstico por imagem , Aniridia/patologia , Angiofluoresceinografia/métodos , Oftalmoscopia/métodos , Tomografia de Coerência Óptica/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
8.
Ophthalmologica ; 242(4): 195-207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31416074

RESUMO

PURPOSE: To report peculiar clinical findings in young choroideremia (CHM) patients. METHODS: We retrospectively reviewed young (age <20 years at the first evaluation) CHM patients examined at the Regional Reference Center for Hereditary Retinal Degenerations at the Eye Clinic in Florence between 2012 and 2018. We took into consideration patients with ophthalmological examinations, fundus color photographs, fundus autofluorescence (FAF) images, optical coherence tomography (OCT) scans, full-field electroretinograms, and Goldmann visual fields. RESULTS: In our series, we studied 8 young CHM patients (average age 13.8 years, median age 12.5, range 10-20) for a total of 16 eyes. Visual acuity (VA) was 20/20 in 7 patients and 20/25 in both eyes of 1 patient. We identified a peculiar central FAF pattern (detectable in 3 patients), characterized by reduced central hypo-autofluorescence. Long OCT scans showed different forms of parapapillary retinal involvement from the mildest to the most severe form when the macula is still preserved. In 3 patients, at the time of atrophic changes at the posterior pole, it was possible to detect a progressive reduction of foveal pigmentation during follow-up. We found mutations of the CHM gene in all 6 patients who had been screened. CONCLUSIONS: CHM is a progressive retinal disorder which involves both the peripheral and the central retina. Using a multimodal imaging approach, we described peculiar central abnormalities underlying the early involvement of the central retina in young CHM patients with a good VA.


Assuntos
Coroideremia/diagnóstico , Angiofluoresceinografia/métodos , Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adolescente , Criança , Coroideremia/genética , Coroideremia/metabolismo , Eletrorretinografia , Feminino , Fundo de Olho , Predisposição Genética para Doença , Humanos , Masculino , Oftalmoscopia/métodos , Linhagem , Fenótipo , Estudos Retrospectivos , Adulto Jovem
9.
BMC Ophthalmol ; 19(1): 185, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420011

RESUMO

BACKGROUND: Horizontal eye movements have been proposed to induce biomechanical stress and strain on optic nerve head. Since strabismus may lead to sustained adduction or abduction, we investigate the effects of long lasting unilateral horizontal strabismus on the morphology of optic disc. METHODS: The observational cross-sectional study included patients with unilateral constant horizontal strabismus lasting for more than two years. The patients underwent an ophthalmological examination including refraction and morphometry of the optic nerve head. A prism cover test using right angle glass prism was performed to measure the magnitude of the ocular deviation. RESULTS: The study included 70 patients with a unilateral constant strabismus (35 esotropic patients, 35 exotropic patients) with a mean age of 26 ± 19 years, mean refractive error of - 0.72 ± 3.3 diopters, mean axial length of 23.8 ± 1.7 mm, and a mean angle of deviation of 87 ± 36 prism diopters (Chinese right-angle glass method) in the esotropic group and - 97 ± 29 prism diopters in the exotropic group. In the whole study population and taken separately in the esotropic group and exotropic group, the disc ovality index (defined as ratio of minimal-to-maximal optic disc diameter) did not differ significantly between the deviating eyes and the contralateral fixating eyes (all P > 0.05). As a corollary, the disc ovality index and the prevalence of parapapillary beta/gamma zone did not differ significantly between the esotropic group and the exotropic group (all P > 0.05). CONCLUSIONS: Optic disc ovality did not differ markedly among long-lasting esotropic eyes, exotropic eyes, and non-strabismic eyes. It suggests that optic disc shape may not be markedly influenced in non-highly myopic eyes by a potential backward pull of the optic nerve on the optic disc structures in adduction or abduction.


Assuntos
Esotropia/diagnóstico , Exotropia/diagnóstico , Oftalmoscopia/métodos , Disco Óptico/diagnóstico por imagem , Acuidade Visual , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
10.
Invest Ophthalmol Vis Sci ; 60(10): 3527-3536, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31412112

RESUMO

Purpose: To examine inner retinal hyperreflective features on adaptive optics scanning laser ophthalmoscopy (AOSLO) in individuals with early cognitive impairment. Methods: In this prospective, cross-sectional study, we enrolled 12 participants with either amnestic mild cognitive impairment (aMCI, n = 10) or early dementia due to Alzheimer's disease (eAD, n = 2) and 12 age-, sex-, and race-matched cognitively normal controls. All participants completed AOSLO imaging of the inner retina. AOSLO montages of the peripapillary area were graded for hyperreflective features including granular membranes, mottled membranes, and nummular features. Regions of interest on AOSLO were compared qualitatively to corresponding optical coherence tomography (OCT) cross sections. OCT was also used to analyze peripapillary retinal nerve fiber layer (RNFL) thickness. Results: Cognitively impaired individuals had a significantly higher number of granular membranes with a larger overall area compared to controls. The proportion of cognitively impaired individuals with two or more granular membranes was 41.7% compared to none in the control group. Granular membrane area was also inversely correlated with cognitive performance on the Montreal Cognitive Assessment. There was no difference between the two groups in terms of other membrane types or RNFL thickness. Conclusions: Individuals with early cognitive impairment related to Alzheimer's show hyperreflective granular membranes on high-resolution imaging, which we hypothesize to be manifestations of inner retinal gliosis. The presence of these subtle hyperreflective membranes may obscure underlying RNFL thinning in these eyes on OCT imaging. The distinctive phenotype of granular membranes surrounding the optic nerve on AOSLO may represent a new potential biomarker of early Alzheimer's.


Assuntos
Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Gliose/diagnóstico , Doenças Retinianas/diagnóstico , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Fibras Nervosas/patologia , Oftalmoscopia/métodos , Óptica e Fotônica , Estudos Prospectivos , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica/métodos
11.
Rom J Ophthalmol ; 63(2): 153-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31334394

RESUMO

Purpose: To assess the variation in cone photoreceptor density on the basis of age compatibility between healthy subjects, on one side, and type 1 diabetic patients with no diabetic retinopathy, on the other. Methods: A high resolution adaptive optics retinal camera in flood illumination regime was employed to image cones of 15 type I diabetic patients and 16 healthy controls. For each subject we scanned the cone mosaic in 4 perifoveal areas (nasally, temporally, superiorly and inferiorly) at 2, 3 and 4 degrees eccentricity. The impact of diabetes duration, gender and age were evaluated. Results: In the type I diabetic group we found a meaningful lower cone density (p<0.05), except for the temporal meridian at 2 and 4 degrees eccentricity. Moreover, a significant asymmetry of cone photoreceptor densities was proved between the horizontal and vertical meridians in both diabetic and control groups. Conclusion: The rtx1 retinal image evaluation demonstrated photoreceptors loss in DM1 diabetic patients prior to any clinical changes. Abbreviations: AO = adaptive optics, SS = swept source, OCT = optical coherence tomography, BCVA= best corrected visual acuity, DM = diabetes mellitus, DR = diabetic retinopathy.


Assuntos
Diabetes Mellitus Tipo 1/patologia , Oftalmoscopia/métodos , Óptica e Fotônica , Células Fotorreceptoras Retinianas Cones/patologia , Tomografia de Coerência Óptica/instrumentação , Adolescente , Adulto , Contagem de Células , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual , Adulto Jovem
12.
Invest Ophthalmol Vis Sci ; 60(8): 3054-3063, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31348823

RESUMO

Purpose: To investigate fluorescence lifetime imaging ophthalmoscopy (FLIO) in neovascular AMD and pigment epithelial detachments (PEDs). Methods: A total of 46 eyes with PEDs (>350 µm) as well as age-matched healthy controls were included in this study. We found 28 eyes showed neovascular AMD (nvAMD), and 17 had nonneovascular (dry) AMD (dAMD). The Heidelberg Engineering FLIO excited fluorescence at 473 nm. Fluorescence decays were detected in two spectral channels (498-560 nm; 560-720 nm) to determine fluorescence lifetimes of endogenous fluorophores in their specific spectral emission ranges. Mean fluorescence lifetimes (τm) were investigated. Multimodal imaging was reviewed by two ophthalmologists who circumscribed and classified PEDs as either serous (n = 4), hemorrhagic (n = 4), fibrovascular (n = 16), drusenoid (n = 17), or mixed (n = 5). Blood samples from a healthy subject and a patient with PED were investigated in a quartz cuvette. Results: Eyes with nvAMD show similar FLIO patterns to dAMD: ring-shaped prolongations of τm 3 to 6 mm from the fovea. Different PED-forms show characteristic τm, while serous and hemorrhagic PEDs exhibit shortened τm, drusenoid PEDs show prolonged τm, and τm in fibrovascular PEDs is variable. Areas corresponding to sub-/intraretinal fluid display shortened τm. Ex vivo studies of blood also show short τm. Conclusions: The previously described dAMD-related FLIO pattern is also present in nvAMD. Short τm in serous, fibrovascular, and hemorrhagic PEDs as well as sub/intraretinal fluid may disrupt this pattern. FLIO appears to differentiate between PEDs, hemorrhage, and fluid. Additionally, ex vivo studies of human blood help to better interpret FLIO images.


Assuntos
Oftalmoscopia/métodos , Descolamento Retiniano/diagnóstico , Epitélio Pigmentado da Retina/patologia , Degeneração Macular Exsudativa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Angiofluoresceinografia/métodos , Fluorescência , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Degeneração Macular Exsudativa/complicações
13.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1971-1979, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312906

RESUMO

PURPOSE: To describe the characteristics of de novo uveitis in patients ≥ 60 years old. METHODS: Retrospective review of patients with uveitis followed in our tertiary center over a 14-year period. Patients aged 60-70 years and patients aged > 70 years were compared. RESULTS: A total of 283/1044 (27.1%) patients with uveitis were ≥ 60 years of age. Idiopathic uveitis (36.1%) and sarcoidosis (31.5%) were the most frequent etiologies. Sarcoidosis was significantly more frequent (31.5% vs. 13.7%, p < 0.0001) after the age of 60 years. Intraocular lymphoma (5.0% vs. 1.1%) and herpes virus infection (5.0% vs. 0.9%) were also more common in this age group, unlike HLA B27-related uveitis and spondyloarthritis (4.6% vs. 14.9%). Pure ophthalmologic entities: birdshot retinochoroidopathy (2.8%) or Fuchs uveitis (0.4%), were rare in patients ≥ 60 years of age and Posner Scholssman, Pars planitis, White dots syndrome, Behçet's disease, and Multiple Sclerosis were never reported. In patients > 70 years old, idiopathic uveitis (41.1% vs. 31.7%) and presumed sarcoidosis (56.5% vs. 25.6%) were more frequent than in the 60-70-year age group. CONCLUSION: In our center, sarcoidosis is the leading cause of non-idiopathic uveitis in older patients. Idiopathic uveitis and other entities account for less than two-thirds of cases. Ophthalmologic entities are rare after 60 years of age. We also report for the first time the characteristics of uveitis after 70 years of age.


Assuntos
Síndrome de Behçet/complicações , Neoplasias Oculares/complicações , Sarcoidose/complicações , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/diagnóstico , Fatores Etários , Idoso , Animais , Feminino , Angiofluoresceinografia/métodos , França/epidemiologia , Fundo de Olho , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Oftalmoscopia/métodos , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Uveíte/epidemiologia , Uveíte/etiologia
14.
Invest Ophthalmol Vis Sci ; 60(8): 3187-3196, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335944

RESUMO

Purpose: To assess the relationship between cone spacing and visual acuity in eyes with rod-cone degeneration (RCD) followed longitudinally. Methods: High-resolution images of the retina were obtained using adaptive optics scanning laser ophthalmoscopy from 13 eyes of nine RCD patients and 13 eyes of eight healthy subjects at two sessions separated by 10 or more months (mean 765 days, range 311-1935 days). Cone spacing Z-score measured as close as possible (average <0.25°) to the preferred retinal locus was compared with visual acuity (letters read on the Early Treatment of Diabetic Retinopathy Study [ETDRS] chart and logMAR) and foveal sensitivity. Results: Cone spacing was significantly correlated with ETDRS letters read (ρ = -0.47, 95%CI -0.67 to -0.24), logMAR (ρ = 0.46, 95%CI 0.24 to 0.66), and foveal sensitivity (ρ = -0.30, 95%CI -0.52 to -0.018). There was a small but significant increase in mean cone spacing Z-score during follow-up of +0.97 (95%CI 0.57 to 1.4) in RCD patients, but not in healthy eyes, and there was no significant change in any measure of visual acuity. Conclusions: Cone spacing was correlated with visual acuity and foveal sensitivity. In RCD patients, cone spacing increased during follow-up, while visual acuity did not change significantly. Cone spacing Z-score may be a more sensitive measure of cone loss at the fovea than visual acuity in patients with RCD.


Assuntos
Distrofias de Cones e Bastonetes/patologia , Fóvea Central/patologia , Células Fotorreceptoras Retinianas Cones/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual/fisiologia , Adulto , Distrofias de Cones e Bastonetes/fisiopatologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia/métodos , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
15.
BMC Ophthalmol ; 19(1): 126, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176357

RESUMO

BACKGROUND: To delineate the characteristics of complicated familial exudative vitreoretinopathy (FEVR) patients diagnosed before surgery or intra-/post-operatively and to analyze the risk factors for the diagnostic timing. METHODS: Forty-eight patients who underwent surgery and were diagnosed as FEVR in our department were retrospectively reviewed. Data were collected including the demographic and clinical characteristics of these patients. FEVR patients were divided into 2 groups according to the diagnostic timing: FEVR diagnosed pre-operatively (23 patients), FEVR diagnosed intra-/post-operatively (25 patients). Multivariable analysis was applied for analyzing the risk factors for diagnostic timing. RESULTS: The clinical characteristics of the FEVR patients were of great variability, including retinal detachment (RD), disappear of anterior chamber, retrolental membrane, epiretinal membrane (ERM), vitreous hemorrhage (VH), myopic foveoschisis (MF), lamellar macular hole (LMH), high myopia (HM). And the referral diagnosis or pre-operative diagnosis were always non-specific. The majority of the referral or preoperative diagnosis were unilateral RD (52.1%), bilateral RD (8.3%), unilateral persistent fetal vasculature (PFV) (8.3%), bilateral PFV (4.2%). There are two risk factors for the complicated FEVR cases diagnosed as FEVR preoperatively: pre-operative ocular manifestations with RD only (OR, 0.104; p-value, 0.022), positive parent's fluorescein angiography (FA) (OR, 0.105; p-value, 0.035). CONCLUSIONS: The phenotypes of FEVR were greatly variable, they can mimic many non-specific vitreoretinal disorders. The most non-specific referral diagnosis/pre-operative diagnosis was unilateral RD, bilateral RD, unilateral PFV, bilateral PFV. A positive family history or a simple ocular presentation with RD only could contribute to diagnose FEVR preoperatively.


Assuntos
Diagnóstico Precoce , Oftalmopatias Hereditárias/diagnóstico por imagem , Angiofluoresceinografia/métodos , Oftalmoscopia/métodos , Retina/patologia , Doenças Retinianas/diagnóstico por imagem , Cirurgia Vitreorretiniana/métodos , Corpo Vítreo/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Oftalmopatias Hereditárias/cirurgia , Feminino , Seguimentos , Fundo de Olho , Humanos , Lactente , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Doenças Retinianas/cirurgia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
Semin Ophthalmol ; 34(4): 189-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31188056

RESUMO

Retinal imaging is a fundamental tool for clinical and research efforts in the evaluation and management of diabetic retinopathy. Adaptive optics (AO) is an imaging technique that enables correction of over 90% of the optical aberrations of an individual eye induced primarily by the tear film, cornea and lens. The two major tasks of any AO system are to measure the optical imperfections of the eye and to then compensate for these aberrations to generate a corrected wavefront of reflected light from the eye. AO scanning laser ophthalmoscopy (AOSLO) provides a theoretical lateral resolution limit of 1.4 µm, allowing the study of microscopic features of the retinal vascular and neural tissue. AOSLO studies have revealed irregularities of the photoreceptor mosaic, vascular loss, and details of vascular lesions in diabetic eyes that may provide new insight into development, regression, and response to therapy of diabetic eye disease.


Assuntos
Retinopatia Diabética/diagnóstico por imagem , Oftalmoscopia/métodos , Óptica e Fotônica/métodos , Angiofluoresceinografia , Humanos , Tomografia de Coerência Óptica/métodos
17.
Rom J Ophthalmol ; 63(1): 29-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198895

RESUMO

Purpose. Adaptive optics (AO) imaging is a promising high-resolution investigation technique in ophthalmology that can bring new information about the pathophysiology of diabetic retinopathy. Material and methods. Seven patients previously diagnosed with diabetic retinopathy were investigated with optical coherence tomography (OCT) scanning, OCT angiography, fundus photo, and AO retinal camera (rtx1TM, Imagine Eyes, Orsay, France). Results. The red lesions on fundus photos appeared on AO imaging as hyporeflective lesions. OCT angiography helped us to differentiate between microaneurysms and hemorrhages. Hard exudates had a heterogeneous granular appearance. Retinal oedema was proved to have a blurring effect on the AO images. In addition to this, cystic spaces were identified to have a hyporeflective demarcation line. Conclusions. AO imaging is offering a fine documentation of retinal lesions and might become an important instrument for early diagnosis of diabetic retinopathy and for explaining its pathophysiological mechanisms. Abbreviations: AO = adaptive optics, AOO = adaptive optics ophthalmoscopy, SS = swept source, OCT =optical coherence tomography, SLO = scanning laser ophthalmoscope.


Assuntos
Retinopatia Diabética/diagnóstico , Angiofluoresceinografia/métodos , Oftalmoscopia/métodos , Óptica e Fotônica/instrumentação , Retina/patologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto , Retinopatia Diabética/fisiopatologia , Desenho de Equipamento , Feminino , Fundo de Olho , Humanos , Masculino , Reprodutibilidade dos Testes
19.
Digit J Ophthalmol ; 25(1): 1-4, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31080369

RESUMO

Purpose: To describe a simple and inexpensive model eye that allows lifelike simulation of indirect ophthalmoscopy and retinal photocoagulation. Methods: A 60 D examination lens, a bulb syringe, foam poster-board, a manila folder, a hobby knife, a fine pair of scissors, a glue gun, and a 2.5 cm square Optos color fundus photograph printed at 1200 dpi resolution on glossy photographic paper were used to create a model eye. Results: This model produces a high-quality, inverted, and aerial image that closely simulates clinical indirect ophthalmoscopy. Pupil size and retinal pathology can be easily changed. Binocular indirect laser photocoagulation can also be simulated, because white laser burns will appear on the glossy inkjet photograph. Conclusions: Binocular indirect ophthalmoscopy and indirect laser photocoagulation are technically challenging diagnostic and therapeutic techniques. This simple and easy-to-build eye model allows for lifelike simulation of indirect ophthalmoscopy and indirect laser retinal photocoagulation.


Assuntos
Fotocoagulação/educação , Modelos Anatômicos , Procedimentos Cirúrgicos Oftalmológicos/educação , Oftalmoscopia/métodos , Retina , Humanos , Retina/diagnóstico por imagem , Retina/cirurgia
20.
BMC Ophthalmol ; 19(1): 115, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101026

RESUMO

BACKGROUND: To compare the quality of the ultra-widefield images acquired by Optos® 200Tx to those acquired by Optos® California. METHODS: Images of the posterior surface of a Gullstrand's model eye obtained by Optos® 200Tx were compared to those obtained by Optos® California in terms of the angular field of view and the symmetry of the image, i.e., vertical and horizontal aspect ratios at the center (0°) and at the periphery (40° and 80°) in each direction. In addition, we compared the enlargement of the image on the posterior surface as the square ratio, and the differences in the contrasts. RESULTS: No significant differences were detected in the angular field of view between the two instruments. The aspect ratios showed that the Optos® California had more symmetrical images than the Optos® 200Tx at the center (0.98 vs 0.89, P < 0.01) and at the 40° periphery (0.93-1.04, △0.11 vs 0.79-1.01, △0.22) and 80° periphery (0.81-1.25, △0.44 vs 0.42-1.12, △0.70) in each direction. The amplitude of the square ratio of the Optos® California was smaller at 40° periphery (1.16-1.28, △0.12 vs 1.06-1.37, △0.31) and 80° periphery (2.12-2.46, △0.34 vs 1.14-3.29, △2.15). The contrast of the Optos® California images was significantly higher in the posterior pole (0.09 vs 0.12, P < 0.01), upper (0.07 vs 0.03, P < 0.01), and right (0.12 vs 0.07, P < 0.01) peripheries. CONCLUSION: Optos® California can record equal angular widefield images to Optos® 200Tx and more symmetrical images with higher contrast in the posterior pole, upper and right peripheries.


Assuntos
Oftalmoscópios , Oftalmoscopia/métodos , Retina/diagnóstico por imagem , Humanos , Modelos Anatômicos
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