HENLE FIBER LAYER MAPPING WITH DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To perform a macular volumetric and topographic analysis of Henle fiber layer (HFL) from retinal scans acquired by directional optical coherence tomography. METHODS: Thirty healthy eyes of 17 subjects were imaged using the Heidelberg spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany) with varied horizontal and vertical pupil entry. Manual segmentation of HFL was performed from retinal sections of horizontally and vertically tilted optical coherence tomography images acquired within macular 20 × 20° area. Total HFL volume, mean HFL thickness, and HFL coverage area within Early Treatment for Diabetic Retinopathy Study grid were calculated from mapped images. RESULTS: Henle fiber layer of 30 eyes were imaged, segmented and mapped. The mean total HFL volume was 0.74 ± 0.08 mm 3 with 0.16 ± 0.02 mm 3 , 0.18 ± 0.03 mm 3 , 0.17 ± 0.02 mm 3 , and 0.19 ± 0.03 mm 3 for superior, temporal, inferior, and nasal quadrants, respectively. The mean HFL thickness was 26.5 ± 2.9 µ m. Central 1-mm macular zone had the highest mean HFL thickness with 51.0 ± 7.6 µ m. The HFL coverage that have thickness equal or above to the mean value had a mean 10.771 ± 0.574 mm 2 of surface area. CONCLUSION: Henle fiber layer mapping is a promising tool for structural analysis of HFL. Identifying a normative data of HFL morphology will allow further studies to investigate HFL involvement in various ocular and systemic disorders.

Differences in the characteristics of subjects achieving complete, partial, or no resolution of macular edema in the READ-3 study.

PURPOSE: To identify baseline characteristics of subjects enrolled in the READ-3 study that would predict the response of macular edema to ranibizumab (RBZ) therapy at year 1. METHODS: In this post hoc analysis of the READ-3 randomized, multicenter phase 2 clinical trial, subjects with diabetic macular edema (DME) were randomized to receive monthly intravitreal injections of RBZ (0.5 or 2.0 mg) for 6 consecutive injections followed by as-needed treatments based on pre-defined retreatment criteria. In this sub-study, subjects were divided into three groups (persistent, rebound, and resolved) based on edema status at month 12 (M12). Multi-logistic regression was utilized to assess the probability of edema outcomes M12, based on the baseline characteristics. RESULTS: One hundred twenty-three out of 152 subjects were analyzed for this sub-study. A significant difference was observed in the baseline (BL) central subfield thickness (CST) among the study groups (p < 0.05). BL CST was a significant predictor for edema outcome at M12 with > 80% probability of the subject having persistent edema if BL CST was > 570 µm (p < 0.05). This association persisted when controlled for the dose of RBZ (relative risk (RR), 1.007; p < 0.05). BL CST was also a significant predictor for having persistent edema at M12 in subjects without vitreomacular adhesion (VMA) (> 80% probability of edema persistence at CST > 570 µm [RR, 1.006; p < 0.05]). However, in the presence of VMA, BL CST was no longer a significant predictor of having persistent edema at month 12 (RR, 1.005; p > 0.05). CONCLUSIONS: Subjects with high CST (> 570 µm) at baseline may not benefit from repeated intravitreal injections of anti-VEGF for resolution of edema.

REPEATABILITY OF CHOROIDAL VASCULARITY INDEX MEASUREMENTS USING DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY IMAGES.

PURPOSE: To investigate the repeatability of choroidal vascularity index (CVI) measurements in centered and decentered (regarding pupil entry position of the beam) directional subfoveal optical coherence tomography (OCT) scans with (CVI1) and without (CVI2) brightness adjustment. METHODS: Thirty-two eyes of 32 healthy volunteers were included in this prospective study. First, the fovea was evaluated by a single horizontal enhanced depth imaging OCT scan in a centered direction. Then, the same subfoveal horizontal line was scanned in a decentered direction. The agreement between CVIs obtained from these centered and decentered directional OCT scans was investigated using Bland-Altman analysis and intraclass correlation coefficient. RESULTS: Intraclass correlation coefficient between centered and decentered CVI1 was 0.71 (95% CI: 0.48-0.85, P value < 0.001). Intraclass correlation coefficient between centered and decentered CVI2 was 0.73 (95% CI: 0.5-0.86, P value < 0.001). The mean difference between centered and decentered directional measurements for CVI1 and CVI2 were 0.5 and 0.8, respectively. CONCLUSION: There is moderate agreement between CVIs obtained from centered and decentered directional single OCT scans of the same subfoveal area. Studies investigating choroidal vascularity should be standardized by using the same OCT beam direction in all scans.

Disease activity and outcomes in juvenile Behçet's disease: 10 years' experience of a single centre.

OBJECTIVES: The aims of this study were to investigate the development of new events (new clinical signs related to Behçet's disease) and to evaluate outcomes in juvenile Behçet's disease (jBD) patients over a 10-year follow-up. METHODS: We included 57 patients diagnosed with jBD according to International Behçet's Study Group (ISG) criteria and/or the International Criteria for BD (ICBD) and/or Paediatric BD (PEDBD) group criteria, followed-up between 2008 and 2018. Any new organ system involvement during follow-up was defined as an event in event-free survival analysis. RESULTS: The patients' female/male ratio was 33/24. The most prevalent clinical feature was recurrent oral aphthosis (100%), followed by musculoskeletal symptoms (63%), genital ulcers (56%), ocular manifestations (47%) and cutaneous manifestations (46%). Vascular, neurological, gastrointestinal and genitourinary manifestations were observed in 4-17% of the patients. Fifty-four (95%) cases fulfilled the ICBD, while 31 (54%) and 34 (60%) fulfilled ISG and PEDBD criteria, respectively. The median Iranian Behçet's disease dynamic activity measure (IBDDAM) score at diagnosis was 5 (range: 3-14) and decreased to 1 (range: 0-6) at the last visit. One to three events occurred in 21 (37%) cases. One fifth (19%) of these events were severe. The event-free survival rate was 95% at one year, 70% at three years and 50% at eight years. CONCLUSIONS: This study shows that with effective treatment, jBD has favourable outcome and a remarkable event-free survival. Underdiagnosed cases according to ISG and PEDBD criteria could be diagnosed using the ICBD.

Magnetic Resonance Imaging of Idiopathic Intracranial Hypertension: Before and After Treatment.

BACKGROUND: This study aimed to identify the reversibility of MRI findings indicative of increased intracranial hypertension in idiopathic intracranial hypertension (IIH) patients after treatment. METHODS: This retrospective, observational study included demographic and clinical data from 10 patients with IIH and 10 controls. Brain MRI findings in IIH patients were recorded twice: once when patients had papilledema and again after resolution of papilledema. Neuroradiologists graded MRI findings in both groups based on an imaging grading scale. RESULTS: After resolution of papilledema, all patients showed improvement in 2 or more of the MRI characteristics of IIH. This was especially the case for the height of the midsagittal pituitary gland and optic nerve sheath thickness (ONST), which were significantly different in all pairwise group comparisons. Sellar configuration, globe configuration, and horizontal orbital optic nerve tortuosity were different between the IIH pre-treatment group and controls, but not between controls and the IIH post-treatment group. We found no difference in optic nerve head hyperintensity or optic nerve thickness among the 3 groups. CONCLUSIONS: We demonstrated that several morphometric MRI characteristics in IIH are reversible to a certain extent after treatment. Enlarged subarachnoid spaces filled with cerebrospinal fluid seem to remain reduced, and the ONST and height of the pituitary gland are not fully normalized after treatment.

Intravitreal dexamethasone implant as an option for anti-inflammatory therapy of tuberculosis uveitis.

INTRODUCTION: Tuberculosis-associated uveitis remains a diagnostic and therapeutic challenge. After diagnosis of tuberculosis and initiation of anti-tuberculosis therapy for tuberculosis uveitis, the clinical responses are favorable. However, at 4-6 weeks of the therapy, there commonly occurs paradoxical deterioration due to an increase in inflammation which is often accompanied by cystoid macular edema. Thus, adjuvant administration of anti-inflammatory regimen should be considered. For this purpose, systemic and periocular steroids, systemic and intravitreal immunosuppressive agents have been tested. Nevertheless, there is no report in the literature about intravitreal dexamethasone slow-release implants for the treatment of this inflammatory condition. METHODS: Case presentation. RESULTS: We presented a tuberculosis uveitis case whose ocular inflammation is partially modified by systemic and periocular steroid injections and then well controlled by the intravitreal dexamethasone implant. CONCLUSION: Intravitreal dexamethasone implant injection seems to be a safe and potent option for the treatment of macular edema secondary to tuberculosis uveitis.

Acute lupus choroidopathy: multimodal imaging and differential diagnosis from central serous chorioretinopathy.

IMPORTANCE: Systemic lupus erythematosus (SLE) is a thoroughly examined multi-organ disease whose common ocular complications are also well documented. However, SLE choroidopathy, being a rare ocular complication, is needed to be better understood, in order to make the differential diagnosis from clinical conditions such as central serous chorioretinopathy and provide adequate prompt treatment. OBJECTIVE: To provide a clear understanding for the clinical course of SLE choroidopathy by the help of enhanced depth imaging optical coherence tomography, fluorescein angiography, and indocyanine angiography. DESIGN: The study is designed as a case presentation, consisting of the physical examination results and the data gathered by the relevant screening methods for each visit, applied by the same ophthalmologists and technicians. SETTING: The visits were organized as same day examinations as needed, in a university hospital which works as a referral center.

Personalized Prognosis of Uveal Melanoma Based on Cytogenetic Profile in 1059 Patients over an 8-Year Period: The 2017 Harry S. Gradle Lecture.

PURPOSE: To determine the personalized rate of uveal melanoma-related metastasis on the basis of individual tumor cytogenetic profile. DESIGN: Retrospective case series. PARTICIPANTS: A total of 1059 patients with uveal melanoma. METHODS: Fine-needle aspiration biopsy (FNAB) for DNA amplification and whole genome array-based assay were performed for analysis of chromosomes 3, 6, and 8. MAIN OUTCOME MEASURES: Melanoma-related metastasis. RESULTS: The mean patient age was 57 years, and most were white (1026/1059, 97%). The melanoma involved the choroid (938/1059, 89%), ciliary body (85/1059, 8%), or iris (36/1059, 3%), with 19% being macular in location. The mean largest basal diameter was 11 mm (median, 12 mm; range, 3-24 mm), and mean thickness was 5 mm (median, 4 mm; range, 1-20 mm). On the basis of individual chromosomal mutations, risk for metastasis was increased for chromosome 3 partial monosomy (hazard ratio [HR], 2.84; P = 0.001), 3 complete monosomy (HR, 6.7, P < 0.001), 6q loss (HR, 3.1, P = 0.003), 8p loss (HR, 21.5, P < 0.001), and 8q gain (HR, 9.8, P < 0.001). Kaplan-Meier estimate for melanoma-related metastasis in 1, 3, 5, and 7 years for 3 partial monosomy was 1%, 5%, 14%, and 17%; for 3 complete monosomy was 3%, 19%, 28%, and 37%; for 6q loss was 8%, 23%, 49%, and 49%; for 8p loss was 8%, 29%, not estimable (NE), and NE; and for 8q gain was 6%, 21%, 35%, 48%, respectively. On the basis of personalized cytogenetic profiles, Kaplan-Meier estimates (1, 3, and 5 years) for melanoma-related metastasis for 3, 6, and 8 disomy (1%, 1%, 4% [HR, 1]) were low compared with the higher-risk combinations of 3 complete monosomy, 6p gain, and 8q gain (0%, 29%, 29% [HR, 10.6, P = 0.02]); 3 complete monosomy, 6 disomy, 8q gain, and 8p gain (14%, 14%, NE [HR, 18.3, P = 0.02]); 3 complete monosomy, 6 disomy, and 8q gain (8%, 27%, 39% [HR, 19.5, P < 0.001]); and 3 complete monosomy, 6 disomy, 8q gain, and 8p loss (3%, 28%, NE [HR, 31.6, P < 0.001]), respectively. CONCLUSIONS: Risk for melanoma-related metastasis strongly correlates with personalized cytogenetic profiles, with 5-year Kaplan-Meier estimates ranging from 4% with chromosomes 3, 6, and 8 disomy up to 39% for 3 complete monosomy, 6 disomy, and 8q gain.

Cytogenetic Abnormalities in Uveal Melanoma Based on Tumor Features and Size in 1059 Patients: The 2016 W. Richard Green Lecture.

PURPOSE: To determine the risks for altered cytogenetic profile based on melanoma features and size. DESIGN: Retrospective case series. PARTICIPANTS: A total of 1059 patients with uveal melanoma. METHODS: Fine-needle aspiration biopsy (FNAB) of tumor for DNA amplification and whole genome array-based assay. MAIN OUTCOME MEASURES: Risk for cytogenetic abnormalities based on features and size: small (≤3 mm thickness), medium (>3-<8 mm), and large (≥8 mm). RESULTS: Of 1059 patients with uveal melanoma sampled for status of chromosomes 3, 6, and 8, comparison (normal [disomy] chromosomes 3, 6, and 8 vs. any 3, 6, or 8 abnormality) revealed differences in mean age (55 vs. 58 years, P = 0.018), ocular melanocytosis (1% vs. 5%, P = 0.027), mean visual acuity (VA) (20/30 vs. 20/50, P = 0.011), poor VA (≤20/200) (9% vs. 15%, P = 0.041), ciliary body location (5% vs. 11%, P < 0.001), extramacular location (73% vs. 87%, P < 0.001), increased mean distance to optic disc (3.3 vs. 5.0 mm, P < 0.001) and foveola (3.1 vs. 4.7 mm, P < 0.001), and increased mean basal diameter (9.8 vs. 12.6 mm, P < 0.001) and thickness (3.8 vs. 5.9 mm, P < 0.001). Tumors classified as small, medium, and large showed abnormalities with loss of disomy of chromosomes 3 (35%/52%/65%), 6 (15%/34%/51%), and 8 (19%/41%/69%), respectively. By comparison (medium/large vs. small melanoma), the odds ratio (OR) included complete monosomy 3 (3.09, P < 0.001), partial monosomy 3 (1.44, P = 0.053), 6p gain (3.78, P < 0.001), 6q gain (1.37, P = 0.537), 6p loss (2.52, P = 0.410), 6q loss (12.61, P < 0.001), 8p gain (6.16, P < 0.001), 8p loss (6.04, P < 0.001), and 8q gain (4.87, P < 0.001). For chromosome 3 monosomy, the OR was highest for ciliary body location (8.17, P < 0.001), tumor thickness ≥8 mm (2.70, P < 0.001), tumor base ≥10 mm (2.59, P < 0.001), and age ≥60 years (1.83, P < 0.001). For chromosome 8p loss, the OR was highest for ciliary body location (53.91, P = 0.008), ocular melanocytosis (3.95, P = 0.038), and thickness ≥8 mm (5.14, P < 0.001), whereas for 8q gain, the OR was highest for ciliary body location (102.87, P = 0.001), thickness >8 mm (4.44, P < 0.001), and ocular melanocytosis (2.75, P = 0.049). CONCLUSIONS: Increasing melanoma size demonstrates greater cytogenetic alterations. Alterations in chromosome 8 show unique correlation with melanocytosis. This suggests that prompt management of small melanoma might reduce chromosomal instability and could improve overall patient survival.

EXTERNAL BEAM RADIATION FOR CHOROIDAL LYMPHOMA: Efficacy and Complications.

PURPOSE: To determine the efficacy and safety of external beam radiation for treatment of choroidal lymphoma (CL). DESIGN: Retrospective case series. PARTICIPANTS: Twenty-five eyes of 24 patients with CL treated with external beam radiation. METHOD: Review of medical records. MAIN OUTCOME MEASURES: Tumor control, visual acuity, and radiation complications. RESULTS: The mean age of the patients was 62 years (median, 65; range, 32-89 years). Only 2 patients (8%) had a history of systemic lymphoma. The most common symptom was painless blurred vision in 14 eyes (58%) and the mean duration of ocular symptoms was 12 months (median, 7; range, 1-36 months). Initial best-corrected visual acuity was 20/40 or better in 10 eyes (40%), 20/50 to 20/150 in 12 eyes (48%), and 20/200 or less in the other 3 eyes (12%). The fovea was involved by the CL in 16 eyes (64%). Mean tumor thickness was 3.1 mm (median, 3.0; range 1.1-6.3 mm). Anterior and posterior transscleral extension of CL were present in 15 (60%) and 14 eyes (56%), respectively. All patients, except 3 (13%), had some form of ocular biopsy confirming the diagnosis of ocular lymphoma. The mean total radiation dose was 2,867 cGy (median, 3,000; range, 1,200-3,600 cGy). At final examination, after a mean follow-up period of 58 months (median, 35; range, 13-228 months), 18 eyes (72%) showed complete regression of CL and 7 eyes (28%) showed partial regression. All eyes (100%) with initial serous retinal detachment (14 eyes), subfoveal fluid (8 eyes), and macular edema (5 eyes) achieved complete resolution of subretinal or intraretinal fluid after treatment. Recurrence of CL after initial partial response developed in only 1 eye (4%). Compared with the initial evaluation, final best-corrected visual acuity had increased in 11 (44%), was stable in 8 (32%), and had decreased in 6 eyes (24%). Only 2 eyes (8%) showed signs of mild nonproliferative retinopathy. CONCLUSION: In this study, external beam radiation was an effective and safe modality for treatment of CL, achieving long-term tumor regression in 96% and stable or improved vision in 76% after mean follow-up period of 6 years.

CLASSIFICATION OF SCLEROCHOROIDAL CALCIFICATION BASED ON ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY "MOUNTAIN-LIKE" FEATURES.

PURPOSE: To describe distinct enhanced depth optical coherence tomography patterns of sclerochoroidal calcification and their correlation to clinical features. METHODS: Retrospective chart review of 67 eyes of 46 patients with spectral domain optical coherence tomography imaging. RESULTS: The mean patient age at diagnosis was 68 years. There were 20 (43%) men and 26 (57%) women of white (n = 45, 98%) or Hispanic (n = 1, 2%) heritage. The most prominent sclerochoroidal calcification lesions were located in the superotemporal quadrant (n = 57, 85%) between the temporal arcades and the equator (n = 58, 87%). On enhanced depth optical coherence tomography, the sclerochoroidal calcification was located within the sclera in all cases and the inner surface topography assumed specific "mountain-like" patterns, including flat (Type 1) (n = 9) at median thickness of 1.2 mm, rolling (Type 2) (n = 28) at 1.4 mm thickness, rocky-rolling (Type 3) (n = 21) at 2.1 mm thickness, and table mountain (Type 4) (n = 9) at a thickness of 1.9 mm. The retinal layers were undisturbed in flat lesions, and outer retinal abnormalities were found in all other types. A comparison of the 4 types revealed that Type 3 lesions were thickest (P < 0.001), showing abnormalities in the retinal pigment epithelium, ellipsoid region, and external limiting membrane most commonly (P < 0.05) and demonstrating the most dramatic thinning of the overlying choroid (P < 0.01) and retina (P < 0.05). Type 4 lesions showed greatest basal diameter (P < 0.01) and least outer retinal abnormalities (P < 0.05) or choroid thinning (P < 0.05). CONCLUSION: In this report, enhanced depth optical coherence tomography has demonstrated that sclerochoroidal calcification is a scleral-based disease and can be classified based on four "mountain-like" topographic patterns, associated with variable effects on the choroid and retina.

Sclerochoroidal calcification: clinical features, outcomes, and relationship with hypercalcemia and parathyroid adenoma in 179 eyes.

PURPOSE: To describe the clinical features and long-term ophthalmic and systemic findings in patients with sclerochoroidal calcification (SCC). METHODS: Retrospective non-interventional clinical chart review of 179 eyes of 118 patients with SCC to evaluate for the relationship of SCC with systemic calcium metabolic abnormalities. RESULTS: The mean patient age at diagnosis was 69 years. There were 47 (40%) men and 71 (60%) women of Caucasian (n = 116, 98%) and Hispanic (n = 2, 2%) heritage. The condition was unilateral in 57 patients (48%) and bilateral in 61 (52%), with a mean of 1.6 lesions per eye (range, 1-7 lesions per eye). The referring diagnosis was choroidal nevus (n = 23, 20%), melanoma (n = 15, 13%), lymphoma (n = 12, 10%), metastasis (n = 6, 5%), osteoma (n = 4, 3%), SCC (n = 6, 5%), and no diagnosis (n = 51, 43%). Of 277 SCC lesions, the most common location was superotemporal quadrant (n = 191, 69%). The largest lesion per eye demonstrated mean basal diameter of 3.6 mm and thickness of 1.8 mm, with yellow or white color (n = 150 lesions, 84%) and located superiorly (n = 105, 61%) at the retinal vascular arcade or near the equator (n = 161, 94%). The lesion demonstrated overlying focal choroidal atrophy (n = 63, 35%) and retinal pigment epithelium atrophy (n = 88, 49%). There was no case of subretinal fluid, hemorrhage, or choroidal neovascular membrane. At mean 4 years follow up, there was no lesion enlargement, decalcification, or related subretinal fluid/hemorrhage, choroidal neovascularization, or vision loss. Ocular treatment was not necessary in any case. Systemic outcomes revealed hyperparathyroidism (n = 9/33, 27%) with parathyroid adenoma (n = 5/33, 15%), Bartter syndrome (n = 1/53, 2%), or Gitelman syndrome (n = 6/53, 11%). CONCLUSIONS: Sclerochoroidal calcification is a stable deposition of calcium in the sclera that, unlike choroidal osteoma, has minimal risk for vision loss. All patients with SCC should be evaluated for underlying systemic calcium disorders, especially parathyroid and renal metabolic conditions.

The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison.

CONTEXT: It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone. OBJECTIVE: To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use. PARTICIPANTS: Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3). MATERIALS AND METHODS: All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75 mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter. RESULTS: Mean duration of treatments were 2.4 ± 0.96 years (1-4) and 2.3 ± 1.01 years (1-4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1-2 compared to Group 3 (p < 0.001, p < 0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1-2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1-2 than that of Group 3 (p: 0.040 and p: 0.040, respectively). CONCLUSIONS: In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.

Isolated foveal hypoplasia: clinical presentation and imaging findings.

PURPOSE: To describe the clinical presentation and imaging findings of a patient with isolated foveal hypoplasia. CASE REPORT: A 16-year-old teenager presented to our clinic with mild to moderate visual impairment since early childhood. Lack of foveal depression was noted on both clinical examination and optical coherence tomography, and absence of the foveal avascular zone was demonstrated on fluorescein angiography. His ocular examination was otherwise unremarkable. CONCLUSIONS: Isolated foveal hypoplasia should be considered in the differential diagnosis of early-onset bilateral visual impairment, especially when the foveal reflexes seem absent.

Congenital glaucoma as an ophthalmic manifestation of Frank-Ter Haar syndrome.

We report on a patient with Frank-Ter Haar syndrome that is associated with high intraocular pressures. A 21-day-old male patient was referred to our clinic for surgical treatment of congenital glaucoma. On ophthalmic examination, he had buphthalmos, mild corneal edema and high IOP readings in both eyes. The patient underwent uneventful trabeculotomy surgery, bilaterally. Marked bilateral anterior iris insertion was noted during the surgery. Childhood glaucoma may be associated with Frank-Ter Haar syndrome.

Fungal keratitis secondary to Scedosporium apiospermum infection and successful treatment with surgical and medical intervention.

To report a rare case of severe fungal keratitis caused by Scedosporium apiospermum, which was treated with a penetrating tectonic keratoplasty and aggressive medical treatment. A 62-year-old woman with a history of soil contamination of the right eye while planting vegetables presented with a severe corneal abscess and ocular pain. The patient received medical treatment and underwent tectonic keratoplasty. Both corneal scrapings and the corneal button were evaluated microscopically. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. Microbiological examinations showed S. apiospermum. The isolate was sensitive to amphoterycine B, caspofungin, voriconazole, and resistant to fluconazole. No clinical improvement was achieved with topical voriconazole, vancomycin, ceftazidime, and systemic voriconazole. A penetrating tectonic keratoplasty and lensectomy with continuation of anti-fungal therapy achieved satisfactory results. A fungal etiology should be suspected in a progressive and untreatable corneal abscess. Microbiological investigation is very important in early diagnosis. Despite early diagnosis and aggressive treatment, in selected cases removing the infected tissue surgically is vital in preserving the ocular globe and vision.

Medical And Surgical Management Of Orbital Cellulitis In Children.

OBJECTIVE: The purpose of this study was to identify features of orbital cellulitis that predict response to conservative treatment without surgical intervention and factors associated with a decision for surgery. PATIENTS AND METHODS: The medical files of patients diagnosed with orbital cellulitis at a tertiary medical center in central Israel between 1995 and 2010 were reviewed for clinical data, diagnosis, complications, and type of treatment. Comparison was made between patients treated with antibiotics and patients treated with antibiotics and surgery. RESULTS: Fifty-one patients (35 male) with a mean age of 6.1 years were identified. Main clinical signs included fever (mean 38.5°C), proptosis (82.3%), extraocular motility restriction (74.5%), and ocular pain (41.1%). Forty-one patients were successfully treated with antibiotics and 10 required endoscopic sinus surgery. On between-group comparison, the surgery group had severe eye pain (p = 0.009), severe proptosis (P = 0.02), longer intravenous antibiotic treatment (13.2 vs. 9.2 days, p = 0.04), and several imaging findings. Additional factors associated with surgical intervention included older children, subperiorbital abscess, larger dimension of the abscess (mean 15 mm), involvement of frontal sinuses and findings of intraorbital air bubbles. There was no visual deterioration in either group and no late sequelae. CONCLUSION: Factors associated with surgery included age older than 9 years, severe ocular pain, severe proptosis, and subperiorbital large abscess. These may be used for early identification of patients at risk of failure of only medical management.

A Retina-Inspired Optoelectronic Synapse Using Quantum Dots for Neuromorphic Photostimulation of Neurons.

Neuromorphic electronics, inspired by the functions of neurons, have the potential to enable biomimetic communication with cells. Such systems require operation in aqueous environments, generation of sufficient levels of ionic currents for neurostimulation, and plasticity. However, their implementation requires a combination of separate devices, such as sensors, organic synaptic transistors, and stimulation electrodes. Here, a compact neuromorphic synapse that combines photodetection, memory, and neurostimulation functionalities all-in-one is presented. The artificial photoreception is facilitated by a photovoltaic device based on cell-interfacing InP/ZnS quantum dots, which induces photo-faradaic charge-transfer mediated plasticity. The device sends excitatory post-synaptic currents exhibiting paired-pulse facilitation and post-tetanic potentiation to the hippocampal neurons via the biohybrid synapse. The electrophysiological recordings indicate modulation of the probability of action potential firing due to biomimetic temporal summation of excitatory post-synaptic currents. These results pave the way for the development of novel bioinspired neuroprosthetics and soft robotics, and highlight the potential of quantum dots for achieving versatile neuromorphic functionality in aqueous environments.

A Retina-Inspired Optoelectronic Synapse Using Quantum Dots for Neuromorphic Photostimulation of Neurons.

Neuromorphic electronics, inspired by the functions of neurons, have the potential to enable biomimetic communication with cells. Such systems require operation in aqueous environments, generation of sufficient levels of ionic currents for neurostimulation, and plasticity. However, their implementation requires a combination of separate devices, such as sensors, organic synaptic transistors, and stimulation electrodes. Here, a compact neuromorphic synapse that combines photodetection, memory, and neurostimulation functionalities all-in-one is presented. The artificial photoreception is facilitated by a photovoltaic device based on cell-interfacing InP/ZnS quantum dots, which induces photo-faradaic charge-transfer mediated plasticity. The device sends excitatory post-synaptic currents exhibiting paired-pulse facilitation and post-tetanic potentiation to the hippocampal neurons via the biohybrid synapse. The electrophysiological recordings indicate modulation of the probability of action potential firing due to biomimetic temporal summation of excitatory post-synaptic currents. The results pave the way for the development of novel bioinspired neuroprosthetics and soft robotics and highlight the potential of quantum dots for achieving versatile neuromorphic functionality in aqueous environments.

Capacitive and Efficient Near-Infrared Stimulation of Neurons via an Ultrathin AgBiS2 Nanocrystal Layer.

Colloidal nanocrystals (NCs) exhibit significant potential for photovoltaic bioelectronic interfaces because of their solution processability, tunable energy levels, and inorganic nature, lending them chemical stability. Silver bismuth sulfide (AgBiS2) NCs, free from toxic heavy-metal elements (e.g., Cd, Hg, and Pb), particularly offer an exceptional absorption coefficient exceeding 105 cm-1 in the near-infrared (NIR), surpassing many of their inorganic counterparts. Here, we integrated an ultrathin (24 nm) AgBiS2 NC layer into a water-stable photovoltaic bioelectronic device architecture that showed a high capacitive photocurrent of 2.3 mA·cm-2 in artificial cerebrospinal fluid (aCSF) and ionic charges over 10 µC·cm-2 at a low NIR intensity of 0.5 mW·mm-2. The device without encapsulation showed a halftime of 12.5 years under passive accelerated aging test and did not show any toxicity on neurons. Furthermore, patch-clamp electrophysiology on primary hippocampal neurons under whole-cell configuration revealed that the device elicited neuron firing at intensity levels more than an order of magnitude below the established ocular safety limits. These findings point to the potential of AgBiS2 NCs for photovoltaic retinal prostheses.