Bilateral idiopathic retinal vasculitis following coxsackievirus A4 infection: a case report.

BACKGROUND: Coxsackieviruses are members of a group of viruses called the enteroviruses, which may cause respiratory and gastrointestinal symptoms, erythema, meningoencephalitis, myocarditis, pericarditis, and myositis. Unilateral acute idiopathic maculopathy caused by coxsackievirus A16 has been associated with hand, foot, and mouth disease, but only a few reports describe retinitis associated with coxsackievirus serotype B3 or B4. We report a case of bilateral multifocal obstructive retinal vasculitis that developed after coxsackievirus A4 infection. CASE PRESENTATION: A 60-year-old woman was referred to our department with bilateral visual disturbance that developed following flu-like symptoms. At the initial examination, best corrected visual acuity was 20/200 in the right eye and 20/50 in the left eye. The critical flicker frequency (CFF) was 23 Hz in the right eye and 27 Hz in the left eye. Fine white keratic precipitates with infiltrating cells were presented in the anterior chamber of both eyes, and multifocal retinal ischemic lesions were observed in the macula and posterior pole of both eyes. The retinal lesions corresponded with scotomas observed in Goldmann visual field test. On spectral domain-optical coherence tomography (SD-OCT), retinal lesions were depicted as hyper-reflective regions in the inner retina layers in both eyes, and disruption of ellipsoid line in the left eye., Fluorescein angiography exhibited findings indicative of multifocal obstructive retinal vasculitis. The patient had a history of current hypertension treated with oral therapy and glaucoma treated with latanoprost eye drops. Blood test for coxsackievirus antibody titers revealed that A4, A6, A9, B1, B2, B3, and B5 were positive (titers: 8-32). Abdominal skin biopsy of necrotic tissue suggested vascular damage caused by coxsackievirus. The general symptoms improved after 6 weeks, and the multifocal retinal ischemic lesions were partially resolved with residual slightly hard exudates. Only coxsackievirus A4 antibody titer increased from 4 to 32-fold after 14 months. However, hyper-reflective regions and disruption of the inner retinal layers on SD-OCT persisted especially in the right eye, and residual paracentral scotoma was observed in the right eye. CONCLUSION: The present case suggests that coxsackievirus A4 causes bilateral multifocal obstructive retinal vasculitis with irreversible inner retinal damage.

OCT angiography measured changes in the foveal avascular zone area after glaucoma surgery.

BACKGROUND/AIMS: To evaluate quantitative changes in the foveal avascular zone (FAZ) area after glaucoma surgery using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: Fifty-four consecutive patients with primary open-angle glaucoma (POAG) who met the inclusion criteria and underwent unilateral glaucoma surgery to reduce intraocular pressure (IOP) between April 2018 and July 2019.Eyes underwent IOP-lowering glaucoma surgery and their fellow (non-surgical) eyes were included. OCTA of the macula was performed in both eyes before glaucoma surgery and 3 months postoperatively. Two blinded examiners reviewed the image quality. Within- and between-group comparisons of the FAZ area and correlation of the FAZ area with age, IOP, central sensitivity and clinical variables. RESULTS: The mean (±SD) age was 66.7±11.3 years. After surgery, the IOP and FAZ area significantly decreased from 22.1±9.5 mmHg to 10.3±3.5 mmHg and from 0.485±0.193 mm2 to 0.446±0.174 mm2, respectively (both p<0.001). Conversely, in the non-surgery group, the preoperative and postoperative mean FAZ areas (0.398±0.119 mm2 and 0.396±0.110 mm2, respectively) did not significantly differ (p=0.469). Change in the FAZ area significantly correlated with the preoperative FAZ area, preoperative foveal sensitivity and change in IOP (all p<0.05). CONCLUSIONS: The FAZ area is decreased with IOP-lowering surgery in patients with POAG, and change in the FAZ area was significantly correlated with both preoperative foveal sensitivity and change in IOP.

Central Visual Field Sensitivity With and Without Background Light Given to the Nontested Fellow Eye in Glaucoma Patients.

PRECIS: This study showed the difference of monocular visual sensitivity between with and without background light given to the nontested fellow eyes in glaucoma patients. Monocular sensitivity measurements of the worse eyes with fellow eye's background light conditions should carefully be considered when assessing the impact of functional impairment in glaucoma patients. PURPOSE: The purpose of this study was to investigate the difference between monocular sensitivities measured with and without background light given to the nontested fellow eye in glaucoma patients using a new perimeter named "imo." METHODS: In this cross-sectional study, we examined 102 eyes of 51 patients (mean age, 65.1±14.9 y) with open-angle glaucoma who were affected with at least 1 significant point in the central 10 degrees. We conducted a routine ophthalmic examination and visual field testing using the Humphrey Field Analyzer 24-2 and 10-2 programs. The eyes were assigned to "better" and "worse" categories based on the visual acuity and central visual thresholding. Subsequently, we compared the central visual sensitivities with and without background light given to the nontested fellow eye. RESULTS: The mean sensitivity (MS) in the central 5 points of the visual field of the worse eyes was better when measured with background light than without background light (P=0.037) given to the nontested fellow eye. No significant difference was seen among the MS in the visual field of the better eyes. After dividing the patients into low (n=25) and high sensitivity (n=26) groups, only the low sensitivity group in worse eyes had higher MS with background light than without background light (P<0.05) given to the nontested fellow eye. CONCLUSIONS: Monocular sensitivities measured with background light given to the nontested fellow eye were higher than those without background light in the worse eye group of glaucoma patients. Monocular MS measurements of the worse eyes with fellow eye's background light conditions and their related indices should thus carefully be considered when assessing the impact of functional impairment in glaucoma patients.

Age-dependent changes in visual sensitivity induced by moving fixation points in adduction and abduction using imo perimetry.

Visual field (VF) testing has usually been performed with the central gaze as a fixed point. Recent publications indicated optic nerve head deformations induced by optic nerve traction force can promote the progression of optic neuropathies, including glaucoma. We generated a new static test protocol that adds 6° adduction and abduction to gaze position (fixation points) movement. The aim of this study was to investigate both whether quantifying VF sensitivities at lateral horizontal gaze positions is feasible and whether horizontal gaze positions change sensitivities differently in subjects of different ages. Healthy adult eyes from 29 younger (≤ 45 years) and 28 elderly (> 45 years) eyes were examined in this cross-sectional study. After VF testing with central gaze as a fixation point using 24 plus (1) imo static perimetry, subjects underwent VF testing with 6° adduction and 6° abduction as fixation points. The average mean sensitivities with central gaze, adduction, and abduction were 29.9 ± 1.0, 29.9 ± 1.3, and 30.0 ± 1.2 decibels (dB) in younger subjects and 27.7 ± 1.2, 27.5 ± 1.7, and 28.1 ± 1.3 dB in elderly subjects, respectively. Visual sensitivity in young healthy subjects was similar among the three fixation points, whereas visual sensitivity in elderly healthy subjects was significantly better with abduction as a fixation point than with central gaze and adduction (both p < 0.05). We expect this test protocol to contribute to our understanding of visual function during horizontal eye gaze movement in various eye diseases.

Comparison of central visual sensitivity between monocular and binocular testing in advanced glaucoma patients using imo perimetry.

BACKGROUND/AIM: This study aimed to compare central visual sensitivity under monocular and binocular conditions in patients with glaucoma using the new imo static perimetry. METHODS: Fifty-one consecutive eyes of 51 patients with open-angle glaucoma who were affected with at least one significant point in the central 10° were examined in this cross-sectional study. Monocular and binocular random single-eye tests were performed using the imo perimeter and the Humphrey field analyser (HFA) 24-2 and 10-2 tests. The eyes were assigned to 'better' and 'worse' categories based on the visual acuity and central visual thresholding. Central visual sensitivity results obtained by monocular, binocular random single-eye tests and binocular simultaneous both eye test were compared. RESULTS: The average mean deviation with the HFA 24-2 was -5.5 (-1.5, -14.6) dB (median, (IQR)) in the better eyes and -18.0 (-12.9, -23.8) dB in the worse eyes. The mean sensitivity in the central 4 points of the visual field (VF) of the worse eyes was lower when measured under the binocular eye condition than under the monocular condition. Conversely, this value of the better eyes was greater when measured under the binocular eye condition than under the monocular condition. CONCLUSIONS: The central sensitivity of the better eyes was better and that of the worse eyes poorer with binocular testing than with monocular testing in patients with glaucoma. Although monocular VF testing is still the most straightforward means to monocularly monitor glaucoma at clinical settings, binocular testing, such as provided with imo perimetry, may be a useful clinical tool to predict the effect of VF impairments on a patient's quality of visual life.

Evaluation of Efficacy and Safety of Latanoprost/Timolol versus Travoprost/Timolol Fixed Combinations for Ocular Hypertension Associated with Uveitis.

PURPOSE: To compare latanoprost/timolol (LT) versus travoprost/timolol (TT) fixed combinations for ocular hypertension (OHT) associated with uveitis. METHODS: Thirty-six patients (55 eyes) who were treated with LT (28 eyes) or TT (27 eyes) for OHT associated with uveitis were reviewed retrospectively. Intraocular pressure (IOP) and inflammation scores at the initiation of treatment and at the last visit during therapy were analyzed. RESULTS: Although IOP was reduced significantly in both LT and TT groups, the reduction rate was significantly greater with TT group than with LT. The differences in the reduction of IOP between the groups remained significant when the cases were classified into inflammation-induced OHT and steroid-induced OHT. Inflammation score was not exacerbated by LT or TT treatment. CONCLUSIONS: Both LT and TT are safe and effective for the treatment of OHT associated with uveitis and greater IOP reduction may be achieved by TT than by LT treatment.

Varicella zoster virus-associated anterior uveitis in a seronegative adult without a history of chickenpox.

AIM: The aim of this report was to present a case of varicella zoster virus (VZV)-associated anterior uveitis, which developed in an adult who was seronegative for anti-VZV antibodies. CASE PRESENTATION: A 66-year-old male patient was referred to the National Defense Medical College, Tokorozawa City, Japan with iridocyclitis in his right eye. On examination, intraocular pressure was 30 mmHg in the right eye, and biomicroscopy revealed ciliary injection, corneal epithelial edema, mutton fat keratic precipitates, flare, and infiltrating cells in the anterior chamber. Serological tests were negative for anti-VZV antibodies, but VZV-DNA copies of 1.28×10(7) copies/mL were detected by quantitative reverse transcriptase polymerase chain reaction using the aqueous humor obtained from the right eye. Iridocyclitis was reduced by administration of oral valaciclovir in addition to corticosteroid eye drops, and serum anti-VZV antibodies were first detected after 4 months' administration. When ocular inflammation was resolved after 6 months, VZV-DNA could not be detected in the aqueous humor any more. CONCLUSION: VZV-associated uveitis may develop in an adult with undetectable serum anti-VZV antibodies. Multiplex polymerase chain reaction of the aqueous humor is the key investigation necessary for the diagnosis in such cases.