Journal of Current Ophthalmology最新文献

Purpose: To present a series of cases demonstrating pulsatile ocular blood flow registered with optical coherence tomography angiography (OCTA) and to describe the clinical characteristics of this phenomenon.

Methods: Seven primary open-angle glaucoma patients (eight eyes) were included, with a median age of 67.0 years (range, 39-73 years), who demonstrated alternating hypointense bands of OCTA flow signal on the macular scan at increased intraocular pressure (IOP). All patients received comprehensive ophthalmic examination, OCTA examination with RTVue-XR, and infrared video scanning laser ophthalmoscopy. Changes in retinal microcirculation were assessed on the raw OCTA scans as well as the resultant vessel density maps before and after IOP reduction.

Results: Median IOP in study eyes was 39.0 mmHg (range, 36-58 mmHg). Hypointense bands of OCTA flow signal were associated with arterial pulsation on video scanning laser ophthalmoscopy in all eyes and agreed with the heart rate and resulted in a spotted grid pattern of hypoperfusion on vessel density maps in seven eyes. Median vessel density in superficial capillary plexus and deep capillary plexus was 32.4% and 47.2%, respectively, at high IOP, and increased statistically significantly to 36.5% (P = 0.016) and 50.9% (P = 0.016), respectively, after IOP reduction.

Conclusions: Alternating hypointense flow signal bands on OCTA scans are possibly caused by the pulsatile character of retinal blood flow during the cardiac cycle in eyes with high IOP and may reflect the imbalance between IOP and perfusion pressure. This phenomenon is responsible for the reversible decrease of vessel density at high IOP.

Purpose: To assess consanguinity as a probable risk factor for congenital ptosis.

Methods: In this case-control study, 97 patients with congenital ptosis and 97 participants as the control group were included. The age, sex, and residence area of the control group were matched with the cases. The inbreeding coefficient (F) was calculated for each participant, and the mean of the inbreeding coefficient (α) was calculated for each group.

Results: The prevalence of consanguineous marriage in parents of cases with congenital ptosis and those of the control group was 54.6% and 30.9%, respectively (P < 0.002). The mean of the inbreeding coefficient (α) in patients with ptosis was 0.026, whereas it was 0.016 in the control group (T = 2.51, degree of freedom = 192, P = 0.0129).

Conclusions: The rate of consanguineous marriage was significantly higher among the parents of patients with congenital ptosis. It implies a probable recessive pattern in the etiology of congenital ptosis.

Purpose: To determine the intrasession, intraobserver, interobserver, and repeatability of choroidal thickness measurements in the healthy subjects imaged on enhanced depth imaging system of RTVue XR spectral domain optical coherence tomography (OCT).

Methods: In this prospective, cross-sectional study, seventy eyes of 70 healthy volunteers with no known ocular disease were imaged using high-density scanning protocol of RTVue XR OCT. In a single imaging session, three sequential 12 mm macular-enhanced depth horizontal line scans were obtained through the fovea. Two experienced examiners measured the subfoveal choroidal thickness (SFCT), choroidal thickness at 500 μm nasally and temporally from the fovea in all the eyes, using the manual calipers provided in the software. The graders were masked to each other's measurement readings. The coefficient of repeatability (CR) and intraclass correlation coefficient (ICC) were used to measure the reliability within graders. Intergrader variability was assessed using Bland-Altman method and 95% limits of agreement (LoA).

Results: Intragrader CR for grader one was 4.11 μm (95% confidence interval [CI], -2.84-11.06) for SFCT and 5.73 μm (95% CI, -3.71-15.16) for the grader two. Intragrader ICC of grader one ranged from 0.996 for SFCT to 0.994 for temporal choroidal thickness. Intragrader ICC of grader two ranged from 0.993 for temporal choroidal thickness to 0.991 for SFCT. Intergrader CR ranged from 5.24 μm (95% CI, -4.66-15.15) for SFCT to 5.89 μm (95% CI, -7.27-19.04) for temporal choroidal thickness. Intergrader 95% LoA for SFCT, nasal and temporal choroidal thickness were, -15.84-12.15 μm, -15.99-17.7 μm, and - 19.12-15.57 μm, respectively.

Conclusion: Choroidal thickness measurements can be quantified with good repeatability using RTVue XR OCT, which would be useful in patients with chorioretinal diseases.

Purpose: To describe the case of a 67-year-old female with proliferative retinopathy secondary to uncontrolled hypertension.

Methods: Retrospective case report including multimodal imaging.

Results: A 67-year-old female presented with mild vitreous hemorrhage, retinal hemorrhage, hard exudate of the left eye and hard exudate, copper wiring of vessels, and retinal hemorrhages in the right eye. Optical coherence tomography depicted macular edema of both eyes. Fluorescein angiography revealed large areas of peripheral retinal ischemia and neovascularization with multiple areas of vascular leakage in both eyes.

Conclusions: Proliferative hypertensive retinopathy has been rarely reported in the literature. Our patient exhibited findings consistent with proliferative retinopathy secondary to hypertensive retinopathy.

Purpose: To report a case of a bilateral complex uveitic glaucoma (UG) with pupillary block, rupture of the anterior lens capsule, and malignant glaucoma in a young high-myopic patient and to report anterior segment optical coherence tomography (AS-OCT) findings initially and following surgery.

Methods: A 21-year-old high-myopic woman who had a history of anterior uveitis with extensive posterior synechiae, presented with acute bilateral ocular pain, redness, and blurred vision following bilateral Nd: YAG laser peripheral iridotomy (LPI).

Results: Visual acuity was limited to light perception in both eyes (OU), with a flat anterior chamber (AC) and anterior luxation of lens fragments. Intraocular pressure (IOP) was over 60 mmHg OU. AS-OCT showed closed angles and hyperreflective heterogeneous material within the flat AC. The iris and lens fragments were plated against the corneal endothelium OU. We performed an urgent pars plana vitrectomy associated with lensectomy. It was uneventful in OU. Repeated AS-OCT revealed a deep AC, widely open angles, and aphakia. IOP was lowered to 9 mmHg and visual acuity improved to 5/10 in OU.

Conclusion: Performing LPI might be harmful in the presence of UG with extensive posterior synechia, resulting in complex mechanism glaucoma with aqueous misdirection syndrome associated with a pupillary block due to anterior lens luxation, even in high-myopic eyes. Nd: YAG LPI should not be performed simultaneously in OU, especially in pathologic eyes, to prevent bilateral vision-threatening complications. AS-OCT was of great help, allowing easy and detailed ultrastructural assessment of the ACs, and iridocorneal angles before and after surgery.

Purpose: To evaluate the efficacy of 3-month administration of topical cyclosporin A (CsA) 0.05% on postoperative recurrence after pterygium surgery.

Methods: In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single-blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best-corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared.

Results: The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups (P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99).

Conclusion: The present study showed no priority for 3-month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.

Purpose: To report a rare case of macular outer retinal and retinal pigment epithelium (RPE) damage following brilliant blue G (BBG)-assisted epiretinal membrane (ERM) removal surgery.

Methods: Retrospective, observational case report.

Results: An 85-year-old lady presented with decreased vision in the left eye and a best-corrected visual acuity of 20/400. The right eye examination was within normal limits. The left eye had a significant cataract, and the fundus examination through the cataractous haze showed an ERM with macular pucker, which was confirmed on an optical coherence tomography (OCT) scan. A combined cataract surgery with intraocular lens implantation and BBG-assisted ERM removal and internal limiting membrane peeling surgery was performed. Over the subsequent visits, a well-defined area of outer retinal and RPE alteration was identified on OCT and fundus autofluorescence without significant improvement in visual acuity. At the last follow-up visit, the visual acuity minimally improved to 20/200.

Conclusions: Macular toxicity due to repeated usage of BBG dye and high intensity focal endo-illumination may lead to poor visual outcome following ERM removal or similar macular surgeries. Adequate precautions need to be taken to prevent vision loss.

Purpose: To analyze the microbiological spectrum and antibiotic sensitivity patterns in children with congenital nasolacrimal duct obstruction (CNLDO).

Methods: One hundred thirty-four eyes of 123 children in the age group of 0-16 years with a diagnosis of CNLDO who underwent lacrimal surgical procedures were included in this prospective comparative study. Sixty-two children in the age-matched group planned for intraocular surgery with patent nasolacrimal duct were deemed controls. The conjunctival swab after performing Regurgitation on Pressure over the Lacrimal Sac in the CNLDO group and the conjunctival swab in controls were sent for microbiological analysis. Antibiotic susceptibility testing was done for commonly employed antibiotics by the Kirby Bauer disk diffusion method.

Results: Of 134 samples collected in the CNLDO group, 111 (82.8%) samples were culture positive. There were 165 bacteria isolated, among which 139 (84.24% of isolates) were Gram-positive bacteria, and 26 (15.75% of isolates) were Gram-negative. Fungal isolates were obtained in 2.23% of cases. The most common Gram-positive isolate was Staphylococcus epidermidis (S. epidermidis) (n = 51, 30.9% of total isolates), and the most common Gram-negative isolate was Haemophilus influenza species (n = 9, 5.5% of total isolates). Gram-positive isolates were sensitive mostly to gentamicin and vancomycin (95.5% each), and Gram-negative isolates to amikacin (92.3%). Both Gram-positive and Gram-negative isolates were susceptible to gatifloxacin (80% each). Probing outcomes were similar among Gram-positive (success, 84.6%) and Gram-negative (success, 84.0%) organisms.

Conclusions: There was a predominance of Gram-positive isolates in children with CNLDO with S. epidermidis being the most common. The microbiological profile did not have any effect on the outcomes of probing.

Purpose: To evaluate circumpapillary vessel density (cpVD) in normal subjects, preperimetric glaucoma, and manifest glaucoma, assess the relationship between cpVD and both structural and functional parameters and compare the diagnostic accuracy of the structural and vascular measurements.

Methods: An analytical cross-sectional study of 153 eyes of 83 individuals divided into three groups: Normal subjects, preperimetric glaucoma, and manifest glaucoma. All individuals underwent standard automated perimetry, spectral-domain optical coherence tomography (SD-OCT), and OCT angiography (OCT-A) centered on the optic nerve. We assessed structural (ganglion cell complex [GCC]/retinal nerve fiber layer [RNFL]) and functional parameters (mean deviation [MD]/loss variance [LV]).

Results: Thirty-three normal subjects (66 eyes), 18 patients (30 eyes) with preperimetric glaucoma, and 32 patients (57 eyes) with manifest primary open-angle glaucoma were enrolled. The comparative study of cpVD showed a significant difference comparing glaucomatous subjects versus preperimetric glaucoma (P = 0.025) groups and normal subjects (P < 0.001). The cpVD was strongly correlated with functional parameters, MD, and LV (P < 0.001). Furthermore, cpVD was better correlated with RNFL (P < 0.001) than GCC (P < 0.001). Best regression was observed with mean RNFL (R2 = 0.752). The cpVD has a higher diagnostic value than RNFL and GCC, only between preperimetric and manifest glaucoma.

Conclusions: Circumpapillary vessel damages seem to be less prominent, as it was seen only for the manifest glaucoma group. Microvascular changes appear to occur secondary to RNFL and GCC damages. They seem to be well correlated with visual function. Therefore, OCT-A is not as sensitive as SD-OCT in detecting early structural alterations.

Purpose: To assess postoperative changes in central retinal thickness (RT) following trabeculectomy and combined phaco-trabeculectomy using spectral domain-optical coherence tomography.

Methods: In a prospective interventional comparative study, 64 consecutive glaucoma patients who underwent trabeculectomy (32 eyes) or phaco-trabeculectomy (32 eyes) were included. A macular thickness map using the Early Treatment Diabetic Retinopathy Study circles of 1 mm, 3 mm, and 6 mm was the standard to evaluate the 9-subfield thickness preoperatively and again at 1 and 3 months after surgery. Four subfields in each of the 3 mm and 6 mm rings were considered parafoveal and perifoveal regions, respectively.

Results: Preoperative measurements were similar in the two groups, except patients in the combined group which were older (P = 0.002). The mean RT in the combined phaco-trabeculectomy group at month 1 was significantly higher than baseline measurements at central subfield retinal thickness (CSRT) (P = 0.01), temporal (P = 0.001), and inferior (P = 0.04) parafoveal and temporal (P = 0.01), superior (P = 0.02), and nasal (P < 0.001) perifoveal quadrants; however, RT changes in the trabeculectomy-only group were not statistically significant at months 1 and 3 (P > 0.05). The increase in the temporal perifoveal RT of the combined phaco-trabeculectomy group persisted at month 3 (P = 0.01), while the RT in other sectors returned to preoperative values. The two treatment groups did not differ in terms of changes in the CSRT over time (P = 0.37). In addition, no difference was observed between the treatment groups regarding the parafoveal RTs at each time points (0.06 ≤ P ≤ 0.29).

Conclusions: There was no significant difference in the pattern of changes of CSRT and parafoveal RT between trabeculectomy and combined phaco-trabeculectomy treatment groups up to 3 months after surgery. Some detectable increase in RT in the combined phaco-trabeculectomy will reverse to baseline values 3 months after surgery, except in the temporal perifoveal region.