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Introduction: Epilepsy is a network disorder that can cause alterations in retinal morphology due to microstructural changes in the brain. The aim of our study was to use spectral optical coherence tomography (OCT) to assess the possible effects of neuronal degeneration on the intraretinal layers and macular structures of people with epilepsy and epilepsy subgroups. Methods: We enrolled 52 consecutive people with epilepsy (37 females, 15 males; mean age 29.8±9.9 years; range, 17-48 years) and 40 healthy volunteers (27 females, 13 males; mean age 33.3±10.2 years; range, 19-49 years) in this study. Both eyes of all participants were assessed by using spectral-domain OCT. Optical coherence tomography was used to assess the thickness of the peripapillary retinal nerve fiber layer (RNFL), ganglion cell layer-inner plexiform layer (GCC-IPL), central macula, and central macular volume. Results: In comparison to healthy controls, people with epilepsy showed a thinner GCC-IPL in the superior and superior-nasal quadrants, as well as reduced macular thickness and macular volume (p<0.05). The thickness of the GCC-IPL layer in the superior and inferior subquadrants was negatively affected by frequent seizures (>5 seizures/year), polytherapy, and long-duration of epilepsy (≥10 years) (p<0.05). However, we did not find any other statistically significant associations between OCT measurements, age, sex, and epilepsy type (focal and generalized onset epilepsy). Conclusion: Individuals with epilepsy exhibited microstructural alterations in the retinal layers, primarily in the superior and inferior quadrants. Frequent seizures, polytherapy, and long-duration of epilepsy may result in neuronal damage in the afferent visual system.
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PURPOSE: To evaluate tear meniscus parameters in soft contact lens wearers (SCL) using optical coherence tomography (OCT) and ImageJ software. METHODS: This prospective study included 50 soft contact lens wearers (group 1: 25 symptomatic SCL wearers (SCLW), group 2: 25 asymptomatic SCL wearers (ASCW)) and 25 healthy non-CL wearers (group 3 (NCLW)). SCLs were fitted on each eye of CL wearers, and the lower tear meniscus was imaged using OCT before CL insertion, immediately afterward, and reimaged 2, 5 and 10 h after insertion. Tear meniscus parameters, including tear meniscus height (TMH), depth (TMD), turbidity, and percentage area occupied by particles (PAOP) were measured in all groups. RESULTS: Turbidity and PAOP measurements at baseline in SCLW were significantly higher than in other groups (p < 0.05). There was no significant difference between TMH, TMD, turbidity, and PAOP parameters calculated at baseline visit and two hours after SCL insertion in all groups (p > 0.05 for 2 comparisons). The symptomatic SCL users had a significant decrease in TMH and TMD in the fifth hour. The turbidity and PAOP measurements of SCLW and ASCW at the fifth and tenth hours were significantly higher than those of NCLW (p < 0.05). CONCLUSION: TMD and height TMH decrease throughout the day in all participants; however, a significant decrease in these parameters was observed only in symptomatic SCL users at the fifth hour, at the earliest. As the duration of CL wear increases, turbidity and PAOP even in asymptomatic SCL wearers become significantly higher than those in healthy non-CL wearers. KEY MESSAGES: What Is Known ⢠Contact lens wear is associated with an increased risk of dry eye. ⢠Tear volume decreases gradually during contact lens wear. What Is New ⢠Tear meniscus turbidity and particle area occupied by particles (PAOP) were higher in symptomatic contact lens wearers and they increase gradually during contact lens wear. ⢠Tear meniscus turbidity and PAOP may be measures of how well the tear film and meniscus are functioning in contact lens wearers.
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Purpose: To evaluate optical-coherence-tomography (OCT)-morphological and clinical parameters three years after primary rhegmatogenous retinal detachment (RRD) repair surgery and the role of postoperative foveal bulge sign. Methods: Of the 32 initially enrolled patients with primary RRD 20 (14 fovea-on, 6 fovea-off) completed this prospective study. Preoperatively and 3 years after surgery best corrected visual acuity (BCVA) and OCT including macula status, central retinal thickness (CRT), central choroidal thickness (CCT), thickness of each single retinal layer, integrity of cone-interdigitation-zone (CIZ) and ellipsoid zone (EZ), and presence of foveal bulge were evaluated. Results: Preoperatively fovea-off RRD patients show significantly thinner CCT, inner nuclear layer (INL) and inner plexiform layer (IPL) compared to fovea-on RRD patients, whereas only IPL and INL were significantly thicker compared to the fellow eye. Three years after surgery this thickening recovered. Final BCVA did not differ statistically significantly between fovea-off and fovea-on patients, no difference in CIZ-integrity or presence of foveal bulge was observed. Presence of foveal bulge at 3 years showed significantly better final BCVA and was associated with intact preoperative CIZ-integrity and postoperative EZ- and CIZ-integrity. The preoperative fovea status showed no correlation to the postoperative presence of foveal bulge. Conclusion: Three years after RRD repair retinal layers show similar thickness. The presence of foveal bulge is associated with better final BCVA. Sufficient pre- and postoperative CIZ-integrity as well as postoperative CIZ-integrity seem to be strongly associated with the restoration of foveal bulge. No correlation was found with the preoperative macular status or BCVA.
We analyzed long-term optical-coherence-tomography changes after rhegmatogenous retinal detachment repair. Three years after rhegmatogenous retinal detachment repair retinal layers show similar thickness and visual acuity did not differ between fovea off and fovea on patients. The restoration of foveal bulge sign was the most important factor for good postoperative visual acuity. Integrity of specific retinal layers, such as the ellipsoid zone and cone-interdigitation-zone, seems to be strongly associated with the restoration of the foveal bulge.
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Ocular inflammatory diseases encompass a spectrum of conditions characterized by inflammation within the eye, presenting diagnostic challenges and necessitating tailored management. Ocular toxoplasmosis (OT) poses a challenge in diagnosis and management due to its diverse clinical presentations. We present a case report of a 17-year-old female adolescent who presented with blurred vision and ocular pain, initially misdiagnosed as optic neuritis. Despite receiving methylprednisolone, her symptoms persisted, prompting further evaluation. Ophthalmoscopic examination revealed a whitish focus of chorioretinitis adjacent to an old scar, indicative of OT. Optical coherence tomography confirmed retinochoroiditis, and sulfamethoxazole-trimethoprim was added, resulting in improvement. This case underscores the importance of considering OT in the differential diagnosis of ocular manifestations, especially in individuals with relevant family history, despite atypical presentations. Timely recognition, accurate diagnosis, and prompt initiation of appropriate therapy are crucial to preserve patients' visual function.
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CLINICAL RELEVANCE: Understanding the causes of visual symptoms in epilepsy patients is important for early diagnosis and taking precautions. BACKGROUND: The aim of this study is to evaluate the anterior and posterior segment parameters in patients with generalized tonic-clonic epilepsy (GTCE). METHODS: This retrospective study included 50 eyes of 50 patients with GTCE and 55 eyes of 55 healthy controls. For all participants, detailed ophthalmic examinations were obtained from the files of patients. Anterior segment parameters were measured using corneal topography and non-contact specular microscopy, and posterior segment parameters were measured using swept-source optical coherence tomography. RESULTS: The mean age of the patients with GTCE was 43.3 ± 13.2 years, and in the healthy controls it was 47.6 ± 10.7 years (p = 0.405). In GTCE patients, 34 patients were treated with monotherapy (MT) and 16 patients with polytherapy (PT). Central macular thickness (CMT) was statistically significantly thin in GTCE patients (p = 0.001). The average and four quadrants (superior, inferior, nasal, temporal) retinal nerve fibre layer (RNFL) were thinner in GTCE patients than in the healthy controls, but there was no statistically significant difference (p > 0.05, all). The central corneal thickness was statistically significantly thin in GTCE patients (p = 0.04). Endothelial cell density (ECD), endothelial cell number (ECN), and average cell area (ACA) were statistically significantly lower in GTCE patients than in the healthy controls (p < 0.05, all). Although the CMT, average, and four-quadrants RNFL were thinner in the PT group compared to the MT group, no statistically significant difference was observed (p > 0.05, all). Total high-order aberrations (HOAs) were 0.6 ± 0.4 in the MT group and 0.4 ± 0.1 in the PT group (p = 0.01). ECD, ECN, and ACA measurements were observed to be lower in the PT group compared to the MT group, but no statistically significant difference was detected (p > 0.05, all). CONCLUSION: There could be statistically significant differences between GTCE patients and healthy controls in anterior and posterior segment parameters. This situation may be due to the epilepsy itself or to the antiepileptic drugs.
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Adult-onset foveomacular vitelliform dystrophy (AOFVD) is a rare disease characterized by accumulation of yellowish deposits in the macula. Rarely, it may be complicated by choroidal neovascularization (CNV). Cases with CNV may be confused with occult CNV in age-related macular degeneration. In our case, we will present the visual and anatomical results of a patient with AOVF-related CNV, in which we administered 3 doses of intravitreal ranibizumab (IVR). A 59-year-old female patient, who attended our clinic with the complaint of decreased vision in both eyes, was diagnosed with AOVF-related CNV in both eyes and was treated with 3 doses of IVR for 3 months. Despite the improvement in visual and anatomical functions 1 month after the first dose, vision decreased, and anatomical functions regressed to the pre-injection state in continued injections. IVR therapy is not an appropriate treatment option in the treatment of AOVF-associated CNV.
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Inhibidores de la Angiogénesis , Inyecciones Intravítreas , Ranibizumab , Distrofia Macular Viteliforme , Humanos , Ranibizumab/administración & dosificación , Femenino , Distrofia Macular Viteliforme/tratamiento farmacológico , Distrofia Macular Viteliforme/diagnóstico por imagen , Distrofia Macular Viteliforme/diagnóstico , Persona de Mediana Edad , Inhibidores de la Angiogénesis/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Neovascularización Coroidal/diagnóstico por imagen , Anticuerpos Monoclonales Humanizados/administración & dosificaciónRESUMEN
Objective In this study, we aimed to evaluate the choroidal thickness in patients with unilateral strabismic amblyopia by using spectral domain-enhanced depth imaging-optical coherence tomography (SD-EDI-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Methods Twenty-five children with strabismic amblyopia and 20 age- and sex-matched healthy controls were included in this study. Seven sections were obtained, each comprising 25 repetitive images from each section at 200-micron intervals, and measurements were taken from nine different points at vertical and horizontal lines (1 and 3 mm from the subfoveal, superior, inferior, temporal, and nasal regions), centered on the fovea, using SD-EDI-OCT. Choroidal thickness values were obtained by measuring the distance between the basal border of the retinal pigment epithelium and the choroidoscleral border. The Mann-Whitney U test was used to compare choroidal thickness between the amblyopic and the control groups. Results The mean age of children with amblyopia and that of controls were 8.4 ±2.7 and 9.9 ±3.3 years, respectively (p=0.120). The mean subfoveal choroidal thickness was 372.8 ±78.9 µm in amblyopic eyes and 372.4 ±79.3 µm in the fellow eyes, both of which were thicker than the control eyes (310.9 ±76.3 µm; p<0.05 for each). Similarly, the mean values for the choroidal thickness of the amblyopic children at 1 mm nasal (320 ±86 µm), 1 mm superior (363 ±70 µm), and 3 mm superior (336 ±62 µm) were also significantly thicker than those of the corresponding control eyes (p<0.05 for each). There was a negative correlation between the subfoveal choroidal thickness and axial length (r=-0.332, p=0.005). There were no correlations between the choroidal thickness, age, and visual acuity. Conclusions The choroidal thicknesses of strabismic and fellow eyes were similar in patients with strabismic amblyopia. However, the choroidal thickness of both eyes in strabismic children was significantly thicker than those of the healthy controls. Emmetropization may be defective in both eyes of strabismic amblyopic patients.
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OBJECTIVE: The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels. METHODS: A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined. RESULTS: An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001). CONCLUSIONS: A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.
OBJETIVO: Comparar e investigar los parámetros de la tomografía de coherencia óptica (OCT) de los lados sanos y afectados de pacientes con pérdida auditiva neurosensorial súbita idiopática (PANSI). MÉTODO: La evaluación ocular bilateral de los pacientes diagnosticados con PANSI se realizó con OCT. Se registraron los valores de espesor del complejo de células ganglionares (CCG) y de la capa de fibras nerviosas de la retina (CFNR), y se examinaron las diferencias entre los dos ojos. RESULTADOS: Se evaluaron 39 pacientes, con una edad media de 44.82 ± 14.90 años. Se determinó que el grosor de la CFNR de los ojos era una media de 89.87 ± 3.65 µm en el lado afectado y 103.87 ± 3.98 µm en el lado de control sano (p = 0.0001). Se determinó que el CCG medio era 90.46 ± 3.49 µm en el lado afectado y 103.77 ± 3.96 µm en el lado de control sano (p = 0.0001). CONCLUSIONES: Se encontró una diferencia estadísticamente significativa entre los ojos sanos y afectados de pacientes con PANSI con respecto al CCG medio y al espesor medio de la CFNR. La OCT podría ser una técnica útil para medir esta degeneración neuronal.
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Axones , Fibras Nerviosas , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Adulto , Femenino , Masculino , Fibras Nerviosas/patología , Persona de Mediana Edad , Axones/patología , Células Ganglionares de la Retina/patología , Pérdida Auditiva Sensorineural/diagnóstico por imagen , Pérdida Auditiva Súbita/diagnóstico por imagen , Adulto JovenRESUMEN
PURPOSE: To study retinal and choroidal microcirculation by optical coherence tomography angiography (OCTA) in pregnant women with unexplained recurrent spontaneous abortion (RSA) and to compare them with healthy pregnant and nonpregnant subjects. METHODS: Pregnant women with an unexplained history of RSA (group 1), healthy pregnant (group 2), and healthy non-pregnant women (group 3) were included in the study. After a thorough ophthalmologic examination:best-corrected visual acuity, intraocular pressure,slit-lamp biomicroscopy, fundus examination,autorefractometer, biometry, and axial length measurement; OCT and OCTA measurements were performed with Swept Source OCT-Angiography (Topcon Co, Japan). RESULTS: The nonpregnant group had higher values for central foveal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD) and lower values for superior, inferior, and mean VD compared with pregnant groups (p < 0.001). Choriocapillaris values (CC) VD were higher in groups 1 and 2 than in group 3 (p < 0.001). The group with unexplained RSA had a relatively smaller FAZ (foveal avascular zone) area than the group of healthy pregnant women (p:0.047). There were no statistically significant differences between groups in the retina, retinal nerve fiber layer, ganglion cell layer, and choroidal thickness (p > 0.05). CONCLUSION: Although our study did not identify any etiology in pregnant women with RSA, we observed detectable differences in FAZ area and vessel density values using OCTA, when comparing them with healthy pregnant women and healthy nonpregnant controls. We believe that OCTA, as used in many pathologies such as diabetic and hypertensive retinopathy and retinal vascular occlusion, can also be extended to unexplained RSA both to detect etiology and to monitor treatment in studies with a larger number of patients.
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Aborto Habitual , Coroides , Vasos Retinianos , Tomografía de Coherencia Óptica , Humanos , Femenino , Embarazo , Tomografía de Coherencia Óptica/métodos , Adulto , Coroides/irrigación sanguínea , Coroides/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Aborto Habitual/diagnóstico por imagen , Angiografía con Fluoresceína/métodos , Estudios de Casos y Controles , Microvasos/diagnóstico por imagen , Microcirculación , Adulto JovenRESUMEN
Leber's hereditary optic neuropathy (LHON) is the most common maternally inherited disease linked to mitochondrial DNA (mtDNA). The patients present with subacute asymmetric bilateral vision loss. Approximately 95% of the LHON cases are caused by m.3460G>A (MTND1), m.11778G>A (MTND4), and m.14484T>C (MTND6) mutations. The hallmark of hereditary optic neuropathies determined by mitochondrial dysfunction is the vulnerability and degeneration of retinal ganglion cells (RGC). We present the case of a 28-year-old man who came to our clinic complaining of a subacute decrease in visual acuity of his left eye. From his medical history, we found out that one month before he had the same symptoms in the right eye. From the family history, we noted that an uncle has had vision problems since childhood. We carried out complete blood tests, including specific antibodies for autoimmune and infectious diseases. Laboratory tests and MRI were within normal limits. A blood test of the mtDNA showed the presence of 11778 G>A mutation on the mtND6 gene. The medical history, the fundus appearance, the OCT, and the paraclinical investigations, made us diagnose our patient with Leber's hereditary optic neuropathy. As soon as possible, we began the treatment with systemic idebenone, 900 mg/day. We examined the patient 2, 6, and 10 weeks after initiating the treatment. Abbreviations: LHON = Leber's Hereditary Optic Neuropathy, mtDNA = mitochondrial DNA, VA = visual acuity, RE = right eye, LE = left eye, OCT = Optical coherence tomography, pRNFL = peripapillary retinal nerve fiber layer, GCL = retinal ganglion cells layer, MRI = magnetic resonance imaging, VEP = visual evoked potentials, VEP IT = VEP implicit time, VEP A = VEP amplitude.
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Atrofia Óptica Hereditaria de Leber , Enfermedades del Nervio Óptico , Masculino , Humanos , Niño , Adulto , Atrofia Óptica Hereditaria de Leber/diagnóstico , Atrofia Óptica Hereditaria de Leber/genética , Diagnóstico Diferencial , Potenciales Evocados Visuales , ADN Mitocondrial/genéticaRESUMEN
PURPOSE: To evaluate the microvasculature during remission in patients with pars planitis (PP-IU) and multiple sclerosis-associated intermediate uveitis (MS-IU) using optical coherence tomography angiography (OCT-A). METHODS: Single-center, descriptive, case-control study was conducted. Adult patients (≥16 years) with IU in remission (PP-IU and MS-IU) and healthy age-sex matched healthy controls (HC) were enrolled to the study. Demographic/clinical features, best-corrected visual acuity (BCVA), ocular findings, neurological symptoms and preferred treatments were recorded. The presence of cystoid macular edema (CME) during follow-up was recorded. All IU patients in remission and HC subjects were scanned with OCT-A. Foveal avascular zone (FAZ) areas of superficial and deep capillary plexus (SCP/DCP) and vascular densities of SCP, DCP and choriocapillaris were obtained from OCT-A and compared between the groups. RESULTS: Sixty-nine eyes of 37 IU patients in remission and 20 HC were included (44 eyes/23 patients in PP-IU, 25/14 in MS-IU, 40/20 in HC). No statistically significant differences were observed in terms of demographic or clinical characteristics of the patients. The vascular density in the SCP was significantly reduced in the PP-IU and MS-IU groups compared to the HC group (p < .05). Nevertheless, there were no significant changes in any of the OCTA parameters between the IU groups. Uveitis duration was found to be correlated with enlargement of the FAZ area in PP-IU (p = .039). CONCLUSION: OCTA may not be useful in differentiating between PP-IU and MS-IU. Nevertheless, the primary implication in SCP potentially elucidates the pathogenesis of these two subtypes of IU, which are characterized by a shared pathogenesis. The monitoring of the FAZ area in the PP-IU group is valuable in terms of chronicity.
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Angiografía con Fluoresceína , Esclerosis Múltiple , Pars Planitis , Vasos Retinianos , Tomografía de Coherencia Óptica , Uveítis Intermedia , Agudeza Visual , Humanos , Tomografía de Coherencia Óptica/métodos , Masculino , Femenino , Adulto , Uveítis Intermedia/diagnóstico , Uveítis Intermedia/fisiopatología , Uveítis Intermedia/tratamiento farmacológico , Angiografía con Fluoresceína/métodos , Agudeza Visual/fisiología , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico por imagen , Vasos Retinianos/patología , Vasos Retinianos/diagnóstico por imagen , Pars Planitis/diagnóstico , Adulto Joven , Persona de Mediana Edad , Estudios de Seguimiento , Estudios de Casos y Controles , Fondo de Ojo , AdolescenteRESUMEN
OBJECTIVES: To evaluate scleral thickness measurements of pterygium patients using anterior segment optical coherence tomography (AS-OCT) and to compare them with healthy individuals. MATERIAL AND METHODS: Scleral thickness was measured from 2, 4, 6 mm posterior to the scleral spur with AS-OCT (Swept Source OCT Triton, Topcon, Japan) in 4 quadrants (superior, inferior, nasal and temporal). RESULTS: Eyes with pterygium were determined as Group 1, and contralateral eyes without pterygium were determined as Group 2. Healthy controls were determined as Group 3. In the measurements made from 4 mm posterior, no significant difference was found between Group 1 and Group 2 in any quadrants (p > 0.05). In all measurements made from 4 mm posterior to the scleral spur, scleral thickness was found to be significantly higher in Group 1 compared to Group 3 (p < 0.05). Measurements made from 2 mm posterior to the scleral spur in Group 1 was found to be significantly higher in the superior and temporal quadrants compared to Group 3 (p = 0.05), while no significant difference was found in the nasal and inferior quadrants (p > 0.05). When Group 2 and Group 3 were compared, scleral thickness measurements made from 4 mm posterior to the scleral spur was significantly thicker in all quadrants in Group 2 (p > 0.05). CONCLUSION: Scleral thickness was found to be higher in pterygium patients compared to healthy controls, especially when measured from 4 mm posterior to the scleral spur. It has been predicted that high scleral thickness may be associated with high fibroblast activity in subconjunctival structures, and this may predispose to pterygium.
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Pterigion , Esclerótica , Tomografía de Coherencia Óptica , Humanos , Pterigion/patología , Pterigion/diagnóstico por imagen , Esclerótica/patología , Esclerótica/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Reproducibilidad de los ResultadosRESUMEN
Various forms of cancer and chemotherapeutics are associated with optic neuropathy. Cisplatin is a platinum analogue chemotherapeutic commonly associated with ocular toxicity among many other serious adverse effects. Carboplatin is a more chemically stable platinum analogue that is generally better tolerated with a comparatively favorable side effect profile. There are very few reports of carboplatin precipitating optic neuropathy. This case report describes a rare occurrence of carboplatin-induced blinding optic neuropathy. We treated a patient receiving carboplatin for neuroendocrine bladder cancer who developed rapidly progressive bilateral optic neuropathy over the course of three days. Upon evaluation at our clinic, his visual acuity had declined to light perception only and 20/60 in his left and right eye, respectively. Carboplatin therapy was immediately held and steroids were initiated. Despite the intervention, the patient's visual deficits have not improved at the one-year follow-up. Although the mechanism by which carboplatin causes ocular toxicity remains speculative, arterial ischemia appears to be the likely mechanism given the irreversible nature of visual decline. As demonstrated by our patient's course, irreversible vision loss despite high-dose steroid intervention necessitates expeditious recognition and management of this rare adverse effect. âââââ.
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Posterior polar annular choroidal dystrophy (PPACD) is a rare ocular disorder and presents as symmetric degeneration of the retinal pigment epithelium (RPE) and the underlying choriocapillaris, encircling the retinal vascular arcades and optic disc. This condition distinctively preserves the foveal region, optic disc, and the outermost regions of the retina. Despite its distinct clinical presentation, due to the infrequency of its occurrence and the limited number of reported cases, the pathophysiology, and the genetic foundations of PPACD are still largely uncharted. This review aims to bridge this knowledge gap by investigating potential genetic contributors to PPACD, assessing current findings, and identifying genes that warrant further study. Emphasis is also placed on the crucial role of multimodal imaging in diagnosing PPACD, highlighting its importance in understanding disease pathophysiology. By analyzing existing case reports and drawing comparisons with similar retinal disorders, this paper endeavors to delineate the possible genetic correlations in PPACD, providing a foundation for future genetic research and the development of targeted diagnostic strategies.
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BACKGROUND/AIM: The aim of this paper is to compare retinal nerve fiber layer thickness (RNFL) and Bruch's membrane opening-based minimum rim width (BMO-MRW) in terms of their performance in detecting early and moderate/advanced glaucoma using receiver operating characteristics (ROC) analysis and the classification using the 5th percentile as a cut-off. METHODS: One hundred eyes from 100 patients with early glaucoma (mean deviation (MD): < -5.0 dB) and 100 eyes from 100 patients with moderate/advanced glaucoma (MD: > -5.0 dB) were carefully matched to healthy controls based on optic disc size. Then, the dataset was divided, based on the 50th percentile of the measured Bruch's membrane opening area (BMO-A), into small (BMO-A < 1.95 mm2) and large optic discs (BMO-A > 1.95 mm2). Finally, the discriminative performance of BMO-MRW and RNFL between glaucoma and controls using ROC analysis and the manufacturer's classification based on the 5th percentile was analyzed. RESULTS: In discriminating between glaucoma and matched healthy controls, global BMO-MRW and global RNFL thickness had comparable areas under the ROC curve for eyes with early glaucoma and both small BMO-As (ROC ± confidence interval [CI] 0.91 [0.87 to 0.95] and 0.88 [0.83 to 0.93]) and large BMO-As (0.86 [0.82 to 0.92] and 0.84 [0.79 to 0.90]), as well as in moderate/advanced glaucoma with small BMO-As (0.99 [0.98 to 1.00] and 0.97 [0.95 to 1.00]) and large BMO-As (0.94 [0.91 to 0.98] and 0.97 [0.94 to 1.00]). Using the calculated 5th percentile as a threshold value, the sensitivities for the detection of early and moderate/advanced glaucoma were comparable for BMO-MRW and RNFL in eyes with small optic discs (early glaucoma: fifty-two percent and 61%; moderate/advanced glaucoma: ninety-one percent and 92%). In eyes with large optic discs, the sensitivity of BMO-MRW was inferior to that of RNFL for both early (38% versus 51%) and moderate/advanced (80% versus 91%) glaucoma. CONCLUSION: Based on an ROC analysis, the discriminative performance of BMO-MRW and RNFL between patients with early and moderate/advanced glaucoma and a healthy control group matched based on optic disc size is comparable in eyes with BMO-As smaller and larger 1.95 mm2. Using a classification based on the 5th percentile, as used in clinical practice, RNFL is shown to be superior to BMO-MRW regarding sensitivity in glaucoma detection with large optic discs. This study underscores the importance of RNFL imaging and measurement in the diagnostic evaluation of glaucoma, especially in cases of large optic discs.
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Lámina Basal de la Coroides , Presión Intraocular , Fibras Nerviosas , Disco Óptico , Curva ROC , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica , Campos Visuales , Humanos , Disco Óptico/patología , Lámina Basal de la Coroides/patología , Fibras Nerviosas/patología , Células Ganglionares de la Retina/patología , Femenino , Masculino , Tomografía de Coherencia Óptica/métodos , Campos Visuales/fisiología , Presión Intraocular/fisiología , Persona de Mediana Edad , Glaucoma/diagnóstico , Glaucoma/fisiopatología , Anciano , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Ángulo Abierto/fisiopatología , Estudios Retrospectivos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Implantation of the left atrial appendage occluder (LAAO) has been proven to prevent stroke effectively in patients with atrial fibrillation who cannot tolerate anticoagulants. Incomplete endothelization of LAAO may cause device-related thrombus, and currently no good image modality exists to clearly see LAAO endothelialization. We aimed to use coronary optic coherence tomography (OCT) to visualize LAAO endothelialization. METHODS AND RESULTS: We enrolled 14 patients (72.8±9.4 years old) undergoing pulmonary vein isolation with a preexisting LAAO implanted more than 1 year ago (5 Watchman and 9 Amulet). After pulmonary vein isolation, we did OCT via steerable sheath and coronary guiding catheter to adjust OCT probe location and injected contrast medium to visualize the LAAO surface. In vitro testing was also performed to see the bare occluder. In vitro OCT showed the surface of the bare device as an interrupted granule pattern, which included the Watchman surface polytetrafluoroethylene membrane string, Amulet disc metal strut, and inner polytetrafluoroethylene membrane string. In the implanted Watchman, OCT showed endothelialization as a smooth surface layer with noninterrupted coarser granules. In the implanted Amulet, OCT showed endothelialization as thin (early) or thick (late) endothelialization layer covering struts with OCT shadows. Among patients with Watchman, 2 showed no, 2 early, and 1 complete endothelialization. Among patients with Amulet, 2 showed no, 3 early, and 4 late endothelialization. CONCLUSIONS: We demonstrated the feasibility of OCT to visualize LAAO endothelization with high resolution. Further studies are needed to determine antithrombotic regimens if incomplete endothelization is detected. A new OCT catheter may be designed specifically for LAAO.
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Apéndice Atrial , Fibrilación Atrial , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Proyectos Piloto , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Accidente Cerebrovascular/etiología , Cateterismo Cardíaco/efectos adversos , Tomografía/efectos adversos , Politetrafluoroetileno , Resultado del Tratamiento , Dispositivo Oclusor Septal/efectos adversosRESUMEN
AIMS: Multiple sclerosis (MS) is characterized by inflammation, demyelination, glial cell pathology and axonal injury in the central nervous system, and also progressive axonal loss of the optic nerve in cases with optic neuritis (ON). The previous transcranial Doppler (TCD) investigations suggest cortical hyperreactivity in patients with relapsing-remitting Multiple sclerosis (RRMS). We investigated the effect of ON involvement on visual reactivity. MATERIAL AND METHODS: One hundred thirty patients with RRMS during attack-free period and 12 healthy subjects were enrolled to the study. Visual evoked potential (VEP), optic coherence tomography (OCT) and TCD examinations of all subjects were performed. RESULTS: Cerebrovascular reactivity measured with breath holding (BH) test was found to be normal. VEP amplitude, visual reactivity and peripapillary retinal nerve fibre layer (pRNFL) measurements were found to be low in patients with ON involvement, whereas VEP latencies were long. Visual reactivity was negatively correlated with VEP amplitude and RFNL measurements, and positively correlated with VEP latency. CONCLUSIONS: The present study supports that cerebrovascular reactivity is preserved in patients with RRMS except for attacks, and neurovascular reactivity is increased in patients without ON involvement.
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AIM: To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease (TED) patients at different stages and the relationship of those changes with risk factors, serum antibodies and the severity of TED. METHODS: A total of 85 participants were enrolled. All participants underwent ophthalmology and endocrinology examinations. Subfoveal choroidal thickness (SFCT), superficial (s) and deep (d) foveal avascular zone (FAZ) area, mean (m) and central (c) superficial vascular density (SVD), deep vascular density (DVD) measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography (OCT)/OCT angiography (OCTA) DRI OCT Triton. Multiple linear regression analysis was used to explore the associations between SFCT, FAZ area, SVD, DVD and the relevant factors of TED. RESULTS: Those with active TED patients had higher c-DVD and m-DVD levels (P<0.05), however there is no statistically significant difference in SFCT between active and stable TED patients. Among the serum antibodies, it was observed that s-FAZ and d-FAZ increased, c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies (TRAB) level, whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin (hTG). There was no significant difference in SFCT, FAZ, SVD and DVD measurement at gender, between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma. CONCLUSION: The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density. It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.
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Antecedentes y objetivo El agujero macular de espesor completo (AMEC) es una lesión foveal causada por un defecto del espesor completo de la retina neurosensorial. En su diagnóstico y en la indicación de tratamiento quirúrgico se tiene en cuenta la medida del agujero según la herramienta proporcionada por la OCT. Dicha medida puede ser realizada por varios oftalmólogos a lo largo del seguimiento de un paciente. El objetivo de este estudio es averiguar si existe variabilidad intraindividual e interindividual en dichas mediciones. Material y métodos Revisión retrospectiva de imágenes de b-scans de OCT con diagnóstico de AMEC. Se realizaron mediciones del diámetro mínimo del AMEC mediante la herramienta manual disponible en el DRI-Triton (Topcon, Japón) en las escalas 1:1 y 1:2, en días diferentes, por 2 especialistas en retina y 2 residentes. Se compararon dichas mediciones para valorar la correspondencia interobservador e intraobservador Resultados Se analizan 34 imágenes. Para la variabilidad intraobservador se obtuvo un índice de correlación superior a 0,98 en todos los casos. Para la variabilidad interobservador, el coeficiente de correlación intraclase fue de 0,94 (IC del 95%, 0,91-0,97) para la escala 1:1, y de 0,94 (IC del 95%, 0.91-0,97) para la escala 1:2. Conclusiones Los valores del tamaño de los AMEC medidos por OCT son reproducibles entre oftalmólogos especialistas y residentes y son independientes de la escala de la imagen en la que se realice dicha medición (AU)
Background and objective A full-thickness macular hole (FTMH) is a foveal lesion caused by a defect in the full thickness of the neurosensory retina. Its diagnosis and the indication for surgical treatment take into account the measurement of the hole according to the tool provided by the OCT. This measurement can be performed by several ophthalmologists during the follow-up of a patient. The aim of this study is to find out whether there is intra-individual and inter-individual variability in these measurements. Material and methods Retrospective review of OCT b-scan images with a diagnosis of FTMH. Measurements of the minimum diameter of the FTMH were performed using the hand-held tool available on the DRI-Triton (Topcon, Japan) at 1:1 and 1:2 scales, on different days, by 2retina specialists and 2residents. These measurements were compared to assess inter-observer and intra-observer correspondence. Results Thirty-four images were analysed. For intra-observer variability, a correlation index higher than 0.98 was obtained in all cases. For inter-observer variability, the intra-class correlation coefficient was 0.94 (95% CI: 0.91-0.97) for the 1:1 scale, and 0.94 (95% CI: 0.91-0.97) for the 1:2 scale. Conclusions OCT-measured AMEC size values are reproducible between ophthalmic specialists and residents and are independent of the imaging scale at which the measurement is made (AU)
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Humanos , Perforaciones de la Retina/diagnóstico por imagen , Variaciones Dependientes del Observador , Tomografía de Coherencia Óptica , Estudios RetrospectivosRESUMEN
Caso clínico Mujer de 48años con escotomas superotemporales persistentes y fotopsias de 2meses de evolución y zonas despigmentadas en retina de ambos ojos con patrón trizonal en imagen multimodal. La resonancia magnética cerebral, la tomografía por emisión de positrones, los anticuerpos antirretinianos y los marcadores inmunológicos, infecciosos y tumorales fueron negativos, por lo que se diagnosticó retinopatía externa oculta zonal aguda. La paciente fue tratada con adalimumab. Sin embargo, 19meses después los síntomas aumentaron y se detectó progresión en la angiografía por tomografía de coherencia óptica, así como también en la prueba de campo visual Humphrey y el electrorretinograma, por lo que se agregó micofenolato de mofetilo, mostrando mejoría y estabilización de la enfermedad durante un seguimiento de 4años. Discusión La angiografía por tomografía de coherencia óptica puede ser una herramienta potencial para monitorizar la progresión y la respuesta al tratamiento además de otras modalidades de imagen en la retinopatía externa oculta zonal aguda, y la combinación de adalimumab y micofenolato puede ser útil en la enfermedad recurrente (AU)
Clinical case A 48-year-old woman with persistent superotemporal scotomas and photopsias for 2months, and depigmented zones in the retina of both eyes with a trizonal pattern on multimodal imaging. Brain magnetic resonance imaging, positron emission tomography, antiretinal antibodies and immunological, infectious and tumor markers tests were negative, thus acute zonal occult outer retinopathy was diagnosed. Patient was treated with adalimumab. Nevertheless, 19months later symptoms increased, and progression was detected on optic coherence tomography angiography, as well as in Humphrey visual field test and electroretinogram, thus, mycophenolate mofetil was added showing improvement and stabilization of the disease in a 4-year follow-up. Discussion Optic coherence tomography angiography may be a potential tool to monitor progression and response to treatment in addition to other imaging modalities in acute zonal occult outer retinopathy, and the combination of adalimumab and mycophenolate may be useful in recurrent disease (AU)