bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful outcome of paediatric cytomegalovirus optic neuritis treated with combined steroid and valganciclovir: A case report
Authors: Margaretha Lydia , Prayitnaningsih Seskoati , Wulandari Lely Retno
Published: December 2022

Purpose: To report the clinical approach for diagnosis and management of paediatric optic neuritis.

Methods: A 13 years old girl patient came to the emergency room with complaints of sudden blurred vision in both eyes and pain with eye movement. On Ophthalmic examination, the visual acuity in the right eye was 6/30 and the left eye was no light perception. There was a positive relative afferent pupillary defect in the left eye. Both the optic disc was swollen. The colour vision was abnormal and there was inferior visual field defect. Laboratory examination showed an increase leukocyte, increase in cytomegalovirus (CMV) immunoglobulin G (IgG) antibody, and decrease in cluster of differentiation 4 (CD4) cell. The head and orbital MRI did not show any intracranial pathological lesion. The patient was diagnosed with optic neuritis caused by CMV and treated with intravenous methylprednisolone 250 mg every 6 h for 3 days followed by oral prednisone 1 mg/kg daily and valganciclovir 16 mg/kg daily for 3 weeks.

Results: After 3 days of only intravenous steroid treatment, her visual acuity improved to 6/9 in right eye and 1/300 in left eye. The vision increase significantly to 6/6 in the right eye and 6/7.5 in the left eye after 1 month treated with combined steroid and valganciclovir.

Conclusions: A comprehensive examination, includes history taking, optic nerve examination, laboratory and serology tests related to infection, also head and orbital MRI to rule out other causes is important in the management of paediatric optic neuritis. Appropriate treatment with IV methylprednisolone and valganciclovir provide a better visual prognosis for paediatric CMV optic neuritis.
Systemic and ocular manifestations of Anti‐MOG disease in Canada
Authors: Lalonde Melanie , O'Neil Alexis , Nguyen Hong‐An , Rush Carolina , Coupland Stuart , Karanjia Rustum
Published: December 2022

Purpose: There is limited published data on anti‐MOG disease in Canada. The purpose of this study was to increase the understanding of the ophthalmic and neurological manifestations of anti‐MOG disease in adults living in a Canadian setting through a retrospective/prospective chart review.

Methods: Data from standard of care ophthalmic and neurological assessments was collected for patients who were diagnosed with Anti‐MOG disease at a quaternary care teaching hospital.

Results: Nineteen patients diagnosed with Anti‐MOG disease were identified. Of these, 70% were female and 30% were male, with ages ranging from 18 to 82 years old. On ocular examination the majority of eyes had normal visual acuity (87%). Three eyes were hand motion or no light perception. On fundus examination, 84% of participants presented with optic disc abnormalities with the most common findings being disc atrophy and temporal pallor. In patients affected with Anti‐MOG with decreased visual acuity, pattern Visual Evoked Potentials were significantly reduced in amplitude. Other than the initial optic neuritis, half of participants experienced no additional neurological effects, while the others experienced variable residual symptoms such as scintillating scotomas, recurrent mild paresthesia of both legs, seizures, urinary urgency, oscillopsia and neuropathic pain. Of the 15 participants with recent MRI results, 67% showed persistent hyperintense T2 abnormalities while 22% showed resolution of prior T2 abnormalities.

Conclusions: The initial results of this study match existing literature for anti‐MOG disease. Optic nerve atrophy and temporal pallor are commonly found ocular signs in patients with anti‐MOG. Interestingly, patients were found to have persistent decreased VEP amplitudes with normal inner and outer retinal function. Overall, the ophthalmic and neurological findings were variable between participants. Study recruitment is ongoing.
Correlation between biomechanical and endothelial corneal properties in myopic children
Authors: Corbu Maria‐Cristina , Voinea Liliana , Coviltir Valeria , Schmitzer Speranta , Constantin Mihaela , Dascalescu Dana , Burcel Miruna , Ciuluvica Radu , Potop Vasile
Published: December 2022

Purpose: The purpose of the study is to investigate the endothelial layer and biomechanical properties of the cornea, in a group of low‐moderate myopic children.

Methods: This prospective study included only the right eye from myopic patients younger than 18. We performed a complete ophthalmologic examination, including autorefractometry under cycloplegia (to determine the spherical equivalent ‐ SE), slit lamp and fundus examination, visual acuity and ocular tonometry. Furthermore, the patients were examined with the Aladdin biometer (Topcon, Tokyo, Japan) to determine central corneal thickness (CCT) and axial length (AL), with the Specular Microscope (Nidek, Gamagori, Japan) to determine number (Num) and density (CD) of endothelial cells, and with the Ocular Response Analyser (Reichert Ophthalmic Instruments Inc., Depew, NY) to determine corneal hysteresis (CH) and resistance factor (CRF). IBM SPSS Statistics 26 was used for statistical analysis.

Results: Our study included 64 right eyes from 64 patients (51.56% male, 48.44% female). The average age was 14.27 years (standard deviation 2.71). The average SE is −2.57 (SD 1.62), AL 24.69 (SD 1.15), CCT 0.565 (SD 0.036), CH 12.32 (SD 1.88), CRF 12.64 (SD 2.24), Num cell 175.17 (SD 38.55), CD 3126.86 (SD 192.74). There are significant correlations between the biomechanical properties of the cornea and the characteristics of the endothelial layer. We found a statistically significant moderate positive correlation between CH and CD in this paediatric myopic population (Pearson's r of 0.353, p 0.004), and also between CRF and CD (Pearson's r of 0.2557, p 0.041). Between AL and the number of cells, there is a significant negative correlation (Pearson's r of −0.287, p 0.025). There are no significant correlations between the number of endothelial cells and CH, CRF, SE or CCT, or between CD and AL, CCT, SE.

Conclusions: Our study reveals that in children with myopia, the endothelial cell count is higher in corneas with a higher hysteresis and resistance factor. Moreover, the relationship between the axial length and the number of endothelial cells suggests an impact of myopia on the endothelial layer and warrants further studies, including a larger number of patients and more corneal properties, such as corneal diameter and curvature.
Swept source optical coherence tomography and optical coherence tomography angiography for diagnosis and follow‐up of type 2 macular telangiectasia
Authors: Fekih Khawla , Ouederni Meriem , Maamouri Rim , Aoun Safa Ben , Sassi Hela , Cheour Monia
Published: December 2022

Purpose: To report the contribution of swept source optical coherence tomography (SS‐OCT) and OCT‐angiography (OCTA) imaging findings in the diagnosis and the follow‐up of type 2 macular telangiectasia (MacTel 2).

Methods: A retrospective study of eight eyes (five patients) with various stages of MacTel2. Clinical staging of MacTel 2 was performed based on SS‐OCT and OCTA.

Results: The average age was 63 years old. The mean follow up was 33.6 months. A very early non‐proliferative stage was found in three eyes, an early non‐proliferative stage in three eyes and a late proliferative stage in two eyes. The most common findings on SS‐OCT were disruption of the inner segment‐outer segment (IS/OS) layer in all eyes, parafoveal hyporeflective retinal cavities in four eyes and superficial retinal crystals in three eyes. Two eyes showed irregularity of foveal contour and internal limiting membrane draping associated with retinal vascular channels connecting the superficial and deep retinal layers and forming retinal‐choroidal anastomosis. OCTA findings included capillary telangiectatic changes and enlargement of intercapillary spaces predominantly in deep capillary plexus (DCP) in comparison with superficial capillary plexus (SCP) in all eyes. Irregularity of capillary size in the perifoveal region of the DCP and SCP, predominantly temporal to the fovea, was found in five eyes. Circumferential capillary distortions and subretinal neovascularization at the level of the outer retina and choriocapillaris were detectable in two eyes. At the mean period of follow‐up, lesions were stable in two eyes, an extension of IS/OS disruption was noted in four eyes, parafoveal cavities' appearance and/or extension was found in two eyes and neovascular proliferation appeared in one eye.

Conclusions: SS‐OCT and OCTA imaging features facilitate the diagnosis, staging and long‐term follow‐ up of MacTel 2. Further prospective studies are need to characterize the progressive and sequential nature of structural changes in this disease.
Retinal macroglial activation over time in an experimental glaucoma model
Authors: Fernández‐Albarral José A. , Matamoros José A. , Chen Lejing , Salobrar‐Garcia Elena , López‐Cuenca Inés , Sanchez‐Puebla Lidia , Lozano María Pilar Rojas , De Hoz Rosa , Ramirez Jose Manuel , Salazar Juan Jose , Ramirez Ana Isabel
Published: December 2022

Purpose: The aim of this study was to analyse the effects of unilateral laser‐induced ocular hypertension (OHT) on macroglia in OHT and contralateral eyes at different time points after laser treatment (1, 3, 5, 8 and 15 days).

Methods: Two groups of albino Swiss mice: naïve group (n = 6) and OHT group (n = 30, six animals for each time study group). In the OHT group, OHT was induced by laser photocoagulation of the limbal and episcleral veins of the left eyes. Retinal whole‐mounts were used to visualize the astroglial plexus throughout the retinal extension, analysing the GFAP‐labelled retinal area (GFAP‐RA), the intensity of GFAP labeling (GFAP‐IRI), and the intensity of MHC‐II expression (MHC‐II‐IRI) in both OHT eyes and normotensive contralateral eyes compared to naïve eyes.

Results: In OHT and contralateral eyes, with respect to naïve eyes, at all the time points, we found the following: (i) astrocytes with thicker somas and more secondary processes, mainly in the intermediate (IR) and peripheral retina (PR); (ii) astrocytes with low GFAP‐IRI and only primary processes near the optic disc (OD); (iii) increased total GFAP‐RA, which was higher at 3 and 5 days, except for at 15 days; (iv) increased GFAP‐IRI in the IR and especially in the PR: (v) decreased GFAP‐IRI near the OD, mainly at 1 and 5 days; (vi) a significant increase in MHC‐II‐IRI, which was higher in the IR and PR; and (vii) GFAP+ and MHC‐II+ immunolabelling in the Müller glia.

Conclusions: Increased IOP leads, both in OHT eyes and in their normotensive contralateral eye, to macroglial activation, demonstrated both by morphologic changes and by the overexpression of GFAP and MHC‐II. The main signs of activation were observed mainly in the IR and PR, being more intense at 3 and 5 days after induction. However, in the OD, astrocytes showed low expression of GFAP and MHC‐II. The bilateral macroglial activation observed in this study would be triggered by the immune response associated with neuroinflammation.
changes in corneal diameter in myopic children during 18 months randomly assigned to orthokeratology lenses or single‐vision spectacles
Authors: Lazar Daniel , Jakobsen Trine Møldrup
Published: December 2022

Purpose: Orthokeratology lenses (OKL) have been shown to reduce axial length elongation in myopic children. OKL are costume fit, reverse geometry lenses. One of the parameters used to ensure lens fitting is the corneal diameter. The purpose of this study was to investigate changes in corneal diameter during 18 months in myopic children randomized to OKL or single‐vision spectacles (SVS).

Methods: This study was an 18‐month 1:1 randomized, controlled trial of Danish myopic children aged 6–12 years with myopia ranging from 0.5 to 4.75 diopters (D) spherical component and refractive astigmatism ≤2.5 D. The intervention was orthokeratology lenses (OKL), while the control group received SVS. The outcome measure was corneal diameter (Pentacam HR, Oculus, Wetzlar, Germany).

Results: A total of 37 right eyes were included, 23 (13 female) in the control group and 14 (9 female) in the intervention group. We found a significant change in corneal diameter in both the control group (difference in medians of 0.20 mm, p < 0.001, Wilcoxon signed‐rank test) and the intervention group (difference in medians of 0.175 mm, p < 0.001, Wilcoxon signed‐rank test). Furthermore, when comparing our 2 groups, we saw a significantly smaller increase in corneal diameter in the intervention group compared to the control group (difference in medians of 0.025 mm, p = 0.03, Mann–Whitney rank‐sum test).

Conclusions: The corneal diameter significantly changes during 18 months in Danish children in both groups, however, the difference is significantly less during OKL treatment. The latter needs further clarification at this point. We can conclude, that to ensure correct OKL fitting in children close monitoring during OKL treatment is necessary.
Visual impairment in Malta ‐ preliminary data from the Malta eye study
Authors: Agius David , Cassar Daniel , Mamo Julian , Carbonaro Francis
Published: December 2022

Purpose: The Malta Eye Study is a cross‐sectional ophthalmic epidemiology study of the Maltese population aged between 50–80 years. We report preliminary data on visual impairment, and the leading causes of visual loss among the Maltese population.

Methods: Data is being collated over 2 years from a randomized sample of 2000 subjects from the Maltese Electoral Register, using postal invitations for assessments. The assessments include questionnaires (National Eye Institute Visual Function Questionnaire, EuroQoL, Ocular Surface Disease Index, the Quick Mild Cognitive Impairment Score), anthropometrics, visual assessment, a slit lamp based ophthalmological examination, OCT scanning, Visionix and saliva collection for DNA analysis. The visual examination involves the use of logMAR chart calibrated at 4 m. This is performed for either eye with occlusion of the other eye. The WHO definitions of mild, moderate, severe visual impairment and blindness have been used.

Results: Up until the date of submission of this abstract, 500 participants were assessed (25% of the target data). The overall prevalence of visual impairment, that is, any vision >0.3 logMAR in the better eye, is 5.8% (95% CI 3.9–8.2%). The prevalence of mild, moderate, severe visual impairment and blindness of the better eyes are 3.6% (95% CI 2.1–5.6%), 1.6% (95% CI 0.7–3.1%), 0.2% (95% CI 0.0–1.1%) and 0.4% (95% CI 0.0–1.4%) respectively. 22.4% (95% CI 18.8–26.3%) of the population have at least one eye with visual impairment, i.e. visual acuity >0.3 logMAR. In the population with visual impairment in at least one eye, the leading causes for such impairment in descending order include uncorrected refractive error, amblyopia, untreated cataract, age related macular degeneration, diabetic retinopathy and glaucoma with prevalence of 29.5% (95% CI 21.2–38.8%), 21.4% (95% CI 14.2–30.2%), 20.5% (95% CI 13.5–29.2%), 7.1% (95% CI 3.1–13.6%), 4.5% (95% CI 1.5–10.1%) and 4.5% (95% CI 1.5–10.1%) respectively.

Conclusions: The findings from this preliminary dataset compare well with large epidemiological surveys of similar populations in Europe and the US.
Microspherophakia and megalocornea with or without secondary glaucoma: A case series
Authors: Houmane Yasmine , Meriem Ouederni , Falfoul Yousra , Abid Yosra , Zeghal Imene , Cheour Monia
Published: December 2022

Purpose: To report a case series of 6 eyes of 3 children diagnosed with microspherophakia and megalocornea with or without secondary glaucoma (MSPKA) and to discuss its clinical features and management.

Methods: We reviewed 3 cases of a boy (case 1) and 2 sisters (cases 2,3) diagnosed with MSPKA from two consanguineous families. Ultrasound biomicroscopy was performed in 2 eyes and anterior‐segment swept‐source optical coherence tomography in 6 eyes.

Results: Mean corneal diameter was 13 mm. Lens equatorial diameters were, in case 1, 6.2 mm in the right eye (RE) and 6.1 mm in the left eye (LE); in case 2, 7.4 mm (RE) and 7.7 mm (LE). Systemic work‐up was unremarkable.

Case 1: A 6‐year‐old boy presented with bilateral lens subluxation and advanced secondary angle‐closure glaucoma (SACG). Best‐corrected visual acuity (BCVA) was 20/200 (RE) and was limited to counting fingers (LE). We performed phacoemulsification, anterior vitrectomy and retro‐pupillary iris‐claw intraocular lens implantation (RPIC‐IOL) in both eyes. At 5 months follow‐up, BCVA was 20/50 (RE) and 20/100 (LE). Intraocular pressure (IOP) decreased to 14 mmHg in both eyes.

Case 2: Ophthalmologic examination in a 5‐year‐old girl showed in both eyes: a BCVA of 20/50, megalocornea, normal IOP and iridophacodonesis. Surgery with scleral fixation of the capsular bag will be considered.

Case 3: An 8‐year‐old girl was referred after a bilateral lensectomy following spontaneous luxation of the lens into the anterior chamber in her RE. Examination showed bilateral megalocornea, aphakia and normal IOP. Secondary RPIC‐IOL implantation and amblyopia management were planned.

Genetic testing for the Latent Transforming Growth Factor Beta Binding Protein 2 (LTBP2) gene mutation was performed in both sisters.

Conclusions: MSPKA is a rare condition that can be associated with extraocular manifestations. Patients are at a high risk of lens dislocation and SACG. Surgical management remains challenging and should not be delayed.
Clinical parameters related to the glial activation and neuronal alterations present in the retinas of COVID‐19 patients
Authors: Albertos‐Arranz Henar , Gil Natalia Martínez , Sáez Xavier Sánchez , Noailles Agustina , Pastor María José Ruiz , Adsuara Clara Monferrer , Sargues Lidia Remolí , Andrés Ramón Calvo , Lax Pedro , Cuenca Nicolás
Published: December 2022

Purpose: Ocular and eye fundus alterations have been described in COVID‐19 patients. In this study, the aim was to establish several stages of response to damage in the retinal cells from human donors with COVID‐19 and analyse their relationship with clinical parameters.

Methods: Retinal sections and flat‐mount retinas from human donors with COVID‐19 (n = 16) and control (n = 12) were analysed with immunohistochemistry. The location of angiotensin‐converting enzyme 2 (ACE2) and the morphology of microglial cells, Müller cells, astrocytes, and photoreceptors were evaluated by confocal microscopy. Microglial analysis and cell death were measured. Clinical data were correlated with different retinal parameters.

Results: Müller cells, outer segment of cones and retinal pigment epithelium presented the ACE2 protein. Larger staining of ACE2 and cellular retinaldehyde–binding protein (CRALBP) was found in the cell bodies of Müller cells in COVID‐19 group. Disorganization of honeycomb‐like pattern formed by Müller cells and disruption of external limiting membrane were observed in the 81.3% of COVID‐19 patients. The 53.3% of COVID‐19 patients showed reactive gliosis as well as astrocytes protruding and epiretinal membranes. Cone degeneration was aggravated in the COVID‐19 group. Activated or ameboid‐shape microglia was found in the 93.8% of COVID‐19 patients. Most retinas showed a reduction of the area occupied by microglia and presented microglial nodules around vessels. Retinal degeneration in COVID‐19 group correlated with the duration of the disease (ro: 0.655; p < 0.01) and age (ro: −0.5; p < 0.05). Moreover, microglia activation was correlated with blood oxygen levels (ro: −0.554; p < 0.05).

Conclusions: Different stages of glial activation and neuronal alterations are present in COVID‐19 retinas and are significantly correlated with the duration of the disease, age and respiratory failure.
Conjunctival tumour as an acute myeloblastic lymphoma presentation in a paediatric patient
Authors: Alarcón‐Correcher F. , Tepper Sergio Maugard , Fabra Yolanda Cifre , García Maria Amparo Lanuza
Published: December 2022

Purpose: The most frequent ocular tumours are those that affect the conjunctiva which have a wide spectrum of presentation and can arise from any cell lineage that forms the conjunctiva, being the most representatives those that origins from epithelial and melanocytic cells. A case of a 10‐month‐old female patient who was diagnosed with acute myeloblastic leukaemia after studying a conjunctival tumour is presented.

Methods: The case of a 10‐month‐old female with a conjunctival lesion located in the right eye who was also being studied for two masses, one on the right preauricular zone and the other on the left zygomatic area is described. About her medical history, she had an aplastic crisis due to parvovirus infection when she was 8 months old. No ophthalmological background was reported. On the clinical exam of the right eye, a pink conjunctival lesion located in the outer corner of the superior conjunctival fornix was found. The ocular motility was normal and the eyeball position was normal.

Results: A biopsy of the conjunctival mass was performed immediately. The histopathology report showed infiltration with leukaemic cells. After this finding, a bone marrow biopsy, lumbar puncture, full‐body CT scan and an orbit MRI were performed, concluding the patient was suffering from an acute myeloblastic leukaemia with extramedullary involvement (face, orbit, ovaries) and central nervous system affection. After two cycles of chemotherapy, complete remission is achieved, including the conjunctival and orbital lesions.

Conclusions: Haematology‐Oncology systemic diseases can imply the eye and the orbit. The manifestations most commonly found in children with leukaemia are proptosis, retinal and choroidal affection, optic nerve damage, and sixth nerve palsy. In the conjunctiva, it usually manifests as a subconjunctival salmon‐pink flesh coloured mass. Excision‐biopsy study is essential in the differential diagnosis of conjunctival neoplasms.
Postural exophthalmos caused by orbital varix
Authors: deRivas Marta Orejudo , Moscarda Eva Núñez , Rivasés Guillermo Pérez , Claveria Julia Aramburu , Arias Pablo Cisneros , Martinez Marta Suñer , el Bakkali Ismael Bakkali , Fernández Miguel Castillo , Laguarta Jesus Castillo
Published: December 2022

Purpose: To describe a clinical case of unilateral and intermittent exophthalmos of subacute onset and persistent course.

Methods: A 43‐year‐old woman who was referred to the orbit section due to a sensation of protrusion of the left eye (LE) that increases when bending down. Shee also reports that she hears an intermittent murmur. It is not accompanied by eye pain or blurred vision. She evidenced it a few months ago, not being related to any traumatic event. She has no personal or family history of interest. It was observed with the patient sitting that the LE seemed to protrude more than the RE. Exophthalmometer measurement revealed a 2 mm proptosis. When the patient was lying on her left side, the exophthalmos increased as the minutes passed. It was a reducible but not pulsatile exophthalmos. No murmur was observed during the examination. The rest of the ophthalmological examination showed no alterations. Given the suspicion of intermittent exophthalmos due to a left orbital tumour, it was decided to perform a contrast‐enhanced CT scan that revealed a varicose venous lesion with an intraconal component and slight extraconal prolongation in the Valsalva sequences.

Results: Due to the difficult surgical access, the small size and the mild symptoms, having ruled out the presence of haemorrhage, varicose thrombosis or compression of the optic nerve, it was decided to carry out clinical follow‐up.

Conclusions: Clinical suspicion of orbital varicocele in a case with typical symptoms is essential. Orbital CT with contrast in Valsalva sequences is one of the most used diagnostic test. Good clinical follow‐up is necessary in cases with mild symptoms.

References

Howells MS, Sharma R. Orbital varices. BMJ Case Rep. 2019;12(12):e232887. doi: 10.1136/bcr‐2019‐232 887. PMID: 31818898; PMCID: PMC6904158.

Shchurova IN, Pronin IN, Melnikova‐Pitskhelauri TV, Serova NK, Batalov AI, Solozhentseva KD. Orbital'nyi venoznyi varikoz: sovremennye metody diagnostiki i differentsial'nyi diagnoz [Orbital venous varices: modern diagnostic methods and differential diagnosis]. Zh Vopr Neirokhir Im N N Burdenko. 2020;84(6):33–48. Russian. doi: 10.17116/neiro20208406133. PMID: 33306298.
A model of the oxygen tension and consumption across the cornea under a contact lens with incorporation of blinking effects
Authors: Lim Clara , Hainey Paul , Goodenough Neil , Crooke‐Alvarez Almudena , Garcia‐Montero Maria
Published: December 2022

Purpose: The aim of this study was to incorporate the influence of the blinking effects on the post‐lens tear film (PoLTF) oxygen tension evolution in a model of a cornea. Indeed, the reservoir effect of the PoLTF has often been overlooked in the previous models. Here, both the oxygen tension and consumption profiles across the cornea are described over several cycles of blinking from the insertion of the lens to the reach of a steady‐oscillation state.

Methods: A numerical model of the cornea was developed based on previous studies, the oxygen consumption of the cornea being described by the Monod kinetics model [1]. The temporal variations of the oxygen tension in the PoLTF were added using the model of Fatt and Hill [2]. The oxygen tension and consumption at different times were calculated, while varying the fractional reservoir volume (FRV) not replenished by the blink, 0.82 being the FRV giving results closest to reality according to Fatt and Hill.

Results: As expected, the higher the value of FRV, the lower the oxygen tension and oxygen consumption were across the cornea. At steady state, the model showed an average corneal oxygen consumption diminution of 5.7% between two blinks for a FRV equal to 0.82. This diminution increases with the value of FRV.

Conclusions: This simple numerical model provides a theoretical support and contributes to the better understanding of the oxygen uptake of the cornea while wearing a lens. However, assuming that the oxygen tension of the PoLTF is not influenced by the oxygen consumption inside the cornea may constitute a limitation.

References.

1. Compañ V, Aguilella‐Arzo M, Weissman BA. Corneal Equilibrium Flux as a Function of Corneal Surface Oxygen Tension. Optom Vis Sci. 2017;94(6):672–679. PMID: 28514247.

2. Fatt I, Hill RM. Oxygen tension under a contact lens during blinking‐‐a comparison of theory and experimental observation. Am J Optom Arch Am Acad Optom. 1970;47(1):50–5. PMID: 5262987.
Large macular hole surgery using an inverted flower internal limiting membrane flap technique
Authors: Chichur Diana
Published: December 2022

Purpose: To evaluate the anatomical and functional results in eyes with large macular holes using inverted flower ILM flap technique.

Methods: This clinical study included 58 eyes with large macular holes, which were divided into two groups: first group included 36 eyes with idiopathic macular holes and second group ‐ 22 eyes with myopic macular holes. In both groups, diameter of the hole was more than 600 μm. All eyes were treated using an inverted flower flap technique, C3F8 gas tamponade and face‐down posturing. The hole closure, postoperative visual acuity and OCT data were analysed at 1 and 6 month after the surgery.

Results: The inverted flower ILM technique was successful in 100% of the cases. We could observe significant postoperative improvements of visual acuity (p < 0.05) in all eyes. However, the first group showed better functional results compared to the second group. Complete resolution of ellipsoid zone defects was observed on 22 eyes (61.1%) in the first group and on 9 eyes (40.9%) in the myopic group.

Conclusions: The inverted flower flap technique confirmed its effectiveness for the closure of large macular holes and good recovery of photoreceptor layers and, consequently, functional result improvement.
Bilateral optic nerve glioma in a paediatric patient with neurofibromatosis type 1
Authors: Moscarda Eva Josefina Núñez , Orejudo deRivas Marta , Cisneros‐Arias Pablo , El Bakkali Ismael Bakkali , Rivasés Guillermo Pérez , Martínez Marta Suñer , Clavería Julia Aramburu , Fernández Miguel Castillo , Garcia Diana Perez
Published: December 2022

Purpose: To describe the presentation and management of gliomas of both optic nerves in a paediatric patient with neurofibromatosis type 1 (NF1).

Methods: A 4‐year‐old female patient referred for ophthalmological evaluation due to a recent diagnosis of neurofibromatosis type 1. She presented better corrected visual acuity (BCVA) of 20/40 in both eyes (OU). Symmetrical and normoreactive pupils, normal extrinsic ocular motility, no proptosis or exophthalmos. In biomicroscopy Lisch nodules are observed in OU. Funduscopy of normal appearance except slight pallor of both optic papillae Refraction measurements with cycloplegia showed anisometropia: Right eye: +0.75–0.25 at 180°; Left eye: +1.75–2.75 at 170°. Stereopsis: 120 s of arc. Correction is prescribed and a follow‐up visit is scheduled. In subsequent visits we found a slight decrease in BCVA (20/50). In the Optical Coherence Tomography (OCT) we observed a clear decrease in the thickness of the retinal nerve fibre layer (RNFL) in the temporal sector. Visual campimetry and colour vision test cannot be performed Because of the patient's age. Due the clinical situation of decreased BCVA without justifiable cause in a patient with NF1, Magnetic Resonance Imaging of the brain and orbit is requested and a fusiform thickening of both optic nerves in their intraorbital portions with prolongation towards the optic chiasm is evidenced.

Results: Due the clinical progression and deterioration on the RNFL OCT tests, an interconsultation with the Paediatric Oncology Department was made and it was decided to start systemic treatment with vinblastine.

Conclusions: A complete ophthalmological examination adjusted to age is currently considered to be of choice in patients with NF1, being necessary annually until the age of 8 years and every 2 years until the age of 18. However, this examination in younger children, who are at greatest risk of developing gliomas, can be complex and requires experience.
Genetic variability of inflammation and oxidative stress genes in retinal detachment patients with and without proliferative vitreoretinopathy
Authors: Lumi Xhevat , Confalonieri Filippo , Ravnik‐Glavač Metka , Goričar Katja , Blagus Tanja , Dolžan Vita , Petrovski Goran , Hawlina Marko , Glavač Damjan
Published: December 2022

Purpose: To investigate the associations of selected single nucleotide polymorphisms (SNP) in genes involved in inflammation and oxidative stress among patients with rhegmatogenous retinal detachment (RRD) and patients with proliferative vitreoretinopathy (PVR).

Methods: 192 patients with primary RRD who underwent 3‐port pars plana vitrectomy were included; 112 patients developed PVR grade C1 or higher within 3 months from surgery (enrolled as PVR cases), and 80 patients did not develop PVR (enrolled as controls). Genotyping was performed for 9 SNPs with known or predicted functional effects across 7 genes important in antioxidant and inflammatory pathways. SOD2 (rs4880), CAT (rs1001179), GPX1 (rs1050450), IL1B (rs1143623, rs16944, rs1071676), MIR146A (rs2910164), IL6 (rs1800795) and TNF (rs1800629) were genotyped using a fluorescent‐based, competitive allele‐specific polymerase chain reaction (KASP, LGC Genomics, Hoddesdon, UK). For quality control, 10% of the samples were genotyped in duplicate, and all results were concordant.

Results: Comparing the genotype frequencies between patients with or without PVR grade C1 or higher, 2 SNPs were found to be statistically significant: (1) SOD2 rs4880 (TT) (p‐value = 0.046; after adjustment = 0.021), as well as CC + TT (p‐value before and after adjustment = 0.05); and (2) IL1B rs1071676 (GC) (p‐value = 0.056; after adjustment = 0.034).

Conclusions: Our data reveal association between polymorphisms in SOD2 and ILB1B and PVR. Further studies, in particular, expanded multicentric population‐based studies, would be necessary to elucidate the role of these findings in PVR development.
Decreasing laquer cracks in high myopie: A case series
Authors: Jonas Rahul , Wei C. C. , Jost Jonas , Wang Yaxing
Published: December 2022

Purpose: Axial Elongation in myopic eyes may be caused by growth of Bruch's membrane along the equator of the eye. This may lead to a change in the eye morphology and may put pressure on the retinal pigment epithelium (RPE) and on BM at the posterior pole of the eye. To relieve the pressure congregating on the posterior pole, an increase in Bruch's membrane opening (BMO) and laquer cracks (LCs) may form. The BMO may develop an enlargement of the parapillary gamma zone (PGZ) defined as a parapapillary region free of BM. Previous studies concluded that an enlargement of PGZ correlates with less disruptions of BM or RPE as in LCs or macular BM defects at the posterior pole. This case series examines three individuals with highly myopic eyes during a 10‐year follow‐up with disappearances of LCs.

Methods: Funduscopy and OCT imaging were used to determine LC occurrence and change in a 10‐year follow‐up study.

Results: The patients were examined in 2001 and 2011. The age of the patients was at the initial exam 45, 63 and 69 years. The axial length was 23.17 and 27.66 mm. The refractive error was between −7.38 diopters and − 17.13dpt. The patients showed initially in 2001 a LC and a vertically oval optic disc head. After re‐examination in 2011 the LC was not visible in funduscopy or optical coherence tomography.

Conclusions: The findings suggest that LCs can decrease in width and severity.
Pseudo‐double anterior chamber following deep anterior lamellar keratoplasty (DALK) with type 2 bubble formation
Authors: Khanderia Neha , Onrubia Luis Garcia , Bhogal Mani
Published: December 2022

Purpose: To describe the clinical features and natural history of pseudo‐double anterior chamber (DAC) after Deep Anterior Lamellar Keratoplasty (DALK) in cases with Type 2 bubbles.

Methods: An observational case series of three patients with Type 2 bubbles. All patients had advanced keratoconus and underwent DALK with a ‘big bubble’ technique. A cohesive ophthalmic viscosurgical device (OVD) was used to maintain separation between the posterior stroma and Descemet's Membrane (DM). A small optical window (5 mm) was created in the centre of the posterior stroma to reduce the risk of perforation. No perforations were observed intraoperatively. Patients were followed up for 1 year with serial anterior segment optical coherence tomography (AS‐OCT).

Results: A characteristic pattern of DM detachment was observed postoperatively on AS‐OCT. Separation was maximal in the periphery and minimal in the centre under the optical window, creating a ‘W' sign. Despite separation between the posterior stroma and DM, stromal deturgescence continued at a normal rate with a return to normal central corneal thickness in 1 month. Complete reattachment of the DM, with resolution of the ‘W' sign, was seen by 6 months in all cases.

Conclusions: Pseudo‐DAC following DALK appears to result from retained OVD in the interface between the DM and stroma. This phenomenon is distinctly different from a classical DAC, which results from a perforation in DM. The pseudo‐DAC does not result in corneal oedema and stromal thickening and restoration of corneal clarity occurs without apposition of the DM. Use of a small optical window and OVD cushion in cases of type 2 bubble is a useful technique to prevent intraoperative perforation. Small amounts of retained OVD will spontaneously resorb. We believe excessive irrigation and aspiration in the space between the DM and the posterior stroma, in an effort to remove all OVD, may risk perforation of DM and this case series suggests it is unnecessary.
Idiopathic macular hole surgery using inverted temporal internal limiting membrane flap technique
Authors: Ham Don Il
Published: December 2022

Purpose: To investigate the anatomic success rate of single‐layered, inverted temporal internal limiting membrane flap (ITF) cover technique for idiopathic macular hole (MH) surgery.

Methods: Clinical records of idiopathic MH patients who underwent surgery using ITF technique. Two techniques were used. Group A had circular internal limiting membrane (ILM) peeling and ITF surgery. Group B had hemicircular ILM peeling and ITF surgery. Postop closure of MH was examined by optical coherence tomography.

Results: Group A included 18 eyes and Group B included 42 eyes. Immediate postop closure of MH was observed in 83.3% (50 eye); 88.9% (16 eyes) in Group A and 81% (34 eyes) in Group B. Anatomic success rate of large MH was 88.9% (24/27 eyes). Among 10 eyes showing persistent MH after the surgery, 6 eyes had additional intravitreal gas injection treatment and MHs were closed. MHs in other 4 eyes were also closed after the second surgery. In two eyes, ITF flipped back to the original position was observed during the surgery, and reinverting the previous flap induced MH closure.

Conclusions: Single‐layered ITF cover technique showed high anatomic success rate in idiopathic MH surgery. However, more attention is needed to prevent the flap flipping.

References

1. Michalewska Z, et al. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a Comparative Study. Retina. 2015;35 (9):1844–1850.

2. Silva N, et al. Inverted internal limiting membrane flap technique: Is it the best option for macular holes? Clin Ophthalmol. 2021;15:3295–3303.
Agreement between anterior segment swept source‐OCT and Scheimpflug imaging corneal aberration measurements in healthy eyes
Authors: Bartolomé Francisco Pérez , Gonzalez Rocío Vega , Nieves Jorge Peraza , Moreno Jose María Ruiz
Published: December 2022

Purpose: To assess agreement between corneal aberration measurements made through swept‐source optical coherence tomography using a new anterior segment imaging device (Anterion) and a Scheimpflug imaging device (Pentacam HR) in healthy subjects.

Methods: Cross‐sectional study. In 50 eyes of 50 healthy subjects, 14 aberration parameters (7 across the anterior corneal surface and 7 across the total surface) were measured in 4 mm and 6 mm optic zones using each device: oblique trefoil (Z3_‐3), vertical coma (Z3_‐1), horizontal coma (Z3_1), horizontal trefoil (Z3_3), spherical aberration (Z4_0), root mean square (RMS) lower order aberrations (LOA) and RMS higher order aberrations (HOA). Data for the two devices were compared through intraclass correlation coefficients (ICC), paired t tests, limits of agreement (LoA) and Bland Altman plots.

Results: Vertical coma was the only corneal aberration parameter that consistently showed excellent agreement (ICC > 0.8, mean difference −0.019, LoA −0.165 to 0.126). Good agreement (ICC = 0.75) between the devices was observed for RMS HOA, but this was slightly worse in the 6 mm optical zone (ICC = 0.667 for anterior RMS HOA). No over‐ or underestimation trend by one or other device was noted. Agreement was poor to moderate for the rest of the corneal parameters (ICC 0.2–0.7).

Conclusions: Despite good agreement overall for vertical coma and RMS HOA values, agreement for the remaining corneal aberration measurements was poor to moderate. As mean differences in our sample were overall small, in normal eyes these devices could be clinically judged as interchangeable.
Glaucoma management in pregnancy, how safe glaucoma medication are?
Authors: Aljasim Leyla Ali
Published: December 2022

Purpose: does the use of glaucoma medication during pregnancy can affect the outcome of pregnancy.

Methods: Multicenter descriptive survey, for female patients age 18–45, who got pregnant while suffer from glaucoma. Charts reviewed for diagnosis, glaucoma severity, and race. Survey questions; they were asked for each pregnancy happened while they suffered from glaucoma about, pregnancy age, medications used, and patient‐reported pregnancy outcomes and complications. Main Outcome Measures: were patient‐reported and included pregnancy result; childbirth, miscarriage, stillbirth, therapeutic abortion (TAB)], method of delivery, occurrence of preterm labor, and other patient‐reported complications.

Results: 114 pregnancies of 56 patients (mean 2.0 pregnancies per patient) were included. Three pregnancies with ended with TAB were excluded from further analysis. Mean age during pregnancy was 29.1 ± 5.7 years. Of the 111 pregnancies, 20 (18.0%) used no medications, 28 used one medication (25.2%), 38 used two (34.2%), 20 used three (18.0%), and 5 used four (4.5%). Medications used were topical carbonic anhydrase inhibitors (CAIs; n = 45), beta‐blockers (BB; n = 55), alpha‐agonists (AA; n = 56), and prostaglandin analogues (PGA; n = 28). Outcome rates in the overall cohort were: pre‐term contractions/labor in 6.3%, miscarriage (pregnancy loss ≤20 weeks) in 4.5%, stillbirth (pregnancy loss >20 weeks) in 4.5%, induction of labor for vaginal delivery in 11.9%, emergency caesarean delivery in 13.9%, neonatal intensive care unit (NICU) stay in 15.8%, congenital anomalies in 8.1%, and low birth weight in 10.9%. Fisher exact test was performed to assess associations of complications with individual agents, use of any agent, and different number of agents. AA use was associated with NICU stay, with a rate of 25.5% in the AA group, and most of the AA use NICU stays occurred in pregnancies with third trimester AA use. All other associations were not statistically significant.

Conclusions: This survey suggests an overall favourable safety profile for topical glaucoma medications in pregnancy. So, glaucoma medications can be used during pregnancy, but caution should be employed regarding third trimester AA use owing to an association with NICU stay.
numerical evaluation of intraocular lens decentration
Authors: Espert Anabel Martínez , Montagud‐Martínez Diego , Ferrando Vicente , García‐Delpech Salvador
Published: December 2022

Purpose: Numerical evaluation of the performance under decentering of an extended depth of focus (EDOF) bisegmented design intraocular lens (IOL).

Methods: The optical assessment of The FEMTIS Comfort EDOF‐IOL was evaluated with a ray tracing software using the Atchison model eye (Atchison 2006). Under monochromatic illumination (555 nm) and 4.50 mm pupil, the Modulation Transfer Functions (MTFs) were calculated at the vergences range + 0.50 D to −2.50 D in both tangential and sagittal directions. They were calculated for IOL displacements of 0.25, 0.50 and 1.00 mm in the horizontal and vertical direction. The area under the MTFs (AMTFs) was calculated as the tangential and sagittal MTFs average for frequencies between 0 and 50 cycles/mm.

Results: AMTF of the IOL has an EDOF profile. When it is decentered horizontally, the AMTF does not differ significantly from the AMTF of the centered IOL. But if it is decentered vertically the AMTF varies. This is due to the bisegmented design of the IOL.

Conclusions: After surgery, decentration may occur due to posterior capsule opacification, capsule fibrosis, etc. (Ashena et al. 2020). Due to its design, this IOL is robust against horizontal decentration, but not for vertical decentration. D.M.‐M. acknowledges the Margarita Salas grant from the Ministerio de Universidades, Spain, funded by the European Union‐Next Generation EU.

References

1. Ashena Z, Maqsood S, Ahmed SN, Nanavaty MA. (2020): Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations. Vision 4(3): 41.

2. Atchison DA. (2006): Optical models for human myopic eyes. Vision research 46(14): 2236–2250.
LINE‐1 insertion in the RP1 gene in a family with retinitis pigmentosa
Authors: Backlund Michael , Repo Pauliina , Sankila Eeva‐Marja , Paavo Maarjaliis , Wartiovaara Kirmo , Turunen Joni
Published: December 2022

Purpose: A family, with dominantly inherited retinal dystrophy in three generations, was negative for alterations in known causative genes upon initial analysis. We aimed to identify the causative pathogenic germline variant.

Methods: Two of the six affected members were treated in the Helsinki University Hospital. The patients were subjected to clinical examination and retinal imaging, and the DNA samples to exome sequencing. The variants were called from the sequencing reads using Illumina DRAGEN™ Bio‐IT Platform. The identified pathogenic variant was visualized using Integrative Genomics Viewer (IGV) and confirmed by PCR and Oxford nanopore adaptive sequencing.

Results: Two of the family members had typical retinitis pigmentosa with narrowed visual fields, peripheral retinal bone spicules, and cystic or atrophic changes in the macula. DRAGEN™ identified a LINE‐1 insertion in exon 4 of RP1 from the index that was also found in the cousin upon closer IGV inspection. The 5′‐end of the LINE‐1 insertion was confirmed by PCR using primers targeting the LINE‐1 fragment and RP1 exon 4 upstream of the suspected insertion site. However, PCR amplification over the LINE‐1 insertion was unsuccessful, indicating a considerably larger insertion than the 54‐bases called by DRAGEN™. Thus, Oxford nanopore adaptive sequencing will be used to resolve the true size and the breakpoints of the insertion.

Conclusions: We report here that the retinitis pigmentosa of previously unresolved origin is caused by insertion of LINE‐1 transposon in the RP1 gene. Furthermore, NGS variant‐calling algorithms do not always detect aberrations from moving elements.
Central serous chorioretinopathy complicated by neovascularization following panretinal photocoagulation for diabetic retinopathy
Authors: Nouri Slim , Sassi Hela , Fehmy Nafaa , Hadrich Wafa , Cheour Monia , Meriem Ouederni
Published: December 2022

Purpose: To report a case of chronic central serous chorioretinopathy (CSCR) complicated by neovascularization following panretinal photocoagulation (PRP) for a proliferative diabetic retinopathy (DR).

Methods: A 51‐year‐old man, with a medical history of diabetes mellitus and chronic CSCR presented to our department for alteration of central vision of the left eye (LE) 6 months after bilateral PRP for proliferative DR. Complete ophthalmic examination with best corrected visual acuity (BCVA) measurement, fundus photography, fundus autofluorescence (FAF), swept source optical coherence tomography (SS‐OCT), swept source optical coherence tomography angiography (SS‐OCTA) and indocyanine green angiography (ICG‐A) were performed.

Results: BCVA was 20/100 in the right eye (RE) and 20/400 in the LE. Anterior segment examination was unremarkable except for a cataract in the RE. Fundoscopic examination of the LE showed multiple areas of retinal pigment epithelium (RPE) alteration and a temporal pigment epithelium detachment (PED). FAF showed multiple hypoautofluorescent lesions associated with gravitational tracks. SS‐OCT revealed a serous retinal detachment, a flat irregular PED with a double layer sign overlying a thickened choroid and dilated choroidal vessels. Mid‐phase ICGA revealed 2 discrete areas of hyperfluorescence. SS‐OCTA confirmed the presence of 2 well‐defined choroidal neovascular membranes. The patient was diagnosed with Pachychoroid Neovasculopathy (PNV). After 2 intravitreal bevacizumab injections, SS‐OCT showed complete resolution of the subretinal fluid whereas SS‐OCTA visualized a mature “dead‐tree” shaped membrane.

Conclusions: This is an unusual case of chronic CSCR progressing to PNV following PRP for RD. The disruption of an active RPE pump mechanism or release of endogenous stress hormones after PRP have been suggested by some authors as possible causes of this progression. Further studies are needed to elucidate the exact pathogenesis.