bluuebunny/crossref_metadata_2025 huggingface dataset:
Autofluorescence imaging for diagnosis and follow‐up of serpiginous choroiditis
Authors: Abellán Maria Victoria Navarro , Perea Juan Antonio Sánchez , Menargues Manuel Almarcha , López Carmen Miquel , Moreno Elisa Foulquié , Molina Celia Gómez , Garcia‐Medina Jose Javier
Published: December 2022

Purpose: To report by multimodality imaging the follow‐up of a patient with posterior uveitis presenting serpiginous choroiditis (SC). To highlight the importance of autofluorescence in the follow‐up of patients with atrophic scarring due to CS.

Methods: We present an observational case of SC documented photographically. Clinical data were gathered retrospectively from several visits. The data included corrected visual acuity (BCVA), fundus examination, optical coherence tomography (OCT) and autofluorescence (AF).

Results: Periodic revision of a 49‐year‐old female being followed up for SC secondary to tuberculosis. Mantoux test was positive in 2010 and she was treated correctly. Twelve years later, BCVA was hand movements in the right eye and in the left eye 20/40. Fundus examination revealed no presence of vitritis and atrophic scars post choroiditis serpiginosa. OCT displayed disruption of outer retinal layers. AF revealed atrophy plaque with a new diffuse hypoautofluorescence halo surrounding hyperautofluorescent rim. Aqueous humour and vitreous sample results were negatives. Finally, the lesion was diagnosed as a serpiginous choroiditis. She was treated with corticosteroid and biological therapy to improve her visual acuity. It should suggest a reactivation of SC the appearance of a new atrophy plaque with ill‐defined creamy rim, early block and diffuse oozing at late times, choroidal hypoperfusion, diffuse hypoautofluorescence halo surrounding hyperautofluorescent rim and disruption of outer retinal layers with ellipsoid loss.

Conclusions: A differential diagnosis should be made between SC and posterior uveitis secondary to tuberculosis. Multimodal imaging by autofluorescence is important for the diagnosis and follow‐up of patients with atrophic scarring due to SC. Differential diagnosis of cause posterior uveitis is essential for the monitoring and treatment. In inflammatory diseases always rule out infection prior to corticosteroid treatment or biological therapy.
Surgical management of exotropia‐hypotropia complex in high myopia
Authors: deRivas Marta Orejudo , Rivasés Guillermo Pérez , Moscarda Eva Núñez , Arias Pablo Cisneros , el Bakkali Ismael Bakkali , Claveria Julia Aramburu , Martinez Marta Suñer , Fernandez Miguel Castillo , García Diana Pérez
Published: December 2022

Purpose: We present an atypical clinical case of high myopia associated with divergent and vertical strabismus in the left eye (LE).

Methods: A 50‐year‐old woman with a history of high myopia and deep amblyopia in the left eye (LE) referred to our center for surgical evaluation of LE exotropia. The clinical examination shows visual acuity (VA) of 10/10 in the right eye (RE) and light perception (LP) in LE. The Cover Test found an exotropia and hypotropia of the LE. In the funduscopic exam of the LE an advanced myopic choroiditis can be seen. Biometry shows an axial length (AL) of 25.10 mm in the RE and 32.25 mm in the LE. A magnetic resonance imaging (MRI) is performed where no pathological findings are evident. It was decided to intervene on the patient with divergent and vertical strabismus of the LE. Under general anaesthesia, a 7 mm shortening of the medial rectus muscle is performed with superior displacement of the insertion. In addition, a 9 mm retroinsertion of the lateral rectus muscle of the LE is performed with plication of the muscle to its anatomical position.

Results: After surgery, the patient presented orthotropia without rectification.

Conclusions: Exotropia‐hypotropia complex can be related with high myopia. The combination of resection and displacement of the insertion of the medial rectus together with recession and plication of the lateral rectus to its anatomical position was found to be effective in correcting the ocular deviation.

References

1. Monga S, Kekunnaya R, Sachdeva V. Exotropia‐hypotropia complex in high myopia. J Pediatr Ophthalmol Strabismus. 2013;50(6):340–6. doi: 10.3928/01913913‐20 131 125‐01. PMID: 24669372.

2. Ganesh SC DO DNB, Jayadev NA MS, Oguego N M Ophthal, Narendran K DO DNB, Rao SG MS. Nasal loop myopexy as a primary procedure to correct exotropia hypotropia complex in high myopia. Strabismus. 2019 Dec;27(4):223–229. doi: 10.1080/09273972.2019.1676794. Epub 2019 Oct 15. PMID: 31612771.
Content identification for the multifocal contact lens patient‐reported outcomes (MCL‐PRO) instrument item bank
Authors: Ros Elsa Albero , Lorente‐Velázquez Amalia , Gonzalez‐Perez Mariano
Published: December 2022

Purpose: Patient‐reported outcomes (PROs) have become remarkably important in the optometric field and now, are essential for healthcare clinical trial end points. However, being presbyopia an important topic in this field and multifocal contact lenses an increasingly popular method for its correction, no comprehensive, patient‐relevant, and precise multifocal contact lens specific PRO is available. Therefore, the purpose of this study was to identify content for the new Multifocal Contact Lens Patient‐reported Outcomes (MCL‐PRO) item bank.

Methods: Four phases were conducted to identify the content: (1) Qualitative review of the literature and existing PRO optometric instruments; (2) Focus groups with presbyopic patients and optometric experts; (3) Review of social media on the subject; (4) Classification and selection of items.

Results: A total of 305 unique items (extant items from PRO instruments and literature review, 53; patient focus group 192; experts focus group 47; social media review 9) were identified. The items were classified in 9 domains: Activity limitation (34 items); Visual symptoms (99 items); General symptoms (7 items); Ocular surface symptoms (48 items); Convenience (45 items); Emotional well‐being (40 items); Economic issues (10 items); Social issues (12 items); Cognitive issues (6 items).

Conclusions: After a rigorous systematic identification of the content of topics important to the presbyopic population, 9 main domains were found. Most of the selected elements were identified from patient focus groups in the hope of getting as close as possible to the evaluation from the patient's point of view.
Succesful systemic treatment of monoclonal gammopathy with corneal significance (MGCS) ‐ a case report
Authors: Kormányos Kitti , Németh Orsolya , Langenbucher Achim , Nagy Zoltán Zsolt , Varga Gergely , Gopcsa László , Mikala Gábor , Szentmáry Nóra
Published: December 2022

Purpose: The most common ocular symptom of monoclonal gammopathy is the appearance of paraproteinaemic keratopathy. Our goal is to present a case with successful haematological treatment of monoclonal gammopathy with corneal significance (MGCS).

Methods: Our 50 years‐old female patient had increasing predescemetal corneal opacification. Serum electrophoresis verified monoclonal gammopathy and no other organ involvement (MGCS). Following penetrating keratoplasty of the right eye, histological examination verified predescemetal kappa‐chains and confirmed our clinical diagnosis. Ten months after surgery, grey‐white corneal stromal opacities appeared again in the transplanted corneal tissue. In vivo confocal microscopy (IVCM) verified 12 spindle‐like corneal stromal opacities in the right and 13 in the left side, per micrograph. As the size of the corneal opacities increased and visual acuity decreased on both eyes, a haematological treatment has been initiated.

Results: Following 4 cycles of plasma‐cell directed bortezomib and dexamethasone treatment (1.3 mg/m2 bortezomib subcutaneously and 20 mg dexamethasone orally) most of the corneal opacities disappeared or decreased in size and best corrected visual acuity increased on both eyes. Following treatment, we could only verify 2 spindle‐like opacities in the right and 5 in the left corneal stroma per micrograph, using IVCM.

Conclusion: In monoclonal gammopathy with corneal significance, bortezomib‐dexamethasone treatment may successfully decrease or diminish paraproteinaemic keratopathy/MGOS. Corneal stromal changes must be further analysed to obtain better insight into their pathophysiology and in corneal symptoms of monoclonal gammopathy.

Keywords: monoclonal gammopathy, MGOS.
Intraocular pressure changes at high altitude
Authors: Mayhook‐Walker India , Westwood Jessica , Simpkins Ciaran , Normando Eduardo , Morris Daniel , Darby‐Smith Andrew
Published: December 2022

Purpose: The effect of altitude on Intraocular Pressure has been debated for decades. The literature is unclear, encompassing exertional and non‐exertional ascents, as well as simulated ascents, with most finding a decrease in IOP, but some finding no change or an increase. Additionally, several papers have previously corrected IOP for Central Corneal Thickness, further confounding efforts to draw conclusions from the literature. The Imperial Remote Medicine BSc's Morocco expedition aimed to assess changes in IOP and CCT during an exertional winter ascent of Mount Toubkal (4167 m) which to our knowledge is the first exertional study conducted partially in sub‐zero temperatures.

Methods: IOP, CCT, clinical parameters and Lake Louise Score (LLS) were recorded daily in 9 participants before, 1 month after and during the expedition. Participants flew into Marrakesh, ascended to Imlil (1886 m) by car, and ascended from there on foot, stayed at the Nelter refuge for 3 nights (3037 m). All measurements were taken in the evening. IOP was measured using an iCare ic200 tonometer. Total IOP and CCT per participant per day was used to assess more fully the overall change in IOP and CCT across the expedition. Differences between eyes were also assessed.

Results: No significant change in IOP was seen. CCT increased significantly at altitude. IOP was significantly positively correlated with LLS and headache, and significantly negatively correlated with SpO2. In line with current clinical practice, IOP was not adjusted for CCT. There was no difference in IOP or CCT between contact users and non‐contact users.

Conclusions: The increase in CCT is in line with the existing literature. The lack of significant change in IOP has precedence, and we propose that it is the interplay of physiological changes at altitude, alongside other factors such as exertion and temperature that alter IOP rather than IOP changes simply being a function of altitude.
Structure–function relationship between central visual field and macular parameters in glaucoma patients
Authors: Ye‐Zhu Cristina , Diez‐Alvarez Laura , Jaumandreu Laia , Huelin Fernando , Diaz‐Montealegre Ana , González‐Pastor Elisa , Martin‐Ares Alvaro , Rebolleda Gema , Muñoz‐Negrete Francisco
Published: December 2022

Purpose: To investigate the relationship between central visual field mean sensitivity (cVFMS) with macular vascularity, ganglion cell layer (GCL) thickness and ganglion cell complex (GCC) thickness in glaucoma patients.

Methods: cVFMS was determined by Humphrey Field Analyser Swedish Interactive Thresholding Algorithm (SITA)‐faster 24‐2 and 24‐2C test grids. Foveal avascular zone (FAZ) parameters and macular vessel density (VD) was assessed by optical coherence tomography angiography (OCTA: AngioVue RTVue XR Avanti, Optovue). GCL thickness was measured by Spectralis‐OCT and GCC thickness by Optovue‐OCT. Relationship between vascular parameters, GCL and GCC thickness with cVFMS tested on 24‐2 and 24‐2C grids, was analysed by Pearson correlation coefficient. The comparison between correlation coefficients was performed by Steiger test.

Results: Transversal study involving 50 eyes from 43 glaucoma patients. No significant correlation was found between FAZ area or perimetry and cVFMS. Instead, lower foveal vessel density (FD300) was associated with worse cVFMS in 24‐2 and 24‐2C grids (0.437, p = 0.006 and 0.438, p = 0.006, respectively). Significant correlations between macular VD and cVFMS were found both with 24‐2 and 24‐2C test grids: cVFMS24 versus whole VD (0.529, p = 0.001) and cVFMS24‐2C vs whole VD (0.553, p < 0.001), cVFMS24 vs parafoveal VD (0.565, p < 0.001) and cVFMS24‐2C vs parafoveal VD (0.602, p < 0.001), cVFMS24 vs perifoveal VD (0.514, p = 0.001) and cVFMS24‐2C vs perifoveal VD (0.539, p < 0.001). GCL and GCC thickness were also associated with cVFMS24 (0.566, p < 0.001 and 0.568, p < 0.001, respectively) and with cVFMS24‐2C (0.542, p < 0.001 and 0.544, p < 0.001, respectively). Worse superior hemi‐cVFMS 24‐2 and 24‐2C was significantly correlated with lower inferior hemimacular VD, GCL and GCC thickness. Similar results were obtained when comparing inferior hemi‐cVFMS with superior hemimacular parameters. No significant differences were detected between correlations with 24‐2 and 24‐2C grids.

Conclusions: The FD300, but not FAZ area or perimetry, was correlated with cVFMS. Worse cVFMS was correlated with lower macular VD and lower GCL and GCC thickness both with 24‐2 and 24‐2C test grids.
Intermediate uveitis associated with Cogan's syndrome
Authors: El Mayel Amina , Amor Hager Ben , Sellem Ilhem , Mesfar Rahma , Khochtali Sana , Ksiaa Imen , Khairallah Moncef
Published: December 2022

Purpose: To describe a case of intermediate uveitis and optic neuritis associated with Cogan's syndrome.

Methods: A case report.

Results: A 29‐year‐old white Caucasian female was referred to our department for decreased vision in her left eye (LE). Previous medical history revealed relapsing intermediate uveitis and optic neuritis in the LE for 5 years and a sensio‐neural hearing loss a year earlier. On presentation, her ophthalmological examination revealed best corrected visual acuity in the LE of 6/60 with a relative afferent pupillary defect. Slit lamp examination revealed a clear cornea, 0.5+ cells in the anterior chamber and 3+ cells in the vitreous. Fundus examination showed an optic disc atrophy. Examination of the right eye was unremarkable. Examination by the internist revealed palmar erythematous lesions. Laboratory work‐up was negative for infectious diseases. Testing for antinuclear antibodies, antineutrophil cytoplasmic antibodies and rheumatoid factor were negative. The diagnosis of atypical Cogan's syndrome was made based on the association of atypical ophthalmological manifestations and typical audio‐vestibular manifestations. The patient was treated with oral prednisone and azathioprine.

Conclusions: Optic neuritis may rarely be an ocular manifestation of Cogan's syndrome.
Main ophthalmological manifestations in patients diagnosed with ocular syphilis attended at Instituto Nacional De Rehabilitacion
Authors: Arevalo Francisco Javier Sanchez , Cataño Martha Cinthia Fuentes
Published: December 2022

Purpose: Describe the ophthalmological manifestations of patients diagnosed with ocular syphilis at the Instituto Nacional de Rehabilitación, and the main complications derived from ocular pathology.

Methods: Adult patients diagnosed with ocular syphilis, treated in the ophthalmology service during the period 2015–2021. A descriptive analysis of the collected data (SPSS 25.0 for Macintosh) was performed, comparing the frequency of ocular manifestations recorded, the frequency of complications reported in patients and analysing the best corrected visual acuity before treatment and after treatment.

Results: 18 patients and 34 eyes were analysed, 16 eyes manifested with posterior uveitis (47.1%), 15 patients with panuveitis (44.1%) and three eyes presented anterior uveitis (8.8%). Of the HIV‐positive eyes (N = 12), posterior uveitis (50%) and panuveitis (50%) occurred equally. Retinal vasculitis (17.7%) was the most frequent finding, followed by vitritis (14.9%) and presence of cellularity in the anterior chamber (11.3%). The main complications reported were ocular hypertension/glaucoma in six eyes (17.65%), posterior segment involvement in six eyes (17.65%) and cataract in four eyes (11.76%). Regarding posterior segment complications, three eyes presented epiretinal membrane (50.0%), cystic macular edema in two eyes (33.33%) and choroidal neovascularization in one eye (16.67%). Best‐corrected visual acuity at presentation was a mean of 0.67 (±0.84) on the LogMAR scale, and best‐corrected visual acuity at the last post treatment visit was a mean of 0.43 (±0.61).

Conclusions: Syphilis should be a diagnostic possibility in patients with intraocular inflammation because it can affect any ocular structure, vasculitis in our population was predominant as a clinical manifestation, serology for HIV and lumbar puncture should be performed in these patients; should always be treated with the neurosyphilis regimen by intravenous administration of crystalline penicillin G for 14 days.
Cross‐sectional surface area of the nerve fibre layer in the optic nerve head in glaucomatous and non‐glaucomatous individuals
Authors: Kisonaite Konstancija , Yu Zhaohua , Soderberg Per
Published: December 2022

Purpose: To quantify the cross‐sectional surface area of the retinal gangion cell axons in the optic nerve had (ONH) in glaucomatous subjects with an AI‐based method.

Methods: From each of 16 subjects aged 50–79, eight with early to manifest glaucoma and eight without glaucoma, one 3D OCT‐capture from one eye was analysed for cross‐sectional surface area. The segmentation model was based on the concept of measuring the minimal distance between the central limit of the pigmental epithelium (ONH Pigmental epithelium, Central Limit, OPCL), and the inner limit of the retina (Inner limit of the Retina, Closest Point, IRCP). The OCT volume was resampled into 500 radial slices at equidistant angles around the center of the ONH. In each angle, coordinates for OPCL and IRCP were recorded. The coordinates were then used to compute the area of surface elements in to each angle. For each subject, the average cross‐sectional surface area around the circumference of the ONH as the Pigmental epithelium – Inner limit of the retina Minimal Area (PIMA) was calculated as PIMA‐2π.

Results: A 95% confidence interval for PIMA‐2π was estimated to 0.86 ± 0.12 mm2 (df = 7) in the glaucomatous group, and 1.85 ± 0.17 mm2 in the non‐glaucomatous control group (df = 7). There was a difference in means between the glaucomatous and non‐glaucomatous group (t‐test for independent groups; test statistic = −8.75, t0.05(2):14 = 2.15).

Conclusions: In the glaucomatous group, PIMA‐2π was significantly smaller. Furthermore, the results agree with other similar studies. Points annotated by our deep learning algorithms can be used to compute cross‐sectional surface area of the nerve fibre layer in the ONH with accurate results.
Adeno‐associated virus (AAV) knock‐down of amyloid precursor protein attenuates retinal ganglion cell degeneration in experimental glaucoma
Authors: Godinez Angela , Rajput Rashi , Chitranshi Nitin , Gupta Vivek , Graham Stuart
Published: December 2022

Purpose: Retinal ganglion cell (RGC) degeneration and visual field loss are distinctive features of primary open angle glaucoma. Similar pathologies have been observed in Alzheimer's Disease patients, concomitant to amyloid‐β aggregation. Here, we investigated the effect of amyloid precursor protein (APP) modulation in the retina and examined the potential neuroprotective effects of APP knock‐down (APP‐KD) in experimental glaucoma.

Methods: AAV‐PHP.eB constructs for APP‐KD (NM_000484) and positive scramble controls were transfected in SH‐SY5Y neuroblastoma cells to validate their expression. Wild‐type C57BL/6J mice (n = 30) were then transduced with APP‐KD (n = 10) or scramble (n = 10) vectors intravenously. Experimental chronic glaucoma was induced via weekly intraocular microbead injections for 8 weeks. Inner retinal function was assessed using positive scotopic threshold response (pSTR) amplitudes. Structural RGC changes were quantified using haematoxylin and eosin staining and manual cell count.

Results: All microbead‐injected eyes showed significantly increased intraocular pressure (Mean ± SEM; Microbead vs. Control; 27.98 ± 0.78 mmHg vs. 10.01 ± 0.13 mmHg). In glaucomatous conditions, there was significant preservation of the RGC layer in APP‐KD treated eyes, compared to scramble and microbead‐only eyes (p < 0.002) (Mean ± SEM; Microbead/APP‐KD vs. Microbead/Scramble vs. Microbead‐only; 41.57 ± 1.61 vs. 37.73 ± 1.50 vs. 35.43 ± 0.95 cells/300 μm). However, there was no significant changes in pSTR amplitudes of glaucomatous APP‐KD eyes, compared to scramble and microbead‐only eyes (p = 0.653).

Conclusions: AAV‐PHP.eB mediated APP‐KD confers significant protection of the RGC layer in glaucomatous eyes, however this protection was not sustained functionally. The molecular mechanisms by which APP‐KD may impart neuroprotection and ameliorate APP neurotoxicity are unclear. Further studies will include biochemical evaluation of synaptic and cellular stress markers.
Optical coherence angiography of optic disc in eyes with primary open‐angle glaucoma and normal tension glaucoma with equal levels of structural damage
Authors: Halkiadakis Ioannis , Kollia Elpida , Tzimis Vasilis , Tzakos Michalis
Published: December 2022

Purpose: To compare visual field (VF), nerve fibre and ganglion cell loss and changes in peripapillary vasculature in age matched patients with normal‐tension (NTG) and high tension glaucoma (HTG) at an equal level of glaucomatous structural damage of the optic nerve head (ONH).

Methods: For the present study a retrospective analysis of patients with NTG and HTG was performed. One eye of each patient was randomly assigned for further analysis. To provide a reliable case by case match of HTG and NTG eyes, an equal optic disk size as measured by available spectral‐domain OCT system (RTVue XR OCT Avanti System; Optovue Inc., Fremont, CA) and an equal estimated excavation of the optic disk were chosen. Optic nerve head parameters, retinal nerve fibre layer (RNFL) ganglion cell (GCC) thickness and vessel densities (VD) in the peripapillary area were measured automatically by OCT with a respective software. Forty eyes with NTG, were matched according to the same glaucomatous ONH damage based on cup to disc ratio rim area and disc size with 40 eyes with HTG.

Results: Mean age of patients was 68.5 ± 12 (27–84) years. The visual field index, RNFL, GCC thickness and peripapillary VDs in the HTG eyes were similar to those in the NTG eyes (mean VFI 79.6 vs. 78.8 p = 0.84, mean RNFL thickness 71.5 vs. 72.05 μm p = 0.87, mean GCC thickness 76.2 vs. 74.5 μm p = 0.62, mean peripapillary VD 43.6 vs. 43.8% p = 0.87). There was no difference in sectoral RNFL thickness and peripapillary VDs between HTG and NTG. In both groups, univariate regression analysis using the Pearson correlation coefficient showed VFI significantly correlated with RNFL thickness (NTG r = 0.423 p = 0.006 HTG r = 0.514 p = 0.002), and peripapillary VD (NTG r = 0.793 p < 0.001 HTG p = 0.534 p = 0.001) in both groups but with GCC thickness (NTG r = 0.585 p < 0.001) only in eyes with NTG.

Conclusions: At an equal level of glaucomatous structural damage of the ONH indicated by cup to disk ratio and RNFL thickness, NTG patients seem to have same losses of peripapillary vasculature. Visual field index correlated with RNFL thickness and peripapillary vessel density in both groups.
Ocular surface manifestations and SARS‐CoV‐2 RNA detection in conjunctival swabs of patients hospitalized for COVID‐19 pneumonia: A Belgian cohort
Authors: Valyi Zsuzsanna , Khalil Maria , Van den Wijngaert Sigi , Konopnicki Deborah , Willermain François , Bruyneel Marie
Published: December 2022

Purpose: Previous studies show a great variability of SARS‐CoV‐2 RNA detection rates in tear fluids. The aim of this study was to investigate the presence of SARS‐CoV‐2 in the tear fluid of hospitalized COVID‐19 patients and to evaluate systemic and ophthalmic clinical features in a Belgian cohort.

Methods: Adult patients hospitalized for COVID‐19 pneumonia confirmed by a chest computer tomography (CT) were included. Patients with a recent diagnosis or exacerbation of an ocular pathology were excluded.

After completing an ocular symptom questionnaire, patients underwent a macroscopic ocular exam and a conjunctival swab. A reverse transcriptase polymerase chain reaction (RT‐PCR) was performed on the swabs to identify SARS‐CoV‐2 RNA. Clinicobiological data (C reactive protein, lymphocyte count, CT scan, risk factors and symptoms) and PCR results of both ocular and nasopharyngeal samples were collected.

Results: Fifty‐eight patients were included between September 2020 and May 2021. 43 (74.1%) were male, the median age was 56 (min 32 ‐max 93). 54 (93.1%) of the nasopharyngeal swabs were positive. Two (3.45%) had a positive conjunctival PCR: one with <10 E3 copies/ml, the second highly positive with > = 10E3 ‐ < 10 E5 copies/ml. Both were males without any ocular symptoms. 13 patients (22%) presented ocular symptoms such as tearing (69.23%), redness (53.85%), burning 38% or itching 15.38%. All but one reported that the symptoms started at the beginning of their SARS‐CoV‐2 infection (92.31%). Statistical analysis by linear regression found that there was a significant statistical correlation between the presence of ocular symptoms and neurological symptoms (p = 0.021).

Conclusions: It is possible to find tear fluids with a high viral load but the probability of this occurrence appears to be rather low. The presence of SARS‐CoV‐2 in tears was however not associated with the presence of symptoms in this study. Ocular symptoms may not be related to the presence of the virus itself.
Loss of neuroserpin exacerbates retinal ganglion cell dysfunction in neuroserpin knockout mice following chronic increase in intraocular pressure
Authors: Rajput Rashi , Chitranshi Nitin , Godinez Angela , Pushpitha Kanishka , Basavarajappa Devaraj , Gupta Vivek , Graham Stuart
Published: December 2022

Purpose: Recent studies have shown neuroserpin (NS) plays a critical role in several neurodegenerative diseases. The neuroprotective role of NS administration in the retina has been reported in an ischemic/reperfusion mouse model of glaucoma. Here, we studied the effect of neuroserpin loss on retinal integrity in normal and experimental glaucoma condition in NS knockout (NS−/−) mice.

Methods: NS−/− and C57BL/6J wild type (WT) mice were subjected to weekly intraocular microbead injection for 8‐weeks (n = 40). Positive scotopic threshold response (pSTR) at −4.3log cd s/m2 and electroretinography (ERG) at 3.1 log cd s/m2 were recorded using Phoenix Ganzfeld at the 8‐week time point. Eye and optic nerve (ON) tissues were harvested after 8‐weeks for histological analysis (retina‐ haematoxylin and eosin and ON‐ toluidine blue staining) and biochemical evaluation.

Results: NS−/− mice showed significant decline in pSTR amplitude (p < 0.0001) with loss of no. of cells in GCL (p < 0.0001) compared to WT in both normal and glaucoma (IOP: 28.5 ± 1.97 mmHg) conditions. However, no change in whole retinal scotopic ERG was observed in NS−/− and WT mice in both conditions. Plasmin inhibitory assay showed the loss of NS inhibitory activity in NS−/− retinas with or without glaucoma (p < 0.004). ON histology staining showed significant loss of axonal density (p < 0.0001) in NS−/− mice compared to WT in normal condition, however glaucoma exacerbated axonal loss in NS−/− compared to WT mice. Increased expression of autophagy markers, Beclin1 and LC3II/I were confirmed in NS−/− retinal lysates in both normal and glaucoma conditions. TUNEL positive cells were significantly higher in the GCL of retinal sections of NS−/− mice in glaucoma (p < 0.002).

Conclusions: NS ablation worsens inner retinal structural and functional damage in glaucoma. This study establishes that absence of neuroserpin in the experimental glaucoma mice increases autophagic response in degenerating retinal cells. The exact molecular mechanism of neuroserpin on autophagy remains undefined. Future biochemical studies will explain the neuroserpin‐autophagy signalling network involvement in the retinal cells in glaucoma.
Anterior‐segment swept‐source ocular coherence tomography and scheimpflug imaging agreement for keratometry and pupil measurements in healthy eyes
Authors: Bartolomé Francisco Pérez , Gonzalez Rocio Vega , Nieves Jorge Peraza , Moreno Jose María Ruiz
Published: December 2022

Purpose: This study examines agreement between the devices Anterion® and Pentacam HR® used for corneal and pupil measurements in healthy eyes.

Methods: The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), anterior astigmatism (D), anterior K max (D), posterior Km (D), posterior K2 (D), posterior K1 (D), posterior K1 axis (°), posterior astigmatism (D), CCT (μm), thinnest point thickness (μm), thinnest point X‐coordinate (mm), thinnest point Y‐coordinate (mm), pupil diameter (mm), pupil center‐corneal vertex distance (mm) (angle kappa), pupil centroid angle (°), pupil centroid X‐coordinate (mm), and pupil centroid Y‐coordinate (mm).

Results: The Student's t test for independent samples identified significant differences (p < 0.05) between devices for the measurements anterior and posterior flat K axis, posterior flat K, steep K, and mean K. For these last three measurements, although significant, none of the differences were clinically relevant. Corneal power and thickness measurements except Kf axis showed excellent agreement between Anterion and Pentacam. Pupil diameter differed significantly between both groups (p < 0.05).

Conclusions: In a clinical setting we would not recommend the interchangeable use of Pentacam and Anterion for measurement of pupil parameters.
Focal laser photocoagulation treatment in polypoidal choroidal vasculopathy: Long‐term follow‐up
Authors: Houmane Yasmine , Meriem Ouederni , Maamouri Rym , Sassi Hela , Cheour Monia
Published: December 2022

Purpose: To report the long‐term effect and safety of focal laser photocoagulation treatment (FLPT), in a case of polypoidal choroidal vasculopathy (PCV).

Methods: We reviewed a 56‐month follow‐up (April 2017–January 2022) of a 54‐year‐old woman with PCV. The diagnosis was made using indocyanine green angiography (ICG‐A). The measured outcomes of the effect of FLPT were changes in best‐corrected visual acuity (BCVA), complications, regression, and recurrence of polypoidal lesions based on fundoscopy, B‐scan swept source optical coherence tomography (SS‐OCT) and ICG‐A.

Results: At the time of diagnosis, the patient had extensive subretinal exudation and haemorrhage in the right eye (RE) related to foveal and juxtapapillary polypoidal lesions. She received 12 bevacizumab intravitreal injections and treatment was interrupted because of extensive macular fibrosis. In the left eye (LE), she had extrafoveal polypoidal lesions with a BCVA of 20/25. At 8 months follow‐up, a decrease in BCVA to 20/50 was noted. Therefore, a first round of FLPT associated with three bevacizumab intravitreal injections, was performed. Four months post‐FLPT, regression of the polypoidal lesions was obtained with a BCVA of 20/25. BCVA and multimodal imaging remained stable for 2 years. The left eye showed recurrence of extrafoveal polypoidal lesions 35 months after FLPT, with a BCVA of 20/50. A second round of FLPT was performed, with a regression of the polypoidal lesions after 1 month, and a stabilization of BCVA at 20/30. After 14 months, BCVA was 20/50, and no signs of recurrence were detected on multimodal imaging. No complications were observed after the two rounds of FLPT.

Conclusions: FLPT can be efficient and safe in treating eyes with PCV with extrafoveal polypoidal lesions. In this case, it allowed us to obtain the regression of polypoidal lesions and to maintain visual acuity without serious hemorrhagic complications during the 56‐month follow‐up.
Effect of crystalline lens on visual quality in pterygium patients before surgery
Authors: Arias‐García Elena , Navarro A. Susana Ortí , Ajenjo Amparo Díez , García‐Domene Mª. Carmen , Cobija Maria Josefa Luque , Martínez Cristina Peris
Published: December 2022

Purpose: The aim of our study was to assess the visual quality of pterygium patients with total ocular aberrations, and not only corneal aberrations.

Methods: 46 eyes of 37 pterygium patients (mean age 48 ± 15 years) were evaluated in a retrospective study. Inclusion criteria were primary pterygium, without any previous surgical treatment. Before surgery, subjective refraction, corrected distance visual acuity (CDVA), with an EDTRS optotype chart, and Zernike coefficients for a 5 millimetres (mm) pupil diameter measured with an Alcon LadarWave total aberrometer (Fort Worth, Texas, USA) were determined. Pterygium size in mm was measured by an experienced ophthalmologist using a slit beam of light from the limbus to the limit of the pterygium. Statistical analysis was performed using SPSS software version 26.0. The Kruskal‐Wallis test with the Tukey–Kramer criterion was used to examine the influence of the extent of corneal invasion on manifest refraction and Zernike coefficients. One‐way analysis of variance (ANOVA) with the Bonferroni criterion was performed to compare different extent values. A p value less than or equal to 0.05 was considered statistically significant.

Results: The sample was divided in four groups, according to the extent of corneal invasion. The upper limits of each category were 1, 2, 3 and 4 mm, with 9, 20, 11 and 6 patients in each group, respectively. Preoperatively spheres more positive were found at high corneal invasion groups, statistically significant between 1 and 3 mm, and between 2 and 3 mm (p = 0.013 and p = 0.011) and cylinder axes were between 20° and 50° in all groups. CDVA was lower in patients with greater corneal invasion. Regarding total ocular aberrations, statistically significant differences between groups were found only in a reduced set of Zernike polynomials but oblique astigmatism (2,‐2) appeared in most of the comparatives. Most of the Zernike coefficients, were out of normal limits, compared to control values, including spherical aberration.

Conclusions: Pterygium‐induced aberrations also modify the visual quality of patients when the effect of the crystalline lens aberrations is considered, the conclusions are similar to those derived from corneal aberrations. CDVA was lower preoperatively in patients with greater corneal invasion (4 mm).
Chromatic characterization of a commercially available enhanced monofocal intraocular lens
Authors: Espert Anabel Martínez , Montagud‐Martínez Diego , Ferrando Vicente , Monsoriu Juan A. , Furlan Walter D.
Published: December 2022

Purpose: The aim of this work is to understand the design strategy employed by the commercial Xact mono‐EDOF lens to achieve focus extension.

Methods: The optical properties of the intraocular lens were measured for three wavelengths 450 nm, 550 nm, 650 nm and with polychromatic light on an optical bench complying with ISO 11979‐2, 2014 [1] for a 4.5 mm pupil. Through the Focus Modulation Transfer Functions were calculated for 50 lines per mm and Point Spread Functions were measured. The USAF test images were also captured at different vergences.

Results: The Xact mono‐EDOF has an asymmetric focus for all 3 wavelengths resulting an increase in the depth of focus. On the other hand, this design shows a longitudinal chromatic aberration (LCA) of 1.41D.

Conclusions: The Xact mono‐EDOF lens has a high LCA which could allow it to increase the depth of focus compared to a monofocal lens.

References

1. ISO 11979‐2. Ophthalmic Implants‐Intraocular Lenses‐Part 2: Optical Properties and Test Methods. International Organization for Standardization: London, UK, 2014.

D.M.‐M. acknowledges the Margarita Salas grant from the Ministerio de Universidades, Spain, funded by the European Union‐Next Generation EU.
Anatomical and functional outcomes of RETINOTOMY on primary inferior RHEGMATOGENOUS retinal detachment
Authors: Teixeira Sofia , Ferreira Catarina , Ribeiro Lígia , Bilhoto Miguel
Published: December 2022

Purpose: To analyse the anatomical and functional outcomes of pars plana vitrectomy combined with retinotomy alone in primary inferior rhegmatogenous retinal detachments (RD).

Methods: Data from 139 patients who underwent vitreoretinal surgery for inferior RD in Centro Hospitalar Vila Nova de Gaia/Espinho, between 2012 and 2021 by the same surgeon, were analysed. Univariate and multivariate analysis were performed. Outcomes such as visual acuity (VA) and occurrence of complications were studied.

Results: From the total 139 eyes analyse, 72 were subject to vitrectomy combined with retinotomy. Among them, 79% had macula‐off at the time of surgery and 94.4% had proliferative vitreoretinopathy (grade B or C). Functional success, with VA improvement or stabilization after surgery, was 75%. VA was significantly improved from 1.61 to 0.73 logarithm of the minimal angle of resolution units (p < 0.001). The anatomic success rate was 95.8% in the first surgery.

Conclusions: Inferior RD is a significant clinical and surgical challenge for vitreoretinal surgeons and the choice between the best surgical technique is still controversial. These cases frequently require some additional measures to vitreoretinal surgery due to its high recurrence rate. Our results show that vitrectomy with retinotomy alone on primary inferior RD has high anatomical and functional success rates.
Multiple sclerosis and occlusive retinal vasculitis: A case series
Authors: Khalil Maria , Buelens Tom , Borrelli Serena , Vanderhulst Julien , Willermain François , Makhoul Dorine , Le Aurelie
Published: December 2022

Purpose: Retinal vascular changes are a common finding in patients with multiple sclerosis (MS). While simple peripheral retinal periphlebitis is by far the most frequent manifestation, a spectrum exists that ranges up to the presence of proliferative retinal vasculitis.

Methods: Case series of four patients with occlusive retinal vasculitis.

Results: Three patients presented with complaints of visual loss and ocular discomfort: a 26‐year‐old man presented with vitreous inflammation, vitreous haemorrhage, macular edema and papillitis; a 44‐year‐old woman presented with intermediate uveitis and macular edema; and a 25‐year‐old woman presented with granulomatous panuveitis, papillitis and foveolar serous detachment. A fourth patient was addressed because of abnormal eye movements detected during a work‐up for dizziness. Examination revealed bilateral internuclear ophthalmoplegia with adduction lag. He had no visual complaints other than subtle floaters in the left eye. Anterior segment examination showed no signs of inflammation, whereas vitreous snowballs were present. Fluorescein angiography revealed occlusive retinal vasculitis in all patients, resulting in active neovascularization in two patients with vitreous haemorrhage in one of them. All patients required retinal laser photocoagulation. Extensive work‐up revealed multiple sclerosis as the underlying disease in three patients; the remaining patient had already been diagnosed with MS at the time of presentation. Nevertheless, additional work‐up was performed in this patient to exclude other possible causes.

Conclusions: Occlusive retinal vasculitis is a rare manifestation in patients with MS and may result in neovascularization, vitreous haemorrhage, retinal detachment and neovascular glaucoma. MS should therefore be considered in the differential diagnosis of ischemic retinal disease. In addition, one should be alert for signs of retinal vasculitis in patients with MS, as it can present with few or no symptoms.
Analysis of the effects of visual quality under different light conditions in different intraocular lenses: Study pilot
Authors: Haddi Inas Baoud Ould , Sánchez Vanesa Blázquez , Arias Cristina Bonnin , Ramos Celia Sánchez , Ramírez Emilio Dorronzoro
Published: December 2022

Purpose: To compare the effects on visual function and quality of life in cataract patients undergoing cataract surgery between different extended depth of focus (EDOF) lenses, when subjected to different illumination conditions.

Methods: Observational, prospective, cross‐sectional pilot study with a total of 31 eyes of 15 patients undergoing uncomplicated phacoemulsification cataract surgery with Tecnis Eyhance, Isopure1.2.3 and Vivity intraocular lenses. All patients underwent a complete preoperative examination. They were also evaluated on different days under mesopic and photopic conditions.

Results: Thirty‐one eyes of 15 patients (70.5 ± 8.6) were included in the study. Statistically significant values were obtained when comparing intermediate visual acuity (VA) between mesopic and photopic illumination conditions for the Isopure and Eyhance lenses with a value of 0.021 and the Isopure lens with Vivity with 0.001. In photopic conditions at intermediate distance a significant value was obtained between Vivity and Eyhance with a value of 0.02 and in mesopic conditions at intermediate distance between Vivity and Isopure with a value of 0.001. Between the different lenses, no significant values were obtained between the photopic and mesopic conditions. No significant values were found for pupillometry and halometry in mesopic conditions either.

Conclusions: All three intraocular lenses provided excellent distance vision in both photopic and mesopic conditions with no statistically significant differences. But in intermediate distance, significant differences were found between photopic and mesopic conditions between the Isopure lens and the Vivity and Eyhance lenses. Therefore, the Isopure lens has worse intermediate VA values in mesopic than the other lenses. There were also no significant differences in near vision in pupillometry and halometry.
Atypical venous vasculitis as a complication of venous thrombosis
Authors: Perea Juan Antonio Sánchez , Menargues Manuel Almarcha , López Carmen Miquel , Abellán Maria Victoria Navarro
Published: December 2022

Purpose: To asses the importance of multimodality imaging in successive examinations of patients with retinal branch vein occlusion in order to evaluate possible unexpected complications.

Methods: We present a descriptive study (case report). We have performed a multimodal imaging study of a patient with an inferior temporal branch vein thrombosis. The best corrected visual acuity (BCVA) is taken in a patient who received 5 intravitreal injections of Ranibizumab. Posteriorly the patient presented with a decrease in visual acuity and the angiographic study showed a venous vasculitis involving the inferior temporal branch retinal vein, resembling frosted branch angiitis. Optical coherence tomography (OCT) showed inflammatory cystic macular edema with neurosensory detachment. To perform angiography and OCT, we use the Heidelberg Spectralis.

Results: Serial evaluation with OCT allowed the observation of a cystic macular edema with neurosensory detachment that was treated with intravitreal Dexamethasone implantation achieving a BCVA of 0.3 to a BCVA of 0.7 after 2 months. Angiography showed a perivenular infiltration that reminded us of frosted branch angiitis. General laboratory tests and serology for cytomegalovirus and Epstein–Barr virus were requested, and the patient was referred to the internal medicine department to rule out systemic diseases.

Conclusions: Serial multimodality imaging is very useful in the follow‐up of patients with venous occlusions. It allows us to observe atypical complications such as vasculitis found in the context of a patient who suffered a venous branch occlusion. Vasculitis can be found in the context of an ocular disease or associated with diseases such as Bechet's disease, Sarcoidosis, Multiple Sclerosis, Lupus, Polyarteritis nodosa, Sjogren's disease, Relapsing polychondritis, Antiphospholipid antibodies, Syphilis, Whipple's disease, Cytomegalovirus infection, leukaemia or lymphomas. Despite the growing popularity of OCT, we cannot ignore the importance of fluorescein angiography for the follow‐up of these cases.
Human palpebral infestation by mysterious laying eggs: A case report
Authors: Hakami Sina , Correa Simon , Deyi Veronique Yvette Miendje , Azzagnuni Younes , Willermain François , Makhoul Dorine , Le Aurelie
Published: December 2022

Purpose: Tick infestation of ocular tissues is a rare occurrence. Ticks are ectoparasites which feed with animal blood. They are vectors of several diseases, as Lyme borreliosis, Crimean‐Congo hemorrhagic fever, typhus, Q fever,... We present the case of a tick infestation of the eyelid of a child.

Methods: A 7‐year‐old girl presented for itchy eyelid, pain, and sensation of moving worms in the left superior eyelid. Her mother reported they just came back from vacation in Thailand, 3 days before. Examination of the left upper lid revealed one large moving ectoparasite with a group of eggs, laid below the upper eyelid. Some eggs had hatched, and small ticks were moving on and under the upper eyelid. Given the age of the girl and the nature of the infestation, it was impossible to remove the parasite and eggs at slit lamp. An appointment was settled the next day to remove them in operating room. The following day, the parasite detached itself from the eyelid. The sample was sent to a specialized center in tropical species. Careful examination revealed a slightly swollen palpebral conjunctiva towards the area where the tick was. Physical examination did not reveal other ectoparasite and treatment with Tobramycine was initiated as a precaution. The girl was sent to infectious diseases specialist to perform serologic tests.

Results: The ectoparasite was identified as amblyomma sp tick. A shell insect infestation on the eyelid is not common at all. The cases found in literature describe cases of ticks feeding on the eyelid, but none of them reports the presence of eggs around the large ectoparasite (1). We supposed that the parasite stayed long enough to lay its eggs.

Conclusions: Ophthalmologists are rarely confronted with ectoparasites and should be aware that removing the whole tick from the affected tissue is of important in the prevention of tickborne diseases and possible local complications (2). Serologic tests for tick‐borne diseases should be done and the patient monitored with clinical observation and follow‐up.

References

1. RR, R. R. V., Varma P, Kumar A. Tick infestation of the eyelid. Rev Soc Bras Med Trop 2020; 53.

2. Uzun A, Gök M, İşcanlı MD. Tick infestation of eyelid: two case reports. Turkish Journal of Ophthalmology 2016; 46(5): 248.