Ali Ayata

Near-Infrared and Short-Wavelength Autofluorescence Imaging in Central Serous Chorioretinopathy

Aims: The aim of the study was to compare the results of short-wavelength (SW) and near-infrared (NIR) autofluorescence (AF) in acute central serous chorioretinopathy (CSC). Methods: Twenty-six eyes of the 26 patients diagnosed with CSC (mean age 37.4 years) were included in this retrospective study. AF images were evaluated and compared with angiographic and ophthalmoscopic findings. Fluorescein angiography and AF imaging were performed using a confocal scanning laser ophthalmoscope. Results: Focally decreased AF at the leakage site was seen in most of the cases with acute CSC (20 of 26 eyes in SW-AF; 20 of 20 eyes in NIR-AF). Twenty-four of the 26 cases had decreased SW-AF corresponding to the area of the serous retinal detachment, while 19 of the available 20 cases had decreased NIR-AF corresponding to the area of the serous retinal detachment. Increased granular AF corresponding to the extent of the former retinal detachment was seen earlier with SW-AF imaging, but disappeared later in the course of disease with NIR-AF imaging. Conclusions: AF imaging in CSC demonstrates different patterns according to the course of the disease, reflecting RPE and outer retinal changes. Combining two different methods of AF imaging could predict recent or former CSC episodes and may be a non-invasive technique for monitoring CSC and performing differential diagnosis.

Validation of the Ocular Trauma Score for Intraocular Foreign Bodies in Deadly Weapon-Related Open-Globe Injuries

BACKGROUND AND OBJECTIVE To evaluate the prognostic value of the Ocular Trauma Score (OTS) in cases of deadly weapon-related open-globe injuries with intraocular foreign bodies. PATIENTS AND METHODS A retrospective, interventional case series included 20 eyes of 20 patients who had deadly weapon-related open-globe injuries with intraocular foreign bodies. The OTS was calculated for each patient by adding the determined numbers of OTS variables at presentation (initial visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect). Patients were categorized based on their score (category 1 through 5). Final visual acuities in the OTS categories were calculated and compared to those in OTS study group. RESULTS No statistically significant difference was found between the categorical distributions of the study patients and those in the OTS study group. No patient in the study was in category 5. CONCLUSION The OTS, which was designed to predict visual outcomes of general ocular trauma, may also provide reliable information about the prognosis of deadly weapon-related open-globe injuries with intraocular foreign bodies.

Autofluorescence and OCT features of Bietti’s crystalline dystrophy

Bietti’s crystalline dystrophy (BCD) is an autosomal recessive retinal degeneration characterised by innumerable glistening intraretinal dots scattered over the fundus. This retinal degeneration was first described in three patients by Bietti in 1937 with crystalline deposits in the retina and limbal cornea.1 Progressive retinal degeneration and sclerosis of the choroidal vessels ultimately result in progressive night blindness and constriction of the visual field approximately in the third and fourth decade of life. Histopathological studies disclosed evidence of advanced panchoroidal atrophy characterised by a marked loss of the RPE and choriocapillaris and mild retinal gliosis. Focal hypertrophy, hyperplasia and intraretinal migration of RPE cells were observed.2 To the best of our knowledge, the optical coherence tomography (OCT) features of BCD have been described in a single case only.3 Herein, we report the OCT, fundus autofluorescence (FAF) and near-infrared autofluorescence (NIR AF) findings in three patients with Bietti’s crystalline retinopathy. …

Carbon Monoxide-Induced Cortical Visual Loss: Treatment with Hyperbaric Oxygen Four Years Later

Objective: We present a patient who developed visual loss after carbon monoxide (CO) poisoning and was treated with hyperbaric oxygen. Clinical Presentation and Intervention: A 21-year-old woman poisoned with CO (with coma lasting 4 h and carboxyhemoglobin level 46%) developed seizures and cortical blindness 3 days after poisoning. Four years later, her visual acuity was 0.2 in both eyes. An 18F-fluorodeoxyglucose positron emission tomography (PET) scan showed reduced metabolism in the bilateral posterior temporal and occipital lobes. The patient received a total of 50 hyperbaric oxygen sessions over 3 months for visual loss and the visual acuity improved to 0.5 in both eyes. In addition, increased metabolism was detected in the brain in post-treatment PET scans. Conclusion: PET documented brain hypoperfusion 4 years after CO poisoning and hyperbaric oxygen therapy improved visual acuity. However, we cannot endorse routine use of hyperbaric oxygen for such patients, until results of further clinical trials demonstrate efficacy of hyperbaric oxygen in CO-induced chronic brain injury.

Hemicentral Retinal Artery Occlusion in a Breast Cancer Patient Using Anastrozole

Background: Anastrozole, an aromatase inhibitor, is commonly used in the adjuvant treatment of breast cancer. Anastrozole treatment is associated with a risk of thromboembolic events and retinal vascular side effects. Herein, we present a case of hemicentral retinal artery occlusion diagnosed in a breast cancer patient using anastrozole. Case Report: A 53-year-old woman with a hypertensive and diabetic background was admitted to our hospital with breast cancer. Anastrozole treatment was started after surgery, adjuvant chemotherapy, and radiotherapy. Sudden painless loss of vision in the patient’s right eye occurred within 13 months of Anastrozole treatment. A fluorescein angiogram revealed hemicentral retinal artery occlusion. Conclusion: To the best knowledge of the authors, this is the first report of hemicentral retinal artery occlusion in an anastrozole user.

Near infrared fluorescence and OCT features of choroidal abnormalities in type 1 neurofibromatosis

1. Jones BE, Jampol LM, Yannuzzi LA et al. Relentless placoid chorioretinitis: a new entity or an unusual variant of serpiginous chorioretinitis? Arch Ophthalmol 2000; 118: 931–8. 2. Orihara T, Wakabayashi T, Okada AA et al. A young Japanese man with relentless placoid chorioretinitis. Jpn J Ophthalmol 2005; 49: 539–42. 3. Gallagher MJ, Yilmaz T, Cervantes-Castañeda RA, Foster CS. The characteristic features of optical coherence tomography in posterior uveitis. Br J Ophthalmol 2007; 91: 1680–5. 4. Souka AA, Hillenkamp J, Gora F et al. Correlation between optical coherence tomography and autofluorescence in acute posterior multifocal placoid pigment epitheliopathy. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1219–23. 5. Lim LL, Watzke RC, Lauer AK, Smith JR. Ocular coherence tomography in acute posterior multifocal placoid pigment epitheliopathy. Clin Experiment Ophthalmol 2006; 34: 810–12. Near infrared fluorescence and OCT features of choroidal abnormalities in type 1 neurofibromatosis

Autofluorescence findings in Vogt-Koyanagi-Harada disease

Purpose To report shortwave autofluorescence (SW-AF) and near infrared autofluorescence (NIR-AF) findings in a case of Vogt-Koyanagi-Harada (VKH) disease. Methods A 22-year-old man presented with a 2-week history of headache, moderate hearing loss, discolored hair, and bilateral gradually decreased vision (20/800 bilaterally). Ophthalmologic examinations revealed bilateral granulomatous anterior uveitis and multiple patchy bullous retinal detachments. Fundus fluorescein angiography (FFA), SW-AF, and NIR-AF imaging were performed with a confocal scanning laser ophthalmoscope at the beginning and after resolution. The patient responded well to systemic prednisolone treatment. Visual acuity and hearing loss improved quickly (visual acuity 16/20 bilaterally). Results Multilobular dye pooling with a dark rim was observed in serous detached retinal areas on late-phase FFA. These areas were observed as hypoAF in SW-AF and NIR-AF mode due to the blockage. After resolution of serous detachment, numerous hypoAF granular dots were observed scattered over the previously serous detached areas in SW-AF and NIR-AF mode. These hypoAF granular dots were seen as window defect lesion in FFA and interpreted as retinal pigment epithelial damage or atrophy. Conclusions SW-AF and NIR-AF imaging confirmed granular retinal pigment epithelium atrophy which corresponds to FFA findings. SW-AF and NIR-AF imaging methods are noninvasive and useful techniques for documentation of fundus changes in VKH disease.

Influence of hyperbaric oxygen therapy on central corneal thickness.

Background/Aims: Hyperbaric oxygen (HBO) therapy is used in the treatment of several disorders. Little is known about the effects of HBO treatment on corneal thickness. The aim of this study was to investigate the effect of HBO treatment on central corneal thickness. Methods: Thirty-two subjects (18 males and 14 females, mean age 57.3 ± 16.7 years) undergoing HBO treatment were consecutively enrolled. The subjects were assigned into diabetic (n = 16) and nondiabetic groups (n = 16). Best-corrected visual acuity was recorded before HBO treatment, and anterior and posterior segment examinations were performed on a slit lamp biomicrosope. Central corneal thickness was measured with an ultrasonic pachymeter before and immediately after HBO treatment, which lasted 120 min at 2.4 atmospheres absolute with three 30-min oxygen and two 5-min air breathing periods. Results: HBO treatment did not change the central corneal thickness in diabetic subjects (547.6 ± 34.5 vs. 548.6 ± 34.6 µm; p = 0.606). In nondiabetic subjects, however, the central corneal thickness was significantly reduced after HBO treatment (576.5 ± 34.8 vs. 569.0 ± 34.8 µm; p < 0.001). Conclusion: A single exposure to HBO treatment reduced the central corneal thickness in nondiabetic subjects but not in diabetic subjects. However, the change in central corneal thickness was minor.

Fundus autofluorescence imaging of macular star.

active retinochoroidal inflammation. Untreated subfoveal CNV secondary to toxoplasmosis is often associated with low VA of 0.2–0.01 (Fine et al. 1981). The results of different therapeutic modalities have been reported in only a few small series, comprising a total of 18 cases (Table 1). Argon laser photocoagulation of subfoveal CNV appeared to be the optimum method with which to stabilize VA. The outcome in VA after subretinal surgery varies considerably. Although V-PDT may stabilize VA, reading vision was achieved in only four of 12 V-PDT-treated eyes. In our case, combined V-PDT and IVTA preserved function for a limited period of 3 months. It remains unclear if photodynamic re-treatment combined with IVTA therapy could have stopped the growth of the reactivated CNV in our patient. We decided to use a different treatment strategy that promised a better chance of preserving the patient’s reading ability. Intravitreal bevacizumab therapy has been reported to have favourable effects in CNV of different inflammatory (e.g. presumed ocular histoplasmosis syndrome [POHS]) and other origins unrelated to age (Teixeira et al. 2006; Adan et al. 2007; Prager et al. 2007). Enhanced expression of vascular endothelial growth factor (VEGF) may be an important feature in inflammatory CNV (Kwak et al. 2000). In our patient, VA increased to normal levels and was preserved until the end of follow-up. We attribute the preservation of VA to the three intravitreal bevacizumab injections and not to previous treatment because VA had decreased following V-PDT but improved shortly after the first bevacizumab injection with scarring of CNV in FA. In conclusion, intravitreal bevacizumab appears to be a beneficial therapeutic option for CNV in toxoplasmosis.

Fundus autofluorescence in choroidal rupture.

PURPOSE To investigate fundus autofluorescence (FAF) imaging findings for patients with choroidal rupture. METHODS FAF images were recorded with a new-generation confocal scanning laser ophthalmoscope. Three patients with choroid ruptures, one acute and two chronic, were included in the study. RESULTS Choroidal ruptures typically appeared as hypoautofluorescent crescent-shaped lesions on FAF images. In the case of acute choroid rupture, the whole extent of the rupture was clearly seen, and visibility of the lesion was found to be better by FAF imaging than by ophthalmoscopy and fundus fluorescein angiography. CONCLUSION Choroidal rupture has a typical appearance by FAF imaging. FAF imaging may be a useful noninvasive tool in the recognition of these lesions early in their course.