Anna Nowinska

Anterior segment imaging: Fourier-domain optical coherence tomography versus time-domain optical coherence tomography.

PURPOSE: To compare anterior segment measurements and morphology of 2 optical coherence tomography (OCT) systems. SETTING: Department of Ophthalmology, District Railway Hospital, and the Nursing Department and Social Medical Issues, Health Care Division, Silesian Medical University, Katowice, Poland. METHODS: In normal eyes and in eyes with corneal and trabecular–iris angle disorders, the central corneal thickness (CCT), trabecular–iris angle, and angle‐opening distance at the nasal and temporal angles were measured 3 times during 1 visit using the Visante time‐domain OCT system and the RTVue‐100 Fourier‐domain corneal anterior module OCT system. Anterior segment morphology was assessed and compared. RESULTS: Fifty‐four eyes were evaluated. The mean values (±SD) by time‐domain OCT and Fourier‐domain OCT were, respectively, automatic CCT, 535 ± 33.07 μm and 538 ± 31.82 μm; manual CCT, 545 ± 30.91 μm and 542 ± 30.57 μm; nasal trabecular–iris angle, 34.7 ± 9.5 degrees and 35.2 ± 8.9 degrees; temporal trabecular–iris angle, 35.3 ± 8.5 degrees and 35.5 ± 9 degrees; nasal angle‐opening distance, 435 ± 95 μm and 444 ± 98 μm; and temporal angle‐opening distance, 443 ± 103 μm and 452 ± 99 μm. There was no significant difference between mean values, and they were highly correlated. On morphologic analysis, time‐domain OCT had lower resolution; however, all anterior chamber structures were visible on 1 image. Fourier‐domain OCT provided precise information about small areas of the anterior chamber. CONCLUSION: Fourier‐domain OCT provided accurate anterior eye segment measurements that agreed with those obtained with time‐domain OCT.

Anterior segment optical coherence tomography in eye injuries.

BackgroundTo evaluate the usefulness of anterior segment optical coherence tomography (AS OCT) for initial diagnosis and for monitoring treatment results in eye injury cases.MethodsWe examined 38 eyes of 34 patients with different types of ocular injuries: penetrating injury (eight eyes), perforating injury (two eyes), intraocular foreign body (four eyes), ocular burn (nine eyes), contusion (13 eyes), and lamellar laceration (two eyes). The mean age of the patients was 33.8 years. AS OCT examination was performed at the initial visit, directly after injury, and repeated as treatment progressed. Both anterior chamber components and corneal pachymetry were evaluated.ResultsSlit-lamp examination did not provide a clear diagnosis in three eyes after contusion because of a nontransparent cornea. In one case of a 44-year-old male patient, only corneal edema was noticed during slit-lamp examination, whereas AS OCT revealed Descemet’s membrane detachment. In a 17-year-old male patient with blood infiltrating the cornea, OCT revealed acute angle closure with a pupillary block. In patients with corneal burns, OCT was valuable for monitoring the corneal healing progress after amniotic membrane application. OCT was also useful for determining whether a lamellar or penetrating technique should be applied in patients that qualified for corneal transplantation. In patients with foreign bodies, AS OCT was helpful in establishing the localization and size of the foreign body.ConclusionsAS OCT is a very valuable tool in ophthalmic departments dealing with ocular trauma, for early diagnosis and for monitoring treatment progress.

Usefulness of anterior segment optical coherence tomography in Descemet membrane detachment.

Purpose To evaluate the usefulness of anterior segment optical coherence tomography (OCT) in diagnosis, choosing the treatment method, and monitoring the treatment outcomes in Descemet membrane detachment (DMD). Methods We retrospectively reviewed the clinical data for 14 eyes of 13 patients: 8 eyes with DMD after cataract surgery, 2 eyes after deep anterior lamellar keratoplasty (DALK), 2 eyes of 1 patient with Ehlers-Danlos type VI syndrome, 1 eye after contusion, and 1 eye with spontaneous corneal edema of unknown origin. We used OCT to confirm or make the diagnosis, evaluate the configuration of detachment, and monitor treatment results. Results DMD was diagnosed in 12 eyes, based on the slit lamp examination. In 2 eyes, because of a very hazy view due to corneal edema, DMD was diagnosed based on OCT findings. We chose the treatment method based on DMD configuration evaluated by OCT examination. Eight eyes were treated conservatively and 6 eyes underwent intracameral air injection with additional ab externo stab incisions. In 12 eyes, Descemet membrane reattached successfully. In 2 eyes of 1 patient with Ehlers-Danlos syndrome, the detachment remained, but corneal thickness had decreased. After anterior chamber air tamponade, we observed the decrease of corneal thickness within 7 days. Conclusions OCT is useful in precise evaluation of DMD configuration and choosing the treatment method, but has a very limited role in diagnosis and monitoring the treatment results, where the clinical examination is the most important indicating factor. (Eur J Ophthalmol 2009; 19: 723–8)

Phenotype-genotype correlation in patients with Schnyder corneal dystrophy.

Purpose: The aim of this study was to analyze the corneal morphology features and define mutations in the UbiA prenyltransferase domain–containing 1 (UBIAD1) gene in patients with Schnyder corneal dystrophy from a Polish population. Methods: Five affected and 15 unaffected members originating from 3 families with Schnyder corneal dystrophy were included in the study. Phenotype analysis consisted of visual acuity, slit-lamp biomicroscopy with photography, time domain optical coherence tomography, spectral domain optical coherence tomography, and confocal microscopy. Three patients underwent a penetrating keratoplasty. Corneal buttons obtained from the penetrating keratoplasty were processed for light microscopy. Results: A novel mutation I245N of the UBIAD1 gene was revealed in 1 proband and associated with the phenotype without central corneal opacities. The analysis of the other patients showed the N102S mutation. In vivo corneal morphology analysis using optical coherence tomography and confocal microscopy confirmed the presence of multiple crystalline corneal deposits in all affected corneas. The histological examination revealed multiple empty widenings of the corneal lamellae that could represent lipids removed from the specimen. Conclusions: N102S may also be a mutation hotspot in the Polish population, as in other previously reported populations. Corneal crystals formed a characteristic pattern on optical coherence tomography scans.

A69S and R38X ARMS2 and Y402H CFH gene polymorphisms as risk factors for neovascular age-related macular degeneration in Poland - a brief report.

Summary Background The wet form of age-related macular degeneration (ARMD) is a leading cause of irreversible blindness in Caucasians. Our purpose was to assess influence of gene polymorphisms A69S (rs10490924) and R38X (rs2736911) ARMS2 and Y402 (rs1061170) CFH on wet ARMD risk in a Polish population. Material/Methods 130 unrelated patients (90 with wet ARMD and 40 controls) took part in the study. Dry blood was used for DNA isolation. PCR amplification and gene sequencing were performed. In subjects with R38X and A69S, SNP gene cloning was used to exclude the possible combined variant. Results Homozygous Y402H and A69S conferred a significance risk of wet ARMD in Poland: Y402H odds ratio (OR) was 5.57 (95% confidence interval: 1.58–19.6), p=0.002; and A69S OR was 7.72 (95% confidence interval: 1.73–34.36), p=0.001. R38X is probably more common in healthy subjects: OR was 0.45 (95% confidence interval: 0.19–1.05), p=0.053. Conclusions The etiologic role in ARMD of A69S ARMS2 and Y402H CFH gene variants were confirmed in a Polish population for the first time. R38X variant of ARMS2 seems to be protective from wet ARMD.

Clinical, confocal, and morphological investigations on the cornea in human mucopolysaccharidosis IH-S.

Purpose: The aim was to describe the confocal and histological findings of 2 corneas from a patient with an advanced case of type I mucopolysaccharidoses Hurler–Scheie disease (MPS IH-S). Methods: Both corneas from an MPS IH-S–affected patient were examined in vivo using confocal microscopy and then removed and processed for evaluation using light microscopy and transmission and scanning electron microscopy. Results: Confocal microscopy evaluation showed basal epithelial cells with either diffuse or granular hyperreflectivity. Keratocytes were highly reflective determining a web-shaped stromal appearance. Endothelial cells were barely visible. The histopathological study demonstrated superficial cells with apical microfolds, small vesicles, and evident intercellular junctions. The wing cells showed either well-evident tonofilaments and small peripheral vesicles, or large paranuclear vesicles. The basal cells showed polygonal shapes, many small vesicles, and enlarged intercellular spaces. The Bowman layer was either normal or thinner and was formed by variably electron dense material. In the stroma, irregularly oriented lamellae, many vesicle-filled keratocytes, and intercellular granular material were present. The Descemet membrane was normal, whereas the corneal endothelium showed marked degenerative changes. Conclusions: The confocal alterations appeared consequent to the anomalous accumulation of material. The histopathological images gave a clue to better understand the corneal changes demonstrated by the confocal studies in MPS IH-S.

Donor disc attachment assessment with intraoperative spectral optical coherence tomography during descemet stripping automated endothelial keratoplasty.

Optical coherence tomography has already been proven to be useful for pre- and post-surgical anterior eye segment assessment, especially in lamellar keratoplasty procedures. There is no evidence for intraoperative usefulness of optical coherence tomography (OCT). We present a case report of the intraoperative donor disc attachment assessment with spectral-domain optical coherence tomography in case of Descemet stripping automated endothelial keratoplasty (DSAEK) surgery combined with corneal incisions. The effectiveness of the performed corneal stab incisions was visualized directly by OCT scan analysis. OCT assisted DSAEK allows the assessment of the accuracy of the Descemet stripping and donor disc attachment.

Photodynamic therapy in VEGF inhibition non-responders—Pharmacogenetic study in age-related macular degeneration assessed with swept-source optical coherence tomography

BACKGROUND Treatment of neovascular age-related macular degeneration (nAMD) remains a major challenge in ophthalmology. It is essential to determine which of VEGF inhibition non-responders can benefit from photodynamic therapy (PDT). As AMD is strongly related to gene polymorphisms, genetic factors can modify efficacy of treatment. Swept-source optical coherence tomography (SS-OCT) gives exceptional insight into the retina and choroid. SS-OCT usefulness needs to be evaluated in nAMD patients. METHODS Prospective 6-month study included consecutive 110 patients (110 eyes) with predominantly classic neovascular AMD treated with photodynamic therapy. Only non-responders to anti-VEGF were included in the study. Greatest linear dimension (GLD) of the lesion, best corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and central choroidal thickness were assessed and compared between CFH and ARMS2 genotype groups. Success rate was the main endpoint. It was defined as not active CNV in the center of the fovea and no worsening in BCVA. Multiple regression was used to assess gene polymorphisms influence on PDT results. Wilcoxon tests were performed to determine significance of changes from baseline values. RESULTS Following genotype frequencies were obtained-CFH CC 35 patients (31.8%), CT 52 (47.3%), TT 23 (20.9%); ARMS2 TT 28 patients (25.4%), GT 43 (39.1%), GG 39 (35.4%) success rate in CC/CT/TT CFH and TT/GT/GG ARMS2 groups were as follows respectively: 22.9%, 28.8%, 30.4% and 28.6%, 25.6%, 28.2%. The differences were not significant with highest odds ratio TT vs. CC CFH 1.57 (95% CI 0.48-5.2, p=0.4). Significant increase in GLD was observed only in CC CFH group. Overall mean following measured parameters were obtained at baseline/day 7/month 3/month 6 (significant changes from baseline are marked with asterisk): GLD-3825±1301μm/3901±1579μm/3861±1463μm/3925±1523μm; CSMT-405±203μm/434±257μm*/321±163μm*/295±157*μm; CCT-235±103μm/278±157*μm/211±113μm*/201±107*μm; BCVA-49.3±12.5/43.2±14.2*/49.6±11.6/48.7±12.2 letters on ETDRS charts. In all patients classic component of the lesion was assessed with SS-OCT with no need to be reaffirmed in FA. Thus FA was used mainly for lesion size calculation. CONCLUSIONS Common genetic factors seem not to influence PDT effectiveness in VEGF inhibitors non-responders. SS-OCT is a valuable tool of nAMD monitoring, especially for choroid assessment. Deterioration of retinal structure and function is observed one week after PDT. It is related to increase in both retinal and choroidal thickness and is accompanied by mild temporary BCVA decrease.

Corneal Structural Changes in Nonneoplastic and Neoplastic Monoclonal Gammopathies

PURPOSE To investigate corneal confocal microscopic changes in nonneoplastic and neoplastic monoclonal gammopathies. METHODS Three groups of subjects were considered: group 1, twenty normal subjects; group 2, fifteen patients with monoclonal gammopathy of undetermined significance (MGUS); group 3, eight patients with smoldering multiple myeloma and eight patients with untreated multiple myeloma. After hematologic diagnosis, patients underwent ophthalmologic exam and in vivo confocal microscopic study. The statistical analysis was performed using ANOVA and Student-Newman-Keuls tests and receiver operating characteristic (ROC) curve analysis. RESULTS Epithelial cells of gammopathic patients showed significantly higher reflectivity than controls, demonstrated by optical density (P < 0.001). Subbasal nerve density, branching, and beading were significantly altered in gammopathic patients (P = 0.01, P = 0.02, P = 0.02, respectively). The number of keratocytes was significantly reduced in neoplastic patients (P < 0.001 versus both normal and MGUS) in the anterior, medium, and posterior stroma. The ROC curve analysis showed good sensitivity and specificity for this parameter. Group 2 and 3 keratocytes showed higher nuclear and cytoplasmatic reflectivity in the medium and posterior stroma. Endothelial cells were not affected. CONCLUSIONS Patients with neoplastic gammopathies showed peculiar alterations of the keratocyte number, which appeared significantly reduced. A follow-up with corneal confocal microscopy of patients with MGUS is suggested as a useful tool to identify peripheral tissue alterations linked to possible neoplastic disease development.

Phenotype and genotype analysis in patients with macular corneal dystrophy

Aim The aim of this study was to analyse corneal morphological organisation and identify mutations in the carbohydrate sulfotransferase 6 gene (CHST6) in patients with macular corneal dystrophy originating in a Polish population. Methods Macular corneal dystrophy was diagnosed in 24 patients based on the slit-lamp exam, confocal microscopy, 1310 nm time domain and 840 nm spectral domain optical coherence tomography. 10 corneal buttons obtained from penetrating keratoplasty were processed for light microscopy. Genetic analysis of the CHST6 gene was performed, followed by a study of the sequencing results. Results Highly reflective, diffuse corneal deposits and a general increase in reflectivity were revealed with optical coherence tomography and confocal microscopy. The deposits extended from the Bowman layer to the Descemet membrane and correlated with the Alcian blue-positive granular-filamentous material into and around the stromal keratocytes confirmed by structural analysis of the corneal buttons. The genetic analysis of the blood samples identified the following mutations and single nucleotide polymorphisms: novel P64L (heterozygous), Y110C (homozygous), R162G and L200R, and M1L (heterozygous and homozygous). Conclusions Genetic mutation heterogeneity was revealed. No phenotype heterogeneity was revealed among patients with in vivo corneal morphology assessment or histological analysis.