Assad Jalil

Swept-Source Optical Coherence Tomography Angio™ (Topcon Corp, Japan): Technology Review.

Optical coherence tomography (OCT) angiography (OCTA) is a novel, noninvasive, three-dimensional imaging technique that allows for the visualization of intravascular flow in the microvasculature. Swept-source OCT technology utilizes longer-wavelength infrared light than conventional spectral-domain OCT. This enables improved penetration into tissue and imaging through optical opacities and is invisible to the subject. Topcon has recently developed an innovative OCTA algorithm, OCTARA (OCTA Ratio Analysis), which benefits from being paired with swept-source OCT. OCTARA aims to provide improved detection sensitivity of low blood flow and reduced motion artifacts without compromising axial resolution. In this chapter, we describe the implementation of OCTARA with swept-source OCT technology, the technical specifications of acquisition (e.g. the number of scans, area of examination field, etc.) along with the algorithms function and principles for analysis of B-scan data to achieve angiographic visualization. Examples of OCTA scans performed using the OCTARA algorithm and a comparison of these scans with images obtained using other technologies are also presented.

New Findings in Diabetic Maculopathy and Proliferative Disease by Swept-Source Optical Coherence Tomography Angiography.

PURPOSE To describe the optical coherence tomography (OCT) angiography (OCTA) features of diabetic retinopathy. METHODS Retrospective serial case reports were examined of patients who underwent routine clinical examination and OCTA with both DRI OCT Atlantis prototype and Triton Swept-Source OCT of the posterior pole and mid-periphery. When considered necessary, fluorescein fundus angiography (FFA) with OPTOS California wide-field imaging was performed. The findings were compared with the current literature. RESULTS Forty-three consecutive patients (86 eyes) were evaluated. Fourteen of these patients (28 eyes) underwent an additional FFA examination due to advanced retinopathy signs, such as diabetic macular edema, ischemia or neovascularization (NV). OCTA was able to detect the microvascular lesions observed on color fundus images in the whole sample. Thirty-six of the 86 eyes showed foveal avascular zone enlargement on OCTA. Microvascular lesions, diabetic macular edema, and NV of the optic disc observed on FFA were also detected on OCTA in all cases (28/28 eyes). Features of NV elsewhere were detected on FFA in 16/28 eyes. Ten of the 16 eyes had signs of NV within the 100 central degrees, and OCTA was able to detect these signs in 9 of the eyes. CONCLUSION OCTA is an effective noninvasive imaging technique that can provide additional information regarding the localization and morphology of vascular lesions in all cases of NV of the optic disc and in more than half of cases of NV elsewhere, suggesting that it is a noninferior technique for the study of posterior pole alterations compared with FFA, which remains the gold standard and is fundamental for the study of the retinal periphery.

Electronic retinal implants and artificial vision: journey and present

Retinitis pigmentosa and age-related macular degeneration are two significant causes of severe visual dysfunction. In both, the retinal photoreceptors degenerate, preventing successful conversion of light into electrical energy that is interpreted in the visual cortex as visual function. Artificial vision or visual function began over two centuries ago with the idea of creating artificial light pulses, or phosphenes, through cortical stimulation. The pursuit is now on to improve artificial visual function. Two retinal implants appear the most likely to succeed in the future having undergone multicentre human trials: the Argus II electronic epiretinal device (Second Sight Medical Products, CA, USA) and Alpha-IMS electronic subretinal device (Retina Implant AG, Germany). The trial results to date are encouraging with visual improvement and acceptable safety profiles reported for both devices. At present, the visual function generated by either device does not offer high enough resolution or acuity for a patient to regain a fully functional life. Despite this, both devices not only have the potential, but have actually improved the vision-related quality of life in a significant number of patients implanted. With this in mind, the economic argument is clear. Provided device-life is long enough, its cost should be acceptable for the obtained improvement in the quality of life. The aim of this Review Article is to assist those readers that may be considering offering any of these devices as a treatment for blindness in Retinitis Pigmentosa.

Swept-Source Optical Coherence Tomography Angiography of Paediatric Macular Diseases

PURPOSE To describe the optical coherence tomography (OCT) angiography (OCTA) features of paediatric macular pathologies. METHODS Retrospective serial case reports of patients who underwent routine clinical examination and OCTA of the posterior pole using both a DRI OCT Atlantis prototype and Triton Swept-Source OCT. When considered necessary, imaging was performed using Optos wide-field imaging or another non-invasive imaging system. The findings were compared with the current literature. RESULTS Three cases with X-linked retinoschisis, 2 with epiretinal membrane, 1 with Best disease and 2 with Coats disease are fully illustrated. CONCLUSION OCTA is an effective, non-invasive imaging technique that can offer additional information regarding the morphologies and vascular characteristics of macular lesions in paediatric ophthalmology. Because of the rarity and characteristics of many paediatric macular pathologies, further multi-centric research is required with regard to the utilisation and features of OCTA imaging.

Exudative retinal detachment following photodynamic therapy for retinal capillary hemangioma

1. D’souza Y, Jones CJ, Bonshek RE. Glycoproteins of drusen and drusen-like lesions. J Mol Histol 2008;39:77–86. 2. Gass JDM, ed. Diseases causing choroidal exudative and haemorrhagic localised (disciform) detachment of the retina and retinal pigment epithelium. In: Stereoscopic Atlas of Macular Disease. Diagnosis and Treatment. 4 ed. St. Louis, Mo.: Mosby; 1997:106–117. 3. Russell SR, Mullins RF, Schneider BL, Hageman GS. Location, substructure, and composition of basal laminar drusen compared with drusen associated with aging and age-related macular degeneration. Am J Ophthalmol 2000;129:205–14. 4. Pauleikhoff D, Zuels S, Sheraidah GS, Marshall J, Wessing A, Bird AC. Correlation between biochemical composition and fluorescein binding of deposits in Bruch’s membrane.Ophthalmology 1992;99:1548–53.

Retinal pigment epithelial tear following intravitreal injection of bevacizumab (avastin®) : optical coherence tomography and fluorescein angiographic findings

Retinal pigment epithelial tear following intravitreal injection of bevacizumab (avastin ® ): optical coherence tomography and fluorescein angiographic findings

Clinical review of periorbital capillary hemangioma of infancy.

PURPOSE To explore the role of intralesional steroid injections (ILSI) and oral steroids in the management of periocular hemangioma of infancy (HOI). METHODS In this retrospective study, treatment options studied were observation, ILSI, and oral steroids. All children received adjunctive amblyopia treatment if required. The main indications for treatment were cosmetic, worsening astigmatism, and visual axis obscuration. Success was defined as complete HOI regression before the age of 5 years (cosmetic group), reduction of astigmatism of at least 1 diopter cylinder (DC) (astigmatism group), or no evidence of amblyopia at the last follow-up (visual axis obscuration group). RESULTS Twenty-four of 41 children (58.5%) had amblyopia at presentation. Eighteen children formed the observation group, 17 children received ILSI, and 6 children received oral steroids. Successful outcome was achieved in all except 2 patients in the cosmetic group and 6 of 7 in the visual axis obscuration group. Mean astigmatic correction of all cases was 1.65 ± 1.34 DC before treatment and 0.91 ± 1.17 DC after treatment, the change being statistically significant (P < .001). CONCLUSION Observation appears to be a highly effective strategy if coupled with amblyopia therapy, especially for mild cases. Intralesional and oral steroids appear to be equally effective for lesions requiring treatment, but their exact role cannot be clearly determined in the presence of a spontaneously resolving lesion.

Vitrectomy for primary symptomatic vitreous opacities: an evidence-based review.

Floaters are a common ocular condition which form as a consequence of aging changes in the vitreous. Although in most patients the symptoms are minimal, they can cause significant impairment in vision-related quality of life in a small population of patients. Recently there has been an increase in awareness of the visual disability caused by floaters, and the evidence-base for treatment of this condition using small-gauge vitrectomy has increased. In this review, we define the term ‘floaters’ as symptomatic vitreous opacities (SVO). We suggest a classification dependent on the presence or absence of posterior vitreous detachment and discuss their pathogenesis and natural history. We review their impact on patients’ quality of life related to visual function. We review the psychological factors that may have a role in some patients who appear to be affected by SVO to the extent that they pursue all options including surgery with all its attendant risks. We summarise the available evidence-base of treatment options available for SVO with special emphasis on the safety and efficacy of vitrectomy for this condition.

Unique case of eyeball tattooing leading to ocular penetration and intraocular tattoo pigment deposition

normal, and spinal fluid culture results were negative. We suspected VKH disease, with bacterial endophthalmitis, metastatic endophthalmitis, Blau syndrome and juvenile idiopathic arthritis considered as differential diagnoses. Bacterial endophthalmitis and metastatic endophthalmitis were unlikely due to the absence of vitreous opacities, whereas Blau syndrome and juvenile idiopathic arthritis were doubtful due to the presence of serous retinal detachment and the absence of articular symptoms. The patient had typical symptoms of VKH, and no vitreous opacities suspicious of endophthalmitis. We made a diagnosis of VKH on the day of referral. Following admittance to our hospital, intravenous methylprednisolone at 30 mg/kg was given for 3 days. According to the recommendation of a paediatrician that was followed by oral corticosteroid administration starting with a dosage of 1.5 mg/kg and then gradual tapering for 9.5 months, with topical corticosteroid simultaneously given for 8.5 months. On day 21, inflammation of the anterior chamber and serous retinal detachment had disappeared in both eyes (Fig. 1f,g). Ten months after starting treatment, angular vision was 1.0 in the right eye and 1.2 in the left. However, a slight posterior capsular cataract and slight focal chorioretinal atrophy were observed in the posterior and peripheral retinas of both eyes (Fig. 1c,d). After 30 months, no relapse was noted. VKH rarely occurs in children, and onset at less than 5 years old is quite rare. El-Asrar reported 23 cases of childhood VKH, with onset ages ranging from 5 to 16 years, whereas Tabbara reported 13 cases with onset from 6 to 16 years old. To the best of our knowledge, the youngest VKH patients reported are two girls aged 4 and 3 years old, of whom the latter had coexisting type-1 diabetes mellitus and coeliac disease. Thus, the present is the youngest case reported without systemic complications. Previous reports of paediatric VKH have noted headache, bilateral visual loss, hyperaemia and serous retinal detachment as common clinical manifestations. A preceding fever was reported in a minority of cases. Early and aggressive high-dose systemic corticosteroid therapy has become the mainstay therapy for VKH, and this form of treatment leads to favourable visual prognosis in most adult patients. However, as with other types of uveitis, treatment of VKH is more challenging in paediatric patients as compared with adults, as prolonged corticosteroid usage increases the risks of growth retardation and other systemic side-effects. Notably the start of treatment in childhood cases tends to be delayed, and intervals longer than 2 weeks between onset and treatment are significantly associated with recurrence of inflammation and poor visual prognosis. Our patient began corticosteroid pulse therapy on day 13, and no relapse was seen after 30 months. Thus, findings in this case suggest that early diagnosis as well as starting corticosteroid pulse therapy as soon as possible may suppress ocular and systemic inflammation and contribute to good visual outcome in childhood VKH cases. Sachiko Takada MD, Rie Tanaka MD, Naoyuki Kurita MD, Kiyoshi Ishii MD PhD and Toshikatsu Kaburaki MD PhD Department of Ophthalmology, Nadogaya Hospital, Kashiwa-City, Chiba, Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo; and Department of Ophthalmology, Saitama Red Cross Hospital, Saitama-City, Saitama, Japan Received 17 August 2014; accepted 18 January 2015.

Choroidal nonperfusion with significant subretinal exudation after PDT of predominantly classic CNV: an OCT and FFA study.

Purpose Despite the increasing use of antivascular endothelial growth factors (anti-VEGF), photodynamic therapy (PDT) with Verteporfin® is still considered the gold standard treatment of subfoveal and juxtafoveal classic choroidal neovascularization (CNV). Methods Case report. Results The authors report a case of a 72-year-old man who developed choroidal nonperfusion and significant subretinal fluid formation with associated severe visual loss following PDT of predominantly classic juxtafoveal CNV. Conclusions Although reported separately, these two complications have not been previously reported to occur in association after PDT treatment of classic CNV and may represent exaggeration of normal events occurring after PDT.