Aziz A. Khanifar

Measurement of choroidal perfusion and thickness following systemic sildenafil (Viagra

Purpose:  To demonstrate anatomic and physiologic changes in the human choroid following systemic sildenafil citrate (Viagra®) using enhanced depth imaging spectral domain–optical coherence tomography (EDI‐OCT) and swept‐scan high‐frequency digital ultrasound.

Retinal nerve fiber layer evaluation in multiple sclerosis with spectral domain optical coherence tomography

Purpose: Histopathologic studies have reported retinal nerve fiber layer (RNFL) thinning in various neurodegenerative diseases. Attempts to quantify this loss in vivo have relied on time-domain optical coherence tomography (TDOCT), which has low resolution and requires substantial interpolation of data for volume measurements. We hypothesized that the significantly higher resolution of spectral-domain optical coherence tomography (SDOCT) would better detect RNFL changes in patients with multiple sclerosis, and that RNFL thickness differences between eyes with and without optic neuritis might be identified more accurately. Methods: In this retrospective case series, patients with multiple sclerosis were recruited from the Judith Jaffe Multiple Sclerosis Center at Weill Cornell Medical College in New York. Patients with a recent clinical diagnosis of optic neuritis (less than three months) were excluded. Eyes with a history of glaucoma, optic neuropathy (other than multiple sclerosis-related optic neuritis), age-related macular degeneration, or other relevant retinal and/or optic nerve disease were excluded. Both eyes of each patient were imaged with the Heidelberg Spectralis® HRA + OCT. RNFL and macular thickness were measured for each eye using the Heidelberg OCT software. These measurements were compared with validated published normal values, and were modeled as linear functions of duration of disease. The odds of an optic neuritis diagnosis as a function of RNFL and macular thickness were calculated. Results: Ninety-four eyes were prospectively evaluated using OCT. Ages of patients ranged from 26 to 69 years, with an average age of 39 years. Peripapillary RNFL thinning was demonstrated in multiple sclerosis patients; mean RNFL thickness was 88.5 μm for individuals with multiple sclerosis compared with a reported normal value of 97 μm (P < 0.001). Eyes with a history of optic neuritis had more thinning compared with those without optic neuritis (83.0 μm versus 90.5 μm, respectively, P = 0.02). No significant differences were observed in macular thickness measurements between eyes with and without optic neuritis, nor were macular thickness measurements significantly different from normal values. As a function of multiple sclerosis duration and controlling for age, RNFL thickness was decreased in patients with a duration of multiple sclerosis greater than five years compared with those with a duration less than or equal to one year (P = 0.008). Conclusions: Patients with a history of multiple sclerosis had RNFL thinning that was detectable on SDOCT. Decreasing RNFL thickness in eyes with optic neuritis was found, and the odds of having optic neuritis were increased significantly with decreasing RNFL thickness. Average RNFL thinning with increasing duration of disease was an excellent predictor of a reported history of optic neuritis. SDOCT retinal imaging may represent a high-resolution, objective, noninvasive, and easily quantifiable in vivo biomarker of the presence of optic neuritis and severity of multiple sclerosis.

Spectral-Domain optical coherence tomography of endogenous fungal endophthalmitis

PURPOSE The purpose of this study is to report the use of spectral-domain optical coherence tomography in monitoring endogenous Candida endophthalmitis. METHODS A patient diagnosed with candidemia was followed for endogenous Candida endophthalmitis. With each clinic visit, the patient underwent visual acuity assessment, slit-lamp biomicroscopy, dilated fundus examination, color fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography. RESULTS At initial examination, the patients visual acuity was 20/200 in both eyes. Creamy yellow fungal lesions were visualized within one disk diameter of the fovea and along the arcades. These lesions, in various stages of evolution, were imaged with spectral-domain optical coherence tomography, localizing their depth within the retina. Deeper retinal lesions corresponded to early active inflammatory lesions as confirmed by hypofluorescent areas with late staining on the fluorescein angiography. More superficial lesions on the vitreoretinal interface corresponded to late inactive lesions corresponding to blocked areas on the fluorescein angiography. After the resolution of most lesions, her final visual acuity was 20/25 in both eyes at last follow-up. CONCLUSION The depth of lesions as shown by the spectral-domain optical coherence tomography corresponds to various stages of fungal infection, allowing clinicians to monitor the disease and its response to therapy.

Acute retinal necrosis and cystic encephalomalacia in a premature neonate.

PURPOSE To report a case of an infant born at 30 weeks gestational age (GA) who, at 37 weeks GA, presented with bilateral acute retinal necrosis (ARN) syndrome and herpes simplex virus (HSV) encephalomalacia. METHODS Observational case report. RESULTS A premature infant was found to have ARN based on dilated funduscopic examination and positive HSV serologies. Herpes simplex virus encephalomalacia was diagnosed base on magnetic resonance imaging (MRI). CONCLUSION To our knowledge, this is the youngest reported patient with ARN. This case demonstrates that neonatal ARN may present with posterior chorioretinal lesions and highlights the importance of considering HSV infection of the central nervous system with MRI findings of cystic encephalomalacia.