Jorge Ruiz-Medrano

Effect of pharmacologic pupil dilation on OLCR optical biometry measurements for IOL predictions.

Purpose To determine the possible influence of pupil dilation on intraocular lens (IOL) power predictions made using optical biometry with Lenstar LS 900® (Haag-Streit AG, Koeniz, Switzerland). Methods A total of 72 eyes of 72 patients scheduled to undergo cataract surgery were prospectively examined using the optical low-coherence reflectometry (OLCR) optical biometer before and after pupil dilation with tropicamide 1%. The measurements made were axial length, central corneal thickness, anterior chamber depth (ACD), lens thickness, mean keratometry, corneal diameter (CD), and pupil diameter. Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between the 2 measurement modes (with and without dilation) was assessed by calculating intraclass correlation coefficients (ICC) and constructing Bland-Altman plots. Results The mean age of the patients was 74.71 ± 7.53 years (range 56–90). Among the variables determined, only ACD varied significantly according to pupil dilation (p<0.001). The ICC data revealed excellent intraobserver correlation between measurements made with and without dilation, except for CD. The IOL power predictions were unmodified. Conclusions The use of pupil dilation does not seem to influence measurements and IOL predictions made using this OLCR optical biometer.

Choroidal characteristics of acute and chronic central serous chorioretinopathy using enhanced depth imaging optical coherence tomography

Purpose Central serous chorioretinopathy (CSC) is an idiopathic disorder characterized by serous detachments of the neurosensory retina and/or the retinal pigment epithelium affecting the macular area in the majority of cases. The objective of this study was to describe choroidal findings in patients with acute and chronic CSC based on enhanced depth imaging optical coherence tomography analysis. Methods This is a cross-sectional, noninterventional study performed at Luigi Sacco University Hospital of Milan. Inclusion criteria were the presence of diagnosed (acute or chronic) CSC and being 18 years or older. Patients were evaluated with Spectralis spectral-domain optical coherence tomography enhanced depth imaging by 2 operators. The main features analyzed were intrachoroidal hyperreflective spots and hyperreflective choroidal vessel walls, as actual measurements of wall thickness could not be performed. Results Patients with chronic CSC had hyperreflective spots in 83.3% of the cases and hyperreflective choroidal vessel walls in 75%, whereas patients with acute course had the same alterations in 33% and 6.7% of cases, respectively. Conclusions These findings, if proven, may be indicative of chronic forms, thus guiding more accurate treatments and guiding clinicians through more accurate prognosis.

Systemic effects of repeated intraocular dexamethasone Intravitreal implant in diabetic patients: a retrospective study

IntroductionThe objective of this study isxa0to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients.MethodsRetrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15xa0months of follow-up after Ozurdex treatment onset.ResultsFifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6xa0mg/dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2xa0mg/dl, pxa0=xa00.04) but after 15xa0months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4xa0mg/dl, pxa0=xa00.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15.ConclusionOzurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction.

Macular Choroidal Thickening in Keratoconus Patients: Swept-Source Optical Coherence Tomography Study.

Purpose To determine the choroidal thickness (CT) profile in keratoconus (KC) patients using swept-source optical coherence tomography (SS-OCT). Methods This was a prospective, cross-sectional study. One hundred two eyes of 52 KC patients were studied using Pentacam and SS-OCT. The macular CT profile was created by manually measuring the distance between the retinal pigment epithelium and the choroid-sclera junction on horizontal b-scans at nine different macular locations. The results were compared to 93 eyes of 93 healthy controls. Results Mean age of the KC group was 34.9 ± 13.5 years and mean axial length (AL) was 24.1 ± 1.3 mm. Mean topographic KC classification (TKC) was 2.0; 39 eyes were classified as early KC (TKC <1–2), 34 eyes as moderate (TKC 2, 2–3), and 29 as advanced (TKC 3+). Mean subfoveal CT was 383.2 μm in KC patients and 280.5 μm in control group (P < 0.001). CT in KC patients was statistically thicker in all measure locations (P < 0.001). CT in KC eyes decreased with age, approaching control group at >45 years old, losing statistical significance (P = 0.37). Conclusions CT in KC patients is statistically thicker than in healthy population. After age 45, CT decreases approaching control group values. Translational Relevance This study describes changes in the CT profile of KC patients, a disease that was considered purely corneal. These choroidal changes argue that KC is a disease that likely involves several ocular structures other than the cornea, and could open new research lines related to the pathophysiology of KC.

Intraocular Tumors Using Swept Source OCT

Swept source optical coherence tomography (SS-OCT) permits a complementary study of retinal and choroidal lesions and diseases, including intraocular tumors. Due to the longer wavelength (1050 nm) employed, SS-OCT allows the visualization of the internal configuration of the tumors, and even the extent of the lesion in small and medium tumors, up to a thickness of around 500 μm in pigmented lesions and up to 1600 μm in non-pigmented lesions [1, 2]. The high-quality images and resolution obtained with SS-OCT allow a better study of the tumors, helping at the time of diagnosis and showing complementary information such as intraretinal edema, subretinal fluid, photoreceptor atrophy, and retinal pigment epithelium (RPE) atrophy or detachments, which will guide physicians to the best treatment.

En Face Swept Source OCT Study of Neovascular Age-Related Macular Degeneration

Swept source optical coherence tomography (SS-OCT) en face mode provides a coronal view of the posterior segment at different depths. This mode provided a way to explore the fundus similar to that of a routine slit-lamp examination, or traditional fundus photographs or angiography. It supplies more information than conventional cross-sectional imaging, allowing the physician to make a rapid diagnosis across the macula with a full macular view at different depths, which gives a three-dimensional perspective. When B-scan and en face mode are used together, they may provide additional anatomic insight into diseases in a non-invasive manner.

Neovascular Age-Related Macular Degeneration Studied with Swept Source OCT

Age-related macular degeneration (AMD) is a chronic degenerative disease that affects the central retina and is one of the most important causes of blindness in the world and the most frequent cause of irreversible legal blindness among people aged 50 or older in the developed countries [1]. 1.5% of Spain’s population (about 680,000 people) are affected by this disease, whereas in the United States the prevalence is around 6.5% in people aged 40 and older, affecting more than eight million people [2]. These figures are surely going to increase due to the exponential growth and aging of world population, with an estimated 288 million people suffering from the disease in 25 years’ time [3, 4].

Chapter 11 – High Myopia

The choroid plays an important role in the physiology and pathology of high myopic eyes. The choroid has been demonstrated to be thinner in high myopia comparing to control patients and also has a different profile, having thicker choroid in the temporal side of the macula. There is a positive correlation between visual acuity and choroidal thickness in high myopia. The choroid is of paramount importance in the pathology of the posterior pole in high myopia. Variation of its thickness has been demonstrated in several diseases as lacquer cracks, dome shape macula, different peripapillary anomalies, and posterior staphyloma.

Choroidal Imaging Techniques: Past, Current, and Future

Abstract The choroid is the middle layer of the eye, a very vascular and pigmented tissue whose role in several ophthalmological pathologies has been clearly established already. However, it was not until the last few years that we have been able to reliably measure and quantify its shape and thickness in a precise manner. Ultrasound technology and indocyanine green angiography were the first techniques used for the study of the choroid, and they still maintain its use and clinical indications for the diagnosis and management of several pathologies. But it was the advent of optical coherence tomography (OCT) that meant the greatest breakthrough in choroidal imaging. In this chapter, we will discuss past, current, and future image modalities for the study of the choroid, with a special focus on OCT and its latest developments.

Panuveítis crónica bilateral como primera manifestación de la enfermedad de Whipple

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