Konstantinos Andreanos

Detection of nonexudative choroidal neovascularization secondary to angioid streaks using optical coherence tomography angiography

Purpose To present a case of nonexudative choroidal neovascularization secondary to angioid streaks in a patient with pseudoxanthoma elasticum. The lesion was monitored over an 8-month period with the use of optical coherence tomography angiography. Methods Case report. Results The neovascular tissue area increased by 0.160 mm2 over a period of 8 months without any sign of exudation seen on optical coherence tomography or fluorescein angiography. Conclusions To our knowledge, this is the first report of a nonexudative choroidal neovascularization secondary to angioid streaks. Given that once a patient with angioid streaks develops choroidal neovascularization in one eye there is a high risk of bilateral involvement within a short amount of time, optical coherence tomography angiography can prove a useful tool for monitoring such lesions over time.

Keratoconus Treatment Algorithm

Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.

Visual field examination method using virtual reality glasses compared with the Humphrey perimeter

Purpose To present a visual field examination method using virtual reality glasses and evaluate the reliability of the method by comparing the results with those of the Humphrey perimeter. Materials and methods Virtual reality glasses, a smartphone with a 6 inch display, and software that implements a fast-threshold 3 dB step staircase algorithm for the central 24° of visual field (52 points) were used to test 20 eyes of 10 patients, who were tested in a random and consecutive order as they appeared in our glaucoma department. The results were compared with those obtained from the same patients using the Humphrey perimeter. Results High correlation coefficient (r=0.808, P<0.0001) was found between the virtual reality visual field test and the Humphrey perimeter visual field. Conclusion Visual field examination results using virtual reality glasses have a high correlation with the Humphrey perimeter allowing the method to be suitable for probable clinical use.

Acute ocular pain during magnetic resonance imaging due to retained intraocular metallic foreign body: the role of ultrasonography and ultrasound biomicroscopy in diagnosis and management of this condition

PurposeTo report the case of a 65-year-old metalworker with no known history of ocular trauma, who suffered from intense ocular pain during magnetic resonance imaging (MRI) of the brain, due to a retained intraocular metallic foreign body (IOFB).Case reportMeticulous ophthalmological examination was inconclusive. An IOFB was confirmed with X-ray scan, whereas its exact localization was enabled by means of ultrasonography and ultrasound biomicroscopy (UBM).ConclusionsDespite appropriate screening protocols, MRI-related ocular complications might occur in the presence of a hidden metallic IOFB. Clinical detection of ocular foreign bodies can sometimes be challenging. Ultrasonography and UBM are valuable adjuncts for the accurate localization, especially of small or hidden particles.SOMMARIOScopo dello studioPresentare il caso clinico di un operaio metallurgico, di 65 anni, con anamnesi negativa per traumi oculari, che durante un esame di Risonanza Magnetica (MRI) del capo ha avvertito intenso dolore oculare a causa di un corpo estraneo ritenuto.Caso clinicoL’esame oftalmologico di routine è stato inconclusivo. La presenza di un corpo estraneo intraoculare è stata documentata con una radiografia (RX) delle orbite, mentre la sua esatta localizzazione e’ stata resa possibile dall’ ecografia oculare (US) e dalla biomicroscopia ad ultrasuoni (UBM).ConclusioniNonostante protocolli di screening adeguati, complicazioni oculari in corso di MRI possono verificarsi in presenza di un corpo estraneo oculare non noto. L’ esatta localizzazione di un corpo estraneo intraoculare talvolta può essere laboriosa e inconclusiva. US e UBM oculare sono metodiche di ausilio per la localizzazione accurata di corpi estranei, soprattutto di piccole dimensioni.

High refractive error due to two intraocular lenses managed with tropicamide: Two intraocular lenses

Posterior chamber (PC) intraocular lens (IOL) dislocation is a rare complication, with an incidence ranging from 0.2 per cent to 2.8 per cent. This condition may require surgical removal of the dislocated IOL as it could potentially cause cystoid macular oedema, refractive errors, floaters or diplopia. In rare occasions, a second IOL is placed without removing the dislocated PC-IOL. There have been reports in the literature of eyes with two IOLs, where surgical intervention was required due to significant visual loss. However, removal of the IOL is often challenging, requiring a large scleral or cornea incision depending on the surgical approach. This report describes a case of a dislocated PC-IOL in the presence of a non-dislocated anterior chamber (AC) IOL that was conservatively managed. The patient involved provided written informed consent in accordance with the tenets of the Declaration of Helsinki to having their medical data used for research purposes.

Optical Coherence Tomography Angiography of Foveal Neovascularization in Diabetic Retinopathy.

Purpose: To report a case of foveal neovascularization in a patient with proliferative diabetic retinopathy as seen on optical coherence tomography angiography (OCT-A). Methods: Multimodal imaging was used for diagnostic investigation. Patient: A 61-year-old male with a 16-year history of insulin-dependent diabetes mellitus was referred to our medical retina department for examination and management. Meticulous fundus examination and multimodal imaging revealed proliferative diabetic retinopathy lesions, including neovascularization located in the foveal area. Results: OCT-A allowed us to detect the neovascular lesion, confirm that it originated from perifoveal capillaries, estimate its retinal depth, and evaluate the vessel blood flow in multiple layers. Conclusion: To the best of our knowledge this is the first report of OCT-A imaging of foveal neovascularization in diabetic retinopathy. OCT-A is a very useful examination for the diagnostic investigation of patients with diabetic retinopathy.

Isolated descemetorhexis for anterior synechiolysis prior to endothelial keratoplasty – case report and technique

Purpose To describe the utilization of descemetorhexis for reformation of the anterior chamber in eyes with central iridocorneal synechiae before endothelial keratoplasty (EK). Methods A 71-year-old man with a history of trabeculectomy complicated by hypotony presented with bullous keratopathy in the presence of extensive iridocorneal synechiae and a flat anterior chamber. In order to proceed with EK, synechiolysis with the use of viscoelastic and scissors was attempted. Despite successful dissection of the peripheral strands, the pupillary margin of the iris remained attached to the endothelium. Therefore, descemetorhexis was performed to detach the Descemet membrane along with central synechiae and create sufficient space for safe EK at a later stage. Results Corneal clarity was restored by ultrathin Descemet stripping automated endothelial keratoplasty, leaving a fibrous membrane in the pupillary plane, which was excised 2 months later, allowing an improvement of best-corrected visual acuity to 0.5. Conclusion Isolated descemetorhexis was successfully employed to reform the anterior chamber and proceed with EK in a case of bullous keratopathy and resistant iridocorneal synechiae. This stepwise approach may be considered in similar cases in order to avoid a more invasive treatment, ie, penetrating keratoplasty and synechiolysis.

Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography: Case report

Rationale: To investigate malignant hypertension ocular lesions with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCT-A). Patient concerns: Visual loss due to malignant hypertension. Diagnoses: Hypertensive chorioretinopathy. Interventions: Patients were thoroughly examined on presentation and 30 days after their first visit, with swept-source optical coherence tomography and optical coherence tomography angiography. Outcomes: Lesions were totally absorbed during the follow-up time. Additionally, they presented fibrin deposits, as multiple solid hyper-reflective structures overlying retinal pigment epithelium, on both—SS-OCT and OCT-A. The last were still detected even larger in size at the last visit of the patients. Lessons: These novel imaging examinations allow the ophthalmologist to detect in detail the several clinical manifestations of malignant hypertension on the fundus, and draw useful conclusions about their peculiar pathogenesis.

Treatment of anterior corneal scarring, following DSAEK graft failure, with combined graft exchange and phototherapeutic keratectomy

BackgroundTo present a method, alternative to penetrating keratoplasty, for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure.Case presentationA 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of pseudophakic bullous keratopathy, presented with long-standing corneal oedema and anterior corneal scarring. A significant improvement in corrected distance visual acuity was demonstrated, as corneal clarity was restored following graft exchange and phototherapeutic keratectomy (PTK).ConclusionsThe combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft.

Optical Coherence Tomography Angiography: Employing a Novel Technique for Investigation in Vogt-Koyanagi-Harada Disease

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease and describe the imaging findings by means of optical coherence tomography angiography (OCTA). Methods: Medical and ophthalmological history, ophthalmological examination, laboratory evaluation, B-scan ultrasonography, fluorescein and indocyanine angiography, and optical coherence tomography (OCT) were performed at baseline, as well as OCTA. Results: A 50-year-old healthy female presented with decreased vision in both eyes. A Topcon DRI OCT Triton Plus swept source OCT system was used to visualize and evaluate the retinal and choroidal vascular plexus. Patchy and confluent dark areas in the superficial and deep retinal capillary plexus and choriocapillaris corresponded to areas of hypoperfusion, analyzed as areas of ischemia. Conclusions and Importance: VKH disease is characterized by ocular, neurological, and integumentary findings in its complete form. We present a case of incomplete disease in a 50-year-old female evaluated by means of OCTA which is a novel technique that provides depth-resolved images of the retina and choroidal microvasculature without dye injection that allows better visualization and detailed evaluation of the retinal and choroidal vascular plexus.