Meira Neudorfer

Retinal thickness in patients with mild cognitive impairment and Alzheimer's disease

OBJECTIVES Mild cognitive impairment (MCI) may represent a transition to early Alzheimers disease (AD). The retinal nerve fiber layer (RNFL) is composed of axons originating in retinal ganglion cells that eventually form the optic nerves. Previous studies have shown that degenerative changes occur in optic nerve fibers and manifested as thinning of RNFL in patients with AD. The objective of this study was to assess the relationship between MCI, AD and loss of RNFL. PATIENTS AND METHODS In this study, patients fulfilling diagnostic criteria for MCI (n=24), AD (n=30) and cognitively normal age-matched controls (n=24) have undergone neuro-ophthalmologic and optical coherence tomography (OCT) examinations to measure RNFL thickness. RESULTS There was a significant decrease in RNFL thickness in both study groups (AD and MCI) compared to the control group, particularly in the inferior quadrants of the optic nerve head, while the superior quadrants were significantly thinner only in AD. Although AD patients may have more severe changes than MCI cases, the differences were statistically nonsignificant. Furthermore among AD patients, there was no relation to the severity of the dementia. CONCLUSIONS Our data confirm the retinal involvement in AD, as reflected by loss of axons in the optic nerves.

Nonpenetrating deep sclerectomy with the use of adjunctive mitomycin C.

BACKGROUND AND OBJECTIVE To determine whether adjunctive use of mitomycin C (MMC) would increase the success rate of primary nonpenetrating deep sclerectomy with collagen implant. PATIENTS AND METHODS Twenty-six patients (26 eyes) with primary open-angle glaucoma uncontrolled with maximally tolerated medical therapy were randomly assigned to undergo nonpenetrating deep sclerectomy and collagen implant, either with (13 eyes) or without (13 eyes) 0.3 mg/mL of adjunctive MMC for 3 minutes. Intraocular pressure (IOP), number of glaucoma medications, and visual acuity were assessed before and 12 and 24 months after surgery. RESULTS The mean age of the study patients was similar in both groups (MMC = 68.1 +/- 8 years, control = 65.8 +/- 6.8 years). At the 12- and 24-month follow-up visits, the mean IOP with or without medications was lower in the MMC group than in the control group (15.6 +/- 3.5 vs 17.2 +/- 3.9 mm Hg at 12 months and 15.8 +/- 5.6 vs 17.8 +/- 2.8 mm Hg at 24 months, respectively). The IOP with or without medications significantly decreased after surgery in both groups (P < .05). Twelve months after surgery, the IOP decreased by 48% in the MMC group and by 35% in the control group. At the end of follow-up (24 months), the IOP decreased by 48% in the MMC group and by 32% in the control group (P = .01). The mean number of glaucoma medications decreased after surgery, there was no significant difference in complications (hyphema and suprachoroidal hemorrhage), and visual acuity was unchanged throughout the study in both groups. CONCLUSION The use of MMC in nonpenetrating deep sclerectomy with collagen implant is safe and improves surgical results.

Differential Optical Density of Subretinal Spaces

PURPOSE We investigated the optical density characteristics of 3subretinal spaces in neovascular age-related macular degeneration (AMD), diabetic retinopathy (DR), rhegmatogenous retinal detachment (RRD), central serous retinopathy (CSR), retinoschisis (RS), and pseudophakic cystoids macular edema (PCME). METHODS Patients in whom subretinal fluid (SRF) was detected by optical coherence tomography (OCT), and whose earliest OCT scans showed sufficient SRF for sampling that did not include tissue edges, were chosen for study. The highest quality B-scan containing SRF (as graded by the OCT image acquisition software) was analyzed. Optical density measurements were obtained using ImageJ, an open code Java-based image processing software. RESULTS The diagnoses of the 71 patients who met the inclusion criteria were AMD in 17, DR in 7, RRD in 18, CSR in 17, RS in 8, and PCME in 4. Optical density ratios (ODRs) were calculated as SRF OD divided by vitreous OD. ODRs were significantly higher in patients with AMD, DR, CSR, and PCME than in those with RRD and RS. No significant difference in vitreous reflectivity was detected between the former and latter patients. CONCLUSIONS The finding that disease states produce significant changes in optical density ratios calls for further investigation of the possible usefulness of the parameter in differentiating between disease states, determining the outcome of various retinal diseases, and designing therapies aimed at treating the disease by correcting the abnormal density.

Retinal Lesions in Septicemia

We explored the association between septicemia and specific retinal lesions in a prospective controlled study. Hemorrhages, cotton-wool spots, or Roths spots were found in 24 of 101 septicemic patients (24%), compared to four of 99 age- and gender-matched control patients (4%) (P = .0002). There was no significant association between types of organisms or focus of infection and the presence of specific lesions. Histologic examination of affected eyes disclosed cytoid bodies in the nerve fiber layer without inflammation. A definite association between septicemia and retinal lesions was found and indicates the need for routine ophthalmoscopy in septicemic patients.

The efficacy of optic nerve ultrasonography for differentiating papilloedema from pseudopapilloedema in eyes with swollen optic discs

Purpose:  To evaluate the diagnostic yield of optic nerve ultrasonography (US) in distinguishing between papilloedema (swollen discs owing to raised intracranial pressure) and pseudopapilloedema.

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

PurposeTo describe the macular findings on optical coherence tomography (OCT) in patients with cat-scratch disease (CSD) neuroretinitis.MethodsMedical records of all patients diagnosed with CSD neuroretinitis at the Tel Aviv Medical Center between April 2006 and May 2010 were retrospectively reviewed. All patients underwent Stratus OCT macular examination.ResultsEight eyes of seven patients with confirmed CSD neuroretinitis, (mean age 33±9.9 years, range 6–48 years) were included in the study. All patients presented clinically with optic nerve swelling and macular edema or macular exudates. OCT demonstrated flattening of the foveal contour, thickening of the neurosensory retina, and accumulation of subretinal fluid (SRF) in all studied eyes. Retinal exudates appeared as multiple hyper-reflective foci in the outer plexiform layer. The average central macular thickness was 460 μm (range 170–906 μm) and the average maximal retinal thickness was 613 μm (range 387–1103 μm), at presentation. The macula appeared normal on repeated exams during follow-up.ConclusionSimilar OCT findings were demonstrated in patients with CSD neuroretinitis. SRF was found in all eyes, although was not visible on clinical examination or fluorescein angiography. OCT may be used as an adjunct imaging tool in the diagnosis and follow-up of patients with CSD neuroretinitis.

Inter-device Variability of the Stratus Optical Coherence Tomography

PURPOSE To assess inter-device measurement variability with the Stratus optical coherence tomography (OCT). DESIGN Evaluation of diagnostic test technology. METHODS Eight eyes of eight healthy subjects were examined with four different Stratus machines in four medical centers during a period of five hours using fast retinal nerve fiber layer (RNFL) and fast macula protocols. Inter-device measurement variability and signal strength was assessed with standard deviation, coefficient of variance, and intraclass correlation coefficient (ICC). Spearman correlation coefficient was calculated between signal strength and thickness measurements. RESULTS Statistically significant differences were not found for all macular parameters and all but one RNFL parameter. Mean signal strengths obtained with the four Stratus machines were significantly different; the newer the machine, the stronger signal strength it produced. Some RNFL parameters were moderately and statistically significantly correlated with signal strength. CONCLUSIONS We did not observe statistically significant differences in any macular and all but one RNFL parameter between the four Stratus OCT machines. Signal strength was significantly different between the machines, and significantly correlated with some RNFL parameters. Inter-machine variability in RNFL measurements may have clinical significance. Signal strength should be included in the assessment of measurements obtained on different machines and in serial examinations with a single Stratus machine during patient follow-up.

Colour Doppler ultrasound imaging findings in paediatric periocular and orbital haemangiomas

Purpose:  To evaluate the combined grey‐scale ultrasonography (US) and colour Doppler imaging (CDI) as the first and primary imaging modalities in diagnosing paediatric orbital haemangiomas.

Recurrent choroidal detachment following timolol therapy in previously filtered eye. Choroidal detachment post filtering surgery.

Abstract A 64‐year‐old patient with open‐angle glaucoma was treated with timolol following two unsuccessful filtering procedures. While on timolol therapy, she deveolped three episodes of choroidal detachment, hypotony and shallow anterior chamber. These findings resolved upon cessation of timolol and reappeared on 3 occasions shortly after reinstitution of the beta blocker therapy.

High-frequency ultrasound biomicroscopy of the anterior segment morphometry before and immediately after pars plana vitrectomy

Purpose TO characterize short-term changes induced by pars plana vitrectomy on anterior segment depth and lens thickness by means of high-frequency ultrasound biomicroscopy. Methods We undertook a prospective case series study on consecutive patients referred for pars plana vitrectomy as the sole procedure in our institution between 2005 and 2007. Twenty-eight eyes of 28 patients undergoing pars plana vitrectomy were studied by ultrasound biomicroscopy. Neither silicone oil nor scleral buckle was used for any of the procedures. Anterior chamber depth and lens thickness were compared before and immediately after surgery, and their results were compared to the postoperative intraocular pressure measurements. Results There was a significant decrease in anterior chamber depth in the study eyes of patients who had undergone gas tamponade (p<0.0001) but not in those who had not undergone gas tamponade. No differences were found between the preoperative and the postoperative lens thickness measurements in any of the patients, nor was there any correlation between anterior chamber depth and increased intraocular pressure. Conclusions Uncomplicated pars plana vitrectomy with gas tamponade can induce short-term changes in anterior chamber depth as measured by morphometry. Surgeons may need to reconsider using gas tamponade at the end of surgery in surgical candidates with shallow anterior chambers.