Miriam Idoipe

Intra and interoperator reproducibility of retinal nerve fibre and macular thickness measurements using Cirrus Fourier‐domain OCT

Acta Ophthalmol. 2011: 89: e23–e29

Changes in Frequency-Doubling Perimetry in Patients with Type I Diabetes prior to Retinopathy

Purpose. To evaluate the ability of frequency-doubling technology (FDT) perimetry in detecting visual field defects in young adults with type I diabetes prior to retinopathy or with minor retinovascular changes. Methods. This comparative cross-sectional study included 30 healthy subjects and 73 age-matched patients with type I diabetes mellitus. All subjects underwent a full ocular examination including an FDT with the threshold C-20-5 strategy. Only one eye per subject was randomly included in the statistical analysis. FDT results and time to perform the test were compared between the groups. Results. The mean age was 27.1 years in the control group and 26.6 years in the diabetic group (P = 0.875). The mean period from the onset of diabetes was 12.6 ± 6.7 years, while minimal retinovascular changes were observed in 18 eyes. Mean deviation of FDT did not differ between the groups. Although global indices of FDT were within normal limits, pattern standard deviation of FDT was higher in the diabetic group (P = 0.035). The area under the receiver operating characteristic curve was 0.647 for pattern standard deviation of FDT (standard error = 0.052; P = 0.017). Conclusion. FDT can detect retinal dysfunctions in diabetic patients prior to the onset of significant vascular complications.

Comparison of retinal nerve fiber layer thickness measurements in healthy subjects using fourier and time domain optical coherence tomography.

Purpose. To compare the retinal nerve fiber layer (RNFL) measurements using two different ocular coherence tomography (OCT) devices: Cirrus Fourier domain OCT and Stratus time domain OCT. To analyze reproducibility of Fourier domain measurements in healthy subjects. Methods. One hundred and thirty-two eyes of 132 healthy subjects were scaned on the same day with both instruments, separated by 10 minutes from each other. Thickness of quadrant, average and the 12 different areas around the optic nerve were compared between Cirrus and Stratus. Repeatability, intraclass correlation coefficients (ICCs), and coefficients of variation (COVs) were calculated in RNFL measurements provided by Fourier domain device. Results. The average thickness in the optic cube was 95.50 μm using Cirrus and 97.85 μm using Stratus. Average thickness and temporal quadrant showed significant differences using Cirrus and Stratus methods. Reproducibility was better with Fourier domain OCT (mean COV of 4.54%) than with Stratus time-domain OCT (mean COV of 5.57%). Conclusions. Both scan options give reproducible RNFL thickness measurement, but there are differences between them. Measurements obtained using Fourier domain device show better reproducibility.

Evaluation of Early Graft Detachment After Descemet Membrane Endothelial Keratoplasty Using New Swept-Source Optical Coherence Tomography.

Purpose: To evaluate the ability of Swept-source optical coherence tomography (SS-OCT) in detecting early endothelial graft detachment after Descemet membrane endothelial keratoplasty (DMEK) and to determine the possible causes of graft detachment using 2 different protocols for anterior segment (AS) imaging. Methods: Eight eyes from 8 consecutive DMEK surgeries were evaluated. High-resolution images were captured with SS-OCT using 2 different radial protocols for AS imaging (16- and 6-mm radial protocols). Central and peripheral corneal changes were evaluated. Results: All eyes developed early graft detachment detectable with the SS-OCT. The 16-mm radial protocol scanned the cornea detecting early graft detachment in 6 out of 8 cases. The 6-mm radial protocol provided detailed images of the cornea, detecting early detachment in all cases. Stromal irregularities and small remnants only detectable using SS-OCT were the possible cause of detachment in 3 cases. One of the 8 eyes had air reinjection. The detachment in that eye was apparent by slit-lamp examination. The detachments spontaneously resolved in the other 7 eyes. AS SS-OCT evaluation was found to have added diagnostic value to biomicroscopy in 5 of these eyes (64.5%). Conclusions: AS SS-OCT is sensitive in detecting early graft detachment after DMEK. The 16-mm radial protocol of Triton SS-OCT is superior regarding quick scan of the entire cornea providing a general visualization of the DMEK graft. The 6-mm radial protocol provides detailed corneal imaging of a selected area, which is useful for evaluating structural alterations that are not detectable with larger scans and may affect the adherence of the endothelial graft.

[Ability of Heidelberg Retina Tomograph III to predict progression in patients with early glaucoma or suspected primary open-angle glaucoma].

PURPOSE To study the ability of Heidelberg Retina Tomography III (HRT 3) measurements to predict perimetry changes in patients with early glaucoma or suspected primary open-angle glaucoma. MATERIAL AND METHODS One hundred and thirty two eyes with early glaucoma or suspected glaucoma with no changes in basal perimetry were prospectively selected and periodically evaluated over five years. The eyes were divided in two groups depending on the presence or absence of progression (changes in glaucoma perimetry). The association between morphometric parameters and baseline HRT 3 indices, glaucoma probability score (GPS) and Moorefields Regression Analysis (MRA), and perimetry progression were studied using Cox multivariate regression analyses. Kaplan-Meier curves were used to illustrate the results. RESULTS Forty-eight eyes (36.36%) showed perimetry progression. Perimetry progression showed higher correlations with the disc area (p = 0.001), the cup area (p = 0.002) and the vertical cup disc area (p = 0.001). Multivariate regression analyses showed that eyes with baseline MRA or baseline GPA changes were at a higher risk of having perimetry abnormalities and a faster progression. CONCLUSIONS MRA and GPA indices are useful to predict perimetry progression in patients with early primary open-angle glaucoma or suspected glaucoma. These indices can be used as risk markers of functional progression in glaucoma.

New pathogenic variant in the FGF10 gene in the agenesis of lacrimal and salivary gland syndrome: Ophthalmological and genetic study

ABSTRACT Aplasia/agenesis of lacrimal and salivary glands is a rare congenital defect that has been associated with disturbances in fibroblast growth factor 10 (FGF10). It can present with symptoms of congenital lacrimal obstruction, dry eye, and dry mouth. We report the ophthalmological and genetic study of a 19-year-old woman and her relatives suffering from this syndrome. A new probably pathogenic variant is described in the FGF10 gene.

Early Changes in Visual Quality and Corneal Structure after DMEK: Does DMEK Approach Optical Quality of a Healthy Cornea?

Purpose To evaluate early changes in visual function and visual quality parameters after Descemet membrane endothelial keratoplasty (DMEK) and to compare the outcomes with healthy controls. Methods Thirteen patients who underwent DMEK and 14 controls were evaluated. All subjects underwent visual function evaluation, including visual acuity under photopic and mesopic lighting conditions and contrast sensitivity (CSV) tests CSV 1000 and Pelli-Robson. Corneal parameters were assessed with Oculus Pentacam. Corneal mean keratometry (Km), corneal densitometry values, and low and high order aberrations (LOA and HOA) were recorded. In DMEK patients, all tests were performed before surgery and 1 and 6 months after surgery. Results In patients who underwent DMEK, photopic visual acuity improved from 0.59 to 0.31 at 1 month (p=0.013) and 0.13 at 6 months (p=0.008); mesopic visual acuity and all contrast sensitivity values (both CSV and Pelli-Robson test) improved significantly in the first month (p < 0.005). A significant decrease was observed in corneal density in the 0–2 mm ring (from 43.83 to 35.60, p=0.043) and mean posterior Km (from −5.84 to −6.80, p=0.005) in the first month. Corneal HOAs and all corneal densities improved at 6 months after DMEK (p < 0.05). All visual function parameters and corneal aberrations remained lower and higher, respectively, compared with healthy controls (p < 0.05). Corneal densities were comparable with controls at 6 months after DMEK (p > 0.05). Conclusions Patients undergoing DMEK present visual function improvement and a decrease in corneal density at 1 month after surgery. Decrease in corneal posterior HOAs can be observed at 6 months. However, visual function outcomes and corneal aberrations remained worse compared with healthy controls.

New Regenerating Agents (RGTA): New Indications in Persistent Corneal Thinning Caused By Fungal Keratitis

Purpose: To assess the effectiveness of new RGTA like Cacicol20 in two cases of persistent corneal ulceration refractory to maximum medical treatment in the context of fungal keratitis. Methods: Case 1 was a 75-year-old woman with malocclusion after ptosis surgery who presented Candida albicans keratitis (yeast). Case 2 was a contact lens wearer 39-year-old man who presented Fusarium keratitis (filamentous fungus). They both improved with antifungals. However, the corneal thinning caused by the infection persisted despite artificial tears, autologous serum and a bandage contact lense (BCL). OCT showed 226 microns corneal thickness in Case 1 and descemetocele in Case 2. Cacicol 20 one drop every two days for one month was prescribed to both of them at that moment, when the infiltrates still persisted. Results: After that regimen, Case 1 corneal thickness rose to 391 microns, and Case 2 rose to 224 microns. Complete epithelial healing was achieved in both cases. The infiltrates continued to decrease and they were eventually replaced by sterile leukomas. None of the patients presented new signs of infection afterwards. No precipitates appeared on the BCLs. None of the patients reported any adverse effects. Conclusion: New RGTA like Cacicol20 could be an effective option for persistent corneal ulceration refractory to maximum conventional medical treatment, which would save surgical procedures. Moreover, they could be prescribed during fungal infection, despite the contraindication in case of active ocular infection that appears in the leaflet of Cacicol20.

Choroidal and optic disk metastases of a laryngeal carcinoma.

PURPOSE To report a case of laryngeal squamous carcinoma metastatic to the eye affecting the choroid and optic nerve. METHODS A 58-year-old man complained of sudden decrease of visual acuity in his left eye on admission to the emergency room. One year previously, he had undergone a surgical removal of laryngeal carcinoma. Funduscopic examination detected a choroidal mass in the macular area. RESULTS After 10 days, the patient complained of pain and a diminished visual acuity and presented an exudative retinal detachment and optic nerve infiltration. CONCLUSION Metastatic tumors are the most common intraocular malignancies, and the choroid is by far the most frequent location for the intraocular metastases. Metastases from a laryngeal carcinoma are quite unusual. Lesions affecting both choroid and optic nerve are extremely rare.

Orbital involvement in multiple myeloma

Purpose To present the case report of a patient with multiple myeloma who develops orbital infiltration in the left side due to the myeloma.