Pedro Gil

Choroidal thickness in diabetic retinopathy assessed with swept-source optical coherence tomography

Purpose: To compare the choroidal thickness (CT) of diabetic eyes (different stages of disease) with controls, using swept-source optical coherence tomography. Methods: A multicenter, prospective, cross-sectional study of diabetic and nondiabetic subjects using swept-source optical coherence tomography imaging. Choroidal thickness maps, according to the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields, were obtained using automated software. Mean CT was calculated as the mean value within the ETDRS grid, and central CT as the mean in the central 1 mm. Diabetic eyes were divided into four groups: no diabetic retinopathy (No DR), nonproliferative DR (NPDR), NPDR with diabetic macular edema (NPDR + DME), and proliferative DR (PDR). Multilevel mixed linear models were performed for analyses. Results: The authors included 50 control and 160 diabetic eyes (n = 27 No DR, n = 51 NPDR, n = 61 NPDR + DME, and n = 21 PDR). Mean CT (ß = −42.9, P = 0.022) and central CT (ß = −50.2, P = 0.013) were statistically significantly thinner in PDR eyes compared with controls, even after adjusting for confounding factors. Controlling for age, DR eyes presented a significantly decreased central CT than diabetic eyes without retinopathy (&bgr; = −36.2, P = 0.009). Conclusion: Swept-source optical coherence tomography demonstrates a significant reduction of CT in PDR compared with controls. In the foveal region, the choroid appears to be thinner in DR eyes than in diabetic eyes without retinopathy.

Purtscher retinopathy: to treat or not to treat?

Purpose To report a case of Purtscher retinopathy and its therapeutic approach. Methods In this observational case report, complete ophthalmologic examination was performed, including best-corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, dilated fundus examination, spectral-domain optical coherence tomography (OCT), fluorescein angiography (FA), and Humphrey 24–2 visual field testing. Results The patient complained of right eye diminished visual acuity 48 hours after a car accident, with severe thoracic and abdominal blunt trauma but no direct ocular trauma. The BCVA was counting fingers at 1 meter, anterior segment examination was unremarkable, and the fundus showed cotton-wool spots and Purtscher flecken. Macular OCT revealed subretinal fluid with neurosensorial retinal detachment. The FA showed peripapillary and parafoveal leakage and visual field testing presented a central scotoma. We opted for an observation-only approach. Follow-up revealed a progressive reabsorption of the subretinal fluid with complete resolution of the macular neurosensorial retinal detachment after 2 weeks. After 2 months of follow-up, BCVA was 20/25 and the OCT revealed atrophic changes, with no subretinal fluid. The favorable outcome in terms of BCVA persisted at 4 and 6 months follow-up, although the central scotoma did not improve significantly. Conclusions The characterization of both acute and late-stage lesions provides a valuable insight to a better characterization of this rare disease. Despite a favorable response with a conservative therapeutic approach, structural and functional late stage sequelae influence the final visual outcome.

Medical and Surgical Treatment in Pediatric Orbital Myositis Associated with Coxsackie Virus

Purpose. To report a case of orbital myositis associated with Coxsackie virus and its medical and surgical approach. Methods. Complete ophthalmological examination and imaging and analytical investigation were performed. Results. A 6-year-old male presented with subacute painless binocular horizontal diplopia. Examination revealed bilateral best-corrected visual acuity (BCVA) of 20/20 and right eye 45-prism-dioptre (PD) esotropia in near and distance fixations, with no motility restrictions. Serologic screening was positive for Coxsackie virus acute infection and computerized tomography (CT) suggested right eye medial rectus orbital myositis. An oral corticosteroid 1.0 mg/kg/day regimen was started. A new CT after two months showed symmetrical lesions in both medial rectus muscles. Corticosteroids were increased to 1.5 mg/kg/day. After imagiological resolution on the 4th month, alternating 45 PD esotropia persisted. Bilateral 7 mm medial rectus recession was performed after 1 year without spontaneous recovery. At 1-year follow-up, the patient is orthophoric with 200′′ stereopsis and bilateral 20/20 BCVA. Conclusions. To our knowledge, this is the first reported case of orbital myositis associated with Coxsackie virus. This is also the first reported case of isolated strabismus surgery after orbital myositis in pediatric age, highlighting the favourable aesthetic and functional outcomes even in cases of late ocular motility disorders.

Influence of the Vitreoretinal Interface on the Treatment with Anti-VEGF for Exudative Age-Related Macular Degeneration

Purpose: To investigate the influence of the vitreoretinal interface on the outcomes of different ranibizumab regimens for exudative age-related macular degeneration. Methods: We conducted a retrospective subanalysis of 2 prospective clinical trials. Patients were treated with ranibizumab for 12 months according to 3 different regimens: pro-re-nata (PRN), treat and extend (T&E), and monthly. Vitreoretinal interface was assessed for absence (group ON) or presence (group OFF) of posterior vitreous detachment (PVD). Results: We included 64 eyes from 64 patients. Visual improvement was poorer for group ON (0.3 ± 10.7 letters) than for group OFF (9.2 ± 13.3; p = 0.007). A significant difference in letters of improvement between groups was observed in the PRN cohort (ON: –5.0 ± 12.9; OFF: 11.4 ± 11.9; p = 0.003), but not in the cohorts with monthly (ON: 5.7 ± 7.8; OFF: 7.9 ± 15.2; p = 0.735) or T&E (ON: 4.3 ± 4.3; OFF: 7.8 ± 11.1; p = 0.424) treatment. Conclusion: The negative impact of absence of PVD is regimen dependent, with monthly dosing providing similar outcomes to PVD patients. In the absence of PVD (group ON), PRN should be avoided, and T&E might be an alternative.

Optical coherence tomography angiography characterization of acute and late stage Purtscher retinopathy

Purpose: To report a case of Purtscher retinopathy imaged with optical coherence tomography angiography. Methods: Case-report. Left eye fundoscopic examination in a 21-year old male after a road traffic accident with chest compression revealed multiple peri-papillary cotton-wool spots and intra- and pre-retinal hemorrhages. A diagnosis of Purtscher retinopathy was assumed. Results: In both the superficial and deep retinal plexuses, acute stage optical coherence tomography angiography identified multiple irregular areas of capillary non-perfusion that extended beyond the clinically visible peri-papillary cotton-wool spots. At 5-month follow-up, despite the clearing of visible cotton-wool spots, there were still permanent areas of irregular capillary non-perfusion and inner retina atrophy. These sequelae, along with a decrease in the peri-papillary retinal nerve fiber layer thickness, were consistent with a suboptimal visual outcome and a dense inferior arcuate scotoma. Conclusion: Baseline and follow-up optical coherence tomography angiography was able to detect, quantify, and map focal microvascular abnormalities at the level of the superficial and deep inner retinal vascular plexuses. These lesions were consistent with late stage structural and functional sequelae, conferring them prognostic value.

Advanced Vestibular Schwannoma: A Case of Optic Disc Oedema without Hydrocephalus

ABSTRACT A wide range of pathologies can cause papilloedema. Vestibular schwannoma is a benign and slow-growing tumour that causes symptoms and findings on ophthalmic examination when the diagnostic is delayed. The authors report a case of a 64-year-old male who presented with bilateral disc oedema secondary to a vestibular schwannoma grade 4. Obstructive hydrocephalus was not evident. The authors suggest that cerebrospinal fluid protein may have a role in the formation of optic disc oedema. A right suboccipital craniectomy was performed to remove the tumour, leading to secondary facial palsy.

Corneal Elevation Topography in Primary Open Angle Glaucoma.

Purpose of the Study: The purpose of the study was to describe and compare anterior and posterior topographic elevation maps in primary open angle glaucoma patients with functional damage staging and in healthy controls. Methods: A total of 217 subjects were consecutively recruited, including 111 primary open angle glaucoma patients (patients), and 106 healthy individuals (controls). All patients performed Pentacam HR corneal topography. Mean anterior keratometry and anterior and posterior topographic elevation maps were compared in the central 3, 5, and 7 mm. Humphrey automated perimetry results from the patient group were classified according to the Glaucoma Staging System. Results: Age (patients: 72.32±8.09; controls: 70.82±8.36; P=0.18) and central corneal pachymetry (patients: 541.13±36.98; controls: 548.67±34.56; P=0.12) were similar in both groups. Maximum elevation readings in the central 5 mm were significantly (P<0.05) higher in the anterior (patients: 8.21±8.63; controls: 5.79±3.62) and posterior (patients: 16.17±8.72; controls: 13.92±6.03) corneal topography of the glaucomatous patients, as well as in the anterior (patients: 17.32±20.78; controls: 9.61±5.64) and posterior (patients: 38.81±19.78; controls: 26.38±12.73) central 7 mm. There was a weak but significant correlation between the Glaucoma Staging System stage and both the anterior 5 mm (r=0.397) and 7 mm (r=0.304) maximum, as well as the posterior 5 mm (r=0.233) and 7 mm (r=0.241) maximum. Conclusions: In patients with primary open angle glaucoma, there is a forward shifting of the posterior and anterior corneal surfaces. This appears to be correlated with more advanced stages of functional damage, pointing to a possible link between corneal structural changes and duration and intensity of elevated intraocular pressure. Further studies may ascertain the potential for this biological marker to be used in monitoring primary open angle glaucoma patients.