Zsuzsanna Géhl

Retinal and choroidal thickness measurements using spectral domain optical coherence tomography in anterior and intermediate uveitis

BackgroundMacular edema is a common cause of visual loss at uveitic patients. The aim of our study was to investigate retinal and choroidal thickness at the macula in anterior (AU) and intermediate (IMU) uveitis and in healthy individuals using spectral domain optical coherence tomography (SD-OCT).MethodsCase-control study of 21 patients with AU and 23 patients with IMU and 34 age-matched healthy controls was performed with Spectralis SD-OCT (Heidelberg Engineering, Germany). High resolution SD-OCT scans and macular mapping were applied for automated measurement of retinal thickness. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields on enhanced depth imaging (EDI) scans. Evaluation of central retinal subfield thickness, 3xa0mm and 6xa0mm perifoveal rings was performed in the corresponding ETDRS zones in patient groups.ResultsThe mean central retinal subfield thickness was significantly higher in IMU (368.65u2009±u2009115.88xa0μm, pu2009=u20090.0003), but not significantly different in AU (290.42u2009±u200926.37xa0μm pu2009=u20090.6617) compared to that of in controls (278.55u2009±u200918.31xa0μm). In both uveitis groups retina was significantly thicker in the 3 and 6xa0mm perifoveal rings than that of in controls (359u2009±u200915.24xa0μm in AU and 390.55u2009±u200970.90xa0μm in IMU vs 345,41u2009±u200915.28xa0μm in the control group, pu2009=u20090.0388 and pu2009<u20090.0001) in the 3xa0mm and (313.83u2009±u200916.63xa0μm in AU and 343.33u2009±u200957.29xa0μm in IMU vs 299u2009±u200913.82xa0μm in the control group, pu2009=u20090.0171 and pu2009<u20090.0001) in the 6xa0mm ring. Central choroidal thickness was 311.94u2009±u200960.48xa0μm in the control eyes, showed no significant difference in AU (312.61u2009±u200990.35xa0μm) and IMU (303.17u2009±u200993.66xa0μm) eyes, and was also similar at the perifoveal rings.ConclusionSignificant topographical changes could be detected in the macula of AU and IMU patients. Retinal thickness in the perifoveal rings was increased both in AU and IMU, but in the center only in IMU. Choroidal thickness seems to be unaffected by uveitis, even in the presence of macular edema, at least in the early stage of the inflammatory disease process.

Spectral domain optical coherence tomography in patients after successful management of postoperative endophthalmitis following cataract surgery by pars plana vitrectomy

BackgroundAcute severe postoperative endophthalmitis may lead to severe vision loss. The aim of this study was the analysis of macular microstructure imaged by spectral domain optical coherence tomography in patients after pars plana vitrectomy due to postcataract endophthalmitis.MethodsA cross sectional study was carried out in 17 patients who had cataract surgery in both eyes and underwent unilateral pars plana vitrectomy due to postcataract endophthalmitis. Postoperative best corrected visual acuity was determined in both eyes. Evaluation of macular thickness, macular volume, peripapillary retinal nerve fiber layer thickness and choroidal thickness using enhanced depth imaging technique was performed by spectral domain optical coherence tomography. The measurements obtained in the operated eye were compared to the fellow eye by Wilcoxon matched pair test. Correlation test was performed by Spearman rank order.ResultsA mean postoperative best corrected visual acuity of 63u2009±u200930 ETDRS letters versus 75u2009±u200921 letters was achieved in the study and fellow eyes, respectively, after a mean of 5.3u2009±u20094.5 months (pu2009=u20090.1). The mean macular thickness was 320.6u2009±u200928.8 μm SD in the study eyes compared to 318.4u2009±u200918.8 μm in the fellow eyes (pu2009=u20090.767). No differences were noted in macular volume (pu2009=u20090.97) and in peripapillary retinal nerve fiber layer thickness (pu2009=u20090.31). Choroidal thickness was significantly lower in the study eyes compared to the fellow eyes (pu2009=u20090.018). Epiretinal membrane was found in 7 eyes after endophthalmitis, while in the fellow eyes only in 3 cases (pu2009=u20090.13, Fisher’s exact test).ConclusionChoroidal thickness decreased significantly after endophthalmitis, but there was no functional correlation with the changes in choroidal microstructure. The development of epiretinal membranes may be associated with either vitrectomy or endophthalmitis in the history. Absence of other significant structural and morphological findings shows that successful treatment may guarantee good clinical results even in long term after this severe postoperative complication.

Diabetes-induced oxidative stress in the vitreous humor

Purpose Diabetes is accompanied by fundamental rearrangements in redox homeostasis. Hyperglycemia triggers the production of reactive oxygen and nitrogen species which contributes to tissue damage in various target organs. Proliferative diabetic retinopathy (PDR) is a common manifestation of diabetic complications but information on the possible role of reactive intermediates in this condition with special regard to the involvement of the vitreous in PDR-associated redox alterations is scarce. The aim of the study was to determine key parameters of redox homeostasis [advanced glycation endproducts (AGE); protein carbonyl and glutathione (GSH)] content in the vitreous in PDR patients. Methods The study population involved 10 diabetic patients undergoing surgery for complications of proliferative diabetic retinopathy and 8 control (non-diabetic) patients who were undergoing surgery for epiretinal membranes. Vitreal fluids were assayed for the above biochemical parameters. Results We found elevated levels of AGE in the vitreous of PDR patients (812.10 vs 491.69 ng AGE/mg protein). Extent of protein carbonylation was also higher in the samples of diabetic patients (2.08 vs 0.67 A/100 μg protein). The GSH content also increased in the vitreous of PDR patients as compared to the control group (4.54 vs 2.35 μmol/μg protein), respectively. Conclusion The study demonstrates that diabetes-associated redox alterations also reach the vitreous with the most prominent changes being increased protein carbonylation and increased antioxidant levels.

Vitrectorhexis in penetrating eye injuries in adults

Introduction: Vitrectorhexis is an alternative for manual continuous curvilinear capsulorhexis originally developed for paediatric cataract surgery. The aim of our study was the evaluation of the technique in adult patients with penetrating ocular injury and traumatic cataracts. Methods: Eight eyes of 8 patients (23–41u2009years, all males) had penetrating mechanical corneal trauma. Anterior lens capsule was penetrated in all cases and additional posterior capsule defect in five cases. Intraocular foreign body was detected in one case in the crystalline lens and in two cases in the posterior segment. Standard 23G infusion cannula and vitreous cutter were applied to perform anterior capsule opening, removal of lens material, anterior vitrectomy and pars plana vitrectomy if needed. No phacoemulsification or irrigation/aspiration probe was used. Results: Vitrectorhexis could be performed in 7 out of 8 cases with the preservation of peripheral anterior capsule; primary implantation of posterior chamber intraocular lens was possible in all cases (in the bag in three eyes and into the sulcus in five eyes). Anterior chamber was stable in all cases intraoperatively, and no dropped nucleus or lens fragment loss was observed. Surgery was combined with pars plana vitrectomy in three cases, with foreign body removal (when necessary). No postoperative complication occurred. Conclusion: Vitrectorhexis was found to be an effective and safe alternative method in the management of complex anterior segment trauma cases. With its use, traditional cataract surgical devices can be substituted and additional benefits of vitreous cutter can be utilized in selected cases, especially in young adults.

Aphakia korrekciója irisklip műlencse retropupillaris beültetésével

INTRODUCTION AND AIMnThe correction of aphakia might be a challenge for the surgeon. The aim of this study is to describe the authors experience with the implantation of the retropupillary iris clip intraocular lens.nnnMETHODnPatients between January 2014 and December 2015 were included in the retrospective study. Retropupillary implantation of iris clip intraocular lens VRSA 54 (AMO Advanced Medical Optics, USA) was performed in all cases. The minimum follow up period was three months. The stability of the intraocular lens and the intraoperative and postoperative complications and the visual acuity were evaluated.nnnRESULTSnDuring this time period 11 cases (1 female, 10 males) were included in the study. The mean age at the time of the implantation was 57.7 years (between 25-74 years). In 4 cases the iris clip lens was implanted during the first intervention, in 7 cases during the secondary procedure. In all cases the lens was fixated onto the iris posteriorly. The best corrected visual acuity before the iris clip implantation was 0.43 (0.1-1.0) and postoperatively at the time of the follow up 0.49 (0.04-1.0).nnnCONCLUSIONSnWith the use of the retropupillary implanted iris clip intraocular lens all of the patients could have been rehabilitated without major complications. Orv. Hetil., 2017, 158(1), 20-24.Bevezetés és célkitűzés: Az aphakia műtéti korrekciója sokszor komoly kihívás az operatőr számára. A szerzők célja a retropupillarisan beültetett irisklip műlencsékkel szerzett tapasztalataik ismertetése. Módszer: A 2014. január 1. és 2015. december 31. közötti eseteket gyűjtötték össze retrospektív módon. Azokat a betegeket vonták be a tanulmányba, akiknél retropupillarisan irisklip VRSA 54 (AMO Advanced Medical Optics, Amerikai Egyesült Államok) beültetését végezték el. A betegek követési ideje legalább három hónapos volt. Értékelték a műlencse stabilitását, a műtéti és műtét utáni szövődményeket és a betegek látóélességét. Eredmények: A fenti időszakban 11 esetben (egy nő, tíz férfi) végeztek ilyen beavatkozást. A műtét idején a betegek átlagéletkora 57,7 év volt (25–74 év). Négy esetben primer, hét esetben szekunder beültetést végeztek. A műlencse az irishez minden esetben rögzíthető volt. A műtét előtti legjobb korrigált látóélesség 0,43 (0,1–1,0), a követési idő végén 0,49 (0,04–1,0) volt. Következtetések: A rertopupillarisan beültetett iriskliplencse-implantációval a betegek minden esetben jól rehabilitálhatóak voltak. Orv. Hetil., 2017, 158(1), 20–24.

[Angiography of the ocular fundus without dye: Optical coherence tomography based angiography in exsudative age-related macular degeneration].

INTRODUCTIONnVascular endothelial growth factor antibody therapy is an established treatment of exsudative age-related macular degeneration.nnnAIMnThe morphologic characterisation of the macular microvasculature after longstanding treatment.nnnMETHODnForty-eight patients (34 women and 14 men; age, 74.4 ± 8.0 years) were enrolled in the study. During follow-up time (53.8 ± 31.0 months), 7.6 ± 4.9 injections were administered in 56 eyes. Optical coherence tomography angiographic examination was performed with AngioVue (Optovue Inc. Fremont, CA, USA).nnnRESULTSnDistortion of the superficial retinal plexus and foveal avascular zone enlargement were noted in 5/56 eyes, deep retinal plexus defect was detected in 9/56 cases. Destruction of the choriocapillaries and the former neovascularisation could be found in 4 different patterns: 1. pigment epithelium and choriocapillary atrophy, 2. submacular scar, 3. active leaking choroidal neovascularisation, 4. intraretinal cysts.nnnCONCLUSIONnOptical coherence tomography angiography is a novel non-invasive method, which enables the follow up of macular degeneration. Orv. Hetil., 2016, 157(42), 1683-1690.Absztrakt Bevezetes: Az időskori maculadegeneracio exsudativ formajanak elfogadott es hatekony kezelese a vascularis endothelialis novekedesi faktort gatlo kezeles. Celkitűzes: Annak morfologiai leirasa, milyen errendszer eszlelhető a macula teruleteben tobb eve tarto tartos kezeles utan. Modszer: A vizsgalatba 48 beteget (34 nő, 14 ferfi, eletkor 74,4 ± 8,0 ev) vontak be, akiknel legalabb 24 honappal korabban kezdtek meg a vascularis endothelialis novekedesi faktort gatlo kezelest (ranibizumab, aflibercept). A kezelt 56 szemnel a kovetesi idő (53,8 ± 31,0 honap) alatt osszesen 7,6 ± 4,9 injekciot alkalmaztak. AngioVue (Optovue Inc., Fremont, CA, Amerikai Egyesult Allamok) keszulekkel optikai koherencia tomografia-angiografia vizsgalatot vegeztek. Eredmenyek: A felszines retinaerek karosodasat 5/56 esetben, a melyebb retinakeringes kieseset 9/56 esetben tapasztaltak. A choriocapillaris karosodasara, az erujdonkepződest kovető elteresekre negyfele kep volt a jellemző: 1. pigmentham- es choriocapillaris-atr...

Beidseitige progressive Chorioretinitis

Ein 23-jähriger Patient stellte sich an unserer Abteilung mit beidseitiger zunehmender Visusverminderung vor. Eine Woche nach Beginn der Beschwerden betrug die bestkorrigierte Sehschärfe bei der Aufnahme 0,05 am rechten Auge und „Fingerzählen“ mit exzentrischer Fixation am linken Auge. Im Amsler-Gitter-Test konnte rechts ein parazentrales Skotom dargestellt werden, während links ein zentraler Gesichtfeldausfall zu sehen war. Zusätzlich berichtete der Patient über eine seit 6 Jahren bestehende epileptische Erkrankung. Regelmäßig würden