Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential ...tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR.
A systematic literature search was performed in PubMed and Embase, including the keywords "OCTA" OR "OCT angiography" OR "optical coherence tomography angiography" AND "diabetes" OR "diabetes mellitus" OR "diabetic retinopathy" OR "diabetic maculopathy" OR "diabetic macular oedema" OR "diabetic macular ischaemia". Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review.
We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease.
OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.
The increase in diabetic retinopathy (DR) prevalence demonstrates the need for the determination of biomarkers for assessing disease development to obtain an early diagnosis and stop its progression. ...We aimed to analyse total retinal (RT) and inner retinal layer (IRL) thicknesses in type 2 diabetes mellitus (DM2) patients and correlate these results with retinal sensitivity using swept-source OCT (SS-OCT) and microperimetry. For this purpose, a total of 54 DM2 subjects with moderate diabetic retinopathy (DR) with no signs of diabetic macular oedema (DME) and 73 age-matched healthy individuals were assessed using SS-OCT to quantify retinal thickness in the nine macular areas of the ETDRS grid. Retinal sensitivity was measured via microperimetry with a Macular Integrity Assessment Device (MAIA). The mean ages were 64.06 ± 11.98 years for the DM2 group and 60.79 ± 8.62 years for the control group. DM2 patients presented lower visual acuity (p < 0.001) and a thicker RT (260.70 ± 19.22 μm in the control group vs. 271.90 ± 37.61 μm in the DM2 group, p = 0.01). The retinal nerve fibre layer (RNFL) was significantly lower in the outer nasal area (50.38 ± 8.20 μm vs. 45.17 ± 11.25 μm, p = 0.005) in ganglion cells and inner plexiform layers (GCL+) in DM2. A positive correlation between the LDL-C and RNFL and a negative correlation between HDL-C levels and the inner temporal and central RNFL thickness were detected. The central (p = 0.021) and inner nasal (p = 0.01) areas were negatively correlated between the RNFL and MAIA, while GCL++ was positively correlated with the outer inferior (p = 0.015) and outer nasal areas (p = 0.024). Retinal sensitivity and macular RNFL thickness decrease in DM2 patients with moderate DR with no DME, and this study enables an accurate approach to this disease with personalised assessment based on the DR course or stage. Thus, GCL+ and GCL++ thinning may support ganglion cell loss before the RNFL is affected.
Background: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) and to correlate with changes in retinal thickness (RT) with ...swept-source OCT (SS-OCT) compared to healthy subjects. Methods: Fifty-four DM2 patients with moderate DR without diabetic macular edema (DME) and 73 age-matched healthy subjects were evaluated using SS-OCT to measure changes in total RT and CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid. Results: The mean age was 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Total RT showed statistically significant differences in the temporal inner area, with higher values in the DM2 group (p = 0.010). CT did not show differences between the groups. There was a significant negative correlation between RT and age in all of the outer ETDRS areas and a positive significant correlation in the central area for the DM2 group. There was also a negative significant correlation between CT and age in all of the ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner, p = 0.028; nasal inner, p= 0.003). Conclusion: DM2 patients with moderate DR have no changes with regard to CT. Both CT and RT decreased with age in DM2, showing a negative correlation between these factors in the central and horizontal parafoveal areas of the ETDRS grid.
Purpose
To describe an atypical case of conjunctival herpetic dendritic ulceration in an immunocompetent patient with no history of herpetic primary infection.
Methods
This is a single observational ...case report and a review of the literature. The patient was followed in successive appointments.
Results
Ocular involvement by the herpes simplex virus (HSV) in its recurrent form is characteristic for dendritic ulcers in the corneal epithelium, which are postulated to obtain this form due to the corneal nerve plexus. We describe the first case to date of an immunocompetent patient, age > 70 years and without prior immunosuppressive treatment, with a primary herpetic infection clinically diagnosed by presenting a dendritic ulcer in the bulbar conjunctiva. The patient had nonspecific corneal involvement, and the case was subsequently confirmed with polymerase chain reaction for HSV‐1.
Conclusions
The presentation of a dendritic ulcer in the bulbar conjunctiva in a case of ocular herpes infection is a rare finding, and the physiopathology is unknown. It casts doubt on the theory that corneal dendritic ulcer morphology is only formed because of the corneal sub‐basal nerve plexus involvement. This suggests that conjunctiva examination is of vital importance in herpetic ocular infection, and that it can used a diagnostic methodology if no other eye conditions are found.
Circumscribed choroidal hemangioma (CCH) is a rare congenital ocular tumor type that is usually benign and asymptomatic. CCH has only been reported once previously in the literature in association ...with a visceral neoplasm. Here, we present a newly described association between CCH and hepatic hemangioma (HH). We report the case of a 57-year-old woman diagnosed with asymptomatic HHs who presented with a 2- to 3-month history of central scotoma and blurred vision in her left eye. Assessment identified an orange-red elevated lesion with a central serous retinal detachment and subretinal edema. Complementary tests suggested a CCH. To our knowledge, CCH has only been reported once previously in association with a visceral neoplasm, making this newly described association between CCH and HH of clinical relevance. Ophthalmologists should be aware of the possible association between CCH and other visceral tumors as this association offers an opportunity for the early detection of this pathology.
Purpose
To describe a case of interlamellar keratitis induced by elevated intraocular pressure (IOP) in a patient with a history of LASIK surgery and the importance of having a strong diagnostic ...suspicion for establishing adequate treatment.
Methods
Intraocular pressure‐induced interlamellar keratitis is one of the potential complications of LASIK refractive surgery. The cases described generally occur a few months after surgery although there are some cases that have been described several years after surgery, usually in a context of uveitis and corticosteroid treatment or silent glaucoma. We present a case of 43‐year‐old woman who came to the emergency room with visual acuity (VA) impairment in the left eye in the setting of elevated intraocular pressure‐induced interlamellar keratitis secondary to the intravitreal corticosteroid implant in her left eye due to a diabetic retinopathy. She underwent LASIK surgery 14 years ago.
Results
The treatment was based on lowering the intraocular pressure. Oral acetazolamide and topical timolol, bimatoprost and brinzolamide were used. The patient recovered her baseline VA and the IOP were properly controlled posteriorly.
Conclusions
This case shows the importance of considering this diagnosis in patients with corneal haze, elevated intraocular pressure and a history of LASIK surgery to establish an adequate treatment. A full recovery is expected.
Bibliography
1. Galal A, Artola A, Belda J, (2006) Interface corneal edema secondary to steroid‐induced elevation of intraocular pressure simulating diffuse lamellar keratitis. Journal of refractive surgery.
2. Lee V, Sulewski M, Zaidi A (2010) Elevated Intraocular Pressure–Induced Interlamellar Stromal Keratitis Occurring 9 Years After Laser In Situ Keratomileusis. Corneal Journal.
3. Lyle W, Jin G, Jin Y (2003) Interface fluid after laser in situ keratomileusis. Journal of refractive surgery.
4. Tourtas T, Kopsachilis N, Meiller R, et al. (2010). Pressure‐Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis. Corneal Journal.
Purpose
Minimally invasive glaucoma surgery (MIGS) using diferent devices is a promising strategy for treating mild glaucoma. However, long‐term complications require further evaluation. We report a ...case of displacement to the anterior chamber and cornea of a previously successful XEN implant.
Methods
A 85‐year‐old female treated for open angle glaucoma with Latanoprost, Timolol and Brinzolamide started presenting IOP of 24 mmHg in her right eye and a progression was also evident in visual field examination and spectral‐domain optical coherence tomography. Due to failure of medical treatment, surgery with a XEN implant was offered to the patient. The XEN implant was successfully implanted in the right eye and an adecuate control of the IOP was achieved for eight months. After that period of time, IOP raised to 22 mmHg and topical treatment with Brinzolamide and Timolol was reintroduced. Nine months later, the patient suffered a visual acuity loss and came to the emergency department. During the slit‐lamp examination intense corneal edema, Descement membrane folds and a dislocation of the XEN implant into the anterior chamber affecting the cornea were described.
Results
Taking into account the patient situation we started adding topical corticosteroid therapy to her previous treatment. Finally a surgical removal of the implant was performed. Rejecting other surgical therapies for now, the patient is at the moment treated topically.
Conclusions
Despite MIGS is a safe and useful technique, long‐term complications require further evaluation. We describe the dislocation of a XEN implant into the anterior chamber or to the cornea as a new potential complication of this device to keep in mind.
Purpose
We describe a case report of hypotonic maculopathy secondary to cataract surgery with phacoemulsification and intraocular lens implant (IOL).
Methods
A 68‐year‐old man, with medical history ...of prostatic hyperplasia, and surgical history of uneventful cataract surgery in his left eye (phacoemulsification and IOL implant), underwent cataract surgery in his right eye. Flopy iris syndrome was manifested, with the consequent traumatic manipulation of the iris. The surgery finished successfully with the IOL implantation in the posterior chamber. During the following postoperative visits, the patient presented a best‐corrected visual acuity (BCVA) lower than 1/10 in his right eye, and an intraocular pressure (IOP) of 4 mmHg. The slit‐lamp examination discarded the presence of leakage throught the corneal incisions. The funduscopic examination showed a macular hypotony with radial folds, wich was confirmed by optical coherence tomography. The examination with ultrasonic biomicroscopy, revealed the presence of a superior cyclodialysis of 180°. An anterior YAG laser capsulotomy was performed to release the anterior capsular fibrosis. Despite treatment with topical steroids and atropine for two months, hypotonic maculopathy remained unchanged. Finally, an encircling procedure was performed, 23 g pars plana posterior vitrectomy, an internal limiting membrane peeling, SF6 20% air‐gas exchange, and superior criopexy of the cilliary body at 3 mm of the corneal limbus.
Result
The postoperative evolution was favourable with resolution of the maculopathy, progressive elevation of IOP (12 mmHg), and resolution of the cyclodialysis cleft. The patient recovered a BCVA of 7/10 with his right eye.
Conclusion
Ocular hypotony is an infrequent, yet potentially vision‐threatening entity. The diferential diagnosis is extense, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures.
Gonococcal conjunctivitis: a case report Lopez Sangros, Isabel; Marco Monzón, Sara; Karlsruher Riegel, Gisela ...
Acta ophthalmologica,
December 2019, 2019-12-00, 20191201, Letnik:
97, Številka:
S263
Journal Article
Recenzirano
Odprti dostop
Purpose
A case report of ocular perforation secondary to gonococal queratoconjunctivitis is presented.
Methods
A 49 year old man visited the Emergency Departement with redness, pain, and purulent ...secretion in his left eye of four days of evolution. He related a risky sexual relationship in the days before the clinic appeared, with direct inoculation of vaginal secretions in his left eye. At the slit lamp examination, he presented a significant corneal thining with ocular perforation in the upper part of the cornea. The direct microscopic examination of ocular secretions showed the presence of gram negative diplococci.Treatment with intravenous ceftriaxone, and topic ceftazidime was instaured. The patient underwent an urgent surgical intervention with a superior conjunctival covering of the upper of the cornea.
Results
The evolution of the patient was favorable with surgical treatment and antibiotic therapy. The results of the culture of ocular secretions confirmed the growth of Neisseria gonhorreae. One month later, the patient underwent a penetranting keratoplasty and a phacoemulsification with intraocular lens implant in the posterior chamber. At the moment, the patient is stable without corneal reject signs and a visual acuity of 1/10 with his left eye.
Conclusion
Gonococal queratoconjunctivitis is a serious infection that can cause significant corneal thining and ocular perforation. The incidence of this disease has increasead in the last years. For this reason it is important to make a differential diagnosis in presence of purulent queratoconjunctivitis asociated with risk factors.
Purpose: To assess the clinical course, structural changes, and choroidal neovascularization detection by SS-OCTA in long-standing and resolved patients with chronic central serous chorioretinopathy ...(cCSC) after successful half-fluence photodynamic therapy (hf-PDT) treatment. Methods: Twenty-four eyes presenting with cCSC were examined with SS-OCTA and were classified as choroidal neovascular (CNV) or non-choroidal neovascular (non-CNV) cCSC depending on the vascular pattern detected by SS-OCTA after one, two, and three years after hf-PDT. Two groups were compared based on the following clinical findings: demographic characteristics, time of clinical signs, best corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CFT), subretinal fluid (SRF), flat, irregular pigment epithelial detachment (FIPED), and features of fluorescein angiography (FA) and vascular pattern by SS-OCTA. Results: All patients showed resolved cCSC during follow-up after hf-PDT. A total of 5 of 24 (20.8%) eyes showed a neovascular pattern by SS-OCTA. No differences between BCVA, CRT, SRF, FIPED, or FA features were found between both groups (p > 0.05). However, CFT and older age were associated with a neovascular pattern by SS-OCTA (p < 0.05) in follow-up. No signs of neovascular activity were detected by SS-OCT during follow-up in CNV cCSC patients, and no antiVEGF treatment was required for three-year follow-ups. Conclusions: Despite patients with cCSC showing a favorable clinical response after hf-PDT, lower foveal thickness and older age were associated with CNV patterns by SS-OCTA during follow-up.
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