Background Monocular vision loss, attributed to either central retinal artery occlusion ( CRAO ), branch retinal artery occlusion ( BRAO ), or ocular ischemic syndrome ( OIS ), is thought to be ...associated with an increased prevalence of cerebral infarcts. However, there is a paucity of data substantiating this. We aimed to investigate this relationship in a Canadian center and further understand the importance of associated internal carotid artery stenosis in potential clinical decision making. Methods and Results We performed a retrospective cohort study at a comprehensive stroke center of patients presenting initially with CRAO , BRAO , or OIS to a centralized ophthalmology center over a 5-year period. Patients were followed for 3 years for the occurrence of a hemispheric stroke. We identified 83 affected eyes, with 31 CRAO , 35 BRAO , and 17 OIS patients. Before ocular diagnosis, 32.3%, 11.4%, and 41.2% of CRAO , BRAO , and OIS patients, respectively, experienced a symptomatic stroke. Of the remaining patients, 4.8%, 12.9%, and 40%, respectively, suffered a hemispheric stroke within 3 years of ocular diagnosis. Logistic regressions suggested that for CRAO and BRAO patients together, the degree of ipsilateral internal carotid artery stenosis is unable to predict the occurrence of a stroke ( P=0.18), whereas our model correctly predicted a stroke in 82.4% of OIS patients ( P=0.005). Conclusions CRAO , BRAO , and OIS are associated with significantly increased symptomatic stroke rates. Degree of ipsilateral internal carotid artery stenosis may not be useful in risk stratification for these patients, suggesting that they should be triaged appropriately for stroke risk-factor management, independent of internal carotid artery stenosis.
Abstract Objective We describe the case of a boy with a TUBA1A mutation presenting with microphthalmia and congenital cataracts in addition to microcephaly and severe brain malformation. Methods A ...boy presented in early infancy with microphthalmia, congenital cataracts, and microcephaly. His neurological course included severe hypotonia and drug-resistant epilepsy. Magnetic resonance imaging of the brain revealed a complex malformation that included agenesis of the corpus callosum, severely hypoplastic cerebellar vermis, mildly hypoplastic and dysplastic cerebellar hemispheres, mildly hypoplastic brainstem, mild posterior simplified cerebral gyral pattern, dysplastic basal ganglia and thalami, hypoplastic optic nerves, and absent olfactory bulbs. Results TUBA1A genetic testing was conducted and revealed a previously unreported heterozygous 808G>T missense mutation. Parental genetic testing was negative, indicating that the child's mutation was de novo. Conclusion The TUBA1A gene encodes tubulin alpha-1A, a protein with an important role in microtubule function and stability. Human mutations can result in a wide spectrum of brain malformations including lissencephaly, microlissencephaly, cerebellar hypoplasia, agenesis of the corpus callosum, pachygyria and polymicrogyria. Although TUBA1A is expressed in both developing brain and retinal tissue, there are no reported cases of TUBA1A mutations in association with major developmental ophthalmologic abnormalities.
Since the publication of this article 1, author Salima Kherani has changed the spelling of her name to Saleema Kherani. The correct author's name has been included to the authors' list of this ...erratum.
Abstract Background: This study aimed to describe and measure the health results of a Category 3 teleophthalmology screening project for diabetic retinopathy (DR). Implemented through mobile ...screening imaging units located within pharmacies, the project had the goal of reaching unscreened diabetic patients in urban communities while lowering barriers to screening and saving medical resources. Methods: Image capture of both eyes of 3505 known diabetic individuals was performed in the provinces of Quebec, British Columbia, Alberta, Manitoba, and Saskatchewan. A photographer performed fundus imaging, and a nurse used mild pupil dilation only when necessary to secure image quality. Screening was provided free of cost in the context of DR health days for DR screening. Through teleophthalmology, ophthalmologists proceeded with data and image interpretation, and timely referral when indicated. Results: This project allowed the resumption of screening of over 38% of the cohort of known diabetics who reported never having undergone any eye examination with pupil dilation, and an additional 30% who reported not having been examined for over 2 years. All known diabetics were under the care of a general physician, and their mean diabetes duration, when known, was 8 years. DR pathology was found in 22.5% (20%–28%) of the cohort, 1.8% requiring urgent referral (within 30 days) as a result of the severity of the DR and 0.6% (0%–l.8%) requiring urgent referral for other reasons. An additional 8.7% (8.1%–19.5%) required ophthalmologic attention within 6 months because of DR and another 2.0% (0%–6.3%) between 6 months and I year. Incidental findings were found in 23%, the majority of which were related to cataract and dry macular degeneration. Urgent or significant incidental findings were found in 0.6% of the screened eyes. Pupil dilation with tropicamide 1% was deemed useful or necessary in 33.7% of the cohort. For 0.7% of the cohort, the images could not be interpreted because of poor image quality and for that reason had to be referred for a traditional dilated eye examination. Ophthalmologists were relieved of the examination of 85.6% of the screened diabetic individuals who benefited from screening without requiring a traditional ophthalmologic examination. On the other hand, ophthalmologists were required to provide urgent (within 30 days) services to 2% of the cohort, either because of threatening DR or because of incidental findings requiring rapid ophthalmologic attention. Interpretation: This screening strategy for DR through mobile teleophthalmology imaging units efficiently lowered barriers to screening and created new screening opportunities for a large number of known diabetic individuals who were lost to the traditional health system. It has the potential to provide better outreach to diabetic populations while identifying individuals truly in need of the services of an ophthalmologist; at the same time it maximizes the use of limited ophthalmologic resources while favouring multidisciplinary collaborations. The significant incidental findings associated with screening highlight the need for ophthalmologic competencies during DR screening within a teleophthalmology approach. Further involvement of government health authorities is pivotal in embracing the opportunities provided by emerging technologies such as teleophthalmology and translating them into better outreach services to diabetic populations and thus better visual health results.
To analyse assessment and management patterns of intraocular foreign body (IOFB) injuries in an urban Canadian setting, providing valuable clinical insights to contextualize management.
...Single-surgeon retrospective chart review from January 2002 to January 2023 examining IOFB patient demographics, investigations, treatments, complications, and best-corrected visual acuity (BCVA).
This study evaluated IOFBs in 32 eyes from 31 patients (96.8% male). Sizes ranged from 1 to 12 mm; 28 (87.5%) were metallic and 15 (46.9%) were work-related injuries. For diagnosis, 19 patients (61.3%) underwent computed tomography (CT) imaging, and 8 (25.8%) received B-scans, with CT detecting IOFBs in 100% of cases and B-scan in 87.5%. At final follow-up, 17 eyes (53.1%) achieved BCVA ≥20/40, up from 7 (23.3%) initially. Presenting BCVA ≥20/200 was associated with a final BCVA ≥20/40 (P = 0.027). The IOFB was extracted in 27 eyes (84.4%), retained in 4 (12.5%), and 1 (3.1%) required enucleation. Intravitreal antibiotics were administered in 19 eyes (59.4%), resulting in one presumed case of drug toxicity. Complications were present in 30 eyes (93.8%), totalling 119 recorded overall, with 72 (60.5%) occurring within the first 24 hours. Traumatic cataracts were most common in 27 eyes (84.4%). Less-common complications included siderosis and retinal detachment with proliferative vitreoretinopathy, each occurring in one eye (3.1%). Four eyes (12.5%) developed secondary glaucoma, with 3 cases in retained or delayed extractions.
The IOFB characteristics and patient demographics are consistent with other regions. CT scans were the most effective investigation tool. Extended follow-up is recommended to monitor complications, particularly in retained or significantly delayed extractions.
To characterize the presentation of Terson syndrome, the occurrence of a vitreous hemorrhage in association with intracranial hemorrhage, and report on the outcomes of vitrectomy at two major centers ...in Canada.
Retrospective chart review of consecutive patients with Terson syndrome undergoing vitrectomy by retina specialists over the last 10 years. Primary outcome was the change in best-corrected visual acuity (BCVA) at 3 months from baseline. Secondary outcomes included the association between baseline BCVA and final BCVA, and the association between final BCVA and timing of surgery (early vs. later than 90 days).
A total of 14 eyes of 11 patients were included. The mean time between observation of intraocular hemorrhage and vitrectomy was 160 days. Baseline preoperative BCVA was logarithm of the minimum angle of resolution 1.57 ± 1.03 (Snellen 20/740), which improved to logarithm of the minimum angle of resolution 0.53 ± 0.82 (Snellen 20/70) at the final postoperative follow-up, P = 0.01. Baseline BCVA was not significantly correlated with final BCVA, Spearman's rho = 0.016, P = 0.957. Final BCVA did not significantly differ between those who had surgery before 90 days compared with after 90 days, P = 0.087.
Vitrectomy is safe and effective and should be considered for nonclearing vitreal bleeding due to Terson syndrome. Ocular hemorrhaging in Terson syndrome can be observed conservatively for spontaneous improvement without the risk of reduced visual potential. Ophthalmic evaluation should be considered promptly after intracranial hemorrhage.
To describe the characteristics of rhegmatogenous retinal detachments (RD) that developed after endophthalmitis and to provide insight regarding incidence, management, and outcomes.
Retrospective ...chart review of consecutive patients diagnosed with endophthalmitis at two Canadian institutions and from one surgeon at a third center over a 10-year period.
316 eyes presented with endophthalmitis of which 32 (10%) were complicated by subsequent RD. The mean age (SD) of patients was 72.0 (13.77). Intravitreal injections (33%) and cataract surgery (31%) were the most common inciting events for the endophthalmitis. Cases were managed with tap and inject (16%), vitrectomy (30%) or both (47%). There were no differences in the rate of RD when comparing the inciting events, microbial growth, or management approaches. Baseline visual acuity was the only predictor of RD (p=0.009). There was an improvement in VA following management of the RD (logMAR 2.33 vs 1.69 or Snellen HM vs 20/980, p=0.009) but final VA in these patients was worse than in those who did not develop RD (logMAR 1.69 vs 1.27 or Snellen 20/980 vs 20/372, p=0.029).
All patients with RD post endophthalmitis required additional surgery and functional outcomes remained poor. Nevertheless, repair of these RDs can preserve some vision and be globe saving.
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