Purpose. To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs’ endothelial corneal ...dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods. We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results. Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant (P = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson’ chi-square, 0.755). Conclusions. Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.
Peripheral neuropathy could complicate diabetes mellitus (DM).
confocal microscopy (IVCM) is an ocular examination for the diagnosis of small fiber neuropathies and the detection of the earliest ...corneal sub-basal nerve plexus (SBP) alterations. Corneal SBP characteristics include focal enlargement along with the nerve fiber, called corneal beadings. These dilatations represent a mitochondrial accumulation induced by the reactive oxygen stress, as a consequence of hyperglycemia. For this reason, corneal beadings are considered indicative of metabolic activity. This study aimed to describe the corneal characteristics of a population of type 1 diabetes mellitus (T1DM) well metabolically controlled, using a new algorithm for the analysis of corneal beading size (BS).
Patients aged ≥18 years affected by T1DM were compared with healthy subjects who underwent IVCM (Confoscan 4; Nidek Technologies Padova, Italy). Starting from the coordinates of the beadings detected by the IVCM, we implemented a new algorithm for automatically measuring BS in corneal SBP images.
We compared 20 eyes of T1DM patients with 26 healthy controls. The corneal nerves' fiber length (
= 0.008), corneal nerves' fiber length density (
= 0.008), and the number of fibers (
= 0.017) were significantly lower in the diabetic group compared with controls. There was no difference between diabetic and healthy eyes in the mean number of corneal beadings both in the frame of analysis (
= 0.606) and for 0.1 mm of SBP nerve (
= 0.145). Regarding the BS, patients with T1DM had corneal beadings larger than controls (
= 0.036).
We found that the corneal beadings parameters are similar in healthy and T1DM individuals. Nevertheless, measuring the BS with our algorithm, we showed that corneal beadings are enlarged in patients affected by T1DM when compared with healthy controls. Identifying beading expansion in corneal nerve fiber using IVCM should become a useful tool to predict peripheral neuropathy at an early stage.
Purpose: To report clinical features and prognosis of HLA B27 acute anterior uveitis.
Methods: 165 patients with recurrent acute anterior uveitis were divided into two groups: HLA B27-positive (group ...1, 60 patients) and HLA B27-negative (group 2, 105 patients). A comparison between the two groups was performed.
Results: Unilateral involvement was higher in group 1 (p = .046), and more simultaneous bilateral cases occurred in group 2 (p = .004). Group 1 was more correlated to systemic diseases than group 2 (50 versus 17.1%, p < .001), particularly to ankylosing spondylitis (35 versus 3.8%, p < .001). Uveitis was diagnosed before spondylitis in 57% of patients. In groups 1 and 2 an immunosuppressive therapy was administered to 20 and 9.5% of patients but was exclusively given to control uveitis in 1.6 and in 2.8% of cases, respectively.
Conclusions: A strong association between HLA B27 uveitis and ankylosing spondylitis was confirmed and usually uveitis preceded rheumatological involvement.
Introduction: We describe a patient with corneal and scleral dellen, which occurred after an uneventful pterygium excision without adjunctive therapy and a subsequent febrile episode. Case Report: A ...43-year-old woman presented with a history of recurrent irritation in her right eye and a diagnosis of pterygium. The pterygium was excised under local anesthesia with the bare scleral technique and without the use of antimetabolites. No complications occurred until 14 days after surgery when corneal and sclera dellen appeared; this was 2 days after a concomitant febrile episode (39°C). Tobramycin and dexamethasone eye drops given after surgery were withdrawn and topical lubricants and antibiotic ointment, in combination with oral L-amino acids, were administered along with eye patching. One week later, the corneal dellen had completely healed and, 4 weeks later, the thinned sclera appeared regularly thick and white in color. Three months after surgery, a small recurrent pterygium was diagnosed, which remained stable without signs of inflammation for additional 18 months. Conclusions: Corneal and scleral dellen might be a late complication of uneventful pterygium surgery without antimetabolites and a subsequent febrile episode.
Background
Many neurologic complications have been described after severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) including atypical cases of optic neuritis (ON), positive to myelin ...oligodendrocyte glycoprotein (MOG) IgG.
Objective
To report a case of MOG-IgG-associated ON and discuss why SARS-CoV-2 infection could be a potential trigger.
Methods
Retrospective single case report.
Results
We report a case of ON with positive MOG-IgG developed 15 days after presentation of SARS-CoV-2 infection.
Conclusion
This report suggests that SARS-CoV-2 infection may have triggered autoantibodies production against MOG leading to ON.
Epidemiology of Macular Edema in Uveitis Accorinti, Massimo; Okada, Annabelle A.; Smith, Justine R. ...
Ocular immunology and inflammation,
02/2019, Letnik:
27, Številka:
2
Journal Article
Recenzirano
Purpose: To describe the epidemiology of macular edema (ME) in patients with uveitis.
Methods: Review of articles listed on PubMed pertaining to uveitic ME.
Results: Reported rates of uveitic ME ...ranging from 20% to 70%, depending on the ancillary tests used (fundus examination, fluorescein angiography, optical coherence tomography). Macular edema might develop due to uveitis itself, or occur as an adverse effect of drugs taken for different diseases. It is more frequently observed in adults than in children, in chronic uveitis, and in intermediate uveitis. Males with ankylosing spondylitis are more prone to develop ME than females. Three patterns of uveitic ME are observed, either isolated or in combination: cystoid ME, the most frequently encountered pattern seen in up to 80% of cases, diffuse ME and serous retinal detachment.
Conclusion: Older age, chronicity of uveitis and intermediate uveitis are risk factors for the development of ME in patients with uveitis.
Previous research suggests that proliferation of the idiopathic epiretinal membrane (IERM) is related to microbreaks in the inner limiting membrane, which are caused by posterior vitreous detachment. ...In this study, we used optical coherence tomography angiography to determine whether a vascular defect in the inner retina is present before the mechanical damage caused by posterior vitreous detachment.
For patients with unilateral IERM (N = 23), optical coherence tomography angiography with blood flow measurement was performed in both eyes at the superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) with 6 mm × 6-mm scans and ETDRS grids centered on the fixation point. These values were then compared with 45 healthy control eyes (CEs).
The optical coherence tomography angiography data showed that blood flow was lower in the fellow eyes of IERM patients than in CEs when the whole enface macula (SCP: P = 0.031, DCP: P = 0.004) and extramacular area (SCP: P = 0.048, DCP: P = 0.026) were compared between groups. The blood flow was also lower in the affected eyes compared with CEs in both whole en face macula (SCP: P < 0.001, DCP: P < 0.001) and extramacular areas (SCP: P = 0.011, DCP: P < 0.001).
Data from this study revealed that blood flow is significantly reduced in the fellow eyes of patients with unilateral IERM when compared with CEs. Overall, the data suggest that a vascular retinal defect could produce changes in the inner retina, preceding and influencing the formation of microbreaks occurring at the time of posterior vitreous detachment in the inner limiting membrane. Understanding the upstream mechanism of inner limiting membrane microbreaks may provide a therapeutic target aimed to ultimately prevent MuCombining Diaeresisller cells, astrocyte, and fibroblast migration, which cause IERM proliferation.
To study macular microvascular changes in ocular Behçet disease (OBD) using optical coherence tomography angiography (OCTA).
Quantitative and qualitative analyses of OCTA were performed on 23 OBD ...patients with active or inactive uveitis and compared with healthy controls.
Deep capillary plexus (DCP) is the most frequently involved in OBD (p < 0.001). Its vessel density (VD) is reduced compared with controls in both active (p < 0.007) and inactive uveitis (p = 0.03). In inactive uveitis, VD is inversely related to the number of uveitis relapses (superficial capillary plexus: r = -0.694, p = 0.004; DCP: r = -0.541, p = 0.037) and it is significantly reduced in patients with a uveitis-free period ≥5 years compared with healthy controls (p < 0.038).
Macular VD is reduced in Behçet patients with active and inactive uveitis, especially in DCP. In inactive uveitis, VD is inversely related to the number of ocular relapses and cannot be restored during time.
to study the clinical features of uveitis-glaucoma-hyphema (UGH) syndrome, particularly those useful for a differential diagnosis from unilateral hypertensive acute anterior uveitis.
A retrospective ...chart review was conducted on the clinical features of 9 patients with UGH syndrome. These features were then compared with those detected in 50 patients with unilateral hypertensive acute anterior uveitis.
Fine and pigmented keratic precipitates (p = .0002 and p = .00004, respectively), iris atrophy (p = .0122), hyphema and vitreous opacities > 2+ (p = .0003), and cystoid macular edema (p = .009) were statistically associated with UGH syndrome. These clinical signs show a high specificity, ranging from 58 to 100%; the presence of pigmented keratic precipitates in the setting of a unilateral acute hypertensive anterior uveitis has a sensitivity and specificity of 89% and 84%, respectively.
In patients operated on for cataract, UGH syndrome can be differentiated from unilateral hypertensive acute anterior uveitis considering specific clinical signs.
A 74-years-old man experienced severe diplopia one month after recovery from an uncomplicated SARS-CoV-2 infection. Neurological examination was normal whereas ophthalmological examination showed ...bilateral exophthalmos with a complex ocular motility disorder characterized by a pseudo-internuclear ophthalmoplegia after fatigue associated to impairment of elevation and infraduction. Antibodies against TSH and acetylcholine receptors were positive; subsequent hormonal tests, ultrasonography of thyroid gland, single fiber electromyography and orbit MRI confirmed the diagnosis of concomitant Graves Disease (GD) and Myasthenia Gravis (MG). The coexistence between MG and GD is not rare but simultaneous onset after viral infection is very unsual. The complex ocular disorder simulated a deficit of the oculomotor nerve nuclei, and on clinical examination it posed some problems in the diagnosis. We suggest that recent SARS-COV-2 infection may have triggered a complex autoimmune response.
PDF
