Ocular Fundus Examination Research Articles

A rare presentation of Nocardia Choroidal Abscess after Glioblastoma surgery.

to report the natural history of a rare ocular manifestation of endogenous Nocardia farcinica infection in an immunocompromised patient, with involvement observed in both the anterior and posterior segments of the eye. Given the patient's limited mobility, a handheld fundus camera was utilized for bedside anterior segment and ocular fundus examinations. The findings included visual acuity of hand motion, posterior synechiae, vitreal opacity, and a large choroidal abscess. We monitored the lesion's progression through a series of follow-ups. Despite not employing intravitreal drug therapy, we noted a significant reduction in the lesion's size until the patient's overall health deteriorated. This case contributes valuable information to our understanding of the natural history of a rare condition like Nocardia endophthalmitis. We highlighted the usefulness of a handheld fundus camera in aiding infectious disease specialists in assessing the immediate response to systemic treatment.

Prospective Study on the Surgical Outcome of Eyelid Carcinoma

Abstract
 Introduction & Objectives : Introduction Resection of eyelid carcinoma may lead to a risk of recurrences which might increase if excision was incomplete. Risk factors of incomplete surgical removal and recurrences are deep infiltration, spreading outside the macroscopic border, eye socket penetration, and histological type of the eyelid carcinoma. Objective To evaluate the surgical outcomes of eyelid carcinomas.
 Methods : This is a hospital based prospective observational study involving 16 patients. Prior to the surgery patients were evaluated for visual acuity, intra ocular pressure, extra ocular motility, fundus examination, and local clinical examinations. The eyelid carcinomas were histological detected concerning carcinoma type and margin involvement. Local anesthesia was applied. Patients were evaluated 1 month, 3 months and 6 months after surgery for local complications, patients satisfaction on surgical results, and recurrences. The surgical technic applied in this study were also observed.
 Results : Dominant tumor type were basal cell carcinoma and squamous cell carcinoma (87, 44%). The locations were at right and left lower eyelid with percentage of 68. 7 % and 31. 3 % respectively. All patients satisfied on surgery outcomes (100%). Three patients (6. 25 %) with complications were found within 6 months after the surgery. There were no recurrences during follow up period. Surgery procedures applied were modified hughe’s procedure (56. 25%) and mass excision and reconstruction (43. 75%).
 Conclusion : There was less complications and no recurrences within 6 months after surgery. All patients satisfied with the surgical outcomes.

Fundoscopic changes in preeclampsia and eclampsia and their association with fetal outcome

Abstract Introduction: Hypertensive disorder is a major cause of maternal and perinatal mortality and morbidity, with preeclampsia and eclampsia being the most common. Preeclampsia is characterized by endothelial dysfunction and vasospasm of vessels, which can be observed by an ocular fundus examination. The fundus usually develops changes such as hypertensive retinopathy, papilledema, exudative retinal detachment, and vitreous and preretinal hemorrhages. Retinopathy is associated with placental insufficiency and intrauterine growth retardation. Therefore, this study has been undertaken to assess the prevalence of retinal changes in preeclampsia and their association with fetal parameters. Objective: To study the fundus changes in preeclampsia. To study the relationship between fundus changes and fetal outcome with respect to various parameters like birth weight, APGAR score, stillbirth, and perinatal death. To study the relationship between fundus changes with respect to proteinuria and serum uric acid. Study Design: Observational study. Methodology: One hundred patients presenting to the department of obstetrics and gynecology diagnosed with preeclampsia at a tertiary care center were included in the study. The patient recruited underwent an ocular examination using Snellen’s chart, a pupillary examination, a slit lamp examination, and a dilated fundus examination. The retinopathy was graded according to Keith and Wagner’s classification. The fetal parameters considered were birth weight, APGAR score, stillbirth, and neonatal death. Results: Patients ages ranged from 25 to 30 years old, with an average of 23.28 ± 3.37. Average systolic and diastolic blood pressures were 156.9 ± 17.961 and 104.88 ± 13.58, respectively. All patients had normal anterior segments. Visual acuity was6/6 in most of the patients. Fundus changes were noted in 48% of patients. Based on retinopathy classification, we found 66.7% patients with Grade 1 and 27.1% patients with Grade 2 hypertensive retinopathy. Only 6.3% of patients presented with Grade 3 hypertensive retinopathy. There was a significant association between retinopathy and proteinuria (P = 0.003), serum uric acid (P = 0.002), and the fetal birth weight (P = 0.001). Conclusion: Our findings suggest that progressive fundal changes in preeclampsia indicate worsening of the pathophysiological status of pregnancy-induced hypertension (PIH) and help in management. The degree of hypertensive retinopathy in women with preeclampsia is a valid and reliable prognostic factor that serves as an indirect marker of the severity of PIH and fetal outcome. Fundus examination is a simple, noninvasive, and cost-effective procedure that could be the initial finding in an asymptomatic patient who may require immediate management, which may help in saving the lives of both the mother and the baby. Fundus evaluation is essential for all patients with PIH.

From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections

In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.

Features of steroidogenesis and arterial hypertension in men in different types of "physiological" male hyperandrogenism

To reveal the peculiarities of steroidogenesis and arterial hypertension in «physiological» hyperandrogenism in men. One-stage simultaneous study. The groups of men with hyperandrogenism caused by increased total testosterone (n=34) and those with hyperandrogenism caused by increased dihydrotestosterone (DHT) (n=66) were compared. In determining the type of hyperandrogenism and allocating patients to groups, DHT and total testosterone levels were determined by enhanced chemiluminescence. Subgroups of men with and without arterial hypertension were compared in the group of patients with hyperandrogenism due to an increase in total testosterone. Body mass index, waist circumference, systolic and diastolic blood pressure, pulse, and LH, SBHG, estradiol, blood multisteroid levels by isotope dilution liquid chromatography/tandem mass spectrometry, glucose, blood lipid spectrum, uric acid, creatinine, renin, potassium, sodium, and blood chloride were assessed in all patients. Patients with arterial hypertension additionally underwent daily BP monitoring, albuminuria assessment, electrocardiography, ocular fundus examination. The baseline threshold level of significance was p<0.05. For multiple comparisons, the p significance level was calculated using the Bonferroni correction. Statistically significant differences were found in the levels of 17-hydroxypregnenolone, 17-hydroxyprogesterone, and androstenedione, which were higher in men with elevated levels of total testosterone. No statistically significant differences in other laboratory parameters were found. No cases of increased blood pressure were detected in the group of men with elevated DHT. In the group of men with elevated total testosterone, 23,5% of men with arterial hypertension without targetorgan lesions were identified, while hyperandrogenism was associated with 17,6% of cases. Arterial hypertension associated with hyperandrogenism was characterized by a rise in blood pressure in the early morning hours. Estradiol levels, while remaining within normal limits, were statistically significantly lower in patients with arterial hypertension compared with men with elevated testosterone but without hypertension. No cases of arterial hypertension were observed in «physiological» hyperandrogenism due to elevated DHT levels, whereas its incidence in «physiological» hyperandrogenism due to elevated total testosterone was 23,5%. The features of steroidogenesis were increased production of 17-hydroxypregnenolone, 17-hydroxyprogesterone, and androstenedione in men with testosterone hyperandrogenism and decreased estradiol production in patients with arterial hypertension compared with patients without testosterone hyperandrogenism.

A DESCRIPTIVE OBSERVATIONAL STUDY ON BRANCH RETINAL VEIN OCCLUSION AND DYSLIPIDEMIA IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Branch Retinal Vein Occlusion is the most common type of Retinal Vein Occlusion prevalent globally. BRVO is twice as more common than CRVO. In India approximately 0.66% of the population has been diagnosed with BRVO. Estimating proportion of persons having Dyslipidemia in Branch Retinal Vein Occlusion(BRVO) in ocular fundus examination. D Study Design : escriptive Observational Study. Total 182 persons examined,73 females & 109 Methods: males. The fundus examined after pupillary dilation using Tropicacyl Plus eyedrops. Fundus examination done using Slit Lamp Biomicroscope with + 90D lens & Indirect Opthalmoscope with +20D Lens. Those with BRVO suggested to get Serum Lipid Prole tested. Out of 182 perso Result : ns examined,95were found to have serum lipid prole reports suggesting Dyslipidemia which estimates to be 52.2% of the number of persons diagnosed with BRVO. Out of those 95 persons, 32are females (33.7%) and 63are males (66.3%). Dyslipidemia in 36.8% of persons suggest a potent Conclusion: ial role in causing BRVO. Dyslipidemia can be controlled with lifestyle modications & appropriate medications, so such persons should be encouraged to follow the advice properly

Application of immersion B-scan ultrasonography in diagnosis of complex retinal detachment, persistent hyperplastic primary vitreous and intraocular tumors

To evaluate the diagnostic value of panoramic immersion B-scan ultrasonography (Pano-immersion B-scan, PIB) in complex retinal detachment (RD), persistent hyperplastic primary vitreous (PHPV) and intraocular tumors. The clinical data of 44 patients collected from May 2012 to December 2019 in Chinese PLA General Hospital was retrospectively studied. All of these patients underwent PIB of the eye, because it was difficult to diagnose by routine ocular fundus examination, conventional ultrasound or/and ultrasonic biomicroscope (UBM) due to opacity of refractive media, pupillary occlusion, large involvement or special location of the lesion. The imaging features of difficult cases in PIB were analyzed. The diagnosis accuracy rating of PIB were evaluated and contrasted with conventional ultrasound or UBM by the standard of intraoperative diagnosis or/and pathological results. According to intraoperative diagnosis or pathological results as gold standard, among the 44 cases, there were 19 cases missed diagnosis, misdiagnosed or difficult-to-diagnose by conventional ultrasound or UBM, including 4 cases of long-standing RD difficult to diagnose, 4 cases misdiagnosed, and 11 cases incompletely observed or miss diagnosed. The diagnostic accuracy rate of PIB and conventional ultrasound or UBM were 100% (44/44) and 56.82% (25/44), and the sensitivity of them were 100% and 56.82%. All the patients underwent PIB and were diagnosed as RD (15 cases), retinal and choroidal detachment (4 cases), subchoroidal hematocele (1 case), vitreous opacity and/or organic membrane formation (4 cases), PHPV (12 cases), iris and/or ciliary body tumors (3 cases), and choroidal tumors (6 cases). According to the intraoperative diagnosis or pathological results, the diagnostic coincidence rate of PIB was 100%, which was significantly higher than conventional ultrasound and UBM. PIB can help to accurately diagnose complex RD, PHPV, and intraocular masses with special location or/and excessive size. It has important diagnostic value for patients with equivocal findings at conventional ultrasound examination.

The relationship between renal renal resistive index and hypertensive end-organ damage

Background/Aim: The prevalence of hypertension increases with age and one out of every three adults over the age of 40 has hypertension. Hypertensive end-organ damage is an important predictive factor for patient morbidity and mortality. This study aimed to investigate the role of the renal resistive index (RI) in predicting retinopathy and nephropathy in hypertensive patients. Methods: This study was cross-sectional in design. Sixty hypertensive patients who were followed in Samsun Research and Training Hospital Internal Medicine outpatient clinic were included in the study. In all patients, a routine ophthalmological examination, including visual acuity, anterior segment examination, and dilated ocular fundus examination, was performed. Urinary albumin to creatinine ratio (mg/g) was measured in spot urine samples, and a level ≥30 mg/g was accepted as the presence of proteinuria. Renal Doppler ultrasonography was performed using Esaote mylab x 9 model sonography device vovex probe (C1-8) 3.5 MHz. RI values were measured using Xflow Doppler at the level of interlobular or arcuate arteries of both kidneys. First, the patients were divided into two groups (with or without retinopathy). The patients who had retinopathy were then divided into two groups according to their retinopathy degree. Hypertensive retinopathy was graded according to the Scheie classification. The patients were also divided into two groups according to their proteinuria status (with or without proteinuria). Results: The mean of renal RI was 0.59 (0.04) in patients without retinopathy (n=15), 0.63 (0.05) in patients with grade 1 hypertensive retinopathy (n=29), and 0.66 (0.04) in patients with grade 2 hypertensive retinopathy (n=15). The difference between groups was statistically significant (overall P=0.001). It has been shown that proteinuria develops more frequently in cases in which the renal value is above 0.7, and these results were statistically significant (P=0.034). Conclusion: This study indicates that renal RI increase is a valuable tool for estimating retinopathy and proteinuria in hypertensive patients.

Chemical Ocular Injury: Case Report

Background refers to Oculusnd: A chemical ocular burn is an emergency that requires immediate management. It can occur under various circumstances. Case Presentation: The present case is a 31-year-old female exposed to an instant burst of chemicals that splashed all over her. The patient was presented to the emergency department with an injury to the eye and face. The immediate step for chemical ocular burn was eye irrigation with an isotonic solution before the examination of the eye. Then an examination of the eye, including ocular, slit lamp, and detailed fundus examinations, was done. The acute management of a patient with chemical eye burns included an antibiotic, tear substitutes, agents to control inflammation and support repair as well as cycloplegic therapy. Conclusion: A chemical ocular burn is an ophthalmic emergency that requires immediate management. Eye irrigation with an isotonic solution is the immediate step that should be done for the affected individual. Then an examination of the eye should be performed. Alkali substances cause more severe burns compared to acid substances. The acute management of a patient with chemical eye burns should include antibiotics, tear substitutes, agents to control inflammation, and support repair, as well as cycloplegic therapy.

Pigmentary Maculopathy in Interstitial Cystitis/Bladder Pain Syndrome Treated with Oral Pentosan Polysulfate: A Review

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a rare and chronic bladder condition. Pentosan polysulfate sodium (PPS) is the only oral medication approved specifically for the management of IC/BPS. In 2018, Pearce et al. reported for the first time a unique pattern of ocular pigmentary maculopathy exclusively in IC/BPS patients following PPS exposure. This publication triggered several published studies, case reports, case series, and media reports claiming a link between PPS and pigmentary maculopathy; however, a clear interpretation of these data is still awaited and there are currently no prospective, well researched, confirmatory data available. The clinical presentation of pigmentary maculopathy is characterised by moderate visual impairments and macular hyperpigmented spots, yellow-orange deposits, and/or patchy retinal pigment epithelium (RPE) atrophy. Most patients experiencing this ocular effect used high doses of PPS over an extended period, with risk of pigmentary maculopathy associated with PPS increasing with exposure. Studies that rule out prevalent retinal abnormalities are lacking. The cause of this particular maculopathy remains unclear and further research is required. The current data suggest that a median duration of 15 years of PPS exposure must elapse before pigmentary maculopathy is detected. Furthermore, no increased incidence of any type of maculopathy is found up to a median duration of 5 years of PPS use. Thus, in line with the current European Medicines Agency (EMA) recommendation, if patients respond to therapy and a decision is made to continue PPS for longer than 6 months, a fundoscopy with optical coherence tomography (OCT) and fundus autofluorescence should be performed. In cases of no findings, the next eye examination should be after a further 5 years of PPS use; in cases of findings, continuation of the treatment should be re-evaluated by the urologist and monitored by yearly ocular fundus examinations. This review provides a framework for evidence-based treatment with PPS in patients with IC/BPS using appropriate monitoring and gives an overview of the current understanding and evidence of the association of PPS and a specific pigmentary maculopathy.

Prevalence of Eye Diseases among Primary and Secondary School Learners in Kabwe District - Zambia

Objective: To determine the pattern and magnitude of eye diseases among primary and secondary school learners in Kabwe District in Zambia.
 Method: A cross-sectional study of 41 primary and secondary schools in Kabwe District. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing, anterior segment and fundus examinations m visually impaired children.
 Results: There was an estimated total of 32,971 learners who were eligible to participate of which a total of23,915 (72.5%) were enrolled into the study. The prevalence of eye diseases was 8.3%, with allergic conjunctivitis 5.7% followed by refractive error 1.5% and the least was pengicular disorder at 0.008%. None of those with refractive errors had an eye examination in the past. Glaucoma was diagnosed in three learners (0.01 %).
 Conclusion: The survey found a moderate prevalence of eye diseases among the learners in Kabwe District with allergic conjunctivitis being the most prevalent cause followed by exceptionally low prevalence of refractive errors.

Prevalence of Eye Diseases among Primary and Secondary School Learners in Kabwe District - Zambia

Objective: To determine the pattern and magnitude of eye diseases among primary and secondary school learners in Kabwe District in Zambia.
 Method: A cross-sectional study of 41 primary and secondary schools in Kabwe District. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing, anterior segment and fundus examinations m visually impaired children.
 Results: There was an estimated total of 32,971 learners who were eligible to participate of which a total of23,915 (72.5%) were enrolled into the study. The prevalence of eye diseases was 8.3%, with allergic conjunctivitis 5.7% followed by refractive error 1.5% and the least was pengicular disorder at 0.008%. None of those with refractive errors had an eye examination in the past. Glaucoma was diagnosed in three learners (0.01 %).
 Conclusion: The survey found a moderate prevalence of eye diseases among the learners in Kabwe District with allergic conjunctivitis being the most prevalent cause followed by exceptionally low prevalence of refractive errors.

Does Vitamin- D Have A Relation to Diabetic Peripheral Neuropathy in Egyptian Type 2 Diabetes Mellitus Patients?

Objectives is to detect relation between vitamin D deficiency and increased risk of peripheral neuropathy in type 2 diabetes (DM). Methods The study included total number of 90 subjects; 60 cases with type 2 DM and was divided into two groups; one with peripheral neuropathy, the other group without peripheral neuropathy and 30 healthy subjects as control. All the included cases were subjected to full history taking, clinical examination (general and neurological), ocular fundus examination and laboratory investigations including Glomerular filtration rate (GFR), glycosylated hemoglobin (HbA1c), assessment of serum level of vitamin D was conducted to all cases. All the included subjects were examined to assess the degree of presence or absence of retinopathy. Results We found that HbA1c and hsCRP (high sensitivity C-reactive protein) level was statistically significantly higher in the T2DM with peripheral neuropathy group as compared with T2DM without peripheral neuropathy and control groups. The serum level of vitamin D was statistically significantly lower in those with peripheral neuropathy group in comparison to those without neuropathy and control groups. By multivariate regression analysis, DM duration, high values of HbA1c, urinary albumin/creatinine ratio (ACR), hs-CRP, systolic blood pressure (SBP) and decreased serum vitamin D levels were shown to be independent predictors for diabetic peripheral neuropathy. Conclusion Serum level of vitamin D was low in Egyptians Type 2 diabetes mellitus patients with neuropathy in comparison to those without

VASCULAR OR CARDIAC? DIFFERENT TARGET ORGAN DAMAGE IN HYPERTENSIVE PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE

Objective: The aim of our study was to evaluate different types of target organ damage (TOD) in hypertensive patients, with or without chronic kidney disease (CKD). Design and method: 90 hypertensive patients were enrolled from our Hypertension Center: 48 with normal renal function and 42 with CKD. We performed a complete echocardiographic study in all subjects in order to evaluate cardiac damage; non-mydriatic digital fundus oculi examination and carotid-femoral PWV to assess, respectively, small vessels and large arteries alterations. We considered Left Ventricular Mass index (LVMi) and h/r index to determine Left Ventricular Hypertrophy (LVH) or remodeling, Arteriolar-Venular Ratio (AVR) to evaluate retinal vessels and carotid-femoral PWV as a measure of arterial stiffness. Results: Both groups showed abnormal values of PWV, but significantly higher in CKD group (13.72 ± 1.3 vs 9.78 ± 0.491, p = 0.0166). Mean AVR values were abnormal only in CKD hypertensive, with a significant difference compared to simply hypertensive patients (0.75 ± 0.006 vs 0.84 ± 0.020, p = 0.0001). In the echocardiographic examination, no statistically significant alterations were found between the two groups (LVMi 118.04 ± 4.870 vs 113.42 ± 3.440, p = 0.123; h/r 0.42 ± 0.119 vs 0.44 ± 0.010, p = 0.454). Conclusions: Our results confirm that TOD is different in hypertensive patients with CKD. In these patients the target is essentially vascular, affecting either big and small vessels. Hypertensive patients without CKD showed a more typical cardiac TOD with an increase of left ventricular remodeling and hypertrophy. The assessment of vascular damage pays an essential role in TOD detection, so the use of PWV and the evaluation of retinal vessels should be always performed.

Magnitude of Prevelance of Refractive Errors in School-age Children: A Cross-sectional Study

Aim: To determine the frequency of refractive errors in school-age children.
 Study Design: Cross-sectional study.
 Place and duration: Two Government and two Private schools of Hyderabad Sindh, screened by the institute of ophthalmology at Liaquat University of Medical and Health Sciences Jamshoro, from January 2021 to June 2021.
 Methodology: Schools and students were selected by stratified random method; a total of four hundred students were screened in four schools. From class one to class ten, 10 students were selected from each class. Prior written permission was obtained from parents. External ocular examination, visual acuity, pinhole test, autorefraction, and fundus examination were done and recorded on proforma along with the information regarding age, sex, family history, and parent’s education. The data was entered and analyzed by SPSS version 22.
 Results: In government schools 27 students out of 200 had refractive errors, myopia was present in 15 (55.55%) students, hypermetropia in 7 (25.93%) students and astigmatism in 5 (18.52%) students, while in private schools 25 students had refractive errors. Myopia was present in 16 (64%) students, hypermetropia in 7 (28%) students and astigmatism in 2 (8%) students. Myopia and astigmatism were more prevalent in female sex being 8.1% and 2% respectively, while in males it was 6.4% and 1.4% cases. In this study, no significant refractive error difference was found between government and private sector schools.
 Conclusion: In our study, the prevalence of refractive errors was 13% (52) out of 400 students. Refractive errors are the most common and easily treatable causes of decreased vision in school-aged children. It is recommended that visual acuity be checked prior to admission to school because refractive errors can be easily corrected with glasses. If it is treated in time, the child can be prevented from amblyopia and squint.

Idiopathic Intracranial Hypertension: Description of an Atypical Case

Background: When dealing with severe and worsening headache with oculomotor dysfunction, it is necessary to take into account the possibility of idiopathic intracranial hypertension (IHH), though it is a rare condition. We present an atypical case of IHH in a 4-year-old patient with no apparent risk factors. Methods: IHH was diagnosed by exclusion, by ocular fundus examination, liquor cerebrospinalis examination, anatomical cerebral magnetic resonance imaging (MRI) and MR angiography (MRA). At the onset of symptoms, the patient was treated with a diuretic and steroid therapy. Results: After one year of medical therapy, we observed headache recurrence with positive ophalmological assessment and positive cerebral MRI. Medical treatment was deemed ineffective and it was necessary for the patient to undergo surgical intervention. Conclusion: We report a case of severe and chronic headache with oculomotor dysfunction in a young, pre-adolescent patient. This case is atypical because of the young age of the patient, and it being refractory to medical therapy. This case confirms that when dealing with severe headache in young patients, it is necessary to take into account any rare cause of symptomatic headache.

Retinal vein occlusion with cerebral infarction in a preterm neonate: a case report

BackgroundRetinal vein occlusion (RVO) is a common disease that causes blindness in elderly patients, and cerebral infarction is also a severe disorder impairing the health of individuals. Both diseases are not common in neonates and are related to thrombosis. To date, only one case of simultaneous occurrence of RVO with intracranial haemorrhage in a full-term neonate has been reported.Case presentationA preterm neonate was diagnosed with cerebral infarction and RVO. Retinal haemorrhage and macular oedema were detected in the left eye after the onset of ipsilateral stroke. Although the retinal conditions in this case resolved spontaneously without ocular treatment, the long-term effect on visual function is still unknown.ConclusionsGiven that ocular fundus examinations are rarely performed in paediatric stroke patients, a screening fundus examination in these newborns with stroke might be worth considering.

Macular Morpho-Functional and Visual Pathways Functional Assessment in Patients with Spinocerebellar Type 1 Ataxia with or without Neurological Signs.

Spinocerebellar ataxia type 1 (SCA-ATXN1) is an autosomal dominant, neurodegenerative disease, caused by CAG repeat expansion in the ataxin-1 gene (ATXN1). In isolated reports of patients with neurological signs [symptomatic patients (SP)], macular abnormalities have been described. However, no reports exist about macular anomalies in SCA1 subjects carrying the ATXN1 mutation without neurological signs [not symptomatic carriers (NSC)]. Therefore, the main aim of our work was to evaluate whether the macular functional and morphological abnormalities could be detectable in SP, genetically confirmed and with neurological signs, as well as in SCA-ATXN1-NSC, harboring pathogenic CAG expansion in ATXN1. In addition, we investigated whether the macular involvement could be associated or not to an impairment of RGCs and of their fibers and of the neural conduction along the visual pathways. Herein, nine SCA-ATXN1 subjects (6 SP and 3 NSC) underwent the following examinations: visual acuity and chromatic test assessments, fundus oculi (FO) examination, macular and peripapillary retinal nerve fiber layer thickness (RNFL-T) analysis by Spectral domain-Optical Coherence Tomography (Sd-OCT) acquisition, multifocal electroretinogram (mfERG), pattern reversal electroretinogram (PERG) and visual evoked potentials (VEP) recordings. In four eyes of two SP, visual acuity reduction and chromatic abnormalities were observed; in three of them FO changes associated with macular thinning and outer retinal defects were also detected. In three NSC eyes, slight FO abnormalities were associated with qualitative macular morphological changes. By contrast, abnormal mfERG responses (exclusively from foveal and parafoveal areas) were detected in all SP and NSC (18 eyes). No abnormalities of PERG values, RNFL-T, and VEP responses were found, but in one SP, presenting abnormal papillo-macular bundle neural conduction. Results from our SCA-ATXN1 cohort suggest that a macular dysfunction, detectable by mfERG recordings, may occur in the overt disorder, and unexpectedly in the stage of the disease in which there is still an absence of neurological signs. In NSC, an exclusive dysfunction of preganglionic macular elements can be observed, and this is associated with both normal RGCs function and neural conduction along the visual pathways.

Assessment of microvascular involvement in lupus nephritis patients by retinal OCT-angiography and kidney biopsies.

Ocular and renal microvascular damage in lupus nephritis (LN) share similar physiopathological pathways that have investigated using traditional fundus examination and high-resolution colour electroretinography. Optical coherence tomography angiography (OCTA) is a recent, non-invasive technique for imaging the microvasculature of retina and choroid. Aim of the study was to investigate through OCTA analysis the relationship between retinal microvascular alterations and renal functional and histologic features. Systemic lupus erythematosus (SLE) patients with LN, SLE without renal involvement and healthy controls were recruited and accomplished an ophthalmological evaluation, including OCTA. SLE-LN patients underwent a rheumatological evaluation, including disease-related clinical and laboratory features collection and kidney biopsy examination. This cross-sectional study enrolled forty-six eyes of 23 LN patients, thirty-two eyes of 16 SLE patients and forty-two eyes of 21 controls. Thirteen SLE-LN patients (56.5%) displayed lupus retinopathy, 10 at moderate (77%) and 3 at severe stage (23%) by fundus oculi examination. Analysis of OCTA data showed with high/moderate accuracy a reduction of retinal capillary vessel density in both SLE and SLE-LN patients compared to controls in superficial and deep plexi. A reduction in fovea thickness and an increase in foveal avascular zone were also detected. OCTA data of LN patients correlated with LN duration, disease activity, kidney function and the presence of LN-vascular lesions at kidney biopsy. Our results suggest the role of OCTA in early detection of systemic vascular involvement in SLE-LN patients and related kidney functional-histological impairment.

Retinal OCT Findings in Patients after COVID Infection

Purpose: The aim of this study was to assess and compare the optic nerve, retina, and retinal vessel parameters in recovered COVID-19 patients and healthy patients by using optical coherence tomography angiography (OCT-a). Methods: In all, 156 eyes of post-COVID-19 patients and 98 eyes of subjects from a control group were enrolled in our study. BCVA, intra ocular pressure (IOP) measurement, fundus examination, and OCT images, including macular cube, OCT-RNFL, and angio-OCT 6 × 6 mm examinations, were performed for both groups. The measurements were acquired using Swept Source OCT DRI OCT Triton. In the post-COVID-19 group, 762 OCT protocols were obtained. For statistical analysis, parameters from only one eye from each subject were taken. Results: In the measured parameters, no significant differences were observed, i.e., central macular thickness (p = 0.249); RNFL (p = 0.104); FAZ (p = 0.63); and vessel density of superficial retinal vascular plexus in central (p = 0.799), superior (p = 0.767), inferior (p = 0.526), nasal (p = 0.402), and temporal (p = 0.582) quadrants. Furthermore, a slit-lamp examination did not reveal any COVID-19-related abnormalities. Conclusion: OCT examination did not detect any significant changes in morphology or morphometry of the optic nerve, retina, or the retina vessels due to COVID-19.