Ocular Fundus Examination Research Articles

Visual quality with corneo-scleral contact lenses after intracorneal ring segment (ICRS) implantation for keratoconus management

To evaluate the visual quality results when fitting a corneo-scleral contact lens (CScL) after intracorneal ring segment (ICRS) implantation for keratoconus management. Twenty-seven eyes of 27 patients with keratoconus underwent ICRS implantation and had CScL fitted as their visual quality was unsatisfactory with their spectacles or contact lenses. Patients received a complete eye examination, refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count, and visual quality assessment using contrast sensitivity and aberrometry tests. A diagnostic trial set was used in the fitting process, and patients were assessed according to a standardised methodology, including subjective visual quality and comfort, and contact lens usage time. The follow-up period was one year. After fitting CScL, log-MAR visual acuity values improved significantly in relation to the best spectacle-corrected vision (0.22 ± 0.17 vs 0.00 ± 0.12; p < 0.001). Total high-order aberrations decreased 33% (2.62 ± 1.31 vs 1.75 ± 1.81 μm; p < 0.009) and the spatial frequencies of contrast sensitivity all improved (all p < 0.05). Furthermore, 70.37% of patients reported high ratings of subjective visual quality (favourable and very favourable) and prolonged usage times (11.78 ± 3.93 h). After wearing CScL for one year, no adverse ocular effects or clinically relevant changes in corneal parameters, visual quality, comfort ratings or usage time were found. This CScL appears to be an alternative reasonable option for keratoconic eyes with ICRS placement, providing an improvement in subjective visual quality.

Ultrasound assessment of visual loss during severe preeclampsia: a case report

Bilateral retinal detachments and cortical blindness are rare complications of preeclampsia and the association of the two pathologies is exceptional. We report the case of a preeclamptic patient who presented with an acute bilateral vision loss. Besides, her ocular ultrasound revealed bilateral retinal detachments and an elevated optic nerve sheath diameter. The patient underwent an urgent cesarean section. Subsequently, magnetic resonance imaging and ocular fundus examination confirmed the diagnosis.

Visual quality with corneo-scleral contact lenses for keratoconus management.

To assess the visual quality achieved by fitting corneo-scleral contact lenses (CScL) for keratoconus management. Thirty patients with keratoconus presented to have CScL fitted because of the unsatisfactory visual quality they experienced with their contact lenses or spectacles. The eye examination included visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count, contrast sensitivity and aberrometry. The fitting process was performed using a diagnostic trial set. Subjective visual quality and comfort, and contact lens wear time were also reported. Patients were monitored for one year. Three patients discontinued CScL wear before one year. Therefore, 27 eyes of 27 patients (19 male and 8 female) participated in this study. The mean age was 36.1 ± 13.1 (mean ± SD) years. Statistically significant differences were found in logMAR visual acuity between the best spectacle-corrected vision and after CScL fitting (mean ± SD, 0.23 ± 0.30 and 0.00 ± 0.14, respectively; p < 0.001). The total high-order aberrations decreased significantly (55%), and the spatial frequencies of contrast sensitivity all improved to normal range values of the population. Furthermore, high subjective visual quality and comfort ratings, and prolonged usage times (mean ± SD, 13.44 ± 2.38 h a day) were reported. No adverse ocular effects or clinically relevant changes in corneal parameters, visual quality, comfort or usage time were found one year after wearing CScL. This CScL seems to be safe and healthy, providing optimal visual quality, comfort and prolonged usage times in patients with keratoconus.

CEFALIUM-INDUCED BILATERAL TRANSIENT MYOPIA, RETINAL FOLDS, AND FOCAL CHOROIDAL DELAY

To describe a case of acute bilateral transient myopia, retinal folds, and island of choroidal delay associated with oral administration of Cefalium, a medication commonly prescribed in Brazil for migraine that combines acetaminophen 500 mg, caffeine 40 mg, dihydroergotamine mesylate 1 mg, and metoclopramide hydrochloride 10 mg. A 21-year-old woman with bilateral blurred vision 1 day after the use of Cefalium. The main outcomes measures were BCVA, ocular fundus, ocular coherence tomography, and angiography findings. The patient developed bilateral myopia, retinal folds, and focus choroidal delay 1 day after the administration of oral cefalium. Ocular fundus examination and ocular coherence tomography revealed retinal folds in the internal surface of the retina. Angiography showed focus areas of hypofluorescence in both eyes. Seven days after Cefalium was suspended, all clinical symptoms had resolved, with full recovery from the abnormal findings on ocular fundus, ocular coherence tomography, and angiography. This is the first report that identified and described bilateral transient myopia, retinal folds, and focus choroidal delay secondary the use of Cefalium.

Effect of Automobile Travel Time Between Patients' Homes and Ophthalmologists' Offices on Screening for Diabetic Retinopathy.

The accessibility of ophthalmologists appears to influence the quality of screening for diabetic retinopathy (DR). The principal objective of this study was to analyze the effect of automobile travel time to the closest ophthalmologist on the time to DR screening. This historical cohort study used reimbursement databases from the principal national health insurance fund. Patients were included if they had been reimbursed at least thrice for oral antidiabetic medications in the 12 months before the study start date. Patients were followed up from January 1, 2008, for 4 years. The expected event was a DR screening by an ocular fundus examination. The automobile travel time to the nearest ophthalmologist was calculated by the distance between communes, estimated by appropriate software. A Kaplan-Meier curve and a multivariate Cox model were used to model the effect of travel time on the time until DR screening. A sensitivity analysis of travel time described the results of the Cox model. At the start of 2008, 6,573 patients living in 328 different municipalities were included. The multivariate model found that patients living 60 min or more away from an ophthalmologist had a lower instantaneous probability of DR screening than those living <30 min away (adjusted risk ratio = 0.82; 95% confidence interval 0.71-0.95; p = 0.009). The sensitivity analysis showed that this difference became significant at 35 min of travel time. Increased automobile travel time for patients with diabetes to the nearest ophthalmologist was associated with a longer time to DR screening.

Clinical efficacy of vitrectomy combined with internal limiting membrane tamping on macular hole and retinal detachment in high myopia

Objective To evaluate the safety and effectiveness of vitrectomy combined with internal limiting membrane (ILM) tamping on macular hole and retinal detachment (MHRD) in highly myopic eyes. Methods 23 patients (23 eyes) were retrospectively reviewed, who were diagnosed as MHRD through examination of the ocular fundus, optic coherence tomography (OCT) and B-mode ultrasonography. There were 5 males (5 eyes) and 18 females (18 eyes). The mean age was (62.35±8.28) years. The mean course of disease was 1.1 months. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) was 2.31±0.72. The mean axial length was (28.66±1.99) mm. All patients underwent 23G microincision vitrectomy. After vitreous gel and cortex were gently resected, the ILM around the edges of the macular hole was stained with indocyanine green, and was folded and pushed to fill the macular hole gently. Then silicone oil or C3F8 gas tamponade was applied in 18 eyes and 5 eyes, respectively. The silicone oil was removed after 3 months. The follow-up was 6 months. The BCVA, macular hole closure, retinal anatomical reattachment were retrospectively observed, and were used to evaluate the safety and effectiveness of the surgery. Results At the 6 months after surgery, the logMAR BCVA was improved to 1.13±0.38, the difference was significant (t=15.33, P=0.00). The postoperative macular hole closure rate and retinal anatomical reattachment rate were 100%. There were no ocular or systemic adverse events observed in all patients. Conclusion Vitrectomy combined with ILM tamping is an effective and safe treatment for the high myopic eyes with MHRD. Key words: Retinal perforations/surgery; Retinal detachment/surgery; Myopia, degenerative/complications; Vitreoretinal surgery

Comparison Study of Ocular Fundus Examination of Pediatric Patients Using the D-EYE device and Conventional Indirect Ophthalmoscopy (P5.200)

Comparison Study of Ocular Fundus Examination of Pediatric Patients Using the D-EYE device and Conventional Indirect Ophthalmoscopy (P5.200)

Effect on HBs antigen clearance of addition of pegylated interferon alfa-2a to nucleos(t)ide analogue therapy versus nucleos(t)ide analogue therapy alone in patients with HBe antigen-negative chronic hepatitis B and sustained undetectable plasma hepatitis B virus DNA: a randomised, controlled, open-label trial

Findings from uncontrolled studies suggest that addition of pegylated interferon in patients with HBe antigen (HBeAg)-negative chronic hepatitis B receiving nucleos(t)ide analogues with undetectable plasma hepatitis B virus (HBV) DNA might increase HBs antigen (HBsAg) clearance. We aimed to assess this strategy. In this randomised, controlled, open-label trial, we enrolled patients aged 18-75 years with HBeAg-negative chronic hepatitis B and documented negative HBV DNA while on stable nucleos(t)ide analogue regimens for at least 1 year from 30 hepatology tertiary care wards in France. Patients had to have an alanine aminotransferase concentration of less than or equal to five times the upper normal range, no hepatocellular carcinoma, and a serum α fetoprotein concentration of less than 50 ng/mL, normal dilated fundus oculi examination, and a negative pregnancy test in women. Patients with contraindications to pegylated interferon were not eligible. A centralised randomisation used computer-generated lists of random permuted blocks of four with stratification by HBsAg titres (< or ≥2·25 log10 IU/mL) to allocate patients (1:1) to receive a 48 week course of subcutaneous injections of 180 μg per week of pegylated interferon alfa-2a in addition to the nucleos(t)ide analogue regimen or to continue to receive nucleos(t)ide analogues only. The primary endpoint was HBsAg loss at week 96 by intention-to-treat analysis. This trial is closed and registered with ClinicalTrials.gov, number NCT01172392. Between Jan 20, 2011, and July 18, 2012, we randomly allocated 185 patients (92 [50%] to pegylated interferon and nucleos(t)ide analogues and 93 [50%] to nucleos(t)ide analogues alone). We excluded two patients from the pegylated interferon plus nucleos(t)ide analogues group from analyses because of withdrawal of consent (one patient) or violation of inclusion criteria (one patient). At week 96, loss of HBsAg was reported in seven (7·8%) of 90 patients in the pegylated interferon plus nucleos(t)ide analogues group versus three (3·2%) of 93 in the nucleos(t)ide analogues-alone group (difference 4·6% [95% CI -2·6 to 12·5]; p=0·15). 85 (94%) of 90 patients started pegylated interferon, three (4%) of whom had a dose reduction and 17 (20%) had an early discontinuation of pegylated interferon (seven [41%] for serious adverse events). Grade 3 and 4 adverse events were more frequent in the pegylated interferon plus nucleos(t)ide analogues group (26 [29%] grade 3 adverse events; 19 [21%] grade 4 adverse events) than in the nucleos(t)ide analogues-alone group (three [3%] grade 3; six [6%] grade 4). Addition of a 48 week course of pegylated interferon to nucleos(t)ide analogue therapy in patients with HBeAg-negative chronic hepatitis B with undetectable HBV DNA for a least 1 year was poorly tolerated and did not result in a significant increase of HBsAg clearance. Institut national de la santé et de la recherche médicale-Agence nationale de recherches sur le sida et les hépatites virales (France Recherche Nord&sud Sida-vih Hepatites).

Régression des fibres nerveuses rétiniennes myélinisées dans un cas de glaucome primitif à angle ouvert

Myelinated retinal nerve fibers observed rarely on ocular fundus examination, usually adjacent to the optic disc, are known to be stable throughout life. However, the possibility of rarefaction, and even disappearance, of these myelinated fibers has been pointed out in very rare cases of ocular or neuro-ophthalmological pathologies. We report such a regression, identified after a six-year period, in one case of primary open-angle glaucoma.

OP.8D.06] OCULAR FUNDUS PHOTOGRAPHY WITH A SMARTPHONE DEVICE IN ACUTE HYPERTENSION

Objective: The ocular fundus (FO) examination is infrequently and poorly performed in the emergency department (ED) clinical settings, placing patients at risk for missed diagnosis of hypertensive emergencies. Aim: to investigate the feasibility of the FO photography with a smartphone small optical device (D-Eye; J Ophtalmol. 2015) in a ED setting and to compare it to a traditional FO examination. Design and method: The study included 41 consecutive patients (mean age 69 ± 16 years, 50% women) presenting to an hospital ED with an acute increase in blood pressure (SBP >180 and/or DBP >100 mmHg). When admitted to the ED all patients had mydriatic FO examination obtained by an Emergency physician (EP) using both a traditional ophtalmoscope and a commercially available FO smartphone device (D-Eye, Si14 S.p.A., Padova). All FO images and videos recorded with the D-Eye system were analysed by 2 independent expert (ophthalmologist) and inexpert (EP) observers. A quantitative score of hemorrages, exudates and/or papillary edema was used (0 absent, 1 early, 2 moderate, 3 severe, 4 very severe). The Cohen K coefficient (Ki) was used to assess the inter-observer concordance index. Results: Six patients had headache, 6 had focal neurologic symptoms, and 4 had acute visual changes. The mean duration of FO examination was 130 ± 39 and 74 ± 31 seconds for traditional ophtalmoscopy and for smartphone D-Eye, respectively. No relevant abnormalities of their FO were detected by traditional ophthalmoscopy, performed by the EP, while a signifcant number of abnormal FO findings were detected by the use of the D-eye device in 17 and 19 patients by the EP and ophthalmologist, respectively. The Ki value ranged from 0,66 to 0,77 (good concordance) for the assessment of hemorrages and exudates, and from 0,89 to 0,90 (optimal concordance) for the evaluation of presence and severity of papilledema. Conclusions: Our results show that a new small smartphone device (D-Eye) may be feasible in an ED setting for the fundoscopic examination, detecting a signifcant number of abnormal FO. The reliability of relevant FO abnormalities seems to be superior in respect to traditional fundoscopy.

In vivo retinal and choroidal hypoxia imaging using a novel activatable hypoxia-selective near-infrared fluorescent probe.

Retinal hypoxia plays a crucial role in ocular neovascular diseases, such as diabetic retinopathy, retinopathy of prematurity, and retinal vascular occlusion. Fluorescein angiography is useful for identifying the hypoxia extent by detecting non-perfusion areas or neovascularization, but its ability to detect early stages of hypoxia is limited. Recently, in vivo fluorescent probes for detecting hypoxia have been developed; however, these have not been extensively applied in ophthalmology. We evaluated whether a novel donor-excited photo-induced electron transfer (d-PeT) system based on an activatable hypoxia-selective near-infrared fluorescent (NIRF) probe (GPU-327) responds to both mild and severe hypoxia in various ocular ischemic diseases animal models. The ocular fundus examination offers unique opportunities for direct observation of the retina through the transparent cornea and lens. After injection of GPU-327 in various ocular hypoxic diseases of mouse and rabbit models, NIRF imaging in the ocular fundus can be performed noninvasively and easily by using commercially available fundus cameras. To investigate the safety of GPU-327, electroretinograms were also recorded after GPU-327 and PBS injection. Fluorescence of GPU-327 increased under mild hypoxic conditions in vitro. GPU-327 also yielded excellent signal-to-noise ratio without washing out in vivo experiments. By using near-infrared region, GPU-327 enables imaging of deeper ischemia, such as choroidal circulation. Additionally, from an electroretinogram, GPU-327 did not cause neurotoxicity. GPU-327 identified hypoxic area both in vivo and in vitro.

Non-mydriatic fundus photography: a practical review for the neurologist

Declining proficiency in direct ophthalmoscopy by non-ophthalmologists has spurred a search for alternative methods of ocular fundus examination. Recent technological advances have improved the ease of use and quality of...

Role of agonistic autoantibodies against type-1 angiotensin II receptor in the pathogenesis of retinopathy in preeclampsia.

To investigate the mechanism underlying AT1-AA-induced retinopathy in severe preeclampsia by measuring the positive rate and titer of AT1-AA in plasma from women with severe preeclampsia and normal pregnant women to see whether AT1-AA titer was correlated with the grade of retinopathy. A preeclampsia rat model was also established by intravenous injection of AT1-AA extracted from the plasma of patient suffering from severe preeclampsia. The results showed that the plasma titer and positive rate of AT1-AA were significantly higher in women with severe preeclampsia than normal pregnant women. The antibody titer in cases of severe preeclampsia was associated with the grade of retinopathy, and positively correlated with the level of TNF-α and VEGF. The animal experiment results showed that the modeled rats presented symptoms very similar to symptoms of human preeclampsia, including retinopathy. Ocular fundus examination showed retinal microvascular abnormalities, hemorrhaging and leakage in the severe preeclampsia. Morphological changes included edema, thickening of the INL and ONL, and pigment atrophy. TNF-α and VEGF levels were increased in the vitreous humor and retina of the model rats. Our studies results suggest that abnormal expression of AT1-AA could induce damage to retinal capillary endothelial cells and increase vascular permeability, resulting in retinopathy.

The management of diabetic retinopathy in the public sector of eThekwini district of KwaZulu-Natal

Background: Estimates from the year 1990–2010 showed an increase in blindness and vision impairment (moderate or severe) because of diabetic retinopathy (DR) in Sub-Saharan Africa’s sub-regions (central, eastern, southern and western Africa).1 The rate of DR in South Africa is expected to increase because of the lack of screening protocols and policies for the management of diabetic eye disease in the district health system of South Africa. Aim: The purpose of this study was to determine the current role of healthcare practitioners (HCPs) towards managing DR in the eThekwini district of KwaZulu-Natal.Method: A cross-sectional study was conducted, and questionnaires were distributed to a total of 104 HCPs in public health institutions situated in the northern eThekwini district of KwaZulu-Natal. Clinics and community health centres (CHCs) were selected based on the assumption that primary healthcare nurses, medical officers (MOs) and ophthalmic nurses and/or optometrists practice at these institutions. The hospitals selected were the referral institutions for the selected clinics and CHCs. The questionnaires distributed included questions relating to diabetic patient registers, referrals to and from other HCPs, management of ocular complications, ocular screening methods, fundus examinations and involvement in screening programmes.Results: Over a third of the ophthalmologists (35.3%) indicated that DR was present at the initial examination in more than 50% of patients, though overall ophthalmologists reported loss of vision in at least one eye in fewer than 5% of patients on presentation. Less than half of the public sector general practitioners or MOs (40.6%) conducted fundus examinations but 90.6% did not dilate pupils, although 71.9% had knowledge on the use of a direct ophthalmoscope. Only 40.6% of the MOs discussed the ocular complications of uncontrolled diabetes mellitus (DM) with patients and 62.5% encouraged regular eye examinations. Less than 50% of the MOs (43.8%) referred patients complaining of visual difficulties to optometrists and 9.4% referred to the ophthalmic nurses. Only 6.25% referred patients with DM needing further evaluation to ophthalmologists. Data from the optometrists were inconclusive because of the poor response rate of 5 (20%). None of the ophthalmic nurses reported doing fundus photography or refractions. Two-thirds of the ophthalmic nurses were interested in training to properly grade DR.Conclusion: The study established that there are key challenges in referral, training and practice in the management of DR. These need to be addressed in order to develop a comprehensive approach for the prevention and management of visual impairment and blindness because of DM.

Vision disorders in the elderly

Visual impairment is one of the common problems in the elderly, and regular screening should be considered for early detection as well as prevention. This article describes some of the common causes of vision loss in older adults, including cataracts, age-related macular degeneration, ametropia (presbyopia) and diabetic retinopathy. Patients with senile cataract should be offered a manifest refraction in the early stage, and surgical treatments are indicated when their vision is less than or equal to 0.4. Prevention and treatment of age-related macular degeneration may be achieved through medication or dietary adjustment. Vascular endothelial growth factor can be used in the treatment of neovascularage-related macular degeneration. Patients with presbyopia are advised to obtain a manifest refraction. Patients with diabetic retinopathy should be regularly offered an ocular fundus examination and receive early treatment when necessary, with particular attention paid to glycaemic control. Key words: Vision, binocular; Cataract; Macular degeneration

Fascicular Visual Field Defects in Open-Angle Glaucoma: Evaluation with Microperimetry.

Purpose. Use of microperimetry (Mp-1), correlating with Humphrey perimetry (30-2 program), in patients affected by primary open-angle glaucoma (POAG) with perimetric defects, in order to obtain an evaluation of the accuracy of the results obtained by Mp-1. Materials and Methods. In this study 40 eyes of 25 patients affected by POAG with perimetric defects were included. All patients underwent microperimetry test by Nidek Mp-1 (NAVIS software version 1.7.2, Nidek Technologies). Mean sensitivity values expressed in decibel (dB) of all tested dots and mean values for each quadrant obtained by microperimetric test were correlated with corresponding quadrants obtained by static perimetry analysis. Data were analyzed by Pearson's correlation and Bland-Altman analysis. Results. Interpolated data showed that mean sensitivity values in all spots tested by Mp-1 (11.98 dB, SD 4.31) may be significantly correlated with mean total values obtained by Humphrey 30-2 perimetry (17.95, SD 4.32), with correlation coefficient of 0.556. Conclusions. Topographic visualization of the perimetric alteration by microperimetry allows retesting areas with reduced sensitivity which are topographically visualized and displayable on the ocular fundus examination, avoiding worsening of the functional defect by better modulation of the antiglaucoma therapy and therefore it allows better monitoring of the pathologic functional damage.

�Œdème papillaire revelant une malformation d’Arnold Chiari type 1: à propos d’un cas

La malformation d'Arnold Chiari de type 1 est définie par une hernie des tonsilles cérébelleuses dans le foramen magnum de plus de 5 mm. Les symptômes sont dominés par les céphalées surtout occipitales, les torticolis, et parfois des troubles de déglutition. Sur le plan ophtalmologique les anomalies de convergences, les paralysies oculomotrices et la diplopie sont les principaux signes cliniques retrouvés. Nous rapportons le cas d'un enfant de 9 ans, qui consulte pour une baisse d'acuité visuelle évoluant depuis 6 mois. L'examen ophtalmologique objective une acuité visuelle chiffrée à 4/10ème aux deux yeux. Une motilité oculaire conservée ainsi qu'un nystagmus rotatoire. L'examen du segment antérieur montre une mégalocornée, sans goniodysgénésie, un iridodonesis associé à une atrophie du muscle dilatateur, et une microcorie avec un reflex photo-moteur paresseux. Le tonus oculaire est correct à 14 mmHg. Le fond d'œil, malgré la difficulté de le réaliser, objective la présence d'un œdème papillaire bilatéral stade II. L'examen général retrouve un torticolis, une scoliose et un syndrome tétra-pyramidal. L'imagerie par résonance magnétique a mis en évidence une malformation de CHIARI type I, associée à une hydrocéphalie et une syringomyélie. Une intervention neurochirurgicale reposant sur une dérivation interne du LCR avec décompression ostéodurale cervico occipitale est proposée. L'évolution est favorable avec une régression des signes cliniques. Sur le plan ophtalmologique, on note une régression de l'œdème papillaire, mais l'acuité visuelle est restée stationnaire. La survenue d'un œdème papillaire est rare dans la malformation de Chiari type 1, il n'a été décrit que chez 2% des patients symptomatiques. Sa physiopathologie est encore mal élucidée. L'originalité de notre observation consiste en l'association de malformations cérébelleuses avec des malformations oculaires à type de mégalocornée et de microcorie rendant l'examen ophtalmologique encore plus difficile à réaliser.

Student attitudes regarding the educational value and welfare implications in the use of model eyes and live dogs in teaching practical fundus examination: evaluation of responses from 40 students.

This study sought to document student opinions on the educational value and welfare implications of use of artificial model eyes and live dogs in the training of veterinary students in examination of the canine fundus. Forty students who had undertaken a practical class on canine fundoscopy involving both use of artificial model eyes and live dogs were asked to complete a short questionnaire using a Likert scale to gauge their opinion on whether the use of live dogs and artificial eyes was very valuable (scoring 2), valuable (1), a neutral response (0), not particularly valuable (-1) or not at all valuable (-2) and to write a free text response on their views of the educational value and welfare implications of using artificial model eyes or live dogs in training for ophthalmic examination of the canine ocular fundus. Likert responses were 1.84±0.37 for using live greyhounds and 0.58±0.79 for using simulator eyes (p<0.0001). Thematic analysis of the written responses showed that while the artificial eyes were considered somewhat valuable in initial training, the live dogs were significantly preferred for their realism and the opportunity to examine the eye while handling a live animal. In conclusion, while model eyes are valuable initial training in use of the ophthalmoscope for funduscopic examination, students consider that examining the eye in the live dog is significantly more valuable and that the welfare of dogs thus used is not in their view unduly compromised.

Dengue-ocular manifestation and disease outcome

Dengue fever is one of the most common arthropod borne viral diseases. A myriad of ocular manifestations, ranging from mild subconjunctival hemorrhage to retinal hemorrhages and rarely to vision threatening complications such as optic neuropathy and panophthalmitis, have been reported. Therefore, this study was undertaken to document the ocular changes among dengue fever patients along with its association on further course of disease outcome and to study the ocular manifestations associated with dengue fever along with its association on further course of disease outcome. An observational Study was conducted in the Departments of Medicine and Ophthalmology, SRMS-IMS, Bareilly, U.P from September 2015 to November 2015 on 100 patients admitted. All patients underwent complete evaluation with respect to systemic and ophthalmic examination. Of 42 patients 10 patients with platelet counts b/w 35–50000 were found to have subconjunctival hemorrhage, rest other have platelet count below 35000. Retinal hemorrhage was not found in any patient having platelet counts above 25000 (at presentation or dropped during daily monitoring during hospital stay). All patient with subconjunctival hemorrhage must go for further ocular (fundus) examination. Retinal hemorrhage if detected early, may prove as a good marker that may further predict course of hemorrhagic complication in a dengue fever patient and also has correlation with platelet counts of patients.

PP.18.12

Objective: Cardiovascular (CV) diseases are the first mortality cause in patients with chronic kidney disease (CKD). Among several CV risk factors, vascular stiffness takes a primary role in those patients, and it seems essential to evaluate the arterial conditions in these subjects in order to better understand their CV risk. The aim of our study was to explore the relationship between arterial stiffness, evaluated using Pulse Wave Velocity (PWV), arteriolar narrowing of retinal vessels by the non-mydriatic digital fundus oculi examination and cardiac damage as Left Ventricular Hypertrophy (LVH) or remodeling by echocardiographic evaluation. Design and method: We studied 65 patients with CKD stage 2–4 NKF-KDOQI (mean age 69,12 ± 6,43, mean eGFR 32 ± 1,5 ml/min), after physical examination, anthropometric and biochemical measurements, every patient underwent office and 24 h ambulatory blood pressure (BP) and 2D color Doppler echocardiography. According to the presence (Group A) or the absence (Group B) of echocardiographic LV geometric alterations they were divided in two groups (LVH and LVR as defined in the current ESH guidelines). Then femoral PWV was measured by applanation tonometry to evaluate the big vessels damage and retinal study was performed to investigate the early retinal vessel changes. The obtained vessel images were analysed by a dedicated software, commonly used to calculate arteriolar-venular ratio (AVR) index of arteriolar narrowing. Results: Group A (34 patients) and B (31 patients) showed similar values of serum Creatinine (2.76 vs. 2.39 mg/dL, p = 0.25) 24 h systolic BP (132,4 vs. 133,2 mmHg, p = 0,65), diastolic BP (73 vs. 81 mmHg, p = 0.18), mean BP (95 vs. 99 mmHg, p = 0.7). and AVR (0,76 vs. 0,77 p = 0,51) Moreover, cfPWV resulted significantly higher in Group A than in Group B (15,245 vs 11.06 m/s p = 0.0002). Conclusions: Our study shows that in patients with CKD, cfPWV is correlated with LV geometric alterations. cfPWV is a standardized, reproducible and easy to obtain marker of large artery stiffening, and can be measured noninvasively. In these patients, in order to better stratificate CV risk, the evaluation of large and small vessels damage is useful and easy to perform.