General Ophthalmological Examination Research Articles

Subclinical structural atypicality of retinal thickness and its association with gray matter volume in the visual cortex of maltreated children

Childhood maltreatment is reportedly associated with atypical gray matter structures in the primary visual cortex (V1). This study explores the hypothesis that retinal structures, the sensory organs of vision, are associated with brain atypicality and child maltreatment and examines their interrelation. General ophthalmologic examinations, visual cognitive tasks, retinal imaging, and structural magnetic resonance imaging (MRI) were conducted in children and adolescents aged 9–18 years with maltreatment experiences (CM) and typically developing (TD) children. The retinal nerve fiber layer (RNFL), the most superficial of the ten distinct retinal layers, was found to be significantly thinner in both eyes in CM. While whole-brain analysis using Voxel-based morphometry revealed a significantly larger gray matter volume (GMV) in the thalamus in CM, no significant correlation with RNFL thickness was observed. However, based on region-of-interest analysis, a thinner RNFL was associated with a larger GMV in the right V1. Although it cannot be ruled out that this outcome resulted from maltreatment alone, CM demonstrated subclinical structural atypicality in the retina, which may also correlate with the immaturity of V1 development. Examination of retinal thickness offers a novel clinical approach to capturing characteristics associated with childhood maltreatment.

Alterations in Corneal Sensitivity, Staining and Biomechanics of Alopecia Areata Patients: Novel Findings in a Case-Control Study.

Background: A higher prevalence of ophthalmological alterations in systemic inflammatory diseases has been demonstrated. Objectives: Our objectives were to determine anterior segment findings and corneal properties in alopecia areata (AA). Methods: This is a case-control study. Severe AA patients (Severity of Alopecia Tool > 50%) and non-AA subjects underwent a general ophthalmological examination, a Pentacam and Corvis scheimpflug technology examination (Oculus Optikgeräte GmbH, Wetzlar, Germany). Visual acuity, refractive error, corneal aesthesiometry, and biomechanical and topographic variables were registered. Results: In total, 25 AA patients (50 eyes; 50.6 ± 8.1 years) and 29 controls (58 eyes; 49.4 ± 8.6 years) were included. AA patients had decreased corneal sensitivity, more corneal staining, and a more advanced cataract (p ≤ 0.004). The anterior topographic flat meridian, mean anterior keratometry, and maximum keratometric point were increased in AA (p ≤ 0.040), while pachymetry values were thinner (p ≤ 0.001). Keratoconus index and Belin/Ambrosio-enhanced ectasia total deviation display were increased (p ≤ 0.007). Two eyes with a topographic diagnosis of keratoconus and four eyes with subclinical keratoconus were detected in AA. Applanation lengths were smaller in AA (p ≤ 0.029). The Corvis Biomechanical Index was increased in AA (p = 0.022). Conclusions: AA patients have reduced corneal sensitivity and increased corneal staining. Topographic and biomechanical parameters are altered, and there could be a higher risk of keratoconus, thus possibly requiring routine ophthalmological examination.

Optical coherence tomography with angiography in the diagnosis of Alzheimer’s disease

BACKGROUND: Alzheimer’s disease is becoming increasingly common and the number of patients with dementia is steadily increasing. Existing diagnostic methods (neuropsychological testing, cerebrospinal fluid examination, magnetic resonance imaging, and positron emission tomography) are either subjective, inaccessible or invasive and expensive, therefore the search for new methods of Alzheimer’s disease diagnosis is necessary. The retina and the human brain share a common embryonic origin. The use of optical coherence tomography with angiography can help in the diagnosis of the disease, especially at an early stage.
 AIM: To perform a comparative analysis of the vascular density of the peripapillary region of the human retina with the severity of cognitive impairment and atrophic changes according to MRI in patients with Alzheimer’s disease.
 MATERIALS AND METHODS: Thirty patients participated in the study: 20 with Alzheimer’s disease and 10 in the control group. All patients underwent collection of complaints and history, general neurological and ophthalmological examination to evaluate inclusion and noninclusion criteria. Subsequently, neuropsychological testing, magnetic resonance imaging of the brain with assessment according to standardized neuroimaging scales, and optical coherence tomography with angiography according to a standard protocol were performed. The results were processed using the Statistica 10 software package (StatSoft, USA).
 RESULTS: Assessment of retinal microvascular bed condition in Alzheimer’s disease patients revealed a significant level of relative vascular density reduction in the upper half of radial peripapillary plexus of the retina due to reduction of small vessel density (p = 0.02). There was a direct correlation between the severity of the decrease in the FCSRT total score and changes in vascular density in the nasal sector of the retina (r = 0.52). There was a significant inverse relationship between vascular density in the temporal sector and the final GCA score for patients with Alzheimer’s disease (r = 0.57). The Fazekas scale score revealed an inverse correlation between its score and the vascular density in the upper retinal half and its upper sector (r = 0.53).
 CONCLUSION: Оptical coherence tomography with angiography is a highly informative and promising method for early, including pre-diagnosis of Alzheimer’s disease, which is considerably more accessible and accurate than other techniques.

Subclinical Ocular Changes after Intravitreal Injections of Different Anti-VEGF Agents for Neovascular Age-Related Macular Degeneration

Intraocular inflammations (IOIs) have been reported to occur after intravitreal injections of brolucizumab, and one of their causes has been suggested to be drug-specific features. We evaluated the anterior chamber by the aqueous flare value (AFV) and the retina by flicker electroretinography (ERG) after the initial intravitreal injection of aflibercept (IVA), brolucizumab (IVBr), or faricimab (IVF) for neovascular age-related macular degeneration (nAMD). The AFV and flicker ERGs were determined before, 2 weeks after, and 4 weeks after the injections in 14 eyes of 14 patients for each drug. After the injections, none of the patients had an IOI, but the AFV increased significantly in the IVA and IVF groups. The increase in the IVF group was +4.6 photon count/ms, which was significantly greater than in the other groups, but was not clinically significant. The implicit time was significantly prolonged in the IVBr group but unchanged in the IVA and IVF groups. These results suggest that brolucizumab, administered at high molar doses, may cause transient retinal disturbances that are not detectable by general ophthalmologic examinations but affect the implicit ERG times.

Preclinical safety evaluation of intradermal SARS-CoV-2 inactivated vaccine (Vero cells) administration in macaques.

Coronavirus disease 2019 (COVID-19) is an acute and highly pathogenic infectious disease in humans caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Six months after immunization with the SARS-CoV-2 vaccine, however, antibodies are almost depleted. Intradermal immunization could be a new way to solve the problem of nondurable antibody responses against SARS-CoV-2 or the poor immune protection against variant strains. We evaluated the preclinical safety of a SARS-CoV-2 vaccine for intradermal immunization in rhesus monkeys. The results showed that there were no obvious abnormalities in the general clinical condition, food intake, body weight or ophthalmologic examination except for a reaction at the local vaccination site. In the hematology examination, bone marrow imaging, serum biochemistry, and routine urine testing, the related indexes of each group fluctuated to different degrees after administration, but there was no dose-response or time-response correlation. The neutralization antibody and ELISpot results also showed that strong humoral and cellular immunity could be induced after vaccination, and the levels of neutralizing antibodies increased with certain dose- and time-response trends. The results of a repeated-administration toxicity test in rhesus monkeys intradermally inoculated with a SARS-CoV-2 inactivated vaccine showed good safety and immunogenicity.

Indications and Visual Outcome in Patients Undergoing Penetrating Keratoplasty

Background: Penetrating keratoplasty is commonly performed surgery in patients suffering from corneal blindness and visual impairment, where full thickness diseased cornea is replaced with healthy cornea. This study aims to outline indications of Penetrating keratoplasty and visual outcomes following the procedure.
 Materials and Methods: This retrospective, hospital-based study included 48 eyes of 48 subjects fulfilling inclusion criteria and underwent Penetrating keratoplasty from January 2017-2020 at Bharatpur Eye Hospital. General ophthalmologic examination was done preoperatively and postoperatively. Indication of the surgery along with demographic outline and requisite investigations were performed.
 Results: Mean age of the subjects was 47±1.83 years (13-74 years) where most of them were in 61-70years (23%) age group. Male subjects were more (62.5%) compared to females. Triple procedure was performed in 6.25 percent of patients. The most common indication was infective keratitis (52%) followed by corneal opacity/ scarring, regrafts, keratoconus and bullous keratopathy. Penetrating keratoplasty was performed slightly more for therapeutic purpose (52%) than optical. Intraoperative complications were observed in 16.7% of patients, positive vitreous pressure being the sole cause. Ameliorated visual acuity was observed in 71% of patients with43.75% of patients having VA of ≥3/60
 Conclusion: Infective keratitis was the predominant indication followed by corneal opacity/ scarring. Penetrating keratoplasty helps in maintaining integrity of the globe along with restoration of vision

Obsructive sleep apnea syndrome: is it a risk factor for ocular surface disease and ocular comorbidities?

To investigate the accompanying ocular findings in patients with obstructive sleep apnea syndrome (OSAS) and evaluate the susceptibility to ophthalmological diseases. In this cross-sectional study, qualifying study subjects were patients who had been diagnosed with severe OSAS (apnea/hypopnea index (AHI > 30/h), n = 31), and control subjects (n = 30) who had an AHI index of < 5 (as normal). General ophthalmological examination, eyelid laxity measurements, corneal topography, visual field, retinal nerve fiber layer parameters, dry eye tests were performed on the patients. It was observed that the two groups had similar characteristics in terms of gender, age, presence of hypertension, diabetes, and body mass index. According to eyelid laxity measurements, the incidence of loose eyelids was higher in the OSAS patient group. Choroidal thickness was thinner in the study group than in the control group. Schirmer test and tear break-up time were significantly lower in the study group than in the control group. The percentage of meibomian gland loss in meibography and the ocular surface disease index score for symptoms was significantly higher in the study group than in the control group. In this study, we found significant changes in ocular surface parameters, eyelid laxity, choroidal thickness, and visual field indices in OSAS patients. Dry eye syndrome might be related eyelid laxity and inflammation in OSAS patients. Early diagnosis and follow-up of ocular diseases in OSAS, which affect the quality of life and visual prognosis in advanced ages, are important.

Прогнозирование рефракционного сдвига при выполнении фототерапевтической кератэктомии на примере пациента с субэпителиальной муциновой дистрофией роговицы (клинический случай)

Purpose. To present the treatment results of a patient with subepithelial mucinous corneal dystrophy by phototherapeutic keratectomy (PTK) using the excimer-laser system WaveLight EX500 (Alcon, USA) taking into account the induced myopic refractive shift. Material and methods. Patient S., 67 years old, with subepithelial mucinous corneal dystrophy and compound hyperopic astigmatism of both eyes. To determine the possibility of surgical treatment, in addition to the general ophthalmological examination, there were performed: optical coherence tomography (OCT) of the cornea to evaluate the total corneal thickness and the opacity depth; Corneal topography to evaluate total corneal refractive power and maximal anterior refractive power. FTK calculations were made basing on OCT data considering clinical refraction. The follow-up period was 3 months. Results. As a result of treatment, the corneal transparency of both eyes was restored. The ablation of the left eye corneal stroma with the standard PTK protocol to a 90-micron depth caused an increase in the patient’s refractive power by 3.87 D in spherical equivalent, which led to excessive myopic refraction. When performing PTK on the right eye, decrease of the ablation depth to 80-micron, as well as the two-stage formation of the anterior corneal profile with the formation of its wider «base» and a smaller optical zone diameter led to less refractive power increase of 2.62 D in spherical equivalent, which caused an emmetropic refraction in this case. Conclusion. The presented clinical case shows that various protocols for PTK implementation in patients with superficial corneal opacities can make it possible to not only achieve corneal transparency, but also to control the refractive shift and to define the final clinical refraction. Keywords: corneal dystrophy, phototherapeutic keratectomy (PTK), refractive surgery.

Risk Factors Associated With Intraocular Lens Decentration After Cataract Surgery

To identify risk factors associated with intraocular lens (IOL) decentration after uneventful phacoemulsification with IOL implantation. A prospective cohort study. All patients underwent a general ophthalmologic examination. One month postoperatively, the magnitude and orientation of IOL decentration relative to the visual axis center were assessed using an OPD-Scan III aberrometer, and the vertical and horizontal decentration values were determined. Univariate and multivariate linear regression analyses were performed to evaluate the association between the IOL decentration and ocular biometric parameters. In total, 143 eyes of 143 patients were enrolled. The mean decentration magnitude was 0.27 ± 0.15 mm, and the decentration axis appeared at any orientation, with no orientation tendency. The horizontal and vertical decentration were -0.02 ± 0.22 mm and 0.01 ± 0.22 mm, respectively. Multivariate regression analysis showed that the white-to-white distance and the magnitude of angle α were positively associated with the decentration magnitude (P < .001, adj. R2=0.121), the horizontal angle κ and horizontal angle α were positively associated with the horizontal decentration (P < .001, adj. R2=0.209), and the anterior chamber depth and vertical angle κ were positively associated with the vertical decentration (P < .001, adj. R2=0.152). The IOL decentration magnitude was greater in patients with a larger white-to-white distance and a larger angle α, the horizontal decentration was greater in patients with a larger horizontal angle κ and a larger horizontal angle α, and the vertical decentration was greater in patients with a deeper anterior chamber depth and a larger vertical angle κ. In these patients, premium IOLs should be implanted cautiously.

The effect of isotretinoin on meibomian glands in eyes: a pilot study

The aim of this pilot study was to quantify the meibography changes in patients administered with oral isotretinoin. This prospective pilot study included 30 eyes of 30 patients who received oral isotretinoin treatment due to acne. Each patient underwent a general ophthalmological examination. After fluorescence staining of the ocular surface, the tear film break-up time (TFBUT) test, meibography and Schirmer test were carried out and noted. All of these procedures were applied before the treatment and repeated at 1, 3, and 6months after the treatment. The percentage of upper meibomian gland (MG) loss at 3 and 6months after the treatment was 22.2% (p = 0.001) and 23.6% (p = 0.001), respectively. The percentage of lower MG loss at 3 and 6months after the treatment was 18.7% (p = 0.001) and 20.7% (p = 0.001), respectively. The corneal fluorescein staining score at 3 and 6months after treatment was 0.57 (p = 0.001), and 0.47 (p = 0.012), respectively. These findings show that oral isotretionin treatment may affect MG morphology. The study findings also suggest that isotretinoin may cause tear film instability with Meibomian gland dysfunction and may cause evaporative type of dryness.

Distributions of crystalline lens tilt and decentration and associated factors in age-related cataract.

To investigate the characteristics and factors associated with crystalline lens tilt and decentration measured by CASIA2 anterior segment optical coherence tomography. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Cross-sectional study. 1097 eyes of 1097 patients who planned to undergo cataract surgery were enrolled. All patients underwent a general ophthalmologic examination. Lens thickness (LT), front curvature radius (FCR), back curvature radius, lens equator diameter (LED), tilt, and decentration of preoperative crystalline lenses were measured by CASIA2. Univariate and multivariate regression analyses were performed to evaluate the relationships between the tilt and decentration of crystalline lens with related factors. The natural crystalline lenses showed a mean tilt of 5.16 degrees toward the inferotemporal direction and a mean decentration of 0.22 mm toward the temporal direction. Of the total 1097 eyes, 119 eyes (10.85%) had a tilt greater than 7 degrees, and 89 eyes (8.11%) had a decentration more than 0.4 mm. Multivariate regression analysis showed that larger decentration, thicker LT, shorter axial length (AL), and FCR were associated with greater lens tilt (P < .001, P = .007, P = .006, and P = .003, respectively). In addition, greater tilt, older and thinner LT were correlated with larger decentration (all P < .001). Preoperative crystalline lens had a certain degree of tilt and decentration in age-related cataract. The greater tilt of the crystalline lens was, the larger decentration of it was. In addition, AL, FCR, LT, and age also correlated with tilt and decentration.

Kuru Göz Hastalarında Noninvaziv Değerlendirme: Gözyaşı Ozmolaritesi, Gözyaşı Menisküs Yüksekliği ve Noninvaziv Gözyaşı Kırılma Zamanının Diğer Testlerle İlişkisi

Objective: To determine the correlation of non-invasive tests with conventional tear function tests in dry eye patients. Material and Methods: One hundred and twenty-two eyes of 61 patients over 18 years old who applied to Çanakkale Onsekiz Mart University School of Medicine, Department of Ophthalmology with dry eye were included in the study. After general ophthalmological examination including best corrected visual acuity, biomicroscopic examination, non-invasive methods like Ocular Surface Disease Index (OSDI) scoring, tear osmolarity, non-invasive tear break-up time (NI-TBUT) measurement with Scheimpflug topography, meibomography, and measurement of the lower lid meniscus height (TMH) with optical coherence tomography were performed. After non-invasive tests, conventional tear function tests like Schirmer test, TBUT, cornea and conjunctiva staining were applied respectively. Results: A positive correlation was found between NI-TBUT and conventional TBUT (p<0.01 Spearman's rho: 0.473). TBUT was found to be positively correlated with Schirmer test and negatively correlated with corneoconjunctival staining (p<0.01 Spearman's rho: 0.393, rho:-0.418). Schirmer test results were correlated positively with TMH and negatively correlated with OSDI scoring and corneoconjunctival staining (p<0.05 Spearman's rho: 0.181; p<0.05 Spearman's rho:-0.214; p<0.01 Spearman's rho:- 0.394). Tear osmolarity test results and meibomography did not correlate with any test. Conclusion: The non-invasive and objective measurement of NI-TBUT may be a better diagnostic modality than TBUT for dry eye patients. Tear osmolarity and meibomography were not significant for diagnosis of early stage dry eye patients.

PUPILLOTONIA AND ADIE SYNDROME.

The aim of the work is to approach the examination of the pupil with afocus on anisocoria, its characteristics and approach to the diagnosis of pupillotonia and Adie&#39;ssyndrome and its clinical evaluation. Pupil function is important not only in neurophthalmological examination but also in general ophthalmological examination. First of all, we need to know how the reflex arc works in order to be able to exclude or confirm whether the parasympathetic or sympathetic is affected. It is also necessary to know the exact characteristics of the pupil, such as size, shape, placement, function and reaction to light and at close range. Only on this basis can we distinguish pathological features. We do not often encounter this diagnosis, but it is necessary to keep it in mind, especially in the field of neurophthalmology but also in general ophthalmology. We also present three cases of pupilotonia and Adie&#39;ssyndrome, which we diagnosed at the Department of Ophthalmology, Faculty of Medicine, Comenius University, after the patient himself came by emergency admission or was sent directly to ophthalmology clinic. In the discussion, we present various other diagnoses, where the reflex arc may not be affected, but the pathological pupil is caused by intraocular tumors, general systemic diseases and, last but not least, local therapy or alkaloids.

Characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery.

To analyze the characteristics and factors associated with intraocular lens (IOL) tilt and decentration after uneventful phacoemulsification with IOL implantation. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Cross-sectional study. All patients underwent a general ophthalmologic examination and anterior segment photography. IOL tilt and decentration were measured with a second-generation anterior segment optical coherence tomography (Casia2). Univariate and multivariate regression analyses were performed to assess the association between IOL tilt and decentration with ocular biometric and systemic parameters, and the visual acuity. A total of 196 eyes of 196 patients were enrolled in this study. IOLs showed a mean tilt of 4.8 degrees toward the inferotemporal direction, and the mean decentration was 0.21 mm. Both eyes presented a mirror symmetry relationship. Twenty-two eyes (11.22%) had a tilt greater than 7 degrees, and 21 eyes (10.72%) had a decentration more than 0.4 mm. Multivariate regression analysis showed previous pars plana vitrectomy (PPV) and short axial length (AL) were associated with greater IOL tilt (P = .014 and P < .001). In addition, long AL, thicker lens, and less capsulorhexis-IOL overlap were positively correlated with decentration (P < .001, P = .029, and P = .026). Corrected distance visual acuity did not directly correlate with IOL tilt and decentration (P = .417 and P = .550). PPV history and short AL were associated with greater IOL tilt, whereas longer AL, thicker lens, and overlarge capsulorhexis contribute to greater decentration. Implantation of toric and multifocal IOLs in these patients should be cautious.

Evaluation of Peripapillary and Subfoveal Choroid Thickness in Asymptomatic Carotid Artery Stenosis.

ObjectiveIn this study, it aims to investigate the effect of asymptomatic carotid artery stenosis on peripapillary and subfoveal choroid thickness using enhanced depth imaging optical coherence tomography.Patients and MethodsWhile investigating for coronary artery disease, 76 patients with asymptomatic carotid artery stenosis and 35 patients with normal carotid artery (total = 111) were evaluated. Patients according to the degree of stenosis were divided into four categories as non-stenosis (n = 35), mild (n = 26), moderate (n = 27) and severe stenosis (n = 23). Subfoveal and peripapillary choroid thickness, ocular perfusion and intraocular pressures of all patients were measured using a Fourier-domain optical coherence tomography after general ophthalmological examination. In addition, hypertension, hyperlipidemia, and whether there is a relationship between smoking status and choroid thickness was compared.ResultsAs the degree of carotid artery stenosis increased, subfoveal and peripapillary choroidal thickness decreased significantly. However, no changes were detected in ocular perfusion and intraocular pressure values (p=0.935, p=0.519). Decrease in peripapillary and subfoveal choroid thickness values was found to be particularly between the group with severe stenosis and the group with control and mild stenosis (p = 0.003, p = 0.001). In addition, as the degree of carotid stenosis increased in patients with hypertension and smoking, peripapillary choroid thickness was found to be thinner (p=0.003).ConclusionWe believe that the possibility of carotid artery stenosis should be considered in cases with decreased choroid thickness. In addition, we think that even if it is asymptomatic, in cases with severe carotid stenosis, in the presence of choroidal thinning, a chance of surgical intervention should be given to the stenosis.

The Prevalence of Visual Impairment in the Adult Population.

The distribution of visual impairment is an indicator of the health status of the population and for the frequency of diseases of the eye. The Gutenberg Health Study (GHS) is a population-based cohort study in Germany concerning adults aged 35 to 74. 15 010 subjects from the Mainz-Bingen region underwent general medical and ophthalmological examination, with measurement of the distance-corrected visual acuity in each eye separately. As per the World Health Organization criteria, visual impairment was defined as an acuity below 0.3 in the better eye, and blindness as an acuity below 0.05. All patients who were found to be visually impaired or blind underwent further individual study with clinical history-taking, split-lamp examination, and fundus photography. Data from 14 687 subjects were evaluated. The mean age of the partici- pants was 55.0 years (standard deviation, 11.1 years). The prevalence of visual im- pairment was 0.37% (95% confidence interval [0.28; 0.49]) (n = 55) and was higher in women (0.44%) than in men (0.31%). Blindness was present in 0.05% [0.03; 0.11] (n = 8) of the subjects. The prevalence of visual impairment from age 65 on- ward was 0.79%, three times higher than in the younger age groups. 54.5% of the visually impaired subjects had multiple underlying ophthalmological pathologies. The causes of visual impairment are manifold. Loss of vision is often the combined effect of multiple pathological factors. The etiology of visual impair- ment is thus a more complex matter than is commonly assumed.

The toxicological effect of 4-week repeated intravenous injection of activin a/BMP-2 chimera and 2-week recovery study in Beagle dog*

The purposes of this study was to determine the toxicological effect of repeated intravenous administration of Activin A/BMP-2 chimera (AB204) in beagle dogs for a long period of four weeks and evaluate two-week recovery. AB204 was administered at doses of 0.08, 0.16, or 0.32 mg/kg/day to three male and three female beagle dogs for 4 weeks as the experimental group. For the control group, sterile saline was administered to three male and three female beagle dogs. For the two-week recovery test, two male and two female beagle dogs were randomly selected from the control group and the 0.32 mg/kg/day administered experimental group. General symptoms, body weight, food consumption, ophthalmological examination, electrocardiogram, urinalysis, hematology and blood biochemistry, organ weights, autopsy, and histopathological examination were observed or conducted. No animals died. There was no significant difference in any parameter evaluated between the experimental group and the control group. Histopathological examination revealed compound inflammation at the administration site in both the experimental group and the control group. The inflammation disappeared during the two-week recovery. These results indicated that repetitive intravenous injection of AB204 in beagle dog for a long period of four weeks did not show any toxicity. Therefore, no observed adverse effects level (NOAEL) of AB204 was 0.32 mg/kg/day in big animal model.

Evaluation of Dry Eye Symptomatology at Patients with Keratoconus

The aim of this study was firstly to determine and quantify the dry eye symptomatology of patients with keratoconus, in comparison with those without this condition and secondly to evaluate the suitability of the spin probe method of electron paramagnetic resonance spectroscopy in analysis of tears secretion. As such were considered two groups of patients for evaluation: 36 cases with keratoconus (keratoconus group) and 36 cases without ocular disease (control group). Besides general ophthalmological examination we have conducted Schirmer test I, tears break-up time (BUT) and quantify the answers about dry eye symptomatology to establish ocular surface disease index (OSDI). We have included a prospective correlation of ophthalmologic parameters with parameters of the spin probes added in tear secretions collected from both groups of patients. The results show that the value of OSDI for patients with keratoconus was higher (41.07 � 23.68) than the corresponding value of the control group (14.63 � 9.27). Also, the patients with keratoconus present lower mean values for BUT and Schirmer tests comparatively with the cases from control group. The electron paramagnetic resonances spectra of the spin probe CAT16 in tear secretions obtained from patients revealed changes that can be related with ophthalmologic parameters.

The Pediatric Eye Examination for Pediatric Neurologists

The pediatric eye examination can be challenging but may provide important diagnostic information to the pediatric neurologist. Most of the examination can be accomplished with toys (visual fixation targets), a penlight, and a direct ophthalmoscope. The most important aspect of assessing the afferent system is visual acuity testing. Based on the patient's age, this may be accomplished by testing the child's response to light, a moving visual target, or a formal visual acuity chart. Evaluation of pupillary size and response to light is critical to assessing both the afferent and efferent visual systems. Other components of efferent testing include evaluation of extraocular motility and ocular alignment. General ophthalmologic examination is important to assess for ocular pathology that may accompany neurologic disorders in children. Referral to ophthalmology for further testing should be considered in any child with an abnormality on the pediatric eye examination.

Retinal thinning correlates with clinical severity in multiple system atrophy.

To analyze retinal thickness changes in multiple system atrophy (MSA) and correlate changes with disease severity and subtypes of MSA. A total of 36 MSA (27 MSA-P and 9 MSA-C) patients and 71 healthy control subjects underwent general ophthalmologic examination and optical coherence tomography (OCT) scans. Peripapillary retinal nerve fiber layer (RNFL) thickness and perifoveal retinal thickness were analyzed separately. The generalized estimating equation model was used with age as a covariate to adjust for within-patient inter-eye correlations and the effect of age on retinal or RNFL thickness. Correlation analysis between RNFL, perifoveal thickness, and clinical parameters, the Unified MSA Rating Scale (UMSARS) and Global Disability Score (GDS), was also done. MSA patients showed significantly decreased peripapillary RNFL thickness in the inferior (P=0.047) and inferotemporal (P=0.017) sectors and significant perifoveal thinning in the superior outer sector (P=0.042) compared to healthy controls. Both RNFL and perifoveal thinning were more marked and widespread in MSA-P than MSA-C patients. The UMSARS and GDS showed significant negative correlation with center and total macular perifoveal thickness and also the inferior and nasal outer sectors. Peripapillary RNFL and perifoveal retinal thinning were observed in MSA patients and retinal thinning correlated with the clinical severity of MSA. Structural changes in the retina may reflect the degree and pattern of neurodegeneration occurring in MSA.