Ocular Features Of Patients Research Articles

Ocular Manifestations of Acute Secondary Angle Closure Associated With Lens Subluxation.

Purpose:To evaluate the clinical characteristics and ocular features of patients with acute secondary angle closure, associated with lens subluxation (ASAC-LS).Methods:We performed a retrospective study at the EENT Hospital of Fudan University, Shanghai, China. A total of 41 affected eyes from 41 patients were enrolled in this study. Furthermore, 20 affected eyes were part of the ASAC-LS cohort and 21 affected eyes were included in the acute primary angle closure (APAC) cohort. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), minimum corneal curvature (K1), maximum corneal curvature (K2), and anterior chamber depth (ACD) were measured and compared between the 2 cohorts. In addition, inter-eye (intraindividual) comparison was performed.Results:The ASAC-LS cohort exhibited younger ages, more frequent trauma history (35%), lower IOP (27.43 ± 13.86 mmHg vs. 41.27 ± 10.36 mmHg), longer AL (23.96 ± 2.60 vs. 22.49 ± 0.77 mm), shallower ACD (1.28 ± 0.38 vs. 1.58 ± 0.23 mm), and bigger ACD differences (0.99 ± 0.52 vs. 0.15 ± 0.19 mm), as compared with the APAC cohort (all p < 0.05). Moreover, eyes from the lens subluxation cohort experienced worse BCVA, higher IOP, and shallower ACD than their matched unaffected eyes (all p < 0.05). Although longer AL, shallower ACD, and bigger ACD differences were strongly correlated with lens subluxation in a univariate logistic regression analysis, only the ACD difference remained significant in the multivariate model (p = 0.004, OR = 1,510.50). Additionally, according to the receiver operating characteristic (ROC) curve analysis, both ACD and ACD differences had greater value in the differential diagnosis of ASAC-LS and APAC, with a cut-off value of 1.4 and 0.63 mm, respectively.Conclusions:Shallower ACD and larger ACD differences provide the promising diagnostic potential for patients with ASAC-LS.

Inter-Eye Comparison in Highly Myopic Patients with Unilateral Myopic Traction Maculopathy

ABSTRACT Purpose To evaluate the risk factors for myopic traction maculopathy (MTM) through inter-eye comparisons of asymmetric ocular features in patients with unilateral MTM. Materials and Method Highly myopic patients with unilateral MTM were enrolled in the study. The results of comprehensive ophthalmologic examinations, color fundus images, and optical coherence tomography (OCT) were reviewed. MTM and myopic atrophic maculopathy was evaluated according to the ATN classification system. The status of the posterior vitreous detachment (PVD), posterior precortical vitreous pocket, vitreoretinal interface abnormalities, posterior staphyloma height (PSH), and the location of the protrusion of the sclera were assessed through OCT. Results Among the 54 eyes of 27 patients 48.89 ± 12.78 years of age, the affected eyes had worse best-corrected visual acuity, a longer axial length (AXL), greater PSH, and higher rates of posterior staphylomas, vitreovascular traction and epiretinal membranes (ERMs) than the fellow eyes (P < .001; P < .001; P < .001; P = .010; P = .002; P < .001). Thirteen cases present obvious anisometropia with an inter-eye AXL difference of more than 1 mm. In the 14 cases without obvious anisometropia, the eyes with MTM still had longer AXL, greater PSH and a higher ERMs rate than the fellow eyes (P = .039; P = .017; P = .001). Besides, in the 7 cases with an inter-eye AXL difference of less than 1 mm and asymmetrical stages of PVD, 5 cases with greater PVD in the affected eyes. Multiple risk factors coexisted in 96% of cases. Conclusions In patients with unilateral MTM, a longer AXL, greater PSH, posterior staphyloma, vitreovascular traction, and ERMs were the main factors contributing to the occurrence of MTM. The process of PVD might involve in MTM development.

Preclinical ocular features in patients with Behçet's disease detected by optical coherence tomography angiography.

The aim of this study was to evaluate the perifoveal and peripapillary microvascular structure in patients with Behçet's disease (BD) without clinically ocular involvement. Fifty-six eyes of 28 patients with Behçet's disease without clinically ocular involvement and 50 age-matched healthy eyes were included in this prospective study. Vessel densities (VD) of macula and optic nerve head, foveal avascular zone (FAZ), choroid capillary plexus (CCP) flow area, perifoveal capillary nonperfusion, capillary dilatation and/or telangiectasia and perifoveal capillary arcade disruption were analyzed with optical coherence tomography angiography (OCTA). The relationship between duration of disease and vessel densities was also evaluated. The FAZ was significantly higher in the BD group (p < 0.001). VD of the foveal and parafoveal region in deep capillary plexus (DCP) were significantly lower in the BD group than in the control group (p < 0.001, p < 0.001). Total disc, peripapillary and inside-disc VD were significantly lower in BD group (p = 0.001, p = 0.002, p = 0.004). Perifoveal morphological changes in DCP were significantly higher in nonocular BD (p < 0.001, p < 0.001, p < 0.001). There was a mild negative correlation between disease duration and whole VD in DCP, total disc VD, peripapillary VD was determined (For whole VD in DCP, r = -0.400, p = 0.035; for total disc VD r = -0.396, p = 0.037; for peripapillary VD r = -0.442, p = 0.018). Perifoveal and peripapillary microvascular changes that can be detected by OCTA may occur in Behçet's patients without clinically ocular involvement.

Role of scleral tectonic graft in saving the vision of a child with apert syndrome

Apert syndrome (AP) is a rare form of acrocehpalosyndactyly with autosomal-dominant transmission. The most common ocular features of patients with AP include proptosis, shallow orbits, and hypertelorism; they can have exotropia and antimongoloid slant of the palpebral fissures. The aim of this report was to study the role of scleral tectonic patch graft (STPG) in managing the corneal exposure due to AP. This was the clinical case report of a 9-year-old girl with AP, presented with right eye corneal perforation. She was treated with homologous STPG instead of tectonic corneal graft with good improvement of her visual acuity (VA). The outcome of the patient VA after 1 year was the improvement of the vision in the affected eye from the hand movement to 6/12, which was considered very satisfactory to the child and her family. This case report revealed that tectonic scleral patch graft is a sight-saving procedure in condition where the scleral tissue is readily available rather than the corneal tissue that needs the presence of cornel banks.

Factors Associated With Poor Response to Aflibercept After Switching From Ranibizumab or Bevacizumab in Neovascular Age-related Macular Degeneration.

The purpose of this study was to analyze demographic and ocular features of patients with age-related macular degeneration who failed aflibercept (Eylea; Regeneron, Tarrytown, NY) treatment after switching from ranibizumab (Lucentis; Genentech, South San Francisco, CA) or bevacizumab (Avastin; Genentech, South San Francisco, CA). Retrospective chart review of patients treated with aflibercept at the Byers Eye Institute from November 2011 to August 2014. Patient visual acuity was noted prior to aflibercept; after 1, 3, and 12 months; and on the most recent visit. Patients who improved vision after switching were compared to patients who lost vision. Demographic and imaging features were analyzed using univariate and multivariate statistics. Patients who lost vision had significantly higher BMI (P = .013, multivariate) and geographic atrophy (P = .0381, univariate; P = .1, multivariate) compared to patients who improved vision. BMI and geographic atrophy may be considered as potential indicators for poor response to aflibercept after switching from ranibizumab or bevacizumab. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:458-465.].

Risk factors for intra-operative complications during phacoemulsification performed by residents.

The purpose of this study was to determine the risk factors for occurrence of intra-operative complications during phacoemulsification performed by residents. One hundred fifty patients with cataract who underwent phacoemulsification by residents, with an experience of five or more phacoemulsification surgery, at a tertiary care centre were included in this study. The pre-operative data of these patients were collected from the hospital records. Surgeons were interviewed immediately after the surgery regarding the surgeon experience, phacoemulsification technique, machine factors, and intra-operative complications. Statistical analysis was done to determine pre-operative and intra-operative risk factors. The overall surgical complication rate in resident-performed phacoemulsification was 37% of which major and minor complications were 21 and 16%, respectively. Success in terms of placement of intraocular lens in capsular bag was 84%. The most common major and minor complications found were posterior capsular tear and irregular capsulorhexis, respectively. Systemic and ocular features of patients as well as type of machine (longitudinal versus torsional longitudinal) had no significant association in terms of complication rate. Increase in success rate was seen with increase in semester and number of surgeries performed. Patient factors including general physical condition, systemic diseases, and anatomical factors do not influence success in resident-performed phacoemulsification. With increase in semester of residents, there is a significant decrease in intra-operative complications. Minor complications in the beginning of case lead to increase in major complications later on during the case and decrease in success rate by junior-semester residents.

Cytokine Profiles in Tears Accompanying the Secondary Conjunctival Responses Induced by Nasal Allergy

Purpose/aim: Allergic conjunctivitis (AC) occurs either in a primary form, due to the allergic reaction localized in the conjunctivae or in a secondary form, induced by an allergic reaction initiated primarily in the nasal mucosa. The purpose of this study was to investigate the cytokine profiles in tears associated with the secondary conjunctival response (SCR) types.Materials and methods: In 47 AC patients developing 16 immediate (SICR; p < 0.01), 20 late (SLCR; p < 0.001) and 11 delayed (SDYCR; p < 0.05) responses to nasal provocation tests (NPTs) with allergens, the NPTs were repeated and combined with recording of cytokine concentrations in the tears.Results: The SCRs were associated with significant concentration changes of particular cytokines in tears (p < 0.05) as follows: (1): SICRs: interleukin (IL)-3, IL-4, IL-10 and granulocyte macrophage colony-stimulating factor (GM-CSF); (2) SLCRs: IL-3, IL-4, IL-5, IL-8, IL-10, IL-12p40, GM-CSF and granulocyte colony-stimulating factor (G-CSF); and (3) SDYCRs: IL-2, IL-8, IL-10, interferon gamma, G-CSF and tumor necrosis factor alpha. No significant cytokine changes were recorded in tears during the phosphate-buffered saline controls or negative SCRs.Conclusions: Different cytokine profiles in the tears accompanying the immediate, late and delayed types of SCR, induced by nasal allergy, would indicate involvement of different hypersensitivity mechanisms in the particular SCR types. The low cytokine concentrations in tears recorded during the SCRs may suggest their origin from the nasal mucosa. These results emphasize the diagnostic value of NPTs with allergens combined with monitoring of various ocular features in patients suffering from the secondary form of AC. These results may also have an impact on the therapeutical approach to this clinical entity.

Pattern of Ocular Findings in Patients with Biopsy-proven Sarcoidosis in Turkey

Purpose: To evaluate demographic, clinical, and ocular features of patients with sarcoidosis.Methods: The study involved 47 biopsy-proven sarcoidosis patients. Patients were divided into 2 groups; group 1 had uveitis and group 2 had no uveitis. Demographic and clinical features of groups were compared. Ocular manifestations in group 1 were also evaluated.Results: Twenty-six patients (53.3%) had uveitis. The incidence of uveitis was more frequent between ages 21 and 40. The most frequent type of uveitis was intermediate uveitis (46.1%), followed by panuveitis (38.4%) and anterior uveitis (15.3%). The incidence of advanced pulmonary disease was significantly higher in patients with uveitis.Conclusions: Intermediate uveitis was the most frequent type of uveitis noted in our series of patients with sarcoidosis.

Ocular Findings in Patients with Autoimmune Liver Disease

Purpose: This is a collaborative study from the ophthalmology and gastroenterology departments of a tertiary care hospital, designed to investigate the ocular features in patients with autoimmune liver disease (ALD).Methods: Seventy-two eyes of 36 patients with ALD, and 40 eyes of 20 controls with normal ocular findings were evaluated. Schirmer test, tear film break-up time, pachymetry, macular thickness with optic coherence tomography, and optic nerve head analysis with the HRT III were performed in addition to complete ophthalmologic examination.Results: Of the 36 patients, 31 were female (86.1%) and 5 were male (13.9%). The average age of patients was 47.7 ± 13.3 years (21–76 years). Autoimmune hepatitis in 22 patients (61.1%), primary biliary cirrhosis in 10 patients (27.8%), and primary sclerosing cholangitis in 4 patients (11.1%) were detected as etiologic causes. Cataract was seen more often in the study group. Tear film break-up time and Schirmer test results were significantly lower in the study group than in the controls. Other parameters were not different from control group.Conclusions: ALD showed a marked preponderance of females, with sex ratios of 6 females per male supportive to literature. The basal tear secretion and tear film stability are lower, and the dry eye symptoms are more common among the cases with ALD.

Demographic, Clinical, and Ocular Features in Patients with Late-onset Behçet Disease

Purpose: To evaluate demographic, clinical, and ocular features of patients with late-onset Behçet disease (BD).Methods: The study included 26 patients with late-onset BD. Onset of their first symptoms was before age 40. They fulfilled the diagnostic criteria after age 40. Patients were divided into 2 groups: group 1 had uveitis and group 2 had no uveitis. Clinical and demographic features of the groups were compared. Ocular manifestations in group 1 were also evaluated.Results: Fourteen patients (53.8%) had uveitis and 12 patients (46.2%) had no ocular involvement. The incidence of genital ulcer was higher in group 1. Twelve patients (18 eyes) had anterior uveitis and 2 patients (4 eyes) had panuveitis. The incidence of anterior uveitis was higher in females. The incidence of panuveitis was higher in males.Conclusions: As compared to potentially devastating posterior uveitis, anterior uveitis is more often encountered in patients with late-onset BD. Hence, with respect to ocular involvement, the prognosis is better.

Ocular manifestations in patients with mucopolysaccharidosis: what do we know and how can we treat?

The mucopolysaccharidoses (MPS) represent a group of inheritable lysosomal storage disorders characterized by a deficiency in enzymes involved in the degradation of glycosaminoglycans (GAGs). The accumulation of GAG deposits in organs and tissues in patients with MPS can lead to clinical manifestations such as coarse facial features, reduced growth, skeletal deformities, spinal cord compression and respiratory and cardiac problems. In many patients, GAG accumulation in ocular tissues leads to ocular manifestations, including corneal clouding, glaucoma, retinopathy and optic nerve swelling/atrophy, often resulting in significant visual impairment. The proceedings in this supplement of Clinical Experimental Ophthalmology provide the outcome of a meeting entitled ‘Mucopolysaccharidosis (MPS) and the eye: What do we know and how can we treat’, that was held on 7–9 October 2009 in Venice, Italy. This meeting was the very first opportunity for paediatricians specialized in MPS and ophthalmologists to present and discuss different aspects of ocular manifestations in patients with MPS. The first presentations provided an overview of the current knowledge on the anatomy and physiology of the eye, with focus on the different parts of the eye that are involved in the ocular manifestations seen in MPS, and discussed the genetic background of corneal diseases and the mechanisms of corneal transparency. These presentations served as a background for further talks focusing on ocular features in patients with MPS, their underlying pathology and the diagnosis and treatment of ocular features in these patients. The goals of this meeting were to understand better the pathology underlying ocular manifestations in patients with MPS, to formulate ideas for improving their condition and to discuss the potential benefit of current ocular therapies for MPS patients. The proceedings of this meeting intend to make ophthalmologists aware of the central role they may play in the early diagnosis and follow up of patients with MPS, and to provide state-of-the art information on ocular problems in patients with MPS for paediatricians managing these patients. The authors are grateful to Ismar Healthcare NV for their support with the organization of the meeting and their writing assistance for the supplement. This was funded by BioMarin Europe Ltd. BioMarin had no role in the content presented and discussed at the meeting and in the content of this supplement.

Ocular manifestations in the mucopolysaccharidoses – a review

AbstractOcular manifestations are very common in all types of mucopolysaccharidoses (MPS) and often lead to visual impairment. They arise as a result of the accumulation of glycosaminoglycans deposits in ocular tissues or secondary to increased intracranial pressure. Typical ocular features in MPS include corneal clouding, retinopathy, glaucoma, optic disc swelling, optic atrophy, and ocular motility and refractive error problems. This paper reviews the ocular features in patients with MPS, discusses the diagnosis of these ocular features and the diagnostic problems that may arise in patients (children) with MPS, and highlights the central role ophthalmologists may play in the diagnosis and follow‐up of these patients.

Late-onset Behçet’s disease: demographic, clinical, and ocular features

To evaluate the demographic, clinical, and ocular features of patients with Behçet's disease (BD) who had first symptom onset after 40 years of age and fulfilled the diagnostic criteria afterwards. This retrospective study included 42 patients with initial BD symptom onset after 40 years of age who fulfilled the diagnostic criteria afterwards, according to the International Study Group for BD. Patients were divided into two groups based on the presence of ocular involvement: group 1 had uveitis and group 2 did not have uveitis. The ocular characteristics of patients in group 1 were further examined according to age groups. Group 1A included patients between 40-50 years of age, and group 1B included patients older than 50 years of age. Clinical and demographic features of uveitic and non-uveitic patients were compared. Ocular manifestations, treatment protocols, and ocular complications in uveitic patients were noted. The ocular characteristics of group 1A and group 1B were further evaluated. Twenty-six patients (61.9%) had uveitis (group 1) and 16 (39.1%) had no uveitis (group 2). There was no significant difference between groups according to sex, age at initial admission, age at the time of initial symptom of BD, and period between initial symptom and the diagnosis of BD. The most frequent initial manifestation was oral ulcer in both groups. No statistical difference between the groups was detected with regard to the mean age of onset of each symptom. Anterior uveitis (73.1%) was the most frequent type of uveitis followed by panuveitis (19.2%) and sclerouveitis (7.7%). Uveitis was bilateral in 80.8% of patients. The incidence of anterior uveitis was higher in group 1B than in group 1A (P = 0.023). Cataract was the most common ocular complication, followed by macular edema sequelae, glaucoma, optic disc paleness, and branch retinal vein occlusion. Late-onset BD usually affects both genders equally, and the prognosis of ocular involvement is usually good. The incidence of panuveitis decreases as age increases, while the incidence of anterior uveitis increases. Ocular involvement is usually bilateral and there is no correlation between gender and uveitis type.

Ocular findings in childhood-onset Behçet disease

To investigate the demographic characteristics and ocular features of patients with childhood-onset Behçet disease. Patients for this retrospective study were selected using the data obtained from medical records of 34 patients with childhood-onset Behçet disease being followed up in the Uveitis Department of Ankara Ulucanlar Eye Education and Research Hospital between January 2003 and May 2008. Of 34 patients, 24 were boys (70.5%) and 10 were girls (29.4%). The average age of patients was 14.5 +/- 1.9 years (range, 10-16 years). Mean follow-up period was 4.5 +/- 2 years (range, 2-10 years). During the follow-up, panuveitis, posterior uveitis, and anterior uveitis were diagnosed in 18 (52.9%), 11 (32.3%), and 5 (14.7%) patients, respectively. Ocular findings included cataract in 20 patients (58.8%), posterior synechiae in 8 (23.5%), posterior capsular opacification secondary to cataract surgery in 8 (23.5%), vitreous condensation due to previous episodes of vitritis in 17 (50%), optic atrophy in 10 (29.4%), cystoid macular edema in 5 patients (14.7%), narrowed and occluded retinal vessels due to retinal periphlebitis and branched retinal vein occlusion in 2 (5.8%), neovascularization of the disk in 1 (2.9%), and phthisis bulbi in 1 patient (2.9%). Based on the results that were obtained in this series, panuveitis was the most common type of uveitis in cases with childhood-onset Behçet disease. Cataract was the most common anterior segment complication. Optic atrophy was the most common posterior segment complication. Male predominance was determined in this study.

Ocular features associated with anticardiolipin antibodies: A descriptive study

PURPOSE: To evaluate ocular features in patients presenting with inflammation in the presence of anticardiolipin antibodies. METHODS: A descriptive study of 13 patients presenting with idiopathic ocular inflammation involving anterior and posterior segment was performed. Patients were followed for a mean follow-up of 22 months (range, 1 to 125). A comprehensive report of ocular involvement, including visual symptoms, visual acuity, clinical characteristics, funduscopic and fluorangiographic features, was reported. Systemic associated symptoms were analyzed. Laboratory investigations included anticardiolipin antibody titers and isotypes, presence of other autoantibodies, and markers of immune system activation. RESULTS: The most common ocular symptom at presentation was blurred vision (eight patients) followed by redness and pain(three patients) and visual loss(two patients). Anterior segment abnormalities, including iritis (eight patients) scleritis (two patients) and filamentary keratitis (one patient), were present in 76% of patients, whereas the most represented feature of posterior involvement was retinal vasculitis (60%) followed by vitritis (38%), retinal detachment (15%), posterior scleritis (7%), and central retinal artery occlusion (7%). All patients had abnormal titers of anticardiolipin antibodies, predominantly IgG isotype; six had markers of immune system activation. CONCLUSIONS: Although posterior pole disease is more commonly associated with anticardiolipin antibodies, the anterior segment can also be involved with a wide spectrum of features. Scleritis has never been previously described as associated with anticardiolipin antibodies. Systemic symptoms are frequently present in association with ocular disease.