Ophthalmic Pathology Research Articles

PSS7 Real-World Analysis of the Pharmaco-Utilization of Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors and Healthcare Costs Among Patients with WET Age-Related Macular Degeneration (WAMD) in Italy

To analyse the pharmaco-utilization of VEGF inhibitors and healthcare costs among wAMD-patients in Italian real-world settings. This retrospective observational analysis was based on administrative databases of 2 regions and 3 Local Health Units in Italy, accounting approximately 6million health-assisted individuals. Patients were included during January/2010—December/2017, if they were ≥50 years old and presented a prescription for VEGF inhibitors (aflibercept/pegaptanib/ranibizumab) and/or i)discharge diagnosis (ICD-9-CM-code=362.52) for wAMD or ii)injections of vitreous substitute (procedural/specialistic code=14.75). Patients with injections of vitreous substitute presenting diabetes diagnosis, dexamethasone intravitreal implant or diagnosis for other ophthalmic pathologies with indications for intravitreal treatments were excluded. Patients were followed-up from index-date (corresponding to the first match with inclusion criteria) to December 2018. Pharmaco-utilization and cost analyses were performed only on alive patients prescribed VEGF inhibitors. Preliminary results showed that 1,287 wAMD-patients were included (51.6% male). Mean age±SD was 73.4±9.8. Patients’ distribution by age decades was: 10.7% in 50-59 age decade, 21.9% in 60-69, 38.2% in 70-79,29.2% ≥80 years old. Mean follow-up length was 4.0±2.1 years; during this time, 153 (11.9%) patients died. VEGF inhibitors were prescribed to 795 patients: 204 (25.7%) aflibercept, 14 (1.8%) pegaptanib, 577 (72.6%) ranibizumab. Mean number of VEGF inhibitor prescriptions decreased during follow-up: 3.6±2.0 (4.0±1.9 aflibercept, 3.6±2.1 pegaptanib, 3.4±2.0 ranibizumab) during 1st year, 1.1±1.9 (0.9±1.5 aflibercept, 0.4±0.9 pegaptanib, 1.2±2.0 ranibizumab) for 2nd year and 0.9±1.8 (0.1±0.5 aflibercept, none pegaptanib, 1.0±1.9 ranibizumab) for 3rd year. During 1st year of follow-up, mean healthcare costs were €6,075.88 for aflibercept-users, €7,737.70 for pegaptanib-users and €5,894.80 for ranibizumab-users. 72.3% of treatment costs per patient prescribed VEGF inhibitor was related to VEGF inhibitor therapies. Treatment costs were €3,545.09(aflibercept-users), €3,212.92(pegaptanib-users), €3,446.13(ranibizumab-users). VEGF inhibitors prescriptions were observed to decrease over time, suggesting a trend of under-treatment among wAMD-patients analysed that could ultimately lead to the worsening of clinical outcomes and higher consumption of healthcare resources.

Validation of the Newly Proposed World Health Organization Classification System for Conjunctival Melanocytic Intraepithelial Lesions: A Comparison with the C-MIN and PAM Classification Schemes

We sought to compare the sensitivity, specificity, accuracy, and interobserver agreement of the two most commonly used classification systems for conjunctival melanocytic intraepithelial lesions with the new World Health Organization (WHO) classification. Retrospective case series and evaluation of classification systems. We reviewed the pathology and medical records of all patients who underwent a primary biopsy procedure for conjunctival primary acquired melanosis (PAM) at Wills Eye Hospital between 1974 and 2002 who had ≥36months of follow-up. Data collected included age, sex, clinical findings, recurrence, and progression to melanoma. Twelve ophthalmic pathologists analyzed scanned hematoxylin and eosin-stained virtual microscopic slides using 3 classification systems: PAM, conjunctival melanocytic intraepithelial neoplasia, and the WHO 4th edition classification of conjunctival melanocytic intraepithelial lesions. Observer agreement, sensitivity, specificity, and diagnostic accuracy of each classification system were assessed. There were 64 patients who underwent 83 primary excisions with cryotherapy for conjunctival PAM who had adequate tissue for histopathologic evaluation. The interobserver agreement in distinction between the low- and high-grade lesions was 76% for PAM, 67% for conjunctival melanocytic intraepithelial neoplasia, and 81% for WHO classification system. Low-grade lesions provided the greatest interpretative challenge with all 3 classification systems. The 3 classification systems had comparable accuracy of 81%-83% in their ability to identify lesions with potential for recurrence. This study highlights the comparable strengths and limitations of the 3 classification systems for conjunctival melanocytic intraepithelial lesions and suggests that the simplified WHO classification scheme is appropriate for evaluation of these lesions.

Prenatal diagnosis of Norrie disease after whole exome sequencing of an affected proband during an ongoing pregnancy: a case report

BackgroundHereditary ophthalmic pathology is a genetically heterogeneous group of diseases that occur either as an isolated eye disorder or as a symptom of hereditary syndromes (chromosomal or monogenic). Thus, a diagnostic search in some cases of ophthalmic pathology can be time- and cost-consuming. The most challenging situation can arise when prenatal diagnosis is needed during an ongoing pregnancy.Case presentationA family was referred to the Research Centre for Medical Genetics (RCMG) for childbirth risk prognosis at 7–8 week of gestation because a previous child, a six-year-old boy, has congenital aniridia, glaucoma, retinal detachment, severe psychomotor delay, and lack of speech and has had several ophthalmic surgeries. The affected child had been previously tested for PAX6 mutations and 11p13 copy number variations, which revealed no changes. Considering the lack of pathogenic changes and precise diagnosis for the affected boy, NGS sequencing of clinically relevant genes was performed for the ongoing pregnancy; it revealed a novel hemizygous substitution NM_000266.3(NDP):c.385G > T, p.(Glu129*), in the NDP gene, which is associated with Norrie disease (OMIM #310600). Subsequent Sanger validation of the affected boy and his mother confirmed the identified substitution inherited in X-linked recessive mode. Amniotic fluid testing revealed the fetus was hemizygous for the variant and lead to the decision of the family to interrupt the pregnancy. Complications which developed during the termination of pregnancy required hysterectomy due to medical necessity.ConclusionsClinical polymorphism of hereditary ophthalmic pathology can severely complicate establishment of an exact diagnosis and make it time- and cost-consuming. NGS appears to be the method-of-choice in complicated cases, and this could substantially hasten the establishment of a diagnosis and genetic risk estimation.

EVALUATION OF MACULAR EDEMA USING OPTICAL COHERENCE TOMOGRAPHY IN DIABETIC PATIENTS AFTER PHACOEMULSIFICATION

Recent studies on cataract surgery in diabetics tend to report a lower incidence of complications and better visual outcomes due to better preoperative management of retinopathy, evolutions in operative techniques, better glycemic and hypertensive control, and better surgical technique of phacoemulsification. Diabetic patients with little or no retinopathy enjoy good visual prognosis similar to that in individuals without diabetes. It is important to differentiate diabetic macular edema (DME) from Pseudophakic cystoid macular edema (PCME), especially because people with diabetes are more prone to develop PCME. The aim of this work was to diagnose macular changes pre- and post-cataract surgery and to identify changes in central foveal thickness (CFT) using spectral domain optical coherence tomography (SD-OCT) relative to age, sex, and presence of concomitant ophthalmic pathologies in diabetic patients. A prospective, comparative, non-randomised cross sectional study was done on 50 eyes, subdivided into two main groups; group A involves 25 eyes of diabetic patients (Diabetic group) and group B involves 25 eyes of non-diabetic patients (control group). Both groups will be examined once before surgery and after 1, 3, and 6 month post-operative after obtaining an informed consent from participants and approval of the study by Alexandria University Ethical Committee. Evaluation of cystoid macular edema (CME) and visual outcome after phacoemulsification in patients with diabetes and its relation with oxidative stress along with other ailing factors will be of great use academically and clinically in modern ophthalmology.

A summary of 70 years' development of diagnostic techniques of ophthalmic pathology in China

With the development of medical science, new techniques and methods of ophthalmic pathology are constantly emerging, which has greatly promoted the advancement of ophthalmology. The Chinese Journal of Ophthalmology has witnessed the growth of ophthalmic pathology in China since its founding 70 years ago. This article reviews the development of diagnostic techniques of ophthalmic pathology in China and speculates their future direction.（ Chin J Ophthalmol， 2020， 56: 641-645）.

Gender characteristics of retinal parameters in patients with uncomplicated hypertension

Aim. To establish gender specificities of retinal arteriolar and venular diameters, foveal avascular zone (FAZ) area, subfoveal choroid thickness (SCT), and to determine their association with cardiovascular risk and prognosis in patients with uncomplicated hypertension (HTN).Material and methods. The study included 70 patients (56 males and 14 females) aged 45-59 years with stage I or II HTN. There were following exclusion criteria: diabetes, liver failure, clinically relevant ophthalmic pathology. We assessed routine hemodynamic parameters, biochemical profile, serum N-terminal procollagen-III peptide, urinary albumin-creatinine ratio, 24-hour urinary albumin excretion, retinal parameters. All patients underwent electrocardiography and echocardiography. Ten-year risk of fatal cardiovascular disease (SCORE) was estimated. Based on scanning laser ophthalmoscopy, central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using optical coherence tomography angiography, we determined FAZ area and SCT. Data processing was performed using StatSoft Statistica 10.Results. Hypertensive women were characterized by significantly larger FAZ area (p<0,001), CRVE (p=0,005), CRAE (p=0,012) compared with men. SCT values (p>0,05) were comparable. CRVE was associated with Cornell voltage product (r=0,3) in the male group. In women, age was negatively correlated with SCT (r=-0,54); SCORE value was inversely associated with SCT (r=-0,56), AVR (r=-0,53), CRAE (r=-0,3).Conclusion. In patients with uncomplicated HTN, the gender specificities of retina are manifested by a relative decrease of arteriolar diameters in males and a relative increase of venular diameters and FAZ in females. SCT decreases most clearly with age among hypertensive women. Men are characterized by a direct association of retinal venular diameters with a quantitative electrocardiographic marker of left ventricular hypertrophy. In women, there are an inverse association of SCT and arteriolar diameters with a ten-year risk of fatal cardiovascular disease.

Comparative Study of Corneal Thickness before and after FemtoLasik Surgery with Pentacam® AXL and Ultrasound Device (Tomey SP-100)

Aims: The purpose of our research is to evaluate corneal thickness, pre-operative and post-operatively after FemtoLasik surgery, using “Pentacam® AXL” and Ultrasound device. To evaluate the correlation of the two devices and their interchangeability.
 Sample and Study Design: Our data includes 70 eyes of patients, age 19- 59 years, who undergone Lasik surgery for myopia. The data concerned pre-operative and post-operative central corneal pachymetry using Ultrasound pachymeter (Tomey SP-100) and “Pentacam® AXL”.
 Methodology - Place and Duration of Study: University of West Attica Dept Biomedical Science Course Optics & Optometry in collaboration with Private Ophthalmology Clinic “Athens Opthalologiko” during the period between May 2018 until September 2018. In this study, a comparison of data taken with Pentacam and Ultrasound was performed concerning central corneal thickness before and after FemtoLasik to evaluate the correlation of these devices. All the FemtoLasik surgeries were performed by the same experienced surgeon in order to ensure good repeatability of surgical procedures and all the patients selected had healthy eyes with no other ophthalmic pathology or systemic disease and myopia ranging from -1.00 to 9.25 Diopters. All patients were measured one month after FemtoLasik having achieved 6/6 visual acuity.
 Results: Central corneal thickness before FemtoLasik measured by ultrasound device had an arithmetic mean value of 552.43 μm ± SD 26.95. The thickness preoperatively with “Pentacam” had an arithmetic mean value of 556.26 μm ± SD 27.82. The corneal thickness after Lasik measured by ultrasound device had an arithmetic mean value of 493.21μm ± SD 36.30, while for “Pentacam” the arithmetic mean value was 499.07μm ± SD 36.17. The two devices correlate strongly (0.9218 and 0.9986 respectively with significant level P<0,0001)
 Conclusion: Our conclusions after statistical analysis are that Ultrasound pachymetry and “Pentacam” topography correlated strong.

The relationship between the indicators of the retina condition and other target organ changes in uncomplicated essential hypertension

Background. Changes in retinal microcirculation are considered a subtle indicator of the other target organ damage in hypertension and might have prognostic value. Objective. To establish the relationship between diameters of retinal arterioles and venules, foveal avascular zone (FAZ) area, subfoveal choroid thickness with parameters of left heart and kidneys in middle-aged patients with essential hypertension (EH) stage I-II. Design and methods . A total of 115 people (86 males, 29 females) aged 45-59 years were examined and divided into 2 groups. The main group consisted of 70 patients with EH stage I or II. The control group comprised 45 normotensive practically healthy individuals. Patients with diabetes mellitus, impaired liver function, clinically significant ophthalmic pathology were not included. The following data were analyzed: anamnesis including smoking status; routine blood hemodynamic and biochemical parameters, serum procollagen III N-terminal propeptide (PIIINP); albumin-creatinine ratio in a single morning portion of urine, diurnal albuminuria; parameters of 24-h ambulatory blood pressure monitoring; quantitative electrocardiography (ECG) markers of left ventricular hypertrophy; transthoracic echocardiography; fundus state. Based on the scanning laser ophthalmoscopy, the central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using the method of optical coherence tomography angiography, we determined the FAZ area and subfoveal choroid thickness. Statistical data were processed using the StatSoft Statistica 10. Results. Compared with normotensive individuals, patients with hypertension were characterized by lower values of CRAE (p = 0,009), larger FAZ area (p = 0,019), and comparable values of CRVE, AVR, subfoveal choroid thickness (p > 0,05 for each indicator). Correlation analysis showed that in hypertensive AVR correlated with low-density lipoprotein cholesterol level (r = -0,3; p < 0,05); FAZ area with female gender (r = 0,42; p < 0,05); FAZ area with PIIINP level (r = 0,3; p < 0,05); FAZ area with diurnal albuminuria (r = 0,37; p < 0,05); CRVE with R wave amplitude in aVL lead of ECG (r = 0,31; p < 0,05); CRAE with left atrial volume index (r = -0,3; p < 0,05); subfoveal choroid thickness with age (r= -0,3; p = 0,01). Conclusions. Middle-aged patients with uncomplicated EH are characterized by the lower CRVE values and larger FAZ area compared to normotensive individuals. In EH stage I-II, retinal microcirculation parameters are associated with indicators reflecting the other target organ damage, in particular, the left atrial volume index, R wave amplitude in aVL lead of the standard ECG, diurnal albuminuria, and serum PIIINP concentration.

Sebaceous carcinoma of the eyelid: 21-year experience in a Nordic country.

To evaluate the clinical features, diagnostic challenges, management, and prognosis of sebaceous carcinoma (SC) of the eyelids and periocular region in a Nordic country. Patients were identified from the Finnish Cancer Registry and the Helsinki University Hospital databases during the 21-year period 1998-2018. Age, sex, location, clinical and histopathologic diagnosis, treatment and outcome were registered. Sebaceous carcinoma (SC) was diagnosed in 32 patients. The incidence was 0.6 per million. Median age at the time of histopathologic diagnosis was 74years, and 72% of patients were women. Diagnostic delay was often long, median 12months. The most common cause for delay was misdiagnosis (72%): a chalazion in 34% and a benign tumour in 22%. The most common location was the upper eyelid (53%) and tumour type a solitary nodule (94%). The SC was not correctly diagnosed in 12 (40%) of 30 preoperative biopsies. The treatment for 31 (97%) patients was complete surgical removal with reconstruction. Conjunctival intraepithelial growth was found in 50%. The leading postoperative problem was ocular irritation (30%). During a median follow-up of 58months, two patients (6%) experienced a local recurrence and one patient died from metastatic SC. The estimated incidence of SC in Finland was somewhat higher than in other Western countries. The diagnosis was often markedly delayed. Especially differentiation from chalazion continues to be essential. To improve outcomes, it is essential to inform the pathologist about the possibility of SC in eyelid biopsies and specimens and ideally submit them to an ophthalmic pathology service.

Ocular Examinations and Investigation of Intraocular Pressure, Tear Production, Central Corneal Thickness, and Corneal Touch Threshold in a Captive Flock of Atlantic Puffins (Fratercula arctica)

Ocular examinations were completed on a group of 10 Atlantic puffins (Fratercula arctica), 5 males and 5 females that ranged in age from 8 months to older than 30 years. The exams consisted of intraocular pressure/rebound tonometry, tear production/phenol red thread test, central corneal thickness/ultrasound pachymetry, and corneal sensitivity/esthesiometry. On ocular examination, there were no corneal abnormalities observed. Bilateral cataracts were diagnosed in 8 puffins, 6 of which were considered incipient, focal subcapsular opacities. One bird had hypermature cataracts and was removed from the study and excluded from data analysis; the other birds had no evidence of ophthalmic pathology that would interfere with diagnostic results (n = 9). All results for 9 birds were included in the study, with the exception of 1 puffin's tear production, which was too low for accurate assessment and was excluded from data analysis. There were no significant differences between right and left eye measurements for intraocular pressure, corneal thickness, and corneal sensitivity. The median intraocular pressure for both eyes (OU) was 13 mm Hg with an interquartile range [IQR] of 12-15 mm Hg. The median corneal thickness OU was 241 µm, IQR 233-248 µm. The median corneal sensitivity OU was 1.13 cm, IQR 0.81-1.50 cm. There was a significant difference between right and left eye measurements for tear production (right eye median, 7.5 mm/15 s, IQR 6.5-9.3 mm/15 s; and left eye median, 5.0 mm/15 s, IQR 4.0-7.3 mm/15 s) (P= .03), with the right eye producing more tears than the left. However, 1 puffin was determined to be an outlier, and when removed, there was no longer a significant difference (OU median, 7.0 mm/15 s, IQR 4.6-8.0 mm/15 s) (P = .38). There was no significant difference between sex and intraocular pressure, tear production, and corneal sensitivity. However, there was a significant difference between sex and corneal thickness (P = .02), with males (left eye median, 249 µm, IQR 241-249 µm) having thicker corneas than females (left eye median, 236 µm, 234-238 µm). Although sample size precluded statistical testing, there appeared to be an association between opacities and increasing age. There were no associations between age and intraocular pressure, tear production, or corneal thickness. There was a moderate correlation between age and corneal sensitivity, with older birds showing decreased corneal sensitivity (r = -0.57). Although the sample size of 9 birds was small, these findings provide preliminary ranges for ocular parameters of Atlantic puffins.

Microsaccades: Empirical Research and Methodological Advances - Introduction to Part 1 of the Thematic Special Issue.

Microsaccades: Empirical Research and Methodological Advances - Introduction to Part 1 of the Thematic Special Issue.

Regional factors of somatic pathologies in pregnant women and predelivery risk factors for retinopathy in premature infants of the Altai region

Despite progress in medicine, the number of preterm births as a result of the use of new reproductive technologies is increasing. Preterm birth is a multifactorial process. The success of neonatal resuscitation in nursing children with extremely low birth weight leads to an increase in the number of surviving children with various ophthalmic pathologies. Retinopathy in premature infants remains one of the urgent problems of pediatric ophthalmology, being one of the leading causes of blindness and low vision in preterm neonates. Premature retinopathy is a multifactorial disease, the incidence and severity of which are due to the influence of many risk factors that adversely affect the immature retina of a premature infant and lead to a violation of its normal vasculogenesis.&#x0D; Aim. To evaluate the state of health of pregnant women and the connection of this factor with the development of retinopathy among retinopathy prematurity in the Altai Region.&#x0D; Material and methods. To achieve this aim, statistical compendiums of the Demographic Yearbook in the Altai Region over an 11-year period (from 2005 to 2016) were analyzed, as were the medical histories of infants hospitalized inThe Altai Regional Clinical Childrens Hospital during the same period.&#x0D; Results. Statistically significant differences (p 0.05) in the incidence of hepatitis and diabetes were discovered. In addition, the most apparent variations, confirming the existence of prenatal risk factors leading to retinopathy in premature infants, were obtained on such indicators as anemia among pregnant women, fetoplacental deficiency, gestational toxicosis, pyelonephritis among pregnant women, and others.&#x0D; Сonclusions. We detected a significant number of somatic pathologies in pregnant women in the Altai Region, which was considerably higher than the average rates in the Russian Federation. The most remarkable antenatal risk factors for the birth of premature babies developing retinopathy of the premature were highlighted, and these should be taken into account when organizing prophylactic screening measures for the early identification of retinopathy of prematurity in the Altai Region.

Diagnostic significance of otorhinolaryngological and ophthalmic pathology in patients suffering from neurosyphilis infected with human immunodeficiency virus

It was found that eye damage can be considered as a marker of neurosyphilis. Similar data regarding the diagnostic value of damage to the ears, nose and throat in patients with syphilis infected with human immunodeficiency virus are single. It was revealed that neurological symptoms in patients suffering from neurosyphilis are equally common in patients infected with human immunodeficiency virus and those not infected with this virus (42,2 and 44,7%, respectively). In other cases, the disease is asymptomatic. At the same time, specific damage to the eyes, ears, nose and throat is diagnosed in 57,8% of patients with neurosyphilis infected with the human immunodeficiency virus. The structure of the specific damage to the ears, nose and throat in patients suffering from neurosyphilis infected with the human immunodeficiency virus is presented in 30,7% of cases with specific angina, in 15,3% - decrease in bone conduction, in 7,6% - hearing loss and in 46, 10% - other unspecified symptoms. The structure of the damage to the organ of vision was papillitis - 38,4%, anterior uveitis and panuveitis - 23,1 and 15,3%, respectively. Neuroveitis, retinal angiopathy, and peripheral chorioretinal dystrophy were equally common in 7,6%. For patients suffering from neurosyphilis infected with the human immunodeficiency virus, a combination of damage to the eyes, ears, nose and throat is characteristic. In particular, in one patient a combination of specific tonsillitis with papillitis was noted, in the other with uveitis. Thus, specific damage to the eyes, ears, nose and throat is characteristic of patients suffering from neurosyphilis infected with the human immunodeficiency virus.

Ocular Syphilis mimicking Acute Zonal Occult Outer Retinopathy (AZOOR)

Ocular syphilis can simulate various ophthalmic pathologies with multiple possible ophthalmic findings. Timely treatment of these patients can minimize visual damage, but its diagnosis is often a challenge for the ophthalmologist. We review a case report of a 45-year-old man with a rare and atypical clinical presentation of ocular syphilis, its clinical and imaging characteristics, its diagnosis, treatment and evolution. The patient presented with bilateral painless loss of vision, photopsia and peripheral scotomas with about 1 week evolution. There were no signs of ocular inflammation. The complementary ophthalmic study revealed an acute zonal occult outer retinopathy-like (AZOOR-like) presentation. Ocular syphilis does not always present with ocular inflammation and its presentation as AZOOR-like is very rare. So, we should always maintain a high index of suspicion for this condition, as early diagnosis and treatment are essential for a better prognosis.

Ophthalmic Pathology - Still the Gold Standard?

Ophthalmic pathology has a long tradition in Germany. And, like in general pathology, there is continuous progress due to new technologies and the improvement of molecular biology techniques. Ophthalmic pathology cannot be disregarded, particularly in the context of basic research but also as a medium for understanding pathophysiologic interrelationships and evaluating innovative surgical techniques. By means of various examples, the "four columns" of ophthalmic pathology shall be illustrated: diagnostics, clinicopathologic correlation, evaluation of new surgical and medical techniques and finally research. Ophthalmic pathology is not a discipline of the past but is rather one of the future. It develops and improves together with medical and ophthalmological progress and serves, at the same time, as a critical evaluation tool. Clinicopathologic correlations are of paramount importance for a lasting quality in ophthalmology, and we should not risk depriving ourselves of this instrument by carelessly saving at the wrong end and closing our laboratories. Ophthalmic pathology was, is and will further be the gold standard in many aspects of ophthalmology.

Diagnostic Criteria for Macular Edema Associated with Venous Occlusions

Background . Macular edema is considered as a risk factor for a significant decrease in the visual acuity and quality of life of the patient, regardless of its cause. The search for the causes of macular edema in some cases should include an interdisciplinary approach and laboratory studies to correctly determine its etiology and management tactics for such patients. Therefore, the differentiation of the etiology and pathogenesis of macular edema at the stage of diagnosis determines the possibility of preserving not only visual functions, but in some cases the patient's life. Aim : to present clinical cases of macular edema associated with central retinal vein thrombosis of various etiologies. Materials and methods . A prospective study of individual patients with macular edema associated with thrombosis of central retinal vein or its branches was conducted in real clinical practice. All patients underwent a standard ophthalmological examination, as well as optical coherence tomography, and a patient with suspected macroglobulinemia underwent a biochemical blood test. Results . In the first clinical case, macular edema was associated with an exudative form of retinal arterial macroaneurysm. The patient underwent direct laser coagulation of retinal arterial macroaneurysm. 6 months after direct laser coagulation of macroaneurysm, the best corrected visual acuity of the left eye was 1.0. The fundus - macroaneurysm, retinal edema, solid exudates are not ophthalmoscopic. In the second clinical case, macular edema, thrombosis of central retinal vein is associated with Waldenstrom disease. Follow-up and treatment of the underlying disease by a hematologist were recommended. Conclusion . Thus, macular edema proceeding against the background of central retinal vein thrombosis and its branches, having atypical symptoms in the form of ring-shaped deposition of hard exudates, exudative retinal detachment, the presence of a bilateral process, as well as resistance to anti-VEGF therapy require a careful collection of the patient's medical history and the presence of other ophthalmic vascular pathology.

Sífilis ocular imitando una retinopatía oculta externa zonal aguda (AZOOR)

Ocular syphilis can simulate various ophthalmic pathologies with multiple possible ophthalmic findings. Timely treatment of these patients can minimize visual damage, but its diagnosis is often a challenge for the ophthalmologist.We review a case report of a 45-year-old man with a rare and atypical clinical presentation of ocular syphilis, its clinical and imaging characteristics, its diagnosis, treatment and evolution. The patient presented with bilateral painless loss of vision, photopsia and peripheral scotomas with about 1 week evolution. There were no signs of ocular inflammation. The complementary ophthalmic study revealed an acute zonal occult outer retinopathy-like (“AZOOR-like”) presentation.Ocular syphilis does not always present with ocular inflammation and its presentation as “AZOOR-like” is very rare. So, we should always maintain a high index of suspicion for this condition, as early diagnosis and treatment are essential for a better prognosis.

Deep Learning in Pathology: Applications and Challenges in Ophthalmic Pathology

Deep learning has received increasing attention in recent years and is used in many different areas. Since image analysis is a strength of deep learning, it would be obvious to use it for histopathological questions too. Our goal is to identify possible deep learning approaches from general pathology which could be used in ophthalmic pathology. In addition, the data of the past year will be used to estimate the proportion of potentially interesting cases and the necessary technical effort. Firstly, a literature search for deep learning models and their possible applications in the field of pathology was carried out. In order to estimate the potential benefit, technical challenges and feasibility, the number of suitable ophthalmopathology cases in our lab in 2019 for the identified models was determined and put in relation to the resulting amount of data and the scanning time. We identified 7 areas of particular interest: determination of regions of interest (ROI), classification of histological images in scoring systems, mapping of tumor fractions, differentiation of different types of inflammation, differentiation of various cutaneous tumors, classification of lymphomas and prediction of patient outcome-based on tumor histology. Within one year, a total of 831 cases (43%) would have been suitable for the above models. The creation of whole slide images (WSI) for all histological cases would have required a storage capacity of 630 GB with a scanning time of 35 h. There are several deep learning approaches which are also interesting for ophthalmic pathology. Most of them would have to be specially trained for the ophthalmopathological aspects. To be able to apply deep learning approaches, it is necessary to have a good IT infrastructure with the possibility to create and permanently store WSI, and this seems to be technically feasible. Future studies should focus on the specific practical implementation of current deep learning possibilities for ophthalmic pathology.

Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures.

Methods Our center's database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery. Results In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D. Conclusions The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.

Optical Coherence Tomography with Angiography in the Analysis of Vitrectomy Effectiveness in Patients with Vitreomacular Traction Syndrome

Micro incision vitrectomy surgery with removal of epiretinal and internal limiting membranes is used for treating various forms of vitreomacular traction syndrome.Objective: to study the condition of retinal microcirculation using the OCTA method in the patients with traction maculopathy and macular ruptures before and after vitrectomy.Patients and Methods. The study included 160 patients, of which 55 had epiretinal fibrosis (Treatment 1), 60 had macular ruptures (Treatment 2), and 45 with no ophthalmic pathology (Control). Treatment 2 group included two subgroups: 2a — patients with large-diameter ruptures (over 800 μm) subject to inverted internal limiting membrane flap technique (n = 12), and 2b — patients with 430–800 μm ruptures subject to rapprochement of the rupture edges with a platelet mass technique. All patients underwent conventional ophthalmology examinations and optical coherence tomography angiography (OCTA) using Sirrus HD-OCT 5000, Carl Zeiss, Germany.Results. In the postoperative period, there was an improvement in retinal microcirculation in the Treatment 1 patients, and the values of both perfusion and vascular densities increased. A month later, an additional improvement of these indicators was recorded against the background of a decrease in retinal thickness and restoration of the vitreoretinal interface configuration. In the early postoperative period, Treatment 2 patients showed significant difference in the capillary density of the superficial vascular complex from the control group. A month later, the density of blood vessels in the Treatment 2 patients achieved control group values. Despite an immediate increase in perfusion measurements after surgical treatment, their values in a month were still lower than in the control group.Conclusions. In the patients with epiretinal membrane and macular ruptures, a statistically significant decrease in both vascular and perfusion densities of the surface capillary complex was revealed by OCTA. The effects of vitreoretinal surgery performed on Treatment 1 and 2 patients with macula traction pathology included increased visual acuity, decreased retinal thickness, and restoration of the proper vitreoretinal profile. Based on OCTA results, we discovered a gradual increase in vascular density of the macula in Treatment 1 and 2 patients after surgical treatment of VMT syndrome. Retinal perfusion in the macular region of Treatment 1 patients achieved the values of the control group within a month, while in Treatment 2 patients they increased, but remained lower than in control group. OCTA is a highly informative method for the diagnostics and monitoring of the eye posterior segment condition in the patients with VMT syndrome.