Ophthalmological Investigation Research Articles

Macrophomina phaseolina: A Phytopathogen Associated with Human Ocular Infections—A Case Report of Endophthalmitis and Systematic Review of Human Infections

Background: Macrophomina phaseolina is an important phytopathogenic fungus affecting over 500 plant species worldwide. However, this fungus rarely causes disease in humans. Methods: We reported the first case of endophthalmitis due to M. phaseolina, describing microbiological diagnostic approaches. Also, we performed a systematic review of human infections by this plant pathogen in literature. We searched PubMed, Scopus, and Web of Science databases from inception to 31 December 2024. Results: Our case involved a male patient who presented with photophobia and pain in his right eye. His recent medical history revealed a superficial corneal injury caused by a metal burr three months prior, managed unsuccessfully by topical treatment and subsequent conjunctival flap surgery two months later. Ophthalmological and microbiological investigations, including microscopic examination, cultures, and DNA sequencing of ocular specimens, revealed M. phaseolina endophthalmitis. Despite intravenous and intravitreal antifungal therapy, the patient’s condition continued to worsen, eventually leading to enucleation. Regarding the literature review, we identified 12 additional cases of M. phaseolina human infections previously reported in literature. Overall, M. phaseolina was primarily associated with ocular infections (76.9% of cases), followed by skin infections and combined skin–joint infections. The majority of patients with M. phaseolina infection (63.6%) had no known immunosuppressive factors. Clinical outcomes were unfavorable in 46.15% of cases. Conclusions: M. phaseolina is an emerging cause of human infections, even in immunocompetent hosts, with a predilection for ocular infections. Further research is warranted to elucidate the pathogenesis of fungal infections caused by plant pathogens in humans.

Results of assessing the dynamics of ophthalmological complications in chronic kidney disease patients after kidney transplantation

Objective. The study objective was to investigate the dynamics of opthalmological complications in the non-diabetic end-stage chronic kidney disease in patients after kidney transplantation.Material and methods. A long-term observation was conducted to assess the changes in morphofunctional parameters of eyes in patients of the study group (after kidney transplantation, n=135 (269 eyes)) and the comparison group (continued on hemodialysis, n=81 (162 eyes)) over 18 months. Both general and specialized ophthalmological investigation methods were employed.Results. The observation showed a positive trend in patients after kidney transplantation, which was manifested by reduced corneal and conjunctival calcification. In the comparison group, both an increase and decrease in qualitative signs of retinopathy were seen as based on optical coherence tomography data, while in the study group, most retinopathy signs decreased, indicating a positive trend possibly brought about by the kidney transplantation. Analysis of optical coherence tomography quantitative parameters showed an improvement in central choroidal thickness and retinal nerve fiber layer thickness in the study group.Conclusion. Kidney transplantation in patients with the non-diabetic end-stage chronic kidney disease leads to a reduction in ophthalmological complications both in the anterior eye segment (reduced corneal and conjunctival calcification) and in its posterior segment (improved optical coherence tomography retinal parameters).

14-3-3 Eta protein as a novel biomarker in early detection of uveitis in Egyptian juvenile idiopathic arthritis and rheumatoid arthritis patients: Diagnostic and prognostic value.

Juvenile Idiopathic Arthritis (JIA) and Rheumatoid arthritis (RA) are autoimmune chronic inflammatory disorders of undetermined cause. Uveitis is one of the commonest and most dangerous extra-articular manifestations of JIA and RA presenting chronic anterior uveitis with non-specific biomarkers for its early detection. We evaluated the role of serum 14-3-3 Eta protein to assess its potential role as a novel biomarker for the early detection of uveitis in Egyptian JIA and RA patients as well as its correlation with disease activity. A case-control study included three patient groups: group I includes 42 JIA patients, group II includes 42 RA patients, and an equal number of apparently healthy individuals matched in sex and age for each group of patients as controls, recruited from the rheumatology outpatient clinic. All participants were subjected to clinical examination, laboratory investigations with assessment of serum levels of 14-3-3 Eta protein, and ophthalmologic investigations to assess disease activity, eye affection, and its relation to 14-3-3 Eta protein level, and other disease variables among those patients. a statistically significant difference was estimated between the two patients' groups and controls regarding 14-3-3 Eta protein level. 14-3-3 Eta protein has a significant positive correlation with disease activity in JIA and RA patients. Also, RA patients with clinical uveitis had higher levels of the 14-3-3 Eta protein, while there were no significant differences among JIA patients with or without uveitis. 14-3-3 Eta protein is a potential diagnostic biomarker in early detection of uveitis in RA patients, as it is higher in patients versus controls especially those with uveitis with a cut-off point 57.5, at which patients must have a thorough eye examination to receive early intervention and, to prevent complications, while it doesn't have the same role in JIA patients. 14-3-3 Eta protein is a potential diagnostic and prognostic marker for JIA and RA being correlated with disease activity.

Respiratory Chain Complex I Deficiency in Leber Hereditary Optic Neuropathy: Insights from Ophthalmologic and Molecular Investigations in Tunisia

BackgroundLeber hereditary optic neuropathy (LHON) is a mitochondrial DNA (mtDNA) rare disease due to the pathogenic variant of the NADH dehydrogenase enzyme. LHON is characterized by a sudden central vision loss due to focal degeneration of the retinal ganglion cell layer and optic nerve. Symptoms usually appear between the age of 18 and 35 years. Some individuals present the mtDNA mutations but not presented the LHON clinical features. The heteroplasmic or homoplasmic character of the mutations among patients explains why they develop the disease or not even though they carry the pathogenic variant.MethodsThis study was performed in collaboration with the department of ophthalmology of Farhat Hached Hospital, Sousse, Tunisia. Screening for the common mutations in Mt-ND1 gene (m.3460G > A), Mt-ND4 gene (m.11778G > A) and Mt-ND6 gene (m.14484T > C) was performed in five Tunisian families by standard RFLP PCR, followed by direct sequencing of the entire of these genes. Indeed, bioinformatics tools were used to predict the potential functional impact of the identified mutations on the Human mitochondrial respiratory complex I protein.Resultsone novel p.L601M (m.1413 C > A) and four previously reported mutations were identified in this study including: rs199476112G > A (m.11778G > A); rs202227543G > A (m.14258G > A); rs1603224763 (m.14510 dup) and NC_012920.1: m.3244G > C. In this present report, only one patient was found carrying the primary point mutation (m. 11778G > A). The ophthalmologic findings showing major fundus changes included hyperemic optic discs; disc pseudo-oedema and microangiopathy leading to optic disc atrophy. The analyses of the stability of protein upon identified mutations using DynaMut tool server demonstrated that these variations induce a rigidification in the region where they are located.ConclusionThis is the first Tunisian report of mtDNA mutations identified in Tunisia causing the LHON. The main factors involved in the pathophysiological mechanisms of this disease are genetic, epigenetic, hormonal and environmental influences.

Multiorgan manifestations of COL4A1 and COL4A2 variants and proposal for a clinical management protocol.

COL4A1/2 variants are associated with highly variable multiorgan manifestations. Depicting the whole clinical spectrum of COL4A1/2-related manifestations is challenging, and there is no consensus on management and preventative strategies. Based on a systematic review of current evidence on COL4A1/2-related disease, we developed a clinical questionnaire that we administered to 43 individuals from 23 distinct families carrying pathogenic variants. In this cohort, we extended ophthalmological and cardiological examinations to asymptomatic individuals and those with only limited or mild, often nonspecific, clinical signs commonly occurring in the general population (i.e., oligosymptomatic). The most frequent clinical findings emerging from both the literature review and the questionnaire included stroke (203/685, 29.6%), seizures or epilepsy (199/685, 29.0%), intellectual disability or developmental delay (168/685, 24.5%), porencephaly/schizencephaly (168/685, 24.5%), motor impairment (162/685, 23.6%), cataract (124/685, 18.1%), hematuria (63/685, 9.2%), and retinal arterial tortuosity (58/685, 8.5%). In oligosymptomatic and asymptomatic carriers, ophthalmological investigations detected retinal vascular tortuosity (5/13, 38.5%), dysgenesis of the anterior segment (4/13, 30.8%), and cataract (2/13, 15.4%), while cardiological investigations were unremarkable except for mild ascending aortic ectasia in 1/8 (12.5%). Our multimodal approach confirms highly variable penetrance and expressivity in COL4A1/2-related conditions, even at the intrafamilial level with neurological involvement being the most frequent and severe finding in both children and adults. We propose a protocol for prevention and management based on individualized risk estimation and periodic multiorgan evaluations.

Central retinal artery occlusion or retinal stroke: a neurosonologist's perspective.

In central retinal artery occlusion (CRAO) or retinal stroke, which is usually a vision-threatening condition, timely diagnosis is imperative to improve the chances of retinal preservation and to establish adequate secondary prevention measures. Even though retinal strokes have been traditionally assigned to the field of ophthalmology, while considering reperfusion therapy as the only way to avoid permanent vision loss, we suggest prompt evaluation of CRAO causes (primarily related to cardiovascular risk factors) performed by a well-organized interdisciplinary team (ophthalmologist and neurologist) in a neurovascular center with stroke expertise. Therefore, the most suitable adjunct method for rapidly diagnosing non-arteritic CRAO could be target transorbital ultrasound, performed by an experienced neurologist/neurosonologist in the stroke unit. Consequently, after an ophthalmological assessment, a final decision on thrombolytic therapy could be made. We accept that further research is obviously needed to determine whether transorbital ultrasound could replace ophthalmological investigation in the case of a suspected acute retinal stroke. We assert that retinal stroke requires interdisciplinary treatment in cooperation with neurologists and ophthalmologists, with an additive value for each to achieve the best results for the patient.

INTRAVENOUS METHYLPREDNISOLONE EFFECTS ON RECTUS MUSCLES IN THYROID EYE DISEASE

Introduction & Objective: Intravenous methylprednisolone has been used in management of Thyroid Eye Diseases (TED) which was an autoimmune inflammatory disease of the orbital tissues and the eyes. Previous study has shown benefits of intravenous methylprednisolone therapy on TED but there was need of quantitative measure to assess the effect of intravenous methylprednisolone therapy on extraocular rectus muscles. This study aimed to report the effect of high-dose intravenous methylprednisolone pulse therapy on inferior, medial, superior, and lateral rectus muscles and providing data distribution of active TED before and after therapy. Methods: Retrospective analyses were used in the data collection of patients with active Thyroid Eye Disease (TED) underwent high-dose intravenous methylprednisolone pulse therapy regiment 500mg every week for six consecutive weeks at Sardjito Eye Centre between January 2022 and December 2022. Ophthalmological investigation and quantitative computed tomography (CT) scan of the orbit were performed before and after methylprednisolone pulse therapy and demographics data were presented in tables and graphs. Results: This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. The mean thickness of Superior Rectus (SR) muscle before therapy were 4.12±2.20 mm and significantly decreased to 3.70±1.54 mm post therapy. There was no significant difference in delta mean Inferior Rectus (?IR) -0.18±1.69 (p=0.381), Medial Rectus (?MR) -0.34±1.68 (p=0.116), and Lateral Rectus (?LR) -0.33±1.94 (p=0.188) Conclusion: The treatment of Thyroid Eye Disease (TED) with high dose intravenous corticosteroid is safe and effective in reducing extraocular muscle tissue thickness with minimal side effects. Keywords: Thyroid Eye Disease, Extraocular Muscle, Intravenous Methylprednisolone Therapy.

INTRAVENOUS CORTICOSTEROID EFFECTS ON SUPERIOR AND INFERIOR RECTUS MUSCLE IN THYROID EYE DISEASE

Abstract
 Introduction & Objectives : Intravenous corticosteroid has been used in management of Thyroid Eye Diseases (TED) which was an autoimmune inflammatory disease of the orbital tissues and the eyes. Previous study has shown benefits of intravenous corticosteroid therapy on TED but there was need of quantitative measure to assess the effect of intravenous corticosteroid therapy on extraocular muscle. This study aimed to report the effect of high-dose intravenous corticosteroid pulse therapy on superior and inferior rectus muscle and providing data distribution of active TED before and after therapy
 Methods : Retrospective analyses were used in the data collection of patients with active TED underwent high- dose intravenous methylprednisolone pulse therapy regiment 500mg every week for six consecutive weeks at Sardjito Eye Centre between January and December 2022. Ophthalmological investigation and quantitative computed tomography (CT) scan of the orbit were performed before and after corticosteroid pulse therapy and demographics data were presented in tables and graphs
 Results : This study included 62 eyes of 31 patients (61,3% female) with mean age of 37.8±13.47 years old. The mean thickness of Superior Rectus (SR) muscle before therapy were 4.12±2.20 mm and decreased to 3.64±1.50 mm post therapy. The mean thickness of Inferior Rectus (IR) muscle before therapy were 4.45±1.80 mm and decreased to 4.26±1.63 mm post therapy. There was significant difference in mean ΔSR -0.47±1.84 mm (p=0.046) but not in ΔIR -0.18±1.69 (p=0.381)
 Conclusion : The treatment of Thyroid Eye Disease (TED) with high dose intravenous corticosteroid is safe and effective in reducing extraocular muscle tissue thickness with minimal side effects.

Evaluation of ocular and genetic findings in patients with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited disease affecting multiple organ systems and showing many different clinical symptoms. The severity of the disease varies from person to person and progresses gradually over the years. In this study, 17 NF1 patients who had a definite diagnosis were evaluated in terms of genetic, ophthalmological, and nervous system investigations. Approximately 5000 patients who visited medical genetics clinic between 2012 and 2022 are recorded in our archive. In 17 of these patients, a definitive genetic diagnosis was made. In the course of the study, the researchers collected some clinical parameters such as antenatal, intrapartum, and postpartum history and family history. In the family history, the researchers did a detailed pedigree with at least 3 generations of analysis, questioned parental kinship, looked for similar members in families, and identified inheritance patterns of the disorder. Peripheral venous blood samples were taken from the patients and sent to a commercial laboratory for gene panels or WES while the karyotyping was carried out in our laboratory. After obtaining the definitive genetic diagnosis of all patients, we compiled a table with the other parameters we questioned. This study presented the genotype and phenotype findings of NF1 patients. Ophthalmological symptoms in patients were also examined. These new-generation genetic disease diagnosis methods can be routinely used in clinical practice by medical geneticists. The diagnosis of a disease is one step ahead of its treatment. Because if the necessary diagnosis is not made, treatment of the disease is not possible. While this situation was more difficult in the past, nowadays, with the developing technology, diseases can be diagnosed more easily. In NF1 disease, more information can be obtained as a result of genetics, imaging, and examinations of other branches.

Ocular Manifestations in Head and Neck Cancer: A Cross-Sectional Study from a Tertiary Care Centre from South India.

Introduction: Head and neck cancers (HNCs) present a significant global health burden, especially in India, where oral cavity cancers, notably affecting the tongue, are prevalent. A substantial portion of global HNCs (57.5%) is concentrated in Asia, India contributing with 30%. Despite advancements, challenges persist due to HNCs' invasive nature and metastatic potential. This study aims to explore the link between HNCs and ocular manifestations. Methods: A cross-sectional study was conducted at Bangalore Medical College and Research Institute involving 47 patients with diagnosed HNCs and ocular complaints. Clinical evaluations encompassed visual acuity, anterior and posterior segment examinations, and specialized investigations when necessary. Results: A diverse range of malignancies were observed, with SCC maxilla and xeroderma pigmentosa, each accounting for 10.63% of cases. Ocular examinations unveiled visual acuity challenges, anterior segment findings like masses, exotropia, pigmented lesions, and varied fundus abnormalities. The anterior segment findings encompassed masses often accompanied by protrusion or relative afferent pupillary defect (RAPD). Additionally, exotropia, pigmented lesions, and other conditions were observed. Fundus examination revealed a spectrum of findings, including media haziness (10.63%), lack of view (17.02%), and pale discs (6.38%). Treatment plans were diverse, including excision biopsies (42.55%), exenteration procedures, Mitomycin-C applications, and referrals for chemotherapy and radiotherapy. Conclusion: The present study underscores the significance of ophthalmological assessment and investigations in patients with diagnosed HNCs, emphasizing the value of early detection and intervention. Abbreviations: HNC = Head and Neck Cancer, OCT = Optical Coherence Tomography, WNL = Within Normal Limits, SCC = Squamous Cell Carcinoma, MRI = Magnetic Resonance Imaging, CT = Computed Tomography, RAPD = Relative Afferent Pupillary Defect, XP = Xeroderma Pigmentosa.

Central retinal artery occlusion in a young child affected by COVID-19: a first case report

BackgroundCentral retinal artery occlusion (CRAO) is an ophthalmic emergency, and its etiology is generally ascribed to vessel occlusion by a thrombus or embolus, eventually due to a hypercoagulable state. CRAO occurrence is described even in the pediatric population, but its incidence is very rare. SARS-CoV-2 infection has a multitude of presentations, and almost any organ may be involved including the ocular district. Cases of CRAO in patients affected by COVID-19 are reported in the literature in the adult population, but not in the pediatric one.Case presentationWe describe the case of a six-year-old otherwise healthy girl, who presented a sudden and complete bilateral vision loss after a one-day fever. All the clinical, ophthalmological, laboratory and instrumental investigations led to the diagnosis of a right CRAO and the suspicion of a contralateral posterior optic nerve affection. These manifestations could not be ascribed to any etiological condition apart from the documented ongoing mild SARS-CoV-2 infection. Treatment with anticoagulants and steroids was tried but the visual outcome was poor during the one-month hospitalization and at the last follow-up.ConclusionsTo the best of our knowledge, this is the first report of CRAO in the course of SARS-CoV-2 infection in the pediatric age. In our review of the literature, we found few cases of CRAO in adults with COVID-19; we highlighted differences in anamnestic, clinical, and interventional aspects and therefore we tried to summarize the state of the art on this topic to facilitate further studies. Even if rare, the prognosis of CRAO is poor and the thrombolytic treatment could be effective only if rapidly administered, so the disease suspicion should be high in a patient with sudden vision loss, also in pediatric age.

Vogt-Koyanagi-Harada Disease Diagnosed in a Black-Skinned Woman in Internal Medicine

Introduction: Vogt-Koyanagi-Harada disease, initially described as an uveomeningoencephalitic syndrome, is a systemic granulomatous autoimmune disease that targets melanocyte-rich tissues, such as the eye, inner ear, meninges, skin and hair. It is one of the most prevalent causes of noninfectious uveitis affecting, more frequently, individuals of pigmented skin, such as Asians, Middle Easterners, Hispanics and Native Americans. However, it is very infrequent among persons of African descent. Here, we report on a case in a black-skinned woman in internal medicine. Clinical Observation: A 45-year-old Malian black-skinned woman with no history of ocular trauma or intraocular surgery presented at internal medicine outpatient clinic with 3-months history of achromic skin patches over the face and trunk, bilateral visual disturbance, bilateral hearing loss with tinnitus and headache. Dermatological examination revealed bilateral, symmetrical achromic lesions over the back, buttocks and eyelids, with scalp poliosis; and perioral pityriasis versicolor lesions. She had no alopecia or other dermatological lesions. Ophthalmological examination revealed a profound drop in visual acuity. Oto-rhino-laringologic examination revealed a discreet hearing loss. Ophthalmological investigations revealed bilateral posterior panuveitis on funduscopic examination, bilateral chronic iridocyclitis on slit- lamp examination, and bilateral choroidal thickening on ocular ultrasound. The diagnosis of Vogt-Koyanagi-Harada was retained, based on the diagnostic criteria established by the American Society for the Study of Uveitis (UAS) in 1978. Prednisone at a dose of 1.5 mg per kilogram tapering courses with adjuvant treatment was initiated. The ophthalmologist's prescription consisted of 1% atropine eye drops, 0.25% timoptol eye drops and dexamethasone eye drops which had been discontinued because of systemic cortitherapy; and that of the dermatologist, Hydrocortisone butyrate 0.1% cream, .......

BILATERAL PRIMARY OPTIC ATROPHY IN A PATIENT WITH HYDROCEPHALUS – A RARE CASE

Objective – To report the rare ophthalmological ndings in a patient diagnosed with hydrocephalus Material And Methods – We report the case of a 2yr old female child who presented with hydrocephalus. CT Brain was done which was suggestive of gross dilatation of both the lateral ventricles and fourth ventricle and thinning of the cortex was seen. A detailed ophthalmological evaluation was done which showed reduced ocular motility, lagophthalmos and right esotropia. Fundus examination showed bilateral primary optic atrophy with blurred margins of the optic disc. The Results – clinical history, detailed ophthalmological examination and investigations suggest that hydrocephalus and thinning of the cortex led to retrograde optic atrophy in this patient. Hydrocephalus and thinning of the cort Conclusion – ex led to retrograde optic atrophy. Due to high degree of thinning of the occipital lobe caused by hydrocephalus, we do not expect the patient's visual functions to develop in future. Awareness regarding consequences of untreated cases of hydrocephalus and screening for ophthalmological signs is important. Timely intervention can prevent progression of the disease and lead to improved quality of life in such patients.

The role of visual electrodiagnostics in management of children with neurofibromatosis type 1.

To evaluate the role of visual electrodiagnostic testing in children with neurofibromatosis type 1 (NF1) despite improved accessibility to magnetic resonance imaging (MRI). The records from 39 children (78 eyes, 15 boys, 24 girls, average age at last visit of 11.5 ± 4.3years, average follow-up time of 7.8 ± 3.9years) with genetically confirmed NF1 were retrospectively analysed. They all underwent a thorough ophthalmological investigation, including age-appropriate visual acuity testing, anterior segment evaluation for Lisch nodules and a dilated fundus examination. If children were cooperative enough, colour vision was tested using the Hardy-Rand-Rittler test, visual fields were evaluated with Goldmann perimetry. All performed MRI of the brain and orbits as part of the standard of care protocol. Visual electrodiagnostics included electroretinography (ERG) and visual evoked potentials (VEP) using a standard protocol in older children, whereas with less cooperative children a modified protocol according to the Great Ormond Street Hospital (GOSH protocol) was used. The average visual acuity was 0.8 ± 0.3, colour vision was abnormal in 6%, perimetry in 8%, Lisch nodules were present in 62%, and the optic disc was pale in 66% of all eyes. Plexiform neurofibroma of the eyelid/orbit was present in 4%. Optic pathway glioma (OPG) was detected with MRI in 22 (57%) and in 6/22 treatment was indicated. Other intracranial NF1-related lesions were documented in 70% of children. VEP were abnormal in 16/39 of all children with NF1 (41%) comprising 14/22 (65%) of children with confirmed OPG and 2/17 (12%) of children without OPG. All full-field and pattern ERG responses were within normal limits. All individual VEP results are described and three cases from this cohort of children are presented in detail to illustrate the importance of VEP testing. In Case 1, VEP abnormality suggested subsequent MRI of the brain under general anaesthesia, which was otherwise contraindicated according to normal clinical findings and his young age. In Cases 2 and 3, VEP provided more precise functional information during the follow-up of OPG, while other psychophysical tests remained unchanged. Electrodiagnostics has multifactorial role and importance in children with NF1, either when visual pathway function is impaired in young children, even before MRI under general anaesthesia and other psychophysical tests can be performed, as well as for a more precise monitoring of the visual pathway function before potential treatment of OPG, or after it, to evaluate its success.

Workplace Trauma with Massive Intraorbital Foreign Body, A Dramatic Outcome

Background: Intra-orbital foreign bodies [IOFB] are considered a rare condition, and an enormous challenge to surgeons, as it might be difficult to diagnose in some cases even with the current advances in imaging technology. Retained IOFB can be a cause of major visual morbidity and blindness, especially in the working population. Purpose: In this article, we report a case of IOFB that occurred as a result of workplace related trauma while drilling ceramic. Methods: Case report and literature review using PubMed. Case Presentation: we present a case of a 30 years old male, not known to have any medical illness, the patient presented to the emergency department after getting trauma while drilling ceramic. Orbital computed tomography [CT] showed multiple high-density objects situated in a circumferential pattern around the globe. Results: The patient underwent lateral canthotomy and cantholysis in the emergency department, followed by three exploratory operations to remove intraorbital foreign bodies [FBs] . Luckily, the patient in our case regained a 0.5 visual acuity, with an impressive improvement in the extraocular muscle motility, with only mild restriction in the upper and lower gazes. The patient was followed up for 2 years after the incident, he was stable during that period. Conclusions: IOFB is an ophthalmological emergency, careful history, examination, and investigations are important steps in diagnosing IOFB since it can be easily missed when depending solely on imaging. Timely management is crucial to prevent irreversible complications.

In vivo depth-resolved morphological analysis of compound eye dioptric system using full-field optical coherence tomography

Presence of a range of insects with different shape, size, and structural morphology of compound eye reveals the diverse pathways adopted by the nature striving to develop a flawless vision under given set of constraints. Exploration of various compound eyes allows researchers to understand better the various stages of visual system development in insects. By far, the most frequently used techniques for the investigation of structural morphology of a compound eye are scanning electron microscopy, transmission electron microscopy, microcomputed tomography, and histology. The nature of implementation of these techniques restricts in vivo studies, and also the requirements for a complicated and costly setup put limitations on its availability at small research facilities. Despite the widespread acceptance of the optical coherence tomography (OCT) as a standard tool for the various ophthalmological investigations, reports on compound eye study using OCT are uncommon. We demonstrate the application of a full-field OCT (FF-OCT) system for depth-resolved structural imaging and morphological analysis of the compound eye dioptric system. We report the application of a time-domain FF-OCT system for depth-resolved en face and three dimensional in vivo imaging of dragonfly’s prominent compound eye with resolutions of 2.8 and 7.2 μm in lateral and axial directions, respectively. The study shows the effectiveness of the FF-OCT approach for label-free and rapid structural morphology analysis of compound eyes. The results have been compared with the histology results reported in literature.

Evaluation of the visual system with visual evoked potential and optical coherence tomography in patients with idiopathic Parkinson's disease and withmultiple system atrophy.

In addition to motor findings, non-motor findings including alterations in visual acuity, decrease in blink reflex, and pupil reactivity cause the impaired quality of life in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). Our study aimed to examine possible latency and amplitude changes in pattern visual evoked potentials (pVEP) along with retinal and macular changes in optical coherence tomography (OCT) in PD and MSA groups. We also intended to investigate whether any OCT parameters could be a biomarker for Parkinson's or MSA. Our study included 50 patients with PD, 15 with MSA, and 50 healthy control subjects. All patients in the study underwent neurological and ophthalmological examination and investigations of OCT to measure the retinal and macular thickness and pVEP to assess visual pathways. When PD, MSA, and control groups were compared, a significant difference was found in all retinal thickness values in average, nasal, and superior retinal nerve fiber thickness (pRNFL), and in all macular thickness values except nasal outer and inferior outer quadrants and in ganglion cell complex (GCC) thicknesses (p < 0.05). Moreover, a significant difference was found in N75, P100, and N145 latencies and N75-P100 amplitude (p < 0.05). The thickness of both pRNFL, inner and outer macular quadrants, was thinner in the MSA group than in PD but GCC thickness was thinner in PD group. The present study compared pVEP and OCT parameters in PD and MSA groups. It was concluded that pVEP and OCT examinations were of importance in that they were easily accessible, affordable, noninvasive biomarkers that might be used in early periods and progression of the disease and in follow-up.

The prevalence, clinical profile, and visual outcome of optic neuritis in Hospital Kuala Lumpur: a Malaysian perspective

Purpose: To study the clinical presentation, visual outcome, and predictors for both recurrence and poor visual recovery among optic neuritis (ON) patients in the Malaysian population.Study design: Retrospective cohort study with longitudinal follow-up.Methods: A total of 113 patients from the neuro-ophthalmology clinic fulfilling optic neuritis inclusion criteria within 4 weeks of onset were included. The study was conducted from May 2015 to June 2018. Demographic data, clinical findings, ophthalmological investigation, serological investigation, and imaging results were documented and tabulated. Patients were followed up to 1 year to assess the visual outcome and evidence of retinal nerve fibre layer (RNFL) thinning. Significant associative factors for recurrence and poor visual outcomes were identified using multivariate analysis.Results: The age of the patients ranged from 13 to 71 years of age. The commonest age of presentation was 15–49 (67.3%) years of age. ON was predominant among Malays (65.5%), followed by Chinese (21.2%), and Indians (13.3%). The commonest form of ON was neuromyelitis optica spectrum disorder (NMOSD), which affected all ethnicities. Significant predictors for recurrence of ON were presentation within the 15–49 age group (p = 0.013) and presence of RNFL thinning following 1 year of treatment (p = 0.001). Indians had significantly lower odds of recurrence, 0.063 (p = 0.015). Significant variables associated with poor visual outcome &gt; 6/18 were poor presenting vision &gt; 6/18 (p &lt; 0.001) and evidence of RNFL thinning following 1 year of treatment (p = 0.003). Females had better visual prognosis (p = 0.005) than males.Conclusion: NMOSD was the commonest form of ON in our study population. The presenting age group of 15–49 along with the presence of RNFL thinning within 1 year of treatment were significantly associated with recurrence. Additionally, evidence of RNFL thinning and poor presenting vision &gt; 6/18 were associated with a poor visual outcome. This group of patients will require regular monitoring and early access to treatment.

Clinical and immunohistopathological study of conjunctival melanocytic lesions in pediatric and adolescent patients. A case series.

Background: Conjunctival pigmented neoplasia can be benign, premalignant or malignant tumors. Our study aims to establish the epidemiological, gross morphological and immunohistopathological features of the conjunctival pigmented lesions in pediatric and adolescent patients (<18 years), to establish an accurate diagnosis. Patients, Material and Methods: This is a retrospective case series study conducted within two Ophthalmology Clinics from Iaşi, Romania, on seven pediatric and adolescent patients. Using the Clinical Observation Chart and the Pathology Registers over a six-years period (January 2015–December 2021), we noted the patients’ demographic data, clinical data, and ophthalmological investigations of the lesion, as well as the type of their treatment. All histological sections stained with Hematoxylin–Eosin (HE) and with five antibodies [pan-cytokeratin (pan-CK) AE1/AE3, S100 protein, Melan A, human melanoma black 45 (HMB45), and Ki67] were re-examined by four pathologists for each case, to identify the type of the conjunctival lesion and its histological and immunohistochemical features. Results: The mean age of all patients was 10.28 years, and the female/male ratio was 1.3. Right eye was more often affected (71.42%). 71.42% of cases presented an elevated lesion, 57.14% of cases showed a lightly pigmented lesion, but 14.28% of cases exhibited a pink lesion and this feature described the inflamed juvenile conjunctival nevus. In all cases (100%) the conjunctival pigmented tumor was removed with safety margins. The microscopic examination revealed a compound melanocytic nevus in 57.14% cases, a junctional conjunctival nevus in 14.28% cases, an inflamed juvenile nevus in 14.28% cases, and a conjunctival melanoma arising from a pre-existing nevus in 14.28% cases. In all cases of nevi, the nevoid melanocytes showed strong immunopositivity for Melan A and S100 protein, variable and weak immunopositivity for HMB45, and a mean Ki67 labeling index of 1.71%. Conjunctival melanoma revealed strong immunopositivity of tumor cells for HMB45, Melan A and S100 protein, and a Ki67 labeling index of 20%. In all cases, the conjunctival epithelium showed strong immunopositivity for pan-CK AE1/AE3. All our cases (100%) had a favorable outcome after the surgical removal of the tumor. Conclusions: Any excision of a conjunctival pigmented lesion must be subject to a systematic immunohistopathological examination, and there is a set of antibodies (anti-HMB45 and anti-Ki67) that are useful for differential diagnosis between a conjunctival nevus and a conjunctival melanoma.

Retinal atrophy and markers of systemic and cerebrovascular severity in homozygous sickle cell disease.

While paramacular retinal atrophy (PRA) is known to be found in 48% of eyes of adults and 42% of eyes of children with homozygous SCD (SS-SCD), the aim of this study is to assess the association between PRA and red blood cell (RBC) deformability, hematological markers and brain imaging abnormalities in SS-SCD. This study is a subset of DREAM2, a prospective observational study performed between August 2015 and August 2016. Children (5-17 years) with SS-SCD and no history of large vessel vasculopathy, were included. Ophthalmological characteristics including visual acuity, fundus examination, OCT of central and temporal retina (with several retinal thickness measurements) were explored in relation with RBC deformability (ektacytometry), hematological and biochemical (hemolysis parameters), and neurological (cerebral oxygenation estimated by Near Infrared Spectroscopy, brain magnetic resonance imaging) investigations. 17 children (5 boys; mean age: 13 years) with complete ophthalmological investigations were included in the analysis; 8 exhibited PRA. RBC deformability was found to be significantly lower in children with PRA for measurements made at 1.69 Pa (0.16 a.u ± 0.02 vs 0.21 a.u ± 0.03, p = 0.02) and above, as well as cerebral oxygenation (59.25% ± 9.9 vs 71.53% ± 4.9, p = 0.02). A significant positive correlation was found between temporal retinal thickness and hemoglobin level (ρ = 0.65, p = 0.007), hematocrit (ρ = 0.53, p = 0.04) and RBC deformability at 3 Pa (ρ = 0.75, p = 0.005) and above. These results suggest that PRA could be an early marker of systemic severity and cerebral oxygenation in SCD. Whether it could help predicting cerebral vasculopathy requires further investigations.