Optical Coherence Tomogram Research Articles

Ocular hypertension in a child of acute lymphoblastic leukemia

Abstract To highlight the case of ocular hypertension in a 9-year-old male who came with fever and swelling in the left eye (LE) for 3 days. He was a known case of acute lymphoblastic leukemia (ALL) on treatment with oral steroids. His best-corrected vision was 6/6 in both eyes (BES). The anterior segment was normal in BES except for mild periorbital edema in the right eye (RE). On applanation tonometry (AT), intraocular pressure (IOP) was 42 mmHg in RE and 36 mmHg in LE. Gonioscopy showed open angles in BEs. Fundoscopy and optical coherence tomogram–retinal nerve fiber layer were normal in BES. He was diagnosed with steroid-induced ocular hypertension in BES and was started on both topical and oral antiglaucoma medications (AGMs). IOP was normal after 2 weeks of treatment. He came after a month of discontinuation of AGMs against medical advice but was still on oral steroids. He was asymptomatic, but his IOP was 28 mmHg in RE and 26 mmHg in LE. Parents were counseled about the disease and need to restart AGMs. Regular follow-up was also emphasized.

Комбинированный метод лечения рефрактерного диабетического макулярного отека

Purpose. To determine the effectiveness of the anatomical and functional results of treatment of refractory diabetic macular edema after removal of the inner limiting membrane using the latest generation anti-VEGF drug. Material and methods. We examined 6 patients with 1st type and 2nd type diabetes mellitus. The average age of the subjects was 47.45 ± 27.15 years. Of these, there were 4 women and 2 men. 1st type diabetes mellitus was detected in 2 people, in other patients — 2nd type. 3 patients had previously undergone pan-retinal photocoagulation (from 1st to 2nd stages). All patients received intravitreal injections (anti-VEGF) of Eylea (4–5 injections) during the last year. According to the optical coherence tomogram (OCT), macular edema was recorded, recurring on average after 1.36 ± 0.85 months. All patients underwent surgical treatment. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. A microinvasive subtotal vitrectomy was performed with the removal of the posterior layers of the vitreous body and proliferative membranes fixed to the retina. The removal of the inner boundary membrane was performed after its staining in the size of two to three diameters of the optic disc without any tamponade. After 2 months, two patients had an increase in retinal thickness in the fovea. These patients received one injection of Vabismo. Results. The compared groups did not differ in morphofunctional characteristics. In the postoperative period, there was a tendency to increase visual acuity and decrease retinal thickness, regression of hard exudates in 4 patients. In 2 patients, an increase in retinal thickness in the fovea was noted after 2 months. After intravitreal injection of the latest generation anti-VEGF drug (Vabismo), these patients also showed an increase in visual acuity, regression of solid exudates and a decrease in retinal thickness. Conclusion. Microinvasive subtotal vitrectomy with removal of the inner limiting membrane in combination with intravitreal injection of the latest generation anti-VEGF drug (Vabismo) is an effective method of treating refractory diabetic macular edema. Keywords: anti-VEGF, Vabismo, diabetic macular edema, intravitreal injections, optical coherence tomogram, subtotal vitrectomy, inner boundary membrane

Automated analysis of retinal microcirculation in type 1 diabetes mellitus

BACKGROUND: The paper is dedicated to the assessment of the retinal microvasculature in patients with type 1 diabetes mellitus (DM) with various features of the clinical course and different stages of diabetic retinopathy (DR). Automatic analysis of optical coherence tomogram angiograms (OCT-A) was carried out with specially developed software that provides the ability to estimate quantitative vascular parameters.AIM: The purpose of the study was to assess diagnostic accuracy of clinical parameters and imaging biomarkers in type 1 diabetes using a new algorithm for OCT-A analysis.MATERIALS AND METHODS: The study involved 186 people (365 eyes) with type 1 diabetes. The analysis of the OCT-A parameters was performed with a specially developed software. The range of studied parameters included: foveal avascular zone (FAZ), vessel area density (VAD), skeletonized vessel density (VSD), vessel diameter index (VDI), vascular curvature index (VCI) at the level of superficial (SCP) and deep (DCP) retinal capillary plexuses in the macular region. A correlation between the involvement of OCT-A biomarkers and age, degree of DM, increased glycated hemoglobin (HbA1c) level, stage of DR, and maximally corrected visual acuity (BCVA) was analysed.RESULTS: A significant dependence of all quantitative OCT-A parameters on the age of and duration of diabetes (p<0.05) was revealed. An increase in FAZ SCP (K=0.788, p=0) and DCP (K=0.764, p=0.03); decrease in VAD SCP (K=-0.476, p=0) and DCP (K=-0.485, p=0); VSD SCP (K=0.692, p=0) and DCP (K=0.713, p=0); an increase in VDI SCP (K=0.698, p=0) and DCP (K=787, p<0.01), as well as an increase in the VCI SCP (K=0.735, p=0) and DCP (K=0.694, p p=0). An inverse relationship was found between HbA1c level and VAD SCP (K=-0.636, p=0) and DCP (K=-0.619, p=0.05) were identified as well as a direct relationship with VDI DCP (K=0.717, p<0.05). The influence of the HbA1c level on other parameters was not confirmed (p>0.05). The presence of correlation between BCVA and FAZ DCP (K=-0.728, p=0), as well as VSD DCP (K=-0.754, p=0) was proved.CONCLUSION: As a result of a comprehensive analysis of clinical data and imaging biomarkers, a number of patterns that have diagnostic value in diabetic retinopathy were identified.

Clinical Features of Post Fever Retinitis and Visual Outcomes with Oral Corticosteroids: A Retrospective Study

Introduction: Post Fever Retinitis (PFR) is an infectious or parainfectious uveitis presenting with visual impairment after a fever episode. The condition can cause potential visual impairment in these patients. There is no national guideline for treatment of PFR. Hence, there is a need to study the clinical features and visual outcomes with the use of corticosteroid therapy. Aim: To describe the clinical features of patients presenting with PFR and visual outcome with the oral corticosteroid therapy. Materials and Methods: This retrospective study conducted in the Outpatient Department (OPD) of Ophthalmology at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The duration of the study was 35 months, from January 2019 to December 2021. A total of 23 eyes of 13 patients treated with oral corticosteroids were included. Data collected included patients’ demographic details including name, age, sex, hospital identification number, duration of vision loss, detailed ophthalmic examination findings, including visual acuity testing with Snellen’s chart, slit lamp examination findings and fundus examination findings including detailed fundus drawings, Optical Coherence Tomogram (OCT) and fundus photographs. Visual Acuity (VA) at the time of presentation and after steroid therapy were recorded. Data was entered in microsoft excel spreadsheet and descriptive analysis was done. Results: Age of the study participants ranged from 15 years to 52 years with an average of 29.6 years. A total of 23 eyes of 13 patients were included in the present study. At the time of presentation, two eyes had visual acuity better than 6/12 on Snellen’s chart. Five eyes had mild vision impairment, five eyes had moderate vision impairment and eleven eyes had vision <3/60, according to the visual impairment classification of World Health Organisation (WHO). Macular oedema was the other most common finding seen in 12 (52.17%) eyes. All the patients showed beginning of resolution of retinitis by 2-3 weeks after starting oral corticosteroids. A total of 23 eyes, 8 (34.7%) eyes recovered vision >6/12, out of which 6 eyes (26.08%) recovered with 6/6 vision. Conclusion: PFR affects predominantly young immunocompetent individuals. Treatment outcomes with oral steroids is found to be satisfactory

Differential diagnostics of incomplete Vogt-Koyanagi-Harada syndrome (clinical case)

Introduction. According to literature sources, choroidal detachment is considered mainly as a complication of surgical treatment. At the same time, bilateral choroidal detachments in combination with retinal detachment are extremely rare. Spontaneous bilateral detachments are mentioned even less frequently. Purpose: To describe and analyze a clinical case of spontaneous bilateral subtotal detachment of choroid, to differentiate the diagnosis. Materials and methods. A 62-year-old patient was urgently hospitalized to the neurological department of Bor Central Clinical Hospital with complaints of severe headache accompanied by repeated vomiting. The computer tomography of brain, B-scanning, optical coherence tomogram were performed. There were ultrasonic results on the next day after the hospitalization: bilateral subtotal detachment of choroid, IOP = 10-11 mm Hg. Results. At the release: A slight local flat choroidal detachment was observed, OD profile of the retina was without pathology, partial detachment of the hyaloid membrane and vitreous body, OS retinal profile was a serous detachment of the neuroepithelium in the macular region. The decreased vision in both eyes was observed at the control examination two months later. The cystic macular edema of both eyes and progression cataract were diagnosed.

Pinosylvin extract Retinari™ sustains electrophysiological function, prevents thinning of retina and enhances cellular response to oxidative stress in NFE2L2 knock‐out mice

AbstractPurposeChronic oxidative stress eventually leads to protein aggregation in combination with impaired autophagy, which has been observed in age‐related macular degeneration (AMD). We have recently developed a dry AMD mice model with a nuclear factor‐erythroid 2‐related factor‐2 (NFE2L2) knock‐out (KO). Pinosylvin, a polyphenol abundant in bark waste, improves retinal pigment epithelial cell (RPE) cell viability in vitro. Therefore, one can estimate that pinosylvin slow down the progression of dry AMD.MethodsWe investigated the effects of commercial natural pinosylvin extract, Retinari™, on the electroretinogram, optical coherence tomogram, autophagic activity, antioxidant capacity, and inflammation markers. Wild type (WT) and NFE2L2 KO mice were raised in 12:12 until the age of 14.8 ± 3.8 months. They were fed with either regular or Retinari™ chow (50–250 mg/kg/day of pinosylvin) for 10 weeks before the assays.ResultsRetinari™ treatment preserved significant retinal function in scotopic and photopic ERG and prevented thinning of the retina in the NFE2L2 KO mice. The NFE2L2 KO mice showed reduced ubiquitin‐tagged protein accumulation in addition to upregulation of the antioxidant enzymes superoxide dismutase 1 and catalase. Furthermore, the treatment seemed to reduce inflammation in NFE2L2 KO mice by causing a climb in the concentration of complement factor H.ConclusionsOur results demonstrate a strong protective effect of Retinari™ on the AMD disease model. We believe that pinosylvin in the Retinari™ elicits the positive effects. Thus, pinosylvin could potentially lower the risk of AMD onset and slow down its progression for which clinical trials with the compound are highly anticipated.

Relationship between diabetic retinopathy and diabetic peripheral neuropathy - Neurodegenerative and microvascular changes.

Purpose:To determine the relationship between diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN), and their associated risk factors.Methods:We conducted a cross-sectional analysis on 500 patients who attended the Endocrinology department at a quaternary health care center in Kerala between November 2017 and April 2018. Patients above the age of 30 years with type 2 diabetes mellitus (DM) were included. They underwent a detailed medical history, dilated fundus examination for DR, assessment and grading of DPN, and blood investigations. Among these, 49 randomly selected patients without DR had peripapillary retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) assessed by optical coherence tomogram. RNFL and GCIPL changes in different grades of neuropathy were evaluated.Results:Out of 500 patients, 303 (60.6%) were males and 197 (39.4%) were females. Prevalence of DR was 48% and DPN 71.8%. Risk factors for the development of DR included duration of DM >15 years, HbA1c (glycated hemoglobin) greater than 6.5%, serum creatinine more than 1.5 mg/dl, and the presence of DPN. There was a statistically significant association between DR and DPN. There was significant thinning of GCIPL in patients with moderate to severe neuropathy without DR.Conclusion:There is a significant association between DR and DPN and their severities. There are early changes in inner retinal layers of diabetic patients without microvascular changes of DR. These neurodegenerative changes parallel DPN in the course of DM. Our study stresses the importance of multidisciplinary approach in the management of diabetes and its complications.

Озурдекс в хрусталике – редкое осложнение интравитреальной инъекции (клинический случай)

A clinical case of unintentional implantation of the Ozurdex dexamethasone implant (Allergan, Inc., Irvine, CA, USA) into the lens is presented. The patient was treated for a long time with intravitreal injections of Lucentis (5) and Ozurdex (4) in various clinics of the Russian Federation for recurrent macular edema associated with thrombosis of the n/temporal branch of the central retinal vein. After the last injection of Ozurdex, he noted a decrease in visual acuity. I applied to the Eye Surgery clinic after 5 months due to a significant decrease in visual acuity. After the examination, a cataract was diagnosed, an implant in the thickness of the lens. Phacoemulsification was successfully performed with the implantation of an intraocular lens into a capsule bag (UltraSert, Alcon). An attempt during the operation to preserve the Ozurdex implant and move it into the retrolental space failed, which was due to the long period of its stay in the eye and rapid hydrotation and destruction under the action of irrigation solution. High visual acuity was obtained. The optical coherence tomogram revealed complete relief of macular edema. Key words: Ozurdex®, intralenticular implantation Ozurdex®, complications of intravitreal injections, macular edema, iatrogenic cataract.

Correlation of Central Macular Thickness and the Best-Corrected Visual Acuity in Three Months After Cataract Surgery by Phacoemulsification and With Intraocular Lens Implantation.

PurposeTo estimate the incidence of central macular edema (CME) following cataract surgery and to correlate the central macular thickness (CMT) to the best-corrected visual acuity (BCVA).MethodsThis cohort study in 2018-2019 included cataract grades I and II. They were operated by phacoemulsification and intraocular lens implantation. CMT was measured using spectral-domain optical coherence tomogram (OCT) before and for three months at one-month intervals after surgery. The change in BCVA and CMT were correlated at three months after surgery. Incidence of CME (more than two SD of pre-surgery CMT) was calculated.ResultsThe mean CMT for 138 eyes operated for cataracts measured before and at one, two, and three months after uneventful surgery was 213 ± 24.9, 222.7 ± 25.5, 217.8 ± 34.8, and 215 ± 28.3 µ, respectively. The median BCVA at three follow-ups was 0.2 (interquartile range [IQR] 0.1; 0.2), 0.1 (IQR 0.0; 0.1), and 0.0 (0.0; 0.03), respectively. The incidence of CME at one and three months was 18% and 4.3%, respectively. The CMT and VA (LogMAR) one month after cataract surgery were significantly correlated (r = 0.4, Pearson P < 0.001). The visual improvement between one and two months post-surgery was not significantly correlated with CMT decline (r = 0.06, Pearson P = 0.5). The BCVA at one, two, and three months was 0.0 LogMAR in 28 (20.3%), 52 (37.7%), and 104 (75.4%) eyes, respectively. Linear regression model, age and diabetes are the risk factors at one month. At two and three months, no significant risk factors were found.ConclusionCME post-cataract surgery seems to be transient. CMT changes correlate with best-corrected vision changes and seem to be affected by age and presence of diabetes in the 1st month after surgery.

Pinosylvin Extract Retinari™ Sustains Electrophysiological Function, Prevents Thinning of Retina, and Enhances Cellular Response to Oxidative Stress in NFE2L2 Knockout Mice.

Chronic oxidative stress eventually leads to protein aggregation in combination with impaired autophagy, which has been observed in age-related macular degeneration. We have previously shown an effective age-related macular degeneration disease model in mice with nuclear factor-erythroid 2-related factor-2 (NFE2L2) knockout. We have also shown pinosylvin, a polyphenol abundant in bark waste, to increase human retinal pigment epithelium cell viability in vitro. In this work, the effects of commercial natural pinosylvin extract, Retinari™, were studied on the electroretinogram, optical coherence tomogram, autophagic activity, antioxidant capacity, and inflammation markers. Wild-type and NFE2L2 knockout mice were raised until the age of 14.8 ± 3.8 months. They were fed with either regular or Retinari™ chow (141 ± 17.0 mg/kg/day of pinosylvin) for 10 weeks before the assays. Retinari™ treatment preserved significant retinal function with significantly preserved a- and b-wave amplitudes in the electroretinogram responses. Additionally, the treatment prevented thinning of the retina in the NFE2L2 knockout mice. The NFE2L2 knockout mice showed reduced ubiquitin-tagged protein accumulation in addition to local upregulation of complement factor H and antioxidant enzymes superoxide dismutase 1 and catalase. Therefore, the treatment in the NFE2L2 KO disease model led to reduced chronic oxidative stress and sustained retinal function and morphology. Our results demonstrate that pinosylvin supplementation could potentially lower the risk of age-related macular degeneration onset and slow down its progression.

A meta-analysis to study the effect of pan retinal photocoagulation on retinal nerve fiber layer thickness in diabetic retinopathy patients

Background. Diabetic retinopathy is a microvascular disease, it is associated with changes in peripapillary retinal nerve fiber layer thickness, these changes being more pronounced in PDR (Proliferative diabetic retinopathy) patients undergoing laser photocoagulation. Objective. To assess changes in peripapillary retinal nerve fiber layer thickness in proliferative diabetic retinopathy patients using optical coherence tomogram (OCT). Methods. The database search was conducted in June 2018 and continued until October 2018. The search engines used included Pubmed, Medline, OVID and Google Scholar. A meta-analysis of weighted mean difference and standard deviation was conducted. Results. A total of 10 studies containing 377 eyes of PDR patients were selected. The analysis of the included studies revealed no significant effect of PRP on average retinal nerve fiber layer thickness (0.249, 95% CI: -0.985 to 1.483) using OCT. Conclusion. Hence, to conclude, our meta-analysis revealed that there was no significant effect of PRP on RNFL thickness and the impact of PRP could vary. Measurement of peripapillary RNFL thickness may yield erroneous and unpredictable results in this subgroup of patients, further confounding the evaluation of nerve fiber layer damage and its progression.

Choroidal neovascular membrane in paediatric patients: clinical characteristics and outcomes

PurposeTo analyse the clinical characteristics and treatment outcomes of choroidal neovascular membranes (CNVM) in paediatric subjects at three paediatric retina referral centres.MethodsMedical charts of patients aged 18 years or less...

Monitoring the appositions of posterior graft-host junctions with anterior segment optical coherence tomogram after penetrating keratoplasty.

This study aimed to monitor the graft-host junction's (GHJ's) apposition with anterior segment optical coherence tomogram after penetrating keratoplasty (PK) and correlate the analysis with the preoperative diagnosis. Fifty-one eyes of 50 patients with various preoperative diagnosis of adherent leucoma, pseudophakic bullous keratopathy, corneal opacity or scarring, graft failure, corneal dystrophy and anterior staphyloma, who underwent PK for optical purposes were reviewed retrospectively. Based on the age, the patients were divided into groups 1 and II: those aged ≤40 and >40years, respectively. Anterior segment optical coherence tomography was done for all these eyes to evaluate the posterior graft-host junction. All graft-host junction patterns were classified as well apposed, and malapposed with various components like hill, gap, step and tag. The comparisons of various clinical parameters were done for the various malapposed junction groups (hill, gap, step and tag). A total of 408 graft-host junction cross sections of 51 eyes were analysed. Amongst them 70 (17.15%) sections were well apposed, and 338 (82.84%) were malapposed. Most frequent type of malapposition was hill: 164 sections (40.19%) followed by step: 139 sections (34.06%). The distribution of graft-host junction alignment patterns varied amongst all the indications. Patients with preoperative diagnosis of adherent leucoma and corneal dystrophy had predominantly steps pattern in 65 (40.62%) and 12 (75%) sections, respectively. Hill pattern was seen predominantly in PBK, corneal opacity, graft failure and anterior staphyloma in 55 (42.96%), 16 (40%), 22 (45.83%) and 8 (50%) sections, respectively. Comparisons of various clinical characteristics like intraocular pressure, central corneal thickness, best-corrected visual acuity, astigmatism and size of graft with the various malapposed patterns showed significant differences in best-corrected visual acuity and keratometric astigmatism in the hill pattern of malapposition group with p values of .004 and .053, respectively, using independent T test. Posterior graft-host junction analysis with anterior segment optical coherence tomography is very important for post penetrating keratoplasty management. The posterior wound profile differed according to the indications of penetrating keratoplasty. Best-corrected visual acuity and keratometric astigmatism showed significant difference with the malapposition hill (pattern).

Diagnosis And Management Of Retained Host’s Descemet’s Membrane After Penetrating Keratoplasty

Retained descemet’s membrane is a rare complication of penetrating keratoplasty. It can lead to graft failure by compromising the endothelial tissue of the cornea. We report a case which was diagnosed as retained descemet’s membrane post penetrating keratoplasty by anterior segment optical coherence tomogram and was managed surgically by descemetorhexis without compromising the graft integrity which led to good visual gain.

Impact of Macular Pigment on Fundus Autofluorescence Lifetimes.

To characterize the macular region and to investigate the influence of the macular pigment (MP) on fundus autofluorescence (FAF) lifetimes in vivo. Forty-eight healthy subjects with a mean age of 24.1 ± 3.6 years (range, 20-37 years) were included. A 30° retinal field was investigated using the fluorescence lifetime imaging ophthalmoscope (FLIO), based on a Heidelberg Engineering Spectralis system, detecting FAF decays in a short (498-560 nm; ch1)- and a long (560-720 nm; ch2)-wavelength channel. The mean fluorescence lifetime τm was calculated from a 3-exponential approximation of the FAF decays. Macular pigment optical density (MPOD) was measured by one-wavelength reflectometry, and macular optical coherence tomogram (OCT) scans were recorded. Correlations between τm and MPOD were analyzed. The τm showed shortest values at the macular region with a mean of 82 ps (ch1) and 126 ps (ch2). We found a strong correlation of τm to the MPOD (ch1: r = -0.760; ch2: r = -0.663; P < 0.001), as well as a topologic agreement of shortest τm with highest MPOD. Macular pigment, which is known to have very short fluorescence decays, considerably contributes to the macular autofluorescence (AF). This study gives indirect evidence for a strong impact of MP on macular τm, although no direct measurement of MP autofluorescence lifetimes in vivo is possible at this point. Potentially, imaging the FAF lifetimes could lead to a novel methodology for the detection of macular pigment properties and pathology-induced changes in the living human retina.

Optical coherence tomogram and demographic profile in central retinal artery occlusion: A South Indian study

Aim: To describe the demographic profile and optical coherence tomography (OCT) findings in patients with central retinal artery occlusion (CRAO). Materials and Methods: Thirty-eight patients with CRAO who presented to Vitreo Retina Department at Minto Ophthalmic Hospital between January 2009 and December 2013 were studied. All the patients underwent detailed ophthalmic examination including OCT and routine laboratory investigations. All patients were subjected to cardiac evaluation. Results: In our study, 27 (71%) were males and 11 (29%) were females. The average age of our patients was 44.8 years (range 25-65 years). Seven patients had diabetes, and six had hypertension. Seven (18%) patients had CRAO with sparing of the cilioretinal artery. History of smoking was present in 15 (56%) of males with an average duration of 16.9 years. OCT showed average central macular thickness of 288.2 mm in acute stage and 163.75 mm in chronic stage. Conclusion: CRAO had varying etiologies but had similar clinical findings and OCT features. In our study, smoking was found to be the most common association in males. CRAO was also seen in younger age groups too. In all cases, OCT in acute stage shows increased reflectivity of inner retina and a hyporeflective band and in chronic stage thinning of sensory retinal layer. OCT findings were similar irrespective of the etiology.

OCT during left main bifurcation PCI

80 years old male was admitted with recent history of acute coronary syndrome. Coronary angiogram showed minimal distal left main disease with significant ostial left anterior descending artery (LAD) lesion (Fig. 1A & Video 1). Optical coherence tomogram (OCT) guided percutaneous intervention (PCI) to Left main and LAD was planned using Provisional T stenting strategy. OCT evaluation showed minimal disease in distal left main (E). Ostial LAD showed thin cap fibro-atheroma with multiple calcified plaques (Fig. 1B, C & D). There was no significant calcium requiring de-bulking. Left circumflex artery (LCX) ostium showed minimal disease. After pre-dilatation and stenting of LAD lesion, there was significant plaque shift into the LCX (Fig. 1F & Video 2). Hence it was converted to two stent strategy and bifurcation stenting of LAD/LCX was done using T and protrusion technique (Fig. 1G, H & Video 3). Post stenting, left main bifurcation was assessed by OCT which showed good apposition of the stents in both LAD and LCX (Fig. 1I). Compared to IVUS OCT with lower penetration has limitations in large vessels like the left main, but its higher resolution helped in identifying a clear landing zone in the left main and a TCFA involving ostial LAD which predicted the plaque shift. Fig. 1 A: CAG in AP cranial view showing tight Ostial LAD lesion without any significant Ostial LCX disease. B: Longitudinal OCT image run from LAD to Left main (orientation-from left to right its distal to proximal) C: Cross-sectional OCT image from mid LAD ... Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j.ihj.2014.08.009. The following are the supplementary data related to this article: Video 1: Initial CAG showing critical Ostial LAD disease without any significant left main or LCX disease. Click here to view.(1.1M, mp4) Video 2: After pre-dilation there was significant plaque shift into the LCX ostium. Click here to view.(1.0M, mp4) Video 3: Final angiogram after successful bifurcation PCI to LAD/LCX with two stents using TAP technique. Click here to view.(1.2M, mp4)

Optical coherence tomogram of spontaneous coronary artery dissection managed with drug eluting stent

A 42-year-old male patient with no known risk factors for coronary artery disease was admitted after an episode of break through seizures. Incidentally his electrocardiogram showed evidence of antero-septal myocardial infarction and the echocardiogram showed regional wall motion abnormality involving the inter-ventricular septum. Cardiac bio-markers including highly sensitive troponins were negative, thus excluding an acute event. Coronary angiogram (Fig. 1A & Video 1) showed dominant left system with intra luminal filling defects (arrow) in the proximal and mid left anterior descending artery (LAD). To further define the nature of the filling defects an optical coherence tomogram (OCT) was done, which showed dissection flaps (Fig. 1B) with multiple false lumens involving the proximal and mid LAD. Successful percutaneous intervention with drug eluting stent was done to the LAD. Good angiographic results (Fig. 1C & Video 2) were confirmed on OCT (Fig. 1D). OCT helped in confirming the filling defects to be dissection flaps and also in deciding the length of the stent to cover the entire diseased segment. Fig. 1 Supplementary video related to this article can be found online at http://dx.doi.org/10.1016/j.ihj.2014.02.005. The following are the Supplementary video related to this article: Video 1: Click here to view.(779K, mp4) Video 2: Click here to view.(1.5M, mp4)

A prospective nonrandomized clinical study on exudative age related macular degeneration

International Journal of Medicine and Public Health,2014,4,4,417-420.DOI:10.4103/2230-8598.144117Published:October2014Type:Original ArticleA prospective nonrandomized clinical study on exudative age related macular degenerationAyakutty Muni Raja, Siddharam Janti, Charanya Chendilnathan, and Adnan Matheen Ayakutty Muni Raja, Siddharam Janti, Charanya Chendilnathan, Adnan Matheen Department of Ophthalmology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India Abstract:Introduction: Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness in individuals over 50 years in developed countries. The objective was to study the various fundus fl uorescein angiogram (FFA) patterns of exudative ARMD and monitor the treatment response and the change in visual acuity, macular thickness, angiographic patterns following intravitreal injection of bevacizumab and to assess the systemic risk factors for exudative ARMD. Materials and Methods: This prospective nonrandomized clinical study was carried out among 50 patients of ARMD diagnosed by FFA and optical coherence tomogram (OCT) with best corrected visual acuity of <6/24 (Snellen’s chart), Macular thickness by OCT, FFA was done before and after giving injection of bevacizumab. Patients were asked for regular followup at 2 weeks, 4 weeks, 8 weeks, 12 weeks and 16 weeks. Results: Fifty-two percent cases with classic choroidal neovascular membrane (CNVM) showed 1 line improvement at the end of 2 months and 56% of cases showing 2 lines improvement at 4 months. About 50% of occult CNVM showed more than 2 lines improvement at 4 months. About 50% of Classic CNVM and 40% of occult CNVM showed reduction in macular thickness of 50 μ at the end of 2 months, and 52% of both CNVM types showed reduction of 100 μ at the end of 4 months. Conclusions: In India ophthalmologists feel that AMD is an uncommon condition. By this study, we proved that although its prevalence rate is low in India as compared with Western countries, Indians are not immune from developing AMD. Keywords:Bevacizumab, Fundus fluorescein angiogram, Optical coherence tomogramView:PDF (1.66 MB)

Visual loss with inner retinal dysfunction, after snake bite: two case reports

To report two cases of visual loss following snake bite. Retrospective review of medical records including history, examination finding, fundus details and investigation reports (visual field, electroretinogram, visual evoked potential and optical coherence tomogram) at two centers. Two cases of snake bite presented to us with reduction of vision at 1 and 3months after the incident. The subnormal b wave and abnormal pattern electroretinography in one case pointed at inner retinal dysfunction and neurotoxicity as the cause of visual loss in an apparently normal-looking fundus. The electronegative b wave in the other gave us a clue that the optic atrophy was consecutive (secondary to inner retinal dysfunction due to central retinal artery occlusion). When presented late, diagnosis of visual loss secondary to snake bite becomes difficult and puzzling due to the absence of classical findings. Electrophysiological tests in such cases give us important clue to reach at a definite diagnosis.