Routine Ophthalmic Examination Research Articles

Evaluation of the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography

Aim To evaluate the effect of phacoemulsification surgery on retinal and choroidal microvasculature in diabetic patients using optical coherence tomography angiography (OCTA). Settings and design A prospective comparative case-control study was performed at the Ophthalmology Department of Ain Shams University hospital, between November 2020 and November 2022. Patients and material A total 50 eyes of 35 cataractous patients were included in this prospective study and divided into two groups: the control group (25 eyes of 19 patients) and the diabetic group (25 eyes of 16 patients with mild nonproliferative diabetic retinopathy). All patients underwent routine ophthalmic examination, OCT and OCTA scans of the macula before phacoemulsification surgery and 1 week, 1, 3, and 6 months after the surgery. Results The best corrected visual acuity significantly improved in both groups by ∼ 0.26 logMAR units in control and diabetic groups (P <0.001 for both). The mean change in central subfoveal thickness was 23.44±43.7 versus 13.6±22 um (P=0.3) in the control group and the diabetic group, respectively but statistically insignificant. There was insignificant change in each group in all vascular parameters during the follow-up period. In addition, there was insignificant difference between the two groups at each visit in most vascular parameters of superficial vessel density, deep vessel density (DVD), and choriocapillaris vessel density (CC VD). On the other hand, the diabetic groups have significantly lower superficial vessel density of whole image and perifovea at 1 week than controls (42.92±4.54% vs. 46.16±3.98%, P=0.01 in the whole image, respectively) (44.29±4.87% vs. 47.32±3.85%, P=0.018 in perifovea, respectively). The diabetic group also showed significantly higher parafoveal deep vessel density than the control group at 1 month postoperatively: 52.67±4.00 versus 47.24±9.85% (P=0.014) that leveled up on month 3 and 6 (P=0.397, 0.538, respectively). The diabetic group showed lower CC VD of the whole image than the control group at 1 week postoperatively: 70.60±2.87 versus 72.22±1.98%, respectively (P=0.025), and also significantly lower CC VD of perifovea than the control group at 1 week: 71.19±2.82 versus 72.72±2.20% (P=0.038), 1 month: 71.08±2.87 versus 72.78±2.61% (P=0.033) and 3 months: 71.35±2.63 versus 72.83±2.52% (P=0.048). Those values leveled up at the last postoperative visit at month 6 (P=0.152). Conclusion Phacoemulsification surgery may lead to the transient and mild reduction of choroidal blood flow in diabetic eyes rather than retinal blood flow. Most of choroidal and retinal vascular changes happened in the perifoveal area within 1 week to 1 month postoperatively and rarely extended to 3 months.

Agreement in non-cycloplegic and cycloplegic refraction between a photoscreener and a calibrated autorefractor

IntroductionPhotoscreeners have been shown to provide excellent measurements of the refractive error. However, whether they could be used for assessing cycloplegic refraction has not been examied. This study aimed to evaluate the agreement between cycloplegic and non-cycloplegic measurements obtained using a photoscreener and stationary autorefractor, respectively.MethodsThis study included all patients undergoing routine ophthalmic examination at the Hygeia Clinic (Poland) from June to July 2022. Each patient underwent non-cycloplegic and cycloplegic refraction assessments using the 2WIN photoscreener (Adaptica SRL, Padova, Italy) and an ARK-1 stationary autorefractor ARK-1 (Nidek Co Ltd., Tokyo, Japan), respectively. Each pair of assessments was conducted in random order, and all values were determined at a vertical distance of 12 mm. The agreement between cycloplegic and non-cycloplegic measurements was assessed using paired t-tests, Bland-Altman and ABCD ellipsoids.ResultsThis analysis included 82 patients, of which 52 were female. Their mean age was 34.39 ± 13.13 years. The non-cycloplegic spherical equivalent (SE) did not differ significantly between the 2WIN (− 1.22 ± 2.45) and ARK-1 (− 1.19 ± 2.96) devices (p = 0.580). However, the cycloplegic SE values demonstrated more negative values with the 2WIN device (− 1.13 ± 2.19) than with the ARK-1 device (− 0.75 ± 3.03; p = 0.007). The non-cycloplegic and cycloplegic measurements were strongly correlated between the devices (r = 0.9473 and 0.9411, respectively). However, the correlation between their cycloplegic shifts in SE was low (r = 0.2645). Ellipsoid refraction aligned better non-cycloplegic (ARK-1 = 1.00; 2WIN = 1.74) than with cycloplegic refraction (ARK-1 = 1.43; 2WIN = 1.90).ConclusionWhile the cycloplegic measurements obtained with the 2WIN photoscreener were strongly correlated with those obtained with the ARK-1 stationary autorefractor for most of the analyzed parameters, they should not be considered interchangeable.

Distribution and associations of anterior lens zonules lengths in patients with cataract.

To investigate the characteristics and associations of anterior lens zonules lengths in cataract patients via ultrasound biomicroscope (UBM) measurement. Patients with age-related cataracts and high myopic cataracts who planned to undergo cataract surgery were included in the study. After routine ophthalmic examinations, the UBM was performed on both eyes to get images of the anterior lens zonules, and Image J software was used to measure the lengths of the lens zonules. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WTW) diameter of both eyes were obtained by IOL Master 700. Univariate and multivariate regression analyses were used to assess associated factors of anterior lens zonules lengths. Forty-nine patients with age-related cataracts and 33 patients with high myopic cataracts were enrolled. High myopic cataract patients were younger and had longer anterior lens zonules. Multivariate regression analysis showed that anterior lens zonules lengths were associated with axial lengths (temporal location: β = 0.036, P = 0.029; nasal location: β = 0.034, P = 0.011; superior location: β = 0.046, P = 0.002) and ACD (inferior location: β = 0.305, P = 0.016) in right eyes. In left eyes, anterior lens zonules lengths were associated with axial lengths (temporal location: β = 0.028, P = 0.017; inferior location: β = 0.026, P = 0.016; nasal location: β = 0.033, P < 0.001) and ACD (inferior location: β = 0.215, P = 0.030; superior location: β = 0.290, P = 0.011). High myopic cataract patients have longer anterior lens zonules. AL and ACD contributed to the lengths of anterior lens zonules. Thus, for patients with long AL and deeper ACD, lens zonules measurement was crucial. www.chictr.org.cn identifier is ChiCTR2300071397.

The Frequency and Manifestations of Ocular Causes of Abnormal Head Posture

ABSTRACT Purpose To determine the frequency and manifestations of different ocular causes of abnormal head posture (AHP). Method This prospective, consecutive case series study was performed on 149 patients with ocular AHP at Farabi hospital, Iran, from February 2020 to June 2021. All patients underwent routine ophthalmic examinations. The manifestation of AHP was determined by direct observation from three viewing angles, while the patient read the smallest line on the vision chart that they could see. In front, above, and lateral gazes, observations were performed to find head tilt, head turn, and chin abnormal position, respectively. A picture with habitual AHP was taken from all patients. The amount of head tilt was measured by calculating the angle between the line that connects the lips center to the center of the eyebrows and the vertical line using the Corel Draw X7 computer software. Results The mean age of 149 patients with ocular AHP [101 (67.8%) males and 48 (32.2%) females] was 16.2 ± 12.2 (range, 2–57) years. The most common ocular sources of AHP were found to be superior oblique palsy (SOP) in 66 (44.3%) patients, 54 (36.2%) cases with Duane’s retraction syndrome (DRS), and 12 (8.1%) patients with nystagmus. Other frequent causes of ocular AHP were dissociated vertical deviation (DVD) in 5 (3.4%), A and V pattern strabismus in 3 (2.0%), and 2 cases (1.3%) in each of Brown syndrome, inferior rectus (IR) palsy, and congenital fibrosis of the extraocular muscles (CFEOM). The most common manifestations of AHP in all cases were “pure head turn” (48.3%), followed by “pure head tilt” (24.8%), “simultaneous head tilt and head turn” (20.8%), and “chin up” (6.0%). The mean head tilt among all patients with head tilt was 10.4° ± 8.9° (range, 5.0°−31.7°). Conclusion The most frequent ocular sources of AHP were SOP, DRS, and nystagmus, followed by DVD, A and V pattern strabismus, IR palsy, CFEOM, and Brown syndrome. In addition, pure head turn and pure head tilt were the most common manifestations of ocular AHP but were not always seen in the same direction or combination as previously reported with these etiologies.

Observing the factors affecting fibrovascular regrowth after pterygium excision and comparing the efficacy and complications of conjunctival autograft with sutures versus fibrin glue.

Aim: To observe the factors affecting fibrovascular regrowth after pterygium excision and to compare the efficacy and complications of conjunctival autograft with sutures versus fibrin glue. Materials and methods: 65 consenting patients with primary pterygium attending the outpatient department having appropriate indications for surgery were enrolled. Data was collected using personal interviews. Routine pre-operative ophthalmic examination was done, including visual acuity assessment, slit lamp examination, and fundus evaluation. Pterygium excision surgery was done on all patients using either Fibrin Glue or 10-0 nylon sutures. Patients were followed up at weeks 1, 4, 12, and 24 and any complications were duly noted. Results: The fibrin glue group showed milder postoperative discomfort, symptoms, and signs compared to the suture group. Pyogenic granuloma (3.12%), corkscrew vessels (6.25%), and subconjunctival hemorrhage (24.99%) were more common in the fibrin glue group. FVG not crossing the limbus was observed in 6.25% of glue cases and 9.09% of suture cases, more in fleshy and large pterygia, while age and gender did not alter the incidence of FVG. No recurrences were observed in any group. Conclusion: The incidence of fibrovascular regrowth (FVG) was not affected by age, gender, smoking, and surgical technique, but was positively correlated with length and grade of pterygium. The complication rate between the two groups was not found to be statistically significant. Despite causing severe postoperative discomfort and requiring prolonged surgical time, suture-assisted pterygium surgery is a cost-effective method still being used with long-term outcomes similar to fibrin glue.

Comparison of intraocular pressure measurements obtained by icare pro tonometer, non-contact tonometer and Goldmann applanation tonometer in healthy individuals

The goal of this paper was to compare the intraocular pressure (IOP) measurements obtained via iCare Pro rebound (IRT), non-contact tonometry (NCT), and Goldmann applanation (GAT) tonometry in healthy subjects. One hundred and twenty-five healthy individuals were included in this study. The participants' IOP measurements were obtained via non-contact tonometry. After routine ophthalmic examination, central corneal thickness (CCT) was measured with a topography device. Intraocular pressure was measured via iCare Pro rebound tonometry. After waiting for 5minutes, three measurements were taken with GAT under topical anaesthesia, and their means were recorded. Interdevice agreement was evaluated with the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The mean IOP measurements for NCT, IRT, and GAT were 15.97±2.99, 17.47±2.86, and 16.46±2.68mmHg, respectively. The mean difference between NCT and GAT was -0.49± 1.89mmHg, the mean difference between IRT and GAT was 1.01±1.90mmHg, and the mean difference between NCT and IRT was -1.50±2.02mmHg. Agreement between devices was found to be >0.8 for each tonometry ICC. There were significant positive correlations between the measurements obtained via these three instruments and CCT. In this study, IOP was measured slightly lower with NCT than GAT, but it was about 1mmHg higher with IRT than GAT on average. All three devices appeared to be affected by CCT, with NCT being the most affected in this regard. The three instruments can be used for routine inspection and screening. However, considering the differences in the measurements obtained by using them, it is clear that following up IOP measurements with GAT measurements is beneficial in advanced glaucoma patients.

Retinal Dialysis and Associated Rhegmatogenous Retinal Detachment in Patients with Neurofibromatosis Type 1: A Case Series.

While ophthalmic manifestations of neurofibromatosis type 1 (NF1), including iris Lisch nodules and optic gliomas have been well described, retinal involvement in these patients has yet to be established. Characterizing the relationship between NF1 and the retina is necessary to optimize outcomes for these patients. Independent chart review of NF1 patients was conducted. Chart review yielded four patients, with a history of NF1, with subsequent retinal dialysis and rhegmatogenous retinal detachment. These four patients presented to our institution with a rhegmatogenous retinal detachment secondary to a retinal dialysis with no history of trauma. These patients also demonstrated hyperreflective choroidal abnormalities on near-infrared reflectance (NIR) imaging and optical coherence tomography (OCT). Seeing that patients diagnosed with NF1 are susceptible to various ocular manifestations and pathologies, routine ophthalmic examinations are essential in maintaining their ocular health and minimizing morbidity.

Is there room for prompt routine ophthalmic examination in neonates with congenital cytomegalovirus (CMV) infection during the neonatal period?

To establish the clinical necessity of routine targeted ophthalmic examination of newborns with congenital cytomegalovirus (CMV) infection during the neonatal period. This retrospective study included consecutive neonates that were referred for ophthalmological screening within the context of a proven congenital CMV infection. The presence of CMV-related ocular and systemic findings was determined. Among the 91 patients included in this study, 72 (79.12%) were symptomatic with one or more of the following manifestations: abnormal brain ultrasound (42; 46.15%), small for gestational age (29; 31.87%), microcephaly (23; 25.27%), thrombocytopenia (14; 15.38%), sensory neural hearing loss (13; 14.29%), neutropenia (12; 13.19%), anemia (4; 4.4%), skin lesions (4; 4.4%), hepatomegaly (3; 3.3%), splenomegaly (3; 3.3%), direct hyperbilirubinemia (2; 2.2%). Not one single neonate in this cohort had any of the ocular findings surveyed. The presence of ophthalmological findings among neonates with congenital CMV infection during the neonatal period is infrequent, suggesting that routine ophthalmological screening may be safely deferred for the post-neonatal period.

Prevalence of Convergence Insufficiency in Patients Suffering from Headache.

Objective: To find out the prevalence of convergence insufficiency (CI) in patients suffering from headache. Study Design: Cross Sectional, Observational study. Setting: Departments of Eye, The Children’s Hospitals and The Institute of Child Health, Multan and Govt. Shahbaz Sharif Hospital, Multan. Period: August 2020 to January 2021. Material &amp; Methods: A total of 95 patients between the ages of 08-62 years with a complaint of headache were examined. Both male and female patients having complaint of headache, patients more than 07 years of age and patients with complaint of discomfort and blur vision at near after focusing for few minutes were included. While uncooperative patients, patients less than 07 year of age and patients having systemic and neurological diseases that can cause headache were excluded. Patient's visual acuity (VA) was recorded with Snellen’s chart and refraction was done with retinoscopy/ auto refractometer. Fundoscopy was carried out to find out any pathology i.e., papilledema. Convergence was checked by pencil push-up test and amplitude of accommodation was measured using RAF rule. Descriptive statistics including frequencies and percentages were extracted for categorical variables and mean ± standard deviation (SD) for quantitative variables. Results: In this study, we recruited 95 patients with a complaint of headache between the ages of 08-62 years and mean age was 27.80 years. 68 (71.60 %) were female and 27 (28.40 %) were male. These patients were examined to determine the prevalence of convergence inefficiency in patients suffering from a headache. Out of these 95 patients having headache 27 (28.4%) had poor convergence, 42 (44.2%) had weak convergence and 26 (27.4%) had normal convergence. This study suggested that 69 (72.6%) patients with headache had varying degree of CI. Conclusion: Our study suggested that headache is more common in females than males and CI is the most common cause of headache among these patients. These patients should be assessed and treated to relieve their symptoms and enable them to spend a better quality of life. We recommend ophthalmologists and optometrists to measure CI as a part of their routine ophthalmic examination.

Distribution Pattern of Refractive Errors in Strabismic Iranian Children

Introduction: The purpose of the present study was to determine the refractive profile of strabismic children under 8 in a tertiary referral center in Tehran, Iran.&#x0D; Materials and Methods: This retrospective cross-sectional study was conducted on the medical records of 357 patients under the age of 8 who had one type of strabismus in Farabi Hospital, Tehran, Iran, between 2015 and 2019. All routine ophthalmic examinations were done for all patients. Cycloplegic refraction was performed after the instillation of two drops of cyclopentolate 1% with an interval of 5 minutes, and the refractive error was measured after 30 minutes. The diagnostic criteria were based on cycloplegic refraction in which myopia, hyperopia, and astigmatism were defined when the refractive error was -0.25, +0.75, and -0.50 diopter (D) or more, respectively. The cycloplegic results were classified into different groups with an interval of 1.00 D, and astigmatism was also assessed separately.&#x0D; Results: In this study, the most common type of refractive error in esotropic patients was hyperopia, with the +2.00 to +4.00 D range having a higher prevalence. In exotropic patients, hyperopia was also prevalent; the most common range of hyperopia was between +0.75 to +1.00 DA Astigmatism had a prevalence of 8% in esotropic patients, and 17.2% in exotropic patients with the most common range from -0.50 to -1.00. Myopia was present in 2.8% of patients with esotropia and 3.2 % of patients with exotropia with the most common range from -0.25 to -1.00.&#x0D; Conclusion: In strabismic Iranian children, hyperopia was the most prevalent refractive error in both esotropic and exotropic patients, with higher degrees of hyperopia in esotropic patients. Low astigmatism was twice as prevalent in patients with esotropia as in patients with exotropia. Low myopia was the least prevalent in both esotropic and exotropia.

Unilateral conjunctival concretions associated with chronic inflammation and tear instability.

Conjunctival concretions are small yellow-white subconjunctival spots that can be asymptomatic for years and are an incidental finding on routine ophthalmic examination.[1,2] The etiologies are chronic vernal conjunctivitis, severe atopic keratoconjunctivitis, and post-trachomatous changes.[1–5] The concretions are located within the conjunctival recesses layered by epithelium and are made up of cell debris and phospholipids.[3,4] Case Report A 24-year-old-female presented with chronic irritation and redness in the right eye for 1 year. Systemic evaluation was unremarkable with no immunosuppressive disorders. Her symptoms were intermittently associated with discharge. Her vision was 20/20 in both eyes. Everted upper and lower eyelids of the right eye showed multiple concretions scattered beneath the tarsal conjunctiva, more in the upper eyelid, protruding through the conjunctiva at two focal points [Fig. 1]. There was diffuse congestion in the tarsal conjunctiva with a normal lid margin appearance. The left eyelid had neither congestion nor concretions. There was no ocular surface staining with fluorescein dye, but the exposed concretions showed fluorescein uptake. Dry eye workup revealed a tear break-up time of 7.8 s with normal tear secretion in the right eye, whereas tear breakup and secretion was normal in the left eye. She gave an antecedent history of a vegetative object falling into her right eye while driving a bike. The ocular symptoms developed 1 month after that trauma. She was using topical lubricants and antibiotic ointment over the eyelid margin for the meibomitis. Because of unilateral presentation and young age, two concretions were removed on slit lamp using a sterile 26-gauge needle under topical anesthesia and sent for tissue processing.Figure 1: (a) Everted right upper eyelid of the 24-year-old female shows scattered numerous concretions in the tarsal conjunctiva, fewer in the lower eyelid (d). (b) Gomori methenamine silver stain (100×) shows presence of fungal elements within the concretions (higher magnification in inset), which are also seen on gram stain (e, 400×) as empty round and vertical spaces. (c and f) Left upper and lower eyelids show normal tarsal conjunctivaThe histopathologic examination of concretions revealed eosinophilic homogenous amorphous material containing fungal elements, which were Gomori methenamine silver stain positive [Fig. 2]. The deepest sections (till the last tissue section) also contained numerous fungal hyphae, which ruled out contamination. Due to atypical histopathologic findings of concretions, a superficial conjunctival incision biopsy containing tarsal conjunctiva, concretions, and a thin sliver of tarsus was taken at 4 mm from the upper eyelid margin. The incision biopsy showed scattered amorphous, acellular eosinophilic hyaline-like material and diffuse lymphocytic infiltration in the substantia propria. The amorphous material had a rim of conjunctival epithelium suggestive of concretions embedded within the pseudoglands of Henle. The periphery of the concretions had a slight basophilic appearance. The concretions were negative for von Kossa stain, Alcian blue, and Congo red but were red on Masson trichrome stain, suggesting cell debris and keratin to be one of the constituents. Alcian blue was focally positive in the conjunctival epithelium at the location of goblet cells. She was started on tablet fluconazole 150 mg once a week for 3 weeks along with 1% itraconazole eye ointment into the eye twice a day. Her symptoms resolved with a reduction in the conjunctival concretions’ number and conjunctival congestion.Figure 2: (a) Everted right upper eyelid with highlighted biopsied part. (b and c) Incisional biopsy from the upper tarsal conjunctiva shows diffuse subepithelial lymphocytic infiltration along with eosinophilic hyaline-like material deposits (c, at 200×). Masson trichrome (d), Congo red (e), and Alcian blue (f) were negative for amyloid and mucopolysaccharide depositsTear film instability and reduced tear production have been reported in patients with conjunctival concretions, where 51% of asymptomatic patients with conjunctival concretions have reduced tear break-up time.[3] The current case had reduced tear break-up time in the eye with concretions. An interesting finding in the current case was the presence of fungal elements, which can be explained by the possible entrapment of organic body containing fungus 1 year back. The organic material dissolved away, but the fungal elements caused persistent chronic inflammation, which resulted in the formation of concretions. This case reports the possibility of having unilateral concretions secondary to chronic inflammation with degenerative changes. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Hyderabad Eye Research Foundation, Hyderabad. Conflicts of interest There are no conflicts of interest.

Correlation Between Contrast Variability and Refractive Error

Background: Contrast sensitivity, is defined as the ability to detect the lowest lumination difference between an object and the background. It is one of the main requisites for good quality vision as the eye works by perceiving an object by comparing the difference between the target and the background contrast difference. Aims and Objectives: To assess patterns of contrast sensitivity functions in patients in different types of refractive errors using Pelli Robson chart and also to measure the severity of refractive error within each group and compared the contrast sensitivity function with severity in different types of refractive errors. Material and Method: This cross-sectional study was conducted on 500 patients (Age range from 10 to 80 years) who presented with chief complaint of refractive errors mainly myopia and hypermetropia. Patients who had previous history of ocular surgery and other ocular co- morbidity were excluded from study. Selected patients were enrolled for the study after taking a written informed consent. The patterns of contrast sensitivity function in different types of refractive errors were recorded on a prescribed proforma with respect to: Visual acuity, type of refractive error, severity of refractive error, duration of refractive error, age of the patient, fundus examination and Contrast sensitivity. Statistical analysis was undertaken with P&lt;0.05 significant. Results: A mild decrease in contrast sensitivity was recorded in majority of patients i.e 250 patients (50%). Maximum decrease in contrast sensitivity was seen in 31-60 years age group. A statistically significant direct correlation (P&lt;0.05) was observed between duration and variation in contrast sensitivity. Both the refractive error showed definite decrease in contrast sensitivity and compound astigmatism showed severe decrease in contrast sensitivity. Conclusion: Despite having BCVA of 6/6, patients showed reduced contrast sensitivity, even without any retinal pathology, making it an essential part of a routine ophthalmic examination.

Scratched cornea: Case report on incidental bilateral posterior polymorphous corneal dystrophy

Posterior polymorphous corneal dystrophy (PPCD) is a dominantly inherited corneal endothelial disorder, typically considered bilateral and asymptomatic. We report a case of bilateral PPCD that presented as an incidental finding on routine ophthalmic examination. Related visual prognosis is discussed. A 27-year-old male presented for a routine ophthalmic examination. Visual acuity was recorded for both eyes. A detailed slit-lamp examination and anterior-segment optical coherence tomography (AS-OCT) was done. Best-corrected visual acuity was recorded as 6/6 for both eyes. Slit-lamp examination revealed band-shaped lesions in the inferior quadrant of bilateral corneas, at the junction of Descemet's membrane and corneal endothelium. AS-OCT revealed central corneal thickness as 556 and 544 µm for the right and left cornea, respectively, along with a hyper-reflective lesion at the level of corneal endothelium in the right eye.

Efficacy of the intracamerally administered mydriatics for cataract surgery in patients with primary open-angle glaucoma.

To compare Mydrane®, mydriatic eye drops, and Mydriasert® in terms of pupil site stability, surgical time, visual field, and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery. Retrospective analysis of sixty patients with POAG and cataract who underwent elective cataract extraction. All patients underwent routine ophthalmic examinations, including automatic visual field examination, anterior chamber configuration, specular microscopy, and arterial blood pressure measurement prior to surgery, and 24 h and 30 days postoperatively. All cataract surgeries were video-recorded and all measurements were performed using a media player. Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops, Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision. The mean change in pupil size from just before capsulorhexis to the end of surgery was 0.43 ± 0.09, 0.42 ± 0.08, and 0.36 ± 0.02 mm in groups 1, 2, and 3, respectively. The mean surgery duration was similar among all the groups. The baseline main cell density slightly decreased at 24 h and remained stable for 30 days postoperatively. The mean deviation and pattern standard deviation remained stable at 1 month after surgery. At 24 h after surgery, the nasal irido-corneal angle, temporal-iridocorneal angle, and anterior chamber depth increased compared with the baseline, remaining stable for 30 days after surgery. Mydrane® produced adequate and stable mydriasis as effectively as produced by Mydriasert® and topical eye drops.

Evaluation of retinal and optic disc vascular structures in patients with familial Mediterranean fever (FMF) via optical coherence tomography angiography.

Familial Mediterranean fever (FMF) is an auto-immune disease characterized by fever and serositis. With this study, we aimed at comparing the retinal vascular structures of FMF patients and healthy individuals using optical coherence tomography angiography (OCTA) device. Sixty-nine patients with FMF and 52 healthy controls who were matched by age and sex, didn't have any comorbidities and were admitted to our clinic for routine ophthalmic examination were enrolled in the study. Sixty-nine eyes of 69 patients and 52 eyes of 52 healthy controls that were not disqualified due to the exclusion criteria were included in the study. OCTA images of the patients and controls were analyzed. The mean average age (± SD) of 69 FMF patients included in the study was 39.86 ± 13.16. Forty-nine patients were female, and twenty patients were male. Total vascular density of deep capillary plexus (DCP) and vascular density of DCP parafovea of the FMF patients were found to be statistically significantly lower than those of the controls (p = 0.045, p = 0.034, respectively), while total retinal parafoveal thickness, total retinal perifoveal thickness, outer retinal parafoveal thickness and outer retinal perifoveal thickness were statistically significantly higher in the patient group compared with the control group (p = 0.012, p = 0.014, p = 0.013, p = 0.009, respectively). This study found reduced vascular density and increased retinal thickness in patients with FMF compared to controls. Larger studies are required to further explore the effect of FMF on the retina.

Bilateral sclerochoroidal calcification in a patient with calcium pyrophosphate deposition disease.

A 60-year-old woman presented with pain and swelling in both of her knees and received a diagnosis of CPPD, based on her clinical characteristics, detection of chondrocalcinosis in multiple joints (including knees and shoulders) (Fig. 1A, B), and a synovial biopsy that was consistent with chondrocalcinosis. The disease was considered to be idiopathic, as she had no other underlying systemic disorders, such as hyperparathyroidism. She was put on colchicine (1.5 mg/day) and (on an as-needed basis) on NSAIDs. The patient was referred to the ophthalmology department because she has longstanding subtle visual complaints. On fundoscopic examination, she had creamy coloured lesions associated with some retinal pigment alterations (Fig. 1C1–C2). An orbital CT scan demonstrated that these lesions were calcified (Fig. 1C3). CPPD is a form of crystal-induced arthritis and it targets the musculoskeletal system. Other system involvements are quite unusual. Eye involvement has only been reported in two cases and has been characterized by sclerochoroidal calcification [1]. Sclerochoroidal calcification may even interfere with the visual function, especially when the deposition is extensive. Moreover, depositions may mimic intraocular tumours, such as a choroidal melanoma [2]. In light of the present case, routine ophthalmic examination should be performed in cases with CPPD, and CPPD should be considered in the differential diagnosis of cases with sclerochoroidal calcification, in addition to the more common causes, such as hyperparathyroidism, parathyroid adenoma, Gitelman syndrome and Bartter syndrome [3]. Informed consent was provided for the publication of this manuscript.

Evaluation and management of systemic corticosteroids-induced ocular hypertension in children with non-Hodgkin lymphoma.

PurposeTo investigate the effect of systemic corticosteroids (CSs) on ocular hypertension (OHT) and to evaluate the management of OHT in children with non-Hodgkin lymphoma (NHL).MethodsMedical records of children with NHL treated in our institution between October 2016 and October 2019 were reviewed. The enrolled patients were divided into the mature B-cell lymphoma (MBL) group and lymphoblastic lymphoma (LBL) group based on pathology. Data on routine ophthalmic examinations and management of OHT were recorded.ResultsOf the 54 recruited patients, 38 patients (70.4%) had LBL, and 16 (29.6%) had MBL. Thirty-one patients (57.4%) developed OHT, 24 patients (77.4%) in the LBL group, and 7 (22.6%) in the MBL group. Twelve patients (38.7%) were identified as high responders (10 with LBL and 2 with MBL). Symptomatic patients had a higher mean peak IOP than asymptomatic patients (p=0.006). A total of 74.2% of OHT was controlled with antiglaucoma medications (100% in the MBL group vs. 66.7% in the LBL group, significant variation, p < 0.001). In total, 8 patients (25.8%) underwent tapering of the CSs dose. The duration of OHT was shorter in the MBL group than in the LBL group (p = 0.003). No patients were found to have glaucomatous damage or cataracts.ConclusionsPatients receiving systemic CSs had a higher risk of developing OHT, but the pattern of CSs administration might be a critical factor in the risk and severity of OHT. Tapering of CSs dose should be considered the first line for the management of OHT during high-dose CSs therapy.

Application of indocyanine green iris angiography in the evaluation of anterior segment blood supply in different strabismus patients

Objective: To evaluate the perfusion features of the anterior segment in patients with different types of strabismus. Methods: A cross-sectional study. Sixteen strabismus patients (16 eyes) who received the examination of iris indocyanine green angiography (ICGA) in Tianjin Eye Hospital from November 2016 to December 2021 were enrolled and divided into two groups according to whether they had a history of extraocular muscle injury/rectus muscle surgery. All patients underwent routine ophthalmic examinations. Angiographic images were obtained by the anterior segment camera, and indicators such as arm to iris circulation time, whole iris filling time, regression onset time, and complete regression time were recorded. The independent sample t test or Mann-Whitney U test was used to compare iris perfusion aspects of the two groups, and the Pearson/Spearman correlation tests was used to analyze the correlation of arm to iris circulation time and whole iris filling time with age and course of strabismus. Results: Among the 16 patients, there were 10 males and 6 females. The mean age was (49.2±13.2) years, and the course of strabismus ranged from 2 to 31 months. There were 7 patients in the group of without extraocualr muscle injury and 9 patients in the extraocular muscle injury/surgery group. There was no significant difference in age and course of strabismus between the two groups (both P>0.05). The arm to iris circulation time [M (Q1, Q3)] of the group without extraocular muscle injury and the group with extraocular muscle injury/surgery were 18 (18, 21) and 22 (20, 24) s, respectively. The average whole iris filling time was (13.86±1.95) and (12.22±3.60) s, respectively. There was no statistical significance between the two groups (both P>0.05). Correlation analysis showed that arm to iris circulation time was not correlated with age and course of strabismus (r=-0.033, -0.079; both P>0.05). And the whole iris filling time was not correlated with age and course of disease (r=0.057, -0.119; both P>0.05). The matrix scatter plots showed that in the group of extraocular muscle injury/surgery, there were three patients who were older than the average (49.2 years) and above the median of arm to iris circulation time (20 s) (two cases with the vertical muscle involved), meanwhile, there were three patients (all with the vertical muscle involved) whose course of strabismus was longer than 6 months and above the median of arm to iris circulation time, which were more than those in the group of without extraocular muscle injury (1 case, respectively). Conclusions: ICGA in patients with strabismus show that a history of injury to the extraocular muscle or surgical treatment beyond 2 months had no effect on iris perfusion. Age and course have no correlation with iris reperfusion. The vertical muscle involvement has more effects on the blood supply to the anterior segment.

Retinal Microvascular Changes in COVID-19 Bilateral Pneumonia Based on Optical Coherence Tomography Angiography.

The purpose of this study was to evaluate retinal and choroidal microvascular alterations with optical coherence tomography angiography (OCTA) in COVID-19 patients hospitalized because of bilateral pneumonia caused by SARS-CoV-2. The vessel density (VD) and foveal avascular zone (FAZ) of 63 patients with SARS-CoV-2 pneumonia who had positive polymerase chain reaction (PCR) tests and who recovered after receiving treatment and 45 healthy age- and gender-matched controls were evaluated and compared using OCTA in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). The VD was also estimated in both groups in the choriocapillaris (CC). In COVID-19 patients, there was a statistically significant difference between the patients and a control group in both superficial (FAZs) and deep (FAZd) avascular zone (p = 0.000). The VD was significantly lower in the foveal area in choriocapillaris (p = 0.046). There were no statistically significant changes in the VD in the superior, inferior, nasal, and temporal quadrants in superficial and deep plexus, or in the choriocapillaris. The VD was not significantly lower in the foveal area in superficial or deep plexus. COVID-19 may affect the retinal vasculature, causing ischemia, enlargement of the FAZ, and lowering of the VD in the choriocapillaris area. Routine ophthalmic examination after SARS-CoV-2 infection should be considered in the course of post-infectious rehabilitation.

Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series.

PurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and Throat Hospital, Shanghai, we evaluated the demographic and clinical characteristics of patients diagnosed with giant cell arteritis between January 2016 and June 2021. Results of routine ophthalmic examinations including fundus examination, optical coherence tomography, color duplex ultrasonography of ocular and superficial temporal arteries, orbital magnetic resonance imaging, and superficial temporal artery biopsy were evaluated.ResultsA total of 15 patients (22 eyes; ten male and five female) were evaluated with a mean age of 77.0 ± 8.5 years. Among them, seven had bilateral involvement that occurred simultaneously or sequentially. Twelve patients presented with arteritic anterior ischemic optic neuropathy, two with arteritic anterior ischemic optic neuropathy combined with cilioretinal artery occlusion, and one with cotton-wool spots. In acute stages of optic neuropathy and retinopathy, optical coherence tomography revealed optic disc edema, thickening of the inner retinal nerve fiber layer and ganglion cell layer, and loss of layer structure. In late stages, optical coherence tomography revealed diffuse atrophy of the inner retina. The “halo” sign was observed in 12 patients in the superficial temporal artery ultrasound, and seven out of eight patients who underwent biopsy demonstrated classic giant cell arteritis pathological changes. Most patients having poor visual acuity but ability to perceive light; 10/22 eyes had permanent vision loss.ConclusionAlthough rare in Asians, giant cell arteritis may be underdiagnosed among elderly Chinese patients presenting with anterior ischemic optic neuropathy. Non-invasive superficial temporal artery ultrasound detecting inflammatory thickening of the intima as the “halo” sign combined with routine elevated erythrocyte sedimentation rate and C-reactive protein may be helpful in diagnosing patients with a high probability of having giant cell arteritis.