Temporal Side Research Articles

Clinical observations of iridociliary cysts and their changes after implantable collamer lens implantation in myopic patients.

To observe the characteristics of iridociliary cysts in myopic patients and evaluate the influences on the position and safety of implantable collamer lens (ICL) after surgery. Totally 270 eyes of 135 patients who underwent ICL surgery for the corrections of myopia were included in this study. Preoperative and postoperative morphology of iridociliary cysts were observed in ultrasonic biomicroscopy (UBM) image. A total of 138 iridociliary cysts were found in 88 eyes of 50 patients among 270 eyes of 135 patients before surgery (37%). Twenty-five patients had cysts in one eye (50%) and 25 had cysts in both eyes (50%). The prevalence of iridociliary cysts was negatively correlated with age, but no gender difference (P>0.05). The incidence of iridociliary cysts was much less in eyes with myopia greater than -9.00 D (P<0.05). The diameter of the largest cyst was 1.96 mm and the smallest cyst was 0.24 mm, with a majority within the range of 0.5 to 1.0 mm. Most of the cysts were located in the inferior temporal quadrant. One year after ICL implantation, 51 iridociliary cysts (37%) remained unchanged, 47 cysts (34%) decreased in size, and 40 cysts (29%) disappeared. Most of cysts that changed after surgery were smaller than 1.0 mm (P<0.05) and located in the nasal and temporal sides around the haptics of implantable lens. All the ICL were in their original position. Iridociliary cysts are commonly seen in myopic eyes. The cysts have no impact on the safety of ICL surgery. Some cysts may decrease in size or disappear after ICL implantation.

Two-dimensional peripheral refraction and retinal image quality in orthokeratology lens wearers.

Orthokeratology (O-K) is a common procedure that uses rigid contact lenses to reshape the cornea while worn overnight. Beyond the correction of refractive error, it has been suggested that this approach can also be used to reduce myopia progression, possibly because it induces changes in peripheral optics. As this hypothesis remains unproven, the aim of the present study was to explore changes in peripheral retinal optical quality in a group of myopic children following O-K treatment. We provide a comprehensive description of optical characteristics in a group of myopes before and after achieving stable corneal reshaping using overnight O-K lenses. These characteristics extended across the central visual field (60° horizontal x 36° vertical) as measured with a custom Hartmman-Shack wavefront sensor. After corneal reshaping, peripheral refraction was found to be asymmetrically distributed, with a myopic relative refraction of approximately 3D in the temporal retina. Astigmatism and higher order aberrations also increased in the temporal side. Based on corneal topography following treatment, subjects were divided into two groups: Centred Treatment (CT, decentration ∈ [-0.5 + 0.5] mm) and Slightly Decentred Treatment (subjects with more decentred lenses). The process was also modelled by ray-tracing simulation. The results indicate that increased myopia in the temporal retina is caused by the decentration of lenses towards the temporal side. Peripheral optics differ significantly following O-K lens treatment, but further research is required to determine whether this is likely to affect myopia progression.

Determination of Referential Rates for Optical Coherence Tomography and Optical Coherence Tomography Angiography Flow Deficits in the Macular Choriocapillaris in Ophthalmologically Healthy Children.

Background and Objectives: Despite the growing number of new research publications, normative references for children’s optical coherence tomography (OCT) parameters are still not completed. We chose to explore this topic because of the lack of normative parameters that is due to an improvement in different technologies and instruments. Our aim was to determine referential rates of retinal nerve fiber layer (RNFL) thickness and flow deficits (FD%) in the macular choriocapillaris (CC) in normal eyes of ophthalmologically healthy children. Materials and Methods: Ophthalmologically healthy 8- to 14-year-old individuals participated (n = 75) in this study. OCT images were taken using an swept-source-OCT (SS-OCT) instrument (DRI-OCT Triton, Topcon, Tokyo, Japan). The early treatment diabetic retinopathy study (EDTRS) grid (6 × 6 mm) divided the RNFL into the thickness maps. The FD% values of the CC were calculated on the 3 × 3-mm scans in a 1-mm circle (C1), 1.5-mm rim (R1.5), and the entire 2.5-mm circle (C2.5), and on the 6 x 6-mm scans in a 1-mm circle (C1), 1.5-mm rim (R1.5), the entire 2.5-mm circle (C2.5), 2.5-mm rim (R2.5), and 5-mm circle (C5). Results: Both scan quantifications of FD% in the C1, C2.5, and R1.5 sectors were similar, but the 6 × 6-mm scan measurements were statistically significantly smaller than the 3 × 3-mm ones. Significant moderate correlations were found between axial length (AxL) and FD% in the 6 × 6-mm scans, namely C1 (r = −0.347, p = 0.002), C2.5 (r = −0.337, p = 0.003), R1.5 (r = −0.328, p = 0.004), R2.5 (r = −0.306, p = 0.008), and C5 (r = −0.314, p = 0.006). Conclusions: The thinnest RNFL layers were on the temporal and nasal sides. FD% values in the C1, C2.5, and R1.5 sectors were similar between the 3 × 3-mm and 6 × 6-mm scans. The negative moderate correlations between AxL and FD% were found in all C1, C2.5, C5, R1.5, and R2.5 sectors of the 6 × 6-mm scans. Further prospective studies are needed to determine more accurate normative references for children’s OCT parameters.

Comparasion of intraoperative triamcinolone and Bevacizumab with conjuctival autograft alone in pterygium surgery

Pterygium is a degenerative condition of subconjuctival tissue that undergoes elstotic degeneration and proliferates as vascular granulation tissue under the epithelium. This ultimately encroaches the cornea destroying its epithelium, superficial stroma and the Bowman’s membrane. It is occurs more commonly on the nasal side than the temporal side, but it can occur on both sides (double pterigium). Pathogenesis is mainly implicated to ultraviolet radiation exposure. It has highest prevalence and in the tropical areas near the equatorand to lesser abd milder degree in cooler climates. The increased levels of proangiogenic factors like basic fibroblast growth factor (BFGF), transforming growth factor Beta (TGF-b), vascular endothelial growth factor(VEGF) and platelet derived growth factor(PDGF) are responsible for formation and recurrence of Pterygium; however the most important of this growth factor is VEGF.To compare the efficacy of intraoperative subconjuctival injection of Triamcinolone and Bevacizumab with conjunctiva autograft alone in primary Pterygium surgery.Total 150 patients divided in three groups (50 patients of each group), underwent primary Pterygium surgery between MAY 2016 to APRIL 2017. In group A, Conjuctivialauto graft alone was done while in groups B &amp; C, it was combined with Intraoperative Subconjuctival Injection of Triamcinolone (0.2mg/ml) and Bevacizumab, (2.5mg/0.1ml).Recurrence rate at 12 month was more in auto graft alone (group A) than in the auto graft in combination with Triamcinolone (group B) and Bevacizumab (group C) respectively.: Subconjuctival injection of Triamcinolone &amp; Bevacizumab can be combined with Conjuctivialauto graft intraoperatively to prevent but Triamcinolone may prefer due to more cost effectiveness.

'The last channel': vision at the temporal margin of the field.

The human visual field, on the temporal side, extends to at least 90° from the line of sight. Using a two-alternative forced-choice procedure in which observers are asked to report the direction of motion of a Gabor patch, and taking precautions to exclude unconscious eye movements in the direction of the stimulus, we show that the limiting eccentricity of image-forming vision can be established with precision. There are large, but reliable, individual differences in the limiting eccentricity. The limiting eccentricity exhibits a dependence on log contrast; but it is not reduced when the modulation visible to the rods is attenuated, a result compatible with the histological evidence that the outermost part of the retina exhibits a high density of cones. Our working hypothesis is that only one type of neural channel is present in the far periphery of the retina, a channel that responds to temporally modulated stimuli of low spatial frequency and that is directionally selective.

Evaluation of choroidal changes in adolescent idiopathic scoliosis using enhanced depth imaging optical coherence tomography

BackgroundWe aimed to evaluate the choroidal thickness (CT) in patients with adolescent idiopathic scoliosis (AIS) using enhanced depth imaging optical coherence tomography (EDI‐OCT).MethodsIn this cross‐sectional, observational comparative study, 56 eyes of 56 patients with AIS and 56 eyes of 56 age‐ and sex‐matched healthy subjects were included. All participants underwent complete ophthalmologic examination and CT measurements at the fovea and at 750 μm intervals from the fovea to 1,500 μm in the nasal and temporal site obtained by spectral domain EDI‐OCT.ResultsThe mean subfoveal CT was lower in the AIS patients (285.2 ± 24.4 μm) than that of the controls (313.2 ± 28.8 μm; p < 0.001). The difference was also significant at all extrafoveal measurement points (p < 0.001 for all). There were negative correlations of CTs at subfoveal and extrafoveal locations with the Cobb's angle in the AIS patients (for subfoveal location: r = −0.71 and p < 0.001; and for extrafoveal locations: r = −0.66 and p < 0.001 at 750 μm in the nasal side; r = −0.64 and p < 0.001 at 1,500 μm in the nasal side; r = −0.71 and p < 0.001 at 750 μm in the temporal side; and r = −0.69 and p < 0.001 at 1,500 μm in the temporal side).ConclusionThis preliminary study showed that AIS patients have thinner CT compared to that of healthy subjects. The lower CT was correlated with the increased angle of scoliosis.

Restriction of eye motility in patients with RETINA IMPLANT Alpha AMS.

To evaluate the motility of the eye in patients with the RETINA IMPLANT Alpha AMS. Eye motility was determined in eight gaze directions in ten blind retinitis pigmentosa patients, who had received the RETINA IMPLANT Alpha AMS, before implantation of the subretinal implant and at six time-points up to one year after. The analysis of eye motility showed a restriction in the upgaze and gaze to the temporal side directly after surgery in eight of the nine patients included. The degree of motility restriction decreased continuously with recovery during the observation time. One year after surgery, eye motility was still restricted in the majority of patients, especially in the upgaze to the temporal side at 20° (five of seven patients). Retinal implants with intraorbital parts (e.g. connecting cables) caused restriction in the temporal and superior viewing directions in the majority of patients. Although this restriction might be cosmetically visible, this limitation in eye motility has no effects on the monocular vision and the implant's efficacy for daily use.

Swept-Source OCT and Swept-Source OCT Angiography before and after Vitrectomy with Stuffing of the Optic Pit

To identify swept-source (SS) OCT and SS OCT angiography (OCTA) patterns predicting outcome in patients with optic disc pit-associated maculopathy and to present the results of a novel surgical technique, stuffing of the optic disc pit. Prospective, interventional study. Fifteen eyes. Swept-source OCT before surgery and then 1 week and 1, 3, and 6 months after surgery, then up to 4 years later. Swept-source OCTA was performed from 2015 (9 patients). After core vitrectomy, internal limiting membrane (ILM) was peeled between the optic nerve and fovea and stuffed into the optic disc pit. Laser photocoagulation was performed at the temporal side of the optic disc pit. Fluid-air exchange followed. The following data were noted: visual acuity, central retinal thickness, distribution of fluid on SS OCT, and diameters and circuit of the foveal avascular zone on OCTA. Normalization of the fovea contour and visual acuity. We subdivided patients into 2 groups. On SS OCT, we observed subretinal fluid with elevation of the fovea (group 1) in 8 eyes. Group 2 comprised 7 eyes without subretinal fluid, but with intraretinal fluid. Five of these eyes additionally showed an outer lamellar macular hole. Anatomic success was achieved in all eyes. The decrease of central retinal thickness 1 week after surgery was more marked in group 1 (P = 0.002). The area of the foveal avascular zone in the superficial retinal vessel layer increased significantly after surgery for group 2 (P= 0.04), but not for group 1 (P= 0.4). Visual acuity improved without statistically significant differences between groups. Stuffing of the optic disc pit with the ILM results in improvement of anatomic and functional results. Prognosis depends on initial morphologic features. Central retinal thickness normalizes faster after surgery in eyes with subretinal fluid when compared with eyes with intraretinal fluid. Faster anatomic improvement does not correlate with improvement of vision. Postoperative increase in the size of the foveal avascular zone in the superficial retinal vessel layer, more pronounced in group 2, may be associated with the prolonged postoperative anatomic recovery in those eyes.

Simple Method for Aesthetic Symmetrical Post Burn Reconstruction of the Temporal and Sideburn Subunits

Post burn scaring and reconstruction of the scalp iscommon condition, which is challenging to plastic surgeons.Which might lead to social deprivation and severe psychologicaltrauma, and patients always try to hide these areas withscarf, hats, wigs, etc…. Although these attempts are commonand useful for the vertex and occipital region, temporo-parietal,temporal, and sideburn are difficult to be camouflaged.Different ways of reconstruction were used including:Serial scar excision, follicular hair transplant, tissue expansion,regional or remote tissue transfer with local or free flaps havebeen described.Although tissue expansion is the best and most popularmethod for scalp reconstruction, the results might be unexpectedand displeasing. Searching on English speaking literature,in all previous studies, success was attributed to theexpansion process in relation to the size, location of thealopecia and donor area ignoring the importance of achievingthe exact or near normal pattern of hair line and symmetry ofthe temporal, temporo-partial and side burn regions. This isdue to the absence of a simple method to guide surgeons whileplanning and reconstructing this critical zone. In this study,I am presenting a simple method utilizing the tissue expansionfor reconstruction of sideburn, temporal, and temporo-partialalopecia to achieve satisfactory, symmetry and near normalreconstruction.This is a retrospective analysis of prospectively maintainedrecords of 29 patients, was conducted from February 2016 toMay 2018 in the Department of Plastic Surgery, Ain ShamsUniversity, Cairo, Egypt. Twenty nine patients with scalp burn alopecia of age 6 to 35 years were included in this study.All patients were examined and assessment was done byobjective and subjective analysis.The results shows that by using this simple method toreconstruct temporal and lateral side burn area, it is provenfrom the objective and subjective evaluation the aestheticoutcome was satisfactory, symmetrical and standardized.

Detection of Glaucoma in Retinal Images Based on Multiobjective Approach

Glaucoma is one of the major causes of blindness. Glaucoma is a condition due to increased pressure within the eyeball, causing progressive, irreversible and gradual loss of sight. It can be prevented only detection in disc ratio (CDR), ratio of blood vessel area in interior and superior side of the blood vessel in the nasal temporal side extracted from retinal fundus images. Reducing the number of features and reducing the error rate are two conflicting objectives. The proposed methodology aims to explore the use of Differential Evolution based multi objective feature selection technique to select a subset of features which minimize both our conflicting objectives. The performance of selected subset of features has been evaluated using KNN classification technique. It has been observed that said extracted subset of five features, KNN classification achieved better accuracy than any other subset of features.

Microsurgical treatment of large and giant parasagittal meningioma invading the superior sagittal sinus

Objective To investigate the method and effect of microsurgical removal of large and giant parasagittal meningioma invading the superior sagittal sinus. Methods The clinical data of 154 cases with large and giant parasagittal meningioma invading the superior sagittal sinus admitted to Department of Neurosurgery, Peking University Third Hospital from May 2009 to May 2019 were retrospectively analyzed. The diameter of the tumors ranged from 4 cm to 8 cm, with an average of 5.5±1.2 cm. Microsurgical resection was carried out along the midline and longitudinal fissure with a horse-shoe shaped skin incision turning to the temporal side. The degree of resection was evaluated by Simpson grading system. The results of clinical follow-up were evaluated by Karnofsky performance score (KPS), and the tumor recurrence was evaluated by imaging follow-up. Results Among the 154 cases, Simpson grade Ⅰ resection was achieved in 112 (72.7%) and grade Ⅱ resection in 42 cases (27.3%). All of them were proved to be meningiomas (World Health Organization grade Ⅰ). The operation time ranged from 30 minutes to 210 minutes (median: 60 minutes), and the length of stay ranged from 5 days to 10 days with an average of 7.2±1.1 days. There was no infection, cerebrospinal fluid leakage, death or permanent aggravation of neurological dysfunction. The patients were followed up for 3 months to 123 months, with an average of 63.5±0.7 months. The KPS score ranged from 80 points to 100 points, with an average of 93.6±0.3 points. Tumor recurrence occurred in 14 patients (9.1%), including 7 in Simpson Ⅰ resection group and 7 in Simpson Ⅱ resection group. There was significant difference in recurrence rate between the 2 groups (χ2=4.01, P<0.05). Conclusion Simpson grade Ⅰ microsurgical resection can be pursued for large and giant parasagittal meningioma invading the superior sagittal sinus which helps minimize the recurrence rate. Key words: Meningioma; Microsurgery; Treatment outcome; Sagittal sinus; Large and giant

A Modified Surgical Technique of Fovea-Sparing Internal Limiting Membrane Peeling: Continuous Arc-Shaped Foldback Peeling.

Purpose To investigate the efficacy of management of high myopic foveoschisis (MF) with a modified surgical technique of arc-shaped foldback fovea-sparing internal limiting membrane (ILM) peeling. Methods A 23-gauge vitrectomy was performed in five patients with high MF. A long strip of ILM was peeled at the temporal side of the central fovea. Next, an ILM forceps was used to grasp the outer side of the ILM flap, and it was moved forward slowly from the outside to the paracentral fovea, followed by folding ILM back in an arc-shaped manner and then removing it. The above operations were repeated, and all ILM flaps were removed from the outside to paracentral fovea until a narrow strip of ILM remained. Finally, the narrow strip of ILM was excised using a vitreous cutter. Results At the patients' last visits, the foveoschisis almost disappeared completely and the fovea reattached. The central macular thickness statistically decreased from 399.0 ± 96.33 μm preoperatively to 164.60 ± 34.20 μm postoperatively (t = 4.289; P=0.013). The preoperative mean logarithm of the minimum angle of resolution best-corrected visual acuity (1.64 ± 0.65) significantly improved to 0.72 ± 0.18 postoperatively (t = 3.265, P=0.031). The average follow-up time was 11.80 ± 3.35 months (range; 8–16 months). Conclusion The arc-shaped foldback fovea-sparing ILM peeling technique for high MF is safe and effective.

Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach.

The sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)-posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique. The authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed. With the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed. The SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.

Corneal Placido Topography And Its Correlation With The Best Fitting Curve For Non-Astigmatic Eyes

Placido topographer CSO Phoenix had been used to measure 30 peoples corneas with astigmatism &lt; 0.50 Dc (University of West Attica) and their refractive maps were taken. The refractive power map was used with measurements taken at the horizontal (180°), vertical (90°), and oblique axes (45° and 135°) for each of these 30 people. The keratometric measurements for &gt; 5mm were recorded. The investigation took place at University of West Attica. The results showed that the shape of the cornea varies in the various meridians (e.g. 180° or 90°) and even with oblique meridians (e.g. in the nasal relative to the temporal side) and its curvature correlates with a different equation for each meridian.

Atrial myxoma with cerebellar signs: a case report

BackgroundAtrial myxoma remains a rare clinical entity with an incidence of surgically resected cases of 0.5–0.7 per million population and prevalence of < 5 per 10,000. It typically manifests in woman after third decade of life; symptoms vary greatly and may present with arrhythmia, intracardiac flow obstruction, embolic phenomenon, and associated constitutional symptoms. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Cerebellar involvement is very rare and only a few cases have been reported in the literature.Case presentationA 55-year-old Brahmin man with no history of diabetes mellitus and hypertension, presented with complaints of dizziness, headache, vomiting, double vision, and unsteadiness of gait for 2 weeks. His headache was sudden in onset, of a pulsating type and localized on left temporal side. Vomiting was projectile and bilious. Double vision was present in all directions of gaze and he had uncoordinated movement of his body and tilting to the left side. On examination, his cerebellar functions were impaired. He was thoroughly investigated for the cause of stroke after abnormal magnetic resonance imaging results with normal computed tomography angiography of his brain. Echocardiography and computed tomography of his chest showed a mass attached to intra-atrial septum and prolapsing through mitral valve, which was suggestive of left atrial myxoma. Five days following admission, he developed abdominal pain due to thromboembolism causing splenic and renal infarct.ConclusionAlthough rare, atrial myxoma has to be considered a cause of stroke and other embolic phenomenon causing multiorgan infarctions. Early and timely diagnosis of the condition can prevent further recurrence and inappropriate anticoagulant therapy. It would be pertinent to have echocardiography done in patients who present with a stroke, arrhythmias, and other constitutional symptoms. The tumor once detected must be removed surgically as early as possible, which not only reduces serious thromboembolic complications but can be potentially curative.

Trichoscopic evaluation of frontal hairline recession in Egyptian female patients.

Since frontal hairline is the most characteristic feature of the face for both men and women, affecting the psychological state of patients, hair loss has been considered to be one of the most prominent esthetic problems. Hair loss either resulting from the androgenetic or nonandrogenetic origin is characterized by changes in the anterior line. The aim of this study was to evaluate the causes of the frontal hairline recession in Egyptian female patients using trichoscopy and to detect the prevalence of each of those causes in Egyptian females. This study was performed on a total of 200 Egyptian female patients aged between 15 and 65years who complained of frontal hairline recession. All patients were derived from Al-Zahraa University hospital outpatient clinic over a period from November 2017 to April 2019. We classified them into two groups according to age: Group A: 15-45 and Group B: 46-65. After full history taking, general and dermatological examination, photographs of hair recession were taken from both frontal and temporal sides. Then, the trichoscopic examination by noncontact dermoscopy was done photographed and evaluated. The most common cause of the frontal hairline recession in Egyptian female patients was androgenetic alopecia (AGA) (50%). Most of the patients were of old age (58%). The high statistically significant trichoscopic findings in androgenetic alopecia were yellow dots, peripilar sign, hair diameter diversity, and single-hair pilosebaceous unit (45.0%, 61.0%, 100.0%, and 96.0%), respectively. On the other hand, perifollicular scaling, absence of hair follicles, and lonely hair revealed a high statistically significant presentation (88.9%, 100.0%, and 22.2%), respectively, with frontal fibrosing alopecia, and vellus hair (100.0%) and perifollicular casts (91.8%) with tractional alopecia. Finally, hair broken at different levels (100%), black powder (88.9%), black dots (100.0%), hook hairs (11.1%), i hair (16.7%),V sign (44.4%), flame hairs (33.3%), coiled hair (5.6%), and burnt match stick sign (5.6%) showed a high statistically significance presentation with trichotillomania. The present study supports the trichoscopic criteria for the diagnosis of causes of frontal hairline recession, which provide a noninvasive diagnostic tool compared with histopathological diagnosis.

Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy.

PurposeTo compare the choroidal thickness in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION) with healthy contralateral eye and normal controls.MethodsThirty-eight eyes with NAION, thirty-eight unaffected fellow eyes, and seventy-four eyes from 37 healthy, age- and sex-matched subjects were included in this prospective comparative case-control study. Choroidal thickness was measured by enhanced depth imaging (EDI) of spectral domain optical coherence tomography (SD-OCT). Peripapillary choroidal thickness (PCT) was measured at 1000 and 1500 m from Bruch's membrane opening (BMO). Subfoveal choroidal thickness (SFCT) was measured in central subfoveal area, and 500 microns apart in temporal and nasal sides. Choroidal thickness among NAION eyes, uninvolved fellow eyes, and control eyes were compared.Results The mean of PCT at 1000 m was significantly thicker in NAION and fellow eyes compared to control eyes (169.7 47, 154.4 42.1, and 127.7 49.9 m, respectively, P 0.001 and P = 0.42). The mean PCT at 1500 m was also significantly thicker in NAION and fellow eyes compared to control eyes (178.6 52.8, 162.6 46.1, and 135.1 59 m, respectively, P = 0.007 and P = 0.048). The mean PCT at 1000 and 1500 m was significantly greater in NAION compared to fellow eyes (P = 0.027 and P = 0.035, respectively). The mean of SFCT was significantly thicker in NAION compared to control eyes (P = 0.032); however, there was no significant difference between uninvolved fellow and control eyes (P = 0.248).ConclusionThicker choroidal thickness in acute NAION and uninvolved fellow eyes compared to normal eyes suggests a primary choroidal role in NAION pathophysiology.

Monitoring Sickle Cell Disease Using Spectral-Domain Optic Coherence Tomography in Pediatric Patients

Introduction: Sickle cell disease (SCD) affects multiple organs including the eye. Ophthalmologists have long relied on funduscopic exam to detect sickle cell retinopathy (SCR). Regular examinations to diagnose and monitor SCR permit timely initiation of treatment to prevent vision loss. Clinical guidelines recommending yearly retinal exam beginning at age 10 were based on data using conventional exam techniques. Optic coherence tomography (OCT) is a quick, noncontact test that provides images of distinctive retinal cell layers at high resolution. OCT has revolutionized the ability to examine retinal structure and provided new information on retinal damage in SCD (Bonanomi, 2013, Chow 2011). Our analysis using data from 69 patients shows that OCT has a higher detection rate for retinal changes in SCD, offering earlier diagnosis than fundoscopy alone (Jin 2018). In the pre-OCT era, patients with the SC genotype, although exhibiting less severe systemic SCD manifestations, were more frequently diagnosed with SCR and seemed to develop vision-threatening proliferative SCR more often than those with SS. In this study, we investigated the correlation between SCD genotype and retinal damage detected by OCT, using our expanded dataset to 97 patients. We also investigated a potential link between hypoxic ischemic injuries in the retina and brain. Stroke is one of the most devastating complications of SCD. The retina and brain share the same embryonic origin, share blood supply from the internal carotid artery, have similar capillary structure and high sensitivity to hypoxia. Thus, improvements in detecting and monitoring retinal ischemia may advance both the surveillance of SCR and cerebral vascular disease (CVD), such as silent cerebral infarcts (SCI), in SCD. Early detection of CVD is critical since prompt intervention can halt progression. Currently, the only available means to detect SCI is MRI, which is costly and often requires sedation. The ability to identify children at high risk for SCI would enable targeted MRI screening. Methods: In this prospective study, conducted over 4 years, 97 consecutive patients with SCD underwent complete ophthalmologic examination and Spectral-Domain OCT (SD-OCT) imaging of both eyes. The posterior pole volume scan involves a 30⁰× 25⁰ cuboid, with 31 raster lines separated by 240 μm. Because of the preponderance of retinal changes on the temporal side of macula, the scanning center was aimed at approximately 3 mm temporal to the foveal center by adjusting the internal or external fixation target. Macular volume scans were assessed for areas of visible thinning. Areas of retinal thinning were determined using the circle grid function on the thickness map. Inner retinal thickness was measured from the internal limiting membrane to the external/outer limiting membrane, and outer retinal thickness was measured from the external limiting membrane to the Bruch's membrane. Retinal exam findings were compared with clinical data. Data analysis was performed using IBM SPSS Statistics 25 (IBM, Armonk, NY). Results: 97 (48 male) patients aged 5-20 years (mean 12.19 ± 4.35) with SCD (34 SC, 53 SS, 5 Sβ+ thalassemia, 5 Sβ0 thalassemia) were examined. Visual acuity ranged from 20/20 to 20/40. On funduscopic exam, 14 of 97 (14.43%) showed signs of retinopathy whereas 59 of 97 (60.82%) showed inner retina thinning on SD-OCT. By SD-OCT, patients with SS/Sβ0 showed a significantly higher frequency of detected SCR change than SC genotype (70.7% vs 47.1%) (Table 1). SS/Sβ0 was also associated with a higher frequency of bilateral SCR (75.6% vs 43.8%) and foveal involvement (22.0% vs 0%). Remarkably, all patients in our cohort with SS/Sβ0 genotype and documented CVD had evidence of SCR by SD-OCT (Table 2). Conclusions: In our cohort, SD-OCT showed greater capabilities than fundoscopy in: 1) a higher detection rate for retinal changes consistent with SCR, offering earlier diagnosis; 2) a significantly higher frequency of SCR and more extensive retinal changes associated with the more severe SCD genotypes SS and Sβ0 as compared to SC; 3) demonstrated correlation between the presence of any form of CVD including stroke, cerebral vasculopathy by MRA, abnormal transcranial Doppler and SCI strongly suggests that retinal exam using SD-OCT may aid in detection and monitoring SCD related CVD. These important findings require further study in a larger patient population undergoing serial exams over time. Disclosures No relevant conflicts of interest to declare.

Statistical Bias Correction of RegCM4 Output Data (Study Area: Indramayu Regency)

Climate data that has limitation on spatial and temporal scale becomes an obstacle in perform the climate-related research such us crop simulation, climate risk assessment and many others. Regional climate models such as RegCM4 can produce adequate outcomes of climate data in term of spatial and temporal sides. Output data from RegCM4 can be used for further research once it has been through correction process. On this study, statistical bias correction with three different transfer function (i.e. linear regression, second order polynomials and third order polynomials) were tested. The correction process that has been done on the RegCM4 rainfall data in Indramayu Regency by using third order polynomials-transfer function is able to produce climatology data with value close to observation data. Similarity between observation data and the corrected RegCM4 output data is indicated by similar temporal and spatial distributions. Based on the historical climate and projection of rainfall (1981-2065), it is known that annual rainfall will decrease by 0.84 mm/year.

Comparison of Vascular Outgrowth Rate and Retinal Vascular Development Border after Intravitreal Injection of Aflibercept or Bevacizumab to Treat Retinopathy of Prematurity

Purpose: It is aimed to evaluate vascular outgrowth rate (VOR) of retinal vessels and retinal vascular development border (RVDB) after intravitreal injections of aflibercept or bevacizumab (IVA or IVB) monotherapy, which have been used to treat retinopathy of prematurity. Methods: In this study, patients were followed by two sequential fluorescein angiography (FA) examinations (Ret-Cam III Imaging System Clarity Medical Systems, Pleasanton, CA, USA) after anti-VEGF monotherapy. RVDB was determined by the ratio between DB (the distance from the center of the disk to the RVDB) and DM (the distance from the center of the disk to the center of the macula). On the other hand, VOR was calculated by the following novel formula: VOR = (DB/DM on the second FA) – (DB/DM on the first FA)/time between two FA examinations. Results: Fifty-one eyes of 27 infants who received aflibercept were included as group 1; 38 eyes of 19 patients who received bevacizumab were included in group 2. There were no significant differences between these groups in terms of demographic variables, percentages of disease at zone 1 and posterior zone 2 (p = 0.260), as well as stage 2+ and stage 3+ disease (p = 1.0) at the time of anti-VEGF injections. VORs, which had been measured in between two sequential follow-up FAs, were estimated to be significantly higher in group 1, both in nasal (p = 0.042) and temporal sides (p = 0.033). However, DB/DM ratios were significantly higher in group 2 in the first FA (p = 0.001 at nasal and temporal sides) and the second FA examinations (p = 0.007 and p = 0.004 at nasal and temporal sides, respectively). Conclusion: VOR was found to be significantly higher in patients who were treated with IVA monotherapy. Paradoxically, RVDB was farther in patients receiving IVB monotherapy despite a slower VOR in these patients.