Structural and functional outcomes after treatment of uveitic macular oedema: an optical coherence tomography and multifocal electroretinogram study

Multifocal electroretinographic findings in angiographic macular leakage in the setting of intermediate, posterior, or panuveitis

OBJECTIVE

To evaluate the functional implications of angiographic macular leakage without the presence of intraretinal fluid on optical coherence tomography (OCT) in eyes with intermediate, posterior, or panuveitis.

METHODS

Retrospective study on patients with a diagnosis of intermediate, posterior, or panuveitis. Patients who had fluorescein angiography, OCT, and multifocal electroretinography (mfERG) within a predetermined time frame were included. Demographic and clinical data including types of ocular inflammation and best-corrected visual acuity (BCVA), in addition to OCT, fluorescein angiography, and mfERG data were collected. The study cohort was divided into 2 groups based on the presence of angiographic macular leakage and macular edema (ME): group 1 (no ME and no macular leakage) and group 2 (presence of macular leakage without ME).

RESULTS

A total of 29 patients (43 eyes) were included in the study, with 13 patients (17 eyes) in group 1 and 16 patients (26 eyes) in group 2. No statistically significant differences in age, sex, anterior-chamber cells, lens status, vitreous cells, vitreous haze, BCVA, or mean central subfoveal thickness were found between groups 1 and 2. All mfERG values, including N1 and P1 response densities and timings for rings 1-5, did not show any statistically significant difference between group 1 and 2. No correlation was found between either BCVA or central subfoveal thickness and any of mfERG values for rings 1-3.

CONCLUSIONS

In absence of ME, angiographic macular leakage in eyes with uveitis might not be associated with worse macular function when compared with eyes without angiographic macular leakage.

Anatomical and Functional Effects of Oral Administration of Curcuma Longa and Boswellia Serrata Combination in Patients with Treatment-Naïve Diabetic Macular Edema

Anti-vascular endothelial growth factor nowdays represents the standard of care for diabetic macular edema (DME). Nevertheless, the burden of injections worldwide has created tremendous stress on the healthcare system during the COVID-19 pandemic. The aim of this study was to investigate the effects of the oral administration of Curcuma longa and Boswellia serrata (Retimix®) in patients with non-proliferative diabetic retinopathy (DR) and treatment-naïve DME < 400 μm, managed during the COVID-19 pandemic. In this retrospective study, patients were enrolled and divided into two groups, one undergoing observation (Group A, n 12) and one receiving one sachet a day of Retimix® (Group B, n 49). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured by spectral-domain optical coherence tomography were performed at baseline, then at one and six months. A mixed-design ANOVA was calculated to determine whether the change in CMT and BCVA over time differed according to the consumption of Retimix®. The interaction between time and treatment was significant, with F (1.032, 102.168) = 14.416; η2 = 0.127; p < 0.001, indicating that the change in terms of CMT and BCVA over time among groups was significantly different. In conclusion, our results show the efficacy of Curcuma longa and Boswellia serrata in patients with non-proliferative DR and treatment-naïve DME in maintaining baseline CMT and BCVA values over time.

Associations between functional and structural measurements in non-acute Vogt-Koyanagi-Harada disease

PURPOSE

To evaluate associations between functional and structural measurements in patients with non-acute VKHD.

METHODS

In this cross-sectional study, 16 non-acute VKHD patients (32 eyes; 14 female) were evaluated with multifocal electroretinogram (mfERG), standardized automated perimetry (SAP) and optical coherence tomography (OCT)examinations. All included patients had a minimum 12 months of follow-up from acute onset and were participants of an ongoing prospective study since acute phase with systematic clinical imaging evaluations and electroretinogram examinations within a predefined treatment. Age- and gender-matched controls were included. Main outcomes were functional and structural abnormalities and their correlation; secondary outcome was correlation of these findings with clinical characteristics, including fundus abnormalities.

RESULTS

SAP and mfERG parameters were significantly worse in patients than in controls. Fourteen eyes (43.7%) had disrupted ellipsoid zone (EZ); visual acuity (VA) was similar between eyes with intact or disrupted EZ. Eyes with intact and disrupted EZ differed significantly concerning N1 and P1 amplitudes and N1 peak time values on mfERG and mean sensitivity (MS), central sensitivity (CS), foveal threshold, visual field index, mean deviation (MD) and pattern standard deviation values on SAP. The area under the curve on receiver operating curves for P1 amplitude was 0.81 (cut-off value = 34.7 nV/deg² ) and for MD value was 0.84 (cut-off value = -5.2 dB). Central retinal thickness (CRT) significantly correlated with N1 and P1 amplitudes and P1 peak time values on mfERG (r = 0.354, r = 0.442 and r = -0.405, respectively) and MD, MS, CS and fovea threshold (log values) on SAP (r = 0.372, r = 0.406, r = 0.431 and r = 0.414, respectively). Statistically significant associations were found with the presence of peripapillary atrophy and recurrent anterior uveitis with a worse MD value (p = 0.004 and p < 0.001, respectively).

CONCLUSION

In non-acute VKHD, disrupted EZ and reduced CRT were correlated with impaired mfERG and SAP parameters, even in patients with good VA.

Electrophysiological examination in uveitis: a review of the literature

Purpose

Uveitis is the inflammation of the uveal tract, which usually also affects the retina and vitreous humor. The electrophysiological examination is an objective ocular examination that includes the electroretinogram, visual evoked potentials, the electrooculogram, the multifocal electroretinogram, and multifocal visual evoked potentials. Our aim is to review the literature of the use of the electrophysiological examination in cases of uveitis.

Methods

We performed a systematic search of the literature of published papers until October 2012 using the PubMed search engine. The key terms that were used were “uveitis”, “electrophysiological examination”, “electroretinogram”, “visual evoked potentials”, “electrooculogram”, “multifocal electroretinogram”, and “multifocal visual evoked potentials” in multiple combinations. To the best of our knowledge, this is the first review concerning the assessment of electrophysiology in uveitis.

Results

Our search of the literature demonstrated that the electrophysiological examination, mainly by means of electroretinogram, multifocal electroretinogram, and visual evoked potentials, is performed in several cases of uveitis for many purposes, including diagnosis and monitoring of disease progression and treatment efficacy. The electrophysiological examination is more useful in patients with multiple evanescent white dot syndrome, acute posterior multifocal placoid pigment epitheliopathy, birdshot chorioretinopathy, Vogt–Koyanagi–Harada disease, Adamantiades–Behçet disease, ocular syphilis, and Fuchs heterochromic cyclitis.

Conclusion

This review summarizes the use of the electrophysiological examination in uveitic patients and underlines its value as a useful tool in the objective assessment and the monitoring of the disease.

Optical coherence tomography in the diagnosis and management of uveitis

Optical coherence tomography (OCT) has become an integral tool in the imaging of numerous diseases of the posterior segment. The diagnostic investigation of infectious and noninfectious uveitic conditions often requires multiple imaging modalities in the appropriate clinical context. Modern OCT technology has proved useful not only in the diagnostic investigation of these conditions, but also in monitoring of their clinical course and therapeutic response. Inflammation-induced changes at the level of the retina, retinal pigment epithelium, and choroid can now easily be identified in these conditions using OCT. Prognostic information on visual acuity outcome can also be estimated based on OCT findings. Numerous OCT findings have been described in the setting of the various uveitides. Although none of these findings appear to be pathognomonic for diagnosis of specific uveitic syndromes, in the appropriate clinical context they can add a great deal of information in the diagnosis and management of uveitis.

Topical dorzolamide treatment of macular cysts in the enhanced S-cone syndrome patient

Purpose

The purpose of the study was to evaluate the efficacy of a topical form of a carbonic anhydrase inhibitor (dorzolamide) on the foveal function and thickness in the eye of a patient with enhanced S-cone syndrome (ESCS) associated with macular cysts.

Methods

Twenty-eight-year-old Polish man with ESCS and macular cysts appearance in the right eye was treated 3 times daily with 2.0 % dorzolamide drops for the period time equal to 6 months. Monthly controls included: best corrected distance visual acuity (BCDVA-logMAR), foveal thickness (optical coherence tomography, OCT) and foveal function (multi-focal electroretinography, mfERG).

Results

Before treatment, BCDVA in the right eye was equal to 0.26 logMAR, improved to 0.1 logMAR during the first 3 months and remained stable for the next 3 months. After 6 months, foveal thickness decreased (from 482 to 224 μm) and foveal function improved (the amplitude of P1-wave density increased from 34.8 to 107.3 nV/deg²) and was between the ranges of normal values. Implicit time of P1-wave remained prolonged.

Conclusions

The results of our short-term study suggest potential efficacy of topical dorzolamide treatment in ESCS patients with macular cysts.