Perinatal risk factors associated with central retinal changes in former preterm children on optical coherence tomography angiography

PURPOSE

To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and central retinal structures of former preterm children seen on optical coherence tomography angiography (OCTA).

METHODS

This prospective cohort study included 40 children with a history of preterm birth and 33 healthy full-term children. We documented their birth weight, gestational age, other significant risk factors for ROP development and presence of ROP. Imaging was performed using swept-source OCTA, and quantitative evaluation was performed. Analytic parameters included the area of foveal avascular zone (FAZ), foveal depth (FD), central subfoveal retinal thickness (CSFT) and capillary density index (CDI) of the deep and superficial capillary plexus.

RESULTS

Preterm children had significantly smaller FAZ, lower FD and higher CSFT compared to controls (all p < 0.001). Both groups exhibited no differences in total CDI at the superficial (p = 0.969) and deep capillary plexus (p = 0.370). The duration of mechanical ventilation correlated negatively with FAZ and FD but positively with CSFT. The duration of supplemental oxygen treatment correlated negatively with FD. The presence of intraventricular haemorrhage correlated negatively with FAZ and FD but positively with CSFT. Regression analysis found that the duration of mechanical ventilation and the presence of bronchopulmonary dysplasia were associated with lower FD (p = 0.002 and 0.01, respectively) and higher CSFT (p = 0.002 and 0.028, respectively).

CONCLUSION

Central retinal anomalies were identified in former preterm children using OCTA. Macular changes were associated with several risk factors for ROP development.

ACUTE IDIOPATHIC MACULOPATHY: A Proposed Disease Staging Based on Multimodal Imaging

PURPOSE

To describe the clinical course and the multimodal imaging of acute idiopathic maculopathy.

METHODS

Medical records and multimodal imaging including color fundus photography, optical coherence tomography, and fundus autofluorescence were retrospectively reviewed. Recognition of the fundus autofluorescence patterns and their relationship with the disease duration, best-corrected visual acuity, and optical coherence tomography features represented the main outcome measures.

RESULTS

Seventeen eyes of 16 patients (7 women; mean age 29.9 years) with a mean follow-up of 23.9 months were included. The mean best-corrected visual acuity at presentation was 0.63 ± 0.54 logarithm of the minimum angle of resolution (Snellen equivalent, 20/85). All but one patient had the best-corrected visual acuity recovery to 20/20. Four sequential patterns of fundus autofluorescence corresponding to 4 proposed stages of disease were observed. Patterns 1 (central hypoautofluorescence with surrounding hyperautofluorescence) and 2 (stippled hyperautofluorescence and hypoautofluorescence) were found at presentation. Patterns 3 (central hyperautofluorescence surrounded by hypoautofluorescence) and 4 (hypoautofluorescence) were observed during the disease course and/or at the last follow-up visit. Duration of the disease was significantly different between patterns at baseline and last visit. Pattern 1 significantly related to the presence of subretinal detachment (Fisher's exact test; P =0.003) on optical coherence tomography in comparison with Pattern 2. Pattern 4 showed unique homogeneously decreased autofluorescence with corresponding attenuation of retinal pigment epithelium and restored outer retinal layers on optical coherence tomography.

CONCLUSION

A sequential disease staging based on multimodal imaging for acute idiopathic maculopathy is proposed. The recognition of the observed imaging patterns may help clinicians in the correct diagnosis and patient counseling.

Choroidal structural changes in preterm children with and without retinopathy of prematurity

PURPOSE

Evaluate choroidal structural changes in preterm children with and without retinopathy of prematurity (ROP) using image binarization technique on swept-source optical coherence tomography (SS-OCT) scans.

METHODS

Prospective case-control study. Forty-one (79 eyes) children aged 5-15 years with a history of preterm birth and 33 (63 eyes) age-matched full-term children were recruited. Demographics including gestational age at birth, birth weight and history of ROP were documented. All subjects had undergone complete eye examinations, including best-corrected visual acuity and SS-OCT imaging. Subfoveal choroidal thickness (SFCT) was calculated, and images were binarized to obtain stromal and luminal areas (LA). The choroidal vascularity index (CVI) was derived from the proportion of LA to the total subfoveal choroidal area.

RESULTS

There were no significant differences in SFCT between the preterm children with (286.63 ± 83.98 μm) or without (306.59 ± 77.29 μm) ROP and the full-term children (311.82 ± 42.87; p = 0.20 and 0.67, respectively). The CVI was significantly reduced in the preterm children with ROP (68.66 ± 3.24%; p = 0.005) compared with the CVI in the full-term control group (71.37 ± 3.63%); however, the CVI in the preterm children without ROP (71.68 ± 3.09%; p = 0.93) was not significantly affected.

CONCLUSION

The reduced CVI in preterm children with ROP may indicate compromised choroidal vascularity. The CVI was found to be a more sensitive OCT biomarker than the SFCT and may be helpful in evaluating associated choroidal structural changes in preterm children, especially those with a history of ROP.

Patients' Perspectives on Their Dry Eye Disease

PURPOSE

Although it has been known that patients' perspectives on their disease can significantly affect their level of functional disability as well as disease outcome, limited data are available on patients' perceptions of their dry eye disease (DED). The aim of this questionnaire-based study was to evaluate patients' perspectives on their DED.

METHODS

This cross-sectional study included 91 patients with DED. In addition to clinical evaluation, all patients completed a questionnaire to evaluate their perspectives on their DED. This included their satisfaction with understanding DED, their opinion on the easiness of following doctors' advice, their opinion on the effectiveness of the treatment, their satisfaction with the eye care, and their general outlook on DED.

RESULTS

This study included 75 (82%) women and 16 men (18%) with a mean age of 57 ± 14 years who had been treated for DED for 5.2 ± 5.4 years. 93% of the patients were satisfied with their understanding of DED, and 76% found it easy to follow their doctors' advice for DED management. Furthermore, 95% thought that the DED treatment had been helpful and 95% were satisfied with their eye care for DED. Forty-eight percent expressed optimism regarding the long-term prospects of their DED.

CONCLUSIONS

Although the majority of DED patients have positive perspectives on their disease, close to half report a lack of optimism regarding the long-term outlook for their condition.

Bilateral Posterior Scleritis: Analysis of 18 Cases from a Large Cohort of Posterior Scleritis

PURPOSE

To describe the clinical and epidemiological characteristics of patients and analyze factors associated with bilateral posterior scleritis.

METHODS

In this retrospective cohort study, records of patients with diagnosis of bilateral posterior scleritis at two tertiary-care centers in the UK and India were analyzed in comparison with the clinical profile of patients with unilateral scleritis.

RESULTS

In total, 18 patients with bilateral posterior scleritis were identified and compared with 96 patients of unilateral posterior scleritis; 14 (77%) were women and the median age was 48 years. Headache (p = 0.04), optic nerve swelling (p = 0.01), and elevated antinuclear antibodies (ANA) titers (p = 0.03) were present more frequently in patients with bilateral than in unilateral posterior scleritis. Seven patients (38.88%) required immunosuppressive therapy to attain resolution of the inflammation and to prevent relapse.

CONCLUSIONS

Bilateral posterior scleritis is an uncommon but severe inflammation of the posterior sclera. The majority of them are idiopathic, often requiring aggressive treatment to prevent visual loss.

Posterior Scleritis: Analysis of Epidemiology, Clinical Factors, and Risk of Recurrence in a Cohort of 114 Patients

PURPOSE

To describe the clinical and epidemiological characteristics of patients with posterior scleritis, and to analyze the response to treatment and time to relapse.

METHODS

Retrospective study of 114 cases of posterior scleritis from two tertiary care, university-affiliated, referral centers in the United Kingdom and India between 2004 and 2013. Data included sociodemographic factors, medical history, clinical, laboratory and ultrasound findings, therapies, and outcomes. LogMAR visual acuity at presentation and final visit and time to relapse were the main outcome measures.

RESULTS

The mean age was 45.9 ± 16.8 years, 71.1% were women, and 18 (15.8%) patients had bilateral disease; 71 (62.3%) cases were idiopathic. Rheumatoid polyarthritis (12.28%), systemic lupus erythematous (4.38%) and pANCA(+) systemic vasculitis (5.26%) were the most frequent systemic associations. VA improved by 0.24 ± 0.36 LogMAR between presentation and last follow up (p < 0.001). The median time to remission was 210 days (95% CI: 184-256 days). Recurrences after remission were observed in 36.63%. The observed incidence rate of posterior scleritis relapse after remission was 15.81% per person-year (95% CI: 11.78-20.77%). Systemic disease was present significantly in patients more than 50 years of age (OR = 2.29; 95% CI: 1.01-5.17; p = 0.044).

CONCLUSION

Posterior scleritis is an uncommon disease causing pain and visual loss. In around 40% of the cases, it can be associated with other systemic diseases. Median time to relapse was 210 days. Relapses may occur in around 1 in 3 patients, with an incidence rate of 15.81% per person/year.

Floating vitreous cyst: two clinical cases

Purpose

To report two cases of solitary unilateral vitreous cyst.

Methods

A complete ocular examination, fundus photography, B-scan ultrasound and spectral-domain optical coherence tomography were performed in both patients.

Results

The first patient (a 39-year-old man) presented with transient blurred vision in the right eye. The second patient (a 78-year-old man) reported transient blurred vision in the right eye when changing head position. He was referred to the Eye Hospital because of vitreomacular traction in the other eye. After examination, a diagnosis of vitreous cyst was made in both cases.

Conclusions

Vitreous cysts are rare clinical findings. They can occur in normal eyes or in eyes with certain ocular pathologies. When a cyst floats into the visual axis area, it can disturb visual function; therefore, patients usually report transient blurring of vision. A prompt clinical examination is necessary for differentiating this rare condition.

Predictive learning, prediction errors, and attention: evidence from event-related potentials and eye tracking

Prediction error ("surprise") affects the rate of learning: We learn more rapidly about cues for which we initially make incorrect predictions than cues for which our initial predictions are correct. The current studies employ electrophysiological measures to reveal early attentional differentiation of events that differ in their previous involvement in errors of predictive judgment. Error-related events attract more attention, as evidenced by features of event-related scalp potentials previously implicated in selective visual attention (selection negativity, augmented anterior N1). The earliest differences detected occurred around 120 msec after stimulus onset, and distributed source localization (LORETA) indicated that the inferior temporal regions were one source of the earliest differences. In addition, stimuli associated with the production of prediction errors show higher dwell times in an eye-tracking procedure. Our data support the view that early attentional processes play a role in human associative learning.

A double-dissociation of English past-tense production revealed by event-related potentials and low-resolution electromagnetic tomography (LORETA)

OBJECTIVES

Evidence of systematic double-dissociations of neural activity associated with the generation of regular and irregular past tense in healthy individuals may prove decisive in distinguishing between single- and dual-route models of morphological processing, because the former (connectionist models of morphological processing) have only been able to simulate double-dissociations of past-tense morphology as low-probability phenomena.

METHODS

Twenty-eight channel event-related potentials (ERPs) were recorded in response to past-tense production and subsequently analyzed using a 3-stage strategy.

RESULTS

A data-driven algorithm temporally segmented the ERPs into 16 distinct epochs of stable field configuration (microstates). A space-oriented brain electric field analysis determined that one of those epochs, 288-321 ms after the verb stem presentation, showed significant differences between the regular and irregular verb conditions. As a further test of these results, a novel source localization technique that computes 3-dimensional distribution of cortical current density in the Talairach brain atlas--low-resolution electromagnetic tomography--found in the above microstate more activity for regulars in the right prefrontal and right temporal areas and for irregulars in the left temporal areas and the anterior cingulate cortex, which can be taken as evidence of systematic double-dissociation.

CONCLUSIONS

The present results achieved with a source localization technique provide evidence of a two-way compartmentalization of neural activity corresponding to regular and irregular past tense, thus corroborating the dual-mechanism character of verb morphology.

Mapping dissociations in verb morphology

Substantial behavioural and neuropsychological evidence has been amassed to support the dual-route model of morphological processing, which distinguishes between a rule-based system for regular items (walk-walked, call-called) and an associative system for the irregular items (go-went). Some neural-network models attempt to explain the neuropsychological and brain-mapping dissociations in terms of single-system associative processing. We show that there are problems in the accounts of homogeneous networks in the light of recent brain-mapping evidence of systematic double-dissociation. We also examine the superior capabilities of more internally differentiated connectionist models, which, under certain conditions, display systematic double-dissociations. It appears that the more differentiation models show, the more easily they account for dissociation patterns, yet without implementing symbolic computations.

Differences in working memory involvement in analytical and creative tasks: an ERP study

If, as suggested, creative (insight) problem solving is less systematic and employs less planning than analytical problem solving, the former requires substantially less working memory (WM) than the latter. Subjects simultaneously solved problems and counted auditory stimuli (concurrent WM task), in response to which ERPs were recorded. Counting disrupted analytical, but not creative performance. Peak and time-window average P300 were more frontal during analytical problem solving as compared to insight or counting tones only (control). A PCA extracted two factors in the P3 range, one frontal and one broad left-lateralized, which distinguished analytical from creative problem solving. The findings indicate distinct processing pathways for the two types of tasks with more WM involvement in analytical tasks.