A Rare Association: Neovascular Glaucoma Accompanying Anterior Chamber Synchysis Scintillans

Synchysis scintillans, also known as cholesterolosis bulbi, is a degenerative eye pathology characterized by the accumulation of cholesterol crystals in the vitreous. It is typically observed bilaterally but can rarely be unilateral. It can be triggered by severe trauma, chronic inflammation, chronic retinal detachment, hyphema, vitreous hemorrhage, Coats’ disease, and retinoblastoma. In this report, we present a case with an uncommon association of anterior chamber synchysis scintillans and neovascular glaucoma.

The Assessment of Radial Peripapillary Capillary Vessel Density in Adult Children of Patients with Primary Open-Angle Glaucoma

PRCIS

The observed decrease in radial peripapillary capillary vessel density among adult children of individuals with primary open-angle glaucoma, in comparison to controls, suggests the possibility of early microvascular alterations in the eyes of these at-risk individuals.

PURPOSE

To compare the radial peripapillary capillary vessel density (RPCVD) and peripapillary retinal nerve fiber layer (RNFL) thickness values of eyes between healthy adults with a maternal or paternal history of primary open angle glaucoma (POAG) and age-matched healthy controls without a family history of POAG.

METHODS

RPCVD values and RNFL thicknesses in the peripapillary region and 4 quadrants (superior, inferior, nasal, and temporal) were evaluated using optical coherence tomography angiography (OCT-A) among 30 adult children of patients with POAG and 30 age-matched healthy controls without a family history of POAG.

RESULTS

The mean whole image RPCVD (51.6±1.7% vs. 49.8±1.7%, P=0.0006) and average RPCD (54.7±1.7% vs. 53.2±2.1%, P=0.006) values were significantly lower in the adult children of patients with POAG compared to age-matched healthy controls without a family history of POAG. There was no difference in terms of RNFL thickness values in any region.

CONCLUSION

Despite having similar RNFL thickness values to the control group, the observation of lower RPCVD in the eyes of adult children of POAG patients may indicate potential early vascular alterations. The result of the present study encourages further longitudinal studies to determine the potential importance of the underlying vascular alterations in these high-risk individuals.

Evaluation of Static and Dynamic Pupillary Functions in Early Stage Primary Open Angle Glaucoma

PRCIS

The dynamic parameters of the pupil, evaluated with an automated pupillometry device, differ in newly diagnosed early-stage primary open angle glaucoma (POAG) patients compared with healthy individuals, and this may guide us in early diagnosis and follow-up of glaucoma.

INTRODUCTION AND AIM

To quantitatively determine static and dynamic pupillary functions in treatment-naive, newly diagnosed early-stage POAG patients and compare them with healthy controls.

METHODS

Forty eye of forty subjects with early POAG were compared with 71 eye of 71 age- matched and sex-matched healthy controls in terms of static and dynamic pupillary functions in this prospective and cross-sectional study. Static and dynamic pupillary functions were obtained with an automated pupillometry device. Static pupillometry parameters are pupil diameter (mm) in high photopic (100 cd/m 2 ), low photopic (10 cd/m 2 ), mesopic (1 cd/m 2 ), and scotopic (0.1 cd/m 2 ) light conditions. Dynamic pupillometry parameters are resting diameter (mm), amplitude (mm), latency (ms), duration (ms), and velocity (mm/s) of pupil contraction and dilation. Measured data were evaluated and compared with t test for independent groups.

RESULTS

Duration of pupil contraction was lower, ( P =0.04) latency of pupil dilation time was longer, ( P =0.03) duration of pupil dilation was shorter ( P =0.04) and velocity of pupil dilation was lower ( P =0.02) in the POAG group. There was no significant difference between the 2 groups in terms of static pupillometry characteristics and the resting pupil diameter ( P >0.05 for all values).

CONCLUSION

These results suggest that dynamic pupillary light responses may be affected in early-stage POAG compared with the normal population. Longitudinal studies with larger series are needed to better understand the quantitative changes in dynamic pupillometry functions in early-stage POAG.

Is the Pupil Involved in Duane Syndrome? Static and Dynamic Pupillometry Characteristics

Objectives

Duane syndrome (DS) is typically characterized by abduction and/or adduction deficiency accompanied by eyelid and ocular motility disturbances. Maldevelopment or absence of the sixth nerve has been shown to be the causative factor. The aim of the present study was to investigate static and dynamic pupillary characteristics in patients with DS and compare the results with those of healthy eyes.

Materials and Methods

Patients with unilateral isolated DS and no history of ocular surgery were enrolled in the study. Healthy subjects with a best corrected visual acuity (BCVA) of 1.0 or higher were assigned to the control group. All subjects underwent complete ophthalmological examination and pupillometry measurements (MonPack One, Vision Monitor System, Metrovision, Perenchies, France) including static and dynamic pupil evaluation.

Results

A total of 74 patients (22 with DS and 52 healthy subjects) were included in the study. The mean age of the DS patients and healthy subjects was 11.05±5.19 and 12.54±4.05 years, respectively (p=0.188). There was no difference in sex distribution (p=0.502). Mean BCVA differed significantly between eyes with DS and healthy eyes, and between healthy eyes and the fellow eyes of DS patients (p<0.05). No significant difference was found in any static or dynamic pupillometry parameters (p>0.05 for all).

Conclusion

In the light of the results of the present study, the pupil seems to be not involved in DS. Larger studies including more patients with different types of DS in different age groups or comprising patients with non-isolated DS may reveal different findings.

Prevalence of Serous Macular Detachment in Recurrent Macular Edema Secondary to Retinal Vein Occlusion

Objectives:

To evaluate the prevalence of serous macular detachment (SMD) accompanying recurrent cystoid macular edema (CME) in patients initially treated for CME secondary to retinal vein occlusion (RVO) with accompanying SMD, and discuss the factors that affect the prevalence.

Materials and Methods:

We retrospectively evaluated the medical records of 71 patients with RVO-associated CME and SMD who achieved complete anatomical resolution after treatment with either a single dexamethasone implant or three loading doses of ranibizumab and developed recurrent CME during follow-up.

Results:

Initial treatment was a single intravitreal dexamethasone implant in 45 patients (63.4%) (Group 1) and three loading doses of intravitreal ranibizumab in 26 patients (36.6%) (Group 2). The mean time to CME recurrence was 4.7±0.8 months (range, 4-7 months) and was similar in both groups (p=0.984). At the time of CME recurrence, SMD was present in 41 patients (57.7%) and absent in 30 patients (42.3%). SMD was present in 27 (60.0%) of the 45 Group 1 patients and 14 (53.8%) of the 26 Group 2 patients (p=0.613). SMD was present in 48.8% of branch RVO and 71.4% of central RVO patients at the time of recurrence (p<0.001).

Conclusion:

SMD accompanied recurrent CME in only 57.7% of patients previously treated for CME and SMD and seems to be more frequent in patients with central RVO. Initial intravitreal treatment choice of either ranibizumab or dexamethasone implant did not affect the prevalence of concurrent SMD in patients with recurrent CME.

Quantitative investigation of the effect of surgically induced hypoparathyroidism on cataract development

INTRODUCTION

Although cataract formation is known in hypoparathyroidism, lens clarity and its correlation with clinical parameters have not been investigated quantitatively before in patients with hypoparathyroidism. The aim of this study was to compare the crystalline lens clarity of patients with surgically induced hypoparathyroidism and healthy subjects.

MATERIALS AND METHODS

Forty female patients with surgically induced hypoparathyroidism and 38 age-matched healthy female subjects were enrolled in this study. Scheimpflug corneal topography was performed to measure lens density (LD) and thickness (LT). Serum calcium, inorganic phosphorus, parathyroid hormone (PTH) levels, and disease duration were recorded.

RESULTS

No statistically significant difference was observed between the hypoparathyroidism and control groups in the Pentacam densitometry zones 1-2-3, LT, and average and maximum LD (p > 0.05 for all). Nine blue-dot-like, two cortical, and two posterior subcapsular cataracts were detected in the hypoparathyroidism group. The frequency of total and blue-dot-like cataracts was significantly higher in the hypoparathyroidism group than in the control group (p = 0.008 and p = 0.002, respectively). In the hypoparathyroidism group, a significant correlation was observed between the maximum LD and the hypoparathyroidism duration (ß = 0.420, p = 0.017), and the maximum LD and serum PTH level (ß = -0.332, p = 0.049).

CONCLUSION

The clarity of the crystalline lens may decrease in surgically induced hypoparathyroidism patients depending on the disease duration and PTH levels. Additionally, this study detected an increased frequency of blue-dot-like cataract in the patient group, which may be due to the effect of hypoparathyroidism.

The pupillary dynamics of patients with physiological anisocoria

BACKGROUND

To evaluate static pupillometric measurements and making inter-ocular comparative analysis in healthy subjects for demonstrating the prevalance of physiological anisocoria in various lighting conditions and to compare the variations of the dynamic pupillometric measurements of the patients with physiological anisocoria.

METHODS

Automatic quantitative pupillometry system was used to measure pupillary diameters in low mesopic (0.1 cd/m²), high mesopic (1 cd/m²), low photopic (10 cd/m²) and high photopic (100 cd/m²) conditions. After inter-ocular comparison of these data, the prevalance of physiological anisocoria was detected in four different lighting conditions. The inter-ocular dynamic pupillometric parameters (amplitude, latency, duration and velocity of pupil contraction; latency, duration and velocity of pupil dilation) of these patients were further analysed.

RESULTS

After inter-ocular comparison of pupillary diameters of 195 participants [96 females (49.2%) and 99 males (50.8%)] with a mean age of 38.4 ± 18.9 years (range 7-78 years), six (3.1%) participants under high photopic; 11 (5.6%) participants under low photopic; 25 (12.8%) participants under high mesopic, and 34 (17.4%) participants under low mesopic illumination levels exhibited physiological anisocoria. The mean relative amplitude of anisocoric small pupils' contraction was lower than the mean relative amplitudes of pupil contraction of both isocoric and anisocoric large pupils (p = 0.021, p = 0.035, respectively). The mean velocity of anisocoric small pupils' contraction was lower than the mean velocity of anisocoric large pupils' contraction (p = 0.013).

CONCLUSIONS

The mean contraction amplitude and contraction velocity of smaller pupils was lower when compared to fellow larger pupils of anisocoric patients.

The relationship between retinal microcirculation and right heart catheterization and echocardiography findings in patients with idiopathic pulmonary arterial hypertension

OBJECTIVE

To determine the possible alterations of retinal microcirculation associated with right-sided intracardiac pressures in patients with IPAH.

METHODS

Twenty patients with IPAH and 20 age- and sex-matched healthy controls were included in the study. Hemodynamic data were obtained from the most recent right heart catheterization. Echocardiographic examination was performed within 24 h of ophthalmological examination. For the right eyes of all participants, high-resolution scans of chorioretinal microvascular networks at different depths of the retina were captured via OCT angiography.

RESULTS

The perfusion of the superficial and deep capillary plexus (SCP and DCP), and choriocapillaris (CCP) flow area were significantly lower than those in healthy control subjects (p < .05 for all). In IPAH group, PVR and mPAP were correlated significantly with the perfusion measurements at SCP and DCP (r = .461, r = .626 and r = .625, r =0.730, respectively, p < .05). sPAP and TRV were positively correlated with the perfusion measurements at SCP and DCP (r = .600, r = .662 and r = .670, r = .655 p < .05).

CONCLUSIONS

The positive correlation of retinal perfusion at SCP and DCP with right-sided echocardiographic and hemodynamic measurements unveiled that retinal microcirculation is affected by the pressure alterations in the pulmonary circulation of IPAH patients.

Multimodal Imaging in a Case of Fovea Plana Associated with Situs Inversus of the Optic Disc

Fovea plana is a congenital condition characterized by anatomic absence of the foveal pit. It may be isolated or associated with congenital ocular anomalies. In this report, we present a case of fovea plana associated with situs inversus of the optic disc, optic disc hypoplasia, tilted optic disc, and prepapillary vascular loop and with best corrected visual acuity of 20/32. The aim of this report is to demonstrate the coexistence of very rare multiple optic disc anomalies and fovea plana, and also to emphasize that the use of multimodal imaging methods facilitates the identification of rare anomalies.

Multimodal Imaging in a Case of Fovea Plana Associated with Situs Inversus of the Optic Disc

Fovea plana is a congenital condition characterized by anatomic absence of the foveal pit. It may be isolated or associated with congenital ocular anomalies. In this report, we present a case of fovea plana associated with situs inversus of the optic disc, optic disc hypoplasia, tilted optic disc, and prepapillary vascular loop and with best corrected visual acuity of 20/32. The aim of this report is to demonstrate the coexistence of very rare multiple optic disc anomalies and fovea plana, and also to emphasize that the use of multimodal imaging methods facilitates the identification of rare anomalies.

Analysis of retinal and choroidal microvasculature in systemic sclerosis: an optical coherence tomography angiography study

BACKGROUND

To investigate the retinal and choroidal microvasculature in patients with systemic sclerosis (SSc) who have no clinical evidence of retinopathy and to compare these structures with those of healthy control subjects.

METHODS

Forty-five patients with a confirmed diagnosis of SSc and no clinical evidence of retinopathy and 45 age- and sex-matched healthy control subjects were included in the study. After complete ophthalmological examination, all patients underwent optical coherence tomography angiography (OCTA) measurement (Optovue Inc., Fremont, California, USA) to assess the foveal avascular zone (FAZ) area; FAZ perimeter; acircularity index of FAZ; foveal density-300; superficial and deep capillary plexus vessel densities; and choriocapillaris flow area at 1, 2, and 3 mm radius. The data from the right eyes of all participants were used for statistical analysis.

RESULTS

The superficial capillary plexus vessel density of the whole image, fovea, parafovea and perifovea, and the deep capillary plexus vessel density of the fovea were significantly lower than those in healthy control subjects (p < 0.05 for all). No significant difference was found in the FAZ area, FAZ perimeter, acircularity index of FAZ, foveal density-300 and choriocapillaris flow area measurements between patients and controls (p > 0.05 for all).

CONCLUSIONS

We demonstrated the ability of OCTA to reveal early retinal microvascular alterations in patients with SSc without any clinical evidence of retinopathy. Reduced vessel density in SSc patients supports the hypothesis of widespread vascular injury, including ocular microcirculation.

Assessment of corneal and lens clarity in children with Wilson disease

PURPOSE

To investigate the effect of copper accumulation on corneal and lens clarity in children with Wilson disease (WD) compared to healthy children.

METHODS

This multicenter cross-sectional study included 24 subjects with WD and 25 age-matched controls. Clinical and laboratory characteristics of the WD subjects were recorded. The Pentacam HR imaging system was used both for lens densitometry and corneal densitometry.

RESULTS

Corneal densitometry values were higher in the posterior 6-10 mm (P = 0.021), posterior 10-12 mm (P < 0.001), posterior total diameter (P = 0.037), total thickness 10-12 mm (P = 0.032), and total thickness 6-10 mm zones and layers (P = 0.040) in the WD eyes than in control eyes. The lens densitometry values of zone 1 were higher in WD eyes (P < 0.001). There was a significant relationship between corneal densitometry values in the posterior 10-12 mm zones (P = 0.012; r = 0.527) and the duration of WD and liver copper content (P = 0.016; r = 0.507). A statistically significant correlation was also detected between lens densitometry values in zone 1 and WD duration (P = 0.018; r = 0.426).

CONCLUSION

In this study cohort, children with WD had decreased corneal and lens clarity even in cases without Kayser-Fleischer rings and sunflower cataracts. Densitometry measurements using Scheimpflug imaging provided detection of corneal and lens involvement in the early stages of WD.

Assessment of Spectral-Domain Optical Coherence Tomography Findings in Three Cases of X-Linked Juvenile Retinoschisis in the Same Family

X-linked juvenile retinoschisis (XLRS) is an X-linked hereditary retinal dystrophy characterized by splitting of the neurosensory retina. On fundus examination, the macula often has a spoke wheel appearance with foveal cystic lesions, and separation of the retinal layers is typical on spectral-domain optical coherence tomography (SD-OCT). Patients with XLRS can exhibit different clinical courses, stages, and SD-OCT findings, even among members of the same family. SD-OCT is an important imaging method that allows us to achieve more detailed information about XLRS. In this study, we report three patients in the same family who have different clinical features and SD-OCT findings.

Assessment of Corneal Densitometry in Rheumatoid Arthritis Patients

Objectives:

To evaluate corneal densitometry and anterior segment parameters of rheumatoid arthritis (RA) patients and compare these results with those of age-matched healthy control subjects.

Materials and Methods:

Anterior segment parameters and corneal densitometry of patients with RA and healthy control subjects were assessed by Scheimpflug corneal topography. For densitometry analysis, the 12-mm diameter area of the cornea was subdivided into four concentric radial zones and anterior, central, and posterior layers based on corneal depth. Right eyes of subjects were used for statistical analysis.

Results:

Twenty-three consecutive patients with RA and 22 healthy control subjects were included in the study. There was no significant difference with regard to age (p=0.487) or gender (p=0.514). When anterior segment parameters of both groups were compared, no significant difference was found (p>0.05). Total corneal densitometry values were statistically higher in the RA group (p=0.030). In addition, when subdivisions of the cornea were evaluated, higher densitometry values were found in the RA group in 0-2 and 2-6 mm radial zones both in the anterior and total depth (p=0.001, p=0.003 for the 0-2 mm zone and p=0.002, p=0.009 for the 2-6 mm zone). Corneal densitometry measurement was not correlated with central corneal thickness or simulated keratometry value in RA patients or healthy control subjects.

Conclusion:

The corneal densitometry values were higher in RA patients when compared to healthy control subjects, even if they had clinically clear corneas. Corneal densitometry as an objective measure of corneal clarity warrants further studies in order to ascertain its clinical relevance in RA patients.

Bedside Diode Laser Photocoagulation Under Remifentanil Analgesia for Retinopathy of Prematurity: Early Structural Outcomes

Objectives:

To evaluate one-year structural outcomes of bedside diode laser photocoagulation with remifentanil analgesia for retinopathy of prematurity (ROP) and discuss clinical and demographic characteristics of infants and other possible risk factors that may affect the outcome.

Materials and Methods:

The medical records of premature infants who were treated with bedside transpupillary diode laser photocoagulation under remifentanil analgesia for ROP were evaluated for clinical and demographic characteristics, accompanying systemic risk factors, laser parameters, complications of treatment, retreatment rate and one-year structural outcomes.

Results:

One-hundred and ninety-five eyes of 99 infants (59 males, 40 females) were recruited for the study. The mean gestational age and birth weight were 27.4±2.3 weeks (23-34) and 1003.3±297.8 g (570-2250), respectively. Laser therapy was performed for high-risk prethreshold ROP in 66.2% of eyes, aggressive posterior ROP (APROP) in 15.4% and threshold ROP in 18.4%. The mean number of laser spots was 1510.4±842.1 per laser session. No adverse effects of laser photocoagulation were observed except small lens opacities in two eyes and corneal opacity in one eye. Retreatment was needed in only three eyes, and vitreoretinal surgery was needed in six eyes of six patients despite laser treatment. Anatomic outcome was favorable in 189 eyes (96.9%) at the end of a 1-year follow-up. Presence of dilated and tortuous iris vessels (p=0.002) and tunica vasculosa lentis (p=0.009) along with type of ROP (APROP and stage 4a ROP at initial presentation) (p=0.001) were associated with poor anatomical outcome.

Conclusion:

Accurate and timely bedside transpupillary diode-laser photocoagulation under remifentanil analgesia is an effective and safe treatment modality for ROP, and may prevent vision-threatening retinal detachment and reduce the need for vitreoretinal surgery.

Retinopathy of Prematurity in Triplets

OBJECTIVES

To investigate the incidence, severity and risk factors of retinopathy of prematurity (ROP) in triplets.

MATERIALS AND METHODS

The medical records of consecutive premature triplets who had been screened for ROP in a single maternity hospital were analyzed and presence and severity of ROP; birth weight, gender, gestational age of the infant; route of delivery and the mode of conception were recorded.

RESULTS

A total of 54 triplets (40 males, 14 females) who were screened for ROP between March 2010 and February 2013 were recruited for the study. All triplets were delivered by Caesarean section and 36 (66.7%) were born following an assisted conception. During follow-up, seven (13%) of the infants developed ROP of any stage and two (3.7%) required laser photocoagulation. The mean gestational age of triplets with ROP was 27.6±1.5 (27-31) weeks whereas it was 32.0±1.5 (30-34) weeks in those without ROP (p=0.002). The mean birth weights of triplets with and without ROP were 1290.0±295.2 (970-1600) g and 1667.5±222.2 (1130-1960) g, respectively (p<0.001). The presence of ROP was not associated with gender (p=0.358) or mode of conception (p=0.674).

CONCLUSION

ROP in triplets seems to be mainly related to low gestational age and low birth weight. Further prospective randomized studies are necessary to demonstrate risk factors of ROP in triplets and to determine if and how gemelarity plays a role in the development of ROP.