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Alenka Lavric

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Flávio Paranhos

PUC Goiás

EYLEM YAMAN PINARCI

Baskent University

The University of New South Wales

Jameel Syed Amin

Bharathidasan University

rajendra p maurya

Banaras Hindu University, Varanasi

Thomas Jefferson University

Daniel Barthelmes

University of Zurich, Switzerland

University of Colorado School of Medicine

Virgilio Canton

UNAM Universidad Nacional Autónoma de México

New York University School of Medicine

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Papers by Alenka Lavric

Do Blue-Light Filtering Intraocular Lenses Affect Visual Function?

Optometry and Vision Science, Nov 1, 2014

Purpose. To study different aspects of visual function, macular changes, and subjective differenc... more Purpose. To study different aspects of visual function, macular changes, and subjective differences between the eye with an ultraviolet (UV) and blue-light filtering intraocular lens (IOL) and the fellow eye with a UV-light filtering IOL. Methods. Thirty patients (60 eyes) with senile cataract had both cataracts extracted, and an IOL was implanted at least 2 years before clinical evaluation. In one eye, AcrySof SA60AT (a UV-light filtering IOL) was implanted, whereas in the contralateral eye, AcrySof IQ SN60WF (a blue-light filtering IOL) was implanted. Each patient underwent visual acuity testing, color vision testing (Ishihara and Farnsworth-Munsell 100-hue tests), and contrast sensitivity (CS) testing. The macula was evaluated with optical coherence tomography and with clinical examination. Patients were asked if they noted any difference between the implanted IOLs concerning visual impression. Subjective visual quality was evaluated using the National Eye Institute Visual Functioning Questionnaire. Results. There was a borderline statistically significant difference in the mean best-corrected visual acuity (p = 0.05). As regards color vision, no significant changes in Ishihara and Farnsworth-Munsell 100-hue error scores were detected between both eyes (p = 0.48 and p = 0.59, respectively). Analysis of CS showed no significant difference between the groups at any spatial frequency. There were also no statistically significant differences in central macular thickness and total macular volume between the two IOL groups (p = 0.72 and p = 0.61, respectively). In both IOL groups, three eyes developed an epiretinal membrane, and six eyes developed early signs of age-related macular degeneration. Conclusions. This study showed no significant effects of a blue-light filtering IOL on visual acuity and no influence on color perception and CS. After more than 2 years, there were no significant differences in macular changes between the IOL groups. Clinical evidence of the effect of a blue-light filtering IOL on macular protection is still lacking.

A Case of Necrobiotic Xanthogranuloma Presenting as Bilateral Posterior Scleritis

Ocular Immunology and Inflammation, Oct 24, 2016

Solitary Iris Plasmacytoma With Anterior Chamber Crystalline Deposits

Cornea, Apr 27, 2017

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

Acta Ophthalmologica, Apr 8, 2021

To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and... more 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.

Multiple Choroidal Ruptures in a Patient With Angioid Streaks

JAMA Ophthalmology, Mar 9, 2017

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

Acta Ophthalmologica, Dec 6, 2019

Evaluate choroidal structural changes in preterm children with and without retinopathy of prematu... more 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 AE 83.98 lm) or without (306.59 AE 77.29 lm) ROP and the full-term children (311.82 AE 42.87; p = 0.20 and 0.67, respectively). The CVI was significantly reduced in the preterm children with ROP (68.66 AE 3.24%; p = 0.005) compared with the CVI in the full-term control group (71.37 AE 3.63%); however, the CVI in the preterm children without ROP (71.68 AE 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.

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

The Lancet Global Health

Choroidal thickening with serous retinal detachment in BRAF/MEK inhibitor-induced uveitis: A case report

World Journal of Clinical Cases

Acute Idiopathic Maculopathy

Retina, 2021

Purpose: To describe the clinical course and the multimodal imaging of acute idiopathic maculopat... more 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 surroundi...

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

Acta Ophthalmologica, 2019

Evaluate choroidal structural changes in preterm children with and without retinopathy of prematu... more 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 AE 83.98 lm) or without (306.59 AE 77.29 lm) ROP and the full-term children (311.82 AE 42.87; p = 0.20 and 0.67, respectively). The CVI was significantly reduced in the preterm children with ROP (68.66 AE 3.24%; p = 0.005) compared with the CVI in the full-term control group (71.37 AE 3.63%); however, the CVI in the preterm children without ROP (71.68 AE 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.

A Case of Necrobiotic Xanthogranuloma Presenting as Bilateral Posterior Scleritis

Ocular Immunology and Inflammation, 2016

Solitary Iris Plasmacytoma With Anterior Chamber Crystalline Deposits

Cornea, 2017

Purpose: To report a case of solitary iris plasmacytoma successfully treated with ruthenium plaqu... more Purpose: To report a case of solitary iris plasmacytoma successfully treated with ruthenium plaque radiotherapy. Methods: A 44-year-old white woman presented with pain in the right eye and raised intraocular pressure. Her medical history included breast cancer treated 11 years earlier with lumpectomy, lymph node clearance, chemotherapy, and radiotherapy. On examination, the right iris had a tan-colored mass with crystalline deposits visible on the mass surface and on the corneal endothelium. The fundus and left eye were normal. An anterior segment ultrasound scan showed a mass with mixed internal echogenicity and internal blood flow. Results: An iris biopsy showed an infiltrate of plasma cells. Immunohistochemistry for kappa and lambda light chains demonstrated lambda light chain restriction. Systemic hematologic investigations including complete blood count, serum paraproteins, bone marrow biopsy, and full-body magnetic resonance image were normal. The monoclonal plasma cell infilt...

Multiple Choroidal Ruptures in a Patient With Angioid Streaks

JAMA Ophthalmology, 2017

Nodular Posterior Scleritis

Retina, 2016

To report the clinical and ultrasound features and outcomes of a series of nodular posterior scle... more To report the clinical and ultrasound features and outcomes of a series of nodular posterior scleritis. Methods: Retrospective medical record review of 11 consecutive patients with nodular posterior scleritis. Patient demographics, ocular and systemic findings, ultrasound features and final anatomical and visual outcomes were recorded. Results: There were 9 females and 2 males (11 eyes) with mean age at presentation of 57 years (range 30-84 years). Underlying systemic inflammatory disease was present in 73%. Symptoms included pain in 73% and blurred vision in 45%. A solitary amelanotic mass without the presence of lipofuscin was found in all cases. Associated ocular features included retinal pigment epithelial changes (67%), intraocular inflammation (55%), subretinal fluid (50%), macular edema (50%) and choroidal folds (30%). B-Mode ultrasound showed a high internal reflectivity sclerochoroidal mass (100%) with mean elevation of 4.1 mm. There was nodular thickening of the sclera (100%) and fluid in Tenon's space or 'T' sign (36%). A complete regression of the nodule after the treatment was observed only in one patient (11 %), and partial regression in 4 patients (44 %). Conclusion: Nodular posterior scleritis should be considered in the differential diagnosis of a single amelanotic choroidal mass showing high internal reflectivity on ultrasound B-scan. It can produce intraocular inflammation in 50% of the cases and may be painless in 25%. It has a high association with a systemic underlying disease.

Iris Ring Melanoma Presenting as Scleral Pigmentation

Case Reports in Ophthalmological Medicine

To report a patient with a very rare variant of iris melanoma that grows in the shape of a ring (... more To report a patient with a very rare variant of iris melanoma that grows in the shape of a ring (ring melanoma). A 65-year-old patient was examined because of a pigmented lesion on the sclera. After a complete ophthalmic and ultrasound examination, a ring melanoma was diagnosed. Enucleation of the affected eye was performed, and histology report confirmed iris ring melanoma. This type of malignancy represents an exceedingly rare variant of uveal melanoma, and because of atypical clinical picture, it can be easily overlooked or misdiagnosed, which often delays adequate treatment. Gonioscopy, transillumination, and ultrasound help us to recognize and diagnose ring melanoma. Suspicion should be raised with a clinical picture that shows unilateral pigmentary glaucoma. The objective of this presentation is to describe and outline the challenging diagnosis and management of this rare disease entity.

Anti-VEGF Treatment of Diabetic Macular Edema: Two-Year Visual Outcomes in Routine Clinical Practice

Journal of Ophthalmology, 2020

Purpose. The purpose of this study was to evaluate 2-year visual outcomes in patients with diabet... more Purpose. The purpose of this study was to evaluate 2-year visual outcomes in patients with diabetic macular edema (DME) treated with anti-VEGF agents in a routine clinical setting. Methods. The medical records of patients treated with ranibizumab or aflibercept due to DME at the Eye Hospital, University Medical Centre Ljubljana, Slovenia, between January 2016 and March 2019 were retrospectively reviewed. After applying inclusion and exclusion criteria, 123 patients (123 eyes) were included in the study. Results. Baseline visual acuity (VA) was 60.9 ± 15.2 letters (median 63; range 7–85). Baseline central retinal subfield thickness (CRT) was 440.7 ± 132.5 μm (median 430; range 114–1000). No significant change in VA over 2 years was found (mean change +2.1 ± 16.8 letters (median 2; range −53–52)). However, there was a significant change in VA in the subgroup with baseline VA <70 letters (mean change +5.7 ± 17.9 letters (median 5; range −52–52)). VA gains of ≥15 letters were achieve...

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

Acta Ophthalmologica, 2021

To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and... more 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.

Floating Vitreous Cyst: Two Clinical Cases

Case Reports in Ophthalmology, 2013

Mesectodermal Leiomyoma of the Ciliary Body Presenting as Anterior Staphyoma

Retinal Cases & Brief Reports, 2016

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

Ocular Immunology and Inflammation, 2015

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

Do Blue-Light Filtering Intraocular Lenses Affect Visual Function?

Optometry and Vision Science, Nov 1, 2014

Purpose. To study different aspects of visual function, macular changes, and subjective differenc... more Purpose. To study different aspects of visual function, macular changes, and subjective differences between the eye with an ultraviolet (UV) and blue-light filtering intraocular lens (IOL) and the fellow eye with a UV-light filtering IOL. Methods. Thirty patients (60 eyes) with senile cataract had both cataracts extracted, and an IOL was implanted at least 2 years before clinical evaluation. In one eye, AcrySof SA60AT (a UV-light filtering IOL) was implanted, whereas in the contralateral eye, AcrySof IQ SN60WF (a blue-light filtering IOL) was implanted. Each patient underwent visual acuity testing, color vision testing (Ishihara and Farnsworth-Munsell 100-hue tests), and contrast sensitivity (CS) testing. The macula was evaluated with optical coherence tomography and with clinical examination. Patients were asked if they noted any difference between the implanted IOLs concerning visual impression. Subjective visual quality was evaluated using the National Eye Institute Visual Functioning Questionnaire. Results. There was a borderline statistically significant difference in the mean best-corrected visual acuity (p = 0.05). As regards color vision, no significant changes in Ishihara and Farnsworth-Munsell 100-hue error scores were detected between both eyes (p = 0.48 and p = 0.59, respectively). Analysis of CS showed no significant difference between the groups at any spatial frequency. There were also no statistically significant differences in central macular thickness and total macular volume between the two IOL groups (p = 0.72 and p = 0.61, respectively). In both IOL groups, three eyes developed an epiretinal membrane, and six eyes developed early signs of age-related macular degeneration. Conclusions. This study showed no significant effects of a blue-light filtering IOL on visual acuity and no influence on color perception and CS. After more than 2 years, there were no significant differences in macular changes between the IOL groups. Clinical evidence of the effect of a blue-light filtering IOL on macular protection is still lacking.

A Case of Necrobiotic Xanthogranuloma Presenting as Bilateral Posterior Scleritis

Ocular Immunology and Inflammation, Oct 24, 2016

Solitary Iris Plasmacytoma With Anterior Chamber Crystalline Deposits

Cornea, Apr 27, 2017

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

Acta Ophthalmologica, Apr 8, 2021

To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and... more 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.

Multiple Choroidal Ruptures in a Patient With Angioid Streaks

JAMA Ophthalmology, Mar 9, 2017

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

Acta Ophthalmologica, Dec 6, 2019

Evaluate choroidal structural changes in preterm children with and without retinopathy of prematu... more 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 AE 83.98 lm) or without (306.59 AE 77.29 lm) ROP and the full-term children (311.82 AE 42.87; p = 0.20 and 0.67, respectively). The CVI was significantly reduced in the preterm children with ROP (68.66 AE 3.24%; p = 0.005) compared with the CVI in the full-term control group (71.37 AE 3.63%); however, the CVI in the preterm children without ROP (71.68 AE 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.

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

The Lancet Global Health

Choroidal thickening with serous retinal detachment in BRAF/MEK inhibitor-induced uveitis: A case report

World Journal of Clinical Cases

Acute Idiopathic Maculopathy

Retina, 2021

Purpose: To describe the clinical course and the multimodal imaging of acute idiopathic maculopat... more 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 surroundi...

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

Acta Ophthalmologica, 2019

Evaluate choroidal structural changes in preterm children with and without retinopathy of prematu... more 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 AE 83.98 lm) or without (306.59 AE 77.29 lm) ROP and the full-term children (311.82 AE 42.87; p = 0.20 and 0.67, respectively). The CVI was significantly reduced in the preterm children with ROP (68.66 AE 3.24%; p = 0.005) compared with the CVI in the full-term control group (71.37 AE 3.63%); however, the CVI in the preterm children without ROP (71.68 AE 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.

A Case of Necrobiotic Xanthogranuloma Presenting as Bilateral Posterior Scleritis

Ocular Immunology and Inflammation, 2016

Solitary Iris Plasmacytoma With Anterior Chamber Crystalline Deposits

Cornea, 2017

Purpose: To report a case of solitary iris plasmacytoma successfully treated with ruthenium plaqu... more Purpose: To report a case of solitary iris plasmacytoma successfully treated with ruthenium plaque radiotherapy. Methods: A 44-year-old white woman presented with pain in the right eye and raised intraocular pressure. Her medical history included breast cancer treated 11 years earlier with lumpectomy, lymph node clearance, chemotherapy, and radiotherapy. On examination, the right iris had a tan-colored mass with crystalline deposits visible on the mass surface and on the corneal endothelium. The fundus and left eye were normal. An anterior segment ultrasound scan showed a mass with mixed internal echogenicity and internal blood flow. Results: An iris biopsy showed an infiltrate of plasma cells. Immunohistochemistry for kappa and lambda light chains demonstrated lambda light chain restriction. Systemic hematologic investigations including complete blood count, serum paraproteins, bone marrow biopsy, and full-body magnetic resonance image were normal. The monoclonal plasma cell infilt...

Multiple Choroidal Ruptures in a Patient With Angioid Streaks

JAMA Ophthalmology, 2017

Nodular Posterior Scleritis

Retina, 2016

To report the clinical and ultrasound features and outcomes of a series of nodular posterior scle... more To report the clinical and ultrasound features and outcomes of a series of nodular posterior scleritis. Methods: Retrospective medical record review of 11 consecutive patients with nodular posterior scleritis. Patient demographics, ocular and systemic findings, ultrasound features and final anatomical and visual outcomes were recorded. Results: There were 9 females and 2 males (11 eyes) with mean age at presentation of 57 years (range 30-84 years). Underlying systemic inflammatory disease was present in 73%. Symptoms included pain in 73% and blurred vision in 45%. A solitary amelanotic mass without the presence of lipofuscin was found in all cases. Associated ocular features included retinal pigment epithelial changes (67%), intraocular inflammation (55%), subretinal fluid (50%), macular edema (50%) and choroidal folds (30%). B-Mode ultrasound showed a high internal reflectivity sclerochoroidal mass (100%) with mean elevation of 4.1 mm. There was nodular thickening of the sclera (100%) and fluid in Tenon's space or 'T' sign (36%). A complete regression of the nodule after the treatment was observed only in one patient (11 %), and partial regression in 4 patients (44 %). Conclusion: Nodular posterior scleritis should be considered in the differential diagnosis of a single amelanotic choroidal mass showing high internal reflectivity on ultrasound B-scan. It can produce intraocular inflammation in 50% of the cases and may be painless in 25%. It has a high association with a systemic underlying disease.

Iris Ring Melanoma Presenting as Scleral Pigmentation

Case Reports in Ophthalmological Medicine

To report a patient with a very rare variant of iris melanoma that grows in the shape of a ring (... more To report a patient with a very rare variant of iris melanoma that grows in the shape of a ring (ring melanoma). A 65-year-old patient was examined because of a pigmented lesion on the sclera. After a complete ophthalmic and ultrasound examination, a ring melanoma was diagnosed. Enucleation of the affected eye was performed, and histology report confirmed iris ring melanoma. This type of malignancy represents an exceedingly rare variant of uveal melanoma, and because of atypical clinical picture, it can be easily overlooked or misdiagnosed, which often delays adequate treatment. Gonioscopy, transillumination, and ultrasound help us to recognize and diagnose ring melanoma. Suspicion should be raised with a clinical picture that shows unilateral pigmentary glaucoma. The objective of this presentation is to describe and outline the challenging diagnosis and management of this rare disease entity.

Anti-VEGF Treatment of Diabetic Macular Edema: Two-Year Visual Outcomes in Routine Clinical Practice

Journal of Ophthalmology, 2020

Purpose. The purpose of this study was to evaluate 2-year visual outcomes in patients with diabet... more Purpose. The purpose of this study was to evaluate 2-year visual outcomes in patients with diabetic macular edema (DME) treated with anti-VEGF agents in a routine clinical setting. Methods. The medical records of patients treated with ranibizumab or aflibercept due to DME at the Eye Hospital, University Medical Centre Ljubljana, Slovenia, between January 2016 and March 2019 were retrospectively reviewed. After applying inclusion and exclusion criteria, 123 patients (123 eyes) were included in the study. Results. Baseline visual acuity (VA) was 60.9 ± 15.2 letters (median 63; range 7–85). Baseline central retinal subfield thickness (CRT) was 440.7 ± 132.5 μm (median 430; range 114–1000). No significant change in VA over 2 years was found (mean change +2.1 ± 16.8 letters (median 2; range −53–52)). However, there was a significant change in VA in the subgroup with baseline VA <70 letters (mean change +5.7 ± 17.9 letters (median 5; range −52–52)). VA gains of ≥15 letters were achieve...

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

Acta Ophthalmologica, 2021

To assess the association between perinatal risk factors for retinopathy of prematurity (ROP) and... more 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.

Floating Vitreous Cyst: Two Clinical Cases

Case Reports in Ophthalmology, 2013

Mesectodermal Leiomyoma of the Ciliary Body Presenting as Anterior Staphyoma

Retinal Cases & Brief Reports, 2016

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

Ocular Immunology and Inflammation, 2015

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