Medical Retina

Aims: To determine the visual outcome of cataract surgeries postoperatively at first day, one and three months.   Study Design: Retrospective, case series study. Place and Duration of Study: Eye Foundation Community Hospital, Ilese-Ijebu-Imushin, Ogun state of Nigeria. 3-month duration from June 1st 2019 to August 31st 2019. Methodology: All patients 18 years and above operated for cataract surgery without comorbidity were included in the study. Type of surgery done were manual small incision cataract surgery (MSICS) and phacoemulsification. Patient data were entered into excel spread sheet created for the study. From where it was cleaned up and exported in to statistical package for social sciences 20. Visual outcome was assessed on the first day, first month and at third month post operatively. Snellen visual acuity was converted to log MAR. P value = 0.05 is determined as statistically significant.  Results: Two hundred and fifty (250) patients or eyes were analysed in this study...

Age-related Macular Degeneration (AMD) is a complex, multifactorial, progressive retinal disease that affects millions of people worldwide. Alterations in phototransduction, renewal of the outer segments of photoreceptors, visual transduction and retinol metabolism have a major impact on retinal health. Mutations within any of the molecules responsible for these visual processes cause different types of degenerative retinal diseases. Increase in membrane potential caused by accidental binding to a foreign molecule, increased temperature or ocular pressure could trigger an electrochemical overload in the photoreceptor which would be inappropriately depolarized. The signs of this process are clearly visible with Optical Coherence Tomography (OCT): hyperreflective vertical lines that cross the choroid at the points of interruption of the ellipsoid zone resulting in atrophy and compromise of the outer hematoretinal barrier. The occasional finding of these lines would represent the first clinical sign of a degenerative process which could subsequently give rise to those events characterizing AMD.

Uveal melanoma is the most common intraocular primary malignancy. The incidence is reported to be four to seven per million per year in the Caucasian population. Patients usually present around the fifth or sixth decade of life; however, this tumor can rarely occur in young children. The large majority of patients are Caucasian, with this malignancy rarely occurring in Hispanics, Asians and African-Americans. 1 There is no sex preponderance. Risk factors for uveal melanoma include fair skin, light-colored eyes, melanocytoma, congenital ocular melanocytosis and neurofibromatosis. Patients usually present with visual symptoms such as metamorphopsia, blurred vision, photopsia and visual field loss. A significant minority are asymptomatic and detected on routine examination. with ultrasonography and, in selected cases, biopsy. 2 Misdiagnosis is rare in specialist centers. Small melanocytic tumors of uncertain malignancy tend to be observed for tumor growth. Shields et al. have described clinical risk factors for growth and metastasis. Traditionally, uveal melanoma has been classified as small (less than 3mm in thickness), medium (3-10mm in thickness or up to 15mm in basal diameter), and large (more than 10mm in thickness or more than 15mm in basal diameter). Treatment is based on tumor size and location, visual acuity, status of the fellow eye, and the patient's fears and wishes. Treatment options for uveal melanoma include brachytherapy, proton beam therapy, stereotactic radiotherapy, trans-scleral local resection, transretinal endoresection, transpupillary thermotherapy, and enucleation. In most centers, the first choice of treatment is brachytherapy, using either an iodine-125 or ruthenium-106 plaque. Proton beam radiotherapy is available only in a few centers, where it is used either in all patients (e.g. Boston) or in selected cases, when brachytherapy is not appropriate (e.g. Liverpool). There is growing interest in stereotactic radiotherapy in centers where proton beam radiotherapy is not available. Trans-scleral local resection is widely practiced for small iris and ciliary body tumors but performed by only a few surgeons as a treatment for large, choroidal melanomas. Transretinal endoresection is controversial because of concerns that piecemeal tumor removal might disseminate malignant cells around the eye and systemically; it is therefore performed only when it offers the only hope of conserving useful vision. Transpupillary thermotherapy and photodynamic therapy can be successful with small tumors, but are less reliable than radiotherapy and therefore administered only in selected cases (e.g. elderly patients with diabetes mellitus). Increasingly, different therapeutic modalities are being combined to enhance local tumor control while minimizing ocular morbidity. Procedures such as secondary local resection, transpupillary thermotherapy, photodynamic therapy, sector laser photocoagulation,

Background: To compare distinctive features of hyperreflective particles observed on spectral-domain optical coherence tomography (OCT) sections in eyes with acute toxoplasma chorioretinitis (TC) and non-infectious uveitis (NIU). Methods: Medical records and the spectral-domain OCT images of the patients with TC and NIU were retrospectively reviewed. The TC and NIU groups were compared in terms of age, sex, mean OCT image quality, mean central macular thickness (CMT), presence of intraretinal fluid (IRF), presence of subretinal fluid (SRF), number of hyperreflective particles in the posterior vitreous area and mean particle measurement in the posterior vitreous area. Results: Non-infectious uveitis group included nine patients (60 %) with Behcet's uveitis, five patients (33.3 %) with idiopathic posterior uveitis or panuveitis, and the remaining patient (6.7 %) with HLA-B27 associated uveitis. Comparison of the mean age, sex distribution, mean OCT image quality, mean CMT, presence of IRF, presence of SRF and the mean number of hyperreflective particles in the posterior vitreous area between the two groups showed no statistically significant differences (p = 0.085, p = 0.051, p = 0.748, p = 0.431, p = 0.109, p = 0.080 and p = 0.152, respectively). However, the mean length of the hyperreflective particles in the posterior vitreous area was 27.22 ± 8.60 μm in the TC group, and 21.91 ± 3.58 μm in the NIU group, with a significant difference between the two groups (p = 0.036). Conclusion: This pilot study aimed to assess the hyperreflective particles in the posterior vitreous area using spectral-domain OCT images and image processing software. Despite its limitations, such as the small sample size, limited understanding of the nature of hyperreflective particles, and the absence of differentiation between acute and chronic uveitis, our study points out the potential role of the measurement of the hyperreflective particle length located in the posterior vitreous in differentiating the acute infectious versus non-infectious uveitis as the hyperreflective particles tend to be larger in infectious cases.

Background: The intraretinal hyperreflective line (IHL) is a novel posterior segment finding demonstrable using careful optical coherence tomography (OCT) examination. It likely indicates a reaction against photoreceptor, Muller cell, and/or retinal pigment epithelial damage. This study analyzed the spectral-domain OCT characteristics of IHLs to disclose their presence in various retinal conditions. Methods: A retrospective review of the charted and imaging records of participants with IHL was conducted at Dokuz Eylul University Department of Ophthalmology between January 2019 and August 2023. The inclusion criterion was the detection of an IHL on good-quality B-scan spectral-domain OCT. An IHL was defined as a vertical line extending from the ellipsoid zone band (or lower) through the outer nuclear layer to the internal limiting membrane in the central fovea. Associated retinal conditions were recorded as potential causative factors for the presence of IHL. Results: IHL was observed on spectral-domain OCT in 40 eyes of 38 participants with several retinal diseases assessment. Fourteen eyes (35%) underwent vitreoretinal surgery pre-IHL detection (12 were operated for full-thickness macular hole [FTMH], one for epiretinal membrane [ERM], and one for rhegmatogenous retinal detachment). In six eyes (15%) a microhole coexisted. Four eyes (10%) had a concurrent lamellar macular hole. The IHL preceded the occurrence of FTMH in three eyes (7.5%), and diabetic macular edema and type 2 idiopathic macular telangiectasia (MacTel-2) were present in three eyes (7.5%) each. The remaining conditions included vitreomacular traction (VMT), nonarteritic anterior ischemic optic neuropathy with central retinal artery occlusion, commotio retinae, exudative age-related macular degeneration, ERM, non-infectious idiopathic posterior uveitis, and Coats' disease, each affecting one eye (2.5%). Of the two participants with bilateral involvement, one was diagnosed with MacTel-2 and the other had IHL with VMT in the right eye that was detected post-vitreoretinal surgery for FTMH in the left eye. Conclusions: Although IHLs are mostly identified in eyes with vitreomacular surface diseases, clinicians may encounter IHLs in other types of retinal pathology. Further large-scale, multicenter, long-term studies on the presence of IHLs in OCT imaging are required to provide more substantial insight on this biomarker.

To evaluate a proposed method for objective measurement of vitreous inflammation using an spectral domain optical coherence tomography (SD-OCT) device in a large cohort of uveitis eyes, including pseudophakic eyes and vitrectomized eyes. Retrospective, observational, cohort study. One-hundred five uveitis eyes (105 patients) with different vitreous haze score grades according to standardized protocols and corresponding SD-OCT images (Cirrus HD-OCT, Carl Zeiss Meditec) were included. Clinical data recorded included phakic status, previous vitreo-retinal surgery and anterior chamber (AC) cells and flare. SD-OCT images were analyzed using custom software which provided absolute measurements of vitreous (VIT) and retinal pigment epithelium (RPE) signal intensities, that were compared to generate a relative optical density ratio with arbitrary units (VIT/RPE-Relative intensity) and compared to VHS. VIT/RPE-relative intensity showed a significant positive correlation with vitreous haze sc...

PurposeOptical coherence tomography (OCT) captures retinal damage in neuromyelitis optica spectrum disorders (NMOSD). Previous studies investigating OCT in NMOSD have been limited by the rareness and heterogeneity of the disease. The goal of this study was to establish an image repository platform, which will facilitate neuroimaging studies in NMOSD. Here we summarise the profile of the Collaborative OCT in NMOSD repository as the initial effort in establishing this platform. This repository should prove invaluable for studies using OCT to investigate NMOSD.ParticipantsThe current cohort includes data from 539 patients with NMOSD and 114 healthy controls. These were collected at 22 participating centres from North and South America, Asia and Europe. The dataset consists of demographic details, diagnosis, antibody status, clinical disability, visual function, history of optic neuritis and other NMOSD defining attacks, and OCT source data from three different OCT devices.Findings to d...

ABSTRACT:
              Purpose: To study the various systemic risk factors of RVO (BRVO & CRVO).
Materials and Methods and Results: Hospital-based study was conducted on all RVO patients attending the OPD of Department of Ophthalmology –K K Eye Institute, Pune. CMT was measured using Heidelberg OCT scan.

        CONCLUSION:
              1.  According to this study incidence of CRVO was 26.3% and BRVO was 71.1% [4]
              2.  According to this study BRVO was found in 51 subjects (92.73%) and CRVO in subjects (7.27%) among the RVO subjects. [5]
              3.  In our Study the incidence of CRVO is 25% and BRVO is 75% (IN BRVO, STBRVO was 58.33%, ITBRVO was 16.66%.). RVO was seen more common among females than males.
                4. Hypertension was found in 37.5% in RVO and 20.8% of subjects with RVO had diabetes mellitus.
                5.  20.8% had history of stress without DM and HTN. RVO was found in 4.16% of the subjects having both diabetes and hypertension. About 12.5% had no history of  STRESS, DM, HTN which needs further evaluation. There was increased risk of RVO among those with hypertension, and those having both diabetes and hypertension.
                 
  The risk was lower, however, among the subjects who had only diabetes.
CMT was maximum in CRVO, followed by ITBRVO and least in STBRVO.CMT was more in males than in females.

Aims: To determine the visual outcome of cataract surgeries postoperatively at first day, one and three months.   Study Design: Retrospective, case series study. Place and Duration of Study: Eye Foundation Community Hospital, Ilese-Ijebu-Imushin, Ogun state of Nigeria. 3-month duration from June 1st 2019 to August 31st 2019. Methodology: All patients 18 years and above operated for cataract surgery without comorbidity were included in the study. Type of surgery done were manual small incision cataract surgery (MSICS) and phacoemulsification. Patient data were entered into excel spread sheet created for the study. From where it was cleaned up and exported in to statistical package for social sciences 20. Visual outcome was assessed on the first day, first month and at third month post operatively. Snellen visual acuity was converted to log MAR. P value = 0.05 is determined as statistically significant.  Results: Two hundred and fifty (250) patients or eyes were analysed in this study...

Цель исследования: оценка состояния сетчатки при сочетанной патологии: миопии средней степени и возрастной макулярной дегенерации (ВМД) разных стадий с помощью современных методов диагностики. Материал и методы: обследовано 48 пациентов (96 глаз) с миопией средней степени и «сухой» формой ВМД. Проанализированы максимально корригированная острота зрения (МКОЗ); показатели светочувствительности сетчатки: MD (mean deviation)среднее отклонение, отражающее среднее снижение светочувствительности, и PSD (pattern standard deviation)-паттерн стандартного отклонения, характеризующий выраженность локальных дефектов по данным компьютерной периметрии Humphrey; центральная толщина сетчатки (ЦТС); переднезадняя ось глаза (ПЗО); состояние макулярной зоны сетчатки по данным оптической когерентной томографии (ОКТ) в режиме β-сканирования и аутофлуоресценции (АФ).

Aim: to assess retinal status in comorbid ocular disorders (moderate myopia and age-related macular degeneration/AMD of various stages)
using modern diagnostic tools.
Patients and Methods: 48 patients (96 eyes) with moderate myopia and dry AMD were enrolled. Best-corrected visual acuity (BCVA), mean
deviation/MD (characterizes mean reduction of sensitivity), pattern standard deviation/PSD (characterizes the severity of local visual field
defects), central macular thickness (CMT), and axial length (AL) were measured. The macular zone was investigated by optical coherence
tomography (OCT) using B scan and fundus autofluorescence (FAF) regimens.
Results: in moderate myopia associated with dry AMD (AREDS categories 1,2,3), a significant reduction in the mean BCVA (20/25) was
detected in 54.2% (26 patients, 52 eyes). Retinal photosensitivity indices (MD and PSD) were also significantly reduced to 2.19 dB (р<0.001)
and 2.14 dB (р<0.001), respectively. AL was significantly increased (25.11 mm, р<0.001). No significant differences in CMT values were
revealed (233 mcm, p=0.123). In comorbid ocular disorders, severe defects and focuses of RPE atrophy, extensive areas of the IS/OS junction
line damage, and drusen are seen among morphological abnormalities of the eye fundus. FAF identified certain pathological patterns, e.g.,
focal hypo- and hyperautofluorescence, hyperautofluorescent halo at the border of staphyloma, linear hypoautofluorescent bands surrounded
with hyperautofluorescence, reticular pattern, patches, focal and multifocal areas of geographic atrophy.
Conclusion: our findings on visual field loss (MD, PSD) in AMD depending on stage and OCT findings in AMD are in line with the results of
other authors. Meanwhile, we investigated a comorbid variant (AMD in association with moderate myopia), compared morphological and
functional parameters, and addressed the relevance of FAF.

The Ad26.COV2.S COVID-19 is a viral vector vaccine (Janssen/Johnson & Johnson) that was issued an emergency use authorization (EUA) by the U.S. Food and Drug Administration for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This vaccine was 66.3% effective in clinical trials at preventing laboratory-confirmed COVID-19 infection.

Spectral domain optical coherence tomography (SD-OCT) is a common useful noninvasive imaging instrument which is used for the diagnosis and follow-up of macular disorders. The clinical findings by OCT in these pathologies are well known. Currently, due to the development of this technology and its wide use, new OCT findings have been reported in the literature. The aim of this chapter is to describe new pathological or abnormal signs and findings in SD-OCT, including hyperreflective spots or dots, flyer saucer sign, outer retinal tubulations, dipping sign, focal choroidal excavation, outer retina-choroid complex splitting, foveal pseudocyst, brush border pattern, dome-shaped macula, pearl necklace sign, choroidal macrovessel, cystoid foveal degeneration, and disorganization of the retinal inner layers (DRIL).

Background: Cataract remains the principal cause of blindness globally at 51%. The cataract surgical rate (CSR) in developed countries is about 4000 to 6000 while in most part of Africa and other developing countries it is 400-500. Cataract backlog and low cataract surgical rate is a constant feature in Nigeria as in other parts of Africa and Asia. Objective: to determine the impact of cataract surgical services in Ogun state of Nigeria. Methods: This was a cross-sectional study whereby the operation registers for the period of one year (1st January to 31st December 2014) at the Eye Foundation Centre (EFC), St Mary's Catholic Eye Hospital (SMCEH) Ago-Iwoye, Babcock University Eye Clinic and all the state hospitals in Ogun state were reviewed. The numbers of operable cataracts (eye with <6/24 due to cataract) in the outreach and clinic registers were noted. The number of eyes operated for age-related cataracts were determined. This research did not consult patients. The name of the surgeon per cataract surgery was noted and number of surgeons per clinic or hospital compiled. Information on Ogun state population was obtained. Cataract backlog and cataract surgical rate in the state were assessed. Results: A total of 8660 operable cataracts were identified and 5410 eyes were done during this period leaving a backlog of 3250 eyes (in this study). Cataract surgical rate for Ogun state for the period was 1098 operations per million per year. The main providers of cataract surgical services in Ogun state are Eye Foundation Centre 3099 eyes (57.2%) and St Mary's Catholic Eye Hospital 1951 (36.0%), totalling 5050 eyes (93.2%). Others did 360 eyes (6.8%). There are 18 surgeons in the state but 11 participated in the study. Therefore an average of 491 cataract operations is performed by an ophthalmic surgeon per year in Ogun state. Conclusion: Cataract surgeries of 5410 performed annually in the state is more than the incidence of cataract blindness in the state which is estimated at 4924. CSR of 1098 is more than the universally accepted cataract blindness incidence of 1000 per million populations per year for developing countries. Therefore, if these figures are surpassed in the coming years with more improved cataract services delivery, the backlog will be drastically reduced.

Objective: To evaluate macular changes in eyes with papilledema from increased intracranial pressure using optical coherence tomography (OCT). Methods: Fifty-five patients with papilledema seen during 1998 and 1999 were studied with OCT of the optic nerve and retinal nerve fiber layer. Nineteen of these also had OCT of the macula during periods of acute, subacute, or recurrent papilledema and were evaluated in detail for this report. Results: Seven patients had OCT evidence of subretinal fluid involving the macula. All had some reduction in visual acuity. The subretinal fluid appeared to arise from the peripapillary region, and all showed some improvement in central vision as the fluid resolved. Conclusions: Subretinal fluid accumulations can cause decreased visual acuity in patients with papilledema. Optical coherence tomography can demonstrate subretinal fluid and can be used to follow the course of this important visual complication of papilledema.

Background: The congenital simple hamartoma of the retinal pigment epithelium is a benign lesion and previous observations with noninvasive imaging have detected potential photoreceptor abnormalities and retinal function interplay. Case presentation: A 35-year-old woman was found to have an asymptomatic, solitary, circumscribed, pigmented lesion in her left eye. The patient underwent ophthalmic examination including multimodal evaluation with fluorescein angiography, near-infrared reflectance scanning laser ophthalmoscopy, blue autofluorescence, enhanced-depth imaging spectralis B-scan optical coherence tomography (EDI-SBOCT), en face OCT angiography (OCT-A) and microperimetry plus adaptive optics imaging. Ophthalmoscopic examination revealed a juxtafoveolar pigmented lesion with feeding retinal arteriole, consistent with congenital simple hamartoma of RPE. There was no macular edema, exudation, hemorrhage, traction or subretinal fluid. Multimodal imaging of the mass using fluorescein angiography revealed intra-lesion late staining, near-infrared reflectance imaging demonstrated intrinsic hyperreflectivity, short-wavelength autofluorescence and red-free filter photography revealed blocked signal, and SBOCT showed abrupt shadowing. On OCT-A, an exclusive ring-shaped vascular circuit with increased foveal avascular zone was noted. Adaptive optics revealed cell density arrangement and retinal sensitivity correlations on microperimetry. Conclusion: These findings suggest that this hamartomatous lesion might cause specific cellular changes that impact retinal sensitivity response and potentially result from vasculature malnourishment to the outer retinal layers.

Purpose To study the optical coherence tomography (OCT) changes in eyes with acute central retinal artery occlusion (CRAO) of different severity and at different disease stages. Methods The study included acute CRAO cases of &lt; 7 days duration, imaged on OCT at various time points. Based on the OCT findings at presentation, cases were classified into three severity groups: mild, moderate, and severe. OCT scans were evaluated and classified into four-time intervals based on symptom duration. Results There were 39 eyes from 38 patients with acute CRAO who underwent 96 OCT scans. At presentation, the study had 11, 16, and 12 cases of mild, moderate, and severe CRAO, respectively. Middle retinal layer opacification was more common in mild CRAO cases, which caused inner retinal layer thinning over time. Moderate CRAO cases had total inner retinal layer opacification, which resulted in retinal thinning over time. Prominent middle limiting membrane (p-MLM) sign was seen in mild and moder...

To report a case of foveolitis associated with dengue fever. Methods: Retrospective, observational case report. Case description: A 12-year-old male child, presented to the retina department with complaints of sudden blurring of vision in left eye since 1 week following dengue fever. His presenting visual acuity in left eye was 20/60, N8. Fundus showed wellcircumscribed, pale yellow-orange lesion at the foveal center in LE. Retinal imaging findings were consistent with the diagnosis of foveolitis. Results: Foveolitis and macular swelling were found to resolve over time on serial OCT, with visual acuity improving to 20/20,N6 with a resolution of scotoma. Conclusion: Infection with dengue virus might be associated with foveolitis. We suggest that serial OCT be performed to monitor maculopathy.

PurposeOptical coherence tomography (OCT) captures retinal damage in neuromyelitis optica spectrum disorders (NMOSD). Previous studies investigating OCT in NMOSD have been limited by the rareness and heterogeneity of the disease. The goal of this study was to establish an image repository platform, which will facilitate neuroimaging studies in NMOSD. Here we summarise the profile of the Collaborative OCT in NMOSD repository as the initial effort in establishing this platform. This repository should prove invaluable for studies using OCT to investigate NMOSD.ParticipantsThe current cohort includes data from 539 patients with NMOSD and 114 healthy controls. These were collected at 22 participating centres from North and South America, Asia and Europe. The dataset consists of demographic details, diagnosis, antibody status, clinical disability, visual function, history of optic neuritis and other NMOSD defining attacks, and OCT source data from three different OCT devices.Findings to d...

This ebook is the 3rd volume of the Collection "Practical Things... My Way", a series of anniversary publications issued in 2023, when Dr Narcisa Ianopol, the main author and publisher, celebrated 30 years of medical practice in Europe and USA. Vol.3 of this collection of ebooks includes the description of the software SITE-App from the initial development in 2007 till present time, when it is at its last variant, SITE-App 2023. Vol.3 also contains a description of the concepts and algorithms for the measurement of retinal lesions on fundus images along the years and what are the unmet needs in the retina specialty that triggered the development of the SITE-App.

This ebook is the second volume of the Collection "Practical Things... My Way", a series of anniversary publications issued in 2023, when Dr Narcisa Ianopol, the main author and publisher, celebrated 30 years of medical practice in Europe and USA. Vol.2 of this collection of ebooks includes shared clinical experience for the management of Age-related macular degeneration, that Dr Ianopol gained during her practice as Consultant Surgeon Ophthalmologist specialized in the retina and ocular trauma. Vol.2 also contains 2 clinical studies with measurements on the ocular fundus images, by using a software developed by Dr Ianopol since 2007 called SITE-App and also has details about different variants of the software following several upgrades.

Today, in the era of cutting-edge technology, demand for the reliable security system is increasing and so the biometric based authentication system. Several biometric based systems such as fingerprint and face recognition are used in various applications such as security devices and forensic identification. Human retina is one of the wellspring of biometric system which gives the most reliable and efficient method for authentication. Even in the medical science, ophthalmologist considers the changes in the retinal vessels as many retinal diseases are characterized by it. Retina feature extraction is a challenging task. In this paper, an easy and reliable method is proposed for retinal feature extraction. The concept of line tracking is used for the binarization of input retina image. A hybrid method of morphology and scanning window analysis (SWA) is applied for obtaining reliable result. Also, the validation of proposed method is checked against the database of 55 images of eyes with healthy, glaucomatous, and diabetic retinopathy.

Purpose To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria. Methods This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20. Results The participants are comprised of 46 (52.3%) males and 42 (47.7%) females, with a mean age of 42.2 ± 8.7 SD years. They were 45 (51.1%) consultants, 31 (35.2%) residents and 12 (13.6%) diplomates. Their years of practice were 8.8 ± 6.7 SD years. They worked mainly in government hospitals located at the southern part of Nigeria. The current practice was mainly comprehensive ophthalmology, 63 (71.6%). Only 2 (2.3%) had strict subspecialty practice. Others, 23 (26.1%), had combined practice. Eleven (12.5%) were glaucoma specialists and had combined practice. The majority of the participants, 57 (64.8%), were routinely diagnosed glaucoma properly. Sixty-three (71.6%) participants underwent trabeculectomy, 48 (54.5%) combined cataract surgery with trabeculectomy, 7 (8.0%) drainage implants, 5 (5.7%) laser trabeculoplasty, and 2 (2.3%) minimally invasive glaucoma surgery. Poor patients' acceptance and satisfaction, fear of complications, lengthy post-operative care and cost were the main deterrents to surgeries. Advocacy, public awareness, training of glaucoma specialists, provision of equipment and health insurance were the major recommendations on improving glaucoma care. Conclusion Given the meagre number of specialists and lack of strict subspecialty practice, optimal glaucoma care in Nigeria is still far from reality.

Purpose: To describe changes in three-dimensional choroidal volume and thickness with full raster scans of enhanced depth imaging optical coherence tomography in patients with birdshot retinochoroidopathy. Methods: This prospective case series collected spectral domain optical coherence tomography images with the enhanced depth imaging technique from eight eyes of eight patients with birdshot retinochoroidopathy including four active patients (four eyes) and four quiet patients (four eyes). Fifty scans of each patient were manually segmented before automated built-in calibration software was used. Results: Of all active patients, there were no statistically significant differences in the total choroidal volume and mean central choroidal thickness between the active and inactive phase over 6 months of follow-up. Alterations in choroidal parameters were evident and consistent after amelioration of inflammation, whereas the retinal volume and thickness remained stable. Regarding the eight inactive eyes at 6 months, the mean total choroidal volume and mean central choroidal thickness were significantly less than historical controls (P = 0.03 and P , 0.001, respectively). Persistent suprachoroidal hyporeflective space in two patients was noted despite the fact that clinical inflammation completely subsided at 6 months. Conclusion: Choroidal volume and thickness changes were consistent with inflammation in patients with birdshot retinochoroidopathy. Patients with inactive birdshot retinochoroidopathy have significant reduction in choroidal volume and thickness than do normal patients.

Purpose:To study the role of intravenous fluorescein angiography in early detection and regression of retinopathy of prematurity.Methods:The Retcam 120 (Massie Research Laboratories, Dublin, CA) was used to perform intravenous fluorescein angiography in 40 eyes of 20 children diagnosed as having treatable retinopathy of prematurity as per Early Treatment for Retinopathy of Prematurity Cooperative Group guidelines and treated with laser photocoagulation.Results:Fluorescein angiography enabled easy visualization of the retinal vasculature and helped to identify early flat neovascularization in zone 1/2 retinopathy of prematurity, detect previously missed areas of active retinopathy of prematurity in the peripheral retina, and identify skip areas following laser photocoagulation, which resulted in good management outcomes. There were no side effects related to sodium fluorescein or the procedure.Conclusions:Retcam-assisted intravenous fluorescein angiography is safe and helps in the ea...

Bone marrow-derived multiple myeloma is a type of plasma cell tumor that may be associated with ocular complications. A 52-year-old male patient was admitted to our eye clinic with the complaint of sudden visual loss and a visual acuity of 20/50 in the right eye and 20/800 in the left eye. Fundus examination revealed common flame-shaped hemorrhages, venous dilatation and tortuosity, Roth spots, serous macular detachment, and yellow macular deposits in both eyes. Evaluation with fundus fluorescein angiography, fundus autofluorescence, and spectral-domain optical coherence tomography resulted in suspicion of hyperviscosity retinopathy and referral to the hematology clinic. After hematology consultation confirmed a diagnosis of multiple myeloma, chemotherapy and plasmapheresis were initiated. Four months after presentation, best-corrected visual acuity was 20/20 in both eyes and improvement in hyperviscosity retinopathy, serous macular detachment, and yellow macular deposits was observed.

Purpose To study the optical coherence tomography (OCT) changes in eyes with acute central retinal artery occlusion (CRAO) of different severity and at different disease stages. Methods The study included acute CRAO cases of &lt; 7 days duration, imaged on OCT at various time points. Based on the OCT findings at presentation, cases were classified into three severity groups: mild, moderate, and severe. OCT scans were evaluated and classified into four-time intervals based on symptom duration. Results There were 39 eyes from 38 patients with acute CRAO who underwent 96 OCT scans. At presentation, the study had 11, 16, and 12 cases of mild, moderate, and severe CRAO, respectively. Middle retinal layer opacification was more common in mild CRAO cases, which caused inner retinal layer thinning over time. Moderate CRAO cases had total inner retinal layer opacification, which resulted in retinal thinning over time. Prominent middle limiting membrane (p-MLM) sign was seen in mild and moder...

Background/aims To study the effectiveness and clinical relevance of eyes treated with good (better than 6/12 or >70 Early Treatment Diabetic Retinopathy Study letters) visual acuity (VA) when initiating treatment with ranibizumab for neovascular age-related macular degeneration (nAMD) in the UK National Health Service. Currently eyes with VA better than (>) 6/12 are not routinely funded for therapy. Methods Multicentre national nAMD database study on patients treated 3-5 years prior to the analysis. Anonymised structured data were collected from 14 centres. The primary outcome was the mean VA at year 1, 2 and 3. Secondary measures included the number of clinic visits and injections. Results The study included 12 951 treatment-naive eyes of 11 135 patients receiving 92 976 ranibizumab treatment episodes. A total of 754 patients had baseline VA better than 6/12 and at least 1-year of follow up.

Background/aims In Portugal, so far, there is no study or even accurate data on the prevalence of diabetic retinopathy (DR), based on a large representative sample and on a long-term follow-up. The objective of our study was to determine the prevalence of DR based on a national screening community-based programme. Methods A 5-year retrospective analysis of the RETINODIAB screening programme results was implemented in Lisbon and Tagus Valley area between July 2009 and October 2014. We estimated the prevalence of retinopathy for all patients with type 2 diabetes and studied the association between known risk factors and retinopathy emergence at their first screening. Results Throughout this period, from a total of 103 102 DR readable screening examinations, 52 739 corresponded to patients who attended RETINODIAB screening at entry. Globally, DR was detected in 8584 patients (16.3%). Of these, 5484 patients (10.4%) had mild non-proliferative (NP) DR, 1457 patients (2.8%) had moderate NPDR and 672 (1.3%) had severe NPDR. Finally, 971 patients (1.8%) had proliferative DR requiring urgent referral to an ophthalmologist. The presence of any DR, non-referable DR or referable DR was strongly associated with increasing duration of diabetes and earlier age at diagnosis. Conclusions The prevalence rate of DR in our study (16.3%) was slightly lower than other published international data. The RETINODIAB network proved to be an effective screening programme as it improved DR screening in Lisbon and Tagus Valley surrounding area.

Objective: Optical coherence tomography angiography (OCTA) is a new, noninvasive imaging modality used to assess the vasculature in chorioretinal disease. The purpose of this study was to describe OCTA findings in several chorioretinal tumors, specifically melanocytic tumors. We correlate these findings with clinical risk factors (RFs) for growth. Study Design: This was a cross-sectional, comparative, observational study. Subjects: We compiled a total of 79 cases consisting of the following: 55 choroidal nevi, 11 choroidal melanomas, 5 choroidal hemangiomas, 3 astrocytic hamartomas, 2 choroidal lymphomas, 1 choroidal metastases, 1 combined hamartoma of the retina and retinal pigment epithelium (RPE), and 1 choroidal osteoma. Methods: We performed OCTA of the 79 lesions to create images that were then analyzed by 3 different physicians. In addition to OCTA, we also used multi-imaging studies, including OCT, retinal color and autofluorescence fundus imaging, Doppler echography, and indocyanine/fluorescein angiography. The melanocytic lesions were divided into 6 different groups according on the number of clinical RFs present. We compared each group with the OCTA findings, seeking any correlation between OCTA findings and the number of RFs present. Outcome Measures: All layers of the OCTA were evaluated and described. In melanocytic lesions, 6 specific variables within the choriocapillaris layer were evaluated. We also studied the quality of the images, the presence of avascular areas within the lesion, heterogeneity of the choroidal plexus over the lesion, the presence of a neovascular membrane associated with the lesion, the definition of the lesion's borders, and the presence of a hyperreflective ring surrounding the lesion. Results: Satisfactory imaging was obtained in 82.7% of the cases. Concordance k indexes between the

Drug-induced angle-closure glaucoma is an important entity for the ophthalmologist as well as the general physician as it represents a preventable cause of potential blindness. This brief review highlights the fact that a high index of suspicion, in a susceptible individual followed by confirmation on appropriate imaging modality (UBM, ultrasound or anterior segment OCT) can alleviate the threat to sight and also help to institute appropriate therapy.

PurposeOptical coherence tomography (OCT) captures retinal damage in neuromyelitis optica spectrum disorders (NMOSD). Previous studies investigating OCT in NMOSD have been limited by the rareness and heterogeneity of the disease. The goal of this study was to establish an image repository platform, which will facilitate neuroimaging studies in NMOSD. Here we summarise the profile of the Collaborative OCT in NMOSD repository as the initial effort in establishing this platform. This repository should prove invaluable for studies using OCT to investigate NMOSD.ParticipantsThe current cohort includes data from 539 patients with NMOSD and 114 healthy controls. These were collected at 22 participating centres from North and South America, Asia and Europe. The dataset consists of demographic details, diagnosis, antibody status, clinical disability, visual function, history of optic neuritis and other NMOSD defining attacks, and OCT source data from three different OCT devices.Findings to d...

Vitamin A is an essential fat-soluble vitamin important for the function of various body systems. In the eye, vitamin A is essential for the synthesis of visual pigments in photoreceptors. Vitamin A deficiency is a rare condition in the developed countries and might follow bariatric or intestinal bypass surgery. We present the case of a 67-year-old male that complained of visual loss and nyctalopia. Patient had bariatric surgery 15 years before for weight loss. Low serum levels of vitamin A confirmed the diagnosis and patient started vitamin A supplementation. Visual fields, macular thickness, and ganglion cell layer thickness were recorded and monitored 1 month, 6 months, and 1 year after the beginning of therapy. Visual fields were significantly altered and central macular thickness and ganglion cell layer thickness were reduced, but the first 2 showed a significant recovery with vitamin supplementation therapy. By the 1st month of treatment patient referred a complete remission of visual symptoms. Further, we observed hyperreflective material accumulating beneath a partially disrupted ellipsoid band in the high definition optical coherence tomography that also improved progressively with vitamin repletion. Newer and more sophisticated imaging systems have increased our knowledge of the mechanisms responsible for retinal diseases. To our knowledge, this is the first description of the effect of vitamin A deficiency and vitamin supplementation on macular thickness. This case also highlights the importance of considering bariatric bypass surgery as a cause of vitamin A deficiency in developed countries.

To assess the occurrence of glaucoma, eyelid, corneal and macular disorders in a cohort of patients with obstructive sleep apnoea (OSA) diagnosed by overnight polysomnography and to investigate into the risk factors for the above eye diseases (EDs). Cross-sectional cohort study between 2014 and 2015. Unit of Respiratory Medicine and Eye Clinic of the University of Verona. 431 consecutive patients were considered eligible. Of these, 87 declined to participate, 35 were untraceable and 13 were deceased. A complete ophthalmic evaluation of both eyes for each patient. Best-corrected distance visual acuity, intraocular pressure, corneal, macular and optic nerve optical coherence tomography, ocular aberrometry, optic nerve laser polarimetry, visual field test, and eyelid examination. 296 patients aged 64.5±12.8 years, 23% female and 77% male, underwent ophthalmic examination. There was 56% (n=166) prevalence of eyelid disorders, 27% (n=80) of corneal disorders, 13% (n=39) of macular disord...

A 53-year-old woman presented to our emergency department with a severe headache, bilateral eye pain, blurred vision and photophobia. She started oral topiramate 25 mg daily for migraine prophylaxis the evening before. Symptoms started immediately upon awakening, and she was brought to our emergency department. She reported a history of allergy to corticosteroids and gastric intolerance to oral nonsteroidal anti-inflammatory drugs (NSAIDs).

Acute traumatic maculopathy included a spectrum of disorders following blunt ocular trauma, such as traumatic pigment epitheliopathy, commotio retina, and choroidal rupture. Our patient was a 47-year-old male who came to the emergency department due to blurred vision in his left eye for the past two weeks following blunt ocular trauma. His best-corrected visual acuity was 10/10 in the unaffected right eye (OD) and 7/10 in the left eye. In fundus examination, we found decreased foveal reflex and gray-white spots in a ring-like pattern at the parafovea and an area of pigmentary change below the superior arcade near the disc. Optical coherence tomography (OCT) demonstrated disruption of the Ellipsoid zone, and Optical coherence tomography angiography (OCTA) showed dark dot signals in choriocapillaris at the same site. As we showed in this article, traumatic choriocapillaropathy, which can be described as spots of flow disruption within choriocapillaris can occur without any injury to t...

To describe baseline characteristics and visual outcome for eyes treated with ranibizumab for diabetic macular oedema (DMO) from a multicentre database. Structured clinical data were anonymised and extracted from an electronic medical record from 19 participating UK centres: age at first injection, ETDRS visual acuity (VA), number of injections, ETDRS diabetic retinopathy (DR) and maculopathy grade at baseline and visits. The main outcomes were change in mean VA from baseline, number of injections and clinic visits and characteristics affecting VA change and DR grade. Data from 12 989 clinic visits was collated from baseline and follow-up for 3103 eyes. Mean age at first treatment was 66 years. Mean VA (letters) for eyes followed at least 2 years was 51.1 (SD=19.3) at baseline, 54.2 (SD: 18.6) and 52.5 (SD: 19.4) at 1 and 2 years, respectively. Mean visual gain was five letters. The proportion of eyes with VA of 72 letters or better was 25% (baseline) and 33% (1 year) for treatment ...

Topiramate is a recognized cause of druginduced acute angle-closure glaucoma. We describe a case presenting with bilateral acute angle-closure glaucoma caused by topiramate intake. Patient subsequently developed severe anterior uveitis caused by sulphonamide derivatives (acetazolamide and co-trimoxazole) due to cross-sensitivity, on two separate occasions. The present case also highlights the role of anterior segment optical tomography in diagnosis and follow-up. In a patient with known drug allergy to topiramate, other sulphonamide derivatives should be avoided to limit the ocular morbidity.

Изобретение оптической когерентной томографии с функцией ангиографии (ОКТА) позволило по-новому взглянуть на ранние стадии диабетической ретинопатии (ДР). Результаты последних исследований демонстрируют значимые изменения фовеальной аваскулярной зоны (ФАЗ)-ее площади, индекса ациркулярности, соотношения осей и угла ФАЗ до возникновения офтальмоскопических проявлений. Большое количество работ посвящено оценке сосудистой плотности на уровне отдельных сосудистых сплетений, причем зачастую авторы используют разные методы обработки изображений, разные количественные и качественные параметры. Не менее важным признаком доклинической ДР является формирование неперфузируемых зон. ОКТА позволяет детектировать их на разных уровнях и вычислять их площадь. Изменение извитости ретинальных сосудов, описанное ранее при анализе изображений глазного дна, может быть зарегистрировано и количественно подсчитано на ОКТА-сканах. Кроме того, в отдельных исследованиях у пациентов без офтальмоскопических признаков ДР выявляются микроаневризмы. В обзоре представлен анализ современных подходов к оценке ранних ангиографических изменений сетчатки, а также дана оценка перспектив использования ОКТА для совершенствования диагностических алгоритмов ДР. Ключевые слова: диабетическая ретинопатия; ОКТ-ангиография; фовеальная аваскулярная зона; индекс ациркулярности; сосудистая плотность Конфликт интересов: отсутствует. Прозрачность финансовой деятельности: никто из авторов не имеет финансовой заинтересованности в представленных материалах или методах; работа выполнена в рамках НИР Медицинского научно-образовательного центра МГУ имени М.В. Ломоносова

Retina recognition is the most stable and reliable biometric system due to its stability, uniqueness and non-replicable nature of vascular pattern. On the other hand, the complexity of vascular pattern in diseased retina makes the extraction of blood vessels very hard, which majorally effects the recognition rate. The main aim of this paper is to design a robust retinal recognition system with reduced computational complexity and to explore novel retinal features. This paper presents two different approaches for retinal recognition; one is vascular-based feature extraction with an improved vessel segmentation algorithm and second is non-vascular based feature extraction. Vascular-based method uses vessel properties of retinal images and aims to improve the efficiency of retinal recognition system. Whereas, non-vascular based method intends to analyze non-vessel properties of retinal images in order to reduce time complexity. The proposed system is assessed on two local and three public databases.

PurposeOptical coherence tomography (OCT) captures retinal damage in neuromyelitis optica spectrum disorders (NMOSD). Previous studies investigating OCT in NMOSD have been limited by the rareness and heterogeneity of the disease. The goal of this study was to establish an image repository platform, which will facilitate neuroimaging studies in NMOSD. Here we summarise the profile of the Collaborative OCT in NMOSD repository as the initial effort in establishing this platform. This repository should prove invaluable for studies using OCT to investigate NMOSD.ParticipantsThe current cohort includes data from 539 patients with NMOSD and 114 healthy controls. These were collected at 22 participating centres from North and South America, Asia and Europe. The dataset consists of demographic details, diagnosis, antibody status, clinical disability, visual function, history of optic neuritis and other NMOSD defining attacks, and OCT source data from three different OCT devices.Findings to d...

PURPOSE. To evaluate the clinical utility of pattern electroretinography (PERG) in the differential diagnosis of ocular hypertension and newly diagnosed primary open-angle glaucoma (POAG) of the initial stage.METHODS. This prospective non-randomized cohort study included patients over the age of 35 years with newly diagnosed ocular hypertension and initial stage POAG in at least one eye. All patients underwent a standard ophthalmological examination, as well as a complex of additional methods used to diagnose POAG: pachymetry, examination of the biomechanical properties of the cornea (Ocular Response Analyzer, Reichert), standard automated perimetry (SAP) (Octopus 900, Haag-Streit Diagnostics), optical coherence tomography (OCT) of the optic nerve head (ONH) and macular area (OCT Triton Plus 3000, Topcon) and PERG (Diopsys Nova, Diopsys, Inc.). Data from both eyes of all included patients were analyzed (12 eyes in the ocular hypertension group and 26 eyes in the POAG group). Statist...

The present report aimed to describe the macular structure’s recovery process in a case of optic disc pit maculopathy (ODP-M) with outer layer hole following pars plana vitrectomy (PPV) with juxtapapillary laser treatment (JPL). We performed repeated optical coherence tomography (OCT) examinations to evaluate the macular structural changes. An 80-year-old man presented with distorted vision and decreased visual acuity (VA) in his left eye, experienced for 1 year, prior to presentation. Fundus examination and OCT showed intraretinal fluid (IRF) in the inner and outer retinal layers. Serous retinal detachment (SRD) with an outer layer hole in the macula was also evident. The IRF was connected to the optic disc; however, the SRD was isolated. Best-corrected VA was 20/100. PPV combined with JPL was performed. Posterior vitreous detachment creation and tamponade with sulfur hexafluoride was performed. Postoperatively, the inner retinal IRF at the fovea disappeared. The outer layer hole g...

Alpha-synuclein is a Parkinson&#39;s disease-linked protein of ubiquitous expression in the central nervous system. It has a proposed role in the modulation of neurotransmission and synaptic function. This study was aimed at analyzing expression of the alpha-synuclein gene in the normal retina, and characterizing its pattern of distribution in the different retinal cell types and layers in a variety of vertebrates, ranging from fish to humans. Reverse transcriptase-polymerase chain reaction and immunoblotting were used to assess alpha-synuclein expression at both mRNA and protein levels. Its retinal distribution profile was characterized by immunohistochemical methods. With this purpose, retinal sections were analyzed under fluorescent confocal microscopy using specific antibodies against alpha-synuclein, alone and in double or triple combinations with a set of antibodies to molecular markers for the distinct retinal neuronal types. Also, synaptophysin was used as a marker for synap...

Purpose. To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) images of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI). Methods. The Wilcoxon signed-rank test was used to compare area measurements and p values of &lt;0.05 were considered statistically significant. FA and OCTA images were independently graded by 2 observers that reached agreement regarding quantitative DMI according established protocols. The ischemic area was divided into…

Purpose: Several case reports of transient drug-induced myopia have been reported, mainly due to sulfa drugs. We present a case of a sudden and significant increase in myopia associated with initiation of Sulfasalazine for long-standing ulcerative colitis in an adult Caucasian female. Case report: Our patient presented to the emergency room with acute bilateral visual loss. Ocular examination was normal, except for myopia of −4 Diopters (D) in both eyes (BE). The patient was advised to stop the medication, and her vision improved within 4 days to best corrected visual acuity (BCVA) of 6/7.5 with a refractive correction of −0.75 D in her right eye (RE) and BCVA of 6/6 with a refractive correction of −0.50 D in her left eye (LE). Conclusion: To the best of our knowledge, this is the second reported case of transient Sulfasalazine-induced myopia.