ABSTRACT
Purpose: To evaluate the absence of external limiting membrane (ELM) and ellipsoid zone (indistinct retinal outer layers, I?ROL) in the walls of idiopathic full?thickness macular holes (FTMHs) circumferentially on optical coherence tomography (OCT) and its correlation with surgical outcome. Methods: In this retrospective observational study, OCT images of patients undergoing vitrectomy for FTMHs with at least 3?months of postoperative follow?up were analyzed for preoperative circumferential extent of I?ROL. Derived macular hole indices such as hole form factor (HFF), macular hole index (MHI), tractional hole index (THI), and hole diameter ratio (HDR) were also calculated. The circumferential extent of I?ROL was correlated with derived hole indices as well as anatomical closure, foveal architecture, and restoration of ELM following surgery. Results: All nine eyes (eight patients) with FTMH (mean size: 610.11 ± 122.95 microns) in the study showed I?ROL in ?1 quadrant. The mean HFF, MHI, THI, and HDR values were 0.72 ± 0.09, 0.35 ± 0.05, 0.71 ± 0.24, and 0.53 ± 0.14, respectively. All eyes achieved type?1 hole closure with improvement in best?corrected visual acuity to 0.58 ± 0.32 LogMAR from 0.81 ± 0.26 LogMAR. Regular foveal architecture was achieved in six eyes. Out of these, five eyes had I?ROL in ?2 quadrants, and one eye had I?ROL in <2 quadrants (P = 0.0476). Restoration of ELM was seen in aforementioned six eyes (complete = 5, partial = 1). Out of the five eyes with complete ELM restoration, four had a circumferential extent of I?ROL in ?2 quadrants (P = 0.0476). Complete restoration of ELM was associated with the complete restoration of the ellipsoid zone in three eyes. Conclusion: Preoperative circumferential extent of I?ROL in FTMH walls can be a potential predictive OCT marker for the type of closure, postoperative foveal architecture, and ELM restoration.
ABSTRACT
Background: Recognizing vitreous haze (VH) patterns on ultra-widefield imaging (UWFI) in nonresolving vitritis can reduce delay in suspecting vitreoretinal lymphoma (VRL) and in performing an early vitreous biopsy for definitive diagnosis. Purpose: To demonstrate role of UWFI in providing a clue for suspecting VRL in case of bilateral nonresolving dense vitritis and demonstrate precautions for high yield of lymphoma cells on vitreous biopsy. Synopsis: A 52-year-old healthy phakic lady came with gradual, painless blurred vision OS>OD for 6 months.Treated elsewhere for OU vitritis with steroids (local and systemic), anti-tubercular therapy for 2 months, and azathioprine, she had no improvement. Presenting best-corrected visual acuty was counting fingers OD and hand movement OS. Anterior segment OU was quiet. Fundus showed OD 3+ and OS 4+ vireous haze (VH). UWFI showed 揳urora borealis� pattern of VH (OS>OD) and 搒tring of pearls� OD. Ultrasonography B-scan OU showed complete posterior vitreous detachment and attached retina. OU VRL was suspected. MRI brain and orbit with contrast was found to be normal. After stopping steroids for 2 weeks, OS underwent pars plana vitrectomy (PPV) and intravitreal (IV) methotrexate 400 mcg/0.1 ml + rituximab 1mg/0.1ml. Vitreous sample sent for cytology and immunohistochemistry showed diffuse large B-cell non-Hodgkins lymphoma with CD20 and MUM1-positive cells. OD underwent two IV rituximab injections at monthly interval initially followed by PPV with IV rituximab and methotrexate. The patient remained in remission during close follow-up. Recognizing VH patterns on UWFI can reduce the delay in the diagnosis of VRL and early initiation of treatment. Highlights: VH patterns in VRL depend on state of vitreous liquefaction and syneresis.Aurora borealis pattern on UWFI results from linear opacities with lymphoma cells uniformly aligned along formed vitreous fibrils.String of pearls pattern results from clumps of lymphoma cells and inflammatory material over the scaffold of vitreous fibrils.These patterns provide high index of suspicion for considering VRL as d iagnosis.IV rituximab has minimal side effects and has been effective in managing VRL with isolated ocular involvement.
ABSTRACT
Context: Insulin users have been reported to have a higher incidence of diabetic retinopathy (DR). Aim: The aim was to elucidate the factors associated with DR among insulin users, especially association between duration, prior to initiating insulin for Type 2 diabetes mellitus (DM) and developing DR. Materials and Methods: Retrospective cross‑sectional observational study included 1414 subjects having Type 2 DM. Insulin users were defined as subjects using insulin for glycemic control, and insulin nonusers as those either not using any antidiabetic treatment or using diet control or oral medications. The duration before initiating insulin after diagnosis was calculated by subtracting the duration of insulin usage from the duration of DM. DR was clinically graded using Klein’s classification. SPSS (version 9.0) was used for statistical analysis. Results: Insulin users had more incidence of DR (52.9% vs. 16.3%, P < 0.0001) and sight threatening DR (19.1% vs. 2.4%, P < 0.0001) in comparison to insulin nonusers. Among insulin users, longer duration of DM (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.00–1.25, P = 0.044) and abdominal obesity (OR 1.15, 95% CI 1.02–1.29, P = 0.021) was associated with DR. The presence of DR was significantly associated with longer duration (≥5 years) prior to initiating insulin therapy, overall (38.0% vs. 62.0%, P = 0.013), and in subjects with suboptimal glycemic control (32.5% vs. 67.5%, P = 0.022). Conclusions: The presence of DR is significantly associated with longer duration of diabetes (>5 years) and sub‑optimal glycemic control (glycosylated hemoglobin <7.0%). Among insulin users, abdominal obesity was found to be a significant predictor of DR; DR is associated with longer duration prior to initiating insulin therapy in Type 2 DM subjects with suboptimal glycemic control.