Impact of Cataract Surgery on Foveal Avascular Zone Detected by Optical Coherence Tomography Angiography

Purpose@#To investigate the influence of cataract surgery on detection of a foveal avascular zone (FAZ) and retinal capillary density (RCD) by optical coherence tomography angiography (OCTA). @*Methods@#In this study, 64 eyes of 64 patients with cataracts who underwent surgery were included and studied retrospectively. All patients underwent cataract surgery of the included eye and a FAZ was detected on OCTA preoperatively and postoperatively using one of two kinds of OCTA devices. The FAZ and RCD were compared before and after cataract surgery using paired t-test. @*Results@#Using the Cirrus Angioplex OCTA device, there was no significant pre- or post-operative difference in the FAZ area (p = 0.060), perimeter (p = 0.052) and circularity (p = 0.190). It also revealed no significant difference between the central (p = 0.310), inner (p = 0.310), and outer (p = 0.310) zones and full RCD (p = 0.228) before and after cataract surgery The Spectralis OCTA device also showed no significant difference in the FAZ area (p = 0.239) before and after cataract surgery. @*Conclusions@#Cataract surgery does not affect detection of the FAZ and RCD on OCTA. Although patients who have a FAZ-related retinal disorder such as diabetic retinopathy and undergo cataract surgery are followed up regularly, it seems that the results gained by OCTA are reliable and comparable to the preoperative result.

A Case of a Visual Field Defect with Optical Coherence Tomography Changes after Sildenafil Citrate Overdose

PURPOSE: A case of a transient visual field defect and a change in spectral-domain optical coherence tomography (SD-OCT) after an overdose of sildenafil citrate is described. CASE SUMMARY: A 67-year-old male with no previous medical history presented with a bluish tinge and visual field defect in both eyes. He had consumed eight tablets of sildenafil citrate (800 mg) 3 days before the visit. His best-corrected visual acuity was 14/20 in the right eye and 20/20 in the left eye. No specific finding was noted on slit-lamp examination. Fundus examination and fundus photography revealed focal foveal hypopigmentation in both eyes. He underwent SD-OCT imaging with the Cirrus HD-OCT (Carl Zeiss Meditec, Oberkochen, Germany), and thickening of the ellipsoid zone and choroid was revealed by SD-OCT scans. He was advised not to take any more sildenafil citrate and was followed for 1 week after the first visit. Central scotomas of both eyes were revealed by a visual field test, and thickening of the ellipsoid zone and choroid remained. His eyes were re-evaluated 1 and 3 months after the first visit, and although the symptoms nearly disappeared, abnormalities in the visual field test and on SD-OCT remained, albeit with some degree of improvement. He revisited us 4 months after the first visit, at which time the visual field test and SD-OCT scans showed results within normal ranges. CONCLUSIONS: Sildenafil citrate overdose can result in a color anomaly (bluish tinge), visual field defects, and thickening of the ellipsoid zone and choroid on SD-OCT scans.

A Case of Unilateral Focal Pigmented Paravenous Retinochoroidal Atrophy

PURPOSE: We report a case of unilateral, focal, pigmented paravenous retinochoroidal atrophy (PPRCA). CASE SUMMARY: A 46-year-old female visited our clinic in complaint of a vague problem with her right eye identified during a general medical examination. The visual acuity (without correction) of both eyes was 1.0. Slit-lamp examination of both eyes revealed no specific signs. Fundus examination of the right eye revealed focal, bony-spicule-shaped retinochoroidal atrophy with pigmentation along the course of the superior retinal vein. A fundus autofluorescence examination revealed principally hypofluorescence with some hyperfluorescence at the margin of the atrophic retinochoroidal lesion. Optical coherence tomography revealed mixed clumping and atrophy of the retinal pigment epithelium (RPE) layer and thinning of the choriocapillaris layer. Fluorescence angiography revealed a window defect and blockage at the site of the lesion (the fluorescent material did not enter the lesion). The site of the window defect was in correlation with the atrophic RPE region. The site of the blockage at lesion also matched with the site of the regional pigment clumping. No definite leakage was observed. CONCLUSIONS: To the best of our knowledge, this is the first case of unilateral focal PPRCA reported from Korea.

Two Cases of Intraoperative Acute Opacification of Hydrophilic Intraocular Lens

PURPOSE: In the present study, two cases of intraoperative acute opacification of hydrophilic intraocular lens were reported. CASE SUMMARY: (Case 1) A sixty-seven year-old female presented with chronic visual impairment. Slit lamp examination revealed nuclear cataract of the left eye. Cataract surgery for her left eye was performed. A hydrophilic intraocular lens was checked before implantation and no defect was noted. Immediately after the implantation of the intraocular lens, acute whitish opacification of the intraocular lens occurred. However, the intraocular lens was not explanted, and the opacification cleared after one day. (Case 2) A 65 year-old male presented with chronic visual impairment of the left eye. Nuclear cataract of his left eye was noted, and he went through cataract surgery of the left eye. After the implantation of intraocular lens, acute whitish opacification of the intraocular lens was noted but it disappeared a day after. CONCLUSIONS: Intraoperative acute opacification of intraocular lens seems to occur due to radical temperature change. There is no need to remove or exchange the intraocular lens as opacification tends to clear within a day. No structural or mechanical change of intraocular lens was noted after opacification. Careful management of temperature for intraocular lens storage is necessary for prevention of intraoperative intraocular lens clouding.

A Case of Double Fovea Artifact Detected with Spectral-domain Optical Coherence Tomography

PURPOSE: In the present study, a case of double fovea artifact on spectral-domain optical coherence tomography (SD-OCT) was reported. CASE SUMMARY: A nine-year-old male presented with blurred vision of both eyes. His best corrected visual acuity (BCVA) was 20/20 in both eyes, and complete ophthalmologic evaluation including fundus examination and fundus photography revealed no abnormality in both eyes. He underwent SD-OCT imaging with the Cirrus HD-OCT. The Macular Cube 512 × 128 protocol of his right eye revealed an unusual pseudo-duplication of the fovea in the vertical meridian. The same protocol in his left eye also rendered a pseudo-duplication of two foveas in the vertical and horizontal meridians on the retinal thickness map. Re-examination with the same OCT system and protocol was performed two weeks later after the patient received counseling on fixation during the examination, and it revealed normal contour of the fovea in both eyes. CONCLUSIONS: Double fovea artifact seen in SD-OCT is a rare artifact that can possibly lead to misdiagnosis and inappropriate clinical treatment. Since the artifact was resolved with better fixation of the patient, repeating the scan with better patient compliance is necessary when such an artifact is encountered.