Spectral-domain optical coherence tomography foveal morphology as a prognostic factor for vision performance in congenital aniridia.

BACKGROUND: Patients with congenital aniridia usually have some degree of foveal hypoplasia, thus representing a limiting factor in the final visual acuity achieved by these patients. The purpose of this study was to analyze whether the foveal morphology assessed by spectral-domain optical coherence tomography may serve as a prognostic indicator for best-corrected visual acuity in congenital aniridia patients. METHODS: Observational two-center study performed between January 2012 and March 2017 in the pediatric ophthalmology department at Vissum Alicante and Vissum Madrid, Spain. A total of 31 eyes from 19 patients with congenital aniridia were included. After a complete ophthalmological examination, a high-resolution spectral-domain optical coherence tomography with a three-dimensional scan program macular protocol was used. A morphological grading system of foveal hypoplasia was used varying from grade 1 in which there is a presence of a shallow foveal pit, extrusion of inner retinal layers, outer nuclear layer widening, and a presence of outer segment lengthening to grade 4 in which none of these processes occur. RESULTS: No correlation between central, mid-peripheral, and peripheral macular thickness and logMAR best-corrected visual acuity was found. The presence of outer segment lengthening was associated with better best-corrected visual acuity with a median best-corrected visual acuity, 0.30 logMAR, whereas the absence of this morphologic feature was associated with poorer VA with a median best-corrected visual acuity of 0.61 logMAR (p < 0.001). CONCLUSION: Foveal hypoplasia morphology can predict the best-corrected visual acuity. Specifically, the morphologic optical coherence tomography feature that is related to a better best-corrected visual acuity in congenital aniridia patients is the presence of outer segment lengthening.

Relationship between corneal biomechanical properties and optic nerve head changes after deep sclerectomy.

PURPOSE: To evaluate corneal biomechanical properties and optic nerve head (ONH) changes following deep sclerectomy (DS) and the relation to each other. METHODS: Forty-nine eyes with primary open-angle glaucoma that underwent DS were studied. Corneal biomechanical properties were assessed using the Ocular Response Analyzer and the ONH was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology before surgery and 3 months postoperatively. Changes in corneal hysteresis (CH), corneal resistance factor (CRF), optic nerve cupping, prelaminar tissue thickness, and lamina cribrosa depth and thickness were registered. A correlation matrix and multiple linear regression models were used to determine predictors of ONH changes. RESULTS: At 3 months after surgery, mean corneal compensated intraocular pressure (IOPcc) significantly decreased by 27.9% (p<00.001) and mean Goldmann-correlated IOP (IOPg) decreased by 30.52% (p<00.001). Mean CH increased and CRF decreased by 18.4% and 10.1%, respectively (p<00.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (p<00.001). Significant associations were found between ONH cupping reversal and prelaminar tissue thickening with preoperative IOPcc (p = 0.046), IOPg (p = 0.02), and CRF (p = 0.002) and with changes in IOP, CH, and CRF (p<00.001, p = 0.004, p = 0.018, respectively) after surgery. CONCLUSIONS: Corneal hysteresis increased and CRF decreased significantly 3 months after DS. Corneal resistance factor was the single largest preoperative factor influencing cupping reversal changes. Despite the influence of preoperative variables, postoperative IOP reduction was the only independent factor influencing changes observed in the ONH after surgery.

Validation of a school-based amblyopia screening protocol in a kindergarten population.

PURPOSE: To validate a school-based amblyopia screening program model by comparing its outcomes to those of a state-of-the-art conventional ophthalmic clinic examination in a kindergarten population of children between the ages of 4 and 5 years. METHODS: An amblyopia screening protocol, which consisted of visual acuity measurement using Lea charts, ocular alignment test, ocular motility assessment, and stereoacuity with TNO random-dot test, was performed at school in a pediatric 4- to 5-year-old population by qualified healthcare professionals. The outcomes were validated in a selected group by a conventional ophthalmologic examination performed in a fully equipped ophthalmologic center. The ophthalmologic evaluation was used to confirm whether or not children were correctly classified by the screening protocol. The sensitivity and specificity of the test model to detect amblyopia were established. RESULTS: A total of 18,587 4- to 5-year-old children were subjected to the amblyopia screening program during the 2010-2011 school year. A population of 100 children were selected for the ophthalmologic validation screening. A sensitivity of 89.3%, specificity of 93.1%, positive predictive value of 83.3%, negative predictive value of 95.7%, positive likelihood ratio of 12.86, and negative likelihood ratio of 0.12 was obtained for the amblyopia screening validation model. CONCLUSIONS: The amblyopia screening protocol model tested in this investigation shows high sensitivity and specificity in detecting high-risk cases of amblyopia compared to the standard ophthalmologic examination. This screening program may be highly relevant for amblyopia screening at schools.

Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids.

BACKGROUND: To evaluate the visual and anatomic outcomes after systemic steroid treatment in non-arteritic anterior ischemic optic neuropathy (NAION). METHODS: Ten eyes from ten patients diagnosed with NAION and treated during the acute phase with 80 mg daily, tapering-down dose of corticosteroids were compared with a non-contemporary cohort of 27 patients that received no treatment. The visual outcomes of treated and untreated group were compared. Patients underwent complete ophthalmic examination including determination of Snellen visual acuity (VA), visual fields (VFs) (standard automated perimetry, Swedish Interactive Testing Algorithm 24-2 strategy), and optical coherence tomography (OCT) scanning of the optic nerve head at diagnosis, 6-8 weeks and 6 months after presentation. RESULTS: No statistical differences were found between steroid-treated and untreated NAION for the median change in VA (Mann-Whitney P = 0.28), median change in VF mean deviation (MD) and median change in VF pattern standard deviation (PSD) (Mann-Whitney P = 0.213 and P = 0.07 respectively). Statistical analysis showed no differences when comparing average RNFL loss (P = 0.871) and RNFL loss for superior, nasal, inferior and temporal optic disc quadrants between both groups. Complications occurred in three of the ten treated patients (30%); in one of them, steroid therapy had to be discontinued. Another two patients developed a NAION in their fellow eye after 2 and 3 months while on low-dose prednisone. No complications developed in the control group. The study was interrupted early due to a significantly higher rate of complications observed in the treated group (P = 0.002) CONCLUSION: High-dose systemic steroid treatment did not show any beneficial effect in visual and anatomic outcomes when given during the acute phase of NAION. Furthermore, it caused serious complications in a third of the patients treated.

Persistent subretinal fluid due to central serous chorioretinopathy after retinal detachment surgery.

BACKGROUND: The causes of persistent submacular detachment after successful rhegmatogenous retinal detachment (RRD) surgery remain unknown. Its presence is associated with poor postoperative visual acuity, but due to its spontaneous resolution no additional therapeutic or diagnostic procedure is recommended. CASE REPORT: A case of central serous chorioretinopathy (CSC) that simulated persistent subfoveal fluid after RRD surgery is presented. CONCLUSION: To the authors' knowledge, no other case of visual impairment after successful retinal detachment surgery due to CSC has been reported in the PubMed database. In view of this report, CSC should be considered in the differential diagnosis of persistent subretinal fluid after successful retinal detachment surgery.

Retinal imaging after corneal inlay implantation.

We report 2 cases of implantation with the Kamra corneal inlay to describe central and peripheral retinal visibility and the quality of optical coherence tomography (OCT) scans. Under pharmacological mydriasis, the central and peripheral retina was explored without disturbance by an experienced retinal ophthalmologist. Central color imaging was done without difficulty, and peripheral imaging was accurate despite a small bright shadow in every image. The quality of the OCT scans of the macular line, macular 3-dimensional cube, and macular radial protocols were 156.51, 77.49, and 84.35, respectively, in patient 1 and 106.66, 63.03, and 64.69, respectively, in patient 2 without artifact scanning. The inlay allowed normal visualization of the central and peripheral fundus, as well as good-quality central and peripheral imaging and OCT scans.

Retrobulbar ocular blood flow changes after orbital decompression in Graves' ophthalmopathy measured by color Doppler imaging.

PURPOSE: To evaluate if decompression surgery produces changes in retrobulbar blood flow parameters in Graves' ophthalmopathy (GO). METHODS: Retrobulbar blood vessels of 26 eyes (14 patients) that underwent orbital bone decompression between June 2009 and May 2010 were measured prospectively using color Doppler ultrasound before and after surgery. The disease was inactive in all patients enrolled according to the European Group on Graves' Orbitopathy. Patients were classified with mild, moderate-to-severe, or sight-threatening disease. All patients underwent a full ophthalmic examination including intraocular pressure and Hertel measurement. An age-matched control group included 20 eyes of 20 healthy volunteers. RESULTS: The resistance indexes (RIs) in the central retinal artery (CRA) and ophthalmic artery (OA) were significantly higher in patients with GO preoperatively than in the control group (P < 0.001, P = 0.001 respectively). After decompression surgery, a significant decrease in RIs occurred in the CRA (5%) and OA (6%) (P = 0.002, P < 0.001 respectively). Proptosis was decreased a median of 6 mm (range, 4-7). Three-wall decompression surgery resulted in a significantly greater reduction in exophthalmos (median 7 mm) compared with two-wall surgery (median 5 mm) and one-wall surgery (2.5 mm). Although no significant correlation was found, the RIs decreased more with major reductions in exophthalmos. CONCLUSIONS: In inactive moderate-to-severe GO, the RIs of the CRA and OA are higher than in normal subjects. The authors hypothesized that increased RIs of inactive GO may be due to orbital extrinsic compression of vascular structures because decompression surgery leads to decreases in the RIs of both the CRA and OA.

Performance of glaucoma progression analysis software in a glaucoma population.

BACKGROUND: To compare visual field progression in glaucoma patients assessed by the glaucoma progression analysis (GPA) used in the Humphrey Field Analyzer perimeter and by objective clinical criteria. METHODS: Retrospective cross-sectional study of 93 eyes of 93 consecutive glaucoma patients with at least five reliable visual fields. Progression of the visual field damage was analyzed by a masked observer using both GPA and defined clinical criteria. Prevalence of progressive visual field damage was determined by clinical criteria and GPA analysis. Agreement between both methods was quantified by kappa analysis. GPA performance was also calculated using clinical criteria analysis as the reference standard. RESULTS: The prevalence of progressive visual field damage was 30% and 29% with GPA evaluation and clinical criteria analysis respectively. Where two consecutive visual fields showing progressive damage were needed to confirm progression, the kappa index of agreement between these two approaches was 0.87 +/- 0.06 (mean +/- standard error of the mean). Where three consecutive fields showing progressive damage were required, the kappa index of agreement was 0.64 +/- 0.1. The GPA performance showed a sensitivity and specificity of 93% (95% CI, 83-100%) and 95% (95% CI, 90-100%) respectively, and a positive likelihood ratio of 20 if the two consecutive visual fields criterion was used. The performance was worse if three consecutive progressing visual fields were required to confirm progression. CONCLUSIONS: There is a strong correlation between GPA identification of glaucomatous progression and a thorough objective clinical assessment of the visual fields. GPA could be a useful test to aid clinicians in the detection of glaucomatous progression, with high specificity, strong positive likelihood ratio, and good sensitivity and negative likelihood ratio.