The Cosine Law to Choose the Correct Forceps Shaft Length for Macular Surgery in Highly Myopic Eyes.

PURPOSE: To demonstrate a mathematical analogy between the Pythagorean theorem using the axial a-scan measurement, i.e., the distance between the central cornea and the sclerotomy, and the lengths of the forceps in eyes of patients with all axial lengths. METHODS: We used the Pythagorean equation (c 2 = a 2 + b 2 ) to calculate the adequate shaft length of the forceps to use in macular surgery, especially in highly myopic eyes, where c 2 represents the axial length (hypotenuse); b 2 the sum of the corneal ray and distance between the corneal limbus and the sclerotomy (base side); and a 2 the distance between the sclerotomy and the fovea (perpendicular side). RESULTS: We reproduced the cosine law to estimate the distance between the sclerotomy and the fovea. The distance between the sclerotomy and the foveal area is shorter than the axial length and can become smaller based on the distance from the sclerotomy to the corneal limbus. CONCLUSION: This simple mathematical formula is useful when performing surgery in highly myopic eyes, in which there can be difficulties reaching the macular area.

Unmeasurable small size superficial and deep foveal avascular zone in nanophthalmos: the Collaborative Nanophthalmos OCTA Study.

AIM: To study the macular structure and vasculature in consecutive nanophthalmic eyes using optical coherence tomography angiography. METHODS: This is a prospective, multicentre, cross-sectional study of patients with nanophthalmos (one or both eyes). The superficial and deep foveal avascular zones (FAZ) were measured both manually and with the machine's built-in automated measurement tool. Correlations between best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveolar choroidal thickness (SFCT) were calculated. RESULTS: Sixty-five eyes of 35 subjects (16 men and 19 women) with a mean age of 37.4 years were analysed. The mean±SD of refractive error was 14.3±3.2 dioptres, axial length was 16.4±1.6 mm, CMT was 410.2±128.3 µm and SFCT was 450.1±108.3 µm. FAZ was unmeasurable small size in both the superficial and deep capillary plexus in all eyes, along with tortuosity of the superficial foveal capillaries and large vessels. Foveal folds were present in 29 eyes. Disc drusen was detected in 27 eyes and was absent in 31 eyes, while fundus autofluorescence was positive in 17 and negative in 24 eyes. BCVA varied from 20/20 to 20/800, with a mean of 20/76. Using Spearman's correlation, logarithm of the minimum angle of resolution BCVA correlated negatively with axial length (r=-0.30; p=0.015). CONCLUSIONS: FAZ attenuation, capillary tortuosity, foveal folds and thickened subfoveal choroid characterise the nanophthalmic macula. These findings may result from a redundant retina and the absence of apoptotic foveolar retraction because of developmental arrest of the optic vesicle after closure of the embryonic fissure.

Physiologic and Psychologic Risk Factors in Central Serous Chorioretinopathy.

PURPOSE: Central serous chorioretinopathy (CSCR) is characterized by macular detachment due to thickened choroid, mostly affecting young men under perceived stress. Although most previous studies on CSCR have been retrospective and have focused on a single facet of the patient's personality, we conducted a prospective, intercontinental, controlled study to analyze the multifaceted personality profile in CSCR. DESIGN: Prospective, cross-sectional, case-control study. PARTICIPANTS: Subjects with CSCR from 6 university-based eye clinics consented to participate in a questionnaire. Controls without retinal disease were recruited from the same clinics. METHODS: The interview consisted of a 60-item questionnaire. Recruitment of participants was from January 2015 to February 2016. Controls were matched for age, gender, and race. Statistical analyses were performed using univariate and multivariate analyses. MAIN OUTCOME MEASURES: The main parameters registered were presence of stress, daily number of cups caffeine intake, and personality traits (Type A; obsessive-compulsive; aggressive). RESULTS: A total of 83 consecutive patients with CSCR (mean age, 45.9 years; male, 80.7%) and 83 controls (mean age, 46.0 years; male, 80.7%) were analyzed for 60 variables. Multivariate analysis revealed a strong association with obsessive-compulsive behavior (P = 0.001), caffeine intake (P = 0.002), Type A personality (P = 0.002), continuous stress (P = 0.001), and premature ejaculation (P = 0.001). CONCLUSIONS: This study sheds light on the unique psychologic functioning of patients with CSCR: preoccupied, inflexible, perfectionist (obsessive-compulsive tendency), competitive, ambitious, impatient, high achiever (Type A personality), and under continuous stress. In addition, caffeine abuse and premature ejaculation were linked to CSCR.

Evaluation of patients with diffuse unilateral subacute neuroretinitis by spectral domain optical coherence tomography with enhanced depth imaging.

BACKGROUND: The purpose of this study was to determine the value of spectral domain optical coherence tomography (SD-OCT) in assessing patients with diffuse unilateral subacute neuroretinitis (DUSN). METHODS: This was an observational case series with clinical imaging correlation performed at the Retina and Vitreous Institute of Londrina and State University of Londrina, Paraná, Brazil. The series comprised ten consecutive patients with a confirmed diagnosis of DUSN, ie, seven patients with late-stage disease and three with early-stage disease, who were assessed by SD-OCT for mean macular, retinal nerve fiber layer, and choroidal thickness using enhanced depth imaging software. RESULTS: Comparing the affected eye with the healthy fellow eye, significant diffuse atrophy of the retinal layers with a decrease in mean macular (P=0.004) and retinal nerve fiber layer (P=0.002) thickness was found in all cases. There was no difference in choroidal thickness (P=0.262). CONCLUSION: The correlation of SD-OCT results with central vision and funduscopic findings may explain the profound loss of visual function in patients with DUSN.

Clinical features and outcomes of patients with diffuse unilateral subacute neuroretinitis treated with oral albendazole.

PURPOSE: To investigate the clinical features, visual function outcomes, and adverse events in patients with diffuse unilateral subacute neuroretinitis (DUSN) treated with high-dose oral albendazole. DESIGN: Interventional case series. METHODS: Twelve Brazilian patients, aged 7 through 36 years, with active DUSN in the early or late clinical stage, were recruited for this study between 1999 and 2001. A small variant motile worm was found in 4 (33.3%) of these cases. All patients were treated exclusively with high-dose oral albendazole (400 mg/d) for 30 days. RESULTS: Improvement of visual acuity, visual field, and active ocular inflammatory signs was observed in all patients after 4 weeks of treatment (median follow-up: 3 years). Also, during the first weeks of treatment, evidence of worm inactivation was documented for the four patients with visible worms. No adverse drug side effects were observed in any of our cases during follow-up. CONCLUSION: High-dose oral albendazole seems to be safe and beneficial for patients with DUSN.

Correlações entre anormalidades de mão e risco de retinopatia diabética / Correlations between Hand Abnormalities and Diabetic Retinopathy Risk - Description of a new syndrom

Uma correlação entre retinopatia diabética e certo tipo de anormalidades de mão, em contratura é analisada sobre uma população de 81 pacientes diabéticos. A gravidade da retinopatia proliferativa e outras alterações microvasculares na presença das contraturas é ressaltada em seis casos com severa anomalia de mão, e 14 com alterações moderadas, onde a frequencia e gravidade da retinopatia foi superior à da população sem anormalidades (50 por cento e 30 por cento respectivamente); alto nível de correlação foi encontrado entre retinpatia diabética proliferativa e presença de alterações de mão. O autor conclui com base na casuístia apresentada e recentes dados da literatura, ser esta população de diabéticos de alto risco ao desenvolvimento de complicações microvasculares, principalmente retinopatia grave, sendo o exame das mãos, de fácil execução, importante subsídio à detecção e triagem dessa população de risco.