Optical Coherence Tomography and Optical Coherence Tomography with Angiography in Multiple Sclerosis.

Multiple sclerosis (MS) is an inflammatory and neurodegenerative, potentially disabling disease of the central nervous system. OCT (Optical Coherence Tomography) and OCT-A (Optical Coherence Tomography with Angiography) are imaging techniques for the retina and choroid that are used in the diagnosis and monitoring of ophthalmological conditions. Their use has recently expanded the study of several autoimmune disorders, including MS. Although their application in MS remains unclear, the results seem promising. This review aimed to provide insight into the most recent OCT and OCT-A findings in MS and may function as a reference point for future research. According to the current literature, the retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform complex (GC-IPL) are significantly reduced in people with MS and are inversely correlated with disease duration. The use of OCT might help distinguish between MS and neuromyelitis optica spectrum disorders (NMOSD), as the latter presents with more pronounced thinning in both the RNFL and GC-IPL. The OCT-A findings in MS include reduced vessel density in the macula, peripapillary area, or both, and the enlargement of the foveal avascular zone (FAZ) in the setting of optic neuritis. Additionally, OCT-A might be able to detect damage in the very early stages of the disease as well as disease progression in severe cases.

Differentiating Degenerative from Vascular Dementia with the Help of Optical Coherence Tomography Angiography Biomarkers.

Alzheimer's disease and vascular dementia account for the majority of cases of cognitive decline in elderly people. These two main forms of dementia, under which various subtypes fall, are often overlapping and, in some cases, definitive diagnosis may only be possible post-mortem. This has implications for the quality of care and the design of individualized interventions for these patients. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality used to visualize the retinal layers and vessels which shows encouraging results in the study of various neurological conditions, including dementia. This review aims to succinctly sum up the present state of knowledge and provide critical insight into emerging patterns of OCTA biomarker values in Alzheimer's disease and vascular dementia. According to the current literature, vessel density seems to be a common biomarker for both forms; inner retinal layer thickness might represent a biomarker preferentially affected in degenerative dementia including Alzheimer's, while, in contrast, the outer-layer thickness as a whole justifies attention as a potential vascular dementia biomarker. Radial peripapillary capillary density should also be further studied as a biomarker specifically linked to vascular dementia.

Ocular biomarkers and their role in the early diagnosis of neurocognitive disorders.

Given the fact that different types of dementia can be diagnosed only postmortem or when the disease has progressed enough to cause irreversible damage to certain brain areas, there has been an increasing need for the development of sensitive and reliable methods that can detect early preclinical forms of dementia, before the symptoms have even appeared. Ideally, such a method would have the following characteristics: to be inexpensive, sensitive and specific, Non-invasive, fast and easily accessible. The ophthalmologic examination and especially the study of the retina, has caught the attention of many researchers, as it can provide a lot of information about the CNS and it fulfills many of the aforementioned criteria. Since the introduction of the non-invasive optical coherence tomography (OCT) and the newly developed modality OCT-angiography (OCT-A) that can demonstrate the structure and the microvasculature of the retina and choroid, respectively, there have been promising results regarding the value of the ophthalmologic examination in the early diagnosis of Alzheimer's disease. In this review paper, we summarize and discuss the ocular findings in patients with cognitive impairment disorders and we highlight the importance of the ophthalmologic examination to the diagnosis of these disorders.

Management of Pseudophakic Malignant Glaucoma in Sunset Syndrome: A Case Report and Literature Review.

To present an interesting case of pseudophakic malignant glaucoma in sunset syndrome, which potentially points to a correlation between a posterior chamber intraocular lens (PCIOL) subluxation and development of aqueous misdirection. Furthermore, we underlined the effectiveness of YAG-laser hyaloidotomy as a first line treatment for malignant glaucoma. This is a case report and literature review. A 76-year-old male with primary open angle glaucoma (POAG) with a history of left monocular diplopia due to inferior dislocation of the PCIOL (sunset syndrome), presented with a sudden onset of pain in the left eye and decreased visual acuity with corrected distance visual acuity (CDVA) of 20/60, seven years after an uneventful left phacoemulsification. The anterior chamber (AC) was shallow, the intraocular pressure (IOP) elevated and the PCIOL extruded in AC. Aqueous misdirection was diagnosed and treated with YAG laser hyaloidotomy. A gush of fluid emerged with simultaneous deepening of the AC and the IOP dropped immediately to 24 mmHg and later to 9 mmHg. A prophylactic YAG peripheral iridotomy was also performed. An IOL exchange surgery with anterior chamber IOL placement was performed a few days later resulting in a final CDVA of 20/30. We argue that postoperative subluxation of a PC IOL is likely to be an initiating event for aqueous misdirection.