Study of change in contrast sensitivity in relation to depth of ablation after wavefront optimized myopic laser-assisted in situ keratomileusis.

PURPOSE: The aim of this work was to study the change in contrast sensitivity (CS) in relation to depth of stromal ablation after wavefront-optimized (WFO) myopic laser in situ keratomileusis (LASIK). METHODS: This was as prospective, longitudinal, comparative study. The study participants were divided into two groups: Group 1 ≤50 µ ablation depth; 60 eyes and group 2 >50 µ ablation depth; 60 eyes. All underwent WFO LASIK. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and CS were measured preoperatively and postoperatively at 1 week, 2 weeks, and 2 and 6 months. Two-way repeated-measures analysis of variance (ANOVA), Unpaired t test and one-way repeated measures ANOVA were used to test differences across time periods within each treatment group. A value of P < 0.05 was considered as statistically significant. RESULTS: The mean ablation depths in groups 1 and 2 were 39.30 µ ± 7.22 µ and 69.90 µ ± 12.09 µ, respectively; the maximum depth was 94.62 µ. In group 1, the preoperative mean CS was 1.91 ± 0.07, which improved postoperatively at 1 week (1.93 ± 0.06) and remained stable in subsequent follow-ups (1.94 ± 0.05). In group 2, the mean CS preoperatively was 1.87 ± 0.12, which postoperatively at 1 week and 6 months were 1.93 ± 0.07 and 1.94 ± 0.03, respectively (P < 0.05). Between the groups, preoperative CS was significantly different (P = 0.04), but the change in CS post-LASIK was insignificant (P > 0.05). CONCLUSION: There was a significant improvement in CS after WFO myopic LASIK in all patients irrespective of ablation depth (up to 94.62 µ).

Ultra-Wide Field Imaging in Paradoxical Worsening of Tubercular Multifocal Serpiginoid Choroiditis after the Initiation of Anti-Tubercular Therapy.

Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional choroiditis lesions, PW and altering the course of therapy in TB MSC.

Longitudinal analysis of serum cytokine profile among patients with tubercular multifocal serpiginoid choroiditis: a pilot study.

PURPOSE: To analyze the serum cytokines profile in patients with tubercular multifocal serpiginoid choroiditis (TB MSC) receiving anti-tubercular therapy (ATT) and oral corticosteroids. METHODS: In this prospective longitudinal study, patients with active TB MSC were included. Serum levels of interferon (IFN)-γ, interleukin (IL)-10, and tumor necrosis factor (TNF)-α were analyzed using bead-based immunoassay. The levels of transforming growth factor (TGF)-ß were measured using cytokine bead array. Serial measurement was performed at baseline, 1, 3, and 6 weeks after initiation of therapy. Patients developing paradoxical worsening (PW) of TB MSC were identified and their serum levels of cytokines were compared with those patients who showed healing of lesions. Comparison of cytokine levels with baseline values was also performed. RESULTS: Twelve patients (three females) were included in the study. Four patients showed paradoxical worsening of TB MSC at 3.2 ± 1 weeks after initiation of therapy. Compared to patients who showed healing of lesions, patients with PW showed higher baseline IL-10 (not significant; p = 0.28). Among patients developing PW, levels of IFN-γ peaked at 1 week ((p = 0.01) and levels of TNF-α peaked at 3 weeks (p = 0.02) (coinciding with PW) compared to patients who showed healing. There was no significant difference in TGF-ß levels at any time point in either group (p > 0.47). CONCLUSIONS: Baseline and serial levels of inflammatory serum cytokines may help in predicting the response to ATT and corticosteroids in TB MSC. Patients with paradoxical worsening may show rise in pro-inflammatory cytokines after initiation of ATT indicating higher bacillary load.

Distinguishing features of acute Vogt-Koyanagi-Harada disease and acute central serous chorioretinopathy on optical coherence tomography angiography and en face optical coherence tomography imaging.

BACKGROUND: The aim of this study is to determine the differences in optical coherence tomography angiography (OCTA) features of acute Vogt-Koyanagi-Harada disease (VKH) and acute central serous chorioretinopathy (CSC). Clinical and imaging data of patients with acute CSC and VKH in a tertiary-care institute were analyzed. Multimodal imaging including fluorescein angiography, indocyanine green angiography (ICGA), and enhanced-depth imaging OCT were performed. OCTA images were analyzed for alterations in retinochoroidal microvasculature. RESULTS: Thirty-four eyes (24 patients; 10 with VKH and 14 with CSC) were included. OCTA en face images showed apparent areas of choriocapillaris flow void due to shadowing effect from overlying subretinal fluid and pigment epithelial detachment in CSC. However, eyes with VKH showed presence of true choriocapillaris flow void on OCTA that corresponded to choriocapillaris ischemia on ICGA. CONCLUSIONS: OCTA is a useful tool to assess choriocapillaris ischemia in VKH and is helpful to differentiate it from CSC in the acute stage.

Optical Coherence Tomography Angiography Features of Paradoxical Worsening in Tubercular Multifocal Serpiginoid Choroiditis.

PURPOSE: To describe optical coherence tomography angiography (OCTA) features of lesions of tubercular multifocal serpiginoid choroiditis (TB MSC) that developed paradoxical worsening (PW). METHODS: In this prospective study, subjects with TB MSC who developed PW upon initiation of anti-tubercular therapy were included. Multimodal imaging was performed using OCTA, enhanced-depth imaging OCT, fluorescein angiography (FA), and indocyanine green angiography (ICGA). Morphologic changes in the retinochoroidal vasculature during progression of TB MSC were assessed on OCTA. RESULTS: Five subjects (4 males, 1 female) were included in the study. PW of the lesions was associated with increased areas of choriocapillaris flow void on en face OCTA in all eyes. The lesions showed partial healing in the center and continuous progression at the active edges. Two eyes showed development of vascular tufts on OCTA as the lesions progressed. CONCLUSIONS: OCTA provides high-resolution imaging of progressive choriocapillaris hypoperfusion among TB MSC patients developing PW of the disease.