Agreement between optical coherence and Scheimpflug tomography: Vault measurements and reproducibility after implantable collamer lens implantation.

PURPOSE: To evaluate the agreement between Scheimpflug tomography (Pentacam, Oculus) and anterior segment optical coherence tomography (AS-OCT, RTVue 100, Optovue) as well as the reproducibility of each technique in assessing the lens-ICL distance (vault) after implantable collamer lens (ICL) implantation. METHODS: The vault was measured manually with Scheimpflug tomography and AS-OCT. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to determine the reproducibility of measurements and the agreement between them. Multivariate regression analysis was performed to identify predictors of differences in vault measurements between devices. RESULTS: 80 eyes of 46 ICL patients were analyzed. Mean patient age was 33.8±7.4 years (range, 21 to 51), and 27 (59%) were women. The preoperative spherical equivalent refraction ranged from -26 to 8.5 diopters (D). The mean vault measured by AS-OCT was 558.8±240.2µm (range, 162 - 1220) vs. 430.1±215.3µm (range, 0 to 1070) by Pentacam. AS-OCT yielded vault values, on average, 128.1±64.6µm higher than the Pentacam (range, -22 to 293µm). The ICC values for consistency and absolute agreement were 0.960 and 0.928, respectively. Reproducibility of vault measurements was excellent for both devices (ICC≥0.946). Four parameters-vault, pupil diameter (PD), PD differences between devices, and preoperative spherical equivalent refraction-were significant predictors of differences in vault measurements (adjusted-R2=0.412; P<0.001). CONCLUSIONS: Agreement between AS-OCT and Pentacam for vault measurement was good. Vaults were higher when measured by AS-OCT. These differences are clinically relevant, and therefore these devices cannot be used interchangeably to measure vault.

OCT de segmento intermedio / Intermediate segment OCT

No disponible

Glaucoma de ángulo abierto secundario a cortisona endógena por microadenoma hipofisario en un paciente joven, a propósito de un caso / Open angle glaucoma secondary to endogenous cortisone due to pituitary microadenoma in a young patient, a case report

CASO CLÍNICO: Varón de 31 años que fue derivado para valoración tras ser diagnosticado de síndrome de Cushing secundario a un microadenoma hipofisario. En la exploración se observó reducción de la agudeza visual y presión intraocular (PIO) de 48 mmHg en ambos ojos. El segmento anterior fue normal, la papila excavada y el ángulo abierto explorado mediante gonioscopia. Se realizó también campimetría que reveló una afectación avanzada. Se diagnosticó de glaucoma secundario a corticosteroides endógenos y se inició tratamiento médico a la espera de la extirpación del adenoma. La PIO no se normalizó tras la extirpación incompleta del adenoma, por lo que se optó por realizar trabeculectomía para controlarla. Como conclusiones: ante una hipertensión ocular con tumor hipofisario se debe sospechar glaucoma secundario a cortisona endógena; el tratamiento precoz del tumor es necesario para normalizar los niveles de la cortisona y controlar la PIO, el diagnóstico tardío o el tratamiento incompleto de estos tumores puede llevar a no obtener un control adecuado de la PIO

CASE REPORT: A 31-year-old male was referred for evaluation after being diagnosed with Cushing syndrome secondary to a pituitary microadenoma. He presented with a reduced visual acuity and high intraocular pressure (IOP) of 48mmHg in both eyes. The examination with biomicroscopy showed normal anterior segment, increased cup to disc ratio, and open angle. There was a moderate-advanced involvement in the visual field. The patient was diagnosed with glaucoma secondary to endogenous corticosteroids, and medical treatment was initiated pending the removal of the adenoma. The IOP did not return to normal after the incomplete removal of the adenoma, so a trabeculectomy was performed to control the IOP. As conclusions: In the case of an ocular hypertension with pituitary tumour, secondary glaucoma to endogenous cortisone should be suspected. Early treatment of the tumour is necessary to bring the cortisone and IOP levels back to normal. Late diagnosis or incomplete treatment of these tumours may lead to not obtaining adequate IOP control

Evaluación de los cambios en la mácula y en el nervio óptico mediante tomografía de coherencia óptica en pacientes con trastorno por déficit de atención e hiperactividad / Assessment of changes in the macula and optic nerve head using optical coherence tomography in patients with attention deficit hyperactivity disorder

INTRODUCCIÓN: Determinar si existen diferencias en el grosor macular y papilar mediante tomografía de coherencia óptica (OCT) en pacientes con trastorno por déficit de atención e hiperactividad (TDAH) comparando con un grupo control, evaluando además si existen diferencias entre pacientes con TDAH con y sin tratamiento. MÉTODOS: Estudio transversal en el que se incluyó a 92 ojos de 46 pacientes, divididos en 2 grupos: 46 ojos de 23 pacientes con TDAH y un grupo control de 46 ojos de 23 sujetos. El grupo de pacientes con TDAH se subdividió en aquellos con tratamiento con metilfenidato o derivados (n = 28) y aquellos sin tratamiento (n = 18). Se midió el grosor macular, el complejo de células ganglionares (CCG) y la capa de fibras nerviosas de la retina (CFNR) a nivel papilar en 12 sectores. RESULTADOS: Se observó un menor grosor macular central en los TDAH que en controles (257,4 ± 20 μm vs. 267,5 ± 20 μm; p = 0,013), no observándose diferencias en el CCG (p ≥ 0,566), ni en la CFNR (p ≥ 0,095). En los pacientes con TDAH con y sin tratamiento no se observaron diferencias en el grosor macular ni en el CCG (p ≥ 0,160 y 0,375, respectivamente), pero se objetivó un menor grosor foveal (p = 0,018) y de la CFNR en 5/12 sectores a nivel papilar (p ≤ 0,033) en aquellos sin tratamiento. CONCLUSIONES: Se observó un menor grosor macular en los pacientes con TDAH que en controles. Además, los pacientes con TDAH sin tratamiento presentaron un menor grosor foveal y de la CFNR que aquellos pacientes en tratamiento

INTRODUCTION: To assess if there are any differences in macular and papillary thickness using optical coherence tomography (OCT) in patients with attention deficit hyperactivity disorder (ADHD) compared with a control group, including if there are differences between ADHD patients with and without treatment. METHODS: Prospective observational study including 92 eyes of 46 patients divided into 2 groups: 46 eyes of 23 patients with ADHD, and a control group of 46 eyes of 23 healthy patients. The group of patients with ADHD was subdivided into those on treatment with methylphenidate (n = 28) and those not on treatment (n = 18). The macular thickness, the ganglion cell complex (GCC), and the retinal nerve fibre layer (RNFL) at the papillary level were measured in 12 sectors. RESULTS: A lower central macular thickness was observed in the ADHD patients than in the controls (257.4 ±20 μm versus 267.5 ±20 μm, P = .013), with no differences observed in the GCC (P=.566), or in the RNFL (P = .095). There were no differences in the patients with ADHD with and without treatment, as regards macular thickness and the GCC (P = .160 and P = .375 respectively), but a lower foveal thickness (P = .018) and RNFL in 5/12 sectors at the papillary level (P = .033) were observed in those without treatment. CONCLUSIONS: A lower macular thickness was observed in patients with ADHD than in controls. In addition, patients with ADHD without treatment had a lower thickness of the fovea and RNFL than those patients on treatment

Assessment of changes in the macula and optic nerve head using optical coherence tomography in patients with attention deficit hyperactivity disorder. / Evaluación de los cambios en la mácula y en el nervio óptico mediante tomografía de coherencia óptica en pacientes con trastorno por déficit de atención e hiperactividad.

INTRODUCTION: To assess if there are any differences in macular and papillary thickness using optical coherence tomography (OCT) in patients with attention deficit hyperactivity disorder (ADHD) compared with a control group, including if there are differences between ADHD patients with and without treatment. METHODS: Prospective observational study including 92 eyes of 46 patients divided into 2 groups: 46 eyes of 23 patients with ADHD, and a control group of 46 eyes of 23 healthy patients. The group of patients with ADHD was subdivided into those on treatment with methylphenidate (n=28) and those not on treatment (n=18). The macular thickness, the ganglion cell complex (GCC), and the retinal nerve fibre layer (RNFL) at the papillary level were measured in 12 sectors. RESULTS: A lower central macular thickness was observed in the ADHD patients than in the controls (257.4±20µm versus 267.5±20µm, P=.013), with no differences observed in the GCC (P=.566), or in the RNFL (P=.095). There were no differences in the patients with ADHD with and without treatment, as regards macular thickness and the GCC (P=.160 and P=.375 respectively), but a lower foveal thickness (P=.018) and RNFL in 5/12 sectors at the papillary level (P=.033) were observed in those without treatment. CONCLUSIONS: A lower macular thickness was observed in patients with ADHD than in controls. In addition, patients with ADHD without treatment had a lower thickness of the fovea and RNFL than those patients on treatment.

Open angle glaucoma secondary to endogenous cortisone due to pituitary microadenoma in a young patient, a case report. / Glaucoma de ángulo abierto secundario a cortisona endógena por microadenoma hipofisario en un paciente joven, a propósito de un caso.

CASE REPORT: A 31-year-old male was referred for evaluation after being diagnosed with Cushing syndrome secondary to a pituitary microadenoma. He presented with a reduced visual acuity and high intraocular pressure (IOP) of 48mmHg in both eyes. The examination with biomicroscopy showed normal anterior segment, increased cup to disc ratio, and open angle. There was a moderate-advanced involvement in the visual field. The patient was diagnosed with glaucoma secondary to endogenous corticosteroids, and medical treatment was initiated pending the removal of the adenoma. The IOP did not return to normal after the incomplete removal of the adenoma, so a trabeculectomy was performed to control the IOP. As conclusions: In the case of an ocular hypertension with pituitary tumour, secondary glaucoma to endogenous cortisone should be suspected. Early treatment of the tumour is necessary to bring the cortisone and IOP levels back to normal. Late diagnosis or incomplete treatment of these tumours may lead to not obtaining adequate IOP control.

Hipertensión ocular como causa de obstrucción de arteria ciliorretiniana en el paciente joven, a propósito de un caso / Ocular hypertension as a cause of cilioretinal artery obstruction in the young patient, about a case

CASO CLÍNICO: Mujer de 16 años que acude a urgencias por pérdida de la agudeza visual (AV) en el ojo izquierdo (OI) y cefalea opresiva de un día de evolución, en tratamiento con corticoide tópico por conjuntivitis vírica. La AV fue de 1,00 en el ojo derecho y 0,05 en el OI, la presión intraocular fue de 42 mmHg en ambos ojos. En el OI la funduscopía se objetivó edema isquémico retiniano en haz papilomacular, con angiografía por tomografía de coherencia óptica (OCT-A) se observó obstrucción de la arteria ciliorretiniana. El estudio sistémico fue anodino, las ecografías cardiacas y de los troncos supraaórticos fueron normales, siendo la hipertensión ocular secundaria a corticoides el único agente causal identificado. Como conclusión, ante una obstrucción de arteria ciliorretiniana debe indicarse un estudio sistémico amplio para identificar posibles fenómenos embólicos. La hipertensión ocular es una de las causas que puede ser responsable de este cuadro

CLINICAL CASE: A 16-year-old patient seen in the Emergency Department due to loss of visual acuity (VA) in the left eye (LE), and oppressive headache of 1 day onset. The patient was on treatment with topical corticosteroids for viral conjunctivitis. The VA was 1.00 in the right eye and 0.05 in LE. The intraocular pressure was 42mmHg in both eyes. In the LE, the funduscopy revealed retinal ischaemic oedema in the papillomacular bundle. The optical coherence tomography angiography (OCT-A) showed an obstruction of the cilioretinal artery. The systemic study was normal, the cardiac and supra-aortic trunks ultrasound was normal, with ocular hypertension secondary to corticosteroids being the only causative agent identified. This case shows that in the event of an obstruction of the cilioretinal artery, a systemic study should be performed in order to identify possible embolic phenomena. Ocular hypertension is one of the possible causes that may be responsible for this condition

Ocular hypertension as a cause of cilioretinal artery obstruction in the young patient, about a case. / Hipertensión ocular como causa de obstrucción de arteria ciliorretiniana en el paciente joven, a propósito de un caso.

CLINICAL CASE: A 16-year-old patient seen in the Emergency Department due to loss of visual acuity (VA) in the left eye (LE), and oppressive headache of 1 day onset. The patient was on treatment with topical corticosteroids for viral conjunctivitis. The VA was 1.00 in the right eye and 0.05 in LE. The intraocular pressure was 42mmHg in both eyes. In the LE, the funduscopy revealed retinal ischaemic oedema in the papillomacular bundle. The optical coherence tomography angiography (OCT-A) showed an obstruction of the cilioretinal artery. The systemic study was normal, the cardiac and supra-aortic trunks ultrasound was normal, with ocular hypertension secondary to corticosteroids being the only causative agent identified. This case shows that in the event of an obstruction of the cilioretinal artery, a systemic study should be performed in order to identify possible embolic phenomena. Ocular hypertension is one of the possible causes that may be responsible for this condition.

Agreement between Fourier-domain and swept-source optical coherence tomography used for optic nerve head measurements.

PURPOSE: To assess the correlation between optic nerve head measurements generated by Fourier-domain (FD) and swept-source (SS) optical coherence tomography (OCT) both in healthy Caucasian subjects and patients with primary open angle glaucoma (POAG). MATERIALS AND METHODS: This was a cross-sectional study of the right eyes of 118 subjects. In each participant, the measurements of disc area, cup to disc ratio (CDR), vertical cup to disc ratio (VCDR), rim area and rim volume were performed consecutively by FD-OCT and then SS-OCT. Participant age, gender and spherical equivalent were also recorded. Agreement between the two devices was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS: The study sample consisted of 95 healthy eyes and 23 eyes with glaucoma. Mean participant age was 48.6±20.0 years, 54.2% were female, and mean spherical equivalent was -1.6±3.0 diopters. FD-OCT and SS-OCT measurements were respectively: mean disc area 1.79±0.3 vs 1.83±0.3 mm2 (ICC=0.71), mean CDR 0.38±0.2 vs 0.33±0.2 (ICC=0.91), mean VCDR 0.58±0.2 vs 0.52±0.2 (ICC=0.92), mean rim area 1.05±0.4mm2 vs 1.03±0.5mm2 (ICC=0.29), and mean rim volume 0.14±0.11 vs 0.21±0.17mm3 (ICC=0.53). Good agreement between the devices was noted for rim area and rim volume in glaucoma subjects (ICC=0.76 and 0.68 respectively), while weak agreement was observed for these variables in healthy subjects (ICC≤0.50). CONCLUSIONS: The CDR and VCDR measurements provided by FD and SS OCT showed excellent agreement for the overall sample. When the devices were used for rim measurements, agreement was excellent only in the POAG patients.

Actualización de la utilidad de la tomografía de coherencia óptica para el estudio del ángulo iridocorneal / Update on the usefulness of optical coherence tomography in assessing the iridocorneal angle

El ángulo iridocorneal por sus implicaciones en la fisiopatología del drenaje del humor acuoso es una estructura fundamental de la cámara anterior. La tomografía de coherencia óptica de segmento anterior es una técnica rápida y no invasiva que obtiene imágenes de los tejidos vivos con una alta resolución permitiendo conocer la anatomía normal del ángulo, sus alteraciones y los cambios que se producen en el mismo tras diferentes intervenciones terapéuticas. La tecnología de la tomografía de coherencia óptica de segmento anterior ha ido evolucionando hasta ofrecer imágenes que permiten identificar y cuantificar estructuras angulares claves en sujetos sanos y en pacientes con glaucoma, especialmente la malla trabecular y el canal de Schlemm, lo que puede contribuir a ampliar el conocimiento de la fisiopatología del glaucoma. Además, permite cuantificar la abertura angular con unos parámetros objetivos descritos en los últimos años, entre los que destacan el ángulo iridotrabecular, la distancia de abertura angular y el área iridotrabecular. La tomografía de coherencia óptica de segmento anterior presenta múltiples utilidades en el estudio de los distintos mecanismos del cierre angular, la evaluación de los cambios angulares tras la realización de una iridotomía láser o iridoplastia, cirugía de la catarata o el implante de lentes fáquicas

The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses