Comparison of choroidal thickness in patients with active and stable thyroid eye disease / Comparação da espessura da coroide em pacientes com doença ocular tireoidiana ativa e estável

ABSTRACT Purpose: To compare the choroidal thickness in active and stable phases of thyroid eye disease. Methods: Forty-seven eyes of 47 patients with thyroid eye disease were prospectively studied. Patients were evaluated on the basis of their clinical activity scores, with scores 33 defined as active disease. Subfoveal, temporal macular, nasal macular, temporal peripapillary, and nasal peripapillary choroidal thickness measurements were performed with Cirrus enhanced depth imaging spectral-domain optical coherence tomography, and the results in the two groups were compared. Results: Twenty-four patients were int he active group, whereas 23 patients were in the stable group. Choroidal thickness was significantly higher in the subfoveal and temporal macular regions in the active group. Although the nasal macular and peripapillary values were also higher in the active group, the difference was insignificant. Conclusions: Subfoveal choroidal thickness was significantly higher in patients with thyroid eye disease in the active phase than in those with stable phase disease.

RESUMO Objetivo: Comparar a espessura da coroide nas fases ativa e estável da doença ocular tireoidiana. Métodos: Quarenta e sete olhos, de 47 pacientes com doença ocular tireoidiana foram estudados prospectivamente. Os pacientes foram avaliados com base em seus escores de atividade clínica, com escore de 33 definidos como doença ativa. As medidas subfoveais, maculares temporais, maculares nasais, peripapilares temporais e da espessura da coroide peripapilar foram realizadas com tomografia de coerência óptica de domínio espectral Cirrus EDI, e os resultados nos dois grupos foram comparados. Resultados: Vinte e quarto pacientes estavam no grupo ativo, enquanto 23 pacientes estavam no grupo estável. A espessura da coroide foi significativamente maior nas regiões macular subfoveal e temporal no grupo ativo. Embora os valores maculares e peripapilares nasais também fossem maiores no grupo ativo, a diferença foi insignificante. Conclusões: A espessura da coroide subfoveal foi significativamente maior em pacientes com doença ocular tireoidiana na fase ativa do que naqueles com doença na fase estável.

Comparison of choroidal thickness in patients with active and stable thyroid eye disease.

PURPOSE: To compare the choroidal thickness in active and stable phases of thyroid eye disease. METHODS: Forty-seven eyes of 47 patients with thyroid eye disease were prospectively studied. Patients were evaluated on the basis of their clinical activity scores, with scores 33 defined as active disease. Subfoveal, temporal macular, nasal macular, temporal peripapillary, and nasal peripapillary choroidal thickness measurements were performed with Cirrus enhanced depth imaging spectral-domain optical coherence tomography, and the results in the two groups were compared. RESULTS: Twenty-four patients were int he active group, whereas 23 patients were in the stable group. Choroidal thickness was significantly higher in the subfoveal and temporal macular regions in the active group. Although the nasal macular and peripapillary values were also higher in the active group, the difference was insignificant. CONCLUSIONS: Subfoveal choroidal thickness was significantly higher in patients with thyroid eye disease in the active phase than in those with stable phase disease.

Dexamethasone Implant in Chronic Diabetic Macular Edema Resistant to Intravitreal Ranibizumab Treatment.

PURPOSE: The aim of this study was to assess the efficacy of a single intravitreal dexamethasone implant (IDI) over 6 months in eyes with chronic diabetic macular edema (DME) that were resistant to intravitreal ranibizumab (IR) treatment. METHODS: This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey. Efficacy outcomes were considered as the change from baseline in best corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS: Thirty eyes of 20 patients with a mean age of 61.6 ± 8.8 (45-85) years were included in the study. The mean BCVA significantly increased from 0.68 ± 0.27 to 0.56 ± 0.30 logMAR (p = 0.001) and 0.57 ± 0.30 logMAR (p = 0.002) at months 1 and 2, respectively. The proportion of patients who gained 3 or more lines in BCVA was 20%. The mean CMT significantly decreased from 578.93 ± 17.95 µm at baseline to 282.10 ± 21.42, 292.26 ± 19.69, 371.70 ± 21.23, and 463.60 ± 23.16 µm at months 1, 2, 3, and 4, respectively (p = 0.001). Intraocular pressure (IOP) increase occurred in 5 (16.7%) eyes. Cataract surgery was required in 3 (13%) out of 23 phakic eyes. CONCLUSION: IDI provides significant benefits in visual acuity gains and anatomic improvements in eyes with chronic DME that are resistant to IR treatment. Increases in IOP and cataract progression can be observed in IDI-treated patients. However, its safety profile is acceptable.

Ab-interno scleral suture loop fixation with cow-hitch knot in posterior chamber intraocular lens decentration.

AIM OF STUDY: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). MATERIALS AND METHODS: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. RESULTS: Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. CONCLUSIONS: Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes.

Corneal sensitivity may decrease in adenoviral epidemic keratoconjunctivitis--a confocal microscopic study.

OBJECTIVES: To report a new clinical finding, decreased corneal sensitivity, in epidemic keratoconjunctivitis and to evaluate this sign with corneal confocal microscopy. METHODS: Forty-one eyes of 28 patients who developed corneal infiltrates after an outbreak of epidemic keratoconjunctivitis were included in the study. Clinical and confocal microscopic findings are described. RESULTS: In this outbreak of 72 patients, 28 (38.9%) developed corneal infiltrates. The corneal involvement was unilateral in 15 patients (53.6%) and bilateral in 13 patients (46.4%). Corneal sensitivities were measured in 35 eyes of 24 patients and found to be decreased in 26 eyes (74.3%). Decreased corneal sensation was a feature of mainly stage 2 (7 eyes) and stage 3 (11 eyes) keratitis. Corneal sensitivity returned to normal levels in all eyes in a mean of 8.5 days. The main confocal microscopic features during the period of decreased corneal sensitivity were morphologic changes in the infected epithelial cells, extracellular bright microdeposits, infiltration with round inflammatory cells and dendritic cells, increased brightness in the extracellular matrix and the stroma surrounding the corneal nerves, and increased keratocyte activity. The intensity of the inflammatory reaction in the extracellular space and corneal stroma and the reflectivity of the corneal nerves had subsided by the second confocal measurements. CONCLUSION: There may be a transient decrease in the corneal sensitivity during the course of epidemic keratoconjunctivitis. Confocal microscopy can help to evaluate the changes in the cornea during this period. Future studies are needed to understand the nature of this clinical finding.

Visual evoked potentials in guillain-barré syndrome.

BACKGROUND AND PURPOSE: Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy with various clinical features. Optic neuritis occurs in rare cases. In this study we determined the incidence and patterns of visual evoked potential (VEP) abnormality in GBS in association with ophthalmologic findings. METHODS: Thirty-two patients with a diagnosis of GBS were included in the study. The correlation between pathologic VEPs and categories of neurologic deficit and electrophysiological findings were examined statistically. RESULTS: The patients ranged in age from 19 to 77 years. Five cases (16%) had abnormal VEPs. All five of these patients exhibited increased P100 latency differences between the two eyes. Other abnormalities were prolonged p100 latency, increased interocular amplitude difference, and distorted p100 configuration. Pathologic signs on ophthalmologic examination were observed in 80% of patients with abnormal VEPs. VEP abnormality was never present in pure axonal forms. There was no significant correlation between pathologic VEP and cerebrospinal fluid protein level or categories of neurologic deficits. CONCLUSIONS: Involvement of the optic pathways is not a frequent finding in GBS. When present it is always asymmetric and generally accompanied with pathologic findings on ophthalmologic examination. VEPs may be abnormal in different clinical variants of GBS, and especially in demyelinating forms.