Optical coherence tomography as retinal imaging biomarker of neuroinflammation/neurodegeneration in systemic disorders in adults and children.

The retina and the optic nerve are considered extensions of the central nervous system (CNS) and thus can serve as the window for evaluation of CNS disorders. Spectral domain optical coherence tomography (OCT) allows for detailed evaluation of the retina and the optic nerve. OCT can non-invasively document changes in single retina layer thickness and structure due to neuronal and retinal glial cells (RGC) modifications in systemic and local inflammatory and neurodegenerative diseases. These can include evaluation of retinal nerve fibre layer and ganglion cell complex, hyper-reflective retinal spots (HRS, sign of activated microglial cells in the retina), subfoveal neuroretinal detachment, disorganization of the inner retinal layers (DRIL), thickness and integrity of the outer retinal layers and choroidal thickness. This review paper will report the most recent data on the use of OCT as a non invasive imaging biomarker for evaluation of the most common systemic neuroinflammatory and neurodegenerative/neurocognitive disorders in the adults and in paediatric population. In the adult population the main focus will be on diabetes mellitus, multiple sclerosis, optic neuromyelitis, neuromyelitis optica spectrum disorders, longitudinal extensive transverse myelitis, Alzheimer and Parkinson diseases, Amyotrophic lateral sclerosis, Huntington's disease and schizophrenia. In the paediatric population, demyelinating diseases, lysosomal storage diseases, Nieman Pick type C disease, hypoxic ischaemic encephalopathy, human immunodeficiency virus, leukodystrophies spinocerebellar ataxia will be addressed.

Multimodal Retinal Imaging Findings in Two Cousins With VCAN-Related Vitreoretinopathy or Wagner Disease.

Wagner disease is a rare, nonsyndromic vitreoretinopathy caused by autosomal dominant variants in the versican (VCAN) gene. It is associated with abnormalities of the vitreoretinal interface that can lead to peripheral traction and retinal detachments, which also occur in other vitreoretinopathies such as X-linked retinoschisis (XLRS), familial exudative vitreoretinopathy (FEVR) and Stickler syndrome. There is variability in the clinical phenotype in Wagner disease potentially due to variants in VCAN gene variants. In this article, we report a family harboring the VCAN c.9265+1G>C variant and describe the clinical and retinal findings in two members. [Ophthalmic Surg Lasers Imaging Retina 2022;53:639-643.].

Vitrectomy-Assisted Excision in the Treatment of Juxtapapillary Retinal Capillary Hemangioma.

Juxtapapillary retinal capillary hemangiomas are sight-threatening hamartomas located on or adjacent to the optic nerve. Nonsurgical approaches including laser photocoagulation and cryotherapy have been shown to be effective to reduce exudation in peripheral hemangiomas. However, in juxtapapillary hemangiomas, the functional outcomes are limited due to associated potential damage of the retinal nerve fiber layer. We present an 18-year-old female patient with von Hippel-Lindau (VHL) disease who presented with a juxtapapillary retinal capillary hemangioma associated with a tractional epiretinal membrane (ERM) and secondary macular hole. After vitrectomy-assisted excision of the lesion and inner limiting membrane (ILM) peeling around the macular hole, visual acuity and macular anatomy were recovered at 10 months of follow-up. [Ophthalmic Surg Lasers Imaging Retina 2022;53:570-573.].

Vitreous hemorrhage in X-linked retinoschisis.

PURPOSE: To report a case of preretinal hemorrhage from extraretinal neovascularization related to capillary non-perfused retina within a large schisis in a pediatric patient with X-linked retinoschisis (XLRS). OBSERVATIONS: A 4-year old male with an RS1 mutation and XLRS presented with preretinal and vitreous hemorrhage in the right eye. Retinal imaging, including wide angle fluorescein angiography (FA) and optical coherence tomography (OCT), showed vitreoretinal traction on extraretinal neovascularization and capillary non-perfused retina in the schisis cavity. Laser treatment to the non-perfused retina within the schisis was successful in reducing extraretinal neovascularization. CONCLUSIONS: Vitreous hemorrhage is a well-known occurrence in XLRS. Imaging using wide angle FA and OCT were helpful to determine the causes of hemorrhage in order to develop a management plan.

En face swept-source optical coherence tomography angiography choroidal vasculography (CVG) a tool to discriminate choroidal abnormalities in polypoidal choroidal vasculopathy.

BACKGROUND: Swept source optical coherence tomography angiography (SS-OCT-A) choroidal vasculography (CVG) is an imaging method which allows the evaluation of deep choroid details, being a promising too in choroidal pathologies as polypoidal choroidal vasculopathy (PCV). RESEARCH DESIGN AND METHODS: Cross-sectional study performed at FOSCAL International Clinic in Colombia. CVG features in patients with PCV were evaluated using SS-OCT CVG. RESULTS: Twenty-two eyes of 21 patients were included. The mean age was 72.7 ± 6.5 years old (range: 48.6-95.4 years old). Twelve (57.1%) patients were male. The mean number of polyps detected by SS-OCT-A CVG before treatment with anti-VEGF therapy was 2.04 ± 1.18, which decreased after treatment to 1.18 ± 0.71. This result was statistically significant (p < 0.05). All polypoidal lesions detected by B-scan were visualized using CVG. Polyp circularity and surrounding reflectivity indicated activity of disease. CONCLUSION: En face SS-OCT-A CVG is an alternative tool to evaluate choroidal structure at different depths without a contrast dye, providing information for the diagnosis and follow-up of patients with PCV. This imaging modality do not pretend to replace gold standard tests in PCV as ICGA, but rather provides choroidal imaging features of PCV, when ICGA is not available.

Differentiation of Features of Inflammatory Neovascular Membrane Versus Active Posterior Uveitis by SS-OCTA.

BACKGROUND AND OBJECTIVE: Neovascularization is a sight-threatening, uncommon complication of posterior uveitis that often goes undetected until persistent clinical findings appear, or in light of treatment failure. This could be attributed to the relative similarity of activity signs in inflammatory neovascular membranes (NVM) and active posterior uveitis. The purpose of the present study is to recognize imaging features that distinguish uveitic neovascularization from active uveitis using swept-source optical coherence tomography angiography (SS-OCTA). PATIENTS AND METHODS: Cross-sectional study. Patients with posterior uveitis with visual acuity (VA) decrease and at least one of the following findings were assessed by SS-OCTA: retinal thickening, subretinal or intraretinal fluid, and retinal hyperreflective areas. The change of VA and imaging features after treatment with anti-vascular endothelial growth factor (VEGF) therapy were analyzed in cases with inflammatory NVM. RESULTS: Forty-five eyes of 40 patients were evaluated. Twenty-four eyes (53.3%) showed signs of activity, of which eight (33.3%) presented inflammatory NVM. Imaging features that differentiate inflammatory neovascularization from active posterior uveitis included: vitreous cellularity (P = .003), outer retinal infiltration (P = .08), choroidal thickness (P = .003), posterior shadowing (P = .013), subretinal fluid (P = .04), and neovascular network (P ≤ .001). According to NVM characteristics by OCTA, multiple anastomoses and peripheral arcades were visualized at baseline in 85.7% of cases. Mean pre-operative best-corrected VA of inflammatory NVM was 20/150 (logMAR: 0.88 ± 0.60) with significant improvement to 20/40 (logMAR: 0.32 ± 0.22) after anti-VEGF treatment (P = .027). CONCLUSIONS: SS-OCTA achieves the distinction of inflammatory NVM from active posterior uveitis through specific imaging features. Inflammatory neovascularization presents a suitable response after anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:129-137.].

Traumatic corneal flap avulsion and loss 13 years after LASIK.

Postoperative flap displacements after Laser In Situ Keratomileusis (LASIK) are uncommon complications, and flap losses are even less frequent, occurring most commonly within 24 hours after the procedure. Although cases of late subluxation have been reported up to 14 years after the surgery, the longest reported time after surgery for late flap loss is four years after LASIK. We report a case of a 54-year-old man that presented a traumatic total flap avulsion and loss 13 years after LASIK. According to our knowledge, this is the longest time reported in such a case in the literature. Medical treatment yielded an acceptable visual result. This case reinforces the concept that there could be a lifelong potential risk of traumatic corneal flap loss after LASIK.

Scleral fixation of a dexamethasone intravitreal implant in a case of subluxated bag-intraocular lens complex.

Macular edema is a condition of retinal tissue treated with anti-inflammatory agents including placement of an intravitreal sustained-release dexamethasone device, designed to deliver a controlled amount of the medication for a prolonged time, representing an excellent therapy. Nonetheless, the implantation cannot be carried out without an anatomical barrier, such as the presence of posterior capsular support, lens, or intraocular lens. The absence of these barriers could lead to several complications, due to migration of the device from the vitreous cavity to the anterior chamber, causing corneal endothelial damage, corneal edema, glaucoma, and uveitis, among others. In consequence, a large number of patients cannot be treated with this useful surgical tool, resulting in chronicity of macular edema and severe visual acuity impairment. Therefore, we modified the conventional technique, through scleral fixation of the device providing a continuous delivering of dexamethasone, avoiding its migration to the anterior chamber in a patient without capsular support.

Characteristics of Polypoidal Choroidal Vasculopathy in OCT Angiography in Latin American Patients.

BACKGROUND AND OBJECTIVES: To describe the imaging characteristics of polypoidal choroidal vasculopathy (PCV) in optical coherence tomography angiography (OCTA) and demonstrate its use as diagnostic method for this pathology in a Latin American population. PATIENTS AND METHODS: A case series. RESULTS: Fourteen eyes were evaluated. At baseline, the most frequent morphology was the "oval" type (76.9%), obtaining a reduction of 53.8% after treatment. The intrinsic finding of the polyps was hyporeflective content prior to treatment (80.8%), which reduced after treatment (7.7%) (P = .016). CONCLUSIONS: OCTA is a useful imaging tool for detecting findings that can guide the diagnosis of PCV without contrast medium. Likewise, it provides signs that can suggest the behavior of the lesion prior to and after treatment, enriching the understanding of the pathology and therefore aiming to an efficient therapy. To the best of the authors' knowledge, this is the first study in a Latin American population. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:748-756.].

Giant intrastromal cleft in corneal hydrops.

A 15-year-old male patient with corneal hydrops and a giant intrastromal cleft (pseudocyst) successfully received medical treatment with topical prednisolone, hypertonic saline solution and ocular hypotensive eyedrops. Anterior segment optical coherence tomography (OCT) was used as an auxiliary tool for assessing the response to treatment during follow-up time (33 months).

An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America.

Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin. Methods: Case report. Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination. Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.

Topical Atropine in the Control of Myopia.

Atropine has been used for more than a century to arrest myopia progression. Compelling evidence of its protective effect has been reported in well-designed clinical studies, mainly performed during the last two decades. However, its exact mechanism of action has not been determined. Experimental findings have shown that the mechanism is not related to accommodation, as was thought for decades. A review of the published literature revealed a significant amount of evidence supporting its safety and efficacy at a concentration of 1.0%, and at lower concentrations (as low as 0.01%).