Macular retinal and choroidal thickness profile in patients with thyroid-associated orbitopathy compared to healthy individuals: A cross-sectional study.

Background and Aims: To evaluate the macular thickness profile and central subfoveal choroidal thickness in patients with thyroid-associated orbitopathy (TAO) compared to healthy subjects. Methods: We used the convenience sampling method and divided all participants into the patients and control groups. Based on the clinical activity score (CAS) in the first examination, the patient group was divided to two subgroups: the patients with CAS < 3 and the patients with CAS ≥ 3. Complete ophthalmologic examinations and optical coherence tomography imaging were performed for all participants. Results: The mean ± SD of central choroidal thickness was 277 ± 76.58 microns for the control and 326.07 ± 56.574 micron for the patient group which was statistically significant (p = 0.003). We also found that the parafoveal inner thickness is significantly lower in patients compared to healthy subjects (p = 0.02). A comparison of neuro-structural data between the two subgroups of patients showed a significant difference in central choroidal thickness (p = 0.05). Conclusion: This study showed that central choroidal thickness in patients with CAS ≥ 3 compared to those with CAS < 3 and also in the patient group compared to healthy individuals have a significantly increasing trend.

Macular microvasculature in patients with thyroid-associated orbitopathy: a cross-sectional study.

PURPOSE: The aim of this study was to evaluate macular blood flow in patients with thyroid-associated orbitopathy (TAO) as compared to healthy subjects. The inflammatory nature of the disease, as well as the vascular congestion caused by the increase in the volume of orbital soft tissue and extraocular muscles, rationalize the assessment of retinal blood flow changes in these patients. METHODS: This is a cross-sectional study with the convenience sampling method. Macular flow density was assessed using optical coherence tomography angiography (OCTA) and compared between patients with TAO and healthy individuals. We also compared macular flow density in two subgroups of patients based on clinical activity score (CAS). RESULTS: Eighty-five cases, including 30 healthy individuals and 55 patients with TAO, participated. The foveal avascular zone (FAZ) area was significantly larger in the patient group than in the control. Patients with active TAO with CAS 3 or more had significantly larger FAZ areas than those with CAS less than 3 (p = 0.04). CONCLUSION: We showed that the FAZ area is larger in active TAO patients and can be considered a possible candidate feature for monitoring disease activity and thyroid-associated vasculopathy.

Evaluation of orbital soft tissue biomechanical parameters in patients with thyroid eye disease using the non-contact Corvis ST.

INTRODUCTION: In thyroid eye disease (TED), all ocular components and adnexa such as extraocular muscles, orbital adipose tissues, eyelids, and tear glands could be affected. This study aimed to study the orbital biomechanical parameters in patients with TED, in terms of differences with healthy individuals and correlation with clinical findings, using Corvis ST (CST, Oculus Wetzlar). MATERIALS AND METHODS: In this study, 26 consecutive patients with TED were recruited. Demographic data were collected, and patients with TED were assessed for exophthalmos, intraocular pressure, and clinical activity score. Biomechanical response parameters of one randomly-chosen eye of each patient, including whole eye movement length (WEMl) and time (WEMt), were evaluated by the CST, and data were compared between patients and age- and gender-matched healthy controls. RESULTS: The mean age was 39.88 ± 11.61 years old for patients with TED and 34.38 ± 8.57 years old for the healthy subjects. Nine out of 26 patients with TED and nine of 26 healthy individuals were male. The median duration of thyroid disease was 36 (IQR 54) months and the median duration of thyroid ophthalmopathy was 27 (IQR 27) months. Four out of 26 patients (7.7%) had active disease. The mean WEMl was 206.15 ± 61.58 µm in the TED group and 254.23 ± 64.01 µm in the healthy group, the difference of which was statistically significant (p = 0.008). The median of WEMt was 20.90 (1.15) msec in the TED group and 21.45 (0.93) msec in the healthy group (p < 0.001). Also, the mean of WEMl and WEMt were lower in patients with active disease compared to patients with quiescent disease. CONCLUSION: The CST-derived WEMl was significantly smaller in patients with thyroid eye disease compared to normal subjects. The WEMl and WEMt were relatively shorter in the patients with active TED compared to the patients with quiescent TED, although small numbers of patients with active TED limits took a statistically significant conclusion. WEMl and WEMt might be useful in evaluating the compliance of the orbit in patients with TED.

Role of Abelson Helper Integration Site 1, Nebulin, and Paired Box 3 Genes in the Development of Nonsyndromic Strabismus in a Series of Iranian Families: Sequence Analysis and Systematic Review of the Genetics of Nonsyndromic Strabismus.

Purpose: To look for causative genetic mutations in a series of Iranian families with strabismus. In addition, we systematically reviewed all the published articles regarding the role of genetic variations in primary and nonsyndromic comitant strabismus. Methods: Four families with a history of multiple cases of primary and nonsyndromic comitant strabismus were enrolled in this study. Polymerase chain reaction and Sanger sequencing of exons 23, 11, and 3 of the Abelson helper integration site 1 (AHI1), nebulin (NEB), and paired box 3 (PAX3) genes were performed, respectively. One offspring of a consanguineous marriage underwent whole-exome sequencing (WES) to look for possible causative variants. To conduct a systematic review, we thoroughly searched PubMed, Scopus, and ISI Web of Knowledge extracting relevant publications, released by April 2021. Results: We examined four Iranian strabismus pedigrees with multiple affected offspring in different generations. Among these 17 participants, 10 family members had strabismus and 7 were healthy. Sanger sequencing did not reveal a causative mutation. Therefore, to further investigate, one affected offspring was chosen for WES. The WES study demonstrated two possible variants in MYO5B and DHODH genes. These genetic variants showed high allele frequency in our population and are thought to be polymorphisms in our series of Iranian families. Conclusions: We demonstrated that mutations in AHI1, NEB, and PAX3 genes were not common in a series of Iranian patients with familial strabismus. Moreover, by performing WES, we revealed that two variants of uncertain significance as possible causative variants for strabismus are not related to this disease in our population.

Minimal Invasive Procedures in Strabismus Surgery: A Narrative Review.

Purpose: To review the principles and different techniques of minimally invasive procedures in strabismus surgery. Methods: This is a narrative review on minimally invasive procedures in strabismus surgery including general aspects and different new modifications on conventional strabismus surgery. We reviewed 24 articles published between 1993 and 2020. Results: Minimal invasive procedures could be categorized into two subsets: one which minimizes conjunctival opening size and another which minimizes the muscle manipulations. Different conjunctival approaches have been introduced, such as Cul-de-sac and minimally invasive strabismus surgery incisions. Furthermore, there are different techniques for extraocular muscle weakening, strengthening, and transposition, such as mini-tenotomy, plication, mini-plication, Nishida, and modified Nishida procedures. Moreover, there are some techniques for handling strabismus in heavy eyes with high myopia and using adjustable sutures for strabismus correction. Conclusions: Minimally invasive procedures in strabismus surgery consist of surgical procedures that minimize tissue disruption, speed up rehabilitation, and often ultimate better outcomes. These techniques could be replaced traditional methods to reduce conjunctival and lid swelling in the direct postoperative period.

Optic nerve head optical coherence tomography angiography findings in patients with thyroid eye disease: a case-control study.

BACKGROUND: To evaluate changes in the vessel density (VD) of the optic nerve head (ONH) microvasculature in thyroid eye disease (TED) using optical coherence tomography angiography (OCTA). This study aimed to applicate the OCTA as a noninvasive modality in screening TED patients to assess sub-clinical changes. METHODS: In a cross-sectional study, the control group patients were healthy individuals with no ocular abnormalities and were euthyroid. All patients with TED had clinical features of the disease. We divided them into two groups using the clinical activity score (CAS). Patients with CAS scores 0-2 were categorized as group A, and scores three or more as group B. All vessels (AV) and small vessels (SV) VD inside disc and radial peripapillary capillary network were measured using the ONH-OCTA. RESULTS: We evaluated 29 patients with TED and 28 healthy controls. The mean whole image AV VD (mean ± SD: 56.33 ± 2.56, p-value = 0.17) and the mean whole image SV VD (mean ± SD: 49.94 ± 2.56, p-value = 0.16) in the TED group had no statically significant difference compared with the control group (AV mean ± SD: 57.20 ± 20.22, SV mean ± SD: 50.84 ± 2.23). We found a non-significant decrease in AV and SV radial peripapillary capillary VD in the TED group. There was a significant decrease in the mean whole image AV VD (mean ± SD: 54.83 ± 3.07, p-value = 0.005) and the mean whole image SV VD (mean ± SD: 48.60 ± 3.18, p-value = 0.013) in CAS group B compared to group A (AV mean ± SD: 57.45 ± 1.33, SV mean ± SD: 50.95 ± 1.37). CONCLUSION: Our study showed non-significant ONH vascular alterations in patients with TED, including reduced VD of ONH in the radial peripapillary capillary. Patients with higher CAS scores had a more noticeable decrease in ONH microvasculature.

Investigation of the Lower Punctum Parameters: A Spectral Domain Anterior Segment Optical Coherence Tomography Study.

PURPOSE: To evaluate the dimensions of lower punctum in a sample of Iranian normal population using spectral domain anterior segment optical coherence tomography (OCT). METHODS: In this cross-sectional study, 102 eyes of 102 healthy volunteers were enrolled. All participants underwent a detailed history and complete ophthalmic examination. Lower punctum metrics were measured using OCT (Spectralis, Heidelberg) with the anterior segment module. External punctal diameter was defined as the largest diameter at the surface of the punctum. Internal punctal diameter was measured at two different depths of 100 µm and 500 µm from the external surface. Measurements were repeated for 30% of data by another grader. The agreement was measured using intraclass correlation coefficient (ICC). RESULTS: The mean age of the participants was 61.5 ± 7.9 years. The mean external punctal diameter was 425.6 ± 124.3 µm. The mean internal punctal diameter at 100 µm and 500 µm was 183 ± 97.5 µm and 77.7 ± 51.4 µm, respectively. The agreement between the graders was high in assessing all punctal characteristics (ICC >0.9 for all measurements). CONCLUSION: The spectral domain OCT can be used for measuring lower punctum diameter with acceptable reproducibility.

The role of early office-based needle aspiration in the management of subperiosteal hematoma.

Subperiosteal hematoma of the orbit is a rare complication that may occur in different situations. The most common cause is blunt trauma to the head region. The victims are usually young boys and the common site is usually orbital roof. There is no uniform approach in the literature in the management of subperiosteal hematoma. Conservative management has been recommended in cases with intact visual function. If conservative management is planned, complete resorption of hematoma may last several months, and the patients must tolerate diplopia and varying degrees of proptosis in this relatively long period of time. In this study, four boys (12-15 years) were referred to our clinic with a provisional diagnosis of subperiosteal hematoma after blunt trauma no more than 10 days after initial trauma. Although in our patients, no one had compressive optic neuropathy, they underwent hematoma aspiration and nearly 7 ml dark blood was drained. All procedures were performed in an office-based setting without local anesthesia or sedation and the patients tolerated the procedure comfortably and the procedure was uneventful. When there is no indication for orbitotomy in cases of subperiosteal hematoma, early office-based needle aspiration in comparison to follow-up or administration of steroid, is a viable approach because of its feasibility, an office-based treatment that obviates the need for general anesthesia and yields immediate recovery.

Preventing silicone tube extrusion after nasolacrimal duct intubation in children.

Herein we report our experience with a simple technique for reducing the rate of silicone tube extrusion after nasolacrimal duct (NLD) intubation for congenital NLD obstruction. Medical records of children older than 2 years, with or without history of failed probing, who had undergone NLD intubation with a Crawford silicone tube over a period of 4 years were reviewed. In all subjects, one end of the Crawford tube was passed through a piece of scalp vein tubing followed by applying one or two knots. All Crawford tubes were removed after 3 months. Main outcome measures included complications such as tube extrusion, nasal discharge, crust formation and pyogenic granuloma formation. Fifty-seven patients, including 49 unilateral and 8 bilateral cases with mean age of 3.8±1.6 (range, 2 to 11.5) years were operated. No complications such as tube dislodgement, significant nasal discharge, crust or pyogenic granuloma formation occurred prior to Crawford tube removal. All silicone tubes were successfully removed from the nasal cavity. In conclusion, passing one end of the Crawford tube through a small piece of scalp vein tubing before knotting it in the nasal cavity seems to decrease the rate of tube extrusion which is the most common complication following NLD intubation in children.