Bacillary layer detachment with malignant choroidal tumors: a case series.

PURPOSE: To study the incidence and characteristics of bacillary layer detachment (BALAD) occurring with the two most common choroidal malignancies, choroidal metastasis and choroidal melanoma. METHODS: A retrospective multicentric record analysis. Eyes with a diagnosis of choroidal melanoma or choroidal metastasis that had good-quality fundus photography and spectral domain optical coherence tomography (OCT) scans of the macular and tumor regions allowing for delineation of the retinal layers were included for analysis. Qualitative image evaluation was done by two independent graders for the presence, location, and OCT features of BALAD, as well as any associated intraretinal or subretinal fluid. Demographic and clinical data were also retrieved. RESULTS: Of the 11 eyes with choroidal metastasis and 7 eyes with choroidal melanoma that were included in the final analysis, 6 (54.5%) and 1 (14.3%) had BALAD, respectively. The BALAD co-localized with the subretinal fluid in all cases and with the intraretinal fluid in 1/3 cases (33.3%), was foveal in location in 3 eyes (42.9%), was overlying the tumor in 6 eyes (85.7%), and varied in number and size. Reflectivity within the BALAD was consistently higher than the vitreous and adjacent subretinal fluid, and discernable suspended hyperreflective particles were noted in 5 eyes (71.4%). CONCLUSION: BALAD is relatively common with choroidal metastasis. The OCT features described supplement our recognition of this new entity.

Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema.

Purpose: This article aims to compare between intravitreal (IV) and suprachoroidal (SC) triamcinolone acetonide (TA) injection for the treatment of diabetic macular edema (DME) in terms of improvement in both best-corrected visual acuity (BCVA) and central macular thickness (CMT), and development of complications (intraocular pressure (IOP) rise and cataract progression), and to identify the efficient dose of TA using the SC route. Patients and Methods: This prospective interventional randomized comparative study included 45 eyes of 32 patients, randomly divided into three groups, group I received 4 mg/0.1 mL intravitreal TA (IVTA), group II received 4 mg/0.1 mL suprachoroidal TA (SCTA), and group III received 2mg/0.1 mL SCTA. Patients were followed up for 6 months. Results: At 1 month, a maximum reduction in CMT (147.33 ± 110.97 µm, 160.80 ± 98.25 µm and 65.64 ± 46.19 µm in groups I, II, and III, respectively) was observed, which was associated with the greatest improvement of BCVA (0.09 ± 0.09, 0.19 ± 0.10 and 0.10 ± 0.09 logMAR lines) in groups I, II, and III, respectively. At 3 months, CMT started to increase, and reduction was not statistically significant compared to baseline, except in group II (4 mg SCTA group) (149.80 ± 106.57 µm with P-value = 0.013). At 6 months, CMT and BCVA returned close to baseline except for group II which had a sustained reduction of 60.16 µm from baseline. Regarding steroid-related complications, IOP elevation of 10 mmHg or more was noted in 1 eye (6.7%), 2 eyes (13.3%), and 1 eye in groups I, II, and III, respectively. Three phakic eyes per group showed cataract progression. Conclusion: SCTA is a safe and effective route for the treatment of DME, which has comparable effects to IVTA, and may even last longer.

Assessment of the Effect of Vitiligo on Subfoveal Choroidal Thickness Using Spectral-Domain Optical Coherence Tomography.

BACKGROUND: Vitiligo is a common skin condition affecting 0.5-2% of the population. The exact etiology of the condition is unknown, but the result is autoimmune destruction of melanocytes. The eye is rich in melanocytes, especially in the retinal pigment epithelium and choroid. Little is known about the effect of vitiligo on the choroid of the eye. METHODS: We cross-sectionally examined 31 right eyes of 31 vitiligo patients and 32 right eyes of 32 age- and sex-matched controls for signs of vitiligo affection and then measured the subfoveal choroidal thickness (SFCT) using spectral-domain optical coherence tomography. RESULTS: There was a statistically significant difference between SFCT in the cases group and the control group (Mean ± SD: 251.9 ± 42.0 µm and 296.8 ± 46.4 µm, respectively, p = 0.0002). The thickness correlated negatively with age (r = -0.5) but did not correlate significantly with disease severity or duration (r = -0.201, -0.1781, p = 0.2783, 0.3381, respectively). Additional examination findings included iris and fundus hypopigmented spots, and peripapillary atrophy. CONCLUSION: SFCT is reduced among patients with vitiligo. The clinical implications of such a finding should be studied further, and eye screening programs should be considered.

Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome.

AIM: To compare the efficacy and safety of collagen matrix implant [Ologen (OLO) implant] versus mitomycin C (MMC) with subscleral trabeculectomy (SST) for the surgical treatment of congenital glaucoma (CG) in Sturge-Weber Syndrome (SWS). METHODS: A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group (MMC Group) included 10 eyes that were subjected to SST with MMC. The second group (OLO Group) included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant (OLO implant). Postoperative evaluation included intraocular pressure (IOP) level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS: The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups (57.9% and 56.3%). At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes (60%), blebitis in only one eye (10%) treated with topical antibiotics, shallow anterior chamber in two eyes (20%). CONCLUSION: This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

Corneal Biomechanical and Anterior Chamber Parameters Variations after 1-year of Transepithelial Corneal Collagen Cross-linking in Eyes of Children with Keratoconus.

AIM: To assess the changes in corneal hysteresis (CH) and corneal resistance factor (CRF) 1-year following transepithelial corneal collagen cross-linking (CXL) treatment in eyes of children with keratoconus. METHODS: This case series was conducted in 22 eyes of 22 children. Children aged < 18 years with progressive keratoconus were included. They were treated with transepithelial CXL. Corneal biomechanical and anterior chamber parameters such as CH, CRF, and peak 1 were noted using ocular response analyzer, Pentacam, intraocular lens master, and anterior segment optical coherence tomography before and 1, 3, 6, and 12 months after treatment. RESULTS: Our series had 22 eyes of 22 children with a mean age 15.7 ± 2.1 years. The CH and CRF 1-year after treatment declined (difference of mean 0.1 mmHg (95% confidence interval [CI] 0.04-0.24), P = 0.2] and (difference of mean 0.1 mmHg [95% CI 0.04-0.30], P = 0.3), respectively. Peak 1 and peak 2 increased (difference of mean 0.1 mmHg [95% CI 0.006-0.008], P = 0.2) and (difference of mean 0.1 mmHg [95% CI 0.007-0.006], P = 0.3), respectively. The uncorrected distance visual acuity improved from 0.95 ± 0.34 logMAR to 0.68 ± 0.45 logMAR (P < 0.05). No statistically significant changes during 12 months follow-up were observed in axial length, corneal volume, anterior chamber volume, and anterior chamber depth (P > 0.05). CONCLUSION: Transepithelial CXL in keratoconus in pediatric age group seems to have good stability in corneal biomechanical parameters after 1-year. Further studies with a larger sample and better study design are recommended to confirm our findings.

Ocular Surface Changes With Sofosbuvir in Egyptian Patients With Hepatitis C Virus Infection.

PURPOSE: To evaluate the effect of oral sofosbuvir on the ocular surface of Egyptian patients with chronic hepatitis C virus infection. METHODS: This prospective randomized comparative study was performed on 300 eyes undergoing sofosbuvir therapy with peginterferon and ribavirin and on 300 eyes undergoing treatment with only peginterferon and ribavirin. Patients were evaluated for dry eye subjectively (Ocular Surface Disease Index questionnaire) and objectively, Schirmer test, tear film breakup time, and conjunctival nucleus/cytoplasm ratio by impression cytology. RESULTS: The Ocular Surface Disease Index score significantly changed from 3.1 ± 2.8 at baseline to 11.9 ± 4.1 and 15.2 ± 3.8 after 1 and 3 months of therapy, respectively, in the sofosbuvir group but had decreased to 7.6 ± 6.2 by 3 months after cessation of therapy. Mean Schirmer test values showed a significant change in the sofosbuvir group from 17.5 ± 2.7 mm at baseline to 10.8 ± 1.4 and 7.0 ± 2.5 mm after 1 and 3 months, respectively, and started returning to normal (11.0 ± 3.3 mm) after 1 month of treatment and mean tear film breakup time varied from 11.0 ± 5.2 seconds at baseline to 9.2 ± 2.6 and 6.1 ± 1.2 seconds at 1 and 3 months, respectively (P < 0.001). The mean nucleus/cytoplasm ratio was significantly different from 1/1.5 at baseline to 1/1.9 and 1/2.4 at 1 and 3 months, respectively, and persisted 3 months after discontinuation of therapy (nucleus/cytoplasm ratio 1/2.0). These changes were not the same in the non-sofosbuvir group. CONCLUSIONS: Impairment of tear function and squamous metaplastic changes in the ocular surface occurred in patients with chronic hepatitis C treated with sofosbuvir combined with other antivirals.

Correlation of visual field defects and optical coherence tomography finding in migraine patients.

AIM OF WORK: The aim of our work was to detect any structural or functional visual defects during and in between the attacks in patients with migraine. PATIENT AND METHODS: Sixty patients with migraine as well as sixty age and sex matched controls were included. All cases were subjected to full ophthalmological examination. Cases with any previously known optic nerve abnormalities or with history of increased intraocular pressure were excluded from this study. A full threshold 24-2 automated perimetry as well as optical coherence tomography (OCT) were performed for retinal nerve fiber layer (RNFL) thickness. Correlations between results of study group with migraine and controls were analyzed and recorded. RESULTS: There was a statistically significant difference between the patients with migraine and the controls in visual field analysis which was (P < 0.05) for generalized visual field deficits and (P < 0.001) for localized visual field deficits during the attack with no statistically significant difference in visual field in between the attacks (P > 0.05). OCT RNFL thickness had no statistically significant difference between migraine and control groups (P > 0.05). CONCLUSION: Migraine can cause functional ocular disorder without any structural abnormalities.

Intravitreal bevacizumab in persistent retinopathy secondary to malignant hypertension.

PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injection in persistent retinopathy secondary to malignant hypertension (MHT). PATIENTS AND METHODS: Single IVB injection of 1.25 mg/0.05 ml in 12 cases with persistent retinopathy secondary to MHT more than one month after control of MHT with pre and post injection evaluation of best corrected visual acuity (BCVA) and anatomical outcome up to sixth month and postinjection complications were evaluated. RESULTS: Progressive reductions in retinal hemorrhages, exudates, cotton-wool spots, and macular star were documented by photography, angiography, and central macular thickness (CMT) measured by optical coherence tomography (OCT) imaging. Decreased macular edema was the most common finding. Improvement or stabilization of visual acuity was noted in all cases. CONCLUSIONS: In addition to proper medical management of MHT, IVB injection is an effective and safe approach to treat persistent retinopathy associated with MHT.

Polymerase chain reaction in pediatric post-traumatic fungal endophthalmitis among Egyptian children.

PURPOSE: The aim of this study was to evaluate the effectiveness of polymerase chain reaction (PCR) in accurate and rapid diagnosis of fungal endophthalmitis in comparison with conventional Gram stain and culture in pediatric fungal endophthalmitis. PATIENTS AND METHODS: This study included 26 cases with endophthalmitis. Age was less than 16 years old, and all were males with history of ocular trauma and with clinical picture suggestive of fungal endophthalmitis. A prospective nonrandomized study was done. For all cases pars plana vitrectomy was done and sample of vitreous wash was collected from the vitrectomy cassette and was sent for laboratory diagnosis. At the end of surgery, intravitreal injection of 1.0 mg/0.1 mL vancomycin was given. PCR, culture sensitivity and ultrasound were done for all cases. Follow-up of cases by visual acuity, full ophthalmological examination, ultrasound, PCR, and other laboratory investigation. The schedule for follow-up was daily for 1 week, weekly for 1 month, and monthly for 1 year than all data collected and analysed. RESULTS: The ages ranged from 7 to 16 years old. All cases were males. Seventeen cases had central corneal ulcer, 5 of them with penetration full thickness, and 9 cases had peripheral corneal ulcer, 2 of them with penetration. Ophthalmological examination revealed a marked drop of vision ranging from HM to PL in the affected eye. Although Gram stain gave negative results in 20 cases (was positive in only 6 cases), KOH wet mount preparation revealed septate hyphae in only 4 cases, and culture on blood agar was negative in all samples, suggestive of Aspergillus niger and showing Candida albicans colonies in 8 samples. PCR assay was positive for the universal as well as for the Aspergillus-specific primers, but it was negative for Candida-specific primer in 4 samples. No recurrence of infection was noticed for the following 1 year The mean follow-up period was 10.3 months (range, 5-24 months), but with trivial improvement in visual acuity. The sensitivity of PCR assay was found to be highly significant, p < .0001, much superior to that of microscopy and culture in detecting fungal endophthalmitis. CONCLUSION: PCR assay was found to be a highly sensitive and specific test that allows rapid and accurate diagnosis of pediatric fungal endophthalmitis. PCR was found to give a much more sensitive and more rapid result than Gram stain and culture technique with comparable high specificity. Thus, we recommend the use of conventional methods as culture and stained smears as they are useful if positive, inexpensive, and available in all laboratories. This is in addition to PCR assay, which must be added to the protocol of management of cases of pediatric fungal endophthalmitis.

Pentosidine - a new biochemical marker in diabetic retinopathy.

AIM: This study was done to evaluate the role of pentosidine in predicting the progression of diabetic retinopathy. PATIENTS AND METHODS: We included 30 subjects with insulin-dependent diabetes mellitus (type 1) and 10 healthy control individuals. A case control study was done. Full ophthalmological examination together with laboratory investigations (blood glucose level, HbA(1C) and blood pentosidine level corrected to blood total protein values were measured) were done in all subjects included in this study. The level of pentosidine was correlated with the duration of diabetes and the stage of retinopathy. All data were analyzed and reported. RESULTS: Significant elevation of pentosidine was found in patients during the earliest detectable phase of diabetic retinopathy (early nonproliferative diabetic retinopathy) and more elevation at the preproliferative stage of retinopathy, returning to lower levels at the proliferative stage of diabetic retinopathy. CONCLUSION: Pentosidine can be used as a biochemical marker for early occurrence of diabetic retinopathy and as an alarming factor in the preproliferative stage of diabetic retinopathy, thus helping decrease ocular complications.