Optic disc cupping after circumpapillary Pd-103 slotted plaque radiation therapy.

OBJECTIVE: To investigate vascular and morphologic optic disc changes after slotted plaque radiation therapy for choroidal melanoma involving the optic disc. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: Thirty-nine patients with choroidal melanoma involving the optic nerve. METHODS: Each melanoma was treated with palladium-103 slotted plaque brachytherapy (incorporating and/or surrounding the optic nerve sheath) between 2005 and 2019. Imaging of the optic nerve before and after radiation allowed for documentation and evaluation of optic nerve pallor and cup-to-disc ratio (CDR) changes. Optical coherence tomography (OCT) CDR measurements and intraocular pressure (IOP) were recorded pretreatment and at follow-up. Of these patients, 22 also had OCT angiography (OCT-A) images with sufficient quality for evaluation of blood vessel density and length. Differences in cup-to-disc measurements were correlated with changes in OCT-A-measured vessel density and length. RESULTS: Following slotted plaque radiation therapy, there was no significant increase in IOP or optic nerve pallor. OCT and colour photography revealed significant increases (both p < 0.001) in CDR from pretreatment to the last follow-up. Increased CDRs on OCT were significantly correlated to OCT-A-measured change in vessel length (p = 0.027). Similarly, increased CDR ratios on fundus photography were significantly correlated with OCT-A-measured change in vessel density (p = 0.043) and length (p = 0.019). CONCLUSION: Fundus photography and OCT measurements revealed increased optic disc cupping following slotted plaque radiation therapy. Cupping was associated with OCT-A evidence of synchronous progressive peripapillary vascular occlusion and attenuation. Therefore, slotted plaque radiation-induced peripapillary and papillary ischemia was associated with increased CDR ratios and optic disc cupping.

OCT-A evaluation of radiation vasculopathy following slotted plaque brachytherapy.

PURPOSE: To determine a reliable diagnostic method to reveal and monitor subclinical progression of neural and perineural radiation vasculopathy. METHODS: A retrospective cross-sectional study, where optical coherence tomography angiography (OCT-A) imaging data was collected and analyzed from 22 consecutive patients that had been treated with circumneural slotted plaque brachytherapy for peripapillary, juxtapapillary, or circumpapillary choroidal melanomas. Pre-operative dosimetry of palladium-103 radiation dose to the optic nerve and fovea were collected. Quantified differences in OCT-A-measured vessel density and length in treated verses untreated contralateral control eyes were collected. Vessel density and length were correlated to radiation dose, plaque slot depth, visual acuity outcomes, and circumpapillary retinal nerve fiber layer thickness. RESULTS: Patients had post-irradiation follow-up of median 39 months, interquartile range 62 months). The mean optic disc radiation dose was 89.9 Gy ± 39.2 (86.5, 30.8-189.0). In comparison to controls, OCT-A imaging revealed significant differences in radial peripapillary capillary vessel density (18 µm2 in case eyes, 34 µm2 in control eyes; p < 0.001) and length (10 µm in case eyes, 14 µm in control eyes; p < 0.001). Change in vessel density did not show a significant correlation to radiation dose, slot depth, or visual acuity. However, change in vessel length was significantly correlated to radiation dose (p = 0.049) and change in visual acuity (p < 0.001). CONCLUSIONS: OCT-A imaging revealed that radial peripapillary capillary vessel density and length were significantly reduced after circumneural irradiation for choroidal melanoma. Therefore, OCT-A imaging can be used to monitor progression of papillary vasculopathy associated with radiation optic neuropathy.

Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study.

PURPOSE: Current ocular antiseptic practice for intravitreal injection (IVI) employs 5% povidone-iodine (Betadine®) drops which frequently cause ocular discomfort and prolonged irritation. In an effort to improve comfort while maintaining efficacy, we studied a hypochlorous acid (HOCL 0.01%) spray washout prior to injection. METHODS: Patients had received a minimum of 3 IVIs prepared with Betadine®antisepsis prior to entry in this study. Their subsequent IVIs were prepared with Betadine®followed by HOCL 0.01% washout. Facets of comfort were measured by a Likert-scaled questionnaire to compare their experiences after IVI. RESULTS: Thirty-seven participants were enrolled. Addition of HOCL 0.01% spray after Betadine®reduced the duration of discomfort (P = 0.001) and need for artificial tears postinjection (P = 0.003). It improved their reported quality of life (P = 0.04) and sleep (P = 0.01). There were neither HOCL-related side effects nor endophthalmitis during this study. CONCLUSION: Topical HOCL 0.01% spray after topical Betadine®antisepsis significantly improved patient comfort following IVIs.

Uncontrolled neovascular glaucoma - an alarming manifestation of chronic myeloid leukemia on imatinib therapy - a case report and review of literature.

A 45-year-old diabetic male, with diabetic retinopathy and medically uncontrolled neovascular glaucoma (NVG) underwent intracameral bevacizumab followed by trabeculectomy, with controlled intraocular pressures (IOP) post-operatively, OD: 12 mmHg; OS: 14 mmHg. Patient was referred to hematology, where he was diagnosed as chronic myeloid leukemia (CML) and started on imatinib mesylate. Thereafter, he presented with recurrence of neovascularization and vascularization of the bleb along with OS vitreous hemorrhage at 6 weeks follow-up. While he was planned for OS vitreo-retinal surgery, he presented with OD spontaneous hyphema with raised IOP (OD: 38 mmHg, OS: 16 mmHg). He had maintained a tight glycemic control. Following imatinib therapy, there was a rapid progression and recurrence of neovascularization, eventually leading to failure of trabeculectomy OD and bilateral severe loss of vision. Imatinib may be implicated in the worsening of NVG in CML patients, especially with co-existing diabetes and thus, such patients should receive regular thorough ophthalmic evaluation as long as imatinib continues.

Changes in Intraocular Pressure and Angle Status After Phacoemulsification in Primary Angle Closure Hypertension.

PURPOSE: To study the change in intraocular pressure (IOP) and angle status after phacoemulsification in a cohort of primary angle closure hypertension (PACHT) patients. SETTING: Tertiary Eye Care, India. DESIGN: Prospective interventional case-series. METHODS: Case-series of 18 eyes of 18 patients. Preoperative biometry including axial length, anterior chamber depth (ACD), lens thickness, and central corneal thickness were studied. Preoperative and postoperative IOP, number of topical glaucoma medications, angle swept source optical coherence tomography (SS-OCT) parameters of nasal and temporal angle opening distance, trabecular iris space area, scleral spur angle, lens vault and circumferential iridotrabecular contact (ITC) were studied and their correlations derived. RESULTS: The mean preoperative IOP, 31±6 mm Hg, decreased to 14±1 mm Hg at 6-months postoperative period, P<0.001, a fall by 58±14%. The number of glaucoma medications reduced from 4(3-5) to 2(1-3), P<0.001. All SS-OCT studied parameters denoted significant angle widening postsurgery. The ITC% reduced from 52(16-100) to 19(0-97), P<0.001. The preoperative ITC showed moderate to strong correlation with all preoperative nasal and temporal angle parameters. It also showed moderate positive correlation with percentage fall in IOP at 1-month postoperative period. The preoperative ACD showed significant negative correlation with preoperative and postoperative ITC. CONCLUSIONS: PACHT patients benefit significantly from cataract surgery with marked angle widening, IOP reduction and a decrease in the number of glaucoma medications. The SS-OCT derived circumferential iridotrabecular contact index can be used as the single best parameter to indicate the preoperative angle status and predict postoperative change in IOP, as against the numerous single section measured angle parameters.

Infective keratitis in Indian patients with corneal dystrophies.

All eight patients seen with various types of corneal dystrophy, a rare hereditary corneal disease, presented with infective keratitis. Unilateral microbial invasion was seen in all patients and the visual acuity of the affected eyes was <6/60 at presentation. We highlight our impression that microbial invasion can occur with all types of epithelial and stromal corneal dystrophy, including macular corneal dystrophy. Regular follow-up to maintain a healthy ocular surface is recommended to avert blindness in such patients.