Ratiometric Analysis of In Vivo Optical Coherence Tomography Retinal Layer Thicknesses for Detection of Changes in Alzheimer's Disease.

We analyzed ophthalmic retinal optical coherence tomography (OCT) images from patients with Alzheimer's disease (AD) to identify retinal layer thickness and ratio changes that may serve as image-based biomarkers for the disease. One three-dimensional volume before and one after diagnosis for each of 48 patients were segmented to identify retinal layer and total retinal thicknesses. Between before- and after-diagnosis retinal OCT images, there were significant thickness changes in six of ten (60%) retinal layers across all 48 patients. Through a comparison with age-matched healthy subjects, the significant changes were attributed to AD only (NFL and PR2 layers), age only (GCL, IPL, and RPE layers), or both AD and age (OPL layer). Analyzing ratios of retinal layer thicknesses, 53 of 90 (58.89%) ratios had significant changes. The four independently non-significant layers were assessed to be affected by neither AD nor age (INL layer) or both AD and age (ELM, PR1, and BM layers). The demonstrated image segmentation, measurement, and ratiometric analysis of retinal layers in AD patients may yield a noninvasive OCT image-based retinal biomarker that can be used to detect retinal changes associated with this disease.

Anatomical and Functional Outcomes of Relaxing Parafoveal Nasal Retinotomy for Refractory Macular Hole Repair.

Purpose: This work aimed to assess postoperative outcomes associated with relaxing parafoveal nasal retinotomy for refractory macular hole repair. Methods: This was a retrospective interventional study of patients with persistent or recurrent macular holes following 1 or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and relaxing parafoveal nasal retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of macular hole closure and changes in visual acuity from baseline. Results: Thirteen patients with refractory macular holes were included, with a median age of 65 years (range, 49-90 years). The aperture diameter of the 13 macular holes ranged from 180 to 799 µm (median, 538 µm). Vitrectomy and relaxing parafoveal nasal retinotomy were performed in all 13 eyes, and after a median follow-up of 12 months (range, 3-34 months), anatomical closure was achieved in 12 of 13 eyes (92.3%). Overall, visual acuity (mean ± SE) improved significantly from 1.20 ± 0.15 logMAR (approximate Snellen equivalent, 20/320) at baseline to 0.84 ± 0.11 logMAR (Snellen, ∼ 20/125) during postoperative follow-up (P < .05). Central and paracentral scotomas were observed in 8 of 11 eyes with postoperative Humphrey visual field 10-2 and/or 24-2 data available. Conclusions: Relaxing parafoveal nasal retinotomy may be an effective method to promote anatomical closure and improve vision outcomes in patients with recalcitrant macular holes.

An Atypical Presentation of Propionibacterium Acnes Endophthalmitis Following Cataract Surgery.

Purpose: To describe a case with an unusual presentation of Propionibacterium acnes (P acnes) with ultimately a good visual outcome. Methods: A case report with review of approaches to P acnes endophthalmitis. Results: We describe a patient with an unusual presentation of P acnes of panuveitis with white, circular preretinal lesions without intracapsular deposits. Diagnosis was made from cultures from pars plana vitrectomy. Eventually, she was definitively managed with capsulectomy, repositioning of her intraocular lens via sutureless intrascleral fixation, and intravitreal vancomycin injection. Conclusion: This is a report of P acnes endophthalmitis presenting with discrete preretinal lesions where surgical and medical management lead to a complete resolution of uveitis and symptoms after a 3-year follow up where the patient's final visual acuity was Snellen 20/20 OU.

A Case of Unilateral Optic Neuropathy Following Influenza Vaccination.

The influenza vaccination has greatly benefited public health, leading to significant reductions in flu season hospitalizations and deaths. However, with more widespread administration of this vaccine, it is expected that the absolute number of patients that present with unusual, adverse reactions will increase. Here, we report a case of a 55-year-old woman who developed a progressive optic neuropathy and severe visual loss associated with optic disc edema following influenza virus vaccination. Our patient also experienced other concurrent symptoms, including bilateral knee effusions, muscle spasms and a facial rash. The strong temporal connection between the vaccine administration and the development of sequelae suggests that the optic neuropathy was an adverse reaction. Furthermore, HLA typing of our patient revealed alleles that have been linked to autoimmune reactions, consistent with the notion that specific HLA alleles could be involved in the pathophysiology of these adverse reactions.

Comparative evaluation of no dye assistance, indocyanine green and triamcinolone acetonide for internal limiting membrane peeling during macular hole surgery.

PURPOSE: To evaluate the anatomical closure rate and visual outcome in patients undergoing pars plana vitrectomy with internal limiting membrane peeling without dye enhancement and with indocyanine green or triamcinolone acetonide assistance. METHODS: This is a retrospective, comparative interventional case series. The electronic charts of 435 eyes of 415 patients with idiopathic macular holes who underwent macula hole surgery were reviewed from January 2003 to April 2010. The patients were assigned to 3 groups: no dye assistance (Group 1), indocyanine green-assisted (Group 2), and triamcinolone acetonide-assisted internal limiting membrane peel (Group 3). The data were recorded for 3-, 6-, and 12-month follow-up visits. Main outcome measures were postoperative visual acuity and macular hole closure. RESULTS: The overall macular hole closure rate with a single surgery was 94.7% (108 of 114). In Group 1: 91.4% (191 of 209), in Group 2: 94.1% (112 of 119), and in Group 3: 95.9% (93 of 97) achieved closure. Closure rate for holes that were ≤400 µm in diameter was 98.8% compared with >400 µm, which was 90.4% (P = 0.001). There was a statistically significant (P < 0.001) improvement from preoperative visual acuity to postoperative visual acuity in all groups across all time points. There was no statistically significant visual acuity difference among three groups. At 12-month follow-up, 77.7% in Group 1, 66.1% in Group 2, and 81.3% in Group 3 achieved 20/50 visual acuity or better. CONCLUSION: The study shows that good anatomical and functional results can be achieved with no dye and with indocyanine green or triamcinolone acetonide dye assistance for internal limiting membrane peeling during macular hole surgery. Overall, visual acuity levels did not differ among groups, although subanalysis of the results suggests subtle indocyanine green toxicity.

Photodynamic therapy of choroidal hemangioma in sturge-weber syndrome, with a review of treatments for diffuse and circumscribed choroidal hemangiomas.

We report three new cases of patients with Sturge-Weber Syndrome and symptomatic retinal detachments from diffuse choroidal hemangiomas successfully treated with photodynamic therapy (PDT) and review medical literature on the available treatment options for choroidal hemangiomas. All patients were treated with a single session of PDT with verteporfin infused at a concentration of 6 mg/m(2) and treated for 83 seconds with 689-nm Zeiss laser that was delivered with total energy level of 50 J/cm(2) with an intensity of 600 mW/cm(2). The exudative retinal detachment (RD) and macular edema completely resolved in all cases by 1-4 months after PDT treatment. Visual acuity improved in all three cases with diminished tumor size in the areas of treatment. One case was followed for 5 months, another for 2 years, and the third case for 6 years, with no recurrence of exudative RD. PDT is an effective treatment option for visual deterioration from exudative retinal detachment in patients with diffuse choroidal hemangiomas.

Retinal artery occlusion and multiple retinal deposits as a consequence of therapeutic arteriovenous fistula embolization.

PURPOSE: To describe a rare case of a patient who underwent a therapeutic arteriovenous fistula embolization and developed painful vision loss in one eye and to describe the clinical course, present sequential images, and propose an explanation. METHODS: The record of one patient with subretinal deposits, including fundus photographs and fluorescein angiography, was reviewed. RESULTS: Fundus photographs show creamy white circumscribed subretinal deposits. Fluorescein angiography shows evidence of retinal and choroidal ischemia. CONCLUSION: This patient had anomalous anatomy with an ophthalmic artery arising from the middle meningeal artery. This allowed the embolic material to reflux into the ophthalmic circulation and deposit in the retinal and choroidal circulation, causing infarcts.