Optical coherence tomography biomarkers in early and intermediate age-related macular degeneration: A clinical guide.

Advanced forms of age-related macular degeneration (AMD), characterised by atrophic and neovascular changes, are a leading cause of vision loss in the elderly population worldwide. Prior to the development of advanced AMD, a myriad of risk factors from the early and intermediate stages of AMD have been published in the scientific literature over the last years. The ability to precisely recognise structural and anatomical changes in the ageing macula, altogether with the understanding of the individual risk implications of each one of them is key for an accurate and personalised diagnostic assessment. The present review aims to summarise updated evidence of the relative risk conferred by diverse macular signs, commonly seen on optical coherence tomography, in terms of progression to geographic atrophy or macular neovascularization. This information may also serve as a basis for tailored follow-up monitoring visits.

Astigmatism Influences Quantitative and Qualitative Analysis in Optical Coherence Tomography Angiography Imaging.

Purpose: The purpose of this paper was to study the influence of astigmatism in optical coherence tomography angiography (OCTA) images in a quantitative and qualitative analysis. Methods: This was a prospective, cross-sectional study. We included 110 eyes of 110 patients: 20 eyes without astigmatism and 90 eyes with astigmatism ≥0.5 diopters (D). We performed a macula centered OCTA as a reference image. In patients without astigmatism, registered follow-up scans were performed after induction of -1 and -2 D astigmatism. In patients with astigmatism, we performed the follow-up scan after astigmatism correction. We used a set of cylindrical lenses attached to the camera head of the SPECTRALIS (Heidelberg Engineering, Heidelberg, Germany). A quantitative and qualitative analysis of the superficial vascular complex (SVC) and deep vascular complex (DVC) was performed. The main outcome measures were vessel density (VD), image quality, and the presence of artifacts. Results: Mean VD of the SVC was significantly higher in the reference images compared with the images after induction of -2 D. Differences with -1 D were nonsignificant. Higher degrees of astigmatisms had higher VD dropout (0.012-0.02 per diopter in SVC). Astigmatism axis showed no relevance in our cohort. Image quality assessed by two independent observers was graded as higher in images without astigmatism. Defocus and attenuation were more prevalent in images with astigmatism. Conclusions: Astigmatism of -2 D affects quantification of VD in OCTA images, mainly affecting the SVC, as well as the subjective quality assessment. Correction of this refractive error might be necessary for an accurate quantitative assessment of OCTA images. Translational Relevance: Correcting astigmatism of 2 D or greater appears to be necessary when analyzing OCTA images.

Long-term complications according to silicone oil type. A single center cohort study.

PURPOSE: To study the incidence of macular edema (ME), ocular hypertension (OHT), emulsification and migration to the anterior chamber (AC) of silicone oil (SO) in patients after complex retina surgery, stratified by SO type. METHODS: Retrospective, cohort study. Patients who underwent retina surgery with SO injection and extraction in our center were included. We compared the complication rates of ME, OHT, emulsification and migration to the AS according to SO type (1300cSt, 5700cSt and heavy SO). Data on age, sex, emulsification time, duration of the tamponade, previous retina surgeries and diagnosis were also gathered and included in a multivariate analysis. RESULTS: We included 163 patients (mean age of 64.8 years; mean duration of the tamponade: 11 months). Rates of emulsification, ME, OHT and SO migration to the AC were similar in all groups (p = 0.998, 0.668, 0.915 and 0.360). ME was the most frequent complication (33.3-47.8%), which resolved after SO extraction in 77.6% of cases. The majority of cases with OHT persisted (61.7%). Emulsification was related to younger age (OR 0.94) and longer duration of the tamponade (OR 1.04). The odds of SO migration to the AC increased with emulsification (OR 2.78), recurrent retinal detachment (OR 0.99) and aphakia (OR 4.05). CONCLUSIONS: We propose SO extraction as the preferred treatment for ME during SO tamponade. SO extraction should be performed sooner in younger patients to avoid emulsification. In selected patients, we suggest a longer duration of the tamponade up to 11 months with a reasonable safety profile, regardless of the SO type.

A Case of Sterile Corneal Stromal Infiltration with Hypotonic Maculopathy Under Brimonidine Treatment.

INTRODUCTION: Brimonidine is a commonly used drug for glaucoma treatment, which has been linked to ocular autoimmune disorders like uveitis and conjunctivitis. Corneal pathology under brimonidine is generally less common. CASE DESCRIPTION: Here, we report a 78 -year-old male patient suffering from immune corneal stromal inflammation with hypotony and resulting hypotonic maculopathy after 6 weeks after introduction of brimonidine treatment. Systemic work-up for system autoimmune and infectious diseases was negative. We discontinued brimonidine and administered topical prednisolone under which inflammatory corneal signs and intraocular pressure normalized. Chorioretinal folds persisted after 9 months. CONCLUSION: Our case report suggests monitoring patients under brimonidine for sterile corneal infiltration.

Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile / Queratitis infecciosa por Staphylococcus epidermidis resistente a meticilina: perfil clínico y microbiológico

Introduction. Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. Ahigh percentage of resistance to methicillin is shown, whichgives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical andmicrobiological variables in patients with infectious keratitisdue to SE.Methods. Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE,between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions,treatment, evolution) and microbiological (susceptibility toantibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE)infection were compared.Results. MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid.Rates of resistance to tetracyclines and ciprofloxacin were50% and 56% in the MRSE group, and 11% and 7% in theMSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not showstatistically significant differences between groups.Conclusions. MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings (AU)

Introducción. Staphylococcus epidermidis (SE) es unacausa frecuente de queratitis bacteriana en ciertas áreas geográficas. Presenta un alto porcentaje de resistencia a meticilina, lo que confiere resistencia cruzada a beta-lactámicos y enalgunas ocasiones también resistencia a otros grupos de antibacterianos. Analizamos variables clínicas y microbiológicas enpacientes con queratitis infecciosa por SE.Métodos. Se analizaron retrospectivamente las historiasclínicas de 43 pacientes con sospecha de queratitis infecciosa yconfirmación microbiológica para SE, entre octubre de 2017 yoctubre de 2020. Se analizaron las características clínicas (factores de riesgo, tamaño de las lesiones, tratamiento, evolución)y microbiológicas (susceptibilidad a antibióticos) y se compararon grupos de pacientes con infección resistente (MRSE) ysensible a meticilina (MSSE).Resultados. El 37,2% de las queratitis fueron por MRSE.Todos los aislados fueron sensibles a vancomicina y linezolid.Las tasas de resistencia a tetraciclinas y ciprofloxacino fueron50% y 56% en el grupo de MRSE, y 11% y 7% en el grupode MSSE. Las características clínicas, incluido el tamaño de lalesión, la afectación del eje visual, la inflamación de la cámaraanterior, la presencia de factores de riesgo y el tiempo de seguimiento, no mostraron diferencias estadísticamente significativas entre los grupos.Conclusiones. MRSE es una causa frecuente de las queratitis infecciosas producidas por SE y presenta una alta tasade resistencia a múltiples fármacos. Clínicamente, no muestradiferencias clínicas con la queratitis por MSSE. Se necesitantrabajos adicionales para confirmar estos hallazgos. (AU)

Monitoring therapy in anterior necrotizing scleritis with inflammation with anterior segment optical coherence tomography.

INTRODUCTION: Early diagnosis and initiation of immunosuppression can prevent the necessity of surgical intervention in necrotizing scleritis with inflammation and lowers the risk of perforation and loss of vision. However, clinical signs for early diagnosis and methods for monitoring response to immunosuppressive therapy are missing. METHODS: Here, we present a case of necrotizing scleritis with inflammation where avascular plaques precede scleral defects. We use slit lamp imaging and anterior segment optical coherence tomography to evaluate evolution lesions depth and impact on scleral structure. RESULTS: The patient presented 5 months after detection of avascular plaques with a new scleral ulcer of the left eye. After 3-day-administration of i.v. corticosteroids anterior segment optical coherence tomography showed progressive scleral thickening. The patient was therefore spared surgical intervention and discharged resulting in complete remission under decreasing doses of oral corticosteroids. CONCLUSIONS: Avascular plaques can precede necrotizing scleritis with inflammation by several months and may therefore qualify as early clinical signs. Anterior segment optical coherence tomography enables objective evaluation of scleral structure for making rational decisions about surgical intervention.