Peripapillary choroidal thickness by enhanced depth imaging optical coherence tomography: the impact of metabolic syndrome.

PURPOSE: To assess the impact of metabolic syndrome (MetS) on the peripapillary choroidal thickness (PPCT) and to characterize the PPCT in a Portuguese population. METHODS: This prospective study included 104 eyes. Detailed medical and ophthalmic examinations were performed; the PPCT was measured by spectral-domain optical coherence tomography (SD-OCT) using enhanced depth imaging (EDI) modality. The PPCT changes with MetS, as well as with other clinical and demographic factors, were investigated. RESULTS: The mean PPCT was 142.4 ± 54.0 µm (58-303 µm); it was thickest superiorly, followed by the temporal, nasal, and inferior sectors. The PPCT was significantly associated with axial length (p<0.001), age (p = 0.001), intraocular pressure (IOP) (p = 0.041), weight (p = 0.015), and arterial hypertension (p = 0.044). The presence of MetS was associated with thinner PPCT in all sectors, being statistically significant in the temporal (p = 0.032) and inferotemporal (p = 0.034) sectors. CONCLUSIONS: The choroidal thickness was significantly less in temporal and inferotemporal sectors in patients with MetS than in controls. This may suggest vascular insufficiency around the optic nerve head.

Half-dose photodynamic therapy for chronic central serous chorioretinopathy: Efficacy and safety outcomes in real world.

PURPOSE: To have an insight of the outcomes of half-dose photodynamic therapy (PDT) for patients with chronic central serous chorioretinopathy (CSC) in a real world population. MATERIAL AND METHODS: This is a retrospective consecutive case series, one-centre study, with a 12-month follow-up period. RESULTS: The study took into account 15 eyes of 13 patients. All patients were male in gender and only 1 eye belonged to a non-caucasian. The sample mean age was 51,27±11,66 (between 36 and 74 years); mean baseline best-corrected visual acuity (BCVA) was 0,40±0,25 logMAR and central macular thickness (CMT) was 411,40±88,44µm. All patients had subretinal fluid (SRF) and retinal pigment epithelium (RPE) detachment involving the fovea. In a month time, BCVA and CMT had remarkable improvements with only one eye not gaining letters. At 6-month visit, 46,7% of the eyes were provided with additional treatment (intra-vitreal anti-VEGF or PDT). In the final visit no eye had worsened more than 5 letters and 53,3% had a BCVA improvement of at least 5 letters, with only 2 eyes remaining with RPE detachment and SRF. There was a steady regression in CMT throughout the follow-up; 93,3% had CMT under 300µm and CMT mean was 249,93±72,78µm. There were no reported complications. CONCLUSION: These results support PDT as a valuable approach for therapeutic decisions on chronic CSC as well as the need of other add up treatments for a better final outcome. Further evaluations with longer follow-up's should be taken into consideration for safety issues.

Enterococcus faecalis Endogenous Endophthalmitis from Valvular Endocarditis.

We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

Intravitreal and subtenon depot triamcinolone as treatment of retinitis pigmentosa associated cystoid macular edema.

We present a case of retinitis pigmentosa (RP) related cystoid macular edema (CME) refractory to oral acetazolamide and topical ketorolac that was treated with intravitreal and subtenon depot triamcinolone. A 32-year-old male with RP presented with complaints of bilateral decrease in visual acuity. His best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/100 in the left eye. After being informed of the available treatment options, the patient received bilateral intravitreal injection triamcinolone. The patient's BCVA improved to 20/40 in the right eye and 20/50 in the left eye and the CME was resorbed. However, 5 months after the injection in the left eye and two months in the right eye, visual acuity decreased due to recurrence of CME. We performed a second intravitreal injection in the left eye with improvement of visual and anatomic results, but we observed a recurrence of CME. Afterwards, we treated the patient with subtenon depot triamcinolone in both eyes, with the result that there was no recurrence after 4 months in OD or after 3 months in OS. We conclude that intravitreal and subtenon depot triamcinolone appear to provide at least temporary benefit in refractory CME as regards the improvement of visual acuity.

Biomicroscopia ultrassônica na viscocanalostomia / Ultrasound biomicroscopy in viscocanalostomy

OBJETIVO: Estudar por biomicroscopia ultrassônica (UBM) de alta frequência as características anatômicas da viscocanalostomia, e a relação dessas características com a redução da pressão intraocular. MÉTODOS: Estudo transversal, que incluiu nove olhos (sete pacientes) submetidos à viscocanalostomia, e posteriormente examinados por UBM de alta frequência (80 MHz). Os parâmetros da UBM avaliados após um follow-up mínimo de seis meses foram: presença de espaço intraescleral, comprimento e altura máximos do espaço intraescleral, e a espessura mínima da membrana trabéculo-descemética (MTD) residual. O sucesso cirúrgico definiu-se como pressão intraocular (PIO) <22mmHg ou redução de 20% da PIO sem medicação tópica. Possíveis associações entre as variáveis da UBM e o resultado cirúrgico foram avaliados. RESULTADOS: O tempo médio entre a cirurgia e a realização da UBM foi de 15,5 ± 8,8 meses (6 - 29 meses). Verificou-se uma redução da PIO de 23,5 ± 6,9 mmHg (13,7-32,0) pré-operatória para 14,5 ± 2,4 mmHg (10,7-17,3) pós-operatória (p<0,05). Identificou-se a presença de espaço intraescleral em todos os olhos. A média do comprimento máximo do espaço intraescleral era 1,83 ± 0,51mm; a média da altura máxima do espaço intraescleral era 0,36 ± 0,17mm; e a média da espessura mínima da MTD era 0,14 ± 0,07mm. Não foram encontradas correlações significativas entre o valor da PIO pós-operatória e o comprimento do espaço intraescleral (r²=0,359), a altura do espaço intraescleral (r²=0,017) e a espessura da MTD (r²=0,003). CONCLUSÃO: Em pacientes submetidos à viscocanalostomia, a UBM após um follow-up mínimo de seis meses identificou o espaço intraescleral em todos os olhos. Não se encontrou qualquer correlação estatisticamente significativa entre os valores de PIO pós-operatória e as características anatômicas do espaço intraescleral.

PURPOSE: To evaluate by high frequency ultrasound biomicroscopy (UBM) the anatomical characteristics of viscocanalostomy and their relationship with the intraocular pressure (IOP) lowering. METHODS: A transversal study which included 9 eyes (7 patients) undergoing viscocanalostomy and examined by high frequency UBM (80 MHz). Several UBM variables were evaluated, including the presence of the intrascleral space, the maximum length and height of the intrascleral space and the minimum thickness of residual trabeculo-Descemet membrane (TDM). Surgical success was considered to be achieved when IOP was <22mmHg or the IOP was lowered 20% or more without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. RESULTS: The mean time between surgery and the UBM examination was 15.5 ± 8.8 months (range 6-29). The mean IOP decreased from a preoperative value of 23.5 ± 6.9 mmHg (range 13.7-32.0) to 14.5 ± 2.4 mmHg (range 10.7-17.3) postoperative (p<0.05). The presence of an intrascleral space was a constant finding. The mean length of the intrascleral space was 1.83 ± 0.51mm, the mean height was 0,36 ± 0,17mm; and the mean TDM thickness was 0.14 ± 0.07mm. There were a poor correlation between the level of IOP at the time of UBM and the lenght of the intrascleral space (r²=0.359), the height of the intrascleral space (r²=0.017) or the thickness of the remaining TDM (r²=0.003). CONCLUSION: In patients undergoing viscocanalostomy, UBM examination after a minimum of 6-month follow-up period showed the presence of an intrascleral space in all patients. There was no statiscally significant relationship between the level of IOP and the anatomical characteristics of the intrascleral space.