Peripapillary intrachoroidal cavitation at the crossroads of peripapillary myopic changes.

AIM: To analyze the prevalence of peripapillary intra-choroidal cavitation (PICC) in eyes with gamma peripapillary atrophy (γPPA), in eyes with peripapillary staphyloma (PPS) and in those combining γPPA and PPS and to analyze border tissue discontinuity in PICC. METHODS: This prospective cross-sectional non interventional study included highly myopic eyes. Non-highly myopic eyes were used as control. Radial and linear scans centered on the optic nerve head were performed using spectral-domain optical coherence tomography. Variables were analyzed along the twelve hourly optical coherence tomography sections in both eyes of each subject. RESULTS: A total of 667 eyes of 334 subjects were included: 229 (34.3%) highly myopic eyes and 438 (65.7%) non highly myopic eyes. The mean age of the highly myopic group was 48.99±17.81y. PICC was found in a total of 40 eyes and in 13.2% (29/220) of highly myopic eyes. PICC was found in 10.4% (40/386) of eyes with γPPA, in 20.5% (40/195) of eyes with PPS and in 22.7% (40/176) of those combining γPPA and PPS. All the eyes with PICC showed the co-existence of γPPA and PPS whereas none of the eyes presenting only one of these entities exhibited PICC. A border tissue discontinuity in the γPPA area was found in all eyes with PICC. CONCLUSION: We confirm the presence of a border tissue discontinuity in the γPPA area of all eyes with PICC. These findings suggest the involvement of mechanical factors in the pathogenesis of PICC which may contribute to PICC-related visual field defects.

Myopic (Peri)papillary Changes and Visual Field Defects.

Purpose: Myopic eyes combining gamma peripapillary atrophy and peripapillary staphyloma were sorted according to the presence of intrachoroidal cavitation (PICCs) or its absence (combinations). Visual field defects (VFDs) and factors discriminating these groups were analyzed. Methods: These groups were sorted by optical coherence tomography. VFDs were assessed using the Humphrey® Field Analyzer 3, SITA standard. Ovality index (OI) was the ratio between the shortest and longest diameters of the disc. The proportions of PICCs, lamina cribrosa defects (LCDs) and clusters in each Garway-Heath's sector (A-F) were analyzed. All variables were compared between PICCs and combinations. A multivariate logistic regression analysis was performed ultimately. Results: Of the 93 eyes, we obtained, 20 PICCs and 73 combinations. The prevalence of VFDs and LCDs in PICCs were 65% (13/20) and 30% (6/20), respectively. PICCs 85% (17/20) and LCDs 12% (11/93) predominated in sector B (inferotemporal) and clusters 9.7% (9/93) in the corresponding sector. The proportion of VFDs was significantly higher in PICCs than combinations (p < 0.001). In sector B, the proportion of LCDs was significantly higher in PICCs than combinations (p = 0.011). The mean OI was significantly lower (p < 0.001) in PICCs than combinations. Multivariate logistic regression analysis concluded that mean OI (p < 0.001) was the only statistically significant factor discriminating PICCs and combinations. Conclusion: Mean OI discriminating PICCs from combinations is further evidence of a gradation of structural changes between them. It could be related to the higher proportion of VFDs in PICCs. The predominant distribution of PICCs infero-temporally supports PICC as a cause of uncertainty in glaucoma diagnosis in high myopia. Furthermore, the highest proportion of PICCs and LCDs in this sector highlights its vulnerability to damage in myopic eyes and deserves further investigation as it is also primarily involved in glaucoma.

Intravitreal methotrexate in vemurafenib-induced uveitis.

PURPOSE: Vemurafenib, a BRAF inhibitor, has revolutionized the prognosis of late-stage melanoma patients, rising at the same time concerns about its potential adverse effects. Here is a case of vemurafenib-induced uveitis, peculiar in both its presentation and management. METHODS: Case report, diagnostic and therapeutic challenge. RESULTS: Uveitis is a known side effect of vemurafenib. It is generally bilateral, moderate, manageable with topical steroids and does not require cancer therapy cessation. We present a patient who suffered from a unilateral, severe uveitis following vemurafenib treatment that fully recovered thanks to intravitreal methotrexate injections, as conventional corticosteroid therapy was contraindicated. CONCLUSION: Uveitis can be a serious ocular adverse effect of vemurafenib, while its risks factors and mechanisms remain unknown. As BRAF inhibitors are now used on a regular basis, it is important for clinicians to be aware of this potentially sight-threatening side effect. Intravitreal methotrexate injections may be considered as an effective treatment choice in severe targeted agents-induced uveitis.

Visual field defects and retinal nerve fiber layer damage in buried optic disc drusen: a new insight.

AIM: To assess the association between buried optic disc drusen (BODD) location using spectral-domain optical coherence tomography (SD-OCT) and the location of associated visual field defects (VFD) using the Garway-Heath mapping. METHODS: This monocentric retrospective cross-sectional study was led at the authors' institution. Adult patients diagnosed with BODD who had complete records with a reliable Humphrey® 24-2 visual field, macular, and papillary OCT were enrolled. Fisher's exact test was used to measure the association between BODD location and VFD distribution according to Garway-Heath's mapping. RESULTS: Totally 20 eyes of 15 patients were included (60% females). The median age (interquartile range) was 63 (43)y and the median best corrected visual acuity (BCVA) was -0.08 (0.08) log MAR. BODD were mostly located in zones A, E, and F. The minimal rim width (MRW) was globally preserved. The retinal nerve fiber layer (RNFL) was predominantly altered in zones D, E, and F. There was a significant correlation between BODD location and that of RNFL alterations in zones D (P=0.03) and E (P=0.025); Moreover, the presence of BODD in the E zone was significantly related to damaged RNFL in the neighbouring sectors D and F (P=0.012; P=0.02 respectively). Sixty-three percent (12/19) of visual fields were abnormal and there was a significant match (Phi=0.7, P=0.009) between drusen location and VFD only in zone D. CONCLUSION: BODD do not only affect young patients and can be more harmful than usually expected, as we found VFD in 63% of cases. There is a correspondence between BODD location, RNFL damage, and VFD distributions. The presence of BODD induces the overestimation of MRW, thereby disrupting its sensitivity as an early indicator of ganglion fibers damage.

Analysis of Peripapillary Intrachoroidal Cavitation and Myopic Peripapillary Distortions in Polar Regions by Optical Coherence Tomography.

Purpose: To compare the peripapillary polar characteristics in eyes combining peripapillary staphyloma and gamma peripapillary atrophy according to whether peripapillary intrachoroidal cavitation (PICC) was present or absent (combination-group). Patients and methods: This prospective non-interventional cross-sectional study included 667 eyes of 334 subjects. From the polar peripapillary regions to the opening of Bruch's membrane, the following elements and their topographic relationships were analyzed using optical coherence tomography sections: configuration of the posterior curvature of the choroid, visibility of the subarachnoid space (SAS), and suprachoroidal detachment (SCD). Chi-squared and Fisher exact tests were used for statistical analysis. Results: The protrusion of the posterior choroidal wall, with anterior elevation on either side, observed in both groups progressed and transformed into a wedge-shaped deformity on the side of gamma peripapillary atrophy. This wedge configuration was significantly more frequent in PICC-group than in combination-group (p = 0.004 and p < 0.001) for the upper and lower poles, respectively. SAS was more frequently observed in PICC-group than in combination-group (p = 0.002 and p < 0.001) for the upper and lower poles, respectively. SCD was detected exclusively in PICC-group (p < 0.001, both poles). The wedge-shaped configuration and the SCD were aligned antero-posteriorly with the SAS. Conclusion: We confirmed that PICC is an SCD. We observed its constant alignment with the SAS. We suggest that the tensile forces of the optic nerve sheaths during adduction promote the collapse of the scleral flange onto the SAS, leading to PICC. Further studies are warranted to confirm this hypothesis.

Moderate forms of COVID-19 among healthcare workers in a Belgian hospital and their immune response.

INTRODUCTION: Healthcare professionals have been treating patients with COVID-19 since the pandemic started in early 2020 while also trying to limit disease spread among their coworkers and communities. This study aimed to identify and follow potentially infected healthcare workers in one hospital in order to develop an epidemiological baseline for COVID-19 infection and spread rates in this population. MATERIALS AND METHODS: This prospective study was conducted between 1 April and 30 June 2020 at a single Belgian hospital. Healthcare workers with symptoms consistent with COVID-19 were included. Participants underwent testing for SARS-CoV-2 infection by nasopharyngeal (NP) swab and analysis of blood samples for antibody response at different timepoints (day 0, 7, 14 and day 30 or 60). Patient exposures, symptoms, and disease progression were collected. RESULTS: Of a total of 150 healthcare workers with symptoms compatible with SARS-CoV-2 infection, 31% (47) tested positive for the virus by NP swab. Of the 47 participants with positive NP swabs, 66% also had positive IgG serology. Of the 99 participants with negative NP swabs who underwent blood sample collection, 5% had positive IgG serology results. Of the 29 participants who presented with at least 3 major symptoms, 15 (52%) had positive NP swabs and 14 (48%) had positive serology. CONCLUSIONS: This study demonstrates that evidence of symptoms, even when major, is a poor predictor for SARS-CoV-2 positivity in health care workers and raises the question of the best way to efficiently screen this population especially during the upcoming flu period.

Methylphenidate-associated Alice in Wonderland syndrome.

INTRODUCTION: We describe the case of a child affected by typical symptoms of Alice in Wonderland syndrome (AIWS), related to the methylphenidate treatment he was taking for an attention deficit hyperactivity disorder (ADHD). To our knowledge, this is the first case of methylphenidate-associated AIWS. METHODS: Retrospective single center observational case report. CASE DESCRIPTION: A 12-year-old boy was complaining of micropsias and macropsias. Except a disruptive ADHD treated by methylphenidate for 2 years, his medical history was banal. His symptoms coincided with a change in his treatment regimen and ceased with methylphenidate discontinuation. Unfortunately, they recurred when the medication was reimplemented by his psychiatrist. The ophthalmological examination was unremarkable. We concluded to an AIWS and prescribed ancillary testing (including blood work, electroencephalogram, and brain MRI) to rule out conditions known to be associated with this syndrome. In the meanwhile, the methylphenidate dosage was readapted, and the symptoms disappeared again. Seen this clear dechallenge and rechallenge effect and the fact that all additional tests returned normal results, we deduced that our patient's symptoms were associated to methylphenidate. CONCLUSION: AIWS could be a potential side effect of methylphenidate. Given the frequency of methylphenidate prescription for ADHD and its widespread misuse, it is important to consider this peculiar adverse effect. Every physician should be aware of the condition to offer reassurance and to prescribe the appropriate additional examinations, as life-threatening disorders can cause this syndrome.