Case image and multimodal imaging of a fully-formed functional chorioretinal anastomosis using OCT angiography.

OCT-angiography description of a fully functional large-diameter chorioretinal anastomosis, or chorioretinal shunt in a 38-year-old female patient with a past history of congenital toxoplasmosis and resulting macular atrophy and scarring.

Optical coherence tomography angiography features of choroidal neovascularization secondary to angioid streaks.

PURPOSE: To characterize the features of choroidal neovascularization (CNV) secondary to angioid streaks (AS) with optical coherence tomography angiography (OCT-A) and to assess its sensitivity in CNV detection in this particular context. METHODS: Consecutive patients, both with treatment-naïve and recurrent CNV associated with angioid streaks were prospectively analyzed. All patients underwent macular imaging by fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain (SD)-OCT, and OCT-A (AngioVue, Optovue, Optovue Inc., Freemont, CA, USA). OCT-A detection rate of CNV associated to AS was evaluated by two independent observers. We studied the association between OCT-A feature and either exudative or active status using Fisher exact test. RESULTS: A total of 32 eyes of 18 consecutive patients were included in the analysis. OCT-A was able to detect CNV associated with angioid streaks in 87.5 % (28/32) eyes. OCT-A phenotypes of CNV were classified into interlacing pattern in 9 eyes, pruned vascular tree pattern in 7 eyes, and combined pattern in 12 eyes (Interuser agreement: 0.871 ± 0.071). CNV were not detectable in 4/32 eyes. There was a statistically significant association between the presence in OCT-A of densely ramified networks with both previous treatment status in the last 6 months (p < 0.001) and with exudative signs on SD-OCT (p = 0.014). CONCLUSION: OCT-A appears as a sensitive tool for detection of CNV secondary to AS. The interlacing pattern was significantly associated with active and exudative features.

Assessment of measurement methods of posterior inflammation in stromal choroiditis: the value of quantitative outcome measures versus the presently qualitatively based paradigm.

PURPOSE: To assess posterior inflammation using a fluorescein (FA)/indocyanine-green angiography (ICGA) scoring system, and compare them to the presently recommended outcome measure, the standardization of uveitis nomenclature vitreous haze score (SUN-VH) in stromal choroiditis. METHODS: This was a retrospective study on patients with a diagnosis of ocular sarcoidosis(OS), ocular tuberculosis(OT), Birdshot retinochoroiditis(BRC) and Vogt-Koyanagi-Harada disease(VKH) seen in the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiography signs were quantified according to an established FA/ICGA scoring system. Vitritis was assessed using SUN-VH. Results were compared. RESULTS: 65 newly diagnosed patients (128 eyes) with stromal choroiditis were included. Angiographic scoring showed variable degrees of choroidal versus retinal involvement (87% for OS, 72% for OT, 62.5% for BRC and 100% for VKH). On the other hand, a mere 22 of 128 eyes (17%) showed a SUN-VH score ≥ 2 necessary for inclusion in clinical trials. Moreover, FA/ICGA values followed a normal distribution curve and presented inter-examiner variations greater than 1-SD in only 8.4% of cases. SUN-VH values' distribution was non-normal and showed inter-examiner discrepancies greater than 1-SD in 51.7% of cases. CONCLUSION: This study highlights the precise measurement of global posterior inflammation achieved by a dual FA/ICGA scoring system in stromal choroiditis. In contrast, SUN-VH scale appears imprecise and inadequate, as only a minute percentage of the studied eyes could have been included in a clinical trial based on this criterion. To evaluate posterior intraocular inflammation meaningfully in stromal choroiditis, the use of dual FA/ICGA is strongly advised and should replace the presently recommended SUN-VH system.

[Influence of cataract surgery on Meibomian gland dysfunction (French translation of the article)]. / Influence de la chirurgie de la cataracte sur le dysfonctionnement meibomien.

PURPOSE: To evaluate the influence of cataract surgery on meibomian gland dysfunction, in particular on postoperative functional symptoms. PATIENTS AND METHODS: Thirty patients who underwent cataract surgery were included in the study. A clinical examination (OSDI questionnaire, measurement of tear break up time [TBUT], corneal staining, meibomian gland expressibility test) and a paraclinical evaluation (loss of Meibomius glands [LMG] measured using ImageJ on meibography, conjunctival redness and non-invasive tear break up time [NIK-BUT]) were performed preoperatively and at 1 month and 3 months after phacoemulsification. RESULTS: TBUT and meibomian gland expressibility were worsened at 1 month and 3 months postoperatively (P<0.05). LMG was significantly more important for the upper eyelid and the mean at 1 month (33.1±15.2 P=0.02; 28.5±15.6 P=0.025, respectively) and 3 months postoperatively (36.5±17.4 P=0.0005; 31.2±17.4 P=0.0002, respectively) than preoperative values (29.4±15.3; 26±15, respectively). There was a significant correlation between LMG on the upper eyelid preoperatively and the OSDI score at 1 month postoperatively (R=0.37; P=0.05). CONCLUSION: The meibomian gland loss in the upper eyelid is associated with an increased postoperative ocular discomfort score. Alterations in the meibomian gland expressibility and TBUT persist for up to 3 months postoperatively suggesting a direct role of cataract surgery by an obstructive mechanism.

Influence of cataract surgery on Meibomian gland dysfunction.

PURPOSE: To evaluate the influence of cataract surgery on Meibomian gland dysfunction, in particular on postoperative functional symptoms. PATIENTS AND METHODS: Thirty patients who underwent cataract surgery were included in the study. A clinical examination (OSDI questionnaire, measurement of tear break-up time (TBUT), corneal staining, Meibomian gland expression test) and a paraclinical evaluation (Meibomian gland loss [MGL] measured using ImageJ on Meibography, conjunctival hyperemia and non-invasive keratograph break-up time [NIK-BUT]) were performed preoperatively and at 1month and 3months after phacoemulsification. RESULTS: TBUT and Meibomian gland expressibility were worsened at 1month and 3months postoperatively (P<0.05). MGL was significantly higher for the upper eyelid and the mean at 1month (33.1±15.2, P=0.02; 28.5±15.6, P=0.025, respectively) and 3months postoperatively (36.5±17.4, P=0.0005; 31.2±17.4, P=0.0002, respectively) than preoperative values (29.4±15.3; 26±15, respectively). There was a significant correlation between MGL on the upper eyelid preoperatively and the OSDI score at 1month postoperatively (R=0.37; P=0.05). CONCLUSION: Meibomian gland loss in the upper eyelid is associated with an increased early postoperative ocular discomfort score. Alterations in Meibomian gland expressibility and TBUT persist for up to 3months postoperatively, suggesting a direct role of cataract surgery by an obstructive mechanism.

[The search for electrophysiological predictors of visual comfort after presbyopia correction with contact lenses]. / Recherche d'indices électrophysiologiques de confort visuel après correction de la presbytie par lentilles de contact.

Starting at 40 years of age, prespyopia affects a quarter of the world population. Many techniques of presbyopia surgery have emerged in recent years. The purpose of this study was to compare monovision and multifocality and to identify clinical and electrophysiological predictive markers of visual comfort for each correction available in clinical practice. Ten presbyopic patients participated in this study. Patients received monovision and multifocal correction using contact lenses for three weeks each in a random order. A clinical evaluation (visual acuity, TNO test, binocular contrast sensitivity and quality of vision questionnaires) and an electrophysiological evaluation (monocular and binocular pattern VEP with multiple spatial frequencies: 60, 30 and 15') were performed before and after each correction modality. The P100 was significantly wider and slightly earlier after binocular compared to monocular stimulation at T0. The TNO stereopsis score decreased significantly after correction. No other significant differences, either on clinical or electrophysiological criteria, were found between the two modes of correction. Several significant correlations were found between the stereoacuity difference depending upon correction and evoked potentials by binocular pattern at T0. The larger the stereoacuity difference (better stereoacuity with multifocal compensation), the longer the latency of the P100 using 60' checks (R=0.82; P=0.004) and the greater the amplitude of the N75 using 30' (R=0.652; P=0.04). Our study found no differences between the 2 types of correction, but it highlights a benefit of VEP used in current practice and measurement of the P100 wave, the best indicator of stereopsis and the most consistent, to predict visual comfort after compensation presbyopia.