Atypical Presentation and Delayed Diagnosis of Gyrate Atrophy: Case Reports of Two Siblings.

Gyrate atrophy (GA) is a hereditary condition characterized by ornithine aminotransferase deficiency-related large areas of retinal pigment epithelium and choriocapillaris lobular-shaped atrophy in the peripheral retina. In this report, we present a case of atypical presentation of GA. The aim of this report is to present two siblings, one of which was associated with a lamellar macular hole and with a history of previous diagnosis of retinitis pigmentosa. The delayed diagnosis of GA was made only after her brother, who was 5 years younger than her was diagnosed with GA. In addition, in this report, we evaluated GA in terms of multimodal imaging findings, differential diagnosis, and treatment of macular complications.

The status of the choroid in patients with optic disc drusen.

PURPOSE: To investigate the subfoveal and peripapillary choroidal thickness (CT) and the choroidal vascularity index (CVI) in patients with optic disc drusen (ODD). METHODS: This cross-sectional study examined the eyes of 17 patients with ODD and 18 healthy control subjects. The CT values were calculated manually from the images captured by enhanced depth imaging-optical coherence tomography (EDI-OCT). The CVI was defined as the proportion of the vascular area to the total choroidal area at the subfoveal and peripapillary areas after binarization of the EDI-OCT images. RESULTS: It was found that the mean subfoveal CVI value in the ODD group was significantly lower than that in the control group (p = 0.006). The mean peripapillary CVI values were significantly lower in all of the quadrants in the ODD group when compared with the control group (p = 0.008 for the temporal quadrant, p = 0.014 for the nasal quadrant, p = 0.024 for the superior quadrant, and p = 0.038 for the inferior quadrant). Regarding the CT, there were no significant differences in the subfoveal and peripapillary CT values between the ODD group and the control group (p >  0.05 for all values). CONCLUSION: The findings of this study indicate ODD to be associated with decreased subfoveal and peripapillary CVI, even though the subfoveal and peripapillary CT values were within the normal range. This result may prove important in relation to identifying a choroidal vascular network that appears to be morphologically normal but microstructurally impaired due to ODD. Further studies are required to verify the significance of CVI in the pathogenesis and complications of ODD.

UNCOMPLICATED PACHYCHOROID IN RELATION TO OBSESSIVE-COMPULSIVE DISORDER: AN OCT-ANGIOGRAPHY STUDY.

BACKGROUND: The aim of this study was to evaluate potential changes in choroidal flow in patients with newly diagnosed obsessive-compulsive disorder based on optical coherence tomography angiography findings and to investigate the relationship between subfoveal choroidal thickness and choriocapillaris flow area. METHODS: This prospective study included newly diagnosed obsessive-compulsive disorder patients and healthy controls. All patients underwent enhanced depth imaging-optical coherence tomography imaging to assess the subfoveal choroidal thickness and optical coherence tomography angiography imaging to evaluate the choriocapillaris flow area. RESULTS: A total of 55 patients with obsessive-compulsive disorder and 50 controls were included. The mean subfoveal choroidal thickness was significantly greater in the obsessive-compulsive disorder group compared to the control group (p˂0.001). Regarding the choriocapillaris flow area, the values for area with a radius of 1 mm, 2 mm and 3 mm were significantly lower in the obsessive-compulsive disorder group than in the control group (p=0.019, p=0.014, and p=0.004, respectively). There was a significant negative correlation between subfoveal choroidal thickness and choriocapillaris flow area with a radius of 1mm (r=-0.387, p=0.024). CONCLUSION: Choroidal changes in obsessive-compulsive disorder patients suggest the choroidal features of uncomplicated pachychoroid. Obsessive-compulsive disorder may be prone to a spectrum of conditions characterized by pachychoroid features.

Association Between Dry Eye Disease and Newly Diagnosed Obsessive-Compulsive Disorder.

PURPOSE: The purpose of this study was to evaluate the association between dry eye disease and patients with newly diagnosed obsessive-compulsive disorder (OCD). METHODS: Thirty treatment-naive patients with OCD and 30 healthy controls were included in this prospective study. The Ocular Surface Disease Index, tear breakup time, Schirmer I test, corneal and conjunctival staining grade (Oxford scale), and neutrophil-to-leucocyte ratio values were obtained for all participants. RESULTS: The comparison of the patients with OCD and healthy controls showed significantly higher values in Ocular Surface Disease Index (34.8 vs. 20.8, P = 0.001), corneal Oxford scoring (0.9 vs. 0.6, P = 0.02), and conjunctival Oxford scoring (0.8 vs. 0.5, P = 0.04), with consistently lower values in the Schirmer I test (15.7 vs. 18.8, P = 0.043) and tear breakup time (9.1 vs. 12.9, P = 0.001). The mean neutrophil-to-leucocyte ratio values were significantly higher in the OCD group compared with the controls (2.4 ± 0.9 vs. 1.6 ± 0.4, respectively; P = 0.001). CONCLUSIONS: Our study showed a relation between dry eye disease and patients with newly diagnosed OCD who were not using any psychiatric drug. Our findings suggest that inflammation, which plays an important role in the pathogenesis of both diseases, may be responsible for this relationship.

Is choroidal vascularity index a useful marker in different stages of idiopathic epiretinal membranes?

BACKGROUND: This study aims to evaluate the choroidal vascularity index in patients with idiopathic epiretinal membrane at different stages. METHODS: This prospective study included 125 eyes of 125 patients with idiopathic epiretinal membrane and 62 eyes of 62 healthy control subjects. In this study, epiretinal membrane stages were defined based on the spectral-domain optical coherence tomography staging system. The choroidal vascularity index was measured as the ratio of the luminal area to the stromal area in the central 1500 µm after binarization on enhanced depth imaging optical coherence tomography images. Data on epiretinal membrane stages, choroidal vascularity index, and best-corrected visual acuity were noted. RESULTS: Of 125 eyes with epiretinal membrane, 38 (30.4 %) had stage 1, 32 (25.6 %) had stage 2, and 55 (44 %) had stage 3 disease. Visual acuity was better in eyes with stage 1 or 2 epiretinal membrane than those with stage 3 epiretinal membrane (p < 0.001). The mean choroidal vascularity index was 2.29 ± 1.02 in the control, 2.23 ± 0.98 in the stage 1 epiretinal membrane, 2.22 ± 0.91 in the stage 2 epiretinal membrane, and 2.23 ± 1.11 in the stage 3 epiretinal membrane group. There was no significant difference between epiretinal membrane subgroups and the control group regarding the choroidal vascularity index (p = 0.81). CONCLUSION: From the results obtained in the present study, the choroidal vascularity index was not effected by either the development or the progression of idiopathic epiretinal membrane.

Sequential Presentation of Superior and Inferior Branch Retinal Artery Occlusion in the Same Eye.

Branch retinal artery occlusion (BRAO) accounts for approximately 40% of retinal artery obstructive disease. The visual prognosis is relatively good, with the exception of recurrent BRAO. Recurrent BRAO may be idiopathic or associated with conditions such as systemic vasculitides, blood dyscrasias, floppy mitral valve syndrome, or Susac syndrome. This report describes a patient who presented with an inferior BRAO without any indication of systemic disease. There was a history of a superior BRAO in the same eye. Patients with a BRAO are at significant risk for future cardiovascular and cerebrovascular events and these patients should be referred to a neurologist and a cardiologist immediately after diagnosis.

The Place of Optical Coherence Tomography in Patients with Obsessive Compulsive Disorder.

OBJECTIVE: Optical coherence tomography (OCT) is an increasingly used new method that investigates changes in the retinal nerve fiber layer (RNFL) in neurodegenerative diseases. It provides high-resolution cross-sectional imaging of biological tissues. This study aimed to investigate the structural changes in RNFL in patients with obsessive compulsive disorder (OCD) using OCT and to investigate the possible effects of retinal function on the etiopathogenesis of OCD. MATERIALS AND METHODS: In this study, 30 patients diagnosed with OCD at the end of the Structured Clinical Interview for DSM (SCID-I), without any drug use status, and 31 healthy participants paired with the patients in terms of their sociodemographic characteristics were included. In the patient and control groups, the RNFL thickness was measured and compared at each locus using OCT. RESULTS: Statistically significant differences were found in RNFL, ganglion cell layer thickness, and central foveal thickness between the patients with OCD and the control group. In this study, the choroidal thickness values of the patient group were found to be higher than those of the control group; and a statistically significant difference was observed in the mean choroidal thickness values (p=0.045). CONCLUSION: The findings of the study suggest that the RNFL thickness of patients with OCD does not decrease, but choroidal thickness may be an important biomarker to determine the etiopathogenesis of the disease and follow neurodegeneration.

Complication of Peribulbar Block: Brainstem Anaesthesia.

Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment.