Contribution of optical coherence tomography angiography OCT-A in diabetic maculopathy.

INTRODUCTION: Diabetic retinopathy (DR) increases the risk of blindness by 25 times. Advanced researchs are justified for better management, leading to the role of Optical Coherence Tomography-Angiography (OCT-A), a new non-invasive imaging technique exploring retinal vascularization.Our purpose is to identify microvascular macular anomalies of DR on OCT-A with qualitative and quantitative evaluation of their impact on retinal vascularization. PATIENTS AND METHODS: This is a descriptive cross-sectional study where 120 eyes of 66 diabetic patients were enrolled. All patients were diabetic and went through OCT-A imaging. RESULTS: Microanevrysms were identified in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) where they were more frequently visualized. Macular edema was present in 16,7% of cases in the SCP, and in 30% in DCP. Edema spaces were more frequently present in DCP (p < 0,05). Capillary nonperfusion areas were identified in 82,5% of cases in SCP and in 60% of cases in DCP. The main peri-foveal vascular density was 18,95 ± 5,37%. The main surface of foveal avascular zone (FAZ) in the SCP was 462,52 µm2 and was 555,04 ± 329,11 µm2 in the DCP where it was larger. CONCLUSION: OCT-A is a modern imaging tool that could be used for the diagnosis and monitoring of DR as well as the understanding of its pathophysiology.

Optic nerve avulsion: Case report.

INTRODUCTION: Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma. CASE PRESENTATION: We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia. CLINICAL DISCUSSION: In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA. CONCLUSION: Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment.

Retinal vasoproliferative tumor in intermediate uveitis: A case report.

INTRODUCTION: Retinal vasoproliférative tumors (VPTs) have been reported as uncommon complications of intermediate Uveitis. CASE DESCRIPTION: A patient consulted for a gradually decreased vision in the right eye (RE). The examination of the RE found a corrected visual acuity at 20/100 with normal eye pressure measured. The anterior segment was deep and quiet and 2+ vitreous haze was found. Funduscopy showed a VPT. Retinal fluorescein angiography of the RE revealed macular cystoid edema also objectified by the Optical Coherence Tomography (OCT). Intermediate Uveitis was considered idiopathic. The patient received a cryoapplication and was put on oral corticosteroid therapy with improvement of visual acuity and a regress of both vitreous inflammation and cystoid macular edema. CONCLUSION: The association of a VPT with intermediate uveitis represents a real diagnostic and therapeutic challenge and imposes rigorous care and monitoring strategy combining internist and ophthalmologist.

Spectral optical coherence tomography findings in patients with ocular toxoplasmosis: A case series study.

PURPOSE: Ocular toxoplasmosis is the most common cause of infectious uveitis worldwide. The diagnosis of ocular toxoplasmosis is primarily clinical when it is a typical presentation.With an atypical presentation in the fundus, parasitological diagnosis is a decisive contribution, as well as multimodal imaging. The aim of this study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using swept source optical coherence tomography. To our knowledge, it is the first study in Tunisia which describes with precision the retinochoroidal lesions caused by Toxoplasma Gondi by means of the optical coherence tomography (OCT). METHODS: A retrospective analysis of fifteen patients diagnosed with ocular toxoplasmosis was conducted. The patients were examined at ophthalmology service of Farhat Hached Hospital in Sousse Tunisia between January 2002 and December 2019. Complete ophthalmologic examination including best-corrected visual acuity, slit lamp biomicroscopy, dilated biomicroscopic and fundus examinations, colour fundus photography as well as fluorescein angiography and OCT were done at the initial visit and during follow-up. RESULT: In the acute phase, thickening, hyper-reflectivity of the neurosensory retina, posterior shading, bumping of the RPE, hyporeflectivity and thickening of choroid were found in 86,6% of patients. During follow-up, neurosensory retinal layers thinning and disorganization, interrupting ofthe ellipsoid zone (EZ), and RPE hyper reflective were noticed in 73% of patients. The choroid became thin and more hyperreflective in 73% of patients. Multiple hyperreflective dots in the vitreous cavity and posterior hyaloid thickening were demonstrated in the acute phase in 60% of patients, with complete resolution and detachment of the posterior hyaloid in the scarred lesions. CONCLUSION: The SS-OCT is an important adjunctive imaging modality in the diagnosis and follow-up of patients with ocular toxoplasmosis.