Five-Year Follow-Up of Repeated Intravitreal Bevacizumab for Macular Edema in a Pediatric Patient with Retinal Arteriovenous Malformation and Excellent Vision.

We report a case of a 9-year-old girl presenting with unilateral retinal arteriovenous malformation (AVM) with symptomatic macular edema. Over 5 years of follow-up includes optical coherence tomography (OCT), fundus photographs, and fluorescein angiography at baseline and at follow-up. Systemic and neurologic workup was completed and negative for intracranial AVM. Vision has correlated with macular edema, ranging from 20/20 to 20/80. The patient has received nine injections of intravitreal bevacizumab and has not required an injection for the last couple of years. Follow-up is ongoing.

Hemorrhagic Occlusive Retinal Vasculitis Associated With Triamcinolone-Moxifloxacin Use During Uncomplicated Cataract Surgery.

This case series describes the outcomes of cataract extraction with intraocular lens placement in 2 patients.

Swept-Source OCT Angiography of Multiple Evanescent White Dot Syndrome With Inflammatory Retinal Pigment Epithelial Detachment.

A 30-year-old woman with photopsias and decreased vision was diagnosed with multiple evanescent white dot syndrome (MEWDS) with an atypical inflammatory subfoveal retinal pigment epithelial detachment (PED) and imaged using swept-source optical coherence tomography (SS-OCT) during several visits. SS-OCT imaging revealed a focal area of attenuated choriocapillaris underneath the PED. An attempt to treat the presumed macular inflammatory lesion with corticosteroids resulted in bilateral exudation consistent with central serous chorioretinopathy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:145-151.].

Comparison of Neovascular Lesion Area Measurements From Different Swept-Source OCT Angiographic Scan Patterns in Age-Related Macular Degeneration.

Purpose: We compared area measurements for the same neovascular lesions imaged using swept source optical coherence tomography angiography (SS-OCTA) and enlarging scan patterns. Methods: Patients with neovascular age-related macular degeneration were imaged using a 100-kHz SS-OCTA instrument (PLEX Elite 9000). The scanning protocols included the 3 × 3, 6 × 6, 9 × 9, and 12 × 12 mm fields of view. Two groups were studied. Group 1 included small lesions contained within the 3 \( \times \) 3 mm scan, and Group 2 included larger lesions that were fully contained within the 6 \( \times \) 6 mm scan. Results: A total of 30 eyes of 26 patients were enrolled in Group 1 and 30 eyes of 25 patients were enrolled in Group 2. In Group 1, the automated mean lesion area measurements were 1.11 (SD = 0.78), 1.14 (SD = 0.80), and 1.27 (SD = 0.82) mm2 for the 3 \( \times \) 3, 6 \( \times \) 6, and 12 \( \times \) 12 mm scans, respectively (ANOVA P < 0.001; post hoc comparisons, P = 0.184, 3 \( \times \) 3 vs. 6 \( \times \) 6 mm; P < 0.001 for the other two pairs). In Group 2, the automated mean lesion area measurements were 5.43 (SD = 2.56), 5.53 (SD = 2.48), and 5.49 (SD = 2.65) mm2 for the 6 \( \times \) 6, 9 \( \times \) 9, and 12 \( \times \) 12 mm scans, respectively (ANOVA P = 0.435; post-hoc comparisons, P = 0.062, 6 \( \times \) 6 vs. 9 \( \times \) 9 mm; P = 0.553, 6 \( \times \) 6 vs. 12 \( \times \) 12 mm; P = 0.654, 9 \( \times \) 9 vs. 12 \( \times \) 12 mm). Conclusions: The similarity in lesion area measurements across different scan patterns suggests that SS-OCTA imaging can be used to follow quantitatively the enlargement of choroidal neovascularization as the disease progresses.

Comparison Between Spectral-Domain and Swept-Source Optical Coherence Tomography Angiographic Imaging of Choroidal Neovascularization.

Purpose: The purpose of this study was to compare imaging of choroidal neovascularization (CNV) using swept-source (SS) and spectral-domain (SD) optical coherence tomography angiography (OCTA). Methods: Optical coherence tomography angiography was performed using a 100-kHz SS-OCT instrument and a 68-kHz SD-OCTA instrument (Carl Zeiss Meditec, Inc.). Both 3 × 3- and 6 × 6-mm2 scans were obtained on both instruments. The 3 × 3-mm2 SS-OCTA scans consisted of 300 A-scans per B-scan at 300 B-scan positions, and the SD-OCTA scans consisted of 245 A-scans at 245 B-scan positions. The 6 × 6-mm2 SS-OCTA scans consisted of 420 A-scans per B-scan at 420 B-scan positions, and the SD-OCTA scans consisted of 350 A-scans and 350 B-scan positions. B-scans were repeated four times at each position in the 3 × 3-mm2 scans and twice in the 6 × 6-mm2 scans. Choroidal neovascularization was excluded if not fully contained within the 3 × 3-mm2 scans. The same algorithm was used to detect CNV on both instruments. Two graders outlined the CNV, and the lesion areas were compared between instruments. Results: Twenty-seven consecutive eyes from 23 patients were analyzed. For the 3 × 3-mm2 scans, the mean lesion areas for the SS-OCTA and SD-OCTA instruments were 1.17 and 1.01 mm2, respectively (P = 0.047). For the 6 × 6-mm2 scans, the mean lesion areas for the SS-OCTA and SD-OCTA instruments were 1.24 and 0.74 mm2 (P = 0.003). Conclusions: The areas of CNV tended to be larger when imaged with SS-OCTA than with SD-OCTA, and this difference was greater for the 6 × 6-mm2 scans.

Egg Activation at Fertilization.

Fertilization is the union of gametes to initiate development of a new individual. The female gamete is formed during oogenesis. The process begins when, in the early embryo, primordial germ cells arise and subsequently colonize the genital ridges. They differentiate into oogonia, start meiosis, and become primary oocytes. The cell cycle of the primary oocytes then becomes arrested in mid-meiosis for an extended period of time. Prior to ovulation the oocytes undergo a growth phase and their sizes increase significantly. A hormonal cue then triggers oocyte maturation that involves the resumption of meiosis, the completion of the first meiotic division, and, as a result, the reduction in the diploid chromosome number. The cell cycle then stops again; in vertebrates this arrest occurs at the metaphase stage of the second meiotic division. Meiosis resumes at fertilization, when the sperm activates the egg, i.e., it causes a series of changes that are required for the initiation of embryo development. This is achieved by triggering an elevation in the egg's intracellular free calcium concentration. In response, the fertilized egg completes meiosis and enters the first embryonic cell cycle.

Choroidal Thickness and Choroidal Vessel Density in Nonexudative Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Imaging.

Purpose: To analyze the relationship between choroidal thickness and the distribution of choroidal blood vessels in eyes with nonexudative AMD. Methods: Eyes with a diagnosis of nonexudative AMD were imaged using a prototype 100-kHz swept-source (SS) optical coherence tomography (OCT) instrument (Carl Zeiss Meditec, Dublin, CA, USA) with a central wavelength of 1050 nm. We used an OCT cube scan pattern consisting of 512 × 512 A-scans over a 12 × 12 mm retinal area. The eyes were partitioned into two groups based on the presence or absence of reticular pseudodrusen (RPD). All scans were segmented using an automated algorithm. In addition, five eyes from each of the two groups were randomly chosen for manual segmentation. Binary choroidal vessels maps were generated from suitable OCT choroidal slabs, and the relationship between the density of large choroidal vessels and choroidal thickness was analyzed using an Early Treatment Diabetic Retinopathy Study-like target centered on the fovea. Results: Twenty-five eyes were enrolled in each group. The automated algorithm produced accurate choroidal thickness maps with an average difference between the manual and automated segmentations of 13.7 µm. There was a significant and stable correlation between choroidal thickness and choroidal vessel density across the two groups. Both average choroidal thickness and vessel density were significantly lower in eyes with RPD. Conclusions: Our fully automated choroidal segmentation algorithm was able to capture the different patterns of choroidal thickness over a wide area. Choroidal thickness has a clear relationship with the density of large choroid vessels in our sample, irrespective of the presence or absence of RPD.

Artifactual Flow Signals Within Drusen Detected by OCT Angiography.

BACKGROUND AND OBJECTIVE: To demonstrate possible flow artifacts when imaging drusen with optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Patients with drusen were enrolled in a prospective OCT study using the Zeiss AngioPlex OCTA instrument (Carl Zeiss Meditec, Dublin, CA). Two kinds of en face slabs were created for visualizing both structure and flow. The first slab followed the contour of Bruch's membrane. The second slab had an inner boundary following the retinal pigment epithelium (RPE) contour and an outer boundary following the contour of Bruch's membrane. The structure and flow signals from within the drusen were compared. RESULTS: Eleven eyes of nine patients with age-related macular degeneration and drusen were imaged. In all 11 eyes, an artifactual flow signal was seen on the first slab where it intersected the RPE. This flow signal was a projection artifact from the overlying retinal vessels. The second slab did not show evidence of flow within drusen. CONCLUSION: OCTA decorrelation projection artifacts can be misinterpreted as apparent flow within drusen if the slab region includes hyperreflective boundary layers such as the RPE. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:517-522.].

Portable, battery-operated, low-cost, bright field and fluorescence microscope.

This study describes the design and evaluation of a portable bright-field and fluorescence microscope that can be manufactured for $240 USD. The microscope uses a battery-operated LED-based flashlight as the light source and achieves a resolution of 0.8 microm at 1000x magnification in fluorescence mode. We tested the diagnostic capability of this new instrument to identify infections caused by the human pathogen, Mycobacterium tuberculosis. Sixty-four direct, decontaminated, and serially diluted smears were prepared from sputa obtained from 19 patients suspected to have M. tuberculosis infection. Slides were stained with auramine orange and evaluated as being positive or negative for M. tuberculosis with both the new portable fluorescence microscope and a laboratory grade fluorescence microscope. Concordant results were obtained in 98.4% of cases. This highly portable, low cost, fluorescence microscope may be a useful diagnostic tool to expand the availability of M. tuberculosis testing at the point-of-care in low resource settings.

The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip.

We explored the mechanical factors leading to the formation of labral tears and the effect of these lesions on hip kinematics at the extremes of joint motion. Using a 3D motion analysis system, the stability of six cadaveric hips was measured during loading maneuvers known to impose anterior loads on the joint margin. These measurements were repeated following venting of the capsule, and after creation of a 15-mm tear in the intact labrum. Compared to the intact hip, 43% and 60% less force was required to distract the femur by 3 mm after venting and creation of a tear. An ER torque of 177 in-lbf in 30 degrees of flexion caused the vented and torn specimens to rotate 1.5 degrees +/- 2.7 degrees and 7.1 degrees +/- 4.7 degrees more than the intact specimen, and the femoral head to displace 1.21 +/- 0.53 mm and 0.67 +/- 0.35 mm, respectively. A breach of the integrity of labral function is shown to lead to decreased femoral stability relative to the acetabulum during extreme ranges of motion.