Assessing Fuchs Corneal Endothelial Dystrophy Using Artificial Intelligence-Derived Morphometric Parameters From Specular Microscopy Images.

PURPOSE: The aim of this study was to evaluate the efficacy of artificial intelligence-derived morphometric parameters in characterizing Fuchs corneal endothelial dystrophy (FECD) from specular microscopy images. METHODS: This cross-sectional study recruited patients diagnosed with FECD, who underwent ophthalmologic evaluations, including slit-lamp examinations and corneal endothelial assessments using specular microscopy. The modified Krachmer grading scale was used for clinical FECD classification. The images were processed using a convolutional neural network for segmentation and morphometric parameter estimation, including effective endothelial cell density, guttae area ratio, coefficient of variation of size, and hexagonality. A mixed-effects model was used to assess relationships between the FECD clinical classification and measured parameters. RESULTS: Of 52 patients (104 eyes) recruited, 76 eyes were analyzed because of the exclusion of 26 eyes for poor quality retroillumination photographs. The study revealed significant discrepancies between artificial intelligence-based and built-in microscope software cell density measurements (1322 ± 489 cells/mm 2 vs. 2216 ± 509 cells/mm 2 , P < 0.001). In the central region, guttae area ratio showed the strongest correlation with modified Krachmer grades (0.60, P < 0.001). In peripheral areas, only guttae area ratio in the inferior region exhibited a marginally significant positive correlation (0.29, P < 0.05). CONCLUSIONS: This study confirms the utility of CNNs for precise FECD evaluation through specular microscopy. Guttae area ratio emerges as a compelling morphometric parameter aligning closely with modified Krachmer clinical grading. These findings set the stage for future large-scale studies, with potential applications in the assessment of irreversible corneal edema risk after phacoemulsification in FECD patients, as well as in monitoring novel FECD therapies.

Agreement and Reproducibility of Anterior Chamber Angle Measurements between CASIA2 Built-In Software and Human Graders.

PURPOSE: This study evaluated the agreement and reproducibility of ACA measurements obtained using the built-in software of the CASIA2 (Version 3G.1) and the measurements derived from expert clinicians. METHODS: Healthy volunteers underwent ophthalmological evaluation and AS-OCT examination. ACA measurements derived from automated and manual SS location were obtained using the CASIA2 automated software and clinician identification, respectively. The intraobserver, interobserver reproducibility, CASIA2-human grader reproducibility and CASIA2 repeatability were assessed using intraclass correlation coefficients (ICCs). RESULTS: The study examined 58 eyes of 30 participants. The CASIA2 software showed excellent repeatability for all ACA parameters (ICC > 0.84). Intraobserver, interobserver, and CASIA2-human grader reproducibility were also excellent (ICC > 0.87). Interobserver agreement was high, except for nasal TISA500, differing between observers 1 and 2 (p < 0.05). The agreement between CASIA2 measurements and human graders was high, except for nasal TISA500, where observer 1 values were smaller (p < 0.05). CONCLUSION: The CASIA2 built-in software reliably measures ACA parameters in healthy individuals, demonstrating high consistency. Although a small difference was observed in nasal TISA500 measurements, interobserver and CASIA2-human grader reproducibility remained excellent. Automated SS detection has the potential to facilitate evaluation and monitoring of primary angle closure disease.

Agreement between Two Swept-source Optical Coherence Tomography: Optic Nerve Head, Retinal Nerve Fiber Layer and Ganglion Cell Layers in Healthy Eyes.

Aim and background: Precision of optical coherence tomography (OCT) measurements of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular ganglion cell layer (GCL) is essential for the diagnosis and monitoring of glaucoma. The purpose of this research was to evaluate the repeatability and reproducibility of retinal and ONH parameters measured with two identical swept-source optical coherence devices. Methods: A cross-sectional study was conducted. A total of 30 eyes of 15 healthy subjects were included. Two technicians performed four OCT-wide protocol scans in the same visit using two identical Triton swept-source OCT (DRI-OCT) instruments. The interdevice and interobserver reproducibility and the repeatability of both instruments for all ONH, RNFL, and macular GCL parameters were evaluated by the intraclass correlation coefficient (ICC). Additionally, Bland-Altman test analysis was used for repeatability and reproducibility measurements. Results: Intraclass correlation coefficient (ICCs) of the ONH, RNFL, and GCL measurements were excellent for repeatability and interdevice reproducibility (>0.9). Interobserver reproducibility was good for all parameters except for RNFL clock hour 11 (ICC = 0.72). The variability of the average RNFL was from -4.103 to 4.97 µm, with a mean percentage of the difference (PD) of 0.37 ± 2.03%. Among GCL parameters, the greatest variability was found in the inferior sector (PD = -0.88 ± 5.39%, limits of agreement (LoA) = -8.345-7.078 µm). Conclusion: Using two identical swept-source OCT instruments for the evaluation of the structural parameters of the ONH, RNFL, and macular GCL showed high repeatability and reproducibility. This allows the clinician to make a therapeutic decision based on OCT findings coupled with the clinical evaluation of the patient. When evaluating RNFL clock hours measurements, interobserver reproducibility might decrease. Clinical significance: The understanding of measurement variability while using different devices and the impact of the observer capturing the images, is clinically relevant. How to cite this article: Prada AM, Tello A, Rangel CM, et al. Agreement between Two Swept-source Optical Coherence Tomography: Optic Nerve Head, Retinal Nerve Fiber Layer and Ganglion Cell Layers in Healthy Eyes. J Curr Glaucoma Pract 2023;17(2):85-90.

Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery.

BACKGROUND: Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS: An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS: The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS: The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

Corneal endothelium assessment in specular microscopy images with Fuchs' dystrophy via deep regression of signed distance maps.

Specular microscopy assessment of the human corneal endothelium (CE) in Fuchs' dystrophy is challenging due to the presence of dark image regions called guttae. This paper proposes a UNet-based segmentation approach that requires minimal post-processing and achieves reliable CE morphometric assessment and guttae identification across all degrees of Fuchs' dystrophy. We cast the segmentation problem as a regression task of the cell and gutta signed distance maps instead of a pixel-level classification task as typically done with UNets. Compared to the conventional UNet classification approach, the distance-map regression approach converges faster in clinically relevant parameters. It also produces morphometric parameters that agree with the manually-segmented ground-truth data, namely the average cell density difference of -41.9 cells/mm2 (95% confidence interval (CI) [-306.2, 222.5]) and the average difference of mean cell area of 14.8 µm 2 (95% CI [-41.9, 71.5]). These results suggest a promising alternative for CE assessment.

Resolución de neuropatía óptica y oft almoplegía después del tratamiento quirúrgico de un mucocele / Resolution of optic neuropathy and ophthalmoplegia following mucocele ethmoidectomy and drainage

Introducción: Los mucoceles de senos paranasales pueden afectar la órbita, más frecuentemente cuando su localización es frontoethmoidal originando un efecto de masa. Objetivo: Reportar el compromiso orbitario y riesgo para la visión permanente en un caso de mucocele. Diseño del estudio: Reporte de caso Resumen del caso: Paciente femenina con proptosis unilateral progresiva de larga data, disminución progresiva de la agudeza visual y oft almoplegía. La tomografía computarizada de la órbita reveló un mucocele del seno etmoidal comprimiendo el nervio óptico y el ápex de la órbita. Posterior al manejo quirúrgico, etmoidectomia y drenaje del mucocele, se presenta una marcada mejoría de la función del nervio óptico, motilidad ocular y proptosis. Conclusión: Es muy raro que los mucoceles etmoidales afecten el nervio óptico sin embargo hay algunas características que los pueden llevar a afectar la visión: infección asociada, compromiso de las celdillas etmoidales posteriores o un mucocele gigante con tratamiento tardío. Es importante conocer los signos y síntomas oft almológicos que nos pueden ayudar a diagnosticar el compromiso orbitario por mucocele en etapas tempranas. Esta patología se debe atender de manera multidisciplinaria con especialistas en órbita y otorrinolaringología.

Background: Orbital involvement of sinus mucoceles, especially frontoethmoidal may result in orbital mass eff ect. Objective: Describe orbital involvement and potential for visual loss in a case with mucocele. Study design: Case report Case summary: Th ese is a patient with longstanding unilateral proptosis, progressive decrease in visual acuity and ophthalmoplegia. Orbital computed tomography (CT) revealed a large ethmoidal sinus mucocele compressing the optic nerve and orbital apex. Improvement in optic nerve function, motility and proptosis resulted from ethmoidectomy and mucocele drainage. Conclusion: Although frontoethmoidal mucoceles seldom aff ect the optic nerve, there may be cases with potential to aff ect vision; this may occur more frequently when a coexistent infection is present, when the posterior ethmoid cell is involved or when a giant mucocele is present and treatment is delayed. Th is pathology must be addressed in a multidisciplinary manner with otolaryngologists and orbit specialists.

Study of marsh foraminifera from the coastal plain of Buenos Aires (Argentina) and its ecological implications.

The objective of this work was determinate the diversity and abundance of benthic foraminifers from recent sediments of Channel 15, Samborombón Bay (35º57´-35º58´S and 57º25´-57º22´W). From this analysis, we identified 31 species grouped within 17 genera. The assemblages were composed mainly of hyaline and agglutinated forms characterized by Elphidium aff. poeyanum, Elphidium gunteri, Ammonia parkinsoniana, Arenoparella mexicana and Trochammina inflata, reflecting an environment of marsh or floodplain. The foraminifer's tests were generally well preserved, with morphologies that indicate predominantly epifauna and epifauna-infauna. The present work shows that despite having a general fauna characteristic of these environments, there are small microenvironments that are characterized by the state of preservation, diversity and abundance of the found specimens. In that context, three associations were recognized; A, dominated by Astrononion sp.1 that was registered in the central part of the channel; association B, characterized mainly by E. aff. poeyanum that was founded in the internal and external areas of the channel and association C, characterized by a considerable increase of mentioned agglutinated species (close to 50%) registered in the center of the channel. This study represents one of the first contributions on the distribution of foraminifera and their ecological characteristics from recent sediments in Samborombón Bay.

Long-term endothelial cell loss with the iris-claw intraocular phakic lenses (Artisan®).

PURPOSE: To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. METHODS: We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. RESULTS: We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm2. None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm2). CONCLUSIONS: There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.

Sífilis ocular en una población Colombiana: manifestaciones clínicas y resultados del tratamiento / Ocular syphilis in a Colombian population: clinical manifestations and treatment outcomes

Diseño de estudio: Retrospectivo observacional descriptivo. Método: Se recolectaron datos de pacientes con sífilis ocular evaluados en un centro de referencia de oftalmología en Colombia desde marzo de 2015 hasta febrero de 2017. Resultados: Dieciséis pacientes fueron diagnosticados con sífilis ocular durante el período estudiado. Cuatro (25%) pacientes tuvieron afectación de ambos ojos, para un total de 20 ojos. Hubo 11 (68.8%) hombres y 5 (31.3%) mujeres. La edad media de presentación fue de 51.1 años (23-86 años). Cuatro pacientes masculinos estaban coinfectados con VIH. La manifestación más frecuente fue la panuveítis en ocho ojos (40%). Seis pacientes (37.5%) presentaron hallazgos dermatológicos sistémicos. El tratamiento incluyó penicilina cristalina y esteroides sistémicos. El seguimiento medio fue de 16.2 meses (12-21 meses). La agudeza visual media mejoró de 1,01 ± 0,71 logMAR a 0,58 ± 0,64 logMAR después del tratamiento. Conclusión: La sífilis es una causa poco común de infl amación intraocular. Sin embargo, la incidencia ha venido en aumento en los últimos años tanto en pacientes VIH positivo como VIH negativo. La panuveítis es el hallazgo ocular más frecuente. El pronóstico visual es bueno si hay un diagnóstico y tratamiento temprano.

Background: Syphilis is a sexually transmitted disease caused by Treponema pallidum. It can remain dormant in the individual throughout life. The manifestations of ocular involvement are similar to other infl ammatory eye conditions. It is crucial to make an early diagnosis and management in order to avoid complication. Objective: to describe the clinical characteristics and the results of the treatment of patients with ocular syphilis. Study design: observational retrospective study. Method: Retrospective cohort of patients with ocular syphilis evaluated in an ophthalmology reference center in Colombia from March 2015 to February 2017. Results: Sixteen patients were diagnosed with ocular syphilis during the studied period. Four (25%) patients had involvement of both eyes, for a total of 20 eyes. There were 11 (68.8%) men and 5 (31.3%) women. The mean age of presentation was 51.1 years (23-86 years). Four male patients were coinfected with HIV. Th e most frequent manifestation was panuveitis in eight eyes (40%). Six patients (37.5%) presented systemic dermatological fi ndings. Treatment included crystalline penicillin and systemic steroids. The mean follow-up was 16.2 months (12-21 months). The mean visual acuity improved from 1.01 ± 0.71 logMAR to 0.58 ± 0.64 logMAR after treatment. Conclusion: Syphilis is a rare cause of intraocular inflammation. However, the incidence has been increasing in recent years in both HIV positive and HIV negative patients. Panuveitis is the most frequent ocular finding. The visual prognosis is good if there is an early diagnosis and treatment.

Surgical management of strabismus following choroidal melanoma plaque brachytherapy.

PURPOSE: To characterize intraoperative findings, surgical approach, and postoperative outcomes in patients undergoing strabismus surgery following plaque brachytherapy for ocular melanoma. METHODS: The records of all patients who underwent plaque brachytherapy for choroidal melanoma between May 2007 and June 2016 were reviewed retrospectively to identify those who subsequently required strabismus surgery. RESULTS: Of the 461 patients who underwent plaque brachytherapy during the study period, 13 (2.8%) met inclusion criteria. Visual acuity of the affected eye was 20/40 or better in 9 patients (69%). Preoperative horizontal deviation ranged from 0Δ to 52Δ; vertical deviation, from 2Δ to 25Δ. At final follow-up mean horizontal deviation ranged from 0 to 4Δ; vertical deviation, from 0Δ to 12Δ. Intraoperatively, all muscles directly adjacent to the treated area appeared macroscopically thicker than normal despite being functionally underacting. Magnetic resonance imaging showed enlarged muscles adjacent to the plaque radiotherapy. Microscopic examination of muscles in 2 patients showed reactive enlargement of the muscle fibers, granulation tissue, and inflammation. CONCLUSIONS: Persistent strabismus after plaque brachytherapy is rare. Typical findings include enlarged, underacting rectus muscles adjacent to the area of the plaque, restrictive connective tissue, and incomitant strabismus. Previously disinserted muscles may be found in abnormal locations. In this patient cohort scar tissue removal in conjunction with tightening procedures on the muscle adjacent to the plaque combined with recession of the antagonist muscle frequently resulted in good anatomical outcome.

Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision.

Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma. Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere® and Contour® microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

Sindrome Straatsma asociado a agujero macular lamelara / Straatsma syndrome asociated with macular lamellar hole

Objetivo: Describir el caso clínico de una paciente con síndrome de Straatsma asociado con agujero macular lamelar. Métodos: Reporte de caso. Resultados: Reportamos un caso de una paciente de 17 años de edad con hallazgos de mielinización de capa de fibras nerviosas en el ojo izquierdo, asociado a miopía y ambliopía, lo cual conforma el síndrome de Straatsma. Además, la paciente presenta agujero macular lamelar, una rara asociación con este síndrome. Conclusión: El síndrome de Straatsma es una patología rara, caracterizada por la presencia de mielinizacion de capa de fibras nerviosas, miopía y ambliopía; el cual puede estar asociado a otro tipo de complicaciones retinianas como oclusiones vasculares, membranas epirretinianas, agujeros maculares de espesor total y lamelares, las cuales pueden llevar a empeoramiento de la visión.

Objective: To describe the clinical case of a patient with Straatsma syndrome associated with a macular lamellar hole. Methods: Case report. Results: We report a case of a 17-year-old female patient with findings of myelinization retinal nerve fibers in the left eye, associated with myopia and amblyopia, which forms the Straatsma syndrome. In addition, the patient has a macular lamellar hole, a rare association with this syndrome. Conclusion: Straatsma syndrome is a rare pathology, characterized by the presence of myelinization of nerve fiber layer, myopia and amblyopia; which may be associated with other types of retinal complications such as vascular occlusions, epiretinal membranes, macular and lamellar holes, which can lead to worsening of vision.

Immune recovery uveitis in a patient with previously undiagnosed cytomegalovirus retinitis.

A 40-year-old man presented to the emergency service of the Department of Ophthalmology, Fundación Oftalmológica de Santander, Floridablanca, Colombia, with blurred vision in his right eye. Anamnesis revealed that he also had newly diagnosed stage C HIV. He had recently started highly active antiretroviral therapy (HAART). Examination disclosed intraocular inflammation, along with plain white peripheral non-exudative lesions with sparse haemorrhaging. The differential diagnosis included cytomegalovirus (CMV) retinitis and immune recovery uveitis (IRU). On follow-up, the patient's left eye presented with decreased visual acuity and increased vitreous haze. A vitrectomy with vitreous tap was performed for microbiological studies. PCR for CMV in the vitreous sample was negative. The patient was discharged with the final diagnosis of IRU. In HIV patients with uveitis, the knowledge of characteristic signs and symptoms of particular entities such as opportunistic infections and IRU will enable the clinician to give the appropriate treatment.

Iris coloboma in one eye and pigment dispersion syndrome in the fellow eye.

We report a case of a 43-year-old patient with coloboma of the iris, zonule, ciliary body, choroid and retina in the right eye and pigment dispersion syndrome in the left eye. Considering the hypothesis of the pigment dispersion syndrome pathogenesis in which a difference of pressures in the anterior and posterior chambers creates a posterior convexity of the iris leading to reverse pupillary block, iris touch and consequently causing pigment dispersion, we suggest that the presence of an iris coloboma, by equalising the pressures in the two chambers, prevented the onset of syndrome in that eye.