Choroidal thickness changes after intravitreal anti-VEGF therapy for age-related macular degeneration: ranibizumab versus aflibercept

In this retrospective study, the medical records of 28 patients with nAMD treated with at least 3 consecutive monthly injections of ranibizumab (0.5 mg/0.05 mL) or aflibercept (2mg /0.05 mL) between December 2013 and June 2014 and who were followed up for at least 3 months were reviewed. Subfoveal choroidal thickness was measured using enhanced-depth-imaging optical coherence tomograph

Attenuation of choroidal tickness in patients with Alzheimer disease: evidence from an Italian prospective study

INTRODUCTION: To compare the 12-month choroidal thickness (CT) change between Alzheimer disease (AD) patients and normal subjects. METHODS: In this prospective, observational study, 39 patients with a diagnosis of mild to moderate AD and 39 age-matched control subjects were included. All the subjects underwent neuropsychological (Mini Mental State Examination, Alzheimer disease Assessment Scale-Cognitive Subscale, and the Clinical Dementia Rating Scale) and ophthalmological evaluation, including spectral domain optical coherence tomography, at baseline and after 12 months. CT was measured manually using the caliper tool of the optical coherence tomography device. RESULTS: After 12 months, AD patients had a greater reduction of CT than controls (P≤0.05, adjusted for baseline CT, age, sex, axial length, and smoking). DISCUSSION: CT in patients with AD showed a rate of thinning greater than what could be expected during the natural course of aging

Management of patients with Graves' disease and orbital involvement: role of spectral domain optical coherence tomography

PURPOSE: To investigate the role of choroidal thickness evaluation with spectral domain optical coherence tomography (SDOCT) and enhanced depth imaging (EDI) technique in the management of patients with Graves' disease and orbitopathy (GO). METHODS: Thirty-six eyes of 18 patients with GO and 36 eyes of 18 age-matched control subjects were included in this retrospective observational study. All the subjects underwent a complete ophthalmological evaluation, including clinical activity score (CAS) and exophthalmometry. The SDOCT images of the choroid were obtained by EDI modality. RESULTS: Choroidal thickness was significantly increased in GO than in control eyes (p < 0.01). A significant correlation was found between choroidal thickness and CAS, proptosis, and the duration of disease (p < 0.05). CONCLUSION: This study shows that choroidal thickness, evaluated with EDI-OCT, is significantly increased in patients with GO and correlates with the activity of the disease, proptosis, and duration of the disease. The choroidal thickening may reflect the ocular hemodynamic changes, and enhanced depth imaging optical coherence tomography may be a useful tool for the evaluation of orbital congestion and management of patients with Graves' disease and orbital involvement

Acquired ptosis associated with oculomotor and contralateral facial nerve synkinesis: the first reported case

Evidence of oculomotor nerve (ON) synkinesis is a common occurrence following both acquired and congenital III nerve palsy. It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy, following intracranial aneurysm, trauma, compressive neoplasms, cavernous sinus thrombosis and basilar meningitis

Long-term ocular biometric variations after scleral buckling surgery in macula-on rhegmatogenous retinal detachment

Background: Myopic shift and biometric ocular changes have been previously observed after scleral buckling (SB) surgery in rhegmatogenous retinal detachment (RRD), but long term-term outcomes had not yet been explored. The purpose of present study is to evaluate long term ocular biometric changes in patients with primary macula-on RRD treated with SB. Methods: In this retrospective, observational study, we reviewed the medical records of patients undergoing SB surgery for macula-on RRD. Ocular biometry was performed before and at the most recent visit after surgery. Axial length (AXL), anterior chamber depth (ACD), anterior corneal astigmatism and spherical equivalent in treated eyes were compared before and after surgery as well as with those of fellow eyes. Results: Thirty-four eyes of 17 patients with a mean age of 57.0 ± 8.9 years were included. The mean follow-up duration was 50.9 ± 21.9 months (median 53.0; range 12 to 82 months). A significant postoperative AXL increase of 0.83 mm and a concomitant myopic shift of 1.35 diopters was observed in the operated eyes (p < 0.0001). The preoperative AXL was the only predictive factor of AXL change after surgery (B = 0.152, 95% CI 0.059 to 0.245, β = 0.668, P = 0.003). Compared to fellow eyes, a postoperative ACD shallowing of 0.1 mm was found in operated eyes (p < 0.05), while there were no long-term changes of anterior corneal astigmatism. Conclusions: We show that the preoperative AXL is the only predictive factor of AXL increase after SB surgery. Scleral encircling induces a concomitant long-term shallowing of the AC, therefore fourth generation intraocular lens (IOL) power calculation formulae should be used for patients requiring cataract surgery after SB

A Novel Two-Channel Continuous-Time Time-Interleaved 3rd-order Sigma- Delta Modulator with Integrator-Sharing Topology

this paper presents a 3rd-order two-path Continuous-Time Time-Interleaved (CTTI) delta-sigma modulator which is implemented in standard 90nm CMOS technology. The architecture uses a novel method to resolve the delayless feedback path issue arising from the sharing of integrators between paths. By exploiting the concept of the time-interleaving techniques and through the use time domain equations, a conventional single path 3rd-order Discrete-Time (DT) ΔΣ modulator is converted into a corresponding two-path Discrete-Time Time-Interleaved (DTTI) counterpart. The equivalent Continuous-Time Time-Interleaved version derived from the DTTI ΔΣ modulator by determining the DT loop filters and converting them to the equivalent Continuous-Time (CT) loop filters through the use of the Impulse Invariant Transformation. Sharing the integrators between two paths of the reported modulator makes it robust to path mismatch effects compared to the typical Time-Interleaved (TI) modulators which have individual integrators in all paths. The modulator achieves a dynamic range of 12 bits with an OverSampling Ratio (OSR) of 16 over a bandwidth of 10MHz and dissipates only 28mW of power from a 1.8-V supply. The clock frequency of the modulator is 320MHz but integrators, quantizers and DACs operate at 160MHz

Management of spontaneous crystalline lens luxation in a patient diagnosed with Takayasu's disease

Takayasu's disease is a chronic granulomatous arteriopathy that affects large vessels and their major branches. Nonspecific symptoms characterize the early phase, whereas findings of arterial occlusion and aneurysmal formation become manifest later. Ocular signs typically refer to retinal vascular involvement, as Takayasu arteritis or hypertensive retinopathy. We report a case of a 63-year-old woman suffering from Takayasu arteritis that complained of sudden onset of blurred vision in her left eye due to crystalline lens luxation in the vitreous cavity. The patient's past medical history was unremarkable for trauma, personal or familiar collagenopathies. Prompt surgical management was performed and the patient reached 0 LogMAR seven days after surgery. Our case illustrates the concomitant occurrence, never reported before, of two rare conditions in the same patient, namely, Takayasu arteritis and spontaneous lens dislocation. Further research and future knowledge are needed to explain whether Takayasu arteritis could obliquely injure zonular or fibrillar structures and whether these features may be possibly related

Self-sealing posterior scleral perforation in airgun ocular trauma, surgical tip: A case report

Background: Intraorbital metallic foreign bodies have varied clinical presentations. Here, we report the unusual case of intraoperative evidence of spontaneously healed posterior scleral perforation in a severe ballistic trauma without previous instrumental signs of penetrating wound and complete visual restoration after surgery. Case presentation: The patient was hit by several lead hunting pellets in the chest, abdomen, limbs, face and orbit. Computed Tomography (CT) images revealed the presence of a pellet within the orbitary cavity, close to the optic nerve, with no signs of penetrating ocular wound. While performing vitrectomy for severe vitreous hemorrhage, a point of strong adherence between a old hemorrhage and retinal surface was identified and managed conservatively, as it was attributed to trauma related-impact area. So, lead foreign body took an unusual trajectory impacting the globe and finally lodging back in the deep orbitary cavity, in absence of significant ocular injury and with visual prognosis preservation. Conclusions: Our findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation

Macular ganglion cell layer thickness after macula-off rhegmatogenous retinal detachment repair: scleral buckling versus pars plana vitrectomy

(1) Background: We evaluated macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness in patients with primary macula-off rhegmatogenous retinal detachment (RRD) treated with scleral buckling (SB) or pars plana vitrectomy (PPV) using spectral domain optical coherence tomography (SD-OCT). (2) Methods: In this retrospective, observational study, we reviewed the medical records of patients undergoing SB or PPV surgery for macula-off RRD. SD-OCT was performed at three and 12 months after surgery. The central and parafoveal GCL-IPL thicknesses in treated eyes were compared with those of healthy fellow eyes. OCT measurements between the SB and PPV group were also compared using the analysis of covariance. (3) Results: Seventy-one eyes of 71 patients with a mean age of 61.2 ± 11.7 years were included. The parafoveal GCL-IPL thickness of the PPV group was significantly reduced, with respect to fellow eyes, at three and 12 months (p < 0.01). After adjusting for age, axial length, spherical equivalent, RD extent, preoperative intraretinal cysts, duration of symptoms and postoperative IOP, the parafoveal GCL-IPL thickness in the PPV group was significantly reduced with respect to the SB group, both at three and 12 months (F = 11.45, p = 0.001 and F = 12.37, p = 0.001, respectively). (4) Conclusions: In conclusion, the GCL-IPL is reduced in thickness in eyes with macula-off RRD treated with vitrectomy and is significantly thinner compared to eyes undergoing scleral buckling surgery

Cocaine abuse as an immunological trigger in a case diagnosed with eales disease

Background: Eales disease is a clinical syndrome affecting the mid-peripheral retina with an idiopathic occlusive vasculitis and possible subsequent retinal neovascularization. The disease can develop into visually threatening complications. Case Presentation: We report the case of a 40-year-old Caucasian male with a history of cocaine abuse who presented with blurred vision in the left eye (LE). Fundus examination showed vitreous hemorrhages, peripheral sheathing of venous blood vessels, areas of retinal neovascularization in the LE, and peripheral occlusive phlebitis in the right eye. The full serologic panel was negative except for the heterozygous mutation of factor V Leiden. Clinical and biochemical parameters suggested a diagnosis of Eales disease. Therapy with dexamethasone, 1 mg per kg per day, tapered down slowly over 4 months, and peripheral laser photocoagulation allowed a regression of clinical signs and symptoms. Conclusion: This case shows an uncommon presentation of Eales disease associated with cocaine abuse. Both cocaine abuse and a thrombophilic pattern, as cofactors, might have sensitized the retinal microcirculation on the pathogenetic route to this retinal pathology. Furthermore, in view of this hypothesis, a thorough ocular and general medical history investigating drug abuse and coagulation disorders is recommended for ophthalmologists in such cases