A Study Of Orbital Fractures In A Tertiary Health Care Center

A retrospective study of patients with orbital fractures had 48% patients in the age group of 20 – 40 years with male : female ratio of 10:1. Road traffic accidents (71.43%) were the most common cause followed by injury due to fall (20%). Eighty five percent of patients had normal visual acuity at presentation and 65.57% patients had no ocular complaints. Diplopia was present in 14.2% of patients. Of the orbital fractures infraorbital rim was involved in 43.13%, floor in 19.6%, lateral wall in 13.7%, pure blow out in 14.28% and the roof in 2.9%. Important ocular findings were extraocular movements restriction in 9 (10.3%), infraorbital dysaesthesia in 3 (3.4%), enophthalmos in 2, RAPD and globe rupture in 1 patient each. 32 patients underwent surgical management. At the end of 4 months of follow up, 3 had restriction of EOM, 1 patient had vision loss due to globe rupture, 2 had RAPD (optic nerve compression), 1 had lagophthalmos, 1 had exotropia and 1 had atrophic bulbi

Optical coherence tomography angiography: a non-invasive tool to image end-arterial system

Optical coherence tomography angiography (OCTA) is a relatively novel technology for in vivo imaging of vascular network. It uses moving erythrocytes as contrasting mechanism and avoids the use of intravenous dyes. A depth-resolved 3-dimensional image set can be generated within seconds using the technique of OCTA. Therefore, it possesses a great potential for widespread application in ophthalmic angiography. Herein we discuss the most common technologies behind OCTA and the scope of future technical improvement. We provide a perspective on advantages and disadvantages of OCTA over conventional fluorescein angiography and indocyanine green angiography. Lastly, current literature on the clinical application of OCTA in common ocular diseases including neovascular age-related macular degeneration, diabetic retinopathy, retinal artery and vein occlusion, and glaucoma are reviewed

3D visualization and mapping of choroid thickness based on optical coherence tomography: A step-by-step geometric approach

Although bodily organs are inherently 3D, medical diagnosis often relies on their 2D representation. For instance, sectional images of the eye (especially, of its posterior part) based on optical coherence tomography (OCT) provide internal views, from which the ophthalmologist makes medical decisions about 3D eye structures. In the course, the physician is forced to mentally synthesize the underlying 3D context, which could be both time consuming and stressful. In this backdrop, can such 2D sections be arranged and presented in the natural 3D form for faster and stress-free diagnosis? In this paper, we consider ailments affecting choroid thickness, and address the aforementioned question at two levels-in terms of 3D visualization and 3D mapping. In particular, we exploit the spherical geometry of the eye, align OCT sections on a nominal sphere, and extract the choroid by peeling off inner and outer layers. At each step, we render our intermediate results on a 3D lightfield display, which provides a natural visual representation. Finally, the thickness variation of the extracted choroid is spatially mapped, and observed on a lightfield display as well as using 3D visualization softwares on a regular 2D terminal. Consequently, we identified choroid depletion around optic disc based on the test OCT images. We believe that the proposed technique would provide ophthalmologists with a tool for making faster diagnostic decisions with less stress

En-face optical coherence tomography in the diagnosis and management of age-related macular degeneration and polypoidal choroidal vasculopathy

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Wide-field choroidal thickness profile in healthy eyes

The introduction of wide field optical coherence tomography (WF-OCT) has provided newer insights in the imaging of peripheral choroid. We evaluated choroidal thickness (CT) and large choroidal vessel thickness (LCVT) of 20 eyes in horizontal and vertical meridians using WF-OCT. A high-definition line scan through the fovea in both horizontal and vertical meridian was captured in primary and extremes of gaze to obtain scans up to mid-equator. CT and LCVT measurements were done across predefined points in macular area and all quadrants. LCVT was calculated after identifying a large choroidal vessel near choroidoscleral interface. The main outcome measures were differences in CT and LCVT in macular and four quadrants. Mean CT (331.23\u2009\ub1\u200976.34\u2009\ub5) and LCVT (201.46\u2009\ub1\u200954.31\u2009\ub5) in vertical macular segment were significantly more than CT (245.79\u2009\ub1\u200955.38\u2009\ub5; p\u2009=\u20090.0002) and LCVT (150.48\u2009\ub1\u200952.58\u2009\ub5; p\u2009=\u20090.004) in horizontal macular segment. CT at peripheral points in all quadrants was significantly reduced as compared to subfoveal CT (all p values\u2009<\u20090.05) with maximum reduction in inferior quadrant (64.5%). Using linear regression, only quadrant had a significant effect on CT and LCVT (both p\u2009<\u20090.001). CT and LCVT are highest at the macular area with reduction towards the periphery. The contribution of LCVT to CT is less at the fovea compared to other peripheral points

Quantitative and Qualitative Assessments of Retinal Structure with Variable A-Scan Rate Spectralis OCT: Insights into IPL Multilaminarity

The aim of this study was to evaluate the qualitative and quantitative differences between 20 and 85 kHz A-scan rate optical coherence tomography (OCT) images acquired by spectral domain OCT. The study included 60 healthy subjects analyzed with horizontal linear scans with a variable A-scan rate (SHIFT technology, Heidelberg Engineering, Heidelberg, Germany). The retinal thickness measurement of each retinal layer was performed in three different positions (subfoveal, nasal, and temporal). The qualitative assessment was performed by two independent observers who rated every image with a score ranging from 1 ("sufficient") to 3 ("excellent") on the basis of three parameters: visualization of the vitreo-retinal interface, characterization of the retinal layers, and visualization of the sclero-choroidal interface. No statistically significant differences in terms of retinal layer thickness between the two A-scan rate scans were observed (p > 0.05). The coefficient of variation of the retinal thickness values was lower in the 20 kHz group (25.8% versus 30.1% with the 85 kHz). The 20 kHz images showed a higher quality index for both observers. An inner plexiform layer (IPL) multilaminarity was detected in 78.3% of patients from the 20 kHz group and in 40% of patients from the 85 kHz group (p < 0.05)

Choroidal structural changes correlate with neovascular activity in neovascular age related macular degeneration

PURPOSE. To correlate changes in choroidal thickness and vascularity index with disease activity in patients with neovascular age-related macular degeneration (nAMD). METHODS. Eyes diagnosed with AMD that had two sequential visits within 12 months and that had no choroidal neovascularization (CNV) or had inactive CNV at the first visit were included. Those that had active CNV at follow-up were enrolled as cases. Eyes that did not developed a CNV or that were still inactive at the second visit were enrolled as controls. Disease activity was based on optical coherence tomography (OCT) and fluorescein angiography findings. Subfoveal choroidal thickness (SCT), mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were assessed on enhanced depth imaging OCT and compared between the baseline and follow-up visit. Subgroup analysis accounting for lesion type and previous treatment, if any, were performed. RESULTS. Sixty-five eyes from 60 patients (35 females) and 50 age-and sex-matched controls were included. At the active visit, cases had an increase from 164 +/- 67 mu m to 175 +/- 70 mu m in mean +/- SD SCT and from 144 +/- 45 mu m to 152 +/- 45 mu m in MCT (both P < 0.0001). The mean CVI also increased at from 54.5% +/- 3.3% to 55.4% +/- 3.8% (P = 0.04). Controls did not show significant changes in choroidal measurements between the two visits. Mean SCT, MCT, and CVI values were similar for previously treated and treatment-naive eyes. CONCLUSIONS. Choroidal thickness and CVI significantly increased with active disease in nAMD eyes. Changes in choroidal thickness may predict CNV development or recurrence before they are otherwise evident clinically

Intravitreal sirolimus for persistent, exudative age-related macular degeneration: a Pilot Study

Background and objective: To evaluate the safety and efficacy of intravitreal sirolimus for persistent, exudative age-related macular degeneration (AMD). Methods: This institutional review board approved, registered (NCT02357342), prospective, subject-masked, single center, randomized controlled trial in subjects with persistent, exudative Age-related macular degeneration compared intravitreal sirolimus monotherapy (every 2 months) versus monthly anti-vascular endothelial growth factor (VEGF) over six months. Results: 20 subjects were randomized to each arm of the trial. Upon completion of the trial 20 patients were analyzed in the control (anti-vascular endothelial growth factor) group and 17 patients were analyzed in the treatment (sirolimus) group. On average, subjects had 33 previous anti-VEGF injections prior to entry. The primary end-point, mean central subfield thickness (CST), increased by 20 µm in the anti-vascular endothelial growth factor group and decreased by 40 µm in the sirolimus group (p = 0.03). Visual acuity outcomes were similar between groups. Serious ocular adverse events in the sirolimus group included one subject each with anterior uveitis, central retinal artery occlusion and subretinal hemorrhage. Conclusion: Monotherapy with intravitreal sirolimus for subjects with persistent, exudative age-related macular degeneration appears to have a limited positive anatomic benefit. The presence of adverse events in the experimental group merits further evaluation, potentially as an adjuvant therapy. Trial registration This trial was registered with the clinicaltrials.gov, NCT02357342, and was approved by the institutional review board at Advarra. Funding was provided by an investigator-initiated grant from Santen. Santen played no role in the design or implementation of this study

Choroidal vascularity map in unilateral central serous chorioretinopathy: A comparison with fellow and healthy eyes

Background: To map the choroidal vascularity index and compare two eyes in patients with unilateral central serous chorioretinopathy (CSCR). Methods: This was a retrospective, observa-tional study performed in patients with unilateral CSCR. Choroidal thickness (CT) and Choroidal vascularity index (CVI) were measured and mapped in various zones according to the early treatment diabetic retinopathy (ETDRS) grid. Results: A total of 20 CSCR patients (20 study and 20 fellow eyes) were included in the study. Outer nasal region CT was seen to be significantly lower than central CT (p = 0.042) and inner nasal CT (p = 0.007); outer ring CT was significantly less than central (p = 0.04) and inner ring (p = 0.01) CT in CSCR eyes. On potting all the CVI values against the corresponding CT values, a positive correlation was seen in CSCR eyes (r = 0.54, p < 0.01), which was slightly weaker in fellow eyes (r = 0.3, p < 0.01) and a negative correlation was seen in healthy eyes (r = −0.262, p < 0.01). Conclusions: Correlation between CVI and CT was altered in CSCR eyes as compared to fellow and normal eyes with increasing CVI towards the center of the macula and superiorly in CSCR eyes