Optic neuropathies that mimic glaucoma.

It can be difficult to tell the difference between a glaucomatous optic nerve and a glaucoma mimic. Here are some tips that well help you to avoid diagnosing glaucoma when there is something else going on

Behaviour of disc oedema during and after amiodarone optic neuropathy: case report

A 73-year-old woman with atrial fibrillation treated with Amiodarone presented with Optic Disc oedema in right eye (OD). Using Optical Coherence Tomography (OCT) we describe the impact of this neuropathy on Retinal Nerve Fibre Layer (RNFL). At diagnosis RNFL average was of 188 µm OD and 77 µm in the left eye (OS), six months after discontinuation of the drug decreased to 40 µm in OD and 76 µm in OS. The RNFL average of OD presented a transient increase during the acute oedema that returned to normal levels during the first month after discontinuation of the drug and fell dramatically to 44 µm at the second month and 40 µm at the sixth month. We show there is axonal loss after amiodaroneassociated optic neuropathy measured with OCT. The OCT may be used in these patients to document changes in RNFL in the follow-up

Sex and Age Morphometric Variations in Bony Nasolacrimal Duct and Fossa for Lacrimal Gland in Mexican Population

SUMMARY: Primary acquired nasolacrimal duct obstruction is greater in women over 40 years and has been associated with morphometric variations in the osseous nasolacrimal duct, which varies according to age and sex. The objective is to determine variations regarding sex and age of the nasolacrimal duct and osseous fossa for lacrimal gland. One hundred sixteen dry orbits from Mexican population were analyzed; subdivided into four groups based on age and sex. The length, transverse and anteroposterior diameters of the bone entrance of the nasolacrimal duct, and the length and width of the fossa for lacrimal gland were determined. Statistical tests were applied to determine the significance of the differences found between groups. The nasolacrimal duct in women had shorter length than men in both age groups. The entrance had a wider transverse diameter in women than men independently of age and its anteroposterior diameter was shorter in men under 40 years than over 40 years. The fossa for lacrimal gland was larger in women under 40 years than in men of same age group and women over 40 years old. The lower third of the was wider in women under 40 years than in women over 40 years. Our study confirms significant differences between sex and age groups in some of the morphometric measurements of bony nasolacrimal duct and fossa for lacrimal gland in Mexican population. Comparative studies with and without clinical illness are needed to clarify if the bony characteristics of those structures participate in the etiopathogenesis and distribution differences observed in sex, age and ethnicity of thisillness. KEY WORDS: Nasolacrimal duct; Fossa for lacrimal gland; Morphometry; Primary acquired nasolacrimal duct obstructio

Olfactomedin‑like 2 A and B (OLFML2A and OLFML2B) expression profile in primates (human and baboon)

Background: The olfactomedin‑like domain (OLFML) is present in at least four families of proteins, including OLFML2A and OLFML2B, which are expressed in adult rat retina cells. However, no expression of their orthologous has ever been reported in human and baboon. Objective: The aim of this study was to investigate the expression of OLFML2A and OLFML2B in ocular tissues of baboons (Papio hamadryas) and humans, as a key to elucidate OLFML function in eye physiology. Methods: OLFML2A and OLFML2B cDNA detection in ocular tissues of these species was performed by RT‑PCR. The amplicons were cloned and sequenced, phylogenetically analyzed and their proteins products were confirmed by immunofluorescence assays. Results: OLFML2A and OLFML2B transcripts were found in human cornea, lens and retina and in baboon cornea, lens, iris and retina. The baboon OLFML2A and OLFML2B ORF sequences have 96% similarity with their human’s orthologous. OLFML2A and OLFML2B evolution fits the hypothesis of purifying selection. Phylogenetic analysis shows clear orthology in OLFML2A genes, while OLFML2B orthology is not clear. Conclusions: Expression of OLFML2A and OLFML2B in human and baboon ocular tissues, including their high simi‑ larity, make the baboon a powerful model to deduce the physiological and/or metabolic function of these proteins in the eye

Disc haemorrhages in glaucoma

Background: Disc haemorrhages (DH) are associated with glaucomatous progression. However, the effect of lowering intraocular pressure (IOP) in patients with DHs seems controversial; it may reduce visual field (VF) progression, but it does not reduce the frequency of DHs. Experiments and investigations: A survey of glaucoma specialists investigated the effect of new DHs on their clinical management. A method based on scanning laser ophthalmoscopy (SLO) to detect DHs was developed and compared to fundus photography and clinical examination. The detection of DHs and their role in visual field progression was investigated in the United Kingdom Glaucoma Treatment Study (UKGTS). The effect of medical and surgical reduction of intraocular pressure was investigated in the UKGTS and a cohort of normaltension glaucoma patients, respectively. Risk factors for DHs and a probability analysis exploring how often DHs appear simultaneously in both eyes were analysed to explore possible pathogenic mechanisms. Results: When a new DH is detected, 80% of clinicians modify their management plan, but the modifications vary. An SLO-based method for DH detection has very good within- and between-observers agreement. A comparison with fundus photography showed that photography is marginally better than SLO when the results of all observers are averaged but similar when the best observers are analysed independently. We confirmed the association between DHs and visual field deterioration. Treatment with latanoprost reduces the risk of VF deterioration in patients with and without DHs, but the frequency of DHs is not affected. Trabeculectomy reduced VF deterioration and the frequency of DHs. Conclusion: The detection of DHs guides most ophthalmologists to modify clinical decisions. An image-based method is required to increase the detection rate of DHs and the SLO-based method is an alternative for detection. IOP lowering with medication or surgery reduces VF progression in patients with DHs

Corneal Melting after Collagen Cross-Linking for Keratoconus in a Thin Cornea of a Diabetic Patient Treated with Topical Nepafenac: A Case Report with a Literature Review

Purpose: To report the case of a 50-year-old woman with diabetes that presented with corneal melting and perforation 6 weeks after collagen cross-linking (CxL) for keratoconus (KC) and postoperative use of nepafenac eye drops, a nonsteroidal anti-inflammatory drug (NSAID). Methods: This is a case report of a patient with diabetes, KC and a thin cornea that had undergone left eye corneal CxL at a different hospital followed by postoperative use of nepafenac eye drops for 6 weeks. Results: The patient presented for the first time to our clinic with left corneal melting, perforation and iris prolapse 6 weeks after corneal CxL and topical nepafenac use. She was treated with a left eye tectonic penetrating keratoplasty, extracapsular cataract extraction, intraocular lens implantation and pupilloplasty. Conclusions: The corneal melting and perforation in this patient was associated with multiple risk factors: (1) nepafenac eye drop use, (2) CxL in a cornea thinner than 400 µm and (3) diabetes. The recommended corneal thickness limits should be respected. Topical NSAIDs should be used with caution if used as postoperative treatment after corneal CxL and in patients with diabetes, epithelial defect or delayed healing, because of the possible increased risk for corneal melting when multiple risk factors are observed

Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report

Introduction and importance: Toxic anterior segment syndrome (TASS) is an acute sterile inflammation of the anterior segment which may occur after surgery. This case presents endothelial cell density (ECD) loss due to months of TASS caused by intraocular migration of ocular ointment. The chronicity of this case and the clinical consequences are rare in the literature. Case presentation: A Colombian 71-year-old man developed TASS secondary to intraocular ointment migration after uneventful cataract surgery with phacoemulsification and intraocular lens placement in the capsular bag. The main complaint for the patient was a chronic red eye, no pain or visual disturbance were reported, rheumatologic diseases were discarded. It was documented the presence of intraocular ointment in the anterior chamber, over the iris and in the anterior chamber angle. The ECD was reduced secondary to TASS and the longterm presence of ointment moving in the anterior chamber, so it had to be removed. Clinical discussion: It is important to avoid using ocular ointment after intraocular surgeries to avoid the risk of ointment migration into the anterior chamber. Intraocular ointments should be removed promptly to reduce ECD loss as documented in the present case report in which after ointment elimination ECD remains stable for 7 years. Conclusion: Topical ointments should not be used after routine cataract surgery because of the risk of intraocular ointment migration and subsequent risk of developing TASS and reduced ECD

Predicting visual fields from optical coherence tomography via an ensemble of deep representation learners

PURPOSE: To develop and validate a deep learning (DL) method of predicting visual function from spectral domain optical coherence tomography (SDOCT) derived retinal nerve fiber layer thickness (RNFLT) measurements and corresponding SDOCT images. DESIGN: Development and evaluation of diagnostic technology. METHODS: Two DL ensemble models to predict pointwise VF sensitivity from SDOCT images (model 1 - RNFLT profile only; model 2 - RNFLT profile plus SDOCT image), and two reference models were developed. All models were tested in an independent test-retest dataset comprising 2181 SDOCT/VF pairs; the median of ∼10 VFs per eye was taken as the best available estimate (BAE) of the true VF. The performance of single VFs predicting the BAE VF was also evaluated. PARTICIPANTS: Training dataset: 954 eyes of 220 healthy and 332 glaucomatous participants. Test dataset: 144 eyes of 72 glaucomatous participants. MAIN OUTCOME MEASURES: Pointwise prediction mean error (ME), mean absolute error (MAE) and correlation of predictions with the BAE VF sensitivity. RESULTS: The median mean deviation was -4.17 (-14.22 - 0.88) dB. Model 2 had excellent accuracy (ME 0.5, standard deviation [SD] 0.8, dB) and overall performance (MAE 2.3, SD 3.1, dB), and significantly (paired t-test) outperformed the other methods. For single VFs predicting the BAE VF, the pointwise MAE was 1.5 (SD 0.7) dB. The association between SDOCT and single VF predictions of the BAE pointwise VF sensitivities was R2 = 0.78 and R2 = 0.88, respectively. CONCLUSIONS: Our method outperformed standard statistical and DL approaches. Predictions of BAEs from OCT images approached the accuracy of single real VF estimates of the BAE