Cefixime-induced angle closure and transient myopic shift in a healthy individual; A case report

Purpose: To report a case of Acute bilateral angle closure and Myopia following oral Cefixime therapy for pharyngitis. Observation: A 49-year-old man presented to the clinic with a history of aggravating ocular pain and blurry vision in both eyes from 5 days ago. He was under treatment with oral Cefixime 400 mg twice a day for acute bacterial pharyngitis since last week. His refractive error was �3.75 and �4.25 diopters in the right and left eye respectively. Intraocular pressure (IOP) was 32 mm Hg in the right eye and 40 mm Hg in the left eye. Slit lamp examination and gonioscopy showed shallow anterior chamber with 360° appositional angle closure. Ultrasound biomicroscopy revealed shallow anterior chamber, narrow angle, supraciliary effusion and anterior rotation of ciliary body in both eyes. With diagnosis of drug-induced acute angle closure, oral Cefixime was discontinued and eye drops Betamethasone every 4 hours, Cosopt and Brimonidine twice a day, and Atropine 1 twice a day were started. Few days after starting treatment all ocular symptoms and signs were resolved. Conclusions and importance: Systemic Cefixime can induce acute angle closure disease with myopic shift and elevated IOP secondary to supraciliary effusion and ciliary body rotation. © 202

Foveal avascular zone segmentation in optical coherence tomography angiography images using a deep learning approach

The purpose of this study was to introduce a new deep learning (DL) model for segmentation of the fovea avascular zone (FAZ) in en face optical coherence tomography angiography (OCTA) and compare the results with those of the device�s built-in software and manual measurements in healthy subjects and diabetic patients. In this retrospective study, FAZ borders were delineated in the inner retinal slab of 3 � 3 enface OCTA images of 131 eyes of 88 diabetic patients and 32 eyes of 18 healthy subjects. To train a deep convolutional neural network (CNN) model, 126 enface OCTA images (104 eyes with diabetic retinopathy and 22 normal eyes) were used as training/validation dataset. Then, the accuracy of the model was evaluated using a dataset consisting of OCTA images of 10 normal eyes and 27 eyes with diabetic retinopathy. The CNN model was based on Detectron2, an open-source modular object detection library. In addition, automated FAZ measurements were conducted using the device�s built-in commercial software, and manual FAZ delineation was performed using ImageJ software. Bland�Altman analysis was used to show 95 limit of agreement (95 LoA) between different methods. The mean dice similarity coefficient of the DL model was 0.94 ± 0.04 in the testing dataset. There was excellent agreement between automated, DL model and manual measurements of FAZ in healthy subjects (95 LoA of � 0.005 to 0.026 mm2 between automated and manual measurement and 0.000 to 0.009 mm2 between DL and manual FAZ area). In diabetic eyes, the agreement between DL and manual measurements was excellent (95 LoA of � 0.063 to 0.095), however, there was a poor agreement between the automated and manual method (95 LoA of � 0.186 to 0.331). The presence of diabetic macular edema and intraretinal cysts at the fovea were associated with erroneous FAZ measurements by the device�s built-in software. In conclusion, the DL model showed an excellent accuracy in detection of FAZ border in enfaces OCTA images of both diabetic patients and healthy subjects. The DL and manual measurements outperformed the automated measurements of the built-in software. © 2021, The Author(s)

Superficial and deep foveal avascular zone area measurement in healthy subjects using two different spectral domain optical coherence tomography angiography devices

Purpose: To compare the area of the foveal avascular zone (FAZ) in the superficial and deep retinal layers using two different spectral-domain optical coherence tomography angiography (OCTA) devices. Methods: A cross-sectional comparative study was conducted to obtain macular OCTA images from healthy subjects using Optovue RTVue XR Avanti (Optovue, Inc, Fremont, CA) and Spectralis HRA+OCTA (Heidelberg Engineering, Heidelberg, Germany). Two independent trained graders measured the FAZ area using automated slab segmentation. The FAZ area in the superficial and deep retinal layers were compared. Results: Twenty-three eyes of 23 subjects were included. The graders agreement was excellent (>0.86) for all measurements. The mean FAZ area was significantly larger at the superficial retinal layer as compared to the deep retinal layer on both devices (0.31 ± 0.08 mm2 vs 0.26 ± 0.08 mm2 in Optovue and 0.55 ± 0.16 mm2 vs 0.36 ± 0.13 mm2 in Spectralis, both P < 0.001). The mean FAZ area was significantly greater in the superficial and deep retinal layers using Spectralis as compared to Optovue measurements (P < 0.001 for both comparisons). Conclusion: In contrast to previous reports, the FAZ area was larger in the superficial retina as compared to deep retinal layers using updated software versions. Measurements from different devices cannot be used interchangeably. © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARCH | PUBLISHED BY KNOWLEDGE

The effect of upper lid blepharoplasty on forehead and glabellar lines

Purpose: To assess the role of upper blepharoplasty on probable reduction of forehead horizontal lines and glabellar frowns in patients who underwent upper eyelid blepharoplasty. Design: This is a prospective study on 32 female patients with aged between 35 and 75 years and underwent standard blepharoplasty. Method: Measurement of mid brow to hairline distance (MBHLD) and inter brow distance (IBD) were performed within 3 days before, 1 and 6 months after the blepharoplasty surgery. The surgeon and patients reported the extent of their satisfaction about the beneficial effect of upper lid blepharoplasty on decreasing forehead and glabellar lines. Results: Compared to MBHLD at baseline time before the surgery, significant increase was observed in MDHLD after 1 and 6 months follow up in both eyes (p-values were less than 0.05). IBD reached the significant increase after 1 and 6 month(s) after upper lid blepharoplasty (p-values were less than 0.05). On the other hand, compared to mean of IBD in 1 month after surgery, IBD decreased significantly. 59.3 of patients reported satisfaction of high level of improvement in lessening of wrinkles. Conclusion: Our observations documented the beneficial effects in reducing the forehead and glabellar line in patients who underwent upper lid blepharoplasty. © 2020 Informa UK Limited, trading as Taylor & Francis Group

Randomized control trial of evaluation of Clemastine effects on visual evoked potential, nerve fiber layer and ganglion cell layer complex in patients with optic neuritis

Objectives: Optic neuritis (ON) is the most common cause of optic neuropathy; typically presenting with a unilateral visual loss in young adults, with incidence of 1�5 in 100,000 per year. We evaluated the effect of Clemastine, a first-generation and CNS (central nervous system)-penetrant H1 receptor antagonist on visual evoked potential (VEP), retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) complex in patients with optic neuritis. Patients and methods: This is a prospective comparative interventional case series in 25 patients with acute optic neuritis. Patients were randomly assigned to group 1 (treated with Clemastine 1 mg orally twice a day for 90 days; 16 patients) or group 2 (received placebo for 90 days; 9 patients) and both groups received standard treatment of optic neuritis. We recorded VEP and peripapillary OCT (optical coherence tomography) of patients before and after three months of treatment. Results: In contrast to patients treated with Clemastine, RNFL thickness loss between base line phase and after three months follow up in control group were statistically significant in temporal, supra temporal, Infrotemporal and almost global sections of RNFL map. The reduction in GCL thickness between base line phase and after three months follow up in control group were significant, while it did not reach significance in treatment group except in inferior region. Conclusion: In contrast to treatment group, RNFL and GCL thickness of most quadrants are decreased significantly after three months in patients with ON in control group. In contrast to control group, p100 wave's amplitude recovered in a significant manner in treatment group. © 2020 Elsevier B.V

Effects of fasting on peripapillary capillary density, peripapillary nerve fiber layer, intraocular pressure and central corneal thickness

Purpose: To investigate the effects of fasting on intraocular pressure (IOP), central corneal thickness (CCT), radial peripapillary capillary (RPC) density and retinal nerve fiber layer (RNFL) thickness during Islamic fasting month of Ramadan. Methods: Twenty-seven healthy fasting volunteers were enrolled. All subjects underwent full ophthalmic examination and optical coherence tomography angiography (OCTA) of both eyes. All measurements were recorded first in the morning (8:00�10:00 a.m.) and then in the evening (4:00�6:00 p.m.). The first visit was performed during the second and third week of Ramadan and then two months later in a nonfasting routine day. Results: Mean age of participants was 40.07 ± 9.29 years. A significant decrease was found for evening IOP (11.17 ± 2.29 mmHg) in comparison with morning IOP (12.00 ± 2.28) (p = 0.00) only on fasting days. A decrease was observed for CCT both on fasting (6 μm) and nonfasting days (3 μm) (p = 0.00 and p = 0.02, respectively) in the evening. There was a significant increase in whole and peripapillary RPC density () on fasting days (48.79 ± 3.08 morning, 49.72 ± 2.85 evening for whole and 50.57 ± 4.06 morning, 51.64 ± 3.71 evening for peripapillary) (p = 0.00). Average RNFL thickness was decreased from morning to evening both on fasting days (0.80 μm) and nonfasting days (1.25 μm) (p = 0.00). Optic nerve head (ONH) vertical cup/disc (C/D) ratio was greater on fasting days (0.30 ± 0.25 morning, 0.31 ± 0.24 evening) in comparison with nonfasting days (0.27 ± 0.25 morning, 0.28 ± 0.25 evening) (p = 0.02). Conclusion: Fasting decreases the IOP and CCT in healthy subjects. OCTA revealed significant difference in RPC vessel density, RNFL thickness and ONH vertical C/D ratio during fasting hours in comparison with nonfasting days. © 2020, Springer Nature B.V

Comparison of Superficial and Deep Foveal Avascular Zone Area in Healthy Subjects Using Two Spectral Domain Optical Coherence Tomography Angiography Devices

Purpose: To compare the area of the foveal avascular zone (FAZ) in the superficial and deep retinal layers using two different spectral-domain optical coherence tomography angiography (OCTA) devices. Methods: A cross-sectional comparative study was conducted to obtain macular OCTA images from healthy subjects using Optovue RTVue XR Avanti (Optovue, Inc, Fremont, CA) and Spectralis HRA+OCTA (Heidelberg Engineering, Heidelberg, Germany). Two independent trained graders measured the FAZ area using automated slab segmentation. The FAZ area in the superficial and deep retinal layers were compared. Results: Twenty-three eyes of 23 subjects were included. The graders agreement was excellent (>0.86) for all measurements. The mean FAZ area was significantly larger at the superficial retinal layer as compared to the deep retinal layer on both devices (0.31 ± 0.08 mm2 vs 0.26 ± 0.08 mm2 in Optovue and 0.55 ± 0.16 mm2 vs 0.36 ± 0.13 mm2 in Spectralis, both P < 0.001). The mean FAZ area was significantly greater in the superficial and deep retinal layers using Spectralis as compared to Optovue measurements (P < 0.001 for both comparisons). Conclusion: In contrast to previous reports, the FAZ area was larger in the superficial retina as compared to deep retinal layers using updated software versions. Measurements from different devices cannot be used interchangeably