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Introduction/Background: The study of factors that influence choroidal thickness may help to better understand the physiology of this vascular layer. The purpose of this study is to analyse ocular and systemic factors that might influence macular and peripapillary choroidal thicknesses and study the correlation between both parameters in healthy subjects. Methods: 46 healthy subjects (46 eyes) were analyzed using enhanced-depth imaging of spectral-domain optical coherence tomography. A vertical and a horizontal raster scan centered on the optic nerve and a horizontal raster scan center on macula were obtained per eye. Macular (MCT) and peripapillary choroidal thickness (PCT) were measured from the posterior edge of the retinal pigment epithelium to the choroid-sclera junction at 500 μm intervals. Statistical analysis was used to correlate average MCT and PCT with ocular and systemic parameters. Results: Mean MCT and PCT in healthy eyes were negatively associated with age (R = 0.42, p = 0.003; R = 0.39, p = 0.007) and positively associated with refractive error (R = 0.37, p = 0.02; R = 0.36, p = 0.02). Mean MCT was also negatively associated with axial length (R = 0.32, p = 0.04). Both MCT and PCT were directly correlated (R = 0.72, p = 0.00) and thinner in subjects diagnosed with dyslipidemia (p = 0.02; p = 0.005). Choroidal thickness was not associated with visual acuity, intraocular pressure, gender, hypertension, diabetes, smoking or sleep apnea obstructive syndrome. Conclusions: Choroidal thickness is significantly associated with age, refractive error and dyslipidemia. MCT is also associated with axial length. These factors should be taken into consideration when interpreting MCT and PCT measurements in clinics. Acknowledgements: None. [ABSTRACT FROM AUTHOR]

Introduction/Background: We would like to enphasize the importance of ophthalmological examination to suspect carotid stenosis. Methods: A 63 year-old male diabetic patient which was referred to ophthalmologist. He described visual impairment in the right eye (RE). Best corrected visual acuity was 0.6 in his RE and 0.8 in his left eye (LE). Intraocular pressure and biomicroscopy showed no abnormalities. Indirect ophthalmoscopy showed intraretinal rounded hemorrhages and vascular engorgement in his RE, and mild diabetic retinopathy (DR) in his LE. Fluorescein angiography revealed a prolonged transit time with slow filling of choroidal and retinal vasculature. No ischemia was evident. OCT showed a discrete thickening of outer layers of the retina. Results: We suspected a case of venous stasis syndrome in the RE due to carotid stenosis. Carotid Doppler ultrasound detected a severe carotid stenosis on the same side. He underwent an uneventful right carotid endarterectomy. We detected fundus and OCT improvement after carotid endarterectomy. Conclusions: Retinal findings are similar to those found in DR, except for unilaterality. We should suspect this disease in cases of asymmetric DR to prevent others complications in the future. Acknowledgements: No comment. [ABSTRACT FROM AUTHOR]

Introduction/Background: Orbitary pseudotumour or idiopathic inflammation of the orbit (IIO), is a benign, non-granulomatous inflammatory process in the orbit or eye without identifiable local or systemic cause. Although classically described as pain, proptosis and ophthalmoparesis, the optic nerve may be affected and its isolated involvement is extremely rare. The purpose of this study is to report a case of isolated optic nerve inflammatory pseudotumour presenting with painful unilateral vision loss and dramatic clinical and anatomical response to steroids. Methods: Case report. Results: A 54 year-old male presented with a 10-day history of painful and gradually decreased vision in his right eye. He had a history of intravenous drug abuse 10 years ago and no other relevant past medical history. On examination, his best-corrected visual acuity (BCVA) was 0.3 in his right eye. Anterior segment examination, intraocular pressure and ocular motility were unremarkable. His right fundoscopy and OCT examinations showed a swollen optic disc with peripapillary haemorrhages and choroidal folds. The MRI revealed a 1.1x0.7 mm gadolinium-enhanced mass located at the orbital apex surrounding the right optic nerve. His neurologic and general examinations were otherwise unremarkable. After a course of oral prednisone (1 mg/Kg), a dramatic clinical improvement was observed during the first week. The funduscopy showed a complete optic disc edema resolution, and another MRI performed 1 month later confirmed the complete regression of the orbitary mass. Conclusions: The IIO constitutes the third most common ophthalmic disorder following Grave's disease and lymphoproliferative disorder. Clinical presentation mainly depends on the location and degree of inflammation. It is considered a clinical diagnosis of exclusion and its physiopathology still remains unknown. In the case reported, the lack of systemic symptoms, serologic markers and the dramatic response to steroids makes the diagnosis. A trial of corticosteroids should be considered when a case of orbitary pseudotumor is suspected. Acknowledgements: None. [ABSTRACT FROM AUTHOR]

Introduction/Background: Ocular lesions result from stasis and occlusion of small eye vessels by sickled erythrocytes in sickle cell disease (SCD). Frequently, patients are asymptomatic until vitreous hemorrhage and retinal detachment occur. Methods: A 25 year old black male with SCD who referred unilateral paracentral scotoma. Visual acuity was 0.9 bilaterally. Normal intraocular pressure was observed and no showed conjunctival signs. Funduscopy showed paracentral arteriolar occlusion, the typical salmon patches and iridescent spots. We observed sunbursts lesion, as pigmented chorioretinal scars usually found in the periphery, peripheral retinal vessels occlusion and the typical sea fans, which suggested proliferative changes. Fluorescein angiography showed retinal capillary nonperfusion, peripheral arteriovenous anastomoses and peripheral neovascularization. Results: Proliferative sickle retinopathy on stage III of Goldberg was diagnosed, so we performed laser photocoagulation in ischemic areas. Conclusions: The increase of migration movements in recent years has led to the emergence of more cases of the disease in our midst. So we must suspect SCD in cases of peripheral retinal ischemia and venous occlusion in young patients. It is therefore recommended that all patients with SCD undergo periodic ophthalmological screening to prevent ocular complications. Acknowledgements: No comment. [ABSTRACT FROM AUTHOR]

Background: To analyze the relationship between Henle fiber (HF) integrity and visual acuity in highly myopic eyes with foveoschisis., Methods: Three hundred and fifty-eight highly myopic eyes were included in this study and divided into three groups according to the Triton optical coherence tomography results. Group 1 included 19 eyes with myopic foveoschisis where the inner and outer retina were connected by a columnar structure in the HF layer at the foveolar area. Group 2 included 17 eyes with myopic foveoschisis where the columnar structure was disrupted in the HF layer at the foveolar area. Group 3 included 322 eyes without myopic foveoschisis or other ocular disease. Clinical and optical coherence tomography findings were obtained and compared., Results: Eyes with vitreomacular traction, arteriolar traction, and longer axial length were more likely to have myopic foveoschisis with intact columnar structure in the HF layer (odds ratio [OR], 12.84; P = 0.001; OR, 7.63; P = 0.04; OR, 2.03; P = 0.03) and with disrupted columnar structure in the HF layer (OR, 65.21; P = 0.001; OR, 6.60; P = 0.02; OR, 2.63; P = 0.01). Moreover, eyes with disrupted columnar structure in the HF layer presented a lower best-corrected visual acuity (P = 0.001), longer axial length (P = 0.001; P = 0.009), higher central foveolar thickness (P = 0.001; P = 0.02), and a higher prevalence of vitreomacular traction (P = 0.001; P = 0.04) than control or integrity HF eyes. Furthermore, worse best-corrected visual acuity was related to myopic foveoschisis with disrupted columnar structure in the HF layer (P < 0.01)., Conclusion: The integrity of HF in patients with myopic foveoschisis appears to play an important role in visual acuity.

Purpose: To investigate patterns of short- and long-term variations in corneal epithelial thickness (CET) after myopic laser in situ keratomileusis (LASIK) using anterior segment optical coherence tomography (AS-OCT) combined with Placido disk-based topography., Methods: In this retrospective study, 36 subjects (72 eyes) who underwent LASIK myopic surgery and 53 healthy subjects (106 eyes) who served as controls were enrolled. AS-OCT (MS-39) was performed in all patients before, 1 day, 1 month, and 6 months after surgery. Statistical analysis was performed to analyze CET changes over time after LASIK and to detect patterns of definitive CET remodeling compared to healthy subjects. Multivariate analysis was performed to look for possible predictors of final CET., Results: There was no statistically significant difference between groups in terms of demographic and anterior segment parameters (all P > 0.05). After LASIK, all sectors and rings got thicker over time (1.62-8.32 μm; P < 0.01). Except for the central sector, all areas achieved the thickest CET value one day after surgery with a progressive epithelial thinning between 1 and 6 months of follow-up. Changes on CET occurred independently of the grade of myopia before LASIK or final refraction (P > 0.05). None of the clinical variables studied, including diopters corrected, were found to be correlated with final CET (P > 0.05)., Conclusion: Independent of anterior segment parameters and diopters corrected, CET becomes thicker after LASIK surgery. Central and inner ring sectors thicken more than those more peripheral. CET remodeling after myopic LASIK should be taken into consideration when planning refractive surgery., Competing Interests: None

Purpose: To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks., Methods: Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples., Results: The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/μL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44)., Conclusion: Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections., Competing Interests: The authors declare that there is no conflict of interest.

Objectives: Early diagnosis in Alzheimer's disease (AD) is crucial in order to implement new therapeutic strategies. The retina is embryologically related to the brain. Thus, the possible usefulness of optical coherence tomography (OCT) in the early detection of AD is currently being studied. Our aim was to study the relationship between retinal nerve fiber layer (RNFL) thickness and AD., Methods: We undertook an observational, analytical, cross-sectional study with consecutive sampling of 32 patients with AD or mild cognitive impairment and a group of healthy controls (C). The total number of eyes studied was 64. An ophthalmological and a comprehensive neuropsychological evaluation were performed in all participants. Quantification of white matter lesions and study of atrophy of the hippocampus by cerebral magnetic resonance were also performed., Results: We observed a significant linear trend towards a thinning of RNFL as the degree of cognitive deterioration increased, in the superior and temporal quadrants of the retina. A significant correlation was also noted between the mean thickness of the RNFL of the left temporal quadrant and occipital white matter lesions (r = -0.579, p = 0.038)., Conclusions: OCT could be a safe, rapid noninvasive tool providing useful biomarkers in the early detection of cognitive deterioration and AD., (© 2020 John Wiley & Sons Ltd.)

Purpose: To review and analyze the surgical outcomes of bilateral medial rectus recession with adjustable suture in acute concomitant esotropia of adulthood (ACEA)., Methods: The charts of all adults diagnosed as having ACEA between 2004 and 2017 were reviewed. Best corrected visual acuity, refractive error, ocular alignment measured in prism diopters (PD), and stereopsis were examined at presentation, 1 day postoperatively, and final follow-up visit (median: 10 months; range: 4 to 144 months). All patients underwent bilateral medial rectus recession using adjustable suture surgery and topical anesthesia. Statistical analysis was used to calculate surgical dose-responses and to study possible correlations with clinical parameters., Results: Fifteen patients diagnosed as having ACEA were included. The mean age was 39.2 ± 10.7 years, and the mean refractive errors in the right and left eyes were -3.97 ± 2.87 and -3.60 ± 2.74 diopters (D), respectively. Average esotropia deviations at near and distance were 22.7 ± 7.2 and 23.0 ± 7.5 PD. All patients improved with medial rectus recession (mean: 12.0 ± 2.2 mm) with a final mean deviation of 0.7 ± 1.8 PD. The mean dose-responses at 1 day postoperatively and final visit were 1.86 ± 0.58 and 1.83 ± 0.43 PD/mm, respectively. There was a significant positive correlation between surgical dose-responses at 1 day postoperatively and final visit and preoperative deviation (R 2 = 0.55; P < .001; R 2 = 0.66; P < .001), whereas there were no significant correlations with age, sex, refractive error, BCVA, or stereopsis (all P > .05)., Conclusions: Good postoperative and final outcomes are achieved with large medial rectus recessions in ACEA. A larger dose-response can be expected in large preoperative deviations, independent of other clinical and ocular parameters. [J Pediatr Ophthalmol Strabismus. 2019;56(2):101-106.]., (Copyright 2019, SLACK Incorporated.)

Background: Although giant cell arteritis (GCA) is a well-known cause of transient and permanent vision loss, diplopia as a presenting symptom of this condition is uncommon. We compared symptoms and signs of patients presenting with diplopia from GCA to those from other causes., Methods: This was a multicenter, retrospective study comparing the clinical characteristics of patients presenting with diplopia from GCA with age-matched controls. Demographic information, review of symptoms, ophthalmic examination, and laboratory data of biopsy-proven patients with GCA were compared with those of age-matched controls presenting with diplopia., Results: A total of 27 patients presented with diplopia from GCA, 19 with constant diplopia, and 8 with transient diplopia. All patients with constant diplopia from GCA were matched with 67 control subjects who had diplopia from other etiologies. Patients with GCA were more likely to describe other accompanying visual symptoms (58% vs 25%, P = 0.008), a greater number of systemic GCA symptoms (3.5, GCA vs 0.6, controls, P < 0.001) such as headache (94% [17/18] vs 39% [23/67]; P < 0.001), jaw claudication (80% [12/15] vs 0% [0/36]; P < 0.001), and scalp tenderness (44% [7/16] vs 7% [3/43]; P < 0.001). Ocular ischemic lesions (26% vs 1%, P < 0.001) were also common in patients with diplopia from GCA. Inflammatory markers were elevated significantly in patients with GCA vs controls (erythrocyte sedimentation rate: 91% [10/11] vs 12% [3/25], P < 0.001; C-reactive protein: 89% [8/9] vs 11% [2/19], P < 0.001)., Conclusions: GCA is a rare but serious cause of diplopia among older adults and must be differentiated from other more common benign etiologies. Our study suggests that most patients with diplopia from GCA have concerning systemic symptoms and/or elevated inflammatory markers that should trigger further work-up. Moreover, careful ophthalmoscopic examination should be performed to look for presence of ocular ischemic lesions in older patients presenting with acute diplopia.

Purpose: This study investigated factors associated with persistent serous retinal detachment in highly myopic eyes with vertical oval-shaped domes., Methods: Twenty-eight highly myopic patients (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmologic examinations, including axial-length measurement and fluorescein angiography. Spectral domain optical coherence tomography scans through the fovea measured choroidal thicknesses, macular bulge height, and vitreoretinal interface factors., Results: No studied variables (age, sex, spherical equivalence, axial length, vitreomacular traction, epiretinal membrane, and internal limiting membrane detachment) except higher macular bulge height (P = 0.03) and a reduced macular choroidal thickness (P = 0.02) were associated with the risk of serous retinal detachment. No statistically significant differences in best-corrected visual acuity were observed between the study and control groups. Serous retinal detachment always occurred at the top of the inward incurvation of the macula and was characterized by multiple hyperfluorescent granular patches on fluorescein angiography., Conclusion: A higher macular bulge height and a reduced macular choroidal thickness might be important factors in the development of serous retinal detachment in patients with vertical oval-shaped domes.

Reliable visual field testing is the gold standard in identifying future vision loss in patients with Idiopathic Intracranial hypertension (IIH). However, when field performance is unreliable, GCC analysis may be useful. We evaluated IIH patients over three visits: initial visit, follow-up visit and a third visit, almost 1 year later. We evaluated mean deviation (MD), GCC and RNFL at presentation and the second visit and compared it to the mean deviation (MD) on fields at the third visit. As early as the second visit, GCC loss correlated with visual field results seen at the third visit.

Purpose: To investigate the posterior anatomical structure of pathologically myopic eyes with dome-shaped macula and inferior staphyloma using spectral domain optical coherence tomography (SD-OCT)., Methods: Our database of 260 pathologically myopic eyes was analyzed retrospectively to identify patients with dome-shaped macula and inferior staphyloma. All patients underwent vertical and horizontal SD-OCT scans across the central fovea, with three-dimensional macular map reconstruction. Best-corrected visual acuity, axial length, and choroidal thickness measurements were recorded. The macular bulge height was also analyzed in eyes with dome-shaped macula. In the three-dimensional images, the symmetry and orientation of the main plane of the inward incurvation of the macula were examined., Results: Twenty-eight (10.7%) of the 260 pathologically myopic eyes had dome-shaped macula of one of three different types: a round radially symmetrical dome (eight eyes, 28.5%), a horizontal axially symmetrical oval-shaped dome (15 eyes, 53.5%), or a vertical axially symmetrical oval-shaped dome (five eyes, 17.8%). The macular bulge height was significantly greater in horizontal oval-shaped dome eyes (p = 0.01, for each comparison). Inferior posterior staphylomas were observed in ten (3.8%) of the 260 pathologically myopic eyes with asymmetrical macular bends., Conclusions: Vertical and horizontal OCT sectional scanning in combination with three-dimensional macular map reconstruction provides important information for understanding the posterior anatomical structure of dome-shaped macula and inferior staphyloma in pathologically myopic eyes.

Purpose: To analyse peripapillary choroidal thickness (PCT) in non-arteritic ischaemic optic neuropathy (NAION)., Methods: 28 patients diagnosed with NAION (37 affected and 19 unaffected eyes) and 38 disease-free control individuals (38 eyes) were analysed using enhanced-depth imaging of spectral-domain optical coherence tomography. A vertical and a horizontal raster scan centred on the optic nerve were obtained per eye. PCT was measured at the superior, inferior, nasal and temporal quadrants from the posterior edge of the retinal pigment epithelium to the choroid-sclera junction at 500 μm intervals up to 2000 μm away from the optic nerve. Statistical analysis was used to compare average PCT and to correlate PCT with other ocular and systemic parameters., Results: Mean PCT in NAION eyes and control group was 148.18±42.68 μm and 182.90±59.81 μm, respectively (p=0.005). Except for inferior PCT (p=0.158), superior, nasal and temporal PCT were significantly thinner in the NAION eyes than in the control group (p=0.006, 0.002 and 0.046). Thinner PCT, adjusted for refractive error, was associated with the diagnosis of NAION (p=0.048). Similarly, unaffected contralateral eyes showed a significant thinner PCT compared with the control group (p=0.024). Diagnosis of NAION was negatively associated with PCT in NAION eyes (p=0.008; OR 0.98; 95% CI 0.97 to 0.99) and in their contralateral unaffected eyes (p=0.043; OR 0.98; 95% CI 0.97 to 0.99)., Conclusions: Eyes affected by NAION and contralateral unaffected eyes showed significantly thinner PCT compared with disease-free control eyes after adjusting for refractive error., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

We present a case of a 40-year-old woman with a fundus image similar to frosted retinal angiitis after undergoing pars plana vitrectomy and intravitreal triamcinolone injection. The patient with diabetic retinopathy was referred to our hospital with vision loss in her right eye secondary to vitreous haemorrhage. After pars plana vitrectomy and injection of triamcinolone acetonide a funduscopy examination revealed deposits of triamcinolone along the retinal vessels simulating a frosted retinal angiitis. Triamcinolone deposits along blood vessels could be the result of the reabsorption process of these crystals by the perivascular macrophages. Further studies are needed., (2015 BMJ Publishing Group Ltd.)