[OCT Visante observation of the progression of a perforated neurotrophic cornea ulcer treated with amniotic membrane grafts]

The Role of Hi-Tech Devices in Assessment of Corneal Healing in Patients with Neurotrophic Keratopathy

To prove the role of high-tech investigation in monitoring corneal morphological changes in patients with neurotrophic keratopathy (NK) using Keratograph 5M (K5M) and anterior segment OCT (AS-OCT), corneal healing was monitored with Keratograph 5M (Oculus, Wetzlar, Germany) and AS-OCT (DRI, Triton, Topcon, Tokyo, Japan) in 13 patients (8F and 5M), aged from 24 to 93 years (67.8 ± 19) with severe NK, who were treated with Cenegermin 0.002% (20 μg/mL) (Oxervate^®, Dompè, Farmaceutici Spa, Milan, Italy). The surface defects were evaluated on Keratograph 5M with ImageJ software and the corneal thickness variations were measured using DRI-Triton OCT software. Instrumental procedures were performed at baseline, and after 4 and 8 weeks of the treatment, respectively. The main outcome measures were reduction of the ulcers’ area and corneal thickness recovery. The mean area of the corneal ulcers was reduced between baseline and 4 weeks examination in all patients, and at 8 weeks all ulcers were completely healed. An increase of the corneal thickness was evidenced between the baseline visit and after the 4- and 8-week follow-up, respectively. Additionally, only in collaborating subjects the In Vivo Confocal Microscopy (IVCM) was performed with HRT Rostock Cornea Module (Heidelberg Eng GmbH) to study the corneal nerves fibres. High-tech diagnostics with K5M, AS-OCT and IVCM proved useful in the assessment of corneal morphology and the healing process in patients with NK and could be extended to assess other corneal pathologies.

Use of amniotic membrane graft in glaucoma shunt surgery

BACKGROUND AND OBJECTIVE

To determine the safety and efficacy of amniotic membrane graft in glaucoma drainage device surgery.

PATIENTS AND METHODS

Institutional retrospective case series of 44 patients undergoing glaucoma drainage device implantation with use of 300-μm thick amniotic membrane as a patch graft. Endpoints assessed were tube exposure, graft thinning, graft clarity, graft-related infection, and inflammation.

RESULTS

A total of 41 (93%) eyes had an uneventful course over a mean follow-up of 22 ± 3 months (range: 17 to 28 months). Tube exposure and hypotony each occurred in one eye and were successfully treated with a tube revision using double pericardial and amniotic membrane patch graft. The translucency of amniotic membrane graft enabled good visualization of the occluding suture when performing laser suture lysis in 16 eyes. Sequential anterior segment optical coherence tomography showed stable amniotic membrane graft thickness with a change from low to moderate reflectivity in the subconjunctival-graft bilayer.

CONCLUSION

Amniotic membrane graft offers good tectonic support and allows direct visualization of the underlying tube.

[Spectral-domain optical coherence tomography in anterior segment imaging: the 3rd dimension]

PURPOSE

Anterior segment imaging using optical coherence tomography (OCT) time domain technology has been used for many years. When it appeared, it was a promising technique in the analysis of the anterior segment, making it possible to reach a definition of the ocular structures comparable with histology. Now with new-generation OCT, it is possible to perform high-definition and three-dimensional imaging.

MATERIAL AND METHOD

A 3D OCT-1000 (Topcon, Tokyo, Japan) parameterized to obtain high-definition and 3D imaging of the iridocorneal structures.

RESULTS

We present a collection of images obtained using this technique.

DISCUSSION

Based on a very sophisticated tool for retinal and glaucoma imagery, it is now possible to obtain very-high-quality imaging of the anterior segment, which, with its great versatility, increases the value of acquiring this type of device.

CONCLUSIONS

The potential of 3D OCT-1000, already a very good exam for the posterior segment, and the only one to perform anterior segment three-dimensional imaging in a single acquisition, should not be neglected.

[Schnyder's crystalline-like corneal dystrophy: a case report]

Schnyder's crystalline corneal dystrophy is a rare bilateral hereditary disease with various clinical features. It typically presents as a central disc-like opacification with or without crystalline deposits. We report the case of a particular crystalline-free and ring-like pattern dystrophy resembling Schnyder's corneal dystrophy in an 82-year-old woman. In addition, we describe the aspects of this dystrophy with in vivo confocal microscopy using the Heidelberg Retina Tomograph II-Rostock Cornea Module and with anterior segment optical coherence tomography (OCT-Visante((R))). These techniques can be useful in the diagnosis or the therapeutic process, showing crystalline structures that are not clinically distinguishable or validating the histological localization of the corneal disease.

[Anterior segment examination of a post-traumatic, multioperated eye with Visante OCT. A case report]

INTRODUCTION

The optical coherence tomography (OCT) exploration of the retina has become almost routine and its semiology is well known. In contrast, the OCT exploration of the anterior segment is still in its preliminary stages.

CASE REPORT

We report the clinical aspects and the OCT Visante((R)) imaging of the anterior segment in a 35-year-old patient, victim of a penetrating injury of the left eye who required several operations including iterative vitrectomy for recurrent retinal detachment caused by proliferative vitreoretinopathy, use of high-density silicone oil, cataract surgery with in-the-bag intraocular lens implantation, and YAG-laser capsulotomy.

DISCUSSION

The correlation between slit lamp examination and OCT imaging is very good. We debate in a nonexhaustive manner the different imaging possibilities of this new technology and discuss its advantages in the postsurgical exam and its value in medicolegal expert reports as well as in comparison with pictures acquired by OCT normally used to image the posterior segment.

CONCLUSION

Future research will undoubtedly confirm the contribution of this new tool to explore the anterior segment in numerous contexts, including ophthalmological trauma medicine.