Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension

PURPOSE

To evaluate the changes in peripapillary microvascularity in idiopathic intracranial hypertension (IIH) and optic disc drusen (ODD) patients, by comparing them with those in healthy individuals, via optical coherence tomography angiography (OCTA).

METHODS

Sixty-two eyes of 33 patients with ODD, 58 eyes of 30 patients with IIH, and 70 eyes of 70 healthy people were imaged for 6 × 6-mm optic disc scans on a spectral-domain OCTA. Vascular densities in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) of ODD, IIH, and healthy eyes were compared with a one-way analysis of variance. Post-hoc analysis was performed with the Gabriel test.

RESULTS

There was a significant decrease in peripapillary vessel density in SCP, DCP, and CC in patients with IIH compared to the control group (p < 0.05). In ODD patients, especially peripapillary vessel density in DCP was significantly reduced compared to the control group (p < 0.05). Peripapillary vessel density in DCP was significantly lower in the IIH group than ODD group (p < 0.05).

CONCLUSIONS

Peripapillary vascular density may be affected during the course of the disease in both IIH and ODD. Compared to healthy individuals, the decrease in vascular density in these patients and the consequent decrease in perfusion in the peripapillary region may guide the pathogenesis of the complications in the course of these two diseases. Although vascular density in DCP and CC differs significantly between IIH and ODD, case-controlled studies are needed to evaluate the role of OCTA in the differential diagnosis of IHH and ODD.

Comparison of corneal, endothelial, and anterior segment parameters in eyes with and without pigment dispersion

BACKGROUND

To evaluate the differences of central corneal thickness (CCT), corneal endothelial cell morphology, and biometric parameters of the anterior chamber and iridocorneal angle in pigment dispersion syndrome (PDS), pigmentary glaucoma (PG), primary open-angle glaucoma (POAG), and healthy group.

METHODS

Twenty- three eyes in the PDS group, 39 eyes in the PG group, 33 eyes in the POAG group, and 45 eyes in the healthy control group were included in this cross-sectional retrospective study. Corneal endothelial cell density, the coefficient of variation in the cell area, hexagonality, and central corneal thickness (CCT) were obtained by specular microscopy (CEM 530, NIDEK, Japan). Anterior chamber depth (ACD), iridocorneal angle parameters and CCT were measured by anterior segment optical coherence tomography (AS-OCT) (Visante OCT, Carl Zeiss AG, Germany).

RESULTS

The mean CCT via specular microscopy (SM-CCT) was measured at the thinnest value in the PG group (531.20 ± 34.91 µm) and the thickest in the control group (569.13 ± 37.52 µm). CV value was higher in PG (34.65 ± 6.84) and POAG group (34.27 ± 9.93) and lower in control group (28.82 ± 5.18) (p = 0,005). The mean AS-OCT-CCT was the thinnest in the PG group (513.61 ± 39.94 µm), and the thickest in the control group (547.04 ± 36.72 µm) (p = 0.001). All parameters of the iridocorneal angle were larger in the PDS and PG groups (p < 0.001). In the correlation analysis of the glaucomatous eyes, a negative correlation between the C/D ratio and SM-CCT and AS-OCT-CCT (p = 0.037, p = 0.017, respectively) and a positive correlation between the pRNFL thickness and AS-OCT- CCT (p = 0.002).

CONCLUSION

CCT values obtained with both SM and AS-OCT were found to be significantly thinner in PG cases. CV, which is the measure of polymegatism, was found to be significantly higher in PG cases.

Comparison of the lamina cribrosa parameters in eyes with exfoliation syndrome, exfoliation glaucoma and healthy subjects

PURPOSE

This study aimed to compare lamina cribrosa (LC) parameters obtained by spectral-domain optical coherence tomography (SD-OCT) of eyes with exfoliation syndrome (PXS), exfoliation glaucoma (PXG) and healthy subjects.

METHODS

In this cross-sectional comparative study, 206 eyes of 206 subjects were included. The Bruch's membrane opening distance (BMOd), the anterior and posterior borders of the LC (LC thickness) and the anterior laminar depth (ALD) were imaged using the enhanced depth imaging (EDI) mode of SD-OCT.

RESULTS

There were 96 eyes in the PXG group, 55 eyes in the PXS group, and 55 eyes in the control group. The LC thickness was the thinnest in the PXG group (151.10 ± 51.18 μm), followed in the PXS group (158.76 ± 49.62 μm), and the thickest in the control group (181.00 ± 39.10 μm) (p = 0.002). In PXG cases where LC was observed in the deepest location, the ALD value was highest (423.92 ± 111.75 μm) in the PXG group, followed by the control group (403.08 ± 63.56 μm), and PXS group (357.43 ± 80.87 μm) (p < 0.001). The BMOd values were largest in the PXG group (1542.43 ± 152.99 μm), followed by the control group (1506.52 ± 169.09 μm) and PXS group (1435.74 ± 141.06 μm) (p < 0.001). In the PXG group, peripapillary retinal nerve fiber layer (pRNFL) thickness, BCVA, and cup to disc (C/D) ratio were also statistically different from the other groups (p < 0.001).

CONCLUSION

We found thinner LC thickness in PXG and PXS cases relative to the control group. Although its severity is associated with the diagnosis and severity of glaucoma, LC thinning can be encountered as an isolated condition in the presence of exfoliation.

Comparison of different tendon transposition techniques for the treatment of monocular elevation deficiency type 2

PURPOSE

To compare results of three different tendon transposition techniques (Knapp procedure and two modified techniques) for the treatment of type 2 monocular elevation deficiency (MED) patients.

METHODS

The medical records of patients with MED type 2 operated on at a single institution from 2000 to 2016 were reviewed retrospectively. Patients were divided into three vertical transposition groups: (1) full tendon width, (2) augmented surgery; and (3) partial tendon width. Surgical success was defined as no severe limitation of upgaze, hypotropia of <6^Δ, and no hypertropia in primary position. Pre- and postoperative vertical deviations in the primary position and limitations in elevation levels were compared.

RESULTS

A total of 39 patients were included. The pre- and postoperative deviations in the full-tendon group were 22.50^Δ ± 4.17^Δ and 3.50^Δ ± 1.27^Δ, respectively; in the augmented surgery group, 23.75^Δ ± 4.78^Δ and 1.75^Δ ± 1.14^Δ; and in the partial-tendon group, 20.50^Δ ± 3.98^Δ and 4.12^Δ ± 2.78^Δ. Corrected vertical deviations were 19^Δ, 23^Δ, and 16^Δ, respectively. The pre- and postoperative limitation of elevations were -2.80 and -0.80 in the full-tendon group, -3.20 and -0.90 in the augmented surgery group, and -2.37 and -1.12 in the partial-tendon group. The pre- and postoperative vertical deviation improvements and limitations of elevation were statistically significant (P < 0.05) in all groups. Success was achieved in 29 patients (74%).

CONCLUSIONS

In this study cohort, all three procedures were reasonably effective in improving vertical deviations and limitation of elevation.

The effects of ranibizumab injections on fluorescein angiographic findings and visual acuity recovery in age-related macular degeneration

Aim

The objective of the study reported here was to evaluate the effect of ranibizumab on retinal circulation times and vessel caliber and to analyze the correlation of these factors with visual acuity (VA) prognosis in patients with age-related macular degeneration (AMD).

Subjects and methods

This prospective cohort study included 52 eyes of 46 patients (mean age 73.5 years [standard deviation 7.7]; 28 males, 18 females). The study parameters were best-corrected visual acuity (BCVA), central macular thickness (CMT) (pre- and posttreatment: for 3 months after the last injection), retinal circulation times, diameter of retinal arteriole (DRA), and diameter of retinal vein (DRV) (pre- and posttreatment: after a loading dose of three consecutive injections of ranibizumab with a 4-week interval in the initial phase). The pretreatment, posttreatment measurements, and their differences were recorded for analyses. The injections were repeated when needed. Eyes were grouped into one of two groups according to VA recovery: Group 1, cases showing significant recovery of VA (n=21, 37%), and Group 2, cases showing preservation of VA (n=22, 42%) and deterioration of VA (n=11, 21%). Differences were compared statistically in and between groups. Logistic regression analysis was undertaken to determine the correlation of these parameters with VA recovery.

Results

There was a significant reduction in DRA (P=0.007) and CMT levels (P<0.001) in both study groups after treatment. When the two groups were compared, the differences in pretreatment values of DRA (P=0.001), DRV (P=0.017), CMT (P=0.039), and mean BCVA (P=0.00) were found to be statistically significant. Posttreatment changes in DRA (P=0.013) and mean CMT (P=0.010) were found to be factors related to VA recovery by logistic regression analysis.

Conclusion

Our findings reveal that ranibizumab treatment is associated with decrease in DRA, CMT, and significant improvement in VA recovery. Further, taking into account the cases in which VA was preserved, when needed, ranibizumab should be re-injected after the loading dose.