Search

Background/aims To determine whether a combination of baseline and change in spectral domain-optical coherence tomography (SD-OCT)-based biomarkers can predict visual outcomes in eyes with diabetic macular oedema (DMO) treated with antivascular endothelial growth factors (VEGF) injections. Methods This is a retrospective cohort study conducted in Hong Kong, China. 196 eyes with centre-involving DMO, who received anti-VEGF injections between 1 January 2011 and 30 June 2018 were recruited. Medical records of the participants were retrieved retrospectively, visual acuity (VA) at baseline, 6, 12 and 24 months and SD-OCT before initiation and after completion of anti-VEGF treatment were obtained. The SD-OCT images were evaluated for the morphology of DMO, vitreomacular status, presence of disorganisation of retinal inner layers (DRIL), sizes of intraretinal cysts, visibility of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tip (COST) and the presence of hyper-reflective foci in retina or the choroid. Results The presence of baseline DRIL, hyper-reflective foci in retina and disruption of ELM/EZ and COST were associated with worse baseline and subsequent VA up to 24 months after treatment. Improvement in DRIL (p=0.048), ELM/EZ (p=0.001) and COST (p=0.002) disruption after treatment was associated with greater improvement in VA at 12 months. Eyes with cystoid macular oedema (p=0.003, OR=8.18) and serous retinal detachment (p=0.011, OR=4.84) morphology were more likely to achieve at least 20% reduction in central subfield thickness. Conclusion and relevance Baseline SD-OCT biomarkers and their subsequent change predict VA and improvement in vision in eyes with DMO treated with anti-VEGF injections. We proposed an SD-OCT-based system that can be readily used in real-life eye clinics to improve decision making in the management of DMO. [ABSTRACT FROM AUTHOR]

We describe multimodal imaging features of right eye choroidal metastasis of non-small-cell lung cancer in a 25-year-old woman. This case report highlights the importance of multimodal imaging and liquid biopsy in making the diagnosis of choroidal metastasis. Spectral domain optical coherence tomography showed a dome-shaped choroidal elevation with subretinal fluid and subretinal hyper-reflective foci. Fundus autofluorescence showed hyper-autofluorescence with alternating spots of hypo-autofluorescence. Fluorescein angiography showed hypofluorescence followed by diffuse and pin-point leakage. Indocyanine green angiography showed a hypofluorescence lesion. The patient was initially misdiagnosed as having choroiditis and treated with oral corticosteroid. However, the exudative retinal detachment progressed and optic disc edema developed. The working diagnosis was thus shifted towards choroidal neoplasm. Positron emission tomography and lung biopsy confirmed the diagnosis of metastatic non-small-cell lung cancer. Blood-based comprehensive genomic profiling detected a rare epidermal growth factor receptor mutation. Target therapy with osimertinib achieved good oncological response. Vision improved to 6/7.5, and the choroidal lesion and subretinal fluid regressed. At 1-year followup, the patient had no systemic or ocular relapse. [ABSTRACT FROM AUTHOR]

Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is a cause for orbital and ocular inflammation. Involvement of the sclera and intraocular tissues is less common, and presentation is mostly unilateral. We hereby describe a probable case of steroid-resistant intraocular IgG4-ROD presenting as a choroidal mass in the left eye, with sequential anterior uveitis and scleritis of the fellow right eye. The diagnostic path was not straightforward and included subconjunctival biopsy, blood tests, magnetic resonance imaging, positron emission tomography-computed tomography, and biopsies in two extra-ocular sites. Disease progression was rapid in the left eye despite high-dose oral steroids, while the inflammation of the fellow eye was controlled with the use of rituximab and secondline immunosuppressants. At the 3-year follow-up, the ocular inflammation was well controlled. The left eye was phthisical, but the right eye maintained a visual acuity of 20/20. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to quantitatively compare the peripapillary vessel density (PPVD), measured with optical coherence tomography angiography (OCT-A), between acute nonarteritic anterior ischemic optic neuropathy (NAION) and other causes of disc swelling ("others"). Methods: In this prospective comparative case series, patients with unilateral disc swelling due to acute NAION (n = 7) and "others" (n = 7) underwent OCT-A scanning of the optic nerve head with a swept-source OCT (Triton DRI-OCT), in addition to functional assessment. OCT-A images were analyzed using an automated customized MATLAB program. Comparison was made between total and 6 sectoral PPVD (radial peripapillary capillary [RPC] and choroid layers) of affected and fellow eyes; and between the 2 groups' affected eyes. Five NAION patients had repeated assessments at 1, 3, and 6 months. Results: Acute NAION eyes had a significantly lower total and superonasal PPVD (both layers) compared to fellow eyes. No such difference was observed in "others" group for the RPC layer. NAION eyes also had significantly lower total RPC PPVD than affected eyes in the "others" group. Over 6 months, NAION eyes had persistently lower RPC PPVD compared to fellow eyes but the reduced choroidal PPVD resolved by 1 month. Conclusion: The study demonstrated reduced superonasal and total RPC PPVD in acute NAION, which persisted over 6 months. Because there is currently no single diagnostic test for NAION, use of OCT-A images to analyze RPC PPVD may potentially help distinguish acute NAION from other causes of disc swelling by quantitatively demonstrating capillary dropout in the RPC layer. [ABSTRACT FROM AUTHOR]

Background/aims While cytomegalovirus (CMV) anterior uveitis (AU) patients often require glaucoma surgery, the effectiveness of systemic anti-viral in longterm intraocular pressure (IOP) control is not well established. Our study aims to identify the 2-year efficacy and safety of oral valganciclovir in CMV AU with uncontrolled IOP. Methods In this retrospective case series, one eye from each of 17 immunocompetent PCR-proven patients with CMV AU who received a single course of oral valganciclovir for 20-148 days for medically uncontrolled IOP during 2008-2018 were identified. They were examined at baseline, week 2, months 1, 2 and 3, then every 3 months up to 2 years after commencement of valganciclovir, or until IOP-lowering procedure. Results Median baseline IOP and IOP-lowering medication were 27.0 mm Hg (IQR: 22.9-31.0 mm Hg), and 4.0, respectively. IOP was significantly lower than baseline from 2 weeks to 12 months and at 21 and 24 months after starting valganciclovir (p=0.001 to 0.041, Wilcoxon sign-rank test), with 16.9-46.0% median IOP reduction. Seven (41.2%) and six (35.3%) patients had IOP=21 mm Hg with same, or reduced, topical medications by 12 and 24 months, respectively. Median time to IOP-lowering intervention or second course of valganciclovir was 12.4 months. There was no serious medication-related adverse event. Common side effects included reduced monocyte count (9 patients) and deranged renal function/electrolytes (5 patients). IOP spike and wound leak occurred in 35.5% and 29.4% of patients, respectively, after diagnostic aqueous tap. Conclusion In CMV AU with uncontrolled IOP, >1/3 of the patients avoided glaucoma surgery over 2 years with a course of oral valganciclovir. [ABSTRACT FROM AUTHOR]

We describe two cases of progressive abducens nerve palsy secondary to a compressive lesion in the Dorello canal. Blood tests, lumbar puncture, nasopharyngeal examination, computed tomography, magnetic resonance imaging, and angiography were performed, but the etiology could not be identified. After consultation with a neuroradiologist, fine-cut magnetic resonance imaging along the course of the abducens nerve with gadolinium and constructive interference in steady state sequences was performed, and the diagnosis was made. In cases of small intracranial pathology, the use of thinner slices or specific sequences is suggested to better visualize the course of cranial nerves. [ABSTRACT FROM AUTHOR]

Aim To examine the correlation of best-corrected visual acuity (BCVA) with intercapillary area (ICA) measured from optical coherence tomography angiography (OCT-A) in patients with diabetes, and to compare the strength of associations between BCVA with ICA and other OCT-A metrics. Methods A cross-sectional study involved 447 eyes from 299 patients with diabetes. All participants underwent OCT-A with a swept-source OCT (Triton DRIOCT, Topcon, Tokyo, Japan). An automated customised MATLAB programme was used to quantify ICA (the mean of the 10 largest areas including foveal avascular zone (FAZ) area (ICA10_FAZ) and excluding FAZ area (ICA10_excFAZ)) and other OCT-A metrics (FAZ area, FAZ circularity and vessel density) from the macular OCT-A images. BCVA was measured using Snellen chart for the patients and then converted to logarithm of the minimum angle of resolution (logMAR) VA. We further defined 'good VA' as Snellen >0.7 and 'poor VA' as Snellen =0.7 as a binary VA outcome for logistic regression analysis. Results In univariate regression analysis, increased ICA10_FAZ and ICA10_excFAZ were significantly correlated with logMAR (p values <0.05). In multivariate regression analysis, only the association between ICA10_FAZ and logMAR persisted (ß=0.103, p=0.024). In multivariable logistic regression analysis, increased ICA10_FAZ (OR=1.300, 95% CI 1.076 to 1.679, p=0.044) and FAZ circularity (OR=1.285, 95% CI 1.031 to 1.603, p=0.026) showed significant associations with poor VA. Conclusions Increased ICA measured from OCT-A, describing enlargement of capillary rarefaction or closure at macular area, is independently associated with BCVA, suggesting that ICA is a potential marker to quantify retinal microvascular abnormalities relating to vision among individuals with diabetes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine and compare the optic disc and macular thickness measurements using two spectral-domain optical coherence tomography (SD-OCT) instruments in long-standing blind eyes diagnosed with non-glaucomatous optic neuropathies (NGON). A prospective observational case-series design was used. Twelve eyes from 12 NGON patients with no light perception for at least 6 months underwent optic disc and macular imaging with Cirrus HD-OCT and Spectralis OCT. The correlation between the peripapillary retinal nerve fibre layer (PRNFL) and macular ganglion cell layer and inner plexiform layer (GCL+IPL) thicknesses, and between the duration of no light perception (NLP) and PRNFL/GCL+IPL thicknesses were determined using Spearman’s correlation analysis. The mean average PRNFL thickness was 55.9 ± 4.8 µm for Cirrus HD-OCT, which was significantly thicker than that measured by Spectralis OCT (31.9 ± 7.4 µm;p< 0.001). The mean central macular thickness on Cirrus HD-OCT was normal, but there was global thinning at the other macular areas. The mean average GCL+IPL thickness on Cirrus HD-OCT was 51.8 ± 5.8 µm. There was a good correlation between average PRNFL thickness and GCL+IPL thickness (r= 0.830,p= 0.002); however, there was no significant correlation between the duration of NLP to the average PRNFL thickness (on either instruments) or GCL+IPL thickness on Cirrus HD-OCT (p> 0.7). These results show that there was residual PRNFL thickness in NGON eyes with NLP, which varied significantly between SD-OCT instruments. The values of the residual PRNFL and GCL+IPL thicknesses in blind eyes (the “floor” effect) may be useful for prognostic purposes for patients with partial optic atrophy. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a common allergic skin disease, characterized by dryness, itchiness, thickening and inflammation of the skin. Infiltration of eosinophils into the dermal layer and presence of edema are typical characteristics in the skin biopsy of AD patients. Previous in vitro and clinical studies showed that the Pentaherbs formula (PHF) consisting of five traditional Chinese herbal medicines, Flos Lonicerae, Herba Menthae, Cortex Phellodendri, Cortex Moutan and Rhizoma Atractylodis at w/w ratio of 2:1:2:2:2 exhibited therapeutic potential in treating AD. In this study, an in vivo murine model with oxazolone (OXA)-mediated dermatitis was used to elucidate the efficacy of PHF. Active ingredients of PHF water extract were also identified and quantified, and their in vitro anti-inflammatory activities on pruritogenic cytokine IL-31- and alarmin IL-33-activated human eosinophils and dermal fibroblasts were evaluated. Ear swelling, epidermis thickening and eosinophils infiltration in epidermal and dermal layers, and the release of serum IL-12 of the murine OXA-mediated dermatitis were significantly reduced upon oral or topical treatment with PHF (all p < 0.05). Gallic acid, chlorogenic acid and berberine contents (w/w) in PHF were found to be 0.479%, 1.201% and 0.022%, respectively. Gallic acid and chlorogenic acid could suppress the release of pro-inflammatory cytokine IL-6 and chemokine CCL7 and CXCL8, respectively, in IL-31- and IL-33-treated eosinophils-dermal fibroblasts co-culture; while berberine could suppress the release of IL-6, CXCL8, CCL2 and CCL7 in the eosinophil culture and eosinophils-dermal fibroblasts co-culture (all p < 0.05). These findings suggest that PHF can ameliorate allergic inflammation and attenuate the activation of eosinophils. [ABSTRACT FROM AUTHOR]