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Aim: to describe and analyze peripapillary microvascular changes in eyes with optic neuropathies using optical coherence tomography angiography (OCTA)., Methods: In this cross-sectional observational study, 63 eyes of 48 patients with different causes of optic neuropathy and 36 healthy control eyes were evaluated by optical coherence tomography (OCT) and OCTA (Topcon DRI OCT; Triton) between January 2018 and December 2018 at the Fattouma Bourguiba ophthalmology department in Monastir., Results: Vascular changes were more frequent in acute non arteritic anterior ischemic optic neuropathy (NAION) than in optic neuritis. Eyes with optic atrophy had capillary rarefaction corresponding to the area of thinning of the peripapillary optic fiber layer (RNFL). The peripapillary vascular density (PVD) was lower (p=0.036) in case of optic atrophy compared to normal eyes. For non arteritic ischemic optic neuropathy and for chronic retrobulbar optic neuritis (NORB), a positive correlation between visual acuity and PVD was observed (p<0.05). An inversely proportional correlation between the PVD and the duration of evolution was noted. In the multivariate study, high blood pressure was a systemic factor correlated with peripapillary microvascular damages., Conclusion: OCTA showed a reduction in PVD and greater vascular changes in acute non-arteritic ischemic optic neuropathy than in edematous optic neuritis. At the atrophic stage, the PVD was reduced. Hypertension was an independent factor correlated with peripapillary microvascular damages.

Purpose: This study aimed to determine predictive factors for low final visual acuity in patients with inactive Vogt-Koyanagi-Harada (VKH) disease using Swept-source OCT and OCT-angiography (OCT-A)., Methods: We conducted a prospective longitudinal study, including 21 patients (42 eyes), who were followed up for the first 24 months after disease onset. Patients were included at the acute phase and subsequently treated. Sequential qualitative and quantitative changes in OCT and OCT-A were assessed. Analytical statistical methods were employed to determine predictive factors for final visual acuity., Results: Structural alterations including focal parafoveal outer nuclear layer atrophy, ellipsoid zone disruption, interdigitation zone disruption, and irregular and thickened retinal pigment epithelium line were observed in 57.1% of eyes at month 3, with no significant improvement over time. The presence of flow voids at months 6, 12, and 24 was significantly associated with low final visual acuity. Serous retnal detachment at presentation emerged as an independent risk factor for structural changes detected by SS-OCT during the first 2 years of the disease. Optic disc edema was predictive factor for both structural SS-OCT and OCT-A changes., Conclusion: This study underscores the importance of monitoring flow voids to predict final visual acuity and highlights the impact of serous retinal detachment at presentation on structural changes in patients with inactive VKH disease.

Objective: To describe a case of Behçet disease (BD) uveitis manifesting with sequential bilateral neuroretinitis associated with prepapillary inflammatory vitreous exudate (PIVE)., Material and Methods: A single case report documented with multimodal imaging., Results: A 37-year-old man developed neuroretinitis with associated PIVE in the left eye. He was diagnosed with ocular toxoplasmosis and treated accordingly based on positive serologic testing and negative work-up for other entities, including BD. The disease course was favorable, but 1 year later a similar neuroretinitis developed in the right eye. Extraocular features of BD became evident only at the time of the second eye involvement, and the patient received corticosteroid and immunosuppressive therapy. Swept source (SS) OCT showed at the acute phase in both eyes a typical "mushroom-shaped" prepapillary hyperreflectivity of the PIVE. SS OCT angiography (OCTA) demonstrated a corresponding prepapillary hypointense area due to shadowing effect, decreasing in size while scanning deeper layers. It also detected peripapillary retinal hypervascularity in both eyes and a sectoral area of flow signal loss in the first involved left eye. Visual acuity improved following the resolution of the PIVE and associated acute inflammatory changes in both eyes. The left eye showed residual optic disc pallor and retinal nerve fiber layer defects., Conclusion: Sequential bilateral neuroretinitis associated with PIVE may occur before other clinical features of BD become evident. SS OCT and OCTA can provide useful information for the diagnosis and management of this rare, but typical, ocular manifestation of BD uveitis.

Aim: To describe a case of posterior ischemic optic neuropathy (PION) revealing carotid arterial dissection occurring after ipsilateral tooth extraction., Case Report: A 56-year-old patient referred for sudden loss of vision of the left eye (LE) since 3 weeks. Initial visual acuity was 10/10 in the right eye (RE) and limited to light perception in the LE. Ophthalmological examination was without abnormalities in the RE. A relative afferent pupillary defect was noted in the LE. Fundus examination of the LE revealed a papillary pallor, without excavation. Fluorescein angiography revealed no abnormalities in both eyes, including normal choroidal filling. The diagnosis of left PION was retained. A careful questioning of the patient revealed the history of tooth extraction under intra-oral local anesthesia one day before the vision loss. Investigational work up revealed a dissection of the left internal carotid artery., Conclusion: Dissection of the internal carotid artery is a rare but possible cause of PION. Ocular involvement may be the only manifestation. Clinicians should be aware of such manifestation especially in case of particular context of micro-trauma, such as dental procedures, and look for an underlying cause that may be potentially fatal.