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Nodular Posterior Scleritis: A Clinical Case Report
Armando Bautista-Barba,
Erick Andres Quiroz-Gonzalez,
Miguel Angel Quiroz-Reyes,
Jhoana Sanchez-Ruiz,
Rafael Valdez-Sosa,
Gerardo Ledesma-Gil,
Miguel Pedroza-Seres,
Federico Graue-Wiechers
Issue:
Volume 7, Issue 1, March 2022
Pages:
1-5
Received:
17 December 2021
Accepted:
4 January 2022
Published:
12 January 2022
Abstract: Background: Scleritis is a rare inflammation of the outer coat of the eye, which is often characterized by pain and redness and may be associated with visual loss and blindness. Posterior scleritis may lead to the formation of a choroidal mass which is often confused with choroidal tumors. A delayed and an inaccurate diagnosis may lead to devastating outcomes, that including unnecessary enucleation. Therefore, a prudent clinical judgement is necessary. Objective: To report clinical characteristics of an outstanding posterior scleritis which required a multidisciplinary collaboration for its management. Method: A young man presented with redness and diminished vision in his right eye for 5 days. A detailed ophthalmological examination was completed, which suggested a final diagnosis of posterior nodular scleritis that was presumed to occur secondary to anti-neutrophil cytoplasmic antibodies-associated granulomatosis with polyangiitis. A multimodal imaging workup suggested posterior nodular scleritis and laboratory investigation confirmed positive antineutrophil cytoplasmic antibodies (C-ANCAs). All other infectious and immunological tests came negative. The patient was subsequently treated with systemic steroids and immunomodulatory therapy, with an excellent visual recovery. Best-corrected visual acuity improved from 20/200 at presentation to 20/25 at eight months after the therapy, and there was no evidence of disease recurrence. Conclusion: Nodular posterior scleritis is an important but benign disease that may mimic an intraocular tumor. Multimodal imaging studies and detailed laboratory investigations are essential for its correct diagnosis and appropriate management.
Abstract: Background: Scleritis is a rare inflammation of the outer coat of the eye, which is often characterized by pain and redness and may be associated with visual loss and blindness. Posterior scleritis may lead to the formation of a choroidal mass which is often confused with choroidal tumors. A delayed and an inaccurate diagnosis may lead to devastati...
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Comprehensive Foveal Avascular Zone and Retinal Evaluation with Their Correlation to Visual Acuity and Glycemic Control in Diabetics Without Macular Edema
Mohamed M. Halfawy,
Abelrahman Gaber Salman,
Azza M. A. Said,
Tarek El Beltagi,
Marwa A. Karim
Issue:
Volume 7, Issue 1, March 2022
Pages:
6-13
Received:
31 December 2021
Accepted:
19 January 2022
Published:
25 January 2022
Abstract: Background: Evaluating Foveal avascular zone by OCTA (Optical Coherence Tomography angiography) in diabetic patients, has a crucial role in early detection of pathophhsiological changes affecting the macular area, and has a pedective value for early retinal neuro degenerative changes. Materials and experiments: Aim: To evaluate dimensions of Foveal Avascular Zone (FAZ) at level of superficial and deep capillary plexuses (SCP/DCP) in patients with different grades of non proliferative diabetic retinopathy without Diabetic Macular Edema (DME) using OCTA. Eighty type II diabetes mellitus patients and 20 healthy control, ecxluding proliferative diabetic retinopathy and DME. Divided to four groups according to ETDRS Classification. All undewent: measurement of glycosylated hemoglobin level, standard Structural OCT for the macula and optic nerve head with OCTA for evaluation of FAZ in both SCP and DCP networks of all eyes using (Heidelberg engineering, OCT spectralis, Germany) (SD-OCT). Results: Mean FAZ in SCP in control group (0.32 ± 0.12) mm2 versus (0.44 ± 0.17) mm2 in patients` group, while FAZ IN DCP (0.23) mm2 ± 0.12 in controls versus (0.34 ± 0.16) mm2 in patients. There was a statistically significant wider FAZ in DR patients (P-value 0.003). Conclusion: Enlargement of FAZ in SCP and DCP in patients with moderate to severe NPDR without DME was detected using OCTA, Preceeded by reduction in thickness of ORL and GCC layer. This can be used to monitor the progression of the disease and to evaluate the response to treatment.
Abstract: Background: Evaluating Foveal avascular zone by OCTA (Optical Coherence Tomography angiography) in diabetic patients, has a crucial role in early detection of pathophhsiological changes affecting the macular area, and has a pedective value for early retinal neuro degenerative changes. Materials and experiments: Aim: To evaluate dimensions of Foveal...
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Hydrostatic Pressure Gradients and a New Membrane-glymphatic Theory of Primary Glaucoma
Juldyz Beisekeeva,
Jamilia Kulumbetova,
Serik Beisekeev,
Sergei Aleksandrovich Kochergin
Issue:
Volume 7, Issue 1, March 2022
Pages:
14-25
Received:
23 January 2022
Accepted:
8 February 2022
Published:
16 February 2022
Abstract: The paper describes a novel theory of primary glaucoma etiopathogenesis based on a new understanding of the glymphatic system of the eye. Glymphatic flow routes of the eye include the vitreous body, uveal tract, paravascular spaces, and the retina. There are different pressure gradients of the intraocular fluid flow within the divided central channel of the vitreous body. In normal conditions above the foveola there is highly positive pressure gradient whereas above the optic disc it is 3 times lower. The retinal pigment epithelium is responsible for water and metabolic exchanges between choroid and the vitreous, therefore may contribute to intra-ocular fluid accumulation. Impairment of the outer blood-ocular and/or blood-aqueous barriers is the key pathogenic element of glaucoma including secondary forms due to uveitis. A disbalance of the pressure gradients above the macula and above the optic disc leads to fluid accumulation above the latter. An abundant intra-retinal fluid flow through the glymphatic pathways in the outer and inner plexiform layers, formed by Muller cell processes, contributes to accumulation of the interstitial fluid before the lamina cribrosa. Excessive interstitial fluid from the retina passes not only through the retinal pigment epithelium to choroid but also through paravascular spaces to the optic disc cup and discharges partly back to the vitreous body through the prevascular vitreous fissures. There is an interstitial fluid flow existing through paravascular spaces, the plexiform layers of retina and along the axons of ganglion cells to the optic nerve and its sheath where excessive fluid is absorbed into the subarachnoid space. The RPE plays a major role in glaucoma etiopahogenesis, probably acting as a regulator of fluid transport in the eye.
Abstract: The paper describes a novel theory of primary glaucoma etiopathogenesis based on a new understanding of the glymphatic system of the eye. Glymphatic flow routes of the eye include the vitreous body, uveal tract, paravascular spaces, and the retina. There are different pressure gradients of the intraocular fluid flow within the divided central chann...
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Recurrence of Lymphoblastic Leukemia Manifesting as Bilateral Optic Disk Neovascularization During Complete Clinical Remission--Case Report
Issue:
Volume 7, Issue 1, March 2022
Pages:
26-29
Received:
4 February 2022
Accepted:
21 February 2022
Published:
28 February 2022
Abstract: Background: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration and retinal neovascularization are unusual, especially in complete clinical remission of ALL. However, neovascularization in optic disk has not been observed in ALL during complete clinical remission. Objective: To report clinical characteristics of a bilateral optic disk neovascularization associated with relapse of ALL. Method: A 31-year-old male with ALL after having reached complete remission from chemotherapy complained about a vision loss in both eyes. First examination showed that best corrected visual acuity (BCVA) was 20/200 for his right eye and 20/160 for his left eye, respectively. Fundus examination revealed bilateral profound optic disk edema with multiple yellow-white exudates and retinal hemorrhages. Optical coherence tomography (OCT) showed bilateral optic disk edema and SRD in both maculas. Fundus fluorescein angiography (FFA) showed bilateral optic disk neovascularization. All these changes were present in remission. The patient received intravitreal Conbercept injection 0.5 mg (10 mg/ml) in both eyes for once on June 29, 2019. Optic disk neovascularization resolved three weeks after treatment. BCVA improved to 20/200 in his right eye, but still light perception in his right eye. No optic disk neovascularization recurrence was observed in 3-month follow-up. BCVA of the right eye maintained 20/200 at the latest follow-up. After intravitreal injection for 4 months the patient suffered from cerebral hemorrhage. He received bone marrow biopsy and cerebrospinal fluid sampling. The results showed relapse in hemogram and lymphocytes in central nervous system (CNS). Therefore, the chemotherapy treatment did not cause a new remission of the disease and the patient failed to recover. Conclusion: Optic disk neovascularization may appear as a sign of extramedullary relapse of ALL months in advance of the hematologic relapse. Intravitreal injection of conbercept could be beneficial and safe in treating this neovascularization.
Abstract: Background: The intraocular manifestations of leukemia are diverse. The retina is the most common ophthalmic involvement site. The most common retinal manifestations of acute lymphoblastic leukemia (ALL) include dilated and tortuous vessels, serous retinal detachment (SRD), intraretinal hemorrhages as well as roth spots. Optic nerve infiltration an...
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The Effect of Artificial Tear Treatment on Central Corneal Thickness in Dry Eye
Al Ahmad Anas,
Mahmoud Rajab
Issue:
Volume 7, Issue 1, March 2022
Pages:
30-32
Received:
27 December 2021
Accepted:
13 January 2022
Published:
4 March 2022
Abstract: Purpose: To evaluate the effect of artificial tear treatment on central corneal thickness in dry eye patients using corneal topography. Materials and Methods: In this before and after study, central corneal thickness measurements using corneal topography (SIRIUS CSO ITALIA) were performed on 192 eyes of 96 patients with dry eye at the ophthalmology department of Tishreen University Hospital/Lattakia from August 2020 to August 2021. Patients underwent ocular examinations, including Schirmer test, slit lamp examination for tear break-up time (BUT), and central corneal thickness (CCT) measurements using corneal topography before and after artificial tear treatment (carboxymethylcellulose and sodium hyaluronate 0,5% eye drop formulations) 3-4 times a day for one month, patients were examined again at a second visit and the results were compared. Results: The mean CCT was (545.79±10.5) before treatment and (571.30±11.3) after treatment (p=0.0001, p=0.0001). CCT statistically significantly increases of 4,7% from baseline (p=0.000) 1. The mean tear BUT and Schirmer-1 tests revealed significant improvement after treatment. Conclusion: Artificial tear treatment in dry eye patients significantly increases the central corneal thickness. This increase could be used as a criterion in the diagnosis and follow up of dry eyes, and this increase in thickness should be considered in intra ocular pressure measurements as well as in refractive surgical procedures.
Abstract: Purpose: To evaluate the effect of artificial tear treatment on central corneal thickness in dry eye patients using corneal topography. Materials and Methods: In this before and after study, central corneal thickness measurements using corneal topography (SIRIUS CSO ITALIA) were performed on 192 eyes of 96 patients with dry eye at the ophthalmology...
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Comparison of the Amplitude of Accommodation Measured Using Push-up, Minus Lens-to-Blur Methods and Hofstetter's Equations in Saudi University Students
Issue:
Volume 7, Issue 1, March 2022
Pages:
33-39
Received:
3 February 2022
Accepted:
24 February 2022
Published:
4 March 2022
Abstract: Background: Commonly, two clinical techniques are used to measure the amplitude of accommodation: push-up and minus lens-to-blur approaches. However, there is no consensus on the accurate technique for assessing the accommodative amplitude in the clinical eye examination. Aim: This study was to compare push-up and minus lens-to-blur methods and Hofstetter's equations for assessing the amplitude of accommodation in Saudi university students. Methods: This was a comparative cross-sectional, performed in the department of optometry clinic between February and May 2020. The amplitude of accommodation was assessed on 79 Saudi young students (62 males and 17 females, mean age and standard deviation was 23.50 ± 2.29 years old using the push-up and minus lens-to-blur methods and calculated using Hofstetter's equations. Results: The findings showed that the highest mean of the amplitude of accommodation was found by using the Hofstetter's maximum equation (15.2 ± 0.9D), whereas the minus lens-to-blur technique provided the lowest result (8.6 ± 1.6D). Using the t-test, significant changes were seen between all methods P<0.0001 except the minus lens-to-blur method and Hofstetter's minimum equation P=0.077. Measurements by different methods revealed an opposite association between subjects' age and amplitude of accommodation. Conclusion: Given the significant variance in results obtained between the different techniques for measuring the amplitude of accommodation, caution should be taken once making decisions regarding amplitude accommodation assessment in young subjects with accommodative disorders and binocular vision abnormalities.
Abstract: Background: Commonly, two clinical techniques are used to measure the amplitude of accommodation: push-up and minus lens-to-blur approaches. However, there is no consensus on the accurate technique for assessing the accommodative amplitude in the clinical eye examination. Aim: This study was to compare push-up and minus lens-to-blur methods and Hof...
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Cornea Confocal Microscopy Study of Patients with Preclinical Keratoconus
Jing Yang,
Minhui Wu,
Yi Wu,
Runzhang He,
Yating Nong,
Chun Zhang,
Sheng Zhou
Issue:
Volume 7, Issue 1, March 2022
Pages:
40-44
Received:
15 February 2022
Accepted:
4 March 2022
Published:
12 March 2022
Abstract: Purpose: To report the difference of corneal confocal microscopy examination in patients with preclinical keratoconus or clinical keratoconus. Methods: 8 unilateral keratoconus patients were examined by confocal microscopy before they had cross-linking surgery. As control groups, 23 patients with myopia and 13 patients with keratoconus in both eyes were also examined by confocal microscopy. Then we used Image J to compared the density of epithelium cell, length of cornea nerve fiber, density of Langerhans cell, density of keratocyte in shallow, middle, deep stroma, and the width and grayscale value of fold near Descement membrane for each group. Result: There was differences in corneal epithelial cell count between three groups (4358.27 ± 635.14 cells/mm2 versus 4057.81 ± 316.29 cells/mm2 versus 3522.65 ± 978.10 cells/mm2). The density of keratocyte in stroma showed a tendency to decrease with increasing depth. The density of keratocyte in keratoconus was less than that in normal eyes. The fold showed much wider and daker in keratoconus eyes than in normal eyes. The density of Langerhans cell was more in keratoconus group than it in normal group. Conclusion: We first report the differences in corneal epithelial cell count and fold near Descement membrane. It might provide a new way to diagnose early keratoconus. The difference of density of Langerhans cell suggested us the possibility of inflammation in keratoconus.
Abstract: Purpose: To report the difference of corneal confocal microscopy examination in patients with preclinical keratoconus or clinical keratoconus. Methods: 8 unilateral keratoconus patients were examined by confocal microscopy before they had cross-linking surgery. As control groups, 23 patients with myopia and 13 patients with keratoconus in both eyes...
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