scholarly journals A Case of Bilateral Optic Edema in a 71 Year Old Diabetic

2021 ◽  
Vol 5 (3) ◽  
Keyword(s):  
Blood Pressure ◽  
Visual Acuity ◽  
Optic Disc ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Type Ii Diabetes Mellitus ◽  
Color Test ◽  
Corrected Visual Acuity ◽  
History Of ◽  
At Home

A 71 year old Hispanic male with a past medical history of hypertension, type II diabetes mellitus, and bilateral anatomically narrow angles status post bilateral peripheral iridotomies presented with the complaint of “looking through a film.” The patient could still drive, work as a cashier, see his computer and television, and read with his glasses. It was worse in the morning and resolved when he washed his face. The patient denied headaches, jaw claudication, weight loss, and anorexia. Pt had no neurologic deficits including diplopia. The patients hemoglobin A1c 4 months prior to being seen was 7. The patient endorsed checking his blood sugars at home and most are less than 200. The patient routinely checks his blood pressure at home and it is usually 130s/70s. The patient’s best corrected visual acuity was 20/20 in each eye at distance, intermediate, and near. His Ishihara color test was 11/11 in each eye as well. His intraocular pressure was 13 in each eye with corneal thickness of 642 OD and 626 OS. There was no relative afferent pupillary defect in each eye, extraocular muscle movements were full, and his confrontation fields were full as well. His anterior segment exam was unremarkable except for nuclear sclerosis of each lens. The fundus examination was remarkable for bilateral optic disc swelling with heme off both optic discs. Fluorescein angiography demonstrated bilateral optic disc leakage. OCT showed a flat sensory retina in each macula. The patient had an emergent MRI that demonstrated diffuse loss of normal high T2 signal, but no intracranial mass was present. CRP and ESR were both within normal limits when accounted for the patient’s age. The patient’s papilledema improved on one month follow-up exam without intervention. Due to the patient’s history of diabetes, normal corrected visual acuity, reportedly well controlled blood pressure, and essentially unremarkable work-up, the patient was diagnosed with diabetic papillopathy.

scholarly journals Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Zahra Ashena ◽  
Thomas Hickman-Casey ◽  
Mayank A. Nanavaty
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

Detecting subclinical keratoconus by biomechanical analysis in tomographically regular keratoconus fellow eyes

2021 ◽  
pp. 112067212110637
Author(s):  
Victor A Augustin ◽  
Hyeck-Soo Son ◽  
Isabella Baur ◽  
Ling Zhao ◽  
Gerd U Auffarth ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Corneal Thickness ◽  
Corneal Thickness ◽  
Case Series ◽  
Biomechanical Analysis ◽  
Corvis St ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Best Corrected Visual Acuity ◽  
Fellow Eyes

Purpose To analyze the tomographically non-affected second eyes of keratoconus patients using the Corvis ST to detect any biomechanical abnormalities or subclinical keratoconus. Methods In this retrospective, single-center, consecutive case series 244 eyes of 122 keratoconus patients were analyzed between November 2020 and February 2021. Fourteen fellow eyes fulfilled the inclusion criteria and showed no clinical or tomographic signs of keratoconus. Main outcome measures included best-corrected visual acuity, tomographic and biomechanical analyses using Scheimpflug imaging: Pentacam and Corvis ST (Oculus, Wetzlar, Germany). Tomographic analyses included anterior and posterior simulated keratometry, K-Max, central corneal thickness, thinnest corneal thickness, Belin/Ambrosio Ectasia Display, and the ABCD grading system. For biomechanical analyses, the corneal biomechanical index (CBI) and tomographic biomechanical index were used. Results The mean best-corrected visual acuity was 0.01 ± 0.10 logMAR. Mean K-Max was 43.79 ± 1.12 D, mean central corneal thickness 529 ± 25 µm, mean thinnest corneal thickness 524 ± 23 µm, and mean Belin/Ambrosio Ectasia Display 1.0 ± 0.32. The mean CBI was 0.30 ± 0.21. Regular CBI values were found in six of 14 patients. The mean tomographic biomechanical index was 0.47 ± 0.22 with regular values observed in only two of 14 patients. No signs of tomographic or biomechanical abnormalities were shown in only one of 14 keratoconus fellow eyes, with regular ABCD, Belin/Ambrosio Ectasia Display, CBI and tomographic biomechanical index values. Conclusions Tomographically normal fellow eyes of keratoconus patients are rare. In these cases, a biomechanical analysis of the cornea may help detect a subclinical keratoconus. The tomographic biomechanical index was the most sensitive index to verify a mild ectasia.

Single-pass four-throw pupilloplasty for Urrets-Zavalia syndrome

2018 ◽  
Vol 28 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Priya Narang ◽  
Amar Agarwal ◽  
Dhivya Ashok Kumar
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Segment ◽  
Anterior Chamber Angle ◽  
Single Pass ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Chamber Angle ◽  
Best Corrected Visual Acuity

Purpose: To demonstrate the efficacy and initial results of single-pass four-throw pupilloplasty in cases of Urrets-Zavalia syndrome. Methods: In this prospective interventional study, single-pass four-throw was performed to reconstruct the pupil in all symptomatic cases with Urrets-Zavalia syndrome. Applanation tonometry, indentation gonioscopy, and anterior segment optical coherence tomography for anterior chamber angle assessment were performed in all the cases. Results: Out of 10 cases that were identified with Urrets-Zavalia syndrome, the procedure was performed in 7 cases, whereas 3 cases were left untreated, as they did not have any visual complaints. Five out of seven eyes had preoperative raised intraocular pressure with appositional closure of the angle. Postoperatively, intraocular pressure was controlled in all the eyes, whereas one eye required antiglaucoma medications to control the intraocular pressure. The mean preoperative and postoperative best-corrected visual acuity was 1.1 ± 1.2 and 0.4 ± 0.4 LogMar, respectively. There was a significant improvement in the best-corrected visual acuity (p = 0.0169) in the postoperative period. The mean preoperative and postoperative intraocular pressure was 26.6 ± 11.23 and 16.3 ± 2.98 mm Hg, respectively (p = 0.0168). All the patients had a minimum of 6-month follow-up period (range = 6–8 months). Conclusion: Single-pass four-throw can be employed for cases with Urrets-Zavalia syndrome, and single-pass four-throw helps to prevent the postoperative glare and narrows down the pupil size effectively. Single-pass four-throw helps to alleviate the anterior chamber angle apposition in patients with Urrets-Zavalia syndrome by mechanically pulling the peripheral iris centrally as demonstrated on anterior segment optical coherence tomography. The study also reports the occurrence of Urrets-Zavalia syndrome after glued intraocular lens surgery.

scholarly journals Photodynamic Therapy for Juxtapapillary Retinal Capillary Hemangioma

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Panagiotis G. Mitropoulos ◽  
Irini P. Chatziralli ◽  
Vasileios G. Peponis ◽  
Vasileia A. Tsiotra ◽  
Efstratios A. Parikakis
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Optic Disc ◽  
Anterior Segment ◽  
Capillary Hemangioma ◽  
Treatment Modalities ◽  
Inferior Margin ◽  
Retinal Capillary ◽  
Retinal Capillary Hemangioma ◽  
The Right

Various treatment modalities have been described for retinal capillary hemangioma. Our purpose is to present a case of juxtapapillary retinal capillary hemangioma treated with photodynamic therapy. A 69-year-old woman with no previous ocular history presented with blurred vision and photopsias in the right eye three months ago. At presentation, her best corrected visual acuity was 6/9 in the right eye and 6/6 in the left eye. The anterior segment was totally normal and IOP was normal in both eyes as well. Dilated fundoscopy revealed a yellowish, well-circumscribed, elevated area with blood vessels, on the inferior margin of the right optic disc, as optic disc edema. Fluorescein angiography and angiogram with indocyanine green confirmed the diagnosis of juxtapapillary retinal capillary hemangioma. The patient was treated with photodynamic therapy with verteporfin and three months later her visual acuity was 6/7.5 in the right eye, while the lesion was slightly smaller. These findings remained stable at the one-year follow-up. In conclusion, photodynamic therapy offers promising anatomical and functional results for juxtapapillary retinal capillary hemangioma, providing visual acuity improvement or even stabilization and restriction of enlargement of the lesion.

scholarly journals Relationship among Corneal Biomechanics, Anterior Segment Parameters, and Geometric Corneal Parameters

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Sadık Görkem Çevik ◽  
Sertaç Argun Kıvanç ◽  
Berna Akova-Budak ◽  
Mediha Tok-Çevik
Keyword(s):  
Corneal Thickness ◽  
Anterior Segment ◽  
Biomechanical Properties ◽  
Negative Association ◽  
Corneal Resistance Factor ◽  
Multivariate Models ◽  
Corrected Visual Acuity ◽  
Biomechanical Parameters ◽  
Anterior Segment Parameters ◽  
The Relationship

Purpose. To investigate the relationship between corneal biomechanical parameters, anterior segment parameters, and geometric corneal parameters in a healthy Caucasian group. Methods. This retrospective study included the healthy eyes with best corrected visual acuity of at least 20/40 of 122 Caucasian subjects. The anterior segment parameters and geometric corneal parameters such as corneal volume, central corneal thickness, horizontal and vertical corneal radii, anterior and posterior steep, and flat keratometric values were measured with a Scheimpflug camera. The biomechanical properties were measured with Ocular Response Analyzer. Results. One hundred and twenty-two healthy Caucasian subjects (67 males, 55 females) with a mean age of 45.32±20.23 were enrolled. Both corneal hysteresis and corneal resistance factor were positively correlated with CCT (r=0.529, p<0.001; r=0.638, p<0.001) and CV (r=0.635, p<0.001; r=0.579, p<0.001) and negatively correlated with age (r=-0.373, p<0.001; r=-0.249, p<0.001). Both in age-gender and multivariate models, CH and CRF had statistically significant negative association with the posterior steep K value. Conclusions. CH and CRF are negatively correlated with posterior steep and average posterior K values.

scholarly journals Ocular imaging findings of bilateral optic disc pit in a child

2013 ◽  
Vol 5 (2) ◽  
pp. 258-261 ◽  
Author(s):  
Abdullah Ozkaya ◽  
Z Alkin ◽  
AT Taylan ◽  
A Demirok
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Anterior Segment ◽  
Rare Condition ◽  
Optic Disc Pit ◽  
Fiber Layer ◽  
Retinal Nerve Fiber

Background: To report a rare condition of bilateral optic disc pit in a child. Case description: A ten-year-old female was admitted with a complaint of headache. Visual acuity was 20/20 in both eyes (OU). Anterior segment examination was normal in OU. Fundus examination revealed optic disc pit (ODP) located temporally with a diameter of 1/5 disc diameter in OU. Intraocular pressure was within normal limits in both eyes. Macular optical coherence tomography (OCT) showed a loss of retinal tissue at the site corresponding to the ODP in both eyes. Retinal nerve fiber OCT revealed decreased RNFL thickness at the temporal side of the optic nerve, corresponding to the ODP in both eyes. The patient and patient’s parents were informed about the disease and called for follow-up examinations every 6 months. In addition, the family was informed about optic pit maculopathy (OPM) and, they were told to return immediately if the patient ever complained of decreased vision in either of her eyes. After a follow-up period of 12 months, visual acuity remained stable, and no complications secondary to ODP were detected. Conclusion: Optic disc pit is diagnosed incidentally unless it is complicated with OPM. The retinal nerve fiber layer thickness is decreased at the side of the optic nerve corresponding to the ODP. Nepal J Ophthalmol 2013; 5(10): 258-261 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8739

scholarly journals Patient use of blood pressure self-screening facilities in general practice waiting rooms: a qualitative study in the UK

2017 ◽  
Vol 67 (660) ◽  
pp. e467-e473 ◽  
Author(s):  
Alice C Tompson ◽  
Sabrina Grant ◽  
Sheila M Greenfield ◽  
Richard J McManus ◽  
Susannah Fleming ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Qualitative Study ◽  
Ease Of Use ◽  
Structured Interviews ◽  
Waiting Room ◽  
Cross Sectional ◽  
History Of ◽  
The Uk ◽  
Patient Use ◽  
At Home

BackgroundBlood pressure (BP) self-screening, whereby members of the public have access to BP monitoring equipment outside of healthcare consultations, may increase the detection and treatment of hypertension. Currently in the UK such opportunities are largely confined to GP waiting rooms.AimTo investigate the reasons why people do or do not use BP self-screening facilities.Design and settingA cross-sectional, qualitative study in Oxfordshire, UK.MethodSemi-structured interviews with members of the general public recruited using posters in GP surgeries and community locations were recorded, transcribed, and coded thematically.ResultsOf the 30 interviewees, 20% were hypertensive and almost half had self-screened. Those with no history of elevated readings had limited concern over their BP: self-screening filled the time waiting for their appointment or was done to help their doctor. Patients with hypertension self-screened to avoid the feelings they associated with ‘white coat syndrome’ and to introduce more control into the measurement process. Barriers to self-screening included a lack of awareness, uncertainty about technique, and worries over measuring BP in a public place. An unanticipated finding was that several interviewees preferred monitoring their BP in the waiting room than at home.ConclusionBP self-screening appeared acceptable to service users. Further promotion and education could increase awareness among non-users of the need for BP screening, the existence of self-screening facilities, and its ease of use. Waiting room monitors could provide an alternative for patients with hypertension who are unwilling or unable to monitor at home.

scholarly journals Short-Term Changes in the Anterior Segment and Retina after Small Incision Lenticule Extraction

2020 ◽  
Author(s):  
Yanwei Chen ◽  
Huaping Liao ◽  
Yue Sun ◽  
Xi Shen
Keyword(s):  
Layer Thickness ◽  
Optic Disc ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Vessel Density ◽  
Small Incision Lenticule Extraction ◽  
Short Term ◽  
Small Incision ◽  
Lenticule Extraction

Abstract Background: To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE).Methods: Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density.Results: Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p<0.05), while LT was thickened after surgery (p<0.05). MT at the fovea decreased 1 day and 1 week after surgery (p<0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. 𝜟ACD and 𝜟LT showed no significant correlation 1 day after surgery. 𝜟ACD was negatively correlated with 𝜟LT and sphere 1 week after surgery (r=-0.847, p<0.000; r=-0.398, p=0.002). 𝜟LT was positively correlated with the sphere 1 week after surgery (r=0.256, p=0.048).Conclusion: The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.

scholarly journals Isolated bilateral optic neuritis revealing a Lyme Disease : case report

2020 ◽  
Vol 7 (3) ◽  
pp. 145-149
Author(s):  
MIRAY LOUIS DE GONZAGUE
Keyword(s):  
Visual Acuity ◽  
Lyme Disease ◽  
Optic Neuritis ◽  
Anterior Segment ◽  
Central Nervous System Involvement ◽  
Optic Disk ◽  
Fundus Examination ◽  
Corrected Visual Acuity ◽  
Disease Case ◽  
Best Corrected Visual Acuity

Optic neuritis (ON) is an inflammation of the optic nerve and one of the most common manifestations of central nervous system involvement caused by various etiologies. Lyme optic neuritis  is a rare ocular manifestation of Lyme Disease. We report a case of a 13-year-old male patient, previously healthy, with decreased central visual acuity on his both eyes . On examination, best-corrected visual acuity on both eyes was 0,3 LogMar. Anterior segment biomicroscopy showed no inflammatory signs and the intraocular pressure was normal. A fundus examination performed under mydriasis revealed a swollen optic disk on both eyes confirmed by fluorescein angiography. The cerebrospinal fluid examination and Lyme Disease blood findings were positive. The diagnosis of Lyme disease-related optic neuritis was made. Treated with Ceftriaxone and Doxicycline, there was a vision recovery. We can state that isolated bilateral optic neuritis is uncommon and exceptional especially in children during Lyme disease.

scholarly journals Changes in the pattern of suicide attempters visiting the emergency room after COVID-19 pandemic: an observational cross sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ji-Hun Kang ◽  
Si-Won Lee ◽  
Jae-Gu Ji ◽  
Jae-Kwang Yu ◽  
Yun-Deok Jang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Suicide Attempt ◽  
Systolic Blood Pressure ◽  
Emergency Room ◽  
Suicide Attempts ◽  
Educational Background ◽  
Management Program ◽  
Cross Sectional ◽  
History Of ◽  
At Home

Abstract Background This study aimed to find out the change in the rate and pattern of suicide attempts during severe acute respiratory syndrome COVID-19 pandemic period. Methods This study was a retrospective analysis of data collected as a part of an emergency room-based post-suicide management program. The data were collected through interviews and from medical records of suicide attempts, maintained in the emergency room, from January 19 to October 31, 2020, during the “COVID-19 period,” and those who attempted suicide from January 19 to October 31, 2019 “pre-COVID-19 period.” We extracted educational background, marital status, occupation, presence of domestic partner, history of mental illness, alcohol consumption, history of previous suicide attempts; suicide attempt method and location (i.e., at home or a place other than home) at the time of attempt, and whether the attempt was a mass suicide. In addition, we compared patient severity between “COVID-19 period” and “pre-COVID-19 period” using the initial KTAS (South Korean triage and acuity scale) level, consciousness level, and systolic blood pressure. In 2012, KTAS was developed through the Ministry of Health and Welfare’s research project to establish triage system in South Korea. Results The analysis of the number of suicide attempts during “pre-COVID-19 period” and “ COVID-19 period” showed that the number of suicide attempts during “COVID-19 period” (n = 440) increased compared to the “pre-COVID-19 period” (n = 400). Moreover, the method of suicide attempts during “COVID-19 period” included overdose of drugs such as hypnotics, antipsychotics, and pesticides that were already possessed by the patient increased compared to the “pre-COVID-19 period” (P < 0.05). At the time of the visit to the emergency room, high KTAS level, low level of consciousness, and low systolic blood pressure, were observed, which were significantly different between “COVID-19 period” and “pre-COVID-19 period” (P < 0.05). Conclusion With the worldwide COVID-19 virus spread, suicide rate and suicide attempts at home have significantly increased. In addition, patient severity was higher in the “COVID-19 period” than that in the “pre-COVID-19 period.” The increasing suicide attempt rate should be controlled by cooperation between the emergency room and regional organizations.

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