Objective: To demonstrate optical coherence tomography for high-resolution, noninvasive imaging of the human retina. Optical coherence tomography is a new imaging technique analogous to ultrasound B scan that can provide cross-sectional images of the retina with micrometer-scale resolution. Design: Survey optical coherence tomographic examination of the retina, including the macula and optic nerve head in normal human subjects. Settings Research laboratory. Participants: Convenience sample of normal human subjects. Main Outcome Measures: Correlation of optical coherence retinal tomographs with known normal retinal anatomy. Results: Optical coherence tomographs can discriminate the cross-sectional morphologic features of the fovea and optic disc, the layered structure of the retina, and normal anatomic variations in retinal and retinal nerve fiber layer thicknesses with 10- μm depth resolution. Conclusion: Optical coherence tomography is a potentially useful technique for high depth resolution, cross-sectional examination of the fundus.

Optical Coherence Tomography of the Human Retina

Distinguishing Highly Asymmetric Keratoconus Eyes Using Combined Scheimpflug and Spectral-Domain OCT Analysis.

Lens opacification or cataract reduces vision in over 80 million people worldwide and blinds 18 million These numbers will increase dramatically as both the size of the elderly demographic and the number of those with carbohydrate metabolism-related problems increase Preventative measures for cataract are critical because the availability of cataract surgery in much of the world is insufficient Epidemiologic literature suggests that the risk of cataract can be diminished by diets that are optimized for vitamin C, lutein/zeaxanthin, B vitamins, omega-3 fatty acids, multivitamins, and carbohydrates: recommended levels of micronutrients are salutary The limited data from intervention trials provide some support for observational studies with regard to nuclear - but not other types of - cataracts Presented here are the beneficial levels of nutrients in diets or blood and the total number of participants surveyed in epidemiologic studies since a previous review in 2007

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Nutritional modulation of cataract

Background/aimThe aim of this study is to report a reduction in the thickness of the ganglion cell complex (GCC) after vitrectomy with internal limiting membrane (ILM) peeling in eyes with idiopathic macular hole (MH).MethodsTwenty-eight consecutive eyes with an idiopathic MH treated by vitrectomy with ILM peeling were studied. All eyes had an intravitreal injection of indocyanine green to make the ILM more visible. The best-corrected visual acuity (BCVA), GCC thickness measured by spectral domain optical coherence tomography, and retinal sensitivity measured by microperimetry were determined before and at 3 and 6 months after the vitrectomy.ResultsThe MH in all eyes was closed after the initial surgery. The BCVA was significantly improved at 3 and 6 months (P<0.001 and P<0.001, respectively). The thickness of the GCC was significantly reduced at 3 and 6 months postoperatively (P<0.001 and P<0.001, respectively). The GCC thickness was significantly correlated with the retinal sensitivity in the central 10 degrees at 6 months (r=0.55, P=0.004).ConclusionA reduction of the GCC thickness was observed after vitrectomy with ILM peeling for idiopathic MH.

Reduction Of Thickness Of Ganglion Cell Complex After Internal Limiting Membrane Peeling During Vitrectomy For Idiopathic Macular Hole With Brilliant Blue G

Purpose To identify the definitions used for the terms sub-clinical keratoconus and forme fruste keratoconus in published articles. Methods This was a prospective, systematic literature review of the electronic database in PubMed, the Cochrane Library, and LILACS Database of all studies using the keywords "subclinical keratoconus" and/or "forme fruste keratoconus" until August 18, 2017. Two independent reviewers analyzed the data. The inclusion criteria for articles were having analyzed subclinical keratoconus or forme fruste keratoconus eyes with a sample size greater than 10 eyes; containing the definition of subclinical keratoconus or forme fruste keratoconus; and the quality of published reports was assessed using standards quality index methods. The following aspects of the selected articles were then analyzed: inclusion criteria for definition and technology used. Results A total of 198 and 95 studies, respectively, including the definition of subclinical keratoconus and forme fruste keratoconus were collected in an initial search, of which 165 and 73 studies, respectively, were excluded. Definitions for subclinical keratoconus and forme fruste keratoconus included the criteria of having keratoconus in the fellow eye in 72.72% (24 of 33) and 77.27% (17 of 22) of the articles, respectively. A total of 96.97% (32 of 33) and 90.90% (20 of 22) of the studies used more than one parameter to define subclinical keratoconus and forme fruste keratoconus, respectively. The most common extra parameters included normal slit-lamp examination and cornea on slit-lamp biomicroscopy and inferior-superior asymmetry and/or bowtie pattern with skewed radial axes. Conclusions This review demonstrates the lack of unified criteria to define subclinical keratoconus and forme fruste keratoconus. According to the literature review, the most common subclinical keratoconus definition used refers to an eye with topographic signs of keratoconus and/or suspicious topographic findings under normal slit-lamp examination and keratoconus in the fellow eye and the most common forme fruste keratoconus definition refers to an eye with normal topography, normal slit-lamp examination, and keratoconus in the fellow eye. [J Refract Surg. 2020;36(4):270-279.].

A Systematic Review of Subclinical Keratoconus and Forme Fruste Keratoconus.

Keratoconus (KC) is usually a bilateral corneal ectatic disease. For significant asymmetric presentation (so called unilateral KC), the fellow eye has the mildest and earliest form of the disease, which is typically called forme fruste keratoconus. The aim of this study was to evaluate the sensitivity and specificity of parameters derived from a Scheimpflug imaging system (Pentacam) as well as the changes in the quality of mesopic vision in the apparently normal fellow eye (forme fruste) to detect the earliest and most sensitive parameters. Patients with clinical keratoconus in one eye and forme fruste keratoconus in the fellow eye were compared to subjects with normal eyes. The patients were examined using a rotating Scheimpflug imaging system (Pentacam).The following parameters were evaluated: keratometry, minimum corneal thickness, pachymetry progression index (PPI), Ambrosio relational thickness (ART), posterior elevation, back difference elevation (BDE) and multimetric D index(D index). Receiver operating characteristic (ROC) curves were analyzed by evaluating the area under the curve (AUC) to detect the sensitivity and specificity of each parameter. Mesopic vision evaluations were performed by contrast sensitivity and glare tests for each group. A total of 48 patients with clinical keratoconus in one eye and forme fruste keratoconus in the fellow eye and 72normal subjects were evaluated. In the clinical keratoconus eyes, the mean K, back difference elevation (BDE), pachymetric progression index maximum(PPI max), and multimetric D were significantly higher compared to the normal subjects, whereas the corneal pachymetry and Ambrosio relational thickness maximum (ART max) were significantly lower. In the forme fruste eyes, the ROC analysis showed that the AUC values of the mean K, thinnest pachymetry, ARTmax, BDE, D index, and PPI max were 0.82, 0.61, 0.88, 0. 67, and 0.64, respectively. The contrast sensitivity and glare tests were significantly affected in the forme fruste cases. In forme fruste keratoconus eyes, the ART max is considered a highly sensitive objective parameter. Contrast sensitivity and glare is an important subjective test, which is affected in forme fruste patients.

Objective and subjective diagnostic parameters in the fellow eye of unilateral keratoconus

Purpose: To investigate the association between smoking and subcapsular cataract and blood levels of cadmium and lead, and serum levels of vitamins C, E, and beta carotene in the middle-age male population.Subjects and Methods: The present study comprised 60 cataractous male patients aged 44–55 years who attended Mansoura University Ophthalmic Center. They were divided into two groups: the first group was comprised of 15 patients who had never smoked before with minimal exposure to cigarette smoking (control group), while the second group was comprised of 45 age and body mass index-matched smokers. Blood cadmium and lead concentrations were measured and their levels in the cataractous lenses were also estimated. The levels of some antioxidants, such as serum vitamins C, E, and beta carotene, were determined.Results: Cadmium had a statistically significant higher concentration in blood and lenses of smokers compared with that of non smokers (p < 0.0001). There was a significantly high accumulation of cadmi...

http://www1.mans.edu.eg/facmed/english/forensic/january2007/S.%201_.pdf

Lens cadmium, lead, and serum vitamins C, E, and beta carotene in cataractous smoking patients.

Purpose The purpose of this study was to report en face optical coherence tomography (OCT) inner retinal changes after internal limiting membrane (ILM) peeling for idiopathic full-thickness macular hole (IFTMH) and to correlate these findings with macular ganglion cell inner plexiform layer (GC-IPL) analysis. Methods This prospective study included 20 patients with IFTMH treated using pars plana vitrectomy with ILM peeling. All patients were analyzed using en face OCT at 6 months after surgery to determinate the effect of ILM peeling on the inner retinal layers. Correlation between the GC-IPL en face OCT findings and that obtained by three-dimensional volumetric OCT scanning also was performed. Results Seven patients (35%) showed defects in the retinal nerve fiber layer (RNFL) that appeared as multiple dark dots with no visible defects at the GC-IPL, either with en face OCT or 3D volumetric OCT scanning. Thirteen patients (65%) showed a similar combination of RNFL defects and well-circumscribed defects in the underlying GC-IPL. These defects could be visualized on en face OCT display, and they correlated with areas of GC-IPL thinning detected in the 3D volumetric OCT scanning. Conclusions With ILM peeling, en face OCT scanning showed two forms of inner retinal layers changes. The first form was the concentric macular dark spots (CMDS) with intact GC-IPL. The second form appeared in the CMDS with evident localized defects in the underlying GC-IPL. These defects correlate with the areas of GC-IPL thinning detected using 3D volumetric OCT scanning.

Correlation Between En Face Optical Coherence Tomography Defects of the Inner Retinal Layers and Ganglion Cell Inner Plexiform Layer Analysis After Internal Limiting Membrane Peeling for Idiopathic Full-Thickness Macular Hole.

Purpose: To evaluate the effect of intravitreal bevacizumab (avastin) injection in cases of neovascular glaucoma. Study Design: Clinical case series. Materials and Methods: Sixteen eyes of 16 patients with rubeosis iridis and secondary glaucoma were administered intravitreal injection of bevacizumab (2.5 mg). The patients were followed for 2 months. Results: We noted partial or complete regression of iris neovascularization 1 week after injection of bevacizumab. Reproliferation of new vessels was detected in 25% of the cases after 2 months. The mean intraocular pressure (IOP) before injection was 28± 9.3 mm Hg under topical β-blocker and systemic acetazolamide. One week after injection, the IOP decreased to 21.7± 11.5 mm Hg (5 cases without anti-glaucoma drugs, 6 cases with topical β-blocker and 5 cases with both topical β-blocker and systemic acetazolamide). Conclusion: Intravitreal bevacizumab (avastin) injection leads to regression of iris neovascularization with subsequent drop of IOP in eyes with neovascular glaucoma.

Intravitreal bevacizumab (avastin) as an adjuvant treatment in cases of neovascular glaucoma.

Objective To evaluate the use of perforated punctal plugs with adjuvant application of mitomycin-C in the management of acquired external punctal stenosis grades 0 and 1. Methods This is a prospective interventional case series including 30 eyes of 30 patients with acquired external punctal stenosis of the lower punctum of grades 0 and 1 presenting with epiphora. They were examined to exclude other causes of lacrimation and epiphora: Slit-lamp assessment of the stenosed punctum and grading was done, probing was done to exclude associated canalicular stenosis, and syringing was done to exclude nasolacrimal duct obstruction. For all cases, dilatation was done, followed by application of mitomycin-C, and perforated punctal plugs were then inserted. Plugs were removed after 6 months, and anatomical and functional success were assessed and followed during and for 6 months after removal of the plugs. Results The study included 30 patients with acquired external punctal stenosis: 9 males (30%) and 21 females (70%) with a mean age of 62.83 ± 8.3 years. Punctal stenosis grade 0 (no punctum) occurred in 9 cases (30%), and grade 1 (the punctum is covered by a membrane) occurred in 21 cases (70%). Six months after removal of the plugs, epiphora improved in 93.3% of patients, and fluorescein dye disappearance test results improved in 90% of patients; 6.7% of cases had early extrusion of the plug, and 3.3% had granuloma formation. Conclusions Application of perforated punctal plugs combined with mitomycin-C is a simple and efficient technique in the management of tight acquired external punctal stenosis.

Amr El-Kannishy

Papers

Objective and subjective diagnostic parameters in the fellow eye of unilateral keratoconus

Lens cadmium, lead, and serum vitamins C, E, and beta carotene in cataractous smoking patients.

Correlation Between En Face Optical Coherence Tomography Defects of the Inner Retinal Layers and Ganglion Cell Inner Plexiform Layer Analysis After Internal Limiting Membrane Peeling for Idiopathic Full-Thickness Macular Hole.

Intravitreal bevacizumab (avastin) as an adjuvant treatment in cases of neovascular glaucoma.

Perforated punctal plugs with adjuvant use of mitomycin-C in management of acquired external punctal stenosis grades 0 and 1.