Methicillin-Resistant Staphylococcus aureus and Methicillin-Resistant Coagulase-Negative Staphylococci From Conjunctivas of Preoperative Patients

To evaluate the incidence and characteristics of carriers of conjunctival methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococci (MRCNS) among preoperative patients at an eye clinic, bacterial growth was studied in 978 conjunctival specimens of 628 preoperative patients without signs of ocular infection. Specimens were evaluated for growth of bacteria on nutrient agar plate, blood agar plate, or chocolate agar plate for 2 days at 37°C. Methicillin resistance was confirmed by disk diffusion and agar screening methods. Susceptibilities of the bacterial strain to ampicillin (ABPC), cefazolin (CEZ), minocycline (MINO), gentamicin (GM), erythromycin (EM), vancomycin (VCM), and ofloxacin (OFLX) were determined by the disk diffusion method. Of the 628 patients (978 eyes), 352 patients (580 eyes) had positive bacterial growth. Among them, 8 (13 eyes) had MRSA growth and 2 (4 eyes) had MRCNS growth. The rate of nasolacrimal duct obstruction was significantly higher in eyes with positive bacterial growth than in eyes with negative growth. Of the 10 patients (17 eyes) with MRSA or MRCNS growth, 8 were older than 80 years, 5 had the same bacterial strains in the anterior nares and throat, 6 had nasolacrimal duct obstruction, 3 had dry eye, and 9 had been recently hospitalized. All 10 bacterial strains were resistant to ABPC, CEZ, and EM, but were sensitive to MINO and OFLX. Five strains were resistant and 5 were sensitive to GM. Two strains examined were sensitive to VCM. After topical antibiotic use for 0.5 to 6 months, the bacterial strains were eliminated. Two of the 17 eyes with MRSA or MRCNS growth did not undergo surgery. No postoperative endophthalmitis developed in 976 of the 978 eyes. Ophthalmologists should be aware that about 50% of preoperative patients without signs of ocular infection may have bacterial growth on the conjunctiva, and that elderly patients with nasolacrimal duct obstruction, dry eye, and recent hospital stays may be carriers of MRSA or MRCNS.     

Relationship between ocular surface infection or colonization of methicillin-resistant Staphylococcus aureus and nasal carriage

PURPOSE: To study the relationship between ocular surface colonization or infection and nasal carriage of methicillin-resistant Staphylococcus aureus(MRSA) among patients at high risk of infection and those who have already been infected. SUBJECTS AND METHODS: We isolated MRSA from ocular surface and anterior nares in 35 patients at high risk of MRSA colonization and from 4 patients who had developed an active MRSA ocular infection in the conjunctiva. RESULTS: Of the 7 patients who were carriers of conjunctival MRSA, 5 patients (78%) were found to be carriers of MRSA in the anterior nares. This ratio of nasal carriers is very high compared to the 11% in 28 patients without MRSA in the conjunctiva. All 4 cases who had active infections of MRSA in the cornea or conjunctiva showed MRSA from the nares. Even after MRSA was negative in their eye lesions, MRSA colonization in their nares continued for a long time. CONCLUSION: A significant relationship exists between MRSA in the ocular surface and MRSA found in the nares.     

Impact of the COVID-19 pandemic on characteristics of retinal detachments: the Canadian experience

ObjectiveTo describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the characteristics of retinal detachments (RD) at a tertiary centre.DesignRetrospective consecutive case series.ParticipantsOne hundred and ninety eyes of 188 patients with primary, rhegmatogenous RD.MethodsPatients with RD who presented over a 1-year period (September 14, 2019 to September 13, 2020). The relationship between demographic, anatomic, and visual acuity parameters were compared before and after onset of the pandemic using generalized estimating equations.Main Outcome MeasuresMacular status and corrected distance visual acuity on presentation.ResultsOne hundred and eighty-seven eyes, divided into 2 cohorts: pre-COVID (n = 100 September 14, 2019 to March 13, 2020) and post-COVID (n = 87, March 14, 2020 to September 13, 2020). Of the eyes, 63.2% (n = 87) presented with macular detachment in the post-COVID group compared with 45% (n = 100) in the pre-COVID group (odds ration [OR], 2.14; 95% confidence interval [CI],1.19–3.86; p = 0.011). As well, eyes in the pre-pandemic cohort had significantly fewer detached quadrants on initial examination (OR, 0.53; 95% CI, 0.30–0.93; p = 0.026). Patients in the post-COVID group had a significantly worse corrected distance visual acuity at baseline (mean difference [MD] = –0.35 logMAR, 95% CI, –0.60 to –0.09; p = 0.008), but not at 1 month or at final follow-up. No differences were seen between groups with respect to demographics, lens status, treatment, time to presentation, or chronicity. Pneumatic retinopexy was the most commonly performed procedure in both cohorts, with a 71.5% success rate.ConclusionsClosures after the COVID-19 pandemic affected the characteristics of RDs at presentation with respect to macular detachment, extent of RD, and presenting visual acuity. At final follow-up, final visual acuity and anatomic outcomes were similar between the 2 groups. These data are helpful for future patient education, triaging, and treatment decision making.     

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases

BACKGROUND: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.     

Characteristics of Geographic atrophy in an elderly UK population—The Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002–2006)

Background/objectivesGeographic atrophy (GA) is a common cause of visual loss. The UK population prevalence is unknown. We studied GA prevalence, characteristics, and associations in an elderly UK population.MethodsMasked grading of colour fundus photographs from 3549 participants in the cross-sectional study of Bridlington residents aged ≥65 years. GA size, shape and foveal involvement were correlated with demography and vision.ResultsGA was detected in 130 eyes (101 individuals) of 3480 participants with gradable images (prevalence 2.90%; 95% CI 2.39–3.52 either eye), was bilateral in 29/3252 subjects (0.89%, 95% CI 0.62–1.28) with bilateral gradable photos, with mean age of 79.26 years (SD 6.99, range 67–96). Prevalence increased with age, from 1.29% (95% CI 0.69–2.33) at 65–69 to 11.96% (95% CI 7.97–17.50) at 85–90 years. Mean GA area was 4.51 mm² (SD 6.48, 95% CI 3.35–5.66); lesions were multifocal in 47/130 eyes (36.2%; 95% CI 28.4–44.7). Foveal involvement occurred in 41/130 eyes (31.5%; 95% CI 24.2–40.0). In eccentric GA, mean distance from circumference to fovea was 671μm (SD 463; 95% CI 570–773). Older age (OR 1.10/year increase; 95% CI 1.06–1.14), RPD (OR 1.87; 95% CI 1.10–3.19) and large drusen/RPD ≥ 125 μm (OR 6.16; 95% CI 3.51–10.75) were significantly associated with GA in multivariate analysis. GA lesions (18/31 eyes; 58%; 95% CI 40.7–73.6) had U-shape configuration more frequently in RPD subjects than those without (9/99 eyes, 9.1%; 95% CI 4.66–16.6) (p = 0.0001).ConclusionGA, commonly solitary and eccentric, occurred in the perifovea. However, one third of GA eyes had foveal and bilateral involvement. Possible association of RPD with GA phenotype exists. Population multimodal imaging studies may improve understanding further.Subject terms: Macular degeneration, Risk factors, Epidemiology     

Assessing the ocular surface microbiome in severe ocular surface diseases

PurposeThere is growing evidence for a critical role of the microbiome in ocular health and disease. We performed a prospective, observational study to characterize the ocular surface microbiome (OSM) in four chronic ocular surface diseases (OSDs) and healthy controls.MethodsSterile swabs were used to collect samples from each eye of 39 patients (78 eyes). Sterile technique and multiple controls were used to assess contamination during DNA extraction, amplification and sequencing. Concurrent use of topical antibiotics, steroids, and bandage contact lenses (BCLs) was documented.ResultsDespite the low biomass of the ocular surface, 47/78 (60%) eyes sampled had positive sequencing reads. We observed that half of patients (8/17, 47%) had distinct microbiomes in each eye. Healthy controls had a Lactobacillus/Streptococcus mixture or significant Corynebacterium. Staphylococcus predominated in 4/7 (57%) patients with Stevens-Johnson Syndrome (SJS) in at least one eye, compared to 0/10 healthy controls. Interestingly, 8/11 (73%) eyes with SJS were using BCLs, including 4/5 (80%) eyes dominated by Staphylococcus. Lax eyelid syndrome (LES) and Dry Eye Disease (DED) patients had similar OSMs, with Corynebacterium being the most prevalent bacteria. Alpha diversity was higher in controls and ocular graft-vs-host (oGVHD) patients compared to the other OSDs.ConclusionsOnly 50% of the 39 patients had similar microbiomes in each eye. A majority of healthy eyes had a Lactobacillus/Streptococcus mix or Corynebacterium microbiome. Staphylococcus predominated in SJS, Lactobacillus in oGVHD, and Corynebacterium in DED and LES. There may be an association between different OSDs and the microbiome.     

Chlamydial positivity of nasal discharge at baseline is associated with ocular chlamydial positivity 2 months following azithromycin treatment

BACKGROUND: Trachoma is the leading infectious cause of blindness. Routes of transmission remain unclear. In this study, the relationship between Chlamydia trachomatis Amplicor-positive nasal discharge and Amplicor-positive ocular swabs was investigated (Amplicor; Roche, Indianapolis, IN). METHODS: A longitudinal study was conducted in Tanzania and The Gambia. Eyes were graded for active trachoma; ocular swabs were taken to test for C. trachomatis. Children with visible nasal discharge had swabs taken of this material. Participants were offered systemic antibiotics. Two months after treatment, participants were re-examined. RESULTS: Of the 1128 children participating, 188 (17%) had nasal discharge. Among 188 children with nasal discharge, 64 (34%) nasal swabs were PCR positive. There was a strong correlation between active disease/ocular chlamydial positivity and positive nasal discharge. Children with Amplicor-positive ocular swabs were 9.9 times more likely to have Amplicor-positive nasal discharge than were children without ocular positivity (95% CI: 4.34-22.53). Two months after treatment, 16% had an Amplicor-positive ocular swab. Children with positive nasal discharge at baseline were 5.2 times more likely to have an Amplicor-positive ocular swab at 2 months than were children without Amplicor-positive nasal discharge at baseline (95% CI: 1.54-17.23), after adjusting for baseline ocular positivity, gender, and study site. CONCLUSIONS: Nasal discharge may provide a source of reinfection with C. trachomatis, after antibiotic treatment for trachoma, either through transfer of secretions from nose to eye or from nasal secretions transferred to bed sheets or dirty clothes and back to the eye; alternatively, nasal discharge may be an indicator of severe persistent ocular chlamydial infection that is not cleared with a single dose of antibiotics.     

Detection of Methicillin-Resistant Staphylococcus Aureus in Donor Eye Preservation Media by Polymerase Chain Reaction

To examine contamination of donor eye preservation media with methicillin-resistant Staphylococcus aureus (MRSA), we studied the media to detect specific genes for MRSA by use of the polymerase chain reaction (PCR) method. The materials were 36 samples of donor eye preservation media (EP-II) in which donor eyes had been stored for keratoplasty. Polymerase chain reaction procedures were carried out to simultaneously detect the spa gene, which codes protein A of S. aureus, and the mecA gene, which codes penicillin-binding protein-2′ contributing resistance to methicillin. Along with PCR analyses, the preservation media was examined by conventional culture methods to determine bacteriologic contamination. The PCR analyses of the 36 samples revealed that both the spa and the mecA genes were positive in five samples, only the spa gene was positive in two, and only the mecA gene was positive in two. The conventional culture of the media showed positive for MRSA in 5 samples, methicillin-susceptible S. aureus (MSSA) in 2, methicillin-susceptible coagulase-negative staphylococci (MS-CNS) in 4, and methicillin-resistant coagulase-negative staphylococci (MR-CNS) in 2 of the 36 samples. The results of PCR coincided well with those of conventional bacteriologic culture. Polymerase chain reaction analysis for spa and mecA genes is useful in detecting contamination of donor eye preservation media by MRSA, MSSA, MR-CNS, or MS-CNS in a shorter time than by conventional culture.     

Biogeography of the human ocular microbiota

PurposeThe human eye is composed of numerous microhabitats. The aim of this study was to understand the communality and differences in the microbiomes of various regions of the eye.MethodsFour ocular sites from different subject groups were assessed including the eyelid margin tissue from patients with lid abnormalities (n = 20), fornix and limbus conjunctival tissue from patients with pterygia (n = 23), ocular (conjunctival) surface swabs (n = 45) and facial skin swabs (n = 16). Microbial communities were analysed by extracting total DNA from samples and sequencing the 16S ribosomal(r)RNA gene using the Illumina MiSeq platform. Sequences were quality filtered, clustered into unique sequences (zOTUs) using the UNOISE pipeline in USEARCH and taxonomically classified using SILVA.ResultsA difference in bacterial richness and diversity was found between sites (P < 0.001) and for age (P < 0.035) but not for sex (P > 0.05). There was a difference in bacterial community structure and composition between sites (P < 0.001). Bacterial distribution could be broadly classified into three groups - zOTUs resident on the skin and lid margin but with low abundances at other sites (Corynebacterium, Staphylococcus), zOTUs found mainly on the ocular surface (Acinetobacter, Aeribacillus) and zOTUs mostly present in the conjunctiva and lid margin (Pseudomonas).ConclusionThe microhabitats of the human eye (ocular surface, conjunctiva, lid margin and skin) have a distinct bacterial biogeography with some bacteria shared between multiple regions while other bacteria occupy a more confined niche.     

Methicillin-resistant Staphylococcus aureus infections after scleral buckling procedures for retinal detachments associated with atopic dermatitis

ObjectiveTo determine the incidence and the clinical course of methicillin-resistant Staphylococcus aureus as a cause of acute-onset infections in patients with atopic dermatitis after a scleral buckling procedures.DesignA retrospective chart review.ParticipantsTwo hundred eighty-seven patients (293 eyes) who underwent scleral buckling procedures to treat rhegmatogenous retinal detachments at either Osaka Rosai Hospital or Osaka University Medical School between July 1, 1995, and June 30, 1997, participated. Of these, 32 eyes (10.9%) were associated with atopic dermatitis.InterventionDemographic and clinical data were abstracted from patients’ medical records.Main outcome measuresThe incidence, clinical features, and management of postoperative infections associated with methicillin-resistant S. aureus were studied.ResultsMethicillin-resistant S. aureus infection after scleral buckling procedures was identified in 6 (18.8%) of 32 eyes of patients with atopic dermatitis but in only 1 (0.4%) of the other 261 cases without atopic dermatitis (P < 0.001). The average interval from the scleral buckling procedures to the initial onset of infection was 8.3 ± 9.1 days (range, 2–28 days). Bacterial infection and inflammation were controlled in four eyes by prompt removal of the infected buckle in combination with vancomycin administration. In the other three eyes, however, repeat intravitreous injections of vancomycin or emergent vitrectomies were required because of the development of endophthalmitis.ConclusionsMethicillin-resistant S. aureus is an important causative pathogen of scleral buckling infections, particularly in patients with retinal detachment associated with atopic dermatitis. Preoperative evaluation and intraoperative attention to contamination are recommended to prevent methicillin-resistant S. aureus infections in these patients.     

Circumpapillary optical coherence tomography angiography differences in perimetrically affected and unaffected hemispheres in primary open-angle glaucoma and the preperimetric fellow eye

Purpose:Evaluation of circumpapillary vessel density (VD) and perfusion density (PD) on optical coherence tomography angiography (OCTa) in mild-moderate glaucoma patients having unilateral visual field defects, with their fellow eyes and controls.Methods:Both eyes of 24 patients having a definitive nasal step or arcuate scotoma in one hemisphere of one eye only, and 24 controls, underwent OCTa.Results:In eyes with a superior field defect, the superior/inferior quadrant ratios, (SQ/IQ) of 3 mm scan of VD and PD were significantly higher in eyes with a superior arcuate scotoma than fellow eyes (P = 0.03,0.02) as also controls, (P = 0.004,0.001). The mean percentage loss of inferior quadrant VD between control to fellow eyes, and superior nasal step eyes were similar, 20.19%/19.57% respectively, P = 0.85, while a loss in arcuate scotoma eyes was 38.81% (P = 0.001). The percentage decrease in inferior quadrant PD in fellow eyes was 14.70%, superior nasal step 23.39%, and an arcuate scotoma 34.74% (P = 0.02). Eyes with a superior nasal step had significantly lower VD and PD absolute values in the inferior quadrant OCTa in 3 mm and 6 mm circle scan only as compared to control eyes, VD, P = 0.03,0.04/PD, P = 0.008,0.02. Fellow eyes of superior field defects had significantly lower VD and PD absolute values in the inferior quadrant in 3 mm and 6 mm circle scan as compared to control eyes, VD, P = 0.006,0.04/PD, P = 0.01,0.03. Eyes with an isolated inferior field defect in only one eye, showed a significant decrease in both VD and PD in all quadrants as compared to fellow eyes and control eyes. A significant positive correlation was found between VD and RNFL thickness in peripapillary superior unaffected quadrants in eyes with superior field defects and inferior unaffected quadrants in inferior defects (P = 0.001 and 0.01).Conclusion:There was a statistically significant increasing SQ/IQ ratio and percentage loss of vascular parameters from control to fellow eyes, those with a superior nasal step, and those with a superior arcuate scotoma. Inferior VFDs appeared to be associated with a more generalized circulatory loss. The asymmetry between hemispheres and between eyes could be used as a biomarker for early glaucomatous neuropathy.     

Multiresistente Keime in der Augenheilkunde

Multidrug-resistant bacteria have emerged as an increasing threat in many areas of medicine. The most prominent multidrug-resistant pathogens are methicillin-resistant S. aureus (MRSA), vancomycin-resistant MRSA (VMRSA), vancomycin-resistant enterococci (VRE), and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL). In particular, MRSA and VRE cause infections seen in ophthalmology. The lids, lacrimal duct, and ocular surface are frequently involved.     

Methicillin-resistant staphylococci and ofloxacin-resistant bacteria from clinically healthy conjunctivas

We evaluated the existence of methicillin (DMPPC)-resistant staphylococci and ofloxacin (OFLX)-resistant bacteria among preoperative patients at an eye clinic. Bacterial growth was studied in 194 conjunctival specimens of 125 preoperative patients without signs of ocular infection. Specimens were evaluated for growth of bacteria on Drigalski's plates, blood agar plates, or chocolate agar plates for 2 days at 37 degrees C. Susceptibilities of the strain to DMPPX, OFLX, minocycline (MINO), gentamicin (GM), erythromycin (EM), cefmenoxime (CMX), chloramphenicol (CP), and sulbenicillin (SBPC) were determined by the disk diffusion method. When DMPPC-resistant Staphylococcus aureus (MRSA) or DMPPC-resistant coagulase- negative staphylococci (MRCNS) were isolated, the susceptibility of the isolated strains to vancomycin (VCM) was additionally examined by the disk diffusion method. Of the 125 preoperative patients (194 eyes), 109 patients (159 eyes) had positive bacterial growth. Methicillin-resistant Staphylococcus aureus (MRSA) were positive in 1 patient. Methicillin-resistant coagulase-negative staphylococci (MRCNS) were positive in another patient. Two eyes with MRSA or MRCNS growth were treated with topical instillation of VCM, which was more sensitive than MINO and GM. They underwent the planned surgery after two subsequent tests showing negative growth. Of 120 isolated coagulase-negative staphylococci (CNS) 8 (6.7%) were resistant to OFLX. OFLX-resistant CNS were sensitive to MINO, CMX, and CP, but also resistant to SBPC. Of 114 isolated aerobic gram-positive rods (GPR), 55 (48.2%) were resistant to OFLX. OFLX-resistant aerobic GPR were sensitive to MINO, CMX, SBPC, and DMPPC. The 157 eyes with positive bacterial growth other than MRSA were treated with topical instillation of sensitive antibiotics. The present findings indicate that DMPPC-resistant staphylococci and OFLX-resistant bacteria exist in conjunctivas without signs of infection.     

Aerobic bacterial flora of the normal conjunctiva at high altitude area of Shimla Hills in India:a hospital based study

AIM:To study the normal aerobic conjunctival flora in lower to mid Himalayan region of Shimla Hills.METHODS:Samples from normal conjunctiva of 200 individuals above the age of 13 years who visited Indira Gandhi Medical College Hospital Shimla for refraction or cataract surgery were taken by anaesthetising the conjunctival sac with sterile 4% Xylocaine solution. Samples were obtained by gently rubbing lower fornix with a sterile cotton wool swab moistened with normal saline and keeping the eye lids wide apart to avoid contamination from lid margins. It was immediately inoculated in Brain Heart infusion and subjected to standard aerobic culture and identification techniques.RESULTS:Totally, 72 eyes (36%) conjunctival sacs were sterile. Predominant aerobes isolated were Staphylococcus spp. in 120 (60%) followed by Haemophilus in 16 (8%), diphtheroids in 10 (5%), and Escherichia.coli (E. coli) in 4 (2%). A single aerobe was isolated from 98 eyes (49%) while 30 eyes (15%) yielded more than 1 aerobe. Staphylococcus epidermidis (S.epidermidis) was the most common bacterium, found alone in 58 eyes (29%) and in combination with another aerobe in 30 eyes (15%), followed by Staphylococcus aureus (S. aureus) in 18 (9%) and 10 eyes (5%) respectively.CONCLUSION:S. epidermidis is the most common commensal organism followed by Haemophilus species. diphtheroids occupied the third position which otherwise are found more abundantly in literature. Pathogens like S. aureus, Staphylococcus citreus and E. coli were also found. Therefore, preoperative administration of topical broad spectrum antibiotics is extremely important in prophylaxis against ocular infection. The variation in microflora of normal conjunctiva in this part of world can be attributed to geographical, climatic and ethnic characteristics of the population under study.     

Longitudinal Observation of Border Tissue Configuration During Axial Elongation in Childhood

PurposeTo investigate the change of border tissue configuration during axial elongation in childhood.MethodsFifty-four subjects (108 eyes; age range, 29.3–132.5 months) who had undergone a series of swept-source optical coherence tomography scans at intervals of 6 months or longer were classified into stable axial length (AXL) eyes (n = 55; AXL change of ≤0.36 mm) and elongating AXL eyes (n = 53; AXL change of >0.36 mm). The angle between the Bruch''s membrane opening (BMO) reference plane and the border tissue of Elschnig was defined as the border tissue angle (BTA). The border tissue angle, BMO distance (BMOD) and minimum rim width (MRW) were measured in the temporal and nasal regions.ResultsDuring 15.6 ± 7.2 months of follow-up, the AXL significantly increased from 22.8 ± 1.3 mm to 23.3 ± 1.4 mm (P < 0.001). Changes of border tissue angle and AXL showed a significant correlation only in the temporal region of elongating AXL eyes (r = –0.409; P = 0.002), but not in stable AXL eyes. Both BMOD and nasal MRW significantly increased from 1482.5 ± 153.0 to 1506.1 ± 154.6 µm and from 310.6 ± 83.2 to 324.6 ± 95.6 µm, respectively (all Ps < 0.001). The changes of BMOD and nasal MRW showed a significant positive correlation with changes of AXL in elongating AXL eyes but not in stable AXL eyes.ConclusionsDuring the axial elongation in childhood, temporal border tissue configuration change, BMO enlargement, and nasal peripapillary tissue elevation showed a significant correlation with changes in the AXL.     

Predictive factors for exudation of quiescent choroidal neovessels detected by OCT angiography in the fellow eyes of eyes treated for a neovascular age-related macular degeneration

BackgroundTo identify predictive factors for exudation for quiescent choroidal neovessels (qCNV) in the fellow eyes of eyes treated for a neovascular age-related macular degeneration (AMD).MethodsProspective observational study. One hundred and forty-four contralateral eyes of 144 patients treated for wet AMD were analysed. At a baseline visit, multimodal imaging including dye angiographies and optical coherence tomography angiography (OCT-A) was performed in order to detect qCNV. Patients were followed up for 12 months with a monthly assessment. The manifestation of any type of exudation (either intra- or subretinal fluid or hyperreflective subretinal material) was monitored.ResultsThe prevalence of qCNV in the treatment-naive eyes was 15.9% with an incidence over a 12-month period of 2.8%. In total, 40.7% of the overall neovessels remained stable with no sign of exudation, while 59.3% presented some fluid during the follow-up. A statistically significant relationship was established for the following variables preceding the exudation: increase in central macular thickness (OR = 116; 95% CI [4.74; 50530] p = 0.038), increase in pigment epithelial detachment height (OR = 1.76; 95% CI [1.17; 3.18] p = 0.021) and width (OR = 1.53; 95% CI [1.12; 2.62] p = 0.042), increase in neovessels’ surface on OCT-A (OR = 6.32; 95% CI [1.62; 51.0] p = 0.033), emergence of a branching pattern (OR = 7.50; 95% CI[1.37; 61.5] p = 0.032) and appearance of a hypointense halo surrounding the lesion (OR = 10.00; 95% CI [1.41; 206] p = 0.048).ConclusionsThe risk of exudation in the treatment-naive fellow eyes of eyes treated for neovascular AMD was notably increased in the presence of qCNV. The biomarkers identified will help to detect their activation in order to ensure prompt antiangiogenic therapy.Subject terms: Risk factors, Tomography     

The micronucleus cytome assay – A fast tool for DNA damage screening in human conjunctival epithelial cells

PurposeTo assess whether the micronucleus cytome assay (MCyt) reliably detects DNA damage occurring in control and pathological superficial epithelial cells from human conjunctiva.MethodsImpression cytology samples from the bulbar conjunctiva of 33 healthy controls, eight patients with conjunctival intraepithelial neoplasia (CIN) and eight with mucous membrane pemphigoid (MMP) were examined using the MCyt modified for the ocular surface.ResultsThe mean number of micronuclei (MNi) in control samples was 0.94 MNi/1000 epithelial cells, with no significant difference between conjunctival quadrants and independent of sex and age. The MCyt assay applied to CIN-affected eyes showed a significantly higher frequency of MNi (18.63/1000 cells), apoptotic cells, nuclear enlargement, multinucleated cells, and keratolysis compared with the corresponding unaffected paired eyes and with the control value. Although the mean MNi frequency in MMP eyes was also higher (1.73 MNi/1000 cells), it did not prove to be statistically different from the control samples. On the other hand, the MMP-affected eyes revealed significantly elevated percentages of cells with snake-like chromatin, multinucleated cells, apoptotic cells, and nuclear buds compared with controls.ConclusionsMicronucleus cytome assay was adapted as a rapid screening test for genomic instability on the ocular surface. We have determined reference levels for MNi and other nuclear alterations on healthy conjunctiva and demonstrated that particularly frequencies of MNi are significantly elevated in conjunctiva affected by CIN. We demonstrate that MNi are more specific than other nuclear abnormalities and thus can be used for screening of ocular surface neoplasia.     

Optical coherence tomography (OCT) findings in patients with optic tract syndrome

PurposeTo analyze retinal nerve fiber layer (RNFL) thickness in eyes with optic tract syndrome (OTS) by using optical coherence tomography (OCT) and to evaluate the capability of OCT to detect the characteristic pattern of RNFL loss.MethodsEight patients (4 males and 4 females) with optic tract syndrome were enrolled in this retrospective collection of medical records. Characteristics including age, sex, etiology of optic tract lesion, visual acuity, visual field defect type were recorded. The diagnosis of optic tract syndrome were made by clinical history and typical optic disc findings, visual field defect and neuro-imaging findings including brain MRI and/or CT. The average of RNFL thickness of optic disc, four quadrants, specific four o’clock meridians and related parameters were analyzed and compared between both eyes.ResultsThe nasal segment average of RNFL thickness was significantly lower in contralateral eyes than that of ipsilateral eyes (37.5 ± 6.7 μm and 67.9 ± 10.3 μm respectively; p < 0.001). The average RNFL thickness and mean thickness of other three quadrants were not significantly different between both eyes. The ratio of superior maximum to nasal segment (Smax/Navg), superior maximum to temporal segment (Smax/Tavg) and inferior maximum to temporal segment (Imax/Tavg) of were significantly different between both eyes (p < 0.001 in all comparisons). The RNFL thickness at nasal, temporal sectors of the contralateral and those at superior, inferior sectors of the ipsilateral eyes were significantly thinner than those of fellow eyes.ConclusionThe RNFL thickness measured by OCT demonstrated a characteristic pattern of optic atrophies in OTS. The difference of nasal average, Smax/Navg, Smax/Tavg, Imax/Tavg values and specific radians between both eyes can provide useful information in the diagnosis of optic tract syndrome.     

Functional evaluation of the macular area in early glaucoma using microperimetry

Purpose:To evaluate the central visual field by microperimetry (MP), in early glaucoma.Methods:Consecutive perimetrically experienced patients with a single nasal step or arcuate scotoma and 14 control eyes underwent MP. Retinal sensitivity on MP was mapped for frequency and depth of loss in the central 10° around fixation.Results:Twenty-one eyes had a single nasal step and 19 eyes with single arcuate scotoma on standard automated perimetry (SAP), with central 10° being normal on 30–2 and 10–2 perimetry. The average mean sensitivity on MP, in glaucomatous and control eyes was 11.8 ± 3.9 dB and 16.6 ± 1.2 dB, respectively, P = 0.0004. The average mean defect on MP-1, in glaucomatous and control eyes was - 6.5 ± 2.0 dB and - 3.0 ± 1.2 Db, respectively, P = 0.05. The corresponding retinal hemisphere showed significant defects in MP. In eyes with single nasal steps, an absolute scotoma was seen in 14–28% of eyes 8–10° off fixation, moderate to mild defects were seen in 10–52% eyes, and 10% eyes showed involvement up to 4° from the fixation. Eyes with arcuate scotoma had an absolute scotoma on MP in 95% of eyes, 6–10° from fixation, with extension up to 2° from fixation in 21%. In glaucomatous eyes, the normal hemisphere on SAP showed a mild defect on MP in 43%. Control eyes did not show any defect in SAP or MP.Conclusion:A significant loss of central retinal sensitivity is recorded on MP in early glaucomatous neuropathy as compared to SAP. Paramacular absolute defects were seen at 6–10° from fixation.