Enhanced depth imaging optical coherence tomography in type 2 diabetes

Purpose. To investigate the changes in macular choroidal thickness in eyes with various stages of diabetic retinopathy, using enhanced depth imaging optical coherence tomography (EDI OCT). Methods. Sixty-three consecutive diabetic patients-who presented without diabetic retinopathy (NDR); with diabetic retinopathy (nonproliferative diabetic retinopathy [NPDR]) and no clinically significant macular edema (CSME-); or with NDPR and clinically significant macular edema (CSME+)-underwent EDI OCT. Twenty-one age- and sex-matched healthy subjects (21 eyes) also underwent EDI OCT. Results. A total of 63 eyes of 63 consecutive diabetic patients (26 female [41.2%]; mean age 65 ± 9 years, range 48-83 years) were included in the analysis. Mean best-corrected visual acuity was 0.13 ± 0.25 LogMAR (range 0-1). Mean CMT was 272.5 ± 16.2 μm in 21 NDR eyes, 294.5 ± 23.5 μm in 21 NPDR/CSME- eyes, and 385.6 ± 75.1 μm in 21 NPDR/CSME+ eyes. There was no difference in mean subfoveal choroidal thickness among each diabetic group (238.4 ± 47.9 μm [NDR], 207.0 ± 55.9 μm [NPDR/CSME-], 190.8 ± 48.4 μm [NPDR/CSME+]; P = 0.23). The mean subfoveal choroidal thickness was significantly reduced in each diabetic group compared with the control group (309.8 ± 58.5 μm, P < 0.001). Conclusions. In diabetic eyes, there is an overall thinning of the choroid on EDI OCT. A decreased choroidal thickness may lead to tissue hypoxia and consequently increase the level of VEGF, resulting in the breakdown of the blood-retinal barrier and development of macular edema.     

Hepatitis E in hemodialysis and kidney transplant patients in south-east Italy

AIM:To investigate the serovirological prevalence and clinical features of hepatitis E virus(HEV) infection in end-stage renal failure patients and in the healthy population.METHODS:HEV infection is a viral disease that can cause sporadic and epidemic hepatitis.Previous studies unexpectedly showed a high prevalence of HEV antibodies in immunosuppressed subjects,including hemodialysis(HD)patients and patients who had undergone kidney transplant.A cohort/case-control study was carried out from January 2012 to August 2013 in two hospitals in southern Italy(Foggia and S.Giovanni Rotondo,Apulia).The seroprevalence of HEV was determined in 801 subjects;231 HD patients,120 renal transplant recipients,and450 health individuals.All HD patients and the recipients of renal transplants were attending the Departments of Nephrology and Dialysis at two hospitals located in Southern Italy,and were included progressively in this study.Serum samples were tested for HEV antibodies(Ig G/Ig M);in the case of positivity they were confirmed by a Western blot assay and were also tested for HEV-RNA,and the HEV genotypes were determined.RESULTS:A total of 30/801(3.7%)patients were positive for anti-HEV Ig(Ig G and/or Ig M)and by Western blot.The healthy population presented with a prevalence of 2.7%,HD patients had a prevalence of 6.0%,and transplant recipients had a prevalence of 3.3%.The overall combined HEV-positive prevalence in the two groups with chronic renal failure was 5.1%.The rates of exposure to HEV(positivity of HEV-Ig G/M in the early samples)were lower in the healthy controls,but the difference among the three groups was not statistically significant(P>0.05).Positivity for anti-HEV/Ig M was detected in 4/30(13.33%)anti-HEV Ig positive individuals,in 2/14 HD patients,in1/4 transplant individuals,and in 1/12 of the healthy population.The relative risk of being HEV-Ig M-positive was significantly higher among transplant recipients compared to the other two groups(OR=65.4,95%CI:7.2-592.7,P<0.001),but the subjects with HEV-Ig M positivity were numerically too few to calculate a significant difference.No patient presented with chronic hepatitis from HEV infection alone.CONCLUSION:This study indicated a higher,but not significant,circulation of HEV in hemodialysis patients vs the healthy population.Chronic hepatitis due to the HEV virus was not observed.     

Intravitreal pegaptanib sodium (Macugen) for refractory cystoid macular edema in pericentral retinitis pigmentosa

The purpose of this paper was to describe a patient with pericentral retinitis pigmentosa (RP) and cystoid macular edema (CME) refractory to oral acetazolamide alone who was successfully treated with adjunctive pegaptanib sodium. A 33-year-old man presented with decreased vision and a best-corrected visual acuity (BCVA) in his left eye of 20/200 due to CME secondary to RP. Although he had been treated daily for 1 month with 500 mg of oral acetazolamide, the edema was unresponsive. When informed of the available treatment options, the patient requested adjunctive intravitreal pegaptanib sodium. One month after receiving an injection of pegaptanib sodium 0.3 mg and continued daily acetazolamide, the patient’s BCVA had improved to 20/40. At the 4-month follow-up visit, no recurrence of CME was found on fundus biomicroscopy, fundus-related perimetry, and optical coherence tomography. We conclude that intravitreal pegaptanib sodium combined with daily doses of acetazolamide appears to provide benefits in CME refractory to oral acetazolamide alone with regards to the improvement of visual acuity. The authors have no proprietary interest in the materials used in this study.     

The role of omega-3 and micronutrients in age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the United States, Europe, and other developed countries. Although the pathogenesis of AMD remains unclear, current evidence suggests a multifactorial aetiology. Nutrition may play an important role in the development and progression of AMD. There have been several epidemiological studies suggesting that omega-3 fatty acids could have a protective role in AMD, but a beneficial effect remains to be demonstrated in randomized controlled trials. There also exists a substantial body of evidence suggesting that protection against AMD may be provided by specific micronutrients (vitamins and minerals and antioxidants). The identification of risk factors for the development and progression of AMD is of particular importance for understanding the origins of the disorder and for establishing strategies for its prevention. We examine the relationship between dietary omega-3 intake and the incidence and progression of AMD, as well as the role of omega-3 supplementation in the prevention of the disorder, and also explore the role of other micronutrients in AMD.     

A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome

Purpose

To analyze the course of eyes with vitreomacular traction (VMT), and to find by optical coherence tomography (OCT) possible correlations between vitreomacular interface area changes and the chance of spontaneous VMT resolution.

Methods

Retrospective analysis of all consecutive patients presenting with VMT over a 24-month period. We introduced a novel OCT evaluation model to assess the vitreomacular interface area. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were also analyzed throughout follow-up.

Results

Twenty-six eyes of 18 symptomatic patients were followed for 12.9?±?4.8 months. Eyes were subdivided into groups according to their clinical course. Six eyes (23%) had a spontaneous resolution of the VMT (group A), and the interface area before its occurrence (39565?±?26409 μm²) was smaller than at study entry (99434?±?38819 μm²; p?=?0.03). The interface area did not significantly change throughout follow-up in the group that underwent surgery (group B, 11 eyes) and in the group that remained overall stable (group C, 9 eyes). At baseline, the interface area was smaller in group A compared to groups with non-resolved VMT (mean values of group B and C together) (785095?±?920721 μm²; p?=?0.002). CFT and BCVA did not significantly change in any of the studied groups. Vitreomacular interface area of 101002 μm² was identified as the threshold value separating the spontaneous VMT resolution group from the group with non-resolved VMT (p?Conclusions The more the vitreomacular interface area reduced over time, the higher was the chance of spontaneous VMT resolution. An area below 101002 μm² was the threshold value indicating a higher chance of spontaneous release of VMT.     

Risk factors for exudative age-related macular degeneration in a large French case–control study

Purpose

The purpose of the CAP (Creteil AMD PHRC-funded) Study was to analyze risk factors of exudative age-related macular degeneration (AMD) in a large French case–control population.

Patients and methods

One thousand and twenty-four patients with exudative AMD and 275 controls were recruited. Information about lifestyle, medical history, and dietary intake were collected. Associations of risk factors were estimated using logistic regression.

Results

After multivariate adjustment, CFH Y402H and ARMS2 A69S polymorphisms were associated with very high risk for exudative AMD (OR?=?6.21 and OR?=?11.7, respectively, p?<?0.0001). Risk for exudative AMD was increased in current smokers (OR?=?3.79, p?=?0.0003) and former smokers having quitted since less than 20 years ago (OR?=?2.30, p?=?0.002), but not in former smokers having quitted since 20 years or more ago (OR?=?0.81, p?=?0.43). Heavy smokers (at least 25 pack-years) were particularly at risk (OR?=?3.61, p?<?0.0001). Use of cooking oils rich in omega 3 fatty acids was significantly associated with a reduced risk of exudative AMD (OR?=?0.55, 95 % CI: 0.36–0.84, p?=?0.006), as well as a high consumption of fruits (OR?=?0.60, 95 % CI: 0.37–0.98, p?=?0.04), but not the consumption of fish, vegetables or oils rich in omega 6. High waist circumference was associated with increased risk for exudative AMD (OR?=?2.53, p?<?0.0001), but not hypercholesterolemia, hypertension, or body mass index.

Conclusions

The CAP Study confirms major genetic risk factors for exudative AMD. It further documents the high risk in heavy smokers and the long persistence of risk after smoking cessation, and the associations with waist circumference and fruit consumption. Furthermore, we observed an inverse correlation between AMD and cooking oils harboring a beneficial omega-3 fatty acid profile.     

Natural course of photic maculopathy secondary to uncomplicated cataract surgery

We report on a 36‐year‐old man who developed photic maculopathy in the left eye shortly after uncomplicated cataract surgery. The visual acuity (VA) of the left eye was 6/39 and spectral domain optical coherence tomography (SD‐OCT), performed one week after surgery, revealed a hyporeflective space in the outer retina (a ‘partial‐thickness hole’) at the fovea. Microperimetry showed a relative central scotoma and multifocal electroretinogram (ERG) showed reduced responses within the central 10°. Two months later, VA in the felt eye improved to 6/6 and SD‐OCT showed an almost complete resolution of the ‘partial‐thickness hole’. Microperimetry showed the resolution of the relative scotoma at the fovea and multifocal ERG showed improved responses within the central 10°. SD‐OCT, microperimetry and multifocal ERG are useful tools in the diagnosis and follow‐up of photic maculopathy after uncomplicated cataract surgery. Its natural history may be characterised by resolution of both morphological and functional changes shortly after surgery.