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A Case of Flickering Spots
Published 2020 by Thuy Phung
Co-Author(s): NULL
Article Type: Residents Day
Abstract: This is a case report of a 23-year-old hispanic male presenting with flickering spots in the right and inferior visual field and a unilateral ODE OS.
Case History: 23 YO HM CC of seeing spots flickering inferiorly and on the right side OU x 4 days when transitioning from dark to bright settings. Hx of traumatic iritis with IOP spike and conjunctival laceration OS 2ο to trauma from a nitrogen hose at 3500 psi in 4/2019. At the time, ONH was found to be WNL.
Allergies: None; Med: Keflex, Truvada prn
Sexual Hx - monogamous relationship w/ wife of 6 month, but prior to that reports 7 sexual contacts over past year both men and women, inconsistent condom use. Denies contacts w/prostitutes/sex workers
-Hx of Venereal warts , Rectal chlamydia-treated 4/2019
Pertinent Findings: Clinical: Sc DVA: 20/20 OD/OS/OU
Manifest Rx: OD: +0.50 - 0.25 x 175, OS: +1.00 - 1.00 x 175
IOP's: 16/18 ; BP: 115/59 (mmHG)
Color Vision/Red Cap Desat Test: WNL
OCT ONH: AVG RNFL Thickness: 125um/241 um;
OCt Macula: Thickness Central subfield: 248 um/259 um; Neg SRF OU; GCA analysis- WNL, no thinning
VF 30-2: OD/OS: scattered inferior misses w/ no pattern
C/D Ratio: OD 0.3R OS 0.2R, blurred margin, elevation and peripapillary NFL edema, mild hyperemia with mild obscuration of few vessels.
FAF- no evidence of drusen
Physical: Denies diplopia, loss of vision, HAs, pain on EOM, or transient vision obscurations.
Chlamydia, Gonococcus, HIV, Hepatitis A/B/C, TB, ACE, Neuromyelitis Optica- Neg
LP: Treponema pallidum Ab SERUM 1:32- REACTIVE (H)
MRI: 2mm focal edema at the OS ONH. No additional lesions along the remainder of OS optic nerve. No intracranial demyelinating lesions.
MRV- Neg venous sinus thrombosis
Chest X-Ray-Lung clear. Pleura: unremarkable. No effusion or pneumothorax. Cardio-mediastinal silhouette: unremarkable.
Differential Diagnosis: Primary/leading: ODE from Optic neuritis secondary to syphilis infection
Other causes unilateral optic disc swelling:
Inflammatory (SLE, sarcoidosis, TB)
Neoplastic (optic nerve sheath meningioma, optic nerve glioma)
Vascular (NAION, AAION)
Infectious (cat-scratch)
Hereditary (LHON)
Ocular (uveitis, hypotony)
Ddx: ONH Drusen (not true ODE)
Diagnosis and Discussion: -High # of social risk factors predisposing to STI's
-LP CSF revealed (+) treponema pallidium
-MRI/MRV/blood work up/Xray- r/o intracranial mass, vascular, inflammatory and other infectious causes
-ODE confirmed on photos/ONH OCT
Unnique -Neg genital sores (primary) or no skin lesions (secondary)
Treatment, Management: Tx: Penicillin G, 2.4 million Units IV continuous infusion for 14 days, then 2.4 million U IM q week x 3 weeks
Follow serum RPR or VDRL to monitor treatment efficacy. Partners to be screened/treated. F/u in 1 month with neuro-ophtho
Reserach: Standard Tx for neurosyphilis and ocular syphillis: Penicillin G, 18"�24 million units per day, administered as 3"�4 million units IV q4 hours or continuous infusion, for 10"�14 days
If pt is allergic to Penicillin G (non pregnant): Doxycycline 100 mg orally BID x 14 days ortetracycline 500 mg QID x 14 days
Pregnancy-Penicillin G is mainstay tx to prevent maternal transmission to the fetus and treating fetal infection
HIV- same as non HIV: Penicillin G, 2.4 million units IM in a single dose
Results: Syphilis is the great masquerader, so always consider it in your list of differentials. Ocular signs and symptoms can occur at any stage (1, 2, or 3) of syphilis Bibliography: Marx, Grace E., et al. "�Variations in Clinical Presentation of Ocular Syphilis."� Sexually Transmitted Diseases, vol. 43, no. 8, 2016, pp. 519"�523., doi:10.1097/olq.0000000000000477.
Singh AE. Ocular and neurosyphilis: epidemiology and approach to management. Curr Opin Infect Dis. 2020;33(1):66-72.
Weiner, Gabrielle. "�Case Studies of Optic Disc Edema."� EyeNet Magazine, Oct. 2015, pp. 43"�48., https://www.aao.org/eyenet/article/case-studies-of-optic-disc-edema#Quick.
Workowski, Kimberly A et al. "�Sexually transmitted diseases treatment guidelines, 2015."� MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports vol. 64,RR-03 (2015): 1-137.
Case History: 23 YO HM CC of seeing spots flickering inferiorly and on the right side OU x 4 days when transitioning from dark to bright settings. Hx of traumatic iritis with IOP spike and conjunctival laceration OS 2ο to trauma from a nitrogen hose at 3500 psi in 4/2019. At the time, ONH was found to be WNL.
Allergies: None; Med: Keflex, Truvada prn
Sexual Hx - monogamous relationship w/ wife of 6 month, but prior to that reports 7 sexual contacts over past year both men and women, inconsistent condom use. Denies contacts w/prostitutes/sex workers
-Hx of Venereal warts , Rectal chlamydia-treated 4/2019
Pertinent Findings: Clinical: Sc DVA: 20/20 OD/OS/OU
Manifest Rx: OD: +0.50 - 0.25 x 175, OS: +1.00 - 1.00 x 175
IOP's: 16/18 ; BP: 115/59 (mmHG)
Color Vision/Red Cap Desat Test: WNL
OCT ONH: AVG RNFL Thickness: 125um/241 um;
OCt Macula: Thickness Central subfield: 248 um/259 um; Neg SRF OU; GCA analysis- WNL, no thinning
VF 30-2: OD/OS: scattered inferior misses w/ no pattern
C/D Ratio: OD 0.3R OS 0.2R, blurred margin, elevation and peripapillary NFL edema, mild hyperemia with mild obscuration of few vessels.
FAF- no evidence of drusen
Physical: Denies diplopia, loss of vision, HAs, pain on EOM, or transient vision obscurations.
Chlamydia, Gonococcus, HIV, Hepatitis A/B/C, TB, ACE, Neuromyelitis Optica- Neg
LP: Treponema pallidum Ab SERUM 1:32- REACTIVE (H)
MRI: 2mm focal edema at the OS ONH. No additional lesions along the remainder of OS optic nerve. No intracranial demyelinating lesions.
MRV- Neg venous sinus thrombosis
Chest X-Ray-Lung clear. Pleura: unremarkable. No effusion or pneumothorax. Cardio-mediastinal silhouette: unremarkable.
Differential Diagnosis: Primary/leading: ODE from Optic neuritis secondary to syphilis infection
Other causes unilateral optic disc swelling:
Inflammatory (SLE, sarcoidosis, TB)
Neoplastic (optic nerve sheath meningioma, optic nerve glioma)
Vascular (NAION, AAION)
Infectious (cat-scratch)
Hereditary (LHON)
Ocular (uveitis, hypotony)
Ddx: ONH Drusen (not true ODE)
Diagnosis and Discussion: -High # of social risk factors predisposing to STI's
-LP CSF revealed (+) treponema pallidium
-MRI/MRV/blood work up/Xray- r/o intracranial mass, vascular, inflammatory and other infectious causes
-ODE confirmed on photos/ONH OCT
Unnique -Neg genital sores (primary) or no skin lesions (secondary)
Treatment, Management: Tx: Penicillin G, 2.4 million Units IV continuous infusion for 14 days, then 2.4 million U IM q week x 3 weeks
Follow serum RPR or VDRL to monitor treatment efficacy. Partners to be screened/treated. F/u in 1 month with neuro-ophtho
Reserach: Standard Tx for neurosyphilis and ocular syphillis: Penicillin G, 18"�24 million units per day, administered as 3"�4 million units IV q4 hours or continuous infusion, for 10"�14 days
If pt is allergic to Penicillin G (non pregnant): Doxycycline 100 mg orally BID x 14 days ortetracycline 500 mg QID x 14 days
Pregnancy-Penicillin G is mainstay tx to prevent maternal transmission to the fetus and treating fetal infection
HIV- same as non HIV: Penicillin G, 2.4 million units IM in a single dose
Results: Syphilis is the great masquerader, so always consider it in your list of differentials. Ocular signs and symptoms can occur at any stage (1, 2, or 3) of syphilis Bibliography: Marx, Grace E., et al. "�Variations in Clinical Presentation of Ocular Syphilis."� Sexually Transmitted Diseases, vol. 43, no. 8, 2016, pp. 519"�523., doi:10.1097/olq.0000000000000477.
Singh AE. Ocular and neurosyphilis: epidemiology and approach to management. Curr Opin Infect Dis. 2020;33(1):66-72.
Weiner, Gabrielle. "�Case Studies of Optic Disc Edema."� EyeNet Magazine, Oct. 2015, pp. 43"�48., https://www.aao.org/eyenet/article/case-studies-of-optic-disc-edema#Quick.
Workowski, Kimberly A et al. "�Sexually transmitted diseases treatment guidelines, 2015."� MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports vol. 64,RR-03 (2015): 1-137.
A Case of Herpes Simplex Keratouveitis Complicated by Hyphema
Published 2020 by Julie Tuten
Co-Author(s): NULL
Program Number: 205128
Article Type: Scientific Program
Purpose: This is a case presentation of herpetic keratouveitis that was further complicated by a hyphema in a 66-year-old male with a history of a kidney transplant on chronic immunosuppression. The features and pathophysiology of herpetic keratouveitis are discussed. Furthermore, the treatment and management of keratouveitis especially when complicated by a hyphema are discussed as well as the importance of comanagement with nephrology when using an oral antiviral in a patient with a history of a kidney transplant.
Case Report: A 66-year-old immunocompromised Caucasian male with a history of cold sores presented with an acute red eye and photophobia of the right eye. Clinical examination revealed a large dendritic ulcer with an anterior chamber reaction, posterior synechiae and unilateral increased intraocular pressure of the right eye. A few days later a hyphema developed in the anterior chamber. This patient was treatment and monitored closely until full resolution occurred.
Results: This case demonstrates the typical features of herpes simplex keratouveitis along with a rare complication of hyphema. The pathophysiology of hyphema secondary to herpes simplex is poorly understood and rarely seen in the literature but thought to be secondary to iris rubeosis. This case shows how to work with nephrology in treating a patient with herpetic keratouveitis who has a history of kidney transplant and on chronic immunosuppressants. This case demostrates the successful treatment of keratouveitis when complcated by a hyphema.
Case Report: A 66-year-old immunocompromised Caucasian male with a history of cold sores presented with an acute red eye and photophobia of the right eye. Clinical examination revealed a large dendritic ulcer with an anterior chamber reaction, posterior synechiae and unilateral increased intraocular pressure of the right eye. A few days later a hyphema developed in the anterior chamber. This patient was treatment and monitored closely until full resolution occurred.
Results: This case demonstrates the typical features of herpes simplex keratouveitis along with a rare complication of hyphema. The pathophysiology of hyphema secondary to herpes simplex is poorly understood and rarely seen in the literature but thought to be secondary to iris rubeosis. This case shows how to work with nephrology in treating a patient with herpetic keratouveitis who has a history of kidney transplant and on chronic immunosuppressants. This case demostrates the successful treatment of keratouveitis when complcated by a hyphema.
A Case of Nodular Scleritis An Unexpected Systemic Association
Published 2020 by Leticia Rousso
Co-Author(s): Julie Rodman
Program Number: 205172
Article Type: Scientific Program
Purpose: Scleritis is a painful inflammatory condition commonly associated with underlying autoimmune conditions such as Rheumatoid Arthritis and Systemic Lupus Erythematosus. Our case will illustrate the effects of an uncommon infectious cause of nodular scleritis, caused by a rare bacterium. Lyme disease is a tick-borne illness caused by the bacteria Borellia Burgdorferi. This infectious disease can spread to the heart, joints, and nervous system causing a myriad of systemic symptoms and findings. Neuro-ophthalmic effects as well as posterior ophthalmic inflammation are well documented ocular sequela of Lyme disease.
Case Report: A 51 year-old Caucasian female presented emergently with pain and redness in her left eye. Clinical examination revealed a superior temporal conjunctival nodule with a focal area of scleral thinning and 3-4+ sectoral injection. Ophthalmological examination of the posterior segment was unremarkable and B scan ultrasonography ruled out presence of posterior scleritis. Her systemic history included spinal trauma but was otherwise unremarkable. She was urgently referred to ophthalmology and rheumatology for a complete workup with serology testing. Lyme antibody testing, ELISA, and Western blot tests came back positive while other rheumatological conditions were ruled out.
Results: The case presentation will provide a systematic approach in the diagnosis and management of nodular sclerosis. Multifactorial considerations and specific serological testing is crucial when determining the underlying etiology of scleritis. Infectious causes are often overlooked in these cases due to the high association with autoimmune conditions. A definitive diagnosis can sometimes be challenging as some cases may present with conflicting symptoms and blood titers.
Case Report: A 51 year-old Caucasian female presented emergently with pain and redness in her left eye. Clinical examination revealed a superior temporal conjunctival nodule with a focal area of scleral thinning and 3-4+ sectoral injection. Ophthalmological examination of the posterior segment was unremarkable and B scan ultrasonography ruled out presence of posterior scleritis. Her systemic history included spinal trauma but was otherwise unremarkable. She was urgently referred to ophthalmology and rheumatology for a complete workup with serology testing. Lyme antibody testing, ELISA, and Western blot tests came back positive while other rheumatological conditions were ruled out.
Results: The case presentation will provide a systematic approach in the diagnosis and management of nodular sclerosis. Multifactorial considerations and specific serological testing is crucial when determining the underlying etiology of scleritis. Infectious causes are often overlooked in these cases due to the high association with autoimmune conditions. A definitive diagnosis can sometimes be challenging as some cases may present with conflicting symptoms and blood titers.
A Case of Polypoidal Choroidal Vasculopathy in the Setting of Uncontrolled Hypertension Clinical Diagnosis and Management
Published 2020 by Alyssa Tursi
Co-Author(s): NULL
Article Type: Residents Day
Abstract: Evaluating a case of polypoidal choroidal vasculopathy in which a clinical correlation can be made with systemic uncontrolled hypertension and overcoming the challenges of making a diagnosis without ICG-A.
Case History: Demographics 70 year old AA male
Chief Complaint A purple haze in his inferotemporal vision which extends into his central vision OD. Onset 12 days ago. He expresses difficulty driving as he cannot distinguish where the lines are on the road.
Ocular History
GL suspect OU
Medical History
HTN, recent ER visit 2 months prior for dizziness due to uncontrolled BP
-Treated with amlodipine and metoprolol
DM type 2
Pertinent Findings: BCVA
OD 20/40
OS 20/20-2
Pupils
PERRL (-) RAPD
EOMS
Full and smooth OU
CVF
FTFC OD/OS
Biomicroscopy
1+ NS OU
IOP
14/14 with GAT
Blood pressure
160/102
Fundus Exam
OD extensive exudation below superior arcade, diffuse subretinal fluid, arteriole attenuation
OS arteriole attenuation
Imaging
Macula OCT
OD subretinal fluid, serous neurosensory detachment of the macula extending through posterior pole, exudates, large PED superior nasal to the macula, peripapillary CNVM
OS unremarkable
FAF
OD areas of peripapillary hypo autofluorescence with surrounding hyper autofluorescence, PED visualized superotemporal to ONH
OCT-A
unable to obtain
Differential Diagnosis: Polypoidal Choroidal Vasculopathy-PCV
Retinal Artery Macroaneurysm-RAMA
Central Serous Chorioretinopathy-CSR
Diagnosis and Discussion: -Traditionally the gold standard of diagnosing PCV is with ICG-A , which was unavailable and further complicated by the patient's inability to fixate for OCT-A.
-After evaluation of the patient's fundus, OCT, age, race and history of poor control of his HTN, a tentative diagnosis of PCV was made and confirmed in the retina clinic shortly after.
-PCV is a subtype of ARMD typically affecting one eye. Polyp lesions in the choroid leak blood or fluid into or underneath the retina.
-Commonly occurs over age 60, predominantly in males of Asian or African descent and pigmented races.
-PCV is classified based on location (subfoveal, juxtafoveal, peripapillary). It is further classified into subtypes (quiescent, exudative, hemorrhagic).
-In our case of exudative PCV, common features include neurosensory thickening, subretinal fluid, PED, and lipid exudation. PCV has a higher incidence of serous RD compared to typical wet ARMD.
-Studies show PCV is thought to be the choroidal vascular equivalent of hypertensive retinal vasculopathy associated with RAMA. The peripapillary preponderance in PCV is analogous to retinal vascular crossing changes, which may be explained by increased intravascular stress and thrombotic predisposition observed by areas aggravated by hypertensive stress.
Treatment, Management: -The patient will initiate treatment with Eyelea, and urged to follow up with his PCP for blood pressure management.
-PDT (Verteporfin Photodynamic Therapy) is another viable treatment option although no longer as commonly used.
-Verteporfin injection with low power laser is used to ultimately seal the leaking blood vessels and induce regression.
-EVEREST study has shown both anti VEG-F and PDT used together it can achieve more superior
Results: compared to using anti VEG-F or PDT alone.
Results: Although ICG angiography is considered the gold standard for diagnosis, there is a downward trend of their use due to its systemic side effects and the increased reliance on less invasive modalities (OCT and OCT-A). Despite some of our limitations in this case, we were still able to make a successful diagnosis and treatment plan for this patient. Bibliography: Lip P, Hope Ross, M W, & Gibson, J M (2000) Idiopathic polypoidal choroidal vasculopathy: A disease with diverse clinical spectrum and systemic associations. Eye,14(5) 695-700
Sho, K (2003) Polypoidal Choroidal Vasculopathy Incidence, Demographic Features, and Clinical Characteristics. Archives of Ophthalmology,121(10)
Koh, A, Lee, W K, Chen, L, Chen, S, Hashad, Y, Kim, H, Lim, T H(2012). Everest Study.Retina,32(8) 1453-1464
Case History: Demographics 70 year old AA male
Chief Complaint A purple haze in his inferotemporal vision which extends into his central vision OD. Onset 12 days ago. He expresses difficulty driving as he cannot distinguish where the lines are on the road.
Ocular History
GL suspect OU
Medical History
HTN, recent ER visit 2 months prior for dizziness due to uncontrolled BP
-Treated with amlodipine and metoprolol
DM type 2
Pertinent Findings: BCVA
OD 20/40
OS 20/20-2
Pupils
PERRL (-) RAPD
EOMS
Full and smooth OU
CVF
FTFC OD/OS
Biomicroscopy
1+ NS OU
IOP
14/14 with GAT
Blood pressure
160/102
Fundus Exam
OD extensive exudation below superior arcade, diffuse subretinal fluid, arteriole attenuation
OS arteriole attenuation
Imaging
Macula OCT
OD subretinal fluid, serous neurosensory detachment of the macula extending through posterior pole, exudates, large PED superior nasal to the macula, peripapillary CNVM
OS unremarkable
FAF
OD areas of peripapillary hypo autofluorescence with surrounding hyper autofluorescence, PED visualized superotemporal to ONH
OCT-A
unable to obtain
Differential Diagnosis: Polypoidal Choroidal Vasculopathy-PCV
Retinal Artery Macroaneurysm-RAMA
Central Serous Chorioretinopathy-CSR
Diagnosis and Discussion: -Traditionally the gold standard of diagnosing PCV is with ICG-A , which was unavailable and further complicated by the patient's inability to fixate for OCT-A.
-After evaluation of the patient's fundus, OCT, age, race and history of poor control of his HTN, a tentative diagnosis of PCV was made and confirmed in the retina clinic shortly after.
-PCV is a subtype of ARMD typically affecting one eye. Polyp lesions in the choroid leak blood or fluid into or underneath the retina.
-Commonly occurs over age 60, predominantly in males of Asian or African descent and pigmented races.
-PCV is classified based on location (subfoveal, juxtafoveal, peripapillary). It is further classified into subtypes (quiescent, exudative, hemorrhagic).
-In our case of exudative PCV, common features include neurosensory thickening, subretinal fluid, PED, and lipid exudation. PCV has a higher incidence of serous RD compared to typical wet ARMD.
-Studies show PCV is thought to be the choroidal vascular equivalent of hypertensive retinal vasculopathy associated with RAMA. The peripapillary preponderance in PCV is analogous to retinal vascular crossing changes, which may be explained by increased intravascular stress and thrombotic predisposition observed by areas aggravated by hypertensive stress.
Treatment, Management: -The patient will initiate treatment with Eyelea, and urged to follow up with his PCP for blood pressure management.
-PDT (Verteporfin Photodynamic Therapy) is another viable treatment option although no longer as commonly used.
-Verteporfin injection with low power laser is used to ultimately seal the leaking blood vessels and induce regression.
-EVEREST study has shown both anti VEG-F and PDT used together it can achieve more superior
Results: compared to using anti VEG-F or PDT alone.
Results: Although ICG angiography is considered the gold standard for diagnosis, there is a downward trend of their use due to its systemic side effects and the increased reliance on less invasive modalities (OCT and OCT-A). Despite some of our limitations in this case, we were still able to make a successful diagnosis and treatment plan for this patient. Bibliography: Lip P, Hope Ross, M W, & Gibson, J M (2000) Idiopathic polypoidal choroidal vasculopathy: A disease with diverse clinical spectrum and systemic associations. Eye,14(5) 695-700
Sho, K (2003) Polypoidal Choroidal Vasculopathy Incidence, Demographic Features, and Clinical Characteristics. Archives of Ophthalmology,121(10)
Koh, A, Lee, W K, Chen, L, Chen, S, Hashad, Y, Kim, H, Lim, T H(2012). Everest Study.Retina,32(8) 1453-1464
A Case of Recurrent Iritis Secondary to Cataract Extraction with Suspected Underlying Herpes Simplex Virus Etiology
Published 2020 by Patricia Salazar
Co-Author(s): Mallory McLaughlin, Jessica Jankiewicz
Program Number: 205124
Article Type: Scientific Program
Purpose: This is a case presentation of recurrent iritis with suspected underlying herpes simplex virus (HSV) etiology following cataract extraction in a 71-year-old African American woman with type 2 diabetes mellitus. The etiology, pathophysiology and ocular complications of herpes simplex virus are discussed, especially regarding follow-up in post-operative care following cataract extraction.
Case Report: A 71-year-old African American woman presented for her one-day post-operative follow-up after cataract extraction OS. Uncorrected visual acuity was 20/40, improved to 20/25- with pinhole. Slit lamp evaluation revealed trace endothelial folds, negative Seidel sign, and moderate diffuse punctate epithelial erosions. Anterior chamber evaluation revealed moderate cells and pigment, and intraocular pressure was elevated (32mmHg). In addition to her already-prescribed topical prednisolone acetate and ketorolac, she was started on timolol twice daily OS and preservative-free artificial tears. At her one-week post-operative visit, she was compliant with her medications and her intraocular pressure was controlled. At her two-week post-operative visit, her intraocular pressure spiked, and a quick topical steroid taper was indicated. Steroid response was suspected, so a second ocular hypotensive medication was added. By her one-month post-operative follow-up, the patient was off of all topical medications, her IOP was reduced, and anterior chamber quiet. Shortly thereafter, she presented to Urgent Care with rebound iritis. With no resolution noted over the next 2 months despite a slow attempted taper off her topical steroid medication, an underlying herpes simplex virus (HSV) etiology was suspected and the patient was empirically started on an oral antiviral. After nearly three months’ use, the patient self-discontinued all topical ocular hypotensive medications as well as her anti-viral medication secondary to adverse gastrointestinal effects. Visual acuity improved to 20/20- with correction and anterior chamber reaction resolved. Additionally, intraocular pressure was reduced. Her condition was presumed to have HSV etiology and she was kept off her antiviral medication. The patient was further educated on possible recurrence.
Results: Clinically, anterior segment inflammation is expected to some degree following cataract surgery. Consideration of underlying etiologies, such as HSV, must be made for recurrent cases with spikes in intraocular pressure, especially in compliant patients. Empirical treatment with oral antiviral medications may be considered in these patients to rule out a herpetic etiology and ensure resolution of inflammation. Eye care providers must identify and acknowledge when such treatment is necessary and monitor the patient closely until the condition is completely resolved.
Case Report: A 71-year-old African American woman presented for her one-day post-operative follow-up after cataract extraction OS. Uncorrected visual acuity was 20/40, improved to 20/25- with pinhole. Slit lamp evaluation revealed trace endothelial folds, negative Seidel sign, and moderate diffuse punctate epithelial erosions. Anterior chamber evaluation revealed moderate cells and pigment, and intraocular pressure was elevated (32mmHg). In addition to her already-prescribed topical prednisolone acetate and ketorolac, she was started on timolol twice daily OS and preservative-free artificial tears. At her one-week post-operative visit, she was compliant with her medications and her intraocular pressure was controlled. At her two-week post-operative visit, her intraocular pressure spiked, and a quick topical steroid taper was indicated. Steroid response was suspected, so a second ocular hypotensive medication was added. By her one-month post-operative follow-up, the patient was off of all topical medications, her IOP was reduced, and anterior chamber quiet. Shortly thereafter, she presented to Urgent Care with rebound iritis. With no resolution noted over the next 2 months despite a slow attempted taper off her topical steroid medication, an underlying herpes simplex virus (HSV) etiology was suspected and the patient was empirically started on an oral antiviral. After nearly three months’ use, the patient self-discontinued all topical ocular hypotensive medications as well as her anti-viral medication secondary to adverse gastrointestinal effects. Visual acuity improved to 20/20- with correction and anterior chamber reaction resolved. Additionally, intraocular pressure was reduced. Her condition was presumed to have HSV etiology and she was kept off her antiviral medication. The patient was further educated on possible recurrence.
Results: Clinically, anterior segment inflammation is expected to some degree following cataract surgery. Consideration of underlying etiologies, such as HSV, must be made for recurrent cases with spikes in intraocular pressure, especially in compliant patients. Empirical treatment with oral antiviral medications may be considered in these patients to rule out a herpetic etiology and ensure resolution of inflammation. Eye care providers must identify and acknowledge when such treatment is necessary and monitor the patient closely until the condition is completely resolved.
A Case of Retinal Dialysis in an Unsuspecting Pediatric Patient When BIO Matters Most
Published 2020 by Abigail Smith
Co-Author(s): NULL
Article Type: Residents Day
Abstract: This case report reviews the management of retinal dialysis in an asymptomatic but abused pediatric patient and highlights the importance of thorough fundus examination in patients of all ages.
Case History: ● 13-year-old African American female
● Patient presented to clinic for a comprehensive eye examination. The patient reported that her specs had been broken for approximately 1 week; otherwise, no visual or ocular complaints.
● Ocular and medical history:
● Patient's caregiver reported history of ocular/head trauma sustained from physical abuse in 2016
● Per caregiver's history "� patient had severe periorbital edema and ecchymosis after being removed from the abusive environment
● Family history is largely unknown, as patient had recently entered into foster care
● Medications: none reported
Pertinent Findings: ● BCVA: 20/20- OD/OS
● Entrance testing and binocular vision testing
Results: unremarkable
● Slit lamp examination: anterior segment normal for both eyes
● Dilated fundus examination:
● OD (photo available): white without pressure in inferior temporal quadrant, linear retinal tear parallel with ora serrata in far periphery of inferior temporal quadrant with surrounding subretinal fluid
● OS: old vitreous hemorrhage settled inferiorly, otherwise normal
● Management:
● Referral was made to a retina specialist for evaluation/treatment
● Upon examination by the retina specialist, it was concluded that the patient would need laser barrier to prevent advancement of the condition
Differential Diagnosis: Primary/leading: retinal dialysis
Others: giant retinal tear, retinoschisis
Diagnosis and Discussion: ● Retinal dialysis "� a retinal anomaly in which there is a retinal break at the ora serrata "� can be of nontraumatic or traumatic etiology1 and is the most common cause of traumatic retinal detachment in children and adolescents2
● Retinal dialysis secondary to trauma most often occurs in the superonasal or, more commonly, inferotemporal quadrants3
● Rhegmatogenous retinal detachments resulting from retinal dialysis may not develop until several months after the insult and often progress slowly3
● Retinal detachments in children (especially if unilateral) can go unnoticed for weeks or months at a time and can be visually devastating
Treatment, Management: ● There is no "�standard of care"� management of asymptomatic retinal dialyses due to the lack of sufficient evidence guiding treatment4
● Laser barrier, if elected as treatment, must span the entire length of the dialysis and extend to the ora serrata on either side4
● In cases of significant retinal detachment associated with retinal dialysis in pediatric patients, the treatment of choice is circumferential scleral buckle1
● Success rate for such procedures in pediatric patients is between 74.9% and 80%1
● Management of pediatric retinal detachment often requires a longer follow-up period than in adult cases1
● In this case, laser photocoagulation was elected as the appropriate treatment, as the detachment was largely localized to the area of the tear
Results: ● It is imperative to conduct a thorough case history on all patients "� always ask about history of head and/or ocular trauma
● If you suspect abuse of any kind "� know the protocol for reporting such suspicions
● For pediatric patients with history of head and/or ocular trauma, perform as complete a fundus examination as possible to identify vision-threatening ocular findings, even if he/she is asymptomatic; photodocumentaiton may be helpful and important Bibliography: 1. Gan, N., Lam, W. Retinal detachments in the pediatric population. Taiwan J Ophthalmol, 2018; 8(4):222-236.
2. Hamrick, K., Helgeson, M. Retinal dialysis. Optom Clin, 1992; g2(3):93-112.
3. Bowling, B. Trauma. Kanski's Clinical Ophthalmology: A Systematic Approach, 2016; 8:861-882.
4. Al-Rajhi, A., et al. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern. Ophthalmology, 2020; 127(1):146-181.
Case History: ● 13-year-old African American female
● Patient presented to clinic for a comprehensive eye examination. The patient reported that her specs had been broken for approximately 1 week; otherwise, no visual or ocular complaints.
● Ocular and medical history:
● Patient's caregiver reported history of ocular/head trauma sustained from physical abuse in 2016
● Per caregiver's history "� patient had severe periorbital edema and ecchymosis after being removed from the abusive environment
● Family history is largely unknown, as patient had recently entered into foster care
● Medications: none reported
Pertinent Findings: ● BCVA: 20/20- OD/OS
● Entrance testing and binocular vision testing
Results: unremarkable
● Slit lamp examination: anterior segment normal for both eyes
● Dilated fundus examination:
● OD (photo available): white without pressure in inferior temporal quadrant, linear retinal tear parallel with ora serrata in far periphery of inferior temporal quadrant with surrounding subretinal fluid
● OS: old vitreous hemorrhage settled inferiorly, otherwise normal
● Management:
● Referral was made to a retina specialist for evaluation/treatment
● Upon examination by the retina specialist, it was concluded that the patient would need laser barrier to prevent advancement of the condition
Differential Diagnosis: Primary/leading: retinal dialysis
Others: giant retinal tear, retinoschisis
Diagnosis and Discussion: ● Retinal dialysis "� a retinal anomaly in which there is a retinal break at the ora serrata "� can be of nontraumatic or traumatic etiology1 and is the most common cause of traumatic retinal detachment in children and adolescents2
● Retinal dialysis secondary to trauma most often occurs in the superonasal or, more commonly, inferotemporal quadrants3
● Rhegmatogenous retinal detachments resulting from retinal dialysis may not develop until several months after the insult and often progress slowly3
● Retinal detachments in children (especially if unilateral) can go unnoticed for weeks or months at a time and can be visually devastating
Treatment, Management: ● There is no "�standard of care"� management of asymptomatic retinal dialyses due to the lack of sufficient evidence guiding treatment4
● Laser barrier, if elected as treatment, must span the entire length of the dialysis and extend to the ora serrata on either side4
● In cases of significant retinal detachment associated with retinal dialysis in pediatric patients, the treatment of choice is circumferential scleral buckle1
● Success rate for such procedures in pediatric patients is between 74.9% and 80%1
● Management of pediatric retinal detachment often requires a longer follow-up period than in adult cases1
● In this case, laser photocoagulation was elected as the appropriate treatment, as the detachment was largely localized to the area of the tear
Results: ● It is imperative to conduct a thorough case history on all patients "� always ask about history of head and/or ocular trauma
● If you suspect abuse of any kind "� know the protocol for reporting such suspicions
● For pediatric patients with history of head and/or ocular trauma, perform as complete a fundus examination as possible to identify vision-threatening ocular findings, even if he/she is asymptomatic; photodocumentaiton may be helpful and important Bibliography: 1. Gan, N., Lam, W. Retinal detachments in the pediatric population. Taiwan J Ophthalmol, 2018; 8(4):222-236.
2. Hamrick, K., Helgeson, M. Retinal dialysis. Optom Clin, 1992; g2(3):93-112.
3. Bowling, B. Trauma. Kanski's Clinical Ophthalmology: A Systematic Approach, 2016; 8:861-882.
4. Al-Rajhi, A., et al. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern. Ophthalmology, 2020; 127(1):146-181.
A Case of Unilateral Mydriasis Secondary to Glycopyrronium Tosylate QbrexzasupTMsup Topical Hyperhidrosis Wipes
Published 2020 by Jennifer Hue
Co-Author(s): Julia Canestraro
Program Number: 205411
Article Type: Scientific Program
Purpose: An acute onset dilated pupil is an urgent presentation, thus timely and accurate diagnosis is critical. While pharmacologic agents are a common culprit, this is the first case in optometric literature to report this ocular side effect from glycopyrronium tosylate (QbrexzaTM) topical hyperhidrosis wipes. QbrexzaTM is an FDA-approved topical wipe used to treat hyperhidrosis. This case depicts the clinical presentation and importance of including this medication when obtaining the case history.
Case Report: A 41-year-old white male presents for evaluation of sudden onset unilateral mydriasis OS. Patient reported noticing the dilated left pupil on the morning of presentation, and denied any antecedent factors such as trauma or exposure to topical or chemical medications. His last eye exam was 6 months prior and was unremarkable except for a history of PRK OU 1 year prior, without complication. Distance VAs were 20/20 OD/OS. Pupil size was measured to be OD: 6mm in dim light and 5mm in bright light; OS: 8mm in dim light and 7mm in bright light (see image). Pupillary response was reactive to light and near target in OD, and sluggish, minimal constriction with light and near target OS. EOMs, confrontation VF, and cover test were unremarkable. Amplitude of accommodation was adequate (10 D OD/OS), HRR Color vision test was normal, and deep tendon reflexive were intact R+L. Slit lamp exam revealed normal adnexa, telangiectatic vessels on upper and lower eyelids OU, 1+ conjunctival injection OU, faint hazy stromal interface s/p PRK OU, normal and intact iris, quiet anterior chamber with no cells or flare, and clear lens OU. No ptosis was noted. An undilated view showed healthy optic nerves with small C/D ratio, distinct borders and pink rim tissue.
Due to the undeterminable etiology and reported negative use of anticholinergic medication, the patient was referred to the emergency department for a CT scan to rule out a posterior communicating artery aneurysm. When the patient presented to the ED, he recalled and revealed that he uses QbrexzaTM wipes nightly, which he did not consider a medication. The attending physician advised deemed imaging to be unnecessary at that point and the patient was sent home to self-monitor for resolution within 48 hours, and to return should the pupil remain dilated. The patient followed up via phone communication the next day and confirmed that the pupil returned to normal size.
Results: Sudden onset mydriasis can be due to benign pharmacological or potentially life-threatening etiology. If the etiology be benign, that should be confirmed with thorough case history and ocular examination to avoid unnecessary imaging. QbrexzaTM is a relatively recent treatment with known ocular side effects, so it should be added to optometrists’ case history questions to investigate mydriasis from anticholinergic medications for appropriate management.
Case Report: A 41-year-old white male presents for evaluation of sudden onset unilateral mydriasis OS. Patient reported noticing the dilated left pupil on the morning of presentation, and denied any antecedent factors such as trauma or exposure to topical or chemical medications. His last eye exam was 6 months prior and was unremarkable except for a history of PRK OU 1 year prior, without complication. Distance VAs were 20/20 OD/OS. Pupil size was measured to be OD: 6mm in dim light and 5mm in bright light; OS: 8mm in dim light and 7mm in bright light (see image). Pupillary response was reactive to light and near target in OD, and sluggish, minimal constriction with light and near target OS. EOMs, confrontation VF, and cover test were unremarkable. Amplitude of accommodation was adequate (10 D OD/OS), HRR Color vision test was normal, and deep tendon reflexive were intact R+L. Slit lamp exam revealed normal adnexa, telangiectatic vessels on upper and lower eyelids OU, 1+ conjunctival injection OU, faint hazy stromal interface s/p PRK OU, normal and intact iris, quiet anterior chamber with no cells or flare, and clear lens OU. No ptosis was noted. An undilated view showed healthy optic nerves with small C/D ratio, distinct borders and pink rim tissue.
Due to the undeterminable etiology and reported negative use of anticholinergic medication, the patient was referred to the emergency department for a CT scan to rule out a posterior communicating artery aneurysm. When the patient presented to the ED, he recalled and revealed that he uses QbrexzaTM wipes nightly, which he did not consider a medication. The attending physician advised deemed imaging to be unnecessary at that point and the patient was sent home to self-monitor for resolution within 48 hours, and to return should the pupil remain dilated. The patient followed up via phone communication the next day and confirmed that the pupil returned to normal size.
Results: Sudden onset mydriasis can be due to benign pharmacological or potentially life-threatening etiology. If the etiology be benign, that should be confirmed with thorough case history and ocular examination to avoid unnecessary imaging. QbrexzaTM is a relatively recent treatment with known ocular side effects, so it should be added to optometrists’ case history questions to investigate mydriasis from anticholinergic medications for appropriate management.
A Clinical Approach to an Acutely Dilated Pupil
Published 2020 by Justin Duong-Mac
Co-Author(s): NULL
Article Type: Residents Day
Abstract: An acutely dilated pupil may be a sign of life-threatening conditions requiring emergent work-up. A case of Adie's tonic pupil detailing a clinical approach to the diagnosis and management of an acutely dilated pupil.
Case History: 39-year old Caucasian male
Chief Complaint: A fixed dilated left pupil for three weeks duration with accompanying symptoms of mild glare and blur. The patient denied of any other ocular or systemic symptoms.
Ocular Hx: Ocular hypertension OU followed for 3 years
Medical Hx: Hypertension, supraventricular tachycardia
Medications: Hydrochlorothiazide 25 mg/lisinopril 20 mg, metoprolol 25 mg
Family Medical Hx: Paternal central nervous system aneurysm
Other case information: The patient initially presented to a community eye clinic and was urgently referred to the local emergency room for evaluation. Magnetic resonance imaging and angiography were negative. He presents to the San Francisco VA Medical Center Eye Clinic two days later for follow-up.
Pertinent Findings: VA: 20/20 OU
Pupils: Round and reactive, 3.5 mm OD; round and not reactive, 6.5 mm OS; anisocoria greater in light than dark. No relative afferent pupillary defect by reverse pupil testing
EOMs: Full and unrestricted OD/OS
Confrontation visual fields: Full to finger count OD/OS
External: No ptosis OU
Anterior segment exam: Unremarkable, iris flat and intact, no evidence of iris traumatic damage
Fundus exam: Undilated views of the optic nerve and macula unremarkable
Pharmacological pupil testing:
0.125% pilocarpine was made by diluting 1 mL of 1% pilocarpine with 7 mL of balanced salt solution
One drop of 0.125% pilocarpine was administered into each eye
Fifteen minutes after administration: OD 3.5 mm, OS 4.5 mm
Twenty-five minutes after administration: OD 3.5 mm, OS 4.0 mm
Blood pressure in-office: 144/90 mmHg
Differential Diagnosis: Leading: Adie's tonic pupil (Adie's)
Others: Compressive third nerve lesion, iris sphincter tear, pharmacological mydriasis, physiologic
Diagnosis and Discussion: Adie's tonic pupil is caused by idiopathic damage to the ciliary ganglion resulting in an acutely dilated pupil. It most commonly presents in young adults between 20-40 years of age, women more than men (2.6:1), and unilateral in 80% of cases.
Typical features: A dilated pupil, light-near dissociation, segmental iris constriction and vermiform movement, denervation hypersensitivity due to upregulation of post-ganglionic acetylcholine receptors
Other features: Progressive miosis, bilateral involvement, loss of deep tendon reflexes
Diagnosis of Adie's is often clinical and other more serious ophthalmologic conditions must be ruled out. A detailed history and careful neurologic evaluation are imperative. Neuroimaging of the head may be indicated in cases with neurologic symptoms suggestive of compressive third nerve lesion. Pharmacological testing with dilute pilocarpine can aid in the diagnosis of Adie's and
Results: in pupil constriction of the affected pupil.
Treatment, Management: Adie's, a benign condition, does not requiring treatment. Recommendations for tints can be made to alleviate symptoms of glare, photophobia, and blur. If symptoms persist, chronic dilute pilocarpine can be considered for further relief.
Results: An acutely dilated pupil can be a sign of a potentially life-threatening condition. Therefore, it is important to understand the potential causes and the necessary evaluations that can assist the clinician in the appropriate work-up and care for the patient. Bibliography: Gross, J. R., McClelland, C. M., & Lee, M. S. (2016). An approach to anisocoria. Current Opinion in Ophthalmology, 27(6), 486"�492. https://doi.org/10.1097/ICU.0000000000000316
Moeller, J. J., & Maxner, C. E. (2007). The dilated pupil: An update. Current Neurology and Neuroscience Reports, 7(5), 417"�422. https://doi.org/10.1007/s11910-007-0064-9
Sarao MS, Elnahry AG, Sharma S. Adie Syndrome (Tonic Pupil Syndrome) [Updated 2020 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531471/
Case History: 39-year old Caucasian male
Chief Complaint: A fixed dilated left pupil for three weeks duration with accompanying symptoms of mild glare and blur. The patient denied of any other ocular or systemic symptoms.
Ocular Hx: Ocular hypertension OU followed for 3 years
Medical Hx: Hypertension, supraventricular tachycardia
Medications: Hydrochlorothiazide 25 mg/lisinopril 20 mg, metoprolol 25 mg
Family Medical Hx: Paternal central nervous system aneurysm
Other case information: The patient initially presented to a community eye clinic and was urgently referred to the local emergency room for evaluation. Magnetic resonance imaging and angiography were negative. He presents to the San Francisco VA Medical Center Eye Clinic two days later for follow-up.
Pertinent Findings: VA: 20/20 OU
Pupils: Round and reactive, 3.5 mm OD; round and not reactive, 6.5 mm OS; anisocoria greater in light than dark. No relative afferent pupillary defect by reverse pupil testing
EOMs: Full and unrestricted OD/OS
Confrontation visual fields: Full to finger count OD/OS
External: No ptosis OU
Anterior segment exam: Unremarkable, iris flat and intact, no evidence of iris traumatic damage
Fundus exam: Undilated views of the optic nerve and macula unremarkable
Pharmacological pupil testing:
0.125% pilocarpine was made by diluting 1 mL of 1% pilocarpine with 7 mL of balanced salt solution
One drop of 0.125% pilocarpine was administered into each eye
Fifteen minutes after administration: OD 3.5 mm, OS 4.5 mm
Twenty-five minutes after administration: OD 3.5 mm, OS 4.0 mm
Blood pressure in-office: 144/90 mmHg
Differential Diagnosis: Leading: Adie's tonic pupil (Adie's)
Others: Compressive third nerve lesion, iris sphincter tear, pharmacological mydriasis, physiologic
Diagnosis and Discussion: Adie's tonic pupil is caused by idiopathic damage to the ciliary ganglion resulting in an acutely dilated pupil. It most commonly presents in young adults between 20-40 years of age, women more than men (2.6:1), and unilateral in 80% of cases.
Typical features: A dilated pupil, light-near dissociation, segmental iris constriction and vermiform movement, denervation hypersensitivity due to upregulation of post-ganglionic acetylcholine receptors
Other features: Progressive miosis, bilateral involvement, loss of deep tendon reflexes
Diagnosis of Adie's is often clinical and other more serious ophthalmologic conditions must be ruled out. A detailed history and careful neurologic evaluation are imperative. Neuroimaging of the head may be indicated in cases with neurologic symptoms suggestive of compressive third nerve lesion. Pharmacological testing with dilute pilocarpine can aid in the diagnosis of Adie's and
Results: in pupil constriction of the affected pupil.
Treatment, Management: Adie's, a benign condition, does not requiring treatment. Recommendations for tints can be made to alleviate symptoms of glare, photophobia, and blur. If symptoms persist, chronic dilute pilocarpine can be considered for further relief.
Results: An acutely dilated pupil can be a sign of a potentially life-threatening condition. Therefore, it is important to understand the potential causes and the necessary evaluations that can assist the clinician in the appropriate work-up and care for the patient. Bibliography: Gross, J. R., McClelland, C. M., & Lee, M. S. (2016). An approach to anisocoria. Current Opinion in Ophthalmology, 27(6), 486"�492. https://doi.org/10.1097/ICU.0000000000000316
Moeller, J. J., & Maxner, C. E. (2007). The dilated pupil: An update. Current Neurology and Neuroscience Reports, 7(5), 417"�422. https://doi.org/10.1007/s11910-007-0064-9
Sarao MS, Elnahry AG, Sharma S. Adie Syndrome (Tonic Pupil Syndrome) [Updated 2020 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531471/
A Clinical Assessment of Dehydration Resistance for a Novel Silicone Hydrogel Lens and Six Silicone Hydrogel Daily Disposable Lenses
Published 2020 by Jeffery Schafer
Co-Author(s): Robert Steffen, William Reindel
Program Number: 205285
Article Type: Scientific Program
Purpose: Maintaining contact lens moisture content throughout the day can help contribute to a consistent wearing experience for the user from the beginning of the day until of the end of day. Contact lens dehydration resistance provides important performance information regarding material chemistry of today’s silicone hydrogel daily disposable lenses. The objective of this study was to evaluate a novel kalifilcon A silicone hydrogel lens compared to six daily disposable silicone hydrogel lenses after 16 hours of wear.
Methods: Ten habitual contact lens wearers completed a sixteen hour, randomized, double-masked, bilateral study. The lenses were removed after sixteen hours of wear, and each lens was immediately weighed (wet weight). The lenses were then completely dried and reweighed (dry weight). The percent water loss was then calculated for each lens from the wet and dry weights and t-tests were used to determine any differences in percent water loss between lens types.
Results: The novel kalifilcon A lenses lost statistically significant less water compared to all six control lenses (p<0.005 in all cases). The mean water loss was 3.7% for kalifilcon A compared to 5.6% for delefilcon A, 4.9% for somofilcon A, 7.7% for senofilcon A, 6.3% for narafilcon A, 5.5% for verofilcon A, and 5.2% for stenfilcon A.
Results: The novel kalifilcon A lens material was designed to maintain moisture throughout the wearing experience. After sixteen hours of wear, the novel kalifilcon A daily disposable silicone contact lenses retained significantly more of its moisture content than all six daily disposable silicone hydrogel comparator lenses.
Methods: Ten habitual contact lens wearers completed a sixteen hour, randomized, double-masked, bilateral study. The lenses were removed after sixteen hours of wear, and each lens was immediately weighed (wet weight). The lenses were then completely dried and reweighed (dry weight). The percent water loss was then calculated for each lens from the wet and dry weights and t-tests were used to determine any differences in percent water loss between lens types.
Results: The novel kalifilcon A lenses lost statistically significant less water compared to all six control lenses (p<0.005 in all cases). The mean water loss was 3.7% for kalifilcon A compared to 5.6% for delefilcon A, 4.9% for somofilcon A, 7.7% for senofilcon A, 6.3% for narafilcon A, 5.5% for verofilcon A, and 5.2% for stenfilcon A.
Results: The novel kalifilcon A lens material was designed to maintain moisture throughout the wearing experience. After sixteen hours of wear, the novel kalifilcon A daily disposable silicone contact lenses retained significantly more of its moisture content than all six daily disposable silicone hydrogel comparator lenses.
A Comparison of Corneal Densitometry between Healthy and Diabetic People
Published 2020 by Santa Rueda-Pinto
Co-Author(s): Alex Saul Salas-Tlapaya, Sabino Chavez-Cerda, Anabel Sanchez-Sanchez
Program Number: 205141
Article Type: Scientific Program
Purpose: To compare corneal densitometry values of diabetic and no diabetic Mexican people
Methods: This is a prospective study. It was authorized by the Ethics Committee of the Association to Avoid Blindness in Mexico. It was performed jointly with the Diabetes Mexican Association (DMA) in León Gto., México. The size of the sample was estimated considering the average of the population served during the last 3 years in DMA, which gives us a total of 86 patients in each group. An ophthalmologist made the classification of the diabetic retinopathy (DR). Pentacam was used to evaluate corneal densitometry. It was performed by a single specialist to avoid biases in the analysis. Patients expressed their agreement by signing informed consent. Exclusion criteria were eyes with surgeries and associated ocular ailments. The inclusion criteria were persons with no evidence of diabetes, with tests evidence that proves it, and people with diabetes without DR regardless of the years of evolution. The F test was employed to analyze the samples.
Results: A group of 84 diabetic patients and a group of 95 non-diabetic patients who met the inclusion criteria were analyzed. The average age in the group of diabetics was 53 +/- 14.39, while in non-diabetics it was 42.16 +/- 13.83. The average number of years of evolution in diabetics was 9.6 years.
The mean densitometry of the entire corneal surface was 17,51 in non-diabetics and 19,58 in diabetics. The mean corneal densitometry of the diameter 0-2 mm for the right eye in diabetic patients was 16.48 and in non-diabetic patients it was 16.16, in 2-6 mm it was 15.64 for diabetics and 15.09 for non-diabetics, in 6- 10 mm it was of 22.20 for diabetics and 18.62 for non-diabetics and finally in 10-12 mm it was 25.76 for diabetics and 22.00 for non-diabetics.
F test comparing the means obtained from corneal densitometry to the right eye, from diabetic and non-diabetic patients was done. Two hypotheses were proposed for the analysis. The null hypothesis mentions that the mean values of corneal densitometry between groups people do not present differences. The alternative hypothesis mentions that the mean values of corneal densitometry between groups present specific differences.
As a result, the null hypothesis was accepted only in the case of the diameter of 0-2 mm, since the calculated F 1.22436467 is less than the critical value of F 1.42547416 where the means have no differences in the corneal densitometry values. In the case of the other diameters, the null hypothesis was rejected, and the alternative was accepted.
Results: Except for the diameter of 0-2 mm, where no significant differences between the means of both groups, in the diameters from 2 to 10 mm there is a statistically significant difference of corneal densitometry in diabetic and non-diabetic corneas. Being non-diabetics corneal densitometry values higher than diabetic in Mexican people.
Methods: This is a prospective study. It was authorized by the Ethics Committee of the Association to Avoid Blindness in Mexico. It was performed jointly with the Diabetes Mexican Association (DMA) in León Gto., México. The size of the sample was estimated considering the average of the population served during the last 3 years in DMA, which gives us a total of 86 patients in each group. An ophthalmologist made the classification of the diabetic retinopathy (DR). Pentacam was used to evaluate corneal densitometry. It was performed by a single specialist to avoid biases in the analysis. Patients expressed their agreement by signing informed consent. Exclusion criteria were eyes with surgeries and associated ocular ailments. The inclusion criteria were persons with no evidence of diabetes, with tests evidence that proves it, and people with diabetes without DR regardless of the years of evolution. The F test was employed to analyze the samples.
Results: A group of 84 diabetic patients and a group of 95 non-diabetic patients who met the inclusion criteria were analyzed. The average age in the group of diabetics was 53 +/- 14.39, while in non-diabetics it was 42.16 +/- 13.83. The average number of years of evolution in diabetics was 9.6 years.
The mean densitometry of the entire corneal surface was 17,51 in non-diabetics and 19,58 in diabetics. The mean corneal densitometry of the diameter 0-2 mm for the right eye in diabetic patients was 16.48 and in non-diabetic patients it was 16.16, in 2-6 mm it was 15.64 for diabetics and 15.09 for non-diabetics, in 6- 10 mm it was of 22.20 for diabetics and 18.62 for non-diabetics and finally in 10-12 mm it was 25.76 for diabetics and 22.00 for non-diabetics.
F test comparing the means obtained from corneal densitometry to the right eye, from diabetic and non-diabetic patients was done. Two hypotheses were proposed for the analysis. The null hypothesis mentions that the mean values of corneal densitometry between groups people do not present differences. The alternative hypothesis mentions that the mean values of corneal densitometry between groups present specific differences.
As a result, the null hypothesis was accepted only in the case of the diameter of 0-2 mm, since the calculated F 1.22436467 is less than the critical value of F 1.42547416 where the means have no differences in the corneal densitometry values. In the case of the other diameters, the null hypothesis was rejected, and the alternative was accepted.
Results: Except for the diameter of 0-2 mm, where no significant differences between the means of both groups, in the diameters from 2 to 10 mm there is a statistically significant difference of corneal densitometry in diabetic and non-diabetic corneas. Being non-diabetics corneal densitometry values higher than diabetic in Mexican people.