Influence of Carotid Endarterectomy on Choroidal Perfusion: The INFLATE Study

The article “Influence of Carotid Endarterectomy on Choroidal Perfusion: The INFLATE Study” by Yi Zhang et al. published in Ophthalmology Retina, explores the impact of carotid artery endarterectomy (CEA) on choroidal blood flow.

The study was conducted using swept-source OCT angiography (SS-OCTA) imaging protocol on patients with clinically significant carotid artery stenosis (CAS) before and after CEA. The main outcome measures were changes in mean choroidal thickness (MCT) and choroidal vascular index (CVI).

The study included 60 patients with a mean age of 71.57 ± 7.37 years.

Baseline MCT was thinner on the surgical side compared to the nonsurgical side, while no significant differences were seen in CVI. However, within one week after CEA, there were significant increases in MCT on the surgical side.

Multivariable regression analysis showed that baseline MCT significantly decreased with age on both sides. The study concludes that there is a rapid and significant increase in MCT on the ipsilateral side of CEA, indicating improved choroidal perfusion after surgery

(Yi Zhang et al., Ophthalmol Retina, 2023).

Scleral Buckle Removal: Long-term Patient Outcomes

The article titled “Scleral Buckle Removal: Long-term Patient Outcomes” by Palak Patel et al. in Ophthalmol Retina (2023) presents a retrospective observational study on scleral buckle removal and its outcomes. The study involved 86 individuals with a history of scleral buckle removal from June 1st, 2000 to January 1st, 2021.

The main indications for removal were exposure (61.63%), infection (20.93%), and diplopia/strabismus (19.77%).

The average time from scleral buckle placement to removal was 12.28 ± 11.16 years. Patients often presented with symptoms like pain, discomfort, diplopia, and drainage/discharge.

Symptom resolution occurred in 86.59% of cases following scleral buckle removal.

Around 6.56% of eyes experienced re-detachment requiring surgery after at least 1 year of follow-up, with an average time to re-detachment of 15.95 ± 25.71 months.

About 9% of eyes required additional strabismus or oculoplastic surgery. The study concludes that scleral buckle removal offers significant symptomatic relief and a low risk of subsequent detachment, although careful monitoring is necessary to detect recurrent retinal detachments.

(Palak Patel et al., Ophthalmol Retina, 2023)

Acute Myeloid Leukemia

The fundus examination of a 22-year-old woman in the eye emergency department revealed bilateral white-centered hemorrhages, flame-shaped hemorrhages, and macular preretinal hemorrhage. The medical interview indicated recent weakness, dyspnea on exertion, and left hypochondrial pain. Physical examination showed skin bruises and subcutaneous nodules. Blood cell count indicated anemia, thrombocytopenia, and hyperleukocytosis. Blood smear revealed Auer rods. Computed tomography scan displayed a hypodense spleen lesion suggestive of splenic infarction. The diagnosis of acute myeloid leukemia was confirmed by flow cytometry on bone marrow aspiration. Urgent chemotherapy (idarubicin-cytarabine) was required.

Auer rods, also known as Auer bodies, are crystalline cytoplasmic inclusion bodies found in myeloid blast cells during conditions such as acute myeloid leukemia, acute promyelocytic leukemia, high-grade myelodysplastic syndromes, and myeloproliferative disorders. These structures are composed of fused lysosomes rich in lysosomal enzymes and can take on various shapes like needles, commas, diamonds, rectangles, corkscrews, or granules. Although named after John Auer, they were first identified by Canadian physician Thomas McCrae in 1905, and both McCrae and Auer initially misinterpreted the cells containing these rods as lymphoblasts.

Reference : Sight Threat, Life Threat – Ophthalmology Retina

Photographic Gel Artifact Simulating International Classification of Retinopathy of Prematurity Notch: Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Report no. 16

This article titled “Photographic Gel Artifact Simulating International Classification of Retinopathy of Prematurity Notch: Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Report no. 16” by Karen M Wai et al., published in Ophthalmol Retina in August 2023, discusses a series of fundus photographs taken for retinopathy of prematurity (ROP) screening that contain artifacts resembling a notch, a classification metric in the International Classification of Retinopathy of Prematurity. The study is a retrospective case series involving infants from the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) and TeleROP telemedicine screening programs. Preterm infants meeting ROP examination criteria were screened using imaging systems, and artifacts mimicking a notch were identified in 17 cases.

These pseudo-notches were caused by the camera illumination system within the gel-lens interface when the lens was not properly apposed to the cornea. The study suggests that pediatric retinal specialists need to be aware of these artifacts, which can be distinguished from actual notches through overlapping and redundant images.

First Author: Karen M Wai
Journal: Ophthalmol Retina
Publication Date: August 2023

0.19-mg fluocinolone acetonide intravitreal implant for diabetic macular edema: intraocular pressure-related effects over 36 months

The article titled “0.19-mg fluocinolone acetonide intravitreal implant for diabetic macular edema: intraocular pressure-related effects over 36 months” by Daniel B Roth et al. published in Ophthalmol Retina in 2023, aims to evaluate the effects of the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant on intraocular pressure (IOP) in patients with diabetic macular edema (DME). This study involves a secondary analysis of a 36-month, phase 4, non-randomized, open-label observational study.

The study included 202 eyes from 159 patients who received the FAc implant following a successful prior steroid challenge. The study assessed IOP values, incidence of IOP elevations, and best-corrected visual acuity (BCVA) for up to 36 months post-FAc implant. The results showed that mean IOP remained stable over the 36-month period, with a peak change from baseline at 9 months.

At 36 months, there was a cumulative probability of 32.5% for an IOP event >25 mmHg and 15.6% for an IOP event >30 mmHg.

The probability of requiring IOP-lowering medication by month 36 was 38.3%.

Most eyes did not have sustained IOP elevations, and BCVA remained stable regardless of IOP status. The study concluded that the FAc implant was associated with relatively stable IOPs over 36 months, and IOP elevations did not significantly impact long-term visual outcomes. However, the article suggests that routine IOP monitoring should be scheduled due to the possibility of IOP elevation beyond predictions from prior corticosteroid challenges.

First Author: Daniel B Roth
Journal: Ophthalmol Retina.
DOI: 10.1016/j.oret.2023.08.004