In the present study we have made a review of the relevant literature on pathogenesis and modern diagnostic methods for macular edema (ME) in uveitis. Macular edema is a typical non-specifi c complication of uveitis, one of the common causes of visual impairment. ME can be found in all types of uveitis. In 85% of cases of intermediate uveitis, the visual impairment is due to the development of cystoid macular edema. The macula is more rarely affected in panuveitis (35%), anterior (20-26%) and posterior (20%) uveitis. The etiological agent is of great importance for the course and treatment of infl ammatory diseases. Among the imaging diagnostic methods that are capable of detecting macular edema with fl uid accumulation in the retina (either diffuse or distributed in cysts) are the fl uorescein angiography (FA) and the optical coherence tomography (ОСТ). OCT allows a quantitative assessment of retinal thickening and how it changes throughout therapy. FA can be used to determine very precisely the site of a vascular leakage and assess how badly the vascular wall has been affected by the infl ammatory process. CONCLUSION: Macular edema occurring during an infl ammatory process is one of the causes for visual acuity loss in uveitis. OCT and FA are useful complementary imaging methods for investigation of structural changes in retinal architecture in uveitis patients.
Aim: To establish the correlation between intraocular pressure (IOP) and thickness of extraocular muscles (EOM), the severity and activity of thyroid-associated orbitopathy (TAO). Materials and methods: 50 patients with TAO were included in the study. They all underwent a thorough ophthalmic examination, Goldmann tonometry (mm Hg) and computer tomography of the orbits, the muscle thickness sum (MTS) of each eye being measured in millimeters. According to the activity of TAO, the patients were divided into two groups – with and without activity, and according to the severity of the disease – into 6 groups: Group 1 (‘O’) had only subjective symptoms, group 2 (‘S’) had soft tissue symptoms, group 3 (‘P’) – proptosis, group 4 (‘E’) – ocular motility disorders, group 5 (‘C’) – corneal damage, and group 6 (‘Si’) – visual impairment; Results: TAO activity was registered in 21 patients (42 eyes, 42%) with MTS 23.39±3.81 and IOP 18.43±4.16. Twenty-nine patients (58 eyes, 58%) with MTS 19±3.21 and IOP 15.98±4.59 showed no TAO activity. The IOP within the groups, in terms of severity, was as follows: group 1 – 19.92+4.05; group 2 – 14.5±2.55; group 3 – 18.04±4.51; group 4 – 18.2±5.05; group 5 – 20.5±4.5; group 6 – 21.5±4.95. A correlation between the IOP and MTS was found. Conclusions: The IOP in patients with TAO depends on the thickness of the EOM, as well as on the activity and severity of the disease.
Aim: To assess relationships between functional changes in visual field and structural changes in advanced open-angle glaucoma (OAG) found using spectral-domain optical coherence tomography (SD-OCT). Methods: Thirty-one eyes of 25 patients with OAG were included in this study. Besides the routine ophthalmological exam the patients underwent standard automated perimetry (SAP) (Humphrey Field Analyzer) and SD-OCT (RTVue–100) performed within 6 months. The global perimetric indices in the study group were as follows: mean deviation (MD) 12.33±6.18 dB and pattern standard deviation (PSD) 9.17±3.41 dB. The relationship between OCT measurements and MD and PSD was evaluated by correlation analysis (Pearson’s correlation coefficient) and regression analysis (linear and nonlinear regression models). Results: Thickness measurements of the lower halves of ganglion cell complex (GCC) and retinal nerve fiber layer by two scanning protocols (ONH and 3.45) showed these to be thinner than the upper halves, but the difference failed to reach statistical significance. The correlations between global indices MD/PSD and most of the analysed quantitative OCT measurements were moderate (r in the range between 0.3 and 0.6). The correlation between MD and GCC showed nonlinear cubic regression (R2=0.417, P=0.004). Good correlation was found between MD and GLV (R2=0.383; P=0.008). Linear regression (P<0.05) was found only between MD and Cup area (R2=0.175, P=0.024) and between MD and RNFL by 3.45 protocol (R2=0.131, P=0.045). Conclusion: Nonlinear regressive models appear to be more appropriate in the assessment of the correlations between functional and structural changes in eyes with advanced glaucoma. The correlations we found were moderate.
Purpose: To evaluate the measurements of the peripapillary retinal neurofiber layers (RNFL) and the ganglion cells complex (GCC) obtained by Optical Coherence Tomography (OCT) in eyes with preperimetric open-angle glaucoma. Methods: One hundred and forty eyes of 75 patients (21 male and 54 female), 80 eyes with preperimetric glaucoma (PPG) (45 patients) and 60 normal eyes (30 subjects) were included in this study. Automated visual field examination was done to all participants using Humphrey field analyzer, program 30-2. The GCC thickness and peripapillary RNFL thickness were measured using RTVue-100 (Optivue, Inc., Fremont, CA). The areas under ROC (receiver operating characteristic)-curves (AUCs) were defined for all examined GCC and RNFL parameters. Results: GCC of the eyes with PPG was significantly thinner than GCC of the normal eyes: (89.58 vs 97.82 microns, P < 0.001). There was no significant difference between upper and lower GCC halves in both study groups. We found a reduction of RNFL thickness in glaucomatous eyes (P < 0.001) compared with normals. AUCs for GCC parameters in eyes with PPG were larger than AUCs for RNFL parameters. Conclusion: Our study showed that the peripapillary RNFL and GCC thickness are lower in preperimetric glaucoma than in normal eyes. Despite the fact that GCC measurements (especially GLV) show better AUC than peripapillary measurements, we suggest that two scans (GCC and ONH) put together are superior in detecting early structural glaucomatous damage. Several diagnostic parameters should be considered in the clinical diagnosis of preperimetric glaucoma.
Fluorescein angiography and spectral domain optical coherence tomography are highly sensitive methods used in detecting macular edema in patients with uveitis, but they might fail to be efficient in this if used independently. Optical coherence tomography is a more informative method, especially in diagnosing diffuse macular edema.
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