Open Access Case Report

Optic Disc Drusen, Important Detail in the Differential Diagnosis of Optic Disc Edema

Mehmet Cem Sabaner, Rahmi Duman, Ersan Çetinkaya, Reşat Duman, Sibel İnan

Ophthalmology Research: An International Journal, Page 1-5
DOI: 10.9734/OR/2016/26569

Pseudopapilledema is used for pathologies that mimicking the optic disc edema. Among these, pseudo papilledema is commonly produced by optic disc drusen (ODD). A 17-year-old female patient was referred to the ophthalmology department from child neurology department with papilledema diagnosis because of bilateral elevated and blurred optic disc. Following ophthalmologic evaluation with fundus examination, B-scan ultrasound, red-free fundus photography with revealed autofluorescence the diagnosis of papilledema was excluded in the case and optic disc drusen was diagnosed. Swelling of optic disk and blurs of the optic disk margins is not equal papilledema. It is important to keep up pseudopapilledema in the differential diagnosis of papilledema.


Open Access Case study

Case Reports of Previously Undiagnosed Cases of Homocystinuria Presenting as Displaced Lenses after Trivial Trauma

Anil Kumar Verma, Vandana Sharma, Avantika Dogra, R. K. Sharma, Rajeev Tuli

Ophthalmology Research: An International Journal, Page 1-5
DOI: 10.9734/OR/2016/27647

Eye is a window to a rare disease. Two children aged 9 year old male and 5 years old female presented with pain, redness and sudden diminution of vision in right eye and left eye respectively following trivial trauma while playing. On complete ocular examination it was found that in the involved eye of both cases the lens has dislocated anteriorly causing pupillary block glaucoma.  Bio-chemical findings include increased levels of homocysteine in blood-52 µmol/L in Case-1 and 26.2 µmol/L in Case-2 (normal levels: 5.9-16 µmol/L). Both children were not a known case of homocystinuria. They were first diagnosed as a case of homocystinuria by an ophthalmologist.


Open Access Original Research Article

Reactivity against the Flavine Adenosine Nucleotide (FAD) Cofactor of Bacterial Enzymes May Explain Positive Flavoprotein Antibody Tests in Patients without Ophthalamopathy

Hooshang Lahooti, Annamaria De Bellis, Sumihisa Kubota, Kazu Gunji, Jack Wall

Ophthalmology Research: An International Journal, Page 1-8
DOI: 10.9734/OR/2016/27302

Background: We have re-visited a possible role of autoantibodies targeting a "64 kDa muscle membrane protein" in the pathogenesis of thyroid-associated ophthalmopathy (TAO). This antigen was identified as the flavoprotein (Fp) subunit of mitochondrial succinate dehydrogenase (SDH). We have addressed the possibility that "molecular mimicry" reactions against SDH can be explained by cross reactivity against the FAD cofactor used by this and other mitochondrial enzymes including bacterial sarcosine dehydrogenase (SarcDH).

Methods: Serum antibodies against SDH, SarcDH, dimethylglycine dehydrogenase (DMGDH) and FAD tested, in patients with TAO, Graves’ Hyperthyroidism (GH) including 11 patients who developed ophthalmopathy following treatment of their hyperthyroidism, and control subjects, by enzyme-linked immunosorbent assay (ELISA) in a prospective study.

Results: Sera from 85% of patients with active TAO and 37% with eye muscle involvement contained antibodies which reacted with SDH only, compared to 37% with Hashimoto's thyroiditis, 29% with type 1 diabetes, 28% with GH and in 32% of normal subjects (Table 2). Conversely, positive responses against SDH could be explained by reaction against the FAD cofactor in over 56% of subjects without ophthalmopathy, but in only 32% of patients with active eye muscle inflammation. Anti-FAD antibodies were detected in all 11 patients (78%) in which 6 patients with GH who developed ocular myopathy after beginning anti-thyroid drug therapy and in 5 out of the 6 who developed congestive ophthalmopathy.

Discussion: Because of the wide distribution of mitochondrial enzymes in nature there are likely to be many opportunities for developing cross reactive antibodies (“molecular mimicry”) in tests for anti-Fp antibodies, especially in patients with organ specific or multisystem autoimmunity.

Conclusion: Because antibodies targeting mitochondrial enzymes, Fp and FAD are unlikely to be pathogenic, as the antigens are intracellular, future studies should focus on their clinical utility as a marker of ophthalmopathy in patients with Graves’ hyperthyroidism.


Open Access Original Research Article

Assessment of the Role of Central Corneal Thickness in Measuring the Intra-ocular Pressure in the Screening for Glaucoma amongst People Residing in a Sub-Himalayan Territory of North India

Anil Chauhan, Anil Kumar Verma, Vandana Sharma, Deepak Sharma, Rajeev Tuli, R. K. Sharma, Ashoo Grover

Ophthalmology Research: An International Journal, Page 1-7
DOI: 10.9734/OR/2016/27553

Aims: To find out the average central corneal thickness (CCT) and intraocular pressure (IOP) and to determine the prevalence of ocular hypertension in the study group.

Methods: It was a cross sectional study conducted on subjects with age more than 30 years. These respondents were subjected to Visual acuity, IOP measurement using hand held Perkins applanation tonometer (PAT), measurement of central corneal thickness using ultrasonic hand held pachymeter and fundus evaluation was done using direct ophthalmoscope.

Results: A total of 2603 subjects participated in the study. 628 subjects (24.1%) were males and 1975(75.8%) were females. The ages ranged from 30 to 91 years (mean=53, median=60 and mode=60). The average CCT in the study population was 528.72±34.40 µm in the right eye and 529.26±35.17 µm in the left eye. The mean IOP for right eye was 13.73±2.89 mm Hg while for the left eye was 13.86±2.86 mm Hg. The mean corrected IOP was 14.71±3.41 mmHg for the right eye and 14.87±3.34 mmHg for the left eye. 

Conclusions: Average CCT in the study population was lesser in comparison to the mean CCT among Caucasians resulting in underestimation of the IOP measured by PAT, inducing a Type II error in making the diagnosis of glaucoma with a potential to reduce the sensitivity, increase in false negative rate, and reducing the diagnostic odds ratio for glaucoma.


Open Access Original Research Article

Relationship of Hemoglobin A1C and Outcomes of Treatment of Diabetic Macular Edema

Robert B. Garoon, Lai Jiang, Petros E. Carvounis, Silvia Orengo-Nania, Robert E. Coffee

Ophthalmology Research: An International Journal, Page 1-7
DOI: 10.9734/OR/2016/28445

Aims: To evaluate the relationship between Hemoglobin A1c (HbA1c) and visual and anatomical outcomes in eyes following treatment with intravitreal anti vascular endothelial growth factor (VEGF) agents and corticosteroids for diabetic macular edema (DME).

Study Design: Retrospective observational case series.

Place and Duration of Study: Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas between January 2012 and November 2014.

Methodology: Case series from a single institution of 194 eyes from 134 consecutive patients with DME in the absence of concurrent retinal disease treated with at least 3 intravitreal injections of bevacizumab, ranibizumab, or aflibercept with at least 6 months of follow-up.

Results: On multivariate analysis, initial HbA1c and initial BCVA were each associated to predict final visual outcome (p = 0.003 and p =0.001, respectively). Subgroup analysis demonstrated no statistical difference in improvement in mean BCVA (p=0.11) or mean CSMT (p=0.11) among patients whose hemoglobin A1c stayed stable, increased during the study or decreased during the study, however the mean number of injections required were respectively 6.5, 9.0 and 8.1 (p=0.02).

Conclusions: The visual outcome following intravitreal bevacizumab, ranibizumab, or aflibercept with or without adjunctive triamcinolone acetonide are weakly related to glycemic control at initiation of treatment. Patients with stable glycemic control during treatment require fewer injections to treat diabetic macular edema compared to patients with improvement or worsening in glycemic control.